ITU gets it wrong about mHealth

Mobile eHealth Solutions for Developing Countries” (6.4MB PDF) is the Final Report of a 4 year study project by the International Telecommunications Union (ITU). After a quick read it’s abundantly clear the report is wildly inaccurate and a very poor advisory document for Healthcare Service providers in developing countries. Personally I think it’s because of the continuation of an outdated focus and agenda:

As Mobile Health is inevitable part of the development and implementation of eHealth Master Plan

I think it’s a fundamental flaw arrived at by the attempt to make mHealth fit the ITU’s “eHealth Master Plan” – as the saying goes: “when you have a hammer everything looks like a nail”. Mobile is the newest and most poorly understood mass media. As such it is as different from the Computer, TV, Radio, Cinema, Newspaper that came before it… everyone involved needs to fully appreciate this before they conclude that mHealth is some part of eHealth. It’s radically different and it’s got 8 already identified unique new attributes that you can learn about here.

While I’m sure some people will accuse me of just mincing words this is really important because documents like this are being used to forward plan the incredibly limited Healthcare IT spends in developing countries. To ignore the potential of the ONLY device that has more distribution in developing countries than developed countries to hold onto our western faith that eHealth will be able to acheive goals (it seldom does because it’s rarely owned-by, built or designed FOR patients) and improve humanity (not just sell some more drugs/computer boxes etc etc) is doing these markets a disservice.

Here’s a few examples I found that highlight flaws in the report:

> The Chapter looking at the definition of mHealth is written by a researcher from the “Solar-Terrestrial Influences Institute in Bulgaria” and asks “m-Health, mHealth, or Mobile Health – which one is correct?”, before recommending the report of the United Nations foundation and Vodafone Foundation “mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World”:

One of its most valuable parts is the short compendium of Mobile Health projects. Those who are interested may not only find brilliant ideas but also contact details. It is not necessary to discover the wheel again and again, let’s use the experience of the pioneers!

Except for the fact that researchers have shown this report outlined little more than ideas and suggestions looking for funding/support. Less than half of the “projects” even made it to the pilot/trial stage so it would actually be referred to as a place for those seeking to avoid and learn from mistakes in mHealth.

> The section on “Clinical Decision Support Software” surprised me as it didn’t even mention the opportunity to host medical text book and learning resources on the memory cards/mobile phones of clinical teams. Instead it offered an online solution requiring “high speed internet connectivity”. Doctors I know working in London prefer mobile phone based solutions that don’t require network access (they work everywhere with zero cost and lower latency) so I can’t imagine the situation is any different for a clinician visiting a rural clinic without reliable power or network coverage.

As for the suggestion that medical diagnosis is going to be replaced by a paint by numbers approach from eClinician CDSS software that gives the correct diagnosis at the top of the list 88% of the time: I think anyone who thinks this needs to go and spend some time learning about the actual job that Nurses and Doctors do. Having them pick from a “list of differential diagnosis” that are “fairly accurate” is plainly inconsiderate of the needs for proper medical training and a patients right to quality care.

> The report made little mention of the potential for 3G (a technology that has been the fastest ever adoption rate in the history of mankind) except for a piece by Isao Nakajima, an ER Doctor in Tokyo Japan, who previously published a paper looking at the opportunity for 3G to connect ambulances. Here’s what the report concluded:

The third Generation (3G)-Mobile phone

Some believe communications with moving ambulances should be based on the 3G mobile phone network. Is this correct? Is the 3G mobile phone network good enough to ensure multi-path high-speed transmission from fast-moving ambulances? The answer is no, even in Japan, where a 3G network is established nationwide

Sounds quite disapproving doesn’t it? Well it does until you realise that the research that led to this conclusion was trying to ascertain whether 3G network technologies would be able to automate “in-ambulance activities (measurement/analysis, activity recording, message transmission)”.

Let me be clear: Whilst this ER Doctor clearly thinks there is a “need to do so” that “will grow in the near future”, it is currently a ridiculous idea to want to support patients through mobile communication technologies when they are in transit onboard ambulances. This is why ambulances typically have more than one member of medically qualified staff and there is lots of evidence that the costs of this staff member are negligible compared to the improved care and patient outcomes that are achievable.

Ambulance crews around the world use 3G network technology today to decide on which hospitial to go to based on live data feeds (waiting times, traffic, etc) to make calls to Doctors, Hospitals and Patients relatives. They also use it in their navigation devices to get turn by turn directions to find patient addresses. To write a paper for developing markets suggesting that they might want to use the tech to better manage the health of in transit patients is completely out of whack with the real world situation

LINK: Learn more about the ITU mHealth Initiative

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