"If you don't have mobility in your [healthcare] strategy, then you don't have a strategy," said Allina Health System's Susan Heichert at a 2012 national health information conference.1 As funds for traditional healthcare—doctors' visits, hospital stays, long-term nursing home residencies—dwindle, some estimates indicate mobile device revenue will reach $1.9 billion globally by 2014.2 The emerging term for mobile health is "mHealth." Who are the stakeholders? They include device makers, software and app developers, investors, providers, payors and insurance companies, not to forget the government and consumers. But, just what is mHealth? This article offers a brief, workable definition and some interesting examples.
Various definitions of mHealth exist in the marketplace as the field defines itself, but they all share certain identifying characteristics. Generally, mobile health is healthcare delivered through mobile communication technology,3 such as applications on an iPhone or web-based software accessed through a mobile device. The federal Department of Health and Human Services defines a mobile health device as:
"[A] handheld transmitting device with multi-functional capabilities used to store, transmit and receive health information and has user control over the access to the health information. Mobile devices combine elements of computing, telephone/fax, Internet and networking functions. This generally includes laptop computers, personal digital assistants (PDA), smartphones, and tablet computers. Mobile transmitting devices generally do not include storage devices such as USB drives."
Here is a simpler definition: mHealth is defined by three fundamental characteristics: 1) a device or software that is 2) health oriented and 3) has mobile use.
Discussion persists on whether mHealth is geared toward consumers ("health and wellness" usages such as personal weight-loss apps and medication reminders), providers and professionals (general medical information guides) or both (chronic-disease remote monitors that transmit information to the provider).4 For providers and their patients, point-of-care and remote-use devices are breaking the confines of traditional hospital and clinic settings. Many mHealth devices and applications are designed to connect to other data systems, including electronic health records (EHRs) and de-identified data sets. mHealth covers all of these uses, as healthcare moves toward greater mobility and increasingly encourages consumers and providers to work collaboratively in medical decision making.
Stakeholders should also be aware of mHealth initiatives taking shape in the public health sector, both nationally and internationally. There are now close to five billion mobile-phone subscriptions in the world, with more than 85 percent of the planet's population covered by a commercial wireless signal.5 The growth of mobile-phone networks in developing nations surpasses infrastructure, such as paved roads and electricity, enabling mHealth to reach far greater distances.
The following examples of mHealth devices and technologies demonstrate a wide range of usages and possibilities.
- A portable device, such as an iPad, that displays radiological images. (physician use)
- An EKG device or sleep-monitoring device hooked up to a patient and attached to a mobile phone that sends data back to the provider. (provider-patient use)
- Consumer apps that provide medication reminders. (consumer use)
- A chip installed in a pill that notifies a provider through a wireless device that the patient has ingested the pill. (provider-patient use)
- Skype software for psychiatric care for patients who need emergency treatment in rural locations. (provider-patient use)
- Text messaging from public health officials to mobile-phone users to send general anti-smoking information and to monitor patterns of smoking cessation. (public health use)
- Point-of-care, patient-specific data accessed by a physician at bedside to determine patient-specific drug interactions. (provider-patient use)
- Electronic medical guides and textbooks on portable devices. (consumer and provider use)
Conclusion
Nothing comes easy, especially with a field that is new, enterprising and breaks from traditional models. An mHealth product—a device or software that is health oriented and has mobile use—exemplifies innovation. Anyone considering staking a claim in mHealth should consider the issues that could determine success or failure: regulatory restrictions on devices, intellectual property issues, development costs, sources of financial support, competition, privacy, reimbursement, insurance, and contract issues, among others. For a list of legal considerations, see our article "mHealth Stakeholders: Bullet List of Legal Considerations." The barn door is now open. Through a balance of marketplace innovation and government oversight, mHealth is destined to reduce the costs and improve the quality of 21st century healthcare.
Lisa Clark practices in the area of healthcare law with emphasis on federal and state regulatory issues applicable to providers, HIPAA and privacy, managed care contracting, advertising and provider reimbursement, including through new delivery models such as pay for performance, shared savings and accountable care organizations (ACOs) and ACO-likes offered by commercial payors. Ms. Clark leads the firm's mHealth Multidisciplinary Team.
Footnotes
1. Susan Heichert, senior VP and CIO of Allina Health System, 2012 Healthcare Information and Management System Society (HIMSS) Conference.
2. The Mobile Healthcare Opportunity: Monitoring, Applications & mHeatlh Strategies 2010–2014. JUNIPER RESEARCH. http://juniperresearch.com/reports.php?id=219 .
3. What is mHealth? ROYAL TROPICAL INSTITUTE (February 7, 2012). http://www.mhealthinfo.org/what-mhealth .
4. mHealth Technologies: Applications to Benefit Older Adults. CENTER FOR TECHNOLOGY AND AGING. March 2011. http://www.techandaging.org/mHealth_Position_Paper_Discussion_Draft.pdf .
5. mHealth: New Horizons for Health Through Mobile Technologies. WORLD HEALTH ORGANIZATION. (Volume 3, 2011). http://www.who.int/goe/publications/goe_mhealth_web.pdf .
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