Tapping the potential applications of mHealth

Mobile health, or "mHealth" for short, describes technology that allows clinicians or public health professionals to monitor and/or deliver health-related messages to patients via cellular phones, tablets, or other wireless devices. mHealth applications can complement and expand care provided at traditional face-to-face visits, and exploring their untapped potential to improve health in the U.S. and abroad was the topic of a recent Georgetown University Health Policy Seminar.

One popular mHealth initiative is the text4baby program, a public-private partnership launched in 2010 that sends free text messages to expectant and new mothers containing appointment reminders, safety alerts, and general prenatal and postpartum health advice. Smartphone apps now include a variety of self-management tools for weight loss, physical activity, and chronic diseases such as hypertension and diabetes. The U.S. Food and Drug Administration recently moved to regulate health apps that act as medical devices (e.g., electrocardiogram) and would pose safety risks to patients if they malfunctioned. However, the vast majority of health apps used by consumers will not require FDA approval.

In the developing world, "mHealth projects are launching at an exponential rate," declared a recent issue of Johns Hopkins Public Health Magazine. Cellular phones have made real-time communication with field workers routine and allowed teams of nurses and midwives to attend births in rural Bangladesh. However, the field of mHealth is hampered by a lack of evaluations of health outcomes and concerns about sustainability of successful interventions:

Using phones to advance public health isn’t as simple as it seems. Researchers are grappling with complex questions that have already doomed hundreds of mHealth projects: How do you know whether mHealth projects are really working and worth the investment? How do you conquer the phenomenon known as “pilotitis,” and scale effective strategies into health systems that have regional or national impacts? And how do you make sure these projects are long-lasting additions, instead of the public health equivalent of a dropped call?

We debated the types of policies that would be most likely to encourage innovations that make a positive difference for individuals and populations. How can we avoid creating "digital divides" that could worsen health disparities? Should state and local governments provide direct grants or tax relief to promising startups? Or should the central planners get out of the way and trust free market forces to produce the future of mHealth?

- Kenny Lin, MD, MPH

  Director, Robert L. Phillips, Jr. Health Policy Fellowship
  Department of Family Medicine
  Georgetown University School of Medicine