mHealth

The term mHealth , and mobile health ( English for mobile health ), is for the support of medical procedures and measures of health care by devices such as smartphones , tablets or personal digital assistants ( PDA ) as well as by lifestyle and health applications, which sensors are operated can.

definition

mHealth developed from the term e-health in recent years . While eHealth generally refers to the use of electronic devices in medical care, mHealth represents electronic solutions on mobile devices. Robert SH Istepanian, professor at the London Imperial College of Electronics and Engineering, coined the term for the first time in 2006. He defined mHealth as "emerging mobile communications and network technologies for healthcare" (English for newly emerging mobile communication and network technologies for healthcare ).

mHealth is becoming more and more important due to the rising costs in health care and the more confident and enlightened patients. For example, mHealth enables a connection between patient and doctor without both having to be in the same place. However, healthy consumers who use prevention or wellness applications are also an important part of the mobile solution.

Mobile health encompasses a number of technical application possibilities. This includes, for example, the determination of vital values such as blood sugar or body temperature, but also communication or motivational applications that may a. remind you to take medication. The use of apps plays a major role here, because a large amount of health-related data can be recorded and processed via the sensors installed in the smartphones. The main area of application of mHealth is remote monitoring . This means the remote monitoring of patients with chronic complaints. According to a publication by AT Kearney, SMS sending and receiving is most often used for this application. Furthermore, therapies for the prevention of dementia are a large area that will expand in the future, as over 30% of those over 70 will suffer from this disease in the future. According to a study by PWC , 30% of the European population will be 65 years and older by 2025. The study predicts that the number of chronically ill people will roughly double in the next 20 years.

classification

Mobile health solutions can be used along the entire classic path of treatment . They can be used in the wellness , prevention, diagnosis, therapy or control phase. With regard to the user groups, three different categories of application can be derived from the treatment pathway:

Citizen area

Here mHealth applications are used that have no medical purpose and that are used more on a voluntary basis by the consumer. This category includes solutions that a. to increase fitness , well-being or self-development. A publication by research2guidance, a strategic consulting and market research company, shows that around 30% of mHealth applications come from the fitness sector.

Patient area

These applications are designed for patients suffering from an acute or chronic illness . The application fulfills a medical purpose and must meet certain quality and safety standards. This category includes, for example, the use of non-invasive sensors for measuring vital parameters such as blood sugar , heart rate , movement sequences or temperature .

Administrative area

mHealth applications are also able to support hospital or practice management. The group of users is not only limited to the patients, but also to healthcare professionals . For example, electronic patient files can be used on mobile devices or solutions can be made available for patients that can facilitate and support the treatment path .

mHealth market

Wireless networking and communication through mobile devices has increased significantly in recent years. Almost every fifth person in the world owns a smartphone . This fact enables many users to operate mHealth applications. It is estimated that 3.4 billion people worldwide will own a smartphone by 2017. One in two of them will have an mHealth application installed.

According to a study by the global industrial association of mobile network operators ( GSMA ), the mHealth market will grow very strongly in the coming years. In 2013 mHealth earned around 2.4 billion US dollars (approx. 2.1 billion euros) worldwide. By 2017, this number is expected to rise to 23 billion dollars (approx. 21 billion euros). In Germany, according to AT Kearney, around 906 million euros were generated with mHealth in 2012. According to estimates, revenue will rise to 3 billion euros by 2017. The hardware segment (this segment includes both medical devices and mobile sensors) had the highest turnover in 2012 with 427 million euros. Although high-income industrialized nations are more actively using mHealth, wireless health applications are becoming increasingly important in developing countries. These mainly focus on more efficient planning of the health workforce and the health system in general.

Potential of mHealth

Efficiency and cost savings in health care

An improvement in medical-technical progress is often associated with an increase in costs. However, mHealth behaves differently, as already existing technologies, such as the mobile Internet , can often be used. Thus, mHealth is able to improve patient care and save enormous costs in the healthcare market .

