APPLICATION OF TECHNOLOGY IN HEALTHCAREAPPLICATION OF TECHNOLOGY IN HEALTHCARE

A MODEL FOR RESPONSE TO HEALTH CRISIS IN DEVELOPING A MODEL FOR RESPONSE TO HEALTH CRISIS IN DEVELOPING COUNTRIESCOUNTRIES

Ernest C. Madu, Ernest C. Madu, MD, FACC, FRCP (Edin)MD, FACC, FRCP (Edin)Professor of Cardiovascular Medicine and Imaging TechnologyProfessor of Cardiovascular Medicine and Imaging Technology

University of Technology, Kingston, JamaicaUniversity of Technology, Kingston, JamaicaChairman and CEO, Heart Institute of the Caribbean, Kingston, JamaicaChairman and CEO, Heart Institute of the Caribbean, Kingston, Jamaica

Washington DC, USA, April 2012Washington DC, USA, April 2012

Noncommunicable diseases in developing countries are a major public health and socio-economic problem

The major challenge to development in the 21st century

Source: WHOSource: WHO

Total deaths around the world:58 million

Deaths from noncommunicable diseases around the world:35 million

Deaths from noncommunicable diseases in developing countries:28 million

Deaths from noncommunicable diseases in developing countries which could have been prevented: an estimated14 million

Source: WHOSource: WHO

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15

20

25

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2004 2015 2030 2004 2015 2030 2004 2015 2030

De

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High income Middle income Low income

HIV, TB, malaria

Other infectious

Mat//peri/nutritional

CVD

Cancers

Other NCD

Road traffic accidentsOther unintentionalIntentional injuries

Noncommunicable Diseases Projected Deaths in 2015 and 2030

Source: WHOSource: WHO

2005 2006-2015 (cumulative)

Geographical regions (WHO classification)

Total deaths

(millions)

NCD deaths

(millions)

NCD deaths

(millions)

Trend: Death from infectious

disease

Trend: Death from NCD

Africa 10.8 2.5 28 +6% +27%

Americas 6.2 4.8 53 -8% +17%

Eastern Mediterranean

4.3 2.2 25 -10% +25%

Europe 9.8 8.5 88 +7% +4%

South-East Asia 14.7 8.0 89 -16% +21%

Western Pacific 12.4 9.7 105 +1 +20%

Total 58.2 35.7 388 -3% +17%

Noncommunicable DiseasesDeath trends (2006-2015)

WHO projects that over the next 10 years, the largest increase in deaths from cardiovascular disease, cancer, respiratory disease and diabetes will occur in developing countries.

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Source: WHOSource: WHO

Lost national income from premature deaths due to heart disease, stroke and diabetes

2005 2006-2015 (cumulative)

CountriesLost national income

(billions)Lost national income

(billions)

Brazil 3 49

China 18 558

India 9 237

Nigeria 0.4 8

Pakistan 1 31

Russian Federation 11 303

Tanzania 0.1 3

WHO: "Heart disease, stroke and diabetes alone are estimated to reduce GDP between 1 to 5% per year in developing countries experiencing rapid economic growth"

(WH

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) Noncommunicable Diseases

Macro-economic Impact: Lost National Income

Source: WHOSource: WHO

Progress Is Not Uniform• Gaps in health between the rich and poor are as wide as

they were half a century ago and are becoming wider still

• Between 1975 and 1995, 16 countries with a combined population of 300 million experienced a decline in life expectancy

• By the year 2025, while life expectancy at birth in 26 By the year 2025, while life expectancy at birth in 26 countries will be above 80 years, in many low resource countries will be above 80 years, in many low resource countries it will be less than 55 yearscountries it will be less than 55 years

• Even more experienced a decline in DALE

A New Approach Needed

• the worsening indices of health status in the worsening indices of health status in developing countries demand a fresh look developing countries demand a fresh look at the way health systems are organizedat the way health systems are organized

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Water Education/ Training

Water resources protection

Waste management/ disposal

River development

Basic drinking water supply & sanitation

Water Policy/ Management

Water supply/ sanitation-large systems

Health Education

Health Training

Basic Nutrition

Family Planning

Medical Services

Medical Research

Basic Health Infrastructure

Reproductive Health Care

Basic Health Care

Health Policy/ Management

Infectious Disease Control

STD & HIV/ AIDS Control

Official Development Assistance for Health(2006, in US$ Billions, total is US$21 billion)

