2010 mHealth Summit: Show me the evidence
One of the topmost trending hash tags was #mHS10 at the recent 2010 mHealth summit in Washington DC, November 8-10 2010. This is one of a series of posts on the summit. Other posts include an overview, Patricia Mechael’s pearls of mHealth wisdom, mHealth is not about technology , mHealth in western vs global contexts and notable tweets.
The program had great content so I did not envy the in-person delegates who had to decide which of the concurrent sessions to attend. A common theme in the conference was evidence and impact, addressed during the Cross Sectoral Perspectives of mHealth and later, during the Comparative Effectiveness Research (CER) session. CER is “the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care.” (IOM 2009). Mobile technologies allow the collection of naturalistic data to inform and accomplish the assessment of comparative effectiveness of treatments, interventions, prevention strategies and information for a variety of purposes.
Are mHealth interventions underpinned by the evidence?
The point was eloquently made that traditional evidence-based approaches are not practical. According to the speakers, there is neither the money nor the time for large randomized trials. Success stories are the best way to build support for mHealth interventions.
- tamusana21 Research results need to get out fast: “research paradigm has got to change… results must not languish”. David Gustafson #mHS10
- Cross Sectoral Perspectives mHealth, pilot studies vs large randomized clinical trial for which there is no time or$’s to implement #mHS10
- CHOP_CBMi 4 barriers to #mhealth adoption. 4. mechanism of translation from research to care is lacking. Can’t rely on decades-long approval. #mhs10
- Speakers at #mHS10 say telling success stories is the best way to build support for m-health quickly as opposed to large randomized trials GLOBALHEALTHorg
- ctorgan Deborah Estrin reinforces theme of lots of iterations – it’s the ‘fail fast’ model vs 5 yr RCTs #mhs10
Michael S. Lauer, National Heart, Lung, and Blood Institute on the other hand held onto the traditional view: it is difficult to make valid conclusions without massive numbers of people – high risk of false discovery. He wondered how we can efficiently bring together large numbers of people to study – in order to incorporate findings into routine care and EHR? Lauer’s position illustrates the tension between the rigour of standard evidence-based approaches and the necessity to support innovative interventions whose benefits will only become apparent in the long term.
What impact are these interventions having on actual health outcomes?
This question was posed to Text4Baby which has so far emphasized its success in terms of the more than 100 000 women who have subscribed to the text messaging servicing on pregnancy and newborn wellness. They said that they would look into what difference the service was making. Through out the summit, Text4baby was frequently mentioned as a success story on which further mobile interventions would be modeled. For example, a text4health task force has been launched to see how mobile technology can be applied to public health issues.
- Wakefield explained that HRSA is funding patient centred outcomes research (PCOR) – research that compares treatments and strategies to improve health outcomes for patients. HRSA seeks to incorporate patient-centered research knowledge into clinical decision-making for the diverse and vulnerable populations that HRSA serves. Do different outcomes occur in seasonal/migrant workers, homeless populations?
- HRSA sees the potential to rely on mobile technology – potentially rich source of information, capacity to produce and track data, harness data points over time.
- HRSA-funded Health Centers provide primary health care services to medically underserved communities and vulnerable populations. The “Find a health centre” feature will be developed into a free iphone app on HRSA.gov. Someone tweeted about the practicality of providing iphone apps to the underserved who presumably would not afford these technologies.
An outstanding question from the audience was: Is CER about comparison with optimal or existing technology? What are we comparing – is it like drugs being compared with placebo?