Through the use of mHealth technologies, communication between all parties involved can take place anywhere and anytime. More people can gain access to health services, especially in remote areas. Both doctors and healthcare professionals can share diagnoses and treatment methods and work out an optimal treatment plan. This could avoid unnecessary consultation hours, reduce the effort caused by missed appointments and save time. Patients can forward their health-related parameters to the doctor or the responsible institution in real time and as often as possible . This enables more efficient personnel planning on the one hand and cost savings on the other. Furthermore, a more efficient handling of chronic diseases can be achieved by introducing remote monitoring and advice. This can be done easily and quickly from the patient's home and leads to a reduction in treatment costs. The outpatient sector can also benefit from mHealth. In larger practices with more than just one consulting room, patient data including all necessary information can be conveniently called up from a mobile device. Medications and prescribed therapies can be recorded and structured. This results in a gain in efficiency in the recording and administration work and an improvement in internal processes.

Improved patient involvement

Mobile health services give patients the opportunity to better deal with their own illness. This gives patients a comprehensive understanding of relevant symptoms and their treatment process. This creates health care that not only puts the patient in the foreground, but also includes them and hands them over responsibility for their own health. Through self-motivating applications, patients are able to control their own treatment in a targeted manner. Motivational incentives can be given when therapeutic results are achieved, such as weight reduction in patients with chronic heart failure . Applications can accompany the patient on his individual treatment path, control it optimally and imply an improvement in coordination with the service providers involved. Further which is adherence to the therapy and compliance improved.

Barriers of mHealth

Privacy and security issues

The protection of the data that is determined, stored and forwarded through the use of mHealth plays an important role, especially in the European context. Accordingly, it must be ensured that mobile health solutions comply with data protection guidelines with regard to the lawful processing of personal data , the security of the data and the education of those concerned. As soon as personal data is processed, the data subject's consent must be obtained in accordance with the Data Protection Act . “At the moment, neither the format nor the process has been defined for such a declaration of consent from the user.” Mobile applications often require access rights to GPS, contact or image data, without which it is often impossible to use them. The problem, however, is the fact that users are often not properly informed about the release of their data about who will ultimately receive the data and what will happen to it. Around 45% of users of health-related applications are skeptical about the unwanted use of their data. This concern is not unfounded, because, according to the Financial Times , nine out of 20 of the best-known health apps transmit personal data to large international health groups. There is still a need for action here so that it becomes clear which data is processed, how and for what reasons and for what purpose to whom. The data protection directive applicable in the EU is currently being revised in order to be able to guarantee improved protection of personal data. A harmonization of data protection regulations is to be achieved in order to a. increase user confidence in electronic services.

Difficult to prove clinical and economic benefits

The successful spread of mHealth is also being hampered by the clinical and economic benefits of the applications, which are difficult to prove. In Germany, no mHealth applications are currently included in the remuneration catalog. On the one hand, this is because therapeutic and diagnostic prescriptions are more likely to be paid for than preventive measures. On the other hand, the evidence in the mHealth area is very difficult. AT Kearney analyzed the level of evidence of 500 mHealth publications and came to the conclusion that only 2% were able to provide unequivocal evidence.

Little trust in mHealth solutions

Due to the complex regulation of the healthcare system and the long process of proving the effectiveness of diagnostics and therapies , Germany is generally reluctant to innovate. The openness towards medical technologies is also not great. The population often lacks confidence in mobile health solutions, as the smartphone or tablet is only seen as a leisure activity. In addition, the age of use is added. Often the older generation does not use mobile devices and when they do, only rarely. Campaigns specially developed for this could bring mobile solutions to the general public.

Recommendations for action for better acceptance in Germany

Proof of effectiveness and benefit

First of all, it is very important to invest in research and innovation to further develop mHealth solutions. The clinical and economic benefits as well as the effectiveness of the applications could be demonstrated. Due to the lack of evidence, it is not yet possible to achieve acceptance among the cost bearers. A solution to the problem could be a pilot project with different medical service providers and a scientific team that can provide evidence for the evidence of certain mHealth solutions.

Empowerment of the user

Potential users should be enabled to deal with and use mHealth. Older people are often not familiar with the Internet , even though they form the core group of the chronically ill, for example . This could be remedied by campaigns across Germany that bring the new technology closer to older people and enable them to control their own illness. On the other hand, suitable reference groups such as social workers or nursing staff can motivate sick people to take part in training courses or training courses in order to learn how to use mobile devices. The same can be offered to health professionals to gain experience in handling and trusting the mobile solutions. Furthermore, employers in healthcare facilities could provide mobile devices for scheduling appointments or for testing interactions between two or more drugs and encourage slow acclimatization.

