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OJHAS Vol. 10, Issue 1:
(Jan-Mar 2011) |
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| Health Phones: A
Potential Game Changer in Health Information Management |
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Geena Mary Skaria, Lecturer, Dept. of Health Information Management, Manipal College of Allied Health sciences, Manipal University, Manipal, Karnataka. |
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Address for Correspondence |
Lecturer,
Dept. of Health Information Management,
Manipal College of Allied Health sciences,
Manipal University,
Manipal, Karnataka.
E-mail:
geena.skaria@manipal.edu |
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Skaria GM. Health Phones: A
Potential Game Changer in Health Information Management. Online J Health Allied Scs.
2011;10(1):10 |
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Submitted: Feb 26,
2011; Suggested Revision:
Apr 1, 2011; Revised: Apr 2, 2011. Accepted: Apr 2, 2011; Published: April 15, 2011 |
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| Abstract: |
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Health
education has to be one of the most effective ways to reduce morbidity
and mortality in developing countries. We need to deliver vital messages
and information to people at the lower quarter of the society to use
changing behaviour and practices which can save and protect their lives.
It is in this context, use of mobile phones in delivering vital health
information is of significance. This article reviews few projects which
successfully use mobile phones for health information delivery.
Key Words:
mhealth; Mobile health; Health information seeking; Health information dissemination
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It
has been predicted that mobile technology is beginning to have a big impact in health care,
especially in developing countries and soon mobile technology
could play a large role in detecting, mapping and responding to epidemics.1
Technology has taken
healthcare industry a long way forward and so people are more aware
about their health status and health needs. But this development has
not fully benefited the lower crest of the society. The uncomfortable
reality is that we live in a world where there is a silent emergency
every day. It is in this scenario the possibility to use mobile phones
in health care industry for effective dissemination of health information
is of significance.
mHealth
(mobile health) is the term used for the practice of medical and public
health supported by mobile devices. The mHealth field has emerged as
a sub-segment of eHealth and telemedicine, the use of information and communication technology,
such as computers, mobile phones, communications satellite, patient
monitors, etc., for health services and information.2,3 mHealth
applications include the use of mobile devices in collecting community
and clinical health data, delivery of healthcare information to practitioners,
researchers, and patients, real-time monitoring of patient vital signs,
and direct provision of care via PDAs, for health services and information.
The motivation behind
the development of the mHealth field arises from two factors. On the one hand,
there are high population growth, a high burden of disease prevalence,
low health care workforce, large numbers of rural inhabitants, and limited
financial resources to support healthcare infrastructure and health
information systems. On the other is the recent rapid rise in mobile
phone penetration in developing countries to large segments of the healthcare
workforce, as well as the population of a country as a whole.4
Worldwide, cellular
technologies have demonstrated the incredible power of communication
as an agent for social change. Mobile phones promise to benefit people
in remote areas by making it easier and cheaper to diagnose diseases
such as malaria and tuberculosis.5
Global Cellular
Subscription
The global
cellular subscription rate has taken a giant leap from a 1,000 million to 5,000
million connections in a span of 10 years (2000 to 2010). (Fig. 1)
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Fig 1:
Global cellular subscription over years |
Over the years, the mobile
phone subscription of developing countries has steadily increased compared to
that in the developed countries.(Fig. 2)
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Fig 2: Mobile subscription comparison
between developed and developing countries |
It is interesting to
note that mobile phones have become the handiest electronic equipment
in the present era and is being used by people from all walks of life.
According to International Telecommunication Union (ITU) statistics,
until November 2010, it is estimated that, there are 5.3 billion active
mobile subscriptions, thus suggesting that 90% of the world’s population have
access to mobile network. It is also interesting to note that 73% of
these mobile subscriptions are in developing countries.6
Reaching large population
in remote areas was unthinkable in olden days. With mobile communications
revolution sweeping across the globe, nearly 90 per cent of the world's population
now has access to a mobile-phone signal, including 80 per cent of people
in rural areas.3
Few cases are reviewed
here which is using mobile phones as tools for health information seeking
as well as for dissemination of data.
