September 2012

mHEALTH Climbs up the Airwaves

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 aboutintegration of computer, networkingsoftware and hardware technologies,such as mobile phones, personaldigital assistants, tablets, patientmonitoring devices, for providing healthservices to patients. The speed ofadoption will vary in different countriesdetermined by how open the variousstakeholders are to use of mobile basedservices.
A PwC report states that mobile healthservices will become a billion dollar opportunityfor India, Asia Pacific and globalmarkets by 2017. The report says themarket will provide a revenue opportunityworth ` 3,000 crore or USD 0.6 billionfor India and USD 23 billion for theworld by 2017.
mHEALTH services are growing fastdue to two basic factors – firstly the mobilesubscriptions are ubiquitous in theemerging market and secondly consumers in developed market access such services forsake of convenience, cost advantage and quality.

Prof K Ganapathy,
President, ApolloTelemedicine Networking FoundationAnyone, Anytime, Anywhereat AffordAble Cost


As every sixth human and every fifth mobile phone is in Indiawe should logically be leading the world in mHealth. HoweverAnyone, anytime, anywhere at affordable cost, Geography isHistory Distance is Meaningless continue to be just slogans. MostmHealth initiatives continue to be pilots and proof of concept studies.We are a long way from incorporating it into the core of our healthcaredelivery system. We are suffering from pilotitis. There are fewer pilots inthe Indian Air Force than in mHealth. Worldwide, mHealth is an mVASdriven by network operators and app developers as it assures a ratherquick return on investment. An apple a day may have kept the doctoraway now apps a day, will keep the doctor far away. Many medicaldoctors of yester year feel threatened. They feel that they may becomeredundant. WiiiFM (What is in it For Me) should not be lost sight of. Forthis he should view the mobile phone as an enabler, a tool to achieve anend, not his replacement. The potential which mHealth has is truly mindboggling. From simple SMS to act as reminders, to ensure complianceand adherence, to knowledge empowerment, to acting as a peripheralmedical device, mobiles can even be used for management of chroniclife style diseases and for video teleconsulting. Technology is not thestumbling block. What is required is a business plan, revenue generating,self-sustaining and scalable. Effort and time spent on change managementwill yield more dividends than talking about 3G and 4G!

Approximately 70 percent healthcareapps are consumer focused, while theremaining 30 percent are designedfor medical professionals. These appsare typically more sophisticated, andcan offer clinicians access to patientinformation and the ability to conductfurther analysis, such as creating 3Danatomical models

Despite demand and the obvious potential benefits of mHEALTH, rapid adoption is notyet occurring. The main barrier is not the technology; rather it is the inherent resistance tochange. 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, devicevendors and content and application players.

Matt Theis,
Founder, Dimagi SoftwareCreating Mobility forthe 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, thepenetration, utility, and potential for what a mobile phone can do has createdinnumerable opportunities. There is a huge rise in the number of organisationsthat are working to enhance the scope of your mobile. As the number ofmobile applications grows, the challenge for us is to figure out which applicationsmake a difference. We need the potential of every application and decide whichof them can be scaled up.
Making an application usable in the last mile is one thing, but making themequally useful for the last user is quite another. In India, for instance, literacyrates pose as a challenge to what an application can do. Phone proficiency canbe very high until it comes to texting. Due to lower literacy rates majority of theusers prefer to communicate through voice calls and this makes the designingof SMS or text based applications quite difficult. Understanding the localand regional context is of utmost importance as an application that works in one area, maynot work in another. An SMS based applicationthat works fantastically in Malawi, may not workat all for many users in the progressive Indianstate of Gujarat.
But these problems can be tackled with theuse of better technology. Interactive voice recognitionoffers a fantastic alternative for applicationsaimed at low literacy users. But, itcomes with its own inherent advantages anddisadvantages. The 4G revolution providespotential to dramatically alter how bandwidthis used. The regional and user context plays alarger role as the technological barriers comecrashing down.
The challenge is to figure out which applicationsmake the biggest difference to the largestnumber of users, how they prove that difference,and whether that difference will be sustainableand effective at scale. The conclusionis simple, but is much easier said than done.


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

MphRx connect, an applicationavailable on Blackberrysmart phones, offers cloudbasedand mobile-based solutions forstoring, retrieving and sharing patienthealth records among hospitals, physiciansand patients across geographieson mobile devices at all Black-Berry platforms and web interfaces.There are various formats of healthreports, which can be accessed onmobile phones. From radiology imagesand reports to lab results, the applicationprovides solutions to supporta hub-and-spoke model for detectingand monitoring retinopathy conditionsfor diabetes patients.
CARE products by i2i Tele Solutions,application developer for Blackberry,connect doctors and patients aroundthe world. The system offers fast datatransmission, best image quality, minimumstorage space and lowest operatingcosts. Companies are engineeringmobile health to serve patients in needin any geography and any economy.The technology is creating telemedicinea practical reality over standardbroadband connectivity.
Companies earn rewards by turningthe anxious look of a patient inwant into reassuring relief that the besthealthcare is now only a moment awayon the internet. Companies are offeringapplications, which allow cardiologiststo access patients ECG reportson BlackBerry smartphones.
Dr Pavan Kumar -Head of TelemedicineDepartment at Mumbais NanavatiHospital was instrumental in conceptualisingthis solution. On a global basisthere simply arent enough physicians and specialists to meet the healthcareneeds of nearly seven billion people.


