Leveraging

m-Health 2010
Whitepaper
Inside:

Introduction

Client server architecture

Applications

Early success in M-Health

Disclaimer: This document is released to provide information related to m-health to all interested participants.
Some of the data and images are taken from public sources to make this topic insightful, illustrative and informative.
BMS holds no copyright of such information already available in the public domain.
How to Leverage M-Health Whitepaper by BMS

1. Introduction
Technology advancement in healthcare sector has a great potential to promote a
healthy lifestyle, improve decisions taken by health care professionals as well as by
patients while improving quality of healthcare services. Real time access to medical
information and facilitating instant communication was not possible earlier. The
increased usage of technology in the health care sector would result in lowered cost,
convenience and enhanced efficiency.

To overcome the limitations of resources, technology plays a vital role and provides
services to the end-users according to their requirements. There are 57 countries in the
world with global deficit of 2.4 million doctors, nurses and midwives in 2007 (Source:
www.Wikipedia.org). This shortage is mostly seen in middle and low income countries.
In order to optimize usage of available resources emerging technologies like m-Health,
telemedicine can play a major role. These technologies facilitate two way information
exchanges between the doctors and the patients.

In the present scenario all developing countries are facing health care related
challenges. Diseases and lack of preventive care take a significant toll on both growing
population as well as on the economy. Despite of current economic advancement there
is still pressing need to improve health care services. The reasons are quite evident
from following facts:

1. A child born in developing country is 33 times more likely to die within the first five years of
life than a child born in any developed country.
2. Every minute at least one woman die due to complications related to pregnancy or child birth.
3. There are more than five million people who are infected with HIV.
4. Due to lack of access to proper drugs and medical treatment diseases such as TB, malaria
continues to claim people’s life.

To overcome all these serious challenges, mobile technology can act as the missing link
to offer health care services in the developing countries. The main areas in which early
and fruitful result can be seen through better technology design and its services are like
safe motherhood, integrated management of childhood illness, addressing diseases like
HIV, TB and malaria. As per the current market analysis there is a boom in the health
sector because of the following reasons;

a. Growing communication and IT infrastructure is opening new ways of

services delivery
b. Domain specific consulting and technology solutions

Current healthcare IT systems offer little cognitive support. Physicians spend a great
deal of time shifting through large amount of raw data and integrating it with their
medical knowledge to form a holistic picture about the patient.
How to Leverage M-Health Whitepaper by BMS

2. Overview of m-Health
m-Health is defined as a combination of mobile computing, medical sensor and
communication technologies used for offering health care services. It uses mobile
telecommunication and the multimedia technologies which creates wireless healthcare
delivery systems.

Innovative hospitals and healthcare providers are increasingly using m-Health concept
to meet the expectations of patients.

Usage of mobile technology is growing increasingly in the developing countries. There

has been considerable research and development spends in this area. Mobile
technology is ruling the world with more than 5 Billion users as on date. The impact of
mobile can be gauged by looking at numbers given below:

Number of Mobile Users

Year India* (Mn.) Globally* (Bn.)

2006 150 2.7
2007 210 3.25
2008 300 3.85
2009 391.8 4.6
*Figures as per available internet resources. There might be minor variations based on source of origin.

On network infrastructure side the cost of the mobile technology deployment is going
down because of the renowned vendors such as Nokia developing cheaper
infrastructure technologies (CDMA) and cheaper phones such as Sun’s Java phone.
Phones in low and middle income countries are also now available with functionalities
like web browsing, GPS navigation and e-mail.

Mobile technology offers direct voice communications and data transfer capabilities. It is
particularly beneficial in remote areas where the mobile phone enabled by wireless
infrastructure is the only way to reach out.

With client/ server computing in its simplest form; an application is used by the mobile
device (known as client) which requests a service from application component from the
application server. In following sections we will discuss emerging models for delivery of
health care services.
How to Leverage M-Health Whitepaper by BMS