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Donors are not responding to requests for technical assistance

Health and Foreign PolicyHealth and Foreign Policy

Source: http://www.economist.com/printerfriendly.cfm?story_ID=693193

Shift from Foreign Aid to Sustainable Development

Source: http://www.economist.com/printerfriendly.cfm?story_ID=693193

The Technological Lag Advances in technology not applied to healthcare delivery in low

resource nations– Low public awareness of appropriate technology options (demand drives

supply)– absence of appropriate technology transfer and access to technological

advances

– Lack of infrastructure and expertise in new technological advances – Deficit in capacity building

– High cost of capital and limited organized private sector involvement in healthcare service

– Absence of favorable policies to support and attract investment in healthcare and mitigate against the risk

Misconceptions about Technology in Healthcare

Myth– Increase healthcare cost

– Widens inequalities

– Reduces access

– Does not improve quality of care

– Unaffordable

– Only fit for the western world

– TOO GOOD FOR THE DEVELOPING WORLD

Reality– Technology improves healthcare– Cost-effective/improves access

– Improves workflow efficiency– Improves patient information

management

– Improves reliability and patient safety

– Opportunity to extend quality care to rural settings

– Expand the reach of limited expertise

– Saves lives……..improves QOL….makes life better

Intervention Through Appropriate Technology Transfer

adapted from Chris Madu et. al

Identif y & ImplementAppropriate Technology

Capabilities

Needs & Objectiv es

Structural Factors(Culture Value

Sy stem)

Inf rastructure Resources

Success of Technology Transf ers

StableGov ernment &

Political Sy stem

Ef f ectiv eManagement

Educate & Train

R&D

Aquisition Factors

FactorsDetermined

by the Country

Figure 1. Critical Factors for Successful Technology Transfer

Madu CN: Long Range Planning, Vol 22(4), 115-24, 1989

Case Studies

• HIC• DOCS• EMS

OUR MODELHEART INSTITUTE OF THE CARIBBEAN

Our Model

• Smart, efficient and cost effective use of appropriate technology anchored on

knowledge and expertise.

• Leveraging advances in technology to improve access, quality and affordability

• Focus on training, research, development and innovation

Our Model: Niche Focus and DeliveryOur Model: Niche Focus and Delivery

• Organization and Strong Management TeamOrganization and Strong Management Team• Capital Formation and AccessCapital Formation and Access• Shift from Aid to Sustainable Development Shift from Aid to Sustainable Development

• Specialization and Economies of ScaleSpecialization and Economies of Scale• Innovative Use of Technology Innovative Use of Technology

• Strategic PartnershipsStrategic Partnerships• Internal Capacity DevelopmentInternal Capacity Development• Evolving Vision and Direction Evolving Vision and Direction

Jamaica 2005

• Population; 3 million

• #1 Cause of Death and Disability: CVD

• Access to CVD Care limited– No Cardiac Center of Excellence

– Few Cardiologists with limited availability– Waiting time for Stress Test 3-6 months

– Waiting Time for Echocardiograms 3-6 months

• The HIC SolutionThe HIC Solution

Our Model: Our Model: Making Technology Work

• Technology applications relevant to low resource economies

• Sustainable international partnerships rather than the current “dumping ground” approach

• Global Telemedical services to expand access to health care.

• Cost effective and clever use of health care resources • Specialization and “niche” positioning for more efficient

service delivery

• Creating value at competitive price• Private-Public Sector Partnerships

Improving Healthcare through Improving Healthcare through TelemedicineTelemedicine

• Implementation of web based image management portal Implementation of web based image management portal and electronic medical reportingand electronic medical reporting

• Training of CV Techs for diagnostic studiesTraining of CV Techs for diagnostic studies• Engagement of Telecardiologists in different countriesEngagement of Telecardiologists in different countries

• Web based interpretation of cardiovascular diagnostic Web based interpretation of cardiovascular diagnostic studies to improve access and outcomesstudies to improve access and outcomes

• Rapid turn around time with improvement in healthcareRapid turn around time with improvement in healthcare

• Cost-effectiveCost-effective• Opportunity to extend quality care to rural settingsOpportunity to extend quality care to rural settings• Expand the reach of limited expertiseExpand the reach of limited expertise

Universal Access to Medical Expertise

Universal Access to Patient Information

andReporting

Just a click away

Impact of Technology in Healthcare

Jamaica 2005

– Echo waiting time: 3-6 months

– ETT waiting time: 3-6 months.

