• mHealth
  • mHealth can help to reduce hospital readmissions

    Using mHealth to improve hospital services’s a common theme in Africa’s eHealth strategies and plans. Reducing readmissions’s an important part of these initiatives. A report from MobileSmith says how three mHealth solutions can help. 

    How to Reduce Preventable Readmissions with Healthcare IT describes:

    Efficient mHealth strategies for reducing hospital readmissionsStrategic use cases for prompt implementationSix best practices for cost-effective apps for engaging patient and doctors. 

    Efficient mHealth should provide:

    Relevant discharge communicationFamily and carer engagementImproved medication adherenceChronic disease control.

    The six best practices are: 

    Research and know target patient groupsThink big, start small, act fast, so avoid mHealth that does everything for everybody, so unlikely to be user-friendlyPolish user interfaces and experiencesKeep mHealth freshEstablish secure data exchangesAdopt analytics. 

    Underpinning each of these’s the core goal to empower patients. mHealth’s the bridge that healthcare can leveraging now to empower patients. It can only work with easy-to-use mHealth so patients are encouraged to become more proactive towards their health. These themes need expanding in Africa’s next wave of mHealth strategies and plans. They also need setting alongside high priority patient groups and clinical conditions.

  • Cancer detecting pen to be piloted in Texas

    We often hear from surgeons that distinguishing cancerous tissues during surgery may be difficult. This  is a challenge that has been tackled by a group of researchers from the university of Texas who have developed a revolutionary pen. The MasSpec Pen is coupled to a mass spectrometer and can identify cancerous tissue during surgery in real time.

    The MasSpec Pen is able to diagnose cancer within twenty seconds during surgery.  The pen is placed over a tissue and uses touch to make a diagnosis. A foot pedal triggers the device to release water droplets which extract molecules from the tissue. The water is drawn into the mass spectrometer.  It then analyses the molecular compositions to determine if the tissue is cancerous or not. This also eliminates time waiting for results to return from the pathologist.

    While the diagnosis may be quick, the accuracy is still spot on. During a trial, 300 patient samples were analysed and the MasSpec Pen was able to detect four types of cancer; breast, thyroid, ovarian and lung cancer with over 96 % accuracy.  This could allow surgeons to remove all cancerous tissue and prevent further complications later on.  Similarly, it will eliminate the risks of unnecessary removal of normal tissue.

    Over the next several months, three of the devices will be installed in Texas hospitals.  The cost of this revolutionary pen is still being debated, but this could well be a useful tool for rural and remote hospitals in Africa to quickly and easily detect cancers.

  • HearX Group makes hearing screening more accessible

    In 2015, eHNA reported on a South African start-up, HearX Group, founded by Prof De Wet Swanepoel and Dr Herman Myburgh.  They developed a low-cost smartphone app that detects hearing loss and connects patients to health services.  

    The product uses a smartphone and headphones along with a custom-developed software application to detect hearing loss.  This inexpensive alternative to conventional screening is 50-70% less expensive and can be administered by non-specialists and screeners with even basic literacy and low digital skills.

    Today, the company boasts a suite of apps and mHealth devices geared towards improving hearing screening in underserved and remote communities, and especially among children.  Other products included in their collection include hearZA, mHealthStudio, hearTest and hearDigits, as well as a partner product in vision called Peek Acuity.  

    Now, HearX group has taken their solution beyond Africa.  A recent collaboration with the American Academy of Audiology saw the launch of America’s first-ever intensive hearing screening mobile app, hearScreen USA.  This was launched at the Academy’s annual conference April 2018 and is freely available on smartphone devices.

    In many nations, the general awareness of hearing impairment is low and shortage of resources has caused a lack of screening programmes.  HearX Group could soon be turning this into a problem of the past with further collaborations in Africa, Europe and Asia.

  • ATM pharmacy will help South Africa achieve its 90-90-90 goals

    Over 7.1 million people in South Africa (SA) are living with HIV.  This is the largest epidemic of HIV in the world.  The country has the world’s largest ART programme, which helps towards achieving 90-90-90 targets.

    Also helping to achieve targets is an innovative Pharmacy Dispensing Unit (PDU), developed by Right To Care in collaboration with Gauteng Department of Health.  The PDU works like an ATM for medication; tele-pharmacists, cloud based electronic software and robotic technology combine to enable medication dispensing.

    This pioneering solution allows patients to quickly and conveniently collect their repeat prescriptions at various community shopping centres where it is being piloted.  It’s even online over weekends and public holidays so that patients can collect medications at their convenience.  Patients are also offered service in all eleven languages and there is a support site to help understand the technology for first time users. 

    The PDU system which is run by qualified pharmacists and pharmacy assistants integrates with the clinical management of patients with chronic conditions at public facilities. It also supports adherence.  Medication receipts indicate the date for the next collection and patients even receive collection reminders by SMS.  If a patient collects their medication late, they are flagged for follow-up at the facility. 

