This is the Executive Summary of the Final Report from the University of Cambridge (sponsored by China Mobile) on Mobile Communications for Medical Care:
“This report examines the use of mobile networks to enhance healthcare (so-called “mHealth”), as an example of how mobile communications can contribute to sustainable development. We define mHealth as “a service or application that involves voice or data communication for health purposes between a central point and remote locations. It includes telehealth (or eHealth) applications if delivery over a mobile network adds utility to the application. It also includes the use of mobile phones and other devices as platforms for local health-related purposes as long as there is some use of a network.”
Innovative mHealth applications have the potential to transform healthcare in both the developing and the developed world. They can contribute to bringing healthcare to unserved or underserved populations; increasing the effectiveness and reducing the costs of healthcare delivery; improving the effectiveness of public health programmes and research; preventing illness (including through behaviour change); managing and treating chronic diseases; and keeping people out of hospital.
mHealth applications are numerous and diverse. They range across remote diagnostics and monitoring, self-diagnostics, management of long-term conditions, clinical information systems, targeted public health messaging, data gathering for public health, hospital administration, and supply chain management. They are emerging in response to opportunities and needs that are similarly diverse, including the threat of pandemics; globalisation and population mobility; an ageing and increasing population; rising income (leading to lifestyle changes); increased expectations of health provision; demands for the personalisation of healthcare; and a growing focus on behaviour change, disease prevention, and keeping people out of hospitals.
These applications are enabled by the fundamental characteristics of mobile networks and devices: near ubiquitous, locatable, connected user interface devices, often personalised, delivering computing power at low cost, integrating a range of sensors and supporting mobility (essential in some applications but not all):
- In many developed countries, the coverage of mobile infrastructure is near-ubiquitous, and in many developing countries, it provides higher penetration of the population than fixed networks. In some places, it is the only ICT infrastructure, and mobiles are the only general-purpose computer available.
- The capabilities of mobile networks (particularly in terms of data-carrying) are increasing rapidly, extending the scope of applications that can be supported to include high-resolution images, video and large file exchange, which are required for some medical purposes.
- Basic phones with voice and text messaging already provide powerful tools; the new generation of “smartphones” offer greater computing power, data storage, the ability to interface with sensors, and intuitive user interfaces that can be used as the platform for sophisticated applications of many kinds.
Business models have emerged that encourage innovation in mHealth applications; many of these models are incremental (i.e. they do not require major infrastructure investment), although they may still rely on interaction with other service providers’ components or platforms. Moreover, for many mHealth applications, deployment requires no intervention by policy-makers or the medical establishment. In such cases, normal market innovation, and consumers’ willingness to pay, will drive deployment. But not all mHealth applications are like this: many will need to interact with established healthcare systems (and therefore be
subject to the regulation of those systems). In these cases, development will play out very differently depending on the maturity of healthcare systems. At the same time, some of the greatest benefits of mHealth are unlikely to be delivered by the market in any environment. In particular, individual consumers are unlikely to pay for applications designed primarily to produce information from which public goods (such as better advance warning of the spread of epidemics) are derived. Such investments for the public good require funding by institutions if the potential benefits are to be realised.
The nature and pace of development will vary between countries. In developed economies, the mobile will be used to collect, store, analyse and upload a wide spectrum of personal and environmental data, from vital signs (heart rate, body temperature, etc.) to location, motion, mood, ambient air temperature and levels, and adherence to medication regimes. The ability of healthcare providers and carers to use this data in real time, and in aggregate form for research, will not only benefit individuals but will also lead to better forms of illness prevention and treatment, and earlier prediction of epidemics. Individuals’ personal health records may come to be stored in electronic form, updatable from a mobile phone, and
capable of being accessed with suitable permission anywhere in the world. Engaging applications will lead to better support for behaviour-change interventions and for treatments such as cognitive behavioural therapy in the area of mental health.
Over time, many of these applications will also reach low-income economies, though in the shorter term mHealth will help to put in place robust administrative systems for healthcare delivery that are taken for granted in developed countries. Increasingly powerful mobile phones will be in the hands of health workers, delivering technologies previously available only in larger population centres. Mobile phones will also deliver training to clinicians, and remote decision support using either automated analysis of data, or real-time contact with specialists. Medical staff will be enabled to diagnose and treat conditions locally without patients needing to travel large distances to specialist centres. Disease outbreaks will be handled more efficiently through better communication.
