Archive for the ‘E-health’ category

mHealth Summit 2010: Notable tweets

November 22, 2010

This is the final of a series of posts summarizing the recent 2010 mHealth summit‘s highlights from my own perspective and through the lens of insightful tweets of avid tweeple who attended the conference in person. Previous posts include an overview, Patricia Mechael’s pearls of mHealth wisdom, mHealth is not about technology, mHealth and the evidence and mHealth in western vs global contexts.

Below are succinct snippets of mHealth wisdom not captured in the previous posts:

  • lundelle RT @eedgerton mHealth can help throughout value chain: prevention/info; data collection; diagnosis; treatment/intervention; homecare. #mhs10
  • RT @Hallicious: Right on: mHealth technology doesn’t have to be perfect. It just needs to be better than what exists today. – Dr Joseph Smith
  • downeym Great point from audience member – don’t forget illiterate, tech-unsavvy users when making #mHealth solutions. Design well! #HCI #mHS10
  • alshar Misalignment: Docs paid for procedures and hospitalization. Patients want avoid both. #mHS10
  • stevemuse No real strategy in mHealth, gov, private sector doing innovative things, supply led direction, but what does society want #mhs10
  • chloevdc audience member: ‘data is great for research and providers, interaction is needed for patients’ #mhs10
  • chloevdc Rural telemedicine is happening in rural India already. Check out http://www.globalhealthpoints.com Big announcement tomorrow morning! #mhs10
  • Mhealth is not  fad, delivers real outcomes – real value across chain; 30% of consumers willing to pay $2 on consultation Lisa D. Ellis, McKinsey & Company
  • @billgates The major problems in a developing country are insolvable at a 3% per year population growth. #mhs10 (via @clickwisdom)
  • mPuleio mHealth consideration: what is the key metric you are trying to improve?-Gates #mhs10
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mHealth Summit 2010: mHealth applications in western and global contexts

November 21, 2010

This is the one of a series of posts on the recent mHealth Summit. Previous posts include an overview, Patricia Mechael’s pearls of mHealth wisdom, mHealth is not about technology, mHealth and the evidence and notable tweets.

Through out the sessions, many speakers spoke about the potential of mHealth applications in western and global contexts. This post summarizes some of these.

Western projects

  • Dr. Karen Clancy, AHRQ began by stating that 88% of MDs would like patients to monitor their health on their own – which makes it imperative to look into how mobile technology can support this. She then outlined some efforts to explore mobile enabled interventions:
    • Denver Health is testing the feasibility of using text messaging for care with elderly Hispanics with diabetes. Half of the patients have cell phones while the others had access via grandchildren. Doctors text patients asking for information about their blood sugar. This program has been well received – patients are enthusiastic and eager to participate.
    • Vanderbilt My Medihealth is a mobile personal health app to support homecare for kids with asthma. It entails a medication safety component. This application has the potential to address the enormous variation in rates of avoidable hospitalization in kids with asthma resulting in huge costs.
    • Salud mobile outreach program uses a mobile medical unit to reach Mexican migrants in rural areas. It follows patients where they are four nights a week. It has enormous appeal and is doing everything to provide patient centric care.

Global projects

The summit shed light on the magnitude of global health challenges and why mobile health has such important potential particularly in maternal health.

