Robyn Whittaker Clinical Trials Research Unit, University of Auckland (Friday, 10.30, Telehealth/mHealth) mHealth or mobile health describes the use of mobile communications devices for health-related purposes. There is much interest in mHealth internationally at this time; including interest in interventions developed in New Zealand/by New Zealanders. A recent research project examined the key issues in the implementation of mHealth and the current opportunities to address those issues in the U.S. The key mHealth issues are outlined here under the themes of policy and regulation, the wireless environment, the health system, current mHealth initiatives in practice and research. This paper examines how these issues may apply in New Zealand and the current opportunities to address them. This information may be useful to those embarking on mHealth developments in New Zealand and may help to inform the inclusion of mobile capabilities within the NZ Health IT infrastructure.

1. Key issues in mobile health
Robyn Whittaker
ISO 9001 Registered

2. mHealth
the delivery of health-related
services via mobile
communications devices
Portable
Personal
Connected

3. mHealth programs can be
• integrated into daily life
• proactive
• there at the „right‟ times
• personal/ised
• interactive
• on-going
• providing social support

4. mHealth programs can be
HEALTHY
BEHAVIOR
• integrated into daily life
CHANGE
• proactive
• there at the „right‟ times
CHRONIC • personal/ised
DISEASE
MANAGEMENT • interactive
• on-going
• providing social support

5. New Zealand has led the way

6. U.S.

7. Objectives
• identify the current key issues in the
implementation of mHealth
– Environmental scan
– text4baby case study
– Key informant interviews
• identify opportunities to address
these
• consider implications for NZ

8. Methods
• Key informant interviews
– List from environmental scan, informal
discussions & recommendations
– Semi-structured interview guidelines plus
some closed Q/likert scales
– By phone or in person
– Recorded & transcribed
– General thematic analysis

9. Prelim findings: interviews
N=27
HHS 10
Integrated health systems 3
Academics 6
Private mHealth companies 4
Wireless networks 2
Private sponsors/funders 2
Priority
10
8
6
4
2
0
low middle high

10. What does mHealth add?
Relationships Persistent interactivity
Behavior change Easy & habitual
Chronic disease Reminders
management Coach
Remote monitoring Efficiencies in system
Personalisation Cheaper alternative
Scalability Convenience
Time and place services Asynchronous
Interact with information Accessibility
Incorporated into daily life
Reliability & standardizing
delivery of care

11. PLUS
Reach into underserved populations
• >25% of US households wireless
• More likely to be uninsured, living in
poverty
• Less likely to have usual place of care
• Use of text messaging
– Hispanic 83%, AA 79%
– Medicaid 79%, uninsured 63%, Medicare
43%
Blumberg 09; Pew Internet Research 10/11; PWC 10

12. “a great equaliser…”
• As long as we use it in such a way to reduce
barriers to care, not just efficiently manage folks
in the system
• If we leave out marginalised underserved
populations when we are moving forward with
technology & health reform, it will only make our
health disparities wider
• Bias in those coming up with solutions
• Change in onus from provider to individual
relies on individuals having skills/tools to do so,
requires concomitant increase in health literacy
& safety net to help those who need it

13. Transformative?
No:
• an extension Yes:
of current health • from provider & location
communication centric system to patient-
or current centered anywhere care
models of care
• from provider control to
individual locus of control
• change the way we search
for and use information

14. Key issues in mHealth
Privacy & data security
Policy &
regulatory
Who pays
Health Wireless
system
In
Research
Need more quality practice
research on cost-
effectiveness & RoI

15. Policy & regulatory issues
• Privacy +/- data security
• FDA regulation
• Bandwidth spectrum availability
• Medical practice regulations e.g.
practice across states/countries,
regulated roles

16. Wireless environment issues
• Large number of wireless networks
• Working across platforms & other
proprietary complexities
• Potential costs to users

17. Health system issues
• Who pays/reimbursement
• Lack of demonstrably sustainable
business models
• Competing priorities & opportunity
cost
• Integration into existing systems,
practice & EHRs
• Clinical roles & accountability

18. mHealth in practice issues
• Immature understanding of how to
do it well (for whom, what, when)
• Lack of demonstrated added value
of existing initiatives & focus on
where it can add value (e.g. under-
served & disadvantaged popns)
• Lack of theory & evidence base
• Technology focus/legacy systems
• Governance issues

19. mHealth in research issues
• Need for more high quality research
demonstrating effectiveness & cost-
effectiveness
• Mismatch in pace & flexibility of
research with tech developments
• Measuring reach & access into
under-served populations

20. Opportunities to address issues
• U.S.
1. Health reform structures & $$
2. Federal level guidance
3. Improve mHealth practice/research
• NZ context
• Electronic health records & NHI
• Primary care
• National coordinated plan towards
accessible patient-centred electronic
health information & shared care plans

21. Implications for NZ
• Expand national strategic &
collaborative approach to mHealth
– Wireless networks & industry, health
services, research
– Shared definitions, standards for
interoperability
– Integration rather than silos
– Open philosophy and shared learnings

22. Implications for NZ
• mHealth is global
– International guidelines, standards &
interoperability
– Health information privacy & security
– Regulation
– High tech stuff once becomes usable
– Research guidelines

23. Opportunities
• Approach to development &
research
– Start with a problem
– Use evidence & theory
– End-users involved through-out
– Learn from others
– Pre-test & iterate
– Consider implementation from start
– Test in good research studies
– Publish/make publicly available

24. Conclusions
• Use of mobile devices in health has
the potential to be transformative
• Need to consider strategic
approach to implementation issues
• NZ can continue to lead the way
with national collaboration &
primary care implementation

25. Acknowledgements
The Commonwealth Fund
Dr Kyu Rhee
Health Resources & Services
Administration, U.S. Dept of
Health & Human Services
Interviewees
and Bill