Recapping Day Two of the mHealth Summit
Opening Keynotes
The second day of the mHealth Summit began with former U.S. Senator Tim Wirth introducing Tom Wheeler, Chairman of the mHealth Alliance and Ted Turner, founder of the UN Foundation. Turner started off by declaring that the key to success in a competitive world is “early to bed, early to rise, work like hell and advertise.”
Turner, through his involvement with the UN Foundation, hopes to strengthen the work of UN because he believes that it’s the one organization in the world most interested in solving global problems. Throughout the conversation, Turner turned to topics such as war and nuclear weapons (saying war is disruptive to people’s health, calling for a reduction in nuclear arms), while Wheeler tried to steer the talk back to health. Turner mentioned that the UN Foundation’s work is highly focused on eradicating three diseases: polio, measles, and malaria. He believes that as we move forward one of the greatest challenges is to figure out how the private sector and NGOs can do UN-like activities.
Next, Dr. Carolyn Clancy of the U.S. Department of Health and Human Services, discusses the important role that evidence plays in healthcare. She is an advocate for practical research that informs and is informed by clinical practice. Dr. Clancy shares some statistics from her research, including:
80% of Medicare patients text regularly.
42% of consumers say they would pay for medical monitoring equipment and monthly monitoring charges.
88% of physicians would like patients to monitor their health on their own.
She highlights the initiative My Medi Health that is used to support homecare for children with asthma.
Panel: Lessons Learned around the Globe
Kathy Calvin, CEO of United Nations Foundation, moderated a panel comprised of major players in academia/research, business, and the public sector to discuss lessons learned from mobile health programs.
Each panelist shared their thoughts on lessons they have learned from working in the mHealth area:
Walter Curioso MD, MPH, Ph.D.c., Research Professor, Universidad Peruana Cayetano Heredia (Peru) and University of Washington (Seattle), said that the focus should be on developing appropriate technologies to meet population’s health needs.
Thierry Zylberberg, Executive Vice President of Orange, notes that Orange is the leading telecom operator in Europe, with a growing presence in Middle East and Africa. Orange set up a health division in 2007 and is hoping to leverage power of ICTs to change the healthcare industry while creating sustainable business models.
From his work leading this division, Zylberberg has found that there are two different perspectives to consider when tackling mHealth. In the developed world, the focus on mHealth initiatives is usually to make the system more efficient. On the other hand, in the developing world, the focus is on improving access to healthcare.
Zylberberg stresses that if you try to apply the wrong set of ideas in the environment, theb you face the risk of failure. He highlights a number of programs where Orange is a partner, including a program with the leading private hospital in Spain that remotely monitors diabetes patients using mobile technologies, Text To Change, which provides health education in Cameroon, and tele-dermatology programs in Egypt and Botswana.
Theresa Cullen, MD, MS, Chief Information Officer, Indian Health Service works with Indian (Native American) populations in the United States. She notes that this population shares attributes of both the developing and developed world. Native Americans live in some of the most remote and austere environments in the United States. In the past few years, Indian Health Service has been able to working to aggressively to build e-health records because of its close working relationship with the community and the way it has involved the community in the decision-making process.
She stresses that mobile access can meet needs of the communities that they have identified, and underscores the importance of using appropriate technologies and involving the community along every step of a project.
Alex Ibasco, Chief Innovation Officer - Strategic Business Development at Smart Communications in the Philippines, notes that the majority of Filipinos do not have smartphones and spend, on average, $4 a month for airtime. This must be taken into consideration when developing mHealth programs. He says that the idea of giving mHealth programs directly to end users isn’t quite there yet, so they focus on the caregivers (who he refers to as those “next to the edge of communities”).
Patricia Mechael, PH.D., MHS, Director of Strategic Application of Mobile Technology for Public Health and Development, Center for Global Health and Economic Development at the Earth Institute, Columbia University, shared her top ten lessons in a Letterman-style countdown.
1. Capitalized on what others have done, what others have learned.
2. Evaluate the impact of mobile technologies to support behavior change.
3. Locally generated content is important. Appropriately contextualize information makes it more meaningful.
4. Adapting materials to mobile is challenging undertaking.
5. Move away from research focus on user satisfaction and actually evaluate the impact of health outcomes.
6. Be realistic and don’t get caught up in the hype.
7. Take a systems-thinking approach and move away from single-issue focus.
8. Recycle, repurpose, reuse; don't reinvent the wheel.
9. mHealth at scale can only come from strong leadership linking tech with health priorities and looking for most appropriate tools that exist . Look for public-private partnerships.
10. It’s not about technology.
Lisa D. Ellis, Principal at McKinsey & Company, dispels common mHealth myths, beginning with the notion that mHealth is not a fad. It delivers real outcomes which translate into legitimate business opportunities. McKinsey found in a study that 30% of consumers in India are willing to pay $2 for a 10 minute consultation with a doctor. mHealth is not a technology game. It’s about driving changes to business models and cultural/behavior changes. Mobile health isn’t just about care delivery and is not a niche business. The specific services and business models differ dramatically by geography.
The question is asked, “Do we need to put phones out there, or are they already there?”
Curioso responds that just giving mobile phones to people will not solve anything. First, stakeholders need to understand the needs of the people. What are their perceptions and values?
Zylberberg argues that mobile penetration in developing countries is already there, and cautions the audience to remember that mobile technology isn’t just about mobile phones. He mentions remote monitoring devices use the same technology, just not the phone itself.
Ibasco stresses that part of the difficulty he faces in the Philippines is equipping the “next to the edge layer” to help patients and that it is challenging in his country which is spread out over 7,000 islands.
Mechael argues that we must pay attention to what strategies and policies are being made at the national level. Are there e-health policies? Is the use of technology prioritized in a more effective way? Through the Earth Institute’s work with eh Challenge seen through Millennium Development Villages, she found that a lack of standards and lack of standardization makes it very challenging to grow and make project sustainable. Similar activities are taking place using different techs, and there are no standards around data. She advocates for openness, and that focus should be given to open standards and policies at the national level.
Ellis discusses the importance of local payer endorsement from the top-down in order to drive adoption. Partnerships are essential between payer, provider, and local telecom operator in any location.
The paradigm shift now being seen is that instead of pushing technologies to the farthest reaches, it’s more more about getting healthcare out to where the technology already is located. That said, there was little discussion on the panel regarding the use of rates and policies friendly to those on the bottom of the pyramid.
