Understanding Mobile Health

Following in the footsteps of my colleague Emin, I’d like to take the opportunity to give a bit of explanation regarding the function and workings of a mobile health platform. First things first, when I say “mobile health” or “mhealth” I don’t mean the use of mobile clinics. These are remarkable initiatives, but people are often confused when I bring up cell phones. mHealth refers to the next generation of “telemedicine” or “remote medicine,” and harnesses new technologies in the cellular industry to preform healthcare. Basically, it’s healthcare with cell phones.

There are three main advantages to using a mHealth platform, the opportunity for home visits, telemedicine/telereferals, and training or continuous training for improvements.

Using mHealth in home visits allow for many advantages. Cell phones equipped with mHealth technology allow a community health worker to take pictures to send to a specialist, refer to texts or auxillarly resources, and transmit patient information in a secured fashion. Home visitations themselves are great, it is often quite difficult for a person in need of constant medical care such as a pregnant mother or someone suffering from lifestyle related chronic diseases to travel to a clinic for routine treatment. It is more resource effective to utilize community health workers or local nurses to make home visitation than expensive specialists. Home visitations allow hospitals and other large institutions to monitor patients continuously and refer to specialists remotely for diagnostics when needed while still providing quality point-of-care treatment. Finally, home visitations coupled with mHealth allows local health worker resources to be leveraged, promoting a greater degree of trust and continuity of care between provider and patient.

Telemedicine or telereferals in rural clinic or during field visits, health worker or nurse can use telemedicine kit to send patient symptoms info to remote doctors to eliminate unnecessary referrals and transport of patients. Doctors can review prior patient history with ease. Coupled with community health workers or local nurses, this practice enables point-of-care diagnostics capability and shortens time to treatment through remote consultation with physicians compared to physical referral into hospital systems.

The use of mHealth for training is another often overlooked advantage to mHealth. Say a community has been identified as at risk for diabetes and all of it’s associated illnesses. The following graphic illustrates how mHealth assists in the training of local, place-based community health workers. As you can see, a key advantage to mHealth is not only in training, but continuous training, ensuring a consistently high quality of care.

For me the natural next question is what about HIPAA requirements? For those of you outside of the know, the Health Insurance Portability and Accountability Act is a 1996 law that regulates the use of electronic patient data. The aim is privacy, and information is subjected to a rigorous criterion of desensitization in order to comply. This means that any medical information on a patient, which is private, has to be unattached to any identifier for that patient, such as social security number or name and birthday. Wouldn’t mHealth and the free and open use of patient data open up a variety of HIPAA noncompliance issues?

In fact not. I’ve spoken with Ting Shih of Clickmedix about this exact issue, and their comprehensive system has worked within the HIPAA regulations in the US and similar regulations abroad. Her company’s system takes data captured at point-of-care by primary care doctors or community health workers- data that is attached to a patient’s personal information- runs it through their system in order to desensitize it, and then sends it to the necessary hospitals or to worldwide network of specialists already collaborating on telehealth issues. Then, once the appropriate diagnosis is made, the data is then sent back to clickmedix, which re-attaches the diagnosis to the particular patient, and returns it to the community health workers. The entire process occurs within five minutes.
In another post, I’ll outline why Kazakhstan is so open for innovation in this sector. For now I’ll leave you with this outline as to how mHealth actually works


Medical Information Infrastructure

The more I learn about the pace and scope of development in Kazakhstan, the more I’m struck by the importance of information infrastructure systems in effective healthcare delivery. In one of it’s strategic planning initiatives, Kazakhstan’s government identified “(the creation of) a new model of healthcare management and a unified information network for the sector” as an important goal in the National Programme for Health Care Reform and Development 2005-2010. To this end, Medical Information Centers were established (2008) in all oblasts of the country (for the uninitiated, an oblast is a type of administrative unit, like a US state).The goals of the Medical Information Centers include

  • coordinating the implementation, maintenance and development of the unified health information system according to set goals and objectives;
  • ensuring the functioning of the health information infrastructure;
  • developing a unified system for medical and statistical reporting and accounting, using new data collection and processing technologies;
  • receiving and processing statistical reports from health facilities, and monitoring the statistical reporting and accounting in oblast health facilities, particularly in rural areas;

Effective management of data in healthcare allow for significant returns to scale in healthcare delivery. Currently,Kazakhstan has no comprehensive mechanism for human resource management and planning that takes into account the distribution and allocation of staff to facilities. Strategic development of information management systems have the potential to alleviate this problem in the future. Public health professionals and planners will be able to organize resources for effectively as data collection improves.

Further, providers are not immune to the data bug. In a recent presentation, I heard Dr. Brent Egan of Medical University South Carolina’s OQUIN network talk about the effect that quantitative data had on primary care physicians. Many physicians were initially reluctant to turn over patient data due to potential HIPPA violations and the increased workload it entailed. However, many were convinced when they could literally see the data organized in front of them in almost real time. Accurate and timely feedback enabled doctors to address patients problems on a macro level as they occurred.

By extending the data collected through the Medical Information Centers to primary care providers in rural areas of Kazakhstan through cell phones and mHealth, physicians are likely to have a better on the ground response to health conditions. By making this a two way system, Medical Information Centers stand to benefit from the increased data collection that widespread mobile use can provide. This can help alleviate the shortfalls in personelle allocation that currently occur.

Finally, the United States is not immune to this problem as well!

Citations, for anyone who is interested:

Katsaga A, Kulzhanov M, Karanikolos M, Rechel B. Kazakhstan: Health system review. Health Systems in Transition, 2012; 14(4):1-154