Personalised care (11)

Most Sexually Transmitted Diseases (STDs), sometimes referred to as Sexually Transmitted Infections (STIs), do not reveal their symptoms initially. This covert nature creates a risk of passing the disease on to other people.

The WHO says there’s a daily global prevalence of more than a million acquired STD. Trichomoniasis, chlamydia, gonorrhea and syphilis are the most common STDs. Globally, they’re responsible for 143 million, 131 million, 78 million, and 5.6 million infections respectively. 

In 2015, the Centre for Disease Control and Prevention (CDC) reported a record increase of STDs in the age group between 15 and 24 years old. Over 1.5 million chlamydia cases and 400,000 new cases of gonorrhea were reported. These alarming rates propelled Everlywell to add STDs testing to their repertoire to equip young people with a simple, hassle-free way to access tests.

Everlywell, based in Austin Texas, launched its diagnostic testing kit last September. It offers a digital platform which provides a convenient at-home testing for clients says an article in MobiHealthNews. By avoiding numerous doctors’ appointments and lab results, Everlywell provides online test orders with required samples sent to the nearest certified laboratory for analysis. Here, expert physicians review the results and report them back online after a few days. It’s like Computerised Physician Order Entry (CPOE) with patients replacing physicians.

The STD diagnostic test kit costs $249. It deals with diseases such as HIV, syphilis, herpes type 2, gonorrhea and chlamydia. In cases of abnormal results, like testing positive for a curable or incurable condition, trained physicians follow-up, provide prescriptions for required medications and, for life changing results, will provide counselling services and guide you through the next steps.

Young people globally face many barriers when they access or receive reproductive health services and quality STD prevention and management services. This is especially true for many African countries that don’t have the resources to allocate to STD prevention and treatment.  These barriers include, lack of transportation, long waiting times, conflicts between clinic hours and work or school schedules, embarrassment and stigma attached to seeking STD services, and concerns about privacy and confidentiality. Consequently, many would rather suffer in silence than try to seek help. By enabling people to perform STD tests in the comfort of their own homes, Everlywell, bridges these gaps. It encourages and increases STD testing, and provides a frequent, easier, less embarrassing and more convenient way to test, treat and manage STDs. For this initiative to succeed in African countries, the cost and healthcare capacity to care for more patients need addressing.

A team for universities and institutes in Seattle and Cambridge Massachusetts has tracked the family trees of individual cells in zebrafish. As more genome data becomes available for personalised care, eHealth will have to expand its capacity to hold and use the data. The findings are in Science

It was already known that multicellular systems develop from single cells through specific lineages, but tracing methods scale poorly to entire, complex organisms. To improve on this, the team used genome editing for progressive and cumulative diverse mutations in a DNA barcode. They repeated it over numerous rounds of cell division.

The barcode’s an array of Clustered Regularly Interspaced Short Palindromic Repeat (CRISPR)/Cas9 target sites. It marks cells and enables elucidation of lineage relationships using mutation patterns mutations shared between cells. In cell culture and zebrafish, the team showed rates and patterns of editing as tunable, and that thousands of lineage-informative barcode alleles, gene variants, can be generated.

Samples of hundreds of thousands of cells from individual zebrafish identified most cells in adult organs deriving from relatively few embryonic progenitors. Future genome editing of synthetic target arrays for lineage tracing using GESTALT can generate large-scale maps of cell lineage in multicellular systems for normal development and diseases.

This type of genome data and knowledge seems set to keep expanding. Using it routinely for mainstream healthcare will need expanded eHealth capacity. It’s another investment stream for Africa’s health systems to consider for their eHealth strategies. They’re becoming more challenging.

There’s no denying that healthcare has undergone dramatic changes in the last ten years. New technology and innovations available to patients enables them monitor and take responsibility for their own health, and improved devices and tools available to doctors and other health professionals can make more informed decisions. Healthcare technology keeps moving along. An article in The Guardian looked at the top eight technologies that’ll keep transforming healthcare. For Africa, the balance and pace of investment in the eight technologies will be different to developed countries.

