eHealth and mHealth come up when the digital transformation breaks into the medical-health sector. What do they mean and how can they help health care around the world? Let’s figure it out together.
In 2018, according to Audiweb data, more than 40 million Italians spent almost 3 hours a day online, 75% of them using a smartphone and smartphone apps. Surely, the way people are online helps us to find out more about them.
Reading online newspapers, browsing social media, playing with apps, shopping through e-commerce sites, booking trips or avoiding boring queues using online payment services are just some of the possibilities offered by the Internet and the digital world. Nevertheless, there are also other sectors in which smartphones and tablets can actually be used to help people to improve their lifestyle and health.
The medical and health sectors, in fact, are increasingly invested by the digital transformation and the next future will see significant changes in the eHealth context.
Without going too far, thanks to specific apps you can already interact directly with the doctor, monitor the progress of a therapy, of physiological parameters and physical activity in general and receive advice and suggestions on treatments at any time and place.
EHEALTH AND MHEALTH: DIGITAL HEALTH THANKS TO THE SMARTPHONE
The term eHealth refers to the use of information technology and telecommunications in the health sector. At the end of the nineties, there was a first formal definition of eHealth and since then the opportunities and challenges that the new digital technologies brought to the attention of clinicians were already clear. Many of the technologies that we now consider part of our daily lives were almost unthinkable a few decades ago. Just think of the renewal of prescriptions, the online booking and the sharing of health data through specific software and medical devices.
mHealth (mobile health) or the use of mobile devices in medicine and health is a sub category of eHealth. The term mHealth is often used referring to the use of mobile technology and communication tools such as smartphones, tablets, PDAs and wearable devices like smart watches for the prevention, promotion, treatment and maintenance of health, information and data collection.
mHealth (mobile health) and eHealth (digital health) interventions are beneficial for several reasons, for example:
Thanks to the growing percentage of citizens who use mobile technology, accessing health services via smartphone apps, several solutions based on mobile medical devices have been developed to improve access to health, knowledge and behaviour in a range of contexts and target groups.
eHealth, widely used in the industrialized nations, is also spreading in the developing countries and in the low-income ones. eHealth is certainly the ideal means of providing greater access to ever-larger segments of the population and improving the capacity of health systems in all countries, in order to provide quality health care. Through the collection of health data and the sending of health care information to doctors and researchers, thanks to the digital tools it is possible to monitor the patient’s health in real time and propose a direct and personalised care.
THE SUPPORT OF MHEALTH TO THE HEALTH SECTOR
Because of the health disparities in the world, the mobile devices cannot be used anywhere to provide excellent healthcare and thus meet the needs of the entire world population. Nevertheless, the proliferation of mobile devices is certainly a stimulus for the development of mobile health apps. Although the advent of global electronic health and mobile health has been going on for two decades, many people are still uncertain about the uses and benefits of these new technologies.
According to the World Health Organization, mHealth is “a practice of public and medical health care supported by mobile devices, such as smartphones, patient monitoring devices, personalised digital assistance and other wireless devices”. Besides the advantage of keeping us always connected to the health workers, how else can mHealth improve our well-being? Certainly, by allowing a better therapeutic adherence and providing aggregated data on the patient’s state of health.
One of the biggest challenges for healthcare professionals is to make sure that patients follow the prescription and treatment correctly. In this sense, the apps that remind patients of which drugs to take can be very useful. The lack of therapeutic adherence is “due to the poor therapeutic result, the continuation of the pathology, and a burden – from billions of dollars a year – in avoidable direct costs for the health system and for families”.
Despite this, various medical devices and mobile health apps already exist on the stores:
The ever-increasing popularity of electronic devices for telecommunications has also favoured the healthcare context. Below some useful apps:
The lack of trust in technology is not a new phenomenon, especially in Italy. It is true that mHealth takes away many of the responsibilities from the hands of health professionals to deliver them to cyberspace, but there is more. The mHealth apps are not at the top of the FDA’s priority list, because their use is not invasive and there is no reason to think that they could cause significant damage to health. For this reason the FDA itself does not believe that the mHealth apps need the same regulation as drugs and other therapies. This allows companies to develop and sell them faster, of course after having developed clinical trials among patients.
