• mHealth
  • Samsung's African mHealth for maternal health

    Samsung is to provide health workers in East Africa with subsidized smartphones as part of its mHealth initiative. The initiative aims to boost maternal health for 15.5 million women across Africa. The partnership driving the initiative is between Samsung and the World Health Organization (WHO) and is already active in Nigeria and South Africa. The initiative will come to East Africa early next year, starting with Kenya, Tanzania and Rwanda.

    Robert Ngeru, chief operating officer of Samsung East Africa also announced a partnership with Strathmore University on the Doctor Smart Solution Project. It’s a telemedicine initiative that allows patients to perform their own tests and upload the results to a cloud platform. Doctors can then access the results, make diagnoses, and recommend appropriate treatments.

    Samsung has made sure the Doctor Smart Solution deals with privacy and security concerns. Any data uploaded to the cloud can only be accessed by patients’ doctors after they’ve entered their secure passwords.

    The solution is still at the deployment stage. Once launched, Samsung will initially work with private hospitals to implement the solution but later will incorporate government institutions through the help of African Medical and Research Foundation (AMREF).

  • GSMA's mHealth study report's out

    GSMA's new paper on “Understanding the needs and wants of pregnant women and mothers” was published in July 2014. It’s the result of interviews with over 2,000 pregnant women and mothers of young children, 15 to 49 years old, across South Africa from February to April 2014. It provides good insights.

    A key finding is that “the business case for using phones to reach out to bottom of the [socio-economic] pyramid women remains compelling.” However, in contrast, the report also shows that women rely mostly on “traditional media” and “experts for health advice.” This suggests that success depends on women changing their services preferences, which is an important finding. Whether what’s needed is simply a first-hand taste of some of mHealth’s numerous possibilities or whether a more fundamental, cultural shift is required, and which is harder to predict, is too early for GMSA to say. More mHealth services or more detailed research, or both, are probably required to tease out the issues and test mHealth uptake.

    The report’s recommendations include:

    Improve awareness, familiarity and credibility, through promotional activities Expand the service beyond Maternal Newborn and Child Health (MNCH) to create a more personalized user experience, including the potential for greater interaction and two-way communication Enhance potential review streams by bundling health and other services.

    Many stakeholders are evaluating the mHealth opportunity and considering the best ways to position it to support health transformations. eHNA will be watching closely to report on progress. Key questions are:

    Will women take up mHealth in a meaningful way? If women don’t soon, how long is it likely to take? What should be done until then?

    GSMA’s Mobile for Development mHealth programme aims to “connect the mobile and health industries, to develop commercially sustainable mHealth services that meet public health needs.”  This is the goal from the website.

  • Text messaging still very effective

    HealthCrowd, a text-message-based patient engagement strategy, has completed a pilot with New York Medicaid plan Healthfirst, showing that 86% of Healthfirst’s Medicaid population was able to receive text messages. While this may seem obvious and trivial to some, it comes as a surprise to many.

    Neng Bing Doh, HealthCrowd’s CEO and cofounder, told MobiHealthNews in an interview that “historically, a lot of Medicaid plans have had the preconception that because their members were lower income, that they didn’t have mobile phones. Another preconception is that people don’t want to pay for these messages or find them intrusive. We absolutely debunked that as well. Our response rate was anywhere from 30 to 60 percent and our opt out rate was really really low; it was 3.7 percent.”

    HealthCrowd worked with 941 patients for two and a half months during the study. The target group included pregnant women and families with children and teens, and the interventions were designed to encourage families to get vaccinations, child visits, and/or prenatal care.

    Doh and her team also wanted to look into whether the text messages were actually successfully driving action. “And in terms of outcomes we were also able to demonstrate that our program was able to get 32 percent of the members that participated to take an action in just a little shy of two and a half months,” said Doh.The company projected that, if given a full year, they could potentially increase that number up to 86%.

    In terms of cost effectiveness, the study showed that HealthCrowd’s text messaging platform was 15 to 100 times more effective than other modalities and provided a three to 30 times better return on investment (ROI) when normalized for cost.Specifically, the messaging platform was 100 times more effective than postcards, 50 times more effective than buckslips in mailers, 30 times more effective than voice calls, and 15 times more effective than email.

    While about 40% of patients had smart phones, convincing them to download apps is not always easy. Getting them to use the app once it’s downloaded has proven to be even more challenging. Given the simplicity and cost effectiveness of the text messaging system its likely to continue to be a very strong communications channel in the years to come.