The smartphone

Although not new, it’s clear that the smartphone’s healthcare potential’s yet to be realised. Smartphones can serve as the hub for new diagnostic and treatment technologies. We’ve seen apps developed to support a wide range of healthcare activities, such as healthier life-styles, diabetic patients, treatment adherence and depression. Patients can also use tools like the AliveCOR ECG, embedded in a smartphone case, which helps interpret heart test results via an app and facilitates sharing with clinicians. They’re also ideal for gathering large amounts of data to improve understanding of diseases in populations.

At-home or portable diagnostics

Clinicians can now bring hospital-level diagnostics devices to patients’ homes, such as portable x-ray machines, blood-testing kits and other technologies.

Implantable drug-delivery

Drug adherence is a big problem, especially for patients with long term conditions. It’s estimated that between a third and a half of all medication prescribed to people with long-term conditions isn’t taken as recommended. Several technologies are already under development to address the problem. There’s sensor technology so small it can be swallowed and combined with drugs in smart pill form. When the pill dissolves in the stomach, the sensor’s activated and transmits data through a wearable patch to a smartphone app. Patients and clinicians can see how well they are adhering to their prescription, though it raises important questions about patients’ privacy and autonomy.

Digital therapy

Digital therapeutics are health or social care interventions delivered using a smartphone or a laptop. They embed clinical practice and therapy into a digital form to provide computerised cognitive behavioural therapy (CBT)

Genome sequencing

Advances in genome sequencing and the associated field of genomics will give doctors a better understanding of how diseases affect different individuals and populations. These genetic profiles of people’s diseases and knowledge of their response to treatment, it should be possible to predict their response to treatment and prognosis more reliably.

Artificial intelligence

Machine learning is a type of artificial intelligence that enables computers to learn without being explicitly programmed, meaning they can teach themselves to change when exposed to new data. Enlitic, IBM’s Watson division and Google’s Deep Mind have started to explore potential applications in healthcare.

Blockchains

Blockchains are decentralised databases that keep records of how data’s created and changed over time. They’re trusted as authoritative records without a single, central authority guaranteeing accuracy and security. Electronic health records are widely used, but they are usually centralised, provided by a small number of suppliers. Some commentators have described how records using blockchain technology would bring benefits like resilience and encourage interoperability, with patients and clinicians given encryption keys to control who sees the data.

Online communities

Social networks bring together people with interests in healthcare to support each other, share learning and provide platforms for tracking health data, helping people manage their condition and contributing to research. 

New technologies bring new opportunities for Africa’s health systems. They can help to improve the accuracy, reliability, availability and add value of information gathered, change how and where care’s delivered and offer new ways to prevent, predict, detect and treat illness. The numerous choices makes rigorous strategies, plans and investment decisions challenging, but essential.

Complete and accurate patient identification’s a long-standing challenge for Africa’s health systems. Health Data Management has a report by Imprivata on Improving patient care with positive patient identification. It starts with the premise that efficient, quality care starts with positive patient identification (ID), then errors jeopardise patient safety, impede patient engagement and cause serious financial and cost inefficiencies.

In the USA, the scale of the problem’s a duplicate medical record rate 8 to 12%, with about 40% of records with blank or default values in one of the key data fields of first name, last name, date of birth, gender or social security number. The American Health Information Management Association (AHIMA) identified these in “Building an Enterprise Master Person Index and at its Convention presentation on Technology Influence on Data Integrity & Impact on Patient Safety in 2008. An estimated 92% of duplicate errors arise from inpatient registration ID mistakes. It’s reasonable to assume that Africa’s health systems aren’t better than this. 

Imprivata says that effective patient ID systems should: 

  • Minimise the opportunity for human error by providing a robust biometric alternative to paper and oral patient ID processes
  • Minimis the chances of algorithmic error by using a strong, unique patient ID method
  • Optimising interoperability by integrating directly with existing information systems by creating a 1:1 match between each patient and their unique medical records
  • Maximise patient adoption and ease of use by providing intuitive, non-intrusive design, easy ICT management, and a pleasant patient experience.

