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Applications of eHealth and mHealth in Mental Healthcare

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A report written mostly from patient perspective about applications of eHealth (IT solutions to support healthcare) and mHealth (mobile applications of eHealth) in Mental Healthcare. 11 pages, including management summary and a list of available ready solutions compiled from several sources.

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Applications of eHealth and mHealth in Mental Healthcare

  1. 1. Compilation ©Armands Kreņģelis & European Consulting Partners ehf, 2015 Page 1 of 11 Applications of eHealth and mHealth in Mental Healthcare By Armands Kreņģelis, MBA (Management Information Systems), lv.linkedin.com/in/armandsk November 2015, Riga, Latvia – Stockholm, Sweden Management summary  There are many internet sites offering information and guidance on Mental health.  Some of the sites also offer self-assesment questionnaires ond other interactive tools.  A leading example in Europe is ifightdepression.com from European Alliance Against Depression  There are several aspects that need to be taken care of when implementing Hospital Information Systems (HIS) and Telemedicine in Mental healthcare: o strong narcotic and psychotropic drugs used in Mental care need strong accounting control; o EEG may be the most important of Laboratory, Radiology and similar investigations; o calendar needs to support group treatment widely used in Mental care.  A subtype of eHealth (application of various aspects of Information Technology to support healthcare), application of mobile devices to support healthcare is called mHealth.  eHealth or mHealth self-service solutions work best if combined with and supporting the traditional meetings with a healthcare professional. They can provide text, sound, video, or games, and use PCs or smartphones.  Some typical applications of mHealth include medication reminders and patient diary among other.  There are many existing mHealth applications internationally; many of them are free.  A problem is that many of the existing applications are not integrated with wider eHealth solutions.  EU supports mHealth through Digital Agenda for Europe, a Europe 2020 Initiative by EC.  In the future we can expect significant growth in mHealth solutions, and especially some areas like games and simplified form of EEG that could be done even in remote villages.  The security concerns need to be taken seriously and addressed from the start of design of mHealth applications and devices. Cloud computing and Internet of Things are great technological advances, but can become security nightmare if used without proper consideration of security aspects. Acknowledgements This report is commissioned and supported by Prof. Dr. Jon Thor Thorhallsson of European Consulting Partners ehf, an international network of consultants with offices in Reykjavik, Brussels, Vilnius and Riga, which is specialized in facilitating business between Nordic and Baltic partners, especially in the areas of Management, Marketing, and Information Technology including eHealth. See www.ecpint.com and www.ksg.lv
  2. 2. Compilation ©Armands Kreņģelis & European Consulting Partners ehf, 2015 Page 2 of 11 Background – advice sites Internet has a long history of sites offering information and guidance on various topics, including of course Mental health, probably since the time when invention of e-mail and World Wide Web made the domain of IT specialists into a public space about 25 years ago. That also coincided – not incidentally! – with the breakdown of Iron Curtain, collapse of Soviet Union and economic changes in the countries of Central and Eastern Europe, including the Baltic countries. More than 20 years ago, Medicīnas Firma „Dziedniecība” (www.mfd.lv, further MFD) was one of the first polyclinics to be privatized, and one of the first medical institutions in Latvia to make a web site. The site included a form for anybody to ask anonymous question to a doctor, while providing just any working e-mail address. Years later, I heard in a conference from representatives of MFD that this form got quite a popularity compared to the number of internet users in Latvia, and that stigmatic health areas like sexually transmitted diseases, sexual and mental health were disproportionally highly represented in the questions. Because people were not afraid to ask „computer” the questions they found hard to ask their Family doctor, even if they were finally answered by a human. Regretfully the form is gone, as MFD has grown into a large medical company for Latvian scale. Now there are probably hundreds of web sites worldwide offering information and guidance specifically on Mental health, not counting the media articles ranging from general press and news portals to professional journals. There are several web sites in Latvia alone:  www.depresija.lv - the footnote refers to Association of Latvian Psychiatrists and Riga Stradins University, the leading medical school. Includes a self-assessment test for potential patients;  www.sauleszimes.lv - a charity (patient group) organizing patient meetings;  www.skalbes.lv - a charity providing 24h helpline on telephone and Skype;  www.stastiundzivo.lv - a forum for patients to share their stories in order to unload the stress and prevent suicide, co-sponsored by Latvian charity „Skalbes” and anonymous similar site in English www.thelivingmemoir.com - could have some connection to Russia;  www.nenoversies.lv - a campaign to reduce the stigma and provide information and guidance, especially on depression and schizophrenia, sponsored by Ministry of Health and Centre for Disease Prevention and Control of Latvia, see www.spkc.gov.lv/about-SPKC . Internationally, a recognized example of such advice site is ifightdepression.com which also provides a self- test and multilingual online tools for registered users. It is co-sponsored by EU and several partners. The leading partner is European Alliance Against Depression, a network mostly consisting of university-level researchers lead by University of Leipzig in Germany, see www.eaad.net The Baltic and Nordic countries are represented in this network by Estonian-Swedish Mental Health and Suicidology Institute (ERSI), www.suicidology.ee which has helped to translate the site into Estonian.
