When it comes to delivering remote healthcare or wellbeing services, nothing – print, radio, TV or even PC – rivals the cell phone.
• At the end of 2010 there were 5.3 billion mobile subscriptions (and counting) – that’s equivalent to 77 percent of the world’s population.
• Mobile phones are personal, always on, always with the patient and location-aware.
• Mobile phones allow self-help or interactive communication by voice, text, instant messaging, Web, video call etc.
• Mobile phones can potentially replace some of the dedicated hardware used for monitoring patients’ health.
This helps to explain the level of attention that mobile health or m-health is receiving from media, governmental and non-governmental organizations, health providers and telecoms companies. Even billionaire philanthropists such as Bill Gates have been getting in on the act.
M-health is a vast arena, when you consider all the ways that healthcare professionals can use mobile devices to help themselves or their patients, and the ways that patients can use their phone for self-help. And while m-health is still in its infancy, compared with its potential, there is a lot going on in all areas. So it’s possible that the media is only providing us with an incomplete picture – the most hyped part – but it appears from articles such as Can your smartphone save your life? or Mobile Health Apps, that m-health – or m-health coverage - is dominated by download/native apps for smartphones. This is a cause for grave concern.
• This blog post was prompted by this excellent introduction to m-health by mobile health guru David Doherty. The guide cited that starting with an iPhone app was one of the typical mistakes in m-health.
M-health apps are exclusive. Health should not be a privilege.
The problem with concentrating m-health services on smartphones – often just one or two types of smartphones – via download apps is that you are only focusing on people who have those smartphones. Not only is this excluding the vast majority of the population, but it is also focusing on a particular demographic – people who are rich enough to afford a smartphone (or, if the app only works on Apple, the most expensive of smartphones).
In 2010, smartphones only accounted for 21-22 percent of mobile devices shipped globally (that’s new phones – the installed base will be considerably less). This means that even if the m-health app works on all platforms – Symbian, Android, BlackBerry, iOS, Windows and so on – it is still unavailable to 80 percent of mobile users. But most m-health apps don’t cover all smartphone platforms, due to expense or ignorance, so they exclude even more people – for example, if it only works on Apple’s iOS, you are excluding over 95 percent of people. While it seems nonsensical for a brand, retailer or publisher to shut out the majority of the population, by focusing exclusively on owners of particular handsets, for health provider/business is it unethical?
Nothing written here is meant to criticize high-end m-health innovations that can only be, or perform better, when delivered by a download/native app. For example, if technology dictates that today cell phone-based heart monitoring has to be a native app, then nobody is claiming this shouldn’t happen (as long as all heart patients receive comparable care). But most m-health apps are generic services, especially those aimed at wellbeing – encouraging healthier lifestyles – which could as easily or cheaply (perhaps more easily or cheaply) be delivered via more inclusive methods such mobile Web or SMS.
The most ridiculous and unfair thing is that the demographic group that is being showered with these exclusive m-health services is populated with the people who need them the least. The people who are rich enough to afford a smartphone, and/or a smartphone price plan, are already privileged. Rich people aren’t necessarily the healthiest, or the best educated in physical wellbeing, but their wealth means that they have more options to eat well, live well, join a gym, have a personal trainer, have a nutritionist, get the best healthcare, take more holidays etc, if they desire.
Shouldn’t m-health be more focused towards the people who don’t have the disposable income to afford an expensive phone/price plan? This isn’t just an altruistic attitude, it’s common sense; healthy people are more productive, take less sick days and are less of a drain on the health services – which all affects the nation as a whole.
The most inclusive m-health services use SMS; the next most inclusive m-health services use mobile Web.
While there are some awe-inspiring m-health apps, it is often the simplest and most obvious SMS services that impress mobiThinking the most, such as your doctor, hospital or dentist reminding you about an appointment; a pharmacy that alerts you when your prescription is ready, such as the service offered by US pharmacy Walgreens or telling you that it’s time to renew your repeat prescription; or maybe reminding you to take your medication.
The beauty of SMS services is that they work with any handset, costs to the user are low or included in their package, and pretty much every phone user knows how to send or receive a text. Text messages are restricted to 160 characters, but can include a link to a mobile site or click-to-call. MMS can include images.
What could be more useful than a national service where people can ask any health-related question by text message – or send in a picture of an ailment, e.g. a rash, by MMS - and receive a private, authoritative reply from an expert for free or a small fee. This could include a question about sexual health that a teen is afraid to ask a parent or friend, or a parent who wants to know if a child’s symptoms suggest they should take them to the doctor, hospital or send them to school as normal. This is a hypothetical service, but elements of it have been used by government and non-government organizations as part of sexual health campaigns – see Learning about living in Nigeria.
Mobile Web is not yet available on all mobile phones, but many if not most handsets (i.e. that’s feature phones as well as smartphones) these days ship with a mobile browser and the price of mobile Web access is falling around the world as unlimited data packages become more common. A mobile site can be accessed by any phone with a browser. Mobile Web apps can - or will be shortly be able to - perform most of the functions of a native app, without requiring the entire app to remain permanently on each handset or the app provider to surrender control and revenue to an app store.
A quick glance at the types of services that can be provided to the masses via the mobile Web, whatever phone they choose to use, should be proof enough that most m-health offerings don’t need to be and shouldn’t be restricted to the already privileged. Check out the following US sites:
• m.webmd.com has useful image-led slideshows on everything from tips on losing weight to help with identifying your child’s rash from Web MD.
• drugs.mobi provides a searchable database of extensive details on 24,000 prescription and over-the-counter drugs, and a pill identifier to help you name mystery medicines, as well as FDA consumer alerts, from the people that brought you drugs.com.
• m.medlineplus.gov is a searchable database of 800 health topics, including diseases, conditions and wellness; searchable database of prescription and over-the-counter drugs; a medical dictionary; and health news, provided by The U.S National Library of Medicine’s consumer-orientated MedlinePlus service.
• ncbi.nlm.nih.gov/m/pubmed, also from the U.S National Library of Medicine, is a searchable database of for medical professionals containing 20 million citations/abstracts from biomedical literature.
• mobile.usablenet.com/mt/www.walgreens.com allows Walgreens customers to order/refill prescription, access prescription history, order photo prints or browse catalogue and purchase from their phone.
• For more m-health resources, see the wapreview.mobi mobile directory.
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