The lack of standards and technological integration are a key barrier to scaling mobile healthcare in low- and middle-income countries, according to a new report from the mHealth Alliance.
The report finds that health systems in both developed and developing countries continue to struggle to realize the full potential of mHealth, and more generally technology, in part due to limited interoperability.
In particular, the mHealth Alliance concludes that there are significant gaps in the capacity and participation of low- and middle-income countries in the development and adoption of health informatics standards, of which the largest challenges are lack of local informatics human resource capacity and insufficient investment into standards activities, which prevents productive engagement with international standards development organizations.
"In our efforts to improve reach and quality of care, standards and systems integration can help ensure that people move seamlessly through the health system and their data can move with them," said Patricia Mechael, executive director of the mHealth Alliance, in an announcement.
The report proposes that greater guidance by governments and donors, promotion of open standards, and a shift in market dynamics would be particularly effective ways to incentivize interoperability. Existing dynamics do not penalize, and sometimes even reward, the development and use of new and non-interoperable systems, but governments, donors and technology partners can all play an important role in effecting this transition, states the mHealth Alliance.
"Low- and middle-income countries have perhaps the greatest potential to extend health systems' reach by using mHealth to integrate remote workers and patients into the health system," argues the authors of the report. "Interoperability in such heterogeneous environments necessitates improved governance and alignment at the national and international levels, and greater diffusion of existing health informatics standards, adaptation of standards to LMIC contexts, and, in some cases, development of new standards."
Two recent reviews published in PLoS Medicine found little evidence that mHealth is having a great impact on managing disease in developing countries. The problem is a lack of rigorous studies in low- and middle-income countries. As the reviews point out, most existing evidence on the success of mHealth comes from trials performed in the developed world and is of poor quality.