The whitepaper by Dr. Nitin Verma discusses the current state of mobile health (mHealth) in India, highlighting the potential benefits of integrating mobile technologies into healthcare, especially in rural areas. It reviews past initiatives, the impact of information and communication technology (ICT) in healthcare, and the challenges facing mHealth adoption, such as technological hurdles and limited acceptance among healthcare workers. The conclusion emphasizes the need for both government and private sector initiatives to prioritize mHealth to improve healthcare delivery in India.

1. HealthFore Technologies Limited
Are we mHealth
Ready?
29/08/2013

2. Are we mHealth Ready?1
Whitepaper Details
Title: Are we mHealth Ready?
Author: Dr. Nitin Verma
Vice President- mHealth, HealthFore Technologies Limited

3. Are we mHealth Ready?1
Introduction
Every decade is being buzzed with a new magical word swear to revolutionize the healthcare deliv-
ery. It promises to bridge the gaps between rural demands and supply of healthcare services over-
night. How much success have we seen with newly emerging technologies in Healthcare in last 25
years? With the introduction of ICT in healthcare almost 30 years back, we have not reached con-
sensus among concerned stake holders even on standardized protocols for data sharing. mHealth
itself has not been able to attain a state of uniformity in addressing & communicating ourselves as
mHealth community.
Are we really mHealth ready yet? How are we going to use it for healthcare delivery? Who is the tar-
get audience and who is going to consume these services? Do we have plans available to educate
the community and make them aware of the benefits of mHealth? There are hundreds of questions
lying underneath which need to be answered before we claim to make a difference using mHealth.
This paper briefly reviews the arrival & advantage of ICT in healthcare followed by mobile revolution
and introduction of mHealth and its potential contribution in Healthcare delivery and our readiness
to embrace it.
What is mHealth?
The term is still perplexing to many of us; mHealth in characterization is not limited to healthcare
information exchange on mobile phones. All the AV devices, be it your Laptop, TV, Tablet, or PDA,
should be able to deliver healthcare service. Though considering the fact that 70% of our population
is in rural India, the definition of mHealth here would be completely different. For rural India, the
mHealth would translate to access to healthcare services through mobile phone. 104 Services being
run by Health Management & Research Institute has proved this, where more than 85% of the calls
for healthcare needs are from rural areas.
"The revolution in communication technology needs to be harnessed to deliver
healthcare services in rural India. The need is to create a Health-care system that is both
affordable and effective" - President Dr. A.P.J Abdul Kalam
ICT in Healthcare
ICT by definition encapsulate Information technology (IT) as well as telecommunication, broadcast
media, all types of audio and video processing and transmission and network based control and
monitoring functions.
Almost 30 years after the introduction of ICT to healthcare, we are still struggling with answers on
RoI, usability and its promise to enhance quality and efficiency of service delivery. ICT provided us
with a vehicle to bridge the digital divide and to transform healthcare delivery to the last mile. It
gave us an opportunity to clean the clutter of papers, files, lost patient records, duplicate tests and
availability of right information to the decision makers at the right time.
Did we really exploit the ICT to its fullest or we failed to drive it to our benefits?
ICT made us felt its presence in telemedicine, electronic health records, hospital administration &
billing, creating paperless hospital settings, e-procurement, healthcare score cards, audits, clinical
information systems etc. In India, ICT in healthcare has seen varying success across states in gov-

