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.