The notion that complex problems demand equally complex solutions is endemic throughout the world of technology, exemplified by mobile health and its gadgets and gizmos that would make the science fiction writers of only a generation ago blanch. Not a day goes by without another startling utilization of sophisticated mobile technology and its countless peripheral devices and resident applications: Whether used as an artificial limb, biometric scanner, or radiology image viewer, our iOS and Android smartphones and tablets have already revolutionized the teaching and practice of medicine wherever the technology is available. But what of most of the world where it isn’t?
"Regions where mHealth has made the greatest impact are also those where the movement owes its origins — countries where complex problems could only be solved with simple solutions."
Interestingly enough the regions where mHealth has made the greatest impact are also those where the movement owes its origins—countries where complex problems could only be solved with simple solutions, literally as simple as SMS, or “Short Message Service” most commonly referred to as texting. Limited to 140 bytes (if you’ve ever wondered why tweets are only 140 characters, that’s why) and paling in comparison to the interactivity and sophistication of even the most remedial smartphone function, text messaging nonetheless has its advantages, especially in those areas of limited or no electricity and Internet connectivity, and where basic cell phones are all that’s available.
Taking a basic SMS network and turning it into a veritable healthcare system, these mHealth pioneers used what they had to overcome financial and geographical boundaries to the access of healthcare services, especially in rural and disadvantaged communities. In 2005 the World Health Organization defined telemedicine and set the benchmark for such projects worldwide: “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities”
Examples of simple mHealth ideas solving healthcare problems of great complexity include:
• Monitoring the health status of communities
o ChildCount+ uses SMS text messages to facilitate and coordinate the activities of community based healthcare providers, allowing them to register patients and report their health status by actively monitoring children for malnutrition, malaria, and other childhood illnesses.
• Creating social networks
o Sibesonke is a social networking service giving people the ability to chat, access classifieds and other data using only SMS and a basic cell phone with no Internet connectivity required. Brings the power of social to communities otherwise isolated from the Web.
• Identifying fake medicines
o mPedigree system empowers African patients to protect themselves from the fatal effects of counterfeit drugs. Program evolved into a voucher scheme to track supplies of malaria nets, creating a sustainable ecosystem involving retailers, suppliers, clinics and NGO’s.
What’s particularly fascinating about these relatively simple and straightforward mHealth solutions for the developing world is how they often roll back into simplified solutions in more technologically sophisticated environments. Social media platforms based on SMS have been extended to makeshift communities such as GeoChat, for instance, which utilise the cloud to crowdsource mobile handsets for crisis response, the basis for disaster response used in major cities today. We also see the convenience of SMS taken up in the UK with the NHS reporting excellent results from their Quit Smoking campaign, and Johnson &, Johnson’s “Text4Baby” showed substantial adoption in the States. Enabling text-driven 911 calls arose out of the 2007 Virginia Tech shootings where students were unable to use phones for fear of exposing themselves to their attacker, while researchers feel text-based emergency calling could lead to quicker response.
"...we owe the elegance and simplicity of these solutions to non-profit innovators struggling to improve the access and quality of healthcare in under-developed countries throughout the world."
Interestingly enough we owe the elegance and simplicity of these solutions to non-profit innovators struggling to improve the access and quality of healthcare in under-served countries throughout the world. For those of us working and consulting in the field of mHealth the lesson is powerful: the success or failure of an mHealth initiative isn’t necessarily dependent on the technology, most importantly, the needs of the user—ultimately the patient—are key, and systems that are simple, intuitive, and easy to learn and use stand the greatest chance for adoption and positive impact.
Part 4 of this series will be published in September
About the authors:
Michelle Petersen is founder of The Healthinnovations community. Blogger, freelance healthcare journalist and healthcare communications specialist, Michelle is a specialist consultant on large scale pharma events sales &, communications. You can follow her at @shelleypetersen, or filter the hashtag #healthinnovations for the latest tweets related to all things healthcare communications, innovations, and mhealth.
Michael Spitz is VP of Digital Strategy at Ignite Health, with offices located in New York City, New York, and Irvine, California. Spitz combines his passion for technology with more than 15 years of clinical content expertise to help engineer healthcare communications solutions across numerous treatment areas for many of the pharmaceutical industry’s major companies. Follow @SpitzStrategy on Twitter for his daily – often hourly – updates on all things digital for the ultimate benefit of patients worldwide.
How might simple systems solve complex healthcare issues?