Chapter Four

Fundamental of mHealth

For 3rd Year HI Students

By
Temesgen Dileba (MSc HI)
 Chapter Objectives
At the completion of this chapter the students
will be able to:
– Define mHealth and related terms
– Explain mHealth strategy in Ethiopia
– Describe the type of mHealth applications
– Discuss the benefits of mHealth
– Explain key considerations for mHealth
interventions
– Familarize mHealth experience in Ethiopian
(IVR, and others)
– Discuss the global mHealth experience
 Overview of mHealth

• Definition of common terminologies

• Mobile health (mHealth)
is providing healthcare support, delivery and
intervention via mobile technologies such as
smartphones, tablets and wearables.
is a rapidly expanding field in the digital
health sector.
can be used to describe a range of healthcare
activities in both clinical and non-clinical
populations.
 Overview of mHealth....

• Definition of common terminologies...

• Mobile health (mHealth)....
is the use of mobile wireless technologies for public
health

is an integral part of eHealth

refers to the cost-effective and secure use of

information and communication technologies in
support of health and health-related fields. (WHO)
 Overview of mHealth....

• Definition of common terminologies...

 Mobile technology
is an electronic device that allows the user to
transport, travel and essentially become
mobile known as a “handheld device”
consists of portable two-way communications
devices, computing devices and the networking
technology that connects them.
 is pervasive and growing.
 Overview of mHealth....
• Definition of common terminologies...
 Mobile technology
 is typified by internet-enabled devices like
smartphones, tablets and watches.
 are the latest in a progression that includes two-way
pagers, notebook computers, mobile phones, GPS-
navigation devices, personal digital assistances,
(PDA) and Patient monitoring devices more.
 The communications networks that connect these
devices are loosely termed wireless technologies.
They enable mobile devices to share voice, data and
applications (mobile apps).
 Overview of mHealth....
• Mobile phone
– is a portable, handheld communications device
connected to a wireless network that allows users
to make voice calls, send text messages and run
applications.
– is a phone that can make and receive telephone
calls around a wide geographic area.
• also known as:Cellular phone, Cell phone, Hand phone
or Simply a phone.
– Real-time voice communication and basic SMS.
 Features of mobile phones

• Features of mobile phones

– are the set of capabilities, services and
applications that offer to their users. 
– contain applications like a clock, alarm,
calendar, calculator and games 
– most handheld devices can also be
equipped with: Wi-Fi, Bluetooth, GPS
capabilities, Camera, Media player
feature, Google map.
 Types of mobile phones
• Types of mobile phones
– Mobile phones could
be classified based on
their features as:
• Feature/Normal
phones

• Smartphones
 Types of mobile phones

• Types of mobile
phones
– Mobile phones
could be classified
based on their
features as:
• Feature/Normal
phones
• Smartphones
 Types of mobile phones
• Types of Mobile phone
• A feature phone is a cell phone which:
– Offer basic telephony
– Low-end mobile phones (with limited capabilities)
– Low cost in contrast to a modern smartphone
• Smart phones
– Handsets with more advanced computing ability
– High-end mobile phones
– The Android, Blackberry and Apple are
smartphones that have great apps and fully stocked
app stores
 Types of mobile phones

• Smart phones....
– More advanced mobile phone technologies
that are enabling the potential for further
healthcare delivery
– Smartphone technologies are now in the
hands of a large number of physicians and
other healthcare workers in low and middle
income countries
– more than 2.5 billion globally
 Types of mobile phones

• Smart phones....
• The spread of smartphone technologies
opens up doors for mHealth service
projects such as:
– Technology based diagnosis support
– Remote diagnostics and telemedicine
– Web browsing
– GPS navigation
– Access to web-based patient information
 Benefits of mobile phone Technology
• Portability

