mHealth

mHealth (also written as m-health or sometimes mobile health) is a recent term for medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, PDAs, and other wireless 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).

Definitions

Mobile eHealth or mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems and is part of a movement towards citizen-centered health service delivery. Mobile technologies by nature lend themselves to more decentralized health service delivery. Although Ministries of Health in low and middle income countries and policy makers are eager to explore the use of mobile phones and other ICT to promote health, the lack of a comprehensive model, knowledge base, and published data on the health benefits poses significant barriers.

The most widely cited and definitive definition is by Istepanian et al. as 'emerging mobile communications and network technologies for healthcare.’

Other later citations include Bardram et al. as m-health is focused on embedded wireless devices that track health-related parameters:

"The recent advances in information and communication technologies (ICT) enable technically the continual monitoring of health-related parameters with wireless sensors, wherever the user happens to be. Small, low-power sensors can, in principle, be embedded in almost anything in our surroundings: furniture, vehicles, wearable devices, and even clothes. Mobile phones or personal digital assistants (PDAs) with wireless networking capabilities may serve as gateweays that process, store, and transfer measured parameters to clinicians for further analysis or diagnosis. This technology trend, also called mHealth (mobile health), is already visible in the market"

mHealth in Low and Middle Income Countries

There has been a growing interest within the health sector to capitalize on the rapid uptake of mobile communication technologies and the overall improvements in telecommunications within the general population throughout the world. Characterized as a ‘leapfrog technology,’ mobile phones have allowed developing countries, even those with relatively poor infrastructure, to bypass 20th century fixed-line technology and jump straight to 21st century mobile technology. The number of global mobile phone subscribers in 2006 was estimated at 2.5 billion of an estimated global population of 6.6 billion (37.9%). These figures are expected to grow to 3.3 billion or approximately half of the world’s population by 2010 with the greatest growth expected in Asia, the Middle East, and Africa . In many countries, the number of mobile phone subscribers has by-passed the number of fixed-line telephones, this is particularly the case in developing countries.

The cost of mobile technology deployment is increasingly going down, with vendors such as Nokia developing cheaper infrastructure technologies (CDMA) and cheaper phones (sub $50–100, such as Sun's Java phone). Cost may not be much of an issue in the near future, especially compared to PC-based solutions. The increasing functionality of phones enables SmartPhone-capability in relatively inexpensive phones. It is worth noting that the capabilities of mobile phones in low and middle income countries has not reached the sophistication of those in high income countries, which now enable web browsing, GPS navigation, and e-mail through what are being called, smart phones. In spite of these differentials, the basic SMS text functions and real-time communication capacity of devices available in low and middle income countries offer a broad range of potential benefits to the health sector. Increased availability and efficiency in both voice and data-transfer systems in addition to rapid deployment of wireless infrastructure will likely accelerate the deployment of mobile-enabled health systems and services throughout the world.

The trends towards mHealth in developing countries are largely due to the overwhelming uptake of mobile phones within the health sector and by the general population as well as the increased uptake, however limited, of smart phones within the health sector for retrieval of web-based information and patient data in decentralized health management information systems (HMIS). In addition, wireless-enabled laptops and specialized health-related software applications are currently being developed, tested, and marketed throughout the world. This is happening primarily in high income countries; however, with broad advocacy campaigns for free and open source software (F/OSS), applications tailored to local contexts may soon become available in low and middle income countries. Efforts to provide resources and training for the localized development of applications and technologies ought to be encouraged in low and middle income countries.

