MHealth

mHealth (also written as m-health or sometimes mobile health) is a recent term for medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, PDAs, and other wireless devices. mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery of healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vital signs, and direct provision of care (via mobile telemedicine).

Definitions
Mobile eHealth or mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems and is part of a movement towards citizen-centered health service delivery. Mobile technologies by nature lend themselves to more decentralized health service delivery. Although Ministries of Health in low and middle income countries and policy makers are eager to explore the use of mobile phones and other ICT to promote health, the lack of a comprehensive model, knowledge base, and published data on the health benefits poses significant barriers.

The most widely cited and definitive definition is by Istepanian et al. as 'emerging mobile communications and network technologies for healthcare.’

Other later citations include Bardram et al. as m-health is focused on embedded wireless devices that track health-related parameters:
 * "The recent advances in information and communication technologies (ICT) enable technically the continual monitoring of health-related parameters with wireless sensors, wherever the user happens to be. Small, low-power sensors can, in principle, be embedded in almost anything in our surroundings: furniture, vehicles, wearable devices, and even clothes. Mobile phones or personal digital assistants (PDAs) with wireless networking capabilities may serve as gateweays that process, store, and transfer measured parameters to clinicians for further analysis or diagnosis. This technology trend, also called mHealth (mobile health), is already visible in the market."

Low and middle income countries
There has been a growing interest within the health sector to capitalize on the rapid uptake of mobile communication technologies and the overall improvements in telecommunications within the general population throughout the world. Characterized as a ‘leapfrog technology,’ mobile phones have allowed developing countries, even those with relatively poor infrastructure, to bypass 20th century fixed-line technology and jump straight to 21st century mobile technology. The number of global mobile phone subscribers in 2006 was estimated at 2.5 billion of an estimated global population of 6.6 billion (37.9%). These figures are expected to grow to 3.3 billion or approximately half of the world’s population by 2010 with the greatest growth expected in Asia, the Middle East, and Africa. In many countries, the number of mobile phone subscribers has by-passed the number of fixed-line telephones, this is particularly the case in developing countries.

The cost of mobile technology deployment is increasingly going down, with vendors such as Nokia developing cheaper infrastructure technologies (CDMA) and cheaper phones (sub $50–100, such as Sun's Java phone). Cost may not be much of an issue in the near future, especially compared to PC-based solutions. The increasing functionality of phones enables SmartPhone-capability in relatively inexpensive phones. It is worth noting that the capabilities of mobile phones in low and middle income countries has not reached the sophistication of those in high income countries, which now enable web browsing, GPS navigation, and email through what are being called smart phones. In spite of these differentials, the basic SMS text functions and real-time communication capacity of devices available in low and middle income countries offer a broad range of potential benefits to the health sector. Increased availability and efficiency in both voice and data-transfer systems in addition to rapid deployment of wireless infrastructure will likely accelerate the deployment of mobile-enabled health systems and services throughout the world.

The trends towards mHealth in developing countries are largely due to the overwhelming uptake of mobile phones within the health sector and by the general population as well as the increased uptake, however limited, of smart phones within the health sector for retrieval of web-based information and patient data in decentralized health management information systems (HMIS). In addition, wireless-enabled laptops and specialized health-related software applications are currently being developed, tested, and marketed throughout the world. This "high-end" work is happening primarily in high income countries; however, with broad advocacy campaigns for free and open source software (FOSS), applications tailored to local contexts may soon become available in low and middle income countries. Another route to increasing local capacity has been pioneered by EpiSurveyor.org, which is the first tool to use a Web 2.0 approach to providing useful software (specifically adopting the cloud-based, software-as-a-service model in order to broadly scale, following the example of commercial proprietary-but-free software such as Gmail, Facebook, et al), in this case to create mobile-phone-based data collection systems. Efforts to provide resources and training for the localized development of applications and technologies ought to be encouraged in low and middle income countries.

Mobile technologies offer direct voice communication (of particular value due to literacy and language capacity in many countries) and information transfer capabilities. The appeal of mobile communication technologies is that they enable communication in motion, allowing individuals to contact each other irrespective of time and place. This is particularly beneficial for work in remote areas where the mobile phone, and now increasingly wireless infrastructure, is able to reach more people at a more rapid rate. As a result of such technological advances the capacity for improved access to information and two-way communication hence becomes available at the point of need.

A two day conference was organized in Lagos, the purpose was to drive the health sector with technology tools in the area of telemedecine, mhealth and ehealth.

