• mHealth
  • An SMS service improves HIV mothers’ and babies health

    The UN’s SDG 3 has two goals to improve health and wellbeing for pregnant women and babies. A study reported in Taylor and Francis Online shows that SMSs can help to improve these.

    An international research team from the University of Witwatersrand, the Karolinska Institutet, Johns Hopkins University, Princeton University and the United Nations Foundation evaluated the effectiveness of an SMS service aiming to improve the maternal health and HIV outcomes of HIV+ pregnant women. 

    Twice a week, SMSs were sent to 235 HIV+ pregnant women. They continued until their children’s first birthday. Content included maternal health advice and HIV support information.

    Outcomes were measured as Ante-Natal Care (ANC) visits, birth outcomes and infant HIV testing. They were compared to a control group of 586 HIV+ pregnant women who received no SMSs. Results showed marked benefits. Intervention group women attended more than 31% more ANC visits, and were more likely to attend at least the recommended four ANC visits.

    Birth outcomes of the intervention group improved too. The women had an increased chance of a normal vaginal delivery and a lower risk of a low-birth weight baby. 

    The intervention group had a trend towards higher infant polymerase chain reaction (PCR) testing for HIV within six weeks of birth. It also had a lower mean infant age in weeks for HIV PCR tests.

    The team concluded that its results add to the growing evidence that mHealth can have a positive impact on health outcomes. It should be scaled nationally after comprehensive evaluation. For a large-scale mHealth programme, Africa’s health systems may have to invest in extra ANC and PCR testing capacity.

  • KardioPro helps to tackle cardiometabolic disease

    Cardiometabolic disease, a cluster of inter-related risk factors that can lead to atherosclerotic vascular disease and type 2 diabetes, is the world’s leading cause of morbidity and mortality. It kills more people than AIDS and malaria combined and places tremendous strain on healthcare resources and costs. Currently, the epidemic of cardiometabolic disease worldwide is being diagnosed, treated and managed in separate silos. Healthcare systems rely on repetitive, duplicated tests and services, which inevitably leads to reduced patient outcomes and increased costs. To address this challenge, the Kardiogroup, a connected health company, has developed the first comprehensive cardiovascular risk reduction and treatment approach.


    The Kardio Ecosystem links connected health devices as a Technology Enabled Care (TEC) to validated Point of Care (POC) blood tests. It provides accurate and validated risk analyses, links to emergency care and access to treatment protocols informed by local and international guidelines.

     

    KardioPro, an mHeath app, is part of the ecosystem. It integrates with diagnostic tools, including a cardiolabs to measure patients’ blood pressure and Ankle-Brachial Index (ABI), a pulse oximeter, a professional wireless core body scale, and a glucometer.  Path Pro’s part of the configuration too. It provides the Alere Affinion Machine and the Abbott Istat POC pathology diagnostic equipment.

    Healthcare workers can use KardioPro to take measurements, connect to the KardioPro app from iPads or Androids, then visualise, track and share the results. It performs tests in 15 – 20 minutes, stores and organises results, simplifies patient monitoring and edits reports in PDF format so they can be shared by treatment teams. It also helps with the interaction of healthcare workers and patients to:

     

       Improve adherence

       Reassess treatments

       Reassure patients and explain to them the evolution of their health status

       Fix goals for patients

     

    The App:

       Is simple and easy to use

       Provides accurate risk analysis

       Has multi step reporting

       Provides treatment suggestions based on guidelines

       Delivers secure cloud based data capturing

     

    Tests performed by the app includes:

    1. HBA1C - Glycated Haemoglobin - This is used to test the 3 month average glucose of patients. It is used for screening for diabetes and used to monitor diabetic patients. 
    2.  Lipogram - This is a full cholesterol panel which is one of the important components in cardiovascular disease. It measures the different types of cholesterol in the body which is important in assessing cardiovascular risk in patients
    3. Crp - known as C-Reactive Protein - This is an inflammatory marker test can be used to determine if antibiotic therapy is required in patients who are ill.
    4. Urine ACR - known as Albumin to Creatinine Ratio - These are the two key markers to test for chronic kidney disease. 
    5. U&E - Urea and Electrolytes - This is an important and common type of biochemistry test. It is used to assess Renal Function in Diabetic patients and are important screening test for patients with hypertension.
     

