Difference between revisions of "MHealth"

Revision as of 19:56, 28 October 2014

MHealth (also m-health or mobile health) while there is currently no generally accepted definition, the World Health organization defines it as: medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.(http://www.who.int/publications/goe_mhealth_web.pdf). It is generally considered to be a category of eHealth. e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology. G Eisenbach. J Med Internet Res 2001;3(2):e20) doi:10.2196/jmir.3.2.e20

Introduction

The promise of mHealth for the United States was stated by then Secretary of HHS Kathleen Sebelius in 2011 as "the biggest technology breakthrough of our time" and that it would "address our greatest national challenge" (Steinbuhl SR, Muse ED, Topol EJ. JAMA 2013;310:2395-2396). It has also been proposed as a breakthrough for so-called low and middle income countries as a way to reach a large underserved population that may not have read access to physicians and quality medical care, especially for chronic disease management.

Terminology

Significant work has been done on smart wearable systems (SWS) in order to communicate information about the patient to a mobile device which then sends the information to a server. that server may or may not be able to incorporate that information directly into an EHR for further use. Some of the following terminology will be useful to know in understanding the process of capturing and send the information:

• SWS: smart wearable systems
• WCNs: wireless communication networks
• BAN: body area network
• BSN: body sensor network
• PAN: personal area network
• WAN: wide area network
• MEMS: micro-electromechanical systems

Devices

For example, sensing systems can be worn as follows:

• as jewelry, wristwatch, ring, necklace,etc:
• as an electronic patch or "second skin"
• as a chest belt or shirt with sensors incorporated into the fabric
• as shoes for measuring gait during rehabilitation
• as eyeglasses or (experimentally as of 2014) contact lenses
• as gloves in order to receive and stimulate movements
• validation of data

(Chan M, Esteve D, Fourniols J-V, Escriba C, Campo E. Artificial Intelligence in Medicine 2012;56:137-156)

The most widely used sensors are accelerometers that measure acceleration of objects in motion along reference axes to discern velocity and displacement by merging data with respect to time.(Appelboom G, Camacho E, Abraham ME, Bruce SS, Dumont ELP, Zacharia BR, D'Amico R, Slomian J, Reginster JY, Bruyere O, Connoly Jr. ES. Archives of Public Health 2014;72:28-37). One of the most used applications is for patients with diabetes in order to continuously monitor serum glucose levels. An investigational contact lens developed by Google is a contact lens that can monitor intraocular glucose levels and has an embedded LED that can activate to let the patient know their glucose level is out of range. Others have been trying to implement decision support systems into their sensor-smartphone interface in order to utilize past information stored in the server (EHR) to provide context to recommendations to the patient (Michael Marschollek. Medical Informatics and Decision Making 2012;12:43-52).

Besides diabetes care, perhaps one of the most useful applications of mHealth may be hypertension which affects nearly 1/3 of all people in the U.S. Titration of blood pressure with real-time monitoring may facilitate pharmacologic therapy without the patient having to constantly come in to the doctor's office for blood pressure checks. This has been done with the Advanced Medical Monitor system (AMON) which is a wristwatch that can measure physical activity as well as blood pressure, oxygen saturation body temperature and electrocardiographic activity (Michael Marschollek. Medical Informatics and Decision Making 2012;12:43-52).

Drawbacks and Limitations

The following is a list of potential obstacles to successful implementation:

• User perception and acceptance of the device as well as usability
• Privacy issues with implementing acceptable levels of security of transmitted information
• Interoperability with the EHR and other sensor derived information; there are currently no standards
• Reimbursement; currently there are no codes for reimbursing clinicians for monitoring the data
• Social inclusion of wearers
• Technological capabilities of the system including power requirements

(Chan M, Esteve D, Fourniols J-V, Escriba C, Campo E. Artificial Intelligence in Medicine 2012;56:137-156)

Acceptance may be dependent on the age and operational understanding of the patient. One study looked at both patients and physicians in terms of their acceptance of these devices. They found that male physicians use of mobile devices was more common than that of female physicians. In fact, physicians overall were more likely to own and use a mobile device than their patients. For patients, there was a strong correlation between the use of mobile devices and age as well as level of education. As expected, younger patients were more familiar and comfortable with device use than the elderly. This was mirrored with level of education as well. Doctors were concerned of loss of physician-patient interaction as a potential problem. Both patients and physicians were wary of privacy issues. (Illiger K, Hupka M, von Jan U, Wichelhaus D, Albrecht U-V. Jmir Mhealth and Uhealth 2014;2:e42).

Critics of the technology claim it is "overhyped". From a global health perspective, this technology was envisioned to become a basic tool for community health workers, especially in regions where few doctors can travel long distances to serve their populations. (CMAJ 2014. DOI:10.1503/cmaj.109-4861). Unfortunately, there is sparse literature demonstrating major outcome successes using this technology.

Mobile health can help solve many problems and challenges that are always facing the medical field and health care organizations such as; offering the emergency service at the proper time without delay, difficult patient drug compliance monitoring, and direct access to EHR at anytime and anywhere, all these problems and more can be managed by the use of continuous communication through wireless networks which show great advances in the mean time.

Mobile-Health represents the revolutionary adoption of new communication patterns in health care through the use of wireless computing devices (m-Devices); mobile phones, PDAs and smart phones, patient monitoring devices and sensors, microcomputers, laptop and mobile tele-medicine. It will help transferring medical information from physician-and hospital-centered system to one that seeks to connect, coordinate and deal with this information including physicians, health care providers, payers, pharmacies and patients themselves.

