the journal of mhealth volume 1 issue 1 (feb 2014)

WHAT’S INSIDE

The

Journal of mHealthFebruary 2014 | Volume 1 Issue 1

NEWS, REVIEWS, CLINICAL DATA, mHEALTH APPLICATIONS

Read the Latest Research

ARTICLES REVIEWS CLINICAL

mHealth Apps & Services

mHealth in Practise

Digital Health

Your

insight

into

mHealth

The Inaugural Edition

The Global Voice of mHealth

The

Journal of mHealthThe Global Voice of mHealth

The thoughts and ideas of our readers and subscribers are essential to us at The Journal of mHealth. We want to hear your opinions on the

mHealth industry. Contact us at [email protected]

We want to hear from you

Let us know the details of any projects that you would like us to cover in upcoming editions of The Journal. Send the details

to [email protected]

Have a project you want us to cover?

If you have developed an Digital Health application, project or service we invite you to submit details of your applications for peer review

from our independent panel.

These reviews will help inform clinicians, healthcare managers, healthcare professionals, and patients as to the effi cacy and real

clinical benefi ts of an application. For more information or to submit an application for review please contact

[email protected].

Submit your Digital HealthApplication for Peer Review

I would like to take this opportunity to welcome all our readers who have subscribed to the new Journal of mHealth. We hope that you fi nd this and subsequent editions engaging and informative.

Our aim with the Journal has been to provide a publication that bridges the diff erent areas of the mHealth industry in order to pro-vide an authoritative source of information for all parts of health-care community. Through the Journal we will be looking to pro-vide industry insight into the ways in which mHealth is being used, developed and implemented across all the possible technical use cases.

In practise this means the Journal will include academic research, industry studies, reports and clinical trial data, as well as news and updates from the global Digital Health industry. We will also feature regular company and organisation profi les looking at the work that diff erent businesses and organisations are doing around the world to develop and implement mHealth services.

Having consulted extensively with participants from across the in-dustry it is hoped that the Journal will become a trusted resource for anyone with an interest in mobile medical applications, devic-es, and services.

In this our inaugural edition we set out to understand some of the issues aff ecting the current global mhealth landscape, with reports and articles covering projects from around the world. Our feature article considers the Global perspectives of the mHealth market. We have reports from the Health and Development Foundation of Russia, the European Public Health Alliance (EPHA) Briefi ng on Mo-bile Health, and an analysis of the FDA Guidance on Mobile Medi-cal Apps. We also have sections that will make a regular appear-ance in each edition, including industry news, company profi les, and events news.

Finally, let me take this opportunity to thank everyone who has been involved with helping us launch The Journal of mHealth, and for all the contributions and submissions made to date. Without you all, we wouldn’t be where we are today.

Thank you for subscribing and we hope you enjoy reading!

Matthew DriverEditor

Welcome

Published by Simedics Limitedwww.simedics.org

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The editor welcomes contributions for The Journal of mHealth. Submissions can be sent to the Editor by email. Images and graphics should be submitted in high resolution format.

The opinions expressed in this publication are not necessarily shared by the editors or publishers. Although the highest level of care has been taken to ensure accuracy the publishers do not accept any liability for omissions or errors or claims made by contributors or advertisers, neither do we accept liability for damage or loss of unsolicited contributions. The publishers excercise the right to alter and edit any material supplied. This publication is protected by copyright and may not be reproduced in part or in full without specifi c written permission of the publishers.

© 2014 Simedics Limited

Editor's Comments

1The Journal of mHealth

mHealth...A Global Market

In This Issue

For our inaugural edition we deliver an insight into the global mHealth market, and consider some of the major industry trends.

nowledge Policy CostEffectiveness

Legal Operating Demand TechnicalExpertise

InfrastructurCosts

4 mHealth... A Global Market

European Public Health Alliance Briefi ng on mHealth—Read the complete briefi ng from the EPHA, relating to the European mHealth landscape.

Read the report containing a summary of results from the Health & Development Foundation (Russia) 2013 national survey among participants of the maternal and child mHealth program.

27 EPHA Briefi ng on Mobile Health

40 The Health and Development

Foundation National Survey Among

Participants of the Maternal and Child

mHealth Program

5.2%6.7%

12.5%

23.9%27.9%

23.8%Less than 1 month

1-3 months

3-6 months

6-9 months

9-12 months

Over 1 year

2

Table of Contents

February 2014

To advertise in

Contact Matthew [email protected]

+44 (0)1756 709605

The


To subscribe to

Please visit our website at www.simedics.org

The


For editorial, research and paper submissions please contact Matthew Driver at [email protected]

8 Scanadu Secures $10.5 Million

in Funding

8 CES 2014...A Digital Health

Showcase

9 Google Unveils Contact Lens

Sensor Capable of Measuring

Gluclose Levels

9 Aff ordable Care Act

10 Samsung Receives FDA

Clearance for S Health App

10 mHealth Alliance announces

move to South Africa

13 QardioArm...A Revolutionary

Blood Pressure Monitor

15 Tactio Health Group

16 Innovative Smartphone Game

Seeks to Discover Cancer

Cures

17 FDA Issues Final Guidance on

Mobile Medical Apps

22 Cisco Study Reveals 74

Percent of Consumers Open to

Virtual Doctor Visit

24 News Highlights from the

2013 mHealth Summit

Industry News

38 Can mHealth Provide Answers

to the Rising Costs of Chronic

Condition Management?

48 Product Profi les

49 Company Profi les

50 Upcoming Events

50 Advertisers Index

Table of Contents


mHealth... A Global Market

The global mHealth market is growing at a rapid pace. A re-port published by Kalorama in 2013 [1] suggests that the size of the market grew by 237% within the fi ve-year period from 2008. With similar predictions being made for the market in the near future, digital health-care looks set to be a signifi cant element of the wider healthcare market, sooner rather than later. The same report describes the market as still being in its in-fancy, considered to be small to

moderate in size. However, the effectiveness of the solutions on offer are providing benefi ts that can be valued far beyond the capitalisation fi gures sug-gest.

“Currently mobile penetration is reaching saturation in de-veloped markets and is rapidly increasing in developing mar-kets such as Asia-Pacifi c, Latin America and Africa. Moreover, increasing exposure to smart-phones along with 3G and 4G

networks is futher boosting the rate of adoption of mo-bile devices across markets and particularily in healthcare systems. Furthermore, a shift can be observed from hospital-care to personal-care as mobile healthcare systems are provid-ing seamless support and care to patients irrespective of their locations. On top of that, the advent of a new generation of connected medical devices and personal health tracking moni-tors are making it easier for

4


February 2014

healthcare providers to serve pa-tients effectively and at a lower cost.” [2]

North America leads the regional landscape of the global mHealth market followed by Europe and Asia Pacifi c. However, by 2020, Europe and Asia Pacifi c are pre-dicted to take away this lead, with each occupying more than 28% of the market. [2]

It is also predicted that the next few years will see the commer-cialisation phase of the mobile healthcare services market, as the industry begins to more effec-tively monetise the solutions that are already on offer, or in devel-opment. Estimates are that this phase will push the market value

upwards of $26 billion by 2017 [3].

“With the growing sophistication level of mHealth applications, only 9% of the total market rev-enue in the next fi ve years will come from application download revenue,” suggests Patrick Houck in a statement in the same report by mobile research company Re-search2Guidance. “84% of total mHealth application market reve-nue will come from related servic-es and products such as sensors.” Factors generating the need for

mHealth services:

- Ageing population. Ageing popula-tions and the associated increase in chronic illness across the devel-oped world is fuelling the growing demand for innovative delivery solutions. Healthcare organisa-tions and national health provi-sion is responding to this growth in demand by seeking methods that improve the access to, and effi cacy of services provided, as well as increase consumer en-gagement with treatment and care pathways, and reduce hospital ad-mission rates.

- Increases in healthcare costs. As costs of healthcare provision continue to rise, health providers, organ-

isations, and governments are all searching for solutions that can keep pace with growing demand, whilst delivering real-term cost savings. mHealth, telehealth, re-mote monitoring and telemedi-cine are all methods that have be-come attractive solutions to these problems.

- Advances in technology. Innovation is rapidly changing the dynam-ics surrounding the delivery of healthcare. Tailored solutions are

helping to drive consumer-led health provision and reduce the number of physical interactions required in the doctor-patient re-lationship.

- Wearable technology. Wearable technology also shows signs of signifi cant residual growth. The world market for wearable tech-nology reached $8.5 billion in revenues during 2012, shipping 96 million devices that year. By 2018, unit shipments are forecast to reach 210 million, driving $30 billion in revenue. These fi gures include a diverse range of product types and applications including healthcare, fi tness, infotainment, industrial and military. [4]

UNITED KINGDOM

A recent report published by PwC [5] highlights the growing inter-est for mHealth solutions in the United Kingdom. The report ref-erences the many projects and ini-tiatives that are underway across the UK to increase the wider use and effi cacy of mobile enhanced services and Digital Health solu-tions.

The UK National Health Ser-

In this article we take a snapshot of the global mHealth market, considering some of the issues infl uencing the industry, in a variety

of diff erent regions around the world

Continued on page 6



vice has recognised the benefi ts of using telehealth and telecare solu-tions with the recent introduction of the “3 million lives” campaign. This massive undertaking by the Service aims to use connected solu-tions to enhance the way in which patients are treated across the whole health system. The campaign, which comes about following the NHS whole system demonstrators (the long-term NHS trials used to de-termine the effi cacy of eHealth and mHealth services), has estimated that the increased use of telehealth and telecare services could help to reduce emergency admissions by up to 20%. As well as decreasing the rates of elective readmissions, the number of bed days required by patients, and overall reduce rates of mortality [6]. In fact in the UK six in ten clinicians and payers (NHS insur-ers and private payers) believe that the widespread adoption of mHealth is inevitable in the near future [7].

A recent survey [8] conducted by re-search company YouGov on behalf of legal fi rm Pinsent Masons found that:

» 31% of respondents agreed mHealth services could improve the NHS

» 33% of respondents would be willing to use mHealth services to have their health monitored remotely

» 50% of respondents would be willing to use an application to book an NHS appointment

This recent shift in attitudes is help-ing to push the mHealth issue and

driving the implementation

of projects, across the country. The Manchester mHealth ecosys-tem [9] is a good example of the way in which collaboration between healthcare providers; universities; and industry partners are helping to develop solutions that integrate be-tween stakeholders. The Manches-ter organisation is part of a wider network of ecosystems for the European Connected Health Alli-ance [10] that is seeking to widen the scope for shared learning and inno-vation, and facilitate access to the international mHealth marketplace.

The market for mHealth is not with-out obstacles. The same YouGov survey found that, prior to being given a defi nition of mHealth, the majority of respondents didn’t know what the term meant. Worse, even when it was explained, 90% stated they never use mHealth services, despite ex-amples given including established applications such as fi tness apps. This demonstrates that there is a signifi cant lack of consumer under-standing surrounding the technol-ogy and it may be that this proves to be a signifi cant barrier to wider adoption.

EUROPE

The same issues that are affecting the UK mHealth market appear to be the same primary issues across many European regions, including, Scandinavia, Germany, France, and Spain. A recent survey by Bryter questioned more than 1,100 adults

in the UK, France, Germany, Italy, Spain and Belgium. The survey took a plain English approach to questioning, removing industry jar-gon and buzz terms, to help deter-mine whether consumers are open to the increased adoption of mobile centred health services. Across a range of topics from, remote health monitoring, and, diet and activity tracking the survey found that the majority of those questioned are open to mobile applications and services that will help them better understand their health issues.

In addition to the consumer-centric issues in Europe, research

analysts suggest that the economic

hardships of recent years experienced in many E u r o p e a n c o u n t r i e s

have forced g over nments

to review options to control costs in the

healthcare systems, which in turn is presenting opportunities for digital medicine.

NORTH AMERICA

The United States and Canada cur-rently represent the largest markets for mHealth solutions and this looks likely to continue between now and 2020. The region has an established demand for technology driven products and services, and benefi ts from a population with a well devel-oped knowledge of technology and mobile applications. This informed consumer base is helping to drive the widespread adoption of mobile health solutions and digital health

59% of patients in emerging

markets use mHealth, compared to 35%

in developed markets

Continued from page 5

6


February 2014

services. Within the market a num-ber of trends look set to shape de-velopment over the next few years, including:

- Smartphone user penetration driv-ing mHealth uptake- mHealth applications becoming more tailored for smartphone and tablet usage- mHealth business models set to mature and broaden- Applications and mobile solutions will enter the traditional health dis-tribution channels

The introduction of the Affordable Care Act in early 2014 should also see organisations moving towards the increased delivery of mHealth services with the aim of increasing consumer choice whilst realising cost-savings through technology-led service introduction.

The appetite amongst investors for digital health start-ups also shows signs of market maturity. Success stories like Scanadu and FitBit dem-onstrate the wider sentiment for op-portunity within the digital health sector.

Demand for remote monitoring solutions has similarly risen in re-sponse to aging populations, dwin-dling healthcare resources, and pen-alties for readmissions. The report by Kalorama Information estimates that this sector alone in the US was valued at $10.6 billion in 2012 and that it could reach upward of $20.9 billion by 2016 [1].

Despite the signifi cant opportuni-ties for growth there still remain some barriers. The FDA fi nal guid-ance on mobile medical applications report 2013 [11] (see page 17) has

gone some way to clarifying the reg-ulatory framework for the develop-ment and implementation of mo-bile applications, but there are still a number of areas that will need clari-fi cation in the near future. In addi-tion industry collaboration on tech-nical interoperability is needed to help ensure that the mobile health ecosystem has the ability to interact between services and solutions.

EMERGING MARKETS

Emerging markets are showing sig-nifi cant growth in mHealth deploy-ment over- and- above the tradi-tional western healthcare markets. Existing healthcare is often scarce — in many cases, mobile technol-ogy is the only (rather than alterna-tive) affordable tool to reach people. The lack of existing infrastructure means fewer entrenched interests, so lower barriers. Change is more welcome.

59% of patients in emerging mar-kets use mhealth, compared to 35% in developed markets – Patients and doctors in emerging markets are much more likely to use mHealth than those in devel-oped countries — and more pay-ers in emerging markets cover the cost of mHealth than in developed countries. A study by PwC identi-fi es a number of trends in coun-tries such as Brazil, China, India, and South Africa [12]. In India the report shows that 81% of patients questioned would be interested in having services that would allow them to better monitor their own health. Similar fi gures were also evi-dent among patient groups in Chi-na, Latin American countries, and South Africa. Respondents in China were also particularly open to appli-

cations and services that would in-tegrate with medical devices to help monitor conditions.

Indeed, it is predicted that China will represent the second biggest mHealth market by 2017. According to PwC the Chinese government’s establishment of electronic health records, healthcare reform priori-ties, and an increase in ‘patient-cen-tric’ healthcare delivery will drive an increase in the need for transforma-tive technologies and medical prac-tices. The report commissioned by the China-Britain Business Council suggests that by 2017 China will be the second largest mobile health market, after the US, generating an estimated $2.5 billion in revenues [13].

This edition of The Journal of mHealth includes reports and stud-ies from a number of regions around the world that consider some of the many complexities surrounding the existing mHealth and Digtial Health care sectors, including predictions for the future.