Bala Mahadevan,
CEO India,Orange Business Services

Standardise Operable Methodsto Connect

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

As per a recent industry study, Indiasrural population is well-suitedfor mHEALTH programmesdue to the high penetration of low-costmobile telephony and given the dearthof qualified medical personnel. Technologystill presents a challenge formHEALTH adopters, as we still donthave that high level of penetration ofmobile and broadband in rural areas.
Orange offers health line in partnershipwith Bhutanese Ministry of Health; it facilitatesreal time healthcare services, realtimehealth advice and 24X7 emergencyresponses for the people of Bhutan. TELUS Health Solutions and Orange joinedforces to develop innovative remote monitoringsolutions for patients with chronicdiseases. A remotely monitored cardiacimplant service launched in US and Europeenables patients to wirelessly uploaddata about their heart condition to adoctor using 3G, 2G or landline.
Other services features long-life SIMcards that can cope with extreme conditionsand be used virtually anywhere inthe world. Orange is also participatingin the fight against counterfeit drugs inKenya and Cameroon by providing anSMS-based system, where up to 25 percentof drugs are potentially affected.

Apps for m-health
The Embedded Area Network (EAN) is aconcept where a cellular module, suchas a SIM card, is embedded in the medicalsensor to communicate to the remoteservice via wireless networks. This newmarket opportunity has seen new devicesin the mHEALTH category appearrecently, the desire is to standardise themethod of connecting through mobilenetworks and enable an interoperable
back end with a plug and play front end.
The project partners share the beliefthat the ability to seamlessly embed cellularservices with medical devices willguarantee compatibility and interoperability,and will be a key contributor tothe success of mHEALTH. The ultimateobjective is to provide an out of the boxexperience to consumers, so that theycan access all kinds of medical servicesthrough their devices.

Abhay Barhanpurkar,
Solution Architect,Symphony TelecaCorporation

Mobile Care

In the next few years, innovations in mobile and connecteddevice technology will fundamentally transform the healthcarelandscape, providing new solutions to address chronicdisease conditions and revolutionise the way treatments areadministered. The monitoring devices are becoming smaller,portable and mobile. Technology such as Micro Electro MechanicalSystems (MEMS) is helping in developing miniaturisedbiological sensing devices. Using such technologies in wearabledevices such as insulin pumps in tele-health applicationsis helping us to stay away from the hospitals thereby reducingthe cost and improving the quality of life of diabetic patients.Other examples include implantable diagnostics including patientvitals monitor, smart pills and wearable diagnostics.
Use of wearable Personal Emergency Response Systems(PERS) systems is becoming feasible for them to age and livein place and independently. Care providers can now monitorthe health and activities of their elderly people using wearableactivity monitors and fall detection technologies such as theone developed by Wellcore and MobiWatch.
As the cost of quality care is increasing, diagnostic tests arebecoming affordable, but not the cure. Therefore people wantto stay fit and are focusing on personal wellness programmesusing devices like FitBit and Nintendo Wii. Gym equipmentsuch as a bicycle or treadmill can talk with your mobile phoneusing ANT+ wireless protocol and one can track his activityand compare against goals.
One of the challenges oftodays technologies is affordability.Secondly, recodingof your vital parametersis considered a time consumingactivity. One has tomeasure his weight, bloodpressure, heart rate, pulserate, temperature separatelyand record it somewhere.Innovators are trying to usemobile handsets to performvital functions like monitoring of temperature, heart rate,pulse rate, BP monitoring instead of having a new device. Asolution to automate the capture of data such as a wearablevitals patch is needed. Standards such as IEEE 11073 standardis making it possible to provide seamless connectivity ofdifferent systems and provide better and accurate health solutions.
Overall the challenge is behavioural and we need a solutionwhich can motivate the user to take required actions. This ispossible though mobile based friendly medication reminders,incentive programmes, prizes, medical games and continuouseducation.

Rajesh Razdan,
Co-Founderand Director, mCarbon TechInnovation

Engineering mHEALTH

We live in a world thatsconnected wirelesslywith almost as manymobile subscribers as there arepeople on the planet. Mobility byits very nature implies that usersare always part of a network, whichradically increases the variety, velocity,volume and value of informationthey send and receive.
mHealth involves the use and capitalisationon a mobile phones core utility of voiceand short messaging service (SMS) as wellas more complex functionalities and applicationsincluding GPRS, 3G and 4G systems,GPS, and bluetooth. Moreover changes inthe ICT environment are also affecting mhealthVAS initiatives, such as the shift fromSMS to interactive voice response (IVR).
Just as SMS-based services have oftenbeen linked to voice communications byhotlines and toll-free numbers, IVR offersa more comprehensive toolkit for reachingout to illiterate people. The ubiquity of MVASsolutions offers tremendous opportunitiesfor the healthcare industry to addressone of the most pressing global challenges:making healthcare more accessible, faster,better and cheaper. The use of mobileand wireless technologies to support theachievement of health objectives (mHealth)has the potential to transform the face ofhealth service delivery across the globe.
A powerful combination of factors isdriving this change. These include rapidadvances in mobile technologies and applications,a rise in new opportunities forthe integration of mobile health into existingeHealth services, and the continued growthin coverage of mobile cellular networks.mHealth applications can be used for supplychain management, reducing delays inmedicine shipments and providing point-ofusetechnologies for consumers to verify theauthenticity of products they buy.
Value Added Products and Services[VAS] for opcos and enterprises has recentlydeveloped a product for pregnantwomen to count their babys movement; itis an easy, non-invasive test that one can doat home through a simple service subscriptionto check their babys well-being. BabyKicks is much more than just knowing thatthe baby moves!

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