M-Health field is so huge and its applications are so many and gathered in 12 m-Health application Clusters by m-Health Initiative (mHI): Patient communication, access to resources, Point of care documentation, Disease management, education programs, professional communication, administrative applications, financial applications, ambulance/EMS, public health, pharmaceutical, and clinical Trials, Body Area Network , these clusters reflects the different fields m-Health can work in to gain better health care process.

Mobile health can help health care field in many ways:

It will provide continuous communication between all health participants for creating more effective and efficient health care system through:

• Enabling the access to HER through m-Devices at any time from anywhere which will lead to reduction of medical errors and immediate dealing with emergency situation.
• It allow better access to resources such as guidelines, polices at the point of care.

-Implementing communication based disease management for chronic patients such as asthmatics and diabetics to reduce emergency visits and monitor drug compliance.

• Using an online appointment system to enable the clinicians and patients to make appointments at the proper time.
• Enabling m-Health use in the emergency ambulance units to allow medical or the paramedical team to gain the needed information from the EHRs.
• Enabling the use of tele-medicine to allow contacting qualified physicians for remote diagnosis and advice.

References

1. Towards an application framework for context-aware m-Health applications, Tom Broens, Aart van Halteren, Martin van Sinderen, Katarzyna Wac.
2. http://en.wikipedia.org/wiki/MHealth]# http://www.mobih.org/observatory/]

Submitted by (Tamer Abd El Wahab Etman)

Patient Monitoring

With the advent of smart phones in the past decade, patients can use their mobile phones to monitor their personal health and upload that information to an EHR for healthcare providers to review. For example, an iPhone 4 has the following types of sensor:

• Accelerometer

• GPS

• Ambient light

• Dual microphones

• Proximity sensor

• Dual cameras

• Compass

• Gyroscope

An iPhone 4’s built-in accelerometer can be used to characterize the physical movements of the person carrying it, including specific movement patterns including sitting, standing, and walking (Lane, Miluzzo, Lu, Choudhury, & Campbell, 2010). The cameras and microphones can be employed to collect information about the patient’s daily routine and environment. The compass, GPS, and accelerometer can be used to collect information related to a person’s preferred mode of transport and daily activities.

Specific apps can be downloaded to improve the effectiveness of this monitoring, and also allow for community sensing. Community sensing applications allow people to access information about recent outbreaks of disease, what general area or areas those outbreaks have occurred in, and what they can do to limit exposure (Lane et al., 2010).

Apps and patient monitoring require a different approach to privacy and security to be compliant with privacy practices. HIPAA requires that electronic protected health information be encrypted at 128-bit blocks or better. Some commercial entities program to higher tolerances – Skype uses 256-bit encryption. Virtual private networks (VPNs) provide a secure way of transmitting information between authorized users (Luxton, Kavl, & Mishkind, 2012).

References

Lane, N. D., Miluzzo, E., Lu, H., Peebles, D., Choudhury, T., & Campbell, A. T. (2010). A survey of mobile phone sensing. Communications Magazine, IEEE, 48(9), 140-150.

Luxton, D. D., Kayl, R. A., & Mishkind, M. C. (2012). mHealth data security: The need for HIPAA-compliant standardization. Telemedicine and e-Health, 18(4), 284-288.

Submitted by (Christopher A d'Autremont)

Summary

Mobile Handheld Technology has heralded the opportunity to provide physicians with access to information, resources, and people at the right time and place. Mobility is an important component for health care delivery (1). Mobile technologies provide benefits of paper charts and desktop computers in their portability and support for information access anywhere and anytime (2). Handheld devices include tablet computers and personal digital assistants (PDAs). These devices are generally small, portable, lightweight computers with wireless network capability. A review demonstrated adoption among health care providers who are primarily hospital-based at 45% to 85% (3). Handheld devices uses include: administrative support (e.g., billing and scheduling); professional activities (e.g., patient tracking and electronic prescribing); documentation; decision support (e.g., clinical and drug references); education and research. Potentially benefits include improved productivity, increased information access, better communication, fewer medical errors, greater mobility, and improved quality and care. Another advantage of handheld devices is providing information and decision support access at the point-of -need. Disadvantages related to entering data, which is slower with a stylus, more erroneous and less satisfactory. Other limitations include smaller screen size designed for individual use so can limit collaboration, present challenges in viewing and entering data, which can lead to errors. However, the literature is limited on demonstrating that handheld devices improve outcomes and workflow efficiencies because of their mobility. Additional research needed to evaluate further the questions related to impacting these mobile devices has on work practices and outcomes (4).

References

1. JE. Activity-based computing: Support for mobility and collaboration in ubiquitous computing. Pers Ubiquit Comput 2005;9(5):312-22.
2. Kuziemsky CE, Laul F, Leung RC. A review on diffusion of personal digital assistants in healthcare. J Med Syst 2005;29(4):335-42.
3. Garritty C, El Elman K. Who’s using PDAs? Estimates of PDA use by health care providers: A systematic review of surveys. J Med Internet Res 2006;8(2):7.
4. Prgomet M, Beorgiou A, Westbrook JI, The impact of mobile technology on hospital physicians’ work practices and patient care: as systemic review. JAMIA. 2009;16:792-801.

Submitted by (Larry W. Holder)