  3. 3. Compilation ©Armands Kreņģelis & European Consulting Partners ehf, 2015 Page 3 of 11 Special requirements and experiences in eHealth From IT specialist and patient perspective, I have heard and noticed several aspects that should be considered when implementing Hospital Information Systems (HIS) and Telemedicine in Mental healthcare:  The main method of treatment is medication (drugs), which is common for all medical specialities, however Mental healthcare makes probably the most extensive use of narcotic and psychotropic substances that require the strongest level of accounting, compared to ordinary non-prescription and prescription drugs. In Latvia, there are government approved paper forms for nurses for handling of those substances, that will be harder to replace with computer systems than ordinary medication management. But harder does not mean impossible, it means just more work (mostly organisational – legal, documentation, training –, not technical).  Radiology, MRI, laboratory and similar investigations are used in Mental health care, but do not seem to play a central role, except the electroencephalogram (EEG, see Electroencephalography) which is especially used to check patients for signs of Neurological problems like Epilepsy. It has the usual integration issues with third party systems provided by the equipment manufacturers, and the choice of whether a Dictaphone is used and which system (HIS, the equipment maker’s system or just word processor) is used to describe the investigation results.  The „calendar” or „booking” features in HIS and other eHealth systems are supposed to handle well the one-to-one meetings of patient with doctor, or the procedures to be done by nurse. However, it is not so sure how those systems will handle group treatment (psychologist meetings, music, arts, occupational and other forms of therapy) widely used in Mental healthcare either in hospital, day hospital and even out-patient settings. But this issue is also probably not unique to Mental care. At the 29th Conference of the European Health Psychology Society, „Principles of Behaviour Change in Health and Illness”, Cyprus, 1st - 5th September 2015 (EHPS), there were several presentations analyzing the use of eHealth and mHealth in various areas of healthcare (not just Mental), related to treatment of various conditions that requires some change in patient’s lifestyle, see www.ehps2015.org Some of the conclusions were that people with various education level appreciated better the websites and mobile applications that provided interactive and audio-visual content, compared to static text. But that still did not prevent dropout (patient stopping to use the site or app). However, dropout rates were lower if the digital intervention was combined with conventional, i.e. the patient used the digital tools and also continued to meet with a doctor or nurse and was not „left alone” with the computer or smartphone. The self-guided search for information on health issues also has the problem of subjective bias: the patient can over-estimate or under-estimate his/her health or the health issue, compared to meeting a health professional. This bias may be a part of the issue, or a part of emotional coping with the issue. „Computer tailored strategies and formats can differ substantially, by targeting one behavior or several behaviors, by providing texts in parts or at once, by using text or video, by using games, and by using PCs or smartphones. Special attention is needed for at risk groups, such as lower educated participants as they are at higher risks of health problems and may react to these interventions in a different way.” [EHPS 2015, Symposium Abstracts „Tailored eHealth and mHealth: findings of recent applications”, H. de Vries, Maastricht University, Netherlands]
  4. 4. Compilation ©Armands Kreņģelis & European Consulting Partners ehf, 2015 Page 4 of 11 Patient and healthcare requirements in mHealth According to EHPS 2015 proceedings [Symposium „Embracing mHealth technologies for health behaviour change”], „mHealth (mobile health) is the practice of medicine, public health and allied healthcare or self- care supported by mobile devices (e.g. smartphones, tablet computers, wearable activity monitors). The use of smartphones has risen exponentially globally and shows no sign of abating. The development of these and other novel mobile technologies provide a unique opportunity for researchers in population health to track real-time, continuous, accurate and objective measures of health indices and related behaviour, as well as provide a powerful platform for delivering behavioural interventions and providing health relevant feedback to users. mHealth interventions have the potential to overcome several barriers to behaviour change, as well as provide flexibility to participants to engage with the educational content of an intervention in any context or time that provides an opportunity. There is emerging evidence that well- designed mHealth interventions can effectively change patient health-related behaviour, improve patient knowledge and support for active involvement in self-management and lifestyle change leading to better health outcomes. mHealth research affords a real opportunity to study, understand, and positively affect human behaviour.” One of