1 Advanced Remote Patient Monitoring Systems, Kal-orama Information 20132 mHealth Market (Devices, Applications, Services & Therapeutics) - Global Mobile Healthcare Industry Size, Analysis, Share, Growth, Trends and Forecast, 2012 – 2020. Allied Market Research3 Mobile Health Market Report, Research2Guidance 20134 http://www.imsresearch.com/report/wearable_tech-nology_world_20135 mHealth in the UK - Paths for Growth. PWC 20126 http://www.3millionlive.co.uk 7 Economist Intelligence Unit, PWC 20128 http://www.pinsentmasons.com/PDF/Digital-Health-Winter-20139 http://www.informatics.manchester.ac.uk/mhealthe-cosystem10 http://www.echalliance.com11 http://www.fda.gov/medicaldevices/productsand-medicalprocedures/connectedhealth/mobilemedicalap-plications12 http://www.pwc.com/gx/en/healthcare/mhealth/opportunities-emerging-markets13 http://www.cbbc.org



INDUSTRY NEWS

Digital Health Dominates CES 2014

This year’s Consumer Electronics Show was once again a tech-lover’s dream with the launch of curved screen televi-sions and ultra high defi nition screens amongst the many other tech and gadgetry innovations on show. One trend that was evident at this year’s event was the dominance of Digital Health solutions.

The organisers have reported a 40% increase, from last year, in the number of digital health exhibitors. In real terms this meant over 300 medical technology exhibitors. John D. Korry, Managing Director of medical equipment technology consultancy at Accenture, attributes this to the growing trends for digital technology across multiple in-dustries. “We believe this is linked to an overarching trend, which is that every business is a digital business and every consumer, or patient, is a digital consumer.”

The show also played host to the 5th Annual Digital Health Summit, with keynote speakers across all areas of digital health, focusing on the latest products and growing con-sumer demand for high-tech health services, particularly through the lens of the Affordable Care Act. Companies on display encompassed solutions for diagnostics, moni-toring and treatmeant of a variety of illnesses -- from obe-sity to ADHD, from poor vision to high blood pressure.

CES 2014...A Digital Health

Showcase

One of the big mHealth stories of 2013 came from Scanadu, and the company looks set to keep making headlines throughout 2014.

The company announced in late 2013 that fol-lowing the overwhelming success of their crowd-funding campaign on Indiegogo, they had re-ceived $10.5 million in December in Series A funding. Relay Ventures led the round of fund-ing with participation from Tony Hsieh’s Veg-asTechFund, Jerry Yang’s Ame Cloud Ventures and others with a track record in building dis-ruptive companies of great value in the mobile, cloud, consumer and healthcare industries. This new round of funding will be used to support Scanadu’s go-to market strategy and manufactur-ing, continue its path to FDA approval and add talent to the team. The company also announced that it has formed a Medical Advisory Board and will conduct its fi rst clinical trials at the Scripps Translational Science Institute.

Scanadu Secures

$10.5 Million in Funding

Continued on page 12

News and Information for Digital Health Professionals

8February 2014

On January 1, 2014, the entire healthcare industry in the United States changed, with the introduc-tion of the Affordable Care Act (ACA). Technol-ogy looks set to play a key role in transforming the way consumers, payers and providers interact with-in the healthcare ecosystem. Consumers are set to have much greater control over the delivery of their

healthcare, and with this the demand for digital solu-tions is on course to dramatically increase over the course of the next few years.

The Journal of mHealth will be featuring the ACA, and considering the impact it is likely to have upon the mHealth industry, in forthcoming editions.

Aff ordable Care Act

Google continues to push healthcare tech innovation with the announcement that they have successfully developed a remote sensing contact lens that helps diabetes patients monitor their glucose levels.

One of the big stories of recent weeks among the mHealth community has been the news that Google is in the process of developing a contact lens that is capable of working as a remote sensor for glucose levels. Much discussion has followed this announce-ment.

Google has stated that it is in the process of testing a smart contact lens that is built to measure glucose levels in tears, using a tiny wireless chip and minia-

turised glucose sensor that are embedded between two layers of soft contact lens material. The com-pany is testing prototypes that can generate a reading once per second. They are also investigating the po-tential for this to serve as an early warning device for the wearer, by integrating tiny LED lights that could light up to indicate that glucose levels have crossed, above or below, certain thresholds. It is still early days for the technology, but Google has completed multiple clinical research studies which are helping to refi ne the prototype.

Google has announced they are in early discussions with the FDA, but that there is still a lot of work needed to turn this technology into a system that people can use. The company has declared that it in-tends to partner with companies in order to develop the technology into products that would be available for market. They suggest that these partners will be able to integrate the technology for a smart contact lens into apps that would make the measurements available to the wearer and their doctor.

This project illustrates the continued ambition of Google to develop technology and solutions that have potential to become intrinsic in the way health-care is delivered.

Google Unveils Contact Lens Sensor Capable of Measuring

Gluclose Levels

Industry News


For the fi rst time, Samsung has received FDA 510(k) clearance for its S Health app. The cat-egorisation of the clearance as a cardiology signal transmitter suggests that the clear-ance will allow S Health to interface with additional connected medical devices in the United States.

Samsung’s S Health app originally launched for Galaxy S III users in the UK in the summer of 2012. At the time, it received data from Lifescan’s OneTouch Ultra-Mini/UltraEasy Blood Glucose Meter via a USB con-nection. It also worked with Omron’s blood pressure monitors and one of its body composition scales via Bluetooth, and similar devices from A&D.

That release never found its way to the US, possibly because of FDA clearance concerns. S Health fi nally launched in the US with the Galaxy S4, but rather than connecting to third party medical devices, it relied on manual entry and purported to connect to three devices from Samsung: a weight scale, a heart rate strap, and a wrist-worn activity tracker. Those devices have still not been made available for purchase in the US, although the weight scale and heart rate strap can be purchased in

Samsung’s UK store.

“S Health periph-erals, specifi cally the

Heart Rate Monitor Band and Connected Weight

Scale, will be available before the end of the year,” the company

told MobiHealthNews in an email last August. “Sam-sung is working on perfecting the S Band and will an-nounce when we’re ready for its commercial launch.”

Meanwhile, Samsung has continued to work on the S Health app in several ways. In August, the company added gamifi ed avatar characters to the Korean version of the app. In October, Cigna and Samsung announced a multi-year partnership to enhance the app with con-tent from Cigna.

Samsung fi led for clearance in July 2013. If FDA clear-ance is the factor that has held the company back from launching the various UK device connectivity features in the United States, this clearance could pave the way for rapid changes for US Samsung customers.

Samsung Receives FDA Clearance for S Health App

The international organisation, composed of more than 300 or-ganisations from 59 countries, has announced a move to South Africa in 2014 and a co-location with the Johannesburg-based Praekelt Foun-dation, a long-standing leader in

the development of programs that promote social well-being. Organ-isation offi cials say the move “re-fl ects the alliance’s natural evolution to engage in projects and initiatives that focus on specifi c countries or regions, while still maintaining the

powerful global voice it has culti-vated through its relationship with the UN Foundation.”

“We’re proud of the catalytic role that the alliance has played in mov-ing the mHealth, as well as the

mHealth Alliance announces move to South Africa

10

Industry News

February 2014

broader global health and develop-ment communities, from the ques-tion of ‘whether’ mHealth ought to be pursued to the question of ‘how’ to most effectively implement it,” said Patty Mechael, the alliance’s executive director, in an interview with mHealth News. “In re-sponse to this shift, the alli-ance has been able to expand its focus and increasingly en-gage with mHealth on the country-level – from our work with the In-novation Working Group mHealth grantees in 14 countries throughout the world, to our engagement with the Government of Nigeria’s Saving One Million Lives initiative, and now to our exciting network of mHealth experts on the country and regional level through the mHealth Expert Learning Program (mHELP).”

“We recognise that with around 700 days left to achieve the current Millennium Development Goals (MDGs), there is need for even more concerted engagement on ca-pacity building for mHealth at the country and regional level,” she added. “When we made the deci-sion to move to the Global South, it was largely in response to the ques-tion ‘How do we best capitalise on this perishable moment?’”

Hosted by the United Nations Foundation, the alliance includes founding partners Norad, the Rock-efeller Foundation, the Vodaphone Foundation, HP and the GSM As-sociation.

Through the years, the mHealth Al-liance has been an active participant

in the HIMSS Media mHealth Sum-mit and delivered 26 catalytic grants and technical support to groups in 14 countries, reaching an estimated 31 million people around the globe with much-needed healthcare infor-mation and services. The alliance

also manages Health Un-bound, an on-line resource, and has pro-duced more than 20 pub-lications and

taken the lead in dozens of initia-tives for improving mHealth access in low- and middle-income nations.

“This move gives the alliance the opportunity to continue our impor-tant convening and global thought leadership work, but we’ll now be able to inform that work with more in-country expe-rience from the Global South,” Mechael said. “This is a tremen-dously positive de-velopment for the alliance and the entire community. It is something that many people have been asking for, and in con-versations with a diverse range of mHealth stake-holders we’ve received an over-whelmingly posi-tive response to this decision. We are looking for-ward to putting a

full transition plan into action next year.”

“The UN Foundation has been proud to provide a home for the alli-ance and act as its ‘incubator’ for the past fi ve years. This transition repre-sents a unique opportunity to move an initiative beyond incubation and to a point where it can have an even greater impact on achieving the MDGs,” said Kathy Calvin, the UN Foundation’s president and CEO, in a recent press release. “We look forward to staying engaged in the important work of mobile health and to supporting the alliance’s ef-forts to mainstream mobile tech-nology into health systems. We will also continue to engage in mHealth work through the Mobile Alliance for Maternal Action (MAMA).”

“This is a tremendously positive development for the alliance and the

entire community”

Industry News


“We focus on backing ambitious entrepreneurs who are using mobile computing to unlock opportunity and create new markets,” said Kev-in Talbot, co-founder and managing part-ner of Relay Ventures. “Walter’s vision for the future of consumer healthcare is profound and Scanadu stands to make a lasting impact on an industry ripe for disruption.”

“Scanadu is right at the heart of the next gen-eration of computing which combines mobil-ity, sensors, cloud and big data,” said Jerry Yang, co-founder of Yahoo! and founding partner of Ame Cloud Ventures. “I am bullish on Scanadu and its po-tential to revolutionise the way we think about our health.”

In July of this year, Scanadu closed a crowd-funding campaign on Indiegogo that quickly became the most fund-ed campaign in the plat-form’s history, raising more than $1.6 million. Those who participated in the campaign will be a crucial part of the company’s road to FDA approval by taking part on a voluntary basis in a usability study for

the Scanadu Scout™ in 2014.

Other participating in-vestors in the Series A round include Broe Group, Mindful Inves-tors and Redmile Group. With this round, Scana-du has raised $14.7 mil-lion in funding to date.

MEDICAL

ADVISORY

BOARD AND

FIRST CLINICAL

TRIALS PAVE THE

WAY TO MARKET

Furthering the company on its path to market, Scanadu will conduct its fi rst clinical trials for Scanadu Scout™ at the Scripps Translational Science Institute (STSI). Those studies will be conducted as part of the Wired for Health mobile trial, which includes pa-tients who live with dia-betes, hypertension and heart arrhythmia. This fi rst baseline study will

help design future con-trolled studies, and will be designed to empow-er adults via a Scanadu Scout™ to yield optimal blood pressure.

“The era of digital healthcare has arrived,” said Dr. Eric Topol, di-rector of the STSI and chief academic offi -cer for Scripps Health. “We are excited to bring Scanadu to Scripps to further the potential of this technology to im-prove lives.”

Scanadu’s newly estab-lished Medical Advisory Board comprises leaders with deep experience from across the medical, regulatory and research fi elds. These advisors all have a stake in advanc-ing consumer healthcare and will actively advise Scanadu on long-term strategy and facilitate the sharing of knowledge and innovation transfer between Scanadu and the larger research and

medical communities.

“We are more deter-mined than ever to make the fi rst medical tricorder a reality,” said Scanadu founder and CEO Walter De Brou-wer. “With the experi-ence and expertise of this group of investors and advisors, we know we’re in the right posi-tion to take our vision all the way and put FDA approved devices in the hands of consumers.”

Scanadu is developing a portfolio of products that put the experi-ence of an emergency room visit in the palm of your hand. Its fi rst device, the Scanadu Scout™, is a vital sign monitor that analyses, tracks and trends your vitals - temperature, re-spiratory rate, oximetry, ECG, systolic blood pressure and diastolic blood pressure - in 10 seconds. The company is also creating a dispos-able urine analysis test-ing platform, ScanaFlo, which works with your smartphone to offer a complete urine analysis test in minutes. Once FDA approved, it could also measure for preg-nancy complications, pre-eclampisa, gesta-tional diabetes, heart-related kidney problems and urinary tract infec-tions.


12

Industry News

February 2014

QardioArm...A Revolutionary Blood Pressure Monitor

Qardio, a London-based start-up, is launching two new medical devices designed for those at risk of cardiovascular disease. This spring (2014) it will launch a blood pressure monitor and an ECG moni-tor, a simple white plastic cross with an Apple-like aesthetic, which send information over the internet to a doctor.

Alexis Zervoglos, a director at Qardio, said it was “completely focused” on the cost-saving drives by the National Health Service in the UK and the Af-fordable Care Act. The ECG monitor costs $449 and can be used indefi nitely, compared with the current option which costs $2,000 for a single day, he said.

“We’re trying to reduce the number of unnecessary doctors’ visits when you go in and take time and the doctor tells you you’re well, as well as focusing on stopping the condition progressing to acute illness

when expenses increase exponentially,” he said.QardioArm is a smart blood pressure monitor that connects wirelessly to a smartphone or tablet. It is controlled through an app, which automatically tracks measurements and uploads them to a dedicat-ed cloud service where it can be shared with family, friends or doctors.

The device is a testament to simplicity. There are no buttons, no displays and no wires, just a sleek device whose design was inspired by a bound notebook. Unwrap it and it switches on, tap it and it pairs with your smartphone or tablet, press “START” and the rest is automatic.

The company have launched the product at CES 2014 and have had considerable early success from their launch campaign on Indiegogo, reaching $25,000 in the fi rst day. www.getqardio.com.

Industry News


Tactio Health GroupNot many digital health companies can boast mil-lions of users worldwide, across 16 different lan-guages, but for Montreal based Tactio Health Group that is the reality of their unique position within the mHealth industry.

Established in 2009 by serial entrepreneur Michel Nadeau, the company provides a suite of mobile software and systems that allow people to easily track their health and manage chronic conditions.

For Michel the use of disruptive technologies has been a founding philosophy in his career and some-thing that has been eloquently applied to the health-care market in the creation of the Tactio Health Group. A Professional engineer, Michel was award-ed the “Young Engineer Achievement Award” by the Canadian Council of Professional Engineers, in 2000, for his fi rst start-up which used software and off-the-shelf diagnostic equipment, to manage very large scale IP Telephony networks, an industry previ-ously dominated by expensive hardware and special-ised computers that barely talked to one another.

The vision for Michel with Tactio Health Group was to deliver a health platform that could be entirely

mobile. From the beginning the concept for the di-agnostic elements of the system was to utilise soft-ware and off-the-shelf connected health devices. In the early days of the company’s development, when connected healthcare was still very much in its infan-cy, this meant that there were very few products and solutions to work with. Fast forward to the present, and the growth of connected devices and mobile so-lutions in the burgeoning digital health market means that the solutions developed by Tactio are uniquely positioned to interface with a whole spectrum of different digital health solutions and devices.

The company has close to 4 million people world-wide across 16 different languages tracking their health on its iOS and Android health applications, which allow for connectivity with almost 75 differ-ent activity and lifestyle tracking devices, and off-the-shelf medical diagnostic tools. In addition to the consumer health market the company serves many large healthcare organisations with its turnkey mo-bile health management solution TactioRPM™, a solution that delivers healthcare applications ranging from corporate wellness to remote monitoring, all within a disruptive business model.

