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.
- 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.
- RT @digiphile: Conditions like obesity, diabetes & smoking cessation are good candidates for #mhealth to address in rich countries, says @BillGates. #mhs10
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.