Wishing You a Safe and Happy Festive Season

Wishing You a Safe and Happy Festive Season

William Yan, Dr¹

¹Senior Editor, Journal of Mobile Technology in Medicine

Journal MTM 6:3:1, 2017

doi:10.7309/jmtm.6.3.1

The era of automated systems to facilitate health care

Rahul Chakrabarti, Dr¹

¹Chief Editor, Journal of Mobile Technology in Medicine

Journal MTM 5:2:1, 2016

doi:10.7309/jmtm.5.2.1

Dear Readers,

7^th July, 2016

It is with great pleasure that we present the second issue of the Journal of Mobile Technology in Medicine for 2016 with excellent examples of translational mHealth research. One of the great challenges confronting global health care is accessibility and affordability to diagnostic technologies and timely referral to specialist services.

In this issue, Ludwig et al provide a brief overview of the existing technologies available to aid automated diagnostic and referral in the field of the ophthalmology. The authors provide a summary of a potential pathway for automated ophthalmic care through the use of mobile diagnostic devices that can facilitate image collection. The first step in the clinical algorithm is safe and accurate image capturing technologies. The authors highlight examples of mobile diagnostic adapters developed by the Peek Vision group (UK), D-eye system (Italy), and iExaminer (Welch Allyn) which convert the modern smartphone into an anterior and posterior segment image capturing device. These images can then be collated, filtered for quality, and interpreted by automated software and results can, in theory, be graded in real-time to provide risk stratification and triaging of patients.

Whilst the concept of automated diagnostics in ophthalmic care is not new, the challenge over the last 20 years has been to develop algorithms that meet sensitivity and specificity criteria to be safe for day to day real world clinical practice.¹ Ludwig et al succinctly illustrate examples whereby the two common modes of automated image analysis, neural networks and deep learning are now meeting the level of reliability and reproducibility for safe clinical practice. Importantly, Ludwig et al highlight examples of the utility of automated grading technologies developed for two of the most common, yet insidious causes of global vision loss, glaucoma and diabetic retinopathy.

The evolution of automated diagnostic technologies now truly positions health care in the 21^st century to reach and provide care to a greater population breadth than ever before. The benefits of such technologies will always be balanced by the caveats of the necessity for clinical correlation by a specialist or appropriately trained medical professional, the costs of equipment, and the need for further evidence in larger population based studies. This is particularly poignant for automated software based learning. Nevertheless, there is a clear value in ability of these technologies to facilitate early diagnosis, triaging and timely referral of patients in rural and remote and low-resourced settings, where the greatest burden of global morbidity exists.

Reference

1. Gardner GG, Keating D, Williamson TH, Elliott AT. Automatic detection of diabetic retinopathy using an artificial neural network: a screening tool. The British journal of ophthalmology. Nov 1996;80(11): 940–944.

The era of tailored mHealth

Rahul Chakrabarti, Dr¹

¹Chief Editor, Journal of Mobile Technology in Medicine

Journal MTM 5:1:1–2, 2016

doi:10.7309/jmtm.5.1.1

Dear Readers,

It is with great pleasure that we introduce the first issue of the fifth volume of the Journal with a diverse range of papers that illustrate the broad engagement of mobile health technologies to target the spectrum of socioeconomic groups in society. Currently the mHealth developers stand at the precipice of the greatest rate in growth of mHealth related apps. Results published in the mhealth App Developer Economics Survey in 2015 showed that the number of mHealth apps has now exceeded 165,000.¹ However, with only 5 per cent of apps being developed from Africa and South America combined (compared to 72% from Europe and North America) there clearly remains a challenge in developing and implementing apps for low-resource settings.

Virtual Environments in Modern Medicine

Dr. Rahul Chakrabarti, Dr. Chandrashan Perera

Journal MTM 4:3:1, 2015

doi:10.7309/jmtm.4.3.1

Dear Audience,

It is with great pleasure that the editorial board presents in the third issue of the Journal for this year a glimpse of the potential for virtual reality (VR) environments in patient care. In the current issue, Lehman¹ and colleagues discuss the current capabilities and limitations of virtual reality environments in assessing the safety of patients in a spectrum of “real-world” settings. The authors highlight poignant examples of VR in simulating complex tasks of personal and social activities of daily living such as shopping, behavior control, memory and attention. Whilst these examples give a glimpse of the current capacity of VR, there remain questions regarding the validity and sensitivity of methods to test these applications. As discussed by the authors, the major foreseeable challenge is the ability of VR devices to remain sensitive to the tasks performed, whilst having the external validity to test the device against a broad range of contexts and situations.

