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