This document summarizes key issues in mobile health (mHealth) based on interviews and research. It identifies five main categories of issues: policy and regulatory concerns around privacy and FDA regulation; wireless environment challenges of multiple networks and costs; health system issues like reimbursement, integration, and business models; challenges implementing mHealth like immature understanding and lack of evidence; and gaps in mHealth research around effectiveness, pace of technology, and underserved populations. Opportunities discussed include leveraging health reform, federal guidance, collaboration, and improving practice and research through iteration.

1. ISSUES IN mHEALTHPanel:Robyn Whittaker, MD PhD, mHealth researcher, Public Health Physician, Commonwealth Fund Harkness fellow 2010/11Barbara Mittleman, MD, internal medicine/rheumatologist, Director NIH Public-Private Partnership Program, co-chair of the first mHealth SummitWendy Nilsen, PhD, Health Scientist Administrator Office of Behavioral and Social Sciences Research NIH

2. mHealth research project To identify the key issues facingthe implementation of mHealth in the U.S. viaEnvironmental scantext4baby case studyKey informant interviews

3. Panel SessionOverview of research & key issues in mHealth (RW)‘Big picture’ issues (BM) Research issues (WN)Opportunities to address mHealth issues

4. mHealththe delivery of health-related services via mobile communications devicesPortable PersonalConnected

5. Prelim findings: interviews

6. Transformative?“a great equaliser”No: an extension of current health communication or current models of careYes: from provider & location centric system to patient-centered anywhere care

7. from provider control to individual locus of control

8. change the way we search for and use information

9. Issues in mHealth: categoriesPolicy & regulatoryWireless environmentHealth systemmHealth in practicemHealth research

10. Policy & regulatory issuesPrivacy +/- data securityFDA regulationBandwidth spectrum availabilityMedical practice regulations e.g. practice across states/countries, regulated roles

11. Wireless environment issuesLarge number of wireless networksWorking across platforms & other proprietary complexitiesPotential costs to users

12. Health system issuesWho pays/reimbursementCompeting priorities & opportunity costIntegration into existing systems, practice & EHRsClinical roles & accountabilityLack of demonstrably sustainable business models

13. mHealth in practice issuesImmature understanding of how to do it well (what, for whom, and why)Lack of demonstrated added value of existing initiatives & focus on where it can add value Lack of theory & evidence baseTechnology focus/legacy systems

14. mHealth in research issuesNeed for more high quality research demonstrating effectiveness & cost-effectivenessMismatch in pace & flexibility of research with tech developmentsMeasuring reach & access into under-served populations

15. Opportunities in mHealth U.S.Optimising opportunities provided by health reform environment CMMI, Beacon demo projects, EHRsSome degree of federal level guidance Strategic collaborative (open) approachImproving mHealth practice & researchIterate, integrate, improve

16. Acknowledgements Dr Kyu RheeHealth Resources & Services Administration, U.S. Dept of Health & Human ServicesThe Commonwealth FundAll interviewees