the typical and simplest applications in mHealth, which is not unique to, but is well applicable to Mental healthcare, is reminders to take drugs. According to EHPS 2015 proceedings [Poster Presentation „Development of an mHealth application for adherence to psychotropic medication”, Cyprus], „Approximately one out of two patients do not take their medication three months after therapy starts, while in patients with mental disorders this number varies, i.e. 35%-45% for bipolar disorder.” The Cyprus project is in the early stages of development and was probably showcased only due to being from the host country, but there are probably many ready solutions for that. The bipolar disorder (ICD-10 code F31) mentioned in previous example is a quite common Mental condition. Everyone has moods, depending on real-life, perceived or imagined events. But a patient with bipolar disorder has moods going as pronounced sinusoid. At -100% (the depression phase) the patient cannot do anything, sleeps a lot, or may be ready for suicide. At +100% (the manic phase) the patient has too many things to do, sleeps too little, and may be ready to take a bank loan without a business plan. This condition is often initially hard to differentiate from single depression (F32), repeating depression (F33) or some forms of schizophrenia (F20.x). The first goal of treatment obviously is to make the lows higher, the highs lower, and transitions slower. But to take the right medication, the patient and doctor need to know where on the sinusoid the patient is, and what is the current trend. Also what triggers the transitions, so that these events can be avoided, minimized or at least predicted. A diary (chart) of moods, sleep patterns, taken medication and events around can help to analyze those trends. And a smartphone app can be a modern solution for organizing such a diary and sharing it with the doctor. The problem of many existing mHealth applications is that they are stand-alone and not integrated in Hospital information systems or other eHealth solutions. In the best case, they provide the functionality to send data to doctor (nurse) by SMS/email, and it is up to doctor (or nurse/assistant for that matter) to print the email and attach it to paper records, or save it in his computer and then attach it to the HIS/eHealth. The doctors and their assistants often do it already with laboratory results etc, but only the most advanced will like to do it for many more messages from many patients.
  5. 5. Compilation ©Armands Kreņģelis & European Consulting Partners ehf, 2015 Page 5 of 11 Some Examples of Existing Applications Doc Ready Doc Ready helps you get ready for the first time you visit a doctor to discuss your mental health. „DocReady is something I’ve found really helpful to use before going to medical appointments as it helps me make a clear list of what I want to talk about which helps me during the appointment.” Person living with mental health issues, UK „When I talked to people about the Doc Ready idea their response ranged from ‘cool’ to ‘erm…’. Some of them had plenty of opinions about how it might, or might not, work. However, as expected this didn’t really give us any solutions about how to make Doc Ready happen or what the final thing should actually be like. This is why it makes sense to co-produce and co-design.” New Mental Health, publishing arm of social enterprise Social Spider, UK COST: FREE. DEVELOPER: Innovation Labs initiative in partnership with Neontribe, Social Spider, FutureGov, Enabled by Design, United Kingdom. Angry Birds Game involving characters modelled on birds and pigs, and which is said to feature physics-based gameplay. COST: Free on Android; Apple £0.79 [approximately €1.14, $1.23]; Blackberry £3.50 [approximately €5.04, $5.46] DEVELOPER: Rovio, Finland Anti-stress Chromotherapy Chromotherapy app intended to reduce mental stress by demonstrating the therapeutic value of 256 shades of colour. Recommended by Roger Gunnarsson, Sweden-based Director of the Board, GAMIAN-Europe (Global Alliance of Mental Illness Advocacy Networks-Europe), Belgium. COST: FREE. DEVELOPER: TungLabs, Brazil Beat Panic [FullKontrol in Norwegian] Designed to guide a user through a panic attack, or through an episode of raised anxiety. „Easy to use, and very effective. But it needs to be available on more platforms.” West Sussex Wellbeing Initiatives, UK „This is such a good idea. Just downloaded it. I really needed something for when I’m panicking on a train full of people or something, and I can’t just run around like a headless chicken. This is discreet, but feels like someone talking you through it. I haven’t used it in a panic attack yet, obviously, but watching it run through made me smile, because it’s exactly the kind of thing you need to think when in a panic.” Blogger on No More Panic, UK Only APPLE smartphones. LANGUAGES: English, Norwegian. COST: £0.79 [approximately €1.41, $1.23] DEVELOPER: Jane Anderson-Hawkes, UK HelpTalk Provides a list of phrases and images that can allow people who have trouble vocalising to communicate some of their needs and feelings. Recommended by AGE Platform Europe (AGE) and by the European Disability Forum (EDF) as part of the 2011 Vodafone Foundation’s ‘Smart Accessibility’ competition. COST: Free. DEVELOPER: 1000 Empresas, Portugal.
