m-Health E-Book

Robert S. H. Istepanian

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: IEEE Press Series on Biomedical Engineering
• Sprache: Englisch

Seitenzahl: 780

Veröffentlichungsjahr: 2016

Beschreibung

Addresses recent advances from both the clinical and technological perspectives to provide a comprehensive presentation of m-Health

This book introduces the concept of m-Health, first coined by Robert S. H. Istepanian in 2003. The evolution of m-Health since then—how it was transformed from an academic concept to a global healthcare technology phenomenon—is discussed. Afterwards the authors describe in detail the basics of the three enabling scientific technological elements of m-Health (sensors, computing, and communications), and how each of these key ingredients has evolved and matured over the last decade. The book concludes with detailed discussion of the future of m-Health and presents future directions to potentially shape and transform healthcare services in the coming decades. In addition, this book:

• Discusses the rapid evolution of m-Health in parallel with the maturing process of its enabling technologies, from bio-wearable sensors to the wireless and mobile communication technologies from IOT to 5G systems and beyond
• Includes clinical examples and current studies, particularly in acute and chronic disease management, to illustrate some of the relevant medical aspects and clinical applications of m-Health
• Describes current m-Health ecosystems and business models
• Covers successful applications and deployment examples of m-Health in various global health settings, particularly in developing countries

Leseprobe

CONTENTS

Cover

Series Page

Title Page

Copyright

Dedication

About the Authors

Foreword

Preface

Acknowledgments

Acronyms

Chapter 1: Introduction to m-Health

1.1 Introduction

1.2 The Concept of m-Health: The Beginnings

1.3 Taxonomy of Telemedicine, Telehealth, e-Health, and m-Health

1.4 m-Health and Digital Ubiquity

1.5 The Paradigm Shift of Mobile Connectivity and m-Health Services

1.6 Impact of m-Health on Cultural, Commercial, and Operational Changes

1.7 Summary

References

Chapter 2: Smart m-Health Sensing

2.1 Introduction

2.2 Fundamentals of m-Health Sensing and a New Taxonomy

2.3 Health and Wellness Monitoring Sensors

2.4 Who is Monitored?

2.5 What is Monitored?

2.6 Wearable Sensors for m-Health Monitoring

2.7 Wearable Fitness and Health-Tracking Devices

2.8 Design Considerations for Wireless Health Sensing and Monitoring

2.9 Diagnostic Sensors

2.10 Prognostic and Treatment Sensors

2.11 Assistive Sensors

2.12 Summary

References

Chapter 3: m-Health Computing: m-Health 2.0, Social Networks, Health Apps, Cloud, and Big Health Data

3.1 Introduction

3.2 The Evolution of m-Health with Web 2.0 and Medicine 2.0: m-Health 2.0

3.3 Mobile Health Applications (m-Health Apps)

3.4 Cloud Computing and m-Health

3.5 m-Health and “Big Data”

3.6 Summary

References

Chapter 4: m-Health and Mobile Communication Systems

4.1 Introduction

4.2 Wireless Communications for m-Health: From “Unwired Health” to “4G-Health”

4.3 Wireless Metropolitan Area Networks for m-Health

4.4 Wireless Local Area Networks (WLAN) for m-Health

4.5 Personal Area Networks (PAN) and Body Area Networks (BAN) for m-Health

4.6 Machine-to-Machine Communications and Internet of Things

4.7 Summary

References

Chapter 5: m-Health Care Models and Applications

5.1 Introduction

5.2 Mobile Phone m-Health Systems and their Impact on Future Healthcare Services

5.3 m-Health for Chronic Disease Management and Monitoring Applications

5.4 Mobile Health for Other Healthcare Services

5.5 Summary

References

Chapter 6: m-Health and Global Healthcare

6.1 Introduction

6.2 m-Health Technologies for Global Health

6.3 Global m-Health Initiatives for the Developing World: Healthcare Challenges and Impacts

6.4 Global m-Health for the Developing World: Barriers and Recommendations

6.5 Summary

References

Chapter 7: m-Health Ecosystems, Interoperability Standards, and Markets

7.1 Introduction

7.2 m-Health Stakeholders and Ecosystems

7.3 m-Health Interoperability and Standardization

7.4 m-Health Markets and Business Models

7.5 Summary

References

Chapter 8: The Future of m-Health: Progress or Retrogression?

8.1 Introduction

8.2 Future Trends of m-Health

8.3 Challenges and Expectations: m-Health “Market” Versus “Science”

8.4 Future m-Health Scenarios

8.5 Summary

References

Appendix

Useful m-Health Online Resources

Index

IEEE Press Series in Biomedical Engineering

End User License Agreement

List of Tables

Table 1.1

Table 2.1

Table 2.2

Table 2.3

Table 3.1

Table 4.1

Table 4.2

Table 4.3

Table 4.4

Table 4.5

Table 4.6

Table 4.7

Table 4.8

Table 4.9

Table 4.10

Table 4.11

Table 5.1

Table 5.2

Table 5.3

Table 5.4

Table 6.1

Table 6.2

Table 6.3

Table 6.4

Table 6.5

Table 6.6

Table 6.7

Table 7.1

Table 7.2

List of Illustrations

Fig. 1.1

Fig. 1.2

Fig. 1.3

Fig. 1.4

Fig. 2.1

Fig. 2.2

Fig. 2.3

Fig. 2.4

Fig. 2.5

Fig. 2.6

Fig. 2.7

Fig. 3.1

Fig. 3.2

Fig. 3.3

Fig. 3.4

Fig. 3.5

Fig. 4.1

Fig. 4.2

Fig. 4.3

Fig. 4.4

Fig. 4.5

Fig. 4.6

Fig. 4.7

Fig. 4.8

Fig. 4.9

Fig. 4.10

Fig. 4.11

Fig. 5.1

Fig. 5.2

Fig. 5.3

Fig. 5.4

Fig. 5.5

Fig. 5.6

Fig. 5.7

Fig. 5.8

Fig. 5.9

Fig. 5.10

Fig. 6.1

Fig. 6.2

Fig. 6.3

Fig. 6.4

Fig. 7.1

Fig. 7.2

Fig. 7.3

Fig. 7.4

Fig. 7.5

Fig. 7.6

Fig. 7.7

Guide

Cover

Table of Contents

Begin Reading

Chapter 1

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m-Health

Fundamentals and Applications

ROBERT S. H. ISTEPANIAN

BRYAN WOODWARD

Copyright © 2017 by The Institute of Electrical and Electronics Engineers, Inc.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey. All rights reserved Published simultaneously in Canada

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Library of Congress Cataloging-in-Publication Data is available.

