• mHealth
  • There’s a template for developing mHealth strategies

    With Africa’s score on the WHO results from its global eHealth survey approaching 60%, there’s still plenty to do. A survey by Spok offers some good practices for the next steps. The start point’s that there isn’t a single definition. Instead, organisations have different interpretations. Common purposes seem to be:

    • Align mobile objectives with organisational goals
    • Feed the framework for all mHealth projects
    • Answer questions such as:

    o   How can mHealth enhance patient care

    o   What strategic initiatives need including in plans for mobile enablement, such as shorter ED and inpatient discharge processes

    o   What integrations are needed meet the larger goals of the hospital, such as easier communication between healthcare teams

    o   How can mHealth improve health workers’ productivity.

    As mobile technology and opportunities develop, healthcare’s mHealth strategies need to move on to match. This needs regularly updated policies. US experience is that mHealth strategies are quite fluid, with organisations amending them as needed:

    Shifting end users’ mobile needs


    New devices available


    New EHR provider capabilities


    Changed strategic goals


    Challenging strategy implementation


    Leadership changes


    Mobility strategy not updated


    A common feature’s that stated strategic goals aren’t embedded sufficiently or explicitly enough in mHealth strategic goals. Examples are:

    • Communications between doctors
    • Nurse to doctor communications
    • Communications between nurses
    • Code team or rapid response team communications
    • Communication with health systems’ doctors networks and and other health professionals
    • Managing critical test results
    • Nurse call and patient monitoring alerts to mobile devices
    • Patient satisfaction scores
    • Patient throughput
    • ED and bed turnover
    • Alarm fatigue.

     Improving on these needs a range of engaged stakeholders. They include ICT, clinical leaders, telecommunication experts, all appropriate healthcare professionals and other health workers and the organisations’ executives. Setting them up as permanent mHealth strategy teams is a priority for Africa’s health systems.

  • mHealth’s MDCS needs better cyber-security

    While mHealth’s been successful in developing countries, many initiatives fail to address security and privacy issues. Leonardo Iwaya’s at Karlstad University’s Faculty of Health, Science and Technology. His thesis, Secure and Privacy-aware Data Collection and Processing in Mobile Health Systems, starts from this perspective and describes solution. 

    He sets a context where mHealth often operates in a setting of no specific legislation for privacy and data protection in developing countries. Africa’s health systems exhibit equivalent limitations. His work has several components:

    • A comprehensive literature review of Brazil’s mHealth
    • Design of a security framework, SecourHealth, for Mobile Data Collection Systems (MDCS)
    • Design of a MDCS to improve public health using geographic Information (GeoHealth)
    • Design of Privacy Impact Assessment (PIA) template for MDCS
    • Study of ontology-based obfuscation and anonymisation functions for health data. 

    These offer Africa’s health systems a route into Information security and privacy that are paramount for high quality healthcare. They also protect healthcare professionals and other workers by creating a secure and explicit working environment for their clinical and working practices.

    Iwaya’s objective’s to enhance knowledge of the design of mHealth’s security and privacy technologies, especially the MDCS. These extend across data collection, reporting and replacing paper-based approaches for health surveys and surveillance. It’s a good place to start from to improve mHealth’s general and cyber-security.

  • Hospitals need better cyber-security from their app developers

    The pace of innovation in healthcare is staggering. mHealth apps are helping to push it along. Innovators are speeding apps through development processes to bring them to market as quickly as possible. It often means cyber-security’s not a priority, leaving healthcare organisations to pick up the consequences.

    “There are a million different apps out there – the problem is the low barrier to entry into the healthcare market,” said Kurt Hagerman, CISO at cyber-security firm Armor Defense, in an article in Healthcare IT News.“When you look at the EHR vendors, they cannot be everything, they have to focus on a core set of services and then allow others to supplement those large, monolithic EHR systems with other apps.”

