Roles and Direction of mHealth

บทบาทและทิศทางของ Mobile Health ในการป้องกันและรักษาโรค

นพ.นวนรรน ธีระอัมพรพันธุ์ภาควิชาเวชศาสตร์ชุมชน

20 ก.พ. 2560

Objectives

• To present a brief overview of mHealth, related concepts, and the current state of adoption• To offer my perspective on related research agenda

Defining mHealth (mobile health)

•WHO: “Medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, PDAs, and other wireless devices. mHealth involves the use and capitalization on a mobile phone’s core utility of voice and SMS as well as more complex functionalities and applications including GPRS, 3G & 4G systems, GPS, and Bluetooth technology.”

eHealth (electronic health)•Use of information and communications technology (ICT) for health,

including• Treating patients• Conducting research• Educating the health workforce• Tracking diseases• Monitoring public health.

Sources: 1) WHO Global Observatory of eHealth (GOe) (www.who.int/goe)2) World Health Assembly, 2005. Resolution WHA58.28

Health IT

• Use of information and communications technology (ICT) in health & healthcare settings

(Source: The Health Resources and Services Administration, Department of Health and Human Service, USA)

eHealth & Health IT

eHealth Health IT

Slide adapted from: Dr. Boonchai Kijsanayotin

Documented Benefits of Health IT• Literature suggests improvement through

• Guideline adherence (Shiffman et al, 1999;Chaudhry et al, 2006)• Better documentation (Shiffman et al, 1999)• Practitioner decision making or process of care

(Balas et al, 1996;Kaushal et al, 2003;Garg et al, 2005)• Medication safety

(Kaushal et al, 2003;Chaudhry et al, 2006;van Rosse et al, 2009)• Patient surveillance & monitoring (Chaudhry et al, 2006)• Patient education/reminder (Balas et al, 1996)• Cost savings and better financial performance

(Parente & Dunbar, 2001;Chaudhry et al, 2006;Amarasingham et al, 2009;Borzekowski, 2009)

HIS

All information about health

eHealthHMIS

mHealth

Telemedicine

Slide adapted from: Karl Brown (Rockefeller Foundation),

via Dr. Boonchai Kijsanayotin

Clinical Informatics

Public Health

Informatics

Consumer Health

Informatics

Patients & Consumers

Providers & Patients

Policy-Makers, Payers, Public

(Also providers)

mHealth Application Domains

(Hersh, 2009)

Fields within Informatics

Consumer Health Informatics

•“The field devoted to informatics from a consumer view.” (Hersh, 2009)

Examples of Areas within Consumer Health Informatics(Online Health Information)

Image Source: http://www.webmd.com/

http://www.webmd.com/

Examples of Areas within Consumer Health Informatics

(False Information Online)

Image Source: http://www.greatdreams.com/cancer-cure.htm

http://www.greatdreams.com/cancer-cure.htm


(Health Literacy)

Image Source: http://www.hon.ch/, http://socialmarketing.blogs.com/r_craiig_lefebvres_social/2007/02/health_literacy.html

http://www.hon.ch/

http://socialmarketing.blogs.com/r_craiig_lefebvres_social/2007/02/health_literacy.html


(Social Media Use by Providers & Consumers)

Image Source: http://michaelcarusi.com/2012/01/01/when-you-should-not-become-a-social-media-manager/

http://michaelcarusi.com/2012/01/01/when-you-should-not-become-a-social-media-manager/


(mHealth)

Image Source: http://ucedtech.wikispaces.com/Welcome

http://ucedtech.wikispaces.com/Welcome

Issues in Consumer Health Informatics•Health literacy & IT literacy•Cultural diversity & sensitivity•Usability, information presentation• Impact of ICT on behavioral modifications• Integration with provider’s systems• Information exchange & interoperability•Business model•Privacy & security

mHealth

http://whqlibdoc.who.int/publications/2011/9789241564250_eng.pdf

•Majority of Member States reported offering at least one type of mHealthservice. Many offered 4-6 programmes. Frequently reported mHealth initiatives were:• Health call centres (59%)• Emergency toll-free telephone services

(55%)•Managing emergencies and disasters (54%)•Mobile telemedicine (49%)


mHealth


•Barriers to mHealth adoption by countries•Competing health system priorities•Lack of evidence on evaluation•Results-based evaluation of mHealth

implementations is not routinely conducted (only 12% of Member States)•Data security


Personal Health Records (PHRs)

• “An electronic application through which individuals can access, manage and share their health information, and that of others for whom they are authorized, in a private, secure, and confidential environment.” (MarkleFoundation, 2003)

• “A PHR includes health information managed by the individual... This can be contrasted with the clinician’s record of patient encounter–related information [a paperchart or EHR], which is managed by the clinician and/or health care institution.” (Tang et al., 2006)

Ideal PHRs

• Integrated

• Accessible

• Secure

• Comprehensive

• Accurate & current

• Patient able to manage sharing & update information

• Engaging & educational

• User-friendly, culturally & literacy appropriate

The “Hub and Spoke” Model(Kaelber et al., 2008)

eHealth Components (WHO-ITU Model)

ตัวอย่างของ Research Agenda ด้าน eHealth และ mHealth

Leadership & Governance

• Review Studies

• What are eHealth leadership & governance structures of other countries (with focus on those with eHealth success and key Asia-Pacific countries)?

