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is very dynamic in nature and it is important for
all providers, patients, payers, and health plan-
ners to comprehend the change in this model,
which would allow access to resources at any
time and place including at a point of care. One
of the organizations advocating this change is the
“mHealth Initiative”. Health care providers need
to understand that communication-based care al-
lows them to connect better to patients, payers,
colleagues, and resources. Patients need to learn
how to use mobile devices to maximize health
and wellness benefits by being very engaged and
better informed about the mobile applications
being deployed. All stakeholders in the mHealth
field need to work on standards, policies, and
functionalities so that all the necessary structural
changes and adjustments to existing health care
infrastructure can be implemented.
strict mHealth QoS requirements, and this can
be attributed to a general lack of understanding
of the pros and cons of these kinds of services.
QoS requirements need to guarantee that in case
of an emergency, an associated health care center
can react in time to bring medical assistance to a
patient. There may also be differences in the QoS
requirements based on different situations, e.g.,
an emergency situation versus a non-emergency
one. In developing countries, health care profes-
sionals need to be informed as to the nature of
end-user service QoS requirements, and from
which service platform they will be derived. These
requirements affect service performance (e.g.,
delay, jitter), expected security level, acceptable
price, etc. Hence, it may be necessary to reach a
general consensus as to what context information
needs to be maintained to satisfy required, agreed
upon QoS metrics. Initiatives in educating health
care personnel on how to maintain and infer such
information to improve delivered QoS needs to be
addressed at structural and all other possible levels.
Quality of Health Care Challenges
In current platforms supporting mHealth ap-
plications, services are delivered in a best-effort
fashion, since there are no guarantees on the
delivered Quality-of-Service (QoS). Allowing
health care professionals to support anyplace,
anytime monitoring of vital signs and providing
real-time feedback poses questions on how the
quality of relayed information can be improved.
In (Katarzyna Wac et al., 2006), the authors
explore QoS issues of an mHealth service plat-
form. They propose using context information,
which is information related to a serviced user's
actual situation (e.g., location, time, current health
status) to improve the delivered QoS. Using an
example of a monitoring telemedicine application
for epilepsy in a 2.5/3G network scenario, they
show that indeed the QoS of delivered information
can be improved. One of the challenges is to ad-
dress what kind of context information to collect
that may be used in mHealth service platforms
to improve the QoS of delivered content. Even
in the developed world, there are currently no
Legal Challenges
Health records are confidential pieces of informa-
tion and there are various legal issues that need
to be addressed to sanitize their handling and
dissemination in a Mobile Health scenario. Acts
such as the HIPAA (Health Insurance Portability
and Accountability Act) in the United States need
to be implemented if no counterparts are already
available in the developing world. This in itself
poses a challenge, as there may be a lengthy leg-
islation process to ensure the confidentiality of
patient records. In the USA, passing the HIPAA
took over a decade and there are still rules that need
to be resolved for national identifiers and security.
In developing countries such a process may take
many years due to political instability and lack of
an efficient legislative body. Responding to such
an act means that hospitals and physicians need
to review their operations pertaining to location
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