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Topics in mHealth

What is mHealth?

It’s a booming field of new opportunities in healthcare opened up by mobile technologies and telecommunications –  harnessing the communications, processing power and personal nature of mobile phones, whether smart or simple. It’s about more than just smartphones and new mobility devices like tablets, it’s also about the amazing reach of SMS, the information richness of the mobile web, and the power of Data:

“The information revolution of the last few decades has the potential to transform the way healthcare functions. Its greatest potential lies in its capacity to change the way that patients interact with the health service, giving them more control over their own health and care. Patients have too often been left in the dark about what is happening to them, and denied the information that they need to fully participate in the decisions about their own health. This participation is not only a patient’s right, but is vital to improving the quality of care”

– Sylvia Wyatt & John Loder, Patients and the Power of Datathe Young Foundation

And the opportunities are not just about addressing the rising cost of healthcare in the West, accompanied by the rising Baby Boomer generation – it’s also about meeting basic health needs around the globe:

“The mobile revolution has been hailed as the enabling force for emerging markets and developing countries to become more active participants in the global economy. Given the right tools and environment, people can harness mobile technology to leapfrog more developed countries, creating services that address local problems and issues, and ultimately close the digital divide.”

– Cynthia Artin, MHEALTH: Mobile Lab On A Chip Improving Diagnostics & Building The Ecosystem, MobileGroove.

The Case for Grassroots Proto-typing and Piloting

It’s pretty hard to miss, but the National Programme for IT has once again been called to account on the giant wastage of taxpayer money, and general wrong-headedness of the top-down approach to major IT platform improvements.

“Today’s report from the NAO presents a depressing account of delays, contractual wrangling and technical glitches. The original vision for the scheme was compelling – a national network connecting hospitals, GP practices, ambulance services and mental health trusts, and an end to the tortuous paper trails that have caused frustration and misery for doctors and patients alike. But the complexity and cost of the scheme meant it was always seen by many as a high risk strategy. And when it ran into trouble the plans were scaled back, and the original vision set aside. Many GPs and hospitals are now working with different systems, prompting the NAO to question whether further investment in the national programme would be pouring good money after bad.”

– Adam Brimelow, BBC Health Correspondent £7bn NHS electronic records ‘achieving little’ for patients, 18 May 2011

The Impact on Compliance

There are a lot of interesting case studies emerging now about the impact that simple reminders can have on compliance:

Use of mobile applications, many medical professionals believe, could make an important difference. Multiple small-scale studies have looked at apps and their impact on patient education, engagement, and compliance, with mostly positive, though not conclusive, findings. Researchers at the University of Washington provided eight diabetic patients with services such as feedback on glucose levels and connection to care providers through cellphones and game systems. The study, published last month in the journal Diabetes Technology & Therapeutics, found patients liked using the system and felt more aware of their health needs as a result.”

– Marion Davis, Boston Globe, Tapping into Smarthealth May 2011

Addressing the Digital Divide

I remember a book that Oprah wrote way back in the 90’s about the power of making the connection between your behaviour & choices and your weight & fitness (the penny finally dropping being the key to change)  – there are some great examples of extrapolating that into your wider health & fitness, still using really lo-fi and lo-tech means of making that connection. Here’s one recent example:

“At one point, each teacher stood up and talked about how many steps the class had taken to date, how that translated into distance on the map of the US (“We have walked as far as Pittsburgh”) and set a goal for the remainder of the school year (“If we each take 500 steps more per day we’ll have enough steps to get to Cleveland”).  The juxtaposition of the quantification of a health behavior and the use of that to educate the students in math and geography was stunning.  Also, the illustration of how quantified health information can be used to motivate teams to improve health is compelling.  The enthusiasm of the kids was truly inspiring.”

– Joseph Kvedar, eHealth Blog, Crossing the Digital Divide with Connected Health, May 2011

Taking Charge of our own Health

I have heard it proposed that we have seen a permanent and radical turn away from the period in human history during which we have been ‘accidentally healthy’. Our daily lifestyles no longer automatically include a degree of physical activity, nor do our most basic eating options offer us a good basic level of nutrition – we must now be purposefully healthy, and create a lifestyle that knowingly builds in physical activity and good nutrition. Our daily actions have long-term consequences that often do not get calculated into the immediate decision-making of the day. The government wants to throw lots of ‘nudges’ our way, but we ultimately have to take charge of our own health and nudge ourselves:

“… How do we motivate and enable people to take responsibility for their own health and health care? It’s really common for us to be very good at caring for our friends and families, not to mention our homes, cars, and jobs, but we don’t always take the same level of care with our own minds and bodies. The trend in consumer electronics toward more personal experiences on tablets, smart-phones, and even television is a perfect wave to catch with the idea of self-care.

I really like the ideas put forth by the Washington Health Foundation around “people-centered health.” Among other things, they take a bit of a rebellious stance and promote the radical idea that people must be empowered to be “partners in their health,” and that the current medical system (and a lot of supposedly “patient-centered design”) discourages individuals from solving their own problems by treating them as “patients.” They propose a number of very interesting design principles that are meant to help create services that actually put people in control of their own health care.

I’d like to add something to those tenets: “Good person-centered health design creates an emotional tone that is conducive to self-care.” What I mean by that is in order to effectively reduce the impact of chronic disease, we have to encourage people to establish sustainable, healthy ways of life for themselves, rather than being “treated” by nurses and doctors. Emotional tone is key because this is how exercise and healthy food become sources of joy, rather than unpleasant chores, and a treatment regimen becomes the enabler of good living, rather than yet another indignity. To create this tone, we must bring the same level of design craft and attention to home-health-care experiences as we do to the best housewares and consumer electronics.”

– Dave Cronin, To Solve our Current Health Crisis, Homecare needs a Makeover, Fast Company, May 2011

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