Data’s abstracted from various resources and studies conducted in
different parts of the world with an intention to study the different
possibilities to use mobile phones in health information management.
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Case 1:
A Case Study From USA on Mobile Phone Use for Health Data Search
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A survey from the Pew
Internet & American Life Project shows how the proliferation of
smart mobile devices cause a shift in the way users are accessing data
and information on health. The survey reveals that 17% of cell owners have used their phone to look up health or medical
information on the Internet. It was also noted that 29% of cell owners
of age group 18 to 29 have done health information searches and 9%
of them have applications downloaded which they use to help track and
manage their health. The heaviest use of health or medical related applications
was by young adults.7
Currently some of the
service providers in US are providing health care applications for counting calories and nutrition information, logging fitness workouts,
providing health tips, to calculate disease risks, to calculate body
mass index, for keeping personal health records, for providing users’
health information to physicians and emergency workers etc.
Surprisingly, the highest
use of cell phone health-information seeking and downloading cell phone
health applications was among 18 to 29 year olds at 29% and 15% respectively.
It suggests that, this new technology is welcomed among young adults
in developed countries like US.
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Case 2:
U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) |
The U.S. President's
Emergency Plan for AIDS Relief (PEPFAR) is the U.S. Government initiative
to help save the lives of those suffering from HIV/AIDS around the world.
PEPFAR is the cornerstone and largest component of the U.S. President’s
Global Health Initiative, with a special focus on improving the health
of women, new-borns and children.
The goals of PEPFAR
include strengthening the partner government capacity to lead the response
to HIV epidemic and other health demands. It aims at integrating and
coordinating HIV/AIDS programs with broader global health and development
programs to maximize impact on health systems. PEPFAR is also investing
in innovation and operations research to evaluate impact, improve service
delivery and maximize outcomes.8
For the purpose of
integrating and coordinating the program, PEPFAR is using technology
to connect health systems in ten PEPFAR-supported countries by 2010
through the GSM Association Development Fund. For this reason ‘Phones for Health’ program was launched. This program will
make timely, relevant information available to program managers and
service providers.9
How will
Phones-for-Health enable the Emergency Plan to support those infected and
affected by HIV/AIDS?
In the developing world,
more than 60% of the population now lives in areas with mobile phone
coverage. GSM Association Development Fund expects this figure to rise
to 85% by 2010. This makes it feasible to use mobile phones to transfer
information directly to health authorities’ computer systems, thus
enabling rapid interventions such as distribution of medication and
education programs for those at risk.9
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Case 3:
‘AMREF’ - African Medical and Research Foundation |
What is AMREF? The African Medical and Research Foundation (or AMREF) was founded
in 1957 by three surgeons as the Flying Doctors Service of East Africa. AMREF is bringing good quality and affordable health care closer to
those who need it most - improving access to health treatment and preventing
poor health through community education. Working closely with African
communities and governments, AMREF ensures that its health projects
are relevant and sustainable.10
An overview of
activities by AMREF over the years:
In the year 1950 when AMREF was founded, its core activities
included Flying Doctors Services delivering health care to remote areas.
By 1960 it introduced Radio programmes on National Radio for health
workers thus strengthening their knowledge on health. In the year 1980
they started Print-based distance education programs and from 2000 onwards
they started using technology to reach the masses by introducing supported
learning systems by using telemedicine, eLearning and mLearning (mobile
learning).10
What
are mobile phones doing at AMREF? Remote areas with limited
access to health professionals were soon reachable and hence passing
vital information to and from health experts became easier. An example
for such mobile phone guided health information diffusion is taking
photos and sending to experts who will guide the health professionals/workers in
the remote areas on what to do. They also used cell phones for mapping hotspots
or areas known to have disease outbreaks of a particular kind. This enabled the
deployment of personnel to these areas. SMS’s are used as reminders for people involved in the program for taking medicine in time, vaccination alerts, alerts
about epidemic outbreaks, first aid etc. Mobile phones are also used for
sharing community practice formed from interventions across various groups.
