When designing mobile health systems the focal point of research is frequently concentrated on the design of innovative developments for improving the practice of healthcare and increase of wellbeing with a strong focus on functional requirements. On this regard, the aspects related to definition of non-functional requirements of mobile health provisioning are often underestimated or left as a secondary item to take into consideration by researchers. However only through a thorough consideration of potential implications on design of non-functional requirements, the mobile health innovations can find an opportunity to transform into sustainable solutions that can be applied in real life contexts. These kinds of requirements comprise all the practical aspects of healthcare provisioning that are necessary to implement mobile health services ranging from human factors to important medical and technological issues.
In this paper we introduce the experiences learnt in MONARCA project for developing a mobile monitoring system for better handling the treatment of bipolar disorder and the challenges found related to its implementation in a real life context. The main contribution of this paper focus not only on the innovative mobile health solution proposed by MONARCA but also on the technological and clinical aspects that were necessary for conducting multidisciplinary research in the context of such project and on other non-functional requirements that are key in the development of technological solutions for the design, development and evaluation of mobile health systems. Such requirements include aspects related to technology, human factors, medical practice, regulatory aspects and other practical issues that are identified in this paper as key challenges in the development of future mobile personal health systems and services (See Figure 1).
Relevant aspects in multidisciplinary IT-based clinical research
Current medical practice of bipolar disorder treatment is based on identification and analysis of mood instability episodes at different intervals of time without possibility of continuous monitoring in a practical way. On this regard, with the use of currently available technology and innovative processes proposed by recent research approaches (Mayora, 2011) it is envisioned in the short term a new generation of services to improve healthcare provisioning in the treatment of mental health diseases (Arnrich et al., 2010; Arnrich et al., 2013). In particular due to the wide acceptability of mobile devices and the growing interest in the development of healthcare-related apps, there is a clear trend on the use of mobile phones as a key enabler of new wellbeing/healthcare services. In fact, some of these new developments are already going in the direction of using mobile phone-based sensing for monitoring conditions related to specific mental diseases such as bipolar disorder (Puiatti et al., 2011). In such kind of applications, the mobile-phone-based sensing architecture integrates the set of novel services and supports key functionalities on sensing and data analysis, patients interfaces (client side) and hospital and health information systems (server side) as in MONARCA system in Figure 2 (Mayora, 2011).
MONARCA system basic components
Regarding the specific treatment of bipolar disorder, during the past years, as well as in other healthcare domains, there has been a major organizational switch in paradigm from inpatient treatment to outpatient treatment. On this regard, there is currently a scientific switch going on in the paradigm of treatment in bipolar disorder from focus on the mood episodes to focus on the inter-episodic mood instability (Bonsall, 2012) (See Figure 3).
Inter-episodic mood instability from Bonsall et al. (2012)