Home patient monitoring means two things: the imminent rise of the Expert Patient whom the health authorities anticipate would self-manage his long-term medical conditions, and the prominence of mobile devices as the go-between for clinicians and patients.

With the geographical distance widening between doctors and their patients, the problem hinges on two things: digital literacy and (mis)communication. “Intervening semiautonomous” individuals such as the carers, and also nursing services (May, 2005: 1492) help to an extent, but with the patients left to ‘self monitor’ in their homes, the buck – or to put it bluntly, the blame – will inevitably be passed on to the devices used for ‘medical’ assistance.

Video call: a trusted medium?

This is where video conferencing via mobile devices such as the smartphone comes in. Video conferencing can never supplant face-to-face consultations. Its role is ancillary: the mode acts in support to existing and more accurate diagnostic methods. But, as a paper in the journal Neurosurgery highlighted, it is still a credible tool for medical professionals to form their judgements. Video conferencing is useful for “early diagnoses and initiation of treatment in emergent cases” (Yamada et al, 2003).

In the context of LCD-centric product development, the significance in software application is immense: User interface (UI) and object-oriented programming have never been so important in m-health design engineering (www.clinica.co.uk, 8 October 2010).

Using the grammar of 'television': Cisco's Joan Brenton captured by a "telepresence videocam", and our Nikon at Smart Healthcare Live 2010, London, UK. Ms Brenton says the 'immersive' experience is makings its way into healthcare, via televisual Photo: Salina Christmas

In December last year, Informa ran a workshop – a post review of the Mobile Health Industry Summit 2010 – which was attended by medtech and telecommunication representatives, and members of the media such as the BBC. The broadcasting channel highlighted the use of video conferencing for monitoring patient with chronic illnesses in its video report, which also features soundbites from Informa Telecoms conference manager and Open Surgery contributor, Sophie Powell (fast forward to 3:50s in the video timeline).

Video conferencing is still at its early stage of application in m-health, so it has to fall back on the grammar of social media. The face-to-face interaction is reminiscent of Skype and of iPhone4’s Facetime streaming. Not television. To some, this is a mind-boggling concept that needs getting used to. Patients need time to feel comfortable with the idea of video conferencing as a ‘trustworthy’ form of communication, like the telephone.

M-health, meet the G-Tab

Privacy is no laughing matter, warns 3G Doctor’s David Doherty, who conducted a live video conference via the Samsung Galaxy Tablet (G-Tab) for the London Design Festival 2010 at University College London for an audience of designers, programmers and Digital Anthropology students. (That event also marked the first time ever that the G-Tab was introduced to members of the public, outside the trade circle.)

Speaking at a m-health meeting in September 2010, Mr Doherty said a patient’s privacy is an issue that needs consideration in the rollout of this video conferencing technology. However, he added that in the context of “telehealth”, a conversation between doctor and patient on a mobile device can be carried out easily anywhere, such as the patient's bedroom, which makes it more private – out of sight and out of earshot (Open Surgery, www.clinica.co.uk, 13 August 2010). You would not want to show the blisters on your skin, or weep before your psychotherapist via a television-like telemonitoring device that sits in your kitchen or living room, where anyone can just walk in mid-conversation. A device like the Samsung G-Tab can be counted on to keep the transaction discreet.

Immersion is the new buzzword

“Immersion” has, for some time, been touted as upcoming user experience where video conferencing is concerned. At the Smart Healthcare Live 2010 at ExCeL, London, Joan Brenton of Cisco explained as she showed us the “telepresence videocam” that the immersive experience is making its way into healthcare via televisual (Open Surgery, www.clinica.co.uk, 30 June 2010). This manner of visual narration is not widespread yet. It seems to suit a much bigger LCD display, and is more suitable in broadcasting complicated tasks such as surgical procedures amongst medical professionals.

However, it won’t be long before this “widescreen” experience gets repurposed for the tablet, for the consumption of the patients as well as the physicians. Mobile hardware is getting more compact, running on powerful chips that guzzle less battery power. Proprietary operating systems are being rolled out with independent developers and programmers in mind (read: SDK). The bricoleurs are allowed room to tinker with the devices. Doctors at a hospital run by Kobe University made headlines last year for their use of iPad in the operating theatre. Maybe video conferencing will always be viewed by some as a no more than a mere passing fad, but that is a good start.

Salina Christmas is doing MSc in Digital Anthropology at University College London. If you have any leads on m-health, in particular on apps and QR codes running on mobile applications, contact her.