Presentation on theme: "ICT 4D CONFERENCE Title: Mobile Digital Diagnosis and Data Management By: Dr. Elias K. Sory, Director, Fio Health Ghana Ltd."— Presentation transcript:
1ICT 4D CONFERENCE Title: Mobile Digital Diagnosis and Data Management By: Dr. Elias K. Sory, Director, Fio Health Ghana Ltd.
2FIO HEALTH GHANAFio Health Ghana Ltd. has partnered with Fio Corporation of Canada to use Fionet in Ghana’s health care delivery system to enable high impact, high quality diagnosis of infectious diseases and real-time readily accessible data for health managers.Directors:Dr. Elias K. Sory, MD – Former Dir. Gen. Of GHSDr. Edem Adzogenu, MD – Sr. Adv. to Ministry of Health
3Fionet Validation Fionet Accra Phase – GHS Luminary deployment with GHSover 150 health workers trainedover 50 sites deployed and functioningover 20,000 patient encountersFionet Clinical Field ValidationUS NIH Center of Excellence in Malaria, ColombiaThe Global Fund, Colombian NIH, MOHUS Department of Defense, KEMRIIfakara Health Institute, TanzaniaExperience7,500 patient sessions, 50 health workers, 30 sites4 countriesConsistently successful
4Two of the Biggest Infectious Disease Mgmt Problems Clinical WorkflowManagers, Administrators, Funders, Public Health, IndustryData AggregationMonitoring and Data MiningHealth Worker GuidanceInadequate CareHealth WorkersDiagnostic TestingInadequate DataData Capture & TransmissionInfectious diseases are a leading cause of global death, disease, and economic disruption. According to WHO, we “stand on the brink of a global crisis in infectious diseases. No country is safe from them. No country can any longer afford to ignore their threat." According to National Institutes of Health, infectious diseases take an economic toll of $120BN/yr in the US alone; in economies with more prevalent infectious diseases the economic toll is far greater.Yet, the setting where the vast majority of the world’s infectious disease patients are seen is where diagnosis is most error-prone and from where data – for resource allocation, evaluation and monitoring, surveillance, quality control, process improvement, and private sector investment - is least available. Most patients everywhere are seen not in central facilities, such as hospitals, but rather at “point of care”: decentralized facilities such as clinics, health centers, health posts, and offices.Infectious disease management at point of care is substantially unoptimized; as a result, it is the source of substantial misdiagnosis, misdirection of resources, and misinformation. For example, in Africa, as much as $1 billion per year of anti-malarial drugs is given to sick patients who do not have malaria, a typical waste of human and economic potential in developed and developing countries alike.This is due to inadequate quality of diagnostic testing and inadequate data capture by health workers on the ground. The root problem with diagnostic testing is that rapid diagnostic test strips are interpreted by eye, commonly resulting in field accuracy far below the performance rating of the test strips, of which 700 million have been sold in 2012, growing at 20%/year. The root problem with data capture is that health workers are just too busy delivering care to add any material effort to capture data, no matter how valuable the data is to stakeholders such as public and private health program managers, administrators, funders, policy makers, payers, insurers, investors, and industry. Point-of-care data, where planning and trends begin and where spending and outcomes have their end, is largely inaccessible.The annual market opportunity for an integrated solution that addresses these two big problems at point of care – inadequate care and inadequate data - is potentially $25-50BN, encompassing all markets and economies.____Public and private health managers worldwide are responsible for overseeing chains of dispersed clinics and health centers, employing large numbers of health workers who deliver healthcare.Inadequate Care Delivery at Point of CareMost current diagnostics are either accurate, expensive machines in central labs or inexpensive, error-prone test strips at point of care.Point of care is wherever the health worker and patient meet, such as clinics, offices, health centers and health posts, pharmacies, emergency centers, or military field operations.