Smartphones in Health Care

8/13/2019 Smartphones in Health Care

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Dougie Barnard11/13/13

The Use of Handheld Devices Will Improve Ford Program’s Maternal Health Clinic

Introduction

The Ford Family Program has plans to build a maternity ward within the Brother Andre

Medical Dispensary in Dandora, Kenya. The Ford Program envisions establishing a maternity

health clinic that utilizes mobile-based health technology. One potential strategy for the Ford

Program to harness mobile technology is the platform of personal digital assistants (PDAs), also

known as smart phones. The Uganda Health Information Network (UHIN), a project carried out

by AED-SATELLIFE, has potential to inform the Ford Program’s maternity health clinic in

Dandora. The UHIN uses PDAs to serve many functions, including equipping community health

workers (CHWs) with up-to-date health information and national health guidelines. The UHIN is

not a perfect model for the Ford Program to use. The UHIN’s aim is to create a health system

coordinated with the Ugandan government, while the Ford Program is interested in improving

context-specific health care services within Dandora. Nonetheless, the UHIN contains lessons

pertinent to the Ford Program’s vision of improving maternal health care, namely that creating a

network of PDAs, wireless access points (WAPs) and cellular telephony has capabilities of

transforming health services and creating new forms of health information delivery.

Overview of the UHIN

The UHIN is a pilot project of AED-SATELLIFE’s Center for Health Information

Technology, a U.S.-based nonprofit organization, which serves an estimated 130,000 health

professionals globally. Launched in 2003, the UHIN aims to improve health outcomes by

equipping health care workers with critical health information through the use of PDAs (4).

The Problem


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Uganda faces the challenge of “information poverty” due to the technology gap between

first-world and third-world countries (3). In addition to lacking healthcare resources (medicines,

equipment, etc.), community health workers (CHWs) in Uganda have difficulty participating in

the global exchange of knowledge among health professionals, which prevents them from

providing lifesaving diagnoses and treatments.

Objectives and Theory of Change

The UHIN seeks to bridge this information gap by building a communication system

featuring a two-way network to collect health data and report medical information (3).

Objectives of the UHIN include improving the collection processes for health management

systems and sending health information for better health management of the patients. The

UHIN’s theory of change is this: information has the power to affect health outcomes and mobile

technology can effectively communicate important health information.

Results

Since 2003, 175 remote health facilities serving more than 1.5 million people have been

able to send and receive health information using PDAs (1). A total of 500 PDAs provided by the

project are being used by CHWs in the 175 health centers in Rakai, Lyantonde, Mbale,

Manafwa, and Bududa (3). Studies evaluating the impact of the project found “a 24% savings per

unit of spending over the traditional manual data collection and transmission approaches, a figure

likely to increase as additional paper forms are converted” (3). Additionally, District of Health

Services reported, “close to a 100% compliance rate on weekly disease surveillance reporting

using the network, compared to the national average of 63%” (3). Furthermore, impact

assessments found, “Over 50% of health workers surveyed rated handheld-accessed information

useful at all stages of patient care” (3). These findings convey important information to the Ford


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Program when considering if UHIN should be the chosen model for the maternity ward in

Dandora. The UHIN is cost-effective, showing a 24% savings per unit of spending. The ease of

implementation is also positive. While some health workers needed to be trained how to use the

PDAs, they expressed ease in learning its functions. The proven benefit, however, of using PDAs

remains a bit unclear. It is important to ask the question, is the health information accessed by

CHWs through their PDAs improving health outcomes? Much of the evidence is self-reported

and vague. For instance, Holly Ladd, Director of AED-SATELLIFE, refers to ‘evidence’ of

improved diarrhea treatment by saying, “We emphasize in the medical treatment alerts that we

send to the handheld devices that rehydration therapy is strongly recommended. We have

evidence that this is now used much more often as a first course of action in those clinics (4).”

Where is this evidence? We know the UHIN has provided health workers at remote sites with

critical health information not previously available to them, but hard evidence of UHIN’s success

is limited. On a positive note, UHIN’s communication network has replaced travel by foot,

improving the overall efficiency of the community health system.

Lessons for Ford Program

Using UHIN as a model for Dandora is made simpler by accessing health system

networks that are already in place. I recommend the Ford Program survey public health systems

and servers of hospitals in the Nairobi area, looking especially for Wireless Access Points,

Cellular Networks such as Safaricom and Orange, and Central Servers. If the Ford Program is

able to identify health facilities already utilizing communication system networks, it will

decrease costs and the time frame of implementing this technology.

An important lesson learned from the UHIN is the capability of connecting CHWs with

current health information through cellular telephony networks. Health workers have


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traditionally attempted to deal with information poverty by visiting libraries, but mobile

technology offers new opportunities to share information and educate CHWs. I recommend the

Ford Program use mobile technology via PDAs to continue educating their health workers. I also

suggest providing the new medical staff at the maternity ward with health information via PDAs

in order to make for a quicker transition into high quality maternal and childcare.

In order to assist CHWs and new maternal health staff in providing health information, I

suggest purchasing PDAs for all medical staff. PDAs will enable CHWs to keep patient records

and disseminate health data. Several factors are working in favor for the Ford Program using

UHIN as a model. Since Dandora is an urban area, cell phone literacy is fairly high.

Additionally, Dandora has a strong team of CHWs that could benefit greatly through receiving

PDAs; CHWs may use the GPS capabilities of PDAs to know exactly where patients are. This is

important because the Ford Program is interested in connecting locations to patients’ problems,

since the large dumpsite is causing a whole slew of health issues.

The use of PDAs to improve health systems is also beneficial because it includes the

opportunity of applications. The Open Medical Records System (OpenMRS) is a free application

for storing electronic medical records in developing countries (4). The application has been used

for patient management and treatment of HIV/AIDS and Tuberculosis, especially in sub-Saharan

Africa. The use of PDAs has promising potential with applications like OpenMRS.

The Ford Program’s commitment to researching the root causes of problems can greatly

benefit from transitioning to a low-cost, simple to use, and energy efficient health system

network utilizing existing cellular telephone networks and PDAs (2). Developing a health

information network similar to the UHIN will improve the collection, storage and dissemination

of health records and patient information.


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Bibliography

1. "Health Management Information Systems." mHealth in Low-Resource Settings. RoyalTropical Institute, n.d. Web. 8 Nov 2013.

2. "ICT for Health > Empowering Health Workers to Save Lives." SATELLIFE Health Information and Technology. fhi 360, 07 Jul 2011. Web. 8 Nov 2013.

3. "AED-SATELLIFE Center for Health Information and Technology." Givewell . AED-SATELLIFE, 09 Jul 2004. Web. 8 Nov 2013.

4. "Connecting Health Clinics and Remote Health Workers (Uganda)." globalproblems- globalsolutions. Wireless Technology for Social Change: Trends in Mobile Use by

NGOs. Web. 8 Nov 2013.

Smartphones in Health Care

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