• Accessibility

• Ease of use

• Applications

• Personalization
 Limitations of mobile technology
• Privacy and security

• Damage/loss

• Power/battery

• Health effect
 mHealth strategy in Ethiopia

• The introduction of mobile health

(mHealth) capabilities gaining
momentum in all global health
communities for:
– preventive health programs
– patient engagement efforts both in
clinical and non-clinical services
– care for vulnerable patient populations
at rural unreachable settings etc.
 mHealth strategy in Ethiopia....
• Adoption of mHealth technology strategies in
ethiopia showed rapid progress in the
healthcare settings even though their impact
and sustainability are still uncertain.
• Factors influencing the mobile health
implementation in Ethiopia:
– Everchanging healthcare priorities
– Unsustainable operating costs
– Inability to consistently measure clinical and cost
effectiveness
 mHealth strategy in Ethiopia....
• Factors influencing the mobile health
implementation in Ethiopia:
– Lack of harmonized health care policy and
governance models to support mHealth initiatives
– Lack of knowledge concerning the possible
application of mHealth and public health outcomes
– Lack of IT infrastructure to support mHealth
programs
– Patient literacy, privacy, and cultural issues
– Inconsistent access to electric power
– Shortage of healthcare workers in the area
 mHealth strategy in Ethiopia....
• The current eHealth applications in Ethiopia
are delivering promising results in different
health programs.
• Several mHealth projects have been
implemented in different priority area
– example maternal health such as cervical cancer
screening, other non-communicable disease
screening etc.
• This is because of the FMOH has ranked
mHealth as one of the five priority areas of the
country’s eHealth strategy.
 mHealth strategy in Ethiopia....
• The following are among the opportunities for
improving sustainable adoption of mHealth
interventions strategies in Ethiopia:
– Collaboration of stakeholders

– Capacity building of health workers

– Information, communication, and technology

infrastructure
 mHealth applications

• mHealth Application
– The mHealth spectrum ranges from:
• Simple mobile phone based applications
for the transfer of health information on
basic handsets via short message service
(SMS) to
• Highly sophisticated diagnostic
applications that rely on advanced
equipment and robust back end data
systems
 mHealth applications......
• In Africa, most mHealth interventions are
targeting general popopulation but used
relatively simple mobile technology and
equipequipmnt

• While the field of mHealth is still young,

dozens of pilot programs that have been
conducted in a variety of geographic and
health system settings
 mHealth applications......
• Health call centers
– are health care telephone help lines
• a service created to deliver health care
advice services by trained health
professionals
• address specific health issues such as
HIV/AIDS, reproductive health/family
planning and drug abuse
• this approach has been found to overcome
widespread health system barriers
 mHealth applications......
• Emergency toll free telephone services
– a toll free telephone number or free phone number
is a telephone number that is billed for all arriving
calls instead of incurring charges to the originating
telephone subscriber

– WHO survey adoption level

– The South-East Asia Region reported the highest

percentage of emergency toll-free telephone
services (88%)
 mHealth applications......

Emergency toll free telephone services

• The African Region reported the least activity
(31%)
– Examples in Africa
• Zimbabwe reported launching a telephone line
for citizens to report cholera cases
• Madagascar had a service to support victims of
domestic violence
• Togo gave an account of an emergency toll-free
telephoneservice set up for citizens to obtain
information on H1N1 andTB
 mHealth applications......
• Mobile diagnosis and treatment compliance
• Mobile diagnosis
– Using camera-enabled phones
– Example: Teleradiology
• Treatment compliance: described as the
degree to which a patient correctly
follows medical care/advice
– Worldwide, non-compliance is a major
obstacle to the effective delivery of health
care
 mHealth applications......

Mobile diagnosis and treatment compliance

• Only about 50% of patients with chronic diseases
living in developed countries follow treatment
recommendations
• Major barriers to compliance are thought to include
the complexity of modern medication regimens and
lack of knowledge of treatment benefits,the
occurrence of undiscussed side effects and poor
communication
• Efforts to improve compliance have been aimed at
providing effective medication reminders and
improving patient
 mHealth applications.....
• Appointment reminders
• Appointment reminders are voice or SMS
messages sent to patients to schedule or attend
an appointment
• Include service follow ups (ANC and
immunization) and treatment follow ups (ART
and TB)
Examples of applications:
• Short Message Service (SMS) alerts,
• E-mail reminders
 mHealth applications.....
Appointment reminders
ENAT Messenger for Maternal Health (SMS focused to
remind HEWs) in Ethiopia
– Each week, HEWs sent ANC data from their health post to
the nearest health center.
– The health center entered the data (sent from the health
posts and the ANC data for pregnant women following
ANC at the health center level) into the Enat system
manually.
– Based on the data entered, the system automatically
calculated the EDD and sent text message reminders to the
respective HEWs one month and one week before a
pregnant woman’s EDD.
 mHealth applications.....

