The Many Innovations of mHealth

Mobile technology has had a meteoric rise in numbers in recent years. According to the UN, slightly over 2 billion people had mobile cellular prescriptions in 2005. By 2013, 96% - or 6.8 billion - of the world’s population had subscriptions. The worldwide gap in mobile technology access was also significantly reduced, with 77% of the world’s mobile cellular subscriptions existing in developing countries. In 2011, Latin America averaged more than one cellphone per person and across the globe ninety-one countries had more cellphones than people. This newfound abundance has opened up an exciting new opportunity for the global health community known as mHealth.

mHealth, or mobile health, is a rapidly growing subset of the broader eHealth, which includes any healthcare practice supported by electronic processes or communication. The WHO defines mHealth as "medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices." Generally, this involves the use of a mobile phone’s abilities of voice and short messaging services (SMS), general packet radio service (GRPS), 3G and 4G systems, GPS, and Bluetooth technology. The widespread usage of mobile devices and their versatility has a vast array of potential uses and contexts. In developing countries, health care sectors are heavily focused on acute care despite the chronic condition dominated disease burden and growing elderly population. In developing countries, inadequate health infrastructure limits rural populations and the urban poor to only the most basic health care at best. Mobile technology has the potential to help alleviate issues in both of these contexts by increasing access to care and moving the large and expensive healthcare systems of the world towards less expensive, prevention based and patient focused systems. So far, there have been some promising results. With a market that grew from $500 million in 2010 to $23 billion by 2013, there should be even more innovation on the way.

The most familiar application of mHealth in the developed world comes in the form of health and wellness apps for smartphones.  These range from diet trackers to emergency first aid and treatment guides to advanced diagnostic and screening tools. Some of the most impactful applications focus on mobile phone-based prevention and early intervention to fight chronic disease. One example is the United States-based WellDoc.inc, designed to reduce blood glucose levels in diabetic patients. Users can enter blood glucose levels and other self-care data into their phones in order to receive real-time responses from a “virtual patient coach”; it helps manage their condition and gives tips on other general diet and lifestyle decisions. It also sends detailed reports that physicians can use to better monitor their patients status. Clinical trials showed a mean 1.9% decrease in A1c (the gold standard measure for diabetes control) in the app’s users compared to the 0.7% decrease in the population that received normal treatment and the 0.5% benchmark that the FDA requires new diabetes drugs to have to qualify as clinically significant. This solution hopes to reduce costs of patients suffering from diabetes by $10,000 dollars per patient annually while allowing the user to gain more control over their condition and make better daily decisions. Diabetes, obesity, and hypertension are considered three of the chronic diseases with the highest potential for mobile management.

In more resource strained settings, mHealth interventions tend to rely more heavily on SMS to deliver services. The services include valuable information to empower and inform pregnant women who cannot access regular antenatal care in Bangladesh, South Africa, and India. The interventions disseminate HIV/AIDS prevention information through text, and messages to ensure health centers do not run out of medicine in Kenya, Uganda and more.  mHealth has had some particularly interesting results in highly populous countries such as India, where serving the 1.2 billion population and its large contingent of poor and rural people is extremely challenging. Apollo Hospitals Group knew that its small core of private hospitals had no chance of directly serving all of those people. However, 900 million of those people owned mobile phones, so they developed a triaged health information and advice system of contact centers. It achieved country-wide coverage 24 hours a day, 7 days a week and is currently trialing remote analytics and monitoring systems. Despite the resource gap between India and the United States, India has still managed to begin implementing a diabetes management program similar to WellDoc.inc called SUGAR. Patients can upload their blood sugar count to the clinician through SMS and receive a text message back explaining the readings and advising any necessary action. Early signs show raised compliance with diet and exercise regimes, leading to discussions on plans for further expansion and testing.

Some applications, such as Peekvision’s mobile app, has potential use in either context. Ordinary smartphones now have the capability to completely replace expensive and complicated ophthalmoscopes that have been used by eye health professionals for decades. The smartphone’s camera automatically focuses on whatever condition it has been set to search for and takes a picture that can then be sent via text message or email for further analysis. 80% of blindness is preventable, yet it is still a serious issue in the developing world as eye exams are often inaccessible to large swathes of the population. Technology like this gives minimally trained healthcare workers the ability to conduct an eye exam. Peekvision technology has already been used in Kenya and Scotland, reliably identifying and capturing cataracts, severe diabetes, and macular degeneration - the three leading causes of blindness.

Much of the technology being developed in mHealth has viability in both developed and developing markets. It has the potential to be very lucrative due to its focus on preventative care. The same technology that would be used to diagnose pneumonia in a developing country could be used by sufferers of chronic respiratory disease in a developed country; they now get regular readings, along with other means to self-manage their conditions. The result is huge savings on chronic disease related healthcare costs, while also giving those in resource restricted settings the ability to access previously unavailable health services.

Granted, privacy, integration into health systems, regulation and network reliability may become issues with mHealth’s growth. Hopefully, the rapid advance of innovation continues quickly enough to address them.