  6. 6. Compilation ©Armands Kreņģelis & European Consulting Partners ehf, 2015 Page 6 of 11 Big White Wall Provides advice helpful to people with anxiety, debt, stress, or work problems COST: Free (sign-up required) DEVELOPER: Big White Wall, UK CBT Keeper Relies on cognitive behavioural therapy (CBT) to help the user overcome anxiety and depression „CBT Keeper is a mobile app that teaches simple techniques to help you overcome depression and anxiety. It’s built upon the principles of cognitive-behavioural therapy (CBT), a proven treatment for depression, anxiety, and many other mental illnesses. CBT works because it helps you change the negative thoughts and behaviours that drag you down.” Self-injury.net, USA Also recommended on Unsuicide, USA COST: Free, upgrade to remove ads costs £1.27 [approximately €1.81, $1.99] DEVELOPER: Euthymic Labs LLC, USA Cognitive Diary CBT Self-Help Aims to teach the user self-help tools of cognitive-behavioral therapy (CBT) as a means of challenging irrational thinking that might otherwise lead to anger, anxiety, depression, relationship conflict, or stress COST: Free DEVELOPER: Excel At Life LLC, USA iCouch CBT Allows people living with anger, anxiety, bipolar disorder, depression, or stress to record negative thoughts COST: £1.91 [approximately €2.37, $2.99] DEVELOPER: iCouch Inc (Brian Dear), USA IMood Journal Diary for recording moods LANGUAGES: English, French, Russian „I have bipolar disorder, and this app has been extremely helpful in charting my moods, and the events surrounding them, so that I can better prepare for future events. It is an awesome app. I have recommended it to others, and they are using it, and getting benefit. My therapist is also using it. I print out a copy of my mood history, and my psychiatrist loves it. The app really helps him with managing my medications. Really great app. I have used it for several months, and I never last at anything that long. I don’t see any drawbacks or weaknesses with the app.” Person with bipolar disorder, USA COST: Android £0.82 [approximately €1.16, $1.55], Apple £1.49 [approximately €2.11, $2.31] DEVELOPER: Inexika Inc, Russia Live OCD Free Interactive app designed to guide adult and child users through evidence-based treatment, called exposure and response prevention (ERP), for obsessive-compulsive disorder (OCD) COST: £19.00 [approximately €27 and $29.99) DEVELOPER: Rebel Vine Studios LLC, USA Lumosity Brain games intended to enhance cognitive abilities (including attention span, flexibility, memory, problem- solving, and processing speed) COST: Free DEVELOPER: Lumos Labs Inc, USA MindShift Aims to help teens and young adults cope with anxiety COST: Free DEVELOPER: Creative B’stro Inc, Canada
  7. 7. Compilation ©Armands Kreņģelis & European Consulting Partners ehf, 2015 Page 7 of 11 Mobilplanforalle Medication manager and reminder app for people with a mental health problem LANGUAGES: Danish COST: Free DEVELOPER: UVdata A/S, Denmark MoodKit A means by which people with anxiety or depression can improve their mood „Mood Kit is the slickest of the cognitive behaviour therapy (CBT) apps, and it has some nice features that make it easy to use and to personalise. The four main functions of the product are: 1. Increase participation in activities that lift mood. 2. Identify and change interfering thoughts. 3.Rate and track mood. 4. Create journals to track thoughts, experiences, etc.” Elisa Nebolsine: Cognitive Therapy for Kids, USA COST: £3.99 [approximately €5.68, $6.23] DEVELOPER: Thriveport LLC, USA Moodometer Interactive mood diary for monitoring and understanding emotional wellbeing COST: Free DEVELOPER: Mubaloo, UK FUNDER: 2gether NHS Foundation Trust, UK Personality Profile Quizzes Personal development tool „Empowers people to take control of their lives and emotional mental health as a first-line treatment approach. Fun, interesting, and easy to incorporate into everyday, busy life. Low expense for result. Drawbacks: cutting-edge in terms of structure/platform, but may take time to ‘catch on’ as a viable alternative to expensive treatment/therapy, as well as to pharmacology.” Master of social work (mental health problems), USA „It is really easy to use, like a 5-minute boost in mental health and positivity. It is only available to iPhone users, though.” Special education teacher (learning disorders), Colombia COST: Free DEVELOPER: TokiiLab-Wearable