The insider’s guide to mobile health (m-health)
Mobile devices are personal, always on, always with the patient and are location-aware; the patient can use them for self-help or to communicate with a professional; and/or to monitor the health of the patient – this makes the cell phone a much more appropriate device for remote healthcare than any other mass media, be that print, radio, TV or even PC.
In the past few years, mobile health, or m-health, has drawn a lot of interest, from mainstream media to billionaire tech philanthropists, such as Bill Gates. This isn’t surprising as it’s one (of several) sectors, where mobile really makes sense and makes a difference in myriad situations, from the person who falls ill in a rural village in Africa where they are otherwise cut off from healthcare to the need to provide lifestyle guidance to a western couch-potato, who’s diet and lack of exercise is leading to ill-health and a potential drain on health resources.
Our guide to m-health is David Doherty, co-founder of the 3G Doctor (a service that offers consultations with registered Doctors in UK and Ireland via mobile video), speaker and blogger on all matters mobile health.
Q1. What is m-health?
M-health is delivering health, defined as the state of complete physical, mental and social well-being, via the mobile channel. There is, however, no agreed industry definition for m-health.
Please note m-health is not a subset of or mobilization of e-health. Mobile devices have unique attributes, including being personal to the patient, always with the patient, and always on and as well as helping to provide social context, e.g. location. This makes mobile a more appropriate channel for delivering health than any other mass media, e.g. cinema, radio, TV, even PC.
Q2. How important is mobile's (potential) role in health a) today b) tomorrow?
When you think about it, we’re surrounded by evidence of how mobile has directly or indirectly revolutionized health today. Just think of the impact of being able to call emergency services from a mobile at the scene of an accident instead of having to find a payphone. Consider the myriad situations where patients, carers (caregivers) and medical professionals can use mobiles to access information or phone for assistance/advice from other patients, carers or professionals, perhaps sending a picture message to help identify a rash; or the common sense of those (unfortunately still only few in number) doctors surgeries that send a simple SMS to remind patients of their appointment. (See Q3 for more examples).
Among emerging technologies, one that is particularly useful for health is mobile video – though clearly I am a little biased, being the co-founder of a mobile video-based 3G Doctor service. Mobile video is perfectly placed to transform health education, motivate individuals to change their behavior and maintain healthier long-term lifestyle choices. One of the best ways to tackle the spiraling healthcare costs and loss of productivity associated with poor health and lifestyle choices in modern societies is to empower patients (and their carers) to help themselves and one of the best ways to do this is by delivering high-quality personalized content to their own personal mobile devices – after all the patient is the most under-utilized individual in today’s paternalistic sick-care (rather than healthcare) system.
But mobile video is just one of many ways that mobile and health will converge. In the same way that the average cell phone became the clock, calculator, camera, music player, games machine and Internet in your pocket over the course of the last decade, (defined as the Nokia decade, so during this decade, you should expect mobile and health technology to converge. Today the top smartphones are powerful enough and more than capable of putting an informed doctor, comprehensive medical library and bio-monitoring device (i.e. monitoring levels of the various natural and unnatural chemicals in the body that influence health) in your pocket.
Q3. Where in the world is m-health making a difference today and will do in the future?
The pervasiveness and capability of mobile devices and networks makes a huge difference to the health of society and individuals everywhere all the time. Even the basic functions of the mobile device – phone calls and SMS – have led and will continue to drive a fundamental change in all societies’ health and healthcare.
• Emergency services: ask anyone who has been working in emergency services for more then 10 years and they'll tell you how much their role has been transformed in a decade, from a time when the majority of calls came from fixed lines to a time when majority of calls come from cell phones. Mobile devices allow people to call from when and where a patient collapses and the person, carer, professional can remain with a collapsed patient, help to direct the ambulance to the precise location of the patient, and get advice directing the administration of first aid. Where 10 years ago emergency services would keep emergency calls brief, when dispatching a response vehicle, now it’s not uncommon for an operator to stay on the line with the caller until the emergency service arrive.
Not only does this offer improved outcomes (I've personally been involved in saving several lives through this new technical ability), but it helps to improve the effectiveness with which emergency services are deployed. But cell phones aren’t all good news – in 2010 most of the calls to emergency services were actually made inadvertently from mobile phones as a result of accidental key pressing.
• Indirect impacts: some health benefits of mobiles are obvious, e.g. parents don't have to stress while waiting for a child to arrive home any more, as they can easily SMS them to find out why they're delayed. Drivers, e.g. taxi drivers, don’t have to rush when they are running late, as they can SMS to warn those waiting. But sometimes the impact is less clear, such as: what's the value to a patient who lives alone knowing that they can catch a friend, family or carer wherever they are on the mobile or the benefit that the additional freedom that a mobile brings to a patient who can now go out, while staying close to the phone in case of emergencies.