4. Are we mHealth Ready?2
ernment initiatives, due to different levels of engagements among various departments of state &
central government. Two of the many examples of ICT enabling healthcare in government and Public
private partner can throw light on its viability in healthcare.
In Uttar Pradesh – which has its own share of developmental issues – a health programme called
‘Aarogyam’ was launched in Baghpat and J.P Nagar districts, an end-to-end community-based digital
health mapping project. Another example is that of a PPP model between GVK & Gov. of AP, GVK
EMRI, which handles medical emergencies through the “108 Emergency service”. This is a free ser-
vice delivered through state of art emergency call response centers. It has ambulances across 12
states.
NRHM Assam, in collaboration with Healthfore Technologies has taken an initiative to further lever-
age ICT for Tele –radiology service delivery connecting 11 district hospitals with a central command
reporting center. These 11 districts will have the imaging center and imaging equipment will be con-
nected to state of the art PACS (Picture Archival & Communication System). The X-rays and CT scans
will be exposed in various districts hospitals of Assam, images transmitted, stored in PACS and re-
ported by Radiologists sitting thousands of kilometers away. This is a pioneering initiative by NRHM
Assam and state government.
eHealth in India
India started to make strides in the fields of telemedicine and eHealth. IT has been a late entrant in
this field and most of the early adopter hospitals started with small systems that were developed in-
house. However, these systems neither gave the desired results nor could be integrated with newer
systems available from other vendors. The major demand for updated solution started with the es-
tablishment of the large corporate hospitals like the Fortis & Apollo groups. Fortis hospital has taken
it a step further by setting up Critinext, the first remote eICU in India. This enabled remote hospitals
to provide advanced consultation, care and supervision to their critically ill patients instead of trans-
ferring them to super specialty hospitals.
While in telemedicine, most of the initiatives are still in pilot project mode, supported by the Indian
Space Research Organization, Department of Information Technology and being implemented
through (NRHM & Ministry of H&FW) state governments. A few corporate hospitals have developed
their own telemedicine networks, prominent among them being the Apollo Telemedicine Network-
ing Foundation, Sri Ramachandra Hospital and Sankar, Nethralaya. In last 30 years no state govern-
ment could create a telemedicine network reaching out to rural and tribal areas and we continue to
debate how mHealth will change the face of healthcare delivery in India. It is quite evident from the
gap between what the technology can deliver and what we delivered that still there is a long way to
go.

5. Are we mHealth Ready?3
Why mHealth?
mHealth seems to be the most promising technology driven
framework already touching the healthcare pyramid from top to
bottom. mHealth qualifies to be an ideal candidate for three (3)
simple reasons, mobile penetration, its cost & ease of use. With
the launch of Health information helpline, mHealth has already
redefined healthcare delivery to the last mile. The Indian tele-
com sector has seen an exponential growth in the last few years.
According to the international Telecommunication Union (ITU),
there were almost 6 billion connections in use by 2011.1. Favor-
able regulatory policies and decreasing tariffs have led to a tre-
mendous increase in the subscriber base. The number of tele-
phone subscribers in India reached 874.68 million at the end of
May 2011, out of which 840.28 million are wireless subscribers.
Only 3% of India‘s population owns a computer and with such a
poor PC penetration mobile phone became an alternate medium
for delivering a variety of healthcare services and content
through mobile.
Global Perspective: A global mHealth research study of 10 coun-
tries by PWC reveals that mobile is going to have significant im-
pact on healthcare delivery. Indian mHealth industry has shown
a higher adoption and acceptance of in comparison to their
global counterparts.
Indian Perspective: Health Management Research Institute
(HMRI) & Emergency Management Research Institute (EMRI),
two pioneer organizations have not only paved the way but
clearly established that mHealth can re-write the healthcare de-
livery framework in India. EMRI having its presence in 12 states
and 2 union territories with 3931 ambulances is the largest pro-
fessional emergency provide in India today3. Mobile technology
played the most important role in connecting patients in need of
emergency services to EMRI and thus transporting them to most
appropriate level of care. HMRI by utilizing Health Information
Help Line (HIHL) in Assam and many other states is bridging the
gap between demand and supply of primary healthcare needs of
the patients till last mile. Whereas Maharashtra, it is comple-
menting to the healthcare workers in field by providing them
medical advice and information on national and state health
program and events.
Key Findings from the
EIU 2012 Report-
commissioned by PWC2
Roughly 50% of
the patients say
mHealth will im-
prove healthcare.
59% doctors be-
lieve it is inevita-
ble but adoption
will take time.
42% doctors have shown
concern over mHealth
making patients too in-
dependent.
69% of doctors in
emerging market
recommend
mHealth
Indian patients &
doctors have
shown a higher
confidence and
willingness to
embrace
mHealth in com-
parison to global
sentiments.

