Improving perinatal care in the rural regions worldwide by wireless enabled antepartum fetal monitoring: a demonstration project.

Background. Fetal and neonatal morbidity and mortality are significant problems in developing countries; remote maternal-fetal monitoring offers promise in addressing this challenge. The Gary and Mary West Health Institute and the Instituto Carlos Slim de la Salud conducted a demonstration project of wirelessly enabled antepartum maternal-fetal monitoring in the state of Yucatán, Mexico, to assess whether there were any fundamental barriers preventing deployment and use. Methods. Following informed consent, high-risk pregnant women at 27-29 weeks of gestation at the Chemax primary clinic participated in remote maternal-fetal monitoring. Study participants were randomized to receive either prototype wireless monitoring or standard-of-care. Feasibility was evaluated by assessing technical aspects of performance, adherence to monitoring appointments, and response to recommendations. Results. Data were collected from 153 high-risk pregnant indigenous Mayan women receiving either remote monitoring (n = 74) or usual standard-of-care (n = 79). Remote monitoring resulted in markedly increased adherence (94.3% versus 45.1%). Health outcomes were not statistically different in the two groups. Conclusions. Remote maternal-fetal monitoring is feasible in resource-constrained environments and can improve maternal compliance for monitoring sessions. Improvement in maternal-fetal health outcomes requires integration of such technology into sociocultural context and addressing logistical challenges of access to appropriate emergency services.

eHealth: extending, enhancing, and evolving health care.

eHealth holds the promise of revolutionizing health care by improving its efficiency; extending and enhancing its reach; energizing and engaging its practitioners and their patients; and in the process, democratizing, decentralizing, and even partially demystifying the practice of medicine. In emerging and developing countries, the use of eHealth and smart health-care planning has the potential to expand access to necessary treatments and prevention services that can serve as underpinnings of rapid economic development. In developed countries, the application of eHealth promises to restructure the business model of health-care delivery, while at the same time improving and personalizing the quality of care received. This article reviews the past, present, and future of eHealth in an effort to illuminate the potential of its impact.

A role for data: an observation on empowering stakeholders.

CONTEXT: This article discusses the role of data in the reform of the U.S. healthcare system by focusing on electronic health records (EHRs) and the role of stakeholders. EVIDENCE ACQUISITION: Review of research published between 2005 and 2012 was conducted in 2012. EVIDENCE SYNTHESIS: Published literature supports the benefit of information technology in the healthcare field. Interoperability among systems is deemed key to successful use. However, incorporating information technology into medical practice will require methodically revamping the system, and consumers will need to learn how to use and manage their personal medical records. The healthcare industry's use of data-driven innovation needs to be based on modernized data systems, increased access to data, and implementation of easy-to-use technology that will enable stakeholders to participate actively in achieving desired health outcomes and cost reductions. CONCLUSIONS: Stakeholders realize the power and potential benefit of data. Access to data and incentives to develop and adopt them must be supported to achieve cost-savings. However, serious challenges remain to achieving a national, interoperable system that provides healthcare data to all stakeholders. These challenges can be addressed only by innovation.