Africa’s health systems and eHealth seem a long way from a biometric solution. Imprivata’s four goals still offer a set of objectives that Africa’s eHealth can move towards. It needs an extra step adding with a reliable link to better registration of births and deaths.

“Answers to our challenges in healthcare relies (sic) in engaging and empowering the individual.” This’s a solution put forward by Elizabeth Homes, the founder and owner of Theranos, a USA blood testing company with some “deficiencies“ recently identified by US inspectors, as reported in Wall Street Journal. If that’s where the answers are, finding them’s important for Africa.

Lenovo’s come up with a checklist of ten actions needed to engage patients. It’s emphasis is on health systems with well-developed connectivity and eHealth and more health workers per head, but the lessons still provide a foundation for African countries to adopt and develop. The ten are:

  1. Show patients and tell them about their health and healthcare, use mobile devices in health facilities to display diagnostic images to describe injuries and illnesses to patients and their families to promote informed decision-making and higher patient satisfaction
  2. Brighten up the bedside with ICT tablets or virtual clients to take advantage of opportunities to enhance patient experience and provide patients with access to health data, educational materials, discharge instructions and order meals
  3. Go where they go and streamline on-demand access to health data and providers anywhere, anytime so it’s easier for patients to view data securely, ask questions, express concerns and share updates, because they’ll then take more responsibility for their own care
  4. Stay connected to make it easy for patients to communicate with their care teams using texts, email, Skype, FaceTime, and other digital channels, so they can interact with health in the same way they do other organisations, but it requires improved responsiveness and stronger patient-physician relationships by keeping in touch through email, secure two-way messaging, video chats or virtual visits
  5. Present the big picture to patients, which includes access to comprehensive data, and ensuring that physicians, laboratories, pharmacies and other healthcare teams can securely share up-to-date data from integrated patient-provided information from wearable fitness devices and health and wellness apps to supports better collaboration
  6. Do your home-work and follow-up by remotely monitoring patients’ progress and health after discharges using wearable sensors. Telehealth, smartphones, ICT tablets or desktops with the aim to reduce readmissions, improve outcomes, and empower patients to engage in healthier, safer behaviours
  7. Put some zip in your patient portal by creating an indispensable, interactive go-to tool that enables patients to:
    1. Schedule appointments
    2. Have repeat prescriptions
    3. Request a referral
    4. Access records, test results, and doctors’ notes and communicate with care providers
    5. Submit information for preregistering for an examination and updating health data
  8. Remember that portals work both ways, so provide post-visit care summaries, post-discharge care management instructions, and educational materials patients available from a secure portal, and automated SMSs and personalised emails for appointments, immunisation, medication reminders and news about new material
  9. Broadcast engagement options so patients know about your patient portal and ensure health workers emphasise the portal’s benefits and educate patients in how to use it
  10. Seek feedback from users and implement the findings.

Africa’s health systems can start the journey. It’s long and important.

EMC2 estimates that healthcare data continues to grow at 48% per year, and healthcare organisations are being challenged by new patient expectations that come from living in a world of always on and right now.  In a recent survey from Vanson Bourne of 236 global healthcare leaders from 18 countries, 89% say technology has already changed patients' expectations. 

Respondents said more than half of their patients wanted faster access to services. About 45% wanted access and connectivity available all day and every day, and 42% wanted access on more devices. Another 47% said they wanted personalised experiences.

To adapt to the changing landscape, healthcare has to adopt a more digitally-focused mindset right across their organisations. EMC2 pointed out five business imperatives that will help them meet these evolving patient demands:

  1. Predictively spot new opportunities, such as population health, value-based care and patient-centered medical home
  2. Demonstrate transparency and trust when it comes to treatment options, success rates and medical records access
  3. Innovate in an agile way, such as clinical research, integration and the Internet of Things (IoT)
  4. Deliver a unique and personalised experience with a 360-degree patient view 
  5. Providers should always be on and operate in real time using telemedicine, mHealth and medication adherence. 

