By Dr Patricia Mechael

03 November 2016 - 16:14

'The costs are going down, but the sophistication of the technology is going up.'
'The costs are going down, but the sophistication of the technology is going up.' Photo ©

Mat Wright

Can a smartphone app really diagnose your symptoms? We asked Dr Patricia Mechael, a 2016 Education UK Alumni Award winner, to explain the latest innovations in mobile health.

What is mobile health? Can you explain the term with some concrete examples?

Mobile health or mHealth is the use of mobile technology to improve people's health. This includes everything from mobile messaging services to encourage healthy behaviour during pregnancy, to remote patient monitoring for diabetes patients.

It's more nuanced than just sending people texts to remind them to book an ultrasound scan or medical appointment. A lot of research goes into understanding people's day-to-day lives, to work out how best to motivate them. For example, the BabyCenter programme sends pregnant women updates on their pregnancy, but they aren't all health-focused. They are also about encouraging women to delight in the experience of being pregnant. So, there would be a message telling women that their baby is now at the stage of growing eyelashes, or when the baby has reached the size of a coconut. Physicians weigh in on the content, but the research of how and when to send the information is done by medical anthropologists and behavioural psychologists.

Who runs the mHealth apps for pregnant women and mothers?

BabyCenter began as an independent company, and is now owned by Johnson and Johnson – so there is a separate advertising and marketing channel component, but the content is still vetted by doctors. Some other programmes are government-run, such as the MomConnect programme in South Africa, which is led by the National Department of Health. Its content is based on BabyCenter messaging, but adapted for the South African context. It aims to register all pregnant women, and provide age- and stage-based messaging throughout their pregnancies and up to the first year of their babies' lives. There's also text4baby in the US, which is a aimed at low- and middle-income mothers and is run by a consortium.

What other mHealth apps are there?

Some other examples are cardiac or heart devices that people wear continuously, or diabetes monitoring apps. One diabetes type 2 mHealth service in the United States is called WellDoc. You enter data about your blood glucose and medications, and it alerts you if your blood sugar is too high or too low. If it is low or high for extended periods of time, the device alerts your health provider. The idea is to stop people having to go in for routine monitoring visits, so they only make an appointment when they actually need to.

How is this technology being used in less wealthy countries?

Other mHealth services include cStock in Malawi, which strives to stop health clinics running out of their stock of medicine and medical equipment. It sends information by text from the clinic to a central health centre about which supplies are running low, and how much more is needed. This is actually a huge problem in developing countries: it's amazing how hard it is to make sure that clinics have enough vaccines and medication – or even something as simple as oral rehydration packets (salt and sugar) that can help a child recover from severe diarrhoea. Many clinics are isolated and the roads can be bad, so transporting medicine and supplies to them can be an epic undertaking. It can mean a child doesn't get the medical intervention she or he needs.

There is also mTrac in Uganda, which is now run by the Ugandan government but was started by UNICEF. It helps health clinics send information about who is coming into the facility, how many patients with malaria they have had that month, how many new HIV cases they have seen, and so on, by text message to a database. The database aggregates that information and maps it, so that you can see whether there has been an uptick in infections in one part of the country, and get a broad sense of what is happening health-wise.

The mTrac programme also has a broad range of what are called 'decision support tools' for health workers. This could be a checklist or flowchart on a tablet or cell phone, that asks questions like 'Does the child have three or more loose stools a day?', 'What is the child's arm circumference?', etc. The healthcare worker can check off the answers that apply, and then the programme uses artificial intelligence to diagnose what the problem is and then recommend the best course of treatment.

How accurate is this method of diagnosis?

It's actually more reliable than a person. You can have three doctors, and they will all make different diagnoses. But if you give them all a tablet, you'll find that they get much closer. It helps them avoid overlooking alternative diagnoses, and it can apply clinical algorithms that help them figure it out.

Do all of these services work on cheap, basic, mobile phones?

