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Published: 19 February 2010
In Mexico, it’s illegal for patients to access their own medical records, and 9.1 percent of Mexicans have an Internet connection at home. 80 percent of them have at least one cell phone.
Conditions like this don’t stifle innovation, they ignite it, and it’s one of the several reasons I think mHealth (“the use of wireless communication devices to support public health and clinical practice”) is different than eHealth (which I’m referring to as desktop Web/computer interaction in health/health care).
I credit Susannah Fox, the Internet’s Informant General, for stimulating the thinking. In 2008 at Health 2.0 in San Diego, she said, “Recruit doctors, let e-patients lead, go mobile” and the data she has been generating since has ceaselessly has been pointing to that reality.
More recently, Washington, DC, hosted the mHealth Initiative Networking Conference last week, and this week, Health Affairs hosted a briefing on their latest issue on E-Health in the Developing World (side note, I know I’m behind in noticing this, but I love HealthAffairs new print form factor – less tome-y and more open).
The mHealth Networking Conference was remarkable for me in terms of the spark I noticed on the part of the attendees and the slightly different focus – a little more public health-y, a little more do-great-things-for-society-y. And, I’m going to say it, a little more exciting for someone like me because of the possibilities that go beyond the desktop web. To learn about them in the City where people believe everything is possible, because it is, is just icing on the cake.
So here’s my list:
#1: When we talk about the web, we still worry about the people who are just not online. According to Susannah’s team, its hovering at 26 %. mHealth is different, everyone has a cell phone or is going to get one, relatively speaking. If you compare use visually, the cell phone thermometer shows much greater penetration – all groups are “pushed up” to higher degrees of access.
Speaking of Mexico and the developing world, the parallels are relevant in the United States to vulnerable populaition, and this is another key difference. Desktop web access favors more educated, more affluent people. There’s an inverse relationship when it comes to wireless. Look at this data from December: If you look carefully, you’ll see something amazing. Access statistics for Black and Hispanic respondents are higher for wireless access to the Internet than for Whites. It’s almost as if the “haves/have nots” are reversed. For people interested in reducing disparities, this is…kind of huge. That’s difference #2.
Difference #3 has to do with ease of set-up. When I speak with iPhone developers or people involved in mobile, I hear the words “difficult, challenging,” which is different than what we heard in 1995 when anyone (me included) could code an HTML page and put it up.
Difference #4, when we talk about the web, there’s not a discussion of telecommunications companies and their innovation. When we talk about mHealth, we have to include telecommunications companies. This year at HIMSS10, in Atlanta, it’s not Sanjay Gupta, MD (whose work I have great respect for) that I want to see speak the most. it’s Dan Hesse, CEO of Sprint/Nextel. People with telecommunications experience, in my opinion will be very important moving forward. In a analogous way, I am as drawn to the CTIA as I am to AMIA.
Difference #5, Reverse Innovation – Unlike the web, a lot of the “cool” stuff has already been pioneered, outside of the United States. Susan Dentzer said it best at the Health Affairs briefing: ”Clearly the US is the developing country when it comes to mHealth“. The term reverse innovation comes from General Electric (this article from Harvard Business Review explains it), and it means that a lot of the inventing to be done is happening in India, China, South America, and as the article linked to above points out, in Mexico. What may work best is something that comes from a place with far less resources than we have. Kind of what health care, a resource-poor industry when it comes to innovation at the level of public health and primary care, needs.
Difference #6, it’s more personal. Some of the apps we saw last week, and others I am hearing about, are things that might not work on the desktop web so well, because a desktop or laptop is not as “personal” a device. The idea of storing information on a web site and forwarding to your doctor seems to make more sense on a mobile phone, because it’s something you hold that’s yours, that you can “share” with someone. Not the same for a web site on a computer.
I want to clarify that this is not 6 reasons why mHealth is better or has more scientific evidence behind it. This is just differences. I’ll report on two great papers in the Health Affairs issue on this shortly.
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Autor(en)/Author(s): Ted Eytan
Quelle/Source: Ted Eytan, 18.02.2010
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