Presentation on theme: "PhD Student, University of Miami"— Presentation transcript:
1PhD Student, University of Miami Health Systems in Urban Poverty Zones Industrial Engineering Proposals for Integrated mHealth SolutionsCaitlin AugustinPhD Student, University of MiamiDulce SanchezIndustrial Engineer, Macys CorporationShihab Asfour, PhDChair, University of Miami Department of Industrial EngineeringNina Miville, DBAAssociate Professor, University of Miami Department of Industrial Engineering
2Project BackgroundPartnership with Project Medishare Hospital in Port au Prince, Haiti and Department of Community Service at the University of Miami Miller School of Medicine to identify key problems with free clinic operations and present innovative engineering solutionsFunding provided by Neighbors for Neighbors, International
3Key DiscoveriesFree health clinics (also called safety net clinics) are severely understaffed which leads to record keeping errors, misdiagnosis, and minimal patient retentionA solution to these problems can be found through the use of mHealth technologies.mHealth technologies can be developed in house and customized to the clinic’s specific needsTraining and education materials can be provided through a web platform.
4Structure of the Presentation Project IntroductionSite StudiesRecommendationsApplicationsData AnalyticsWeb PlatformConclusion
5Project IntroductionThe Universal Declaration of Human Rights, adopted by the United Nations in 1948, proclaimed that "everyone has the right to a standard of living adequate for the health and well-being of oneself and one's family, including food, clothing, housing, and medical care."
6Problem StatementThe most severe problem in global public health is the profound lack of trained local healthcare workers.The World Health Organization notes critical healthcare workforce shortages in 57 countries—and a global deficit of 2.4 million doctors, nurses, and midwives.
7Project Objectives Identify barriers to operations in free clinics Analyze key problems in patient retention in free clinicsApply industrial engineering tools to enhance operational efficiencyDevelop telemedicine tools for patient management in free clinics
8General Assessment Methodology Performed a literature reviewSelected four free clinic sitesEmployed industrial engineering tools of facilities layout, time studies, and work studies for onsite data collectionConducted on-site interviews with the directors, administrators and other personnel of the mobile clinics and hospitals.Developed analysis tools for cost analysis, resource allocation, patients seen
9Industrial Engineering Tools Used Risk Assessment Models: Failure Mode and Effects Analysis, health and safety risk assessmentTime studies :Patient in system and operations of the telemedicine operatorsWork sampling studies: Current system analysis from doctor, nurse, check in perspecticeTime and motion studies: Therblig analysis and design to better suite the ergonomic needs of telemedicine operators.Statistical Quality Control: Xbar and R charts createdCost Analysis: Created a cost analysis of the cost required to implement telemedicine in various situations.Optimization models: Usage of population density, safety and availability of routes were identify to created the optimum routes for the telemedicine operators to travel. Models include traveling salesman and product-mixDecision Support Systems: Programs were designed in VBA/Excel for managers to createARENA simulation model: Model was created to analyze the impact of the telemedicine.Engineering Project Management: Project was organized and managed using software such as Microsoft Project, and Microsoft Visio.