• Developing world: many people think the biggest opportunity in m-health is in emerging markets where mobile can help patients who do not have access to services via other channels. There have been lots of externally- or government-funded m-health pilots/projects over the last few years, such as: Freedom HIV/AIDS in India that uses mobile games to promote HIV/AIDS awareness; Learning about Living in Nigeria, where teenagers can ask sexual health questions by text message; Handhelds for Health in India, which uses mobile technologies (instead of pen and paper) to collect field data on disease or public health; Mobile Telemedicine System in Indonesia which allows remote patients to receive a routine check-up using a mobile phone; and many more. Some of these projects have been successful and continue to develop into long-term services that help those in need, but many have simply fallen by the wayside. In my opinion, the real power of m-health is to enable patients and providers in these regions to help themselves – usually these won’t be a glamorous as the externally-funded projects. These might include the ability to send a SMS to request an ambulance in a remote village in India, or services that are set up to enable clinicians and patients to do things more effectively, such as a service set up by surgeons in Tanzania to send bus fares to patients via m-money so they can make it to the hospital to have their operation.
• Machine-to-machine (M2M) technologies: healthcare has also begun to benefit from advances in security and automotive that enables machines to send alerts automatically. For example, high-end vehicles now have sensors and connectivity embedded that can automatically alert emergency services when the vehicle is involved in an accident, providing information in great detail e.g. three airbags deployed, make, model, license number, registered keeper, whether the vehicle is reported stolen, prior travelling velocity, direction of travel.
• In the future, network technologies will reduce inefficiency in the way that emergency medical calls are handled. So, instead of 1,000 people simultaneously ringing in to report the same accident on a busy motorway, the first few callers will be put through to the operator, then subsequent callers from that location will be greeted with "If you are calling to report an accident between a blue van and white car on the westbound carriageway of the M25 motorway, thank you for your help but we are already responding to this emergency. If you have any further information, please hold the line and one of our operators will be with you shortly."
• In the future, patients and emergency medics will be linked by video call by services such as 3G Doctor. Video will help to personalize and improve communications and enable more effective documentation of the experience.
Q4. What stage of adoption are we at?
M-health, like the mobile phone itself, is still in its early stages, but the close mutual interrelationship between wireless communications and healthcare is a century old. When the Titanic sank it was able to send out distress signals by radio, without which even more people would have perished – this was only 10 years after Marconi sent the first transatlantic radio message.
Fast-forward to the pager (the forerunner of the mobile phone) – medics were the target customer and early adopters of pagers.
In the early days of the mobile phone, long before SMS caught on with the masses, text messaging was used widely by deaf patients. A lot of this is a credit to Nokia, which caught on to the potential of SMS from the start and made it easy to create/send a message by touch alone.
Today examples of m-health include:
• Giving midwifes remote access to and the ability to update patient records via BlackBerry devices and digital pens, and enabling healthcare professionals to search for and match organs for transplant patients, both in the UK.
• In the Republic of Ireland, out-of-hours doctor cover is managed entirely via SMS.
• Medical students receive part of their education via mobile device (more on this in Q5).
• The UK’s top doctors can send informational videos to patients via Harley Street World/3G Doctor.
Mobile hardware is also evolving rapidly. Research I'm party to makes me confident that m-health monitoring technologies will become a key differentiator for mobile device manufacturers/operators. To people who query the convergence of health and mobile, I point out that a decade ago people thought camera/phone convergence wouldn’t happen, but today Nokia is the world’s biggest camera manufacturer. Consider the effectiveness of this sales pitch next time you purchase a mobile phone: "Did you know that for the same price, you can buy this other cell phone that also works as a smoke and carbon monoxide alarm?"
Q5. What types of organizations are using/benefiting from m-health today? What organizations will use/benefit from m-health in the future?
Increasingly medical schools e.g. Stanford (in the US); Leeds, UCL, Cardiff, and Manchester University (all in the UK) are making course materials and text-book resources available on mobile devices, either smartphones and/or tablet computers. For tutors this can do away with the need to conduct roll calls, and offers the potential to deliver rich interactive multimedia course materials or the ability to instantaneously survey students. This has a huge potential for assessing the effectiveness of course materials and student attainment and monitoring tutor performance.
But the most important thing is that as these students, who have experienced the benefits of mobile first hand, graduate and enter the medical profession, they should become the leading advocates of the need to deliver healthcare to their patients via mobile.
Q6. What's driving m-health forward?
