Last week I had the pleasure of attending Texting4Health, organized by the partnership of Stanford Persuasive Technology Lab and CDC.

When I first wrote about T4H conference and covered Richard Adler's mobile healthcare report, my comment was that the use of SMS in healthcare is a nascent area with huge potential - but the "islands of expertise" are highly disconnected. The real accomplishment of the conference was bringing together some of the most prominent projects and practitioners of the field.

First, a few general observations about "mobility in healthcare"

Text messaging applications for health are still somewhat under the rader, but expect to hear a lot about them in the coming decade. The reason is that mobile devices are going to account for a greater share of Internet access and keep improving their usability, cost, connectivity and social acceptance. Right now health applications are still quite primitive, but simplicity is certainly a virtue.

Europe and the developing world lead the way, as mobile handsets there are often used in place of phone landlines. Mobile phone acceptance as a primary communication device drives people to adopt them for more applications, including texting. Most amazingly even in US, residents of low income and under-served areas tend to pick mobile phones ahead of landlines.

Mobile devices have a few special reasons to play a prominent role in health and wellness. The key is always-on, on-the-go access to information which makes them idea for wellness alerts. Sensors might come sometime in the future to monitor your physical condition and react with actionable suggestions. The possibilities are dazzling, yet lots of work is needed to figure out what will work.

A lot of these applications are still "in the future" with more near term challenges being getting people used to text messaging. Receiving a text is trivial and works on most mobile phones. But sending one at this time might have a lot in common with proverbial "programming of a VCR". Teens grow up knowing how to do this, while adults might not have time or inclination to figure this out. Yet.

Now let me go through the most notable highlights of the event

As you can see from program posted on the conference site, there was a full day of presentations and panels with two half-a-day workshops. I missed "Introduction to Texting" on Thursday, but as far as I understand this was a tutorial on SMS basics. The Saturday post-conference was focused on "how-to's" of launching your own "texting intervention", led by some of the speakers from the prior conference day representing the vendor side.

With several dozens speakers going through rapid-fire 10 minute presentation for the whole day, there is no way I can do justice to all in covering all their points and solutions. So, I am just going to highlight the most interesting and important aspects relevant to each of "Six Main Topics", mentioning key speakers and companies wherever most appropriate. So here they go:

I. Intro to Texting 4 Health

BJ Fogg and Richard Adler gave an excellent overview of why T4H is important. Key trend is the growth of mobile is still on the exponential curve with 95% of US handsets text-capable, but each carrier's network is a "walled garden". In US, 41 million people send texts every day. Receiving usage even across age groups, but ability to send drops sharply for older users. Despite availability of various pricing plans, perception of "extra costs" is still an issue.

Then Stew Skomra from Qualcomm gave a broader overview of "mobile messaging". Looks like the handset makers are eager to move consumers to more premium offerings. This means going from over plain SMS (Short Message Service) to MMS (Multimedia Message Service), IM (instant messaging) and Mobile Email. Immediate usage of higher-end messages drops off sharply, compared to SMS.

II. Public Health, Public Policy, SMS

The session was dominated by presentations from public agencies and their contractors. Janice Nall of CDC gave the overall introduction of why public health agencies care about SMS (hint: because they can use it to reach most people with public health messages anywhere). Nick Sabadosh, with Northrop Grumman, presented several projects they implemented for CDC, mostly focused on integrating these alerts with web presence - a lot of case studies.

One of these projects focused on promoting HIV testing has been done in partnership with Kaiser Family Foundation, represented by Tina Hoff. Tina talked about how partnerships with MTV and Viacom drove PSA ad traffic directly from TV to sending SMS for finding the local HIV testing center, bypassing websites. Finally Claus Møldrup gave us a perspective how SMS for public health was tested in Europe (Denmark) for smoke cessation - with interactive surveys.

III. Changing Health Behavior via SMS

A dazzling array of case studies discussing several specific SMS interventions. Kevin Patrick from UCSD talks about their weight management intervention. Deb Levine (I love her organization's name: Internet Sexuality Information Services) discussed the famous SEXINFO hotline, I highlighted earlier. Michele Ybarra discussed uses for teen health and parenting.

More international case studies: An awesome "SweetTalk" program from Scotland for diabetes reminders (dietary, emotional support, goal setting & glycaemic control). More from Claus Møldrup (Denmark) on supporting self-management for asthma care (HandyMentor project). Finally, I'd mention HealthPhone from New Zealand (smoke cessation) that was actually presented in Session I.

IV. Physical Activity, Mobility, and Text Messaging

Several presentations about use of texting in conjunction with specific physical activity regimens. Anne Friedlander from Stanford Center for Longevitygave a basic overview, while several solution vendors (Kadoink, B! Fitness, Mosoci) discussed how these could be integrated into social networking and life-streaming applications. Generally this seems as a very promising area to me.

V. How to design and launch a texting intervention

Stanford Persuasive Tech Lab members and alumni (BJ Fogg, Adam Tolnay and Dean Eckles) lead the discussion on human interface and usability. I especially liked Dean's presentation with some specific findings on what gets people to engage through texting. You can check out his publications on Nokia Research profile page. The subsequent panel brings together several additional speakers to talk about nuts-and-bolts of designing an intervention.

VI. Showcase of Texting Applications

I found this session one of the most interesting, as a showcase of tools, platforms and really high-volume SMS applications (health and non-health). Eric Holmen from SmartReplytalked about their mobile marketing platform and Lee McArthur from 4INFO discussed a very similar product. Ken Banks talked about FrontlineSMS, a simple windows-based tool for developing countries. Rajiv Mehta introduced ZumeLife, a specialized wellness device.

VII. Envisioning the Future of Texting 4 Health

Jason Tester from the Institute for the Future shows us the visions of what "longer-term future" will look like. Think of wearing "intelligent goggles" with sensors that will prompt you about the foods you are considering buying or people you are meeting, etc. etc. etc. Looks very enthralling, though of course seems to be way out in the future. In my view it would take quite a while for even some pieces to become available widely.

All said and done, Texting4Health was a remarkable conference for a remarkable field. Next year CDC will be taking the lead on getting it organized and I look forward to seeing further development of solutions in this arena.

This is a space definitely worth following closely.