ISBN: 978-1-118-49698-5

‘Behold, I will bring to it healthand healing, and I will heal them and reveal to them abundance of prosperity and security’

Jeremiah 33:6

‘Mespot,’ to the day when the palm trees will smile again

and

To the centenary of ‘Forget-Me-Not.’

Robert S. H. Istepanian

About the Authors

ROBERT S. H. ISTEPANIAN

Robert Istepanian is recognized as one of the leading authorities and pioneers of mobile healthcare and the first scientist to have coined and defined the concept of “m-Health.” He holds a Ph.D. in Electronic and Electrical Engineering from Loughborough University, UK, and he has held several academic and research posts in the UK and Canada. These included visiting professor at the Department of Electrical and Electronic Engineering, Imperial College, London; professor of Data Communications for Healthcare and founding Director of the Medical Information and Network Technologies Research Centre at Kingston University, London; senior lectureships in the Universities of Portsmouth and Brunel University, UK; and associate professor at Ryerson University, Toronto with adjunct professorship at the University of West Ontario, Canada. He has also held a visiting professorship at St. George's Medical School, University of London, and was the Leverhulme distinguished visiting fellow at the Centre for Global e-Health Innovation, University of Toronto.

Professor Istepanian was awarded the 2009 IEEE award for the best and most cited paper by the IEEE Engineering in Medicine and Biology Society for his seminal paper on mobile healthcare (m-Health) published in 2004. He was also the recipient of the IEE Heaviside Award in 1999 from the Institution of Electrical Engineering, UK. He has led numerous funded multidisciplinary research projects on m-Health, e-Health, and telehealth funded by the UK Engineering and Physical Research Council, the European Commission, the British Council, the Royal Society, the Royal Academy of Engineering, and the Leverhulme Trust, in addition to sponsored projects and clinical trials funded by global telecom and mobile industries.

He has served as the Vice-Chair of the International Telecommunication Union focus group on standardization of machine-to-machine (M2M) communications. He has also served as an expert on numerous assessment and peer evaluation panels on healthcare technology innovations, well-being, m-Health, and e-Health, including the Dutch–Philips partnership program on “Healthy Life Style”, the Science Foundation Ireland Strategic Research Cluster Grants program, the Finnish Strategic Centers of Science, Technology and Innovation, and the Canada Foundation for Innovation. In addition, he has been a peer reviewer for the following UK Funding bodies: EPSRC, BBSRC, Wellcome Trust, Department of Health, Service Delivery Organisation, Health Innovation Challenge Fund, National Institute of Health Research, BUPA Foundation, and Diabetes-UK. Further, he has served on the editorial board of IEEE Transactions on Information Technology in Biomedicine, IEEE Transactions on NanoBioScience, IEEE Transactions on Mobile Computing, International Journal of Telemedicine and Applications, Journal of Mobile Multimedia, and Journal of World Medical & Health Policy, and as guest editor of the first two of these journals.

Professor Istepanian has served on numerous IEEE committees and chaired organizing and technical committees of national and international conferences in the United Kingdom, the United States and elsewhere, including the Telemed Conferences at the Royal Society of Medicine, London, the IET, London, the 2000 World Medical Congress, Chicago, and the successive IEEE Engineering in Medicine and Biology International Annual Conferences. He has been invited to present numerous keynote lectures at international conferences and meetings in the UK, Europe, the US, Canada, and other countries. His publications exceed 200 peer-reviewed papers and books on mobile communications for healthcare, m-Health, control systems, and biomedical signal processing.

BRYAN WOODWARD

Bryan Woodward holds two UK doctorates, a Ph.D. in physics from the University of London (Imperial College) and a D.Sc. in electronic engineering from Loughborough University. He has held positions with the UK Atomic Energy Authority, the Royal Australian Navy, Guy's Hospital Medical School, the Australian Atomic Energy Commission, and Loughborough University, where he was Head of the Department of Electronic and Electrical Engineering and a professor with the department's Centre for Mobile Communications Research.

Professor Woodward has been an external examiner for higher degrees at universities in the United Kingdom, France, India, and Australia; a referee for professorial appointments at 12 universities; an invited lecturer in Australia, Burma, China, India, France, Poland, and the United Kingdom; and an expert assessor for peer review research panels for the Australian, Canadian, and Spanish governments, for the UK Engineering and Physical Sciences Research Council (EPSRC), and for the European Commission's 5th and 6th Framework Programmes. Furthermore, he has been a chief examiner and moderator for the UK Engineering Council examinations and a consultant to over 20 companies. He has published over 60 academic journal papers and 120 international conference papers, as well as many articles for professional and popular magazines, and he has also done over 30 radio interviews. Finally, he has been a publications referee and book reviewer for Electronics Letters; IEEE Communications Magazine; IEEE Journal of Information Technology in Biomedicine (as Associate Editor and editorial board member); International Journal of Electronic Healthcare; International Journal of Telemedicine and Applications; Journal of Mobile Multimedia; Medical Engineering and Physics; Optics and Lasers in Engineering; Proceedings of the IEE (Circuits, Devices and Systems); Proceedings of the IEE (Communications); and Ultrasonics.

Professor Woodward has participated in or led 10 multinational research projects funded by the European Commission and others funded by the EPSRC, the UK Department of the Environment, the Indian Department of Science and Technology, and industrial companies. He has also co-ordinated a major m-Health project funded by the British Council's UK–India Education and Research Initiative (UKIERI), with the aim of using mobile communications to improve the monitoring of heart disease and diabetes, which are prevalent in both developed and developing countries. The UK partners were Loughborough University and Kingston University; while the Indian partners were the Indian Institute of Technology Delhi, the All-India Institute of Medical Sciences, and Aligarh Muslim University.

Having retired, Bryan Woodward is now an Emeritus Professor of Loughborough University.

Foreword

The prominence of mobile health technologies as a driver for national and international healthcare strategies will undoubtedly grow as modern medicine advances into the 21st century. With smartphone penetration nearly ubiquitous in both the developed and developing world, the global potential to enable high-quality, cost-effective healthcare services - and meaningful patient engagement with patients and the public - is enormous. However, there are unique challenges in tailoring these m-Health strategies to make them accessible in the developing world and to an ageing population burdened with chronic disease. We must also address the important issues of public trust in data sharing, security, consent and privacy that will enable the profound benefits of digital, connected healthcare systems or, which, as likely, could inhibit progress if not tackled head-on.

m-Health: Fundamentals and Applications is a wonderfully comprehensive introduction to the subject of m-Health with valuable examples of studies and successful applications of this rapidly emerging innovation in healthcare. It highlights the crucial work that needs doing if we are to close the gap between what we know—in terms of the clinical evidence supporting m-Health innovation—and the challenges of consumer acceptability that may prevent wider adoption and diffusion of this exciting technological platform.

