mHealth: what is it and how can it help us?

Many healthcare professionals and many patients are still wary of mHealth, or mobile health. Physicians complain that they do not have enough time, while patients are concerned about managing their data and privacy.These are some of the reasons why the adoption of apps and tools on mobile devices(mHealth, mobile Health) has been slow. With this in mind, let us therefore find out the pros and cons of this revolution.

Given the size and speed of technological advances in recent decades, it is not surprising that some 4.68 billion people will own a smartphone by 2019.

In the United States, only 40 percent of family physicians also work evenings or weekends, which excludes large numbers of patients who work office hours.

However, in African countries such as Zimbabwe, the situation is even worse: 1 doctor for every 10,000 people. The same is true in many other developing countries.

We can intuit, therefore, that it is possible to use this worldwide spread of mobile devices to provide more convenient health care for all, especially in those settings where there is a lack of a basic national health care system or not enough to meet the needs of the population.

According to West Wireless Health, "the proliferation of mobile devices on the planet, is a spur to the development of mHealth apps."

Although the worldwide advent ofeHealth( electronic Health), and specifically mobile health (mHealth), has been underway for about 20 years, many remain uncertain about the possible uses and benefits of these technologies.

What is mHealth?

TheWorld Health Organization (WHO) has stated that "there is no standard definition [of mHealth]." However, mHealth has been defined as "a public health and medical care practice supported by mobile devices, such as smartphones, patient monitoring devices, personalized digital assistance, and other wireless devices."

With nearly 4.7 billion cell phones and other mobile devices in the world, their use in health care is certainly a step toward spreading good health worldwide.

The most recognized benefit is undoubtedly the ability of mHealth to keep us connected to our health care providers at all times, no matter the distance.

How else can it improve our well-being?

How can mHealth help us?

The connectivity and convenience that mHealth-and all declinations of eHealth-enables can improve quality of life and simplify care when used effectively: from improved therapeutic adherence, to aggregated data on patient health status.

Therapeutic adherence

Nowadays, one of the biggest challenges of healthcare professionals is to make sure that patients follow prescription and therapy correctly and according to indications.

A 2014 study published in the journal Risk Management and Healthcare Policy informs us of some troubling data.

"Lack of therapeutic adherence is widespread and varies by disease, patient characteristics, and health care coverage," the author writes, "with (medication) nonadherence ranging from 25 percent to 50 percent."

The study also tells us that lack of therapeutic adherence, or non-compliance, among many reasons, is "a cause of poor therapeutic outcome, disease continuation, and a burden-billions of dollars a year-in direct avoidable costs to the health care system and families," 

Indeed, non-compliance with a treatment regimen leads to so many other issues, includinghospitalization, redeviations, flare-ups, worsening quality of life, and even death.

Despite this, there are already a number of mHealth apps-easily downloadable from smartphones or tablets-that can help people follow medical prescriptions through, for example, trackable pills that allow them to find out which ones they have taken and which ones they have not, or apps that suggest taking a particular medication or record all symptoms.

More efficient and effective monitoring

Many mHealth apps allow you to connect directly with your doctor to improve the ease and speed of contact. Messaging in real time with one's doctor or getting an opinion on an illness, symptom, or medication offers many benefits, surely the most important of which is the ability to intervene early.

If the patient is concerned about his or her health status but cannot physically reach his or her doctor, he or she can use the mHealth app to communicate. The physician could then assess and decide whether to intervene, potentially saving the patient's life.

Improving monitoring offers benefits to a very large population; some mHealth apps are able to collect patient and general population health data and aggregate and store them in one place.

This mechanism allows the health care provider to use cutting-edge technologies in the field and ensure the best possible therapy and outcomes for the patient.

With the ability to access trends in health care-often even in real time-the practitioner can stay abreast of practices and procedures, and get a better idea of how to proceed with patient care.

Digital information

The ever-increasing popularity of electronic telecommunication devices, such as laptops, smartphones and tablets, have also benefited the healthcare environment. The adoption of these devices has led to the abandonment of written communication on paper and paper filing.

Many companies-including Expensify, which offers a tool for managing expense reports, and TicketText, a reservation ticketing company-have "dematerialized" many of the tools used to date, favoring Internet-based data storage in the Cloud.

Digitization not only cuts office and hospital supply expenses and waste, it decreases the accumulation of documentation and paperwork for the physician. It also helps store patient data in a secure and ubiquitous location.

Although some claim that the reduction of paper records can reduce the risk of patient data loss, the studies conducted have not proven this; this study also states that inconsistencies may be generated during the coexistence of paper and digital records, and it is therefore recommended to migrate entirely and quickly to an electronic digital records system.

