Strengthening Health Systems through the application of Wireless Technology

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)

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

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
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
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 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

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Strengthening Health Systems through the application of Wireless Technology

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Strengthening Health Systems through the application of Wireless Technology Presentation Transcript