A roadmap for the implementation of mHealth innovations for image-based diagnostic support in clinical and public-health settings: a focus on front-line health workers and health-system organizations

Figures & data

Figure 1. Categorization of the field of mHealth according to domain of application, place of use and medical field where mHealth is currently being applied.

Figure 2. Components of a roadmap to the implementation of image-based mHealth solutions.

Table 1. Distribution of the participants to the roundtable by sector of activity and country.

CountrySector	RSA	Africa: Other	Sweden	Europe: Other	North and Central America
Clinical	2	5
Clinical research	1			1	1
Research	7	1	8	4	1
Policy		4	3
Business	4		1		1
Doctoral students			3
Medical students			2		1

Figure 3. Procedure for data collection and priority setting by theme (session).

Figure 4. Illustration of the session where the participants proceeded to vote on the strategies they thought should receive priority, one theme at a time. The question related to each theme is at the top of the white board and the strategies proposed underneath the question. [Photo: Lisa Blom].

Figure 5. Illustration of the session where the participants proceeded to vote on the strategies they thought should receive priority, one theme at a time. The question related to each theme is at the top of the white board and the strategies proposed underneath the question. [Photo: Lisa Blom].

Table 2. How should the most important barriers to the implementation of image-based mHealth consultation in the clinical setting be overcome? (n = 122 votes).

Strategy	Votes
	n	%
Ensuring the novel technology can be integrated into local infrastructures for routine use (e.g. ensuring there is the appropriate electrical power, network connectivity and availability of devices).	41	33.6
Addressing policy deregulation and ‘light-touched regulations’ to implementation and scale of innovative technology.	25	20.5
Continuous quality improvement initiatives to ensure the highest practice standards are maintained over time, and mechanisms to ensure that the mHealth innovations meet (and preferably exceed) acceptable standards of care.	24	19.7
Ensuring the most suitable environment for the introduction, scale and maintenance of devices through multi-sectoral stakeholder engagement (government; clinical health care, public health, end-users; business and business models).	21	17.2
Implementation of education strategies for all users (e.g. among health care, the general public, government).	8	6.6
Ensuring that the novel technological tools meet the requisite ‘gold standard’ for implementation.	3	2.5

Table 3. How can front-line health-care workers be enabled to adopt image-based mHealth in their practice? (n = 121 votes).

Strategy	Votes
	n	%
Value – The system must add value to the users – both clinicians and patients – and that value must be immediately visible.	48	39.7
Usability – The system must have a user-friendly design and be simple to use	35	28.9
Workflow – The system must fit into the clinical workflow of the unit and the clinicians.	27	22.3
Advocates – Use early adopters to be local peer champions to drive uptake.	7	5.8
Communication – Apps will have a core medical functionality, but to be most useful must include a simple-to-use communication function.	4	3.3

Table 4. Which are the key strategies to overcome organizational challenges to the implementation of image-based mHealth within the health sector? (n = 121 votes).

Strategy	Votes
	n	%
mHealth initiatives should be aligned with other ICT infrastructure development strategies in a country.	32	26.4
Ensure that all relevant ministries i.e. ministries of health, technology and education are included in the process.	27	22.3
mHealth solutions should promote standards and be integrated with the local health-information system	25	20.7
A national mHealth strategy with interoperability framework is needed	20	16.5
Cost-effectiveness analyses of mHealth solutions should be included in the development process	17	14.0

Table 5. Which are the key strategies to overcome technical challenges in implementing image-based mHealth within the health sector? (n = 123 votes).

Strategy	Votes
	n	%
Basic infrastructure must be in place, including electricity and connectivity for mHealth to succeed	25	20.3
Understand local context but build for scale	24	19.5
By whom, how and where images are interpreted should be considered from a clinical, legal and technical point of view.	23	18.7
Light-touch regulation and policy should remove hindrances and enable innovation	18	14.6
Development should be led by a multidisciplinary team from the public and private sector, including technology experts	18	14.6
Funding should not rely on end-user to pay	8	6.5
Standards for interoperability should be set and easily available	7	5.7

Table 6. Examples of differences in the distribution of technical resources in the sub-Saharan Africa (SSA) region (in % of population).

Country	Malawi %	Ethiopia %	South Africa %
Electricity – urban	32	85	90
Electricity – rural	4	10	77
Internet users	9	12	52

Source: Factbook.