    With some EHRs having a narrow focus, there’s a rush to capitalise on using mHealth to provide personal health data and advice. These factors combined are a challenge for health systems to use the latest innovations without compromising protected health information and personally-identifiable information. 

    The first step’s educating developers about the healthcare industry and its unique requirements. Health systems working with app developers need to be explicit from the outset about their cyber-security requirements. Hagerman says “To protect confidentiality, integrity and availability, you have to build strong authentication credentials, you have to encrypt.

    Beyond education, it’s up to health systems to be better at enforcing cyber-security, ask app developers the right questions and demand the protections that defend patient health data. “A sense of urgency is building – you cannot just build an app, there are security requirements. The industry is starting to correct this a little bit,” he added.

    Healthcare providers need to construct a stronger message for developers. Better cyber-security’s crucial to protect patients’ personal data. They can’t afford to carry the risks of insecure and vulnerable mHealth.   

  • Can high-speed broadband improve health?

    Acfee sees a huge role for eHealth as helping to achieve healthier Africans. It seems the American Medical Informatics Association (AMIA) has taken it further. In a long letter to the Federal Communications Commission (FCC), AMIA says high-speed Internet access to low-income populations could enable them to benefit from mHealth interventions. Examples include disadvantaged populations accessing mHealth and participating in research studies without paying data charges. 

    It also proposes that FCC policies should leverage broadband-enabled solutions for specific patient populations, such as substance abusers and patients with chronic diseases. Wider and cheaper Internet access is seen as increasing mHealth use by underserved communities, improving their access to health information and care and improving clinical outcomes.

    The concept builds on the FCC’s assertion that of broadband-enabled services and technologies are improving availability and accessibility and transforming healthcare. AMIA also says broadband access is, or soon will be, a social determinant of health, defined as” structural determinants and conditions in which people are born, grow, live, work and age.” Examples are socio-economic status, education, physical environment, employment, life-style choices, clean water supplies and social support.

    This paradigm shift enhances mHealth’s role in health and healthcare. For Africa’s health systems, it may mean a shift to a wide, integrated and bigger mHealth strategies with more explicit, realisable benefits.

  • mHealth lessons may not be easy to transfer

    As the volume of the mHealth initiatives across the world expand, transferring the successes offers an effective way to make use of scarce mHealth development skills. It’s a valuable concept, but “may as readily translated to a country like India as proponents of mHealth might assume.” It’s a conclusion of a study from Durham University in the UK. If it’s a challenge for India, it may prevail across Africa too.

    “MHealth and the management of chronic conditions in rural areas : (sic) a note of caution from Southern India” draws from fieldwork to explored challenges facing mHealth implementation in Andhra Pradesh. It reviewed mHealth in chronic medical conditions, type 2 diabetes and depression. The research:

    • Identified ways people in a rural area access medical treatment
    • Assessed how adults use mobile phones in daily life to gauge the realistic chances of mHealth uptake
    • Identifies different pathways to care for the two medical conditions
    • Emphasised the importance to the rural population of healthcare outside the formal health system, and provided by Registered Medical Practitioners (RMP) who are neither registered nor trained
    • Demonstrate the limited use of basic mobiles by most of the older adult population
    • Examine how promoting self-management by patients may not be as readily translated to a country like India as mHealth proponents of might assume. 

    These combine into significant mHealth inhibitors. An important finding’s that it can be difficult to identify a clinical partner for patients or their carers for mHealth designed to help manage chronic ill-health in rural India.  

    While mHealth offers an effective potential response for better public health surveillance and healthcare, a more appropriate perspective’s is its probability of success. Invariably, probability has a lower socio-economic return on investment. The study raises a note of caution for India’s rural communities, suggesting that some more ambitious hopes for mHealth may be hard to realise. Factors at play include:

    • Tendency diabetics to avoid the government or formal health sector as a whole
    • The role of RMPs are central to such choices
    • Difficulties in seeking and sustaining treatment for depression
    • The viability of patients managing their own healthcare to realise benefits of self-management.