3. Applications of M-Health
Medical areas like anaesthesia, surgery systems (Symbian, Windows Mobile),
and hospital management has made with more processing power and
possible the assimilation of patients and memory, and new possibilities of
more complex processes in the application development (Symbian C++,
Ambulatory Major Surgery (AMS) field. .NET, J2ME, etc.). The software
These patients are not hospitalized after application that the nurse utilizes in
the operation, and only a post- order to store the patient answers has
operational control is done by a nurse, been extended with the aim of allowing
by means of a protocol of cell phones the visualisation of the pictures captured
(carried out 6 times per patient following by the patient on-line.
a time schedule) where a set of
questions is asked to the patient at their After the emergency call from the
home. After compiling the results patient, the nurse can ask the patient to
obtained in the questionnaire, the nurse take the picture of the affected area of
decides whether the patient condition is his/her body by means of the smart-
better or, on the contrary, he/she must phone. The picture is then transmitted
go to an emergency health care centre. and the nurse can examine it almost on
The main problem with this method is real time basis. The result shall be
the subjectivity of the patient’s answers. transmitted to nurse for being stored into
It is sometimes a problem when the the database which will be used for
result of the questionnaire is just in the future reference.
region to order him/her to come back to 3G video calling is another application
the hospital. where a doctor can know the patient
To improve efficiency of patient’s post- condition through his/her mobile phone.
operational control there has been First of all the patients has to register
developed an m-health application and create an account by paying pre-
called mobile CMA which is used in specified subscription fees. Once the
AMS. Application uses new wireless account is created then the patient can
wide area access data networks (GPRS, login and answer some of the questions.
UMTS), that allows data delivery in a The answers of the questions are then
cheaper and faster way, and the new forwarded to a registered doctor who
multimedia smart-phones, that makes it reviews them before video calling on the
possible to capture pictures and video, patient’s mobile and conducting an
featured by more advanced operating informed consultation session.
The main benefits for this 3G video calling are

1. Effective and improved advice

2. Better action during the time of emergency
How to Leverage M-Health Whitepaper by BMS

3. New way of delivering health care services

4. Giving proper training to the patient

Members of 3G mobile An advanced interactive

The answer to the
can only visit the medical history
medical questionnaires
website and answer questionnaire securely
is forwarded to the
the questions gathers complete
registered doctor who
history of illness
reviews them.
information directly
from patient’s mobile
phone.

(Source: 3G Mobile)

Dr. SMS is a SMS based m-Health application which will help people to reach to the
nearest hospital in the town. It is an innovative way which provides healthcare
information through SMS. This service was launched in 2008 in Kozhikode city in
South India. This information based service helps people to contact the hospital
concerned through the mobile phone as soon as the emergency arise. Dr SMS is a
successful story of Kerala and BSNL (Bharat Sanchar Nigam limited) has played a
significant role in it.One can even track the health clinics and hospitals in case of
emergency to avail medical services in the nearest possible health care centre.

Another application of m-health is m-fitness which produces smarter exercise option,

more flexibility and better feedback by integrating smart-phone sensing technology like
GPS. Example of commercial success in this field can be seen with Adidas/Samsung
MiCoach and Apple/Nike Nike+ and next generation companies building on fitness
gaming phenomenon. It’s basically targeted towards youth segment because youth are
more conscious about their fitness and exercise regularly.

Communication and training for health workers is another application of m-Health.

Nursing shortages, especially in rural areas, are common in developing countries. In
Guatemala one such program is being implemented i.e. Primary Healthcare Nursing
How to Leverage M-Health Whitepaper by BMS

Promotion Program which is based on the mobile technology. This program is a virtual
nursing course, which is taught via a combination of telephone and two-way data
communication.

In order to provide effective patient care and enhanced nurse access for quality care
and knowledge transfer, mobile technology is playing a vital role. The training through
mobile enhances professional development and improves quality of care for the patient.
How to Leverage M-Health Whitepaper by BMS

4. Global trends in m-
m-Health
The usage of mobile technology is growing rapidly. We all know that kids under 18 have
cell phones now a days and the age of first mobile ownership is dropping further. The
next wave of mobile technology may need to focus on applications, integration and
capabilities. If we go for the application and capabilities the main thing comes to our
mind is iPhone. Capabilities and applications are part of what has driven to iPhone’s
popularity. The most popular iPhone applications are calorie counter, weight loss
coaches, workout trackers, and a symptom checkers from WebMD mobile
application. Looking at these innovative applications makes it easy to see how one’s
mobile phone can hold a lot of potential to manage health.

Already 54.2 million online adults in US have browsed the internet on their cell phone
and 10.2 million online adults have looked up health related information using their cell
phone. Mobile phone usage for health care related activities will continue to rise in the
near future. A lot of health care related applications are already there on the mobile
phone.

The beauty of the technology is that it is not limited to any one country or region; it is
spreading all over the world. Now days in developing countries mobile technology can
significantly affect healthcare outcomes. In Africa and parts of the Latin America text
message is used to increase compliance with treatment program/s.

In places like South Africa where HIV/AIDS carried out serious stigma, people can
receive text messages personally which helps in creating awareness and education.