Therapy, Canada Safe&Sound Addresses a way for teens to manage stress and feelings of depression COST: Free DEVELOPER: Tri-Tech Skills Center in Kennewick, Washington, USA Self Help for iPad Series of self-help guides on common mental health issues COST: Free DEVELOPER: Northumberland, Tyne and Wear NHS Foundation Trust, UK Stay Alive Suicide prevention toolkit COST: Free DEVELOPER: Switchplane, UK FUNDER: Network Rail, Sussex Partnership NHS Foundation Trust, Grassroots Suicide Prevention, UK Stress Tips Provides people with more than 40 audio tips from fellow anxiety sufferers on how to manage anxiety and stress COST: Android £0.69 [approximately €0.97, $1.09], Apple £0.79 [approximately €1.11, $1.24], Blackberry £0.75 [approximately €1.06, $1.18] DEVELOPER: Encore, UK
  8. 8. Compilation ©Armands Kreņģelis & European Consulting Partners ehf, 2015 Page 8 of 11 T2 Mood Tracker Allows people with anxiety, brain injury, depression, post-traumatic stress, or stress to monitor their moods and their general well-being COST: Free DEVELOPER: National Center for Telehealth and Technology (T2), USA Your Medicine 1-2-3 pro Pill reminder with customisable features, which adapts to time zones when travelling COST: £0.63 [approximately €0.89, $0.99] DEVELOPER: Sombrero Mobile, USA Epilepsy Action App to support the management of epilepsy, including medication reminder. COST: Free DEVELOPER: Epilepsy Action (Based in United Kingdom) LifeForceTeam Fertility Visual consultation programme which aims to improve the chances of conception by bringing together the medical and spiritual factors that influence fertility. COST: £0.79 [approximately €1.14, $1.23] DEVELOPER: Back Door Production and Management, UK FUNDER: LifeForce [UK-based fertility consultancy] eTangram Utilises Tangram, a Chinese game in which several shapes can be assembled to make larger shapes, to teach a user how to make more complex shapes (such as a rabbit) in several levels of difficulty „The latest application has more to do with aging than with children. Tangram can significantly help to keep the mind active, so more and more initiatives practising this game in stimulation programs are being designed to tackle diseases like Alzheimer’s.” Serdonmas, not-for-profit community home help, Spain COST: Free DEVELOPER: Bilbomática, Spain Source: PATIENTVIEW The myhealthapps directory 2015-2016 myhealthapps.net/ Publisher: PatientView Ltd, UK www.patient-view.com BellyBio Free app that teaches a deep breathing technique useful in fighting anxiety and stress. A simple interface uses biofeedback to monitor your breathing. Sounds cascade with the movements of your belly, in rhythms reminiscent of waves on a beach. Charts also let you know how you’re doing. A great tool when you need to slow down and breathe. Operation Reach Out Literally a lifesaving app, this free intervention tool helps people who are having suicidal thoughts to reassess their thinking and get help. Recommended by followers of @unsuicide, who report that this app has helped in suicidal crises. Developed by the military, but useful to all. Worth a download even if you’re not suicidal. You never know if you might need it. Cost: Free Deep Sleep with Andrew Johnson Getting enough sleep is one of the foundations of mental health. A personal favorite I listen to all the time, this straightforward app features a warm, gentle voice guiding listeners through a Progressive Muscle Relaxation (PMR) session and into sleep. Features long or short induction options, and an alarm. Cost $3
  9. 9. Compilation ©Armands Kreņģelis & European Consulting Partners ehf, 2015 Page 9 of 11 WhatsMyM3 A three minute depression and anxiety screen. Validated questionnaires assess symptoms of depression, anxiety, bipolar disorder, and PTSD, and combine into a score that indicates whether or not your life is impacted significantly by a mood disorder, recommending a course of action. The app keeps a history of test results, to help you track your progress. Free Optimism Track your moods, keep a journal, and chart your recovery progress with this comprehensive tool for depression, bipolar disorder, and anxiety disorders. One of the most popular mood tracking apps available, with plenty of features. Free. iSleepEasy A calm female voice helps you quell anxieties and take the time to relax and sleep, in an array of guided meditations. Separately controlled voice and music tracks, flexible