  • Babatunde Osotimehin, Ph.D., Professor of Medicine, University of Ibadan, Nigeria
    • Chilling statistic: since the beginning of the session, in Nigeria, 1000 women had  had died in child birth due to ignorance, poverty and lack of infrastructure
    • Wireless and cellphone communication is growing rapidly in Nigeria: In 1988, there were 0.4 M lines for 100 M people; today, GSM networks support 60 M cell phones for 150 M people.
    • Access to mobile technology is ubiquitous across economic strata – practically everyone has a cell phone. How can these technologies help address maternal mortality? Maternal mortality causes are complex but these technologies can provide information, educate and support the provision of services remotely.
    • Cell phone technology was successfully deployed to educate 200 000 women – advising them about their pregnancy, and very importantly, collecting valuable data about the births. As this technology is expanded, structures that generate real, quality data will help provide quality care over time.
  • Christopher Tomlin Bailey, Coordinator, eHealth & Informatics, World Health Organization
    • Of note, the WHO Ehealth & Informatics group helps resource poor countries catalyze and adopt sustainable e-health solutions.
    • African countries often ask: What software is needed? More immediate questions: What’s your health system like, what do you want to accomplish and, what are your needs? Later, the issues of functionality and requirements need to be addressed before the software can be identified.
    • Is it feasible to replicate western systems? It’s good for them to learn from other models and what others have done but there are inevitable differences: For example,
      • in some parts of East Africa, standardized names are taboo – people use a diff name each time they access health services.  Aligning their EHR systems to international standards has to be done in a meaningful way.
      • Rwanda seeks a deidentified system to avoid a situation where the health system data can be used to identify and kill people – as tragically happened with the genocide.
    • A success story: in the Kenyan internally displaced camps,  mobile devices supported continuity of care for displaced patients who didn’t have identification. Rural clinics are benefiting from standardized EHR systems.
  • Alex Ibasco Chief Innovation Officer – Strategic Business Development, Smart Communications
    • Average spend in the Phillipines is $4 for air time per month and 90% of people do not have smart phones
    • The Phillippines prone to Typhoons and tropical disease. Disaster aversion and management and disease control are priorities.
    • Mhealth involvement:
      • Enhancing communication with the next to the edge: to intermediaries [care givers] rather than the end users as mobile phone access is not yet universal
      • Data gathering for doctors [3 per hospital] – info about diabetic amputees for scheduling prosthesis
      • Echo system- connecting participants: bringing in the sources of funds, the payments – to ensure sustainable model
  • Dr Julio Frenk, Harvard
    • The face of global health is changing – to realize full potential, institutions must innovate
    • Global health Context – health is a social objective, needs multi-sector engagement
    • Primary care is not primitive care – it is essential to transforming and extending healthcare reach
    • Connectivity key in quest for equity, continuity of care, access in remote care, timely responses

Global vs Western needs: Access vs Efficiency

  • Thierry Zylberberg, Orange made the important distinction between the role of mhealth in developed and developing settings. To the Developed world: mhealth brings more efficiency, to the Developing world: access to health.
  • It is essential to use the right application for the right environment. He gave examples of mhealth applications in different contexts such as
    • Europe: In Spain, people with diabetes and obesity can be remotely monitored.  The UK healthgateway program sends text reminders for appointments to improve efficiency. By 2011, mobile technology is to be used for the remote mgt of pacemakers and defibrillators.
    • Africa: In Cameroon, mobile technology is being used to send text messages for health education. In Egypt and Bostwana, teledermatology is supporting diagnostics from pictures, thus extending health services reach and access.

mHealth Summit 2010: It’s not about the technology

November 21, 2010

This is one of  a series of posts on the recent 2010 mHealth summit. Previous posts include an overview, Patricia Mechael’s pearls of mHealth wisdom, mHealth and the evidence, mHealth in western vs global contexts and notable tweets.

This post briefly outlines various themes that emerged.