    This ATM-like approach to dispensing medication demonstrates innovative thinking to overcome challenges in ensuring people stay on HIV treatment or treatment for other chronic illnesses.

  • Malawi uses eCCM app to combat child mortality

    In Malawi, Health Surveillance Assistant’s (HSA’s) serve as a link between the the local community and the national healthcare system.  They make use of the WHO and UNICEF community case management (CCM) clinical decision tool to identify those requiring urgent referral to hospitals and those who can be treated at the local points-of-care before going back home.  The Supporting LIFE project has created an mhealth app that replicates this CCM tool to ease decision-making and workload for HSA’s.  

    The app supports a similar workflow to the paper-based CCM tool, allowing the HSA to enter patient information on an easy to use touch-screen interface.  It’s developed for the Android platform and is functional in an offline environment, making it ideal for countries like Malawi, where internet connectivity is a problem.  Power was also an issue during the Malawi pilot, so HSA’s were also provided with mini solar powered chargers for their devices. 

    During the pilot 3 indicators were measured to assess the potential impact of the app;

    Improvement in the number of children correctly referred to a health facility as a result of using the app.Increased attendance rates, as a result of correct referrals made by HAS’s using the app; andDecreased re-consultation rates through correct diagnosis and referral from the app

    The results of the pilot were presented at an mHealth strategy workshop and provided the health ministry and key policy makers with valuable data to improve the health systems in Malawi.  HSA’s using the app reported mostly positive responses.  

    While such projects offer great community benefits and health system improvements, further assessment is needed around the feasibility of scaling nationally, as well as integration with core systems like the DHIS2.

  • Low-cost video laryngoscope developed in South Africa

    “Innovation is change that unlocks new value” - Jamie Notter. This is what Cape Town Anaesthesiologist, Dr Caroline Corbett, is doing with her video laryngoscope invention.  SmartBlade, is a cost effective, novel and real-world solution to the management of a difficult airway. 

    It uses forward-thinking smartphone technology to link with video laryngoscopy, thus allowing clinicians to easily intubate difficult airways. The clinician can suction a soiled airway or perform apnoeic oxygenation, both without interrupting attempts to intubate. 

    The customised mobile application also facilitates video conferencing, image capture, recording and secure data storage.  SmartBlade aims to become a standard of care in advanced airway management. 

    This novel device won the WFSA-Fresenius Kabi Anaesthesia Innovation Award in 2017.  The South African Society of Anaesthesiologists (SASA) is proud of this accolade and looks forward to seeing it being used in South African hospitals in the future.

  • An HIV-free future: improving adherence to antiretroviral treatment

    It is common knowledge that HIV and AIDS has long been an overwhelming challenge in Africa. East and sub-Saharan Africa is the most affected region in the world.  Statistics indicate that at least 19.4 million people are living with HIV in this part of the continent. South Africa alone has the biggest HIV epidemic in the world with 7.1 million people living with HIV.  In 2016, there were at least 270 000 new infections and 110 000 AIDS-related deaths in the country.

    These statistics are worrying, but there is hope. It is estimated that 61% of adults and 51% of children in East and Southern Africa are on anti-retroviral therapy (ART). Antiretroviral medications (ARVs) are life-saving drugs that have turned HIV into a manageable chronic condition. The disease is no longer a death-sentence and when HIV-positive people take their ARVs responsibly and strictly.

    Adherence to ART is often an overlooked issue despite its incredible importance. In order for an HIV-positive person to achieve an effective level of viral suppression, adherence to ARVs needs to be more than 95%. This means that there is very little room for those living with HIV to skip their ARVs.

    Remembering when to take medication on time can be challenging for many reasons. People use different methods to remind themselves, but in most cases, these methods are not always reliable or effective.

    MyTherapy, a medication reminder and health tracker app designed in Germany, is an effective and easy-to-use app that has been proven to raise adherence levels significantly. In a short space of time, the app has improved adherence by over 45% and currently has over 500,000 users.

    While the app’s main function is to help its users keep track of their medication intake, it has also been designed to improve their overall health and sense of wellbeing. Users can record important measurements, like blood pressure and weight, and track their symptoms, and for those living with HIV, the app allows users to enter lab-results data, such as blood tests, kidney-function tests and viral load.

    The app is easy-to-use and all users have to do is enter the relevant data and set alarm times. The app is designed to handle complex medication regimens, perfect for ART which requires multiple medication intake per day, and all recorded data can be printed out at the end of each month in easy-to-read graphs, which is useful for the user’s doctor. Furthermore, while the app does rely on self-efficacy and self-discipline, users can invite family and friends on the app to help them stick to their treatment plans, ensuring that various parties are involved to promote adherence further. MyTherapy also takes data protection and privacy seriously, and users also have the option to use a passcode to prevent others from accessing the app and seeing personal data.