    All health data generated by the device is secured and stored in an approved secure healthcare database. This is increasingly important with the rise in cyber-security threats.

    KardioPro is currently being used by 40 practitioners in South Africa. The solution has the potential to benefit resource poor communities across the continent. KardioPro is looking to expand internationally with interest to collaborate with international partners. 

  • Whatsapp helps to demystify cancer in Tanzania

    Cancer rates are soaring in Africa and people are taking note. The answer to why the disease is spreading so rapidly on the continent is not straightforward. Doctors and health workers attribute the spike to poor health education, environmental changes, high HIV rates, improved diagnostics and the fact that people are simply living longer.

    WHO has recently warned that Non-Communicable Diseases (NCD) are likely to kill more people in Africa than infectious disease. It set these out as a forecast by 2030. Cancer’s a major contributor.

    The Ocean Road Cancer Institute (ORCI), Tanzania’s major cancer centre, has estimated that the country’s heading for 30,000 new cancer cases a year. The diseases’s a huge public health concern.

    Combating the increase in misleading cancer information is part of Tanzania’s contributing. An article in allAfrica says it includes false cancer cures claims and alarming stories on social media linking some foods and human behaviour with cancer. Experts are trying to demystify the disease by curbing this damaging information.  

    Radiotherapists in Tanzania say WhatsApp, the cross-platform instant messaging service for smartphones, can help to tackle the problem. In February, radiotherapists formed Saratani.info a set of WhatsApp groups to disseminate cancer awareness. Currently, there are five groups. Each one has 251 members, so 1,255 people have so far joined. Each group has five educators, including radiotherapists, doctors and nurses.

    Mr Franklin Mtei, Saratani.info’s founder, and managing director of the Tanzanian Cancer Society (Tacaso), formed in 2014, leads the team of educators.  They’re expected to become future cancer ambassadors. Other group members included people from the general public, the private sector, public officials, students, entrepreneurs, professionals and non-professionals.

    The groups were formed by adding the WhatsApp users that the radiologists already had in their own phone books. Other people were invited through Facebook. People can join and leave any of the groups voluntarily through their Facebook Page.

    A co-founder of Tacaso, Mr Ally Idris, a radiotherapist, says people's perception about cancer in Tanzania has been wrong for many years. Society’s information gap is huge. Many people believe that cancer is contagious, while others think that treatment by radiations causes more cancer.

    The founders want their initiative to provide services beyond the WhatsApp groups. They plan to expand across Tanzania, targeting vulnerable people who lack information about cancer, its causes, prevention and how to access treatment. It’s an initiative that could benefit all Africa.

  • Nokia launches its digital health tools

    As the eHealth market expands, Nokia has expanded its contribution by launching its suite of eHealth tools. They include connected scale, blood pressure monitor, thermometer, activity tracker and Patient Care Platform (PCP) an mHealth programme for chronic condition management. An article in MobihealthNews says it’s an updated version of the Health Mate app that provided personal histories of health data, including activity, sleep and weight, to show trends, track progress, and seek improvements.

    Health Mate has a coaching feature too. Nokia plans to keep building on its mHealth services. It’ll incorporate findings from collaborations with major medical institutions that develop the new devices, including Scripps Research Institute, the Mayo Clinic, the Pennsylvania University and Stanford Medicine X.

    Nokia’s been testing its PCP in Europe. It integrates the Nokia’s full portfolio of devices to provide near-real time data to patients and their care teams. The goal’s to support diagnosis and management, and prevent chronic illness. The over-arching concept’s delivering better targeted care.

    This could be another mHealth opportunity for Africa’s health systems. Their challenge is choosing between competing claims and impact.

  • There’s a template for developing mHealth strategies

    With Africa’s score on the WHO results from its global eHealth survey approaching 60%, there’s still plenty to do. A survey by Spok offers some good practices for the next steps. The start point’s that there isn’t a single definition. Instead, organisations have different interpretations. Common purposes seem to be:

    • Align mobile objectives with organisational goals
    • Feed the framework for all mHealth projects
    • Answer questions such as:

    o   How can mHealth enhance patient care

    o   What strategic initiatives need including in plans for mobile enablement, such as shorter ED and inpatient discharge processes

    o   What integrations are needed meet the larger goals of the hospital, such as easier communication between healthcare teams

    o   How can mHealth improve health workers’ productivity.

