Patty Mechael, Director of Strategic Application of Mobile Technology to Public Health and Development

Eight years ago Patty Mechael traveled to Bangladesh hoping the country would be a good place to do her PhD research on the use of mobile technology for health in developing countries.  Despite the fact that the country was one of the first to go fully mobile, there wasn’t enough health-related mobile usage in 2002 to build a case study.

Patty and Bangladesh have come a long way in those 8 years.  Bangladesh now has multiple nationally-scaled mHealth implementations and Patty not only has her PhD, she’s also the Director of Strategic Application of Mobile Technology to Public Health and Development at The Earth Institute, Columbia University which includes advising on the mHealth activities of the Millennium Villages Project.

Patty carved an hour out of her busy schedule last week to chat with me about how the demand for mobile health has become incredibly strong in the last twelve months and how getting wedded to a particular system can be a big mistake.  Below you will find an edited version of our discussion.

Q: What’s your definition of mobile health and are there multiple definitions out there?

A: I take the broadest definition of mobile health, which is essentially any health-related use of mobile technology. Mobile technology to me doesn’t just include cell phones. It can be remote sensors or other mobile devices like a watch that has a cardiac monitor to measure your heart rate.

In regard to the field of mHealth, some people just focus on the mobile communication side and how that relates to public health.  Other people focus on the use of mobile technology as a data collection tool, and then there’s another group that looks at mHealth as a mechanism for remote patient monitoring.  In other words, mobile devices are increasingly enabling the transfer of data, including vital signs or blood sugar levels through a mobile device into some kind of smart artificial intelligence backend that can provide guidance to a patient.

Q: The health field seems to have embraced mobile and coalesced around it.  Why do you think that is and are there any lessons that this field has learned that others can benefit from?

A: Health has been foraying in and out, and then in and out, when it comes to mobile technology.  And now, just in the last twelve months it’s ALL IN.  And “all in” in a way that I don’t think anybody ever fully thought would happen.

This is great except that you can really screw things up in a big way if you don’t do the due diligence needed to prioritize and identify the tools and systems needed to address one’s priorities.  For example, you need to know your users and what they’re going to want or need, and how they think about things.  Looking at existing workflow, information flow and communication flow issues is also important.

Sometimes, at the end of such due diligence, you might find that mobile technology is not the right strategy for the issues that you have identified.  Then, you need to be willing to say ‘We’re not gonna go with this.  We’re gonna go with this other thing instead.”

Mobile Health is an evolving field. I can’t tell you exactly what would work in any given setting but I could tell you which approaches for adapting or deciding upon a set of tools might give you greater likelihood of success.

Q: What is the most common request from organizations or governments that are venturing into mobile health? Are they all focusing on one area in particular?

It ranges.  A lot of governments now are saying “telemedicine, telemedicine.”  What they generally mean is access to voice consultation services via a mobile phone.  In some cases it may also mean transferring images via camera phones or remote patient monitoring in urban settings.  But a lot of telemedicine is going to be multiple mechanisms for accessing voice consultation-type services.

The other major interest area is basic data collection. A lot of times traditional data collection systems are one way – people report into the system, but the data goes into a black hole that they never see again.  One quick fix is to encourage health administrators to print out a report once a month and send it back to the people submitting the data.  That way they can see how they are doing from one month to the next based on the data they submitted. It’s even better if you can push the summary data back to them on their mobile device.  A step further than that is to create a decision support tool or platform for a health worker that enables data collection as a by-product.

One of the pieces of work that a colleague of mine at Columbia has been leading is called Child Count Plus.  It’s an SMS-based system where a community health worker enters in data such as the mid-upper arm circumference of a child under five years old. The health worker sends the data into a system via their mobile phone and the system sends a message back on what to do for the child based on the data that they submitted.

There’s some decision support in this system and if you ask the community health worker the benefit of having that feedback it is huge.  At the same time, you have a data repository sitting there to track progress related to nutrition targets.

Q: Is there an organization that helps people get started with Mobile Health?

A: There’s a great deal of collaboration in the Mobile Health space, including the mHealth Alliance along with many meetings scheduled in 2010 on the subject.  There’s also a less-known group called the Open Mobile Consortium that started around open sourced tools for social development, many of which are being used for health.  They aim to answer these questions:

  • Can we reduce duplication of effort?
  • Can we take each other’s tools and apply them to different issues?
  • Can we advance the tools so that users can download them and work with the different tools?

The Millennium Villages Project is a very active participant as is UNICEF.  A number of large organizations and groups that do mHealth are committed to this ethos of “let’s work together and let’s standardize around a few platforms.”

Q: I’m glad you brought up the Millennium Villages Project.  What interested you in that project and what about it is unique?

A: It was an opportunity to actually apply what I had studied in a real-life situation.  It was quite serendipitous because I had started to interface with Columbia University at the time they launched the partnership with Ericsson.  They aimed to improve connectivity in the Millennium Villages and they wanted to start thinking strategically about how to better leverage mobile technology there.

To start, one of the things that we did to help support the sites was to negotiate, through Ericsson, with mobile phone operators to get a toll-free emergency line.  For most of the sites, that has been a game-changer.  That access to emergency transportation has helped reduce the number of women who die in childbirth or the number of children that die from emergency situations.  The combination of communication plus transport for emergencies has been transformative.

We’ve done some work with mobile learning as well, deploying educational modules to community health workers on issues like family planning, reproductive health and immunization through the java-enabled cell phones Sony Ericsson donated.

We also took a lesson out of a program in Ghana where one of the mobile phone operators was providing medical doctors free calls to each other.  For the Millennium Village sites we created closed user groups so that facilities, community health workers and the ambulance drivers could all talk to each other for free.

Q: So would it be fair to say you’re starting to build some smart practices based on a sort of test and learn process?

A: In a way, it’s a very iterative process.  We are learning a lot as we implement and engage with governments to prioritize health objectives and standardize on data and systems.  It’s important to test, learn, and if you fail, fail fast and move on.  Just don’t get wedded to something that is going to lock you into a specific system or technology.  Technology changes fast and we need to keep up with advances to support people’s health.

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