Patricia Mechael
Mobile health: from silos to systems
By Patricia Mechael | Published: 31 May, 2010
Still in its infancy, the emerging field of mHealth – the use of mobile technologies to improve health outcomes – runs the risk of not realising its full potential.
With the number of mobile phone subscriptions rising over 5bn, many of the world’s poorest prioritise mobile phones over basic necessities, including health. The massive prevalence of mobile phones in developing countries presents a tremendous opportunity, which today has a broad range of health and technology stakeholders contemplating the “value” of mHealth. Studies have shown that mobile phones can improve access to, quality of, and efficiency in the delivery of health care, as well as disease prevention and well-being.
For the telecommunications industry, mHealth provides an opportunity to do well by doing good in what many are anticipating will be a relatively large untapped market. Telecommunications industry stakeholders are not health experts, and health experts rarely fully comprehend the potential that technology may provide in achieving critical health objectives. Therefore, the two groups need to work closely together to expand mHealth services.
Similar to the success of mobile banking systems, enabling policies that minimise entrepreneurial risk and maximize reward for industry will help spur market-driven solutions for mHealth. At the same time governments and health practitioners need to understand the power of supporting health delivery with modern information and communications technologies.
As a first step towards informing this process, the mHealth Alliance, an umbrella body launched last year by the Rockefeller Foundation, United Nations Foundation and Vodafone Foundation, commissioned The Earth Institute, Columbia University, to conduct an in-depth analysis of the current challenges and obstacles to the implementation and scaling of mHealth projects. The results highlighted three core constraints to optimisation, scale, and sustainability of mHealth, as well as research gaps.
Firstly, mHealth must transition from stand-alone solutions to integrated, interoperable systems that account for broader health issues. Primarily funded by private donors, mHealth applications such as mobile electronic medical records on smart phones are implemented in silos without consideration of the health outcomes they produce. Integration within national health information and communication systems and enterprise architectures with a focus on open source, open standards, and open APIs are critical. This would help ensure interoperability and optimise the aggregation and use of data for care reporting, management and planning.
Secondly, mHealth implementers should be held accountable for aligning programs with health priorities and helping to bridge the know-do gap by documenting and assessing costs and benefits. There is a large gap in health systems research on the cost and impact of eHealth and mHealth initiatives.
While it is obvious that going digital and mobile makes sense, that overall conclusion does not guide investment. Without this information, policy-makers in low and middle income countries lack incentives to create policies that would enable the more effective use of mobile technologies for health. mHealth is finally beginning to shift from pilot phases into integration and mainstreaming within existing health systems. Since measuring impact requires long periods of time and is challenging with small, point-solution projects, the movement to scale poses an opportunity to generate quantitative data to assess and increase mHealth value.
Finally, mHealth stakeholders ought to consider the public good of improved health and well-being above their own self-interests. The market is large enough that there will be enough work and money to go around. The lack of collaboration on development, implementation and policy and competition for resources has stymied growth. Public health scientists and technologists must jointly establish a set of mHealth standards within broader eGovernment and eHealth policies and promote public-private partnerships and policies that aim to leverage mHealth to address health priorities.
In low and middle income countries, to move from silos to systems, constraints can be overcome through the development of enabling policies and enterprise architectures to bring cohesion and synergy along with healthy “coopetition” to multiple private, public, NGO, and academic mHealth activities. Such movement towards cooperation and systems will significantly advance the field of mHealth, and in turn, have a profound effect on health outcomes.
Patricia Mechael is director of strategic application of mobile technology for public health and development at the Center for Global Health and Economic Development, Earth Institute, Columbia University
