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 mHEALTH Panel: Robyn Whittaker, MD PhD, mHealth researcher, Public Health Physician, Commonwealth Fund Harkness fellow 2010/11 Barbara Mittleman, MD, internal medicine/rheumatologist, Director NIH Public-Private Partnership Program, co-chair of the first mHealth Summit Wendy 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. via Environmental scan text4baby case study Key informant interviews

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

4. mHealth the delivery of health-related services via mobile communications devices Portable Personal Connected

5. Prelim findings: interviews

7. from provider control to individual locus of control

8. change the way we search for and use information

9. Issues in mHealth: categories Policy & regulatory Wireless environment Health system mHealth in practice mHealth research

10. Policy & regulatory issues Privacy +/- data security FDA regulation Bandwidth spectrum availability Medical practice regulations e.g. practice across states/countries, regulated roles

11. Wireless environment issues Large number of wireless networks Working across platforms & other proprietary complexities Potential costs to users

12. Health system issues Who pays/reimbursement Competing priorities & opportunity cost Integration into existing systems, practice & EHRs Clinical roles & accountability Lack of demonstrably sustainable business models

13. mHealth in practice issues Immature 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 base Technology focus/legacy systems

14. mHealth in research issues Need for more high quality research demonstrating effectiveness & cost-effectiveness Mismatch in pace & flexibility of research with tech developments Measuring reach & access into under-served populations

15. Opportunities in mHealth U.S. Optimising opportunities provided by health reform environment CMMI, Beacon demo projects, EHRs Some degree of federal level guidance Strategic collaborative (open) approach Improving mHealth practice & research Iterate, integrate, improve

16. Acknowledgements Dr Kyu Rhee Health Resources & Services Administration, U.S. Dept of Health & Human Services The Commonwealth Fund All interviewees