By Jeff Gray
Innovative mobile health devices and applications continue to transform global health and clinical care worldwide, while there are growing concerns in the research community about the lack of evidence and evaluation of mHealth approaches. At the fourth annual mHealth Summit, more than 4,000 attendees from 56 countries convened in the Washington area to describe advances and new products, and discuss problems and concerns related to the rapidly growing field. The summit was organized by the nonprofit organization mHIMSS in partnership with the Foundation for National Institutes of Health, the mHealth Alliance and the NIH.
Some experts at the conference warned that many new applications are being quickly developed and implemented without rigorous study. NIH Director Dr. Francis S. Collins challenged mobile health researchers and engineers to base their approaches on research findings and to properly evaluate new tools through randomized control trials. According to Collins, only 20 such trials testing mobile health applications were documented in peer-reviewed literature between 2008 and 2012. "Surprisingly few have been tested systematically," he said. I urge this audience to think of ways to test them. The plural of anecdotes is not data."
Mobile health specialists should adopt a "learning ecosystem" approach that would involve constantly evaluating outcomes and incorporating discoveries into mHealth projects, said Dr. Wendy Nilsen, a behavioral health expert at the NIH. Nilsen led a public-private partnership session designed to address these concerns and spark dialogue between the research and business communities regarding evidence-based design. She also hosted a weekend-long training institute for academia, government officials and industry experts to provide a better understanding of how to work with subject matter experts across varied technical fields to develop an mHealth application.
Many of the successes described by global health experts at the summit were related to maternal health, particularly in rural regions of developing countries, where cellphones provide an inexpensive connection between new or expectant mothers and health professionals. (See the related article, Mobile health researchers seek to improve emergency obstetric care in Bangladesh.) "In developing countries the average doctor to patient ratio is one doctor to every 250,000 patients," said Dr. Patricia Mechael, executive director of the mHealth Alliance. "Yet these same countries account for 80 percent of mobile subscriptions worldwide. More people now have access to a mobile phone than to clean water, electricity or a bank account."
Technology has the potential to change behavior and the way in which health systems operate, giving health professionals in developing countries information that can improve the quality of care, according to Dr. Ariel Pablos-Mendez, assistant administrator for global health at the USAID. "Without a doubt, mHealth is a promising new tool in our global health tool kit," he said.
Dr. Jeffrey Sachs, director of the Earth Institute at Columbia University, echoed this enthusiasm, predicting that mobile health will help transform the U.S. health care system as a result of gains made in the developing world. "We will see huge breakthroughs in Africa, in South Asia, and other low-income settings," said Sachs. "Those breakthroughs will eventually become breakthroughs in the United States.