September 2012

mHEALTH Climbs up the Airwaves

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mHEALTH represents the acme of innovation in cellular services, it enables anytime, anywhere healthcare

By Shally Makin, Elets News Network (ENN)

Still in its embryonic stage, mHEALTH market brings about integration of computer, networking software and hardware technologies, such as mobile phones, personal digital assistants, tablets, patient monitoring devices, for providing health services to patients. The speed of adoption will vary in different countries determined by how open the various stakeholders are to use of mobile based services.
A PwC report states that mobile health services will become a billion dollar opportunity for India, Asia Pacific and global markets by 2017. The report says the market will provide a revenue opportunity worth ` 3,000 crore or USD 0.6 billion for India and USD 23 billion for the world by 2017.
mHEALTH services are growing fast due to two basic factors – firstly the mobile subscriptions are ubiquitous in the emerging market and secondly consumers in developed market access such services for sake of convenience, cost advantage and quality.

Prof K Ganapathy,
President, Apollo Telemedicine Networking FoundationAnyone, Anytime, Anywhere at AffordAble Cost

As every sixth human and every fifth mobile phone is in India we should logically be leading the world in mHealth. However “Anyone, anytime, anywhere at affordable cost,” “Geography is History” “Distance is Meaningless” continue to be just slogans. Most mHealth initiatives continue to be pilots and proof of concept studies. We are a long way from incorporating it into the core of our healthcare delivery system. We are suffering from pilotitis. There are fewer pilots in the Indian Air Force than in mHealth. Worldwide, mHealth is an mVAS driven by network operators and app developers as it assures a rather quick return on investment. An apple a day may have kept the doctor away – now apps a day, will keep the doctor far away. Many medical doctors of yester year feel threatened. They feel that they may become redundant. WiiiFM (What is in it For Me) should not be lost sight of. For this he should view the mobile phone as an enabler, a tool to achieve an end, not his replacement. The potential which mHealth has is truly mind boggling. From simple SMS to act as reminders, to ensure compliance and adherence, to knowledge empowerment, to acting as a peripheral medical device, mobiles can even be used for management of chronic life style diseases and for video teleconsulting. Technology is not the stumbling block. What is required is a business plan, revenue generating, self-sustaining and scalable. Effort and time spent on change management will yield more dividends than talking about 3G and 4G!

Approximately 70 percent healthcare apps are consumer focused, while the remaining 30 percent are designed for medical  professionals. These apps are typically more sophisticated, and can offer clinicians access to patient information and the ability to conduct further analysis, such as creating 3D anatomical models

Despite demand and the obvious potential benefits of mHEALTH, rapid adoption is not yet occurring. The main barrier is not the technology; rather it is the inherent resistance to change. In order to support the successful roll out and adoption of new health services, governments, regulators and healthcare providers need to work with mobile operators, device vendors and content and application players.

Matt Theis,
Founder, Dimagi SoftwareCreating Mobility for the End User

The number of non-mobile subscribers across the globe is falling rapidly. As mobile subscriptions in India alone approach the one  billion mark, the penetration, utility, and potential for what a mobile phone can do has created innumerable opportunities. There is a huge rise in the number of organisations that are working to enhance the scope of your mobile. As the number of mobile applications grows, the challenge for us is to figure out which applications make a difference. We need the potential of every application and decide which of them can be scaled up.
Making an application usable in the ‘last mile’ is one thing, but making them equally useful for the ‘last user’ is quite another. In India, for instance, literacy rates pose as a challenge to what an application can do. Phone proficiency can be very high – until it comes to texting. Due to lower literacy rates majority of the users prefer to communicate through voice calls and this makes the designing of SMS or text based applications quite difficult. Understanding the local and regional context is of utmost importance – as an application that works in one area, may not work in another. An SMS based application that works fantastically in Malawi, may not work at all for many users in the progressive Indian state of Gujarat.
But these problems can be tackled with the use of better technology. Interactive voice recognition offers a fantastic alternative for applications aimed at low literacy users. But, it comes with its own inherent advantages and disadvantages. The 4G revolution provides potential to dramatically alter how bandwidth is used. The regional and user context plays a larger role as the technological barriers come crashing down.
The challenge is to figure out which applications make the biggest difference to the largest number of users, how they prove that  difference, and whether that difference will be sustainable and effective at scale. The conclusion is simple, but is much easier said than done.

 

Annie Mathew,
Head of Alliances, RIM IndiaEngineering mHEALTH
To be effective, mHEALTH has to work across geographic, time, social and cultural barriers

MphRx connect, an application available on Blackberry smart phones, offers cloudbased and mobile-based solutions for storing, retrieving and sharing patient health records among hospitals, physicians and patients across geographies on mobile devices at all Black- Berry platforms and web interfaces. There are various formats of health reports, which can be accessed on mobile phones. From radiology images and reports to lab results, the application provides solutions to support a hub-and-spoke model for detecting and monitoring retinopathy conditions for diabetes patients.
CARE products by i2i Tele Solutions,application developer for Blackberry, connect doctors and patients around the world. The system offers fast data transmission, best image quality, minimum storage space and lowest operating costs. Companies are engineering mobile health to serve patients in need in any geography and any economy. The technology is creating telemedicine a practical reality over standard broadband connectivity.
Companies earn rewards by turning the anxious look of a patient in want into reassuring relief that the best healthcare is now only a moment away on the internet. Companies are offering applications, which allow cardiologists to access patient’s ECG reports on BlackBerry smartphones.
Dr Pavan Kumar -Head of Telemedicine Department at Mumbai’s Nanavati Hospital was instrumental in conceptualising this solution. On a global basis there simply aren’t enough physicians  and specialists to meet the healthcare needs of nearly seven billion people.