It’s being driven by the passion that people feel for making a difference. This has always been the way in medicine – if you go to a medical conference, you inevitably end up in the early hours of the morning talking passionately about your work. But this is also the case in the mobile business. I'm always amazed by how many talented mobilists are prepared to give me their time, ideas, introductions and even, in some cases, their financial support. They appreciate the value in moving m-health forward – it is one of the few revenue opportunities in mobile that's also makes sense to the consumer and makes you proud to play a part.
The momentum behind m-health is witnessed by the number of well-attended m-health events. In 2009, I helped to launch the world’s first m-health conference, the in London Mobile Healthcare Industry Summit. It attracted 120 delegates, including many key mobile leaders, such as Vittorio Colao, chief executive of Vodafone Group as the conference chair. By 2010 the m-health Summit in Washington drew an audience of 2,000 delegates - including at least 5 billionaires. In 2011, there are lots of m-health-related events – there’s a list here – this is all a good thing, but some of these may just be me-too events that don't add much value – so choose carefully.
Q7. What's holding it back?
The lack of leadership and knowledge and a failure to appreciate the real risks associated with implementing m-health projects. That’s why it’s essential that all interested parties collaborate and share knowledge – this is one of the principle reasons why I document all advances in m-health in a blog and I set up the m-health discussion group on Linkedin.
Q8. Who are the key gurus in m-health?
The key gurus for me are those clinicians who are prepared to use mobile to engage with their patients more effectively. We can push technological solutions all day, but if anything is to change the technology needs to be accepted and adopted by clinicians, and they need to feel confident enough to change their working practices.
Q9. What are the typical mistakes in m-health?
The biggest mistake is developing/introducing products and services without proper consideration of the importance of patient privacy. This is particularly bad in emerging markets. I've seen m-health initiatives funded by global mobile operators that have completely insecure patient record databases. At the other extreme, I’ve seen initiatives by organizations that should know better – the digital divisions of the UK’s National Health Service have attempted to engage with (or snoop on) patients on public communication channels such as Twitter.
Another typical mistake, is starting with an iPhone App. Bristol NHS Primary Care Trust (PCT) recently launched an app that offered exactly the same information as was also available on the mobile website. This ignored the fact that the majority of public patients don't have iPhones or unlimited data plans and that the small minority of people with an iPhone could just as easily got the same information through their mobile browser (without needing to download an app). To my mind, the healthcare in Bristol would have been better improved if the PCT provided GP clinics with secure websites or SMS appointment-reminder alerts – services that would benefit the majority of patients. As advised by mobile guru Tomi Ahonen, the order for mobile investment should be voice, SMS and then mobile Web.
Q10. What are the trends or technologies to watch in m-health?
As the founder of 3G Doctor, I'm clearly biased, but from my research nothing will have as much impact as mobile video. The medical profession is blighted by a failure to communicate effectively – I believe that mobile video is the only viable solution as it enables access to information when and where it is required on a personal device. In the future, I believe mobile video will be used in every part of the healthcare industry, through highly personal informative videos, video education, video enabled adherence programs, augmented reality and video connectivity with clinical team and patient communities.
Q13. What are your top tips for anyone wanting to get involved in developing m-health services?
• Read up on the mobile industry. Tomi Ahonen and Alan Moore’s book Communities Dominate Brands or the accompanying blog.
• Start your research by watching a loved one interact with the healthcare system. Read the patient information they've been given (normally impersonal generic leaflets or marketing materials from a pharmaceutical company) and check out the search results and websites they visit to find out more about their ailments.
• Alternatively check out the volume of junk mail that healthcare professionals receive on a daily basis. Also study the Websites of the various medical professional organizations to see what they're doing to support the continual educational and training needs of their busy members.
• If you're a mobilist with a good idea for an m-health project, I recommend inviting your family doctor out for lunch, offering to donate some money to their favorite charity in return for getting their reaction to your plans.
• If your interest is in helping create m-health for people in emerging markets, first focus on making a successful m-health service in your home market – the one you know best. Then share your insights, findings and source code via a blog with everyone, which enables others to copy and adapt it to make it successful everywhere else.
David Doherty is co-Founder of 3G Doctor, a service that provides members of the public with 3G video mobile access to informed registered Doctors anytime any place. The service costs £35 per consultation and is available in the UK and Ireland, where 97 percent of the population have 3G coverage. David blogs on the m-health opportunity at m-healthInsight.com [http://mhealthinsight.com] and is a regular speaker at industry events.
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The mobile device is personal, always on and always with the patient.
Learning about living, Nigeria: allows young people to text in their questions about sex and sexually transmitted diseases.
Cardiff University’s iDoc Project provides doctors with a medical reference books on a smartphone.