Sophia Salenius leading expert in the international IT healthcare field

A few weeks ago I was invited to the EU Commission to give a speach for a workgroup in mHealth. Many interesting things were discussed, such as privacy, ownership of data and ethics.

But the most important issue, that many app-developers seem not to be aware of within the Lifestyle and Health arena, that it can be classified as a medical device. If so, it needs to be CE marked and to get that clinical trials etc is required. I quote from the summary of the workshop; (more…)

Business Today, India, today published a pressrelease on “Medical advice around the clock” services that have started in India. When I read the article two statements raised concerns with me;

1. “In almost 70 per cent of cases, physical presence is not needed,” says Dr Vinay Aggarwal, National Head, Indian Medical Association.

2. Ultimately we are only providing medical advice,” says Dr Singal. “The final responsibility rests with the doctor who is treating the patient

The statement that physical presence is not needed in 70% of the cases, must be incomplete. 70% of what cases? I have a hard time believeing that 70% of all patients seeking help in an ER, outpatient clinic, private clinic etc. could do it without physical presence.

If that would be the case, the careproviders could just publish their e-mail adress for the patients and the Doctors could reply by mail to their queries in 70% of all cases. And imagine the waitrooms, how empty they would be ………

I still believe that a Doctor in order to be able to give correct advice and diagnosis, need to see the physical patient and be able to examine and touch the patient.

The second comment worries me even more, they only provide advice, the final responsibility is still with the treating Doctor. So what does this service then add value too, if the patient still has to visit the treating Doctor?!? And how confusing for the patient who might receive two contradictionary advice as the electronic doctor and the treating doctor base their advice-assesment on two totally different material. And how frustrating for the treating Doctor, who gives advice based on the entire patient history, tests, face-to-face meetings etc.

And how would this be good for the patient, who has to pay for the subscription in addition to paying the treating Doctor????

I agree that second opinions from specialists is good to have in a country where they are not readily available everywhere. But they should be between professionals, not between a patient and an electronic Doctor, who does not have access to the whole picture and who is not taking responsibility for his advice.

Last week I attended the EuMHA meeting in Manchester, UK. EuMHA has managed to get all key-players from the health eco-system around the same table, in order to implement mHealth in a constructive and efficient way. And always with the patients interest in mind!

There are only a few countries in Europe where EuMHA is present, but there are more to come. And as the countries multiply, it will create a very good network for implementation of mHealth applications. To strecth it I would like to say, that those countries who are in the EuMHA network will avoid costly and seldom very efficient pilots, parallell pilots or pilots on applications that have already proven useless.

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mHealth should be an aid for patients and caregivers. Lately I have realized that as there are predicted to be so much money in mHealth, that in it self threathens the entire future of it.

Ads for conferences like

“Its 2015 and the value of the mHealth industry has reached US$10bn, healthcare providers worldwide are reporting considerable cost savings and improve processes.

What are you doing to ensure that you secure your bit of the mHealth pie?”

keeps filling my inbox. This can jeaprdize the entire credibility of mHealth in the future. mHealth can only be a success if the applications are developed by healthcare proffessionals and if they fill a real need for the patients. I know, I said that before and probably will say again!

Just like everybody praised healthinformation on the Internet when it arrived, everybody parises mHealth applications today, without checking out the credibility of the service and if the information in it is validated by a professional.

Anyone can develop an app. But can you trust the information in it when you are not face to face with the information provider and when everybody is racing for it’s piece of pie of the mHealth pie?

I am so delighted that Professor Ganapathy today in his key-note speach at the GSMA-mHA summit highlighted what I have failed to hear on other congresses and that I am a strong advocate for;

mHealth must meet a real need of the patient!

Not just a mHealth application where the “homework” is not done by new and old players who are eagerly trying to get a large piece of the big mHealth cake.

As I mentioned before, no business decision should be made before the new product – in this case mHealth services – clearly meets the need or solves a problem for the end user – in this case patient.

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Can a mobile handset spread bacteria and diseases as it is difficulet to clean?

Knowing that Doctors love latest mobile technology/smartphones, the question arises; is it really the optimal hardware to use for them in the hospital?

A mobile phone is difficult to clean several times a day and the debate is going on, if this can be an infectious spreader…… I must agree.

