The Journal of mHealth Vol 1 Issue 3 (June 2014) | Page 9

Deploying mHealth: Overcoming Barriers to Adoption
technical/maintenance contracts, training provision, and regulatory adherence,
all of which further complicate deployment and lead to additional management
tasks within the organisation. That said
by implementing a digital commissioning strategy, much of the bureaucracy
can be standardised, and the overall
process streamlined to encourage more
rapid adoption.

LIABILITY AND LEGAL
IMPLICATIONS
The legal and regulatory landscape surrounding digital and mobile
health solutions is still
very much in its
infancy, leaving
considerable
uncertainty
for care
providers and
solution
developers.
At present
this
means many
solutions are
potentially being
deployed
without
the necessary regulatory
oversight to ensure that they are
fully fit for purpose.

Problems arise when there is a need to
change workflows and clinical pathways
in order to incorporate the technology.
When solutions are considered from
this context, the short-term expenditure
necessary for implementation e.g. equipment, staff training, policy changes, and
changes to working practices are often
viewed by commissioners as prohibitive,
rather than as precursory enablers of
long-term investment.
The only way to change this perception of cost, is to introduce policy that
encourages the use of innovation, whilst
accepting that initial investment needs to be weighed
against longer term
returns. A number
of western countries have begun
to adopt this
outlook, but
it
requires
vision from
multiple
stakeholders
throughout the
healthcare system hierarchy, initiated at government
level, to successfully
ensure that the cost implications are acknowledged.

Potential
patient safety,
economic and
reputational damage
may arise if organisations
lack appropriate
security and privacy
controls.

Where a solution has been designed
to deliver clinical monitoring, analysis, and/or insights then it is vital that
the technology is reliable and effective.
This necessitates a robust testing and
quality control strategy, as well as significant multi-agency regulatory oversight. Should a solution fail to perform
as designed then the question of where
liability falls is questionable, i.e. the care
organisation or the developer.

COST IMPLICATIONS
The implementation of mobile digital
solutions is often seen as a double-edged
sword when it comes to the issue of
costs. Many of the solutions that are currently in use, or which are being developed, promise to significantly reduce
the costs of delivering healthcare. This
means that they are attractive to providers and payers, as a means of containing
expenditure.

HEALTH ECONOMICS
In a similar manner, the way in which
provider reimbursements are handled
also need to be assessed, in order to
accurately calculate the value of mobile
digital health solutions. Many secondary
care organisations around the world are
reimbursed for their services, either by
central funding or insurance payments,
based upon the number of patients they
treat, as well as a number of key, care
quality, criteria. At present, many of these
methods for calculating reimbursements
are actually prohibitive of digital health
solutions, despite their ability to improve
patient outcomes, reduce hospital visits
and reduce readmissions. By keeping
patients in their homes for longer or by
treating them away from traditional care
environments, digital solutions actually
reduce the number of patients that are
physically coming through the doors of
hospitals. Outdated reimbursement tariffs can sometimes then fail to acknowl-

edge that treatment has been provided.
This is a barrier that can be easily overcome, through central initiative, in order
to invoke new ways of calculating the
health economics of mobile digital
health solutions and integrating them
into a fair method of reimbursement.
In turn this would facilitate the commissioning process and significantly accelerate the rate of adoption.

GOVERNMENT POLICY AND
PAYMENT
Never in human history has the general
health of most ordinary people been better than it is now. But paradoxically, there
can scarcely ever have been a time when
health care has been a more difficult
political problem for the governments
of advanced countries than it is now. It
is precisely because of the advances in
the treatment of disease that the role of
government has become so contentious.
With the scope for life-prolonging medical intervention now virtually limitless –
and thus spending on it being potentially
limitless as well – there are moral and
practical questions about its availability
and distribution which every democratic
society has to address.
The task for government is to balance
the distribution of all healthcare solutions including digital to ensure that
resources are well distributed, and access
to services is equitable.

REFERENCES
1. Global health care outlook – Shared
challenges, Shared Opportunities. Deloitte
Report 2014
2. Patterson ES, Et al. 2002. Improving
patient safety by identifying side effects from
introducing bar coding in medication administration. J Am Med Inform Assoc; 9: 5, pp.
540–553
3. Kushniruk A, Et al. 2004. The relationship of usability to medical error: an evaluation of errors associated with usability problems in the use of a handheld application
for prescribing medications. Studies Health
Technol Inform; 107 (Pt 2), pp. 1073–1076
4. Buijink AW, Et al. 2013. Medical Apps
for Smartphones: Lack of Evidence Undermines Quality and Safety. Evidence-Based
Me