An Introduction to mHealth

Jessica Jacobsjess.a.jacobs@gmail.com

Georgetown University

April 14th 2011

Learning about the Preventive Health IT Toolbox

What is mHealth?

Current Trends

Applications

Opportunities

What is mHealth?: Questions to Consider

There is not a consensus on what mHealth is.

Questions to Consider:

1) What kind of connection does it have to have? Broadband? Wifi? Wired Internet?

2) What technology does it include? Cell phones? PDAs? Devices? Computers?

3) What’s the application? Clinical Data? Community Health? Personal Health?

4) What’s it part of? Telehealth? eHealth?

http://vimeo.com/17125591

What is mHealth?: Broad Definition

All the definitions focus on mobile communications and healthcare.

Broader definitions seem to be gaining more steam.

“The integration of mobile technology, computing devices, and emerging delivery system capabilities into a patient-centered

model of care.”

– Indian Health Service US Department of Health and Human Services

What is mHealth?

Current Trends

Applications

Opportunities

Current Trends: Federal Support

•HITECH Act to spur the adoption of EHRs, HIEs, and other Health IT.

•Provisions in PPACA for telehealth and innovation in healthcare.

•Continued Presidential commitment to “the need to increase coverage of high speed wireless networks to 98 percent of all Americans within the next five years”: “This isn’t about faster Internet or fewer dropped calls. It’s about connecting every part of America to the digital age. It’s about a rural community in Iowa or Alabama where farmers and small business owners will be able to sell their products all over the world. It’s about a firefighter who can download the design of a burning building onto a handheld device; a student who can take classes with a digital textbook; or

a patient who can have face-to-face video chats with her doctor.”

- President Barack Obama 2011 State of the Union Address

Current Trends: Technology Adoption

Own a Cellphone Send/Receive Text Messages

Access Internet on a Cell Phone

90% 86%

59%

88%

72%

38%

82%

47%

15%

57%

11% 6%

Utilization of Mobile Technology

Aged 18-29 Aged 30-49Aged 50-64 Aged 65 and Over

Current Trends: Technology Adoption

Medicare

VA

No Insurance

Individual Policy

Employer Policy

Tricare

Medicaid

43%

45%

63%

65%

68%

74%

79%

SMS Utilization by Insurance Coverage

Source: Pricewaterhouse Cooper HRI Study, 2010, http://apps4android.org/hhc/New_business_models_delivering_care_anywhere_chart_pack.pdf

What is mHealth?

Current Trends

Applications

Opportunities

Applications: Continuum

Management Promotion Surveillance

Personal PopulationPublic

Applications: Management

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•Patient-centered personal health management.

•Patient or care-giver driven.

•Typically includes a device or smartphone application.

•PHR and EHR integration is possible.

•Particularly beneficial for conditions where continual tracking is warranted:

• Diabetes• Asthma/COPD• CHF• Aging in Place• Medication Adherence

Applications: Management - Diabetes

Link glucose meter readings to patient records electronically.

This link ensures that readings are recorded correctly and allows for physicians to passively monitor a patient’s blood glucose.

Pilot studies show that this kind of application is effective; indeed, it is correlated to a reduction of 5 points in blood glucose readings and a 1% reduction in HbA1c readings over a three-month period.

Watson et al. “Diabetes Connected Health: A Pilot Study of a Patient- and Provider-Shared Glucose Monitoring Web Application” Journal of Diabetes Science and Technology, March 2009, Volume 3, Issue 2: Page 345-352. http://www.connected-health.org/programs/diabetes/research-materials--external-resources/diabetes-connected-health-a-pilot-study-of-a-patient--and-provider-shared-glucose-monitoring-web-application.aspx

Applications: Promotion

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• Educational messages targeted at behavior modification.

• Third Party driven (public health depts, governments, insurance companies)

• Usually utilizes cell phone messaging because it’s quick, easy, and cheap.

• May be one way or two way messaging.

• Particularly beneficial for chronic. Smoking Cessation Sexual Health Pregnancy Depression

Applications: Promotion – text4baby

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Free national SMS health information service. One way text messaging. Signup by texting “baby” to

511411. Large public-private partnership.

Healthy Mothers Healthy Babies (HMHB), Voxiva, The Wireless Foundation (CTIA), HHS/OSTP, J&J, etc.

3 messages/week. Pregnancy through first year of child’s life.

* As of April 5, 2011, Text4Baby Tuesday Newsletter

16% 84%

2012 Million Mom Goal

Enrollees To Go

Applications: Surveillance

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• Health tracking for timely notification.

• Health Worker and/or community driven.

• Low cost reporting mechanisms.

• Particularly useful in remote areas.• Web and SMS based.

• Potentially Useful for: • Disease Outbreaks• Program Evaluation• Contaminations

Applications: Surveillance - EpiSurveyor

Allows people to design forms for data collection on the internet.

Data is entered into the forms using either a smart phone application or SMS messaging.

Allows for real-time data uploads and analysis.

Been used to evaluate: anti-malarial bednet distribution and

vaccination campaigns in sub-Saharan Africa clean water initiatives in Vietnam drug supplies in several African countries health delivery systems in Guatemala

* 2011 World Bank Report: http://siteresources.worldbank.org/INTLAC/Resources/257803-1269390034020/EnBreve_166_Web.pdf

"drastically cut costs while facilitating quality control

and improving implementation speed.“

- The World Bank

What is mHealth?

Current Trends

Applications

Opportunities

Opportunities

Prepare to engage and be engaged with mHealth.

Contribute to the growing body of knowledge.

Review for efficacy and separate “signal” from “noise.”

Innovate to discover applications for new and existing technologies.

In Conclusion…

Current trends show that the utilization of mHealth will increase.

Its applications are numerous and widely encompassing:

Management: Connecting mHealth applications with traditional health IT systems will provide a groundbreaking continuum of personal care, particularly for those with chronic conditions, keeping them out of hospitals.

Promotion: Wide scale education and behavior modification will improve the health of the public due to its ability to be anywhere the person is at anytime.

Surveillance: Real-time health tracking and data aggregation leads to actionable information for preventing disease outbreaks and improving population health.

Source: http://www.healthcareitnews.com/news/mhealth-apps-forecast-increase-threefold-2012-0

I’d now like to welcome any questions…