Improving health outcomes and efficiencies
Technology integration within the health sector has great potential to promote healthy lifestyles, improve decisions by health professionals as well as patients, and enhance healthcare quality by improving access to medical and health information and facilitating instantaneous communication in places where this was not previously possible. The increased use of technology can help reduce health care costs by improving efficiencies in the health care system and promoting prevention through behavior change communication (BCC). It also has the potential to advance clinical care and public health services by facilitating health professional practice and communication and reducing health disparities by applying new approaches to improve the health of isolated populations.

The Millennium Development Goals (MDGs) that specifically address health as set forth by the United Nations Millennium Declaration in 2000 include reducing child mortality; improving maternal health; combating HIV and AIDS, malaria, and other diseases; and increasing access to safe drinking water. A progress report published in 2006 indicates that childhood immunization and deliveries by skilled birth attendants are on the rise, while many regions continue to struggle to achieve reductions in the prevalence of the diseases of poverty including malaria, HIV and AIDS and tuberculosis (TB). Increasing attention has also been drawn to the critical shortages in trained healthcare personnel throughout the world whereby there are now 57 countries with critical shortages in health work force density with a global deficit of 2.4 million doctors, nurses, and midwives. Investing in the training and ongoing development of the healthcare work force is considered among the most effective means of improving health. Three key areas in which early and rapid gains can be achieved through technology design and integration are in the areas of Safe Motherhood, routine immunization and integrated management of childhood illness, and in addressing the diseases of poverty, namely HIV and AIDS, malaria, and TB- where significant resources have been mobilized to reduce the disease burden in low and middle income countries.

Efforts are ongoing to explore how a broad range of technologies, and most recently mHealth technologies, can improve such health outcomes as well as generate cost savings within the health systems of middle and low income countries. The specific potential of mHealth lies in its ability to offer opportunities for direct voice communication (of particular value due to literacy and language capacity in many countries) and information transfer capabilities that previous technologies did not. This is particularly beneficial for work in remote areas where the mobile phone, and now increasingly wireless infrastructure, is able to reach more people at a more rapid rate. As a result of such technological advances the capacity for improved access to information and two-way communication hence becomes available at the point-of-need and for healthcare workers at the point-of-care. Mobile communication technologies are tools that can be leveraged to support existing workflows within the health sector and between the health sector and the general public.

Some of the MVP strategic objectives for m-health are:


 * Improvement of the access to emergency and general health services
 * Improvement of the efficiency of health service delivery
 * Improvement of the clinical practice for enhanced health outcomes
 * The reduction of child and maternal mortality and morbidity in MVPs

Program areas
Mobile devices have been used in a number of different settings, but most applications can be classified as follows:


 * Education and awareness
 * Helpline
 * Diagnostic support, treatment support, communication and training for healthcare workers
 * Disease surveillance and epidemic outbreak tracking (malaria, HIV/AIDS, TB, Avian Flu)
 * Treatment support and medication compliance for patients, including chronic disease management (such as diabetes)

Technology
Key mobile communication technologies relevant to mHealth include:
 * Mobile phones
 * PDAs and smart phones
 * Patient monitoring devices
 * Mobile telemedicine/telecare devices
 * MP3 players for mLearning
 * Microcomputers

mHealth Technology capabilities:

Voice

Voice is usually personal two-way communication although automated systems may provide voice recorded information as well.

Data

Data access is primarily focused on visualizing static text but can also extend to interactive decision support algorithms, other visual image information, and also communication capabilities through the integration of e-mail and SMS features. Integrating use of GIS and GPS with mobile technologies adds a geographical mapping component that is able to “tag” voice and data communication to a particular location or series of locations. These combined capabilities have been used for emergency health services as well as for disease surveillance, health facilities and services mapping, and other health-related data collection.

Emerging trends and areas of interest in mHealth

 * Emergency response systems (e.g., road traffic accidents, emergency obstetric care)
 * Human resources coordination, management, and supervision
 * Mobile synchronous (voice) and asynchronous (SMS) telemedicine diagnostic and decision support to remote clinicians
 * Clinician-focused, evidence-based formulary, database and decision support information available at the point-of-care
 * Clinical care and remote patient monitoring
 * Health extension services
 * Health services monitoring and reporting
 * Health-related mLearning for the general public
 * Training and continuing professional development for health care workers
 * Health promotion and community mobilization

According to Vodafone Group Foundation on February 13 2008, a partnership for emergency communications was created between the group and United Nations Foundation. Such partnership will increase the effectiveness of the information and communications technology response to major emergencies and disasters around the world.