We expect applications to develop most rapidly in countries where healthcare delivery, and public services generally, are in transition from established to new structures (through market change, deregulation, other infrastructure change, or demographic change). Rapid development will also be encouraged where the population has rising expectations for healthcare, and where those involved in healthcare delivery are willing and able to experiment with new models. Such conditions may apply in any country, but are perhaps
most likely to apply in major emerging economies.
In all parts of the world, the next phase of development and deployment will see generic service platforms playing a crucial role, providing processing power, storage, security, access control and other services to a wide range of mobile applications, including (but not limited to) mHealth. Until recently, an application that required “off-phone” services required dedicated servers that had to be dimensioned for the application, but the emergence of cloud computing is obviating this need. Few current mHealth applications use cloud-computing facilities; however, if these generic services were provided as publicly available platforms, like the mobile network and Internet themselves, the upfront investment required to deploy new applications would be decreased. The actors best placed to drive a move toward publicly available platforms include large network operators.
Investments in generic services have the potential to contribute to multiple applications, and not all of those applications have to succeed for the investment to be justified. This consideration is particularly true for the operator, where scale and brand allow a very effective spreading of financial risk; reputational risk is also decreased, because the operator need not enter the health sector application business at all, merely enable it. This both encourages sector-driven innovation, and allows applications to be developed which
have too small a user base to be of interest to a large operator. It also separates any trust issues related to information privacy from the operator-provided infrastructure.
Our recommendations for the principal players in mHealth are presented below:
Policy-makers (including governments, health NGOs, and regulators)
- Policy-makers should ensure that policies and priorities for healthcare are complemented by financial incentives that reward those who deliver outcomes, particularly in disease prevention.
- Policy-makers, healthcare agencies and professional healthcare bodies should provide guidance for assessing the healthcare and public financial benefits from emerging applications in a manner that can be understood by application providers, and create an expectation that such assessment should be an integral part of provision.
- Public health authorities and agencies should engage in assessing the benefits and costs of acquiring information – whether as “by-products” or directly – from mobile applications, either to replace existing data gathering or to gain new knowledge. This requires clarity of ownership of, and access to, personal information.
- Regulatory regimes and the medical establishment’s guidance-setting need to strike an appropriate balance between the risks and benefits of specific mHealth applications, distinguishing between those apps for which a light touch or a market-based approach is appropriate (i.e. those that pose no risk to health and may be effective, and which typically have little or no interaction with the established health delivery system) and those which have the potential to bypass or substitute other healthcare systems (i.e. those that might pose a risk to health unless properly regulated, or which might need to be robustly evaluated if health system money is to be put into them).
- Telecoms regulators should review any constraints that existing regulations may place on the deployment of mHealth applications. In particular they should consider allowing mobile operators to operate as micropayment banks, i.e. directly handling small financial transactions.
- Operators should have clear strategies – which might be different in different markets – for how much of the value chain (basic services, generic platforms, application provision) they wish to operate, balancing investment, financial return, reputational risk and the presence/absence of other players operating parts of the value chain.
- Mobile operators should promote their networks as platforms for innovation and small-scale application deployments, and should invest in the provision of generic service platforms for this purpose. They should facilitate the use of the platform for domain specific innovation (here healthcare, though the recommendation is more generally applicable) by third parties, recognising that, even if they choose to operate some applications directly, some applications will be too small (or present excessive risk) for the operator to provide.
System Integrators, Manufacturers and Technology Providers
- Medical device manufacturers should exploit the power of the mobile handset as a computing and communications platform, even when the computation required to deliver a particular application cannot reside completely on the handset. The swiftest take-up will be of applications that rely only on voice, SMS and WAP.
- There is an opportunity for technology providers to provide the tools for creating or running managed services related to mHealth, which will in turn enable operators to provide generic service platforms. Technology providers need to decide whether their strategy is (a) to build and sell or (b) to build, sell and operate, perhaps in direct competition with operators.
Healthcare Providers (including Insurers)
- Healthcare providers should examine mHealth applications as a means of managing exposure to costs – e.g. through the use of in-home monitoring to avoid hospital or residential stays. This might allow reduced charges or premiums, or increased profits.
- Healthcare providers should consider how they might use data generated by mHealth applications to monitor and optimise the healthcare delivery chain itself, e.g. by improving the management and efficiency of expensive assets, or by better understanding the patterns of use.”