    HealthCrowd has recently launched other options for health plans that don’t want to use text messages exclusively. HealthCrowd has added instant messaging, email, interactive voice response, web and mobile web, social media and paper-based outreach to its portfolio. Health plans in Africa can certainly learn from the study’s findings and can create their own combination for their communication platform, one which they believe will work best in their healthcare environment.

  • Smartphones and diabetes fit together

    At Med-e-Tel 2014 a presentation of Actelin, the smartphone app for diabetes management showed its value. A short summary is in the Med-e-Tel Newsletter.

    Actimage, a Luxembourg ICT company, developed Actelin using functional insulin therapy. It delivers advice following its complex expert system and calculates the bolus required in case of detected hyperglycaemia depending on carbohydrate intake and physical exercise. A a large database of nutrients and typical physical activities are part of the application. ActiHome, a service platform for the elderly at home, is another Actimage product.

    It seems like a market with considerable potential. Clinical Diabetes, the American Diabetes Society’s online service said that in 2011, over 85% of Americans used a mobile phone, and half of them also had internet access through them. The post goes on to describe the value of ten apps for diabetes. It found that they are versatile, usable, functional and low cost. Smartphone applications and tools for managing diabetes may be effective in reducing diabetes progression and improving the quality of life.

    eHNA described an equivalent initiative in Senegal that provides an app for diabetics Diabetes applications are appearing in other countries too.

    In addition to their mHealth role, mobile phones are an important connectivity resource for African countries too. Their impact is essential for modern healthcare for low-income countries.

  • mDiabetes to help Senegal battle Diabetes

    A new mHealth project, mDiabetes, has been launched in Senegal. It’s the first project established for a French-speaking country under “Be He@lthy Be mobile”, a joint global initiative by WHO and the International Telecommunication Union (ITU).The initiative uses SMSs and is currently in its first phase of implementation, with a larger and wider-reaching programme scheduled for roll out in November 2014. mDiabetes aims to combat diabetes with an ambitious and innovative campaign designed to improve prevention by raising awareness among diabetic patients and training health professionals. To accommodate illiterate patients and to make the initiative more effective, the Minister of Health and Social Action is planning to incorporate voice notes and voice messages.

    The WHO has estimated that there will be roughly 552 million diabetics in the world by 2030, 75% of whom will live in low-income countries where diabetes will be the seventh cause of death. The WHO believes that mHealth could significantly contribute to slowing down the increase.

    There’s a variety of major stakeholders in the project. They include the Senegalese Ministry of Health and the Ministry of Communication, ITU, WHO, the Senegalese Association for the Assistance and Support of Diabetes Patients, (ASSAD), the African branch of the International Diabetes Federation, the NGO UNFM, the Marc Sankalé Diabetes Center, Alcatel-Lucent, Sonatel/Orange, BUPA, the global international health insurance and services company, and Sanofi.

    The aim is to help implement strategies for preventing and combating diabetes and other non-communicable diseases. For diabetics, it’s an opportunity to interact directly with health professionals for better management of their disease.

    “We are convinced of the value of this project for improving the conditions for diabetes patients in Senegal and are genuinely delighted to be involved as a technological partner in contributing to the success of the mDiabetes project. This is an ambitious initiative which could ultimately be replicated in other countries in the fight against diabetes or any other disease,” said Alpin Verlet, Managing Director of Alcatel-Lucent for West and Central Africa.

    Sending SMS or voice messages has several objectives:

    Educate and raise awareness among the population Provide information on the diabetes and lifestyle to limit its occurrence Appointment reminders, lifestyle, dietary advice, and complying with treatments to limit complication risks Ttrain health professionals Provide and implement tools for prevention, screening, diagnosis, treatment and monitoring, particularly in rural areas.

    mDiabetes has a wider value beyond Senegal. It’s transfer to other African countries should follow rapidly.

  • MomConnect offers a sound focus for SA's eHealth strategy

    South Africa is a fertile home for new mHealth, with a number of initiatives underway. A new one is emerging that’s set to be important.

    MomConnect provides continuous links with pregnant women. The partners are UNICEF South Africa, Virtual Purple, Praekelt Foundation and the provincial Department of Health in KwaZulu-Natal (KZN). It’s an SMS based project.

    It’s part of the South African National Department of Health’s nationwide maternal mobile health system due for launch this year, as reported by Africa Health It News. The efforts contribute to the campaign on Accelerated Reduction of Maternal and Child Mortality in Africa (CARMMA), and aim to register 1 million pregnant mothers into a national public health database.

    GSMA describes MomConnect as an “SMS-based project that aims to remind pregnant mothers about critical clinic visits during pregnancy, as well as check-ups and immunizations until the child is 18 months old.”

