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Pesinet: Mobile Monitoring and Micro-Insurance for Children in Mali
Posted by AnneryanHeatwole on Dec 19, 2011
Mali has one of the highest infant mortality rates in the world. There are roughly 111 deaths for every 1000 live births in the country and the under-5 mortality rate is 191 out of every 1000 children. The need for early detection of diseases and stronger local health structures led to the creation of Pesinet, a non-profit that uses mobile technology to provide regular health checkups and affordable health insurance for young children in Mali's capital, Bamako.
Roughly 600 children are currently enrolled in the program in the neighborhood of Bamako Coura, under the care of four Pesinet agents (each covering around 150 children). Pesinet combines both early warning systems and insurance. Families pay 500 CF a month for each enrolled child; the payments cover doctor examinations and half the cost of any medications the child needs if he or she gets sick.
Enrolled children are tested weekly for symptoms of illness such as fever, cough, diarrhea, low weight, or vomiting by community health workers who enter data from each visit into a custom-designed Java application on their phone. The data is sent via GPRS to an online database. Doctors at local community health centers monitor the patient data for sudden changes in health. If changes occur, the community health workers receive an alert on their phones and then go back, in turn, to alert the family that the doctor needs to give the child a checkup.
Pesinet's Lucie de Clerk recently contributed to an ICT4CHW (ICT for Community Health Workers) discussion. She writes, "The ICT system we use has been fully designed by us. It enables remote follow-up of children, keeping of medical records, and production of activity reports and health statistics. It is thus used for medical as well as management purposes."
De Clerck estimates that it takes the community health workers about ten minutes to complete each child's check-up and record the data. Only children that need immediate attention are contacted after the data is reviewed by the health center doctors, so the field workers only have to take action if something is wrong.
The organization is working to become self-sustaining through enrollments but is currently still partially dependent on funds raised outside of the insurance program. De Clerck writes "Our first aim was to achieve local operational self-financing, i.e monthly subscription fees covering the running costs of the service. Experience shows that we are able to achieve 50%, while the other 50% are currently covered by the funds we raise. We have yet to find a sustainable economic model."
De Clerck says that the community health workers adopted the technology quickly; she attributes the rapid pickup to a simple design and the relatively small amount of data collected. However, the organization has faced network connectivity issues which has resulted in the fieldworkers keeping separate, paper-based records and limiting the real-time usefulness of the program. This would also limit the use of Pesinet in more rural areas where network connectivity is weaker and Internet connections less reliable than in the capital (as the doctors at health centers need Internet access to view the data from the field workers). The organization is currently working on new specifications for its technology so that the application will be less reliant on mobile and web connectivity.
Another challenge was creating demand among beneficiaries, as insurance and preventative medicine are not very prevalent in Mali. So Pesinet and the field workers have to promote the idea of paying for non-sick children as a precaution against future illnesses. However, among the families of the 600 children who have been enrolled since the program launched, satisfaction rates are high.
A survey of participating families found that the service has been well received by beneficiaries so far; 94% reported satisfaction with Pesinet, 97% of participating families called the service "very affordable", and participating health centers have seen a 37% increase in visits through Pesinet subscribers.
For an in-depth look at Pesinet, check out our case study on the project, or listen to Pesinet co-founder Anne Roos-Weil describe the project in this video from the MobileActive Mobiles for Women Tech Salon.
Hospitals are increasingly challenged to engage patients in healthcare management and aid them in making informed decisions to improve their overall health and wellness. Federal regulations and meaningful use requirements urge hospitals to use health information technology and other initiatives to increase patient engagement, understanding and compliance. Hospitals that engage patients often see better outcomes, reduced readmissions and enhanced patient and staff satisfaction.
Some hospitals are implementing creative techniques to meet current expectations for patient-centric healthcare, such as on-demand digitized video education technology and interactive patient education systems. These interactive services allow hospitals to customize patient education and information sharing for a variety of medical needs.
Via Andrew Spong
Noah Rahman has moderate Cerebral Palsy affecting his communication, cognition and upper and lower body movement. When he turned two, his language, cognitive abilitity and fine motor skills were diagnosed by a developmental specialist as being at least 12 months behind. Then Noah got an iPad.Four months later, his language and cognition were on par with his age level. His fine motor skills had made significant leaps.
