By Matt Pueschel | FHP&R Staff Writer
As part of an increased emphasis on international medical outreach efforts, the MHS is taking a strong look at leveraging the growing use of cell phones in the Third World to improve public health through text messaging.
There are a handful of DoD-funded mobile health, or mHealth, projects underway and several more being discussed. Some are aimed at promoting health in U.S. service members returning from deployment, while others are focused on supporting global medical capacity building efforts.
The potential use of cell phones as innovative, inexpensive and efficient tools for public health was a primary theme in a Mobile Health Summit convened by the MHS last December that included the Combatant Command surgeons and experts from multiple federal agencies, nongovernmental organizations and the World Health Organization (WHO).
|
| Click PLAY above to listen to a Dot Mil Docs podcast featuring Col. (Dr.) Ron Poropatich in a discussion on mHealth and telemedicine. |
“Over half the world (or about 4 billion people) own a cell phone and only 400 million own a computer, so it’s only a matter of time before everyone uses a cell phone for all their computing needs,” said Col. (Dr.) Ron Poropatich, deputy director of the Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Fort Detrick, Md.
Poropatich called the growing use of cell phones (it is estimated there are 1.8 billion mobile phones in the Third World and a million coming online daily) and the tremendous health needs of developing countries a “perfect storm” to utilize the inexpensive technology in medical care. Cell phones are even seen being used in some rural areas that have no electricity, fixed lines or running water.
Poropatich said mHealth can be used for such applications as clinical consultation, education, research, biosurveillance and disease management. DoD projects include an ongoing research protocol being conducted by the Walter Reed Army Medical Center’s Diabetes Institute, which is utilizing Internet-enabled cell phones to pull up 15- to 30-second video clips that provide educational content on exercise, blood glucose monitoring and diet.
All 170 diabetics enrolled in the study received the phones, but only half were sent the daily video clips. The first three months of study showed that the subjects in the intervention group viewed the daily reminders about half the time, and those who did had reduced hemoglobin A1C blood sugar levels and improved glycemic control. “The preliminary data is favorable,” said Poropatich.
Another cell phone project is being carried out at several community-based Warrior Transition Units through a secure, HIPAA-compliant platform that is aimed primarily at Reserve and National Guard members with traumatic brain injury (TBI) or suspected TBI.
The first phase of the project will send out text messages to the members’ cell phones and will include educational announcements, sleep hygiene measures, medication and appointment reminders, and helpful hints tailored to the unique problems they may be encountering. Subsequent phases of the program include a formalized research study that will examine clinical and technical issues, and outreach efforts across the Army and eventually the Navy, Air Force and VA.
International mHealth efforts include a project in Peru being carried out by DoD’s Global Emerging Infections System (DoD-GEIS) in conjunction with the U.S. Naval Medical Research Center in Lima and the Peruvian military. It utilizes cell phones for biosurveillance detection and sending out alerts about suspected emerging infections.
The GEIS Division of the U.S. Armed Forces Health Surveillance Center is funding the pilot project in Peru using cell-phone based reporting of infectious diseases as a mechanism for early detection of outbreaks. This represents a joint endeavor by the Naval Medical Research Center Detachment, Lima, Peru, and the Peruvian military, with the intention of offering an optimized open-source product to public health partners worldwide.
U.S. Africa Command Surgeon Col. (Dr.) Schuyler Geller said there is “significant potential” for cell phones in health. “Teaching people about exercise, sending reminders to take their medicine, [conducting disease] surveillance and alerting in regional response” are just some of the possibilities, he said.
Among the challenges with mHealth in the international health arena and developing world are the many languages that will require translation, and illiteracy rates that will have to be overcome through the use of audio clips or images. The key is to leave behind low-cost and sustainable software solutions that support public health.
“We have to be careful not to encroach on the State Department and [the U.S. Agency for International Development],” Poropatich said. “Our job is to complement them, not take over. But if we do [U.S.] military to [foreign] military [health outreach projects], [the host nation military members] have family members [that could benefit, too]. We need to work with USAID and the [host country’s] Ministry of Health to give them the server and they can coordinate with the phone company. We rely on local [efforts], but in Iraq and Afghanistan we’re improving the communications infrastructure.”
Poropatich said that in the future the use of mobile phones could potentially be expanded to areas such as maternal and child health care; clinical consultations where pictures of a rash, for example, could be exchanged between providers to reach a diagnosis; biosurveillance research; and medical logistics in which information from the field is uploaded about medication stocks so supply chain personnel know when they need to be resupplied.
Much further in the future, Poropatichenvisions a doctor, for example, attaching a colposcope to a cell phone to take pictures of a patient’s cervix and sending them to a specialist to help determine if there are any early signs of cancer. Other distant technologies could include a phone adapter to upload and project slides on new disease treatments.
But as new mHealth technologies are developed, another important issue will be cost.
“The problem is it becomes very expensive to use proprietary software,” Poropatich said. “We’re beginning to dialogue with organizations to develop open source software. We’re making efforts to pursue it.”
The potential extreme health impact of a cell phone can be traced to a BBC report last December of a British doctor saving the life of a teenage boy who had a badly infected and gangrenous arm wound in the Democratic Republic of the Congo. The report said the doctor performed a successful forequarter amputation on the boy after receiving step-by-step instructions by text message from an expert colleague in England.
However, for now it is too early to tell what real effect cell phones will have on health. Poropatich hopes the diabetes and TBI studies will illustrate that more clearly. “We hope that over time there will be a body of science developed that will allow us to make strong statements, but right now it is anecdotal,” he said.