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Strengthening Health Systems through the application of Wireless Technology
 

Strengthening Health Systems through the application of Wireless Technology

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Presentación realizada por el Dr. Trishan Panch, de Harvard School of Public Health, el 20 de Septiembre en OPS Colombia, en el espacio de intercambio sobre e-health....

Presentación realizada por el Dr. Trishan Panch, de Harvard School of Public Health, el 20 de Septiembre en OPS Colombia, en el espacio de intercambio sobre e-health.
El Dr. Panch, participa, con el auspicio de esta Representación, como conferencista en el IV Congreso Colombiano de Bioingeniería e Ingeniería Biomédica que se realizará en Barranquilla del 21 al 24 de septiembre del 2011.

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  • Sana was born with the goal of addressing these problems. It is a volunteer organization hosted by the Computer Science and Artificial Intelligence Laboratory at MIT and consists of doctors, informaticians, engineers, public health experts, business entrepreneurs and social scientists. We are brought together by a mission to improve quality of care in resource-poor settings using an open-source cellphone-based tele-health software.
  • Sana was born with the goal of addressing these problems. It is a volunteer organization hosted by the Computer Science and Artificial Intelligence Laboratory at MIT and consists of doctors, informaticians, engineers, public health experts, business entrepreneurs and social scientists. We are brought together by a mission to improve quality of care in resource-poor settings using an open-source cellphone-based tele-health software.
  • Sana was born with the goal of addressing these problems. It is a volunteer organization hosted by the Computer Science and Artificial Intelligence Laboratory at MIT and consists of doctors, informaticians, engineers, public health experts, business entrepreneurs and social scientists. We are brought together by a mission to improve quality of care in resource-poor settings using an open-source cellphone-based tele-health software.
  • In summary, Sana uses an inter-disciplinary and collaborative model that enables (1.) technical innovation based on an open-source platform, (2.) business innovation based on models designed and tested with our partner organizations, and (3.) development of value-creating networks by building coalitions of local and international academic and provider organizations to pool resources and share best practice.
  • Sana started as a product to address the problem of rural-urban divide in health care delivery, especially in resource-constrained settings. Doctors and specialists in these countries are scarce and often are only found in the cities. For people living in remote villages, travel to see these doctors and specialists might deprive them of a whole day’s income. As a result, diagnosis and treatment are often delayed and lead to worse outcomes and more costly care.
  • Beyond this lies bigger systems problems. In these places, care provision is fragmented with health providers working independently. There is also a lack of process standardization, resulting in care that is very “ad hoc”. Finally, there exists a weak system for quality assurance and improvement.
  • Our goal thus shifted from one that is technology-focused to one that is capacity-building. We help create and sustain collaborative ecosystems that incubate, implement and scale eHealth solutions. We advocate grassroot project support and accountability among our partners, and share with them what we learn at MIT and Harvard.
  • The primary screening will be performed by health workers using the questionnaire hardcoded into the phones and visual inspection. Suspected cases are referred to the district dentist who validates the findings and obtains a photograph of the oral mucosa. The images are queued for review by the oral cancer specialists. Clinical impression is relayed to the health worker and the district dentist, and the patient with a suspicious lesion is scheduled to see the specialist, streamlining the referral process.
  • In addition to data capture and transmission, the cellphone will also uploaded with an oral cancer prevention program. We believe that an education and targeted screening program will increase awareness of oral cancer risk factors among rural population.
  • Thirty thousand patients have thus far been served in a pilot implementation and based on the success of this pilot, the National Rural Health Mission of the Indian Government has decided to fund and support adoption of the Sana cancer-screening program on a larger scale. Two hundred and fifty ASHA workers (government funded community health workers) will use Android phones enabled with Sana cancer screening algorithms to screen a population of about 1.5 million people over one year to detect early warning symptoms and signs of breast cancer and oral cancer. Screening will initially be focused on the Kolar district with plans to spread to the rest of Karnataka.
  • MIT student Chris Moses conducting needs assessment.
  • MIT student John Blakeney getting feedback about user experience.

