The National Institutes of Health launches a mHealth Online Training Course

I think this is a great initiative by Wendy Nilsen at the NIH. A few of my notes on watching the introduction video:

> “What is mHealth?”

at NIH, we think about this really as diverse application of wireless and mobile technologies designed to improve health research, healthcare services and health outcomes and I think this is really important because it’s not just cell phones. You can think of it as sensors, any kind of sensors you can think of

I think it’s critical that organisations agree on a definition of mHealth as it makes little sense to be offering training courses about things that an organisation hasn’t itself yet reached an accepted definition.

In the introduction video Wendy Neilson reminds us of the importance of this (“always remember in mobile to ask what the acronyms mean, ask what the words mean. When we’re communicating across disciplines, we often don’t know each other’s words“)

I’ve offered this robust and time tested suggestion back in 2010 that might be useful:

mHealth is the leverage of Mobile for Health (where Mobile is the newest Mass Media and Health is the state of complete physical, mental and social well-being)

Failing that it’s interesting to consider alternative definitions that have been put forward by others eg. “What is mHealth”.

> Beyond Telemedicine

I also want to stress, too, this (mHealth) is really beyond what we traditionally think of as telemedicine

I think this is a very important point. A lot of people who have worked in telemedicine think that mHealth is a subset. Then get disorientated when I tell them to describe how it’s telemedicine when I’m at 30,000 ft in a plane accessing a full medical library on my smartphone and taking the ECG of a panicking passenger using the Alivecor app.


We talk about SMS all the time but it is Short Message Service. It’s really the most widely used data application in the entire world, billions and billions of active users. And the thing is that this is changing by the hour

It’s critically important that the healthcare industry understands SMS so please read this fascinating post by Tomi Ahonen from 2010 (also don’t miss his 2013 ‘Mobile Moment’ Almanac). Key takeaways that you will gain include an appreciation of SMS as not just the most widely used ‘data application’ but as the most popular and accessible means of electronic communication eg. back in 2010 87% of the total population who have a mobile phone do not originate voice calls but do send SMS – it’s for this reason that most people in the world don’t refer to their ‘mobile’ as their ‘phone’ (because while it can be a talking device it’s not owned for it’s voice call purposes but for messaging).

> The office based model isn’t going to work for young people

And young folks. I think if we don’t worry about mobile for any other reason, we have to think about a generation coming up where we have a chance to embed health in their life from the very beginning to have health and health interventions whether they be public health, whether they be clinical, whether they be epidemiological, we can start from the very beginning. Kids are going to have phones, We know even the youngest have phones and what’s really Important Is thinking about the world they are growing up in, and they have never been in a brick and mortar bank. They think that ATMs are it, you deposit through your phone. When they finally go to get a mortgage, should they be that lucky, they’ll do it online. So they are never going to use a brick and mortar bank and the idea of only being able to access a world with brick and mortar, as we do in healthcare, I think we’re going to have to be really there with them

I think this is a big misconception. From my experience of the last fortnight talking with hundreds of Consultant Psychiatrists at the RCPsych’s International Congress in London it’s clear that young people are driving transformational change in healthcare services as they simply refuse or avoid using services that fail to modernise. More concerning is the fact that we’re leaving senior citizens behind as we adopt mHealth. Note: There are many things we can do to change this but it’s also critical we appreciate that there are also opportunities to implement mHealth that seniors are already expecting.