Research, coordination and strategy

 * m-Health NZ Conference on mobile health in the Pacific region
 * mHealth Alliance Formed in February 2009 by the Rockefeller Foundation, United Nations Foundation and Vodafone Foundation to facilitate global innovation and ensure maximum impact in the field of mobile health (mHealth)
 * mHealth Initiative Boston USA-based not-for-profit organization, the successor to the Mobile Healthcare Alliance (MoHCA)
 * Columbia University, Center for Global Health and Economic Development: Global eHealth Program Academic center conducting training, research and implementation for technologies to meet global health challenges
 * MobileActive A resource for activists using mobile technology for social purposes
 * Open-Mobile Consortium Promoting cooperation on open source development, testing, program implementation, and evaluation of mobile technology for social good.
 * Grameen Foundation Mobile Technology for Community Health (MoTeCH) Launched in November 2008, the first project of the Mobile Technology for Community Health is to determine how mobile phones could be used to improve antenatal and neonatal care in rural Ghana
 * West Wireless Health Institute The West Wireless Health Institute identifies, validates and accelerates the use of innovative and cost-effective wireless technologies for health needs.
 * Carso Health Institute (Mexico/LATAM) Funded by Carlos Slim, the Carso Health Institute is focused on researching and finding innovative solutions to priority health issues in Latin America. TelSalud, an intervation based-programme, seeks to harness the power of the telecommunications for health.
 * Wireless Life Sciences Alliance

News and information sources

 * Wireless Healthcare News
 * mobihealthnews The mHealth industry monitor
 * iPhoneMedicalApps The iPhone Medical Apps and News monitor
 * Mobile WellBeing Mobile digital devices in service of human wellbeing
 * Android Medical Apps The Android Medical Apps and News monitor

Technology and applications developers

 * Cell-Life (South Africa) SMS data gathering applications
 * Cinterion (Germany) Medical Device M2M enabler
 * DataDyne.org A US and Kenyan not-for-profit consultancy creating mobile data collection applications to serve public health and international development. DataDyne created EpiSurveyor (DataDyne's EpiSurveyor.org), a free, very easy-to-use software suite to collect, analyze, map, and report data using handheld computers and cellphones.
 * EpiHandy Set of tools for collection and handling of data using mobile devices: mobile phones, smart phones, PDAs, and handheld computers
 * Free and/or Open source software packages for mHealth
 * FrontlineSMS Free open source software that turns a laptop and a mobile phone into a central communications hub that enables users to send and receive text messages with large groups of people through mobile phones, without requiring an internet connection

Program implementers (may also be applications developers)

 * AED-Satellife Information and communications technologies (ICT) initiatives through the USA-based not-for-profit Academy for Educational Development providing support for HIV/AIDS, malaria, child and maternal health, and health systems management programs in Uganda and Mozambique
 * D-Tree (USA) In Partnership with Harvard School of Public Health, D-Tree develops treatment protocols for the most commonly diagnosed illnesses based on best field practices. The protocols are programmed into inexpensive handheld computers and mobile phones for use by frontline health workers in both clinical and community settings. These devices are augmented with a system of patient-held data cards with embedded computer chips that record individual medical information needed for diagnosis and treatment. D-Tree has projects in Tanzania.
 * Freedom HIV/AIDS Freedom HIV/AIDS, a social initiative of the Indian firm ZMQ Software Systems, comprises four mobile games promoting HIV/AIDS awareness messages. The games have been introduced in India, Uganda, Tanzania, Kenya, Malawi, Mozambique and Namibia.
 * eConsult India’s largest non-profit telemedicine initiative serving approximately 100,000 subscribers, with 10,000 healthcare partners
 * InSTEDD (USA) An acronym for Innovative Support for Emergencies, Diseases and Disasters, InSTEDD is a California, USA based organization with programs in southeast Asia. InSTEDD has developed applications including GeoChat, which integrates SMS messaging and mapping, and tools for information sharing and decision support.
 * MPedigree (Ghana)
 * Phones for Health (USA)
 * SexEdText (Philippines)
 * SexInfoSF (USA)
 * Text to Change (The Netherlands)

Private Sector

 * 3G Doctor (Worldwide)
 * German mHealth Project Inprimo
 * GlucoMON-ADMS by Diabetech (Worldwide-GSM/GPRS)
 * IBM mHealth wireless solution (USA)
 * IQMax Mobile Healthcare Solutions
 * Mobile Healthcare Industry Summit (London)
 * Polka (USA/Worldwide)
 * Sinovo (Germany/Worldwide) Diabetes Management with SiDiary
 * Voxiva (USA/Worldwide) Interactive Health Engagement