eHealth to mHealth
By
Nondzwakazi Z. Gumede
(CIO: Eastern Cape Department of Health)
21/10/2014
Introduction
• mHealth is an emerging term for medical and public health practice
supported by mobile devices, such as mobile phones, patient monitoring
devices, personal digital assistants (PDAs), and other wireless devices.
• mHealth applications include the use of mobile devices in collecting
community and clinical health data, delivery of health care information to
practitioners, researchers, and patients, real-time monitoring of patient
vital signs, and direct provision of care.
• mHealth use mobile and wireless technologies to support the achievement of
health objectives.
• The widespread use of mobile phones is one reason why this practice is
rapidly progressing.
• An mHealth project that uses mobile phones to access data on HIV/AIDS
rates for example would require an eHealth system in order to manage,
store, and assess the data. Thus, eHealth projects many times operate as
the backbone of mHealth projects.
Rational for mHealth
• According to the International Telecommunication Union, there were almost 6
billion mobile phones in use worldwide in late 2011. Mobile technology offers
tremendous opportunities for the healthcare industry to address one of the
most pressing global challenges: making healthcare more accessible, faster,
better and cheaper.
• Technologies such as electronic medical records, remote monitoring and
communication platforms, etc. is in many ways the prerequisite for the
flourishing of mHealth. Patient-centric, ‘care anywhere’ is becoming a reality.
• mHealth will be a major factor in providing personal toolkits that will help
manage predicted vulnerabilities, chronic illness, and episodic acute conditions.
• Improvements in quality have been demonstrated by increased adherence to
guideline-based care, enhanced surveillance and monitoring, and fewer
medication-related errors, such as incorrect prescriptions involving the wrong
drug, wrong dose or incorrect route of administration. Other areas that show
improvements are efficiency and reduced costs related to utilization (reduced
numbers of laboratory and radiology tests), improved drug dosing and
decreased medication related adverse events. Personal history records have
additional potential benefits to improve patient health and communication with
providers.
6 Principles for mHealth
• mHealth solutions have begun to embrace the following six principles:
Interoperability – interoperable with sensors and other mobile/nonmobile devices to share vast amounts of data with other applications,
such as electronic health records and existing healthcare plans.
Integration – integrated into existing activities and workflows of
providers and patients to provide the support needed for new
behaviours.
Intelligence – offer problem-solving ability to provide real-time,
qualitative solutions based on existing data in order to realise
productivity gains.
Socialisation – act as a hub by sharing information across a broad
community to provide support, coaching, recommendations and other
forms of assistance.
Outcomes – provide a return on investment in terms of cost, access and
quality of care based on healthcare objectives.
Engagement – enable patient involvement and the provision of ubiquitous
and instant feedback in order to realise new behaviours and/or sustain
desired performance.
ECDoH Strategic Direction
Business Drivers
Strategic Goals
National Health Council 10 point plan
Functional quality driven Public Health
System
National Health Council 10 point plan
Combat and reduce non-communicable
disease and mental conditions
Millennium Development Goals
Improve and strengthen mother and child
health services
Millennium Development Goals
Combat and reduce impact HIV/AIDS and
TB
Shortages in skilled healthcare
workforce
Enhance institutional capacity
ECDoH Challenges
• High population growth, a high burden of disease
prevalence, low health care workforce, large numbers of
rural inhabitants, and limited financial resources to support
healthcare infrastructure and health information systems
• Admissions take too long
• Referrals not monitored
• Duplicate prescriptions (double dipping & no stock planning)
• Medication default e.g. TB
Current Business ECDoH Challenges
Drivers for mHealth
• If mHealth succeeds in delivering such things as a greater focus
on prevention, better monitoring of chronic conditions and
patient-centred care, its impact will be dramatic.
• The drivers of mHealth in each country are thus different. The
three biggest attractions are cost reduction, convenience of
access and ability to obtain otherwise unavailable information.
• Cost is also the leading driver of mHealth for the public sector
and doctors, followed by the opportunity to provide new services
and to reach previously inaccessible patients.
• The adoption of mHealth, if it is to be meaningful, must be part of
a wider disruption of healthcare.
