m-Health Developments : History And Future

The World Health Organization recognizes that e-Health — the application of Information and Communication Technology for Health — has a great potential to promote healthy lifestyles, improve healthcare provider decision-making, and empower patients by improving access to medical and health information. E-health can also enhance the quality of care by facilitating instantaneous communication to remote locations, as well as curbing costs through improved efficiency and behavior change communication promoting preventive health.

The initial push in e-Health was using the internet to provide better access to information. The fruits of this era are the Health Information System (HIS), Electronic Patient Health Records, open access to electronic medical journals and the like. Until 2008 however, the penetration of the internet was 21% globally, with a huge digital divide creating a gulf between the developed west (73% penetration in North America) and the lower and middle income countries of the east and the south (5.8% in Africa and 14.0% in Asia).

Public health bodies are investing a lot of thought, effort and resources to make the most of this boom. Educational institutions, research bodies and regulatory authorities are building apps that can support health professionals working in remote areas by providing information, tools to aid clinical decision making, resources to stay updated on medical literature, enhance patient communication and improve patient follow up. In addition to these, a range of applications are available that promote healthy lifestyles and health seeking behavior in patients.

The UN Foundation defines 6 broad inroads by which m-Health can impact health in developing countries:

• Education and Awareness,
• Remote Data Collection,
• Remote Monitoring,
• Communication and Training for Healthcare workers,
• Disease and epidemic outbreak tracking and finally
• Diagnostic and treatment support.

There are plenty of case studies demonstrating the positive effect that these programs have at ground level. A remote monitoring application given to TB patients in Thailand increased medicine compliance to 90%. In another groundbreaking endeavor in Andhra Pradesh, India, information gathered by real time tracking of incidence of Japanese Encephalitis was used to prioritize vaccinations based on clustering of cases. A lot of research is also going on in m-Health applications. More than 300 clinical trials are going on, over half of which targets the aging population. The evidence says that there is a definite positive role of these apps in the management of diabetes type 2, cardiac disease, obesity and mental health. 

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In the meantime a parallel m-Health industry has also mushroomed with thousands of developers bringing out apps every other day. The AppStore on iOS and Google Play on Android devices now feature thousands of health related apps directed both at health professionals and patients.

There has also been a rise in the number of apps that can be linked to social media. 

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About a third of physicians have begun prescribing apps to patients, and those who get such prescription have a 10 percent higher adherence to treatment. The adherence rate is about 30% higher for fitness apps. To date however, only 2% of apps are integrated with electronic medical records. The m-Health industry is expected to grow to a net worth of 18 billion dollars by 2018, with 50 percent of physicians already resorting to mobile health applications to assist their clinical practice.

A major concern about m-Health is the lack of evidence for the safety and efficacy of most apps. Though several independent organizations and websites are engaged in reviewing and evaluating these apps, an overarching public infrastructure that can comprehensively undertake this task is the need of the hour. Because many of these apps provide health related information to the public and guide people on lifestyle and diet, it is important that the information catered is correct. For doctors to confidently prescribe apps for remote monitoring and follow up of patients, it is important that they have evidence to support their decisions. With the overwhelming number of apps on the market it is impossible for clinicians to sift through the whole lot and decide on the best.

According to the mobile computing research community the next big thing are the wearables and the internet of things. At present about 10 percent of available mobile health applications connect to a sensor device that provides functional data. With the incorporation of wearables — from motion sensors that work as step counters to ECG recorders that can be held in the palm of your hand, the m-Health industry is entering this exciting new phase.

Millions of wearable devices have been sold in recent years and a steady technological advancement is ongoing. The form and function of contemporary wearables have changed a lot since the first experiments by Shannon and Thorpe in 1961. Though there are conflicting design issues when it comes to devices that can be worn, the wearables and embeddables present tremendous opportunity for capturing a continuous stream of data about the users kinesiology and physiology which can empower people, as well as facilitate remote monitoring by doctors. Several of these sensors have already been granted approval by national governments. The global wearable computing market is expected to reach 35 billion dollars by 2020 with a 20% annual growth rate thereafter.

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The internet of things is an emerging paradigm that explores the infinite opportunities opened up by pervasive connectivity. It involves systems where networks and computing capability are expanded to everyday items (including sensors) autonomous of human involvement. Building on existing computing devices including smartphones, tablets and personal computers, a new concept of user focused IoT is on the table. By exchange of data between connected and wearable devices the IoT is capable of enabling a more personalized form of care. While the IoT facilitates self-management and self-monitoring, it also portends the integration of m-Health services with Electronic Health Records by means of sensors and data transmitters.