Does “mHealth” really do more harm than good?

In Technology for Doctors Online Mike Martineau makes a interesting counter argument to the topic of this blog so I thought it would be worth sharing my thoughts.

I think he’s made a great job of highlighting some of the key issues that arise when you are confused about the definition of mHealth eg. you don’t appreciate Mobile as the newest mass media and mHealth as what we have when this new mass media is leveraged to improve health.

OK, I’ve had enough. I have grappled with understanding and explaining the difference between an EMR (electronic medical record), an EHR (electronic health record), and an EPR (electronic patient record). I have struggled to distinguish how a PHR (personal health record) tethered to an EMR is different from a patient portal. I have even wrapped my head around how telehealth, telemedicine, and eHealth might in fact refer to somewhat different concepts. I draw the line, however, at mHealth! As Howard Beale said in the 1976 movie Network, “I’m mad as hell, and I’m not going to take this anymore!”

It’s completely understandable to me that someone who’s been working with the internet (“e”) to make healthcare advances would be frustrated. While I can also imagine a Ted Turner of the 1920’s pulling his hair out trying to create a 24 hour news channel for his cinema chain, we have to be able to accept it’s perfectly possible for well meaning people to have the right idea at the wrong time.

Before anyone picks up their iPad to compose a message extolling the virtues of mobility, let me state in no uncertain terms that I believe in the transformative potential of mobile technology. I have owned a laptop of some form since 1990 (back when they had monochrome screens and track balls). I got my first RIM device when they were still the size of a pager. I even went to the U.S. to pick up an iPad because I couldn’t wait for them to go on sale in Canada. So, to be clear, I am NOT anti-mobile in any way!

In 2012 the mobile opportunity is so abundantly obvious even if you don’t have a smartphone or a iPad as long as you keep current with the news – especially in the USA thanks to the recent transformation of Apple Computers into a mobile company and the worlds largest tech firm.

What I object to is the proliferation of yet another made-up word to describe the use of a particular type of information technology in the health sector. I cringe when I hear self-professed mHealth proponents suggest that eHealth is passé and that money allocated for eHealth initiatives should be redirected to mHealth initiatives. Seriously!? As if it isn’t challenging enough trying to convince key stakeholders that health IT is a worthwhile investment and not a frill to be cut when budgets get tight

In my opinion it’s really obvious why it’s “challenging” for the “key stakeholders” in “health IT”. It’s because the key stakeholders in this market aren’t actually the key stakeholders: friends and family of patients continue to remain largely excluded from actually having any personal access to the results of the majority of healthcare industry IT investments.

There’s no doubt we’re at a point of change and in my opinion the future of healthcare will follow a similar progression to that we’ve seen in other industries: Look out for reform that is end user (patient) led and collaborative. It’s time to get on board or get off because the innovation only starts when you appreciate this future.

If you need evidence look to the record adoption levels that are being reported by mHealth leaders eg. Kaiser Permanente who recently enabled their patients to accessible their records and communicate with their carers via a secure mobile website.

It’s interesting that Mike points to the potential for Healthcare IT to be seen as “frills” to be cut when budgets get tight as I see this as another prime reason for healthcare IT providers to be pushing for patient accessible records because only once they are participating will they have any idea of which/what cuts are being made. At the moment the digital processes that are used to support care processes are largely invisible to patients and this is why they are under such threat (always better to cut something no one will be able to see).

It appears that I might not be alone in my views (though likely in a minority). A December 2011 article by Eric Wicklund, editor of mHIMSS, asks the question, “Does the mHealth movement have an image problem?” He notes that while an early winter symposium on mHealth held in Washington, DC, “attracted its fair share of health system and health plan executives, vendors and entrepreneurs,” it did not “seem to feature many primary care physicians, nor did it concern the general public.”