The TactioRPM™ system has three main compo-nents: RPM1000™, RPM6000™ and RPM7000™, collectively working together for the patient, clini-cian and secured cloud respectively. What makes the TactioRPM™ unique is the ability to bring together multi-vendor connected health devices, lifestyle vi-tals, physical activity and chronic disease measure-ments into a single mobile platform that applies science-based medical rules to every data point re-ceived. Providing instant feedback to patients as to where they stand, how well they are doing or how they are controlling their disease. The solution pro-vides Hospital Groups, Pharmacy Chains, Home Care Service Providers, Nursing Institutions and other care organisations, who need to make the ‘build or buy decision’, with all the components required to deploy a mobile health system and start integrating it with their EHR, Patient Portals, and other digital health systems.

Tactio Health Group


Cancer Research UK has unveiled Play to Cure: Genes in Space - a world-fi rst mobile phone game in which people across the globe will be able to help scientists unravel gene data to fi nd the answers to some of cancer’s toughest ques-tions.

When playing the interactive space-ship game, people will simultane-ously analyse Cancer Research UK’s gene data, highlighting genetic faults which can cause cancer – and ulti-mately help scientists develop new treatments.

Players must guide a fast-paced spaceship safely along a hazard-strewn intergalactic assault course to collect precious material called ‘Element Alpha’. Each time the player steers the spaceship to fol-low the Element Alpha path, this information is fed back to Cancer Research UK scientists – cleverly providing analysis of variations in gene data. Researchers can utilise this information to work out which genes are faulty in cancer patients – and ultimately develop new drugs that target them, speeding our prog-ress towards personalised medicine. Each section of gene data will be tracked by several different players to ensure accuracy.

Hannah Keartland, citizen science lead for Cancer Research UK, said: “Our world-fi rst Smartphone game is simply out of this world. Not only is it great fun to play – but every

single second gamers spend

directly helps our work to bring for-ward the day all cancers are cured. Our scientists’ research produces colossal amounts of data, some of which can only be analysed by the human eye – a process which can take years.

Genes in Space is trying to help sci-entists analyse data generated by a technology called gene microarrays. Researchers use gene microarrays to look for regions of our genome that are frequently faulty in differ-ent cancers – a sign that they may be responsible for causing the cancer. If scientists can fi nd genes that pro-mote cancer development, they can design drugs to stop them.

Gene microarrays are useful for an-alysing large genetic faults known as copy number alterations – when a whole section of the chromosome is gained or lost. As these large sec-tions of chromosomes may involve many different genes, scientists need a way to work out which are the ones driving cancer, and which

are just “passenger” genes along for the ride.

Microarrays let scientists analyse DNA from many thousands of tu-mour samples simultaneously, to fi nd the most frequent changes that are more likely to be the culprits. Many scientists are trying to use computer software to trawl through the huge amounts of data generated to spot the precise location of copy number changes, but in many cases these are not accurate enough. The human eye is still the best technol-ogy we have for picking up these patterns, and Play to Cure: Genes in Space, is harnessing this power.

Professor Carlos Caldas, senior group leader at the Cancer Research UK Cambridge Institute, Univer-sity of Cambridge, said: “Future cancer patients will be treated in a more targeted way based on their tumour’s genetic fi ngerprint and our team is working hard to understand why some drugs work and others won’t. But no device can do this re-

Innovative Smartphone Game Seeks to Discover Cancer Cures

16

Innovative Smartphone Game Seeks to Discover Cancer Cures

February 2014

FDA Issues Final Guidance on Mobile Medical Apps

September 2013 saw the U.S. Food and Drug Adminis-tration issue their long-awaited fi nal guidance for devel-opers of mobile medical applications.

The agency intends to exercise enforcement discretion (meaning it will not enforce requirements under the Federal Drug & Cosmetic Act) for the majority of mo-bile apps as they pose minimal risk to consumers. The FDA intends to focus its regulatory oversight on a sub-set of mobile medical apps that present a greater risk to patients if they do not work as intended.

Mobile apps have the potential to transform health care by allowing doctors to diagnose patients with potentially life-threatening conditions outside of traditional health care settings, help consumers manage their own health and wellness, and also gain access to useful information whenever and wherever they need it.

Mobile medical apps currently on the market can, for example, diagnose abnormal heart rhythms, transform smart phones into a mobile ultrasound device, or func-tion as the “central command” for a glucose meter used by a person with insulin-dependent diabetes.

“Some mobile apps carry minimal risks to consumer or patients, but others can carry signifi cant risks if they do not operate correctly. The FDA’s tailored policy pro-tects patients while encouraging innovation,” said Jef-frey Shuren, M.D., J.D., director of the FDA’s Centre for Devices and Radiological Health.

The FDA is focusing its oversight on mobile medical apps that are intended to be used as an accessory to a regulated medical device – for example, an application that allows a health care professional to make a spe-cifi c diagnosis by viewing a medical image from a pic-ture archiving and communication system (PACS) on a smartphone or a mobile tablet; or transform a mobile platform into a regulated medical device – for example, an application that turns a smartphone into an electro-cardiography (ECG) machine to detect abnormal heart rhythms or determine if a patient is experiencing a heart attack.

Mobile medical apps that undergo FDA review will be assessed using the same regulatory standards and risk-


USA

“Our [FDA] mobile medical app policy provides app developers with the clarity needed to support the continued development of these

important products”

liably and it would take a long time to do the job manually. Play to Cure: Genes in Space will help us fi nd ways to diagnose and treat cancer more precisely – sooner.”

Dr Harpal Kumar, Cancer Research UK’s chief executive, said: “We’re enormously proud to launch our fi rst mobile phone game which we believe will build on the great

progress we’re making to discover and develop the most effective new treatments for all cancers.

“This is ambitious – it’s no mean feat combining the most advanced genetic data with cutting-edge gam-ing technology. But Cancer Research UK will go to whatever lengths pos-sible to pursue the most innova-tive approaches to increase survival

from cancer.

“And now we’re calling on our sup-porters to join in by asking everyone to give up fi ve minutes to play this fantastic game and help us discover cures for cancer sooner.”

For more information and to down-load the game visit: www.genes-in-space.org.



based approach that the agency applies to other medical devices. The agency has stated that it does not regulate the sale or general consumer use of smartphones or tablets nor does it regulate mobile app distributors such as the ‘iTunes App store” or the “Google Play store.”

“We have worked hard to strike the right balance, reviewing only the mobile apps that have the potential to harm con-sumers if they do not function properly,” said Shuren. “Our mobile medical app policy pro-vides app developers with the clarity needed to support the continued development of these important products.”

The agency has cleared about 100 mobile medical applica-tions over the past decade; about 40 of those were cleared in the past two years.

The following extracts from the guidance re-port sets out the type of apps that the FDA consid-er may meet the defi nition of medical device but for which FDA intends to exercise enforcement discretion, and those that the department will not consider to be a medical device and therefore outside of the regulatory scope. That is not to say that these applications will not have to meet other regulatory requirements.

Examples of mobile apps that are NOT considered medical devices

This extract provides a representative list of mobile app functionalities to illustrate the types of mobile apps that could be used in a healthcare environment, in clinical care or patient management, but are not considered medical devices. Because these mobile apps are not con-sidered medical devices, FDA does not regulate them. The FDA understands that there may be other unique and innovative mobile apps that may not be covered in this list that may also constitute healthcare related mo-bile apps. This list is not exhaustive; it is only intended to provide clarity and assistance in identifying when a mobile app is not considered to be a medical device.

Specifi c examples of mobile apps that FDA does not consider to be devices and with no regulatory require-ments under the current laws administered by FDA in-clude:

1. Mobile apps that are intended to provide access to electronic “copies” (e.g., e-books, audio books)

of medical textbooks or other reference materials with generic text search

capabilities. These are not de-vices because these apps are

intended to be used as ref-erence materials and are not intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease by facilitating

a health professional’s as-sessment of a specifi c pa-

tient, replacing the judgment of clinical personnel, or per-

forming any clinical assessment. Examples include mobile apps that are:

• Medical dictionaries;• Electronic copies of medical textbooks or lit-

erature articles such as the Physician’s Desk Ref-erence or Diagnostic and Statistical Manual of Mental Disorders (DSM);

• Library of clinical descriptions for diseases and conditions;

• Encyclopedia of fi rst-aid or emergency care in-formation;

• Medical abbreviations and defi nitions;• Translations of medical terms across multiple

languages.

2. Mobile apps that are intended for health care pro-viders to use as educational tools for medical training or to reinforce training previously received. These may have more functionality than providing an electronic copy of text (e.g., videos, interactive diagrams), but are not devices because they are intended generally for user education and are not intended for use in the diagnosis of disease or other conditions, or in the cure, mitiga-tion, treatment, or prevention of disease by facilitating a health professional’s assessment of a specifi c patient,


Mobile apps have the potential

to transform healthcare by allowing doctors to diagnose patients with

potentially life-threatening conditions outside of traditional healthcare

settings...

18


February 2014

replacing the judgment of clinical personnel, or per-forming any clinical assessment. Examples include mo-bile apps that are:

• Medical fl ash cards with medical images, pictures, graphs, etc.;

• Question/Answer quiz apps;• Interactive anatomy diagrams or videos;• Surgical training videos;• Medical board certifi cation or recertifi cation

preparation apps;• Games that simulate various cardiac arrest sce-

narios to train health professionals in advanced CPR skills.

3. Mobile apps that are intended for general patient edu-cation and facilitate patient access to commonly used reference information. These apps can be patient-spe-cifi c (i.e., fi lters information to patient-specifi c charac-teristics), but are intended for increased patient aware-ness, education, and empowerment, and ultimately support patient-centered health care. These are not de-vices because they are intended generally for patient ed-ucation, and are not intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease by aiding clinical decision-making (i.e., to facilitate a health professional’s assessment of a specifi c patient, replace the judgment of a health professional, or perform any clinical assess-ment). Examples include mobile apps that:

• Provide a portal for healthcare providers to dis-tribute educational information (e.g., interactive diagrams, useful links and resources) to their patients regarding their disease, condition, treat-ment or up-coming procedure;

• Help guide patients to ask appropriate questions to their physician relevant to their particular dis-ease, condition, or concern;

• Provide information about gluten-free food products or restaurants;

• Help match patients with potentially appropriate clinical trials and facilitate communication be-tween the patient and clinical trial investigators;

• Provide tutorials or training videos on how to ad-minister fi rst-aid or CPR;

• Allow users to input pill shape, color or imprint and displays pictures and names of pills that match this description;

• Find the closest medical facilities and doctors to the user’s location;

• Provide lists of emergency hotlines and physi-cian/nurse advice lines;

• Provide and compare costs of drugs and medical products at pharmacies in the user’s location.

4. Mobile apps that automate general offi ce operations in a health care setting and are not intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease. Examples include mobile apps that:

• Determine billing codes like ICD-9 (international statistical classifi cation of diseases);

• Enable insurance claims data collection and pro-cessing and other apps that are similarly adminis-trative in nature;

• Analyse insurance claims for fraud or abuse;• Perform medical business accounting functions

or track and trend billable hours and procedures;• Generate reminders for scheduled medical ap-

pointments or blood donation appointments;• Help patients track, review and pay medical

claims and bills online;• Manage shifts for doctors;• Manage or schedule hospital rooms or bed spac-

es;• Provide wait times and electronic check-in for

hospital emergency rooms and urgent care facili-ties.

5. Mobile apps that are generic aids or general purpose products. These apps are not considered devices be-cause they are not intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease. Examples include mobile apps that:

• Use the mobile platform as a magnifying glass (but are not specifi cally intended for medical pur-poses);

• Use the mobile platform for recording audio, note-taking, replaying audio with amplifi cation, or other similar functionalities;

• Allow patients or healthcare providers to inter-act through email, web-based platforms, video or other communication mechanisms (but are not




specifi cally intended for medical purposes);• Provide maps and turn-by-turn directions to

medical facilities.

Examples of mobile apps for which FDA intends to exercise enforcement discretion

This extract provides examples of mobile apps that MAY meet the defi nition of medical device but for which FDA intends to exercise enforcement discretion. These mobile apps may be intended for use in the di-agnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease. Even though these mobile apps MAY meet the defi nition of medical device, FDA intends to exercise enforcement discretion for these mobile apps because they pose low-er risk to the public.

The FDA understands that there may be other unique and innovative mobile apps that may not be covered in this list that may also constitute healthcare related mo-bile apps. This list is not exhaustive; it is only intended to provide clarity and assistance in identifying the mo-bile apps that will not be subject to regulatory require-ments at this time:

• Mobile apps that help patients with diagnosed psychiatric conditions (e.g., post-traumatic stress disorder (PTSD), depression, anxiety, obsessive compulsive disorder) maintain their behavioral coping skills by providing a “Skill of the Day” behavioral technique or audio messages that the user can access when experiencing increased anx-iety;

• Mobile apps that provide periodic educational information, reminders, or motivational guidance to smokers trying to quit, patients recovering from addiction, or pregnant women;

• Mobile apps that use GPS location information to alert asthmatics of environmental conditions that may cause asthma symptoms or alert an ad-diction patient (substance abusers) when near a pre-identifi ed, high-risk location;

• Mobile apps that use video and video games to motivate patients to do their physical therapy ex-ercises at home;

• Mobile apps that prompt a user to enter which

herb and drug they would like to take concurrent-ly and provide information about whether inter-actions have been seen in the literature and a sum-mary of what type of interaction was reported;

• Mobile apps that help asthmatics track inhaler usage, asthma episodes experienced, location of user at the time of an attack, or environmental triggers of asthma attacks;

• Mobile apps that prompt the user to manually enter symptomatic, behavioral or environmen-tal information, the specifi cs of which are pre-defi ned by a health care provider, and store the information for later review;

• Mobile apps that use patient characteristics such as age, sex, and behavioral risk factors to provide patient-specifi c screening, counseling and pre-ventive recommendations from well-known and established authorities;

• Mobile apps that use a checklist of common signs and symptoms to provide a list of possible medical conditions and advice on when to con-sult a health care provider;

• Mobile apps that guide a user through a question-naire of signs and symptoms to provide a rec-ommendation for the type of health care facility most appropriate to their needs;

• Mobile apps that record the clinical conversation a clinician has with a patient and sends it (or a link) to the patient to access after the visit;

• Mobile apps that are intended to allow a user to initiate a pre-specifi ed nurse call or emergency call using broadband or cellular phone technology;

• Mobile apps that enable a patient or caregiver to create and send an alert or general emergency no-tifi cation to fi rst responders;

• Mobile apps that keep track of medications and provide user-confi gured reminders for improved medication adherence;


“Some mobile apps carry minimal risks to consumer or patients, but others can carry signifi cant risk if they do not operate correctly. The FDA’s tailored policy protects patients while encouraging innovation”

20


February 2014

• Mobile apps that provide patients a portal into their own health information, such as access to information captured during a previous clinical visit or historical trending and comparison of vi-tal signs (e.g., body temperature, heart rate, blood pressure, or respiratory rate);

• Mobile apps that aggregate and display trends in personal health incidents (e.g., hospitalisation rates or alert notifi cation rates);

• Mobile apps that allow a user to collect (elec-tronically or manually entered) blood pressure data and share this data through e-mail, track and trend it, or upload it to a personal or electronic health record;

• Mobile apps that provide oral health reminders or tracking tools for users with gum disease;

• Mobile apps that provide prediabetes patients with guidance or tools to help them develop bet-ter eating habits or increase physical activity;

• Mobile apps that display, at opportune times, im-ages or other messages for a substance abuser who wants to stop addictive behavior;

• Mobile apps* that are intended for individuals to log, record, track, evaluate, or make decisions or behavioral suggestions related to developing or maintaining general fi tness, health or wellness, such as those that:

» Provide tools to promote or encourage healthy eating, exercise, weight loss or other activities generally related to a healthy life-style or wellness;

» Provide dietary logs, calorie counters or make dietary suggestions;

» Provide meal planners and recipes; » Track general daily activities or make exer-

cise or posture suggestions; » Track a normal baby’s sleeping and feeding

habits; » Actively monitor and trend exercise activ-

ity; » Help healthy people track the quantity or

quality of their normal sleep patterns; » Provide and track scores from mind-chal-

lenging games or generic “brain age” tests; » Provide daily motivational tips (e.g., via

text or other types of messaging) to reduce stress and promote a positive mental out-look;

» Use social gaming to encourage healthy lifestyle habits;

» Calculate calories burned in a workout.

