This document discusses mobile health (mHealth) and the use of mobile technologies to support health and wellness. It provides context on the digital divide being smaller for mobile phones than the internet. Mobile phones are described as cost effective and able to reach diverse populations. The document then outlines drivers of mHealth including rising healthcare costs, advances in wireless technology, and a need for personalized medicine. Examples of mHealth apps are provided for areas like clinical references, diagnostics, treatment, public health, and disease management. Research findings on texting improving health outcomes are also summarized.

1. E. Rachel Mutrux
Director, Missouri Telehealth Network
Operations Director, Missouri HIT Assistance Center
State Director, Heartland Telehealth Resource Center
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2. Jama, 10/24/2013 definition:
“use of
mobile telecommunication technologies
delivery of health
care and in support of
wellness”
for the
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3. Mobile Phones & Smart Phones
1. Digital divide is smaller for
phones than for Internet
2. Mobile phone technology
easier/cheaper to roll out to
large areas than fixed
technologies
3. Mobile phones immune to
social prejudices
Male/female;
rural/urban;
young/old
Cost effective & cost saving
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4. Dr. Sebelius lists 3 forces driving mHealth
1. $$- unsustainable cost of healthcare
2. Wireless & technology!!
3. Need for individualized medicine
Per capita spending on healthcare, Kaiser Foundation
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5.  Measurement
 Tracking- diet, exercise
 Blood sugar, blood pressure
 Diagnostic
 Portable imaging
 Sensors
 Treatment
 Chronic disease management
 Remote clinical trials
 Comprehensive
 Dissemination of health information
 Disease surveillance
 Prevention & Wellness
interventions
 Education & awareness
 Helpline
Klasnja, P., & Pratt, W. (2012). Healthcare in the pocket: Mapping the space of mobile-phone health interventions.
Journal of Biomedical Informatics, 45(1), 184-198.
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6. 



Nexercise
Free app that tracks exercise- GPS
Uses support system
Allows you to win points- money
 Fooducate
 Scan bar codes to get nutrition
information
 Grades food choices (A,B,C)
 Suggests better alternatives
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7.  Clinical Reference Apps
 The Merck Manual
 WebMD
 Medscape
 Diagnostic Apps
 Mobile MIM- FDA approved for radiology
 AirStrip- Cardiology App- see EKG
 Public Health Apps
 For Cancer prevention- Target Heart Rate
Calculator, Calorie Counter, Cigarette Calculator
 Telehealth Apps
 Videoconferencing
 Tele MDID- developed here at MU!!
 Disease Management Apps
 Asthma
 Crohn’s Diary
 Kidney Diet
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8. Tele- MDID Project
Far Site
Near Site Clinic –
University Hospital

9. The iPad apps were deployed to 10 far sites, as well as MU dermatology
clinics. Pre-launch and post-launch internet-based surveys were
distributed to far site patient presenters and dermatology clinic providers
in 2013.
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University of Missouri Institutional Review Board (IRB) #1207257.

10.  Texting improves health outcomes
 Effective chronic disease management
 Effective self-management of disease and
successful clinical outcomes
 Better quality of life
 Reduction of error
 Better control of infectious diseases in
developing countries.
 Accessibility of healthcare in rural areas.
 Cost effective
 Better medication adherence
 Texting leads to better medication adherence
 Better maternal child health
 Improve attendance to healthcare appointments
**caveat much research was inconclusive showing need for
additional research
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11.  Current reimbursement structure
 Physician concerns
 Reducing face-to-face interaction
 Increased workload
 Security, Privacy
 Under-regulation- Over-regulation
 Safety
 Big-Brother
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12.  Estimated 100,000 apps
on the market today
 Health & Wellness apps
are leading adoption!LoseIt! Fitbit
 Healthcare moving out of
the Dr. office to the
patient
 Improve health, increase
access, decrease cost
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13.  E. Rachel Mutrux
 Phone: 573-884-7958
 E-mail:
mutruxe@health.missouri.edu
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14. Reference List
1)http://www.brookings.edu/~/media/research/files/papers/2012/5/22%20mobile%20health%20
west/22%20mobile%20health%20west.pdf
2)A mobile telephone-based interactive self-care system improves asthma control Eur Respir J
2011 37:310-317; published ahead of print 2010, doi:10.1183/09031936.00000810
3)Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., ... & Haines, A. (2013). The
effectiveness of mobile-health technology-based health behaviour change or disease management
interventions for health care consumers: a systematic review. PLoS medicine, 10(1), e1001362.4)Lv, Y., Zhao, H., Liang, Z., Dong, H., Liu, L., Zhang, D., & Cai, S. (2012). A mobile phone short
message service improves perceived control of asthma: a randomized controlled trial.
Telemedicine and e-Health, 18(6), 420-426.
5) http://www.fiercemobilehealthcare.com/story/texting-improves-health-outcomes-youngasthmatics/2013-05-02
6)http://ebn.benefitnews.com/news/mobile-wellness-apps-increase-employee-engagementdecisionmaking-health-out-2729886-1.html?CMP=OTC-RSS
7) Ryan, D., Price, D., Musgrave, S. D., Malhotra, S., Lee, A. J., Ayansina, D., ... & Pinnock, H. (2012).
Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre
randomised controlled trial. BMJ: British Medical Journal, 344.-Not effective self-management for
asthma.
8) Obermayer, J. L., Riley, W. T., Asif, O., & Jean-Mary, J. (2004). College smoking-cessation using
cell phone text messaging. Journal of American College Health, 53(2), 71-78. Retrieved from
www.scopus.com
9)http://www.ey.com/Publication/vwLUAssets/mHealth_Report_January_2013/$FILE/mHealth%2
0Report_Final.pdf
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