Strengthening Health Systems through the application of Wireless Technology Strengthening Health Systems through the application of Wireless Technology Presentation Transcript

  • Strengthening Health Systems through the application of Wireless Technology
    • Dr Trishan Panch MBBS BSc DRCOG MRCGP MPH
    • Harvard-MIT Division of Health Sciences & Technology
    • Sana Mobile
    • “ Globalization is no longer driven by governments, countries or large multinational companies, but by the new found power of individuals to collaborate and compete globally”
  • Dr Trishan Panch
    • Medical Doctor (Internal Medicine)
    • Harvard MPH
    • Clinical lead Sana Mobile @ MIT
    • Lecturer in Health Sciences @MIT
  • Current projects
    • Multiparameter Intelligent Monitoring in Intensive Care (MIMIC) II database
    • Clinical Strategy lead at eHealthpoints
    • Founder at wellfra.me
    • Clinical Lead at Sana
  • MIMIC II
  • Collaborative Ecosystem
    • Beth Israel Deaconess Medical Center
      • Department of Medicine
      • Surgical ICU
      • Division of Cardiothoracic Anesthesia
      • Division of Dermatology
      • Department of Pharmacy
      • Division of Infectious Disease
  • Collaborative Ecosystem
  • Evidence-Based Medicine
    • Multi-center PRCTs and systematic reviews are gold standard
    • PRCTs provide aggregated outcomes – difficult to apply to individual patients
    • Benefits may not translate into the real world – efficacy vs. effectiveness
    • Errors and biases abound: 41% of the most cited original clinical research later refuted (Ioannidis, JAMA 2005)
  • Evidence-Based Medicine
    • 2007 analysis of >1000 Cochrane systematic reviews
      • 49%: current evidence does not support either benefit or harm
      • 96%: additional research is recommended
    • Most of what clinicians do has never been formally put to the test
  • Evidence-Based Medicine
    • Large-scale evidence impossible to obtain for the millions of questions posed in day-to-day practice
    • Is there a role for highly granular clinical databases such as MIMIC?
  • Collective Experience
    • Aggregation of knowledge extractable from actual patient care of numerous clinicians
    • Capture clinician heuristics mathematically : predicting fluid requirement (Celi et al ., Crit Care 2008)
    • Build patient subset-specific models: mortality prediction (Celi et al ., J Healthcare Eng 2011)
    • Examine areas with significant care variability
  • eHealthpoints
  • Wellfra.me
  • Sana
  • Sana
    • Volunteer organization hosted by the Computer Science and Artificial Intelligence Laboratory consisting of students and alumni of MIT, Harvard School of Public Health and Harvard Business School
    • Offers an OPEN-SOURCE mobile tele-health platform for resource-poor settings
  •  
  • Mission
    • To create and sustain an academic environment to facilitate the delivery of quality health care through the use of our open-source mobile health platform.
  • Mission
    • Empower front-line health workers
    • Early disease detection and treatment
    • Patient monitoring and outcomes reporting
    • Build the framework of a learning system to facilitate quality improvement
    • Establish best practices in implementation and scaling of information systems
  • Sana
    • Inter-disciplinary and collaborative to enable
      • Technical innovation (based on an open source platform)
      • Business innovation (based on models being designed and tested with partner organizations)
      • Development of value-creating networks by building coalitions of local and international academic and provider organizations to identify and share examples of best practice and to pool resources
    • A lack of trained physicians is one of the largest issues
    • facing healthcare in the developing world.
    Paper based medical records further contribute to inefficiencies. Patients often make long journeys to clinics, only to be referred to expensive and far away medical centers for a diagnosis.
  • Bigger Systems Problems
    • Care provision is often fragmented
    • Lack of process standardization
    • Weak system for quality assurance
  • Sana Technology
  • Sana Technology
  • Sana Technology
    • Facilitates real-time decision support for CHWs from remote experts
    • Enables development of clinical database to build customized decision support systems
  • But
    • Technology won’t fix broken systems
    • Information system, without an accompanying organizational transformation, will reinforce failed processes
  • Bottom Line
    • Innovations need to address gaps in quality, otherwise they won’t sustain or scale.
    • Quality improvement in healthcare requires a multi-disciplinary and collaborative approach.