Appointment reminders
– The reminder served as a prompt for the
HEW to visit the mother to assess her status.
– After each visit, the HEW are expected to
send an SMS confirmation back to the
system to confirm the visit.
– The responses were monitored by health
care workers at the health center.
– The system could also be used to prompt transport
of a mother in labor to a health facility
 mHealth applications.....
• Awareness and Educarion
o This series of mHealth strategies focuses largely
on the client to improve people’s knowledge,
modify their attitudes, and change their behavior.
o Needs targeted, timely health education and
actionable health information
Examples of applications
Short Message Service (SMS)
Multimedia Messaging Service (MMS)
Video clips
 mHealth applications.....
• Mobile Telemedicine
– Telemedicine applications that use photo and video
features may allow for more sophisticated
consultation
Examples:
– Using a mobile phone camera for tele-consultation
and diagnosis of soft tissue injuries in Taiwan,
China.
– They found an 85% accuracy rate in the diagnosis
 mHealth applications.....
• Decision Support Sytem
– Point of care decision support tools through mobile
phones can help ensure quality of care.
• Information, Protocols, Algorithms, Checklists
• Rule-based instructions
– Examples of applications
• Stored information ‘‘apps’’
• Interactive Voice Response (IVR)
 mHealth applications.....
• Health Survey
– Health surveys, health related data collection and
reporting
• Mobile-based data collection software
• Reporting system : Mobile or web interfaces

– Data exchange : To collect and transmit critical

indicators related to health status, health outcomes
and system performance for use at all levels of the
health system
 mHealth applications.....
• Mobile Referrals
– Notification of incoming referral so that care is
immediate
– Improving the referral system
• Skilled delivery especially for high-risk
pregnancies
– Such communication could facilitate transportation via
ambulance or other means, while allowing facilities to
ensure they have the staff and equipment available to
accommodate incoming patients.
• This is critical to reducing the “third delay” of
care
 mHealth applications.....

• Remote Monitoring
– In situations where the patient and provider are far
away
– Extending the reach of health facilities into the
community and into clients’ homes to:
• Conduct, store, transmit and evaluate diagnostic
tests through mobile phones
 mHealth applications.....
• Diagnostic and Communication
• Diagnostic and treatment support systems are
typically designed to provide healthcare workers in
remote areas advice about diagnosis and treatment
of patients.
• Both diagnosis and treatment support projects
attempt to alleviate the cost and time of travel for
patients located in remote areas.
• Improved communication projects attempt to
increase knowledge transfer amongst healthcare
workers and improve patient outcomes through
such programs as patient referral processes.
 mHealth applications.....
• Disease surveillance
and epidemic
outbreak tracking
– Mobile phones
ability to collect and
transmit data quickly,
cheaply and
relatively efficiently.
 Benefits of mHealth
• Gives patients faster access to providers and
care
– mobile health technologies enable patients to
quickly send secure messages, schedule
appointments, and connect to providers 24/7 for
telemedicine visits.
– patients love the convenience of conducting a
provider visit on their phone or tablet, as well as
the fact that they don’t need to travel to the
physician’s office or take time off work.
 Benefits of mHealth....
• Improves medication adherence
– Poor medication adherence is a significant reason
for poor management of a patient’s chronic
condition. It can also result in hospital
readmissions and poor outcomes.
– mHealth apps and mobile technology solutions
improve medication adherence by:
• automated medication and refill reminders, and
educational information, that improve the chance they’ll
take their medications properly.
• Examples: Medisafe, Mango Health, Round health,
WellthApp, Dosecast, MyMeds, Meds 360o
 Benefits of mHealth....
• Makes remote patient monitoring possible and
easy
– Remote patient monitoring has ability to track
patient conditions in between visits, and notify a
clinician or care manager when the patient’s
biological data is putting the patient at risk

– wearable devices such as watches, fitness trackers,

and wristbands - continuous tracking and
monitoring of such data would be convenient by
using mobile technology
 Benefits of mHealth....
• Makes remote patient monitoring possible and
easy....
– used to help patients manage a chronic condition,
or to ensure they are following their hospital
discharge instructions and taking their medications
correctly.
– Types of data transmitted from mobile devices
include:
• Weight, blood pressure, and heart rate monitors
• Glucose meters
• Diet data trackers etc.
 Benefits of mHealth....
• Increases medication reconciliation accuracy,
which improves patient safety
– many patients cannot accurately recall their
medication names and dosages they are taking,
when clinicians aren’t sure which medications a
patient is taking, it creates an opportunity for drug-
to-drug interactions and, adverse drug reactions
can occur.
• Example: polypharmacy patients (those taking
more than five different prescription
medications each day), elderly patients, and
other high-risk patients.
 Benefits of mHealth....
• Increases medication reconciliation accuracy,
which improves patient safety....
•Cureart - is a practitioner’s most useful tool.
– Cureatr’s Meds 360 gives healthcare providers
something they have never had before:
• the ability to reliably fill in the blanks of a patient’s
medication usage, from what has been prescribed to
what is being picked up and what is not.
• It’s revolutionary for clinicians, but moreover,
potentially life-saving for patients.Information is a
practitioner’s most useful tool.
 Benefits of mHealth....
• Improves provider communication and
coordination
– Mobile health technology improves the ability to
connect across the health system and with referring
physicians and office staff using secure messaging
and texting, mobile health record access, and
cellular phone calls.

