With the emergence of m-health, the notion that technology can actually be good for healthcare seems to have definitively taken a hold. It may seem obvious to many, given the enormous progress in life expectancy gained in Western countries since the advent of modern medicine, but this is not the case. Distrust of science and institutions has spread like wildfire, contaminating what until recently were considered achievements (from vaccines to fast mobile internet technologies). However, connection and data sharing are essential components of the daily lives of billions of people, and the perfect tool for these purposes is the smartphone. For some years now, institutions, scientists, governments, companies and hospitals have been wondering whether this type of device can be used for medical research and healthcare. This has led to the development of m-health, a set of knowledge and technologies that makes use of smartphones and other mobile devices with the aim of improving the quality and efficiency of healthcare systems. Another way to address the issue of m-health is: what if we, as users, no longer had to follow technology’s latest innovations, but technology followed us? What if tech systems monitored our health, prevented illness and even treated us wherever we were?
WHAT IS M-HEALTH
The implementation of mobile health for medical research is bringing about a progressive and radical change in the way doctors and researchers identify new models and practices for public and individual healthcare. While e-health has been talked about since the late 1990s, it is only recently that e-health has also been defined as ‘mobile’. The shift is mainly due to the exponential spread of smartphones and wearable devices, tools through which one can simultaneously operate both in terms of treatment and prevention and in terms of data collection for medical research. Specifically, some of the main emerging fields in which m-health is being applied are:
WHAT IS THE DIFFERENCE BETWEEN E-HEALTH AND M-HEALTH
E-health is an umbrella term that encompasses all those practices in which healthcare is supported by electronic processes. Its potential includes benefits in all areas of medicine, from surgery to clinical decision support, from drug prescriptions to the treatment of mental illness. In many countries, its application is already making hospitals more efficient, leading to savings for public finances through better allocation of resources and immediate benefits for the health of citizens. M-health, on the other hand, emphasises on access to therapies, direct involvement of doctors, information and making patients aware of changes in habits that are harmful to health.
The first definition of m-health, fifteen years ago, was very general: the use of “emerging mobile and networked communication technologies in healthcare” (Istepanian, 2006). A second definition, used in 2010 by the US National Institutes of Health’s ‘m-Health Summit’, already marks a step change: ‘The provision of health services through mobile communication devices’. Subsequent interpretations tend to emphasise the interest of m-health in medical research. The World Health Organisation (WHO) in 2018 spoke of m-health simply as ‘the use of wireless mobile technologies for public health’. The deliberately vague phrase seems to have a dual purpose: to highlight the infinite potential of m-health while simultaneously excluding the self-care apps proliferating on app stores. The WHO goes on to define m-health as “an integral part of e-health” and mobile technologies as “particularly relevant because of their ease of use, broad reach and wide acceptance”. A growing segment of the global population is increasingly turning to their mobile devices to access health information and services. Mobility, no longer just digitalisation or dematerialisation, is m-health’s answer to the health needs of a citizenry on the move: you don’t necessarily need to be at a medical centre at all stages of an illness or its prevention, because the health services provided through your smartphone are always with you. The ability to carry a device in your pocket through which you can book a doctor’s appointment, receive blood test results, request a consultation, monitor and correct your harmful habits and receive alerts on health emergencies is an undoubted advantage for both individual and collective health. Much emphasis is placed on wireless communication technologies for healthcare and medical research in remote locations or emerging countries where the use of m-health can save time and money.
M-HEALTH FOR MEDICAL RESEARCH: DEVELOPMENTS AND APPLICATIONS
Mobile technology is used by 3 billion people who are increasingly turning to digital technology for health information and advice. On one side of the screen is the user who can consult his or her doctor or get information and even show their health record in an emergency. On the other side of the interface are doctors and researchers no longer alone in the office or laboratory, but sharing data and findings in real time, immediately asking a colleague for a second opinion, receiving support during training thanks to instant messaging services. The use of mobile devices and inventions in the field of collecting and analysing large amounts of data are tending towards a radical change in the healthcare professions. Today, doctors have at their fingertips the patient’s entire medical history, real-time data for monitoring and models for correct diagnosis. When we talk about m-health, we must also think about all the recent innovations in cloud computing, big data analytics and machine learning, of which mobile health is a major beneficiary. This does not mean that doctors have seen or will see their role diminished, quite the contrary. It is true that with Google and mobile applications direct intervention by the professional is often bypassed, but for medical science mobile connection devices are above all an opportunity to anticipate needs, rather than follow them.