*When these items are not marketed, promoted or in-tended for use in the diagnosis of disease or other con-ditions, or in the cure, mitigation, treatment, or preven-tion of disease, or do not otherwise meet the defi nition of medical device, FDA does not regulate them. When they are marketed, promoted or intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, or oth-erwise meet the defi nition of medical device, FDA in-tends to exercise enforcement discretion.

The publication of this report signifi es a step change for developers of applications and services that rely upon mobile delivery for provision of healthcare solu-tions. The FDA’s clear position allows for developers to more easily interpret the regulatory landscape and to determine the best strategy to ensure compliance.

Ref: Mobile Medical Applications – Guidance for Industry and Food and Drug Administration Staff. U.S Department of Health and Human Ser-vices Food and Drug Administration. September, 2013. For full report go to: http://www.fda.gov/medicaldevices/productsandmedicalprocedures/connectedhealth/mobilemedicalapplications

The


Contact Matthew at [email protected] oron +44 (0)1756 709605 for more details

This could be your advertisement



A 2013 study conducted by Cis-co demonstrates the growing acceptance amongst consumers for the provision of healthcare services delivered using tech-nology.

The results of the report dem-onstrate that as information, technology, bandwidth, and integration of the network be-come the centre of the “new world,” both human and digital aspects are key parts to the over-all patient experience. These components lead to more real-time, meaningful patient and doctor interaction.

The survey studied the views of consumers and healthcare decision makers (HCDMs) on sharing personal health data, participating in in-person medi-cal consultation versus remote care and using technology to make recommendations on per-sonal health. Views on these topics differed widely between the two groups (consumers and HCDMs) and the ten geogra-phies surveyed. The global re-port conducted in early 2013, includes responses from 1,547 consumers and HCDMs across ten countries. Additionally, consumers and HCDMs were

polled from a wide variety of backgrounds and ages within each country.

PRIVACY AND

PERSONAL SERVICEThis portion of the survey fo-cused on how comfortable con-sumers and HCDMs are with sharing personal health and medical information for a better experience. Overall, health care practitioners were more willing to share personal and private information than patients or other citizens. The degree to which all clinicians, patients and citizens are willing to share per-sonal health information and to improve the quality of care var-ies by geography.

Key fi ndings: » Most consumers are com-

fortable with having all of their health records securely available on the cloud except for those in Germany and Japan.

» Nearly half of the consum-ers surveyed and two-thirds of the HCDMs surveyed would be comfortable shar-ing and receiving health in-formation through social media channels.

» Most North American consumers – nearly eighty percent – are comfortable submitting a complete medi-cal history and diagnostic information to help ensure they have all the informa-tion available to treat them and offer the most personal diagnosis possible. Ninety percent of Russian con-sumers expressed comfort, while fi fty percent of Japa-nese customers expressed discomfort with the idea of submitting DNA.

» Though roughly half of HCDMs believe data protec-tion is adequate for protect-ing health and medical data privacy in their respective countries, fewer consum-ers believe data protection is adequate. The largest dis-crepancy among consumers and HCDMs is observed in Brazil, as approximately two-thirds of consumers feel data protection in their country is adequate while about 8 in 10 HCDMs believe otherwise. In the U.S, close to sixty per-cent of HCDMs expressed confi dence while only forty percent of consumers shared that sentiment.

Cisco Study Reveals 74 Percent of Consumers Open

to Virtual Doctor Visit

USA

22

Cisco Study: 74% of Consumers Open to Virtual Doctor Visit

February 2014

IN-PERSON VS. VIRTUAL

CUSTOMER SERVICEThe report fi ndings challenged the assumption that face-to-face interaction is always the preferred health care experience. While con-sumers still depend heavily on in-person medical treatments, given a choice between virtual access to care and human contact, three quarters of patients and citizens would choose access to care and are comfortable with the use of technology for the clinician inter-action.

Key fi ndings: » Three quarters of consumers

indicate they are comfortable with the idea of communicat-ing with doctors using technol-ogy instead of seeing them in person.

» In China, Russia and Mexico, nearly three-quarters of con-sumers would be comfortable communicating with a special-ist using virtual technology (e.g. video chatting, text mes-saging) for a health condition.

» More than 60 percent of con-sumers from Germany, Japan and the U.S. indicate being comfortable with the idea of being treated by a specialist us-ing virtual technology.

» Patients and citizens will give up anything, including cost, convenience and travel, to be treated at a perceived leading health care provider to gain access to trusted care and ex-pertise.

HOW MUCH DO

CONSUMERS AND

HCDMS RELY ON

TECHNOLOGY? As machines become connected and networked, they play an even larger role in the overall health care experience. Interest in accessing health information on mobile de-vices is growing rapidly and is the No. 1 topic of consumer interest In Mexico, Brazil and China.

Key fi ndings: » About 4 in 10 consumers in-

dicate they would be interested in receiving recommenda-tions about doctors, hospitals, medication, etc., automatically through their computer or mo-bile devices.

» While the majority of con-sumers who have health care apps on their mobile devices indicate their apps are related to healthy eating and exercise, 25 percent indicate they are for chronic disease management.

» Nearly one in four indicates receiving health-related re-minders on their device.

“The patient and care provider experiences are top of mind in health care around the world. Due to the increasing conver-gence of the digital and physical, there is an opportunity to provide increased collaboration and infor-mation sharing among providers to improve the care experience and operate more effi ciently,” said Kathy English, Public Sector and Healthcare Marketing, Cisco.

Cisco Study: 74% of Consumers Open to Virtual Doctor Visit


WebMD Health Corp the leading source of health information, an-nounced at the mHealth Summit that it is expanding the beta pro-gram for its Patient Instructions feature, which enables physicians who use Medscape Mobile to se-curely send education and instruc-tions on thousands of conditions, procedures and drugs to their pa-tients who use the WebMD app for iPhone, or access WebMD on a PC or other mobile device.

“WebMD is partnering with inno-vative companies like Qualcomm and developing new products and services like Patient Instructions to make health information more actionable and accelerate consum-er-provider connectivity,” said David Schlanger, Chief Executive Offi cer at WebMD. “As consum-ers and providers assume more fi nancial risk for the provision of care, WebMD believes that facili-tating this kind of engagement is essential to producing quality out-comes and reducing the cost of care.”

Qualcomm Life and WebMD fi rst announced plans to enable consumers to upload biometric data to WebMD in an effort to proactively manage health and fi tness, as well as chronic health conditions such as obesity and diabetes, at the HIMMS confer-

ence in March 2013. WebMD will introduce its new app and set of services that deliver personalised content and actionable insights, as well as a new online storefront where consumers will be able to purchase a variety of biometric devices from the industry’s lead-ing providers, in the fi rst quarter of 2014.

“WebMD is uniquely positioned to facilitate consumer-provider connectivity and accelerate the roll-out of quantifi ed health so-lutions to the masses,” said Bill Pence, EVP, Chief Technology Offi cer and Chief Operating Of-fi cer, WebMD. “Our Patient In-structions service will enable consumers and their providers to jointly manage their care, and our partnership with Qualcomm Life will provide consumers with a more personalised WebMD expe-rience that makes biometric data more actionable.”

As part of the expanded Patient Instructions beta, Medscape pro-viders can simply select from a set of over 4,200 clinically reviewed patient instructions and provide them to patients securely and confi dentially by enabling patients to access and review the informa-tion in the WebMD app or in their browser. In addition, providers can manage lists of patients and

save favorite instruction sets for easy retrieval during the course of their daily workfl ow. WebMD expects to expand this capability over time to allow for more cus-tomisation and other types of in-formation and services to be sent securely to patients.

WebMD initiated the Patient In-structions beta in September 2013 to a limited number of Medscape Mobile physician users, and early feedback regarding features, func-tionality, workfl ow and the overall user experience confi rmed strong interest in, and demand for, this capability. The beta is being ex-panded now to provide WebMD with additional feedback, which will be used to inform future product enhancements.

BIOSENSICS AND

AVENTYN INC.

ANNOUNCE A

PARTNERSHIP TO

OFFER A MOBILE

REMOTE MONITORING

PLATFORM FOR

PHYSICAL ACTIVITY,

ECG, GAIT, AND

POSTURE

PAMSys™ is a unique platform for long-term objective evaluation of individual’s physical activity during everyday life. Combined

News Highlights from the 2013 mHealth Summit

24February 2014

with Aventyn’s Vitalbeat chronic disease management ecosystem, this web-based solution will en-able hospitals, physician offi ces, university medical centres, home care providers, hospices and clini-cal researchers to remotely moni-tor patient physical activity and capture relevant changes in activi-ties of daily living. The patented PAMSys technology is based on over 10 years of research sup-ported in part by the National Institutes of Health. PAMSys is a lightweight, wearable motion sensor that uses advanced signal processing algorithms and novel biomechanical models of human motion to monitor body position, evaluate walking patterns, auto-matically detect falls, and assess sit-to-stand and stand-to-sit pos-tural transitions.

Vitalbeat™ is a simple, cost ef-fective remote patient monitor-ing and integrated chronic disease management system for manag-ing long term conditions. With Vitalbeat and advanced telehealth sensors like PAMSys, clinicians remotely monitor patient vital signs and activity levels securely using smartphones and tablet computers, and design long term disease management programs for co-morbidities associated with heart failure, diabetes, obesity, and many other conditions. Patients

manage diet, physical activity, and medication compliance by confi g-urable alerts and reminders based on personalised thresholds, goals and clinical requirements. Patient electronic health record data in-tegrates with Vitalbeat along with social networking sites like Twit-ter and Facebook to provide care continuity, group sharing and net-working with clinicians, family and like-minded friends.

PAMSys™ with Vitalbeat™ is selectively available for clinical research and commercial deploy-ment by healthcare providers and payers. The two companies plan to provide remote patient moni-toring solutions and subscription services for a variety of disease conditions to be billed under ex-isting CPT codes for ambulatory electrocardiographic monitoring, education and patient self-man-agement, and fall risk assessment, as well as new CPT codes based on clinical outcomes from ongo-ing and future clinical trials.

VISI MOBILE

PRESENTED DURING

ERIC DISHMAN’S

MHEALTH SUMMIT

KEYNOTE ADDRESS

Following his keynote address at the mHealth Summit in Washing-

ton, D.C., Eric Dishman, Intel Fel-low and general manager of Intel’s Health & Life Sciences Group, reiterated Intel’s belief that next generation technology for con-tinuous monitoring of patient vi-tal signs, such as ViSi® Mobile by Sotera® Wireless shown live dur-ing the keynote, could transform the delivery of care and benefi t health outcomes, patient satisfac-tion, and healthcare costs.

“A great example of mobile tech-nology that holds promise to im-prove patient safety and the whole experience of being a high-risk patient is continuous monitoring of vital signs in the hospital,” said Dishman. “Rather than incon-venient manual spot checks that yield intermittent data, this mo-bile technology makes it possible for the fi rst time to monitor all vital signs continuously through a small, wearable device that trans-mits data wirelessly.”

A fi nalist for CONNECT’s 2013 “Most Innovative Product” Award, the ViSi Mobile System packs powerful patient monitor-ing capabilities into a 4 ounce wrist-worn device ensuring clini-cians anytime, anywhere access to accurate and trended vital sign in-formation. With the recent addi-tion of continuous, cuffl ess non-Continued on page 26


invasive blood pressure (cNIBP) technology, the ViSi Mobile Sys-tem is the fi rst body-worn moni-tor able to non-invasively measure all core vital signs on a highly ac-curate, beat-to-beat basis.

Today, most patients who re-side on general medical/surgical fl oors in hospitals lack access to continuous monitoring and in-stead receive infrequent vital sign spot checks throughout the day and night approximately every 4 hours.

To collect vital sign measurements hospital clinicians must wheel monitoring equipment from pa-tient to patient and use various tools, such as a blood pressure cuff, and fi nger clip to obtain vital sign readings at fi nite time points. Patients often complain that the process is disturbing, especially to measure blood pressure with a cuff, while clinicians must rely on limited, sometimes hours-old data to evaluate their patients’ health.

“Spot checks are labor-intensive and analogous to driving a car and opening your eyes every 4 hours to make sure you are still on the road,” said Gunnar Trommer, Ph.D., Sotera Wireless vice presi-dent of marketing. “Potentially dangerous patient deterioration can occur unnoticed in the in-tervals between manual vital sign spot check measurements.”

Trommer believes that the ViSi Mobile System’s unique capa-bilities will eventually change the standard of care by which non-ICU hospital patients will be

monitored in the very near future:

ViSi Mobile is the only monitor on the market that allows contin-uous monitoring of all fi ve core vital signs (SpO2/PR, ECG/HR, Resp, BP, Skin Temp) with ICU-level accuracy in a wearable pack-age that does not limit patient mobility.

The nurse has access to the vi-tal sign information “whenever

wanted”, meaning he or she can view patients’ vital signs on the wrist monitor itself, or on various remote viewing devices (central station, mobile tablet PC). The vital sign information can also be automatically fed into the patient record in the EMR.

If a patient deteriorates, and a no-tifi cation to the nurse is needed to prevent worsening of the pa-tient’s condition, an automatic

alert is sent to the remote view-ing/alarming device of choice.The resulting clinical / economi-cal value includes:

» Avoiding expensive, prevent-able adverse events.

» Keeping patients in lower cost beds (e.g. out of the ICU) and allowing for faster patient dis-position due to greater avail-ability of “monitored beds” on the general fl oors.

» Not waking patients up in the middle of the night only to check their vitals, allowing for restful sleep – which will also increase fi nancially relevant pa-tient satisfaction.

» More effi cient use of clini-cians’ time – avoiding human error and time gaps in measur-ing, documenting and inter-preting vital signs.

“Eric Dishman’s vision of care anywhere aligns with our long-term strategy of connecting patients to clinicians across a multitude of healthcare settings – including the home. Adapting our healthcare system to such change begins in the hospital, where the advantages and benefi ts of com-prehensive and wireless patient monitoring are imminent,” said Trommer.


The


Find out what’s on across the mHealth industry in our Upcoming Events section on page 50

26

News Highlights from the 2013 mHealth Summit

February 2014

INTRODUCTION

The use of mobile and wireless technolo-gies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service deliv-ery (...) A powerful combination of fac-tors is driving this change. These include rapid advances in mobile technologies and applications, a rise in new opportunities for the integration of mobile health into existing eHealth services and the contin-ued growth in coverage of mobile cellular networks [1].

