• Apps
  • Rwanda has a new eHealth solution

    A new eHealth solution in Rwanda helps patients to access doctors by using mobiles. AllAfrica says the service lets smart phone holders download an app and access the service through a USSD code. 

    Over a million people in the United Kingdom are already using the service since its launch in 2014. Rwanda’s part of the global expansion programme aiming to promote universal health care.

    Babylon works in partnership with Rwanda’s Ministry of Health, Rwanda Social Security Board and mobile networks to launch the service. Babyl’s recruited and trained Rwandan doctors and nurses tol provide expert healthcare to Rwandans countrywide. They’ll roll out the service in Kigali in October. The rest of the country will follow over the following few months. At least 30 pharmacies are ready to provide services, starting with a pilot at Conseil Pharmacy in Kacyiru. 

    Dr Patrick Singa, Babyl Rwanda’s Medical Director’soptimistic about the new services and usingeHealth for non-emergency cases and alleviating hospital queues. He said "Having practiced medicine in Rwanda and for the last 7 years, I have witnessed the Rwandan healthcare system grow leaps and bounds setting precedence for other markets to follow. However, we still face shortages in doctors and patients still experience queues at clinics and hospitals. This service will enable those without emergency cases to access doctors saving time and money whilst still receiving top healthcare service from our doctors."

    The service’s is now in its testing phase. Users can now dial *811# from their MTN or Tigo service to register for updates and joined the free trial period. They can also contact the call center on 8111 for more information.


    Image from Babylon

  • An app can reduce readmissions

    Hospitals are a scarce resource. Acfee’s database shows Africa with about 15 hospital beds per 10,000 people in a range of 0.4 to 63, so well down the global league table. It’s essential that their utilisation’s efficient and effective. Avoiding avoidable readmissions makes a big contribution.

    A big research team in the USA reported in the Journal of the American Medical Association (JAMA) Internal Medicine that a quarter of readmissions might be prevented. A high priority recommendation’s to improve communication between healthcare teams, and healthcare professionals and patients. It also said improvements are needed in assessing patients’ readiness for discharge and disease monitoring, coupled with better support for patients’ self-management.

    To succeed, these have to be effective in a setting with many “Potential underlying factors.”  They’re “Medication safety, care coordination, discharge planning, advance care planning, promotion of self-management, enlisting of help and social supports, diagnostic and therapeutic problems, and monitoring and managing of symptoms after discharge.”

    Now, a team of students at New York State’s Binghamton University has developed Post Discharge Treatment and Readmission Predictor (PDTRP), an Android app.

    Eurek Alert has a report saying PDTRP was second at the 2016 Institute of Industrial and System Engineers CIS Division Mobile App Competition. Its recognition isn’t surprising. Discharged patients who need further help can communicate directly with their healthcare provider instead of turning to emergency services. This messaging service between healthcare providers and patients is alongside its data mining techniques that help to evaluate and estimate readmission risk rates. Their prediction accuracy’s up by 20% over traditional logistic regression prediction models.

    The development team hasn’t finished. It’s improving PDTRP’s quality and user-friendliness. Future features could include better accessibility and user-friendliness of the Graphical User Interface (GUI) for tablets, a medicine scheduler and tracker that connects PDTRP to home medicine dispensers and fitting it to other smartphone platforms such as iOS.

    Africa’s emphasis on mHealth offers a good opportunity for PDTRP. Its hospitals are a scarcer resource than in most other regions.

  • There’s now an app to read 2D barcodes

    Vaccination services across Africa are a high-priority. They can benefit from continued modern eHealth investments. As vaccine vials increasingly use two dimensional (2D) barcodes, health workers need devices to take advantage of the enhanced documentation of vaccinations at points of care. A study by a team from Ottawa University and Karolinska Institutet and reported in the Journal of Medical Internet Research (JMIR) says this is limited to facilities equipped with dedicated barcode scanners and compatible record systems.

    The team has developed and tested an app with two goals. One is a cost-effective alternative to 2D vaccine vial barcodes. The other’s to improve information about vaccines in EHRs. Using four different types of mobile phones, the team tested its new app’s scan success rate, data accuracy, and time to scan for factors of barcode size, curvature, fading and ambient lighting conditions. Each experimenter completed four trials ten times; a total of 2,160 barcode scans.

