This document discusses applications of eHealth and mHealth in mental healthcare. It provides examples of existing websites and mobile applications that provide self-assessment tools and information for mental health issues. It also discusses special considerations for implementing electronic health record systems and telemedicine for mental healthcare services. Some key applications of mHealth mentioned include medication reminders and patient diaries. The document concludes by noting the need for mHealth applications to be better integrated with broader electronic health systems.

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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

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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.

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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]

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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.

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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.

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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

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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

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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

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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

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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).

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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.