• Describing evolution of Thailand’s eHealth leadership & governance so far + critical analysis & lessons learned

• Original Research• How stakeholders think of the current & future eHealth

governance structures?

• Evaluation of existing governance structure’s outcomes

• eHealth as enablers/facilitators & barriers of other health programs

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Strategies & Investment

• Policy Research & Development

• Developing national eHealth roadmap/strategies/master plan

• eHealth policy development as part of Digital Economy policy

• Lessons learned from the process of policy development (e.g. lessons on applying WHO-ITU eHealth Strategy Toolkit)

• IT Research & Development

• Enterprise architecture for Thailand’s eHealth

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Strategies & Investment


• Optimal model for national data clearing house (NDCH)’s structure, policy & process

• Original Research

• Viewpoints & concerns of stakeholders on establishment of national data clearing house


• Designing systems architecture for NDCH

• Designing NDCH’s data model for data warehouse & big data analytics

• Developing data standards for NDCH data exchange

• Other research depending on national roadmap 28

Infrastructure for eHealth


• Digital Economy’s IT infrastructure development

• Critical analysis of MOPH provincial data centers

• Design of architecture for nationwide health information exchange


• Status of “Digital divide” of broadband/telecom infrastructure for health

• New health IT adoption study (status, trends & associated factors)

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Standards & Interoperability

• Policy Research & Development• Translating WHA resolution to Thailand’s roadmap: policy

recommendation

• IT Research & Development• Developing data standards for various key use cases

• Clinical Documentation

• Referrals

• Medication Management

• Claims & Reimbursements

• Emergency Information Access

• Security & Privacy

• Biosurveillance / outbreak control

• Patient’s data sharing32

Services & Applications


• Consolidating eHealth applications: policy recommendation

• Needs assessment/market research/ environmental scan of domestic health IT market

• Best practices of healthcare IT management


• Designing & developing applications for various programs

• Usability & user interface designs of health IT

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• Health IT attitudes & use behaviors of clinicians

• Evaluation studies of health IT in various types and settings (e.g. outcomes of EHR, computerized order entry & PACS in hospitals)

• Factors of successful health IT implementation

• Sociotechnical/people & organizational issues of health IT

• Stakeholder perspectives on health IT implementation

• Outcomes of Health IT Quality Framework Pilot Project

• Lessons learned by various approaches of health IT implementation in Thai hospitals

• Lessons learned/evaluation of various software development processes in health care

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• Consumer attitudes & behaviors

• Information needs & IT use patterns

• Health literacy & information literacy

• Social media for consumer health & mHealth

• Privacy & security awareness & practices

• Evaluation of consumer-focused health IT applications (e.g. personal health records)

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Legislation, Policy & Compliance

• Review Studies

• Current laws related to eHealth & critical analysis


• Proper legislation to protect health information privacy & facilitate health IT adoption/exchange

• Impact assessment of new ICT laws

• Guidelines for security & privacy best practices in health care

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Workforce

• Review Studies

• Update on current academic programs on health informatics

• Review of informatics competencies from other countries


• Developing Thailand’s informatics competencies

• Informatics professionals in various roles

• Doctors & other health professionals

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Workforce


• Needs assessment of Thailand’s health informatics workforce and workforce in specific roles

• Attitudes of Thai health informatics professionals on career facilitators and barriers

• Evaluation/lessons learned of academic programs in health informatics in Thailand

• Evaluation of e-learning methods for health professional education

• Attitudes, use behaviors & evaluation of IT among health professional students

41

Workforce

• Informatics Research & Development / Projects

• Informatics curriculum content development

• Identifying roles of MOOC in health informatics education

• First Thai textbook in health informatics

42

References• Amarasingham R, Plantinga L, Diener-West M, Gaskin DJ, Powe NR. Clinical information technologies and inpatient

outcomes: a multiple hospital study. Arch Intern Med. 2009;169(2):108-14.

• Balas EA, Austin SM, Mitchell JA, Ewigman BG, Bopp KD, Brown GD. The clinical value of computerized information services. A review of 98 randomized clinical trials. Arch Fam Med. 1996;5(5):271-8.

• Borzekowski R. Measuring the cost impact of hospital information systems: 1987-1994. J Health Econ. 2009;28(5):939-49.

• Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006;144(10):742-52.

• Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293(10):1223-38.

• Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch. Intern. Med. 2003;163(12):1409-16.

References• Parente ST, Dunbar JL. Is health information technology investment related to the financial performance of US

hospitals? An exploratory analysis. Int J Healthc Technol Manag. 2001;3(1):48-58.

• Shiffman RN, Liaw Y, Brandt CA, Corb GJ. Computer-based guideline implementation systems: a systematic review of functionality and effectiveness. J Am Med Inform Assoc. 1999;6(2):104-14.

• Van Rosse F, Maat B, Rademaker CMA, van Vught AJ, Egberts ACG, Bollen CW. The effect of computerized physician order entry on medication prescription errors and clinical outcome in pediatric and intensive care: a systematic review. Pediatrics. 2009;123(4):1184-90.

• World Health Organization, Global Observatory for eHealth. mHealth: New horizons for health through mobile technologies -- Based on the findings of the second global survey on eHealth. Global Observatory for eHealth Series - Volume 3 [Internet]. Geneva (Switzerland): World Health Organization; 2011 [cited 2017 Feb 19]. 102 p. Available from: http://www.who.int/goe/publications/goe_mhealth_web.pdf

Roles and Direction of mHealth

Healthcare

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