    More than 1,830 were successful, with no incorrect data about the vaccine product. Five-millimetre barcodes were the slowest, by an average of only by 0.5 seconds. Barcodes with up to 50% fading had a 100% success rate. Success deteriorated beyond 60% fading. Curved barcodes took longer to scan compared with flat, but success rate deterioration was only observed at a vial diameter of ten mm. Light conditions didn’t affect success rate or scan time between 500 luminous flux per unit area (lux) and 20 lux. Below 20 lux, device’s scanning is less successful. Variable scan times occurred with devices in all tests.

    The results show that mHealth apps can scan 2D vaccine barcodes in the majority of conditions. From the finding, the next steps are to evaluate the opportunities to gain health workers’ acceptance and improve vaccination workflows and performance.

    There are several types of 2D barcodes. They’re described by Barcode Man. As developments enable an increasing amount of data held in them, it’s important that Africa’s health systems and eHealth strategies take advantage of these new opportunities to improve vaccination coverage.

    2D barcodes contain more information than 1D, linear barcodes. 1D’s become longer as more data’s added. 2D barcodes are viable with scanning using Charge-Coupled Device (CCD) and laser scanners that have replaced light pen scanners. When data items reach between ten and twenty, 2D barcodes should be used instead of 1D.

    PDF417 is an established 2D barcode standard. It offers the greatest amount of data in the smallest space. In a very short time PDF417. There’s more than one type.

    This’s one example of a 2D barcode.

    It has the same number of data characters earlier types, with the same number of data characters. There’s no extra benefit than using earlier types of barcodes.

    This’s another:

    It contains more characters, so can achieve more than conventional barcodes. Another important feature is its manageable barcode. It’s important for Africa’s vaccination services to keep up with barcoding technology developments and invest in the eHealth capabilities needed to gain the additional benefits they offer.

  • Heart failure apps need improving

    Few apps for Heart Failure (HF) conditions meet the required criteria for quality, content, or functionality. This’s the finding of a study by a team from Columbia University, its College of Physicians and Surgeons and New York-Presbyterian/Columbia University Medical Center, and reported in the Journal of Medical Internet Research (JMIR). The team proposed that the apps need refining and mapping to evidence-based guidelines to meet the need for overall quality improvement in monitoring HF symptoms and self-care.

    HF’s a common, complex, and costly cardiovascular condition. A study by Banerjee and Shanthi Mendis in Current Cardiology Reviews identified a need for a global health perspective because “HF is likely to grow as a major clinical and public health challenge due to demographic changes as well as rising prevalence of causative risk factors in aging patients, including hypertension, coronary artery disease, degenerative valve disease and obesity.” Africa’s stretched health systems will have to deal with this challenge, and effective mHealth should offer a viable solution. It seems that it’s some way off.

    The Columbia study’s the first to undertake a comprehensive, independent review and evaluation of commercially available apps for HF symptom monitoring and self-care. Disappointingly, and despite the HF patients’ needs, most mHealth apps support healthy living rather than chronic disease management. However, many apps are used with minimal knowledge of their functionality and ability to integrate data into health care systems, and with limited efficacy for improving patient or clinical outcomes.

    Consequently, many HF apps have not yet been readily adopted into routine clinical management. They need further development to support comprehensive symptom management for HF patient. These findings are important for cardiologists and their patients in Africa. mHealth for HF needs rigorous assessment and business case before a decision to proceed.

  • How many apps enable good patient engagement?

    Successful patient engagement using mHealth doesn’t rely on one app. Different patient groups have different mHealth needs, so it’s important to create an agile multi-app strategy for effective patient-centred care. Patient-Centered Care, One App At a Time is an eBook by Mobile Smith and available from mHealth Intelligence.

    Answers to three questions are important for progress:

    What kind of mobile experiences your patients want, expect and embrace? How to capture their mobile moments at each turn in the patient journey? Are All Patient Demographics Ready for Mobile? 

