This document describes an urban e-health pilot project in Santa Marta, Rio de Janeiro that aimed to address barriers to healthcare access using portable electronic health technology. The project found that the e-health backpacks enabled nurses to perform in-home visits and detect chronic diseases earlier, reducing healthcare costs and hospitalizations. Patients and health workers largely reported positive experiences with the backpacks. The results supported the value of using mobile health innovations to improve care for underserved communities.

1. URBAN E-HEALTH PROJECTSanta Marta Community, Rio de Janiero

2. BACKGROUND

3. BACKGROUND
• Low and middle-income countries are urbanizing rapidly
• More processed foods, less exercise
• Shift from communicable disease to non-communicable diseases
• Communicable Diseases
• Malaria, TB, Hepatitis
• Non-Communicable Diseases ( Chronic )
• Long duration and not passed from individual to individual
• Cardiovascular, Cancer, Respiratory Diseases, and Diabetes
• In 2007, 72% of deaths in Brazil

4. STATISTICS
• 1980 – 2008, 10-year increase in life expectancy of every baby
• At 2050, life expectancy of every baby in Brazil is 81
• In 2005, 15% of Brazil’s population were 65 years old and older
• At 2050, they would be 55% of Brazil’s population
• Higher demand for health services

5. WHY RIO DE JANIERO?
1. A rapid-aging population
• Highest ratio of elderly population
2. Changing dietary habits
• Obesity also targeting the poor
• Chronic diseases on poor neighborhoods
3. Public heath-care that are adjusting
4. Rise of real-estate prices
• For new hospitals
5. Prevalence of underprivileged urban areas
• 22% or 1.4 Million, Little or no access to healthcare

6. WHY SANTA MARTA?
• Transportation is a problem
• Slow and overcrowded cable car
• Nearest public hospital, 6 km from Sta. Marta
1. Pacification Program
• To reduce high level of violence and crime
2. Saude Presente ( 2009 )
• Expand health services to remote areas
• Currently, Santa Marta’s Family Clinic
• 1 doctor, 1 nurse, 1 nurse technician, 2 oral health teams, 6 community
heath agents ( INFOMEDIARIES )

7. SCOPE

8. SCOPE
• The Pilot Program
• Portable e-health kit for Santa Marta’s Family Clinic
• Measurements of blood pressure, glucose level, quickly and efficiently
• Backpack can be transported easily
• Can e-health technology reduce the cost of healthcare in a previously
underserved community?
• Does e-health technology help overcome barriers to healthcare in this type
of community?

9. SCOPE
• Directly addresses the gap in access
to public services
• Accelerates the process of health care

10. OBJECTIVES

11. OBJECTIVES
1. Address current and future health challenges affecting major emerging
cities
2. Tackle the economic, social and physical barriers to healthcare for
underserved communities
3. Develop a new economic model of healthcare

12. TASK FORCE MEMBERS

13. TASK FORCE MEMBERS
• The Pilot Project
1. City of Rio de Janeiro
2. Support of the Municipal Secretary of Health
3. GE
• Founding member of the New Cities Foundation
• Technology, strategic and financial support
4. Cisco
5. Department of Clinical Medicine at the State University of Rio
• Independent research team

14. TARGET POPULATION

15. TARGET POPULATION
• Elderly inhabitants of Santa Marta
1. Quality of Life
2. Good Nutrition
3. Physical Exercise
4. Rehabilitation
• 100 patients over the age of 60
• Data collection: 7 months
• August 2012 – March 2013

16. E-HEALTH BACKPACK

17. E-HEALTH BACKPACK
• Problem
• No equipment for blood analysis
• Chronic diseases cannot be detected
• Solution : E-Health Backpack
• Detect an average of 20 diseases in minutes
• Nurses can perform in-home visits
• Cost : USD $42,000 or Php 19 000 000.00

