The strongly emerging sector of healthcare is quickly becoming a topic of national and international organizations. It is being examined from business, regulatory, and healthcare stakeholders. As with all new types of technologies that are being considered by payers, patients, and providers, the questions that arise most are “Is this going to improve healthcare?” and “Is there anything showing that this product is effective?” The HHS received a set of recommendations from the Text4Health Task Force regarding text messaging as a healthcare tool. This was discussed in a previous post by this author (http://davidleescher.com/2011/09/22/clinical-studies-highlighted-in-hhs-task-force-recommendations-for-mhealth-text-messaging/).One of them was “to establish plans for evaluation and implementation.”
The World Health Organization recently held a Global eHealth Evaluation Meeting in Bellagio, Italy. Some of the core principles laid out at were:
- Evaluating eHealth both demonstrates its impact and fosters a culture that values evidence and uses it to inform improvements in eHealth deployments.
-To ensure the greatest benefit from eHealth and enhance sustainability and scale, eHealth evaluations should recognize and address the needs of all key constituencies.
-Evidence is needed to demonstrate costs and benefits of eHealth implementations, and maximize eHealth’s beneficial impact on health system performance and population health.
-The value of a complete evaluation program is enhanced through research that is attuned to the differing requirements throughout the life-course of the project, whether at needs assessment, pilot-, facility level-,regional and national scale-up stages.
-Independent and objective outcome-focused evaluation represents the ideal of impact evaluation.
- More investment in rigorous evaluation studies and capacity building is needed; adequate resources in every eHealth funding stream should be committed to evaluation.
It is clear that not all wireless technologies require rigorous studies. However the issue of clinical studies still arises. Studies, although not mandated by the FDA for approval, act as evidence of efficacy that a consumer or payer will ask about. When there are many products have the same focus for disease management, it is natural to question comparative effectiveness. Studies need not all be at a peer-review journal or NIH level, nor recruit many hundreds of patients. Reducing these products, which will be purchased by hospitals, payers, and others at large expenses, to “Take my word, this works” is doing a disservice to the consumer/patient, potentially the taxpayer, and to the mHealth industry itself. Surely it will add some costs, but in the end, it will pay off.
Globalization of healthcare is happening now and mHealth technologies is both helping and benefiting from this (see http://davidleescher.com/2011/11/17/mhealth-and-globalization-of-healthcare/). We should therefore not discount recommendations by the WHO. For a complete copy of the Bellagio report, see http://www.ghdonline.org/tech/resource/call-to-action-on-global-ehealth-evaluation/.