HIV Confidant, running on palm500™ was successfully used in Africa to manage the
HIV test result of a patient. The screen shots of HIV Confidant is given below

Enter username and Verification of the Patient provide two Result is displayed
password using the HIV patient codes to the nurse
Confidant

(Source: dimagi)
How to Leverage M-Health Whitepaper by BMS

5. Early success in m-
m-Health
Some of the recent successes in m-Healthcare are

1. My Food Phone
2. The Pill Phone
3. Medical intelligence-Columba bracelet

My Food Phone

Consumers are always seeking for expert information and counsel to see positive
change in their health and of their family members. My Food Phone is an application
which is basically used for monitoring the users’ nutritional behavior and also it connects
the user to an expert in meaningful ways. It also helps in modifying the eating habits of
the consumers. Based on My Food Phone another broader mobile platform is
developed named Pacifica.

The Pill Phone

The Pill Phone is patented mobile medication reminder software that is available in
many wireless phones. The Pill Phone is the only wireless application which is having
FDA approval for medication management. It has the following advantages

1. Provides visual/audible promotional messages

2. Tracks and stores pill record
3. Confirms once dose is taken
4. Displays potential side effects

The Pill Phone application is available exclusively through Verizon Wireless. Customer
can access more than 1800 medication and prescription through the wireless network.
The pill phone has an alarm tone or vibration, which reminds an individual to take the
required prescription on time. This application is compatible with the latest devices from
LG, Motorazer and Samsung.

Medical intelligence-Columba bracelet

The Columba bracelet has a hands-free mobile phone, GPS positioning and an alert
system which warns caretaker or relatives when patient wanders outside his/her home
zone. It instantly indentifies the patients’ location and sends the same to
caretaker/relatives for immediate action.
How to Leverage M-Health Whitepaper by BMS

6. Module for m-
m-Health
The various modules associated with the mobile technology are

1. Patient management System

2. Decision Support System
3. Messaging to other system

Core Patient Information System

(EMR, Patient Contact Management, Demographics)

Decision Support

Population health management

Disease Management System
Integration Service and
Data Entry

consulting

system
Personal Health Information

Patient access to health related data

Messaging to other system

(Source: MEDtech)
How to Leverage M-Health Whitepaper by BMS

Data Entry

Every user must enter username and password before using mobile based health care
application in order to prevent unauthorized copying of private data.

Patient access to health related data

Once the patient credentials are verified then the physician sends him/her proper advice
about the health related problem/issue. Patient can also access the medication records
prescribed by the doctor.

Messaging to other system

Whenever the patient sends any health related information from his/her mobile it will go
to the physician’s PC or laptop only. From there only authorized doctor can access the
information of the patient and can revert back.

(Source: Deloitte report-2009)

How to Leverage M-Health Whitepaper by BMS

7. Client/ Server model for mobile

Wireless connector link

Mobile Host
Application Application
Client Server

Fixed Network

The figure above shows traditional client server model used for health care applications.
The extension of the above traditional model is three tiered models (explained in next
page) where agent come in-between the client and the server. Agent splits the
interaction between mobile clients and the server into two parts i.e. between the client
and the agent and other between the agent and the server.
How to Leverage M-Health Whitepaper by BMS

8. Client/Agent/Server model for mobile

Wireless Link

Agent Application
Application
server
client
Mobile Host

Fixed Network

The above model is also called as extended client server model where agent comes in-
between client and server applications. The client /agent/ server is the most appropriate
for light weight client with limited computational power and limited battery life. It moves a
lot of tasks from the client to the agent. For example the agent can manage a complex
client request with only the final result getting transmitted to the client. The agent can
access high bandwidth links and large computational resources that it can use to benefit
the client. To reduce the load on the mobile unit and thus preserve valuable resource
the agent might be responsible for starting/stopping specific functions at the mobile unit
for executing client specific services.

To deal with the disconnection, a mobile client can submit its request to the agent and
wait to retrieve the results when connection is re-established. In the meantime, any
requests to the disconnected client can be queued at agent to be transferred upon
reconnection.
How to Leverage M-Health Whitepaper by BMS

9. M-Health as a service provider

In today’s era a lot of health care related informational programs are provided by
mobile. These messages are stored in a server and sent to the end user by using
appropriate software based applications.

The introduction of third generation (3G) public wireless network infrastructure gives rise
to new mobile services in all kinds of area. Patient tele-monitoring service is a mobile
health care application which collects the patient’s vital signs from health care center,
with the use of 3G and 2.5G communication networks. One of the scenarios of tele-
monitoring named Epilepsy Safety System (ESS) uses BAN (Body Area Network). A lot
of companies are using mobile as a channel to disseminate health care related
information.
How to Leverage M-Health Whitepaper by BMS

10. Ecosystem of M-
M-Health
Emerging field in healthcare includes biotechnology, nanotechnology and information
and communication technology (mobile health). All of these technologies together form
a basket of tools to address the health care issues.

