Third in a series –  Even before the coronavirus struck, large swathes of Africa, as well as parts of South-East Asia and Latin America, still relied on fragmented paper-based medical records, making it difficult to track people’s medical history – and thus provide high-quality treatment and care.

The Virtual Innovation Fair, which is a key feature of this year’s Geneva Health Forum, that began Monday, 16 November, shows how digital health innovations are moving countries into a new era of healthcare, with the creation of digitized personalized medical records that will allow for more systematic follow-up care – not to mention far better disease surveillance. The Fair also showcases some new algorithm-based devices for more precise diagnosis of common conditions like childhood pneumonia. The innovation fair, which will be held from Monday to Wednesday between 12:00-12:30 CET, is open to all GHF participants to chat with innovators about their products. 

There are two particularly promising digital health innovations, both of which will be presented at next week’s Geneva Health Forum, that could help healthcare workers save lives, time, and provide better care for their patients. If all goes well, they could even become the bread and butter of primary health care, and replace paper-based data collection methods forever. 

One of those DataSanté, a seemingly simple, yet highly robust solar-powered software that allows healthcare workers to care for patients of all ages through a digital shared medical record. The second one is IeDA, a slick, Swiss-made job aid tool that enhances the diagnosis of childhood disease, and improves the performance of healthcare workers in real-time through artificial intelligence (AI) algorithms. We took a look at both to see how they work and what impacts they might have on patient care and disease surveillance. 

DataSanté -A Shared Medical Record, Created For Doctors By Doctors 

At first glance, DataSanté may seem quite simple, especially to AI-aficionados. Yet, healthcare workers find it “life-changing”, notes French doctor Pierre Costes, who founded the project almost a decade ago in response to his frustration with digital healthcare in France, as well health data fragmentation in west Africa. 

“Data Sante is a tool we created as doctors, for other doctors and healthcare workers, to simplify their day-to-day work,” says Costes. “It’s quite simple and easy to use, yet it has given rise to a new era.”

Before DataSanté materialized, African doctors in Mali and Benin would lose up to three days a month of potentially life-saving work filling out their Monthly Activity Report – a mandatory administrative report that is almost always prepared by hand. It involves an array of tedious aggregations of patient conditions that were treated, ranging from measures of disease prevalence to vaccination coverage levels, and disaggregated by sex and age,. 

About eight years ago, Coste’s team sought to help doctors do their job and to treat patients more efficiently, instead of spending time writing reports for authorities. 

Today, doctors armed with DataSanté can produce their Monthly Activity Report in no less than one click, saving them up to three days of work. Once their report is ready, all they have to do is to copy the report on paper and mail it to the Ministry of Health.

But automated reports represent only the tip of the iceberg in terms of what DataSanté really does. 

DataSanté’s main aim is to centralize a patient’s medical information in one file through the so-called “shared medical record” – allowing healthcare workers to follow tens of thousands of residents in their region throughout their lives. 

The shared medical records can be simultaneously accessed by nurses, doctors, midwives, or lab technicians, each with their own authentication codes and different levels of authorization.

DataSanté also offers healthcare workers a plethora of handy tools that are tailored to their day-to-day needs and troubles. These include diagnostic support tools, severity alarms, prescription support, continuing education, as well as recall for follow-up care, adds Costes.

Pregnancy Due Date Calculator – Useful Tool For Midwives

The “pregnancy due-date” calculator is a particularly useful tool for midwives. Sometimes, pregnant women that come to the clinic are unaware of their last period, making it difficult to estimate their due-date, which comes about 280 days after their last menstruation. 

Instead, midwives can measure a woman’s uterine height and enter it into DataSanté to quickly estimate her last menstrual period – as well as her due-date. Costes notes that midwives can only use the due-date calculator if they have opened a personalized medical record for each woman, thus ensuring that DataSanté is properly used, without corners being cut.

DataSanté also facilitates teamwork and information-exchange at the local level. If healthcare workers face issues during their workday, they simply click the red alert button on the DataSanté platform and summarize their problem in a sentence, thus alerting the clinic’s head doctor within seconds.

In just four to five days of training, healthcare workers can run the DataSanté package on their tablets, smartphones or laptops. According to Costes, DataSanté can function for dozens of years without requiring a single software update. 

The software can be set up in places that lack internet access through a local server and integrated wifi network, which is either powered through solar energy or a mains power supply of 220 volts.

In Mali, almost three dozen healthcare centers are now equipped with DataSanté. In total, a quarter of a million personal medical records have been created in the three years since the platform was established – and demand is increasing every day, says Costes. 

The NGO has also developed a low-energy version of DataSanté, the “Databox”, for regions that lack electricity. The Databox is as small as a matchbox, with the same functionalities as its larger counterpart, except that it can run on 5-volt supplies. So far, 37 ‘databoxes’ have been installed in Madagascar – and the project aims to expand to Burkina Faso and Niger as well. 

Two years ago, Datasante was presented as an award-winning innovation at the 11th World Convergence Forum in Paris. The project is funded by the Agence Française de Développement.

IeDA – A Digital Tool To Diagnose Childhood Illness, With A Few Quirks Up Its Sleeve

In some regions of Sub-Saharan Africa, nearly one child in ten dies before the age of five, often because illnesses like pneumonia, diarrhea or malnutrition are misdiagnosed.

