The Future of mHealth

by Mary Heekin          

          This Wednesday, November 11^th marks the final day of the 2015 mHealth Summit.  This annual conference explores the latest innovations in mobile, connected and telehealth, as well as their impact on healthcare delivery, patient engagement and clinical outcomes.  The growing role of technology in healthcare management and delivery and the diversity of platforms currently employed for health promotion are revolutionizing the healthcare industry.  Within the last two decades, these technologies have moved beyond electronic medical records to include tools such as smartphones, mobile applications, video calling and fitness trackers.  Individuals utilize “a variety of mobile tools including: app-enabled patient portals, telehealth services and text communications” (2015 HIMMS Mobile Technology Survey). These innovations are giving care providers a more optimistic outlook on the future of public health by integrating health more fully into patients’ everyday lives.

            Mobile health technologies offer many advantages in increasing patient knowledge and access to personal health data, individualizing care and encouraging patient engagement.  As a result of the availability of more tangible health indicators, such as blood glucose levels, daily steps and blood pressure measurements, individuals are provided with some of the necessary information to assist them in making informed health decisions.  Patients are empowered to engage in consistent self-management, and studies reveal that people who use mobile health technology are more inclined to follow physicians’ advice and be proactive in their care (Health Information and Management Systems Society, 2015).  In an NIH-sponsored study conducted on the uses and benefits of mobile devices and applications for health care professionals (HCP), many care providers responded positively to the advantages of health technology.  HCPs associate mobile health with greater efficiency when accessing patient data, accuracy in documentation, improved productivity with an average increase in electronic prescriptions and enhanced clinical decision-making. Check out article here.

               Despite widespread support for the use of technology in improving patient outcomes, long-term benefits from mobile health remain in question.  There is no significant data which might reveal the effect of mhealth on societal burdens, like chronic disease, due largely to the recent application of health information systems.  Will those patients who currently use mobile health technology continue to do so in 5 years, or will these applications face a fate similar to that of many fitness trackers like FitBit: user apathy.  In the midst of these uncertainties, continuous technological advancements are one constant.  Responding to the growing emphasis on outpatient care, mobile, connected and telehealth may be the future of healthcare. 

Additional articles:

http://www.jmir.org/2015/2/e26/#-Results

http://www.himss.org/ResourceLibrary/genResourceFAQ.aspx?ItemNumber=39175

Dr. Christiana Hena: A Physician to Many & A Front-Line Provider in the Ebola Crisis

by Callie Jacobs

Jet-black, slicked hair neatly piled into a tight bun reveals a warm, kind face. Wide brown eyes, a rich chocolate color, look out into the audience in front of her. Standing tall, poised in her vibrant floral shawl, she is a woman whose grace and composure is noticeable at first glance. This is Dr. Christiana Hena, a Liberian physician who is visiting the United States to share her perspective as an Ebola front-line care provider.

Dr. Hena was born in Liberia and later attended medical school in Russia. Afterwards, she practiced medicine all over the world; for instance, she lived in Kazakhstan for several years treating patients who were affected by nuclear testing. Meanwhile, in her home country, Liberia was facing a civil war, at the end of which 200,000 people had died—a staggering number, given the fact that the country has a population of about 4.2 million.

In the face of this situation, Dr. Hena felt called to return home to Liberia. Always finding a way to serve the people around her, Dr. Hena began a clinic in her front yard. The clinic, while simple and constructed mostly of hanging shower curtains, served a tremendous role in the surrounding communities. Dr. Hena was one of only 51 doctors in the country, and the dentist who worked at the clinic was the only one for the 200,000 people in the area. Together, they saw about 50 patients a day for hours on end, with patients still waiting in lengthy lines at the end of the day. Meanwhile, 22 community health workers ventured daily into the surrounding 36 communities, treating patients and referring more serious cases to the clinic. The clinic bridged the gap between the community and other services, too. Dr. Hena has now instituted an After School Program in her yard, and she also teaches young men and women various life skills like sewing and collecting data. The clinic has been so successful that Dr. Hena, in partnership with the Building Goodness Foundation, is now building a larger, more permanent structure that will open its doors in the summer of 2016.

