Opinion: the future of health is mobile
Never has there been a technology with such rapid uptake globally as that seen with the spread of mobile phones. In New Zealand, we have had more mobile phone subscriptions than people since around 2008. While that may not mean every single person has a mobile phone, there is certainly very high penetration. And there is some evidence of a lack of a digital divide – that is, access to mobile phones is not affected by socio-economic status, unlike access to the internet.
The majority of New Zealanders with a mobile phone keep it close at hand 24 hours a day. The proportion of phones that are smartphones with a computer operating system is rapidly increasing, with up to 60 per cent of all mobile phones in 2013. This means that at any time of day, regardless of location, most people have a personal, portable, connected computer on them. This also means that they have unprecedented access to health information and close to 100,000 health and wellness apps.
What does all of this mean for health services? It could mean the rise of the well-informed and engaged patient. Particularly in the context of the ‘quantified self’ movement and the rapid increase in mobile and wearable sensors, people are becoming more aware of their body’s responses to lifestyle changes and medications.
This could lead to several changes in the way care is provided, with patients coming to the consultation as the experts in themselves and the clinician bringing their expertise and experience to co-develop a care plan. Potentially, far greater amounts of data will be available to inform care. Where data are currently available for particular time points, mobile and wearable sensors bring the ability to fill in the gaps with continuous monitoring data. This will entail a greater reliance on smarter health IT systems and algorithms capable of interpreting that data so that we know when to act on it.
At this point in time, this may look like a system only for the engaged and motivated. However, systems are being developed that will passively collect data via the smartphone, with no motivation or action required. This leads to the concept of a health coach in the pocket, quietly collecting and analysing data in order to intervene with programs to support healthy behaviour change and self-management of long-term conditions.
If this all sounds a step too far into an idealised future, let’s consider some of the current impacts of mobile on health services. Clinicians of all types are currently being asked to recommend apps to help support a myriad of conditions. How do they know which ones are evidence-based or adhere to treatment guidelines? How would they assess whether they are at all useful for their patients?
The idea of a New Zealand 'App Formulary' with evaluations of apps for various medical conditions that can be prescribed by clinicians for their patients is being discussed in many fora. The current lack of a decent evidence base in smartphone health apps should render this task quite do-able in the short term.
New Zealand has led the way internationally in evidence-based text messaging mHealth programs. We were the first to develop and publish a randomised controlled trial on a health intervention delivered solely by text messages, and have gone on to confirm the effectiveness of text messaging for smoking cessation programs in Cochrane systematic reviews.
At the National Institute for Health Innovation, we have been working with Waitemata and Auckland District Health Boards (DHBs) on two new text message programs. These include TextMATCH, a text message health information program for pregnant women and their families, and for the families of young children. This program supports a broader Healthy Babies, Healthy Futures initiative to prevent the onset of childhood obesity. It has been designed with different versions for Maori, Pacific, Asian and South Asian families and is currently being evaluated for its impact on attitudes and behaviours.
SMS4BG is a two-way text message program to support people with diabetes to self-manage between clinic visits. A pilot study across Waitemata DHB showed that it was appreciated by participants, supported them to manage their condition better, and improved diabetes control (measured by change in HbA1c level) in 81 per cent of participants with data available. We have recently been awarded funding for a large trial of its effectiveness.
Many other good local mHealth examples exist including apps like FoodSwitch, Listen Please and Tapuaki (look them up on iTunes or the Google Play store). Health and wellness are happening around us, supported by mobile technologies, all the time. There can be little doubt that the future of health is mobile.
About the author
Dr Robyn Whittaker is a program leader in health informatics technology at the National Institute for Health Information, University of Auckland, and a public health physician with the Waitemata District Health Board. Her research concentrates on the use of mobile health technology for population health interventions, as well as clinical trials and epidemiology.
Posted in New Zealand eHealth