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10/20/2011
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Telehealth Faces Challenges Worldwide

In developing countries, low cost wireless biometric sensors and cell phone technologies are being developed to monitor and screen patients.

Wireless mobile technologies have great potential to improve global health. But the challenges facing the implementation of mobile health IT worldwide are different than those faced by the efforts to use health IT in the U.S. to transform patient outcomes.

In developing countries, such as nations in Africa and Asia, including Uganda and India, low cost wireless biometric sensors and cell phone technologies are being developed and piloted to monitor and screen patients for developing heath concerns, ranging from problems in patients with HIV to complications in pregnant women, said speakers during a panel this week at the annual Connected Health Symposium presented by Partners Healthcare in Boston.

Unlike the U.S., there are no established IT infrastructure or installed clinical systems in many developing countries, so there are fewer struggles with integration or interoperability because those other nations are "starting with a blank slate," said Nathan Pendleton, chief growth officer at Generation One, a maker of telehealth applications.

In fact, for some researchers, trying out new mobile health applications in developing nations is easier and often more fruitful than launching them in the U.S. because those countries lack of established clinical IT standards and, in some cases, even medical records.

"We decided to go to developing countries first before the U.S. because there is no clinical documentation yet in many places and no need for interfaces for existing clinical devices," said Dr. Leo Anthony Celi, a physician at Beth Israel Deaconess Medical Center in Boston and a project lead for various global medical informatics projects. "The path is easier where there's nothing in place."

However, big hurdles remain, including poverty and limited communications infrastructures and scant availability of healthcare services in general.

In many developing nations, even when there are mobile phone capabilities, there is very little disposable income for many people to buy devices that could help them be monitored for life threatening situations, including women in labor suffering complications.

If a person earns $2 a week or less, they're not likely to spend even 10 cents for a mobile device app, said. Dr. Jessica Haberer, research scientist at the center for global health at Massachusetts General Hospital. Haberer and her team are developing wireless biosensors to monitor patients with HIV as well as pregnant women in developing nations.

That's one reason why Haberer is planning to pilot her biosensor technology first in India before rolling it out in some poor African nations. Even in poor regions of India, there is often "some disposable income that could help make a new product viable, she said.

"That was frustrating to me and where I'd like to help," she said. Nonetheless, the goal is for her technology to be scalable so that its use can be widespread and "you don't waste money" developing a product that can't be used by many in part because of affordability.

Other challenges for mobile health applications in developing nations is that limited resources for health spending also compete for other important initiatives, such as immunization, said Celi.

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