mHealth: What does it mean and what’s included

(originally published in March, 2013 but even more relevant today.) 

What is mHealth, and does the term stand for: Mobile Health or Modern Health? 
That’s the subject of a an online discussion started by David Doherty, moderator of a LinkedIn group interested in using mobile technologies to improve health. He started the discussion to support my view that any definition of mHealth that only includes smartphones is both limiting and arrogant. This article supports that discussion by expanding the definition of mHealth and what’s included.

Much of this article builds on an earlier article that I wrote in May 2012, where I addressed confusion among syllogisms, using the analogy that Lions & Tigers are both Animals, but not all Animals are Lions or Tigers. Likewise, there are some confusing overlaps among the terms mHealth, eHealth, Wireless Health, Connected Health, Digital Health, Telehealth, and Modern Health. The devices that serve these market segments overlap too, so I must discuss them collectively.

Syllogism observations

Clearly, Lions & Tigers are both cats, and cats are animals, but the healthcare syllogisms aren’t as straight forward. People often associate Mobile Health with the ambulance that shows up to provide care and transportation, rather than the use of mobile devices and wireless networks. They may also associate Mobile Health with the tablet device the doctor uses as she moves about, rather than a smartphone device. That’s why I drew the diagram with mHealth not entirely within Wireless Health or within Telehealth. And it’s why I added a new term to  encompass them all – Modern Health.

I apologize to my consumer audience if this article sometimes gets a bit technical. That’s because it was partially written to address a technical audience. You can skip the technology, go straight to the Cool mHealth Trends.

mHealth & Telehealth

Telehealth is the delivery of health-related services and information via telecommunications technologies. These services could be as simple as two health professionals discussing a case over the telephone, a video call between patient and practitioner(s), or doing robotic surgery between facilities at different ends of the globe. Telehealth is an expansion of telemedicine, because it’s not limited to clinical treatment but can also apply to prevention. Likewise, telehealth is an expansion of mHealth, because it’s not limited to cellular technologies.

mHealth & Wireless Health

Wireless health differs from mHealth in that wireless health solutions will not always be mobile and mobile health solutions will not always be wirelessly enabled. Wireless Health integrates wireless technology into traditional medicine, such as for diagnosis, monitoring and treatment of illness. Wireless technologies eliminate the cost and effort to install wires and support the ability to move about without being tethered. Wireless networks can cover very short distances such as between wearable sensors and a smartphone, entire buildings such as Wi-Fi home networks; or wider areas such as cellular networks that extend from tower to tower. These mobile broadband networks are especially useful in reaching new patients in remote areas than previously possible.

mHealth & eHealth

eHealth describes any healthcare practice supported by electronic information processing and communication, so it has broader reach than mHealth, which relates to practices using mobile  (phone or computing) technologies.

mHealth: Mobile Health or Modern Health?

Many app developers view mHealth as exploiting mobile telecommunication in health care delivery. That can include mobile phones (voice & SMS text), smartphones, or a variety of other devices that include laptop computers, patient monitoring devices, MP3 players, PERS systems, and more.  The term can extend to both mobile and stationary devices, as long as they used mobile/cellular telecom technologies, but what if they don’t communicate at all?

What if a smartphone app uses sensors to collect health & fitness data and then stores and tracks it on the device itself without ever sending it anywhere? If the device itself is viewed as a telecom device, it might fit in the mHealth category, but the iPod Touch has no mobile phone connection, and even though it uses the same iPhone technology, it arguably would not fit the mHealth definition, even though it’s running the exact same code. That’s where the traditional mHealth definition breaks down, and it’s one reason that I prefer to extend mHealth to Modern Health, rather than just Mobile Health.

Modern Health encompasses innovations that collectively define the future of healthcare. They include: digital, electronic & mobile health, telehealth & telemedicine, electronic sensors & cloud-based monitoring services, video calls & telepresence, electronic medical & personal health records, big data & analytics, healthcare robotics & artificial intelligence, personalized medicine & genomics, and the wireless connections (ANT+, Bluetooth LE, ZigBee, Z-Wave, Wi-Fi, 4G, LTE), big broadband networks (fiber-optics), and regulatory & payment reforms that bind them.

Yes, nearly 40,000 health-related apps are available today for smartphones, and that number is up ten-fold from about 4,000 in 2010. So clearly smartphone availability and fast Internet access are driving much of the growth of modern healthcare applications, but don’t discount large mHealth opportunities on other devices and in other geographic markets.

Developing Markets 

Expanding one’s perspective is important when defining mHealth, since 2.8 million patients worldwide are monitored at home using networked equipment but without a smartphone or PC, and that’s expected to grow 26.9% CAGR through 2017 to 9.4 million.

With its global perspective, when the WHO looks at mHealth it sees the large number of developing countries without much access to fast 4G networks or smartphones. Even without smartphones, people can still get voice calls or SMS text messages from their healthcare provider to  remind them to take their meds. And expectant moms can still get texts telling them what to expect during each stage of their pregnancy and asking if anything is out of sorts.  These relatively simple mHealth apps are extremely popular in sub-Saharan Africa and developing nations across the globe, since basic SMS and voice communications are still the most common uses of mobile phone technology.

A primary motivation and mHealth driver concerns the various constraints felt by healthcare systems of developing nations, including high population growth with large numbers of rural inhabitants, an unhealthy workforce with a high burden of disease prevalence, and limited financial resources to support healthcare infrastructure and information systems.

A secondary factor is the rapid rise of mobile phone penetration to large segments of the healthcare workforce and population as a whole. With greater access to mobile phones in all segments of a country, including rural areas, the potential of lowering the costs of healthcare delivery improves.

