6 Reasons why mHealth is different than eHealth

In Mexico, it’s illegal for patients to access their own medical records, and 9.1 percent of Mexicans have an Internet connection at home. 80 percent of them have at least one cell phone.

Conditions like this don’t stifle innovation, they ignite it, and it’s one of the several reasons I think mHealth (“the use of wireless communication devices to support public health and clinical practice”) is different than eHealth (which I’m referring to as desktop Web/computer interaction in health/health care).

I credit Susannah Fox, the Internet’s Informant General, for stimulating the thinking. In 2008 at Health 2.0 in San Diego, she said, “Recruit doctors, let e-patients lead, go mobile” and the data she has been generating since has ceaselessly has been pointing to that reality.

More recently, Washington, DC, hosted the mHealth Initiative Networking Conference last week, and this week, Health Affairs hosted a briefing on their latest issue on E-Health in the Developing World (side note, I know I’m behind in noticing this, but I love HealthAffairs new print form factor – less tome-y and more open).

The mHealth Networking Conference was remarkable for me in terms of the spark I noticed on the part of the attendees and the slightly different focus – a little more public health-y, a little more do-great-things-for-society-y. And, I’m going to say it, a little more exciting for someone like me because of the possibilities that go beyond the desktop web. To learn about them in the City where people believe everything is possible, because it is, is just icing on the cake.

So here’s my list:

#1: When we talk about the web, we still worry about the people who are just not online. According to Susannah’s team, its hovering at 26 %. mHealth is different, everyone has a cell phone or is going to get one, relatively speaking. If you compare use visually, the cell phone thermometer shows much greater penetration – all groups are “pushed up” to higher degrees of access.

Speaking of Mexico and the developing world, the parallels are relevant in the United States to vulnerable populaition, and this is another key difference. Desktop web access favors more educated, more affluent people. There’s an inverse relationship when it comes to wireless. Look at this data from December: If you look carefully, you’ll see something amazing. Access statistics for Black and Hispanic respondents are higher for wireless access to the Internet than for Whites. It’s almost as if the “haves/have nots” are reversed. For people interested in reducing disparities, this is…kind of huge. That’s difference #2.

Difference #3 has to do with ease of set-up. When I speak with iPhone developers or people involved in mobile, I hear the words “difficult, challenging,” which is different than what we heard in 1995 when anyone (me included) could code an HTML page and put it up.

Difference #4, when we talk about the web, there’s not a discussion of telecommunications companies and their innovation. When we talk about mHealth, we have to include telecommunications companies. This year at HIMSS10 , in Atlanta, it’s not Sanjay Gupta, MD (whose work I have great respect for) that I want to see speak the most. it’s Dan Hesse, CEO of Sprint/Nextel. People with telecommunications experience, in my opinion will be very important moving forward. In a analogous way, I am as drawn to the CTIA as I am to AMIA .

Susan calls it

Susan calls it

Difference #5, Reverse Innovation – Unlike the web, a lot of the “cool” stuff has already been pioneered, outside of the United States. Susan Dentzer said it best at the Health Affairs briefing: ” Clearly the US is the developing country when it comes to mHealth“. The term reverse innovation comes from General Electric (this article from Harvard Business Review explains it) , and it means that a lot of the inventing to be done is happening in India, China, South America, and as the article linked to above points out, in Mexico. What may work best is something that comes from a place with far less resources than we have. Kind of what health care, a resource-poor industry when it comes to innovation at the level of public health and primary care, needs.


ZipHealth: Where would you rather track your health; here, or on a desktop website?

Difference #6, it’s more personal. Some of the apps we saw last week, and others I am hearing about, are things that might not work on the desktop web so well, because a desktop or laptop is not as “personal” a device. The idea of storing information on a web site and forwarding to your doctor seems to make more sense on a mobile phone, because it’s something you hold that’s yours, that you can “share” with someone. Not the same for a web site on a computer.

I want to clarify that this is not 6 reasons why mHealth is better or has more scientific evidence behind it. This is just differences. I’ll report on two great papers in the Health Affairs issue on this shortly.

Comments/additions/subtractions welcome.


Hi Ted,

Very interesting post. You might be interested in checking out a recent blog post of mine that looks how ALL of the "8 Unique Abilities of Mobile as the newest Mass Media" can create an enabling environment that will differentiate mHealth from eHealth. We're still in the early days but this will eventually happen just like quality TV programming eventually managed to demonstrate advantages above, beyond and different from what was available on the Radio (the mass media that preceeded TV).


From what I saw in Barcelona at Mobile World Congress this week I think it's obvious that the only limiting factor is our imagination…

Hi David,

I am interested, and thank you – great additions, and insight, thank you for putting them here. I'm the novice here, compared to you, so I appreciate the teaching, and the fact that it's coming from outside the United States. Imagination rules!


Wow, my first thought about mobile access was that most people still do not have access to the internet on their mobile phone, but when you brought in statistics showing the relationship between socioeconomic status and wireless web access it blew that presumption out the window.

Insightful post.

I don't take issue with how you've categorized the mHealth market, it is growing, it is dynamic and it opens many new opportunities for for innovative approaches of care. But eHealth…

I think a more conventional way to look at this is that eHealth is the overarching term and mHealth is a component – a delivery mechanism, if you will – for some parts of the eHealth domain.

It may seem a minor point but I believe its importance is that it underscores one reason why eHealth/Health 2.0/Connected Health/ etc. all have had a slow route to adoption.

As this industry evolves it continues to shift focus from one technology to another. Some might point to "medical devices" as the starting point. And then there were networks, and then there were mobile sensors, and then there were home-hubs, and then… you get the point.

mHealth is an incredibly valuable tool that should and will be used. But it is only one of the tools. The migration towards digitization of health and wellness data is the tipping point, IMHO. And there will be many "tools" that are needed – and no "one" will serve every population segment. We need to stop focusing on the technological components of the "system" and start focusing on the "system."

The sooner we, the participants, can start figuring out how to aggregate the technologies towards a system, the sooner the ecosystem that is missing for truly integrated broad scale deployments can be achieved.

Again, I agree with your points. I just want us to move away from anything that resembles a siloed approach to changing healthcare.

Hi TBHome (Computer Associates?),

Thank you very much for this – not minor at all to my eyes and much better stated than I did in the beginning of my post. As my words and title of the post read, they might imply "it's this tool or that tool," which as you say, isn't really the way to think about changing health care.

Sometimes (okay, a lot of times) I write blog posts knowing that I am not stating something well, with the hope that comments from others will make it better, just like you've done,


Goolgle would agree with #6 !!! They will now code all applications for Mobibe before coding for PC.

[…] Wireless health is linked to, but not the same as, mobile health. When we talk about ‘mHealth’, it may have to do more with developing countries and delivering services via mobile phones, than it does with transmitting vital signs and other “physiological metrics,” as Topol calls them, to an iPhone. (For more on the varying shades of m, e, and other ‘healths’, see this excellent blog post). […]

Ted Eytan, MD