Private companies, mostly mobile network operators (MNO) change the shape of the
traditional health care industry. MNO companies are looking for a new way to stay
competitive and are implementing innovative ideas to increase the revenue and reduce
the crunch rate. The MNO has become an integral part of the diagnostic and monitoring
process in which healthcare providers become part of the investigation process and
mobile phones provide the monitoring tools.

Mobile health service is a new technology based actor in the field of the healthcare. It
can be formed publicly, privately or as a public-private partnership. Such partnerships
would offer a value added services by connecting healthcare system and healthcare
providers with a citizen mobile phone over the mobile network with pharma industry,
and handset manufacture industry as stakeholders.

The entire ecosystem is a citizen centric where the major players are healthcare
providers, mobile phone manufacturer, MNO, ministry of health care.

Pictorial view of the ecosystem (Source: IDB Report-2009)

Pharma
Industry

Ministry of Health care

health providers

MNO Citizens/patient

Handset
manufacturers
How to Leverage M-Health Whitepaper by BMS

Mobile service providers must implement applications which can work across wide
range of handsets. Mobile health architecture is not fully dependent upon the capability
of the handset but it must include a centralized repository and a service backbone
system. This would facilitate health care information transfer to various locations
through mobile.

Nokia is one of the major players in the mobile industry which is seriously considering
that where and how to enter the mobile health value chain. Nokia offers one of the
global platforms which support a lot of services related to healthcare. Health care value
chain demands an element of trust which is not the core business of Nokia; therefore
Nokia expects to partner with private entities to successfully address the market.

According to the analysis by a global pharmaceutical and healthcare market research

company Manhattan Research, consumer with smartphones tend to be more interested
in mobile health applications for prescription in drug tracking and for information
regarding diseases and its remedies.

IT plays a major role in m-health implementation and deployment. The deployment of

m-health in any health care organization provides the opportunities to maximize their IT
infrastructure and deliver valuable solutions which provide the meaningful ROI to the
organization.

IQMax is software for m-health which connects nurse, physician and patients and also
provides opportunities to physician, nurse and doctors to access clinical data,
information, images, capture charges and write prescriptions. IQMax enables clinicians
to view clinical data quickly and efficiently at the point of care. IQMax’s proprietary
healthcare platform allows clinical data taken from diverse healthcare information
systems to be aggregated into one simple view. Clinicians are always connected to the
most recent clinical data, no matter where they are- at the hospital, clinic, at home. With
IQMax, there are no paper charts, trying to locate the nearest computer terminal to view
clinical information, or wasted time on multiple logins to access clinical data and lab
results, common with most desktop based HIS systems. All patient and clinical data is
aggregated into one simple view that can be accessed quickly and efficiently anytime,
anywhere on the clinician’s mobile device.

According to various services provided by m-health its patients are using it for multiple
reasons. Given below are some interesting numbers:

1. 54 percent people are learning more about health risk, prevention, and mental
health.
2. 66 percent smokers are trying to quit.
3. 40 percent of alcohol drinkers are trying to cut back.
(Source: Deloitte report-2009)
How to Leverage M-Health Whitepaper by BMS

11. Conclusion - The New Era

Era
The field of m-Health is at critical juncture with dozens of projects implemented and
proven beneficial for the end user. Technological innovation will bring enhanced
benefits particularly in the area of data collection, patient monitoring and remote
diagnostic where application development is already proceeding at path-breaking
speed.

Health needs in developing world is rapidly evolving including chronic diseases and
communicable diseases in the developing countries. M-Health is placed well to address
the challenges using currently available technologies. For example SMS in m-Health
can be useful in increasing public health awareness of HIV/AIDS. Emerging
technologies like BAN will also be an asset for the today’s fast paced world. M-Health is
coming in a big way and will rule the world in near future.

12. References
1. www.dmoz.org/Business/Healthcare/Healthcare_Management
2. http://www.allbusiness.com/management/business-process-analysis/870829-1.html
3. http://www.researchandmarkets.com/research/817e21/india_healthcare_t
4. http://www.sjoki.uta.fi/~shmhav/med-volviz-faq.txt
5. http://www.antya.com/topic/Medical-Sofware-Companies
6. http://www.indianhealthcare.in
7. http://ibef.org & www.blooray.in/9995/
8. www.siliconindia.com/magazine/articledesc.php
9. http://www.expresshealthcaremgmt.com/200809/itspecial01.shtml
10. http://www.health-infosys-dir.com/yp_hc.asp
11. http://www.infosys.com/research/publications/SETLabs-briefings-healthcare-lifescience.pdf
12. www.mindfiresolutions.com/healthcare-software-development.htm
How to Leverage M-Health Whitepaper by BMS

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