Via Mary Ryan, Special Programs PUE, dbtmobile
Facebook isn’t just for connecting with friends – doctors are finding uses for the social network in diagnosis.
Doctors from the Mayo Clinic used the social media site in investigating the stroke of a 56-year-old woman. They published a report about it in the journal BMJ Case Reports.
The patient had a clogged artery in her neck that needed to be opened for treatment. This type of stroke, called ischemic, happens because of reduced blood flow to the brain as a result of narrowed or blocked arteries.
There are usually two main causes of this blockage: One is trauma, which is more common in young people. The second type comes from risk factors such as diabetes, heart disease, high blood pressure and high cholesterol. The Mayo Clinic patient did not appear to have a history of these risk factors, or a history of trauma.
Dr. Manoj Mittal noticed that the woman's right eyelid was droopy and her right pupil was slightly smaller than the left. The doctor asked the woman and her husband if this was abnormal for her; they said they weren’t sure.
These symptoms may be associated with injury to a neck artery – in other words, through trauma.
“That made me think, if I can establish whether this is new or old, that can help us figure out what was the main cause,” Mittal said.
Mittal asked for the patient’s driver’s license, but it was old and torn. He couldn’t clearly see her eyes. The patient didn’t have any other photos with her, or on her phone, but said she had photos on Facebook.
The patient showed him several different profile photos from Facebook, giving Mittal recent examples of what she looked like. He discerned that her eyes were more symmetric in the photos – taken within the previous few months – than they were after the stroke.
Based on this information, it appeared more likely that the stroke had happened because of trauma.
Although the woman had said she hadn’t experienced any trauma, Mittal then asked if she had been to a chiropractor lately. There is some association between chiropractic manipulation and stroke, although it is not a definitive link and studies have shown contradictory evidence.
She had gone to a chiropractor because she had neck stiffness, and had spinal manipulation to treat that, two days before the stroke.
Doctors had already treated the patient for the stroke before the Facebook revelation, but it’s important to know the cause for the purposes of preventing a second stroke, Mittal said.
“If we did not know that she had any trauma or anything, it’s very hard to explain why she had a stroke,” Mittal said. “Once you why the stroke happened, it’s more comfort for the patient.”
Because of the early intervention she received, the patient had a good outcome, and was discharged after five days in the hospital, Mittal said. When she first came to the ICU, she had slurred speech, droopiness of the face and complete paralysis of the left side of the face. But after hospitalization, the paralysis had gone away, although she still had some symptoms.
Younger patients always do better for a stroke, and timing is crucial, Mittal said. She got IV medication within two hours of the onset of her stroke, and intervention was done relatively quickly. When a blood vessel is blocked in the brain, the chances of recovery are higher the quicker the person gets to the hospital.
Via Andrew Spong, Tiffany Jésus
having been online, blogging and doing other social media, it has become increasingly clear to me that I need to be there—and that more doctors need to be there with me.
The main reason? Because that’s where the patients are.
We need more doctors and other health professionals writing good content, but getting online doesn’t necessarily mean writing. It could mean finding good websites and sharing them. It could mean commenting when we see something that we agree with—or don’t. It could mean engaging in one of the many conversations going on in social media about health.
It seems like most of the conversation about doctors being online involves concern about ethics and professionalism. I admit that I’ve seen some stuff on Facebook and Twitter that has made me cringe, and clearly it’s not a good idea to give specific medical advice online (nothing can replace a good history and physical examination). But this is all manageable.
Dr. Katherine Chretien did a study of Tweets sent by doctors and found that only 3% might be considered unprofessional, and less than one percent had any private patient information. Overall, these are small numbers. As my doctor-blogger colleague Wendy Sue Swanson says, we are way worse on elevators than we are online. It’s easy enough to come up with guidelines and education to help doctors navigate the online space ethically, professionally and safely. Another doctor-blogger friend of mine, Bryan Vartabedian, who writes a great blog called 33 Charts, has some really good ideas about this, including a recent post about how he handles online questions from patients.
And, by the way, we still want the convenience of being able to go online to schedule an appointment and check out lab tests.
Via Thierry Geufroi, Fabrice Vezin, Henri Lefèvre, dbtmobile
Ford is developing a car seat capable of monitoring drivers’ ECG to provide real-time health information and alerts of imminent cardiovascular issues such as a heart attack or arrhythmias.