> Obsession with the ‘Randomised Controlled Trial’ approach to mHealth

My boss, Robert Kaplan and Art Stone just recently did a review in looking at the evidence in mHealth and they only found 20 randomised control trials, 20 projects that were mature enough for randomised trial, because you don’t want to start a randomised trial at the beginning. You want to do it when you have something that you think really is going to work. But of those, 55%, 55%, 11 out of 20, showed no clear benefit, So what does that tell me? And what does it tell you? I mean, the one thing I think about when I think about that is, wow, we got a long way to go. We’ve got to learn, we’ve got to learn what works, we’ve got to learn what didn’t, and we need to know how to do this better. There is some problems with the current literature, too. There aren’t many published studies. Caroline Free recently did a review, there’s been a whole bunch of reviews that have been happening. But there’s not a lot of research. There’s a lot of projects without a lot of research. And a lot of times they are with a few people and they may not be with the people you want to generalise

I think this really highlights a major issue I see presenting when non techies get bowled over by the mHealth that is envisioned by technologists. Big Pharma makes similar oversights and I’m always encouraging clients to stop looking to the future possibilities and focus on the issues with the fundamentally broken ways in which we care for Patients today and the opportunities mobile offers for the modernisation of processes:

Why Big Pharma struggles to innovate with mHealth

The rate of change can seem overwhelming but the alternative is wasting your time trying to clinically validate outdated tech. Asking for yet another RCT showing the effectiveness of using SMS or mobile calls instead of stamped addressed envelopes won’t make a piece of difference because there is no logic to printing and sending snail mail in 2014.

Why would a rapidly growing mHealth company that has proven it’s mHealth service can save an employer $3,300 per employee per year in healthcare costs and hasn’t yet even got competitors in the market go and waste money and time waiting for more research to further prove that it’s valuable to collect data when the continually improving search algorithms used by Google prove to us everyday the valuable insights that can be made when data is seamlessly collected?

> It’s critically important for us to move beyond the in-office model before mHealth will make any sense

NIH is funding mHealth, but how do we think about augmenting this in different ways. It’s interdisciplinary research. As a leader of NIH’s mHealth Training Institute, including this online course. One of the things we’ve been really trying to think about is how do we get what Bonnie Springs and others have labeled team science? How do we get that to happen all the time for mobile? We have the genius of behavioural scientists, the genius of computer scientists, the genius of medical providers, nurses, doctors, healthcare professionals, dentists. We have engineers building devices. But you know what? If you’re not working together you are going to end up with a device that seems like it makes sense but it isn’t. I know when I first started at this one of the things that really prompted me to think about our role in this was someone who showed me a great cardiac monitoring system. It was really lovely, lovely interface, lovely everything. But when I said what happens when there is a cardiac event, this was for people with congestive heart failure. What happens when there is a cardiac event? And the man looked at me and said, we email the nurse. And I know there is many of you out there now chuckling because it’s not a chuckle-able event in some ways, but it’s almost funny. Email a nurse should never be in the same sentence. And he said, well do nurses have email? Yes they do, we know that. But emails and cardiacs don’t go together. So how do we have nurses and doctors working together with people that are building these devices with behavioural principles, because if we don’t know how behaviour works we’re not going to be able to change it. Just monitoring your cardiac function may not be enough. We’ll probably want you to change your diet, your physical activity, your stress, your smoking. How do we do all that? We’re going to need to work together to get there. Also, research methodology

Other industries have got over this challenge of being always on (eg. I can use by bank card anywhere in the world even when my local branch is closed) so I see no reason why healthcare is going to different as soon as we all realise a ‘video call to a properly staffed bank of trained nurses with up to date access to all your information’ can achieve more than an email to your nurse (who might be asleep, out at dinner, on holiday, etc, etc) will ever be able to manage.

But more importantly very few mHealth innovations will make any sense until we all appreciate that:

a) The Healthcare experiences we’re all familiar with are fundamentally undocumented or inefficiently documented.

b) The product we choose to make should not be visits.

c) ‘the 2000 year old model of healthcare is broken forever’.

d) mHealth is introducing algorithmic transformation to what healthcare services are possible eg. in 10 years mHealth will make many unthinkable things possible.

What were your thoughts on the NIH introduction to their mHealth Online Training Course?

Related: Click here (on the Healthcare Informatics Society of Ireland website) or here (another page on the mHealth Insight blog) to find out more and book the mHealth for Healthcare Professionals Course that we developed together with the Healthcare Informatics Society.

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