Does the definition of mHealth vary depending on the use case?

SearchHealthIT Dr Joseph Kim How the Definition of mHealth varies depending on uses cases

A​t SearchHealthIT the ‘digital entrepreneur and physician technologist‘ Joseph Kim MD asks what’s the definition of mHealth before concluding that it’s something that “varies depending on uses cases​”.

I think it’s clear that a definition isn’t very robust when it fails to work at the first test. Perhaps the problem originates because it seems to have been drawn from the flawed ​definition that’s posted on Wikipedia (something I commented on here before):

​”​Wikipedia’s definition of mHealth is “a term used for the practice of medical and public health, supported by mobile devices.” Well, in today’s digitally connected world of healthcare delivery, that would encompass a lot. Wikipedia continues by saying, “The term is most commonly used in reference to using mobile communication devices, such as mobile phones, tablet computers and PDAs, for health services and information, but also to affect emotional states.” ​ ​Is there a framework that will help us differentiate between what is mHealth and what’s not? Smartphones, tablets, laptops and desktops overlap in functionality, making it more difficult to separate and adequately segment these devices. However, patients and healthcare providers use these digital tools for different functions, so maybe we could start there​”

I think a better way of understanding something we’re unfamiliar with is to look at the differences between a mHealth and a non-mHealth experience eg. although accessing a Doctors website might be regarded to be something you can do on equally on a mobile phone, a laptop, a PC, a networked computer in an internet cafe, a SmartTV, etc, etc, the reality is internet access via mobile in 2013 far outstrips PC access, Patients are obviously more comfortable communicating about personal issues via an unshared device that belongs to them, accessibility is transformed when it’s available on an always carried always on and always available device, etc, etc.

​”​If a patient uses a symptom checker app on a smartphone, is this mHealth? The same symptom checker may also exist for a desktop computer. Once again, this is an example where the mobile symptom checker demonstrates the benefit of immediate, always-accessible information. If a person feels ill while dining at a restaurant, he may not have time to run home, power on a desktop and research his symptoms. Being able to pull out his smartphone and research his symptoms while sitting at the restaurant is an example of mHealth

I think this helps reinforce the definition I have proposed for mHealth eg. this explanation sums up the unique attribute only mobile has of being ‘available at the point of inspiration’.

​”​If a patient uses an iPad to perform a Google search for flu symptoms and reads about fevers and aches, is the patient engaged in mHealth? The person could have done the exact same thing on a desktop computer, but that would not be considered mHealth​”

I think it is critically important that anyone looking to understand and create valuable mHealth experiences reads this post by Tomi Ahonen and begins to understand ‘mobile’ (the ‘m’ in mHealth) as the newest and most poorly understood mass media:

7 Mass Media

Once that’s appreciated I think it becomes easy to appreciate how we can leverage the unique attributes of this new mass media for health AND also do with mobile many of the things that we did and can still continue to do with the older mass medias:

> Print (you can read/write a ​self help ​book on your mobile)
> Recordings (you can relax and perfect your breathing technique to a relaxing MP3 tune to reduce your stress levels and lower your blood pressure)
> Cinema (you can watch the Supersize Me movie on your mobile)
> TV (you can watch the BBC’s program profiling mHealth monitoring tech via your smartphone)
> Radio (you can listen to Dr Richard Hammond on Radio 4)
> PC (you ca​n share your medical history with your Doctor via the browser on your mobile phone)​

It’s interesting to note that this isn’t actually a new phenomena – throughout history new mass medias have been received as merely new ways to deliver the old mass media eg. the first cinema adverts were simply a combination of the static newspaper advert (projected onto the big screen) and the radio advert (played through the cinema’s sound system), TV at first was considered to just be a little cinema we could watch in the home at scheduled times (just like the big brother cinema) and it wasn’t until decades later that the billionaire entrepreneur Ted Turner realised TV had unique attributes that set it apart (eg. it could be always on and support a rolling 24 hr news format), etc.