My comment=> The technology is evolving rapidly. How this will compete with or integrate with mobile devices and wearable monitoring devices remains to be seen. The auto industry has had reasonable commercial success integrateing technology for entertainement purposes and also new safety technologies. This health monitoring approach seems like a commercial gimmick, but might help sell cars. i can envision the marketing of the speeding car with tachometer and heart rate monitor displayed side by side.
Via Seth Bilazarian, MD, Lionel Reichardt / le Pharmageek
Be mindful of HIPAA. Don't mention information which can identify patients. Don't write anything where a patient could identify themselves.
Share information. If you find a good article, share it! You can re-tweet (RT) blogs or relevant information. Respond and acknowledge mentions—you earned them.
Think easy and simple. Try not to use medical jargon. Patients don't always understand. Don't use a big complicated word when a shorter and simpler one will do. If you need to clarify a complex procedure, link to your blog or health care website.
Know your patient base. Determine who your followers will be, before you start your blog or website. Aim your posts or articles to align to what they would like to hear. Your Twitter account may rank high in search engine results, so you want to ensure your messages are appropriate and relevant.
Be engaging. Work with your doctors, nurses, and researchers to get more evidence-based positive health messages out. Follow, RT posts, and engage them in conversations by replying to their posts.
Francis Koster writes:
In 1854, Dr. John Snow started treating victims of cholera in London. More than 500 people died in the first week the disease surfaced. Desperate to figure out what was causing the epidemic, he worked round the clock for days to hand-draw a map containing the location of all the homes of the sick and dying, and he realized that everyone who was sick got their water from the same well. He persuaded local officials to remove the well pump handle, and the epidemic stopped.
Today, a high school student using Google Maps could probably draw that same map in a few minutes by combining death notice addresses and well locations readily available on the Internet.
Data mining of accumulating electronic health records across platforms will reframe the healthcare debate.
Via Andrew Spong
This is Andrew Chen's response to his own post on why the App model is broken for startups.
If you're skeptical about the App model for iOS or are considering an iPad App, I encourage you to read it and make your own opinion.
Reading this, I still feel that while some have obviously been doing damage control, Apps are not an easy win. Still skeptical...
Via Guillaume Decugis
The world's largest internet and mobile user population, expected to hit 700 million by 2015, is also rapidly expanding its professional information and knowledge segments. In the Chinese healthcare field in particular, digitization of information and healthcare IT are poised to become increasingly important as the Chinese Ministry of Health plans to invest 800 billion Yuan (about 126 billion USD) in health system reform.
Wolters Kluwer has an important position in the Chinese healthcare market offering high quality, innovative solutions for healthcare professionals through information products and services including UpToDate, Lippincott Williams & Wilkins, Ovid, and, most recently, through a joint venture with Medicom, leading China drug information provider. Medicom now offers the most robust suite of Chinese drug information products in use by hospitals in China.
Wolters Kluwer CEO Nancy McKinstry opened the seminar. According to McKinstry, "This seminar gives us an excellent opportunity to meet with the next generation of healthcare professionals. The medical students in this classroom will have an excellent opportunity to learn about innovations in the way health information is disseminated and applied to improve healthcare outcomes for doctors, hospitals, and patients. We also learn from their ideas and great enthusiasm to improve healthcare in China."
Professor Guan Yuanzhi, Dean of Medical Education, Peking Union Medical College, discussed recent changes in medical education at PUMC. Susan Driscoll, President & CEO, Wolters Kluwer Health, Professional & Education, shared her insights on the digitization of medical education and practice in the U.S. Dr. Zhang Lei spoke about medical education in the networked era and the role of social media. Andrew Richardson, VP Business Development and General Manager Europe, Wolters Kluwer Medical Research, discussed how mobile technology is transforming the healthcare industry and user behaviors in terms of content. Li Tiantian, founder of the largest online academic portal for physicians and life science professionals, DXY.com, looked at the topic of how to use social media in improving academic achievement.
Via Parag Vora
Innovega is developing a contact lens called the iOptik lens that will provide the crucial step necessary to perceive an augmented, superimposed 3-D virtual reality.