To date, no standardised defi nition of mHealth has been established. According to the National Institu-tion of Health in the United States, it can be defi ned as ‘using mobile and wireless devices to improve health outcomes, healthcare ser-vices and health research’ [2]. It is a subcomponent of the larger disci-pline of eHealth [3], which in turn describes the use of Information and Communication Technologies (ICT) for health purposes. Due to its wider accessibility via mobile de-vices – especially smartphones and self-monitoring gadgets - mHealth is a key emergent area in health today [4]. It includes solutions for direct care provision in health ser-vices, real-time monitoring of pa-tients’ conditions, the provision of healthcare information to health professionals, patients and re-

searchers, and it can support public health, e.g. by collecting communi-ty and clinical health data.

As stressed on the European Commission’s Digital Agenda for Europe website, ‘mobile health doesn’t focus exclusively on the de-vice, but on the fact that the infor-mation and data is mobile (…) The information is able to be collected wherever it is needed and transmit-ted wherever it needs to go,’ [5]. A commercially lucrative sector with global reach, mHealth could be-come an important growth market under the Digital Agenda [6], as evidenced by hundreds of smart-phone ‘apps’ placed on the market every week.

But mHealth’s adaptability and faculty to provide information ‘on the go’ also poses new challenges for healthcare. The Commission’s eHealth Action Plan 2012-2020, rightly declares that ‘(…) such ap-plications potentially offer infor-mation, diagnostic tools, possi-bilities to ‘self-quantify’ as well as new modalities of care. They are blurring the distinction between the traditional provision of clinical care by physicians, and the self-ad-ministration of care and wellbeing.’ [7] While the extent of its impact on health systems is diffi cult to predict, mHealth is set to play a

role in renegotiating the relation-ship between health professionals and patients. In so doing it trig-gers ethical questions about who is steering and managing health, and what this means for society.

Crucially, while mHealth holds potential for improving access to healthcare services and mitigating health inequalities, it cannot sub-stitute face-to-face contact. Like other eHealth solutions, it is best deployed as a complementary tool for the benefi t of end users. Pro-vided that the challenges described below can be overcome, It can help improve quality and continuity of care [8], inter alia by facilitating ele-ments of healthcare provision and remote monitoring, allowing cross-border and interregional collabo-ration between health institutions and professionals, and providing more user-friendly and compre-hensible ways for different catego-ries of patients to manage health, including disadvantaged groups in need of ‘tailored’ support.

Recent Developments in

Healthcare

In the majority of EU Member States healthcare systems are in need of reform as a result of bud-

EPHA Briefi ng on Mobile HealthThe European Public Health Alliance (EPHA) is the European Platform bringing together public health organisations representing health professionals, patients groups, health promotion and disease specifi c NGO’s, academic groupings and other health associations. This is the full version of the briefi ng reproduce with permission of the EPHA.

EUROPE


EUROPE EPHA Briefi ng on Mobile Health


get squeezes and workforce short-ages, coupled with ageing popula-tions and the simultaneous rise in chronic diseases. In the absence of political prioritisation, the public sector is forced to save healthcare costs while trying to cater to an increasingly diverse clientele de-manding quality services. Hence policy makers are looking to foster innovation and effi ciency in health-care delivery.

Many patients and older people also wish to be more engaged in their own care. In order to take ad-vantage of personalised treatment regimes they require information and state-of-the-art technology. In this regard, mHealth can offer customised ‘toolkits’ for predictive, participatory and preventive care.

While arguably, Europeans are becoming more informed about health thanks to online informa-tion, individual circumstances re-garding access to technology, as well as competences regarding ICT use and applying health knowl-edge, still differ greatly between social groups, regions and Member States. About a quarter of Europe-ans have never used the Internet [9], and there are signifi cant differenc-es between Member States when it comes to computer access at home and on mobile devices [10]. Those who use eHealth regularly, confi -dently and effi ciently can be more aware of the treatment options, medicines and medical devices [11] available to them. In stark contrast, most people struggle with various literacy problems, and lack of sup-port and empowerment can lead to misunderstandings when putting

online information into con-

text, and to inaccuracies when ap-plying it to health decision-making. For example, self-diagnosis and treatment based on data derived from mobile technologies can be harmful if fi ndings are not dis-cussed with qualifi ed health pro-fessionals. The challenge is to fi nd the right balance between conven-tional and ICT-enabled health-care that can support the work of health professionals while empowering patients and expanding their (e)health literacy.

That said, the foun-dations for the digital-isation of hea l thcare are already well in place – electronic health records (EHR) and wireless communication and re-porting devices are commonplace in many EU Member States. While health professionals may not al-ways easily embrace new technol-ogy, they share the hope of many patients that it can make routine tasks easier.

mHealth Applications

Currently mHealth can fulfi l a number of different functions, many of which have been imple-mented in the developing world where mobile phones are funda-mental due to the absence of con-ventional health system technolo-gies.

Indeed the ability to perform sim-ple tasks, such as sending remind-

ers by text for ensuring treatment compliance (e.g., patients receiving SMS messages about the correct time and way of taking a medicine) and keeping medical appointments, is one of the strengths of mHealth. At the same time, sophisticated technologies merging the intricate features of eHealth and medical devices provide the backbone for functions involving real-time re-

mote monitoring and transfer of patient data in outpa-

tient settings, e.g. for managing chronic

diseases. A con-nected function concerns sup-porting health i n f o r m a -tion systems and providing

po in t -of -ca re support. More-

over, broader aims in support of public

health management, e.g. data collection and disease surveil-lance to control pandemics, can be achieved.

Some specifi c examples (including wireless health and electronic care solutions) include the following, which testify to the increased con-vergence of health technologies and tools [12]:

» Medical devices acting as re-mote patient monitors – used in clinical, home, mobile & other environments

» Software applications allowing patients to upload or download health information at any time

» Clinical body area network sen-sors for wireless capture and

Remote access to

centralised EHRs can reduce administrative

burdens by 20 to 30%


28

EPHA Briefi ng on Mobile Health

February 2014

forwarding of physiological data for further analysis

» Medical implants for neuro-muscular micro-stimulation techniques: used in order to re-store sensation, mobility & oth-er functions to paralysed limbs and organs

» Medical device data systems allowing the transfer, stor-age, conversion or display of medical data through wired or wireless hubs, smartphones or broadband enabled products.

» Mobile diagnostic imaging ap-plications making it possible for doctors to send or review medi-cal images from virtually any place and at any time

» Patient care portals which can be accessed everywhere, allow-ing patients to share experienc-es, engage in self-reporting and self-management

» Accessible clinical decision support tools allowing doctors to help patients in real time with diagnosis, treatment options, necessary medical calculations at the point of care

» Broadband enabled health in-formation technology infra-structures for healthcare pro-viders to share electronic health information across institutions and geography

Since smartphones and other de-vices enable end users to be both senders / receivers of information and active agents in data genera-tion, mHealth is arguably more en-gaging and interactive than other

health technologies.

mHEALTH

STAKEHOLDERS

Chances are that over time, mHealth will become routine as it refl ects wider societal trends to-wards mobility and individualisa-tion, coupled with issue-specifi c social networks. Especially for young people, there is no distinc-tion anymore between on- and of-fl ine identities. This phenomenon heralds profound changes for healthcare.

Apart from the principal stake-holders mentioned below, there is a broader range of players taking part in mHealth, including other formal and informal health provid-ers, regulators, NGOs and manu-facturers of products able to con-verge with mHealth.

Patient-consumers

mHealth can be a potentially use-ful tool for patients and consum-ers, whether by providing more control over disease management and treatment, assisting parents in safeguarding their children’s health, or by helping individuals improve their fi tness and wellbeing. Conve-nience features such as managing hospital and health professionals’ appointments, updating prescrip-tions, accessing personal health re-cords and advice hotlines facilitate patients’ engagement with health providers and can heighten cus-tomer satisfaction.

By being able to self-monitor vital signs (e.g. blood pressure, pulse) and condition-specifi c measures

(e.g. glucose rate) through smart-phone ‘apps’ and other gadgets, people are able to keep an eye on their health. They may stimulate individuals to become more ‘am-bitious’ about their health – even competitive in a group setting – as they encourage users to practice self-control, e.g. by attaining daily or weekly exercise targets. Howev-er, caution must be taken when it comes to self-testing and diagnos-ing given the differences in quality, reliability and capability of mobile technologies, especially phones.

A number of ‘apps’ are designed to restore patients’ personal auton-omy, e.g. people with dementia and Alzheimer’s, while others encour-age people to control their health behaviours, for instance intake of alcohol, smoking and nutrition.

While mobile technology can benefi t the immobile (e.g. remote monitoring via interactive termi-nals installed at home) it also holds appeal for those habitually mo-bile themselves: travellers can ac-cess up-to-date information about health threats, such as disease out-breaks and epidemics, and they can transmit self-generated infor-mation to health professionals at home in case of problems.

Research undertaken by the Boston Consulting Group demonstrates that patients, when assuming more self-responsibility, generally be-come more (pro)active in improv-ing their health. 86% of women having adopted this approach undergo breast cancer screening (compared to an average of 57%) and 99% undergo cholesterol test-




ing (compared to an average of 55%). Meanwhile, proactive care results in a 10 percent reduction in primary and urgent care visits. [13]

Health Professionals

For health professionals, mHealth can also bring multiple benefi ts. In a climate of workforce short-ages and scarce support, they can be empowered by accessing accu-rate information and evidence any-where and anytime, while commu-nication with colleagues becomes

easier to better coordinate care.In addition, it allows for closer, more direct contact with patients. By being ‘virtually available’, health professionals can demonstrate their commitment, ask direct ques-tions and provide targeted advice in an unobtrusive way, which may help them better understand pa-tients’ concerns. Communication with patients living in geographi-cally isolated or underserved areas also becomes easier, and condi-tion- or community-specifi c health information can be sent directly to particular categories of patients.

The use of tablets and health gad-

gets at the bedside can help illus-trate conditions and reassure pa-tients that they are being looked after by competent staff. Health professionals are also able to in-stantly record and share vital infor-mation during consultations (e.g. diagrams, instructions).

It has been shown that monitor-ing and diagnostic ‘apps’ are more reliable if they involve transmis-sion of information to qualifi ed health professionals who analyse the information remotely. Given the range of tasks smartphones can perform – from recording to

planning and reporting on data – their use will likely become more common as bodily functions are monitored automatically. Another interesting use of apps supports, for instance, the identifi cation of medicines and of counterfeit prod-ucts by pharmacists.

Nevertheless, mHealth will not work if it creates new professional burdens. For example, overloading health professionals with addition-al data input/processing and elec-tronic communication tasks com-promises rather than boosts quality of care. That is why these devices must be designed according to end

users’ needs. Continuous profes-sional training in eHealth will also help build up confi dence in using new technology.

Vulnerable Groups

The rapid expansion of smart-phones is bringing the digital world closer to those who were hitherto excluded from ICT. This is be-cause they are portable, compact, multifunctional (including camera, texting, diary / logs, GPS, maps, entertainment, e-mail, etc.), and with easy user interfaces (e.g. touch screens). ‘Apps’ provide relevant information in a more condensed, practical, and intelligible fashion than traditional Internet content. Mobile content also tends to be more adapted to quick reading and sharing.

More importantly, smartphones are relatively affordable compared to other mobile technologies such as laptop computers or tablets al-though the cost of phones and re-lated charges is still high enough to make them off-limits to the poor in many parts of Europe.

While the ubiquity, speed of change and complexity of new technol-ogy can be overwhelming, older people may benefi t from mHealth solutions that are easy-to-use and that assist them in checking their conditions, combined with regu-lar supervision by qualifi ed health professionals. This can make them feel safer and more in control.

At least in theory, vulnerable groups such as migrants and other minority populations (e.g. Roma communities) can also benefi t from mHealth, e.g. by accessing

Thanks to mHealth, a larger percentage of the population can be

served, including vulnerable individuals who may be more comfortable using mobile devices as they allow them to

explore and ‘practise’ mHealth step-by-step, in their own time, and in informal

settings.


30


February 2014

tailored information in their own language(s) and reporting prob-lems. Given the plethora of diffi -culties (social, legal, discrimination, etc.) vulnerable individuals are sub-ject to, health is often neglected and pain endured. There is poten-tial for mHealth to reach out to people on the margins of society, e.g. by providing anonymous ad-vice, meaningful and multilingual content (e.g. respecting religious and cultural peculiarities) and loca-tion tracking for people in danger.The possibilities for customisation are extensive since mobile content

does not rely on traditional literacy skills. Instead, it can integrate pic-tograms, voice-recognition, video content, etc. If a concerted effort is made to ‘Include Everyone’ as recommended in the eHealth Task Force Report [14], mHealth could represent a step towards reducing health inequalities.

Conversely, much remains to be done to improve the availability and functionality of ‘apps’: each technology requires its own ap-proach regarding design and con-tent. Many are presently either too ‘cluttered’ or only available in Eng-lish, hence they remain inaccessible to the majority. It is also problem-atic that some require social media memberships as a prerequisite. Un-

surprisingly, those who make the most use of ‘apps’ are individuals living in technologically advanced Member States [15] while the poor and lesser educated have little if any exposure.

Industry

mHealth involves the IT and telecommunications sectors, the pharmaceutical industry, medical devices companies and consultan-cies. For all of them it represents an interesting market to tap into, especially in the current economic

climate in which healthcare is dif-fi cult to deliver without private in-vestments. At European level, the European Innovation Partnership on Active and Healthy Ageing [16] stimulates multi-sector partner-ships for providing eHealth and mobile health solutions, e.g. in the areas of ambient assisted living and domotics.

The market for mHealth ‘apps’ is still highly fragmented and im-mature. Many solutions are being developed without much consider-ation of health and social inclusion objectives. In 2012, the fi rst Eu-ropean Directory of Health Apps [17] was launched by the European Commission’s Directorate-General for Communications Networks,

Content and Technology (DG CONNECT). This repository of health and wellness apps reviewed by patient groups and consum-ers provides a status quo of what is available, with products ranging from the useful (e.g., toilet fi nder) to the quirky (e.g., yoga poses). In order to fi nd long-term viabil-ity and focus, solutions will need to have both mass appeal and be fl exible enough for tackling health inequalities.Clearly, fostering equitable mHealth depends on the extent to which end users are able to infl u-ence the policy-making and design process. mHealth takes eHealth to another level in the sense that it moves health into a consumer realm that can be diffi cult to con-trol and legislate, as the experience of unauthorised internet pharma-cies and bogus health websites has shown.

Hence, it will be crucial to develop ethical guidelines and sustainable business models in line with end users’ needs. Partnerships must be formed to ensure that stakehold-ers understand the stakes and con-straints (including legal, operation-al, security, educational and access issues), and to avoid that mHealth aggravates offl ine health inequali-ties in the face of mass unemploy-ment and austerity measures. [18]

Governments and Healthcare

Managers

mHealth is of importance to na-tional and regional policy makers as it promises signifi cant savings by providing services remotely and targeting specifi c population


While mHealth can create effi ciencies, it must be underlined that health decision-making requires more than raw data, including information obtained from face-to-face contact that can put the data into context, which is unique for each individual.



groups. In this context it will be important to recall the importance of ‘Health in all Policies’. mHealth only makes sense if it is integrated into overall health system policies – it must not exacerbate workforce shortages.

Practically speaking, it can help re-duce paperwork and bureaucracy in hospitals and health settings while speeding up processes, re-ducing human mistakes (e.g. medi-cation errors), increasing inter-departmental communication and avoiding duplication of work. Re-mote access to centralised EHRs can reduce administrative burdens by 20 to 30%. More savings can be gained through better patient com-pliance with treatments and drug adherence, and better observance of medical appointments. Interop-erability, training and task division are critical prerequisites.

