creating an enabling envirnoment for mhealth

Creating an Enabling Creating an Enabling Environment for Environment for mHealthmHealth

Patricia N. Mechael; PhD, MHSPatricia N. Mechael; PhD, MHS

presented at presented at

International Technology Institute International Technology Institute 55thth Conference on Information and Conference on Information and

Communication Technology: Communication Technology: Media ConvergenceMedia Convergence-- Moving to the Moving to the

Next GenerationNext GenerationCairo, EgyptCairo, Egypt

1616--18 December 200718 December 2007

Presentation OutlinePresentation Outline

•• IntroductionIntroduction

•• Identification of Identification of mHealthmHealth opportunitiesopportunities

•• Technology lifecycle and integration decisionTechnology lifecycle and integration decision--makingmaking

•• Maximization of Maximization of mHealthmHealth: Lessons and : Lessons and challengeschallenges

•• Improving health outcomes and efficienciesImproving health outcomes and efficiencies

Technologies under Technologies under consideration & applicationsconsideration & applications

Mobile technologies that facilitate Mobile technologies that facilitate communicationcommunication, , processingprocessing of data, and of data, and transfertransfer of informationof information

•• Mobile phonesMobile phones

•• PDAsPDAs

•• Patient Monitoring DevicesPatient Monitoring Devices

•• MP3 PlayersMP3 Players

•• Microcomputers and mobile computingMicrocomputers and mobile computing

mHealthmHealth OpportunitiesOpportunities

•• Mobile phones enable direct communication and Mobile phones enable direct communication and information transfer in motioninformation transfer in motion

•• Increasing numbers of subscribers and coverageIncreasing numbers of subscribers and coverage--reaching & superceding reaching & superceding MDGsMDGs for connectivityfor connectivity

•• Direct relationship between improved Direct relationship between improved communication and access to health carecommunication and access to health care

•• Technology prioritized by people in developing Technology prioritized by people in developing countries for work and social communication countries for work and social communication (connectedness)(connectedness)

Key Outcomes of InterestKey Outcomes of Interest

•• Reducing mortality Reducing mortality •• Reducing morbidityReducing morbidity•• Reduced feelings of isolation for rural health care Reduced feelings of isolation for rural health care

workersworkers-- part of a networkpart of a network•• Saving timeSaving time•• Saving moneySaving money•• Increased productivity within health systemIncreased productivity within health system•• Enhanced quality of careEnhanced quality of care•• Enhanced disease surveillance and controlEnhanced disease surveillance and control

Health Systems OpportunitiesHealth Systems Opportunities•• Emergency response systems (Emergency response systems (MVAsMVAs and EOC)and EOC)•• Disease surveillance, management, and control Disease surveillance, management, and control

(including health promotion to general public via SMS (including health promotion to general public via SMS for early detection and warning)for early detection and warning)

•• Mobile telemedicine (diagnostic and decision support)Mobile telemedicine (diagnostic and decision support)•• Human resources coordination, management, Human resources coordination, management,

supervision, and support (decentralized health supervision, and support (decentralized health services)services)

•• Services monitoring and reporting (HMIS, vaccine Services monitoring and reporting (HMIS, vaccine programs, quality assurance, patient programs, quality assurance, patient hotlines/directories, accountability to clientshotlines/directories, accountability to clients-- increasing increasing demand) demand)

•• Supply chain managementSupply chain management

Health Communications Health Communications OpportunitiesOpportunities

•• Health promotion campaigns/ messages to Health promotion campaigns/ messages to general publicgeneral public-- BCC especially youthBCC especially youth

•• Public service messages and early warning Public service messages and early warning systemssystems

•• Training and capacity building of health care Training and capacity building of health care personnelpersonnel--mLearningmLearning (formal and informal)(formal and informal)

•• Call centers and hotlinesCall centers and hotlines

•• NetworkingNetworking-- communities of practicecommunities of practice

•• AdvocacyAdvocacy

Technology Integration Technology Integration

Pre-tech Strategic Planning: Identifying objectives, users, resources, workflows

Adoption of off-shelf software

In-house development

Small-scale testing and mature development

Customization or configuration

Large-scale distribution, utilization, training

Full Integration

Evaluation

Strategic Aims and ObjectivesStrategic Aims and Objectives

Improve function of health care systemImprove function of health care system•• Patient care, administration, patient informationPatient care, administration, patient informationImprove delivery of health careImprove delivery of health care•• Accessing up to date medical information, Accessing up to date medical information,

professional development, remote diagnostic professional development, remote diagnostic support, decision support, quality assurance, support, decision support, quality assurance, disease surveillancedisease surveillance

