The mHealth Opportunity: From Kamphaeng Phet to Capitol Hill

I'm working in Thailand and the Philippines for Dimagi, a Boston-based technology company that develops and deploys mobile phone-based solutions to public health issues around the world, particularly in developing countries. Here in Southeast Asia, Dimagi was hired to support a major vaccine trial for dengue fever, and I'm helping roll out a system that will use text messages to help keep the clinics running the trial in closer contact with their patients. Appointment reminders, health tips, and general encouragements to watch for fever symptoms will be automatically delivered on a mass scale to the patients who receive the trial vaccine.

How is it possible that we're running a high-tech project like this in off-the-beaten-path Thailand? All the system needs to operate is a central server with a good internet connection, and a network of patients with mobile phones. And everybody-- everybody-- has a mobile phone. With over 5 billion of them now in use around the world, we're simply leveraging a network that already exists to facilitate better communication between patient and doctor.

About two years ago, NDN helped promote the release of "mHealth for Development" a report jointly published by the UN Foundation and the Vodafone Foundation that describes the opportunity for mobile phones to be used to improve healthcare in the developing world, and includes a number of case studies of interesting projects already underway (a few Dimagi projects are included in the case studies). The report is a great starting point for beginning to understand this field and its potential.

But mHealth isn't just a developing world opportunity.  In the U.S. and other developed nations, the potential of the ubiquitous mobile phone network to help monitor symptoms and vital signs, faciliate remote diagnosis and treatment support, track epidemics, and otherwise improve the quality of care (while reducing costs) is huge. Particularly in the treatment of chronic diseases including diabetes, heart disease, and cancer-- which together account for 75% of healthcare costs in the U.S.-- mobile phone-based solutions can offer patients individualized monitoring and management of their health. 

Currently, only about 50% of chronic disease patients in the U.S. take their prescribed medication on time, which inevitably leads to their becoming sicker, requiring hospitalization and high-cost procedures. But even the most simple solutions can have a huge impact on that rate. SIMpill, a project piloted in South Africa, is a system that sends automated SMS reminders to tuberculosis patients to take their medication, and has led to an increase in compliance rates from less than 50 percent to over 90 percent. If simple solutions like SIMPill can help raise that rate in the U.S., Americans can all benefit from both improved medical care and greatly reduced costs.

What's more, applications that can successfully help manage chronic disease will have a huge global market. Dr. Darunee Tannitisupawong, a physician based here in Kamphaeng Phet, Thailand, has observed in the past decade a dramatic rise in diabetes and heart disease-- and she ranks those as the single greatest public health issues in this small provincial city today. Fifteen years ago, infectuous diseases like dengue fever were the greatest scourge of the population here, and while rates have remained steady (and will hopefully begin to decline if this vaccine trial proves successful), worsening eating and lifestyle habits have caused a dramatic rise in the incidence of chronic disease.

As KFC and McDonalds continue their conquest of every corner of the globe, chronic disease will be an increasingly large quotient of the world's illness. Fortunately, the best tool to combat that illness is already in the pocket of 70% of the people on earth.

CTIA, Day One: The Promise and Potential of m2m

If you've ever been to the CTIA conference, you know it can be a little hard to come away with much more than a tote bag full of tote bags and a gambling debt to rival your mortgage. This year, the big news (at least according to Twitter) has centered around the release of a new phone-- the first 4G phone-- from HTC and Sprint. It's pretty, and it'll sure be fast, and it may even serve as a WiFi hotspot for 8 other devices (cool!), but it's basically the next generation phone we knew was coming.

In the sessions/discussions/panels I've attended, and in my wanderings of the Wyoming-sized exhibit floor, a pretty clear theme has arisen around machine-to-machine (m2m) communications.  There are a number of companies exhibiting here that are working directly in the m2m space in one capacity or another, whether manufacturing modems that will feed information to a database, writing the software to govern the devices, or building the consumer products that will put it together.

Beyond that, the broader areas that seem to be host to the most activity are facing their greatest challenges-- and seeing their greatest innovation-- in the m2m space.  I'm thinking particularly of mHealth and the energy/smart grid spaces, both of which have a lot of people talking out here. 

In healthcare, the great promise of wireless in the U.S. is to facilitate remote monitoring of patients, and to collect data-- both on the individual patient level and on the broader, society-wide level. There's a great deal of innovation coming from all the big players and a number of smaller ones to craft devices that will monitor everything from your blood pressure, to your weight, to your heart rate and ECG in real time, wirelessly. These devices then feed the data they gather into a smart database capable of identifying health problems from what it gleans.  There are all sorts of issues with this-- backend compatibility, successful business models, and some mondo liability issues to start with-- but there is incredible opportunity here for these devices to do tremedous good, and I'm pleased to report that pretty much everybody is on it.

In energy, NDN/NPI fanatics already know about the potential of the smart grid, thanks to the work we've done on Electricity 2.0. A crucial piece of the smart grid-- part what will make it smart-- is broadband connectivity built-in.  Some of this connectivity will come from wireless, which will tie together the devices in our homes, let our smart meters talk to the other nodes on the grid.  In this, as in mHealth, there will be great reliance on smooth, secure, reliable m2m connectivity.  With an emphasis on the secure-- you don't want your health data getting lost in transit, or your neighborhood losing electricity.

The handheld devices and the hott new apps to run on them might still be what's sexy here at CTIA (so far as anything is really sexy here), but the real innovation to make life-- not just more convenient-- but truly different and better is happening in this machine-to-machine, data-gathering and analysis space.

The Dazzling Future of mHealth

Dr. Eric Topol of Scripps Health and the West Wireless Health Institute spoke on the Hill last year, at an event co-hosted by CTIA and NDN.  His amazing presentation was a look into the future of wireless technology in healthcare. He showed off devices and applications-- not so far removed from the iPhone apps of today-- that will be able to track vital signs, monitor chronic diseases, and collect data about our bodies: about sleep, about pregnancy, about disease, and about just about everything else.

Dr. Topol gave a talk at TEDHealth last fall, and the video gives a good picture of the (amazing) near-future in mobile Healthcare.  Enjoy:

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