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Fig:
3 How the system works in AMREF10 |
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Case 4:
Health Phones in India |
India has a vast
population at the lower strata of the society who are deprived
of quality health care. They remain unaware of the modern technology
and development in the health care industry, thus resulting in causalities
which could be avoided if proper health information and facilities are
available.
The studies have revealed
that the five diseases – pneumonia, diarrhoea, malaria, measles
and AIDS - together account for half of all deaths of children
below the age of 5 years. Majority of these
deaths are due to the lack of knowledge in handling critical situations.
For the illiterate, currently the only source of information is probably
going to be the people around them, who are also, in many cases, illiterate. The lack of knowledge remains the root cause of such causalities.11
Health education has
to be one of the most effective ways to reduce maternal and child mortality.
We need to deliver vital messages and information for people at the
lower strata of the society to use changing behaviour and practices
which can save and protect the lives of children and help them grow
and develop to their full potential. With the continuous
rapid growth in population and shrinking budgets, governments are finding
it increasingly difficult and expensive, to effectively manage programmes
and efforts that involve training and educating their large numbers
of departments and staff. This is leaving health workers, and by extension,
families and communities ignorant of the basic knowledge that could
help prevent diseases and improve the quality of health of their families
and communities. It is in this context ‘Health phone’ is
significant.11
Mobile phones have made it possible to reach our large population
in remote areas, something that was truly unthinkable until very
recently. With a population of 1.17 billion and a wireless user base
of about 700 million (as of Oct., 2010), and growing at the rate of 15 to 20
million a month, cell phone penetration will reach 97% of our population by 2014,
according to a recent study.11 As per Telecom Subscription
in India, as on 31st March 2010, total telephone
subscriber base had reached 621.28 million, the wireless subscription had reached
584.32 million and wire line subscription remained at 36.96 million.12
In such a scenario, the mobile phones can
be a potential game-changer, which
means we can reach the excluded, the illiterate, all those women, men
and children. We can reach families and communities as a whole which
was something we were never been able to do before.
What will health
phones do in India?
Health phones will
have preloaded content on low-cost mobile phones. It will provide health
and nutrition content scripted on knowledge, prepared jointly by UNICEF,
WHO, UNESCO, UNFPA, UNDP, UNAIDS, WFP and
The World Bank.11 The main areas of concern
for such interventions are timing births, safe motherhood and new-born health, child
development
and early learning, Breastfeeding, nutrition and growth, immunization, diarrhoea,
coughs colds and more serious illnesses, hygiene, malaria,
HIV, child protection, injury prevention, emergency preparedness
and response etc.
How does it work?
The content will be
pre-loaded on popular low-cost models of mobile phones for which no
signal is required, nor cost to download videos and other media. Users
choose what they want to watch and listen to and when, wherever they
happen to be. Health Phone provides families with their own personal
reference library and guide to better health practices. It is available
in real time, right to those who need it, when they need it and when
a health problem is about to strike, where they are, and as they are.
The pilot content of
health phones is available in English and 15 Indian languages like Hindi,
Assamese, Bengali, Gujarati, Kannada, Konkani, Malayalam, Marathi, Oriya,
Punjabi, Rajasthani, Sanskrit, Tamil Telugu and Urdu.11
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Case 5: Mobile Phones in Family Planning |
A study was conducted
to assess the acceptability and feasibility of delivering the Standard
Days Method (SDM) using mobile phone application developed by Institute
for Reproductive Health (IRH) at Georgetown University in Washington,
DC, United States. SMS technology has been used to provide health-related
information directly to users and to serve as reminders to people needing
to take medicines at regular intervals. In light of the high unmet need
for family planning (FP) and reproductive health (RH) information, there
is the significant potential to help women avoid pregnancy and improve
their reproductive health by providing them with timely, actionable,
personalised information through SMS.13 IRH developed a mobile
application called CycleTel that supplies the Standard Days Method (SDM)
directly to a user's cell phone.
SDM is a fertility
awareness-based method that requires the user to avoid unprotected sex
during days 8-19 of her menstrual cycle. It was found to be more than
95% effective in avoiding unplanned pregnancy and has since been recognised as an
evidence-based practice by the World Health Organization
(WHO).13
How does the system
work?