Professor the Lord Ara Darzi of Denham OM KBE PC FRS

Director, Institute of Global Health Innovation, Imperial College London

Preface

Mobile health (m-Health): Is it one of the greatest technological breakthroughs of our time or just another much-hyped smart healthcare technology bubble that could burst soon? Such a paradoxical view is perhaps an accurate reflection of the current status of m-Health. This important, if not essential, healthcare technology is known today to millions of people, both medical and nonexpert alike, as a powerful and transformative concept much needed for twenty-first century healthcare services.

This book has been written to continue the story of m-Health and its development since 2003. Over a decade ago, when m-Health was first introduced and defined, there was no indication then that it would be transformed into today's global multibillion dollar industry, albeit viewed critically and cautiously by the medical and healthcare communities.

M-Health was first defined as mobile computing, medical sensor, and communications technologies for health care. This simple yet powerful interpretation of m-Health as a scientific and technological concept has been driven to successful implementation by enthusiastic stakeholders and by rapid developments of these three enabling pillars. Unsustainable healthcare costs and ever-increasing demands for better access and quality of care make m-Health an important technology concept. Unfortunately, m-Health has been distorted and undermined by misleading interpretations, leading to the current spectrum of contradictions and paradoxical views. The collision of the end objectives, requirements, and evidence from opposing business and medical targets is fuelling this status quo and inhibiting the as yet unseen potential of m-Health. As an example of this scenario, we all see today major industrial power houses from global telecom, mobile phone, pharmaceutical, health, and insurance companies, and other health-related industries, all vigorously advocating different “consumer m-Health” products and services in a variety of standards and formats. They range from smart consumer well-being trackers and health monitors, smart health watches, and various targeted healthcare and mobile disease management tools. These and other consumer-based m-Health monitoring devices are becoming increasingly popular and widely used in spite of the absence of large-scale clinical evidence of their healthcare outcomes and improved patient care. The proponents of this consumer's face of m-Health argue that this represents the best realistic path for future predictive healthcare and well-being, and that it potentially alleviates the current burdens of the symptomatic healthcare costs.

At the opposite end of the spectrum, we witness an increasing level of interest in the academic and medical research communities, which target cutting-edge research conducted in different areas of mobile healthcare, leading to many publications, reports, and articles that reflect the clinical outcomes of these studies. Mobile health is also being increasingly taught in related medical and health information training courses. However, regardless of the clinical outcomes of m-Health, there is an increasing trend by some healthcare providers to voice a cautionary note concerning the hype of m-Health, with nonconviction as to the real benefits, questioning its clinical effectiveness and efficacy. These are increasingly justified by the lack of global evidence of large-scale endorsements and acceptance of m-Health by healthcare providers and services. This picture, however, detracts from the clear global health benefits of m-Health.

Increasingly, experts and nonexperts alike are also confused by the plethora of alternative terms and abbreviations being used, such as connected health, smart health, and even digital health, which perhaps reflect this conundrum. These terms are being increasingly used to either replace or justify a new beginning or even shy away from m-Health for one reason or another. Perhaps these newer terms might also reflect the answer to the key question that everyone has been asking for years: Is m-Health dead or has it just moved address?

The answer clearly lies in the powerful market forces and economic benefits already mentioned, in addition to the daily supplement of hundreds of m-Health-related documents published in research and NGO reports, academic papers, books, market analysis documents, and online blogs and articles, as well as annual conferences and summits organized globally, reflecting a decade-long evolution of this healthcare technology concept.

Consideration for brevity and the desire to avoid wearying the well-informed by cataloguing what they will regard as obvious has led us to omit from these pages lengthy explanations of certain broad technical issues as much as possible. These issues might be unknown to that large group of general readers who look perplexed when the name “m-Health” arises in conversations, and who only brighten up when it is explained to them that in its most simplistic form it is the use of smartphones for healthcare! This book may, however, serve to bring before the wider spectrum of interested readers some clarification of such a “black hole” and outline something of the infinite variety of the concept. Furthermore, we hope that it will help both expert and lay readers to understand the complexity of m-Health. For this reason we have omitted mathematical equations from the text, but have referenced more detailed papers and books where appropriate.

Chapter 1 charts the evolution of m-Health more than a decade ago and how it was transformed from a mere academic concept to a global, albeit controversial, healthcare technology phenomenon.

Chapters 2–4 describe in detail the basics of the three enabling scientific technological elements of m-Health (sensors, computing, and communications). We describe how each of these key ingredients has evolved and matured over the last decade. We describe, for example, the rapid evolution of m-Health in parallel with the maturing process of its enabling technologies from biowearable sensors to the wireless and mobile communication technologies of 4G and 5G systems and beyond. We also detail in these chapters the impact of new computing and Internet paradigms from the Internet of things (IoT) to Web 2.0 and Health 2.0 on m-Health. We also discuss the role of the current m-Health Apps phenomenon and their clinical efficacy and design challenges, together with other issues such as the role of social networking and healthy data mining concepts on the future advances of “m-Health 2.0.”

Chapter 5 illustrates some of the relevant medical aspects and clinical applications of m-Health. We endeavor to clarify some of the concerns and varying views that are being discussed and advocated by the medical community, particularly on the clinical efficacies and effectiveness of some of these smartphone-centric m-Health interventions and applications. These applications are supplemented by clinical examples and current studies, particularly in acute and chronic disease management, and in other important medical conditions. The studies provide clear clinical outcomes in some areas as well as ambiguous and unclear evidence in others.

Chapter 6 presents one of the most rewarding and successful areas of m-Health, which is the endorsement of the success of mobile health as a global health phenomenon. In this chapter, we describe successful applications and deployments of m-Health in various global health settings, particularly in developing countries. We also describe some examples of m-Health in postconflict regions in the world. These examples represent ample proof of the success of m-Health as a transformative concept for better and more effective healthcare delivery, especially in those areas where it is most needed, and where its clinical evidence is clear and its economic impact is justified.

