Big Players, Small Players: Innovations in Mobile Health

| February 1, 2012 | 0 Comments

Currently, over 70 percent of the five billion wireless subscribers in the world live in low or middle-income countries. As usage expands, so does the potential for the application of mobile phones in improving healthcare. In a recent WHO report, 22 low-income countries and 29 high-income countries reported having at least one initiative in mobile health (mHealth). mHealth empowers patients and health workers to better manage health with varied applications spanning diagnostics, text-message reminders, and electronic training manuals.

A man uses the simple EyeNETRA clip-on apparatus to take an optical test. (Courtesy of EyeNETRA)

The diverse group that has come together around mHealth initiatives includes “big players,” such as government systems and large humanitarian organizations with the manpower to restructure a country’s healthcare system, and “small players,” which are innovative individuals and teams that tend to focus on creating smaller-scale solutions to specific problems. Increased future collaboration between these groups is crucial to resolving larger economic, social, and health issues.

D-Tree International is a large mHealth provider that works on maternal and child health issues in Tanzania. One of D-Tree’s current projects deals with the electronic conversion of Integrated Management of Childhood Illness (IMCI) protocols. Instead of using confusing paper protocols while under high-stress situations, health workers with the eIMCI can pull up step-by-step instructions on smartphones to correctly diagnose common diseases like pneumonia and measles. In an interview with the HCGHR, President of D-Tree International Dr. Marc Mitchell explained that these electronic protocols allow health workers to ask more questions and perform essential procedures that might not otherwise have been conducted. The protocol accuracy is promising: the eIMCI made the correct diagnosis 64 percent of the time for severe pneumonia and 91 percent of the time for severe diarrhea, whereas the rates were 22 percent and 67 percent, respectively, for paper protocols. Dr. Mitchell stated that the accurate diagnosis of patients would lead to an increased confidence in the reliability of the healthcare system: “What is important is that we consistently correctly treat patients so that people build trust in the system and not only use it when they are sick, but believe the messages they are given about preventive care and disease medicine.”

Interestingly, Dr. Mitchell views the difference between D-Tree and other mHealth organizations as a systemic one. “Many organizations working in mHealth are basically technology organizations that are looking for ways to apply their technology to a health problem. We are a health organization that looks at how to use technology more generally to solve systemic problems. We are focused on using mHealth to transform the way healthcare is delivered, rather than simply adding a new tool to an existing system,” he declared. In the future, Dr. Mitchell foresees that many of the point-of-care diagnostic tools will be integrated into the health-care system. He also agreed that isolated mHealth projects are significant but ultimately asserted that there is a greater need to improve the system. “Health systems in most poor countries don’t work very well, and [although] we can use texting to get people on TB drugs to take their drugs, if half the people with TB are misdiagnosed, it doesn’t really solve all the problems…we must fundamentally make the whole system better,” he argued.

A healthcare worker using the eIMCI protocol to treat patients in Tanzania. (Courtesy of Dr. Marc Mitchell)

Instead of focusing on the entire flow of healthcare in a country, smaller players can concentrate on bringing high-impact technology and health services closer to people. As a simple eye exam clip-on to a smartphone, the MIT Media Lab’s award-winning NETRA (Near-Eye Tool for Refractive Assessment), led by Professor Ramesh Raskar, shows the impact that smaller projects can have on local healthcare accessibility. Professor Raskar called NETRA the “thermometer for the eye” because of its ability to inexpensively characterize refraction errors that health workers can subsequently act upon to detect preventable blindness earlier. Commenting on its portable nature, Professor Raskar stated that “many times, [health care workers] had to pay 300 or 400 dollars for custom duties just to carry [bulky equipment] across borders” and that the mobile phone “makes it extremely good for them to travel with the solution.” The NETRA lab has implemented its technology in India, Brazil, and Kenya and successfully overcome unanticipated challenges, such as language barriers and local “discomfort with technology,” through establishing a collaborative relationship with local workers. Furthermore, Professor Raskar and his team are hoping to target children through the use of game applications. With a simple shooting game, researchers can identify defects such as near-sightedness or astigmatism by observing the sequence of keys that a child types while playing.

In general, larger mHealth organizations have been actively encouraging entrepreneurs and scientists to come up with inventive projects. NETRA itself was a winner of the Vodafone Americas Foundation Wireless Innovation Project in 2011, hosted by Vodafone and the mHealth Alliance. Such increased interaction can enhance global healthcare access by scaling up creative solutions for local problems, allowing for increased awareness of new mHealth tools, and creating possible opportunities for collaboration between groups. Dr. Mitchell noted the existence of an active mHealth community in Tanzania that is coordinated by the government and two NGOs—one of which is D-Tree—and meets quarterly to discuss both different mHealth initiatives and new chances for partnership.

The mHealth movement is just beginning to revolutionize healthcare management, and can be further propelled by increasing discourse between big and small players. Like Dr. Mitchell and Professor Raskar, it is imperative for us going forward to consider how we, too, can translate our passions to induce positive healthcare change.


Category: Features, Spring 2011

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