– Cardiology Consultation: 2-3 months

– Increased healthcare cost

– Wide inequality in care

– Reduced access to many

– Limited access to quality care

Jamaica 2012

– Echo waiting time; Same Day

– ETT waiting time: Same Day

– Cardiology Consultation: Same Day

– Reduced healthcare cost

– Equality of care and expertise

– Open access to many

– Opportunity to extend quality care widely and to rural settings

– Improved Quality of Life

NIGERIA 2012PROBLEM

– Limited access to timely healthcare or reliable health information

– Limited access to Specialist Opinion

– Absence of emergency medical response system

SOLUTION– Open access through 24

hour medical hotline (DOCS)

– DOCS Telemedicine Clinics

– Introduce EMS service run by medical professionals

Universal Access to Medical Advice and Healthcare Information

Looking to the FutureLooking to the FutureElectronic and Mobile Health PlatformsElectronic and Mobile Health Platforms

Launching July 2012• Access to Doctors 24/7 from anywhere• Medical advice, drug information, clinic and

hospital information• Internationally approved protocols• Aimed at improving access and reducing cost of

accessing healthcare – Physician and hospital visits– Transportation costs and Forgone earnings

• Earlier intervention = better outcomes• Invaluable “peace of mind” 24/7

DOCS Nigeria Medical Hotlines

• Innovative healthcare delivery model aimed at improving access– Will make widespread infrastructure accessible at low cost– Leverage 60-90 million unique mobile phone accounts to disseminate

healthcare services– Circumvents lacking infrastructure– Improves quality of care and will yield better outcomes– Will drastically reduce overall cost of healthcare by delivering accurate

information at the right time – Reduction in healthcare spending and productivity loss

Real World Examples – Call AnalysisTelehealth Service Ontario, Canada

• Data collected demonstrates that 43% of healthcare inquires can be resolved by self-administered care• 35% resulted in the need for physician consultation• An even smaller 16% resulted in the need for emergency care

DOCS TELEMEDICINE CLINICSDOCS TELEMEDICINE CLINICS• Real Time Audiovisual

Telemedicine • Direct connection to US

based Specialists• Virtual diagnosis and

treatment• VOIP based solution• Flexible access from

smart phones, tablets and laptops

• “an emergency medical service - contains 3 words that are critical;

1. It must be available and accessible in emergencies.2. It must be led by medical professionals.

3. It must be a service - integrated from the point of patient collection, to the nearest hospital with all the emergency care facilities i.e a fully functional surgical

theatre”– Source; http://www.nigeriahealthwatch.com/

• March 13, 2012

• “So far in 2012, 52 years after independence there is no functional "Emergency Medical Service" in Nigeria. Terms like ‘The Golden Hour’ and the ‘Platinum Ten Minutes’ that define Emergency Medical Services all over the world are practically irrelevant in Nigeria. EMS is an essential part of the overall healthcare system as it saves lives by providing care immediately”.– Source: http://www.nigeriahealthwatch.com/

• March 13, 2012

• Launching in Enugu, Nigeria, July 2012• Will be readily and widely available and accessible at minimal

cost• Led by experienced medical professionals with experience in

emergency medicine• Fully equipped EMS vehicles and trained personnel to

respond to emergencies• Will be integrated with key participating hospitals in Enugu• Model will be replicated in other cities nationwide

DOCS EMS PHONESDOCS EMS PHONES

SUSTAINABLE SOLUTIONS• Anticipate, adapt and respond

• Develop cost effective multidimensional technology transfer policy and action plan

• Build and maintain relevant infrastructure• Build internal capacity

• Open up access to capital• Bridge socio-economic inequalities• Embrace new and emerging technology

solutions

Take HomeTake Home

• Good healthcare is possible everywhere

• The Developing World can and should leapfrog using advances in technology