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mHealth – Using mobile technologies to improve access and efficiency in health care delivery

From mountain to ocean, cliff top to farm gate – open spaces, fresh air and easy access to the natural environment are just some of the benefits of life in western Victoria.

However, these benefits come at a cost. Many western Victorians have insufficient access to hospitals, primary health centres and medical professionals. Moreover, as our population ages, the proportion of Victorians living with physical disabilities, chronic health conditions and reduced mobility increases, making health service delivery more difficult and costly.

It is estimated that by 2046 health care costs will consume all the revenue collected by Australian states and territories.1 New and more efficient ways to deliver health services will be crucial to the maintenance of health, and especially for those of us in regional and rural/remote communities.

mHealth

The World Health Organization defines mHealth as ‘the use of mobile and wireless technologies to support the achievement of health objectives.’

These technologies are now ubiquitous: mobile phone ownership is near-universal among Australian adults, and nearly 90 per cent own a smartphone.2 This enables health promotion activities to be delivered through text messaging, mobile internet and mobile applications (apps) to reach a very wide audience – and even to modify potentially harmful behaviours as they occur.

Mobile phone text messaging has been shown to improve adherence to antiretroviral therapy in people living with HIV;3 to be a useful tool for monitoring depression;4 and to significantly increase rates of attendance at health care appointments.5 It also shows great promise in sexual health promotion6 and decreasing high-risk alcohol and other drug use.

Mobile-enabled harm reduction

Dr Megan Lim, of Melbourne’s Burnet Institute, will soon trial the Mobile Intervention for Drinking in Young people (MIDY), a VicHealth-funded intervention designed to reduce alcohol consumption and associated risky behaviour in young Victorians. When drinking alcohol, participants use their phones to periodically record their consumption on a mobile-enabled website and receive hourly text messages tailored to their alcohol intake and gender, age and major concerns, interests or goals (work, sporting activities, friendships, bank balance) to induce them to consider how their drinking might affect these things.

In an interview published on VicHealth’s website, Dr Lim said, ‘Through MIDY we hope to reduce drinking on big nights by just a couple of drinks. Even this small reduction is associated with a halving of the odds of a serious accident or death for young Victorians.’

Wireless and mobile health monitoring

In a recent interview broadcast on ABC Radio National (25 April 2016), Dr Norman Swan spoke to Dr Ricky Bloomfield of Duke University in the United States about his team’s evolving mHealth technology. Dr Swan noted that ‘as a doctor during the day [Dr Bloomfield] takes care of children and adults one at a time. But as the director of Mobile Technology Strategy, he reckons he takes care of patients a million at a time.’

Dr Bloomfield is using free, third-party software to develop smartphone apps that enable patients’ data – such as blood pressure, weight and physical activity – to be sent directly to their physicians, who can then make real-time decisions about health management. Patients have total control over which data is sent and when, but they can elect to have, for example, a reading sent to their doctor whenever they step on their wireless-enabled scales.

In response to a question about how doctors are reacting to these new developments, Dr Bloomfield said ‘We actually have physicians knocking down our door to use these technologies … They have been asking us for years for ways to get this information from patients more easily.’

Interestingly, these data collection systems also allow doctors’ performance to be measured against their colleagues’ or current best practice, enabling payers and insurance companies to reimburse on that basis, potentially opening up a new avenue of health care financing.

Wearable devices

The generation of nearly continuous health data from wearable devices is another form of mHealth with obvious possibilities for expansion. The current popularity of fitness and activity trackers, mostly in ‘wristwatch’ and bracelet form, which download data to a smartphone or computer, shows how easily people take to this idea.