    Health workers often acknowledged communication problems between clinics and patients, but tend to assume it’s more straightforward to identify appropriate clinical end of the communication. The study challenges this assumption. The hypothetical self-managing individual fits well with popular western notions of self-actualisation, but may not transfer to India’s remote rural communities. Does this description fit Africa’s remoted rural communities too? The study’s cautious about generalisation across India, but does emphasise social and systemic challenges in addition to the technical features. So, while mHealth may not readily transfer across rural communities, the challenge to maximise mHealth’s health and healthcare benefits might.

  • More mHealth strategies are in place

    As mHealth expands across Africa, a report from Spok identifies an expansion of mHealth strategies. It’s improving, but there’s still plenty to do. From 2012 to 2017, healthcare organisations with mHealth strategies have increased from 34% to 65%. The Evolution of Mobile Strategies in Healthcare also identifies areas for improvement. 

    While many healthcare organisations have explicit healthcare development goals for clinical and working practices, it seems that mHealth’s contribution’s lagging behind. Spok’s findings are:


    Stated goal

    In mHealth strategy

    Physician-to-physician communications                 



    Nurse-to-physician communications    



    Nurse-to-nurse communications



    Code team or rapid response team communication



    Communication with health professionals networks




    Critical test results management



    Nurse call and patient monitoring alerts to mobile devices



    Patient satisfaction scores



    Patient throughput        



    ER and bed turnover



    Alarm fatigue    



    The findings provide a lesson for Africa’s health systems to ensure their mHealth plans and initiatives aren’t left outside conventional healthcare improvement projects. It seems it’s easy to overlook mHealth’s potential.

  • Patients in EDs have faster treatments when lab results use mHealth

    Being in ED isn’t a preferred way to spend quality time. Waiting longer than necessary makes it worse. Using mHealth can make shorter times feasible. A Canadian study in Annals of Emergency Medicine found that ER patients with chest pain spent 26 minutes less waiting to be discharged when doctors received the lab results on their smartphone. It took longer when doctors waited for results to show in EHRs. The approach, a push-alert system, sends all laboratory results simultaneously to both EHRs and an ED server. The server continuously searches for test results in the push-alert programme, such as troponin levels. When it finds them, it sends an email with patients names and test results to the most responsible doctors’ smartphones. An audible alert enables doctors to access the results as soon as they can. Only push-alert emails are sent to these phones.

    A 26 minute shorter wait’s significant for patients. The time savings the difference between 68.5 minutes for doctors decisions using mHealth alerts compared to 94.3 minutes for doctors who didn’t, but used EHRs. It also means EDs can be less crowded. The study dealt only with troponin tests, but it seems a reasonable assumption that other test results send to mHealth services under the right circumstances may yield equivalent results. 

    These results offer significant mHealth investment opportunities for Africa’s very busy EDs. The productivity and patient gains are attractive.

  • Bouy determines a person’s medical condition

    Doctors and computer scientists in Boston and New York have developed Buoy, a free AI platform. It helps people to use their symptoms to determine their medical conditions and make better decisions. The eHealth tool began in 2014 at the Innovation Laboratory at Harvard. Buoy’s co- founder and CEO, Andrew Le says currently, medical information provided by simplistic web symptom checkers are often risky and unreliable. To overcome these limitations, Buoy leverages advanced machine learning algorithms to provide personalised and accurate analyses and diagnoses to users so they can quickly and easily have more control of their healthcare.

    Bouy asks users to enter their ages, genders, and symptoms. It then asks a few questions, such as the severity of their symptoms and their durations. It uses this information to analyse against millions of medical records to generate other important, more specific questions. After two to three minutes of analysis, Buoy has an accurate and detailed understanding of users’ conditions. It will then recommend appropriate healthcare alternatives. If immediate treatment’s needed, it provides directions on how to connect with a nearby healthcare providers.