– mHealth apps can also be used to alert providers to

patients that need attention or that have been
admitted to the hospital.
 Benefits of mHealth....

• Improves provider communication and

coordination....
– Cureatr platform is improving care
transitions using mobile health solutions
such as Clinical Event Notifications.
– it easy to see the full picture of a patient –
where they’ve been, who has treated them,
for what, and where they’re going – so they
can do more to coordinate their care in
transitions across settings.
 Benefits of mHealth....

• Improves provider communication and

coordination....
– Cureatr solution:
• providers are notified about:
–patient ED arrivals
–admissions
–discharges
–transfers in real-time on their mobile
device
 Key considerations for mHealth
interventions
• Manage patients’ expectations
– reduce patient waiting time at hospital (MRD,
OPD, X-ray, Ultrasound, Pharmacy, Billing corner,
etc.)
– reduce travel cost and improve developmemnt
• Improve communication (need help?-use the
call button on your remote)
– familarize patient with their healthcare team
– standardized open lines of communication
• Patient referral, education and sharing
information
 Key considerations for mHealth
interventions....
• Improved staff/patient communication

• Eleveted staff and provider satisfaction

• Low upfront cost and rapid implementation

• Targeted patient referals

• Improved complaince for pateint education

• increased patient satisfaction

 Challenges of mHealth implemntation

 Expense (mHealth infrastructure)

 Stakeholders resistance
 e-literacy and usability
 Incompatibility of hardware/software
 Security and privacy
 Lack of technical expertise
 Network access and reliability
 Global mHealth experience....

 In US and EU many patients and consumers

use their cell phones and tablets to access
health information and look for healthcare
services.
 Doctors, nurses and clinicians use mobile
devices to access patient information and other
databases and resources.
 In parallel the number of mHealth
applications grew significantly in recent years.
 Global mHealth experience
 Higher-income countries use mHealth
activities more frequently than lower-income
countries.
 Countries in the European region are
currently the most active and those in the
African region the least active in using
mHealth.
 The capabilities of mobile phones in low and
middle income countries has not reached the
sophistication of those in high income
countries.
 mHealth in developing countries
Largely emerges as a means of providing
greater access to larger segments of a
population in developing countries, as well as
improving the capacity of health systems in
such countries to provide quality healthcare
Governments are expressing interest in
mHealth as a complementary strategy for
strengthening health systems

In Ethiopia, got emphasis under HSTP I &II

 In summary....

mHealth is refers to the cost-effective and secure use of

information and communication technologies in support of
health and health-related fields.
Features of mobile phones are the set of capabilities, services
and applications that offer to their users. Smartphone
technologies are now in the hands of a large number of
physicians and other healthcare workers in low and middle
income countries to provide mHealth services.
 The introduction of mobile health (mHealth) capabilities
gaining momentum in Ethiopian health communities
for:preventive health programs, patient engagement efforts
both in clinical and non-clinical services and care for
vulnerable patient populations at rural unreachable settings
etc.
 In summary....
mHealth applications are simple mobile phone based
applications for the transfer of health information on
basic handsets via short message service (SMS) to
highly sophisticated diagnostic applications that rely on
advanced equipment and robust back end data systems.
 some of benefits of mHealth are giving patients faster
access to providers and care, improving medication
adeherance, making remote patient monitoring
possible, increasing medication reconciliation
accuracy, which improves patient safety, and
improving provider communication and coordination.
 Self Assessment Questions
• Define mHealth and related terms?

• Breifly explain mHealth strategy in

Ethiopia?

• Describe the type of mHealth

applications?

• Discuss the benefits and chellenges of

mHealth implementation?
 Self Assessment Questions....

• What are key considerations for mHealth

interventions in Ethioipia?

• How can you explain mHealth experience in

Ethiopian (IVR and ENAT messenger)

• Discuss the global mHealth experience?

 Reading Assignment Two

• The history of mobile phone and mHealth

• mHealth experiences in the world
• Mobile network generation
• IVR and IVR in Ethiopia