Levels of Institutions
Home
(Community Health
Worker, Mobile Clinic)
(WBOT)
District Hospital
(GP, 24 Hrs)
Clinic
(Professional Nurse)
Regional Hospital
(Specialists)
CHC
(Professional Nurse,
GP)
Tertiary Hospital
(T1: Provincial Tertiary,
T2: Central,
T3: National)
(Specialist, Academic)
Family Profile
Information collected by Ward Based Outreach Teams to provide
household profiles
Girlfriend
(25yo,
unemployed)
Father
(64yo,
R10,000pm,
Alcoholic
Daughter
(25yo,
unemployed)
Son
(8yo, TB)
Daughter
(7yo)
Mother
(60yo,
Diabetic)
Son
(30yo, stays
at home, HIV
+ve)
Son
(5yo, HIV
+ve)
Daughter
(15yo, @ Gr.
7)
Patient Journey
Patient visits mobile
clinic
Healthcare worker
does prelim routine
checks and refers
patient to a district
hospital
The GP refers the
patient to a regional
hospital and
prescribes some
medication
Patient is handed a
referral slip &
appointment card for
xRays at a regional
hospital
Patient arrives at a
regional hospital and
presents UPN to
admissions/info
centre
Patient is handed a
ref. # and an
appointment date &
time
The GP diagnoses the
patient and find that
the symptoms might
be something more
Patient is immediately
sent to xRay
department who are
expecting the patient
On arrival at the
hospital the patient
makes his way
directly to admissions
and presents his
referral note
Patient is sent to
relevant section and
waits for GP to see
him. The GP logs onto
the computer and
types in UPN and
adds notes and
findings
xRays are done based
on GP’s notes and
instructions
The admissions
clerks types in the
Unique Patient
Number (UPN) and
the records
appear, describing
the referral and
also schedules the
required for the
next steps
xRays are scanned
and stored in the
system (incl.
report) and the
referring GP is
notified. The GP
then makes
recommendation
for further case
analysis…
mHealth Solution Recommendation
Improve coordination and communication between caregivers to improve quality of care and
patient experience
mHealth Patient Perspective
• mHealth will offer patients easier access to care and more control
over their own health.
• Locate nearby healthcare providers and schedule appointments.
• Provide basic education and awareness by ward based out reach
teams along with primary care and make quality healthcare reach
millions who currently have no access to physicians.
• mHealth involves triaged health information and advice via contact
centres staffed by paramedics, physiotherapists, nurses, doctors
and health advisers, using an IT platform with a structured query
database to give an appropriate health response.
• Upload their health readings (e.g. blood sugar count, BP readings,
etc.) to the clinician through SMS and mobile applications, with an
SMS text delivered back to the patient explaining the readings
and advising whether further action is required.
mHealth Healthcare Provider Perspective
• Healthcare providers are buying into mobile technology
because it can help meet some of their needs, such as
monitoring patient compliance, accessing records and
communicating with colleagues. One of the most popular
medical apps, for example, is Medscape, a free service which
provides the latest medical news and information about
diseases and drugs.
• While improvement of care is a bigger driver than simple
convenience, healthcare providers hope that it will happen
through streamlining, rather than re-inventing, existing
systems.
mHealth Allows Managing Patient Information Across
the Care Continuum
•
Patient Relationship
Management
•
Document
management
Advisory
Services
•
Hospital Management
Emergency Services
Management
BI &
Analytics
Planning &
Forecasting
•
Depot Management
Quick Wins
• Some quick wins to be had, that will almost certainly come from the simpler,
more boring things:
 Health call centres/health-care telephone helpline: Use of mobile phones
by trained health professionals to provide health advice and triage services;
Education and information: Use of mobile phones to provide citizens with
education and information on health topics;
Treatment compliance: Use of short message service (SMS) and other ICT
applications by health services to send citizens reminder messages aimed at
achieving medication compliance for themselves, their children, and other
family members;
Appointment reminders: Messages sent using mobile phones to make or
attend an existing appointment, such as reminder messages for antenatal
care;
Citizen feedback regarding services: Use of ICT to allow citizens to provide
feedback or complaints concerning health services;
Community mobilization/health promotion campaigns: Use of mobile phones
for health promotion or to alert new and expectant motcitizens of particular
health campaigns; and
Telemedicine/Teleconsultation: Consultation between health practitioners
about patients by using mobile phones.
mHealth Partnerships
• The public sector, while seeking to optimise access and quality, is
looking towards the private sector for innovation and efficiency.
mHealth enables both sectors in this regard, helping to improve
access and quality while at the same time providing dramatic
innovation and cost reduction opportunities.
• Development of a cadre of trained professionals, to facilitate the
adoption of health information systems. In time, these
professionals can provide a sustainable bridge to improved use of
health information and most importantly, better health.
Thank You