Across the globe, harsh economic realities have forced healthcare providers to find creative ways to treat patients, a movement that has healthcare professionals in this country taking notice.

FAST FOCUS

  • The same technology that lets Americans book a vacation on their wireless phones allows doctors in India to counsel diabetics on proper nutrition.
  • Remote monitoring of patients can help reduce costs significantly by reducing the amount of time the patient spends in hospitals and by lowering the frequency of follow-up visits.
  • In Africa, India and Bangladesh, pregnant women receive recorded voice mails on their cell phones in which medical practitioners offer advice on prenatal and well-baby care. 

From low-tech, downward innovation—redesigning expensive products into simpler ones; to downshifting to lower-skilled health care workers; to higher-tech mobile medicine that stretches the availablility of medicine’s scarcist resource—doctors; new ideas are front and center around the globe to control costs and make health care affordable. Creative minds are proving that despite what many believe is the direction of medicine in the United States, not all innovation is high tech or expensive.

In sub-Saharan Africa, cellular telephones save lives every day by bringing access to medical advice to remote regions where the nearest doctor may be 1,000 miles away. In Brazil, children admitted to hospitals are not just treated for their immediate injury or disease. The children routinely receive additional resources for improving their personal care and hygiene. And in an attempt to stop the cycle of repeat hospital visits caused by extreme poverty and the inability to carry on treatment, the children also get information about sexuality, disease, nutrition and other topics. In India, a visionary doctor applies process-improvement tactics normally used in the auto industry to drastically reduce the cost of open-heart surgery.

 “Somebody said that it’s out of the stresses of not having enough money that innovations are likely to emerge because they have no choice,” says Dr. Arnold Milstein, director of the Stanford University Clinical Excellence Research Center. “You can’t use conventional methods. What I think is interesting about that from the perspective of a country like ours is that some of those ideas, even though they are born out of the stress of not having enough money, are potentially transferrable to this country.”

Mobile Health’s Promise

The same technology that lets Americans book a vacation on their wireless phones allows doctors in India to counsel diabetics on proper nutrition and send reminders to other patients to take their scheduled medicines. In Africa, where counterfeit meds are so prevalent that an estimated one in three prescriptions dispensed from a pharmacy is fake, customers can text a simple code to find out instantly if the medication is what it purports to be. In remote parts of Mexico, patients use Skype to communicate with their doctor, who may be hundreds of miles away. It is part of a global revolution in what is being called mHealth—the use of wireless technology and mobile devices such as cellular phones to make healthcare more accessible, faster and less expensive.

Rapid adoption of wireless phone technology is expanding the geographical reach of the medical community. It is no longer necessary to live near a hospital or clinic to access their services, and the emerging countries of the world are quick to realize its promise.

“People spend 99.9% of their lives outside of a doctor’s office,” says Dr. Douglas Wood, who directs the value program at the Mayo Clinic Center for the Science of Healthcare Delivery and is director of strategy and policy at the Mayo Clinic Center for Innovation. “So if we were to think about health and home together, we would think about how we would take care of people where they live rather than saying the only way you can get healthcare is through a traditional doctors’ office visit or clinic visit.”

Mobile health is changing the way patients receive healthcare. According to Transparency Market Research, the most impactful trend in the mHealth market is the growth in remote patient monitoring. Remote monitoring of patients can help reduce costs significantly by reducing the amount of time the patient spends in hospitals and by lowering the frequency of follow-up visits. Transparency Market Research estimates the global mHealth market, $1.3 billion in 2012, will reach $10.2 billion by 2018.

Sometime this year the number of mobile telephones in use worldwide will exceed the number of people on the planet. At the end of 2011, the International Telecommunication Union estimated that the planet earth’s nearly 7 billion people were using 5.9 billion cellular phones. The union says 87% of the planet’s population has a mobile-cellular subscription—79% in the developing world. Additionally, one third of the world’s population has Internet access.

Changing Face of Health

Many low- and middle-income countries face what the World Health Organization describes as a double burden of disease. While they continue to deal with the problems of infectious disease and under-nutrition, they are seeing a rapid increase in non-communicable disease risk factors, such as obesity and overweight, particularly in urban settings.

Some of those ideas, even though they are born out of the stress of not having enough money, are potentially transferrable to this country.

