A spirited 'Super Session' asks, who's driving the mHealth bandwagon?

By Eric Wicklund, Editor, mHIMSS
Who's more important to the advancement of mHealth -- the physician or the patient?

To Krishnan Ganapathy, of the Apollo Telemedicine Networking Foundation in India, the answer quite clearly is the physician -- and he's quite sure that all this new technology and all these new services won't be accepted by people unless it's all recommended by their physicians first. But to Joseph Kvedar of Partners Healthcare's Center for Connected Health, the future of mHealth may lie with the patient.

"I think there is a role for automated coaching and maybe, maybe, the doctor isn't the center of the universe," he said.

Ganapathy and Kvedar were two members of a five-person panel for Tuesday morning's Super Session, titled "Mobile Health in the Clinical Enterprise." In an hour-long session taken up almost entirely by each panelist's opening remarks, the conversation centered primarily on how mHealth initiatives can be advanced, and who should do the advancing.

Ganapathy's argument focuses on his native country of India, which holds one-sixth of the world's population but where "mHealth is conspicuous by its absence." He said primary care physicians aren't adopting mHealth because it might hurt their business, and the general public won't adopt it unless their doctors tell them to.

"Unless the general practitioner is incentivized he isn't going to fall in love with mHealth," Ganpathy added. "The ordinary physician is yet to be excited by this fancy new tool. … Is it possible that the mobile phone is perceived as a threat?"

Ganpathy said mHealth initiatives need to focus on the human being rather than the technology – the health, rather than the 'm.' There are more mHealth pilots than there are pilots in the American and Indian air forces, he added, because the emphasis isn't on the physician or the patient, but the technology.

"Good healthcare is not ordering pizza on a mobile phone," he concluded.

Kvedar took a different view. "Our patients are our biggest untapped resource," he said, outlining "an exciting new frontier" that focuses on patient-centered care. He argued that mHealth initiatives are moving toward improving the lines and levels of communication between physicians and their patients, so that the patient can be empowered to take care of his or her own health.

In that sense, he said, the physician would be part of a network but not at its center.

Another point of view was offered by Eric Yablonka, of the University of Chicago Medical Center, who took the CIO's side.

"CIOs are at the forefront of transforming healthcare inside and outside of the medical enterprise," he said, so they're at the top of the decision-making process. Of mHealth, he pointed out: "We all talk about it, we're all excited about it, but actually has to work."

For mHealth initiatives to succeed, he said, providers, payers and legislators have to develop a reference architecture for connectivity, a business model for connectivity beyond the hospital's walls and a proven testing and certification process for devices.

Rounding out the panel were Donna Ramos-Johnson, of the District of Columbia Primary Care Association, and Russell Glasgow, of the National Cancer Institute. Both brought the conversation back to the ability of mHealth to affect healthcare on an individual level.

Ramos-Johnson agreed with Ganpathy that physicians need to be incentivized to adopt mHealth, but patients also have to be incentivized. To do this, she said, mobile health tools need to be made accessible, relevant, inexpensive and culturally sensitive.

Glasgow said mobile health tools, particularly apps, hold great promise for the nation's 11 million to 12 million cancer survivors in that they enable the patient to make new connections in healthcare – to the doctor, to a network of specialists, and to others who have or have had cancer.

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