Canadian Mobile Health Initiatives: Lessons Learned

Recent Canadian initiatives suggest that mobile health applications can help integrate healthcare into individuals’ daily lives, by enabling remote communication between healthcare providers and patients. These first initiatives have revealed significant opportunities for healthcare, as well as important challenges to be addressed. What lessons do we need to learn from these experiences in order to expand the scope of mobile health?

In the last few years, mobile health applications have been launched by several Canadian hospitals and healthcare organizations. Mobile health applications extend healthcare beyond traditional settings by making it possible to monitor patients’ health remotely. Mobile phones and tablets have been adapted to monitor heart rate, blood glucose levels, and other health indicators and upload results to online portals accessible to patients’ healthcare providers. Mobile applications can also be used to educate and inform patients and to enable more frequent communication between patients and healthcare providers. To offer a couple of examples, these capabilities are being used to help patients prepare for surgery and to monitor patients just released from hospital. As for future possibilities, mobile applications are especially well-suited to supporting patients with complex and chronic health conditions that need to be monitored continuously.

Mobile health initiatives have begun to take healthcare into new domains, uncovering new opportunities and challenges. Creators and managers of mobile health applications have had to learn as they go, and adapt to unforeseen obstacles. What can we learn from these initial experiences? We offer a few points of interest to organizations considering the potential of mobile health.

Mobile health lessons learned

Mobile app purchasing is different from software or hardware purchasing.

When healthcare organizations seek to purchase computer hardware, there are usually about ten major vendors to consider. With software, there are perhaps fifty established companies to choose from. There are thousands of mobile application creators. Organizations need support from people with experience in mobile health to formulate clear requirements and priorities and help narrow down an extremely wide field of vendors.

Mobile health apps need to work on more than one kind of phone.

Mobile health applications are often intended to be installed on patients’ own phones. Even where healthcare organizations choose to provide phones to patients, the Canadian Radio-Television Telecommunications Commission (CRTC) requires that they be given the option of switching telecommunications service providers, which may mean switching phones. In either case, mobile health applications have to work on different types of phones (e.g., iPhone, Android, Blackberry). Compared to software, mobile applications rely more heavily on a device’s operating system, with the result that the same app is likely to behave quite differently on different phones. Mobile applications need to be written and tested for different phone operating systems. Since applications are often intended for a large number of users who have different kinds of phones and may lack technological proficiency, considerable technical support is needed to address the variety of problems that may arise.

Calculate costs per capita.

Because different versions of mobile applications need to be designed for different phones, applications usually have higher operating costs than software. Costs of ongoing development and support are also considerable; for instance, the application will need to be updated every time a phone operating system is updated. Before launching an application, organizations need to consider the cost per patient for the patient population they expect to serve. Because of relatively high ongoing costs, it makes most sense to design applications relevant to large populations in order to benefit from economies of scale.

Don’t forget about backend support.

Mobile health apps used by patients or health professionals need to be supported by backend databases and systems (e.g., hospital servers) that manage data collection and storage, user identification, security, and privacy, among other functions. Data collection and access systems need to be designed to protect patient privacy. For example, before the application is launched, it needs to be decided whether incoming data streams will be linked to identifiable individuals or not. Applications will also need to integrate patients’ previously stated privacy and confidentiality preferences regarding who can view their health information. While telecommunications systems can generally assure secure data transmission, backend security systems need be configured to ensure that telecommunications providers do not have access to patients’ personal health information.

Backend support infrastructure requires considerable resources, and is a much better investment if it is capable of supporting future updates and applications. If possible, backend support systems should be aligned with Canada Health Infoway architectural standards, which will allow them to be adapted more easily to future needs and integrate better with other systems.

Plan ahead for operating support.

When healthcare organizations purchase a mobile application from outside IT service providers, they cannot simply turn over responsibility for access, privacy, and security to the provider. If outside service providers are going to provide operating support, healthcare organizations need very well-written agreements to ensure that the service providers comply with the organization’s privacy policies and legal obligations. Mobile health applications cannot be managed in isolation from the organization’s regular operations, but need to be integrated with existing business processes, such as patients’ privacy and confidentiality directives. Deciding how the healthcare organization and IT service provider will work together to manage an application takes careful planning in terms of both policy and operations.

Thinking ahead

Mobile health applications to date have generally been designed along unique lines for specific contexts. Now that they are becoming more common, it makes sense for healthcare organizations to consolidate what they have learned and begin to develop common standards. Comparing notes with other organizations on their application designs and launch experiences would help developers to establish broadly applicable standards, such as a common nomenclature for mobile health applications or a common interpretation of Infoway architecture as it applies to mobile health. Common standards would make it possible for developers’ experience and knowledge to be transferred from one context to another, rather than each new application being designed from scratch.

Common standards would also make it possible to create cornerstone solutions that could be integrated into multiple applications. In particular, designing backend support infrastructure to support a variety of applications would greatly reduce the cost of new applications and enable more complex features, such as linking data collected through different applications. More fully developed privacy and security infrastructure would support the collection of more complex data, and make it possible for users to access some applications anonymously by integrating de-identification or anonymization into data collection.

Mobile health initiatives have opened up a number of new possibilities for healthcare. A variety of applications are beginning to enable more frequent communication between patients and healthcare providers, increase patients’ involvement in managing their own health, and generate high quality information for health research. Learning from early initiatives can help healthcare organizations to begin to take advantage of the full potential of mobile health by designing better applications, integrating them more smoothly into existing infrastructure, and managing them more efficiently and economically.