“mHealth – Can You Hear Me Now?” by Christen Brownlee features in a special issue of the Johns Hopkins Bloomberg School of Public Health magazine and begins with the odd statement “There’s no app for saving lives… yet”.
It continues to amaze me how anyone who uses a mobile phone can be unaware of how common it is for mobile technology (and the Doctors and carers that it supports) to be involved in saving the lives of patients (and increasingly people who don’t know they’re patients).
Maybe it’s all the TV programmes that show Emergency Doctor scenarios that blind people to the lives that community health workers save everyday when they refer a patient into hospital with a condition like pneumonia or meningistis or make a visit in time to turn around the life of a patient suffering from serious depression, etc.
Things I found interesting in the article:
> “Alain Labrique (assistant professor in International Health) opened… ….a new red and yellow DHL package… …enclosed were several glass slides with swipes of bacterial vaginosis, a disease that Labrique is well trained to diagnose, from women in rural Bangladesh. About half the slides were broken into tiny shards. Immediately, he pulled out his phone and snapped a picture of the damage, sending it to his colleagues in Bangladesh — a technologically savvy image worth a thousand words on how not to package slides. “That’s mHealth 101 right there,” Labrique joked“
Perhaps a more accurate description of mHealth would be a training video for use by the individual who is preparing the slides or the use of a digital microscope (perhaps in Dhaka Medical College and Hospital) and the electronic transmission of these images to Alain’s Washington DC office.
Even at the most basic level how about a preventative strategy where they inform the packers (perhaps with a mobile video tutorial) of how to properly pack biological materials that they’re sending via DHL to Washington DC?
> “mHealth is short for mobile health, a growing field that takes advantage of mobile communications devices—mostly cell phones—to enhance access to health information“
As I’ve mentioned before at length this is a description that’s going to become outdated very quickly as entrepreneurs begin to increasingly leverage the opportunity for mobile communication networks to also add value from network intelligence and cloud based services (such as mPayments, etc).
> “With a new University-wide project called the JHU Global mHealth Initiative, Labrique, his faculty colleagues and students from across Johns Hopkins are coming together to face these questions while building a new community—one that embraces this evolving technology as a game-changer with the potential of revolutionizing health“
What’s all this about the “potential”? Show me a Doctor in Washington DC who’s prepared to give up her mobile phone. Point me to an ambulance in Washington DC that doesn’t have mobile connectivity. Heck show me a taxi cab!
> “about half the women in their study who’d experienced an obstetrical crisis had used a mobile phone to try to turn their situation around—by calling a provider, arranging transportation to a clinic, getting financial aid to pay providers or seeking out medical advice“
Great reminder that mHealth isn’t something we’re going to have to spend much time trying to teach patients to use. While they might not understand why their healthcare providers are so slow to get it – they already do!
> “Labrique and his colleagues decided to start up a mobile phone–based labor and birth notification system. In a recent study, led by International Health Professor Parul Christian, when pregnant women went into labor, they or their families called or sent text messages to a central number. This action dispatched nurse-midwife teams to the women’s homes, where 90 percent of births take place in rural Bangladesh. Results showed that about 89 percent of these births—which would normally have taken place without any medical care—were attended by highly skilled health care workers with the new system“
Great use of resources. Unless this is a limited pilot (the article states this was provided to about 89% of the 90% of rural births) the take away headline is: nearly 2 million rural births in Bangladesh will be attended in 2012 by a healthcare worker because of SMS!
I think it’s impossible that these healthcarer delivering SMS’s aren’t going to be saving lives.
> “Labrique’s team will launch a new project this year called mCARE… …supplying cell phones [in-expensive Chinese-made Android] to the community health workers who visit women periodically to get those who are pregnant into prenatal care as soon as possible. On their regular pregnancy surveillance visits, these workers can use these phones to register their clients, possibly even snapping a quick picture so supervisors can verify who they’re talking with in subsequent visits. Guided by a customized app on the phone, the workers will then ask a series of questions incorporating lunar calendars and local events, to sort out when the woman’s last menstrual period took place. If it was more than five weeks ago, the app notifies the worker that this client is potentially pregnant. That pivotal revelation will automatically trigger a series of other events. Based on the woman’s expected due date, the app schedules several prenatal appointments. It will send her reminders on her own phone, if she owns one, and to the community health worker, who will stop by a couple of days before appointments to emphasize the importance of each visit to the woman and her family“
This seems quite similar to the services Turkish 3G Mobile Operator TurkCell have already rolled out (and are already used by 1/3 of all pregnant women in Turkey). I hope they’re learning from these first hand experiences.
> “But mHealth isn’t just for the developing world, according to Betty Jordan, an assistant professor in the Johns Hopkins School of Nursing… …[commenting on the Text4Baby SMS educational program] “I thought it was a fabulous idea … A 16-year-old inner city pregnant teen may not be going to the library to read a pregnancy website or be able to afford childbirth classes, but she might be willing to read the message that comes across her phone“
I wonder if I’m alone in thinking this patronizing view is going to positively discourage prospective patients engaging with the Text4Baby service?
> “According to Piers Bocock, project director for the Knowledge for Health Project, run by the Bloomberg School’s Center for Communication Programs (CCP), mHealth evaluation remains a huge hurdle. Governments and donors want to make sure that mHealth interventions can be measured so they can make the right decisions about funding comprehensive mHealth programs. “There are a lot of pilots out there,” says Bocock, “but not a lot at scale.”
I really hope Piers Bocock gets to see my back of an envelope calculations above on the mHealth situation today in Bangladesh. In what was is nearly 2 million attended births per year through SMS alone a pilot?
> “Garrett Mehl, PhD ’00, MHS ’94, a WHO scientist and a chair of its Health Data Forum Working Group on mHealth“
Whilst critical of other developers efforts I didn’t know the WHO had such a working group. A google search throws up nothing either…
Perhaps it’s a similar lack of visibility and open sharing of the research findings that “has been the downfall of” the “countless other mHealth projects” that are being referred to here?
> “from the outset, Mechael [PhD ’98 and Executive Director of the mHealth Alliance] says, programs should examine how mobile technology can be leveraged to strengthen the health system as a whole and interact with other platforms, even if the initial funding is specifically targeting a particular health condition“
Although I can obviously see the benefits of this it seems like a sure fire recipe for innovation paralysis to me. In my experience the biggest impact of mobile is going to be by making obsolete many of the expensive and labour intensive processes that exist in our health systems. Working with people to introduce technologies that make them superfluous (eg. remote care replacing patient transfer services) might seem like a great idea for everyone involved but in practice you’ll find the existing individuals and businesses (the drivers, ambulance companies etc) involved in the already established processes will do all they can to sabotage efforts that might effect their incomes. Sometimes we just have to accept the right road might be a rocky one…