In Sub-Saharan Africa, the most widely used guideline to diagnose children under five is the “Integrated Management of Childhood Illness” (IMCI) algorithm, developed three decades ago by the WHO and UNICEF. 

In countries like Burkina Faso, where half of children die in their first two weeks of life, only 15% of children are correctly diagnosed with IMCI, mostly because frontline healthcare workers fail to adhere to the IMCI algorithm. 

For over ten years, Terre des hommes has refined their solution to optimize the diagnosis of childhood illness. Since the NGO began, its product, IeDA, has gone through twelve iterations.  

IeDA’s idea is in fact quite simple – it’s a digitized version of the IMCI that can be used on tablets in health centres, using mobile network connections. Its intuitive design, combined with short video tutorials, guide healthcare workers throughout their consultations with children, allowing them to obtain a comprehensive picture of a child’s health. 

Heads of clinics can then visualize the data through simple dashboards to improve the performance of the clinic and to increase the quality of care. The datasets are also sent to Burkina Faso’s Ministry of Health to become an important source of vital statistics, as well as national evidence-based decision-making.

As of August 2020, IeDA has helped undertake 7.5 million consultations, or 200,000 clinical consultations every month, according to a massive 3-year evaluation run by the London School of Hygiene and Tropical Medicine. It has also improved adherence to IMCI by 50%, and reduced unnecessary antibiotic prescription by 7-15%, notes Riccardo Lampariello, Head of the Tdh health programme. 

In Burkina Faso, IeDA has been set up in 1,350 healthcare centres, covering almost two-thirds of the country. If scaled-up to cover the remaining one-third of Burkina Faso, 1.5 million CHF could be saved each year as a result of improved diagnosis and healthcare worker performance, says Lampariello. 

“We have drastically reduced the number of incorrect diagnoses thanks to IeDA and the children benefit from better treatment,” said Dr. Robert Kargougou, Secretary General for the Ministry of Health of Burkina Faso, referring to IeDA. 

But Ministries of Health are not the only ones that are thrilled by IeDA. Healthcare workers are pleased to use the tool because it allows them to quickly finalize monthly reports for authorities, according to qualitative analyses of 21 healthcare workers in 10 primary healthcare facilities. As a result, healthcare workers employ IeDA in 8 out of 10 consultations. 

Sometimes, caretakers even request IeDA because they perceive it as the most accurate option available, says Lampariello. And some communities, like the Boussougou District in the Kadiogo region, have even raised their own funds to gain access to IeDA after hearing about its successes elsewhere.

But IeDA has several other quirks up its sleeve.

Using clever AI algorithms, IeDA can improve the performance of healthcare workers in real-time by anticipating common mistakes, or “bizarre combinations of symptoms”, explains Lampariello.

“In many ways, IeDA is a job aid tool that can detect common errors based on existing clinical data,” he says. “If, for example, a healthcare worker reports high levels of anemia in a region that has historically had low anemia, IeDA will send the healthcare worker a friendly message to check whether anemia has been well measured.“

As the pandemic brings with it a new array of challenges, Terre des hommes’s IeDA has responded through a range of online tutorials to raise awareness on coronavirus prevention and management. IeDA has also developed a triage algorithm to identify and follow up suspected cases of Covid-19, in collaboration with the local authorities. Eventually, the data collected by IeDA may help anticipate new outbreaks with “great precision”, says Lampariello.

Soon, IeDa could also be used in synergy with the Pneumoscope, another promising innovation that will be featured at next week’s GHF. Co-developed by Terre des hommes, it can detect pneumonia in less than seven minutes.

With financing from The Global Fund, Terre des hommes is in the process of handing IeDA over to Burkina Faso’s Ministry of Health. The NGO is also piloting IeDA in Niger, Mali, and plans to expand to India’s state of Jharkhand next year. 

Big Challenges For Digital Health Still Remain – Both Technical & Human 

In past years, smartphone ownership and internet coverage on the African continent has increased exponentially, but there is still a long way to go – especially in rural regions where coverage, bandwidth, and smartphone ownership is still low, note Lampariello and Costes.

For digital health to be successful, considerable ‘human challenges’ also need to be addressed, says Costes. Local leadership is needed, he adds, noting that sometimes, when new heads of clinics are appointed, they are less motivated to use DataSanté, letting their clinic backslide into old-fashioned methods.

Users also need to take ownership of the digital health tools that are created for them – and demand changes when they are needed, so that digital health stays relevant and useful. 

“Some healthcare professionals have not yet taken ownership of this software [DataSanté],” says Costes. “They are not aware that this is their own system. They can, and should ask for changes to keep control of DataSanté. 

If healthcare workers fail to take ownership of digital health tools, national authorities could take over, and instead appropriate DataSanté to serve their own interests, which are sometimes misaligned with those of healthcare workers, warns Costes. 

While DataSanté’s door is “open for dialogue” with health ministries, it can be challenging to harmonize between the priorities of healthcare workers and ministries of health, he adds. 

According to Costes, digital health’s primary objective should be to serve its users. The needs of decision-makers are important, but they should come once the groundwork is laid.

Image Credits: Terre des hommes, DataSanté, DataSanté , Researchgate, Our World in Data.