Eric Wicklund’s article is an interesting choice, I personally think he’s using these quotes out of context. If the 50+ year old HIMSS organisation was in any doubt about the value of the mHealth Summit surely it wouldn’t have felt the need to acquire the rapidly growing event (in the preceding 12 months it grew by more than 300%) a few weeks later. Of course Clinicians are precisely one of the big assets that HIMSS will be bringing to the next event in December 2012.

Mr. Wicklund muses that perhaps the reason primary care physicians lack interest in mHealth is they are not convinced that it is a “means of improving clinical outcomes.” He notes while there are likely many projects employing mobile technology to improve clinical outcomes, these projects are “lost in the crush of apps and jargon.” I respectfully suggest to Mr. Wicklund that the term “mHealth” is part of that jargon

Stating that family Doctors are lacking interest is wildly inaccurate. Physicians actually seed funded the mobile networks (don’t forget how US mobile networks evolved from pager networks) and their enthusiasm isn’t lacking when it comes to smartphones eg. by 2010 more than 20% had already started using the Epocrates app – which contrasts sharply with the 17% of US physicians who had started using a basic EHR system (despite the Billions of $’s in Federal government funds).

Ms. Olga Khazan, a Washington Post columnist who attended the same conference was left with the impression that there might be an “enthusiasm gap” between mHealth startups and doctors. While her article on this subject offered views from various thought leaders and health IT experts, the consensus opinion appeared to be that it was the physicians and their reluctance to change that was the problem. Seems like a lame excuse to blame the potential customer when they aren’t buying what you are selling

Is it being suggested here that Doctors are somehow enthusiastic about Healthcare IT projects? I think there’s very little evidence to date of that – most look at Healthcare IT in it’s current format as a billing engine.

All the same it’s important that we appreciate that mHealth is no more about Doctor engagement as it is about patient engagement and if mHealth startups can transform the way patients present (and we’ve reported on how well they can do that already) you can bet Doctors will be only too happy to work with these patients.

It’s also worth noting that while the majority of Doctors don’t buy information technologies they can be massive advocates and supporters of it’s adoption and events like the mHealth Summit serve an important service in that they bring clinical leaders closer to the possibilities and potential that mHealth offers.

It’s interesting to note that this can actually be a more effective way of introducing new mHealth initiatives than the old process where Healthcare IT vendors tried to pack exhibition halls and talks with an audience of Doctors eg. at the 2010 event I remember meeting with members of Kaiser Permanente’s IT team but none of their Doctors. In the next 14 months these executives built out and launched a mHealth service that their 14,000 plus Doctors now use with their 9 million patients. For me this conference might be doing things differently but it’s definitely helping to create positive results.

Although smartphones, tablets, and other mobile technologies offer many benefits, perhaps, just perhaps, their supporters are overplaying their virtues. Despite their smaller size, they are, in essence, a computer and not all that different from other computers such as desktops and laptops. Both have processors, a display, a keyboard, a pointing device (biological or mechanical) and an Internet connection

This is where readers need to remind themselves of the 8 already identified unique abilities of mobile as the newest mass media and how these can be applied to healthcare. When you carry your permanently internet connected laptop with you all the time and leave it on while you sleep give me a call…

Both can run a variety of software applications, interface to various medical devices (e.g glucometer, blood pressure cuff, or scale) and provide access to a plethora of information resources. The key difference is the smaller size of mobile devices and the consequent ability to carry them on your person. Does this smaller size really warrant a new and distinct term? Or, is mHealth really just marketing spin to create hype?

Of course mobile’s not just some smaller form factor. If you think this is valid please explain to me how mobile money transfers through mPesa in Kenya exceeded Paypal’s global volumes last year? (The answer is because mobile is an unique new mass media that has its own built in payment mechanism).

As for hype, speaking from experience I can’t see how when you’ve saved patients lives and added massive convenience to many others through using mobile technologies why wouldn’t you want to talk about it?

