Making mHealth work: Will the expectations meet the realities?

Albert Shar

I don’t know of an area in health that has generated more excitement about its potential than mHealth. There is something magical that happens in discussions about mHealth. People start to believe in all of the wonderful things that a phone, together with the right gadget, can do – remind me to take my medicine, monitor my vitals, inform my doctor when something goes wrong and just plain keep me healthy.

At the Pioneer Portfolio at the Robert Wood Johnson Foundation, we have been involved with mHealth for quite a while. We funded the first mHealth Summit in 2009 because mobile health, conceptually, had the power to positively disrupt health and healthcare; it also seemed to have a connection to a few of our Project HealthDesign grants. Then came our involvement with and support of Quantified Self, Open mHealth, the 2011 Stanford Mobile Health conference and the mHealth Evidence workshop. Other programs – such as our national program Health Games Research, the Games for Health Conference and the MIT Reality Mining meeting that we funded in 2009 – also have strong mHealth associations.

But with all that excitement, I think there needs to be a note of caution. Are we constructing a bubble of expectation that will pop, leaving the field in disarray? That would be a tragedy, because there is so much potential good that can come from mHealth.

For the good to be realized, however, it’s essential that there be a way to understand how mHealth innovation works in a positive way. I think the data collected needs to be replicable (in the way, say, my bathroom scale keeps giving me the same, discouraging results), presented in a way that’s easy to understand and actionable and, most of all, that it does some good. There needs to be some credible evidence that the innovation can make people healthier. This last area is fraught with complexity. The randomized controlled trial (RCT) is often seen as the universal and exclusive gold standard for evidence. There is a large and growing collection of scientifically valid alternatives to the RCT that are slowly gaining traction, but that’s only part of the problem. Knowing that something can work doesn’t mean it will be used. And an unused miracle intervention is of no value.

So while it’s important to grow mHealth for all it can do, we have to also focus on showing that it will work and actually will get used. Separating the wheat from the chaff is important, good design is important, but finding useful mHealth interventions that will actually make a difference in improving health and healthcare is essential. We’ve begun the process of making mHealth work through our sponsorship of the NIH mHealth Workshop. We continued the process in our special session at the 2011 mHealth Summit, and will be continuing this in future work. The long-term health of the field (and the health of people) depends on this.

Albert Shar, PhD, is vice president and program officer for the Pioneer Portfolio at the Robert Wood Johnson Foundation (RWJF). RWJF’s mission is to improve the health and healthcare of all Americans, and the Pioneer team seeks bold ideas that push beyond conventional thinking to explore solutions that will transform health and healthcare.