Mobile heralds healthcare revolution

With developing countries leading cellphone subscriber growth, while facing pressing healthcare needs, mobile technologies are emerging as key platforms for medical information and services.

Yashik Singh, lecturer at the University of KwaZulu-Natal's department of tele-health, says m-health is the next big step in terms of healthcare delivery. “Mobile penetration is very high in SA, with GSM coverage estimated at 93%. Leveraging this infrastructure is vital and the benefits to healthcare are limitless.”

According to a recent UN report on the opportunity of mobile technology for healthcare, 64% of all mobile phone users are now found in developing countries.

It adds that estimates reveal half of all individuals in remote areas of the world will have mobile phones by 2012. “This growing ubiquity of mobile phones is a central element in the promise of mobile technologies for health,” it states.

Several m-health programmes have been rolled out in SA, with initiatives such as Project Masiluleke providing information and surveys via SMS.

A collaborative effort between the Praekelt Foundation, iTeach, LifeLine, Nokia, and MTN, among others, Project Masiluleke uses the 120 spare characters in “please call me” messages for HIV education and awareness. According to Project Masiluleke, it sends out one million text messages throughout SA each day, encouraging people to be tested and treated for HIV/Aids.

These messages connect mobile users to existing HIV and TB call centres, where trained operators provide callers with healthcare information, counselling and referrals to local testing clinics.

Gustav Praekelt, MD of the Praekelt Foundation, which developed the technology for the project, says mobile technology provides an efficient and low-cost way to communicate, on an individual basis, with people most in need of social and development services.

According to Singh, the portability of m-health can improve quality of care. “Guidelines may be referred to in any location that has cellphone coverage. The caregiver may log onto a Web site via the mobile network and determine the next course of action given the circumstances. This will also reduce the number of referrals to hospitals,” he says.

One of the project's services, TxtAlert, sends messages to patients on ARV therapy, reminding them of scheduled clinic appointments, to ensure they remain on their treatment regime. Praekelt says the immediacy of SMSes can help prevent communication bungles that waste time and money.

“In the past, people had to walk long distances, get on a taxi, and wait in long queues to access treatment, only to find out (as they get to the front of the queue) that their appointment was actually scheduled for the next day, and they have to come back the next day,” explains Praekelt.

“With mobile technology, you can remind someone of their appointment via SMS, allow them to reschedule that appointment if the date does not suit them, and incentivise them (via an airtime transfer for example) if they attended on time.”

M-health is the next big step in terms of healthcare delivery.

Yashik Singh, lecturer, University of KwaZulu-Natal tele-health department

Similarly, the SIMpill is a locally developed device, which monitors whether patients take their chronic medication at the scheduled time. The SIMpill consists of a SIM card and transmitter attached to a medicine bottle, with the patient's medication schedule programmed in, and sends a message to a server when opened. If the bottle isn't opened, the device sends a reminder message to the patient or a family member or caregiver's cellphone.

According to Tellumat, which owns the technology, a pilot run in Khayelitsha in 2007 showed 90% of patients adhered to their medication regime, compared with the usual compliance rate of 22% to 60%. While the SIMpill is now available overseas, it has not been fully rolled out in SA.

In future, Praekelt predicts such location-based tracking of medication will become more widespread. “While this technology is available, it is still very expensive,” he adds.

Peter Benjamin, GM and director of Cell-life, a Section 21 company that sponsors thousands of HIV/Aids informational messages monthly, says mobile survey systems have greatly streamlined data collection. Its Emit service uses cellphones to collect any structured information, such as in a questionnaire, for organisations that do training, or donors to follow up on medication distribution.

“Where previously with paper-based systems it could take up to three-and-a-half weeks to get data into a system, it now takes a few minutes,” says Benjamin.

Konstantinos Tzingakis, director of innovations and new business services at Ericsson, believes that, as mobile technology progresses, increasingly advanced m-health solutions will be made possible. “This includes everything from the simple communication of medicinal reminders or test results, to making real-time online mobile diagnoses and healthcare tracking across the nation.”

According to Tzingakis, one of Ericsson's health services is mobile diagnosis, where trained workers go into villages and collect medical information and photos of people with ailments. This data is sent to doctors hundreds of kilometres away to diagnose and prescribe medicines in real-time. The health worker can then prepare and administer these medications to the patient on site.

Tzingakis says the convergence of health and mobile has made the possibility of healthcare a reality for everyone. “We have only begun to scratch the surface of what is possible through mobile technologies. Sometimes the best solutions are the simplest ones, so much so that they are sometimes overlooked.”

Singh notes that mobile networks may eventually give rise to virtual mobile hospitals, where patients can use these technologies to contact clinicians. “This will allow patients or caregivers to be in contact with experts from various locations. Imagine the implications in times of natural disasters and war.”

Praekelt believes self-service mobile systems will be one of the major future developments. “The best way to have a lasting effect is to place more control in the hands of patients. Providing mobile services for patients to access health information and medical history will empower a holistic understanding of their health.”