Improve communication about healthImprove communication about health•• Patient data, interactive communication, media, Patient data, interactive communication, media,

research, advocacyresearch, advocacy

Target beneficiariesTarget beneficiariesDirect and intermediaryDirect and intermediary……General public and health sectorGeneral public and health sector……•• InternationalInternational•• RegionalRegional•• NationalNational•• ProvincialProvincial•• Local Local

Look at needs, capacity (including Look at needs, capacity (including literacy and language), location, literacy and language), location, accessaccess

Additional burden? Or relief?Additional burden? Or relief?

Participatory approaches Participatory approaches (beneficiaries, program (beneficiaries, program implementers, technology implementers, technology developers)developers)

Monitoring and evaluationMonitoring and evaluation•• Formal integration programFormal integration program-- targeted application of targeted application of

mobile technology to support a specific health mobile technology to support a specific health programprogram

•• Informal integrationInformal integration-- mobile technology widely used mobile technology widely used to support programming without consideration of its to support programming without consideration of its specific contribution to program objectivesspecific contribution to program objectives

•• Begin with documentation and internal learning and Begin with documentation and internal learning and standardizationstandardization

•• Expand to assessment of select interventionsExpand to assessment of select interventions-- and and the specific role and contribution of mobile the specific role and contribution of mobile technologies (positive and negative)technologies (positive and negative)

•• Learn from other ICT and Development Programs Learn from other ICT and Development Programs (esp. Education and Commerce)(esp. Education and Commerce)

mHealthmHealth ChallengesChallenges

•• Limited documentation and Limited documentation and impact evaluationimpact evaluation-- effects of effects of integration lost within broader integration lost within broader programming programming –– many case many case studies and anecdotes studies and anecdotes

•• Individual haphazard Individual haphazard integration without knowledge integration without knowledge of the range of possibilities, of the range of possibilities, standards for standards for implementation, or indicators implementation, or indicators to measure success to measure success –– internal internal and external learning and and external learning and exchangeexchange

•• Differential access to mobile technologies and Differential access to mobile technologies and capacity to maximize integrationcapacity to maximize integration

•• Increasing trends to focus on mobile health without Increasing trends to focus on mobile health without proper learning mechanisms from proper learning mechanisms from eHealtheHealth

•• Rapidly changing technologies and environmentRapidly changing technologies and environment

•• Poor quality of health information and services Poor quality of health information and services especially in rural areasespecially in rural areas

mHealthmHealth ChallengesChallenges

Key Lessons in Key Lessons in mHealthmHealth•• Technology is a tool Technology is a tool

•• Successful integration requires full network Successful integration requires full network participationparticipation

•• Local access and availability should drive integrationLocal access and availability should drive integration

•• Build on existing Build on existing mHealthmHealth patternspatterns

•• Simple, userSimple, user--friendly, and sustainablefriendly, and sustainable

•• Creative combination of new and old technology Creative combination of new and old technology

•• Training and capacity developmentTraining and capacity development

•• Regular monitoring and evaluationRegular monitoring and evaluation

•• Clear plan for sustainabilityClear plan for sustainabilityBased on InfoDev Assessment

•• Identify key areas in which mobile technologies can Identify key areas in which mobile technologies can leverage international policy and programming objectives leverage international policy and programming objectives [Develop a strategic framework[Develop a strategic framework……]]

•• Move from case studies and anecdotes to intensive Move from case studies and anecdotes to intensive evaluationevaluation

•• Develop standard protocols and indicators to assess and Develop standard protocols and indicators to assess and compare the effects of improved telecommunications and compare the effects of improved telecommunications and integration of mobile technologies on health integration of mobile technologies on health

•• Explore the role of various partners including industry: Explore the role of various partners including industry: Corporate Social Responsibility and social marketing of Corporate Social Responsibility and social marketing of technologytechnology

The way forwardThe way forward……