  • It’s not about technology – behaviour change is complex
    • RT @AudieAtienza:Vijay Vaitheeswaran “health depends on behavior & behavior is very difficult to change!” not about the technology… #mhs10
    • downeym “Bathroom scales have been around a long time, but we still have obesity.” –Vaitheeswaran at #mHS10
  • Partnerships and collaboration are key
    • RT@mHealthAlliance Dr. Mwenesi, Tanzanian Health Ministry: Collaboration btwn public & private only way to move #mHealth forward #mHS10
    • Text4baby was repeatedly cited as an amazing success story of a private public partnership.
    • Partners should be drawn from relevant stakeholders in the eco system: Private [telecom industries], NGO; open source developers; public health system; community health workers
    • Ministries of Health must be involved– interventions need to be health demand driven not technology led. There is a risk of letting the technology experts lead the enterprise and yet they don’t realize the complexities of health systems.
    • South–to–south collaboration is essential as a sustainable approach which can promote equity.
    • Rockefeller didn’t want to replicate the same old silos – built mHealth alliance
  • From pilots to full scale but where’s the funding?
    • The mobile technology landscape is characterized by many pilots with few scale-ups. Why? Lack of leadership and project management skills as well as sustainable funding models
    • The unrelenting criticism of pilotitis [ pilots that fail to scale into larger scope implementation]  was only matched by the scarcity of a clear strategy on a self sustaining business model that could evolve into a full scale, established service. The notable exception was text4baby which quickly became a nationwide project as a result of rare support from multiple partners and stakeholders including the White House. How easily can its success be replicated?
  • Caution: user needs must come first
    • EndoGoddess David Gustafson says high volume Internet info/mobile health info can be conflicting/confusing to patient and may not result in improved health outcomes. #mhs10
    • kwalser We haven’t addressed what patients and families need [for #mHealth] to be truly helpful. – Dr. Gustafson #mHS10#ux#design#usability
    • It is important not to bombard the clinicians with too many alerts – some are about minor issues while others contradict one another
    • RT @haddadda: we should be designing mhealth applications with rather than for patients and health workers. #mhs10
    • For mHealth, it’s the responsibility of app developers to maximize ease for users, taking into account language & literacy #mHS10
    • We must address the issues of tinfrastructure. Automating poor paper records leads to equally poor EHRs, Louis I. HochHeiser, Humana, Inc. 
    • Just giving cell phones will not accomplish much: first understand the needs of the people/health care providers, perceptions, values, cultures – systems are not always transferable; use ethnography to characterize the needs of the people; involve end-users at the beginning of the project using participatory design Walter Curioso
    • Smart phones are the exclusive domain of the rich; realistic technology should focus on simpler phones
    • Simple health solutions –  reminders can be text messages but should be carefully designed; beyond the message, think about the right context. In Peru, people with HIV prefer the subtle coded message: it’s time for your…life in order to mitigate privacy, security and stigma issues
    • mHealth helps collect data
      • mHealth outcomes can make an essential contribution to data collection which can support health system strengthening.
      • RT @mHealthAlliance: For CDC in Kenya, mobile data collection saves time and money. CDC now collects 20 times more health data than just a few years ago #mHS10
      • Michael S. Lauer cautioned that data collected naturalistically is not rigorous protocol – there will be missing information and it is hard to mine
        • a fad: it delivers real outcomes – real value across chain; 30% of consumers are willing to pay $2 on consultation
        • a technology game but change to business model and cultural behaviour worldwide – existing care regimens can be used
        • just about care delivery; can transform business model – for example how payors interact with patients submitting claims
        • a niche business: mobility is transforming many sectors around the world eg. in utilities, smart metering tech for consumption monitoring, retail and banking
        • a one solution fits all as models differ geographically
          • mature: delivery – where real savings are
          • emerging: reach – most rapid adoption of mobile health
        • Healthcare systems and institutions must change to improve performance
          • Interventions cannot take place in a vacuum.: Leadership Institutions Systems Technologies (LIST required)
            • Leadership: strategy, vision, political skills and ethical perspectives
            • Institutions: development only  possible thru the vehicle of institutions that mobilize the pursuit of goals – hospitals…needs long term investments against political pressures
            • Tech: Knowhow to deliver appropriate interventions – biomedical as well ICTs to improve performance
            • Systems design – procurement, info, personnel so that requisite structures can mobilize the necessary resources

          • Whether patients, providers, epidemiologists or policy makers…human oriented approaches are essential.

          mHealth Summit 2010 overview

          November 16, 2010

          Last week, one of the trending twitter hash tags was #mHS10. Organised by mHealth Alliance, the 2010 mHealth summit was certainly the most galvanizing mHealth event globally – bringing together 2000 delegates from more than 38 countries. This is one of a series of posts summarizing the highlights. Other posts include Patricia Mechael’s pearls of mHealth wisdommHealth is not about technology, mHealth and the evidencenotable tweets and mHealth in western vs global contexts.

          According to Wikipedia,

          “mhealth (also written as m-health or mobile health) is a term used for the practice of medical and public health, supported by mobile devices… mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery of healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vital signs, and direct provision of care (via mobile telemedicine).

          I was able to follow some of the sessions via live webcast but mainly relied on the informative tweets of enthusiastic tweeple/tweeps (twitterers). In the next few posts, I will capture memorable tweets and my thoughts and reflections.

