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Mobile technologies in healthcare: systematising the move from point solutions to broad strategies
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  1. Payal Agarwal1,
  2. Onil Bhattacharyya1,2
  1. 1 Institute for Health Systems Solutions and Virtual Care, and Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario M5G 1N8, Canada
  2. 2 Frigon Blau Chair in Family Medicine Research and Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Onil Bhattacharyya, Institute for Health Systems Solutions and Virtual Care, and Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, ON M5G 1N8, Canada; onil.bhattacharyya{at}wchospital.ca

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The presence of powerful computers in the pockets of most patients should transform how we practise medicine. Yet changes in practice to date have remained modest and occurred only gradually.1 Applications of new technologies often only emerge once the underlying technologies have become ubiquitous and long passed the period of counting as new. As one writer put it: ‘Communication tools don’t get socially interesting until they get technologically boring.’2 Once a technology reaches the stage of being taken for granted, it becomes easier to harness it for new functions and activities.

Cellphones with short message service (SMS) or text messaging first appeared 25 years ago,3 and by 2010, users were sending 6.1 trillion texts per year globally.4 This tool had obvious applications for communication between physicians or to advise about critical lab results, where information could be displayed directly rather necessitating a return call on a pager.5 However, privacy concerns have limited texting of personal health information among healthcare providers.6 But there remains enormous potential benefit from this technology to engage with patients outside of clinic visits, since they all use text routinely.

In BMJ Quality & Safety, Hirshberg et al describe the use of cellphone text messages to address postpartum hypertension (HTN).7 Squeezing clinic visits into busy lives is difficult for many patients, but mothers with newborn children clearly face particular challenges in this regard. While this randomised trial provides convincing evidence of the effectiveness of texting in this population, one wonders why it has taken so long to generate this use case, and how to realise the benefits of this approach in other clinical areas faster.

The trial compared the impact of text versus in-person visits to monitor postpartum HTN on the proportion of patients recording a single blood pressure …

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