There has been much talk about innovations in mobile health technologies among the international aid community in recent years. But now there’s a new kid on the block.
Point of care is a term that will inevitably be added to the lexicon of the most tech-savvy development professionals in the course of 2015, with a number of industry experts marking POC devices out as something we’ll all soon be talking about as an emerging trend.
So what is POC all about? It's about the convenience of not having to refer a patient to another facility to get a test, according to Dr. Alain Labrique of the Johns Hopkins University’s global mHealth initiative.
POC devices allow the user to perform a diagnostic or support function at the location where care is being provided, whether at the hospital bedside, in the home, or out in the field. One example is a portable electrocardiogram system that allows physicians to test a patient at their bedside and make a clinical decision in an expedited way.
Devex spoke to Labrique and other experts about some emerging mHealth and POC trends to watch out for that might impact providers in resource-limited settings, notably in developing country environments.
So what trends need to be on the global development radar, what challenges and barriers need to be overcome to drive innovation forward, and what needs to be in place to ensure scalability and sustainability?
Here are four of the innovations raised by the experts during our conversations:
1. Compressing links in the chain: test results via text message.
In a rural population, each step in a diagnostic test is a potential obstacle to effective treatment. A specimen has to be collected, stored and safely transported to the testing facility. Then, results must be sent back to the rural location.
“In these rural populations, those interactions are very difficult to facilitate because someone could be living out in the bush and they don’t have the opportunity to meet with a clinician, so each of those steps is an obstacle towards the successful end point,” Labrique said. “If one of the things goes wrong in the chain, the entire process breaks.”
It’s important, he said, to look at the whole chain of events and think about which link can be compressed. For example, as part of a Clinton Health Access Initiative in Malawi, there is an HIV test for newborns that is not a traditional POC test, but results are delivered via text message. This reduces the six-to-eight-week waiting time by half.
2. Using mobile phones to interpret test results: mobile microscopy.
In classic POC testing, such as a pregnancy test dipstick, it is possible to misread the results. In addition, for many diseases, “we don’t have the dipstick test that is readily available, so it’s cheaper and faster for someone to take a drop of blood, smear it onto a slide and then look at it under a microscope for parasites,” said Labrique.
Technology is being developed that will allow health care providers to put that slide under a smartphone camera that has an attachment to help magnify it. The phone will have the computing capacity to identify red blood cells, white blood cells and malaria parasites, among other applications.
Shifting that task onto a phone that can take a picture with a very precise camera is a way technology is being used to interpret POC tests. Results are available immediately, and the health care worker can provide treatment recommendations without a waiting period.
When you get a complete blood count at the doctor’s office, a huge machine essentially sorts and counts each kind of blood cell.
“Imagine being able to do that on your phone,” Labrique said. “There’s a whole area of research on nanotechnology and microfluidics that basically takes all these massive room-filling machines and miniaturizes them to a very small footprint.”
“But at the same time, what’s really exciting is that it also uploads [the results] to a server and stores the data in a medical record,” the expert explained.
3. Pushing forward with POC CD4 testing.
One example of this is the CD4 testing, a crucial part of HIV treatment, currently underway at GSMA Mobile for Development, an organization that brings together mobile operator members, the wider mobile industry and the development community to drive commercial mobile services for underserved people in emerging markets.
GSMA’s Craig Friderichs said the organization has been working closely with Omega Diagnostics, a company that manufactures a POC HIV test. The test is read by an algorithm on the health care provider’s phone. The algorithm then captures the data and the result and links it to patient registers, reminder systems, stock management and dispensaries.
According to Friderichs, the test is being distributed at a fraction of the cost of normal CD4 testing.
“We think companies like [Omega Diagnostics] with good innovative technologies that rely on some form of mobile integration … to create a register — be it a pregnancy register, a death register, an immunization register or in this case, a CD4 register — are hugely valuable for the development of the backbone of any health care system,” he said.
The players involved in implementing the testing are the diagnostics company, mobile operators, an in-country implementing partner — World Vision International, for example — and technology partners who manage the mobile component.
Friedrichs said the project, currently in a trial phase in South Africa, Zimbabwe and Kenya, is scalable. Initially, the project was funded through the Bill & Melinda Gates Foundation and developed through the Burnet Institute in Australia. Intellectual property was then transferred to a U.K.-based diagnostics company.
“[I]t’s very much a for-profit company … We’re hoping to take it out of an externally funded initiative into a scaled, sustainable project that is integrated into the health system,” Friderichs said.
The test might be a good way to prevent what he calls the “lost follow-up,” where HIV patients come in for a CD4 test and do not have the resources to come back for a follow-up two to four weeks after traditional testing.
“Imagine being able to go into a clinic, and within 40 minutes you have the results in your hands,” Friedrichs said. “You can fundamentally shift the dynamics of HIV treatment if you’re engaged with that client on the same day and you can refer them to the dispensary for their medications … link them up to patient reminders.”
4. Putting an entire lab on a chip.
Microchip labs are not new technology.
“You can actually preload a little tiny chip with the ability to identify dozens of pathogens or markers of infection at a time. So I could take one drop of blood, put in onto a chip and tell you that you do or do not have one or more of these different infections,” Labrique said.
But while the technology exists, the machinery to power the lab on a chip is a massive stretch because of the computational power, electricity and the capacity needed to produce results.
“So a lot of effort is going on to move the lab on a chip into the phone footprint. You could have your little lab on a chip and have your phone and do both with a very small space at the point of care,” he concluded.
Are you working on innovations around mHealth and POC devices? Tell us about them! Have your say by leaving a comment below.
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