This document discusses mobile health (mHealth) and the use of mobile technologies to support health and wellness. It provides context on the digital divide being smaller for mobile phones than the internet. Mobile phones are described as cost effective and able to reach diverse populations. The document then outlines drivers of mHealth including rising healthcare costs, advances in wireless technology, and a need for personalized medicine. Examples of mHealth apps are provided for areas like clinical references, diagnostics, treatment, public health, and disease management. Research findings on texting improving health outcomes are also summarized.
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Director Rachel Mutrux on mHealth Apps and Telehealth
1. E. Rachel Mutrux
Director, Missouri Telehealth Network
Operations Director, Missouri HIT Assistance Center
State Director, Heartland Telehealth Resource Center
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2. Jama, 10/24/2013 definition:
“use of
mobile telecommunication technologies
delivery of health
care and in support of
wellness”
for the
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3. Mobile Phones & Smart Phones
1. Digital divide is smaller for
phones than for Internet
2. Mobile phone technology
easier/cheaper to roll out to
large areas than fixed
technologies
3. Mobile phones immune to
social prejudices
Male/female;
rural/urban;
young/old
Cost effective & cost saving
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4. Dr. Sebelius lists 3 forces driving mHealth
1. $$- unsustainable cost of healthcare
2. Wireless & technology!!
3. Need for individualized medicine
Per capita spending on healthcare, Kaiser Foundation
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5. Measurement
Tracking- diet, exercise
Blood sugar, blood pressure
Diagnostic
Portable imaging
Sensors
Treatment
Chronic disease management
Remote clinical trials
Comprehensive
Dissemination of health information
Disease surveillance
Prevention & Wellness
interventions
Education & awareness
Helpline
Klasnja, P., & Pratt, W. (2012). Healthcare in the pocket: Mapping the space of mobile-phone health interventions.
Journal of Biomedical Informatics, 45(1), 184-198.
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6.
Nexercise
Free app that tracks exercise- GPS
Uses support system
Allows you to win points- money
Fooducate
Scan bar codes to get nutrition
information
Grades food choices (A,B,C)
Suggests better alternatives
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7. Clinical Reference Apps
The Merck Manual
WebMD
Medscape
Diagnostic Apps
Mobile MIM- FDA approved for radiology
AirStrip- Cardiology App- see EKG
Public Health Apps
For Cancer prevention- Target Heart Rate
Calculator, Calorie Counter, Cigarette Calculator
Telehealth Apps
Videoconferencing
Tele MDID- developed here at MU!!
Disease Management Apps
Asthma
Crohn’s Diary
Kidney Diet
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9. The iPad apps were deployed to 10 far sites, as well as MU dermatology
clinics. Pre-launch and post-launch internet-based surveys were
distributed to far site patient presenters and dermatology clinic providers
in 2013.
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University of Missouri Institutional Review Board (IRB) #1207257.
10. Texting improves health outcomes
Effective chronic disease management
Effective self-management of disease and
successful clinical outcomes
Better quality of life
Reduction of error
Better control of infectious diseases in
developing countries.
Accessibility of healthcare in rural areas.
Cost effective
Better medication adherence
Texting leads to better medication adherence
Better maternal child health
Improve attendance to healthcare appointments
**caveat much research was inconclusive showing need for
additional research
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12. Estimated 100,000 apps
on the market today
Health & Wellness apps
are leading adoption!LoseIt! Fitbit
Healthcare moving out of
the Dr. office to the
patient
Improve health, increase
access, decrease cost
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14. Reference List
1)http://www.brookings.edu/~/media/research/files/papers/2012/5/22%20mobile%20health%20
west/22%20mobile%20health%20west.pdf
2)A mobile telephone-based interactive self-care system improves asthma control Eur Respir J
2011 37:310-317; published ahead of print 2010, doi:10.1183/09031936.00000810
3)Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., ... & Haines, A. (2013). The
effectiveness of mobile-health technology-based health behaviour change or disease management
interventions for health care consumers: a systematic review. PLoS medicine, 10(1), e1001362.4)Lv, Y., Zhao, H., Liang, Z., Dong, H., Liu, L., Zhang, D., & Cai, S. (2012). A mobile phone short
message service improves perceived control of asthma: a randomized controlled trial.
Telemedicine and e-Health, 18(6), 420-426.
5) http://www.fiercemobilehealthcare.com/story/texting-improves-health-outcomes-youngasthmatics/2013-05-02
6)http://ebn.benefitnews.com/news/mobile-wellness-apps-increase-employee-engagementdecisionmaking-health-out-2729886-1.html?CMP=OTC-RSS
7) Ryan, D., Price, D., Musgrave, S. D., Malhotra, S., Lee, A. J., Ayansina, D., ... & Pinnock, H. (2012).
Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre
randomised controlled trial. BMJ: British Medical Journal, 344.-Not effective self-management for
asthma.
8) Obermayer, J. L., Riley, W. T., Asif, O., & Jean-Mary, J. (2004). College smoking-cessation using
cell phone text messaging. Journal of American College Health, 53(2), 71-78. Retrieved from
www.scopus.com
9)http://www.ey.com/Publication/vwLUAssets/mHealth_Report_January_2013/$FILE/mHealth%2
0Report_Final.pdf
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Notes de l'éditeur
I have no conflicts to report.
Technologies for m-healthThe main device for m Health application is mobile phones (and smart phones). The advantages of using such phones in healthcare settings are illustrated in one research as :“ Living in resource-poor environments is not a barrier to the use of mobile phones for several cultural and economic reasons, but there appears to be a lower threshold of access to cell phones.(13) There is evidence that the existence of a so-called "digital divide" along the socio-economic gradient is less pronounced in mobile phones than in other communication technologies such as the Internet.(14) Furthermore, mobile phones cost less to rollout over large areas and mobile networks can be built faster than fixed lines and the social value of a mobile phone is highly valued even in resource-poor areas.(15) In addition, the use of mobile phones is immune to social prejudices. Men and women alike can use the phones. Similarly, due to the advancement of the technological infrastructure they are accessible to people from rural and urban areas, young and old, and can be designed to be used in any language.Lastly the mobile phone initiative is cost effective. Because mobile technology infrastructure already exists in African nations, there is no need for funding for development. The SMS intervention is inexpensive, and according to the Kenya case, each SMS costs about US$ 0,05, equivalent to US$ 20 per 100 patients per month, and follow-up voice calls averaged US$ 3,75 per nurse per month.(16) This protocol is also probably less expensive than in-person community adherence interventions, on the basis of travel costs alone. Thus, the intervention could be both cost effective and cost saving.(17)”http://www.consultancyafrica.com/index.php?option=com_content&view=article&id=615:an-sms-a-day-keeps-the-doctor-away-the-use-of-mobile-phones-to-improve-african-health-care-outcomes&catid=57:africa-watch-discussion-papers&Itemid=263
Application of m Health fieldDiagnostic and treatment supportDisease and epidemic outbreak trackingRemote monitoringEducation and awarenessRemote Data collectionHelpline Klasnja, P., & Pratt, W. (2012). Healthcare in the pocket: Mapping the space of mobile-phone health interventions. Journal of Biomedical Informatics, 45(1), 184-198.
mhealth is still in its infancy. A lot of researches on mHealth have produced inconclusive result. The researches which showed promises still could not produce significant result due to poor research design and lack of available data. Health outcome improvement (as research showed)Texting improves health outcomes Effective chronic disease managementEffective self-management of disease and successful clinical outcomesBetter quality of lifeReduction of errorBetter control of infectious diseases in developing countries. Accessibility of healthcare in rural areas.Cost effectiveBetter medication adherenceTexting leads to better medication adherenceBetter maternal child healthImprove attendance to healthcare appointments 1)http://www.brookings.edu/~/media/research/files/papers/2012/5/22%20mobile%20health%20west/22%20mobile%20health%20west.pdf2)A mobile telephone-based interactive self-care system improves asthma control EurRespir J 2011 37:310-317; published ahead of print 2010, doi:10.1183/09031936.00000810 3)Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., ... & Haines, A. (2013). The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS medicine, 10(1), e1001362.-Inconclusive Research 4)Lv, Y., Zhao, H., Liang, Z., Dong, H., Liu, L., Zhang, D., & Cai, S. (2012). A mobile phone short message service improves perceived control of asthma: a randomized controlled trial. Telemedicine and e-Health, 18(6), 420-426. 5) (http://www.fiercemobilehealthcare.com/story/texting-improves-health-outcomes-young-asthmatics/2013-05-026)http://ebn.benefitnews.com/news/mobile-wellness-apps-increase-employee-engagement-decisionmaking-health-out-2729886-1.html?CMP=OTC-RSS7)Ryan, D., Price, D., Musgrave, S. D., Malhotra, S., Lee, A. J., Ayansina, D., ... & Pinnock, H. (2012). Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentrerandomised controlled trial. BMJ: British Medical Journal, 344.-Not effective self-management for asthma. Not cost effective 8) Obermayer, J. L., Riley, W. T., Asif, O., & Jean-Mary, J. (2004). College smoking-cessation using cell phone text messaging. Journal of American College Health, 53(2), 71-78. Retrieved from www.scopus.com