Top Ten Lessons Learned on mHealth

In the past 10 years I have witnessed a shift in the mhealth industry from solutions in search of problems, to a real demand for mHealth from within the health sector.  During this time, my research and work has taught me the art of capitalization—It’s critical to capitalize on what others have already accomplished, and build on existing work, information, and communication flows and practices.  By all means, do not reinvent a mobile application if there is already one that does what you would like it to do.

In preparation for my panel discussion at the mHealth Summit, I decided to take a page out of the play book of one of the God-parents of mHealth: Holly Ladd from AED SatelLife in conjunction with David Letterman, to come up with my “Top Ten mHealth Lessons Learned List.”  As with most things that I do and advocate for as a medical anthropologist by training and spirit, I engaged 20 mHealth colleagues in a free-list exercise of their top three lessons learned, and then mapped them against my own top ten list. Here is the outcome:

Number 10: We must try to unpack the pathways to mobile-mediated behavior change.  Just because you send one million text messages does not mean that people are living their lives any more healthily.  In mHealth, we need greater consensus on the research agenda and a move towards standardized metrics and methodologies to evaluate impact.

Number 9: We need more locally generated content.  Adapting content for mobile phones is much more than reformatting. It requires fundamental rethinking, paring down, and testing with target audiences.

Number 8: We need to move away from research that focuses on user satisfaction and towards research that evaluates the impact of mHealth on health outcomes.  We also need to start setting some targets and benchmarks within mHealth programs and track progress against them with our own tools.

Number 7: Be realistic. Be realistic about the upfront and recurring costs needed to support mHealth, and don’t underestimate the human resources needed to deploy, use, and maintain mHealth applications. The demands within the health system and available technologies are changing rapidly, and one needs to build on the past while planning for the future. Be aware of the devices and technology available today, but plan ahead for what may be available tomorrow.  Stay flexible.

Number 6: Invest in participatory design processes.  Actually involve the end user as well as all stakeholders that may be affected by the deployment of new technology or the data it captures and generates.  If you just pay lip service, people can tell!  User-centric design will generate better applications and greater buy-in during implementation over the short and long-term.  Invest in local capacity building by training and hiring local developers.  This will promote sustainability and adaptation to the evolutionary changes in technology and priorities.

Number 5: Take a “systems thinking” approach.  We need to move from single focus/single function solutions to an examination of the entire health system and determine where technology can be leveraged to strengthen it, even if the deployment is done in a step-wise fashion.  mHealth needs to move to a greater state of open-ness: open source, open standards, open APIs, open collaborations, and transparency with governments and other members of the mHealth ecosystem.

Number 4: Collaborating is more fun than competing.  It isn’t about applying for joint funding, it’s about actually working together.  In the end, we can’t do it all by ourselves.  The whole is greater than the sum of our parts.  We need to reduce duplication of efforts and the thousands of applications that do the same thing and move towards interoperability.  Open Source and collaboration reduce the risk of failure.

Number 3: By all means recycle, re-use, repurpose!  Understanding all the existing platforms and working on the most advanced, relevant, and proven ones is much more productive than creating a new platform. Build out what additional functionality is needed as this will also contribute to a larger community than one’s own individual needs.  Adopt best practices from past deployments. Share successes, failures and bumps in the road.  Learning from the past and each other is key; otherwise, we will keep spinning our wheels without making progress.  Claims of success need to be validated before donors and/or governments continue dumping money into them.

Number 2: mHealth at scale will only come from government ownership and meaningful engagement with the private sector.  Countries and donors need to support the development of strategies, policies, data and interoperability standards that will drive the additive impact of mHealth. Involve the Ministries of Health from the start of your work in any country.  In addition, work with governments to become smart consumers and industry to become smart producers of mHealth.  Support the strengthening of independent ICT review capacity within the health system.

Number 1: It is not about technology; did I mention that it’s not about technology? There is no such thing as one system to rule them all. It’s about process , people and a bit about software.  Think about the problems you are trying to solve. Technology is an enabler, but it is one part of a much larger puzzle.  It cannot be about technology for the sake of technology.

When all is said and done, we (all 6 billion of us) will benefit if we get this right, either as individuals maintaining our well-being and state of health through mHealth or as a patient with access to the right tools at the right time that can make a diagnostic and treatment experience that much more effective.

Many thanks to the writing team of Peter Benjamin, Erica Kochi, Rose Donna, Bruce MacLeod, Andrew Marder, Matt Berg, Ben Nemser, Jorn Klungsoyr, Hajo van Bejma, Casey Iiams-Hauser, Albert Lui, Heather Cole-Lewis, Nadi Kaonga, Olivia Velez-Benenson, Tamsyn Seimon, Eduardo Jezierski, Jonathan Jackson, Neal Lesh, Chris Fabian, Merrick Schaefer and the many others whose work I have gleaned wisdom from over the course of the past 10 years.  It truly has been an amazing journey of collaboration and fun.