According to Uduak Thomas’s article ‘Mobile technology is changing healthcare in developing nations’, which was re-posted in the Berkeley Science Review in December last year, the World Health Organisation (WHO) defines ‘mHealth’ or ‘mobile health as ‘…a subset of ‘electronic health’ that is concerned with the use of mobile and wireless technologies to support the achievement of health objectives…’. Looking at the many other articles concerned with mHealth projects that have emerged since, there appears to be little doubt that mobile and digital technology has indeed been used to do just that: to support the achievement of health objectives and thereby make a real difference in the provision of healthcare in the developing world.
The majority of the projects these articles cover seem to focus on improving the provision and distribution of vital healthcare information to remote, rural communities via SMS on mobile networks, where innovators have sensibly exploited the massive proliferation of mobile phone use in the communities concerned, particularly in Africa.
There is a question to be asked though, as to whether mHealth solutions such as these – which deserve huge merit in the achievements they have delivered – are to be the pinnacle of what can be accomplished in this field, as principally ‘data gathering and information distribution’ initiatives, or is it possible to extend the concepts of mHealth and eHealth to provide healthcare practitioners with more dynamic and interconnected tools, that do more than just deliver health advice messages and gather statistics. Is current technology being utilised to its full potential to provide more complex services to doctors and health practitioners in the field, such as access to complete health records and dynamic community health data whilst working at a remote rural location, in spite of the challenges presented by a lack of reliable internet connectivity or intermittent power supplies in many of the communities concerned?
The answer is arguably ‘yes’ with the three cases highlighted here, which all go some way towards demonstrating how technology can go a stage further by bringing additional complex functionality, the like of which was previously only available in larger hospitals and health centres, to healthcare workers ‘in the field’, thereby assisting to an even greater degree in their efforts to help people and their communities in the more remote and disparate communities in which they work.
Carego International: Utilizing open-source and the cloud to provide a practical solution
The Yahoo Finance website seemed an unlikely source for a story on a relatively new solution to provide access to health records in remote locations, but that is where I read about Carego International, and how their new product utilises developments in digital storage and open-source technology to provide a real solution to support the provision of remote healthcare.
According to the article, last month Carego International announced the launch of a new software application, built on Progress Pacific’s cloud-based, open-source platform, to ‘…help remote health clinics improve quality of care in developing regions around the world…’
Referring to the findings of Carego’s CEO Steve Landman, much of the existing medical software he had found in health institutions in developing countries ‘…wasn’t compatible with local needs, largely due to complexity and an inability to tolerate frequent Internet service outages common in developing regions…’
Building on their previous experience in developing applications for the health sector, Carego decided to develop their latest product using the Progress Pacific development environment, with which they were able to deliver a cloud-based health records solution, which is inexpensive to deploy, easy to manage, and can be rolled out and accessed over nearly any device, be it fixed or mobile. These features make the product ideal for medical organisations in the developing world, which often have limited resources for expensive back-end support systems or mass data storage, and whose staff work in remote rural locations.
Kujua – Medic Mobile’s new communications hub for healthcare providers
In June of this year, following successful roll-out in various locations in Africa, Asia and Latin America, Medic Mobile announced the global launch of Kujua, their open-source information and communications hub for clinics in the developing world. As described in the announcement made on their website: ‘…Kujua, which means “to know” in Swahili, is a web-based application for sending and receiving regular messages and forms, and also for scheduling time-targeted confirmation messages. Right now KujuaLite is optimized for three priority use cases — disease surveillance, stock monitoring, and service monitoring — but can be utilized for a wide range of communication and data collection activities…’ The article goes on to provide a link to a demo of the product, which can be found here: http://medicmobile.org/tools/kujua-lite/
Coupled with Medic Mobile’s existing programmes of distributing basic feature mobile phones to medical practitioners in the field, the company can now provide an end-to-end solution, connecting community members with health volunteers, doctors and the Kujua system as a back-end hub for collaboration and storage of information, to assist with monitoring emerging disease concerns and logging and maintaining communication between all those involved.
Prize winning idea provides practical solution to streamline information management in rural healthcare
Maintaining accurate health records in some sub-Saharan hospitals where paper-based systems still exist, whilst storing them securely and yet still having the means to safely transfer them if a patient moves; – these concerns are challenging enough, without the added difficulties that are sometimes encountered in identifying patients, matching them to their medical records and then needing to share that information as required between healthcare agencies, centres and hospitals. This is the impression one gets when reading an article in the Engineering for Change website (www.engineeringforchange.org), celebrating the winners of the recent ‘IEEE Global Humanitarian Conference’s Young Professionals Project Contest’, who have come up with an ingenious response to these challenges, with the application of an affordable, practical solution utilising RFID (radio frequency identification) cards. In basic terms, Radio-frequency identification (RFID) technology utilises radio-frequency electromagnetic fields to transfer data, for the purposes of identifying and tracking ‘tags’ containing electronically stored information that are attached to objects, such as the cards suggested in this solution.
The Engineering for Change article explains how, in the example of tracking and dealing with a disease outbreak in a rural community, the RFID solution could help:
‘…When polio or cholera or any disease breaks out in a community the local clinic will be the first to notice the uptick in cases. If clinics can share their records with central hospitals, then a local tragedy in one community becomes data points on a nationwide map. Then medical authorities can respond, and other communities can prepare and try to prevent new outbreaks…. Those two problems – sharing information between medical centres and identifying patients and their medical records – may have a solution. An entirely electronic health data system plus radio frequency identification chips implanted into ID cards for every patient might be a low-cost and simple way to address both issues…’
As the article continues to explain, RFID technology was chosen as it is a relatively low-cost approach and doesn’t depend on complex networks for communication. The winning team’s chosen system uses standard network protocols and can run on existing or inexpensively sourced hardware.
Accepting that there has been some opposition to using ID cards for similar purposes in the past – understandable, in the context of some of the locations and environments in which the communities concerned live – the project team acknowledged that some work needed to be done towards local community ‘outreach’, before pilot schemes could be undertaken, but they remain positive on the long-term benefits the solution could provide.
With reference to a proposed pilot in the Kerala region of India, Hassaan Idrees and John Avrett , both involved in the project, added:
“…We would like to give a physical shape to our project by working with federally-endorsed government and non-government organizations. There still are a few grey areas: increased consumer-directed care, new methods of organizing care delivery, and new approaches to financing, but we hope to resolve these with the help of the appropriate stakeholders.”
Benjamin Smith 