Posted by: davidjolson | 11/29/2010

Putting the “m” in mHealth

This blog was written by Global Health Council Policy Communications Intern Allison Kline.

This month, the annual mHealth Summit in Washington D.C. brought together over 2,400 individuals from 50 countries representing the private sector and governmental and non-governmental organizations to discuss the application of mobile technology to public health.

The name assigned to the use of mobile technology in public health really struck a chord with me, with its hip prefix that could be capitalized or hyphenated, but stays understatedly lowercase and attached, sans hyphen.

While I applaud the genius behind the name for not attempting to create an awkward public health portmanteau, the lowercase ‘m’ is misleading: How could a single innocuous ‘m’ really change public health that much?  Like its name, the main points brought up during the summit illustrated the potential pitfalls that could befall the poor m if the technical side doesn’t keep pace with rapidly changing public health issues.

The mobile aspect should be careful to avoid being classified as a novelty or fad technology if mHealth is to stand the test of time and transcend its trendy connotations. In an age defined by gmail, iPads and e-commerce, how can mHealth differentiate, drop its prefix and pretensions, and become an integrated part of public health interventions?

The summit highlighted several hurdles to widespread implementation of mobile technology in public health:

  1. Many programs will have a long lag time before results become apparent, or attributable to a particular program. Behavior modification programs present a challenge to measuring and presenting outcomes. Many of the individual reflections at the summit seemed to focus around the point that a particular program goes to scale with measurable health outcomes. How should we evaluate programs that don’t have clear-cut statistical outcomes or with variables that are difficult to measure, such as programs focused on behavior modification? For that matter, it is difficult to directly attribute results to a specific program, as is the case for most public health pilot programs. How should we evaluate something that worked in one country but not another? Two lines of thought echoed during the summit seemed to contradict one another, with the majority promoting the notion that programs will need to be country-specific, or even more local in scope: What works for one village or clinic may not be true for another that is just less than fifty miles away.
  2. Another sentiment echoed was that mHealth innovators must be careful to avoid “pilotitis.” The tendency to place too much emphasis on trial runs and successive runs to produce measurable outcomes can impede efforts to fully integrate programs within existing healthcare systems. However, without formal trials and clear-cut results, gaining funding and regulatory approval become more complicated.
  3. In terms of regulatory barriers, mHealth has more hoops to jump through due to its interdisciplinary appeal to various government agencies and intergovernmental organizations. During the 2010 World Health Assembly in Geneva, determining who should be responsible for regulating counterfeit drugs was a hot topic. The Indian representation was quick to bring up the semantic issue of the difference between the labels of “counterfeit” and “QSE” (quality, safety and efficacy).  The former connotes economic and intellectual property interests, and would interest World Intellectual Property Organization and the World Trade Organization more than the latter, which would be within the domain of the WHO and the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use.  The mobile technology would be relevant to the International Telecommunication Union and other international efforts to harmonize technology. From a U.S. domestic standpoint, whether or not mHealth applications will be classified as medical devices will influence the technology’s longevity. The FCC has a much faster turnaround rate for device approval, whereas filing for approval through the Food & Drug Administration requires more patience. Unlike the pharmaceutical approval process, regulatory barriers could make or break the future of mHealth due to the rapid turnover rates of mobile technology, which requires constant tweaking and updates, as many experts were quick to point out during the summit.
  4. Even if mHealth has the regulatory approval, sufficient funding, and the results to back its effectiveness, it must fit into day-to-day life and existing healthcare paradigms to ensure its survival. What about all the signs in hospitals that say “no phones allowed?”  What about at an airport, when individuals with pacemakers must undergo a physical security check to avoid stepping through the scanner? What about when you board the plane and the flight attendant tells you to switch off your phone? What about the flight attendants that seem unable to tell the difference between a phone, an e-reader, and devices such as iPhones that integrate multiple technologies? What about across borders? Will you be sure your device will still operate during your business trip to Dubai?  What about privacy concerns? The possibility of opening the door to insurance fraud and identity theft is still a concern for many in the United States. Confidentiality also is an issue for other countries, such as those where fear of stigmatization due to HIV/AIDS infection still has a strong impact on the decision of many to be tested, and also in determining their individual treatment plans.

Other concerns voiced included issues with populations where literacy is not a given, much less access to mobile technology and signal reception.

The amount of interagency cooperation required to regulate mobile technology in its application to public health is immense. Luckily, the summit offered some solutions:

  • Making data talk using personal stories instead of pure statistics
  • Interagency cooperation from the get-go
  • Cooperation and transparency across sectors, especially public-private partnerships
  • Finding a compromise between regulatory policy and encouraging innovation, and a balance between business models and personal success stories to illustrate to potential funding sources and healthcare ministers across the world that improved health will benefit all participating parties.

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