This issue includes:

•  mHEALTH: Mobiles in health development 
•  Vote in a POLL on e-health research and development. 
•  eHEALTH: ICTs improving health care
•  eHealth Connection: REPORTS from the Bellagio Conference

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eHealth is an area of healthcare practice that seeks to use information and communication technology (ICT) to the advantage of patients and health care professionals by drawing on the communication, diagnostic, management, research, and knowledge archiving aspects, among others, offered by recent technological innovation. This issue of The Drum Beat features summaries on eHealth - use of the internet for various kinds of access to health information and diagnosis - and mHealth - use of mobile devices, particularly cell phones, to survey public health risks, diagnose, coordinate treatment, and access health information. It includes a selection of reports prepared for the 2008 conference "Making the eHealth Connection: Global Partnerships, Local Solutions" in Bellagio, Italy.

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 mHEALTH: MOBILES IN HEALTH DEVELOPMENT

1. Mobile Phone Diagnosis Approaches Field Trials

by Katherine Nightingale

This news report highlights the fact that two devices that use modified mobile phone technology to diagnose disease have garnered funds for more research and field tests in developing countries. The "CelloPhone" and the "CellScope" work by interpreting the "shadows" of cells. The CelloPhone loads samples of blood, urine, or other bodily fluids into a modified mobile phone. The images are captured using a special light source and the phone's camera, and then sent by multimedia message to a central station, from where a computer programme returns a diagnosis as a text message. The CellScope harnesses traditional optical microscopy, clipping a small microscope onto a camera phone, then sending the captured image for diagnosis.

2. mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World

This paper is a response to mounting interest in the field of mHealth - the provision of health-related services via mobile communications. It is part of a series of publications from The United Nations Foundation and Vodafone Foundation Technology Partnership, a public-private alliance using strategic technology programmes to strengthen humanitarian efforts worldwide. The Partnership is inspired by a growing body of evidence that demonstrates the potential of mobile communications to radically improve healthcare services - even in some of the most remote and resource-poor environments. To that end, this report examines issues at the heart of the rapidly evolving intersection of mobile phones and healthcare, surveying the current mHealth landscape.

3. Are Cell Phones Leading the mHealth Revolution?

by Nellie Bristol

According to this article from the Global Health Council Magazine, cell phone use in developing countries is driving a new industry in health-related electronic applications for programmes that range from diagnosis and health worker education to social marketing and the flow of emergency food rations, many focused on geographically remote areas. As stated here, "Global health and technology experts cite dozens of projects using electronic methods (known as "eHealth") that are increasing data collection opportunities and leveraging meager health care work forces. But the technology explosion is facing many of the same problems as in developed countries: lack of interoperability, funding shortfalls and scant solid evidence of outcomes improvement." 

4. Vid@net - Mexico

In 2008, a global provider of mobile centric information solutions called Voxiva joined with Instituto Carso Salud and TelCel to create a mobile-phone-based service for people with HIV on antiretroviral treatment. Its purpose is to support treatment adherence, especially in the lives of those without easy access to the internet, by providing a discrete, timely health intervention in the form of short messaging service (SMS) information and reminders. If a user ever becomes non-adherent, automated messages are sent to pre-designated "treatment buddies", who can then lend that person the social support needed to stay adherent.

Contact: Paul Meyer paul@voxiva.net OR info@voxiva.net

5. mHealth for Development - Mobile Communications for Health

This brochure outlines the opportunity presented by the growing field of mobile health (mHealth). It provides a landscape analysis of the role and impact of mobile communications in health delivery in the developing world, highlighting ways in which mobile technology is making it possible for workers in low-resource environments to address urgent public health issues. The initial portions of the document provide context in order to introduce the reader to key health challenges affecting the developing world. Trends in the adoption and geographic reach of wireless technology (e.g., 64% of all mobile phone users are in the developing world, and 80% of the world's population now lives in an area with mobile phone coverage - a figure that the GSM Association (GSMA) expects to rise to 85% by 2010) indicate great promise, according to the report, to address health challenges.

6. Mobile Health Alliance - Global

The Alliance is an umbrella organisation established in February 2009 to complement, draw together, and expand upon the mobile health (mHealth) initiatives of multiple organisations around the world. The Rockefeller, Vodafone and United Nations (UN) Foundations are working to cultivate cross-sector, public, and private collaboration in an effort to maximise the impact of mHealth, particularly in emerging economies. Its initial activity will focus on providing: thought leadership to the mHealth sector; global advocacy and collaboration; and partnership for selective implementations.

