Are Cell Phones Leading the mHealth Revolution?

According to this article from the Global Health Council Magazine, cell phone use in developing countries is driving a new industry in health-related electronic applications for programmes that range from diagnosis and health worker education to social marketing and the flow of emergency food rations, many focused on geographically remote areas.

As stated here, "Global health and technology experts cite dozens of projects using electronic methods (known as "eHealth") that are increasing data collection opportunities and leveraging meager health care work forces. But the technology explosion is facing many of the same problems as in developed countries: lack of interoperability, funding shortfalls and scant solid evidence of outcomes improvement. It also faces hurdles unique to global health - sustainability, inability to scale, and hardware and infrastructure challenges." For example, "18 percent of clinics in South Africa have connected computers while 96 percent have a least one cell phone." Thus, the private-industry-driven proliferation of cell phones, spurred by low-cost handsets and pay-as-you-go airtime purchasing, is receiving health communication development attention.

Examples of new cell phone developments listed here include:

•      "ClickDiagnostics, a Boston-based group that uses smart phones with high-resolution photography to snap photos of skin problems. The image is transmitted to a computer and downloaded on a website accessible by pass code. Participating dermatologists can access the site from anywhere in the world and make a diagnosis. After starting in Egypt, Ghana, Botswana, Bangladesh and Haiti, the group is now conducting projects in a number of other countries and is struggling to keep up with demand for services.
• Cellphones 4 HIV, developed by Cell-Life, offers remote patient monitoring that tracks vital signs and drug adherence. It also is establishing patient support networks and helps build organizational capacity for HIV groups. 
• EpiSurveyor, open source software that allows data collection in remote areas, largely with personal digital assistants [PDAs], is taking a major step forward this year with a web-based version that will use cell phones as collection devices. Improvements to the system, developed by Washington, DC, United States-based DataDyne, will allow surveys to be collected and transmitted in real time to a central administrator."

Issues in mobile health (mhealth) include: financing constraints, lack of connectivity among various systems and devices, the challenge of securing local buy-in, and lack of language variability - multilingualism and cultural diversity are not well developed in the mobile context, as stated here, and are not high on the current agenda of many governments. Also, many projects are being tried in a small scale, but few are being scaled up to a size that can suggest a business model.

In order to address these challenges, "[t]here are efforts to bring some standardization and coordination to the field so that devices and systems can talk to each other and provide a common data set of individual, community and country health information. The UN [United Nations] Foundation, the Vodaphone Foundation, and the Rockefeller Foundation announced in February [2009] the launch of a Mobile Health Alliance to join the disparate elements of the growing movement, including manufacturers and operators, NGOs [non-governmental organisations], global governance groups and donors. The alliance aims to limit fragmentation and duplication while building scale and sustainability."

A problem that remains unaddressed is the tendency to develop systems without thought to the training of the field worker, who might have to cope with multiple systems developed in "silos of operability". The questions posed in combining the many features being developed include, "... have we done good design, have we understood the work of a community health worker, have we understood the work of a facility nurse, have we understood the work of a warehouse manager?...It would be a sad day if, in fact, you saw community health workers carrying two or three different phones because they were designed to work for different ways of collecting health information."

The article concludes that the potential of electronic technologies, particularly the cell phone, has many in the global health community interested in the potential for using technology to empower people with health information, communication, and interactive service.