    An article in eHealth news says Bouy’s been through a battery of quality control tests. The result’s that it can accurately analyse a wide range of symptoms, such as common colds, abdominal pains and how a change of running shoes has created muscular or skeletal issues.

    The study tried to determine how Buoy interprets a cough compared the top five web-based symptom checkers. It examined 100 standardised cases involving 33 different diagnoses with severity ranging from life-threatening pulmonary embolisma to benign, normal cough. Prevalence was assessed too, ranging from rare histoplasmosis to common cold. Results were that Buoy’s analyses were 92% accurate as compared to WebMD at 56%, Healthline at 53%, Mayo Clinic at 38% and Isabel at 28%. Buoy has over 5,000 users and is available as an app on Apple store and directly from Buoy.

  • An mHealth app increases smoking cessation chances

    Globally, over 1.1 billion people smoked tobacco. That’s an estimate for 2015 from the WHO. Many more men smoke than women. Tobacco is the only legal drug that kills many of its users when it is used exactly as its manufacturers intended. WHO has estimated  that tobacco use, both smoking and smokeless, causes about six million deaths a year across the world. Many of these are premature. It includes approximately 600,000 people estimated to die from the effects of second-hand smoke.

    Clickotine, is an mHealth app that aims to help reduce the number of smokers. It emphasises the chances of successful rehabilitation from tobacco use. Research in the Journal of Medical Internet Research  (JMIR) shows that a personalised app for smoking cessation can help smokers who wish to quit, but who prefer using less intensive clinical intervention.

    An article in mHealth Intelligence says Clickotine offers a user-friendly way for patients to engage with their needs. It is developed with effective personalisation and engagement features of a smartphone app but includes components to support personal intervention complying with US clinical practice guidelines (USCPG). A questionnaire starts up when Clickotine is opened. It probes users to record their smoking behaviours and quitting goals. They also create a user profile with their unique smoking behaviours and input for personalised updates and messages.

    A log tool allows users to record smoking behaviours like cravings, sentiments, and number of cigarettes smoked. It is one of the app’s most popular features.  An article published in PubMed.gov says people between 18 and 65 used the app to start quitting on their own. About 45% abstained for seven days. Almost 27% abstained for 30 days. It seems that mHealth apps could provide a good step towards smoking  cessation across Africa. However, they need more testing.  Will this app have the same effect in All Low and Middle Income (LMIC) countries?

  • Medical Aid Films and Econet are transforming malaria health education in Zimbabwe

    Roughly 50% of Zimbabwe’s population live in areas with a high risk of malaria transmission. In response to the need for improved awareness about the disease, Medical Aid Films have been working with Econet Wireless on an innovative project to reach health workers and communities with vital information on their mobile phones. With over 9 million subscribers, Econet Wireless is Zimbabwe's biggest mobile operator, reaching over 65% of the mobile market.

    “This is an extraordinary opportunity to share free, easy-to-access information through animated films, which people can watch on their phones and share again and again, to improve knowledge and save lives.” Mr Douglas Mboweni, CEO Econet Wireless Zimbabwe.

    Produced with Zimbabwe’s Ministry of Health and Child Care and a team of experts, the mobile-friendly animations focus on the prevention, diagnosis and treatment of malaria and are available in English, Shona and Ndebele.

    The animations are available to watch for free on the zero-rated Econet Health website, with the link disseminated via blast SMS to all subscribers. They will also be shared with communities across Zimbabwe, supporting training and awareness-raising work of Zimbabwe’s National Malaria Control Programme.

    We are extremely proud to be working with Econet on this project – a fantastic example of the public and private sectors coming together to improve access to vital health information for people across Zimbabwe”. Chair of Medical Aid Films Board of Trustees, Richard Meredith 

    The films address Malaria Prevention, Diagnosis and Treatment.