POTENTIAL BENEFITS

AND DISADVANTAGES

Digitalisation in healthcare: sup-port or hazard?

Many hail mHealth as a potential panacea for the health system chal-lenges described above. Projects worldwide have resulted in the fol-lowing positive observations [19]:

» Increased access to healthcare and health information, e.g., for hard to reach populations

» Increased effi ciency and lower cost of healthcare service deliv-ery

» Improved ability to prevent, diagnose, treat, care and track

diseases

» Timely, more actionable public health information

» Expanded access to ongoing health education and training for health professionals

However, all new technologies are disruptive by nature: it often takes several years for end users to ac-cept them. This means that, before mHealth will become integral to health system structures, experi-ences are bound to be based on trial and error.

Improving Access & Reducing

Health Inequalities

Eligibility rules for accessing healthcare vary greatly in the EU, depending on available resources, the overall organisation of the health system, reimbursement schemes, legal barriers, etc. These rules in com-bination with the social deter-minants of health cre-ate vast h e a l t h inequali-ties with-in and b e t w e e n countries.

Thanks to mHealth, a larger percentage of the population can be served, including vulnerable individuals who may be more comfortable using mobile devices as they al-low them to explore and ‘practise’ mHealth step-by-step, in their own

time, and in informal settings. Al-though focused on the individual, mHealth also encourages individu-als to join networks.

To improve access, two courses of action could be pursued. One involves creating incentives for health professionals to become ac-tive users of mobile broadband-en-abled technologies for current and preventive care. The second would be to ensure universal access to mobile broadband for households in underserved areas. However, both depend on the removal of regulatory barriers. In developing nations, mHealth is already provid-ing access for larger segments of the population while maximising health professionals’ time [20] but more research and evaluation is re-quired to determine how this can be ‘translated’ in Europe.

Home Monitoring

A key tool for health professionals and

patients alike are home monitoring s e r v i c e s. Some of the most common c o n d i -tions being

monitored are chronic

diseases, such as cardiac prob-

lems that reduce life expectancy and quality of

life. The application of ICT in this area can lead to lower healthcare costs, more effi cient care delivery and improved sustainability.

...the negative

impacts of excessive ICT use on health

outcomes (both physical and psychological)

must not be underestimated.


32


February 2014

Home monitoring can also greatly improve the lives of the frail and elderly. Sensors connected to home alert systems help prevent inci-dents, such as falls, turn into life-threatening events. [21] Smart sys-tems thus provide reassurance that help is only minutes away.

Educational and Public Health

Use

A number of educational tools strive to educate patients and care-givers about the conditions they are dealing with, and they provide relevant information and links to networks where expertise and anx-ieties can be shared. Other tools build up user skills for navigating common eHealth functions.

For health professionals and train-ees, there are training modules for specifi c conditions, purposes (e.g. echocardiographies) and learning objectives (e.g. the extensive ‘Anat-omy on the Go’ app [22]), as well as for building up skills for working with vulnerable groups.

A number of mHealth solutions, in particular texting via SMS, are more generally useful raising aware-ness of prevention and health pro-motion. In the developing world, a number of public health campaigns have been successfully carried out to combat HIV/AIDS infections, outbreaks of communicable dis-eases and epidemics, and for fam-ily planning, allowing recipients to make informed choices and sup-porting disease management.

Promotion of Health and Well-

being

Given its multifunction, mHealth

can be a tool for promoting health and well-being. Its extensive range of gadgets is seductive for patient-consumers as it takes health out of the scientifi c sphere into the realm of day-to-day activities and social ties, thereby allowing individu-als to explore both conventional and emerging health methods, e.g. complementary and alternative medicine (CAM). Through rou-tine deployment, mHealth can also contribute to better prevention and healthy behaviours.

It is, however, imperative to recog-nise the limitations of technology: data can be erroneous, tools used incorrectly, and results may depend on performing tasks in the right se-quence at the right time. Moreover, the negative impacts of excessive ICT use on health outcomes (both physical and psychological) must not be underestimated.

Gaming

ICT-enabled games are ubiquitous as people pass time with their mo-bile phones 24/7, e.g. in waiting rooms, on public transport, during lunch break, even in bed. Gamifi -cation describes the application of game elements and digital game design techniques to non-game problems such as health.

While online marketing and inap-propriate information to patients (e.g., by unauthorised vendors of medicines) represent a growing concern, especially for individu-als unable to distinguish between ‘good’ and ‘bad’ sources of health information, education-oriented health games are arguably a fun way for individuals to become more conscious of their health.

Seen in this way, ICT has the po-tential to improve quality of life [23], especially since mobile games are played by people of all ages and across social groups. Examples are action games for youth with dys-lexia, games offering pain relief via ‘information overload’ (e.g., for patients with permanent pain due to severe burns, etc.), but also Wii sports for people suffering from obesity. [24]

There are also interesting solutions for health professionals, e.g. simu-lations and interactive learning for physicians controlling ‘virtual pa-tients’. It has even been suggested that playing video games can help develop surgeons’ manual dexter-ity. [25] Cost Reduction vs. Evidence

The Boston Consulting Group re-ported that mHealth can reduce the cost of health services (amongst the old age group) by about 25%, and of data collection by 24%. [26] Patient care can be improved by capturing information for provid-ers and allowing them to rapidly analyse large amounts of informa-tion to better understand a person’s health status over time. [27] In addition, mHealth can reduce the number of hospital nights for rehabilitating patients, home moni-toring can decrease care costs and improve quality of life for the el-derly, and EHRs can cut adminis-trative burden and encourage pa-tients to take more responsibility. [28]

While mHealth can create effi cien-cies, it must be underlined that




health decision-making requires more than raw data, including in-formation obtained from face-to-face contact that can put the data into context, which is unique for each individual. [29]

What is more, the evidence base for mHealth needs to be further developed. As noted in a study by the European Connected Health Alliance (ECH Alliance), more data is needed to demonstrate that mHealth scenarios do, in fact, lead to improved health system per-formance, improved health status and health-related quality of life for older people.’ [30] In this con-text health technology and impact assessments will be important to determine whether investments in mHealth technologies are worth-while in the long term.

As any area in healthcare, mHealth is also open to abuse. For exam-ple, under the banner of ‘wellness apps’ are products promising bet-ter health outcomes (e.g. weight loss, smoking cessation, stress re-

duction), which are not backed up by evidence.

Implementation Challenges

The World Health Organization (WHO) has identifi ed nine key barriers to the implementation of mHealth. They are divided into two groups –ecosystem and regu-latory/policy barriers. As shown in the graph below, competing priori-ties and lack of knowledge are the top challenges for mHealth diffu-sion. Due to the lack of a strong evidence base to back up its impact on health outcomes, about half of the responding WHO Member States reported competing priori-ties as their main obstacle. mHealth programmes require evaluation so that policy-makers, administrators and other actors can base invest-ment decisions on facts. [31]

Policy Issues

Effective and coherent policy-making will become important as mHealth matures. As mentioned before, a key obstacle is lack of access to fi xed and mobile broad-

band coverage for health providers and individuals, particularly in rural and peripheral areas.Reimbursement policies will also require adjusting given that remote care and treatment [32] will become more relevant with the transposi-tion of the Cross-border Patients’ Rights Directive.Furthermore, technology chang-es faster than the legal regula-tory framework it is situated in. mHealth is situated in a complex policy and legal environment; the boundary between eHealth and medical devices needs to be clearly defi ned given that the latter are increasingly digital and integrated into eHealth. One potential way forward would be to maintain a clear focus on technical and data interoperability and to ensure that the eHealth Task Force recom-mendations [33] are implemented, e.g. by developing policies that are aligned with the technological de-mands of mHealth. [34]

Data protection and patient safe-ty are particularly important in healthcare. The security of person-al information entered, transferred

Ecosystems barriersRegulatory/policy barriers

Priorities Knowledge Policy CostEffectiveness

Legal Operating Demand TechnicalExpertise

Infrastructure OtherCosts

0%

10%

20%

30%

40%

50%

60%Share of countries listing barriers as important

Nine key barriers to implementation of mHealth identified by the WHO

mHealth faces multiple barriers to full-scaleimplementation

Source: WHO, BCG Report 2012


34


February 2014

and processed via mHealth tools has legitimately been indicated as a crucial point of concern [35]. Transparency about privacy and confi dentiality rules is clearly criti-cal for building public trust, while interoperability is essential for scal-ing up projects.

A particular barrier to using mo-bile technologies for data collec-tion and disease surveillance is the implementation of multiple health-related data collection sys-tems, fl ows and platforms within the health system that can track information directly as health ser-vices are delivered. Currently there is no standard practice for this and incoherence reigns at system and at policy level, e.g. regarding data col-lected at community level, within public and private health facilities, within national and district health reporting information systems, and within systems specifi cally des-ignated for surveillance [36]. There are many mHealth application sys-tems and platforms (both open source and proprietary) but there is still no common ‘architecture’. A key challenge is that there is almost never a single owner of all the in-formation to ensure interoperabil-ity.

SOLUTIONS

Research undertaken by PwC (2012) [37] has shown that mHealth is beginning to embrace the follow-ing principles:

» Interoperability–interoper-able with sensors and other mobile/non-mobile devices to share vast amounts of data with other applications, such as elec-

tronic health records and exist-ing healthcare plans;

» Integration –integrated into existing activities and work-fl ows of providers and patients to provide the support needed for new behaviours;

» Intelligence–offering prob-lem-solving ability to provide real –time qualitative solutions based in existing data in order to realise productivity gains;

» Socialisation–act as a hub by sharing information across a broad community to provide support, coaching, recommen-dations and other forms of as-sistance;

» Outcomes–provide a return investment in terms of cost, ac-cess and quality of care based on healthcare objectives; and

» Engagement–enabling pa-tient’s involvement and the pro-vision of ubiquitous and instant feedback in order to realize new behaviours and/or sustain de-sired performance.

Standards for improved Access

and interoperability

In a resource-constrained environ-ment, one way of overcoming sys-tem challenges is to move towards clearly defi ned and harmonised data standards at EU level for mo-bile and computer-based platforms to achieve interoperability and transparency.

Legal clarity and operational har-monisation would also facilitate

deployment of mobile technology for public health purposes such as real-time data collection in the community and reporting within health institutions, which could then be linked to larger health in-formation systems for aggregation, provided that secure access is es-tablished at regional and national level (the level of access being de-pendent on the function of the in-dividual within the health system) [38].

Moreover, the development of standards can help foster the inclu-sion of vulnerable user groups. A comprehensive ‘quality manage-ment system’, including impact assessments on various end us-ers, should be part and parcel of mHealth’s development. Regard-ing ‘apps’, users require guidance for selecting the most appropriate products.

Guidelines

Successful implementation of mHealth services is pursued through the establishment of mechanisms generating a stron-ger link between evidence and public policy outcomes. Evidence based guidelines can help further implementation of these services through sharing best practice, con-solidating and making the evidence base available, including indicators for evaluation and implementation, developing consistent guidance, analysing requirements for new skills and offering direction for the necessary structural changes that will achieve the successful imple-mentation of eHealth services




globally and mHealth devices in particular.

Develop Digital and Health

Literacy

To achieve economic, health and social objectives, and mitigate the causes for health inequalities, eHealth literacy must be enhanced in the wider framework of health literacy, so that users are well in-formed not only about mHealth but are able to make meaningful use of it. Flexible dialogue with end users about mHealth and its exigencies should be the fi rst step. All users must be clear about potential ad-vantages and pitfalls, and the skills required to reap its benefi ts.

CONCLUSIONS &

RECOMMENDATIONS

The eHealth Action Plan 2012-2020 recognises the current lack of legal clarity for mHealth:

Given the complexity created by ‘mHealth’ and ‘health and wellbeing ap-plications’ in particular, further clarifi ca-tion is needed on the legal framework ap-plicable to these specifi c areas. The rapid developments in this sector raise questions about the applicability of the current frameworks, the use of the data collected through these applications by individuals and medical professionals, and whether or not and how they will be integrated in healthcare systems. Clarity of informa-tion and ‘user-friendliness’ are also im-portant to consider. [39]

Given mHealth’s innovation and employment potential, the Com-

mission is increasingly exploring it as part of eHealth policies in order to attain the targets of the Digital Agenda and Europe 2020, It will publish a Green Paper in the sec-ond half of 2013.

As online transactions and com-munication are commonplace in sectors such as travel and bank-ing, it will be interesting to follow whether mHealth can bring health closer to people by encouraging routine use in a safe, equitable and meaningful way. As demand is ris-ing, it is vital that mHealth prod-ucts provide tangible benefi ts. Hence they should be made avail-able and tested by healthcare stake-holders to avoid abuse. [40]

From a policy perspective, it is important to take into account ex-isting and evolving pieces of Eu-ropean and national legislation in areas impacting on mHealth, and to systematically monitor the quality of information and tools provided to end users. The follow-ing points should be considered as the discussion continues to unfold:

» Develop policies that sup-port integrated patient-centred chronic disease care

» Foster patient empowerment: in the process of self-manage-

ment: patients need to be able to take control of their condi-tion and be reassured that feed-back and necessary adjustments from a healthcare professional are available when necessary

» Ensure processes that facilitate meaningful end-user involve-ment

» Improve mHealth literacy: A perceived lack of knowledge and skills needed to be able to use mobile health services is one of the most common barriers to user acceptance of mHealth. In line with the Eu-ropean Commission’s eHealth Action Plan 2012-2020, ini-tiatives aimed at developing mHealth training and education programmes should be devel-oped, e.g. through relevant EU programmes and/or policy ini-tiatives.

» Clarify data protection regula-tion as it applies to mHealth, ensuring end-user trust and ease of use, while recognising the ‘power’ of data in disease man-agement, diagnosis and preven-tion.

» Encourage and facilitate mHealth stakeholder engage-ment: Given the potential of


‘mobile health doesn’t focus exclusively on the device, but on the fact that the information and data is mobile (…) The information is able to

be collected wherever it is needed and transmitted wherever it needs to go,’

36


February 2014

mHealth in offering innovative and sustainable solutions for the prevention, treatment, care diagnosis and management of chronic diseases, an mHealth stakeholder working group should be created where oppor-tunities and challenges could be discussed and the exchange of information and good practice could be stimulated.

The core question is whether mHealth can contribute to better public health or whether it will ag-gravate health inequalities. In order to harvest its potential for provid-ing equitable healthcare, mHealth needs to be incorporated into health policies so that it becomes a standard element of health sys-tems rather than a market-driven consumer alternative for the well-to-do and educated. This will re-quire dialogue between public, pri-vate and civil society actors and a policy and business environment that encourages innovation for health equity purposes.

