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mHealth, Patient Reported Outcomes, & Registries · 2014. 5. 13. · Creative solutions for LMCs No...
Transcript of mHealth, Patient Reported Outcomes, & Registries · 2014. 5. 13. · Creative solutions for LMCs No...
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mHealth, Patient Reported Outcomes, & Registries UICC Presentation
Bradford Hirsch, MD, MBA August 30th, 2012
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New Cancer Diagnoses
0
5
10
15
20
25
1975 1985 2000 2008 2010 2015 2020 2025 2030
Mill
ions
Globally'
United'States'
Source:(GLOBOCAN(2008(
World(Cancer(Report(2008(
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Doctors per 1000 Patients (2012)
0.6 0.6
1.1 1.3
1.7
2.2
3.3 3.5
3.8
India South Africa
China Brazil Turkey UK US Denmark Germany
Source:(Economist(Intelligent(Unit(
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Penetration of Mobile Technology
Source:(ITU(World(TelecommunicaCon/ICT((Indicators(database(
0
1
2
3
4
5
6
7
2006 2007 2008 2009 2010 2011
Fixed Telephone Line Internet Users Mobile Subscriptions
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Need Creative Solutions
! LMCs represent the majority of the worldwide cancer burden
– 7.6 million deaths from cancer in 2008 – 64% in LMCs
! Must understand cancer burden ! Must augment workforce to address specific needs ! Must create unique ways to engage providers and patients in
order identify and monitor cancer diagnoses, pursue treatment, and conduct surveillance
! mHealth tools are positioned to address these issues
Source:(GLOBOCAN(2008(
World(Cancer(Report(2008(
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Spectrum of mHealth Tools
Workforce Support
& Cancer Registries
Limited Patient
Engagement
Sophisticated PRO
Systems
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Duke Center for Learning Health Care
! ePRO = prototype system for collection of patient information & analysis
! On-the-ground, real-time mechanism to gather data on: � Diagnosis & patient history � Symptoms � Quality of life � Medication use and compliance � Patient satisfaction � “Value” of treatment
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Collection Methods
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Validated Questionnaires Available
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Interface
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7
H
Research Clinical Operations
& Quality
Clinician
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Evolution
! Improve visualization
! Trigger interventions & education
! Provide scorecards
! Enable rapid learning clinic
! Embed randomization
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Evidence Based Medicine: A Paradigm Shift
African CRs monitor 11% of the population, the Costa Rican registry covers 90%, U.S. and Madras cancer registries reach 96%. In the “validity” domain the key criterion was pathologic diagnosis confirmation. Most LMC CRs are not pathology-based. CRs in wealthier settings like Hong Kong report histological confirmation in >85% of cases. In the “timeliness” domain standards for timely data reporting are largely undocumented.
First'steps'
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Creative solutions for LMCs
No need to wait for greater technology adoption by clinics as mHealth can be used to circumvent the system ! Must understand cancer burden
– EpiSurveyor in Tanzania ! Must augment workforce
– Education for providers and patients in India and China
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Registries in LMCs
! 2/3rds of global cancer burden occurs in LMCs ! Registries only monitor 11% of the African population vs 96% of
the U.S. population ! Infrastructure to identify and monitor diagnoses, treatment, and
surveillance is the cornerstone of clinical and research oncology ! WHO, among other organizations, has advocated for the creation
of standardized cancer registries in LMCs
Source:(GLOBOCAN(2008(
World(Cancer(Report(2008(
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Episurveyor - What does it do?
Adapted from slides
by Joel Selanikio
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How does it work?
Adapted from slides
by Joel Selanikio
Create forms online and push to common mobile
phones�
Works with Android, Symbian, Blackberry,
SMS, and iPhone�Not just smartphones�
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How does it work?
Adapted from slides
by Joel Selanikio
Data is secure, encrypted, password protected�
Data can be collected offline�
Data�Visualization�
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More than 9000 users in more than 170 countries
Adapted from slides
by Joel Selanikio
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Collection of Primary Data
Malaria surveillance in Malawi* Basic Patient Experience Data
*Applying or Integrating Mobile-based Episurveyor Technology into Malawi
Malaria Supervision – episurveyor.com
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India & China
! Augmenting workforce – Implementation of limited PROs, adapted for literacy
and technologic capabilities – Basic education
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Creative solutions for LMCs
! Many complex and targeted mHealth platforms, but don’t forget about basic solutions with great flexibility
! Goal is to – provide patients and populations what they need in their
communities – provide open, creative solutions – avoid waiting for traditional infrastructure to be built