Increase of transparency and trust in mHealth solutions

The mHealth market is growing and bringing more and more new innovative solutions to the fore. In 2015 alone, more than 103,000 new applications were published in the app stores. With such a large selection, it is not easy for users to find the right solution for themselves. Applications are often not carefully checked so that errors occur which, in the worst case, could endanger the safety of the user. In addition, it is often not known which company is behind the development of the app and whether the apps go through a medical check before they are offered on the market. This problem can be solved by creating quality seals or certifications that prove the security of the mobile solution, for example with regard to the protection of personal data. There are already good solutions for this, such as the European Directory of Health Apps (English for European Directory of Health Apps ), which has 200 mHealth apps that are recommended by European patient groups.

In Germany, too, there are several online directories that provide information about tested apps and, in some cases, other digital health applications (DiGA):

Healthon: The information and evaluation platform for health apps tests health apps, awards seals of quality and provides information on innovations and trends. Apps that meet the 7 criteria of the HealthOn code of ethics are listed with the corresponding seal. There is a checklist for users with which they can check apps with regard to their risk.
digimeda: The database for digital medicine in Germany gives an overview of which health apps (and other digital health applications) are available for certain diseases and which of them have been checked by different institutions (e.g. with regard to data protection and data security, transparency or medical Use).

appcheck: This information and evaluation platform for health apps is operated by the Center for Telematics and Telemedicine (ZTG). Together with cooperation partners, the ZTG checks health apps and publishes the results. For example, the DiaDigital seal is awarded in cooperation with diabetes associations.
MHAD - Mobile Health App Database: A team of several scientists checks German and English-language apps using the Mobile App Rating Scale (MARS). The focus is on apps that can be used for various mental health problems. Further subject areas are to be added.

Web links

Individual evidence

^ World Health Organization: mHealth: New Horizons for health through mobile technologies. Geneva 2011, p. 6.

↑ Susan Adibi: mHealth Multidisciplinary verticals. Boca Raton 2014, p. 1.

↑ Robert SH Istepanian, Costantinos S. Pattichis, Swamy Laxmiinarayan: Ubiquitous mHealth systems and the convergence towards 4G mobile technologies. In: mHealth. Emerging Mobile Health Systems. 2006, p. 3.

↑ ^a ^b ^c A. T. Kearney: Mobile Health. Who Pays? . New York 2013. p. 6.

↑ ^a ^b ^c A. T. Kearney: Mobile Health: Fata Morgana or Growth Driver? . Düsseldorf 2013, p. 8 f.

↑ European Commission: Green Paper on Mobile Health Services. Brussels 2014, p. 3.

↑ PricewaterhouseCoopers: Study mHealth: The healthcare market is becoming more mobile, faster and more flexible . In: PwC . ( pwc.de [accessed October 23, 2016]).

↑ ^a ^b ^c Rainer Endl, Thomas Jäschke, Christian Thiel, Diana Victoria Wickinghoff: mHealth in the context of the electronic patient record. A study commissioned by eHealth Suisse. ( Memento of the original from June 10, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 2015, p. 7. @1@ 2

↑ Research2Guidance: mHealth App Developer Economics 2014. Berlin 2014, p. 11.

^ Robert Diemer: Mobile technology. Non-invasive sensors make telehealth mobile. Now it is time to bundle the potential of the numerous technology projects and implement them in mHealth services. Frankfurt 2008, p. 18.

↑ Worldwide Smartphone Usage to Grow 25% in 2014 . Website of the research company emarketer. Retrieved May 25, 2015.

^ Research2Guidance: Mobile Health Market. Report 2013–2017. The commercialization of mHealth Applications (Vol.4). 2013, p. 104.

↑ Research2Guidance: mHealth App Developer Economics 2014. Berlin 2014, p. 13.

↑ GSMA; PwC: Touching lives through mobile health. Assessment of the global market opportunity 2012, p. 5 (PDF)

↑ AT Kearney: Mobile Health: Mirage or growth driver ?. Düsseldorf 2013, p. 19

↑ European Commission: Green Paper on Mobile Health Services . Brussels 2014, p. 7.

↑ ^a ^b Doro Germany: On the future of the German health system: The role of mHealth and technology in providing sustainable health care for an aging population. Cologne 2012, p. 20.

↑ European Commission: Green Paper on Mobile Health Services . Brussels 2014, p. 5.