1 WHO (2011), mHealth. New horizons for health through mobile technologies2 See http://www.hrsa.gov/healthit/mhealth.html3 EPHA Briefi ng on eHealth4 See http://www.who.int/goe/en/5 European Commission, 12/2012. The “Mo-bile” in “Mobile Health” Isn’t the Gadget; It’s the Data.6 EPHA Briefi ng on the Digital Agenda for Europe7 COM(2012) 736 fi nal, eHealth Action Plan 2012-2020 –Innovative healthcare for the 21st-century8 EPHA Position on the eHealth Action Plan 2012-2020(May 2011)9 See Internet use in households and by indi-viduals in 2012, Eurostat 50/201210 Ibid.11 For more information on the revision of the medical devices legislation, see EPHA Briefi ng on Medical Devices12 mHealth Task Force: Findings & Recom-mendations–September 24, 2012 (pre-publica-tion public draft)

13 BCG Telenor Report, The Socio-Economic impact of Mobile Health, April 201214 See lever 5 for change in the eHealth Task Force Report ‘Redesigning health in Europe for 2020’(2012)15 ‘Italiani, abbiamo tanti smartphone ma ora scarichiamo poche app’, La Reppublica, 7 Sep 2013. The article describes that ‘apps’ are pre-dominantly used by citizens of technologically advanced countries like South Korea and Swe-den.16 More information is available on the EIP on AHA website17 European Directory of Health Apps 2012-201318 EPHA Position on Reforming health sys-tems in times of austerity19 Barriers and Gaps Affecting mHealth in Low and Middle Income Countries: Policy White Paper; Centre for Global Health and Economics Development Earth Institute, Co-lumbia University, May 201020 Ibid.21 BCG Telenor Report, The Socio-Economic impact of Mobile Health, April 201222 For more information see www.thieme.com.23 See EPHA article ‘Policy dialogue on Ac-tive and Healthy ageing –with Information and Communication Technologies (ICT)’24 For more information see www.games-forhealth.org25 James Rosser et al. ‘The impact of video games on training surgeons in the 21stcentury’. Archives of Surgery, 2007;142(2), pp. 181-18626 See http://www.who.int/goe/en/27 mHealth Task Force: Findings & Recom-mendations–September 24, 2012 (pre-publica-tion public draft)28 From eHealth to mHealth –C. Peter Waege-mann, see above29 Ibid.30 GSMA, AARP, WE , 02.2011.Mobile Health for Independent Living.31 WHO: mHealth. New horizons for health through mobile technologies, Global Observa-tory for eHealth series, Vol. 3 32 Ibid.33 eHealth Task Force Report, ‘Redesigning Health in Europe for 202034 BCG Telenor-Mobile-Health-Report (May 2012)35 See EPHA Briefi ng on Cyber Security36 Barriers and Gaps Affecting mHealth in Low and Middle Income Countries: Policy White Paper; Center for Global Health and Economics Development Earth Institute, Co-lumbia University, May 201037 PwC Report, Emerging mHealth: Paths for growth, June 201238 Barriers and Gaps Affecting mHealth in Low and Middle Income Countries: Policy White Paper; Center for Global Health and Economics Development Earth Institue, Co-

lumbia University, May 201039 EC COM(2012) 736 fi nal on ‘’eHealth Ac-tion Plan 2012-2020 -Innovative healthcare for the 21st century’’40 Ashley Bolser, ‘Why healthcare profession-als can’t afford to ignore the potential of apps’. Guardian Professional, 9 May 2013

Article reproduced in full with permission of the EPHA. [EPHA Briefi ng] Mobile Health (mHealth), 2013. Original report available at http://www.epha.org

The


Let us know the details of any projects that

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The soaring number of people with long-term medical condi-tions such as diabetes and demen-tia is threatening to “overwhelm” the NHS, one of the health ser-vice’s most senior fi gures warns.

The challenges posed by patients with chronic medical conditions are so great that they represent the “healthcare equivalent to cli-mate change” and must force the NHS to undertake a major rethink of how it cares for such patients, Dr Martin McShane says in a re-cent interview with the Guardian Newspaper in the UK.

Looking after the 15.4 million people in England with at least one long-term condition already takes up 70% of the NHS’s £110bn budget – £77bn – as well as £10.9bn of the £15.5bn spent on social care in England,

he says. The costs are so huge

that the NHS could become un-sustainable unless it gives those with long-term conditions better care, with much of it provided by GPs performing enhanced roles rather than hospital doctors, says McShane, NHS England’s nation-al director for people with long-term conditions.

McShane is responsible for those ongoing illnesses or diseases that see patients become regular users of NHS services, through check-ups, tests and operations. They include arthritis, heart disease, breathing problems, obesity and mental health conditions such as depression. Their numbers have risen dramatically in recent years, largely as a result of the ageing population and lifestyle factors such as smoking, drinking and overeating.

“I would say it’s the healthcare

equivalent to climate change. It is putting pressure into the sys-tem, which, unless we change the way we address the problems, will overwhelm the system,” says Mc-Shane.

“This is the biggest problem fac-ing the health system and the care system and the costs are grow-ing year on year. They are huge already and they will continue to grow.”

The NHS in its current form is not well set up to look after pa-tients who are medically compli-cated, especially if they have sev-eral long-term conditions, such as arthritis, heart failure and the early signs of dementia, McShane says. While the total number of people with long-term conditions is expected to stay at around 15 million, the number with three or more conditions is expected to rise from 1.9 million to 2.9 million by 2018.

“People with multiple long-term conditions often fall through the gaps as their secondary [hospital] care is highly specialised and their GP care highly generalised, with little continuum between the two, meaning those with multiple long-term conditions can fall through the gaps when confronted with confusing and fragmented sec-ondary care,” he says.

Can mHealth Provide Answers to the Rising Costs of Chronic

Condition Management?

UK UK

38

Rising Costs of Chronic Condition Management

February 2014

The burgeoning costs of manag-ing patients with chronic condi-tions are a problem facing health-care providers and organisations the world over. Many of the con-ditions that are beginning to place these unsustainable strains on the Healthcare systems of the devel-oped world are also becoming is-sues for many countries of the de-veloping world. A report recently published by UK think tank the Overseas Development Institute suggests that the number of obese people in developing countries has quadrupled since 1980, represent-ing over a billion people. With growing middle classes in these countries growing rapidly, then it seems likely that the global oc-currence of lifestyle related illness

and chronic conditions will place, potentially, unmanageable burdens on the healthcare providers tasked with managing these patients.

The facts illustrate a potential ‘Cli-mate Change’ event for not just the UK, but for healthcare provi-sion on a global scale. The need to develop and implement new strat-egy for the effi cient management of chronic conditions, has been well identifi ed. Many senior fi gures across the healthcare industry view mHealth and eHealth services as no longer just a possible option for the delivery of future care path-ways, but as a vital and essential format for delivering effective and wide-scale programs to help cater to patient needs.

Healthcare organisations have in the past proven slow to implement technology and mHealth is likely to encounter similar problems. That is not to say that lessons haven’t been learnt. In the UK for example cost overspend and delays with the delivery of network data systems in the recent past have resulted in changes to the way in which the service procures and implements technology, which suggests that mHealth could potentially be more easily incoporated into services.

The original article referenced in this report can be found at: http://www.theguardian.com/society/2014/jan/03/nhs-over-whelmed-long-term-medical-con-ditions

Rising Costs of Chronic Condition Management


The Health and Development Founda on Na onal Survey Among

Par cipants of the Maternal and Child mHealth Program

The Journal of mHealth, 01 (2014) pp 40-47Received: 06 February 2014

Dr. Elena Dmitrieva, Sergei Frolov, Marina Grishina, Sara Buzadzhi, Venera MalakhovaHealth and Development Foundation, 107031, Moscow, Kuznetskiy most 19, b.1, Russia

Keywords: SMSmame, mHealth Russia, Text4Baby, Child Health, Maternity

ABSTRACT

SMSmame, “SMS to Mom” in Russian, also known as Text-4baby Russia, is a free national service sending new and expect-ant mothers in Russia text messages to their mobile phones with information on caring for their own health and the health of their children.

This program is based on the successful U.S. maternal and child health initiative, text4baby, and was developed under the auspices of the U.S.-Russia Bilateral Presidential Commission in 2010-2011 and launched nationwide in Russia by the Health and De-velopment Foundation (HDF) in February 2012.

Text4baby Russia is intended as a general health guideline and system of reminders that encourages women to engage in healthy be-haviors and visit their doctors in accordance with a generally accepted timeline. These reminders are also intended to jumpstart conversa-tions between mothers and doctors, and motivate subscribers to seek out additional information from other reliable sources, by notifying women of early warning signs of health problems or introducing new information.

Subscribers are also able to participate in free, live webinars with medical experts on text message topics. The program had over 50,000 participants as of the end of 2013.

HDF conducted a national survey during April-October 2013 among 751 respondents from 64 Russian regions. Of these, 49 respondents were interviewed at the Federal Kulakov Centre for Obstetrics, Gynaecology, and Perinatology on April 2, 2013. These respondents (pregnant women) were attending two classes led by

medical specialists at the centre on the fi rst anniversary of

the SMSmame program launch. The other respondents were reached through an Internet survey in September-October 2013. Of these, 50 were pregnant, and 652 were mothers whose children were under one year of age.

The Health and Development Foundation recently carried out a national survey among participants of its maternal and child mHealth program, SMS-mame. This program (“SMS to Mom” in Russian, also known as Text4baby Russia) provides new and expectant mothers with free text messages to their mobile phones with information on caring for their own health and the health of their children.

This program is based on the successful U.S. mater-nal and child health initiative, Text4baby, and was developed under the auspices of the U.S.-Russia Bi-lateral Presidential Commission in 2010-2011 and launched nationwide in Russia by the Health and Development Foundation in February 2012.

Text4baby Russia is intended as a general health guideline and system of reminders that will encour-age women to engage in healthy behaviours and visit their doctors in accordance with a generally accepted timeline. These reminders are also intended to jump-start conversations between mothers and doctors, and motivate subscribers to seek out additional in-formation from other reliable sources, by notifying women of early warning signs of health problems or introducing new information.

RUSSIA

40

Health & Development Foundation - Survey

February 2014


Text messages are sent to subscribers (pregnant women and mothers with children up until their fi rst birthday, and family members). Message top-ics include nutrition, safety, substance abuse prevention, legal rights, men-tal health, exercise, developmental milestones, breastfeeding and more. Subscribers receive personalised in-formation, as messages are organised and sent in accordance with their chil-dren’s due date or birth date. Messag-es contain no advertisements, spam, or product promotions.

Subscribers are also able to participate in free, live webinars with medical ex-perts on text message topics. The pro-gram had over 50,000 participants as of the end of 2013.

This survey was conducted during April-October 2013 among 751 re-spondents from 64 Russian regions. Of these, 49 respondents were inter-viewed at the Federal Kulakov Cen-tre for Obstetrics, Gynaecology, and Perinatology on April 2, 2013. These respondents (pregnant women) were attending two classes led by medical specialists at the centre on the fi rst an-niversary of the SMSmame program launch. The other respondents were reached through an Internet sur-vey in September-October 2013. Of these, 50 were pregnant, and 652 were mothers whose children were under one year of age.

TARGET AUDIENCE

The total number of respondents was 751. Women from various age groups took part in the survey, but the ma-jority were 24-28 (36.5%) and 28-32 (26.4%) (fi g. 1)

Further analysis of personal informa-

0.3%

15.6%

36.5%

26.4%

14.9%

4.7%

1.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

under 18 18-24 24-28 28-32 32-36 36-40 40 and over

Age

Age

Figure 1

3.4%

84.0%

10.7%

1.9%

Marital Status

Unmarried

Married

Unmarried but with a partner

Divorced

Figure 2

0.9%

5.8%

16.0%

8.9%

66.9%

1.5%

Education

Secondary education, incomplete

Secondary education

Specialized secondary education

University degree, incomplete

University degree

PhD equivalent

Figure 3



tion about respondents revealed that a majority of re-spondents, 84%, were married (fi g. 2) and 66.9% had a university degree or higher (fi g. 3).

A majority of the pregnant participants surveyed (70.8%) were expecting their fi rst child. However, the fact that nearly a third of respondents (29.2%) were expecting their second child demonstrates that the program is also popular among women who have al-ready experienced pregnancy and motherhood, not only those approaching both for the fi rst time. (fi g. 4)

Survey respondents had been subscribers to the SMS service for different time periods; cli-ents had been receiving program text messages for 6-9 months (23.9%), 9-12 months (27.9%), and over a year (23.8%) (fi g.5).

The survey was conducted nationally and is comprised of respondents from 64 Russian regions. The most com-mon regions were Moscow (22.6%) and the Moscow Region (6.8%), St. Petersburg (5.7%), Tatarstan (4.5%), and the Chelyabinsk Region (4.5%).

The main channels through which par-ticipants learned about the program were: posters advertising SMSmame, fl yers, and other sources (37.8%); phy-sician recommendations (23.5%), the Internet (18.5%) (including the www.smsmame.ru site). The fact that nearly a quar-ter of respondents received recommendations from their doctors speaks to the high opinion the professional medical community has of the initiative (fi g.6).

PROGRAM

EFFECTIVENESS

Behaviour change in pro-gram participants: SMS-

70.8%

29.2%

Are you expecting your first child?

Yes

No

Figure 4

5.2%6.7%

12.5%

23.9%27.9%

23.8%

How long have you been a subscriber?

Less than 1 month

1-3 months

3-6 months

6-9 months

9-12 months

Over 1 year

Figure 5

37.8%

2.4%

6.9%

18.5%

10.9%

23.5%

Posters, flyers, other sources

On social networks

Internet (other sources)

On smsmame.ru

From friends, acquaintances

From my doctor

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

How did you learn about SMSmame?Figure 6


42


February 2014


mame messages as motivation to seek out more information from reliable sources

One of the main goals of this initiative is to increase the interest and attention of expectant and new mothers regarding their health, and to motivate them to seek out additional information about pregnan-cy and child care from reliable sources.

The following questions were asked in or-der to determine whether the program was meeting this goal.

To the question “Do you talk with your gynaecologist about topics covered in SMS messages?” 24.9% gave positive answers (“sometimes” - 21.8%, “on a regular basis” - 3.1%). The remaining respondents did so “rarely” (18.4%) or never did so (56.7%). The data shows that at the moment, only a quarter of respondents approach their physicians for further information related to program messages. (fi g.7)

Respondents were more positive about whether program text messages motivated them to seek out additional information related to message content: 56.5% replied “sometimes,” 15.8% “on a regular basis”, and 18.6% “rarely.” The high percentage (90.9%) of respondents who replied in the affi rmative indicates that the program is meeting its goal to motivate a majority of subscribers to seek out additional, reliable information. (fi g.8)

PARTICIPANT EVALUATION OF

THE PROGRAM

The next topic in the survey was a gen-eral evaluation of the program by respon-dents. Figure 9 clearly demonstrates the overall positive nature of participant opin-ion: 41.6% of respondents say they like the service very much, and 33.7% like it. Only a very small number of respondents did not like the service at all – 3%.

3.1%

21.8%

18.4%

56.7%

Do you talk with your gynecologist about topicscovered in SMS messages?

Yes, on a regular basis

Yes, sometimes

Rarely

No

Figure 7

15.8%

56.5%

18.6%

9.1%

Do SMSmame text messages motivate you to seek out additional information related to message content?


Yes, sometimes

Rarely

No

Figure 8

41.6%

33.7%

21.7%

2.2%

0.8%

Do you like the text message service?

Yes, I like it very much

I like it

I like some things about

I do not like it very much

I do not like it all

Figure 9

it, dislike others



A key goal of this program is to provide sub-scribers with important, timely information. How they use the text messages is a strong indicator of whether subscribers feel that the program is meeting this goal. The data shows that 62.4% regularly save text messages to re-fer to them later and 20.9% sometimes do so (fi g.10). A much smaller number never did so (9.9%) or did so rarely (6.8%).

Another criteria demonstrating participant opinion of the program is whether or not they recommend it to others. Of all the respondents surveyed, 30% had recommended the service to at least one friend or acquaintance, and 42% had done so two or more times (fi g.11). This high percentage of personal recommenda-tions (72.3%) shows that the majority of re-spondents have an overall positive view of the usefulness and effectiveness of SMSmame.