18. E-HEALTH BACKPACK
V-Scan
• Pocket-sized ultrasound device
for obstetric, abdominal and heart tests

19. E-HEALTH BACKPACK
Tuffsat pulse Oxymeter
• Blood oxygenation and heart rate

20. E-HEALTH BACKPACK
Electrocardiogram
• Electrical activity of the heart
Picture taken from : sanwinmed.pp.alibaba.com

21. E-HEALTH BACKPACK
Accutrend blood monitor
• Monitors glucose, cholesterol,
and triglycerides level

22. E-HEALTH BACKPACK
Tapemeasure

23. E-HEALTH BACKPACK
Scale
• Assess bioimpedance, weight,
fat, and hydration
• Bioimpedance – response to external
electric current ( blood flow, fat content )

24. E-HEALTH BACKPACK
Blood pressure monitor

25. E-HEALTH BACKPACK
Thermometer

26. TRAININGAND OUTREACH

27. TRAINING AND OUTREACH
• The Team
• 4 Doctors
• 1 Nurse manager
• 3 Nurses
• 3 Nurse technicians
• Doctors
• Trained to use the V-Scan
• Interpreting data collected from
the backpack

28. TRAINING AND OUTREACH

29. DATA COLLECTION

30. DATA COLLECTION
• 30 weeks of Data Collection
• 200 visits with backpack
• 6.6 visits per week
• To diversify the data pool, the study
included:
• Pregnant women
• Patients under 60
• Patients with disabilities

31. DATA COLLECTION

32. RESEARCH METHODOLOGY

33. RESEARCH METHODOLOGY
1. Is e-health cost effective from the public healthcare perspective?
• Economic Benefits
• Based on the avoided hospitalizations
• If patients condition can be prevented from advancing to the next stage
• Avoided clinical outcomes

34. RESEARCH METHODOLOGY
2. Does the pilot improve access to healthcare services for underserved
populations?
• Clinical Impact
• Patients in the pilot VS a control group
• Difference in healthcare costs

35. RESEARCH METHODOLOGY
3. What is the end-user experience?
• End-user Satisfaction
• Patient’s and clinical staff’s satisfaction with the backpack
• A questionnaire was used to survey the users

36. RESULTS

37. RESULTS
Economic Impact
• Significant positive impact
• In-home visits were enhanced with the E-heath Backpacks
• Early detection of chronic diseases
• USD $200,000 per 100 patients per year
• Decrease severity of cardiovascular illness
• Reduction of 360 hospitalizations per 1000 patients
• USD $135,876 per 1000 patients per year

39. RESULTS
Clinical Impact
• Lower prevalence of clinical conditions VS historical control groups

43. RESULTS
Social Impact
• Majority of the patients and health workers : POSITIVE
• Reduction in time for medical results

44. RESULTS
Terrible
Poor
Neutral
Good
Excellent
Not Evaluated

45. RESULTS
Terrible
Poor
Neutral
Good
Excellent
Not Evaluated

46. RESULTS
Terrible
Poor
Neutral
Good
Excellent
Not Evaluated

47. CHALLENGES

48. CHALLENGES
1. Delays
• Authorization process
• Completion of the E-Health kit
2. Technical
• Need for a medical specialist to interpret images
3. Process
• Breaking the routine, using the backpack
4. Data Collection
• Slow at the early stage because of the 3 previous challenges

49. CONCLUSIONSAND
RECOMMENDATIONS

50. CONCLUSIONS

51. CONCLUSIONS
1. E-Health kit benefits the patients as well as the healthcare professionals
2. Morbidity reduced for chronic disease suffering patients
3. The e-health project is worth the investment
4. High tech innovations can be used to improve healthcare in underserved
communities

52. RECOMMENDATIONS
1. From m-health to e-health
• Full potential of the backpack should be utilized
• Use wireless technology within the backpack
2. Expand the type and location of patients
• Other communities with fewer health services
3. Extend the analysis of measurements taken
• Cost saved for patients ( fare, etc. )
• Carbon emissions reduced
• Add another team member : social scientist

53. SOURCE
New Cities Foundation (2013), An Urban E-Health Project in Rio, [online] Available:
http://www.newcitiesfoundation.org/wp-content/uploads/PDF/Research/New-Cities-
Foundation-E-HealthFull-Report.pdf

54. END