Mobile health aims to do nothing less than turn traditional healthcare on its head. As numerous speakers at Mobile Health Europe pointed out, to describe care provided away from a doctor’s office or hospital clinic as "remote care" misses the point entirely if you’re a patient.
The promise of mobile healthcare is to enable care to be better delivered at the location most convenient to patients, by using mobile devices — be they PDAs, handheld computers, smart phones or laptops — to provide practitioners with patient information, clinical knowledge and other tools including access to patient records at the point of care.
As yet mobile health remains a seductive vision and collection of neat technology rather than a widespread reality. Wireless enabled devices with sufficient memory and functionality are only just beginning to become available and employed in healthcare, and companies are still trying to develop the killer applications that will prove compelling for clinicians and viable business models.
Significantly many of the mobile health projects and tools demonstrated at Mobile-Health 2002 in Maastricht were pilots and technology demonstrators, often partly funded by European Commission investments to help support and develop the nascent market.
While one visionary told the conference the PDA would become "as important as the stethoscope" to medicine, the reality is that few doctors yet use what until recently have been essentially beefed up electronic personal organisers for clinical care.
Studies from the US show that despite very high levels of ownership of PDAs among clinicians, few are using them to write electronic prescriptions, order tests or remotely call up a patient’s electronic record.
But with the availability of faster wireless networks and more sophisticated mobile devices over the next few years many believe that mobile-health will provide the vital missing component of e-health, freeing health professionals from tyranny of desktop PCs.
Judging from the presentations in Maastricht the applications most widely in use Europe so far appear to be administrative tools or clinical information and reference guides, using handheld devices to provide convenient access to databases of knowledge, clinical guidelines and medical journals.
A good example of this type of application was demonstrated by Sampo Suvisaari, managing director of Lumisoft Ltd UK, which provides software for putting evidence-based medical guidelines on a handheld device, a system now used by over 200 Finnish clinicians.
Ton Spil, from the University of Twente, meanwhile presented on the Mobile Care Provider, a project in Twente, the Netherlands, in which 500 community nurses have been provided with PDAs. Clinical functionality is planned but the project has initially focused on getting nurses to use the PDAs for administrative tasks.
Another project initially focusing on using mobile devices for clinical administrative tasks within a hospital was described by Kambiz Darabi, managing director of M-Creations, Germany, which has put in a wireless and Bluetooth network into the Neurology department of the University of Mainz,
“Medical staff in hospitals are highly mobile, and you’ll find them anywhere but at their desk,” said Darabi, "You need to bring in ICT that keeps pace with them."
He stressed that as well as providing clinical documentation at the patient bedside, exchanging information with other parts of the hospital mobile devices had the advantage of being much cheaper than a standard desktop PC. Darabi said that use of wireless mobile devices had reduced time spent on documentation by "half-an-hour to an hour per doctor".
A pan-European project underway in Germany, Italy and Spain is “Ward in Hand”, designed to address the day-to-day activity in hospital wards. "The system uses wireless technology to allow doctors to access patient information, communicate and co-ordinate with hospital staff," explained Silvatoro Virtuoso, project manager with TXT e-solutions, Italy.
Virtuoso said wireless devices had the potential to dramatically improve the efficiency of processes, which at the moment can see hospital nurses spending up to 30% of their time entering or re-entering data. He added that the "Ward in Hand" system worked best in conjunction with an existing hospital EPR system.
One of the biggest wireless projects underway in Europe is the procurement of a new national digital radio network for the NHS ambulance service. Mike Sprague, Mobile radio and Ambulance Support Manager, with the NHS Information Authority, explained that the near future an ambulance paramedic is likely to require mobile access to "clinical support protocols, electronic patient records and at risk registers", together with mobile telemedicine, requiring networks capable of handling patient identifiable data.
In the mobile-health vision of Dr Simon Wallace, medical consultant for Medic-to-Medic, the broadband wireless networks of 2010 will mean that videoconferencing "means that GPs are no longer swamped by patients" and can call up detailed medical records on their PDA instantly.
"I often fly by the seat of my pants as a doctor, to be able to have instant access to clinical information in the patient’s home would seem to be a no brainer," said Dr Wallace
He argued that with the advent of third generation mobile networks – beginning to be built at great expense by the mobile phone companies – would see teleconferencing and remote consultations become routine.
However, a more pragmatic note was sounded by Dr Olinga Ta’eed of UK wirless mobile media firm Padagog Ltd, which is working on a mobile-health project in Wales with BT.
He stressed that the mobile networks that will be available in the immediate future — the so-called 2G and 2.5G networks — will only offer limited bandwidth. "For the next five years you won’t get much more than 38k outside a hospital".
Dr Ta’eed also stressed that successful wireless applications in health would be determined by price: "The success of wireless multimedia is because it is cheaper than wired systems".
He advised healthcare organisations and commercial firms to work together and with the bandwidth available now, and predicted that firms will only succeed if they stick to the basic commercial tenants of price, delivering savings and adding competitive value.
Dr Ta’eed warned delegates to be wary of the large amount of white noise currently surrounding mobile health and predicted "98-99% of companies in mobile health will disappear".