~700 million point-of-care test strips, called rapid diagnostic tests or “RDTs”, were sold in 2012 for infectious diseases, growing at 15-20%/yr worldwide. Read by eye, RDTs are prone to human error, commonly resulting in low field accuracy, contributing to significant waste through inappropriate care and misdirected resources. For example, in Africa $1BN/yr of antimalarial drugs are administered to sick patients who don’t have malaria.The clinical workup (which questions to ask, tests to administer, and therapies to give) by health workers at point of care often fails to meet quality or efficiency standards known to their health program managers, who lack the means to readily monitor, supervise, address deficiencies, and disseminate evolving standards of practice to health workers at point of care.Inadequate Data from Point of Care to Healthcare Managers and FundersMillions of point-of-care procedures, diagnoses, and treatments are performed daily, with negligible quality data flowing back to health program managers, their supervisors, or their funders.The current system does not capture accurate, timely point-of-care diagnostic, clinical, and demographic patient data. It does not capture health worker activity or outcomes of expended resources.The result is a big gap between large annual expenditures and tracking, essential for public and private rationalization of resourcing and investment decisions: unknown patient data, diagnostic patterns, demography and epidemiology; unknown resource need and deployment detail; unknown health worker and clinic performance and activity, systemic inefficiencies and abuses; and, unknown opportunities.Error-prone diagnostic testingIneffective clinical work-up and therapyNegligible data capture and transmission, despite enormous information accessIncomplete, inaccurate, untimely dataIneffective tracking and direction of resources, results, performance, epidemiology, demography, surveillance, accountability, …Blind spending and investment
5Readers, Tablets, Phones Web Portal CloudAggregates data, continually and automatically uploaded from Fio smart-devices at point of careDelivers information services via web portal to managers, administrators, workers, funders, health agencies, patientsvia local cell networksvia standard browsersReaders, Tablets, Phonesfor health workers at point of careWeb Portalfor managers & data stakeholders, anywhereAutomated diagnostic interpretation, workflow guidance, data captureGateway: for data mining, analyzing, reporting; and, for remotely managing health workersFio automated both diagnostic test interpretation and large-scale data capture and integrated them, using only existing infrastructure and usable by minimally trained personnel. To deliver this affordably, while retaining attractive margins, Fio adapted the recurring fee model common to cell phone carriers and the software-as-a-service industry.The solution consists of: (1) handheld smart-devices that provide on-the-spot, automated, accurate reading of diagnostic tests, clinical guidance, and automated data capture; (2) cloud database to aggregate the data; and (3) web portals through which to mine the cloud database. The time-stamped and geo-tagged data thus gathered includes diagnostic, patient, demographic, epidemiological, logistical, environmental, and health worker activity data.The solution enables high-quality healthcare delivery to individual patients while simultaneously converting routine diagnostic interactions, performed hundreds of millions of times yearly by health workers, into automated data capture events fully integrated with cloud informationIntegrated m-phone, cloud computing, and bioassay technologies to transform infectious diseaseThe Fionet TM system improves healthcare delivery at point of care while simultaneously converting diagnostic tests, routinely performed hundreds of millions of times yearly, into automated data capture events. It connects mobile health to big-data capture and utilization. Fionet TM comprises:Deki TM Reader a compact sidekick device for health workers at point of care in a broad range of settingsAutomatically, accurately reads existing rapid diagnostic tests (RDTs) on the spotGuides health workers through the workup and treatment of the patientDeki TM application software, minus RDT interpretation, also runs on smartphones and tabletsAutomatically, continually captures unlimited data (patient, diagnostic, demographic, workflow, environmental)Continually uploads, via local cell networks, all data (geo-tagged and time-stamped) to airFioTMDownloads Fio-qualified third-party mobile health appsairFio TM Cloud Continuously grows a secure infectious disease database, on path to be world's largest in several yearsOffers suite of real-time Fio Information Services to exploit the Fio DatabaseEnables communication among dispersed health workers, managers, and other stakeholdersHosts third-party infectious disease apps and other resource materialsSpiri TM Web PortalSecure gateway to airFio TM via any computer browsers (tablet, laptop, desktop)Offers private and public clinic managers, administrators, and funders unprecedented access to:- data capture, storage, retrieval, analysis; report generation; data export/import to other databases- dissemination of clinical workup and treatment protocols, data capture forms, apps, alerts to Deki TM- remote monitoring, guidance, quality control of workers, and communication with all stakeholders- mining, mapping, surveilling, screening, analyzing global or regional aggregated, anonymized dataFio Clinical PanelsTM (not shown) are proprietary test strips that can simultaneously detect multiple pathogens relevant to a clinical situation, and at an accuracy level that matches central labs
