Professor Robert S. H. Istepanian

1 Professor Robert S. H. IstepanianMobile Health (m- Heal...

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1 Professor Robert S. H. IstepanianMobile Health (m- Health): A decade of Myopia Clinical pilots, Business Models and m-health policies Professor Robert S. H. Istepanian Visiting Professor Institute of Global Health Innovation Imperial College, London, UK CEO and Founder ikhare Ltd., London, UK Mobile Government- The World Summit 7-9 May 2017, Brighton, UK © 2017 Prof. Robert Istepanian, UK – All Rights Reserved

2 Summary Digital Transformation and the disruption of m-Health in healthcare What is m-Health ? The Beginning and the current status The business of ‘ Smart phone centric mobile health Apps’ v/s the ‘Science of m-Health’ Mobile health from the clinical and global health perspectives Plethora of m-Health ecosystems and business models - The good, the bad and the ugly m-health : Progress or Retrogression © 2017 Prof. Robert Istepanian

3 Digital transformation and the global disruptive economy & businessSources: Wikipedia, Google, Google Images Sources: Wikipedia, Google, Google Images Sources: Wikipedia, Google, Google Images But what about Healthcare ? © 2017 Prof. Robert Istepanian

5 m-Health: Transformative hype or fad?2011 : ‘Mobile health is the biggest technology breakthrough of our time’ Kathleen Sebelius Former US Secretary of Health and Human Services, m-health Summit 2011. 2016 : Formerly mHealth summit ! ‘m-Health’ moved address to ‘connected health’? © 2017 Prof. Robert Istepanian, UK – All Rights Reserved

6 m-Health: A global Multi $ Billion Industry

7 The business of ‘ Smart phone centric mobile health Apps’v/s The ‘Science of m-Health Mobile health (m-health) is expected to grow to more than $20 billion by 2018. . Google Hits of mHealth > 2.2M @ May, 2017 REF: Ale REF: & Research2Guidance REF: Research2Guidance © 2017 Prof. Robert Istepanian, UK – All Rights Reserved

8 m-Health: The scientific beginningThe first DNA representation of m-health was defined : Istepanian; ‘Mobile computing, medical sensor and communications technologies for healthcare’ – (Istepanian etal , 2003 &2004). WHO; 2011 Medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices’ (WHO, 2011). Ref: Istepanian etal. , m-health; Beyond seamless mobility IEEE Trans. InfomTechnology in Biomedicine, 8(4), 2004 Ref: M-Healh : new horizons for health through Mobile technologies, WHO, 2011. © 2017 Prof. Robert Istepanian,

10 Istepanian curve of m-health development since 2003The development of the business, science and clinical aspects of m-Health 100 m-Health Activity Business D C B Science A Clinical Istepanian curve of m-health development since 2003 © 2017 Prof. Robert Istepanian,

11 m-Health ( smart phone centric ) model From the clinical and global health perspectivesm-Health = Mobile (smart) phone + APP software + User ( patient) + Remote healthcare delivery -provider A literature review cited more than publications on m-Health ( ) Ali EE, et al. BMJ Innov 2016;0:1–8. doi: /bmjinnov e.g. In UK: 100,000 m-Health Apps in the iOS and Android phone market Source: NHS digital; NHS choices, NHS England, 2016 © 2017 Prof. Robert Istepanian

12 m-Health (mobile phone-centric) areas/applicationsCommon m-Health ( smart phone centric) applications m-Health (mobile phone-centric) areas/applications Examples Health and wellness monitoring and disease management Remote patient monitoring and mobile disease management, patient education, mobile EPR & EHR access. Remote diagnostic and treatment services Point-of-care diagnostics, mobile ultrasound and remote diagnostics. Patient education and behavioural change SMS for patient education, appointment and medication reminders. Home and elderly care Ambient Assisted Living, fall detection, m-rehabilitation Public and global health applications Patient education and health promotion, maternity and child health, logistics management, healthcare workforce training Medical training and learning and healthcare workflow processes and management Remote medical education and training for healthcare workers and medical personnel. Primary and emergency care A&E and trauma services, primary care clinics. . REF: Istepanian & Woodward, m-Health: Fundamentals and Applications, 2017 © 2016 Prof. Robert Istepanian, UK – All Rights Reserved

14 Example (s) : M-Health diabetes self management and care model1200 Diabetes m-Health Apps in the ioS and Android markets REF: Istepanian& Woodward, m-Health; fundamentals & Applications 2017 © 2016 Prof. Robert Istepanian, UK – All Rights Reserved