    There are four main app groups:

    General health system apps that deal with topics such as contacts, insurance, access to directories, waiting times and news Apps for specific conditions, such as Congestive Health Failure (CHF), diabetes, malaria, TB and HIV that provide access to searchable libraries for articles, images and video, personalised care teams, symptoms and medication trackers and connection to patient support communities Pregnancy and maternity apps with services such as illustrated weekly pregnancy calendars, kick counter, contraction timers, appointments, medications and postpartum and newborn care resources Directional apps that include, geofencing, virtual barrier and function using Global Positioning System (GPS) or Radio Frequency Identification (RFID) to define the geographical boundaries, push messages for specific locations, 2D and 3D Maps, overlay photo pointers and tips and alerts.

    All these can help to engage patients efficiently without direct integration with EHRs. This makes it easier to develop mHealth by applying five characteristics: 

    Personalised, where the User Interface (UI) and functionality are tailored to specific audiences and patient groups Less is more, so don’t try to make your app do too much, but stick with two to three key features and two to three secondary features Dynamic, so new content can be added regularly without having to resubmit or re-download apps Has a mobile hook, so performs helpful and frequently needed functions that makes it indispensable Easy to navigate, so the UI elements are optimised to make user experiences easy for target audiences and groups, and there are no unnecessary steps, bulky splash screens, upfront registration, or annoying adverts.

    Applying these should start small and act fast. Patients want these two requirements from their mHealth experiences. Innovative and fancy apps are less important to patients than simple, straightforward Health tools.

    This broad mHealth view helps Africa’s health systems to develop their mHealth strategies and priorities over the medium term. They can then commission apps that match this.

  • WHO Zika app for healthcare workers

    The World Health Organization (WHO) is building an arsenal of digital tools to support patients and healthcare workers. It already has an e-pocketbook app for children and recently released an mHealth checklist for the reporting of mobile health studies. Their latest mobile app supports healthcare workers in their fight against Zika, a fast-spreading virus that the WHO has declared a global public health emergency. The Zika app is a medical app for physicians and health professionals to reference for the latest information about Zika, says an article in iMedicalApps. 

    The virus is an emerging mosquito-borne illness that was first discovered in the 1940’s. It is spread via the bite of the Aedes mosquito, though we now know the virus can also be spread via blood and semen. 

    Although outbreaks in the past in Africa and Pacific countries had noted microcephaly, the current outbreak that started in French Polynesia and Brazil has brought the proposed microcephaly link to the forefront. The WHO predicts that over 2,500 babies in Brazil will be born with microcephaly attributed to Zika.

    The virus has spread rapidly throughout the Americas. The Centers for Disease Control ahs reported says there are now cases in over 40 countries and territories. Zika’s also now reached Africa’s shores as numerous cases in Cape Verde, off Western Africa, has been reported in eHNA. 

    Currently there are very few medical apps on Zika, which is why the WHO Zika app is a welcome addition. The Zika medical app has three main modules: general information, health care workers, and news. Each one has many sub topics, ranging from symptoms to transmission to prevention. The healthcare worker section contains all of WHO’s technical guidance, ranging from birth defect surveillance training to prevention through sexual transmission. The medical app contains numerous WHO graphics, PDF’s and videos along with the most current Zika news. 

    It’s a crucial tool for healthcare workers. The app’s free, available in English, French, Spanish and Portuguese and provides detailed content on the Zika virus. Its life-saving information and news section will ensure healthcare workers are familiar with the latest developments and spread of the virus, allowing healthcare providers and policy makers to track its spread and make better informed decisions. It’s essential for Africa’s health systems.

  • Entries open for MTN Business SA app of the Year

    Submissions for the MTN Business SA App of the Year Awards 2016, one of the biggest and most prestigious of its type in South Africa, are now open. The competition’s a springboard for creative developers and their original solutions. Previous winners have gone on to launch their apps internationally, been acquired by blue chip corporates, or become well-known and loved South African digital products in their own right, says an article in IT NEWS AFRICA.

    Vula Mobile, is one example. It started as a small start-up focusing on medical referrals between health workers and ophthalmology specialists, making it easier to refer patients from remote communities.