lengths, and an alarm. Includes a special wee hours rescue track, and tips for falling asleep. Developed by Meditation Oasis, who offer an great line of relaxation apps. Cost $5 Magic Window – Living Pictures Not technically a mental health app, it makes no miraculous claims about curbing anxiety. However, there is independent research indicating that taking breaks and getting exposure to nature, even in videos, can reduce stress. This app offers an assortment of peaceful, ambient nature scenes from beautiful spots around the world. Cost $3 Relax Melodies A popular free relaxation sound and music app. Mix and match nature sounds with new age music; it’s lovely to listen to birds in the rain while a piano softly plays. Free. Source: Top 10 Mental Health Apps, World of Psychology Blog, see psychcentral.com/blog/archives/2013/01/16/top-10-mental-health-apps/ Buddhify Meditation is ancient, but Buddhify is new. This friendly interface guides modern technology users in meditation practices for modern life. The rainbow wheel of options asks what you’re doing — waking up, feeling stressed, taking a break at work — then dials in the right meditation for the moment. There are over 80 custom guided audio meditation tracks. Each topic has timed meditations from five to 30 minutes. Rate your relaxation level and keep stats on your progress. Cost: $4.99, iPhone, Android Headspace Lively but not overwhelming animation keeps the mood light. Beginners start with Headspace’s Take10 program to learn meditation basics in 10 minutes a day for 10 days. You can subscribe to broader programs to work on specific issues like sleep or relationships. Headspace has received rave reviews from the famous (Emma Watson) to just regular folks who have used it to increase their mental peace. Sometimes you just need a little headspace. You know — a little time to rest your mind, collect your thoughts, and generally keep the top of your head from blowing off. Cost: Free, iPhone. Android Source: The Best Meditation iPhone and Android Apps of the Year, Healthline, see www.healthline.com/health/mental-health/top-meditation-iphone-android-apps#2
  10. 10. Compilation ©Armands Kreņģelis & European Consulting Partners ehf, 2015 Page 10 of 11 EU/EEA legislation and activities in mHealth Digital Agenda for Europe, a Europe 2020 Initiative by European Commission, lists mHealth as one of the sub-categories of eHealth in the „Digital society” page, see https://ec.europa.eu/digital-agenda/en/mhealth It defines that „Mobile Health (mHealth) is a sub-segment of eHealth and covers medical and public health practice supported by mobile devices. It especially includes the use of mobile communication devices for health and well-being services and information purposes as well as mobile health applications.” In April 2014, the European Commission launched a public consultation alongside the Green Paper on mobile health (mHealth) to help identify the right way forward to unlock the potential of mobile health in the EU. The Consultation, open between 10 April and 3 July 2014, looked for inputs from interested stakeholders on barriers and issues related to the use of mHealth. You can find the results of the consultation here. Together with the Green Paper, the Commission also published a Staff Working Document on the existing EU legal framework applicable to lifestyle and wellbeing apps, providing legal guidance on EU legislation in the field to app developers, medical device manufacturers, digital distribution platforms, etc. More information on mHealth in Europe and next steps. eHealth projects supported by EU include among many other, for example:  The help4mood wearable sensor network for inconspicuous activity measurement of depression patients (see cordis.europa.eu/project/rcn/97478_en.html);  ARMOR, Advanced multi-paRametric Monitoring and analysis for diagnosis and Optimal management of epilepsy and Related brain disorders (see cordis.europa.eu/project/rcn/101414_en.html);  NYMPHA-MD, Next Generation Mobile Platforms for HeAlth, in Mental Disorders (see cordis.europa.eu/project/rcn/188921_en.html);  PSYCHE, Personalised monitoring SYstems for Care in mental Health (see cordis.europa.eu/project/rcn/93581_en.html). Regretfully, in the „My Country” subcategory of the Digital Agenda, only the EU member states are listed, but not the EEA countries and Switzerland, and very limited information is