    ARVs are exceptional drugs that have changed the face of HIV and AIDS forever.  There is potential for an HIV-free future, only if those living with the virus are responsible and take their ART strictly.

    Knowledge of HIV/AIDS is continuously expanding. Information in the article's taken from Avert and the NCBI. 

  • mHealth’s proven impact still seems elusive

    Africa has an expanding, diverse mHealth core to its eHealth initiatives. The Journal of Medical Internet Research (JMIR) found limited evidence of mHealth’s impact, and hinted that in low-income countries, mHealth’s still at an early development stage.

    JMIR’s systematic review covered 10,689 mHealth articles, including 23 systematic reviews of 371 studies with over 79,609 patients. Seventeen reviews included studies of low- and middle-income countries’ initiatives. 

    SMS for a wide range of purposes seems to be the most common type of mHealth. It includes reminders, alerts, educations, motivation and illness prevention. Ten reviews gave them an Assessment of Multiple Systematic Reviews (AMSTAR) score of 0 to 4, low quality. Seven were rated as moderate quality, an AMSTAR score of 5 to 8. Six were rated as high quality, an AMSTAR score of 9 to 11. 

    mHealth for  chronic disease management scored well for impacts of:

    Improved symptoms and peak flow variability in asthma patients and fewer hospital admissions and improving forced expiratory volume in one secondImproving Chronic Obstructive Pulmonary Diseases (COPD) symptomsImproving heart failure symptoms and fewer deaths and hospital admissionsImproving glycaemic control in diabetes patientsImproving blood pressure in hypertensive patientsReducing weight in overweight and obese patientsBetter attendance ratesBetter adherence to tuberculosis and human immunodeficiency virus therapy in some scenarios, with evidence of decreased viral loads.

    While these are positive results, the benefits may still be moderate.  JMIR concluded that “Evidence for efficacy is still limited. In general, the methodological quality of the studies included in the systematic reviews is low. For some fields, its impact is not evident, the results are mixed, or no long-term studies exist.”

    The lack of reliable evidence doesn’t mean that Africa should slow down its mHealth investment. Instead, it means it should set up a reliable methodology to reveal the range of good and bad impacts. Lessons from these will be invaluable.

  • A smart watch can detect epilepsy

    Epilepsy is a leading serious neurological condition worldwide.  It has particularly significant physical, economic and social consequences.  Recognising the need for an intervention, Empatica Inc. has developed a smart watch to detect seizures in epileptic patients.  They’re calling it Embrace.

    Embrace uses machine learning algorithms to monitor and detect different seizure types, including grand mal or generalised tonic-clonic seizures. Electrodermal Activity (EDA)* sensors in the watch are used to measure multiple indicators of a seizure. 

    It’s also accompanied by an app that will send an alert, via text message, to a healthcare provider or caregiver once a seizure is detected.  Additionally, the app serves as an electronic seizure diary and health record for the user.

    During a clinical study involving 135 epileptic patients, Embrace’s algorithm was shown to detect 100% of the seizures, including the 40% of silent seizures that were unreported in patient clinical diaries.  Following this, the smart watch has received FDA approval as well as approval in Europe as a medical device for epileptic monitoring.

    Embrace’s high sensitivity is revolutionising seizure reporting.  It serves as a much awaited alternative to wearing an EEG, that is automated, and isn’t bulky or cumbersome to wear.

    *signals used to quantify physiological changes in the sympathetic nervous system 

  • Three mHealth apps help with treatment adherence

    Adherence to medication is an increasing problem in primary health care in Africa. It is important for many things, from birth control to antibiotics to ARTs. When medications are forgotten or skipped, most treatments are no longer as effective.  This becomes both costly for the healthcare system and detrimental to a patient’s health.

    Factors impacting adherence are multifaceted and include social, economic and psychological motives.  A sub-Saharan study in 2017 reported the most common barriers to adherence were;

    ForgettingLack of access to adequate foodStigma and discriminationSide-effects of the medicationTraveling

    With the uptake of smartphones in Africa, mHealth apps targeting treatment adherence could be a simple solution.  Here are the top 3 downloaded treatment adherence apps on Google Play Store. 

    PatientPartner

    This app turns patient education into an adventure game and shows patients the importance of sticking to a treatment schedule.

    Medisafe

    In addition to medication reminders, this app will notify friends and family if the user defaults. Medisafe also launched a low-tech version that sends reminders through automated phone calls and text messages. 

    MyTherapy

    After logging their medications on the MyTherapy app, users will receive reminders and alerts to take their medications.  Other features on the app include symptom tracking, healthy lifestyle tips and friends and family support groups.

    Improved adherence means a healthier society and ultimately, a reduced burden on healthcare systems.  Moreover, access to adherence data from these apps could help doctors and policy makers make better informed decisions about how to improve the healthcare system.