There are five key challenges facing the implementation of mHealth in the United States: privacy and data security, funding, a lack of good examples of the efficacy and cost effectiveness of mHealth in practice, and the need for more high-quality research, according to an article in the Journal of Medical Internet Research.
The article concludes that many of these challenges could be addressed by making the most of the move to healthcare reform, developing a strategic and coordinated approach including federal-level guidance and coordination across the industry, as well as improving mHealth practice with good intervention development principles and sound research methodology.
"While mHealth is in an early stage of expansion with much hype, private investment (estimated to be more than U.S. $500 million in 2011), and federal government interest, it may be timely to consider a strategic approach to these issues," the article states.
The author, Robyn Whittaker from the University of Auckland's National Institute for Health Innovation in New Zealand, conducted interviews with 27 people in the federal health services and the private mHealth sector. At the time, she was the 2010/11 Commonwealth Fund Harkness Fellow in Healthcare Policy and Practice. Based on these interviews, Whittaker's article summarizes the main issues facing U.S. implementation of mHealth and outlines opportunities to address them.
In the policy and regulatory environment, interviewees considered privacy of personal health information to be a major issue requiring high-level guidance and widespread discussion. Another issue raised by the majority of interviewees was the regulation of mHealth tools and programs as medical devices.
When it came to the wireless network environment, interviewees commented on the large number of wireless networks in the U.S., which "can make establishing relationships and interfaces for comprehensive implementation difficult." Some imentioned a barrier to the development of more widely available and more comprehensive solutions as a result of proprietary systems and multiple platforms.
In the health system environment, the fee-for-service reimbursement structure of the U.S. health care system was "seen by almost all as less than ideal for the implementation of mHealth." Several interviewees mentioned that more urgent priorities within the health system are monopolizing focus and resources, particularly around the implementation of electronic health records (EHR) systems.
On the issue of mHealth practice, several interviewees raised the concern that many mHealth applications available in practice "may not be effective, engaging, usable, or meeting the needs of users." Many interviewees felt that "not a lot is known as yet about what aspects of mHealth work, for whom, and why."
When she asked participants about mHealth research, many rated the state of the evidence as "early or weak" and identified various areas as being in need of more high-quality research. Most felt that there is sufficient proof that mHealth is worth pursuing, although more solid evidence is required in terms of cost effectiveness and in determining what works.
To learn more:
- read the JMIR article