Fewer than 25% of the respondents said they address each of these five extremely well. There’s clearly scope for improvement. 

For healthcare organisations focused on providing good quality care, new technological solutions may be overwhelming. With many promising to transform healthcare, it’s crucial that they consider which options works best for them as an onganisation and what will benefit patients. Offering new and exciting healthcare technology solutions that don’t add value to doctors, nurses or patients will only end up costing organisations money, wasting time and frustrating staff. 

Healthcare leaders also identified the top technology trends that will impact the delivery of healthcare tomorrow, including:

  • Big Data analytics
  • Automation
  • Cybersecurity
  • Smart communities
  • Hybrid cloud.

Healthcare providers already have a lot on their plate. Prioritising healthcare technology solutions and keeping an eye on technology trends are part of it.

Some people see mHealth as different to eHealth. Others see mHealth as a subset of eHealth. Jesse Coleman, the mHealth programme manager at Wits Reproductive Health & HIV Institute in Johannesburg and a researcher at the University of the Witwatersrand sees it as a combination, so meHealth. He describes it in an article about HIV in De vex.

meHealth services provide personalised health support to people in health systems, whether patients, nurses, doctors, Community Health Workers, administrations, or anywhere in between. Using eHealth for personalised healthcare hasn’t needed the combined definition so far, and it applies to people outside health systems, such as family and informal carers.

He describes meHealth as about communicating information within a health care system to improve desirable health outcomes. For effective population health management, it sometimes has to extend beyond the health system to citizens who aren’t patients. 

Africa’s seen as the global hotbed of meHealth pilots, projects and programmes to improve HIV outcomes. Part of the reason’s that Africa has over 70% of diagnosed HIV cases in the world. The content of meHealth interventions vary but range across: 

  • Electronic patient databases, such as EHRs and patient registries
  • HIV test reminders
  • Medical data collection
  • Partner status notifications
  • Links to care
  • SMS-based laboratory results
  • Treatment adherence alerts
  • Appointment reminders
  • Health education
  • Preventing Mother-To-Child Transmission (PMTCT) messaging
  • Health worker decision support. 

Realising net benefits depends on several factors. Asking leads of proven, successful meHealth projects inevitably produces explanations with several caveats about what’s not worked, or what remains uncertain. Sometimes, when an intervention has worked, its exact opposite’s worked somewhere else in a different situation. 

His reinforces the view that enabling personal devices to communicate information isn’t enough. It needs to work at human levels, and humans are not as simple as technology. They’re complex, dynamic, and change to match their contexts. meHealth cannot be everything to everyone at all times.

Nuanced differences between interventions may seem slight on paper, but research is now revealing the extent to which small tweaks matter. So meHealth pilots should scale up when we know they work. Why the work’s important to know too. These need a continuous pursuit of a deeper understanding of different human contexts around interventions because we don’t have the answers. This applies to mHealth and eHealth too.

Some of Africa’s health systems are starting to embrace IBM Watson. It understands natural language, generating hypotheses based on evidence, and learning as it goes. This means it works more like a person’s brain than a computer.

  • IBM and Mubadala Development Company, based in Abu Dhabi, to have a health project extending across North Africa and the Middle East
  • IBM and Metropolitan Health have a project that aims to enhance and personalise healthcare in South Africa and extend it across rest of the African continent

These are part of IBM Research’s Project Lucy, named after Africa’s earliest known human descendant. Her remains were discovered in Africa 40 years ago.

IBM has a YouTube video explaining some of the beneifts.

A report in FierceHealthIT on the USA’s healthcare experience with IBM Watson may show it’s impact in Africa’s healthcare. Professor Thomas H. Davenport from Babson College, Massachusetts, and a research fellow at the Massachusetts Institute of Technology (MIT) Center for Digital Business, interviewed some Watson users. His report in the Wall Street Journal (WSJ) says healthcare leaders are enthusiastic and there are challenges too. Examples are:

  • Dr Mark Kris, an oncologist Memorial Sloan Kettering Cancer Center, said it's "the way medicine is going to be practiced"
  • It's also difficult, long-term and time-draining, for example, Sloan Kettering started its Watson oncology project in 2012 and it's not yet complete
  • Dr Lynda Chin MD Anderson Cancer Center, at Texas University said using Watson needs several organisational changes, including network infrastructure, security controls, data sharing and reimbursement
  • The number of cognitive application program interfaces (API) needed for simulation and modelling is growing, including APIs that help image analysis and an English language dialogue.