          Pluses

          • The conference was graced by such remarkable and influential thought leaders as Bill Gates and Ted Turner. It drew speakers from respected organizations like Rockefeller foundation – which lends important credibility and visibility to the growing mHealth field.
          • The experts represented diverse areas: public and private; technology and health; rural and urban; policy makers, practitioners and academics. Such rich multisector dialogue with the resulting cross fertilization of ideas has promise of systemic impact.
          • Despite its huge size, the summit provided an ideal forum for different players  to share ideas and lessons learned. The global health arena is highly prone to fragmented and uncoordinated interventions fraught with wasteful duplication rather than productive collaboration. mHealth Alliance’s Health Unbound was promoted  as precisely the forum to promote knowledge sharing and collaboration in the mHealth community.
          • The conference afforded the rare opportunity to address the potential of mHealth in both western and global contexts:

          It was particularly heartening to note the recognition that developing countries are further along in these technologies as they a) have had to be more innovative and b) have not been hindered by legacy systems which tend to interfere with the adoption of new technologies. It is a refreshing shift when the north finds positive lessons to learn from the south.

          Minuses

          • Some seasoned tweeps, notably @downeym who attended mHealth 2009 summit reported a déjà vu feeling as the same issues came up. According to @downeym, the previous summit mainly featured “doers” while the 2010 summit was dominated by “talkers”.
          • Awareness is a good thing but there was valid concern that the summit overhyped mobile phones as the antidote to all global health problems, creating unrealistic expectations. Is mHealth  yet another bandwagon that will, predictably, underdeliver?
          • It is challenging to meaningfully address both the global health challenges and western perspectives in the same forum because the contexts differ significantly. There may be transferable experience but the different regions have unique challenges and needs.
            • Thierry Zylberberg, Orange aptly highlighted this when making the distinction between the role of mhealth in developed and developing contexts: To the Developed world: mhealth brings more efficiency, to the Developing world: access to health. Needless to say, it is essential that the application is appropriate for the environment.
            • RT @clarkritchie: In the US, mobiles are personal devices, but in many other cultures they are shared or communal #mhs10

          mHealth Summit 2010: Patricia Mechael’s pearls of wisdom

          November 10, 2010

          This is the one of a series of posts on the recent 2010 mHealth summit. Other posts include an overviewmHealth is not about technology, mHealth and the evidence, mHealth in western vs global contexts and notable tweets.

          Patricia Mechael, a panelist at the Lessons Learned Across the Globe panel shared ten lessons learned from pioneers in mHealth à la David Letterman’s Top 10 format. These were practical, concisely put and audibly resonated with the audience.   

          10: We must unpack the pathways to mobile mediated behavour change: selling texts doesn’t mean that people will do things differently. Needless to say, behaviour change is very complex and exposure to information is only the first step in the continuum that results in action. Cultural context is particularly important and often overlooked.

          9: Locally generated content – content from developed countries may not be meaningful to expectant women in Africa. It is also essential to adapt material for optimal mobile delivery which requires careful thought and execution.

          8: Move away from focus on user satisfaction and evaluate impact of health outcomes ; set targets and bench marks. This is interesting as it implies that an intervention may have value in the user’s view but not demonstrate impact on health outcomes. Why not shoot for both? I would argue that user acceptance is important too.

          7: Be realistic as there is a risk of overhype: focus on what works. Clearly there is a danger of expecting too much from mobile technology and overlooking other key determinants of behavioural change.

          6: Invest in participatory design processes and involve users who will be affected, work flow; invest in local development and strategists…who will continue to modify and adopt the technology.

          5: Take a systems approach: rather than single issue implementation, address other adjacent issues. Health is very much a multi-sectoral field that demands a multi-dimensional systemic response.

          4: Collaboration is more fun than competition; not survival of the fittest. This is very instructive as in the global development field, organizations tend to work in parallel as they compete for a limited pot of donor funding.

          3: Recycle, reuse and repurpose. Of course, it makes sense to share lessons learned, build on and replicate successful models and avoid reinventing the wheel.  The Health Unbound Forum (HUB) hosted by the mHealth Alliance and others, is a newly created forum that “aggregates health content, facilitates idea exchange, and creates community between the diverse constituencies that can benefit from, and improve access to, health information and care.” Secondly, the AHRQ Health Care Innovations Exchange offers an avenue for health care professionals and researchers to share, learn about, and adopt evidence-based innovations.

          2: mHealth at scale, link technology to priorities, identify the best tools to address these priorities. Build on the strengths and contributions of private public partnerships. It takes a wide range of players to  needs to accomplish progress in the mHealth field as well demonstrated by the text4baby program.

          1: It is not about technology – there are no killer apps, there is room for all the initiatives underway. We’re all impacted by these systems.