Chapter 7 discusses m-Health markets, business and ecosystem models, and policy-related issues. This illustrates how consumer-led “m-Health” markets are, and will continue to be, one of the driving forces behind the global proliferation of m-Health markets, especially in specific areas of wellness and health monitoring, regardless of the healthcare outcomes and medical efficacy objectives and the pros and cons of markets.

In the last chapter, Chapter 8, we discuss the future of m-Health and we present a vision for its future direction and how this concept can potentially shape and transform healthcare services in the coming decades of the twenty-first century.

Finally, although it is not an easy task to write a book on m-Health and at the same time cover all the important aspects in one volume, we have attempted to include the most relevant issues. This book is mainly written to increase the general awareness and importance of m-Health, not only to interested stakeholders, such as clinicians, healthcare providers, patients, consumers, telecommunications and mobile phone industries, and health insurers, but also to interested lay readers. The aim is to describe the initial philosophy of m-Health, its evolution, and current state of the art, where it is heading and, most importantly, how it can transform some the current healthcare services to better, more efficient, and affordable means of personalized care delivery.

Robert S.H. IstepanianLondon, UK

Bryan WoodwardLoughborough, UK

Acknowledgments

The authors would like to express their deep gratitude to Lord Darzi of Denham of Imperial College London for his very gracious and generous foreword for this book.

Robert S. H. Istepanian would like to acknowledge the support of the late Professor Swamy Laxminarayan, founding Editor-in-Chief of IEEE Transactions on Information Technology in Biomedicine (now IEEE Journal of Biomedical and Health Informatics), for his vision and leadership in publishing one of the first papers on m-Health in the Transactions.

He would also like to thank all his clinical, academic, and industrial colleagues with whom he collaborated over the last two decades. Special thanks are due to Jose Lacal (Stryker MAKO), Kunle Ibidun (formerly with Orange, France Telecom), Yuan Ting Zhang (Chinese University of Hong Kong), Emil Jovanov (University of Alabama, Huntsville, AL), Costas Pattichis (University of Cyprus), Aura Ganz (University of Massachusetts, Amherst, MA), Nada Philip, Ala Sungoor, Bee Tang, and Barbara Pierscionek (Kingston University, London, UK), Nazar Amso and John Gregory (Cardiff University Medical School, UK), Ken Earle (St. George's Medical School and NHS Trust, London, UK), Tony Constantinides (Imperial College, London, UK), Garik Markarian (Lancaster University, UK), Adel Sharif (Surrey University, UK), Hamed Al-Raweshidy (Brunel University, UK), Alex Jadad, Joseph Cafazo, and Tony Easty (Centre of Global e-Health Innovations, University of Toronto, Ontario), Kaamran Raahemifar (Ryerson University, Toronto, Ontario), and others I may have inadvertently omitted.

Special Acknowledgement: To Bryan, what can I say? Fate brought us together one autumn day in October 1990 when I stood for the first time at your office door at Loughborough University as your new Ph.D. student. Perhaps now you wish you had the Star Trek “Tricoder” to “energize” me away to another Galaxy! Many thanks for your wonderful friendship and English sense of humor, and most of all for all the years of support that I will not forget.

Bryan Woodward would like to thank former colleagues, research students, and final-year students of the Department of Electronic and Electrical Engineering at Loughborough University, particularly David Mulvaney, Sekharjit Datta, Paul Harvey, Omar Farooq (now with Aligarh Muslim University, India), Fadlee Rasid (now with University of Putra Malaysia, Malaysia), Anoop Vyas (now with Indian Institute of Technology Delhi, India), and Bhaskar Thakkar (now with G H Patel College of Engineering and Technology, Gujarat, India).

Special Acknowledgement: My 40-year career at Imperial College London, Guy's Hospital Medical School, the Australian Atomic Energy Commission, and Loughborough University would never have come to fruition but for my good fortune to have met a great teacher when I was 15 years old. The most influential person in my life was the late Harry Morgan, who taught me the power and beauty of the English language and whose inspirational teaching during a difficult period I will remember all my life.

Most of the contracts and grants for our research on m-Health has been awarded by the Engineering and Physical Sciences Research Council, the European Commission's IST, FP7 and Marie Curie Programmes, industrial sponsorships (Motorola USA, Orange, and France Telecom), The Leverhulme Trust, The Royal Society, The Royal Academy of Engineering, The British Council's United Kingdom–India Education and Research Initiative, and the Indian Department of Science and Technology.

We are also particularly indebted to Mr. Harry Istepanian for his excellent work and support in preparing all the graphics and figures in the book, with the assistance of Mr. Dilip Romesh Aravinda (figures graphic design) and Ms. Barbara Lauger (proof reading).

Many thanks are also due to Ms. Mary Hatcher at John Wiley-IEEE Press for offering us the opportunity to publish this work and also for her patience during the much delayed writing process. We would also like to thank Mr. Brady A. Chin at John Wiley-IEEE Press, Danielle Lacourciere (Wiley) and Shikha Pahuja (Thomson Digital) for their editorial assistance in the final preparation of this book.

Finally, we acknowledge our families for their unfailing support and encouragement during the years, and their unrecorded kindness that has rendered our work less difficult.

Acronyms

AAA

Authentication, Authorization, and Accounting

AAL

Ambient Assisted Living

ACA

Affordable Care Act

AECOPD

Acute Exacerbation of Chronic Obstructive Pulmonary Disease

AED

Academy for Educational Development

AHIMA

American Health Information Management Association

AI

Artificial Intelligence, Adherence Index

API

Application Programming Interface

ART

Anti-Retroviral Therapy

ASHA

Accredited Social Health Activists

ATM

Asynchronous Transfer Mode

BAN

Body Area Network

BANN

Body Area Nano-Network

BASN

Body Area Sensor Network

BG

Blood Glucose

BLE

Bluetooth Low Energy

BMI

Body Mass Index

BPM (bpm)