Children in low- and middle-income countries are more vulnerable to inadequate pre-natal, infant and young child nutrition. They are exposed to high-fat, high-sugar, high-salt, energy-dense, micronutrient-poor foods, which tend to be lower in cost. These dietary patterns conspire with low levels of physical activity to sharply increase the incidence of childhood obesity. The problem of under-nutrition, meanwhile, remains unsolved.

But mHealth is showing promise in attacking these issues. Healthcare providers worldwide are mining mHealth to bring advice and counsel to people in desolate locales.

For example: Nearly 300,000 women a year do not survive childbirth or pregnancy, and nearly 3.1 million newborn deaths occur annually. Most of these deaths occur in underdeveloped nations where access to doctors and medical advice is scarce.

·         In Africa, India and Bangladesh, pregnant women receive recorded voice mails on their cell phones in which medical practitioners offer advice on prenatal and well-baby care. It’s part of a program by the Mobile Alliance for Maternal Action (MAMA), a public-private partnership between USAID, Johnson & Johnson, the United Nations Foundation, mHealth Alliance, and BabyCenter.

·         The program uses voice mail to deliver critical, stage-based information to pregnant women, new mothers and their families. The majority of the culturally sensitive messages are delivered as entertaining mini-dramas designed for people with low literacy levels. In Bangladesh alone, more than 12,000 mothers, family members, and organizations across the country have registered for the service and will receive the messages through the pregnancy and the baby’s first year of life.

“MAMA’s work in Bangladesh continues to show the power of mobile technology to improve the health of vulnerable communities across the country,” says Kirsten Gagnaire, MAMA global director. “Families rely on (it) to get direct information in their language, right in the palm of their hands.”

·         In Malawi, the nonprofit Clinton Health Access Initiative uses SMS technology to quickly track down patients who miss scheduled health appointments, communicate early infant diagnostic results and identify patients with other urgent and pressing medical conditions. The program boasts that patients who miss an appointment are seen within two weeks of being reminded.

·         In Mali, the nonprofit International Institute for Communication and Development has partnered with a local phone carrier to improve child and maternal health monitoring in Yirimadjo, a poor outskirt community of Bamako. The program calls for training local mothers as community health workers and providing them with mobile phones and a special app to conduct prevention programs and to diagnose and treat patients more efficiently.

MAMA’s work in Bangladesh continues to show the power of mobile technology to improve the health of vulnerable communities across the country.

·         Drug counterfeiting in emerging nations is responsible for millions of deaths a year, according to the World Health Organization. In some countries an estimated one of every three drugs dispensed is fake—they may contain the wrong ingredients or not have as much active ingredient as advertised. Mobile phone company Orange, in collaboration with m-Pedigree, has developed an SMS system that allows patients and clinicians in Kenya, Cameroon and Ghana to determine whether their drugs are safe by sending a single text and receiving an instant verification. Each medication has a one-time code that is revealed by scratching the cover ink, similar to a lottery ticket. Callers then text the number that is revealed to a server, which sends an instant text reply verifying whether the drug is legitimate.

·         In India, an estimated 700,000 people do not have access to a doctor. Apollo Hospitals, one of India’s largest healthcare providers, established call centers staffed by paramedics, doctors, nurses and other health advisors who rely on an IT platform with a structured query database to provide appropriate information. In the decade since its inception, more than 700,000 calls have been handled by the call center triage service.

“People are doing things in new and really different ways, and problems are getting solved,” says Dr. David Levy, global leader, healthcare, for PwC, a global consulting company. “There is a fantastic explosion of creativity and innovation, and the way that people are newly engaging with their physicians and providers in different ways—that is relentless. It is irrevocable, and if anybody thinks that this is going to be any different than what we’ve seen happen in financial services or hospitality or travel, they are nuts. It’s not going in any different direction.”

Aging and Chronic Disease

According to the U.S. National Heart, Lung, and Blood Institute, every year more than 35 million people worldwide die from chronic non-communicable diseases—especially heart disease and stroke, diabetes, lung diseases, and cancer. That’s twice the number of people who die each year from infectious diseases, maternal and perinatal conditions and nutritional deficiencies combined. Developing countries are hardest hit. Although chronic diseases account for about 60% of all deaths globally, 80% of these deaths occur in low- and middle-income countries.

At the same time, the populations of developed nations are increasingly becoming older, and thus susceptible to age-related issues such as dementia and arthritis.

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