Now Reading: “Texting and Other E-Tools to Manage Chronic Disease” and “Health via Cell Phone in Mexico”

As I alluded to in my post yesterday, this month’s issue of Health Affairs is devoted to E-Health in the developing world, a great validation of the importance of learning from this trend, given this journal’s ability to attract the best authors.

With that in mind, I eagerly approached these two.

The first, Kahn JG, Yang JS, Kahn JS. ‘Mobile’ Health Needs And Opportunities In Developing Countries [Internet]. Health Aff 2010 Feb;29(2):252-258. , attracted me because its lead author, James Kahn, MD, is an innovator in the developing world, through his work to support patients with AIDS in San Francisco. I was fortunate to meet Jim in previous work (and blogged about it here) and think his perspective is very valuable to people thinking about mHealth.

This article is particularly useful for the mHealth inexperienced (that’s me) as well as the mHealth and eHealth inexperienced. For those of us that live in the stew of innovation, we forget that most people don’t know what we mean when we say, “mHealth,” so starting off with a helpful definition is great (“the use of wireless communication devices to support public health and clinical practice”).

Beyond basic definitional elements, the article has a nice table of mHealth applications listed, along with their potential benefits and risks. The article also links to a report that was mentioned in the HealthAffairs briefing that also seems worthwhile. You can find that report here. The most important thing that the authors state is this:

“We found minimal formal evaluation of m-health.”

So, as much as it excites me/us for its potential, we have to remember that it doesn’t yet excite us for its outcomes. I/we have been here/there before with eHealth and the web, so we understand the dance, and in retrospect it seems that in the absence of hard evidence, these technologies will be used; however, they may be more strongly used to provide better service and access rather than hard clinical outcomes. And, this is okay, service and access to health care (and let’s say, prevention and primary care specifically) do improve health. But why not be aspirational this time around, right?

The second article,  Feder JL. Cell-Phone Medicine Brings Care To Patients In Developing Nations [Internet]. Health Aff 2010 Feb;29(2):259-263., is a description piece about some of the innovation that’s happening in Mexico City. As I remarked yesterday, the article dropped a big bomb for me when it mentioned that giving patients access to their medical records is prohibited by law. It’s part of the description of the background that results in the innovation that is seen there, and, as usual, I see lots of parallels to our health system here.

I did notice one review article mentioned here that was not mentioned in the Kahn article above, that you can see the reference for here, which reviews some outcomes from SMS.

Specific services are discussed covering the areas of cardiovascular disease and HIV, co-created with Voxiva, who I also met last year (and who are behind the new Text4Baby service). When it comes to the next service, Diabetes, there’s an implication in the article that this is taking longer to launch, and maybe (or maybe not) this highlights some of the limitations of text-based mHealth services.

Whether there are limitations or not, however, the environment that this work is happening is going to push toward removing hurdles, not creating them. In this sense, discovery about how to use mHealth is more likely to be global, which can only foster the best kind of innovation, the kind crosses borders, not just physically, but nationally and experientially as well.


Dear Ted,

This is Rodrigo Saucedo from the Carlos Slim Health Institute. In your last entry, you presented six differences between mHealth and eHealth. One of them, which I particularly agree with, is Dentzer's vision that the forefront of mHealth is in the developing countries, out of which Mexico is one of them.

Regretably, this comment overestimates the impact of mHealth in Mexico as mHealth solutions are not part of public policies yet; the Carlos Slim Health Institute, through strategic partnerships, has done the development and operation of these solutions. Our concept is based on the idea that the solutions must be directed to the end-user if a solution is to succeed. For that to be a reality, we have associated with Voxiva, one of the largest global health technology providers, and América Móvil, leader in the provision of mobile services, to develop a technological platform in which the internet, the mobile phone and the fixed phone interact.

We are scaling these solutions through public-private partnerships: Johnson&Johnson, West Wireless Health Institute, Qualcomm and Jumex (one of the Mexican leaders in the beverage industry) and state and municipal governments.

We have focused our solutions in three major public health problems with which governments and the population are struggling with:

– First, chronic diseases. We have developed a solution focused in changes in lifestyle and cardiovascular risk factors; we also developed a solution to promote self-management for those with diabetes, and we are developing a second solution focused in weight control and healthy nutrition.

– Second, maternal and child health. We are working in the development of a solution for pregnant women with continuous interaction through the mobile phone; a solution for primary healthcare workers with an real-time application that has interaction for both the mobile phone and the internet; for those with high risk pregnancies we are working on an interactive home-care health system; finally, once the mom delivers, a solution focused on monitoring the baby's health evolution with an electronic vaccination schedule.

– Finally, we have developed a solution for those with HIV/AIDS to provide a self-management tool with special focus in emotional health and adherence to the therapy.

For these solutions to become a public policy we need evidence through rigorous evaluations. We are now in the process of doing them.

I'd like to have a further talk with you should you consider it convenient.



Dear Rodrigo,

Well thank you for taking the time as expert-in-residence to add information from your experience. I and others are obviously impressed with the possibilities you are starting to make real.

I'd be happy to talk more and to share information here about that, and refer people to learn more about your work; as I said in a previous post, there's a lot we can learn,


Mr. Saucedo (Rodrigo) and Ted

Thanks for the interesting blog and comments. I am an informatics physician at the Barrow Institute in Phoenix. Somewhat bizarrely, I was aksed to comment on an evolving partnershpi wee have between our institute and the Slim Foundation several weeks ago. There is interst in leveraging telehealth solutions to provide neurorsurgical domain expertise with others in Mexico, but notably the foundation wants to broadly impact the many, not just the few.

My particular focus is patient enablement, how one allows the base of the health pyramid- afterall, there is limitless power if the patient can contribute to their own wellness. Sadly, current efforts are largely focused on the provider- better EMR, rather than better patient diaries. All of these methodolies need to be outcomes based as well.

For me, technology needs to be agnostic to the patient. The front end needs to be something the patient is comfortable with…text, email, snail mail, TV…whatever the patient is comfortable engaging, but the backend needs to monitor, message and aggregate this information. The solution also should incoprorate more than the patient and their direct provider. In particular, there is value in engaging the family and others in the patient's wellness. For example, juvenile patients with diabetes often view parental involvement as an intrusion, but the parent is worried. The system needs to reach out to the parent when the child is in need of help with alerts.

I am working with a different group of companies than the ones you called out (MSFT, Google, Cisco) in the PHR space as well as connectivity. My sense is our paths are going to converge soon.

Again, thank you for the comments

Alan Pitt, M.D.

Ted Eytan, MD