Mobile Communications for Medical Care a study of current and future healthcare and health promotion applications, and their use in China and elsewhere Final Report 21 April 2011 Mobile Communications for Medical Care – Final Report 2 21 April 2011 Mobile Communications for Medical Care a study of current and future healthcare and health promotion applications, and their use in China and elsewhere Final Report 21 April 2011 Contents Executive Summary 5 About the Authors 8 Foreword by China Mobile 9 1. Objectives, Approach and Overview of the mHealth Market 11 2. Overview of Existing Applications of mHealth 19 3. Overview of Potential Next-Generation Applications of mHealth 29 4. Illustrative Business Cases for mHealth Provision 41 5. Realising the Health Benefits to Society 59 6. Deployment of mHealth Applications 69 Special Feature: Summary of Case Studies of mHealth Deployments in China 81 Annexes A mHealth Applications Identified in the Course of the Project 93 B Participants in the Workshop and the Interview Programme 113 References 119 Mobile Communications for Medical Care – Final Report 4 21 April 2011 Mobile Communications for Medical Care – Final Report 5 21 April 2011 Executive Summary This report examines the use of mobile networks to enhance healthcare (so-called “mHealth”), as an example of how mobile communications can contribute to sustainable development. We define mHealth as “a service or application that involves voice or data communication for health purposes between a central point and remote locations. It includes telehealth (or eHealth) applications if delivery over a mobile network adds utility to the application. It also includes the use of mobile phones and other devices as platforms for local health-related purposes as long as there is some use of a network.” Innovative mHealth applications have the potential to transform healthcare in both the developing and the developed world. They can contribute to bringing healthcare to unserved or underserved populations; increasing the effectiveness and reducing the costs of healthcare delivery; improving the effectiveness of public health programmes and research; preventing illness (including through behaviour change); managing and treating chronic diseases; and keeping people out of hospital. mHealth applications are numerous and diverse. They range across remote diagnostics and monitoring, self-diagnostics, management of long-term conditions, clinical information systems, targeted public health messaging, data gathering for public health, hospital administration, and supply chain management. They are emerging in response to opportunities and needs that are similarly diverse, including the threat of pan- demics; globalisation and population mobility; an ageing and increasing population; rising income (leading to lifestyle changes); increased expectations of health provision; demands for the personalisation of health- care; and a growing focus on behaviour change, disease prevention, and keeping people out of hospitals. These applications are enabled by the fundamental characteristics of mobile networks and devices: near- ubiquitous, locatable, connected user interface devices, often personalised, delivering computing power at low cost, integrating a range of sensors and supporting mobility (essential in some applications but not all): In many developed countries, the coverage of mobile infrastructure is near-ubiquitous, and in many developing countries, it provides higher penetration of the population than fixed networks. In some places, it is the only ICT infrastructure, and mobiles are the only general-purpose computer available. The capabilities of mobile networks (particularly in terms of data-carrying) are increasing rapidly, extending the scope of applications that can be supported to include high-resolution images, video and large file exchange, which are required for some medical purposes. Basic phones with voice and text messaging already provide powerful tools; the new generation of “smartphones” offer greater computing power, data storage, the ability to interface with sensors, and intuitive user interfaces that can be used as the platform for sophisticated applications of many kinds. Business models have emerged that encourage innovation in mHealth applications; many of these models are incremental (i.e. they do not require major infrastructure investment), although they may still rely on interaction with other service providers’ components or platforms. Moreover, for many mHealth applic- ations, deployment requires no intervention by policy-makers or the medical establishment. In such cases, normal market innovation, and consumers’ willingness to pay, will drive deployment. But not all mHealth applications are like this: many will need to interact with established healthcare systems (and therefore be subject to the regulation of those systems). In these cases, development will play out very differently depending on the maturity of healthcare systems. At the same time, some of the greatest benefits of mHealth are unlikely to be delivered by the market in any environment. In particular, individual consumers are unlikely to pay for applications designed primarily to produce information from which public goods (such as better advance warning of the spread of epidemics) are derived. Such investments for the public good require funding by institutions if the potential benefits are to be realised. Mobile Communications for Medical Care – Final Report 6 21 April 2011 The nature and pace of development will vary between countries. In developed economies, the mobile will be used to collect, store, analyse and upload a wide spectrum of personal and environmental data, from vital signs (heart rate, body temperature, etc.) to location, motion, mood, ambient air temperature and pollution levels, and adherence to medication regimes. The ability of healthcare providers and carers to use this data in real time, and in aggregate form for research, will not only benefit individuals but will also lead to better forms of illness prevention and treatment, and earlier prediction of epidemics. Individuals’ personal health records may come to be stored in electronic form, updatable from a mobile phone, and capable of being accessed with suitable permission anywhere in the world. Engaging applications will lead to better support for behaviour-change interventions and for treatments such as cognitive behavioural therapy in the area of mental health. Over time, many of these applications will also reach low-income economies, though in the shorter term mHealth will help to put in place robust administrative systems for healthcare delivery that are taken for granted in developed countries. Increasingly powerful mobile phones will be in the hands of health workers, delivering technologies previously available only in larger population centres. Mobile phones will also deliver training to clinicians, and remote decision support using either automated analysis of data, or real-time contact with specialists. Medical staff will be enabled to diagnose and treat conditions locally without patients needing to travel large distances to specialist centres. Disease outbreaks will be handled more efficiently through better communication. We expect applications to develop most rapidly in countries where healthcare delivery, and public services generally, are in transition from established to new structures (through market change, deregulation, other infrastructure change, or demographic change). Rapid development will also be encouraged where the population has rising expectations for healthcare, and where those involved in healthcare delivery are willing and able to experiment with new models. Such conditions may apply in any country, but are perhaps most likely to apply in major emerging economies. In all parts of the world, the next phase of development and deployment will see generic service platforms playing a crucial role, providing processing power, storage, security, access control and other services to a wide range of mobile applications, including (but not limited to) mHealth. Until recently, an application that required “off-phone” services required dedicated servers that had to be dimensioned for the application, but the emergence of cloud computing is obviating this need. Few current mHealth applications use cloud- computing facilities; however, if these generic services were provided as publicly available platforms, like the mobile network and Internet themselves, the upfront investment required to deploy new applications would be decreased. The actors best placed to drive a move toward publicly available platforms include large network operators, as shown below: Figure 0: • Servers, databases, devices, peripherals • App distribution • Medical knowledge • Data about users • Communication to use Potential for value • Concept • Transaction and payment processing app capture by main Application components Communications Applications actors in mHealth provision Application platforms Mobile operators System integrators Non-telecommunications service providers No clear advantage or opportunity Already established Niche application developers and providers Large growth opportunity Mobile Communications for Medical Care – Final Report 7 21 April 2011 Investments in generic services have the potential to contribute to multiple applications, and not all of those applications have to succeed for the investment to be justified. This consideration is particularly true for the