 

Bala Mahadevan,
CEO India, Orange Business Services

Standardise Operable Methods to Connect

This industry lacks stable business models that can help reduce the economic and health divide

As per a recent industry study, India’s rural population is well-suited for mHEALTH programmes due to the high penetration of low-cost mobile telephony and given the dearth of qualified medical personnel. Technology still presents a challenge for mHEALTH adopters, as we still don’t have that high level of penetration of mobile and broadband in rural areas.
Orange offers health line in partnership with Bhutanese Ministry of Health; it facilitates real time healthcare services, realtime health advice and 24X7 emergency responses for the people of Bhutan. TELUS Health Solutions and Orange joined forces to develop innovative remote monitoring solutions for patients with chronic diseases. A remotely monitored cardiac implant service launched in US and Europe enables patients to wirelessly upload data about their heart condition to a doctor using 3G, 2G or landline.
Other services features long-life SIM cards that can cope with extreme conditions and be used virtually anywhere in the world. Orange is also participating in the fight against counterfeit drugs in Kenya and Cameroon by providing an SMS-based system, where up to 25  percent of drugs are potentially affected.

Apps for m-health
The Embedded Area Network (EAN) is a concept where a cellular module, such as a SIM card, is embedded in the medical sensor to communicate to the remote service via wireless networks. This new market opportunity has seen new devices in the mHEALTH category appear recently, the desire is to standardise the method of connecting through mobile networks and enable an interoperable
back end with a plug and play front end.
The project partners share the belief that the ability to seamlessly embed cellular services with medical devices will guarantee compatibility and interoperability, and will be a key contributor to the success of mHEALTH. The ultimate objective is to provide an out of the box experience to consumers, so that they can access all kinds of medical services through their devices.


Abhay Barhanpurkar,
Solution Architect, Symphony Teleca Corporation

Mobile Care

In the next few years, innovations in mobile and connected device technology will fundamentally transform the healthcare landscape, providing new solutions to address chronic disease conditions and revolutionise the way treatments are administered. The monitoring devices are becoming smaller, portable and mobile. Technology such as Micro Electro Mechanical Systems (MEMS) is helping in developing miniaturised biological sensing devices. Using such technologies in wearable devices such as insulin pumps in tele-health applications is helping us to stay away from the hospitals thereby reducing the cost and improving the quality of life of diabetic patients. Other examples include implantable diagnostics including patient vitals monitor, smart pills and wearable diagnostics.
Use of wearable Personal Emergency Response Systems (PERS) systems is becoming feasible for them to age and live in place and independently. Care providers can now monitor the health and activities of their elderly people using wearable activity monitors and fall detection technologies such as the one developed by Wellcore and MobiWatch.
As the cost of quality care is increasing, diagnostic tests are becoming affordable, but not the cure. Therefore people want to stay fit and are focusing on personal wellness programmes using devices like FitBit and Nintendo Wii. Gym equipment such as a bicycle or treadmill can talk with your mobile phone using ANT+ wireless protocol and one can track his activity and compare against goals.
One of the challenges of today’s technologies is affordability. Secondly, recoding of your vital parameters is considered a time  consuming activity. One has to measure his weight, blood pressure, heart rate, pulse rate, temperature separately and record it somewhere. Innovators are trying to use mobile handsets to perform vital functions like monitoring of temperature, heart rate, pulse rate, BP monitoring instead of having a new device. A solution to automate the capture of data such as a wearable vitals patch is needed. Standards such as IEEE 11073 standard is making it possible to provide seamless connectivity of different systems and  provide better and accurate health solutions.
Overall the challenge is behavioural and we need a solution which can motivate the user to take required actions. This is possible though mobile based friendly medication reminders, incentive programmes, prizes, medical games and continuous education.


Rajesh Razdan,
Co-Founder and Director, mCarbon Tech Innovation

Engineering mHEALTH

We live in a world that’s connected wirelessly with almost as many mobile subscribers as there are people on the planet. Mobility by its very nature implies that users are always part of a network, which radically increases the variety, velocity, volume and value of  information they send and receive.
mHealth involves the use and capitalisation on a mobile phone’s core utility of voice and short messaging service (SMS) as well as more complex functionalities and applications including GPRS, 3G and 4G systems, GPS, and bluetooth. Moreover changes in the ICT environment are also affecting mhealth VAS initiatives, such as the shift from SMS to interactive voice response (IVR).
Just as SMS-based services have often been linked to voice communications by hotlines and toll-free numbers, IVR offers a more comprehensive toolkit for reaching out to illiterate people. The ubiquity of MVAS solutions offers tremendous opportunities for the healthcare industry to address one of the most pressing global challenges: making healthcare more accessible, faster, better and  cheaper. The use of mobile and wireless technologies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service delivery across the globe.
A powerful combination of factors is driving this change. These include rapid advances in mobile technologies and applications, a rise in new opportunities for the integration of mobile health into existing eHealth services, and the continued growth in coverage of mobile cellular networks. mHealth applications can be used for supply chain management, reducing delays in medicine shipments and providing point-ofuse technologies for consumers to verify the authenticity of products they buy.
Value Added Products and Services [VAS] for opcos and enterprises has recently developed a product for pregnant women to count their baby’s movement; it is an easy, non-invasive test that one can do at home through a simple service subscription to check their baby’s well-being. ‘Baby Kicks’ is much more than just knowing that the baby moves!

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