Probably no mHealth app has ever been subjected to clinical trials or approved by the FDA, but nevertheless many patients use them on a daily basis. Doctors probably fear that patients may rely solely on the apps rather than going to physicians. It was discovered, in fact, that among the first 23 symptom-testing apps, “the correct diagnoses were listed first in only 34% of standardised patient assessments.” Misdiagnosis and lack of diagnosis can endanger the patient’s life.
To enable the growth of mHealth, there is a need for serious regulation that goes beyond the socio-political and health boundaries for the provision of health care. The future of healthcare is all around the patient, but the patient has no decision-making power. Insurance companies, large pharmaceutical companies, doctors, managers, suppliers, manufacturers, governments and many other forces influence the future of health.
Currently, most digital healthcare technologies are limited to single services such as the confirmation of an appointment via SMS, the sending of medical reports via email and the use of wearable apps and devices that monitor individual parameters. There are specific apps that can measure and track some parameters like blood glucose and arterial pressure, as well as physical activity in general. The great potential of mobile technology in the health field, however, does not seem to be enough for an organizational and administrative update: in fact, the reduction of costs and the implementation of adequate tools should go hand in hand with an adequate training of the health professionals.
eHealth can be an excellent support to traditional health care to monitor patients’ psychophysical conditions and their vital parameters in real time. In this way, the patient becomes an active part of the healing and therapy management process.
DIGITAL TECHNOLOGIES AND PUBLIC HEALTH
For years now, digital technologies have become an important resource both for the provision of health services and for public health. Thanks to their ease of use and wide range, mobile wireless technologies are particularly relevant in optimising medical services.
Digital technologies, such as mobile wireless technologies, have the potential to revolutionise the way populations interact with national health services. In fact, digital health, particularly mobile health, has proven to be able to improve the quality and coverage of care, increasing access to health information and services, in order to prevent the onset of acute and chronic diseases.
EHEALTH AND MHEALTH: NEW OPPORTUNITIES
The reduction in the costs of health spending is certainly one of the most important points in favour of eHealth. It allows patients to easily access online health services and to make the delivery of health services more efficient.
In addition to the practical aspects, the perspective for health professionals and patients also changes: doctors can easily communicate with colleagues and they can benefit from long life training and the new standards can be shared to improve the quality of care.
From the patient’s point of view, instead, we talk about engagement: what is taken into consideration is not only the diagnosis, but also the socio-cultural context and the behavioural, cognitive and emotional dimensions. Especially in the case of chronic diseases, the intervention must also include psychological support. Indeed, the active involvement of the patient is one of the key features of eHealth.
EHEALTH AND MHEALTH: FUTURE GOALS
The main purpose of eHealth technologies is certainly their large-scale diffusion and cost containment without having to compromise on quality. Nevertheless, what are the factors that can influence the results of eHealth interventions in various ways?
Obviously, while computer science is running fast, the evolution of health systems is linked to bureaucratic and operational aspects that affect the implementation of these new technologies, although already approved.
The major problems encountered are related to the outdated facilities, the lack of shared protocols and lifelong training. Even the lack of a direct relationship with the patient and the fear that a reduction in costs corresponds to an impoverishment of the quality of services generate many doubts.
CHRONIC PATIENT MANAGEMENT THROUGH EHEALTH
The consequence of longer life expectancy translates into the increase in the number of patients with permanent conditions that must be considered in the long term.
Taking care of a chronic patient means having a patient in charge for years with high costs that in the long run and in large quantities weigh on the national health system. Furthermore, care goes beyond the single treatment and affects the patient’s daily life. For this reason, its management involves various services and various professional figures.
It is not easy to combine health information sharing, self-monitoring instructions and patient’s active involvement. Precisely for these reasons, mHealth appears to be the most valid answer to create new protocols and manage the treatment in a more functional manner.
THE IMHEALTH PROJECT
An example of mHealth initiatives is the iMHealth project, a system that provides the patient and the clinician with an app and a software with integrated and updated information in real time on the shared system. Belonging to the category of medical devices, the system has been developed for a specific chronic condition, spina bifida, a congenital malformation of the spine that involves a wide range of motor and functional disabilities. The set of discomforts caused by the disease greatly affects the quality of life and the mood of the patients who suffer from it.
The possibility of eHealth technologies to monitor diseases in real time and at reduced cost becomes a significant area of development precisely due to the ease of use and practicality of mobile devices.
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