Mobile health: Four emerging themes of research

Highlights

• We present an integrated view of mobile health.

• Mobile health can lead to many significant improvements in healthcare.

• There are many important challenges in mobile health.

• We classify mobile health challenges in four categories.

• For each category, the challenges and possible solutions are discussed.

Abstract

Mobile health has been receiving a lot of attention from patients, healthcare professionals, application developers, network service providers and researchers. Mobile health is more than just some healthcare applications on a mobile phone and it can involve sensors and wireless networks in monitoring various conditions, mobile devices to access numerous healthcare services, healthcare professionals to make decisions and provide emergency care, and for the elderly to manage their daily activities in independent living. More specifically, m-health can result in major advances in (a) expanding healthcare coverage, (b) improving decision making, (c) managing chronic conditions and (d) providing suitable healthcare in emergencies. To help realize these advances, there are major research challenges that need to be addressed. We classify these challenges in four categories of (a) patients related, (b) healthcare professionals related, (c) IT related and (d) applications related challenges. Within each category, we identify several research problems, and we present some high-level and preliminary solutions along with an agenda for future research. The paper may provide a platform for future research and decision-making related to patients, healthcare professionals, applications, and infrastructure. These decisions will significantly impact how future mobile health services will be designed, developed, evaluated, and adopted globally.

Introduction

Mobile health is broadly defined as “healthcare to anyone, anytime, and anywhere by removing locational and temporal constraints while increasing both the coverage and the quality of healthcare” [59]. Mobile health is much more than just accessing healthcare applications on a mobile phone as m-health can involve sensors and wireless networks in monitoring various conditions, mobile devices to access a variety of healthcare services, healthcare professionals to make decisions and provide emergency care, and the elderly to manage their daily activities for independent living among other things. Thus mobile health can include numerous sophisticated applications that deal with disease prevention & wellness [61], monitoring and remote care [47], [62], mobile decision making [1], and emergency interventions [59]. In addition, several applications on horizon include highly personalized health monitoring [42], mobile healthcare data access [23], and sophisticated mobile telemedicine [65].

We do not claim that m-health can fix all the healthcare problems, but it can improve the reach of healthcare, decision making, management of chronic conditions and emergencies. Mobile health can truly change the way healthcare services are delivered: from the current healthcare professionals-controlled to healthcare professionals-managed. One of the major effects of m-health is empowering patients with information to help them make suitable healthcare decisions, follow advice and medical regimen, and in general have better control of their healthcare. The availability of numerous m-health applications, more than 100,000 at the time of writing this paper, is a major step towards such empowerment of patients. Some other areas of improvement include reduction in cost, more efficient processes, and meeting some of the workload needs of healthcare professionals. Certainly much more work is needed to evaluate the effectiveness of mobile health in terms of quality of decision making, quality of care, efficiencies of healthcare processes, outcomes of patients, and reduction of overall cost.

Several advances in sensing devices, miniaturization of low-power electronics, and wireless networks [5] are fueling the emergence of mobile health. The wireless technologies can be effectively utilized by matching infrastructure capabilities to healthcare needs. These include the use of location tracking, intelligent devices, user interfaces, body sensors, and short-range wireless communications for health monitoring; the use of instant, flexible and universal wireless access to increase the accessibility of healthcare providers; and reliable communication among medical devices, patients, health-care professionals, and vehicles for effective emergency management.

The recent FCC spectrum allocation for mobile medical telemetry can improve both the quality and quantity of medical data that can be transmitted from patients to healthcare professionals [23]. The interoperability among various systems is being addressed by the development of medical standards, industry alliances, and consortiums, such as the IEEE 802.15.6 wireless body area networks (WBANs), Continua Alliance and the European Telecommunications Standards Institute's eHEALTH [23].

One of the major advances fueling the growth of m-health is the worldwide availability of mobile technologies, such as mobile phones of 3rd and 4th generation (3G and 4G), that are usable almost anywhere anytime. The decline in price of access, improved portability and comfort of people in using mobile technologies have all helped m-health moving forward at a rapid pace.

M-health can play many different roles based on the patients' conditions, their needs and availability of healthcare services. The roles include providing necessary healthcare information anytime anywhere, providing remote and expanded care, access to healthcare professionals anytime anywhere via mobile devices, integrated and real-time information to healthcare professionals for decision making, and the broadcasting of information in cases of disasters.

M-health can reach to places where little or no healthcare is available such as rural areas especially in developing countries and can also allow people in urban areas and developed countries to access some healthcare services while being mobile/away from their places. M-health is likely to be incremental in the developed countries as it plays an adjunct role to what is already supported by e-health. M-health is likely to be revolutionary in developing countries, where little infrastructure is available and presence of mobile phones can lead to rapid adoption of mobile health, especially in rural and remote areas. M-health in developing countries will play a major role in health interventions [8], prevention of communicable diseases [61] and in improving health literacy [33]. A comparison of m-health in developed and developing countries is shown in Table 1 and different scenarios are presented in Fig. 1.

M-health will also change the way healthcare services are delivered. With mobile devices being integrated in various healthcare processes, many sub-processes will be automated while the rest can be efficiently supported by healthcare professionals. For example, m-health can enable highly personalized healthcare in general and suitable interventions for patients to managing their chronic conditions in particular. Highly sophisticated interventions can be designed, developed and offered to patients to manage their complex regimen of medications to improve medication adherence, avoid adverse drug events (ADE) and communicate with healthcare patients as and when necessary in real-time.

M-health cannot solve all problems of healthcare as it is highly dependent on sensors, mobile devices and wireless infrastructure. In places where there is no wireless coverage or when mobile devices have battery or access problems, mobile health is simply not possible.

M-health cannot, and should not, completely automate the delivery of healthcare services. There are many m-health applications that must have human involvement due to their potential for damage or injury to the patient's health. FDA has offered some guidelines on what mobile health applications can do and what they cannot and who is liable if a patient is injured due to mobile health applications. In general, if an application is providing healthcare information and is not connected to any healthcare delivery device, the FDA rules will not apply to such applications.

Mobile health is not likely to play a primary role in cities in developed countries, where both “wireline” network infrastructure as well healthcare facilities are readily available. Certainly much more work is needed to evaluate most suitable m-health services in developed as well as developing countries.

One of the goals of this paper is to integrate advances and various challenges for mobile health and identify many important research problems. Towards this goal, we first envision what mobile health can do by focusing on (a) extending the reach of healthcare, (b) improving the healthcare decision making processes and their outcomes, (c) better management of chronic healthcare conditions and (d) managing emergencies in Section 2. We then present a framework for mobile health based on four categories of research problems based on patients, healthcare professionals, IT and m-health applications in Section 3. Then, in Section 4, we present research problems and some preliminary solutions for four categories that can be expanded by other researchers. Then we make some concluding remarks in Section 5.