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mHealth: Technology Changing Health Care

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E. Rachel Mutrux: Director, Missouri Telehealth Network …

E. Rachel Mutrux: Director, Missouri Telehealth Network
Missouri Health Policy Summit 2013


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  • Technologies for m-healthThe main device for m Health application is mobile phones (and smart phones). The advantages of using such phones in healthcare settings are illustrated in one research as :“ Living in resource-poor environments is not a barrier to the use of mobile phones for several cultural and economic reasons, but there appears to be a lower threshold of access to cell phones.(13) There is evidence that the existence of a so-called "digital divide" along the socio-economic gradient is less pronounced in mobile phones than in other communication technologies such as the Internet.(14) Furthermore, mobile phones cost less to rollout over large areas and mobile networks can be built faster than fixed lines and the social value of a mobile phone is highly valued even in resource-poor areas.(15) In addition, the use of mobile phones is immune to social prejudices. Men and women alike can use the phones. Similarly, due to the advancement of the technological infrastructure they are accessible to people from rural and urban areas, young and old, and can be designed to be used in any language.Lastly the mobile phone initiative is cost effective. Because mobile technology infrastructure already exists in African nations, there is no need for funding for development. The SMS intervention is inexpensive, and according to the Kenya case, each SMS costs about US$ 0,05, equivalent to US$ 20 per 100 patients per month, and follow-up voice calls averaged US$ 3,75 per nurse per month.(16) This protocol is also probably less expensive than in-person community adherence interventions, on the basis of travel costs alone. Thus, the intervention could be both cost effective and cost saving.(17)”http://www.consultancyafrica.com/index.php?option=com_content&view=article&id=615:an-sms-a-day-keeps-the-doctor-away-the-use-of-mobile-phones-to-improve-african-health-care-outcomes&catid=57:africa-watch-discussion-papers&Itemid=263
  • Application of m Health fieldDiagnostic and treatment supportDisease and epidemic outbreak trackingRemote monitoringEducation and awarenessRemote Data collectionHelpline Klasnja, P., & Pratt, W. (2012). Healthcare in the pocket: Mapping the space of mobile-phone health interventions. Journal of Biomedical Informatics, 45(1), 184-198.
  • mhealth is still in its infancy. A lot of researches on mHealth have produced inconclusive result. The researches which showed promises still could not produce significant result due to poor research design and lack of available data. Health outcome improvement (as research showed)Texting improves health outcomes Effective chronic disease managementEffective self-management of disease and successful clinical outcomesBetter quality of lifeReduction of errorBetter control of infectious diseases in developing countries. Accessibility of healthcare in rural areas.Cost effectiveBetter medication adherenceTexting leads to better medication adherenceBetter maternal child healthImprove attendance to healthcare appointments 1)http://www.brookings.edu/~/media/research/files/papers/2012/5/22%20mobile%20health%20west/22%20mobile%20health%20west.pdf2)A mobile telephone-based interactive self-care system improves asthma control EurRespir J 2011 37:310-317; published ahead of print 2010, doi:10.1183/09031936.00000810  3)Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., ... & Haines, A. (2013). The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS medicine, 10(1), e1001362.-Inconclusive Research 4)Lv, Y., Zhao, H., Liang, Z., Dong, H., Liu, L., Zhang, D., & Cai, S. (2012). A mobile phone short message service improves perceived control of asthma: a randomized controlled trial. Telemedicine and e-Health, 18(6), 420-426. 5) (http://www.fiercemobilehealthcare.com/story/texting-improves-health-outcomes-young-asthmatics/2013-05-026)http://ebn.benefitnews.com/news/mobile-wellness-apps-increase-employee-engagement-decisionmaking-health-out-2729886-1.html?CMP=OTC-RSS7)Ryan, D., Price, D., Musgrave, S. D., Malhotra, S., Lee, A. J., Ayansina, D., ... & Pinnock, H. (2012). Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentrerandomised controlled trial. BMJ: British Medical Journal, 344.-Not effective self-management for asthma. Not cost effective 8) Obermayer, J. L., Riley, W. T., Asif, O., & Jean-Mary, J. (2004). College smoking-cessation using cell phone text messaging. Journal of American College Health, 53(2), 71-78. Retrieved from www.scopus.com
  • Transcript