    As mobile technology and opportunities develop, healthcare’s mHealth strategies need to move on to match. This needs regularly updated policies. US experience is that mHealth strategies are quite fluid, with organisations amending them as needed:


    Shifting end users’ mobile needs

    44%

    New devices available

    35%

    New EHR provider capabilities

    36%

    Changed strategic goals

    23%

    Challenging strategy implementation

    21%

    Leadership changes

    16%

    Mobility strategy not updated

    7%


    A common feature’s that stated strategic goals aren’t embedded sufficiently or explicitly enough in mHealth strategic goals. Examples are:

    • Communications between doctors
    • Nurse to doctor communications
    • Communications between nurses
    • Code team or rapid response team communications
    • Communication with health systems’ doctors networks and and other health professionals
    • Managing critical test results
    • Nurse call and patient monitoring alerts to mobile devices
    • Patient satisfaction scores
    • Patient throughput
    • ED and bed turnover
    • Alarm fatigue.

    Improving on these needs a range of engaged stakeholders. They include ICT, clinical leaders, telecommunication experts, all appropriate healthcare professionals and other health workers and the organisations’ executives. Setting them up as permanent mHealth strategy teams is a priority for Africa’s health systems.

  • mHealth’s MDCS needs better cyber-security

    While mHealth’s been successful in developing countries, many initiatives fail to address security and privacy issues. Leonardo Iwaya’s at Karlstad University’s Faculty of Health, Science and Technology. His thesis, Secure and Privacy-aware Data Collection and Processing in Mobile Health Systems, starts from this perspective and describes solution. 

    He sets a context where mHealth often operates in a setting of no specific legislation for privacy and data protection in developing countries. Africa’s health systems exhibit equivalent limitations. His work has several components:

    • A comprehensive literature review of Brazil’s mHealth
    • Design of a security framework, SecourHealth, for Mobile Data Collection Systems (MDCS)
    • Design of a MDCS to improve public health using geographic Information (GeoHealth)
    • Design of Privacy Impact Assessment (PIA) template for MDCS
    • Study of ontology-based obfuscation and anonymisation functions for health data. 

    These offer Africa’s health systems a route into Information security and privacy that are paramount for high quality healthcare. They also protect healthcare professionals and other workers by creating a secure and explicit working environment for their clinical and working practices.

    Iwaya’s objective’s to enhance knowledge of the design of mHealth’s security and privacy technologies, especially the MDCS. These extend across data collection, reporting and replacing paper-based approaches for health surveys and surveillance. It’s a good place to start from to improve mHealth’s general and cyber-security.

  • Hospitals need better cyber-security from their app developers

    The pace of innovation in healthcare is staggering. mHealth apps are helping to push it along. Innovators are speeding apps through development processes to bring them to market as quickly as possible. It often means cyber-security’s not a priority, leaving healthcare organisations to pick up the consequences.

    “There are a million different apps out there – the problem is the low barrier to entry into the healthcare market,” said Kurt Hagerman, CISO at cyber-security firm Armor Defense, in an article in Healthcare IT News.“When you look at the EHR vendors, they cannot be everything, they have to focus on a core set of services and then allow others to supplement those large, monolithic EHR systems with other apps.”

    With some EHRs having a narrow focus, there’s a rush to capitalise on using mHealth to provide personal health data and advice. These factors combined are a challenge for health systems to use the latest innovations without compromising protected health information and personally-identifiable information. 

    The first step’s educating developers about the healthcare industry and its unique requirements. Health systems working with app developers need to be explicit from the outset about their cyber-security requirements. Hagerman says “To protect confidentiality, integrity and availability, you have to build strong authentication credentials, you have to encrypt.

    Beyond education, it’s up to health systems to be better at enforcing cyber-security, ask app developers the right questions and demand the protections that defend patient health data. “A sense of urgency is building – you cannot just build an app, there are security requirements. The industry is starting to correct this a little bit,” he added.