What can be the problems with mHealth?

Lack of confidence in technology is not a new phenomenon; for decades we have resisted all forms of technological change and advancement that could reduce our power.

It is true that mHealth is going in this direction: taking much of the responsibility out of the hands of health professionals and practitioners and handing it over to cyberspace; but is it actually more harmful than beneficial?

Lack of regulation

For a drug to be placed on the market, entities such as the Food and Drug Administration (FDA) in the United States and the Italian Drug Agency (AiFA) must approve its safety.

The FDA states that they are "responsible for defending public health by ensuring the efficacy and safety of human and animal drugs, biological products and medical devices."

According to research2guidance, as of 2017, about 325,000 mHealth apps have been made available. Although users have welcomed them, the FDA has approved only a small fraction of them.

The mHealth apps are probably not high on the FDA's priority list; in fact, experts consider these apps to be "low-risk," meaning their use is noninvasive, and they are unlikely to cause significant harm to health.

This is why the FDA does not believe that mHealth apps need the same regulation as drugs and other therapies.

This allows companies to develop apps and put them on sale more quickly, but it implies that clinical trials among patients are minimized, leaving open the possibility that in the long run these may prove hazardous to health.

Interestingly, however, there have been hints that it may be the software development companies themselves who get approval to create the apps, rather than subjecting the apps to FDA reviews.

Excessive dependence

As it turns out, despite the fact that most mHealth apps have never undergone clinical trials or been approved by regulatory bodies such as the FDA, many patients rely on their use in everyday life.

There is one concern: many users of these mHealth apps may decide to rely solely on the apps instead of going to a doctor for a professional consultation.

Indeed, the concern is realistic for several reasons, including the fact that most of these apps have not been vetted and audited by the appropriate agencies.

In 2015, researchers at Harvard Medical School in Boston conducted a study of several websites and apps created for the purpose of symptom testing.

The researchers found that among the top 23 symptom-checking apps, "the correct diagnoses were listed first in only 34 percent of standardized patient assessments."

The analysis also showed that correct diagnoses were listed among the "top 20 possible diagnoses" in less than 60 percent of the evaluations.

These data reveal dangerous implications: misdiagnosis or even lack of diagnosis, a serious obstacle where treatment is needed, which can put the patient's life in danger.

The future of mHealth

Many believe that mHealth will be the future of healthcare; what then is this future of healthcare? In what direction will the healthcare industry and all stakeholders move, thanks to or because of these technologies?

In an ideal world

In many ways, the future is already here; so-called "wearables," wearable devices, are already part of millions of people's lives, and talking to a doctor via app has never been easier. What else can we expect from mHealth?

We can imagine that mHealth, mobile health, will provide a greater opportunity for access to care in those developing countries, lower health care costs in developed nations, and transform spending systems from a prevention model to a patient-centered one.

The mHealth apps that are used to monitor symptoms and stay in touch with health care will reduce the need for invasive therapies because they will allow people to stay one step ahead of the disease.

Openness is a key goal for developers in mHealth. James Michiel, senior mHealth analyst at Emory University's Rollins School of Public Health in Atlanta, Georgia, USA, says that "the future of mHealth is open-open access, open source, open data, and open innovation."

All in all, mHealth will face many obstacles to achieve this goal.

Challenges to be faced

For mHealth to continue to grow, there is a need for regulation.

According to researchers M. Mars and R.E. Scott, "eHealth's ability to transcend sociopolitical boundaries includes the potential to create a borderless world for health systems and health care delivery."

"But," he writes in the journal Health Affairs, "the policy needed to drive eHealth development is limited and only now emerging in developing countries."

"What is needed to promote the growth of eHealth in developing countries is thoughtful policy to facilitate patient mobility and data exchange, both within international and regional borders within countries."

What lies ahead?

Researcher Harold Thimbleby - in 2013 wrote. Journal of Public Health Research - explains that "the future of healthcare is all about the patient (or preventing people from becoming patients), but patients are not the main stakeholders in healthcare."

"Insurance companies, big pharmaceutical companies, physicians, managers, providers, manufacturers, governments and many other forces will influence the future," he adds. "Will innovation help patients or will it help in part to monitor the physicians who provide health care?"

Perhaps the answer to this question is the key to the development of mHealth; after all, appropriately developed means of delivering therapy can mitigate risks to patients, and put in place best practices for physicians.

Regardless of what happens next, Michiel acknowledges that "never in the history of development have there been so many tools and platforms available to those who have traditionally been marginalized and excluded from the vanguard of technology and innovation."

"It is imperative, however," he continues, "that these tools and technologies be used deliberately and efficiently, with an eye toward the end user so as to ensure long-term sustainability and development."