In the 9 March edition of the British Medical Journal was an article calling for the mass screening of patients in the UK for atrial fibrillation, a heart complaint that can lead to strokes. The article, penned by hospital consultants, called not for massive use of new technology but for a pulse check to be performed by the patient’s general practitioner, or GP. The disconnect between primary and secondary care seems to be ever growing, with the reactive consultants calling for the front line clinicians to be more proactive.
 
Trying to initiate a step change is never easy. Persuading clinicians to regularly perform testing on all their patients, when previously only the weakest dataset of health performance metrics was employed is always going to be a big ask.
 
New mobile technologies exist that allow both simple mass screening and risk stratification. Identifying which one of two apparently healthy-looking members of the aging population are at most risk of contracting a long term condition, or have already a long term condition that needs monitoring, is the task of automated testing systems, drawing on software and algorithms that can produce the rational statistics that allow for automated identification.
 
The operation and advice given to support these systems is critical, and should not be overlooked by mobile health systems. The location of the testing equipment and the environment where the patient undertakes the tests will be paramount in acceptance by the patient of the results.
 
The most logical place would be in the clinician’s office, during a normal clinical interaction. It can be seen that moving away from this, the next most logical place would be in the reception of the clinician’s office, where support and advice may be sought locally on the interpretation of the results from a test.

Moving further down the clinical interaction pathway, community clinics and pharmacies play the next obvious role in mass screening, again with the patients being supported proactively by the professionals that will have some involvement in the patients' risk stratification outcome.  Finally opportunistic screening by parties such as gyms or by charity personnel in shopping malls, provides the last acceptable outpost for mass screening to take place.

Understanding that risk stratification is the first step in a successful mHealth long term condition monitoring process is critical. Getting patients to accept the systems and the subsequent testing is the first step along the digitisation of personal healthcare. Empower the patients themselves to actively participate in an mHealth system or service, will allow better adherence and performance of the system itself, thus advising people to move to mobile health systems is best performed as close to the clinician’s office as possible.

So the first people to adopt and embrace mobile health systems must be the clinicians themselves. Only when these social interaction foundations have been laid, can we develop and expand on such systems, to make use of the technological potential that exists.

So what next? If clinicians are actively promoting self monitoring, what kind of systems will come next? Again focusing on patient acceptable criteria based on past experience, the location of clinical services delivery would logically remain in the clinics themselves.
 
It is possible to envisage a monitoring station located in a clinic's reception where the patient may pop in to enter their data. It is only when the patient is not able to attend a clinic that the real transition to mobile health for long term conditions becomes apparent as the solution.

If we can get around the data protection and ownership issues, then moving the testing stations out to remote locations, such as pharmacies or community clinics, becomes an option. Once we have achieved this, then we can contemplate the option of mobile-enabled healthcare systems, bringing the telemetry of patient data, perhaps through associated devices, onto mobile phones.

The systems that champion and demonstrate success within mHealth at present, focus around a tele-presence service, bringing the patient into the clinician’s office through the use of technology such as video conferencing. Such systems preserve the patient/clinician interaction, and this is fundamental to success. We need to start from the clinician’s office and over the next few years work as an industry away from this epicentre of patient reassurance.
 
It will be a while before we can empower the world of the mobile app to take care and monitor the patient in the patient’s domain, as we still need the bond with the clinician. Maybe the next big break-through will be the virtual clinician as an app.

Chris Crockford is the founder of Formula Innovation, a thinktank specializing in corporate innovation thinking, and Cardiocity, a UK based SME which specializes in heart monitoring and medical device design.

The editorial views expressed in this article are solely those of the author(s) and will not necessarily reflect the views of the GSMA, its Members or Associate Members.