Three critical challenges remain for mHealth

Mobile healthcare must overcome three fundamental challenges if mHealth is to fulfill its promise of transforming the delivery of health services worldwide, argues an article in the journal PLoS Medicine.

"Given the challenges for mHealth, cooperation and coordination between very different stakeholders will be necessary to deliver on its potential," the article says.

The article is an attempt to provide mHealth with a "reality check," according to the authors, who say the major challenges confronting mHealth include interoperability, open standards, and the ability to properly evaluate clinical outcomes or evidence. Interoperability and open standards go "hand in hand" when it comes to mHealth.

"Interoperability is a critical issue for mHealth (and for eHealth more generally), because patients may have multiple clinical needs and conditions at one time, and will interact with the health systems via multiple points, providers, and professionals," the article states. "Although many mHealth applications may appear simple (e.g., a system sending texts to patients reminding them of their next appointment), such systems will have greatest potential for wider use if they can easily and accurately exchange information with other systems--for example, microscopy images taken using a mobile phone can be securely imported back into the electronic health record."

The development of open standards can help solve the lack of interoperability between systems, the authors say, by eliminating the multiple "standards" that exist in eHealth and mHealth. Closed standards create a knowledge barrier for systems developers in low- and middle-income countries, they say.

"Without access to the standard, programmers and policy makers cannot understand how the systems or standards work, cannot develop technical capacity, and ultimately cannot make good decisions for their country about what systems they need to develop and how," the article states. "There is a need for a governing body--for example, World Health Organization--to certify open standards and enable countries' access to standards that meet key criteria."

The third challenge facing mHealth is in the area of evaluation, according to the article, "not just the need for better and more evaluation, but also the challenge of knowing how to evaluate."

The article points to a January 2013 PLoS Medicine article on two systematic reviews of randomized mHealth trials that found many studies to be of poor quality and few with low risk of bias and very few with clinically significant benefits for the interventions.

"The authors emphasize, crucially, that high-quality trials are needed to provide a much more rigorous evidence base to inform scale-up of mHealth applications," states the article. "Furthermore, the authors found very few studies that had been conducted in low- and middle-income countries, which are needed to evaluate feasibility and efficacy of mHealth in such settings, including comparing interventions with control groups that reflect real-world conditions."

Another pitfall cited by the article is the mistake of focusing exclusively on randomized trials as the "gold standard" for evaluating interventions. These randomized trials are "too restrictive" for mHealth, the authors say, and take too narrow a view of what constitutes evidence.

To learn more:
- read the PLoS Medicine article