Contact: Adele Waugaman awaugaman@unfoundation.org OR technology@unfoundation.org

7. TeleDoc - India

TeleDoc provided handheld mobile phone devices to village health workers in India, permitting them to communicate with doctors who use a web application to help diagnose and prescribe for patients. Launched as a pilot project in 15 villages in Haryana in April 2003, TeleDoc was a project of Jiva Institute, an India-based non-profit research and development organisation that aimed to foster sustainable development by producing innovations. Jiva hoped that TeleDoc would deliver low-cost diagnostic and prescription services to rural villages currently underserved by existing healthcare systems, thereby improving treatment of diseases in these settings.

Contact: contact@jiva.com

SEE ALSO:

•  Mobiles Combat Kenyan Polio Outbreak
•  Mobile Phones for Mother and Child Care

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Please VOTE in our current ICT4D Poll:

In what direction should current e-Health research and technical development go?

Direction:

•  Diagnosing through mobile phones. 
•  Building a menu of types of health providers (e.g., MD, traditional, clinic, pharmacy) into mobiles. 
•  Linking remote clinics with specialists. 
•  Linking communities in "the last mile" with hospital or clinic diagnosis and care centres.

VOTE and COMMENT click here.

RESULTS thus far (May 29);

57%: Linking communities in "the last mile" with hospital or clinic diagnosis and care centres.

23%: Linking remote clinics with specialists.

16%: Diagnosing through mobile phones.

5%: Building a menu of types of health providers (e.g., MD, traditional, clinic, pharmacy) into mobiles.

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 eHEALTH: ICT IMPROVING HEALTH CARE

8. e-Health & Learning Project - Bangladesh

Launched in January 2003, this project aimed to improve co-operation between Asia and Europe in the identification and implementation of ICT solutions in the health care sector. The project was developed to promote the idea of accessing web-based medical guidelines and medical literature as part of medical practice. The project focused on training health operators to keep themselves informed about new diseases and treatments. It also aimed to explore the use of web-based seminars as a training tool. Participants were health operators from both continents, who were encouraged to participate by joining the network through a medical portal and attending a series of health and learning seminars.

Contact: Elena Murelli elena.murelli@unicatt.it

9. Global Observatory for eHealth - Global

The World Health Organization (WHO) General Assembly endorsed the establishment of the Global Observatory for eHealth (GOe) in 2005 to study and understand the impacts of ICTs for health by providing up-to-date, reliable information and guidance on best practice, policies, standards, access, and security in the eHealth domain. The first global survey on eHealth conducted in 2005 provided global baseline data on the current state of eHealth, and a set of recommendations for Member States. The second global survey on eHealth was scheduled to be conducted in early 2009. Key areas of interest include: policy and strategy frameworks, funding, infrastructure, legal and ethical issues, electronic medical records, eLearning, and mHealth.

Contact: Dr. Misha Kay kaym@who.int OR Mr. Jonathan Santos santosj@who.int

10. Bibliomed - Brazil

Bibliomed is one of the components of eHealth Latin America, an internet company devoted to integrating health services. Created in the United States, eHealth Latin America uses the worldwide web to provide solutions to health system administration problems. The Bibliomed portal provides information on and education about how to develop the technology required to provide more effective health care. It is designed for health professionals and all those interested in effective patient care and medical research, as well as in curing and eradicating disease and promoting health. Available in Spanish and Portuguese, this portal offers a health news service whose purpose is to provide a rapid, updated daily means of informing health professionals about events related to their professional activities or their patients' well-being. In addition, the portal offers daily news articles on issues of immediate use for professional practice based on critiques and abstracts of international publications. Bibliomed also electronically reproduces medical reviews and publications.

Contact: Martin Gurria bibliomed@corp.bibliomed.com.br

11. Five Cs: An e-Health Model

This is a framework for analysis to inform the development of eHealth in developing countries. The framework has five components - the 5Cs: Context, Content, Connectivity, Capacity, and Community. Context, for example, includes: "The nature of the existing ICT infrastructures in developing countries will of course vary, but it forms an important part of the context for developing an eHealth infrastructure. To what extent, for example, should eGovernment strategies focus on delivering content to rural communities rather than on making back-end applications more efficient for those who already have Internet access?..."

SEE ALSO:

•  Donate Life California: A Campaign Launch Case Study

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eHEALTH CONNECTION: A 2008 BELLAGIO CONFERENCE

The summaries in the following group are a selection from papers generated from a conference on eHealth, organised by The Rockefeller Foundation and partners. For background and details click here. The initial summary below presents the conference context.