15 Clinical Evidence of m-health diabetes remote monitoring and self managementCase Manager reviews Results / Reports . Real time access to patient diabetic and clinical information Awareness of progress and adjusting care plan between clinic visits if necessary Provide feedback and Advice Patient Education Improves self management Measure the relevant diabetes data © 2017 Prof. Robert Istepanian, UK – All Rights Reserved

16 Review of m-Health for Diabetes Care papers (2010-2015)- 212 articles of m-Health for Diabetes were published ( ) - Only 20 of these were considered robust RCT for this review - 7 of the interventions reviewed showed significant reduction in HbA1c by 0.83% from a base average of HbA1c of 8.9% REF: Mobile phone for diabetes care and self management: Garabedian etal.; Curr Diab Rep; 15, 109; 2015

17 M-Health from the Global health perspectiveMDG4: Reducing child mortality; MDG5: Improving maternal health; MDG6: Combating infectious diseases ( e.g.HIV, Malaria ) REF: Istepanian & Woodward, m-Health Fundamentals, 2017 © 2017 Prof. Robert Istepanian,

18 m-Health stakeholdersPlethora of m-Health ecosystems and business models - The good, the bad and the ugly Users and consumers Medical & healthcare Personnel Healthcare Providers Business and Finance Enterprises Technology and Innovations Policy and Regulatory m-Health stakeholders REF: Istepanian & Woodward, m-Health Fundamentals, 2017 © 2017 Prof. Robert Istepanian

23 The Future of m-Health ( Beyond 2020)Consumer driven m-Health systems Healthcare/Medical driven m-Health systems 5G (Post 2020) and the next Billion users ( 5G Millmeter- Wave Communications) Tactile m-Health Internet M2M The Cloud and m-Health Rising intelligent in Internet Technologies Big m-health Data Analytics © 2017 Prof. Robert Istepanian

24 Takeaways m-health is a transformative healthcare innovation concept that will drive major healthcare delivery changes within the global healthcare systems both in the developing and developed worlds. Major drivers of m-health include for the developed world: Out of control healthcare costs, shift from acute to more preventative care models, and some form of other healthcare models. (ii) A value added reimbursement model to replace the current fee for service model. (iii) More quality and co-ordinated care with cost saving outcomes. (iv) The rise of the ‘consumer’ and ‘ retail’ care models . For the developed and low resource settings: (i) The increasing availability and access to affordable mobile and Internet . (ii) The need for simple and frugal technologies to provide population wide healthcare benefits. (iii) The high demand of healthcare services in remote and isolated areas and the economic drive. (iv) m-health can be the major delivery path of healthcare to the vast majority of people in the developing world with available limited resources and infrastructure. © 2017 Prof. Robert Istepanian

25 Takeaways m-health has been around since 2003, with major successful business and estimated $40 Billion industry by Majority of the innovations in this sector are coming from the developed world. However, major challenges for the developing world include: Appropriate financing models and m-health leadership and vision that are tailored for each country’s healthcare service systems ( Tailored m-health ecosystems) (ii) m-Health education and understanding of the concept fro the full clinical and technological spectrum and not only viewing it from the business perspective (iii) Development of the appropriate m-health policies by the governments. Acceptability by the healthcare providers and change of thinking. Development of frugal m-health system that are tailored to be affordable and not only to adapt the’ iPhone based centric m-health’ model. (vi) The need for ‘ reverse m-health innovation’ i.e. innovations coming from the low resource settings and transferred back to the developed economies (vii) The need for developing patient centric m-health system and not ‘ business centric’ model. (viii) Better m-Health security and interoperability and standardisation and with robust patient privacy regulations. . © 2017 Prof. Robert Istepanian

26 Conclusions: Final Thoughts (m-Health 2.0) new era of m-HealthChallenges: Understanding the asymmetry between ‘ The ‘m-Health business’ v/s and ‘m-Health Science’ - Security and Privacy. ‘ Frugal m-Health Models. Differentiation of the correlation between m-health, and e-Health, telehealth and telemedicine. Standards and interoperability. Behavioural change and patient Long term usage and acceptance Istepanian &Woodward, m-Health- Fundamentals and Applications, 2016 © 2017 Prof. Robert Istepanian

28 www. istepanian.co.uk www.ikhare.co.uk # mhealth2012 Robert www. istepanian.co.uk Robert S H Istepanian https://scholar.google.co.uk/citations # mhealth2012 © 2017 Prof. Robert Istepanian, UK – All Rights Reserved

Professor Robert S. H. Istepanian

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