  • Capacity Building
    • Share what we learn at MIT and Harvard to our counterparts in developing countries
    • Collaborate with partners on
      • Creating a new application or customizing an existing one
      • Iterative system re-design
      • Pilot and scaling
      • Monitoring and evaluation
  •  
  •  
  • The syllabus
    • Value Chain Analysis
    • Operations Management
    • Lean Sigma
    • Positive Deviance
    • Organizational Learning
    • Process Improvement
  •  
  • Sana Colombia
    • Strategic partnership with the Telemedicine Center at CES University, Medellin (COL).
    • Different research groups and key partners concur on technology and knowledge transfer to the business and health sector.
      • Education
      • Provision of technical services / project management
      • Collaborative research
  • Sana Colombia
  • Sana India
    • Screening of cancer and chronic diseases (heart disease, diabetes) – 20% of disease burden, 40% by 2016
    • Early detection: less costly care, better outcomes
  •  
  • Sana India
  •  
  •  
  • Sana India
  • Sana Brazil
    • Screening for common eye conditions
      • Error of refraction
      • Cataract
      • Trachoma
      • Retinal disease
  • Sana Brazil
    • Partners:
      • Prof. Raskar’s group at MIT Media Lab
      • Instituto Nacional de Telecomunicações
      • Universidade Federal de Sao Paolo
  •  
  • Sana Philippines
    • Primary care application
    • Partners:
      • Negros Women for Tomorrow Foundation
      • Center for Community Transformation
      • Integrated Open Source Solutions
      • University of the Philippines
  •  
  •  
  • Sana Taiwan
    • Assist Taipei Medical University to implement mHealth in Swaziland as part of Taiwan Medical Mission, established in 2008
  • Sana Taiwan
    • Pilot project: Surgery follow-up of patients from Mbabane General Hospital
  • Sana Greece
    • Application: Diabetic foot ulcer management
    • Partners:
      • Trikala Telehealth Service
      • Thessaly University (Dept. of Vascular Surgery, Dept. of Medical Physics-Informatics)
      • University of Western Macedonia (Faculty of Engineering Informatics and Telecommunications)
      • Vidavo Telecare
  • Sana Greece
  • Health IT
  • Health IT/eHealth
    • “ The application of information processing involving both computer hardware and software that deals with storage, retrieval, sharing, and use of healthcare information, data, and knowledge for communication and decision making.”
    • -Brailer and Thompson, 2004
  • Core Functions of Health IT/eHealth
    • Patient care: health IT as a healthcare intervention
    • Quality monitoring and process improvement
    • Supply chain management
    • Research and evidence creation
    • Health system evaluation
    • “ We found that despite support from policymakers, there was relatively little empirical evidence to substantiate many of the claims made in relation to these technologies. Whether the success of those relatively few solutions identified to improve quality and safety would continue if these were deployed beyond the contexts in which they were originally developed, has yet to be established. Importantly, best practice guidelines in effective development and deployment strategies are lacking.”
    • “ There is a large gap between the postulated and empirically demonstrated benefits of eHealth technologies. In addition, there is a lack of robust research on the risks of implementing these technologies and their cost-effectiveness has yet to be demonstrated, despite being frequently promoted by policymakers and ‘techno-enthusiasts’ as if this was a given.”
  • The State of Health Innovations
    • Reverse engineering in health technology: Build solutions first then look for clinical scenarios where they can be applied.
    • Multitudes of “sexy” solutions do not or only partially address the problems they were designed for.
    • Very inefficient system driving healthcare costs
  • The role of change management
    • Introducing innovations often requires change management.
    • There will be significant change in roles and responsibilities in the organization.
    • Cultural norms and communications will need to adapt.
    • There will be push back from people who are scared and/or don’t understand.
  • Conclusions
    • Lots of opportunity
    • Powerful tools available + free!
    • Multidisciplinary approach needed
    • Solutions to problems not problems looking for solutions
  • Conclusions
    • “ Globalization is no longer driven by governments, countries or large multinational companies, but by the new found power of individuals to collaborate and compete globally”
    • The World is Flat