available for Latvia, for example. According to COCIR, the European Trade Association representing the medical imaging, health ICT and electromedical industries (Source: www.cocir.org/index.php?id=153), some other EU legislations and policies applying to mHealth are:  the Medical devices Directive and the related EC guidelines on the qualification and classification of stand alone software used in healthcare (see ec.europa.eu/health/medical-devices/files/meddev/2_1_6_ol_en.pdf);  the e-privacy Directive 2002/58/EC (related more to the telecommunications sector) (see eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32002L0058:en:HTML);  the Data Protection Directive 1995/46/EC, which will be replaced with new legislation in 2016 according to other sources (see www.dvi.gov.lv/ in Latvian for example) (see eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:31995L0046:en:HTML).
  11. 11. Compilation ©Armands Kreņģelis & European Consulting Partners ehf, 2015 Page 11 of 11 Future – games, Internet of Things, mind wave reading – and security nightmare One of the least explored aspects of mHealth as defined before is Games. A game can make a treatment or brain development exercise into fun, both for children and young or elderly adults. Various physical games and toys are long used for children’s development. Puzzles are used in Occupational therapy, and also the arts and music therapy in Mental healthcare is sometimes also not far from games. But the digital era opens a lot of new possibilities. At the expo RIGA COMM 2015, companies Overly and Brain Games demonstrated enhanced (virtual) reality solutions and games for brain development, and there are probably many more worldwide and many more to come. At the Nordic IT Security Forum on November 3, 2015 in Stockholm, one of the key topics was Internet of Things (IoT). The technology now allows to insert a little networked computer into practically any device – from TV and fridge to cars and the pacemaker used in Cardiology healthcare. But if the built-in software cannot be upgraded after a bug is found (or is too easy to change either), if default passwords, debug ports or other backdoors are left in the final product, or if other common security mistakes are made, IoT can become security nightmare – hacker can order the wrong products from the fridge, drive the car off the cliff or airplane into mountain, and turn off the pacemaker. The smartphones used in mHealth are already a part of IoT, and any connected device will become, and the security aspects need to be properly considered. Another buzzword in IT is Cloud computing. For example, the Latvian Mobile Telephone company is now offering mHealth weights and blood pressure meter as a part of its campaign to sell additional gadgets for the smatphones. The apps made by the manufacturer keep the data in the Cloud. The same already happens for the Mental diary apps. Great advance! But what legislation applies and what personal data protection nightmare happens if the Cloud is located not in EU/EEA but, let’s say, in Donetsk or Simferopol, Ukraine/Russia conflict area? Or if it starts in USA, goes through Ukraine/Russia and ends in China? As for connected devices, let’s remember the EEG. It requires a nurse to attach a lot of electrodes to the patient’s head, a lot of equipment to make sounds and lights and to induce and record the waves, and a doctor to interprete and describe the results. Let’s say, the doctor is the most expensive part and does not sit in the same room, but many kilometers away. That becomes a typical fixed Telemedicine case like the tele-imaging radiology so loved and studied in Tromso, Norway. A Lithuanian company Baltic Orbis was demonstrating in Riga a simple Personal EEG headset, notebook computer and software kit from NeuroSky MindWave (store.neurosky.com) for reading a small subset of mind waves. I tried it, and it could read when I was concentrating and when relaxed. It currently reads only Alpha and Beta waves and does not induce anything, so compares to full EEG like children’s carting compares to World Rallye Championships. I am not a doctor and cannot tell if the headset could be used with a smartphone for checking a Mental patient in a remote village for signs of Epilepsy. But my IT feeling says, even if it probably cannot do it today, it is a wide step in that direction.

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