Life in your hands
It wasn't too long ago that the mobile phone was a luxury, a brick-sized contraption that could only make calls. These days, not only is it pervasive - with 5.9 billion cellular subscriptions worldwide or a global penetration of 87 per cent - but the mobile phone has also taken on many new functions. Of these, its role as a health care tool has attracted particular attention in recent years.
Innovative advances in the use of mobile technology in health care have evolved into a new field called mobile health, or 'mHealth', which is medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants and other wireless devices.
'Mobile health is a very broad opportunity; what can be deployed can vary from basic SMS [short message service] and phone calls to more advanced technologies,' says Jeanine Vos, head of mobile health at GSMA, an organisation working with more than 800 mobile network operators globally to develop mobile solutions.
The field's potential is certainly being recognised. The UN included mHealth as a key innovation to achieve the goals outlined in the Global Strategy for Women and Children's Health launched in New York in September 2010, while the World Health Organisation included a module on mHealth in the 2009 global eHealth survey.
As the WHO puts it: 'The use of mobile and wireless technologies to support the achievement of health objectives has the potential to transform the face of health service delivery across the globe.'
In Hong Kong alone, there are more than 14.4 million mobile phone subscriptions - more than double the number of people in the city - according to the regulator, the Office of the Telecommunications Authority. Although not widespread, there have been a number of mHealth initiatives here.
FindDoc is an award-winning free local phone app that allows users to efficiently research, find and make an appointment with the best doctor for them. Released last year but set to go fully live with the booking system next month, it is the brainchild of philanthropist Kevin Yeung Ka-wei, neurologist Dr Michael Lim and technologist Ivan Ng Chun-yin. Users enter their location, insurance plans, and/or the speciality they require, and FindDoc then displays physicians' schedules in real time, along with their credentials, to help patients select a suitable medical practitioner who best fits their needs.
Mobile communications operator CSL provides a mobile link service designed to help elderly patients live more independently. A specialised device with an embedded mobile chip is able to track a person's whereabouts. There is also an emergency alarm function, and a speaker to provide active guidance.
Last year, the Health Department's Tobacco Control Office launched a free Chinese-language iPhone app, Quit Smoking, which offers advice, tracks quitters' progress and issues reminders according to individuals' smoking habits. English and Android versions are scheduled for release later this year.
In the area of traditional Chinese medicine, the Health Department is using mobile technology to promote standards for the safety and quality of herbal medicine under the Hong Kong Chinese Materia Medica Standards project. An iPhone app brings together traditional medicine and new technology, providing academics, researchers, traders and the scientific community with easy access to the monographs of reference standards on commonly used herbs in Hong Kong.
There are two broad categories in the sphere of mHealth, according to Vos: wellness and self-management services, where there is no medical professional involved, and services involving a doctor, nurse, or carer tracking treatment compliance.
A UN report published online in September in The Lancet highlights some innovative ways that mobile technology is being used to improve the health of poor women, newborns and children in low- and middle-income countries. In some remote areas, health workers equipped with fetal monitors and wireless ultrasound transmit information by phone to a clinic. A South African project called Cell-Life sends text messages to HIV-positive mothers to provide helpful tips and reminders for appointments and medications. Interactive software installed on mobile phones help frontline health workers give individualised treatment to acutely malnourished children in Tanzania.
According to the WHO, most mHealth projects in developing countries to date have focused on HIV and malaria primarily, with awareness campaigns implemented via text messages. Now, in some remote communities, where patients may have to walk for hours to see a medical professional, phone companies are launching helplines, reachable on any type of handset.
For more advanced economies, mHealth could benefit those with chronic conditions. Measuring devices such as blood pressure monitors might be connected to mobile handsets, with daily information sent over a network to a doctor, eliminating the need for constant check-ups, and thus freeing up time for patients and doctors.
Smartphone technology may also offer a solution to better management of health care costs, says Dr Mark Gaynor, an associate professor at St Louis University's school of public health in the US. 'The only way to cut the cost of caring for people with chronic conditions is to enable the patients to self-manage their health,' says Gaynor, who was part of a research team that implemented an interactive diabetes self-management system in China in 2009. 'In order to do that, though, self-management must be reasonable and easy to do. Smartphone technology makes it easy for patients to track important health information.'
Looking forward, it will be important for governments to explore ways to fund mHealth effectively if it is to be part of the health care of the future.
According to a WHO report, mHealth: New Horizons for Health Through Mobile Technologies, published last year, of 114 member states surveyed - including China - 83 per cent reported offering at least one type of mHealth service. Many countries offered four to six programmes.
The four most frequently reported mHealth initiatives were health call centres (59 per cent), emergency toll-free telephone services (55 per cent), managing emergencies and disasters (54 per cent) and mobile telemedicine (49 per cent). With the exception of health call centres, emergency toll-free telephone services, and managing emergencies and disasters, about two-thirds of mHealth programmes are in the pilot or informal stage.
The Health Department says it 'recognises the importance and growing use of new media in communicating health issues with the community and improving public health.' The Hospital Authority, however, reports vaguely that it is 'still exploring the use and application of mHealth in clinical operation', suggesting there is room for greater awareness.
Some medical professionals may worry that mHealth will replace some of their work, with technology detracting from traditional patient-doctor interactions. However, Vos says: 'Often these technologies are about supporting the role of the health care professional, not eliminating that relationship.' Tapping into current technologies is vital, she says, but stresses that these solutions must be fitted carefully around existing health care systems.
Nancy Finn, author of last year's e-Patients Live Longer, The Complete Guide to Managing Health Care Using Technology, believes more education is needed. 'Physicians need to be educated so they can help their patients become empowered and engaged,' she says. '[And] patients need to understand how to find reliable, credible health information on websites and social networks.'
Alex Backer - founder and CEO of QLess, a US company that aims to eliminate waiting times in surgery waiting rooms by making use of mobile phones to hold patients' places - agrees. 'The biggest obstacle to the implementation [of mHealth] is that people don't yet know about it,' he says.
If mHealth is really going to move forward, Vos says partnerships are key. 'It's about bringing together both the health care and the mobile ecosystems,' she says. 'Generally speaking, a mobile network will work with either a hospital, foundation or a specialist interest group like a diabetes trust.' Phone companies can thus be better informed how their technology can be adapted to specific uses.
So what is the future for mHealth?
In her book, Finn predicts that 'when a child is born, a digital health record will be created that will belong to that individual for the rest of his or her life and in which every health transaction, test and procedure will be stored. A microchip embedded in the arm or foot of that baby will point to the health record so that wherever in the world that individual seeks care, the record will be available.'
Finn also foresees wearable electronic devices, such as watches, that will remotely monitor implants and medical conditions, as well as the widespread use of telemedicine, so that doctors anywhere can be guided by top specialists.
Embedded microchips and smart implants may sound a little far-fetched right now. But given the pace of mobile saturation in a market such as Hong Kong, it seems likely our health will increasingly rest in our own hands.
Percentage of the 114 member states surveyed by the World Health Organisation that offer at least one type of mHealth service