Schyler Cole
Within 15 minutes of waking up, 4 out of 5 smart phone users reach for their phone. During their waking day, 79% of smart phone users are without their phone for a mere 2 hours or less. Additionally, the average person user at his or her phone 150 times a day, once every 9.6 minutes.1 With these mobile devices an individual can check Facebook, answer texts, trade stocks, deposit a check, and get directions. Now, with Mobile Health (mHealth) devices and applications, phone users can use their hand held devices in conjunction with tools, such as the wireless blood pressure cuff and blood glucose level tracker, to manage their own health.
Healthcare systems are experiencing a shift from a physician-centric to patient-centric system. In the current, physician-centric system, physicians steer patient health provision; however, as health care shifts to a patient-centric system, patients will be empowered to control and monitor their own health. This movement is fueled by mHealth, the provision of health services and information through the use of mobile technologies. As described by Dr. Marta Zanchi, Medical Innovation Advisor, lecturer, co-director of Stanford’s “Biodesign for Mobile Health” course and Managing Director at Medinnovo LLC, mHealth is not just a technological movement. It is multi-faceted. It is a movement that is revolutionizing technology, changing consumer and physician perspective, and changing the way care is delivered. mHealth can help individuals and communities manage their health in many ways: provide education, disease surveillance, disaster mitigation in the case of epidemics, and positive health practices; send text messages to remind patients to take medicine or go to an appointments; and even provide a virtual platform with which to meet with doctors one-on-one2. Wearable mHealth technology allows users to monitor daily vitals and activity, which becomes especially important when treating chronic diseases. Also in development are heart and brain monitoring devices, m-ECG and m-EEG, and WiFi enabled devices, such as pacemakers, that continuously monitor and automatically send alerts to physicians when abnormalities arise.
While mHealth can potentially improve healthcare, many barriers to implementation remain. Further implementation is hindered by start up costs, lack of coordination between users and devices, inaccurate or misleading information, loss of human interaction, and issues of privacy and security. What if your grandfather’s pacemaker or electronic health records database were hacked? Currently there is “little solid evaluation”3 of the mHealth’s clinical and economic performance; however, overcoming mHealth’s barriers can allow for a more patient-centric and individually tailored healthcare system.
This is the power of mHealth. You can possess this power. Your aunt in Rhode Island can possess this power. People across the world in Kenya and Bangladesh can possess this power too. While the field of mHealth has only recently emerged, both developed and emerging countries are making great efforts to reap benefits from the mHealth movement and to put new healthcare technologies in the hands of their citizens.
A wide range of benefits can accrue from mHealth for all countries, but developing nations in particular are expected to see the most immediate and profound benefits. Two prime examples are India and Nigeria where current efforts are demonstrating the potential of mHealth.
India
In India, mHealth technologies benefit both rural and urban populations. The rural populations being targeted by mHealth, which currently consist of approximately 247,000 households4, will benefit from applications and devices that link them to healthcare facilities at a low cost. Urban populations will benefit from devices that provide convenience in accessing high quality healthcare facilities and improving monitoring services for individuals with chronic diseases such as diabetes, heart disease, and obesity.
Currently a number of mHealth organizations and non-profit organizations are contributing to the patient-centric movement by utilizing mHealth technologies in target areas of need and disease. SANA, an MIT student and volunteer organization, creates open source mobile apps to guide community health workers on how to screen and diagnose patients, as well as link their data to doctors through the open source medical records system, OpenMRS, used in India and other developing countries. Another mHealth initiative being used in India is mPedigree, which implements a mobile platform to track and check the validity of medicines to combat the widespread practice of drug counterfeiting. To combat HIV in India, ZMQ Software Systems offers mobile games to change adverse health behaviors5. The games offer a “fusion of digital entertainment” that provides valuable information in an appealing format.
