Kendra Keith | TechChange | The Institute for Technology and Social Change

By Samita Thapa and Kendra Keith

When we interviewed Nobel Peace Prize winner, Muhammad Yunus, at the 2013 mHealth Summit, he said that mobile phones are the “Aladdin’s lamp for healthcare”, a statement that still rings true today. Two years after that interview, we take a look at how digital health is beginning to expand beyond mobile phones. Mobile phones – especially smartphones – have been revolutionary in health care, especially in developing countries. With budding industries like add-ons to smartphones and wearable tech, the mHealth landscape is evolving.

Here are 5 digital health tools that extend beyond the mobile phone:

1. Pre cancer screening phone attachment

Photo source: Cellphone Beat

In areas of the world with high amounts of tobacco consumption and limited access to affordable dental care, oral cancer is a major concern. Oral cancer can be prevented with early detection and to equip rural health workers, the OScan team at Stanford university has developed a screening tool that mounts on a camera phone and conducts screenings for oral lesions. The data can then be transmitted to dentists and oral surgeons for assessment. OScan is in the process of conducting field tests with grants from Stanford, Vodafone Americas Foundation, and previously received funding from the mHealth Alliance.

2. STD testing smartphone attachment

Columbia University researchers have created a dongle (an attachment with a specific software) that can plug into Androids or iPhones and conduct tests for HIV and syphilis in about 15 minutes. The attachment costs $34 to manufacture, unlike the current method of conducting these tests in labs which can cost nearly $18,000. The dongle was recently tested in Rwanda on 96 patients and is still under development to improve its accuracy before doing a bigger trial run.

3. Ultrasound attachment for smartphones

Photo source: MobiSante

Seeing how an infant is developing during pregnancy allows any dangers to mother and baby to be addressed at an early stage, and is important to reducing mortalities related to pregnancy and birth. Urban hospitals may be equipped to provide ultrasound services to pregnant women, but it is difficult to extend these services to rural communities. To make ultrasound imaging accessible to everyone, MobiSante, Inc, an imaging technology company has developed a “smartphone based ultrasound device that allows health workers to perform ultrasounds anywhere and share the images via secure Wi-Fi, cellular networks, or USB.” With this attachment, the benefits of ultrasound services can be put in the hands of community health workers in even the most remote clinics.

4. Sensory patch for remote patient monitoring

Photo source: Mashable

USAID recently launched the ‘Grand Challenge’ calling for innovative approaches in the fight against the ongoing Ebola crisis. One of the two innovations unveiled at SXSW ‘15 is the multisense memory patch or Smart Band-Aid. It’s a flexible patch that takes a patient’s baseline vitals and measures the changes from the baseline remotely. The vitals can be measured from outside the hot zone, or area containing active ebola cases, as the patch uses a USB cable to transmit data (the final version will use Bluetooth). With 7 – 10 hours of battery life, it costs $100 and is disposable. Wendy Taylor, Director of the USAID Center for Accelerating Innovation (pictured above), calls the smart band-aid a game changer!

5. Data Collection Necklace for Infant Vaccinations

Photo source: Khushi Baby

Developed to address the challenge rural clinicians and parents face in documenting children’s vaccination records, Khushi Baby stores children’s medical history in a digital necklace. After winning the Thorne Prize for Social Innovation in Health in 2014, this Yale University classroom project has become an organization and has conducted a successful field test in the village of Mada Daag, India. When vaccinations are administered, the healthcare worker can scan the necklace with their Khushi Baby app on their smartphone to transfer vaccination data to the necklace. The data is also automatically uploaded to the cloud once the healthcare worker returns to the clinic. Parents then receive automatic voice calls reminding them about vaccination clinics and during their next visit, the healthcare worker simply scans the necklace of the baby to see which vaccines are due.

As amazing as mobile phones and these new attachments and wearables are in global health, these new technologies also raise important issues. For example, when it comes to wearables, battery life can be an issue. Erica Kochi, a senior advisor at UNICEF noted that internet connectivity has beat electricity to many rural parts of the world, so access to electricity may still be minimal or non-existent in parts of the world where wearable tech can help. While finding better ways to collect more data is vital in healthcare, data privacy and security is increasingly becoming an important concern as we are realizing that there is too much data to manage.

The overall issue of practicality is another concern. Are these innovative solutions practical, cost-effective, and cost-saving? These are the conversations we will be having in our upcoming mHealth online course. We will be discussing new mHealth approaches like the ones mentioned in this post among others. We have a great group enrolled already and will be hearing from guest experts from organizations like Medic Mobile, National Institutes of Health (NIH), D-Tree International, PATH, and more!

Before the recent Ebola outbreak, the terms “contact tracing” and “Ebola” were spoken by only a small community of public health specialists consisting of infectious disease physicians and epidemiologists. As total cases of Ebola Virus Disease reported by the Centers for Disease Control and Prevention (CDC) exceed 10,000 across Guinea, Liberia, and Sierra Leone – almost 5000 of those fatal – these terms are increasingly entering general conversation.

What is Ebola contact tracing?

Rapid contact tracing is essential to the identification and isolation of symptomatic cases of Ebola disease, interrupting secondary transmission, and slowing exponential spread of the virus. It involves identification, documentation, and monitoring of all individuals who have come in contact with a single symptomatic case. In many cases, this is an analogue process of recording data on paper case notification, contact follow-up and field report forms, transporting those to a data entry center, and entering them into an electronic database. In other cases, mobile device can be used in the field for direct data entry into an electronic database.

Contacts have been exposed and are at risk for developing Ebola disease, but have yet to show symptoms. This is where understanding a few basics about Ebola virus and disease is helpful.