CycleTel provides a
woman with information about her daily fertility status according to
the SDM and advice on avoiding or achieving pregnancy. The woman provides
the date of her menstrual period starts (each cycle), after which she can
be advised of her fertility status on a daily basis via text messaging.
Additional messages support correct use of the SDM, monitor her cycle
lengths to identify whether they are in the 26-32 day range, and offer
information on other FP options and RH issues, with an emphasis on the
importance of healthy timing and spacing of pregnancies. As the project
develops, women and men will be able to access, via SMS, answers to
their questions about SDM and other RH issues.13
The CycleTel project
is being carried out as part of the Fertility Awareness-based Methods
(FAM) Project, a 5-year global project with the main aim of taking modern,
natural FP methods (NFPs) that were developed and tested by IRH.13
It is clear from the cases discussed
that the use of mobile phones holds promise for improving health of the
developing world. The significant benefits of mobile phones in health care
industry are:
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Extending the ability
of Ministries of Health to create national health information networks
that reach all communities.
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Bringing together the
existing mobile phone infrastructure in the developing world, and extend
the span of health information networks to reach the vast majority of
populations, even in remote areas.
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The health workers in the field can use software on their
mobile phones to submit critical health information directly into central
computer systems.
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It will allow health officials
and service providers to view, analyse and respond to this vital data
immediately.
Mobile phone has made
communication possible in ways that were truly unthinkable until very recently.
It is used in multiple ways in the field of health information sharing
in different parts of the world. Mobile phones are emerging as vital
equipment in disseminating health information data. It will be used
widely for Personal Healthcare Intervention (e.g. adherence to
medication, immunization rates, self reporting (e.g., blood glucose
levels, Lipid profile etc.) and Public Health Intervention
(e.g. wide area surveillance and notification, mass notification etc.)
in the future.
- A world of witnesses: When everybody becomes a nomadic monitor,
A survey of mobility. The Economist. Apr 10, 2008,
- Vital Wave Consulting. mHealth for Development:
The Opportunity of Mobile Technology for Healthcare in the Developing World. United Nations Foundation,
Vodafone Foundation. February 2009. Available at
http://www.vitalwaveconsulting.com/insights/articles/mHealth.htm
- Germanakos P, Mourlas C,
Samaras G. A Mobile Agent Approach for Ubiquitous and Personalized eHealth Information Systems. Proceedings of the Workshop on 'Personalization
for e-Health' of the 10th International Conference on User Modelling
(UM'05). Edinburgh, July 29, 2005, pp. 67-70.
- Ranck J. Time to get mHealth
moving. Available at
http://www.scidev.net/en/opinions/time-to-get-mhealth-moving-1.html
- mHealth. Available at
http://en.wikipedia.org/wiki/MHealth
- World Telecommunication/ICT
Development Report 2010; monitoring the WSIS targets, A mid-term review.
Available at
http://www.itu.int/dms_pub/itu-d/opb/ind/D-IND-WTDR-2010-PDF-E.pdf
- Steven Wilkins MPH. Health
information seeking: Who is using a cell phone to find it? Available at
www.healthecommunications.wordpress.com
- PEPFAR's Five-Year Strategy.
Available at
http://www.pepfar.gov/strategy/document/133251.htm
- Connecting to a Healthy
Future (Updated January 2009).
Available at
http://www.pepfar.gov/press/80384.htm
- Otieno PK.
Are Mobile Phones Better Learning Tools than Computers? African Medical
and Research Foundation (AMREF).
Available at
http://www.amrefusa.org/.../uganda-m4d-conference-presentation-nov2010-.ppt%20-%20United%20States
- Health Phones: What every
family and community has a right to know.
Available at
www.healthphones.org
- Telecom Regulatory Authority
of India. Annual Report 2009-10.
Available at
http://www.trai.gov.in/annualreport/AnnualReport_09_10English.pdf
- Lavoie KS, Jennings
VH, Puleio
M, Jha P,
Lundgren R. Family Planning
via Mobile Phones: Proof-of-concept Testing in India (CycleTel), November
18, 2009. Available at
http://www.comminit.com/en/node/307314/2674
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