In conclusion, we can say that participant opinion of SMSmame is, overall, positive, as shown by the number of respondents who found message content useful enough to save it for further reference and the number who recommended the service to others.

SATISFACTION WITH MESSAGE

CONTENT AND FEEDBACK

In order to determine the level of sub-scriber satisfaction with message con-tent, a key element of program effec-tiveness, respondents were asked more specifi c questions about message topics. Pregnant women and new mothers were asked different sets of questions.

Figure 12 shows that pregnant respon-dents received the largest amount of useful and relevant information on the following topics: 1) healthy eating (68.7%); 2) information about govern-ment benefi ts (62.6%); 3) warnings about fl u and viral respiratory infection

62.4%20.9%

6.8%

9.9%

Do you save text messages from SMSmame to refer to them later?


Yes, sometimes

Rarely

No

Figure 10

42.3%

30.0%

27.7%

Have you recommended the SMS service tofriends or acquaintances?

Yes, two or more times

Yes, once

No

Figure 11

59.6%

38.4%

62.6%

45.5%

49.5%

34.7%

36.4%

68.7%

47.5%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%

Flu and virus epidemic warnings

Vaccinations

Information on government benefits

Physical exercise

Work and pregnancy

Your emotional state during pregnancy

Information about alcohol, tobacco, and drug use

Healthy eating

Recommendations to discuss specific topics with your doctor

Have you received useful information from the SMS service on the following topics?

Figure 12


44


February 2014

epidemics (59.6%). On the whole, information on each topic was useful to nearly half the respondents.

The new mothers surveyed indicated that they found information on the following topics most useful: 1) information about newborn health (95.8%), 2) key de-velopmental stages for children in their fi rst year of life (88.2%), 3) vaccination (75.8%) (fi g.13). Overall, the data makes it clear that almost all topics were of interest to subscribers.

Two more questions about message content qual-ity were given to only the group of respondents who took the survey in person at the Kulakov Centre.Figure 14 displays information about which topics

respondents would like to receive more information on: 1) physical exercise (16.3%), 2) healthy eating (12.2%), 3) information on govern-ment benefi ts (12.2%). Respon-dents were also asked which new topics they would like to see added to the text message service, and the most common replies were: 1) get-ting ready for the birth (12.2%), 2) advice for each week (8.2%), 3) ad-vice for fathers (6.1%), 4) informa-tion about necessary tests (6.1%). (fi g.15)

The data shows that respondents are interested in expanding the

range of topics that SMSmame addresses, which will infl uence future text message content development. The last question related to program im-provement addressed the frequency of text messages (fi g.16). A third (31.6%) of respondents are satisfi ed with the current rate of 1-2 messages per week. However, a majority would prefer to receive more messages; among that group, 31.1% would like to receive 3-4 messages weekly. The remaining third would like to receive 5 or more messages per week. It is clear from this response that the majority of respon-dents would prefer greater frequency of messages, indicating the usefulness and importance of the service in keeping them

informed.

In addition to directing the attention of program de-velopers to areas for improvement, (expansion and re-fi nement of text message content, message frequency, etc.), survey data also show the overall positive atti-tude to the service among respondents. The fact that a large group of respondents save text messages for future reference, recommend the program to others, and would like to receive more text messages weekly all demonstrate that SMSmame is meeting the key pro-gram goals of providing reliable, useful information to pregnant women and new mothers throughout Russia.


69.6%

75.8%

49.6%

59.9%

88.2%

95.8%

64.8%

48.9%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 120.0%


Vaccinations

Government benefits and assistance

Physical exercise

Key developmental stages for children under 1

Information about newborn health

Information about maternal health after birth

Recommendations to discuss specific topics with

Figure 13

your doctor

Have you received useful information on the following topics?

2.0%

2.0%

12.2%

16.3%

4.1%

6.1%

12.2%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0%


Vaccinations

Information on government benefits

Physical exercise

Work and pregnancy

Your emotional state during pregnancy

Healthy eating

Which topics would you like to learn more about?Figure 14



SUMMARY

SMSmame, “SMS to Mom” in Russian, also known as Text-4baby Russia, is a free national service send-ing new and expect-ant mothers in Rus-sia text messages to their mobile phones with information on caring for their own health and the health of their children.

This program is based on the success-ful U.S. maternal and child health initia-tive, text4baby, and was developed under the auspices of the U.S.-Russia Bilateral Presidential Com-mission in 2010-2011 and launched nation-wide in Russia by the Health and Devel-opment Foundation (HDF) in February 2012.

Text4baby Russia is in-tended as a general health guideline and system of reminders that encour-ages women to engage in healthy behaviors and visit their doctors in ac-cordance with a generally accepted timeline. These reminders are also intend-ed to jumpstart conversa-tions between mothers and doctors, and motivate

2.0%

2.0%

6.1%

2.0%

2.0%

2.0%

6.1%

2.0%

4.1%

2.0%

4.1%

4.1%

8.2%

12.2%

4.1%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0%

Information about webinars

Dangerous symptoms during pregnancy

Information about necessary tests

Information about illnesses among children under 1

Traveling with small children

Participation of the father during birth

Advice for fathers

Information about classes for pregnant women

Information about exhibitions and seminars

Information about maternity hospitals

What to buy for a new baby

Advice on morning sickness, bloating, etc.

Advice for every week (changes in the mother'sbody during fetal development)

Preparing for birth

Reading recommendations (books, articles)

What new topics would you like to see introduced?Figure 15

3.7%

16.9%

16.7%

31.1%

31.6%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

"9 or more"

"7-8"

"5-6"

"3-4"

"1-2"

Number of text messages per weekFigure 16


46


February 2014

subscribers to seek out additional information from other reliable sources, by notifying women of early warning signs of health problems or introducing new information.

Subscribers are also able to participate in free, live we-binars with medical experts on text message topics. The program had over 50,000 participants as of the end of 2013.

HDF conducted a national survey during April-Oc-tober 2013 among 751 respondents from 64 Russian regions. Of these, 49 respondents were interviewed at the Federal Kulakov Centre for Obstetrics, Gyn-aecology, and Perinatology on April 2, 2013. These respondents (pregnant women) were attending two classes led by medical specialists at the centre on the fi rst anniversary of the SMSmame program launch. The other respondents were reached through an In-ternet survey in September-October 2013. Of these, 50 were pregnant, and 652 were mothers whose chil-dren were under one year of age.

CLIENT SATISFACTION

SMSmame clients who responded to the survey re-ported an overwhelmingly positive opinion of the service: 41.6% said they were highly satisfi ed with it, and 33.7% were satisfi ed.

Beyond their stated satisfaction, the actions of re-spondents demonstrated their high opinion of SMS-mame. One measure of client satisfaction is the length of time they had been subscribers. Nearly a quarter of respondents had been subscribers for over a year (23.8%) and 27.9% had been subscribers for 9-12 months.

Clients continue to participate in programs that provide a useful service. One of the key goals of SMSmame is to provide reliable, relevant health in-formation to subscribers, and the fact that 91% of respondents save program text messages for future reference (62.4% doing so regularly) demonstrates that the program is meeting this goal.

Another telling indication of client satisfaction is that 72% of respondents had recommended the program

to friends or acquaintances, and 42% had done so more than once.

MOTIVATION TO SEEK OUT

ADDITIONAL INFORMATION

SMSmame is intended not only as an information re-source, but also as a way to motivate subscribers to seek out additional information from reliable sources on message topics. Survey results indicate that the service does indeed function as a source of motiva-tion for the majority of respondents (90.9%). Of that percentage, 56.5% of clients were “sometimes” mo-tivated by text messages, and 15.8% were motivated “on a regular basis.”

One area for improvement is client motivation to speak with their doctors about text message topics; only a quarter of respondents were motivated by the service to do so (21.8% “sometimes,” and 3.1% “on a regular basis”). Program developers will take this data into account for future revision and improvement of services.

OTHER AREAS FOR DEVELOPMENT

Survey data also indicated other areas in which the program could be developed and improved. Respon-dent replies show client support for an expansion of text message topics. Respondents suggested the in-troduction of such topics as advice for fathers, read-ing recommendations, preparing for the maternity hospital, and more.

Survey respondents would also prefer to receive text messages more frequently: a third (31.6%) of respon-dents are satisfi ed with the current rate of 1-2 mes-sages per week. However, a majority would prefer to receive more messages; among that group, 31.1% would like to receive 3-4 messages weekly. The re-maining third would like to receive 5 or more mes-sages per week. This desire for greater frequency of text messages is yet another positive sign of the value of the service for pregnant women and new mothers.

For more information on this project and other projects please visit the Health and Development Foundation at www.fzr.ru/eng.



48

Product Profi les

February 2014

Product Profi les

Canadian company SensiMAT Systems have recently begun taking pre-orders for their SensiMAT for wheelchairs product. A unique mobile enabled system that allows wheelchair users to monitor and track the pressure being exerted by them, as they use the chair, and to identify when high levels of pressure build up.

The SensiMAT for Wheelchairs is a thin mat containing pressure sensors that is insert-ed underneath the gel, air, or foam cushion. These sensors send pressure data to a mobile device, where SensiMAT System’s proprietary PressureRisk™ algorithm alerts the user when there is a high amount of built up pressure, it then facilitates and tracks pressure relieving exercises. The system uses Bluetooth Low-

Energy, to consistently monitor pressure, us-ing a mobile device, completely wirelessly, and without draining the battery. The mat itself is simply charged once a week, making it easily integrated into everyday life.

This unique product has great potential to en-able wheelchair users to limit pressure related sores and problems commonly associated with the use of a chair. At the same time the system actively encourages people to manage their condition and prevent further complications. In the long-term this is likely to have signifi -cant appeal to healthcare organisations seeking to reduce admissions of wheelchair users with common pressure related problems.

SensiMAT for Wheelchairs

Recently, N o r t h Carol ina

based orthopaedic surgeon Selene G. Parekh, M.D. utilised Google Glass during a successful foot and ankle surgery in Jaipur, India.

Dr. Parekh conducted surgery while wearing the technology and broadcast live streaming video via the Internet. The technology al-lowed for hands-free recording video without the operating room disruption of a video crew and related risk of infection. Additionally, it provided viewers the surgeon’s unique vantage point during the surgery.

Dr. Parekh commented, “This technology opens up a whole new world for surgery. Not only are we able to obtain a different view of the surgery, we are also able to communicate live with fellow surgeons at the same time. Simply amazing technology.”

Nextremity Solutions, an orthopaedic medical device company which specialises in forefoot surgery implants, recently obtained Google Glass and will be evaluating its applications in its surgeon training initiatives. The company will work closely with Dr. Parekh to ensure the technology is used in a manner most benefi cial to surgeons.

Nextremity Solutions adopts GOOGLE Glass for product and surgeon training

Company Profi les

Company Profi les


Infi eld Health helps patients recover from hospital procedures by putting discharge instructions on mobile phones. Because better educated patients have better outcomes and a lower total cost of care. We include informative video, medication guidance, and two-way communication right inside the app. And because each provider customizes the instructions, patients are guided by a voice they trust.

We’ve worked with US organizations such as The National Cancer Institute, the American College of Cardiology, VCU Medical Center and The George Washington University Hospital, and we concentrate in surgical, cardiac, and rehabilitation patient populations.

Infi eld is keen to help UK providers, public and private, engage patients to enhance outcomes and reduce the total cost of care. For more informa-tion visit www.infi eldhealth.com

Zoeticx, Inc. have announced the launch of their healthcare industry software suite dedicated to improving patient outcomes, enhancing the quality of care, containing costs, and simplifying hospi-tal administration. The suite of four software modules is designed for the new healthcare landscape ushered in by Obamacare and the changes within the medical industry itself. The software will improve healthcare industry profi tability by curtailing medical errors that cost the industry billions of dollars annually and reducing preventable deaths. Zoeticx champions these new government and industry paradigms through software innovation with a patient-centric approach. The Zoeticx software suite resides on its Patient-Clarity collaboration platform. The suite is comprised of four modules: CareIntelligence, CareSynergy, CareHistory, and CareCompliance.

Zoeticx offers software solutions for the healthcare industry which are dedicated to Improving Patient Outcomes , enhancing the quality of care, containing costs, and simplifying administration. These solutions offer an immediate increase in the quality of care by delivering the right informa-tion to the right caregiver at the right time, in a manner that can be easily understood. Addition-ally, as the Affordable Care Act continues to roll out, healthcare providers will face new challenges which arise whenever there is a transition from an old system of doing business to a new one. Zoeticx helps solve those challenges, allowing care providers to focus on what is most important, the patient. www.Zoeticx.com

Zoeticx

Infi eld Health

Upcoming Events

7-9 April 2014

11th Annual World Health-

care Congress, National Harbour, MD, USA. For more

information visit www.world-congress.com/events/HR14000

6-8 May 2014

Africa Health, Johannesburg, South Africa. For more infor-mation visit www.africaheal-

thexhibition.com

19-21 May 2014

Saudi Health, Riyadh, KSA. For more information visit www.saudihealthexhibition.com

20-23 May 2014

Hospitalar 2014, Sao Paulo, Brazil. For more information

visit www.hospitalar.com

3-4 June 2014

The European Future Health-

care Forum, Dublin, Ireland. For more information visit

www.informa-ls.com/event/EuropeanHealthForum2014

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Consultation Plus 51

Dacadoo 11

Dacadoo 39

Infi eld Health 39

Tactio Health Group 14

30 April - 1 May 2014

Pharma 3.0: The Digital

Medicine Era, Philadelphia, PA, USA. For more information visit www.event.pharmicaconsult-

ing.com

3-4 March 2014

Health and Care Innova-

tion Expo 2014, Manchester, England. For more information

visit www.expo.nhs.uk

28-29 April 2014

Medical Informatics World

Conference, Boston, MA, USA. For more information visit

www.chidb.com

6-8 May 2014

mHealth Summit Europe, Berlin, Germany. For more

information visitwww.mhealthsummit.org/eu

50

Upcoming Events

February 2014

Consult…..connect…..engage……respond……improve

In today’s fast changing health landscape understanding and responding to patient needs is becoming ever more critical. Designing healthcare services to match more closely the profi le and lifestyle of your local population can bring benefi ts for patients and the effi ciency of the health system.

Consultation Plus is an online system tool that helps organisations improve their consultation exercises and encourage customer and user engagement. Designed by communications and engagement experts the system is simple to use and provides meaningful feedback to aid improved decision making via meaningful engagement.

» Easy to use with simple ‘wizard’ menu to guide all users though the consultation and engagement process

» Low cost – multiple users can access the system via PCs and mobile devices to provide ongoing feedback and up to the minute information about user and customer views and experiences

» Feedback can be analysed demographically and geographically to give a clear picture of emerging themes and key issues

» Ability to manage multiple consultation exercises» Upload data from meetings, web sites, or community outlets such as GP surgeries, town halls and

schools» Provides a clear ‘audit trail’ of activity to ensure ‘good practice’ and the meeting of legal

requirements such as the ‘duty to consult’ » Mapping feature shows ‘hot spots’ to identify areas where greater engagement is needed» Analysis of feedback creates presentations for management and public meetings» Our team can set up the system and upload an organisation’s existing databases for use in the

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organisation to improve customer and user experiences and enhance service delivery » Bespoke solutions – building on the basic system we can add and tailor additional features to

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For further information and a free demonstration email: [email protected]

The


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We invite you to work with us...We hope that you have enjoyed reading the inaugural edition of The Journal of mHealth and that you continue to subscribe to our future issues. We will be publishing six editions of the Journal throughout 2014.

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the journal of mhealth volume 1 issue 1 (feb 2014)

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