Transmission: direct contact with the body fluids of someone, ill or deceased, with symptoms of Ebola disease; or contact with objects contaminated by their body fluids
Symptoms: fever, headache, diarrhea, vomiting, stomach pain, unexplained bleeding or bruising, and muscle pain developing up to 21 days after exposure to the virus

If a contact develops symptoms within the 21 days of monitoring, they are immediately isolated and contact tracing begins for this new symptomatic case.

Ebola and Contact Tracing

Contact tracing can get complicated, so much so that the CDC has a dedicated program, the Epidemic Intelligence Service, to build US health professional capacity and expertise to do so. A single Ebola case can result in the need to trace numerous contacts. In the early outbreak stages, rapid response is most critical as contact tracing efforts are somewhat manageable. If not contained, exponential transmission can make contact tracing efforts unwieldy, as is the case in the current West Africa Ebola outbreak.

Why is it so difficult to integrate mobile phones for contact tracing?

Several challenges in contact tracing could potentially be addressed with mobile solutions. Given wide geographic spread, remote locations and limited resources, real-time data collection and monitoring with mobile phones could facilitate rapid alert of new cases and contact follow-up. These tools could reduce time lag between data collected in the field and response, and serve as a more relevant basis for assessment and prioritization of control interventions. Given that solutions are developed with the Principles for Digital Development in mind, particularly open standards, open data, and open source software, the use of mobiles could address asynchronous data collection and reporting while lowering barriers to stakeholder collaboration.

Irrespective of the integration of mobile devices, contact tracing in Guinea, Sierra Leone and Liberia presents challenges unique from those in which the methods were developed. How do you identify and quarantine an affected patient effectively in a culture where many objects – from mattresses, toilets and food, to the burden of caring for the ill– are shared? How can reliable data be collected if interviewees intentionally misdirect or misinform surveillance officers in fear of response efforts? Social behavioral change communication could address these challenges, with mobiles playing a role.

Several groups are currently working to address data related issues in the West Africa Ebola outbreak. Notably, the World Health Organization’s Harmonized Ebola Response built on the Ona platform, the Ebola Open Data Jam, and mHero, a collaborative effort partnering IntraHealth International’s iHRIS software and UNICEF’s mobile messaging platform RapidPro. Three initiatives running in parallel leave one questioning if any single effort is actually impacting harmonization?

The challenges hindering rapid integration of mobile solutions are not necessarily unique from larger challenges in implementing mobile solutions, nor aid for that matter. Do you understand the user and ecosystem, did you design for sustainability and scale, and did you leverage opportunities for collaboration? There are suggestions that the WHO and mechanisms for responding to global health challenges are outdated, positioning the West Africa Ebola outbreak as a defining moment in their reevaluation. Perhaps it will also bring new perspective to effective leverage of mobile solutions.

Are you a “healthie”, “techie” or someone in-between interested in the use of technology in global health? Then don’t miss your chance to join course facilitator Kendra Keith and the next cohort of TC309: Mobiles for Public Health starting November 17th, 2014!

In the Fall 2013 session of TechChange’s online course on mHealth – Mobiles for Public Health, several participants attended the fifth annual mHealth Summit, a dynamic conference welcoming clinical, policy, tech, business, and academic experts to reflect on the evolution and future of mHealth.

Setting up an exhibition booth, the TechChange team attended the 2013 mHealth Summit to document the perspectives of mHealth newcomers and experts alike. We were fortunate to see some of the guest experts in our upcoming mHealth class such as Kelly Keisling from NetHope and the mHealth Working Group, Alain Labrique from Johns Hopkins, and alumnus Apera Iorwakwagh of the mHealth Alliance.

Among those we interviewed at the 2013 mHealth Summit, Dr. Layla McCay, physician, policy influencer, Huffington Post blogger, and TC309 alumna, shared her online learning experience in TC309:

See a segment of her blog post, Why mHealth Is Caught Between Vision and Reality, submitted as a TC309 final project, and published on HuffPost Tech:

At the mHealth Summit, Steve Case defined the three stages of entrepreneurship as hype, hope, and happiness. The collective imaginations of Summit delegates have been inspired by “hype” — we believe in the potential of mHealth as a health service improvement tool. That’s why we showed up. This conference seems to be planting us firmly in the “hope” phase — we recognize the significant barriers, the practical challenges to implementation. These are still early days in mHealth. What’s clear is that while mHealth may be caught between vision and reality, it’s not stuck there. It’s going to be amazing. Eventually. When it is, we’ll move into the “happiness” phase, where the potential is realized: the infrastructure’s in place, and mHealth is just a conventional, effective tool that everyone’s using in health care. The specifics of what this success will look like is impossible to predict as the field is moving so fast. What can be easier predicted, is at this point, the entrepreneurs will circle to the next hype.

We look forward to hearing and reading more from Layla and other TC309 alumni!

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Want to learn more about mHealth and the latest developments in mobile technology in public health? Register now for this 4-week online course on mHealth. Join Kendra Keith, a global health professional specializing in mHealth, as she facilitates of the Fall course starting November 17, 2014.

Kendra is a global health professional passionate about integrating mobile technologies in public health programs, particularly those targeting quality improvement of maternal and newborn health services, elimination of mother-to-child transmission of HIV, and meeting the information and training needs of community health workers. She has diverse mHealth experience including program pilot, evaluation and scale-up in Southern Province, Zambia and donor policy and implementation with the USAID Office of Health Systems. She is a “healthie”, holding a MPH from Boston University School of Public Health, but envious of all “techies”. As a TC309 alumna, she is excited to join the TechChange team to assist facilitation of the upcoming session.