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M-Health: Disease Surveillance and Management

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Amit Sharma, Head - Strategy & IT, Cytcare Cancer HospitalCytcare Cancer Hospital providers highly specialized, modern diagnostic services, treatment and care for Cancer.

The use of mobile and wireless technologies to support the achievement of health objectives has the potential to transform the face of healthcare system across the globe. A powerful combination of factors is driving this change. These include rapid advances in mobile technologies and applications, a rise in new opportunities for the integration of mobile health into existing eHealth services and the continued growth in coverage of mobile cellular networks.

The unprecedented spread of mobile technologies, as well as advancements in their applications to address health care needs, has evolved into a new field of eHealth, known as M-Health. M-Health, also known as mobile health - refers to the practice of medicine and public health supported by mobile devices such as mobile phones, tablets, personal digital assistants and the wireless infrastructure. According to the International Telecommunication Union, there are now close to five billion mobile phone subscriptions in the world, of which India accounts for over one billion. Today, over 85 percent of the world’s population is covered by a commercial wireless signal. The growing sophistication of these networks offering higher and higher speeds of data transmission alongside cheaper and more powerful handsets are transforming the way health services and information are accessed, delivered, and managed. With increased accessibility comes the possibility of greater personalization and citizen-focused public health and medical care.

The term M-Health was coined by Robert Istepanian as the use of “emerging mobile communications and network technologies for healthcare”. A definition used at the 2010 M-Health Summit of the Foundation for the National Institutes of Health(FNIH) was “the delivery of healthcare services via mobile communication devices”.

Within the M-Health space, healthcare providers use mobile technology to:

• Access clinical information (e.g., through mobile health apps and mobile-enabled EHRs),
• Collaborate with R&D teams (e.g., with secure text messaging),
• Communicate with patients (e.g., through patient portals),
• Offer realtime monitoring of patients, and Patients use mobile health technology to:
• Track their own health data through M-Health apps and devices like the Fitbit, My Fitness Pal,
• Access their clinical records through mobile-enabled patient portals, and
• Communicate with their providers.

Surveillance of Diseases via M-Health
A key component of any M-Health initiative is the collection and transmission of health-related data via mobile devices. Disease surveillance began in the 17th century with John Graunt’s “Natural and Political Observations Made upon the Bills of Mortality.” While Graunt’s analysis was the first of its kind, he still faced many insurmountable challenges. Fortunately, we have made tremendous strides in health, science and
communications technology since the days of John Graunt.

Today, mobile devices and other digital approaches are one of the main drivers of this revolution. In a world with a mobile penetration rate of over 62 percent, we are seeing an unprecedented opportunity to use this relatively new tool to improve the health and safety of billions around the globe.

In India, UK-based Lough borough University’s engineers entered into a partnership with Indian experts to develop a unique mobile phone health monitoring system. The system, which was first unveiled in 2005, uses a mobile phone to transmit a person's vital signs to a hospital or clinic any where in the world.

The Govt. of India has also launched the National e-Health Authority(NeHA), which will be the nodal authority to develop an integrated health information system along with the application of telemedicine and mobile health by collaborating with various stakeholders.

One of the most advanced apps for chronic disease management and remote monitoring, approved by the FDA, is the WellDoc Diabetes Manager software. In the initial clinical trial of WellDoc, the intervention group showed improved self-care in diet, medication, and exercise compared to the control group receiving usual care. The study demonstrated the possibility of improving treatment outcomes with mobile phone and web portal communications when used by both patients and their HCPs.

The MyTherapy app by SmartPatient is designed to not only remind patients to correctly take their medication on time but to also document and analyze patient values. Also available is the option to schedule activities, rest periods and appointments. The app creates an individual task list with assignments to be checked off daily. An added incentive is that users can directly see whether they have met their self-imposed goals and thus assess their own progress.

M-Health: Managing
Chronic Diseases
The invention of the smartphone may be the single most important development in the fight to ensure medication adherence, healthy lifestyle choices, and regular contact with the healthcare system. From text message reminders to calorie counters and on the go access to patient portals, many of the strategies currently employed to keep patients on track would be impossible without mobile technology.

There exists a general view among the population that technology is the answer to all our problems. However, according to the study “Impact of M-Health Chronic Disease Management on Treatment Adherence and Patient Outcomes: A Systematic Review,” published in the Journal of Medical Internet Research(JMIR), argues that M-Health interventions for chronic disease management can have some impact on certain patients and conditions, but more work is needed to ensure that the potential of M-Health is realized. The study goes on to state that these interventions must be well designed, comprehensive, easy to maintain and encouraging for participants to continue using it.

Increasing patient adherence to their regimens is important and may produce positive results in the short term, but measuring the clinical outcomes of this improved behavior is the key to measuring whether or not a chronic disease management program is worth the investment.

M-Health: The Road Ahead
Overall, M-Health interventions seem to be able to promote significant improvements in glycemic control (for diabetes patients), as well as in physical activity, weight loss, and smoking cessation, among other outcomes. However, these benefits seem to be dependent on the characteristics of the intervention (e.g.,bundle of features, use of behavior change theories,‘stickiness’)and the specific patient population (e.g., age, digital literacy).

In order to improve the uptake and impact of M-Health services, the following measures should be adopted:
1. Integration of M-Health into the healthcare service, and not simply as a standalone service
2. Bundling of features to enable action (such as decision support, followed by task support)
3. Measures in place to maintain participant interest and hence, minimize dropout
4. Ensuring the fidelity of M-Health services (accurate delivery and enactment of the service)

Technology has opened avenues that did not exist before and will continue to do so. This perpetual advancement will continue to revolutionize the healthcare system. However, Medicine has also always been a human endeavor and it is this combination of technological revolution and human ingenuity that will lead to further and greater inventions and innovations in healthcare.