Beats Per Minute

BPSK

Binary Phase Shift Keying

BRICS

Brazil, Russian Federation, India, China, and South Africa

BSN

Body Sensor Network

BVP

Blood Volume Pulse

BWL

Behavioral Weight Loss

CCM

Chronic Care Model

CDISC

Clinical Data Interchange Standards Consortium

CDMA

Code-Division Multiple Access

CGM

Continuous Glucose Monitor

CHA

Continua Health Alliance

CHD

Coronary Heart Disease

CHW

Community Healthcare Worker

COPD

Chronic Obstructive Pulmonary Disease

CPS

Cyber-Physical System

CRED

Center for Research on the Epidemiology of Disasters

CRM

Cardiac Rhythm Management

CVD

Cardio Vascular Disease

D-AMPS

Digital Advanced Mobile Phone Access

DICOM

Digital Imaging and Communications in Medicine

DID

Device IDentification

DoS

Denial of Service

DPWS

Devices Profile for Web Services

DSCDMA

Direct Sequence Code-Division Multiple Access

ECG

Electro Cardio Gram

EDGE

Enhanced Data Rates for GSM Evolution

EEG

Electro Encephalo Gram

EHR

Electronic Health Record

EMA

Ecological Momentary Assessment

EMG

Electro Myo Gram

EMR

Electronic Medical Records

EPC

Evolved Packet Core or Electronic Product Code

EPR

Electronic Personal Record

ETSI

European Telecommunications Standard Institute

EU

European Union

EV-DO

Evolution-Data Optimized

FC

Frequency Channel, Frequency Control

FCC

Federal Communications Commission

FDA

Food and Drug Administration

FDD

Frequency-Division Duplex

GB

gigabyte

GDM

Gestational Diabetes Mellitus

GFSK

Gaussian Frequency Shift Keying

GHS

Ghana Health Services

GOLD

Global Initiative for Chronic Obstructive Lung Disease

GPRS

General Packet Radio Service

GSM

Global System for Mobile Communications, Group Spécial Mobile

GSMA

Group Spéciale Mobile Association

HA

Home Agent

HARQ

Hybrid Automatic Repeat Request

HBC

Human Body Communications

HbA1c

glycated hemoglobin (A1c)

HDFS

Hadoop Distributed File System

HetNet

Heterogeneous Networks

HIMSS

Healthcare Information and Management Systems Society

HIPAA

Health Insurance Portability Accountability Act

HITECH

Health Information Technology for Economic and Clinical Health

HIV

Human Immunodeficiency Virus

HR

Heart Rate

HRV

Heart Rate Variability

HSDPA

High Speed Downlink Packet Access

HSPA

High Speed Packet Access

HSPA+

Evolved High Speed Packet Access

HSUPA

High Speed Uplink Packet Access

HTTP

Hypertext Transfer Protocol

IaaS

Infrastructure as a Service

ICT

Information and Communication Technology

IDRC

International Development Research Council

IEEE

Institution of Electrical and Electronics Engineers (USA)

IETF

Internet Engineering Task Force

IHD

Ischemic Heart Disease

IHE

Integrating the Healthcare Enterprise

IHTSDO

International Health Terminology Standardization Committee

IHTT

Institute of Health Technology Transformation

IMS

Information Management System

IMT

International Mobile Telecommunications

IoE

Internet of Everything

IoT

Internet of Things

IP

Internet Protocol

IrDA

Infrared Data Association

ISM

Industrial, Scientific, and Medical (band)

