Telehealth Faces Challenges Worldwide

Wireless mobile technologies have great potential to improve global health. But the challenges facing the implementation of mobile health IT worldwide are different than those faced by the efforts to use health IT in the U.S. to transform patient outcomes.

In developing countries, such as nations in Africa and Asia, including Uganda and India, low cost wireless biometric sensors and cell phone technologies are being developed and piloted to monitor and screen patients for developing heath concerns, ranging from problems in patients with HIV to complications in pregnant women, said speakers during a panel this week at the annual Connected Health Symposium presented by Partners Healthcare in Boston.

Unlike the U.S., there are no established IT infrastructure or installed clinical systems in many developing countries, so there are fewer struggles with integration or interoperability because those other nations are "starting with a blank slate," said Nathan Pendleton, chief growth officer at Generation One, a maker of telehealth applications.

In fact, for some researchers, trying out new mobile health applications in developing nations is easier and often more fruitful than launching them in the U.S. because those countries lack of established clinical IT standards and, in some cases, even medical records.

"We decided to go to developing countries first before the U.S. because there is no clinical documentation yet in many places and no need for interfaces for existing clinical devices," said Dr. Leo Anthony Celi, a physician at Beth Israel Deaconess Medical Center in Boston and a project lead for various global medical informatics projects. "The path is easier where there's nothing in place."

However, big hurdles remain, including poverty and limited communications infrastructures and scant availability of healthcare services in general.

In many developing nations, even when there are mobile phone capabilities, there is very little disposable income for many people to buy devices that could help them be monitored for life threatening situations, including women in labor suffering complications.

If a person earns $2 a week or less, they're not likely to spend even 10 cents for a mobile device app, said. Dr. Jessica Haberer, research scientist at the center for global health at Massachusetts General Hospital. Haberer and her team are developing wireless biosensors to monitor patients with HIV as well as pregnant women in developing nations.

That's one reason why Haberer is planning to pilot her biosensor technology first in India before rolling it out in some poor African nations. Even in poor regions of India, there is often "some disposable income that could help make a new product viable, she said.

"That was frustrating to me and where I'd like to help," she said. Nonetheless, the goal is for her technology to be scalable so that its use can be widespread and "you don't waste money" developing a product that can't be used by many in part because of affordability.

Other challenges for mobile health applications in developing nations is that limited resources for health spending also compete for other important initiatives, such as immunization, said Celi. But even in the U.S., where affordability of mobile healthcare applications is often much less an issue, various mobile and other new healthcare-related innovations "will be gone in three years" because use by patients will fade, whether it's cell phone apps that provide dietary information or other various telemetry monitoring apps, predicts Celi.

"Unless these apps stick to patients and result in better outcomes, they're likely to go away, said Celi.

Also, in developing nations as well as the U.S., less is better--whether it is the amount of information patients are asked to provide and enter or instructions they are asked to follow. "You need to make these applications as easy as possible," Haberer said.

Also, the ways cell phones are used in different countries also affect how telehealth applications can be best used, she said.

For instance, cell phones are often shared among many individuals in poor countries, so having users answer questions like how many pills they took of their medication isn't a simple process if others are also using the phones, she said.

"We went through a lot of processes to understand the end users and the context of how these devices are used, also considering many users are illiterate," she said.

Still even in the U.S., there are still discoveries being made on how different individuals and demographics can best use smartphones and other mobile devices for health related issues.

For example, common stereotypes often don't apply. While conventional wisdom might say that elderly people tend not to use smartphones, some research indicates that elderly patients who have grandchildren of a certain age--probably those kids old enough to have smartphones of their own--are more likely to use the devices.

As for privacy, many patients in developing nations aren't freaked out by the notion that someone else can monitor their health with mobile devices, said Haberer. "In some African countries they love [the idea that] how someone wants to spend time and money to help them get better," she said.

Other challenges include the lack of facilities and clinicians to monitor patients or offer care when there is a medical crisis. So, a lot of the monitoring devices might have more potential inside clinics, Haberer said.

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