Although far from ubiquitous, the spread of newer smartphone technologies opens doors for even more comprehensive mHealth projects, including diagnosis support, telemedicine, web browsing, GPS navigation, access to web-based patient information, and decentralized health information management systems (HIMS).

Product Development

mHealth product developers may take one design approach or another depending on how they view the market. If they see mHealth as only including smartphone apps and attachments, which ones? Must they support all operating system platforms (iOS, Android, Windows 8, Blackberry, Symbian) or just the most popular? Operating Systems must be agile and evolve to effectively balance and deliver the desired level of service to an application and end user, while managing display real estate, power consumption and security.

What about HTML5 and other cross-system platforms? In a real sense, any cloud-based Internet app that’s used for healthcare and accessible from a web browser on a mobile device can be described as mHealth, but many of those apps also run on desktop PCs.

While some app developers optimize their code for specific device features, others develop for cross-platform compatibility, sacrificing functionality for a broader audience. Device-specific features might include long battery life, higher resolution displays, new sensors & cameras, ambient light detectors, accelerometers, gyroscopes, barometers, GPS systems, voice & video enhancements, Web 2.0 collaboration, and more. Each new feature can be useful for medical diagnosis, education, treatment and monitoring, so when apps lack support of these features, are they disqualified as mHealth? Of course not, but the questions help us understand why the accelerating pace of tech innovation can confuse definitions.

When you put a desktop PC in the trunk of your car as you head off to college, is it mobile, or just transportable? The PC may use Wi-Fi for wireless network access, but you might say a truly mobile device is entirely wireless. So what about a laptop that nicely fits on the small student desk in the dorm room and stays there or occasionally moves to the bed. It could be carried to class too, but if it’s not used that way and instead is used as a stationary device, does that change our definition of mobility? Possibly.

While some people say mHealth must use cellular phone technology, what about notebook PCs that have cellular cards, or smartphone like devices like iPod Touch that can access all Internet functions (and mHealth apps) through a Wi-Fi network but lack the SIM card that turns it into a phone? Just like a smartphone, the iPod Touch can complete phone & video calls, but over Wi-Fi using voice-over-IP. And if it’s used for healthcare apps, doesn’t it fit into the mHealth definition? (Are you buying into my expended Modern Health definition yet?)

What about the many health-oriented devices already in homes supporting wireless networks (cellular or Wi-Fi)? Some run off of batteries, such as the Withings bathroom scale, but that’s not very portable. Withings also makes a connected blood pressure monitor that is very portable. Many of these products send their collected data to a remote service, some through a gateway device (smartphone, tablet, PC or dedicated gateway) and others integrate cellular support into the product itself so they don’t need a gateway. I see all of these devices as part of mHealth in my expanded definition.

 mHealth Applications and Benefits

The United Nations has identified seven application categories within the mHealth field, including:

1. Remote monitoring
2. Remote data collection
3. Education and awareness
4. Diagnostic and treatment support
5. Disease and epidemic outbreak tracking
6. Communication and training for healthcare workers
7. Helpline

Benefits include the ability to:

• Access healthcare info;
• Diagnose & track disease;
• Gather actionable public info; and
• Deliver medical education & training.

About my bias

Understanding one’s perspective is important when considering their opinions, so here’s what you should know about mine. I have 40+ years of experience in computer operations, programming, product engineering, and strategic marketing at IBM, Dell, Siemens, and CAZITech, a digital home consulting firm that I founded before starting Modern Health Talk. While I’m not a medical professional, I’m married to an RN and supported large hospital accounts as an IBM systems engineer, giving me a solid understanding of healthcare IT products. I see myself as a consumer advocate and see technologies from a consumer perspective, so my (broader) view may differ from that of a developer or smartphone apps for the iPhone.

Cool mHealth Trends

I’m not surprised there’s so much mHealth excitement among developers. Wearable devices and smartphones are becoming like supercomputers in your pocket or on your wrist. Real-time monitoring of wearable sensors are starting to give doctors an idea of the context behind the data, like what’s the patient doing, what did he eat, what’s going on in the environment, etc. Researchers are testing credit card-sized lab-on-a-chip prototypes. Some 40,000 health & wellness apps are available for smartphones, and they’re coming to market so quickly that the FDA hasn’t determined how it can regulate them. IBM’s Watson supercomputer demonstrated its ability to learn, understand English, and  read & analyze the equivalent of 300 million books in 3 seconds to win the game of Jeopardy and is now being applied to medical diagnostics and big-data analytics. Hospitals are encouraging patient engagement as part of their own care team. Social media is helping people connect with other e-patients sharing the same conditions, collectively doing medical research that their doctors have less time and motivation to do, and comparing notes about what seems to work and what doesn’t.

The future implication of smart sensors, wearable computers, smartphones, wireless networks, and remote computing services in the Internet cloud is inspiring and exciting to me as a technologist, and it’s the basis of some of the talks I give. I used to start my Beyond the PC presentations by holding up my Philips Sonicare toothbrush and describing its embedded processing power as being able to execute 10 times more machine instructions than the multi-million dollar IBM mainframe I worked on 35 years ago. Now I can now add the smartphone and WIMM wrist-computer to my list of examples, since they’re like supercomputers of old.

As written in Forecasts for the Future of Healthcare, consider the labor and healthcare implicatio­ns of extending Moore’s Law out 50 years since these futurist prediction­s could all happen in our lifetime. According to Ray Kurzweil:

• By 2013, a supercompu­ter will have the reasoning and processing capacity of the Human Brain;
• By 2023, a $1,000 home computer will have that power, and by 2037, a $0.01 embedded computer will; AND…
• By 2049, a $1,000 computer will have the power of the human RACE, and by 2059, a $0.01 computer will.