    Vula isn’t just about eye care anymore. It now extends across a wide range of other specialties of: 

    Cardiology Orthopaedics  Burns. 

    The Vula team’s also planning to add more specialties including:

    Ear, Nose and Throat (ENT) Dermatology HIV Paediatric surgery Oncology

    Participants benefit from the rigorous judging process that includesconstructive input from industry experts that in turn helps them to refine their pitch and product. They also receive extensive media coverage from the event and a networking opportunity, taking home valuable prizes.

    Entries can be for one or more categories and subcategories:

    Best Enterprise

    Media and communications Ecommerce Business solutions and sales Utilities Navigation, the and geo location apps.

    Best Consumer

    Finance and banking Entertainment and gaming, including children’s apps Media and communications, including community and social activities Lifestyle, including health and fitness, and personal education Productivity, including utilities Creative apps including photo and video Best Enterprise Development App, drawn from the MTN Foundation app development programme alumni Best Breakthrough Developer Most Innovative App.

    Descriptions of the categories, entry fees, and the entry form are all available at www.appoftheyear.co.za. Deadline for entries is Thursday 2 June, 2016. The MTN Business App of the Year Awards ceremony is at Sandton Convention Centre on 4 August, 2016.

  • Uganda uses mHealth to boost reproductive health

    Health app developers in Uganda received a boost with a two day hackathon completion organised by Vodafone Uganda in partnership with Marie Stopes Uganda and Hostalite Limited, an e-commerce solutions provider. The 2016Health App Challenge was aimed at developing mobile app solutions to increase uptake of sexual reproductive health information and services. The event was on May 13 to 14 2016, says an article in BIZTECHAfrica.

    The hackathon attracted local developers and innovators from twelve universities across Uganda They came in response to the growing commitment to leverage ICT to empower young people, complimenting Marie Stopes Uganda’s ongoing work in reproductive health. Speaking at the launch of the Challenge, Faith N. Kyateka, the Communications and External Relations Manager, Marie Stopes Uganda, said, “Reaching young people with Sexual Reproductive Health information and services is one of the key focal priorities of Marie Stopes Uganda. Developing an app is essential because 80% of youth in Uganda have access to media through mobile phones.”

    At the end of the day, students from Ndejje University developed the winning app dubbed Munno. Once complete, the app will make it easy for users to interact with it, receiving answers to health-related queries and the nearest places where one can get medical help.

    In March 2016, Vodafone Uganda held the 4th Edition of Power Talks whose main focus was on forging ways on how ICTs, including mobile apps, can be utilised to enhance the delivery of health care to millions of Ugandans. Using methods drawn from design thinking and creative problem solving, the hackathon encouraged participants to think outside the box and design unconventional solutions to promote young people’s sexual reproductive health. The hackathon followed the principles of “user-centred design”, actively engaging young people in the development of solutions that are based on their real needs and experiences. 

    As part of its Corporate Social Responsibility, Hostalite Limited has offered to mentor and incubate the developers of the winning app at its fully facilitated Labs at Hostalite Cyber Academy in Bukoto.

  • South Africa's eHealth on the move

    The Department of Health in South Africa’s implementing a number of mHealth and eHealth initiatives to strengthen its health system. It says its mobile app, which allows it to monitor medicine stock at health facilities, is already helping it to overcome the challenge of shortages, says an article in allAfrica. 

    The stock visibility system (SVS) is a mobile app that healthcare professionals use to scan medicine barcodes and enter the stock levels for Antiretroviral Drugs (ARV), TB medication and vaccines. "This information is in real-time and is availed at any geographic location via the web. Six provinces have the SVS, covering 1 900 or 60% of our clinics. We plan to have 100% of all primary health clinics reporting medicine availability into a national medicine surveillance centre within the next three months," Health Minister Aaron Motsoaledi said in his briefing to the media after tabling his department's 2016/17 Budget Vote in Parliament. 