Well, you can find a decent smartphone for USD 50 or less now. The costs are going down, but the sophistication of the technology is going up.

What can healthcare providers do with mobile phones, smart phones and tablets, that they can’t do with, say, paper notes, computers, or even face-to-face consultations?

We live in a world in which we use our phones to do almost anything and everything, from talking to friends on social media to online shopping. By 2017, the number of mobile phone users will reach 4.7 billion.

For healthcare providers, just like everyone else, mobile technology is making everything more efficient. You can use it to schedule and send appointment reminders, make referrals (sending a patient's notes to a more specialised doctor), diagnose illness and recommend treatment, manage your stock of medical supplies, and get access to electronic medical records.

In many low- and middle-income countries, the only form of telecommunications is mobile. Only two per cent of African households have a landline, compared to two thirds in the US, but in places like Nigeria, more than 90 per cent of people have mobile phones. In these parts of the world, it isn't always possible to access health information and services, so it's here that mHealth will provide the greatest opportunities for improvement. Tablets are great for multimedia, and especially in areas where literacy is not high - using video and audio is really helpful when talking about nutrition and giving basic healthcare education.

Some people in the US and the UK say their smartphones make them less happy, as they find themselves constantly checking them. What are some practical ways we can use our mobile devices to be healthier and happier? 

Technology is neither inherently good nor inherently bad, but it can have both positive and negative effects on health. My work has mostly concentrated on exploiting technology to create positive health outcomes, but I am also very aware of some of the negative effects it can have. There is research showing that, as a society, smartphones are having a negative impact on our work, productivity, sleep, and how we communicate with each other, and lead to increased anxiety.

There are recommendations to limit the use of phones to specific hours during the day, to charge the phone outside of one’s sleeping area, to engage in frequent technology 'detoxes' and to go fully off-line during one's personal time and especially while on vacation.

Can you use mHealth apps for mental health?

There's a company called Muse that can actively monitor brain activity. You listen to ocean waves through headphones. The waves roar aggressively when your brain is active, and they lap softly when your brain is calm. So it's a way to get people to train themselves to calm down, and it can help treat anxiety. There are mobile health apps that can help with depression and pain management.

In a lot of developing countries, there may be only a handful of psychiatrists in the entire country. Mental health problems are a significant burden, and have many knock-on effects. If you can treat people from a distance, in places where there is no access to a specialist, you can make a huge difference.

How can healthcare providers deal with security of online data?

The reality is that privacy and security will never be 100 per cent secure. However, to be able to share and access health data quickly and directly between doctors, and with patients, is a good thing. Opting out presents a risk: it could be at the expense of one's own health. What's more, cloud computing is a more secure way to host and transfer health information, rather than hosting it on more vulnerable independent servers.

Do you use any mobile health applications yourself?

I do. I use a broad range of mobile health apps, including BabyCenter and One Medical’s tools (a membership-based US private healthcare provider).

How do you see this field developing in the future?

We're getting to a place where things are much more personalised – so for example, there are support services for those pregnant women who have diabetes. This will happen even more, as technological innovations merge with genomics (the study of the human genome) and health and fitness devices like the FitBit, a wristband that measures your physical activity.

We are also starting to move beyond the use of estimates in public health to real numbers, because mobile health tools allow us to track the data. We used to do broad-based estimates, but these would still have a margin of 'give or take' that could be 50,000 people. If we can track the numbers more exactly, we can get those people into the services they need. That could have a huge impact. For example, if we could register every pregnant woman who is HIV positive, we could help them prevent transmission of the virus to their children. And when the baby is born, if he or she is HIV positive, we could get the child into pediatric care quickly.

In general, it's quickly evolving into a broader field of digital health, where it is being combined and integrated with other technology tools, services and systems.

Dr Mechael studied for a PhD in Public Health and Policy at the London School of Hygiene and Tropical Medicine.

If you studied in the UK and have gone on to achieve success and contribute to society, your profession or community, apply for this year's alumni awards before 7 November 2016, 23.59 GMT.

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