    South Africa’s Minister of Health Dr Aaron Motsoaledi describes MomConnect as one of a number of important steps underway to reduce South Africa’s maternal and child mortality by improving communication with the 1.5 million women who become pregnant every year. “This service will enable us to send SMS messages to every registered pregnant woman.” He told parliament on 19 June 2014.“The messages will be appropriate to the stage of pregnancy and will advise them on what to do at that stage. It will also advise them on how to take care of their newborn.”

    It’s an ambitious programme that fits the passionate leadership style and service focused approach of the minister. “Apart from us sending messages to them, they will also be able to send us SMS messages,”  he adds, “about the problems they encounter when they try to access health services. They may also call to compliment the health facility if they think the service they received was good.”

    One of the challenges faced by South Africa’s Prevention of Mother-to-Child Transmission (PMTCT) is to provide a continuum of care to HIV positive pregnant mothers and their children from antenatal to postnatal periods.

    MomConnect aims to close the gaps in the continuum of care, using mobile technology linked with patient electronic medical records to support PMTCT, including the improvement of maternal and child health outcomes. A pilot has been running in selected KZN facilities since 2011.

    Otty Mhlongo’s is a PMTCT manager in KZN. She presented at last year’s South African Aids Conference where she said,“MomConnect aims to improve Maternal & Child Health, and ultimately eliminate paediatric HIV transmission through the use of on-going SMS messaging to the mom.”

    The pilot tests the efficiency of personalised, unique antenatal and postnatal SMS reminders to 6,000 pregnant women, irrespective of their HIV status, in two KZN districts. It showcases MomConnect’s ability to enable early recognition of HIV positive women with a low count of CD4 cells, white blood cells that help maintain the body’s immune functions, who require Anti-Retroviral Treatment (ART). Regular, tailored supportive messages and reminders during antenatal and postnatal periods, the facilitation of clinic visits for mothers and babies and the improved communication between patients and treatment providers add considerable benefits to health and healthcare effectivness.

    Messages will be in six languages at its launch, with plans to ultimately accommodate all of South Africa’s 11 official languages. It’s a substantial undertaking.

    Scaling up MomConnect is an important project. It’ll need high levels of Semantic Interoperability (SIOp) and Health Information Exchange (HIE), possibly and bi-directional levels to support information flows, EHRs and population health services. These two facilities often need an expansion in ICT capacity to support in the increased traffic that this type of scale-up needs. Dealing with these eHealth technicalities in a patient setting is a good way to proceed.

  • The mHealth super app

    Bill Gates remarked that “software is a great combination between artistry and engineering.”According to Natalie Hodge and Brandi Harless of Personal Medicine Plus, good mHealth apps are about combinations too, though for them it’s mHealth and Internet of Things (IoT), intersecting to produce the super app. They wrote about it recently in mHealthNews.

    eHNA’s had numerous posts about mHealth and a number on the IoT. This is the first time they’re together. It’s a novel idea, that if we connect all the apps that tell a patient how they are doing or what they should do next, we might end up with a health promoting, or healthcare, platform, or both. It would help people stay healthy and allow them, in some cases, to take their health into their own hands and bypass the conventional healthcare system. It’s the approach Google Fit is following too.

    Hodge and Harless suggest that winning super apps have six attributes:

    Use multiple proven technologies in mHealth in tandem Leverage proven engagement strategies Leverage application programming interfaces Use connected health devices Automate interpretation of data with actionable and immediate instructions for behavior change Build on evidence-based prevention principles.

    The themes match well with important eHealth topics, such as interoperability, analytics and sound stakeholder engagement. They also raise questions about risks of cybercrime and the complexity of conducting impact assessments.

    The list is different to those eHNA reported in eHNA’s piece on a new recipe for successful mHealth apps. Perhaps their combination would be good too.

    eHNA will watch for reviews of projects that show how the concept develops. We look forward to more posts on fortuitous combinations, particularly about new ways of using eHealth to improve health and healthcare.

  • More mHealth services coming to sub-Saharan Africa

    According to IT News Africa, GSMA has announced the launch of its new cross-ecosystem partnership. It aims to provide a range of mHealth services to women and children across Sub-Saharan Africa. The initial launch partners include Gemalto, Hello Doctor, Lifesaver, Mobenzi, Mobilium, MTN, Omega Diagnostics and Samsung.

    In September 2014, services will be launched in seven countries. They are Côte d’Ivoire, Ghana, Nigeria, Rwanda, South Africa, Uganda and Zambia. Phase two starts in 2015. It incorporates more partners and services and four more countries: Kenya, Malawi, Mozambique and Tanzania.