In this exciting new field, other health-related ‘wearables’ include:

  • a smart bandage that incorporates touch and temperature sensors and drug-delivery systems7
  • a smart shirt that performs continuous, real-time health monitoring using conductive fabrics and wearable sensor devices8
  • sensor nanomembranes, woven invisibly into fabric, that can diagnose and deliver therapy for movement disorders.9

These and other emerging technologies can be used to transmit data wirelessly, enabling health professionals to monitor patients remotely and receive early warning of rapid decline or changes in health status. Automatic detection of problems and delivery of appropriate therapy can improve quality of life – and even save lives – without requiring direct or frequent intervention. In addition, patients can maintain their independence, hospitalisations and health care costs can be reduced, and waiting lists for specialist appointments shortened.

What’s the evidence?

As with any emerging and rapidly evolving technology, the evidence for the effectiveness of mHealth lags behind its promise.

A recent American Heart Association review of studies of mHealth tools related to cardiovascular disease prevention confirmed the need for more research, while noting that ‘the ubiquity of mobile technologies among low income and racial and ethnic minority groups speaks to the vast potential for mHealth in these populations.’

In a supporting commentary, Dr Wendy Nilsen and Dr Nivedita Mohanty of the National Science Foundation concluded, ‘if used correctly, mobile health can ensure that important social, behavioral, and environmental data are used to provide a comprehensive health picture. Health outcomes may be improved and cardiovascular disease can be reduced across the entire nation by building a robust body of evidence that includes diverse groups.’

Of course, if mHealth tools are not used as intended – for example, if patients ignore alerts, lack the requisite health literacy to respond appropriately, or simply forget to charge their mobile devices – then the user’s health could be at risk. The novelty of these concepts and tools also means that regulations and protocols are still under development, so little guidance is available regarding their optimal use.

mHealth and the western region

Unfortunately, mobile phone and internet coverage remains patchy or non-existent in many parts of regional and rural/remote Australia, but efforts are being made to ensure that it improves over time.

As it does – and if backed by research evidence – mHealth is sure to play an increasingly important role in health care in the western region. Several partners in Western Alliance are already using mHealth in clinical practice, and evaluations of its efficacy are underway.


References

  1. Altman L, Fernando S, Holt S, Maeder A, Margelis G and Morgan G (2014) One in four lives – The future of telehealth in Australia, Sydney: AIIA.
  2. Wright CJ, Dietze PM, Crockett B and Lim MS (2016) Participatory development of MIDY (Mobile Intervention for Drinking in Young people), BMC Public Health 16(1): 184. doi: 10.1186/s12889-016-2876-5.
  3. Horvath T, Azman H, Kennedy GE and Rutherford GW (2012) Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection, Cochrane Database of Systematic Reviews, 3: CD009756.
  4. Richmond SJ, Keding A, Hover M, Gabe R, Cross B, Torgerson D and MacPherson H (2015) Feasibility, acceptability and validity of SMS text messaging for measuring change in depression during a randomised controlled trial. BMC Psychiatry, 15: 68. doi: 10.1186/s12888-015-0456-3.
  5. Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R and Car J (2013) Mobile phone messaging reminders for attendance at healthcare appointments, Cochrane Database of Systematic Reviews, 12: CD007458.
  6. Sheoran B, Braun RA, Gaarde JP and Levine D (2014) The hookup: Collaborative evaluation of a youth sexual health program using text messaging technology, Journal of Medical Internet Research Mhealth and Uhealth, 2(4): e51. doi: 10.2196/mhealth.3583.
  7. Honda W, Harada S, Arie T, Akita S and Takei K (2014) Wearable, human-interactive, health-monitoring, wireless devices fabricated by macroscale printing techniques, Advanced Functional Materials, 24: 3299–304.
  8. Leea Y-D and Chung W-Y (2009) Wireless sensor network based wearable smart shirt for ubiquitous health and activity monitoring, Sensors and Actuators B: Chemical, 140(2): 390–5.
  9. Son D, Lee J, Qiao S et al. (2014) Multifunctional wearable devices for diagnosis and therapy of movement disorders, Nature Nanotechnology 9: 397–404.