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Mobile health at the forefront of translational research

Rahul Chakrabarti

Journal MTM 4:2:1, 2015

doi:10.7309/jmtm.4.2.1

Dear readers,

It is with great pleasure that we present the second issue of the Journal for the year. The current issue highlights excellent examples of the capacity for translational research in mobile health. Fundamentally, the concept of translational research refers to the evolution of “bench to bedside” care. In the past the concept has referred to the application of knowledge attained through basic science research to improving clinical outcomes for patients. In this context, mobile technologies such as smartphones and tablet devices with their increasing accessibility and user-friendly interfaces have a great potential to demonstrate clinical benefits.

Smith et al demonstrate the ability of mobile technologies to improve quality of care through facilitating clinician-patient interaction. In their proof-of-concept study, the authors demonstrate that barriers to clinician-patient interactions can be overcome with video-conferencing using tablet devices. Using the example of patients with short bowel disorders receiving home parenteral nutrition, the authors demonstrated that home-based video conferencing was feasible, and received well by patients and their families in the daily management of chronic disease. Furthermore, the scheduled videoconferences provided an out-of-hospital forum for clinicians to monitor the symptoms, clinical parameters, and examine potential clinical risks including intravenous line sites for infection. Whilst the authors acknowledged obvious limitations of internet connectivity and privacy, overall the study showed that this modality of clinical interaction clearly has a role for chronic disease management. This particularly poignant to the management of conditions whereby patients often have prolonged intervals between scheduled hospital outpatient follow-up during which potentially avoidable complications occur necessitating hospitalization.

Over the past half decade, governments and health policy makers have mandated the imperative for research institutes to focus on translational research. The United Kingdom has invested 5 billion Pounds to establish translational research centres, mirroring 6 billion Euro by the European Commission for translation health research.¹ Mobile technologies stand at the forefront of effective translation of the application of novel devices to facilitate and enhance patient care. As demonstrated in the current issue, the applications of translation research in mHealth are varied and diverse. Continued engagement of commercial, government and private stakeholders are required to keep up the momentum in ensuring these technologies are safe, reliable, accessible and affordable, particularly to those in low-resource settings, where the greatest growth potential rests. Only then will we have realized the potential of translational research in mobile health.

References

1. Woolf SH. The meaning of translational research and why it matters. Jama 2008;299(2):211–13.

JMTM Editorial Volume 4 (2015) Issue 1

Rahul Chakrabarti^1,2

¹Chief Editor, Journal of Mobil Technology in Medicine; ²Ophthalmology Registrar, Royal Victorian Eye and Ear Hospital, Melbourne, Australia

Journal MTM 4:1:1, 2015

doi:10.7309/jmtm.4.1.1

It is with great pleasure that we present in this first issue of 2015 a compendium of publications outlining the global impact of mHealth applications, particularly in developing countries.

The perspective piece by Germann and Franz articulates the challenges that need to be met in order for mHealth to be utilised and upscaled in low resource resource settings. Whilst low-resource countries clearly have great potential to benefit from expansion of mHealth applications, the authors outline key barriers for mHealth expansion in developing regions. They highlight the imperative for strong governance. Critical elements identified include appropriate planning, consideration of feasibility, strengthening private and government partnerships in mHealth projects, and ensuring there is a dynamic auditing process that can record the effectiveness and identify areas for improvement during a project. The authors cite the example of ‘mTrac’, an e-Health initiative overseen by the Ugandan Ministry of Health which is a central auditing and data collection tool to monitor community based projects within their country. The tool is intended to assist in collection, verification of quality and reliability, and ultimately in analysis of data collected across mHealth projects. Whilst the tool is being disseminated in preliminary phases across the country, it demonstrates a change in paradigm particularly from within low-resource countries to improve quality and rigour of data collection and analysis.

Whilst there is an escalating demand for mHealth, the emphasis must now shift to quality of evidence rather than quantity. This is particularly important given it is these low-resource areas where there is a clear demand for data regarding effectiveness of mHealth interventions yet a definite paucity of high quality evidence.¹ The publication of Germann anf Franz echo similar themes highlighted previously in our Journal by Bullen regarding the importance of planning, consideration of local factors affecting feasibility, and the tantamount importance of governance in the success of translating mHealth initiatives to real-world functional projects.² Similarly, an independent report conducted by Price Waterhouse Coopers on the emergence of mHealth outlined that the key principles for upscaling mHealth included finding applications that bring concrete value to stakeholders, the imperative to engage multiple stakeholders at a national level, and to focus on solutions rather than technology.³ Thus, in order to realise the full potential of mHealth there must be a weight of high quality evidence in order to engage the attention of government and non-government investors, and most importantly, patients and communities.

References

1. Free C, Phillips G, Watson L, et al. The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS medicine. 2013;10(1):e1001363.

2. Bullen P. Operational challenges in the Cambodian mHealth revolution. Journal of Mobile Technology in Medicine. 2013;2(2):20-23.

3. Emerging mHealth: Paths for growth. Price Waterhouse Coopers;2012.