M-HEALTH: TYPES OF SMARTPHONE APPLICATIONS
The UK’s National Institute for Health and Care Excellence (NICE), in a study in collaboration with the National Health System (NHS), categorised m-health apps into three different types:
The first ones are especially relevant in cases of emergency triage, when symptoms are most evident. Advances in image-recognition software have made apps for diagnostics through photographs and movement recordings particularly efficient. The second type has more to do with prevention and information, partly through the use of smartwatches and other wearable devices that can monitor diet, physical activity and blood sugar levels and is the one that has produced the least results so far from a clinical point of view. In all likelihood, this is because these applications are closely related to patients’ personal habits and perceptions, and because there is often a lack of standards at state level that developers should aim for. At the same time, developers are often under pressure from their funders to deliver operational applications quickly. Finally, digital therapy applications are particularly suitable for the treatment of depression, stress, insomnia, chronic pain and for facilitating in certain circumstances the meeting – even anonymously – of patients with the same condition, as in the case of HIV patients.
M-HEALTH FOR RESEARCH ON DISEASE OUTBREAKS
Another area where m-health is finding enormous potential is in monitoring and surveillance of the spread of diseases around the world. M-health applications collect aggregate data, while digital health technologies compute and correlate these data, making assumptions about causal and correlative relationships between diseases and environmental factors. In addition, m-health technologies are already being used to contain epidemics by exploiting the clustering and case-tracking capabilities of mobile devices. The need to exploit this aspect has been made more evident than ever by the coronavirus pandemic. Several studies, from 2014 to March 2020, underlined the multiple positive effects of using m-health during an epidemic or pandemic: tele-visits, real-time information for healthcare professionals, educational, diagnostic and treatment programmes, and population monitoring.
HOW MEDICAL RESEARCH IS CHANGING WITH M-HEALTH
It is clear that in 2021, it is no longer just a matter of running healthcare services through mobile applications, but also of designing new software and improving existing ones according to the needs of healthcare professionals and users. This flow of needs is facilitated by the ease of use of smartphone applications themselves, which encourage feedback or record, with consent, the user’s habits, symptoms and health. In addition to large amounts of aggregated data, healthcare professionals and researchers have start-ups and other companies at their disposal to provide customised solutions for different hospitals and research. While most m-health projects have an e-health backbone, the use of m-health for medical research has become more and more important due to the ability to collect data that then expand the compendium of e-health information. Thus, on the one hand, mobile health brings medicine closer to the patient who seeks advice, learns about health habits and receives a prescription on a single device. On the other hand, it brings the patient’s data closer to the doctor, who can then have all the data he or she needs at their fingertips to, for example, create targeted treatment paths and make decisions based on local or global statistics. And all this can happen regardless of whether the doctor and patient are in the same place. M-health aims at the horizontalization of healthcare, encouraging the globalisation of best practices, the dissemination of innovative therapies and the timely response to emergencies. At the same time, WHO emphasises that mobile health should not become a substitute for general healthcare: in several developing countries, for example, it is easier to get a mobile phone than clean water. The idea of mobile health that can reach patients and support health workers at any time and place is at the heart of m-health. The rapidity of solutions that can arise from the instant sharing of technologies and resources represents a further step forward: the blurring of boundaries between research, treatment and prevention. Each of these three components, in traditional medicine, represents a vast complex of well-defined practices and knowledge. M-health facilitates the blending of the three. To date, according to European Commission figures, there are more than 100,000 m-health apps on the market. From this basis, the potential for starting a virtuous circle for improving the quality and efficiency of public health is clear, and IPPOCRATE AS, the software house specialising in digital transformation for healthcare with long experience in the acquisition of funds for medical research, both Italian and European, has been working on this vision for years. Click here if you want to ask IPPOCRATE AS for more information on the development of m-health applications.