    • 1. E. Rachel Mutrux Director, Missouri Telehealth Network Operations Director, Missouri HIT Assistance Center State Director, Heartland Telehealth Resource Center 1
    • 2. Jama, 10/24/2013 definition: “use of mobile telecommunication technologies delivery of health care and in support of wellness” for the 2
    • 3. Mobile Phones & Smart Phones 1. Digital divide is smaller for phones than for Internet 2. Mobile phone technology easier/cheaper to roll out to large areas than fixed technologies 3. Mobile phones immune to social prejudices Male/female; rural/urban; young/old Cost effective & cost saving 3
    • 4. Dr. Sebelius lists 3 forces driving mHealth 1. $$- unsustainable cost of healthcare 2. Wireless & technology!! 3. Need for individualized medicine Per capita spending on healthcare, Kaiser Foundation 4
    • 5.  Measurement  Tracking- diet, exercise  Blood sugar, blood pressure  Diagnostic  Portable imaging  Sensors  Treatment  Chronic disease management  Remote clinical trials  Comprehensive  Dissemination of health information  Disease surveillance  Prevention & Wellness interventions  Education & awareness  Helpline Klasnja, P., & Pratt, W. (2012). Healthcare in the pocket: Mapping the space of mobile-phone health interventions. Journal of Biomedical Informatics, 45(1), 184-198. 5
    • 6.     Nexercise Free app that tracks exercise- GPS Uses support system Allows you to win points- money  Fooducate  Scan bar codes to get nutrition information  Grades food choices (A,B,C)  Suggests better alternatives 6
    • 7.  Clinical Reference Apps  The Merck Manual  WebMD  Medscape  Diagnostic Apps  Mobile MIM- FDA approved for radiology  AirStrip- Cardiology App- see EKG  Public Health Apps  For Cancer prevention- Target Heart Rate Calculator, Calorie Counter, Cigarette Calculator  Telehealth Apps  Videoconferencing  Tele MDID- developed here at MU!!  Disease Management Apps  Asthma  Crohn’s Diary  Kidney Diet 7
    • 8. Tele- MDID Project Far Site Near Site Clinic – University Hospital
    • 9. The iPad apps were deployed to 10 far sites, as well as MU dermatology clinics. Pre-launch and post-launch internet-based surveys were distributed to far site patient presenters and dermatology clinic providers in 2013. 9 University of Missouri Institutional Review Board (IRB) #1207257.
    • 10.  Texting improves health outcomes  Effective chronic disease management  Effective self-management of disease and successful clinical outcomes  Better quality of life  Reduction of error  Better control of infectious diseases in developing countries.  Accessibility of healthcare in rural areas.  Cost effective  Better medication adherence  Texting leads to better medication adherence  Better maternal child health  Improve attendance to healthcare appointments **caveat much research was inconclusive showing need for additional research 10
    • 11.  Current reimbursement structure  Physician concerns  Reducing face-to-face interaction  Increased workload  Security, Privacy  Under-regulation- Over-regulation  Safety  Big-Brother 11
    • 12.  Estimated 100,000 apps on the market today  Health & Wellness apps are leading adoption!LoseIt! Fitbit  Healthcare moving out of the Dr. office to the patient  Improve health, increase access, decrease cost 12
    • 13.  E. Rachel Mutrux  Phone: 573-884-7958  E-mail: mutruxe@health.missouri.edu 13
    • 14. Reference List 1)http://www.brookings.edu/~/media/research/files/papers/2012/5/22%20mobile%20health%20 west/22%20mobile%20health%20west.pdf 2)A mobile telephone-based interactive self-care system improves asthma control Eur Respir J 2011 37:310-317; published ahead of print 2010, doi:10.1183/09031936.00000810 3)Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., ... & Haines, A. (2013). The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS medicine, 10(1), e1001362.4)Lv, Y., Zhao, H., Liang, Z., Dong, H., Liu, L., Zhang, D., & Cai, S. (2012). A mobile phone short message service improves perceived control of asthma: a randomized controlled trial. Telemedicine and e-Health, 18(6), 420-426. 5) http://www.fiercemobilehealthcare.com/story/texting-improves-health-outcomes-youngasthmatics/2013-05-02 6)http://ebn.benefitnews.com/news/mobile-wellness-apps-increase-employee-engagementdecisionmaking-health-out-2729886-1.html?CMP=OTC-RSS 7) Ryan, D., Price, D., Musgrave, S. D., Malhotra, S., Lee, A. J., Ayansina, D., ... & Pinnock, H. (2012). Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial. BMJ: British Medical Journal, 344.-Not effective self-management for asthma. 8) Obermayer, J. L., Riley, W. T., Asif, O., & Jean-Mary, J. (2004). College smoking-cessation using cell phone text messaging. Journal of American College Health, 53(2), 71-78. Retrieved from www.scopus.com 9)http://www.ey.com/Publication/vwLUAssets/mHealth_Report_January_2013/$FILE/mHealth%2 0Report_Final.pdf 14

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