6. Where are we in mHealth?
Fig: 1 – Comparative landscape of mHealth services, their adoption & penetration in developing
and developed world.
The progress in mHealth in India is rather limited. Most mHealth projects in India started their jour-
ney in early 2000. Despite the promises of data collection using mobile devices, the experiments are
yet to conclusively establish the acceptance and feasibility of this method for large scale deploy-
ment. In particular, a sizeable number of ASHAs in northern India have shown their limited ac-
ceptance of data collection using SMS and mobile forms. This process needs further research and
development. Few projects in India have contributed to the development of a fuller understanding
of behavior change processes facilitated by mobile communication.
Challenges in the adoption of mHealth are multiple. There are technological challenges in input, dis-
play, transfer and processing of data in English and Indian languages (especially for people with dif-
ferent levels of literacy), security and integration with medical devices. Traditional health research
institutions lack capacity to develop mHealth interventions that require multidisciplinary approaches
of behavioral, medical, business and computer sciences. The public health departments in central
and state governments also lack capacity to design and implement mHealth on the ground level.

7. Technological research and development are required in multiple areas, especially in medical devic-
es, network, security, data, language, among other areas. Both open and commercial innovations
can add value to the advancement of mHealth.
Conclusion
Be it a government, patient or care provider, we are intrinsically afraid of new technologies and fur-
ther frightened if it is related to healthcare. Our adoption of new technologies in past was directly
proportionate to its Return of Investment (RoI). Majority of these adoptions were in the areas of ad-
vanced treatment by corporate hospitals. We chased the western healthcare in search of most ad-
vanced treatment that could bring more footfalls and increased our revenue but we failed to follow
them in adopting new technologies and regulatory compliance. We kept looking at government
stakeholders to take the initiative and invest millions in implementing Healthcare IT. This does not
seem to be the immediate priority or the need for the healthcare system. The priority for the gov-
ernment is to fulfill the gap between demand and availability of primary and secondary healthcare
infrastructure including human resources.
In absence of adoption of mHealth as an immediate priority by government health authorities, it is
clearly evident that the corporate and private players need to take the lead in adoption and dissemi-
nation of mHealth among patient and provider community. There is a clear need for a credible study
by device makers and provider community to establish the evidence based adoption of mHealth in
Chronic disease management, remote patient monitoring, real time availability of patient’s vital pa-
rameters in case of critical patients in post op care, ICU & trauma units.
We followed in past, We did not lead………………….Let us change it now.

8. References
 http://www.itu.int/dms_pub/itu-d/opb/ind/D-IND-ICTOI-2012-SUM-PDF-E.pdf
 http://www.pwc.com/en_GX/gx/healthcare/mhealth/assets/pwc-emerging-mhealth-full.pdf
 http://emri.in/states.html
About Author
“Dr. Nitin Verma (VP- mHealth, HealthFore Technologies Limited) leads the Tele Triage Practice. He
has 20 years of experience in Healthcare IT. A qualified M.B.B.S, MS professional with experience in
healthcare product development, consulting, regulatory compliance, pre-sales, business develop-
ment and pharmacy benefit & claims management. He spearheaded several healthcare initiatives in
various states of India including prestigious sickle cell screening program with Govt. of Gujarat. He is
one of the key architects involved in design, development and deployment of many low cost
healthcare solutions for the Health Management & Research Institute (HMRI) enabling healthcare
delivery to 42 million underserved rural populations in Andhra Pradesh (India)”

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