European policymakers see shifting chronic illness care into the home as a panacea to rising healthcare costs. But to get mobile healthcare off the ground, a lot of back-end work needs to be done.
Yeona Yang, professor of information systems at the Desautels faculty of management at McGill University in Montreal, who has been studying developments in electronic and mobile health, says she is a telehealth optimist. But, she said, "despite positive signs, there are still some major challenges and obstacles" which, she said, will keep it from becoming the kind of truly mainstream healthcare delivery platform people want. As a result, she said, it is still three to five years out.
Her logic: we have certainly seen an explosion in take up of things like smartphones in daily life, so people naturally ask, "Why can't these very useful things play a part in healthcare too?" The problem is that the smartphone, great as it is, is just an enabler. "It's also worth pointing out that we've had cellphones for 20 years, but it took that long for them to reach this level of functionality and acceptance. Yes, there are positive signs in demographic terms, people are much more tolerant of digital devices, they are much happier using them. In fact they are now quite demanding about what they expect them to deliver ... Being able to use one is a life skill now, which just wasn't true even five years ago. But there are just so many other factors."
For one, she said, there is the issue of local differences in Europe. Different countries use phones differently and so will adopt mobile health differently. "They also have different healthcare systems and cultures, of course. But that's far from the main obstacle to mHealth. The problem is, mHealth is not just about the hardware, the phones. It's about the infrastructure you need to make that hardware actually serve a useful purpose. Say you start collecting lots of useful data from patients on, say, their weight, or their glucose levels, or exercise patterns, via mobile. What are you going to do with all that great data?"
Yang claimed there is no infrastructure as yet to properly collect and process all of it. It also has to be acted on, she pointed out, or is there is no purpose in collecting it. There is no system in place to do that yet, in either the U.K. or Europe as a whole.
"What we have is the front end of the system for mHealth, in other words, but no back end -- no defined, agreed processes the care provider has put in place, yet," she said. "There is therefore a lot of work still to be done to make this approach useful for the medical practitioner, who, again, has no current incentive to do this -- how would they be compensated for this extra work looking at all this data collected by patient mobile [devices]?"
Yang continued, "I agree there is lots of interest, lots of potential, lots of attention from investors in healthcare mobile, but until we have that robust back end, that infrastructure, we are still going to face delay. And by the way, I do agree that mHealth as a way to manage chronic patients better is the way to go – it's just that processes, the workflow, the insurance structures and the payment plans need to catch up first before we can really start doing it."
It seems Hunt's telehealth ambitions may come up against a very hard brick wall – and soon.
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