I also don’t see the benefits of having a mobile phone with small display as a recording tool for the Doctor in the clinic, where computers – tablet PC’s, PC’s, portable PC’s – are available everywhere. The risk for errors increase with the small size of the display and writing area.

The biggest benefit with mobile technology in health care is the communication with the patient. This can be done between a PC in the Doctors office and the patients mobile phone. This is how we have developed our service.

Like our mHealth services can bridge the gap between doctor and patient, our tsunami notification service can bridge the gap between sesimologists and people in coastal areas.

We all remember Boxing Day 2004. What everyone does not know is that it normally takes 30 – 90 minutes after an earth quake in the Indian Ocean, before the wave hits the shore. In 2004 it took about 30 min to hit A&N Islands, 1 hour 40 min to hit Sri Lanka and  1 hours 30 min to hit Thailand.

In Japan March 2011, it took 30 minutes before it hit the shore. It takes 8 – 12 minutes for a seismologist to send out a notification .

So, when an earth quake occurs of  M>6.5 in the Indian Ocean, and if a tsunami is expected, or already confirmed, the seismologists working in the tsunami center will send out an notification to the subscriber’s mobile phone.

Initially, the center will send out an sms  notification directing the recipients to view a detailed bulletin on the web for further information.  In the near future, location based messages will be sent out, including location based ETA’s (estimated time of arrival), EWA’s (Estimated wave amplitude) and Threat Status.

It will be launched by Airtel on June 7th and you can subscribe for it, as follows;

Customer has to send ‘HEALTH’ as SMS to 54444. He will receive a menu of options to choose from. Customer shall reply with another SMS by selecting and typing 5 (Option No. 5 = MORE). On selecting option 5, customer will be prompted to send keyword “EARTH” to 54444 and he will be subscribed to the notification service.

Imagine if this mobile tsunami notification service had been in place in Japan in March 2011.

In todays world, the PC is slovely moving to the mobile phone. More and more people – also in the developing countries – have access to a mobile phone and know how to use it.

To increase awareness and knowledge of a disease educational messages can be sent to the patients mobile phone. Formal studies and anecdotal evidence demonstrate that SMS alerts have a measurable impact on and a greater ability to influence behavior than radio and television campaigns. The message can be read in all confidentiality and stored if wanted.

If we can achieve a better insight in the disease for the patient and educate the public on chronic diseases, we can decrease complications and reduce false perceptions, stigma and discrimination, by influencing the public by factual information.

In a few weeks time we will launch the first educational service for HIV in India together with Heroes Project http://www.heroesprojectindia.org and Airtel – the largest operator in India.

Every complication, every discriminating act due to mis-perception that we can avoid with this service, will make it worth while. My nurse heart fills with happiness to see the devotion from Heroes Project and Airtel to get the information out to the public. Organisations like theese, brings back the hope for life and a better world.

I read in the news that healthcare is really going to go mobile now. Ford has begun producing a car seat to monitor the driver’s heart rate – a development that Ford hopes may warn motorists of a possible heart attack, thus better providing for their safety and the safety of others on the road.

Is this mHealth or cHealth – where the c is standing for car?

And I have a few other thoughts about this;

If we start monitoring our heart rate, bloodpressure, sugar etc. are we not becoming even a higher risk in traffic then?

The American Heart Association and other medical experts say the body likely will send one or more of these warning signals of a heart attack:

• Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting more than a few minutes.
• Pain spreading to the shoulders, neck or arms. The pain may be mild to intense. It may feel like pressure, tightness, burning, or heavy weight. It may be located in the chest, upper abdomen, neck, jaw, or inside the arms or shoulders.
• Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath.
• Anxiety, nervousness and/or cold, sweaty skin.
• Paleness or pallor.
• Increased or irregular heart rate.
• Feeling of impending doom.

Not all of these signs occur in every attack. Sometimes they go away and return. Soooo, will the chair that only monitors heart rate really save lives, or is this again another expensive experiment in the mHealth arena????

And the person him or herself? Should any of theese symptoms pass un-noticed and if so, then it might be too late anyway…..

My speeech that I rewrote after listening to other presentations the days before on a mHealth conference in Dubai. Enjoy;