Key Issues in Mobile Health


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Robyn Whittaker
Clinical Trials Research Unit, University of Auckland
(Friday, 10.30, Telehealth/mHealth)

mHealth or mobile health describes the use of mobile communications devices for health-related purposes. There is much interest in mHealth internationally at this time; including interest in interventions developed in New Zealand/by New Zealanders. A recent research project examined the key issues in the implementation of mHealth and the current opportunities to address those issues in the U.S. The key mHealth issues are outlined here under the themes of policy and regulation, the wireless environment, the health system, current mHealth initiatives in practice and research. This paper examines how these issues may apply in New Zealand and the current opportunities to address them. This information may be useful to those embarking on mHealth developments in New Zealand and may help to inform the inclusion of mobile capabilities within the NZ Health IT infrastructure.

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Key Issues in Mobile Health

  1. 1. Key issues in mobile health Robyn Whittaker ISO 9001 Registered
  2. 2. mHealth the delivery of health-related services via mobile communications devices Portable Personal Connected
  3. 3. mHealth programs can be • integrated into daily life • proactive • there at the „right‟ times • personal/ised • interactive • on-going • providing social support
  4. 4. mHealth programs can be HEALTHY BEHAVIOR • integrated into daily life CHANGE • proactive • there at the „right‟ times CHRONIC • personal/ised DISEASEMANAGEMENT • interactive • on-going • providing social support
  5. 5. New Zealand has led the way
  6. 6. U.S.
  7. 7. Objectives• identify the current key issues in the implementation of mHealth – Environmental scan – text4baby case study – Key informant interviews• identify opportunities to address these• consider implications for NZ
  8. 8. Methods• Key informant interviews – List from environmental scan, informal discussions & recommendations – Semi-structured interview guidelines plus some closed Q/likert scales – By phone or in person – Recorded & transcribed – General thematic analysis
  9. 9. Prelim findings: interviews N=27 HHS 10 Integrated health systems 3 Academics 6 Private mHealth companies 4 Wireless networks 2 Private sponsors/funders 2 Priority10 8 6 4 2 0 low middle high
  10. 10. What does mHealth add?Relationships Persistent interactivityBehavior change Easy & habitualChronic disease Reminders management CoachRemote monitoring Efficiencies in systemPersonalisation Cheaper alternativeScalability ConvenienceTime and place services AsynchronousInteract with information AccessibilityIncorporated into daily lifeReliability & standardizing delivery of care
  11. 11. PLUS Reach into underserved populations • >25% of US households wireless • More likely to be uninsured, living in poverty • Less likely to have usual place of care • Use of text messaging – Hispanic 83%, AA 79% – Medicaid 79%, uninsured 63%, Medicare 43%Blumberg 09; Pew Internet Research 10/11; PWC 10
  12. 12. “a great equaliser…”• As long as we use it in such a way to reduce barriers to care, not just efficiently manage folks in the system• If we leave out marginalised underserved populations when we are moving forward with technology & health reform, it will only make our health disparities wider• Bias in those coming up with solutions• Change in onus from provider to individual relies on individuals having skills/tools to do so, requires concomitant increase in health literacy & safety net to help those who need it
  13. 13. Transformative?No:• an extension Yes:of current health • from provider & locationcommunication centric system to patient-or current centered anywhere caremodels of care • from provider control to individual locus of control • change the way we search for and use information
  14. 14. Key issues in mHealth Privacy & data security Policy & regulatory Who pays Health Wireless system In ResearchNeed more quality practiceresearch on cost-effectiveness & RoI
  15. 15. Policy & regulatory issues• Privacy +/- data security• FDA regulation• Bandwidth spectrum availability• Medical practice regulations e.g. practice across states/countries, regulated roles
  16. 16. Wireless environment issues• Large number of wireless networks• Working across platforms & other proprietary complexities• Potential costs to users
  17. 17. Health system issues• Who pays/reimbursement• Lack of demonstrably sustainable business models• Competing priorities & opportunity cost• Integration into existing systems, practice & EHRs• Clinical roles & accountability
  18. 18. mHealth in practice issues• Immature understanding of how to do it well (for whom, what, when)• Lack of demonstrated added value of existing initiatives & focus on where it can add value (e.g. under- served & disadvantaged popns)• Lack of theory & evidence base• Technology focus/legacy systems• Governance issues
  19. 19. mHealth in research issues• Need for more high quality research demonstrating effectiveness & cost- effectiveness• Mismatch in pace & flexibility of research with tech developments• Measuring reach & access into under-served populations
  20. 20. Opportunities to address issues• U.S. 1. Health reform structures & $$ 2. Federal level guidance 3. Improve mHealth practice/research• NZ context • Electronic health records & NHI • Primary care • National coordinated plan towards accessible patient-centred electronic health information & shared care plans
  21. 21. Implications for NZ• Expand national strategic & collaborative approach to mHealth – Wireless networks & industry, health services, research – Shared definitions, standards for interoperability – Integration rather than silos – Open philosophy and shared learnings
  22. 22. Implications for NZ• mHealth is global – International guidelines, standards & interoperability – Health information privacy & security – Regulation – High tech stuff once becomes usable – Research guidelines
  23. 23. Opportunities• Approach to development & research – Start with a problem – Use evidence & theory – End-users involved through-out – Learn from others – Pre-test & iterate – Consider implementation from start – Test in good research studies – Publish/make publicly available
  24. 24. Conclusions• Use of mobile devices in health has the potential to be transformative• Need to consider strategic approach to implementation issues• NZ can continue to lead the way with national collaboration & primary care implementation
  25. 25. Acknowledgements The Commonwealth Fund Dr Kyu Rhee Health Resources & Services Administration, U.S. Dept of Health & Human Services Interviewees and Bill