This appeared in the New England Journal Of Medicine last week.
The Promise, Growth, and Reality of Mobile Health — Another Data-free Zone
November 8, 2017DOI: 10.1056/NEJMp1713180
The use of mobile communication technologies to improve the health of individuals and populations — dubbed “mobile health,” or “mHealth” — has grown dramatically since 2008, when the term mHealth became widely used. The excitement over the use of mHealth technology especially in low- and middle-income countries (LMICs) stems from the recognition that mobile phones have penetrated the market like no other technology. There are more than 5 billion wireless communication subscribers, and more than 70% of them are in LMICs1 (though the subscription rate in low-income countries is 60% overall, and much lower in rural areas). Moreover, commercial wireless signals reach 85% or more of the world’s population, extending much farther than the electrical grid.1
Early on, for-profit companies harnessed the potential to disseminate advertisements using short message service (SMS) technology (text messages). SMS for disseminating health information soon followed, usually in the form of one-way messages pushed out to populations. For example, by 2010, the “Text for Baby” program was sending millions of one-way text messages promoting healthy pregnancies. Yet while small-scale evaluations sometimes show changes in health knowledge, no changes in health outcomes have been documented except in intensive pilot studies that have often incorporated two-way messaging.2
To date, more than 1200 mHealth tools or apps have been catalogued.1 The majority are designed to improve data collection, deliver health education messages, promote real-time remote monitoring of patients, or improve health care delivery.3 Determining which apps are effective is challenging. For example, earlier this year my team searched the iTunes store for apps providing breast-feeding support. Of the more than 340 apps retrieved, the majority were designed to help track breast-feeding, and the only quality-appraisal information available was user ratings. Our research showed that only 15 apps had any evidence supporting their use, and that was from pilot evaluations.
The most common use of mHealth has been to collect health-related data, and there are several examples of local and national agencies successfully using apps to enhance vital registries, particularly in remote and low-resource areas. Mobile devices have been used for decades to enhance supply-chain–management systems with real-time inventory-data collection; with the use of mobile phones now widespread, this approach is being applied in smaller health systems in LMICs. Mobile technology is also used to update electronic health records; U.S. providers, for example, are increasingly using tablets to record patient data. In theory, this practice can allow for real-time updates to a patient’s record as well as access to past records. There is compelling evidence that these tools offer a time- and cost-effective method for collecting and delivering crucial health data, and their use is expected to continue to grow.3
The second most common use is enhancing behavior-change and communication programs by delivering health education messaging (usually one-way messages). Although programmers, governments, and donors are all excited about these programs, the evidence to support their rapid and widespread use is limited.3 In fact, most programs are not evaluated in any meaningful way. The scientific literature in this area is dominated by case studies or small-scale pilot studies, and though some of the latter are randomized, controlled trials (RCTs), there have been almost no effectiveness studies.2
Several programs have deployed mHealth tools to enhance health workforce training and education, and early evidence from pilot studies has demonstrated the potential of such efforts. mHealth apps incorporating decision aids have been developed to help community health workers (CHWs) stay current on clinical information. For health workers in remote settings, mHealth offers otherwise unavailable opportunities to connect with experts and receive routine feedback to improve their performance. For example, in Malawi, an app was developed to allow CHWs to report back to primary health facilities about patients’ adherence to tuberculosis treatment and receive guidance from physicians.3 As a result, the 75 CHWs enrolled in a pilot study doubled their patient capacity and saved more than 2000 hours and $2,750 in fuel by avoiding travel.
Finally, mHealth shows promise for improving access to sensors and point-of-care diagnostics. Most commonly, a mobile device is linked to an external device that monitors a patient, often measuring health markers; for example, mHealth interventions have linked mobile phones to blood-glucose monitors or blood-pressure monitors to transmit results in real time.4 In high-income countries, platforms that permit remote measurement of vital signs using a patient’s mobile device have been approved; for example, a clinic-grade electrocardiography device is available that can be run on a mobile phone, allowing physicians to monitor patients’ hearts remotely.
Lots more here:
There is also a summary here:
As mHealth nears the decade mark, questions about its effect on patient outcomes persist
by Gienna Shaw
Nov 9, 2017 11:15am
There are thousands of mHealth apps, tools and technologies. But do they actually work?
It’s been about 10 years since the word “mHealth” became part of the healthcare lexicon. And since then, the number of mobile technologies, tools and apps has exploded. But has the trend had any impact on outcomes?
Well, it’s hard to say.
“The evidence to support their rapid and widespread use is limited,” writes Amira Roess, Ph.D., in a recent New England Journal of Medicine “Perspectives” piece. Most programs aren’t evaluated in any meaningful way, she adds, noting the scientific literature is dominated by case studies or small-scale pilot studies with “almost no effectiveness studies.”
Still, pilots and other small tests of specific mHealth uses do show promise. For example, there’s evidence that mHealth enhances healthcare workforce training and education and mHealth apps that incorporate decision aids to help community health workers stay current on clinical information and aids health workers in remote settings.
And these programs aren’t going anywhere anytime soon. “Text4Baby,” once the novel darling of the mHealth crowd, is still going strong, for example.
Lots more here:
So, in summary, for all the hype, we are not really there yet. Maybe the ADHA should seek some real evidence before having the myHR go mobile?
David.
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