6Consistent, Accurate RDT Results Digital Diagnosis:Consistent, Accurate RDT ResultsRDTIdentificationRDTProcessing QCIncubationTimingInterpreting RDT ResultsProblem:While manufactured to be chemically accurate, RDTs are read by eye, prone to human error in a circumstance affording little quality control, resulting in real-world field accuracy as low as 65% and contributing to significant waste through misdirected resources, mistreated patients, and wasted RDTsSolution:The Deki Reader provides automated reading of RDTs. Currently compatible with various commercially-available malaria RDTs, other disease targets to follow in short order (i.e., HIV, syphilis, hepatitis B, etc.)The Deki Reader digitally replaces key RDT processing steps, where human error occurs:Identifies RDT disease target and manufacturer, thus recognizing if the wrong test strip is inserted into cassette drawerWill reject RDT if it was left to incubate longer than the manufacturer’s recommended time (monitored via the Deki Reader’s chronometer)Images and identifies poorly processed RDTs (e.g., mistakes in the quantity or placement of blood and buffer)Assures the RDT is optically analyzed in a controlled chamberRenders an objective, automatic, accurate interpretation of the RDTTrust in the accuracy of RDT results leads to a more rational use of drugs, significantly reducing costs and positively influencing the quality of care.Auto-detecting RDT make/modelAccepting or rejecting RDT processingEnabling accurate multiple patient throughputDigitally analyzing RDT results
7Capturing Records, Connecting Anywhere Custom HealthForms/SurveysEasy-to-useData EntryClinical PatientDemographics…via any Android deviceDeki ReaderWorkflowGuidanceDeki TabletAlerts /MessagingProblems:The data captured at point-of-care is, in general, manually captured and aggregated by overloaded health workers and health managers. This leads to poor quality data, reporting delays, and lack of follow-up care. Service providers and managers are faced with diverse and duplicative data sources and reporting processes.Communication between frontline health workers and managers is limited, impeding workflow guidance, training and adequate human resource management.Solutions:Fio has designed custom software to run on its Deki Readers or any Android device (smartphone or tablet) that is used for data capture by health workers at point-of- care. This software can be integrated with RDT diagnostics (i.e. with the Deki Reader), with other diagnostics (e.g., microscopy) or where no diagnosis is made at all (e.g., patient follow-up visits, surveys, immunization records, treatment recommendations, etc.)Its data capture functionality prompts the health worker through complete clinical, demographic and survey forms that are remotely programmable by their health managers (e.g., public health reporting forms, insurance claim forms, etc.); data from these forms are automatically aggregated on Spiri leading to streamlined workflow, reduced errors, and timely reporting of high- quality dataThe software can be easily integrated with existing HMIS systemsVia airFio, health program managers are continuously connected with frontline health workers in both urban and rural centres, enabling the implementation of training and quality control measures; dissemination of workflow guidance, treatment protocols, operational and business process guidance; and monitoring health worker activity for improved human resource managementDeki Phones and Tablets upload clinical and health worker activity data to airFio, where it is integrated with data from Deki Readers, and to which authorized health managers and other stakeholders have access via SpiriTrainingDeki Phone
8Health worker connectivity: Remote Configuration/Communication with DekiDeki ManagementVia Spiri, managers track/administer their fleets of Deki devices:Locations, activities, configurations, problems, user permissions, alerts, …Shut down, reset, or group Deki devicesMultidirectional communication for managers and health workers via Deki devices & Spiri
9Automated Reporting of Point-of-Care Data Process Improvement:Automated Reporting of Point-of-Care DataDataReportsReports can be flexibly configured to present data about devices, users, diagnostic results, demographics, surveys, time, geo-location, ...
10Process Standardization RDT image captured in the record Example: Monitoring service deliveryRDT image captured in the recordManagers identify deviations from protocol, correlate diagnostic activity to drug dispensingManagers track worker activity and performance patterns over timeRDT images are captured and routinely included as part of the recordManagers assess RDT processing skills of healthcare workers and over-read RDTs if necessary
11Pricing ModelDeki : no capital equipment barrier; rental pegged to usageSpiri: fee per dataset upload for information services; uploads pegged to usage“dataset” is the data associated with one patient session, which is uploaded at oncefees organized to fit into existing data budgets… not from diagnostic budgetpricing model designed for sustainabilityPurchase order a three-year contract