Enabling better healthcare through mobile technology

A few years back I got involved in a mobile based diagnostic project for oral cancer. The scope of the project was to identify high risk patients in semi-urban and rural communities who had developed symptoms of oral cancer. Oral cancer accounts for over 30% of all cancers recorded in India. People in resource poor environments seldom take the time off to visit the doctor in the city for minor symptoms since it means a day lost in travel and without income. When they do decide to travel, the tumour is normally in an advanced state of cancer and little can be done to save the patient. Moreover, since the government or the insurance provider has to subsidize the care of the patient, the disease burden on the state increases significantly in what could have been a preventable or treatable case of cancer if detected earlier.

The project involved community health workers (CHWs) going house to house with a low cost smartphone, with an application on it that ran the oral cancer screening questionnaire. At the end of it, if the case was shown to be high risk using the in-built decision support system, they would snap a picture with the phone camera that would automatically be transmitted via the phone network to doctors/dentists in city hospitals who would verify and recommend appropriate treatment/hospital visits to the patient. This helped bridge the urban-rural gap in access to healthcare, while lowering costs and improving the quality of life of patients who would have otherwise developed the lesion into full oral cancer.

This is just one instance of Modern Healthcare being practiced by leveraging low cost technology. Over the past few years, a lot of people have been working on using technology to solve problems using simple tools to diagnose, treat and prevent diseases and different conditions while keeping things affordable and accessible to larger sections of the population. And unlike the MRI machine that costs over a million US Dollars, most of the innovative modern day healthcare delivery systems are being developed through ubiquitous and low-cost mobile phone technology.

It is a well known fact that more people have phones than toilets in the world. That opens up a lot of avenues to make healthcare affordable to the masses. But at the same time, one has to ensure challenges like compliance, data privacy and effectiveness of modern day healthcare delivery systems are provided for in the mobile health ecosystem.

Scanadu is attempting to build a medical tricoder that is able to monitor body temperature, heart rate, oximetry, ecg, urine, stress and community outbreaks tailored to your needs, all in one small device that fits in the palm of your hand connected to your phone providing information in real time. Their video provides an insight into how the future of healthcare might look like and turn your mobile phones into an easy to access family doctor.

Then there are wearable devices that help solve specific problems. LUMOback is a wearable belt that provides you insant feedback on your posture, thereby helping you prevent injury and improve chronic back pain condition. Zeo is a headband that tracks your sleep and helps you sleep better. Fitbit helps you monitor and track your activity levels and meet wellness targets.

There are several other such products that empower a patient or a caregiver to diagnose, monitor and track their state of wellbeing without visiting a hospital. However there are a lot of situations where empowering an individual might not be the best solution to their health problems and a community based solution is required.

In India a lot of people die due to poor delivery models of treatable and preventable diseases like Tuberculosis and other infectious diseases. While there is the Bacille Calmette Guerin (BCG) vaccine available for protecting children from Tuberculosis, it is not that effective in protecting adolescents and adults. Tuberculosis is treatable and curable through a standard six-month program of four antimicrobial drugs made available for free by the Indian government through clinics and primary health centres. The treatment however involves around 40 visits to a clinic over a 6 month period for periodic medication. This results in high dropout rates and people who do not complete the regimen are at risk for multidrug resistant tuberculosis (MDR-TB) which does not respond to normal treatment and is costly to treat.

Technology in this case has to simply play the role of education and compliance to ensure people follow and complete the program. Microsoft Research and Operation ASHA ran a pilot in India where they built a low cost biometric system along with a connected device to transmit and remotely monitor compliance. They trained health workers and setup the centres at places of religious worship which helped improve the frequency of patient visits. By moving the delievery centre away from the clinic and closer to the patient and keeping it discreet, the social stigma prevalent in many cases with taking medication is curbed, thereby increasign compliance.

Mobile phones in maternal and neo-natal care have been used in several parts of India. Commcare, with deployments in the Indian states of Jharkhand, Uttar Pradesh, Madhya Pradesh, Rajasthan and Maharastra, is one such example. Their mobile workflow typically involves a community health worker periodically visiting houses of pregnant women and new mothers to impart education and monitor the health of the mother and the new-born with data synced to a central facility. Extending the phone’s capabilities by using external sensors is another area that mobile health has been experimenting with. The ODK Sensors project has tested out a framework to use mobile phone and sensor technology to reduce costs and standardize efficient workflows in the milk pasteurization process in milk banks for new borns in South Africa.

While a lot of innovation is happening in this space, it remains to be seen as to how these tools and technologies can be used to scale access to healthcare and integrate with existing provider networks like hospitals, clinics and pharmacies. The next decade of modern digital and mobile healthcare does look promising.