When the Ebola outbreak began in Liberia, Dr. Hena’s clinic provided her a unique firsthand perspective of the problems on the ground. Firstly, because many of the doctors currently practicing in Liberia at the time of the outbreak were foreign, they were required to leave Liberia once Ebola took hold of the country. This left Liberia, a country that already had a shortage of physicians, with about 30 doctors. Furthermore, as Dr. Hena explained to us, one of the most difficult aspects of the situation was the incompatibility between cultural practices and the necessary actions to end the crisis. For example, all corpses, whether the cause of death was Ebola or not, had to be cremated, despite that cremation was not the traditional burial practice. Moreover, people could not shake hands or hug one another—a difficult restriction in such a tight-knit community.

Fortunately, the community eventually realized the gravity of the situation. As Dr. Hena told us, “once the community came together, we immediately saw the decline of Ebola.” According to Dr. Hena, the most significant intervention was the implementation of buckets full of chlorine for washing hands in each community. As a result, Ebola slowly stopped spreading, and the crisis came to an end.

Now, it is time to look to the years ahead. For Dr. Hena, the main goal should be “to use limited resources more carefully.”  For the short-term future, she suggests that the country should turn to doctors from abroad. These doctors will be able to respond to the extremely high demand for primary care physicians that Liberia currently has. However, in the meantime, these doctors should also focus on training locals in Liberia in order to have a stable supply of physicians in the long run.

While there is much work to be done, I am excited to see what comes of calls to action like these from Dr. Hena. This discussion of next steps is not only crucial for Liberia but for all of us as avid participants in the exciting world of global health.  

Scrutinizing the Sustainable Development Goals

by Maddie Shiff 

At the turn of the millennium, leaders from around the world convened to commit their intentions to solving what they deemed as the world’s most pressing, transnational problems. The resulting set of objectives, known as the Millennium Development Goals, is set to expire at the end of 2015. While progress was made towards many of these goals, not nearly all of them were achieved. These goals have now have been replaced by a brand new list of aims, labeled “Sustainable Development Goals.”

A link to the Sustainable Development Goals can be found here:

http://www.theguardian.com/global-development/2015/jan/19/sustainable-development-goals-united-nations

The 17 SDGs include:

•         End poverty in all its forms everywhere
•         End hunger, achieve food security and improved nutrition, and promote sustainable agriculture
•         Ensure healthy lives and promote wellbeing for all at all ages
•         Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
•       Achieve gender equality and empower all women and girls
•        Ensure availability and sustainable management of water and sanitation for all
•        Ensure access to affordable, reliable, sustainable and modern energy for all
•        Promote sustained, inclusive and sustainable economic growth, full and productive employment, and decent work for all
•         Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation
•       Reduce inequality within and among countries
•        Make cities and human settlements inclusive, safe, resilient and sustainable
•       Ensure sustainable consumption and production patterns
•       Take urgent action to combat climate change and its impacts (taking note of agreements made by the UNFCCC forum)
•       Conserve and sustainably use the oceans, seas and marine resources for sustainable development
•       Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification and halt and reverse land degradation, and halt biodiversity loss
•       Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels
•         Strengthen the means of implementation and revitalize the global partnership for sustainable development

These goals were created to “follow and expand on the millennium development goals” (The Guardian). What makes these goals more sustainable than the previous set of goals? How can they be more effective?

First of all, these goals were created by an open working group rather than a group of leaders at the Headquarters of the United Nations. The SDGs were born from the UN’s “largest consultation program in its history” to gather “opinion[s] on what the SDGs should include” (The Guardian). Additionally, these goals incorporate first world countries in a much more comprehensive manner than the MDGs by making rich countries “sites of development themselves” (The Guardian). These goals apply to all countries rather than just acting as “targets for poor countries to achieve” (The Guardian). The creators of the SDGs also recognized that, although the MDGs” provided a focal point for governments,” they “were too narrow” (The Guardian). Further, these goals do appear more detailed than the Millennium Development Goals, for they each incorporate specific targets under each main heading, adding up to 169 targets overall.

Major aspects of the SDGs remain up for debate, however, including sources of funding and measurement indicators. Both these goals and the international collaboration that it took to create them are promising, but only time will tell if they are truly sustainable and successful.