Global health workers in developing countries frequently find insufficient communications infrastructure available but Johns Hopkins University’s Electronic Mobile Open Source Comprehensive Health Application or eMOCHA is working to bridge these gaps. eMOCHA is designed to assist health programs in developing countries improve provider communication and education as well as provide better patient care by coordinating wireless devices with local server-based clinical training and patient care support services.
Dr. Robert Bollinger, a Fogarty Informatics grantee and his team have been trying to create tools for distance learning programs in low resource settings in India and sub-Saharan Africa. Though many of the platforms developed so far have been based on older technologies, eMOCHA relies on the use of mobile phones to transmit and receive instructional data.
Uganda has good communication access with powerful 3G capacity in 80 percent of the country. This coverage is particularly well suited for mobile health training projects so that large files such as databases and videos can be sent. The eMOCHA platform is being used by PEPFAR and connects 17 partners throughout Uganda.
The program’s nerve center at Mulago hospital in Kampala has a group of local experts, a server base, and a decent fiber network. If the programs aren’t having an impact, according to Dr. Bollinger, the Mulago team responds by pushing out new training data to the phones and then the cycle starts again. The team is building a toolbox of different tools for distance learning including eMOCHA, but the ultimate goal is to hand off that toolbox to the people in India, Uganda, and other places.
However, questions have been raised concerning the sustainability and scalability of mobile platforms that must be addressed along with concerns about the compatibility needed among various operating systems. One of the most important compatibility issues is the tendency of cell phone and PDA manufacturers to require specialized chargers for each of their devices.
Another concern is that while some pilot programs are technically innovative, they may not be well suited for large scale implementation because of costs, logistical concerns, or copyright issues. Some projects involve the use of both open source and copyrighted software and this makes them less attractive options for some countries.
Security, privacy, and other ethics related issues are also emerging as mobile health platforms become more commonplace. Market forces and the secure management of data often is a problem for cell phones users. Since cell phones are recycled annually with many villages sharing phones, this means that underserved populations are especially at risk for the theft or misuse of medical data. However, most experts agree that patients in low and middle income countries would probably choose the benefits of mobile health over secure data.