After having written six research reports on mobile health (or mHealth), and attended two mHealth Summits in Washington, D.C. (see my review of mHealth Summit exhibitors from 2011 to 2012), I thought I was on top of this topic. But, a thin volume of essays and case studies edited by Rick Krohn and David Metcalf, titled mHealth: From Smartphones to Smart Systems, showed me that I have more to learn. This book, published by the Healthcare Information and Management Systems Society (HIMSS) in 2012, has plenty of insights for everyone.
The book starts off with a forward by Robert McCray, president and CEO of the Wireless-Life Sciences Alliance, who argues that wireless technology can reduce costs, improve healthcare quality, and increase access and transparency. In their introduction to the book, the two editors echo that sentiment, and contrast the experience of introducing useful health technologies like computerized provider order entry (CPOE) and electronic medical records (EMR) with the experience of introducing mobile health. The first experience was characterized by scepticism and tepid growth while, they state, “with amazing speed, mHealth is becoming the clinical data medium of choice for clinicians and consumers, typified by compact devices and tools that are cheap, reliable, persistent and convenient.” They add, “It’s the care management platform that the EMR always should have been, with an important distinction – it’s reaching its potential.”
In the first full essay, Rick Krohn makes the case for an mHealth ecosystem. He shows the difference between the old episodic model of healthcare delivery with a doctor at the center and a new engaged mobile healthcare ecosystem with the patient at the center. “Information is now portable, personalized and participatory, making a patient-centric mHealth ecosystem unbound by age, location or economic strata,” he says. Just as is the case for mobile learning, what is revolutionary here is that mobile health is characterized by a bidirectional information flow enabled by the mobile network, which empowers patients by involving them in their own care. But, there are lots of barriers as well, and Krohn concludes, “It’s going to take a wholesale restructuring of healthcare delivery to achieve an mHealth ecosystem.”
In Chapter 2, Mehran Mehregany and Enrique Saldivar continue with a listing of opportunities and obstacles to the adoption of mHealth. Opportunities include enhancing the quality of healthcare, increasing convenience for everyone, and cost reduction. Obstacles include a lack of consumer awareness, barriers created by regulation, problems with reimbursement, and resistance to innovation. In developing nations, there are even more obstacles such as a lack of resource capacity, inability to meet costs, and lack of access.
Claudia Tessier discusses the “mHealth stakeholder” in chapter 3. Four groups are identified – patient/consumers, clinicians and other healthcare providers, healthcare executives and nonclinical personnel, and other stakeholders including payers, farmer, vendors, developers, first responders, researchers and educators. The needs and advantages for each of these groups of stakeholders are discussed in some detail.
In chapter 4, Rick Krohn and David Metcalf examine the mobile building blocks of the mHealth ecosystem in more detail. First, the hardware that is necessary to set up mobile is presented, including smartphones, tablets, and peripheral devices such as digital stethoscopes, digital blood pressure monitors, digital weight scales, and many others. Then, the software necessary to make the system work is described. Tens of thousands of healthcare-related apps are now available in the various mobile app stores and many more are on the way. Apps for healthcare include tracking of public and population health, software for emergency response systems, professional and patient communications, point-of-care documentation, telemedicine diagnostic and decision support, financial and administrative applications, health extension services, consumer education, and the organization of pharmaceutical clinical trials.
David Metcalf takes the reins in chapter 5 and describes an integrated mHealth ecosystem in detail, as well as integration and deployment strategies for such systems. There is a lot involved in setting up such a system, including understanding informatics, clinical decision support, electronic medical records, laboratory information systems, mobile computerized physician order entry systems (CPOE), patient communication and insurance reimbursement, time tracking systems, health training systems and security. Two major development approaches are also compared and discussed – the waterfall model and agile systems.
Rick Krohn comes back in chapter 6 with an important section on developing an mHealth strategy. There are many issues to consider here, including business planning, technology choice, mobile capacity, compatibility and conductivity, security, regulations, and standards. And, the author warns us, the situation is continually changing. The next wave of mobile health will have to take into account such emerging technologies as cloud computing and new wireless protocols.
In chapter 7, Rick Krohn takes up the important topic of business modeling for mobile health. He contends that “despite its early successes, mHealth has yet to establish a proven business strategy. To do so, mHealth must address business issues like workflow bottlenecks, the cost/benefit calculus, customer engagement and much more.” But, there’s lots of room for growth. New areas that mobile health businesses should consider include remote patient monitoring, telemedicine, mobile medical equipment (not the machines that are wheeled around on carts!), real-time location systems, health and fitness software, secure mobile messaging, electronic medical records, mobile clinical solutions, mobile consumer solutions, and mobile applications for population health. This chapter includes a brief business plan that lists the topics that should be included, as well as a section on how to measure success.
Jeff Brandt provides a chapter on security and compliance, his specialty. In chapter 8, he starts with security goals and risk assessment, looks at multiple options for data storage on mobile devices, assesses legal issues and regulations that apply to mobile health, and discusses the elements of an organizational security policy. In the end, he says, “remember to always expect the best, but prepare for the worst.”
Finally, in chapter 9, David Metcalf provides concrete examples of successful mobile health deployments in a chapter called “Practical Applications and Complementary mHealth Technologies.” He briefly looks at mobile applications in medical education, nursing, telematics, telemedicine and rural health.
In addition to the substantive material in the chapters, there are nine case studies included in the book, which range from “using tablet computers to improve clinical workflow and information security” to “providing centrally managed data security for 400 laptops.” Case studies are important at this stage of the development of the field because those who are contemplating adoption need to justify their budgets and proposals with stories about what already has been successful.
While this is a relatively short book, it is very useful because it is breaking new ground and giving examples of what works in mobile health. Anyone contemplating adoption of mobile systems in their healthcare settings will find it very helpful in formulating their plans.