    Getting ready for NHI

    Minister Motsoaledi said another programme helping the country get ready for the National Health Insurance (NHI) is the Central Chronic Medicine Dispensing and Distribution (CCMDD). It enables patients to collect their medication from a pick-up point near their homes or work, saving them time and money. "CCMDD also reduces waiting times at clinics by reducing volumes of patients who have to come to a clinic. We currently have 400,000 patients enrolled on this programme, accessing their medicines from over 1,000 pick-up points including adherence clubs, occupational health sites, GPs and private pharmacies," said the Minister. The department plans to reach 800,000 patients by the end of this financial year. 

    Mobile app for standard treatment guidelines

    The mobile app, launched in November 2015 to disseminate standard treatment guidelines, has already been downloaded 15,000 times in South Africa and 1,000 times by international users. The app is freely available from all app stores and also works offline to assist health professionals in remote areas with poor or no connectivity. It helps decision making at the point-of-care and has a function to report any stock shortages of essential medicines. 

    The app’s not only for healthcare workers. Patients and members of the public can also download it to inform the department about side effects of any medication they are using. This valuable feedback is collected by the app and is available for healthcare workers to make better informed decisions.

    Strengthening primary health care

    The Department of Health is in the process of installing computer hardware for the rollout of the Patient Health Information System in clinics. According to the Minister "This system will be able to trace any patient within the system, like when and which clinic have they have visited before, what medication they received and what amount of medication was dispensed." Out of the 700 primary health care facilities in the NHI pilot districts, 657 have already been covered. A total of 1,400 additional facilities are expected to be completed in this financial year, with the remaining facilities to be completed in 2017/18. Next month the system will be officially launched after loading one third of the uninsured population.

  • Apps can track your heart rate

    Numerous apps are available to measure and track your heart rate. They use a combination of the phone’s camera and flash. When covered by your finger, the flash lights up the flesh and the app measures subtle changes in light reflection as blood pulses through. Basic versions are generally free to download. 

    Standard features with most of the apps include options to add various types of information, to help track what you were doing when you measured your heart rates. This information can be processed through an analytical engine to provide insights into your state of health, and feed it back to you in graphical views that help you to make sense of the numbers. Cloud storage and cloud processing are common, as are ways to export or share the information with others, either directly via the app or through email or social media. 

    One of my favourite heart rate apps is Cardiio (rated 4* for iOS) that I’ve written about before. Cardiio adds a novel second way of capturing the heart rate by measuring subtle changes in your face when you look into the camera. 

    Cardiograph (rated 4* for Android and iOS) adds a geotag to each heart rate saved, helping to create a record of where you were for different heart rates. It also allows synchronization of the readings captured across multiple devices.

    Instant Heart Rate by Softonic (rated 4* for Android) is another. It’s available on iOS and Android. The basic version is Free. The preium version, needed to unlock some of the more sophisticated analytics, will cost you R199,99 per month or R579,99 per year.

    Among other features, the premium license adds automatic acquisition of sleep length from it’s sleep app, including this data in the analytics that estimate your state of health. Instant Heart Rate also integrates with the Argus calorie counter and activity app to help you plan to improve your fitness levels.

    Upgrading also gives you access to its StandUpTM test. It collects two readings, one seated and one standing, and provides additional insights from analytics run on this data.

    There are many more heart rate apps available. With so many choices, you may want to examine the field carefully before committing to one. You’ll need to consider which features you need, such as:

    Other information you’d like the app to collect Insights you’d like analytics to provide Ways to share information form the app with other people

    That should narrow the choices. Next, consider:

    How easy do you find the interface to use? Is there support for when you get stuck? What’s the cost of the feature package you need? Have there been any formal reviews of the app, in reputable publications, and what do they say? Does you doctor, nurse or other health worker support integration between their systems and the apps, possibly even accepting automatic alerts if your readings raise any red flags?

    Working through these questions is likely to be tedious, so I expect many of you will simply download the apps that look interesting and use the first that seems to fit your requirements. That’s what I did. But as the role of apps and their health-enhancing potential grows, more rigorous evaluation and reporting, in more accessible ways, is likely to become valuable.

    In the mean time, email eHNA if you discover something you’d like to share with other eHealth enthusiasts in Africa. We’ll publish your views.