Nigeria
Recently, Nigeria, Africa’s most populace country, has used mHealth technologies to help the country address Ebola. On October 20, 2014, Nigeria was declared Ebola-free by the World Health Organization (WHO) thanks in part to the implementation of a social media campaign and a real-time reporting Android app6. After the outbreak, the phone app aided in the reduction of reporting times of infections by 75%. As the Nigerian Minister of Communication Technology Ombola Johnson explained at the International Telecommunication Union’s Plenipotentiary Conference on October twenty-first, “Test results were scanned to tablets and uploaded to emergency databases, and field teams got text message alerts on their phones informing them of the results.”7 This phone app was provided by eHealth & Information Systems, a California- based non-profit.
The success of this Android app was in part due to widespread mobile plan subscriptions. Today in Nigeria, there are over 131 million mobile phone plans, up from 87 million users just four years ago. Fruther diffusion of mobile phone subscriptions and devices in Nigeria and elsewhere will continue to catalyze improvements in health and well-being.
United States
In addition to the benefits developing countries have and will hopefully continue to experience, United States citizens can also look forward to advancements in mHealth implementation in the US itself. Devices such as the Breast Cancer Smart Bra and smartphone ECG devices8 are having impact in monitoring and treating heart disease, obesity, diabetes, HIV, and cancer, among many other diseases. Within the United States, the Bay Area along with the Northeast are the leaders in digital health funding activity, contributing more than 41% of total spending from 2010-20139.
Closer to home, there are many resources and opportunities to engage with and utilize mHealth, both on the Stanford campus and at the local Target or Apple Store. Remote monitoring Hubs and Sensors including the iPhone glucometer and the Parkinson Ring Center are making strides in combating chronic and degenerative diseases. Wearables such as the FitBit and BodyMedia armband are available to help students monitor their activity levels and consumption. Stanford students can also study Mobile Health formally through the Biodesign course (Fall, BioE 23/ Med 273) and by learning more about the Stanford Medicine X Conference.
As further research and implementation is done to overcome current challenges in mHealth, everyday people can help spur progress by making the choice to be in control of their health. Around the world, the critically ill as well as the healthy can take advantage of mHealth to access both preventive and curative care. With healthcare systems becoming more patient-centric, individuals will be empowered to control and monitor their own health. It is time to pick up the phone; health is on the line.
Endnotes:
1. Dias, J. (2014, October 13). MHealth: The Most Underutilized Force in Patient Engagement? Retrieved November 1, 2014, from http://hitconsultant.net/2014/10/13/mhealth-the-most-underutilized-force-in-patient-engagement/
2. G. Kahn, J., Yang, J., & S. Kahm, J. (2010). ‘Mobile’ Health Needs And Opportunities In Developing Countries. Health Affairs, (2), 254-261. Retrieved November 13, 2014.
3. G. Kahn, J., Yang, J., & S. Kahm, J. (2010). ‘Mobile’ Health Needs And Opportunities In Developing Countries. Health Affairs, (2), 254-261. Retrieved November 13, 2014.
4. Lunde, S. (2013, January 1). The mHEALTH Case in India. Retrieved October 20, 2014, from http://www.wipro.com/documents/the-mHealth-case-in-India.pdf
5. Schafran, D. (2010, November 18). MHealth India: Untapped Potential. Retrieved October 29, 2014, from http://www.triplepundit.com/2010/11/mhealth-india-mobile-health/
6. McCann, E. (Ed.). (2014, October 24). WHO credits mHealth app with helping Nigeria get rid of Ebola. Retrieved October 27, 2014, from http://www.mhealthnews.com/news/who-credits-mhealth-app-helping-nigeria-get-rid-ebola
7. McCann, E. (Ed.). (2014, October 24). WHO credits mHealth app with helping Nigeria get rid of Ebola. Retrieved October 27, 2014, from http://www.mhealthnews.com/news/who-credits-mhealth-app-helping-nigeria-get-rid-ebola
8. Baum, S. (2014, September 24). So far, cardiology dominates FDA-cleared devices for mhealth. Retrieved October 29, 2014, from http://medcitynews.com/2014/09/so-far-cardiology-dominates-fda-cleared-devices-for-mhealth/
9. Zanchi, M. (2014). Stanford Biodesign for Mobile Health – Health Everywhere at Inventathon. Presentation, University of California Los Angeles.