12. Making the eHealth Connection: Global Partnerships, Local Solutions - Global

During the summer of 2008, The Rockefeller Foundation joined with several partners to organise an invitation-only international conference on harnessing internet-enabled technologies to improve public healthcare, even in the most challenging conditions. Academics, ICT experts, health professionals, researchers, and policy analysts from around the world gathered in Bellagio, Italy, for two parallel conference sessions (July 13 to August 8 2008). Conference conversation examined eHealth barriers, enablers, and successful sustainability models, and is being continued through an interactive website. The purpose of this in-person and online gathering is to help focus greater global attention on the under-utilised opportunities associated with use of ICTs for improving health, as well as to support the development of a sustainable plan for rolling out internet-based platforms, to promote interoperability and open standards, and to encourage new partnerships, collaboration, and coalitions.

Contact: ehealthconnection@rockfound.org

13. Global eHealth - Measuring Outcomes: Why, What, and How

by Richard E. Scott and Ayida Saeed

This document intends to provide "perspective to allow workshop participants at the eHealth Connection: Global Partnerships, Local Solutions conference of 2008 to understand: 1) why outcomes associated with eHealth applications implemented globally should be measured, 2) what elements of an eHealth initiative might be measured, and 3) how we might, individually and collectively, identify and measure key global eHealth outcome indicators." The authors recommend that, because eHealth data are sparse and there is no global consensus on qualitative or quantitative health indicators for data collection, a "minimum data set" of global eHealth outcome indicators should be identified and agreed upon by consensus, and should be universally applied.

14. eHealth Policy - The Road to the New Digital Divide?

by Maurice Mars

This is a description of the potential of eHealth as an example of an environment without boundaries or borders in which "a patient-centric system can allow patients, as individuals, to have greater access to information and decision-making and move freely across borders with their electronic clinical records safely stored and accessible from foreign shores. So too can health professionals see and treat their patients at a distance, offer services to those who do not have direct access to specialist care, and assist in improving services in resource-poor developing countries while in the comfort of their own homes or offices." The author states that there is a danger of policy interference unless international global policy or at least a set of "common principles and complementary global eHealth policy [that] will minimize the risk of developing an eHealth policy divide between developed and developing countries..." is put in place.

15. The Current Status of eHealth Initiatives in India

by Saroj Mishra, K. Ganapathy, and Baljit Singh Bedi

The strides of telemedicine and eHealth in India are the subject of this report. As stated here: "Most telemedicine activities are in project mode, supported by the Indian Space Research Organization and the Department of Information Technology and being implemented through state governments. A few corporate hospitals have developed their own telemedicine networks, prominent among them being the Apollo Telemedicine Networking Foundation.... Around 500 telemedicine nodes are in place across the country." According to the authors, an impact evaluation is scheduled and will be used in determining details of the next 5-year plan for eHealth development nationally. National telemedicine standardisation and practice guidelines are being developed by the Department of Information Technology.

16. mHealth: A Developing Country Perspective

by Saroj Mishra

mHealth, as it is described in this document, is one of the major challenges confronting both medical practice and health care policies. According to the author, "[a]pproximately 50%-60% of government services including primary health management can be delivered via mobile channel." The document cites examples of the implications of the development of mHealth, such as the need to examine the financing of mobile medical services and the challenge of clarifying the boundaries between physician services and so-called "do-it-yourself" medicine. The author suggests that mobile providers may offer built-in access features for mHealth.

17. mHealth: A Potential Tool for Health Care Delivery in India

by K. Ganapathy and Aditi Ravindra

This document describes mHealth as "the application of emerging mobile communications and network technologies ...involv[ing] the use of mobile computing, medical sensors, and communications technologies for health care." The authors describe the potential role mHealth might play, based in part on the example of India, in the new health care delivery model as wireless technology increases in flexibility, popularity, and distribution. They see the same promise for health care in cost-effective, need-based, and appropriate technology that some economists (notably, Mohammed Yunus) see for poverty alleviation through the mobile telephone. As stated here, "At present, the total world population served by mHealth services is probably less than one hundred thousand, though 80 percent of the world's population lives in areas with mobile phone coverage."

18. Barriers to Equitable Access to Quality Health Information with Emphasis on Developing Countries

by Naina Pandita and Sukhdev Singh

This document describes barriers in developing countries to access to quality health information. It discusses 8 main barriers to equitable access: connectivity, medical writing skills, language, copyright, information technology (IT) skills, economic support, national/regional resources, cultural issues, and government policies. Internet connectivity is generally limited to urban centres. A barrier to free distribution of health-related information is the copyright barrier, as well as the high cost of journals, linguistic and/or cultural barriers, the limited availability of regional and national information resources, restrictive government policies, and lack of medical writing and IT skill training. However, there is a trend toward internet growth. Advances in internet-enabled mobile devices are opening possibilities of remote patient monitoring applications and patient information retrieval.

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This issue of The Drum Beat was written by Julie Levy.

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The Editor of The Drum Beat is Kier Olsen DeVries.

Please send material for The Drum Beat to The CI's Editorial Director - Deborah Heimann dheimann@comminit.com

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