After winning last year’s Vodafone Americas foundation mhealth Alliance award and Vodafone wireless innovation prize it wasn’t too big a surprise that Dr Trishan Panch MRCGP, strategy lead at Sana mobile MIT, picked up third place in the University Challenge that I moderated.
Titled “strengthening health systems for the application of the Sana wireless technology” Trishan’s talk opened up by explaining how Sana Mobile is a volunteer organisation contributed to by students and alumni of MIT, Harvard School of Public health and the Harvard business School: “many disciplines. One vision”.
The technology is a open source customisable mobile app and tele-health platform that enables smart phones to conduct structured medical assessments and two-way sharing of sensitive medical data between a central medical record database and the mobile phone device.
The service has been designed to provide tools to streamline triage and the referral system, facilitate coordination of care, enable the delivery of real-time access to expert opinion, bring evidence based medicine into the hands of healthcare workers and help develop a database of decision support tools.
The company’s vision is to apply artificial intelligence to develop population specific disease support tools enabling image analysis, machine learning and algorithm searches.
Strategy is for collaborative innovation that can bring together government and public health experts, developers and clinical infomaticians, health care providers and academic institutions to identify local needs, customise the platform and perform outcome studies and accurate analysis of cost-effectiveness. By considering the technology as “centrepiece”, Sana intends to not only improve health outcomes but also remodel the healthcare delivery process itself.
I was disappointed to then see in Sana’s Bangalore implementation that the product didn’t extend outside waiting room. In my opinion the opportunity for mHealth to transform the healthcare delivery process requires us to see it starting before the patient encounters the healthcare provider checkin process.
I was further disappointed to then learn that the mobile devices were being used as clinical tools:
This has got to be one of the most poorly considered uses of a clinicians mobile phone I’ve ever seen. I wonder if they’ve even considered the safety concerns that originate from droplet spread, MRSA, TB, Flu, Sars etc etc???
The Delhi/Punjab use case involving risk assessments (for cardiovascular and diabetes) seemed to address a much larger opportunity:
Sana Brazil’s programme that was “screening for common eye conditions” such as”error of refraction, cataract, trachoma, retinal disease”:
IMAGE REMOVED AT REQUEST OF COMMENT BELOW
The Sana team has decided to develop the applications to run on touch screen mobile devices installed with the android operating system. Interestingly as I looked into the seated audience I saw one of the founders of Symbian (the worlds leading open source Smartphone OS). and it made me think of the opportunity if Sana mobile had built on this OS and could rely on being able to leverage the existing larger market opportunity for Symbian devices in these regions.
The Sana Philippines project was being implemented in conflict regions where the shortage of Doctors is even more pronounced. In partnership with the National tele-health centre, Asia-Pacific College, integrated open source solutions and centre for community transformation they had got a antenatal system off the ground to try to address the Millennium Development Goals Target 5 (improve maternal health). This was similar to something I had seen before by Dr Nahum Kovalsk CIO of Terem Emergency Medical Services who has translated WHO recommendations into practice, creating electronic records for pregnant women, enabling high-risk pregnancies to be detected using decision tree algorithms and a obstetrician referral system.
Interestingly it had built on these with SMS visit reminders which I was surprised wasn’t something that we saw more of across the entire range of Sana projects.
Looking at the system overview:
I think there is a lack of appreciation here of the transformational effects the point of care doesn’t have to start start with presentation to a midwife, with patient access to online questionnaires via a mobile the reach of this would be extended considerably. Especially as patients could use any Internet connected mobile (SMS or even use an inbound voice call service running an IVR system URL jonathan marks URL) and so wouldn’t be required to use android devices which will remain scarce in emerging markets despite their rapid uptake in more developed regions.
From a quick glance at the dashboard mockup I can also see several major design issues that will present when clinicians try to use the service. The very smart folks at Primetime Medical (producers of the instant medical history questionnaires that we utilise within the 3G Doctor service) have spent 20+ years making a workable solution and I would recommend collaboration as this isn’t something that comes naturally and real value can be created by incorporating the clinical expertise of the senior clinicians (such as Prof John Bachman MD) who have contributed to this solution.
Be sure to check out the website where they’ve uploaded some great video content (although it I really can’t wait until they start seeing the opportunity for the mobile reporting process to be made available on patient owned devices!):
This blog post is part of a series of mHealth reviews from the 2nd Mobile Healthcare Industry Summit 2010. Click here to get the full review.