ISO

International Organization for Standardization

IT

Information Technology

ITS

Intelligent Transport System

ITU

International Telecommunications Union

IVR

Interactive Voice Response

IWBAN

Implantable Wireless Body Area Network

IWG

Innovation Working Group

JIC

Joint Initiative Council

KM

Knowledge Mobilization

LEARNS

LEprosy Alert and Response Network and Surveillance System

LED

Light-Emitting Diode

LOS

Line-Of-Sight

LTE

Long Term Evolution

LTE-A

Long Term Evolution Advanced

LoWPAN

Low-Power Wireless Personal Area Network

MAC

Media Access Control

MARP

Most At-Risk Populations

MBAN

Medical Body Area Network

MBOFDM

Multiband Orthogonal Frequency-Division Multiplexing

MCC

Mobile Cloud Computing

MC-CDMA

Multi-Carrier Code-Division Multiple Access

MCOT

Mobile Cardiac Outpatient Telemetry

MDDS

Medical Device Data Systems

MDG

Millennium Development Goal

MEC

Mobile Edge Computing

MENA

Middle East and North Africa Region

MGMP

Mobile Gateway/Mobile Patient

MGSP

Mobile Gateway/Static Patient

MHRA

Medicine and Health Care Products Regulatory Agency

MICS

Medical Implant Communications Service

MIMO

Multiple-Input Multiple-Output

MMA

Mobile Medical Apps

MMC

Massive Machine Communication

MMS

Multimedia Messaging Service

MoH

Ministry of Health

MNO

Mobile Network Operator

MOS

Mean Opinion Score

m-QoE

Medical Quality of Experience

m-QoS

Medical Quality of Service

MTD

Machine-Type Device

M2M

Machine-to-Machine

M4RH

Mobile for Reproductive Health

NB

narrowband

NCD

Non Communicable Disease

NFC

Near-Field Communications

NGN

Next-Generation Networks

NGO

Nongovernment Organization

NHS

National Health Service

NICE

National Institute for Health and Care Excellence

N-LOS

Non-Line-Of-Sight

OFDMA

Orthogonal Frequency-Division Multiple Access

OLAP

Online Analytical Processing

OMI

Operational Medicine Institute

OQPSK

Offset Quadrature Phase-Shift Keying

PaaS

Platform as a Service

PAN

Personal Area Network

PANACeA

Pan-Asian Collaboration for e-Health Adoption and Application

PCC

Patient-Centered Care

PDA

Personal Digital Assistant

PGHD

Patient-Generated Health Data

PHC

Primary Health Centre

PHD

Personal Health Device

PHR

Public Health Record

PHY

PHYsical layer

PIN

Personal Identification Number

POC

Point Of Care

POTS

Plain Old Telephone Service

PPG

Photo Plethysmo Graphy

PQRST

Refers to Specific Points on an Electrocardiogram

PwC

PricewaterhouseCoopers

P2P

Peer-to-Peer

QCI

Quality of Service Class Identifier

QoE

Quality of Experience

QoS

Quality of Service

RCT

Randomized Control Trial

R&D

Research and Development

RFID

Radio Frequency Identification

RHM

Remote Health Monitoring

RMNCH

Reproductive, Maternal, Newborn, and Child Health

ROI

Return Of Investment

ROM

Read-Only Memory

RR

Respiratory Rate

SaaS

Software as a Service

SBA/FD

Skilled Birth Attendance and Facility Delivery

SC-FDMA

Single-Carrier Frequency-Division Multiple Access

SCII

Subcutaneous Insulin Infusion

SCL

Service Capabilities Layer

SD

Standard Deviation

SDN

Software-Defined Networking

SDO

Standards Development Organizations

SGSP

Static Gateway/Static Patient

SGMP

Static Gateway/Mobile Patient

SHARP

Strengthening HIV/AIDS Response Partnerships

S-ICD

Subcutaneous Implantable Cardiac Defibrillator

SIM

Subscriber Identity Module

SMAC

Social Networking, Mobile, Analytics and Cloud

SMBG

Self-Monitoring Blood Glucose

SME

Small-to-Medium-Sized Enterprise

SMS

Short Message Service

SNMP

Simple Network Management Protocol

SOC

System-On-Chip

SO-FDMA

Scalable Orthogonal Frequency-Division Multiple Access

SpO

2

Blood Oxygen Saturation

STI

Sexually Transmitted Infections

TB

Tuberculosis

TCP/IP

Internet Protocol

TDD

Time-Division Duplex

TDM

Time-Division Multiplexing

TDMA

Time-Division Multiple Access

TTC

Text to Change

T1D

Type 1 Diabetes

T2D

Type 2 Diabetes

UID

User Identification

UKIERI

United Kingdom–India Education and Research Initiative

UMTS

Universal Mobile Telecommunications System

UNHCR

United Nations High Commissioner for Refugees

USAID

United States Agency for International Development

UWB

Ultra-Wide Band

VLAN

Virtual Local Area Network

WAN

Wide Area Network

WBAN

Wireless Body Area Network

W-CDMA

Wideband Code-Division Multiple Access

WHO

World Health Organization

WIBSN

Wearable and Implantable Body Sensor Network

Wi-Fi

Wireless Fidelity

WiMAX

Worldwide Interoperability for Microwave Access

WISE

Wireless Intelligent Sensors

WLAN (and Wi-Fi)

Wireless Local Area Network

WMAN

Wireless Metropolitan Area Network

WMTS

Wireless Medical Telemetry Services

WPAN

Wireless Personal Area Network

WSN

Wireless Sensor Network

WWAN

Wireless Wide Area Network

WWBAN

Wearable Wireless Body Area Network

1G

First Generation of mobile phones

2G

Second Generation of mobile phones

2.5G

“Two and a half G,” midstage between 2G and 3G

3G

Third Generation of mobile phones

3GPP-LTE

Third Generation Partnership Program Long Term Evolution

3.5G

“three and a half G,” midstage between 3G and 4G

3.9G

pre-4G Generation of mobile phones

4G

Fourth Generation of mobile phones

4PSK

Quadrature Phase Shift Keying

5G

Fifth Generation of mobile phones

5GPP

Fifth Generation Public–Private Partnership

8PSK

8 Phase Shift Keying

Units

kbps

kilobits per second

Gbps

gigabits per second

Mbps

megabits per second

mmHg

millimeters of mercury

mg/dl

milligram per deciliter (measurement of blood glucose level)

mmol/l

millimole per liter (measurement of blood glucose level)

1Introduction to m-Health

We have a seemingly insatiable desire to communicate, search, find, share, watch, listen, learn, experience, download and upload information. Year on year the demand grows exponentially.

Peter Cochrane, Technology Futurologist.

1.1 Introduction

When the concept of mobile health (m-Health) was first introduced and defined in 2003, there was no indication a decade on that it would become the fourth ICT for healthcare pillar after telemedicine, telehealth, and e-Health. Since then, numerous papers and books have appeared in the literature on this topic, together with a multi-billion dollar healthcare delivery-related industry embracing m-Health as its main service. While m-Health is rapidly expanding in the commercial world and has effectively evolved into a separate applied scientific discipline, it is still “under the radar” in general and probably some way from being fully adopted by the medical world, although this gap is narrowing.

The introduction of smartphone technologies has played a major influential role in the evolution of m-Health, albeit in a focused way, particularly in well-being and health-monitoring applications. This role is both a blessing and a curse: the blessing is that technological breakthroughs in mobile and Internet communications are putting m-Health on the global radar, while the curse is the false notion among many people that m-Health is merely another “App” (application). This book is an attempt to present the full picture.

Nowadays, if you type the word “m-Health” into a search engine, the result will be an astounding 100 million or more hits. The 2009 inaugural m-Health Summit, a partnership between the Foundation for the National Institutes of Health and the m-Health Alliance, attracted 800 people; this attendance increased to over 4000 participants from 56 countries at the Fifth Summit in 2013 (Slabodkin, 2013). This is the level of interest that m-Health has generated globally among healthcare providers, academia, and the telecommunications, biomedical, and pharmaceutical commercial sectors.

In this chapter, first we look back briefly at where it all started, then we consider the digital world and the impact it has had on the concept of m-Health. Finally we discuss the correlation between mobile communications and Internet technologies, their role in the future of m-Health, and consequently their social impact on future healthcare services; this is currently being termed “smart health” or “digital health.”

We start by defining the various labels that constitute the “Information and Communication Technology (ICT) for Health” domains and how they have been adopted in relation to m-Health, sometimes incorrectly. The notion of m-Health (which we define later) implies an underlying digital ingredient, and the ubiquity of the digital world is exploited in all healthcare applications. The main components that constitute the “building blocks” of the m-Health concept, that is, wireless medical sensors, mobile communications, network connectivity, and the Internet, are themselves invariably digital systems. This combination comprises a powerful trilogy that has spawned an impressive number of applications, but in the years ahead, now with the availability of 4G connectivity, cloud services, Internet of Things (IoT) and Web 2.0, and doubtless future technologies previously undreamed of, these advances will transform the world of medicine and healthcare in a truly spectacular way.

1.2 The Concept of m-Health: The Beginnings

The parable of inventing the wheels on travel luggage is perhaps the best way to describe the beginnings of m-Health. On August 16, 2012, the USA Today Travel newspaper published a special report in their travel section (Clark, 2012) entitled “The innovation that revolutionized the traveler's world had humble beginnings,” which highlighted how a simple idea, the invention of travel luggage with wheels, can cause millions of people to say: “why didn't I think of that?” The originator of the idea was Robert Plath, a Northwest Airlines pilot who noticed, while queuing behind passengers at an airport security check point in 1987, how many of them were struggling to detach their bags from bulky metal luggage trolleys. Nowadays, almost every sizeable travel bag and case has in-built wheels, which has changed everyone's travel experience for the better. But no one today has heard of Bob Plath, the originator of an innovation used daily by millions of travelers!

The relevance of this story is that it has a parallel with the inception of m-Health. Few know that the Eureka moment on m-Health came in 1996 when the lead author of this book was reading a magazine article at San Francisco Airport about using the then new cellular phones to remind elderly patients to take their medications. From that moment, the concept of using a mobile phone for other medical applications emerged, followed by the publication of the first paper on the modeling of a wireless telemedicine system (Istepanian, 1998). Around 1999–2000, several landmark papers mentioned the principle behind m-Health and presented the basic concept but did not define it clearly as “m-Health” (Istepanian, 1999, 2000; Istepanian and Laxminarayan, 2000).