↑ ^a ^b Rainer Endl, Thomas Jäschke, Christian Thiel, Diana Victoria Wickinghoff: mHealth in the context of the electronic patient record. A study commissioned by eHealth Suisse. ( Memento of the original from June 10, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 2015, p. 19. @1@ 2

↑ Rainer Endl, Thomas Jäschke, Christian Thiel, Diana Victoria Wickinghoff: mHealth in the context of the electronic patient record. A study commissioned by eHealth Suisse. ( Memento of the original from June 10, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 2015, p. 17f. @1@ 2

↑ ^a ^b European Commission: Green Paper on Mobile Health Services . Brussels 2014, p. 10.

↑ ^a ^b Rainer Endl, Thomas Jäschke, Christian Thiel, Diana Victoria Wickinghoff: mHealth in the context of the electronic patient record. A study commissioned by eHealth Suisse. ( Memento of the original from June 10, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 2015, p. 38. @1@ 2

↑ Blue Chip Patient Recruitment: Leveraging Mobile Health Technology for Patient Recruitment: An Emerging Oportunity ( Memento of the original from June 10, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . Northbrook 2012, p. 9. @1@ 2

↑ Emily Steel, April Dembosky: Health apps run into privacy snags . In: Financial Times. September 1, 2013. Accessed May 28, 2015.

↑ AT Kearney: Mobile Health: Fata Morgana or Growth Driver? . Düsseldorf 2013, p. 16.

↑ AT Kearney: Mobile Health: Fata Morgana or Growth Driver? . Düsseldorf 2013, p. 14.

↑ ^a ^b Doro Germany: On the future of the German health system: The role of mHealth and technology in providing sustainable health care for an aging population. Cologne 2012, p. 26.

↑ European Commission: Green Paper on Mobile Health Services . Brussels 2014, p. 20.

↑ ^a ^b ^c Rainer Endl, Thomas Jäschke, Christian Thiel, Diana Victoria Wickinghoff: mHealth in the context of the electronic patient record. A study commissioned by eHealth Suisse. ( Memento of the original from June 10, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 2015, p. 75f. @1@ 2

↑ The market for health apps is growing rapidly - Medizintechnologie.de. (No longer available online.) In: www.medizintechnologie.de. Archived from the original on August 28, 2016 ; accessed on August 28, 2016 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.

↑ Rochelle Sharp: Lacking regulation, many medical apps, questionable at best ( Memento of the original from June 10, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . In: Necir. November 18, 2012. Retrieved May 29, 2015. @1@ 2Template: Webachiv / IABot / necir.org

↑ European Commission: Green Paper on Mobile Health Services . Brussels 2014, p. 14 f.

↑ Urs-Vito Albrecht: Creating transparency and providing orientation: Methods and tools as decision support for the use of health apps. Creation of an initial layout for the development of a tool for Swiss users . Hannover Medical School Library, 2019, doi : 10.26068 / mhhrpm / 20190116-000 ( gbv.de [accessed on August 10, 2019]).

↑ HealthOn. Retrieved August 10, 2019 .

↑ digimeda - the database for digital medicine | digimeda. Retrieved August 10, 2019 .

↑ ZTG AppCheck | The information and evaluation platform for health apps. Retrieved on August 10, 2019 (German).

↑ MHAD | Home page. Retrieved August 10, 2019 .

[1] World Health Organization: mHealth: New Horizons for health through mobile technologies. Geneva 2011, p. 6.

[2] Susan Adibi: mHealth Multidisciplinary verticals. Boca Raton 2014, p. 1.

[3] Robert SH Istepanian, Costantinos S. Pattichis, Swamy Laxmiinarayan: Ubiquitous mHealth systems and the convergence towards 4G mobile technologies. In: mHealth. Emerging Mobile Health Systems. 2006, p. 3.

[Kearney-4] A. T. Kearney: Mobile Health. Who Pays? . New York 2013. p. 6.

[Deutsch-5] A. T. Kearney: Mobile Health: Fata Morgana or Growth Driver? . Düsseldorf 2013, p. 8 f.

[6] European Commission: Green Paper on Mobile Health Services. Brussels 2014, p. 3.

[7] PricewaterhouseCoopers: Study mHealth: The healthcare market is becoming more mobile, faster and more flexible . In: PwC . ( pwc.de [accessed October 23, 2016]).