The Journal of mHealth Vol 1 Issue 1 (Feb 2014) - Page 36

EPHA Briefing on Mobile Health mHealth faces multiple barriers to full-scale implementation Nine key barriers to implementation of mHealth identified by the WHO Share of countries listing barriers as important 60% 50% 40% 30% 20% 10% 0% Priorities Knowledge Policy Ecosystems barriers Regulatory/policy barriers Cost Effectiveness Legal Operating Costs Demand Technical Expertise Infrastructure Other Source: WHO, BCG Report 2012 Continued from page 33 health decision-making requires more than raw data, including information obtained from face-toface contact that can put the data into context, which is unique for each individual. [29] What is more, the evidence base for mHealth needs to be further developed. As noted in a study by the European Connected Health Alliance (ECH Alliance), more data is needed to demonstrate that mHealth scenarios do, in fact, lead to improved health system performance, improved health status and health-related quality of life for older people.’ [30] In this context health technology and impact assessments will be important to determine whether investments in mHealth technologies are worthwhile in the long term. As any area in healthcare, mHealth is also open to abuse. For example, under the banner of ‘wellness apps’ are products promising better health outcomes (e.g. weight loss, smoking cessation, stress re- 34 February 2014 duction), which are not backed up by evidence. Implementation Challenges The World Health Organization (WHO) has identified nine key barriers to the implementation of mHealth. They are divided into two groups –ecosystem and regulatory/policy barriers. As shown in the graph below, competing priorities and lack of knowledge are the top challenges for mHealth diffusion. Due to the lack of a strong evidence base to back up its impact on health outcomes, about half of the responding WHO Member States reported competing priorities as their main obstacle. mHealth programmes require evaluation so that policy-makers, administrators and other actors can base investment decisions on facts. [31] Policy Issues Effective and coherent policymaking will become important as mHealth matures. As mentioned before, a key obstacle is lack of access to fixed and mobile broad- band coverage for health providers and individuals, particularly in rural and peripheral areas. Reimbursement policies will also require adjusting given that remote care and treatment [32] will become more relevant with the transposition of the Cross-border Patients’ Rights Directive. Furthermore, technology changes faster than the legal regulatory framework it is situated in. mHealth is situated in a complex policy and legal environment; the boundary between eHealth and medical devices needs to be clearly defined given that the latter are increasingly digital and integrated into eHealth. One potential way forward would be to maintain a clear focus on technical and data interoperability and to ensure that the eHealth Task Force recommendations [33] are implemented, e.g. by developing policies that are aligned with the technological demands of mHealth. [34] Data protection and patient safety are particularly important in healthcare. The security of personal information entered, transferred