Letter from the Secretary General and Editor-in-Chief

Dear Reader,

In just two more years, people will access the Internet from their cell phones more often than from their PCs. Now that some of the early challenges such as compact-format data, data synchronization, and secure data transmission protocols have been met, patients and providers are looking to cell phones as a cost-effective delivery system to manage a variety of chronic conditions, including mental disorders.

Mobile health is variously known as mHealth, ubiquitous or pervasive healthcare computing, “edge” care (care in homes, workplaces, or mobile environments), or personal health systems. To be sure, health providers have been using handheld technology for almost 15 years to manage patients at nonclinical sites. Four years ago, the European Commission convened a Personal Health Systems conference, which attracted 400 participants. What is new in 2011 is the move to empower patients by putting mental health applications on their cell phones.

In an overview of the potential for wireless mental health monitoring, Varshney (2009) proposes that certain mental health conditions – such as posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, eating disorder, and major depression — are particularly well suited to remote monitoring. A context-based algorithm could be used, for example, to weight activity monitoring and sleep monitoring variables that might suggest the possibility of PTSD.

The U.S. Army is made up of 86% males, and 68% of soldiers are less than 29 years of age – the profile of the typical smartphone user. The RAND study found that 14% of Operation Enduring Freedom/Operation Iraqi Freedom veterans screened positive for PTSD, 14% screened positive for major depression, and 19% reported a probable traumatic brain injury during deployment. The use of smartphones is perceived as a way to overcome the stigma attached to seeking mental healthcare for this highly mobile, computerliterate population. In addition to scheduling and reminder capabilities, smartphones are evolving into devices capable of delivering podcasts, engaging patients in game-like simulations, and providing automated assessments and other evidence-based tools. Smartphones can provide immediate self-management of mild symptoms, as well as immediate two-way contact with support systems during crisis.

In the U.S., insurance reimbursement is the biggest barrier to adoption, with Food & Drug Administration regulations, liability questions, and an entrenched healthcare establishment, among other barriers. Conversely, mHealth enablers include the rise in the number of smartphone users, nextgeneration wireless chips that will make healthcare delivery more seamless, algorithms enabling richer and more useful data sets, and the government’s interest in wireless health. Indeed, support for wireless mental health was originally included in President Obama’s healthcare plan.

Europe was ahead of the curve on mHealth, and today the European Union is supporting research into personal health systems under the Seventh Framework Programme (FP7). The U.S. is catching up quickly, convening a Digital Health Summit at the January 2011 International Consumer Electronic Show. Today, there are about 5,000 health-related applications for smartphones.

In both Europe and the U.S., the cost of caring for aging populations is a driver of mHealth. The total cost of chronic diseases in the U.S. is more than $1.4 trillion. By 2014, using mHealth, public and private payers may save up to $6 billion.

A recent report summarizes: “This new approach to healthcare will reduce financial strain throughout the system (providers, payers, and patients) while promoting far better overall health. In practice, edge care will enable better preventive care so that many patients will avoid major problems altogether. Patients will be far more knowledgeable about their own health status, and empowered and motivated to maintain their health. All of this should lead to greatly reduced spending while providing improved patient outcomes.”

I invite C&R readers and researchers to look at the cell phone in your hand and embrace it as an extension of your arm, enabling you to begin to change eHealth into iHealth, truly individualized healthcare.

Create your own reality!                                                                                                   Brenda Wiederhold