FierceHealthIT has reported on other Watson initiatives. They include: 

  • India’s Manipal Hospitals use the cognitive computing system to create personalised treatments for cancer patients
  • At Boston Children's Hospital, Watson’s used to improve understanding of rare paediatric diseases
  • Johnson & Johnson use it to create apps for consumer products that provides them with a virtual health coach
  • Medical students at Cleveland Clinic use it to for better solutions better outcomes by analysing medical problems and developing evidence-based solutions.

These examples can help Africa’s health systems to design and develop their strategies and plans for Watson. Lessons on benefits and challenges are accumulating. They offer Africa’s eHealth the opportunity for realistic investment.

Registries are seen as effective ways to improve health, develop proactive healthcare and manage population’s health. These are big claims. Achieving them needs rigorous research into how to assemble and use the data. The USA’s Agency for Healthcare Research and Quality (AHRQ) is investing in researching how to use eHealth, including registries to improve healthcare quality, safety, delivery and patients’ outcomes. These are goals for Africa’s health systems too.

An AHRQ brief sets out how it’s helping clinicians to use Big Data to transform healthcare and develop personalised medicine. The initiative includes collaborations of informatics experts, researchers and clinicians to develop better ways to link EHRs with claims, pharmacy data and diagnostic data. It also looks at ways to collect and use specific, individual information about patients, such as medication side effects, pain after surgery, disease symptoms, and experiences of healthcare to create comprehensive pictures of patients’ experiences. Maintaining and protecting patients’ confidentiality is paramount. The project also supports the development of new analytic tools to use data promptly to produce information that improves decisions and clinical care.

Linking data from patients, clinicians, and researchers across many clinical sites can create enhanced clinical registries. These aim to lay a foundation for a learning healthcare system by providing real-time access to knowledge about each patient’s healthcare. Clinicians can then use the knowledge to devise better ways to treat and care for patients. This is essential to achieve broad, proactive healthcare.

Projects already underway deal with paediatric Inflammatory Bowel Disease (IBD), including Crohn's disease and ulcerative colitis. The condition can have many severe complications. AHRQ says clinicians are finding new answers from the Enhanced Registries Project. Since 2007, the results include:

  • Children's remission rate increased from 55% to 78%
  • 49% sustained remission for at least one year
  • 94% achieved satisfactory growth
  • 91% achieved satisfactory nutrition
  • 95% don’t take steroids.

Other projects include a hospital surgical checklist and a total joint replacement project. Both have their enhanced registries.

These AHRQ initiatives show a way of maximising EHRs’ benefits, and the need for eHealth projects that are much wider than just ICT. With many of Africa’s eHealth programmes still at early stages, the time is right for them to start to put these registry research initiatives in train.

Frost & Sullivan presented the 2015 Growth, Innovation & Leadership Awards in Cape Town on the 20th of August 2015. The evening highlighted companies in various industries demonstrating superior performance. The South African team from Hello Doctor won the leadership award for personalized healthcare innovation in Sub – Saharan Africa.

Hello Doctor is an interactive platform designed to give users instant access to personalised health, wellness and medical information. All information has been reviewed and approved by their team of doctors.

The Hello Doctor App provides users with professional, confidential and trusted medical advice and guidance, either from their online library of health and wellness articles or during one of their online health chats with a doctor. While they admit they can never replace face-to-face consultations with a GP, they are online and available to give relevant and reliable health information whenever you need it.

The Hello Doctor is expanding and has recently launched Sema Doc in Kenya. The idea behind the initiative is simple: get reliable health information to people who need it to help save lives.