The Journal of mHealth Vol 2 Issue 4 (August) - Page 42

mHealth in Developing Countries Exhibit 4: EHRI HarmoniMobile (EHR) (image sources: http://ehrinternational.com/harmonimobile/) Continued from page 39 patients, prescribe medicine, take photos of injuries, and scan QR codes that identify a patient via a code on a wristband or card. It also follows the international standards for data capture, enables remote access, structures treatment plans, includes surgical checklists, has communication abilities, and more (Exhibit 4). The data is encrypted and protected by a strong firewall.24 It costs an astonishing $3,000-$5,000 to set a hospital up with this system. Reverse Innovation McKinsey identified two factors that explain why some of the most compelling innovations in healthcare come from developing nations rather than developed ones. First, the sheer necessity of improved healthcare makes it absolutely imperative that local entrepreneurs innovate.25 Second, a weakness in infrastructure means that there are fewer constraints from e ntrepreneurs. Included in this is the lack of institutions, regulations, and resources.25 Also, because developing nations are battling the high-cost of healthcare, these healthcare innovations must be low-cost to adhere to a low-income, rural population. This is also referred to as “frugal innovation,” which involves simplifying ideas and focusing on just necessities.26 Finally, these innovations must be stable and reliable because they are being used in rugged, remote environments. In this context, developing countries serve as a laboratory for global health care innovation.27 One successful example of reverse innovation in mHealth is the mini pacemaker developed by Medtronic in India to tackle the issue of the high cost of pacemakers, as well as the shortage in healthcare professionals. India only has 100 electrophysiologists for a population of over one billion people.28 Cardiologists traditionally have to create a pocket in the chest to insert the pacemaker while threading leads through blood vessels and into the heart. Not only is this procedure complex, but it also requires highly trained and skilled healthcare professionals, which there is a shortage of globally. Medtronic’s mini pacemaker is the size of a vitamin pill, and is inserted via catheter through the femoral artery and up into the heart (Exhibit 5). This process does not require the use of a highly skilled specialist, it costs significantly less than a traditional pacemaker, the surgery is less complex and therefore less 40 August 2015 risky, and remote sensors in the pacemaker send out signals via smartphone to a cloud network.29 This innovation will make its way to Europe and the U.S. Challenges While all these projects and pilots show promise for the use of mHealth in developing nations, there are some challenges to globally implementing these technologies and processes. These challenges are also areas of opportunity for global healthcare innovators and entrepreneurs. One of the main challenges involves a lack of theory. In The Promise and Peril of mHealth in Developing Countries, Arul Chib argues that there is a failure of pilot projects in mHealth to replicate and scale to become sustainable ventures. He attributes this to a lack of theory. While mHealth studies do a good job of focusing on the technology and the methodology, they lack the theory, or the theoretical support. We do not fully understand mobile technology; particularly its usage, penetration, and adoption in healthcare and in the nations where studies take place. Therefore, we have no knowledgebase for the implementation of mobile health technology.30 Patricia N. Mechael, in her study titled The Case for mHealth in Developing Countries, argues that before we consider where mHealth can be applied, we must first look at organic examples of mHealth use in developing nations. Her first organic example of the use of mobile technology to exchange health related information comes from Egypt, where a new mother, now living with her husband’s family in a rural area away from access to educated individuals who could consult her on healthrelated issues, uses a mobile phone to contact her mother.10 This exchange of health-related information between mother and daughter is common in Egypt. From studying this behavior, we can further identify opportunities in mHealth. Additionally, mHealth studies focus heavily on technology usage and job-related data as performance indicators rather than impact factors such as how the mHealth technology has improved the individual using it, the health worker using it, or the whole community. Therefore, while the technology and the usage of the technology in a given developing nation for a given disease and/or set of patients and a local clinic may prove successful, we lack clear evidence of overall improvement