The Military Health Service (MHS) is taking a strong look at international medical outreach efforts to see how the military can improve public health in the Third World by using cell phones. There are a handful of DOD funded mobile health or mHealth projects now underway with several more being discussed. Some projects are aimed at promoting health for service members returning home while other projects are focused on building up global medical capacity.
“Over half the world owns a cell phone and only 400 million own a computer, so it is only a matter of time before everyone uses a cell phone for all their computing needs,” said Colonel Ron Poropatich M.D., Deputy Director of TATRC at Fort Detrick Maryland. He continued to point out that the tremendous health needs in developing countries are creating the “perfect storm” for the need to use this inexpensive technology to deliver care.
Colonel Poropatich said “mHealth can be used for clinical consultations, education, research, biosurveillance, and disease management. For example, DOD is doing ongoing research at Walter Reed Army Medical Center’s Diabetes Institute. The researchers are using internet-enabled cell phones to pull up 15 to 30 second video clips to provide diabetics educational content on exercise, blood glucose monitoring, and diet.
All 170 diabetics enrolled in the study received the phones, but only half were sent the daily video clips. The first three months of study showed that the subjects in the intervention group viewed the daily reminders about half of the time, and those diabetics who do view the reminders had reduced hemoglobin A1C blood sugar levels and improved glycemic control.
The plan is to target Community Based Warrior Transition Units (CBWTU) providing outpatient care to the Army National Guard and Reserve members with TBI after they are released from inpatient medical facilities. Soldiers suffering with TBI can suffer from a wide variety of functional limitations and these limitations can interfere with their ability to manage their care.
Through the program, each eligible soldier coming into one of the designated CBWTUs will be given a personal cell phone upgraded with the mCare application. Once upgraded, the phones will receive text messages with information on new treatments, program information, and appointment reminders. Even with the special software, cell users must open the secure application by entering a password before being able to access appointment reminders, as well as to obtain health and medical information that is specifically geared to their treatment plan.
The first phase of the CBWTU project will send out text messages to the member’s cell phones and will include educational announcements, sleep hygiene measures, medication and appointment reminders, and helpful hints tailored to unique problems the service members face with TBI.
International mHealth efforts include a project in Peru being carried out by DOD’s Global Emerging Infections System (GEIS) in conjunction with the Navy Medical Research Center in Lima and also with the Peruvian military. The project is using cell phones for biosurveillance detection to send out alerts about suspected emerging infections.
“There are however challenges using mHealth internationally in the developing world. There are many languages that require translation and also illiteracy issues will have to be overcome. It is also important not to encroach on the State Department and the USAID efforts”, said Poropatich. “We need to work with USAID and the host country’s Ministry of Health to give them the server so that they can coordinate with the phone company.”
Poropatich said that in the future, the use of mobile phones could be expanded to help in maternal and child healthcare, for clinical consultations where pictures could be exchanged between providers and the patient, and for biosurveillance research. It also can be used for medical logistics so that information can be uploaded on the quantity of medication stocks to help supply chain personnel know when to resupply medications.
As new mHealth technologies are developed, a major issue will be cost. “The problem is that it becomes very expensive to use proprietary software,” Poropatich said. “We’re beginning to dialogue with organizations to develop open source software.”