10Study SitesEight hundred thirty-seven million urbanites currently reside in densely populated, overcrowded unsanitary conditions often lacking access to basic health, water and sanitation services.-United Nations
11Project Medishare Hospital Little Haiti DOCS Clinic Study LocationsProject Medishare HospitalSan Juan Bosco ClinicLittle Haiti DOCS ClinicSouth Dade DOCS Clinic
12General Study Observations Fundamental functions1) providing cost-effective quality care,2) educating the community on health issues3) providing a medical and social structure deeply embedded in the neighborhoodsBackgrounds of clinic directors vary from certified physicians to individuals with no professional background in the medical fieldsMedical record management varies between clinics but each dealt with inadequate storage, incomplete records and follow up careAll clinics are consistently understaffed and rely on volunteers to provide servicesEach clinic relied on grants and donations for the bulk of its annual budget
13Data Collection Barriers to Health Care Access Population according to economic classlowest 25%26-50th %51-75%75-100%Distance from Health Center (miles) 6.710 10 xUsage of Public Transportation as Primary form of transport74.3%39%6.3%xUninsured 36.64%27.42%19.85%Immigrant Population92.90% 85%50.32%No Citizenship49.38%Patients60%25% 15% Adapted from Cervantes-Rodriguez, M. Free Clinics: Their Role as Safety Net Providers 2009
16General Recommendations Let’s send in doctors to save people from cholera. Let’s send in aid workers to build sustainable sanitation and water systems to help people help themselves. Let’s help educate Haitian children and improve the port so that it can become an exporter. But, above all, let’s send in business investors to create jobs.-Nick Kristof
17RecommendationsAdoption of mHealth technologies to reduce bottlenecks in clinic, have a consistent patient record, and increase follow-up careIntegration of patient records into OpenMRSProvision of training to managers on mHealth and optimizationUsage of tools developed for data management and maximize existing clinic resources
18Tools Recommended and Designed End To End mHealth ApplicationsAndroid-based Sana General FormIphone-based mHealth engineering General FormHTML 5 applicationData AnalyticsDecision support systems for optimization of travel and orderingData mining tools for disease vector analysisArena simulation for evaluation of new techniquesWeb PlatformTools and apps for downloadVideosPresentationsTraining MaterialsLiterature Review
19Applications“Biggest impacts of mhealth: patient reminders, supply chains for commodities, health records”-Bill Gates
20Application DesignDesigned to promote patient care by providing doctor designed forms for patient intake/triage that can be operated from a mobile device by unskilled workersUpload capability to OpenMRSRequired informationDemographic information: patient name, sex, birth date, locationVitals: patient height, weight, blood pressure, temperatureMedical History: past surgeries, family historyTriage: why the patient is seeking treatment that day.
21Applications Designed SANA Android AppSeattleClouds Iphone App
22Decision Support Systems Data in isolation is not very meaningful. It does not reveal the total picture. You need to present data in some context. Suppose you are presenting this data; India's military budget is $ XYZ billion. This makes less sense in isolation. But once you look at it in relation to some other data point (say military budget of US) then you get a better picture. Comparison makes data more meaningful.-David McCandless
23Decision Support System General Questions Distance to Care RoutesPatients seen/daymHealth technology purchases per hospitalDistance: traveling salesmanPatients: lp optimization problemPhones: inventory control problem
24Ordering Optimization Product-mix modelInputs of hours open, investment budget, total staff, current patients seenWith a $10,000 investment budget, Project Medishare could purchaseTwo tabletsThree phonesOne computer training course4.45 FTE Nurse for one year
25Patient MaximizationMaximin modelInputs of hours open, investment budget, total staff, current patients seenUsing mHealth Project Medishare could increase the number of patients seen per day up to 43%
26Distance to Care Minimization Traveling salesman problem modelFive mobile clinics maintained by Project MedishareTravel distance to mobile clinics maintained in Haiti’s most poverty stricken areas can be reduced by over 70%
27Disease Mapping Program The power of mHealth allows data to be collected, stored, and analyzed virtually everywhere.This DSS is designed for the healthcare worker with limited excel experience to create a map of disease populations and assess risk to determine treatment.Input of latitude and longitude, type of disease (from selection menu), notes
28we are at the very beginning of the Information Revolution. Conclusionswe are at the very beginning of the Information Revolution.This third revolution rewards those who control and process information. It gives them a competitive advantage, and a road to national affluence.-William Kennard
29Web PlatformmHealthengineering.com is a platform that hosts all applications, data tools, and troubleshooting materials for mHealth projects.
30Project ImpactsDissemination of viable mHealth smartphone applicationsEducation provided to free clinic managersA reduction in supply costs due to the reduced use of paper and photocopying.Maximization of existing resourcesElimination of redundancies in patient flow, mobile clinic deliveryIncreases in patients seen/dayIncrease in patient retention and follow up care
31Questions?"We need to focus on the uninsured and those who suffer from health care disparities that we so inadequately addressed in the past."— Sen. Bill Frist (R-Tenn.), Senate majority leader on his priorities for the 108th Congress