HST.S14
Information Systems and Quality Improvement
1
Trishan Panch
MD MPH
2
Information Systems
3
1. Sana - Open Source Telemedicine
Information Systems
4
Information Systems
2. The Challenge of Chronic Disease
5
Sana
✦
Multi-disciplinary research group at MIT CSAIL
✦
Free open source cellphone-based telemedicine platform
✦
Distributed network of volunteers
✦
Not just technology
6
sana.mit.edu
sustainable change
health system strengthening
quality improvement
capacity building
<hard coded> algorithms to empower front line health workers
7
Chronic
CV
Diabetes
Respiratory
TB/HIV/Malaria
Child
Acute
ER Minors
Surgery Dx/Fu
TB/Malaria/HIV
Ca Screening
IMCI
Development
Mental
Womens
Anxiety
Depression
Psychosis
Personality Disorder
Organic
Family Planning
Abortion
Antenatal
Delivery
Post Natal
8
Primary
9
The process
10
Evaluation
PARTNERS
Acute
Chronic
Child
Mental
Womens
DEPLOY
Client
DESIGN
HEALTH
Open MRS
SPEC
11
WhatWhy
12
An example
13
eHealthpoints
• Network of 38 clinics in rural Punjab, India
• Walk in primary care and clean water
• Currently acute walk in care.Want to move into chronic disease
management
• First condition : Diabetes
• First challenge : Screening to find cases in community so they can
be treated in clinic
14
The Project
• Protocol for Diabetes Screening
• v1 international
• v2 local
• Client developed. Server implemented
• Pilot
15
Community based screening for risk factors for Diabetes
1
Sex
male
5
3
2
6
7
18
Age
<30
Does anyone in your close family
have diabetes
Do you have high blood pressure?
no
Are you:
thirsty all the time?
worried that you pass urine a lot?
worried that you have frequent
infections?
no
Do you have high cholesterol?
no
LOW RISK
Diabetes
yes
yes
any yes
yes
>11.1mmol/l
12,13,17
8
10
9
female
2
Risk of Diabetes
Test Glucose using Glucometer
any risk factor
RIsk
Have you eaten anything or drunk
anything except for water in the
last 12 hours
no
What is the blood glucose
reading?
>6.0 mmol/l
Oral
Glucose
Tolerance
Test
Video invitation to
attend healthpoint
clinic in fasted state.
Fasting Glucose
75g Oral Glucose
Load
Test at 2 hours
Written information
leaflet
7.8<glucose<11.1 mmol/l
Impaired
Glucose
Tolerance
<7.8mmol/l
2
Age
>=30
<30
3
Does anyone in your close family
have diabetes
New Diagnosis
materials
+
Refer for
Appointment with
Doctor
Referred for clinic test
Community based capillary blood glucose testing
>=30
yes
no
4
yes
yes
Did you have diabetes during
pregnancy?
no
yes
any yes
5
Do you have high blood pressure?
7
6
no
Do you have high cholesterol?
yes
12,14,16
Are you:
thirsty all the time?
worried that you pass urine a lot?
worried that you have frequent
infections?
11
Poor sensitivity for random blood glucose testing
No action
18
LOW RISK
<6.0 mmol/dl
16
Retest at Six months
Identify and Manage
Cardiovascular Risk
Community based
screening of rural
population for risk factors
and current symptoms of
Type 2 Diabetes
If at risk : community
based capillary blood
glucose testing using
Sana/Sensaris system
If at risk : clinic based
definitive diagnosis of at
risk population for
Diabetes
DIAGNOSIS
Patient Education/Dietary
advice and lifestyle
intervention
Manage Lipids
Lower Blood Glucose
Targets and monitoring
using HBA1c
Identify and Manage
complications
Kidneys
Manage Blood Pressure
Anti-thrombotic therapy
Oral hypoglycaemic
Agents
Insulin
Peripheral Nerves
Regular schedule of monitoring
Focus on lifestyle change
SCREENING
MANAGEMENT
17
Eye Care
The Project
1. Implementation by local team needs to be managed
2. Collect data and evaluate screening
1. number screened
2. case finding rate
18
Experiment
1. With UC Berkeley
2. 2 Interventions
1. Committment Contract
2. Price discount
19
Lessons
✦
Technology but not just technology
✦
Non Communicable diseases...
20
Non-Communicable Disease
!
Cognitive Bias: Immediate gain.
!
Environment: Obesogenic.
!
Time discounting: Today’s behaviour. Tomorrow’s disease.
!
Primary Care: Long feedback cycle. Dimensionality.
!
Risk: Not understood...
Room for innovation
22
Room for innovation
!
Metadata: Distributed sensors. Predictive models.
!
Reframe risk: Resilience.
!
Feedback: Connected to index behaviour.
!
Simplify: Collapse to 1 dimension...
MIT OpenCourseWare
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HST.S14 Health Information Systems to Improve Quality of Care in Resource-Poor Settings
Spring 2012
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