What is m-Health? Literally, it means “mobile health,” which in the context of this book means the use, for health-related applications, of sensors, mobile devices such as “smartphones,” tablets, and laptops, and the huge infrastructure of communications networks already in place. New language abounds in m-Health, not least confusing expressions such as “mobile health eco-system,” which defines the scope of mobile health in terms of patient, clinician, healthcare provider, service provider, mobile device, and applications (GSMA, 2011).

To the best of our knowledge, the first citation of the word “m-Health” was mentioned in 2003 (Istepanian and Lacal, 2003), followed by the first definition of the concept as mobile computing, medical sensor and communications technologies for healthcare (Istepanian et al., 2004). These three basic building blocks are now widely adopted globally for m-Health as one of the main domains of ICT for health. It is also well known that there were no “m-Health” or “mobile health” terms mentioned anywhere prior to these seminal papers. These facts on the beginning of the concept and its original definition have never been documented prima facie.

In 2011, the World Health Organization (WHO) defined m-Health as covering “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices” (WHO, 2011). This and other confusing definitions have contributed to the status quo and to ambiguity over the concept's original definition.

Why is m-Health important? One reason is to reverse the traditional event-driven situation in which a patient consults a doctor only when he or she is ill. Instead, recent advances in m-Health allow the patient to be continuously monitored (which may be resisted by some people and is possibly controversial) by a smart sensor network to detect any indication of illness before it occurs. This “well-being” monitoring model can prevent emergencies and empowers patients to be proactive. It therefore allows the realization of a patient-led (or patient-centric) healthcare model rather than a doctor-led model, something that governments are keen to support as a potential means of reducing health expenditure. Some 6 billion mobile phone users globally who are concerned about their health can now exploit the unprecedented evolution of m-Health, with phones that are increasingly equipped with touch screens and Apps that control sensors, Global Positioning System (GPS), camera, and many other features, linked globally by a variety of communications networks. The latest smartphones are even equipped with embedded heart rate and well-being sensors that can calculate real-time heart rates and exercise levels with a touch of the screen. This does not imply that m-Health is merely a smartphone health delivery system as is widely recognized. We will discuss this issue further throughout the book.

There is another reason why m-Health is important; it is that advances in its three main building blocks have enabled the parallel development of innovative mobile healthcare applications and services. To cite an example of its importance, a search of “m-Health” on YouTube results in more than 10 million hits. Another example where the concept entered a major yet controversial leap in its evolutionary process was the introduction of the first smartphone (the iPhone) in 2007; nowadays, tens of thousands of medical Apps are downloaded and used for different medical, well-being, and healthcare delivery applications worldwide on Apple Store or Google Play. This relates to a further reason, and perhaps the most important one, which is the market potential of m-Health, particularly for developing new healthcare delivery models and services that can be more efficient and cost-effective.

In a study by the IMS Institute of Health Informatics, it was estimated that by October 2013 there were 43,689 Apps under the categories of “healthcare and fitness” or “medical,” out of which only 23,682 were considered genuine healthcare categories (IMS online).

Table 1.1 shows the results of a survey indicating an increasing trend by physicians and healthcare providers to perform different healthcare activities on mobile devices between 2010 and 2014 (PwC, 2014). Although these results relate to the United States and other high-income countries, similar trends are becoming increasingly evident in many global healthcare service delivery settings.

Table 1.1 Survey of the Increased Trend of Healthcare Activities Performed by Physicians on Mobile Devices 2010–2014

Healthcare Activities Performed by Physicians on Mobile Devices

% in 2010

% in 2014

Access

Electronic Health Records

(EHR)

12

45

Prescribe medications

14

41

Review images

7

32

Communicate with patients

21

31

Receive data from medical devices

11

20

Initiate and track a referral

6

17

Conduct clinical consultation from different location than the patient's

5

12

Monitor patients who are hospitalized

N/A

17

Receive data from a mobile AppPatient tracks data

N/A

14

Adapted from PwC HRI (2014).

This evolution would not have been feasible without rapid advances in wireless communications and network technologies from about 2000, when progression from the Global System for Mobile Communications, or Group Spécial Mobile (GSM), to the General Packet Radio Service (GPRS) made it possible to send packet data over networks linked to the Internet. This, for example, enabled for the first time medical “vital signs” such as electrocardiogram (ECG), blood pressure, body temperature, and photoplethysmography (PPG) signals to be sent to a remote server using cellular networks (Istepanian, 1998). This synthesis of mobility and healthcare that forms the basis of m-Health has been quickly adopted by telecommunications, and mobile and medical devices industries, reflecting the huge potential markets envisaged; this has already been realized, albeit with mostly consumer-driven rather that clinically driven outcomes. For example, one study estimated the opportunities in the global mobile healthcare market to be worth between $50 and $60 billions (McKinsey, 2014). In 2014, there were more than 60 industry-sponsored and academic conferences and events relating to m-Health (m-Health Insight, 2014). These activities reflect the global interest and commercial opportunities in m-Health.

The concept is still evolving in its second decade, and as sensing, computing, and networking technologies become ever more refined, advanced, and accessible, there will be a growing demand for all that m-Health has to offer in the future.

1.3 Taxonomy of Telemedicine, Telehealth, e-Health, and m-Health

Before we present details of the m-Health domain, it is imperative to clarify some of the different terminologies used in the ICT for health domains. The increasing number of terms has become so confusing, to experts as well as to lay people, that attempts to classify them have been made, including developing different “taxonomies” (Bashshur et al., 2011). These aim to establish a clear classification of how telemedicine fits with other related domains, notably telehealth, e-Health, and m-Health. These labels have led to the spawning of several international journals since the early 1990s, notably Telemedicine and e-Health Journal and Journal of Telemedicine and Telehealth, and numerous books, reports, and literature reviews (Bashshur et al., 1997; Yang and Hui, 2008; Olla and Tan, 2009; Currell et al., 2010).

A practical reason for this classification is to attempt to shed light on the true effect of these domains in terms of the cost, quality of service and access to care, or for treatment or monitoring. Further considerations are the place for medical research, health policy, and reimbursement of network charges. For many years it has been asserted that the main benefit of remote medical access is to save time and money, especially for patients, who then do not need to travel from home to a hospital or clinic for a consultation with a doctor. This has still to be verified but it is a worthy goal; for example, if new m-Health procedures could save just 1% of the UK's National Health Service budget, this would amount to more than $1.5 billion annually.