Mobile technologies offer direct voice communication (of particular value due to literacy and language capacity in many countries) and information transfer capabilities. The appeal of mobile communication technologies is that they enable communication in motion, allowing individuals to contact each other irrespective of time and place. This is particularly beneficial for work in remote areas where the mobile phone, and now increasingly wireless infrastructure, is able to reach more people at a more rapid rate. As a result of such technological advances the capacity for improved access to information and two-way communication hence becomes available at the point of need.

mHealth to Improve Health Outcomes and Efficiencies

Technology integration within the health sector has great potential to promote healthy lifestyles, improve decisions by health professionals as well as patients, and enhance healthcare quality by improving access to medical and health information and facilitating instantaneous communication in places where this was not previously possible. The increased use of technology can help reduce health care costs by improving efficiencies in the health care system and promoting prevention through behavior change communication (BCC). It also has the potential to advance clinical care and public health services by facilitating health professional practice and communication and reducing health disparities by applying new approaches to improve the health of isolated populations.

The Millennium Development Goals (MDGs) that specifically address health as set forth by the United Nations Millennium Declaration in 2000 include reducing child mortality; improving maternal health; combating HIV and AIDS, malaria, and other diseases; and increasing access to safe drinking water. A progress report published in 2006 indicates that childhood immunization and deliveries by skilled birth attendants are on the rise, while many regions continue to struggle to achieve reductions in the prevalence of the diseases of poverty including malaria, HIV and AIDS and tuberculosis (TB). Increasing attention has also been drawn to the critical shortages in trained healthcare personnel throughout the world whereby there are now 57 countries with critical shortages in health work force density with a global deficit of 2.4 million doctors, nurses, and midwives. Investing in the training and ongoing development of the healthcare work force is considered among the most effective means of improving health. Three key areas in which early and rapid gains can be achieved through technology design and integration are in the areas of Safe Motherhood, routine immunization and integrated management of childhood illness, and in addressing the diseases of poverty, namely HIV and AIDS, malaria, and TB- where significant resources have been mobilized to reduce the disease burden in low and middle income countries.

Efforts are ongoing to explore how a broad range of technologies, and most recently mHealth technologies, can improve such health outcomes as well as generate cost savings within the health systems of middle and low income countries. The specific potential of mHealth lies in its ability to offer opportunities for direct voice communication (of particular value due to literacy and language capacity in many countries) and information transfer capabilities that previous technologies did not. This is particularly beneficial for work in remote areas where the mobile phone, and now increasingly wireless infrastructure, is able to reach more people at a more rapid rate. As a result of such technological advances the capacity for improved access to information and two-way communication hence becomes available at the point-of-need and for healthcare workers at the point-of-care. Mobile communication technologies are tools that can be leveraged to support existing workflows within the health sector and between the health sector and the general public.

Applications

Mobile devices have been used in a number of different settings, but most applications can be classified as follows:

• Telemedicine
• Data collection (for public health or clinical domains)
• Decision support
• Access to information

Emerging trends of interest in mHealth include the use of technologies in the following capacities:

• Emergency response systems (e.g., road traffic accidents, emergency obstetric care)
• Disease surveillance and control (Malaria, HIV/AIDS, TB, Avian Flu, chronic diseases- esp. diabetes)
• Human resources coordination, management, and supervision
• Mobile synchronous (voice) and asynchronous (SMS) telemedicine diagnostic and decision support to remote clinicians
• Clinician-focused, evidence-based formulary, database and decision support information available at the point-of-care
• Clinical care and remote patient monitoring
• Health extension services
• Health services monitoring and reporting
• Health-related m-learning for the general public
• Training and continuing professional development for health care workers
• Health promotion and community mobilization

mHealth Technology

Key mobile communication technologies relevant to mHealth include:

• Mobile phones
• PDAs and smart phones
• Patient monitoring devices
• Mobile telemedicine/telecare devices
• MP3 players for mLearning
• Microcomputers

mHealth Technology capabilities:

Voice

Voice is usually personal two-way communication although automated systems may provide voice recorded information as well.

Data

Data access is primarily focused on visualizing static text but can also extend to interactive decision support algorithms, other visual image information, and also communication capabilities through the integration of e-mail and SMS features. Integrating use of GIS and GPS with mobile technologies adds a geographical mapping component that is able to “tag” voice and data communication to a particular location or series of locations. These combined capabilities have been used for emergency health services as well as for disease surveillance, health facilities and services mapping, and other health-related data collection.