While many industries are investing heavily in mobile applications and adding mobile support to their websites, they don’t appear to be doing so at the expense of other computing platforms. Indeed, these industries seem to effectively leverage the infrastructure already in place to support larger, less mobile platforms and treat mobile devices as yet another channel through which to interact with their various stakeholders (customers, employees, etc). They leverage all technologies, from home computers to kiosks (an ATM is a form of kiosk) to mobile devices and create an integrated technology ecosystem in which they all co-exist

Really? I recall Google’s CEO Eric Schmidt telling the world a few years ago that ‘mobile is so important for any business you have to put your best people on it – if you don’t have a mobile strategy soon you will no longer be relevant”. If Apple had followed Mike’s advice they would be obsolete today.

The good news is that most healthcare providers and consumers are using some form of information technology on a regular basis, whether it is a desktop computer or a mobile device

Here seems to be a rather fundamental awareness gap on Mike’s part. While I use a desktop computer on a regular basis I use my mobile devices on a continual basis.

Healthcare has always been mobile and always on (despite the persistent attempts of Healthcare IT providers to tether it) so is it really any surprise that a mass media that uniquely shares these advantages will find a natural synergy with this need?

Equally important, they don’t need to be encouraged to buy a smartphone or tablet because they are already doing so at a record pace. So, enough with the acronyms and the marketing terms. Let’s just focus on convincing healthcare providers and individuals to use the technology with which they are familiar. mHealth is a divisive concept that risks splitting health IT advocates into separate camps at a time when we all need to be working together to promote health IT in general

Again I think this misunderstanding arises from the lack of appreciation of the mHealth definition and opportunity. Even if every single man, woman and child in the USA had a brand new iPad and Smartphone there is still going to be a need to provide healthcare services through these devices and with these individuals.

This record pace is not (yet) extending to healthcare services eg. 911 services in the USA still don’t enable a Kaiser Permanente patient to share her medical information with the operator (using caller ID).

This record pace is not extending to care sensors eg. the smoke alarms in the homes of elderly, disabled and the independently living largely remain unconnected and in the case of about 30% of them they’re not working because the batteries are removed or have run out.

This record pace is not extending to consulting services eg. a 3G Doctor style of service that is pay as you go (ie not subscription based) is not yet available to the public in the USA.

What are your views regarding use of the term mHealth? Does it, as I contend, do more harm than good? Or, do you believe that there is value in having a separate term to promote what is clearly a transformative and perhaps even disruptive technology? Drop me a line at michael.martineau@avenant.ca or comment on my blog posts on this topic at eHealthMusings.ca

My point of view is that Mobile is saving lives and reducing suffering the world over and the term “mHealth” lets people with have a shared interest identify with the opportunity to do more and coordinate themselves better.

I’d recommend people who share Mikes feelings check out the following TEDXVienna talk by Alexandra Oswald (HatTip: Ruth Muinde, mHealth Group) as it highlights for me how an abundance of Healthcare IT resources can make it very difficult for us see the massive opportunity in the small, inexpensive and transformational things like a connected smoke alarm or home care monitor:

By all means ignore mHealth but be mindful of what John Scully said about the future belonging to those who see possibilities before they become obvious…

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5 Responses to Does “mHealth” really do more harm than good?

  1. Marianne Lynch, Esq. says:

    Brillant insights, solutions are right in front of us. It was significant that during the recent mHealth Summit in Washington D.C. this year most of the innovative health programs were coming out of developing counties such as Keyna. At times they are light years ahead of the times.

  2. Pingback: The first rule of FDA regulation of mHealth: You don’t talk about FDA regulation of mHealth « mHealth Insight: the blog of 3G Doctor

  3. Pingback: Bill Gates: the proliferation of mobile devices hasn’t yet revolutionized life in developing countries « mHealth Insight: the blog of 3G Doctor

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  5. Pingback: The Lancet “Mobile health-care information for all: a global challenge” | mHealth Insight: the blog of 3G Doctor

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