The presumed advantage of establishing the taxonomy—as with flora and fauna—is to bring order out of confusion, to try to fit the various domains and components into a pattern. By its nature, this is not an exact science and numerous iterations may be expected before some definitive blueprint is widely accepted.

In has been proposed that ICT for health domains, or classes, may be thought of as consisting of four key “domains of care” (Bashshur et al., 2011): telemedicine, telehealth, e-Health, and m-Health, as illustrated in Fig. 1.1. The premise is that these terms are not interchangeable because they represent different concepts and related activities, and this becomes evident if we consider their origins.

Fig. 1.1 Key domains of ICT for health. (Adapted from Bashshur et al. (2011).)

Telemedicine has been in use since about 1969 (Currell et al., 2010). Since then, telemedicine has been extensively adopted as an umbrella term, and it is appropriate to quote some of key definitions as a starting point: “telemedicine involves the use of modern information technology, especially two-way-interactive audio/visual telecommunications, computers, and telemetry, to deliver health services to patients and to facilitate information exchange between primary care physicians and specialists at some distances from each other” (Bashshur et al., 1997). Another broad definition defines telemedicine as “the use of telecommunications for medical diagnosis and patient care. It involves the use of telecommunications technology as a medium for the provision of medical services to sites that are at a distance from the provider. The concept encompasses everything from the use of standard telephone services through high speed, wide bandwidth transmission of digitized signals in conjunction with computers, fiber optics, satellites and other sophisticated peripheral equipment and software” (Scannell et al., 1995). More concisely, telemedicine may also be defined as the use of communications to exchange medical diagnostic and therapeutic information, usually between a doctor and a patient who are in different places (Woodward et al., 2001).

The simplest application of telemedicine is, of course, a telephone call or text message between a doctor and a patient. Far from trivializing the subject, this is an example of the literal meaning of telemedicine: tele, meaning far or distant, and medicine, meaning to treat or to cure. A recent review outlined the empirical evidence of telemedicine interventions for diabetes as an example of the effectiveness of telemedicine in some important clinical specialisms and chronic diseases (Bashshur, 2013; Bashshur et al., 2015).

Telehealth came along in 1978 to mean a broadening of the scope of telemedicine to include public health, health education, health services, environmental and industrial health, among others. In terms of taxonomy, telehealth may be seen as a separate domain but there is no hard and fast rule about this. In general, telehealth (sometimes assumed to come under the telemedicine umbrella) deals with remote monitoring by health professionals of a patient's physiological data for diagnosis and disease management. There is also the term telecare, which is generally defined as the use of different sensors and alarms to assist people to live independently. This again leads confusingly to the erroneous notion of m-Health as being another telehealth application that uses wireless technologies for remote monitoring using mobile phones.

e-Health has an origin that is still debatable, but there is a general consensus that it started in about 1999–2000 with the start of “dot com bubble.” There is now a profusion of words with the “e-” prefix, such as e-book, e-ticket, e-business, e-commerce, and e-government. It seems, then as now, that anyone can make up such a word! In 2005, a study on this topic revealed 51 definitions of “what is e-Health?” (Hans et al., 2005). There is no doubt that more of these definitions have been introduced since then.

e-Health was defined by the WHO as “the cost-effective and secure use of ICT in support of health and health-related fields, including health-care services, health surveillance, health literature, and health education, knowledge and research.” The key common ground for e-Health is the use of technology, electronic processing, and communication networks for different healthcare services.

A proposal for the components in the e-Health domain is shown in Fig. 1.2; here, e-Health comprises electronic health records, health information, clinical decision support systems, and physician order entry (Bashshur et al. 2011). This concept has also led some global institutions to categorize m-Health as an offshoot of e-Health with an added wireless element.

Fig. 1.2 Key domains of e-Health. (Adapted from Bashshur et al. (2011).)

The WHO, in their Global Observatory for e-Health service report, asserted that there is so far no standardized definition of m-Health, citing it as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, PDAs, and other wireless devices” (WHO, 2011). However, some of the terminologies and interpretation used in this definition (e.g., the now obsolete PDA) are strongly debatable and add to the confusion surrounding the nature of the m-Health concept. There is also the obvious view that the inclusion of m-Health as a subdomain of e-Health reflects the current paradox of the differentiation between the two concepts.

m-Health, as mentioned earlier, was first coined and defined in 2003 as mobile computing, medical sensor and communications technologies for healthcare (Istepanian and Lacal, 2003; Istepanian et al., 2004). This basic definition is still valid today, as it simply represents the essence of what the m-Health concept is all about. It also reflects the adoption of this domain as a triumph of digital ubiquity and technical evolution that we witness today, from technologies such as smartphones, 4G cellular networks and beyond, cloud computing, smart wearable medical sensors linked with the IoT, and machine-to-machine (M2M) communications. Telecommunication industries were the first to embrace mobile health as part of their future business and revenue models, with Vodafone being the earliest in 2006. As already mentioned, this domain is defined as much in terms of associated technology as with health concepts (Istepanian et al., 2006).

Several derivative definitions of m-Health have been cited that erroneously categorize mobile health as part of e-Health, telehealth, or telemedicine (Free et al., 2013; Fiordelli, 2013; Kwan et al., 2013). Observers argue that it does not matter how you define m-Health. However, such arbitrary definitions fuel the confusion and sometimes misunderstanding to the lay reader on the essence of the m-Health concept. It widens the gap between understanding the science of m-Health as opposed to viewing it as the provision for healthcare services and information using smartphones, as it is widely understood.

The basic concept of m-Health is illustrated in Fig. 1.3. This concept has evolved into a major technological and applied scientific domain with global commercial interest that embraces advances in the healthcare, computing, and telecommunications sectors. It brings together academic researchers, medical specialists, and business experts worldwide to achieve innovative solutions in healthcare delivery using advances in these technologies. Further developments in the near future will benefit from ultrafast mobile broadband connectivity with new Internet architectures, enabling much wider global access to healthcare services on demand.

Fig. 1.3 Basic building blocks of m-Health. (Adapted from Istepanian et al. (2004).)

These technological advances are well known to be spiraling almost out of control and are therefore inevitably way ahead of any changes adopted by the medical profession, even in the developed world. While something may be achieved technically, it is another matter for doctors to introduce a new treatment or mode of working or clinical procedure into everyday use. This is a challenge for the future.

1.4 m-Health and Digital Ubiquity