    Healthcare providers need to construct a stronger message for developers. Better cyber-security’s crucial to protect patients’ personal data. They can’t afford to carry the risks of insecure and vulnerable mHealth.   

  • Can high-speed broadband improve health?

    Acfee sees a huge role for eHealth as helping to achieve healthier Africans. It seems the American Medical Informatics Association (AMIA) has taken it further. In a long letter to the Federal Communications Commission (FCC), AMIA says high-speed Internet access to low-income populations could enable them to benefit from mHealth interventions. Examples include disadvantaged populations accessing mHealth and participating in research studies without paying data charges. 

    It also proposes that FCC policies should leverage broadband-enabled solutions for specific patient populations, such as substance abusers and patients with chronic diseases. Wider and cheaper Internet access is seen as increasing mHealth use by underserved communities, improving their access to health information and care and improving clinical outcomes.

    The concept builds on the FCC’s assertion that of broadband-enabled services and technologies are improving availability and accessibility and transforming healthcare. AMIA also says broadband access is, or soon will be, a social determinant of health, defined as” structural determinants and conditions in which people are born, grow, live, work and age.” Examples are socio-economic status, education, physical environment, employment, life-style choices, clean water supplies and social support.

    This paradigm shift enhances mHealth’s role in health and healthcare. For Africa’s health systems, it may mean a shift to a wide, integrated and bigger mHealth strategies with more explicit, realisable benefits.

  • mHealth lessons may not be easy to transfer

    As the volume of the mHealth initiatives across the world expand, transferring the successes offers an effective way to make use of scarce mHealth development skills. It’s a valuable concept, but “may as readily translated to a country like India as proponents of mHealth might assume.” It’s a conclusion of a study from Durham University in the UK. If it’s a challenge for India, it may prevail across Africa too.

    “MHealth and the management of chronic conditions in rural areas : (sic) a note of caution from Southern India” draws from fieldwork to explored challenges facing mHealth implementation in Andhra Pradesh. It reviewed mHealth in chronic medical conditions, type 2 diabetes and depression. The research:

    • Identified ways people in a rural area access medical treatment
    • Assessed how adults use mobile phones in daily life to gauge the realistic chances of mHealth uptake
    • Identifies different pathways to care for the two medical conditions
    • Emphasised the importance to the rural population of healthcare outside the formal health system, and provided by Registered Medical Practitioners (RMP) who are neither registered nor trained
    • Demonstrate the limited use of basic mobiles by most of the older adult population
    • Examine how promoting self-management by patients may not be as readily translated to a country like India as mHealth proponents of might assume. 

    These combine into significant mHealth inhibitors. An important finding’s that it can be difficult to identify a clinical partner for patients or their carers for mHealth designed to help manage chronic ill-health in rural India.  

    While mHealth offers an effective potential response for better public health surveillance and healthcare, a more appropriate perspective’s is its probability of success. Invariably, probability has a lower socio-economic return on investment. The study raises a note of caution for India’s rural communities, suggesting that some more ambitious hopes for mHealth may be hard to realise. Factors at play include:

    • Tendency diabetics to avoid the government or formal health sector as a whole
    • The role of RMPs are central to such choices
    • Difficulties in seeking and sustaining treatment for depression
    • The viability of patients managing their own healthcare to realise benefits of self-management.

    Health workers often acknowledged communication problems between clinics and patients, but tend to assume it’s more straightforward to identify appropriate clinical end of the communication. The study challenges this assumption. The hypothetical self-managing individual fits well with popular western notions of self-actualisation, but may not transfer to India’s remote rural communities. Does this description fit Africa’s remoted rural communities too? The study’s cautious about generalisation across India, but does emphasise social and systemic challenges in addition to the technical features. So, while mHealth may not readily transfer across rural communities, the challenge to maximise mHealth’s health and healthcare benefits might.

  • More mHealth strategies are in place

    As mHealth expands across Africa, a report from Spok identifies an expansion of mHealth strategies. It’s improving, but there’s still plenty to do. From 2012 to 2017, healthcare organisations with mHealth strategies have increased from 34% to 65%. The Evolution of Mobile Strategies in Healthcare also identifies areas for improvement.