    Tom Phillips, Chief Regulatory Officer for GSMA said, “This new mobile ecosystem partnership is committed to connecting the mobile and health industries to develop commercially sustainable mHealth services that meet public health needs.” 

    The partnership aims to reduce barriers to handset owners and improve connectivity for consumers and health workers by:

    Offering discounted Samsung handsets and tablets to consumers and health workers across Africa Providing access to Samsung’s ecosystem, such as music, video and other value-added services as an incentive to drive health usage Pre-embeding a Smart Health application with a range of professional applications, information and services on 80 million Samsung handsets Leveraging existing and new MTN SIMs to allow free access to health content, health registration and data collection with the Smart Health application Providing simpler access to MTN mobile money, advertising and billing capabilities Making innovative diagnostics, like the Omega Diagnostics Visitect HIV CD4 gene solution, more affordable and accessible with mobiles.

    Health content, patient registration, data collection and critical diagnostics will increase the access to healthcare for vulnerable women and children across Africa. It also aims to provide a delivery mechanism for mHealth services that are commercially sustainable and scalable.

    “Healthcare in Africa has benefited greatly from advancements in mobile technology. Simultaneously, the healthcare industry is moving towards a delivery model that is more patient-centered, value-based and accessible in even remote environments,” said Thabiet Allie, Head of Content and Services at Samsung Electronics Africa. “Samsung is perfectly positioned to add value to this digital evolution in healthcare, as our devices are both at the cutting edge of innovation and available widely across the continent.”

    eHNA is looking forward to seeing the results of the monitoring and evaluation to show the net benefits and the options for expansion.

  • Google's passionate about your fitness, and health

    Does the difference between health and fitness matter? Maybe not too much. Fitness is about 17% of the USA mobile app market according to reserach2guidence in its report mHealth App Developer Economics 2014 The State of the Art of mHealth App Publishing.

    The Verge has a report on Google’s unveiling of Google Fit, its personal health application, at the launch of the Google I/O developer conference 25-26 June 2014. Google Fit aims to collect data from popular fitness trackers and health related apps. It will allow a wearable device that measures data such as steps or heart rate to interface with Google’s cloud-based services and become part of the Google Fit network. These are important components of fitness, but health too. It’s an exciting development.

    The personal health application is expected to compete with Apple’s HealthKit application, the concept modelled on Apple’s Passbook app, an effective pocket accessory for keeping important information like boarding passes, tickets, gift cards and coupons.

    Forbes reports on it too, indicating that it’s too soon to confirm whether Google Fit will be an app or whether it will be built into the next version of Android, the operating system that currently runs on over 1 billion smartphones and tablets globally.

    Google announced several partners for its Google Fit initiative. It includes Nike, Adidas, Withings, RunKeeper, and Basis. Phew, it’ll be hard to keep up with these. App developers may want to start warming up – access to the software development kit should be available in the coming weeks.

  • Mobile technology's profiled in an eBook

    Keeping up with mHealth developments is hard. FierceHealthIT has released its commentary as an eBook on the latest example and profile that helps. Verizon, a wireless and technology provider, sponsored the eBook. It includes examples of: St. Luke’s Cornwall Hospital in New York, where care transition teams send nurses into the community with a mobile EKG device that attaches to a smartphone and mobile, Internet-enabled technologies ensure that patients have the right care in the right setting at the right time

    Boston Children’s Hospital uses a range of mobile apps both patients and physicians, including one that helps patients and their families navigate the healthcare system and another that helps them coordinate and communicate with their healthcare team The Veterans Health Administration is working to make its electronic medical system available on mobile devices, with plans for apps for doctors to access other back-end systems At Children’s National Medical Center, a texting pilot program has had early success in improving care transitions and outcomes for asthma patients and has improved patients’ and parents’ experiences.

    mHealth has expanded fast and shows no signs of slowing down. It has the potential to make patients feel more connected to their care and clinicians more connected to their patients, especially during care transitions.

    The range of mHealth opportunities is both wide and skewed. Research2Guidance has published its latest mHealth economics assessment. It shows a USA mHealth distribution[1] across twelve mHealth categories:

    Fitness  30% Medical reference: drugs, disease, symptoms information  7% Wellness apps  15% Nutrition  7% Medical conditions  7% Personal health record  3% CME  2% Diagnostics  2% Compliance  1% Reminders  1% Remote consultation  1% Others  14%

    The mHealth snapshot in the eBook is a good way to keep up with this changing array.

    [1] mHealth App Developer Economics 2014 The State of the Art of mHealth App Publishing research2guidance