It’s worth getting yourself familiar with the 8 already identified new attributes of Mobile as a mass media and ways that we can leverage these as in these lie the big opportunities to realise value above and beyond anything that was or could be achieved with the previous mass media. If we fail to do this it’s all too easy to just get confused and swamped in thinking about the similarities ​and overlaps that mobile has with the PC/Internet:

“​The ​ ​capabilities of mobile devices such as smartphones and tablets overlap significantly with the capabilities of desktop computers. Laptops can essentially do everything a desktop can, but the device itself is mobile. This slight difference makes laptop computing a gray area in mHealth​”

In Joseph Kim’s confusion about the iPad being used by a Patient to search for healthcare information you can imagine it’s quite easy to realise that this is mHealth because it enables several completely different new opportunities eg. access via an iPad enables Patients who are in a Hospital bed that doesn’t provide WiFi to Patients (because they have decided to treat their Patients as customers to whom they want to sell extortionately expensive bedside TV/phones) because then it’s quite obvious the Patient couldn’t be using a desktop computer eg. if they won’t give you access to a WiFi network imagine trying to convince anyone to let you plug your desktop PC in beside your bed?

​”​Similarly, a doctor who uses a smartphone to research a medication interaction could have done the same thing on a desktop computer. However, the doctor always carries a smartphone, so he now always has access to resources that can help him be a better doctor. This is mHealth

I think this helps reinforce the definition I have proposed for mhealth eg. this explanation sums up the unique attribute only mobile has of ‘always being carried’

​”…If your lab results are sent to you by Short Message Service or via a mobile app, then that is an example of mobile technology facilitating the delivery of health services. You could have also received the same information on a desktop, so although the process is the same, the fact that you are receiving the information on a mobile device makes it different​”

I think it’s interesting to look to the mHealth success in the USA at Walgreens where mHealth has made them more money in 18 months than they made in the previous decade via the PC/Internet and a mobile prescription is now requested every second (and already more than half of all online refill requests come through a smartphone app that Patients have installed on their smartphones).

​”​Perhaps the most compelling example of mHealth is when patients use mobile devices to receive healthcare services. If a villager in India takes a photo of his swollen toe and sends it to a physician, he can receive a diagnosis of gout and also get a prescription for treatment. This is mHealth at its best. Without the camera phone, the patient would not have been able to receive proper care

I disagree that the camera is vital. A red swollen painful small joint described by a Patient using an interactive medical history taking questionnaire on their Doctors mobile optimised website will be just as effective and much easier to do (eg. you could do it on the train to work as for one thing you won’t have to take your sock off).

Also I think surely mHealth is at it’s very best when it helps prevent health issues arriving eg. providing Patients with dietary advice so that they can avoid the development of gout in the first place eg. cutting down on alcohol, etc.

​”​Another example is when a paramedic arrives at the scene of an accident and transmits patient electrocardiogram (ECG) data to a remote cardiologist. The cardiologist then instructs the paramedic to give certain medications. The patient would not have received optimal care without mobile technology and a wireless infrastructure to support the two-way communication​”

Even more exciting is that this technology is now so low cost and easy to use Patients don’t have to wait for a paramedic – buy your own Alivecor ECG here today.​

​”​Communication between a healthcare provider and a patient is not just about exchanging information. That communication changes when you enhance it with photos, videos and biometric patient data

While I agree with this I also think it’s a very typical Doctor view of the opportunity. We are all so accepting of a status quo in which we document so little of Patient ​encounters that we’re all too often missing the fundamental opportunity for providing Patients with a written record of their encounters as we rush to satisfy our fascination for technical solutions involving biometric data. Perhaps I’m just jaded because I’ve seen far too many pilots that have failed because they’ve overlooked the poor quality foundation that undocumented care processes provide?

​”​Some people insist on distinguishing among such terms as mHealth, telemedicine,telehealth, remote monitoring, digital health, wireless health and connected health. There are some clear distinctions, but we are seeing more overlap as mobile devices become ubiquitous. Soon, it will be hard to find a person who doesn’t have a mobile device. When that day comes, we will not need the “m” in mHealth. We will simply be talking about health​”

I agree the distinctions are becoming blurred – particularly as medical devices get their own mobile connectivity – but I think it’s already difficult to find a person who doesn’t have a mobile device and that as mobile devices become ever more ubiquitous it will be increasingly hard to get the FDA to approve a medical device that doesn’t have mobile connectivity and we’ll be talking about mHealth as being just another mobile experience.

Mobile plus Health plus adoption equals Mobile

What do you think?

About David Doherty
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