          Patricia Mechael should know as she has worked on mHealth initiatives since 2001 with a broad range of
          institutions beginning in 2001. She has worked on the  Millenium Villages Project at the Earth Institute, Columbia University.  I first learned about her work from the landmark  Motech Ethnography mHealth Report research into the potential of mobile phone applications to improve maternal health in Ghana.

          2010 mHealth Summit: Show me the evidence

          November 9, 2010

          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.

            Dr. Mary Wakefield, Health Resources & Services Administration (HRSA) was part of a comparative effective research (CER) panel.

            • 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?

            Social media session at IHA Health Literacy Conference 2

            May 15, 2010

            I recently had the privilege to facilitate a social media session breakout session at the  9th IHA Health Literacy Conference. For the background, see earlier post.

            Highlights

            With Rosetta Keeton, St. Louis ConnectCare

            Rosetta Keeton planned to use FaceBook with her teen audience

            It was very heartening to hear several participants say that the presentation encouraged them to think about using social media tools in ways they had not considered before. Rosetta came up to me during the reception and said that she had learned a lot of useful ideas. She was very enthusiastic about David Armano’s “listen, learn and adapt” cycle and was considering FaceBook for engaging teens in an upcoming theatre for HIV prevention project. To the extent that the session stimulated interest in social media tools and got participants thinking about new ways of reaching their audience, I consider the session highly successful. The participants expressed appreciation for the handout and I continue to receive positive feedback. I am in the process of moving the handout to Google Docs so that it can be collaboratively edited.

             
            Lessons learned
            • Polling the participants ahead of time was a good idea. Pro: I was able to get a sense of the audience, learn about their needs and invite some advanced users to contribute their experiences. Con: There was no way to respond to all the fantastic issues in a 90 minute session.
            • I knew from the poll that participants were at different levels of experience but I was still thrown off by the challenge of engaging such a mixed crowd. Happily, they were all a model audience – enthusiastic and eager to learn. With the focus of the session on examples and strategies, there wasn’t enough time to address questions such as: what’s a Twitter hashtag in satisfactory detail as I worried about boring the advanced participants stiff with indepth explanations of  basic concepts.  Clearly, I was expecting too much when I asked the busy participants to review my social media 101 post as many beginners needed to learn what the tools are and how they work. There are many barriers to learning – for example, one participant  explained that she couldn’t review the post because her workplace blocks *all* blogs!! Beth Kanter, who is a social media training guru may have valuable input on how to address the challenge of mixed level groups and I wish to acknowledge her wisdom which she generously shares on her blog and social media lab wiki. The ideal scenario would be separate sessions for beginners and more advanced learners.
            • It may be helpful to divide the participants into loose groups based on their target audience. It was clear that those targeting patient groups face different challenges from those reaching health literacy practitioner communities.
            • I may have tried to cover too much content too quickly and with hindsight, it was overly ambitious to expect the participants to work on the  activity that I had planned for them – an exercise to brainstorm their audience, objectives, strategies and technologies [based on Forrester’s POST methodology].  There was not enough time to absorb the basic concepts and envision implementation particularly for the beginners.
            • Helen Osborne, who I respect a great deal, had valuable feedback for me. She was very interested in my analysis of my pre-session survey findings and would have liked us to spend more time on this.
            Plenary session at the IHA conference

            Plenary session at the IHA Conference

            Next steps

            The participants had lots of questions and we ran out of time while there was a clear appetite for animated discussion. Predictably, a common concern was how to address privacy and HIPAA regulations and my basic response was a) HIPAA applies to health care providers not patients b) get informed consent when interviewing patients for blogs c) use social media for general education not specific patient advice. Other concerns: What do you do with negative comments? How do you track all the FaceBook comments about your organization? How often should you post updates? Sara Browne, a physician made the valid observation that it’s challenging to keep up with all this information without experiencing an information overload.

            To address these and other issues raised in the pre-survey, I offered to start a forum where we would continue this conversation. I am considering creating a FaceBook page where participants can hone their skills with this platform as they share their experiences with and learn from like-minded colleagues. I wish to acknowledge the wonderful contributions of all those who I have consulted on my journey to IHA where I gained rich insights. I am particularly grateful to Erin Macartney of Palo Alto Medical Foundation for diligently compiling excellent content which I am working into a blog post. And of course, a big thank you to my wonderful audience many of whom spoke to me afterwards and planned on staying in touch.

            I welcome thoughts from all: the session participants and those who have facilitated similar sessions on how to sustain these great conversations.