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The Use of Mobile Phones to Improve Health

The Use of Mobile Phones to Improve Health. Marc Mitchell, M.D., S.M Harvard School of Public Health and D-tree International. What does a phone do?. send and receive voice data send and receive alphanumeric data - SMS run applications store data, voice

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The Use of Mobile Phones to Improve Health

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  1. The Use of Mobile Phones to Improve Health Marc Mitchell, M.D., S.M Harvard School of Public Health and D-tree International

  2. What does a phone do? • send and receive voice data • send and receive alphanumeric data - SMS • run applications • store data, voice • take and show video or photos • use peripherals (diagnostics) • know where it is (GPS)

  3. How does this affect healthcare? • decision support at POS • linked medical record • continuum of care • across time, place • communications between • community – hw – manager • enhanced diagnostics

  4. How sick? very □ mild □ well □ Symptoms fever □ RR > 40/50 or chest indrawing □ diarrhea □ abd. pain □ rash □ Emergency? unconscious □ bleeding □ seizure □ other □ next  next  Treat Fever NOW Symptoms REFER URGENTLY getting sicker □ neck stiff/headache □ ear pain □ urine cloudy or pain □ sore throat □ no source found □ ampicillin 500 mg+ ALu 1 tab+ paracetemol 1 tab+ fluids next  next  Decision Support at POS for frontline HW   Bringing evidence-based medicine to frontline health workers worldwide next  

  5. Decision Support at POS for frontline HW

  6. Decision Support at POS for frontline HW

  7. Decision Support at POS for frontline HW • Facility • Integrated Management of Childhood Illness (IMCI) • Maternal and Child Health (Ante-natal, Post-natal, Neo-natal) • Active Management of Third stage of labor • Immediate Newborn Assessment • HIV triage • Severe Acute Malnutrition • Community • Maternal and Child Health • (Ante-natal, Post-natal, Neo-natal) • TB screening • Home based care • Orphans and Vulnerable Children • Family Planning • Community IMCI

  8. Decision Support at POS for frontline HW reproductive health chronic disease child health preventive care • HIV/AIDS • Diabetes • Hypertension • TB • antenatal • family plan. • labor + del. • newborn • IMCI • malaria • newborn • HIV/AIDS • antenatal • immunizations • care and support

  9. linking Community – HW – Manager client (basic phone) information alerts reminders surveillance (tweets) CHW (java phone) pt. registration pt. record protocols scheduling training alerts reminders msg to clinic clinic (smart phone) pt. registration pt record protocols scheduling training alerts reminders telemedicine supervisor (phone or netbook) messaging exception rules for supervision surveillance learning notifications alerts manager (laptop) exception rules for supervision surveillance learning data queries

  10. Linked Medical Record running on phone Performance Report patient database patients lost to f/u 1. ali samuel 2. ben hasan 3. etc. Clinical Protocol Enable continuum of care • growth monitoring • immunizations • lab tests • pregnancy registration • referral tracking

  11. Enhanced Diagnostics patient database • respiratory rate • BP • weight • glucose • CD 4 Clinical Protocol

  12. Example: Obstetric plan B • Obstetric plan A: supervised delivery in a health facility • BUT 58% of births occur at home • Obstetric Plan B: • Can we reduce the 3 delays of home births: • delay in identifying problem • delay in transportation • delay in treatment at facility Grand Challenges

  13. Example: Obstetric plan B • Can we reduce the 3 delays: • protocols: Danger signs • mPesa to pay for transportation • cell numbers of local vehicles • pre-recorded permissions for emergency transfer • SMS or phone call to receiving hospital

  14. Example: Obstetric plan B Results . . . . 2012

  15. Where are we going? • eProtocols used universally as platform for • care and counseling • POS diagnostics including CD4, glucose, etc. • use of durable electronic medical record • continuity of care • chronic disease • surveillance • management • integration of banking, health, GIS, nutrition, ??? • shift in health delivery models • greater involvement of private sector • remote sensing, telemedicine, etc.

  16. Whis needed to get there? Standards technology: interoperable, robust clinical: customizable but consistent Infrastructure technology: how to support data flows technology: how to manage equipment logistics (drugs, equipment) Financing models who pays for what what is role of telecoms, pharma, MoH, others

  17. Whis needed to get there? Leadership national: data policies, task shifting, funding global: need for international standards, etc. accountability across the entire spectrum Cooperation and humility donors must cooperate, not be so arrogant for profit and government must learn to work together and share responsibility Do not lose sight of the client the goal of mHealth is Health not phones

  18. The Use of Mobile Phones to Improve Health Marc Mitchell, M.D., S.M Harvard School of Public Health and D-tree International

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