It can also enhance your vision as you’re seeing normal reality. Using nanotechnology, the contact lenses allow users to perceive both reality and information provided by the Internet or another source.
The military is already exploring the use of these lenses, which could enable the distribution of Unmanned Aerial Vehicle intelligence in real time to soldiers in the field.
For civilian uses, the augmented view could allow for web surfing on the go. Innovega is particularly excited about 3D video gaming and is already laying the groundwork for that avenue. Everyone from tourists exploring a new city to drivers navigating a new route could benefit from augmented-reality lenses.
Via Wildcat2030, ddrrnt
Health insurance companies are turning to social media, health gaming apps, and other mobile health apps to increase patient engagement in their own health care, according to a new report from Chilmark Research.However, this is still a very new phenomenon, and most payers are still sitting on the sidelines, the report said."Despite the over 40 consumer technology-enabled member engagement strategies profiled in this report, the industry is still very much in the early-innovator adoption stage," said John Moore, founder and CEO of Chilmark, in a press release.
In a blog post written in June, Moore pointed out that payers have been experimenting with these technologies since 2008. That's when Kaiser Permanente and Humana started creating online health games for children. "In 2010, UHG [UnitedHealth Group] released the first version of the OptumizeMe social game app, Anthem released its Grocery Guide app... and Aetna partnered with OneRecovery.com to provide a social network for members in recovery."
Today, he said, a total of 15 social games are available from United, Aetna, Humana, Cigna, Highmark, Kaiser Permanente, Blue Shield of California, and Independence Blue Cross.
[ Wearable devices equipped with sensors and Web connections help consumers track health and fitness. Take a look at what's possible now at 10 Wearable Devices To Keep Patients Healthy. ]
Moore also cited 10 non-social, non-gamified initiatives, many focused on chronic diseases, and seven social-only initiatives, keyed mainly to exercise and diet. Examples include health plan partnerships with Healthrageous and Welldoc, and Aetna's coverage of Mindbloom's Life Game. The New York Times recently reported that two unnamed health plans will pay more than $100 per patient per month for Welldoc's FDA-approved Diabetes Manager, which has been shown to reduce blood sugar levels in patients with diabetes. The two plans will reportedly begin covering the use of the smartphone app and its related coaching service in January.
Blue Shield of California, meanwhile, has started offering its members the Healthrageous wellness app, which gets patients involved in preventive and chronic care. Based on personal health data collected via mobile devices, Healthrageous advises users on how to meet their health goals.
Blue Shield of California also has programs that use the Shape Up Shield app, which focuses on increasing physical activity, and the Daily Challenge from MeYouHealth, which gets users to meet physical, emotional, or mental challenges. Both apps involve social media and gaming.
According to an e-book from FierceHealthPayer, Kaiser Permanente and some other payers have created their own mobile apps. Among Kaiser's mHealth offerings are Mix It Up, an online nutrition program; Thrive Across America, a physical activity program; Everybody Walk!, a personalized walking program; and KP Preventive Care, an app offering personalized health reminders.
In his blog post and press release, Moore emphasized that health plans are being forced to become more proactive in engaging patients because of societal pressures to reduce health costs. In addition, payers' use of social and mobile technologies extends their longstanding interest in promoting wellness and good health behavior and encouraging members to fill care gaps.
In an interview with InformationWeek Healthcare, Moore noted that these activities have been "going on for a long time with varying degrees of success. Health plan members haven't necessarily trusted payers enough to share information with them. And many of the payer solutions have been half-baked or rudimentary. What they're trying to do now is leverage these consumer technologies to meet consumers where they already are--using the social media, leveraging gaming applications, and providing mobile apps that are specific to a given patient."
Moore noted that the early adopters like UnitedHealth Group, Aetna, Kaiser Permanente, and a few Blues plans are still driving the market but haven't gotten as far as he'd expected. Most insurers involved in this area are still in the early stages of their initiatives, conducting pilots that were launched six to 18 months ago. One reason is that when they tried these technologies earlier and members didn't flock to their mobile or social media offerings, some plans simply gave up.
But now, Moore said, "The payers realize they need to rethink this as they move into new modes of reimbursement. So they're trying to figure out what works."
InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital CIO Roundtable issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.)
Via Sam Stern, dbtmobile