world healthcare conference madu-v3
TRANSCRIPT
APPLICATION OF TECHNOLOGY IN HEALTHCAREAPPLICATION OF TECHNOLOGY IN HEALTHCARE
A MODEL FOR RESPONSE TO HEALTH CRISIS IN DEVELOPING A MODEL FOR RESPONSE TO HEALTH CRISIS IN DEVELOPING COUNTRIESCOUNTRIES
Ernest C. Madu, Ernest C. Madu, MD, FACC, FRCP (Edin)MD, FACC, FRCP (Edin)Professor of Cardiovascular Medicine and Imaging TechnologyProfessor of Cardiovascular Medicine and Imaging Technology
University of Technology, Kingston, JamaicaUniversity of Technology, Kingston, JamaicaChairman and CEO, Heart Institute of the Caribbean, Kingston, JamaicaChairman and CEO, Heart Institute of the Caribbean, Kingston, Jamaica
Washington DC, USA, April 2012Washington DC, USA, April 2012
Noncommunicable diseases in developing countries are a major public health and socio-economic problem
The major challenge to development in the 21st century
Source: WHOSource: WHO
Total deaths around the world:58 million
Deaths from noncommunicable diseases around the world:35 million
Deaths from noncommunicable diseases in developing countries:28 million
Deaths from noncommunicable diseases in developing countries which could have been prevented: an estimated14 million
Source: WHOSource: WHO
0
5
10
15
20
25
30
2004 2015 2030 2004 2015 2030 2004 2015 2030
De
ath
s (
mill
ion
s)
High income Middle income Low income
HIV, TB, malaria
Other infectious
Mat//peri/nutritional
CVD
Cancers
Other NCD
Road traffic accidentsOther unintentionalIntentional injuries
Noncommunicable Diseases Projected Deaths in 2015 and 2030
Source: WHOSource: WHO
2005 2006-2015 (cumulative)
Geographical regions (WHO classification)
Total deaths
(millions)
NCD deaths
(millions)
NCD deaths
(millions)
Trend: Death from infectious
disease
Trend: Death from NCD
Africa 10.8 2.5 28 +6% +27%
Americas 6.2 4.8 53 -8% +17%
Eastern Mediterranean
4.3 2.2 25 -10% +25%
Europe 9.8 8.5 88 +7% +4%
South-East Asia 14.7 8.0 89 -16% +21%
Western Pacific 12.4 9.7 105 +1 +20%
Total 58.2 35.7 388 -3% +17%
Noncommunicable DiseasesDeath trends (2006-2015)
WHO projects that over the next 10 years, the largest increase in deaths from cardiovascular disease, cancer, respiratory disease and diabetes will occur in developing countries.
(WH
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Source: WHOSource: WHO
Lost national income from premature deaths due to heart disease, stroke and diabetes
2005 2006-2015 (cumulative)
CountriesLost national income
(billions)Lost national income
(billions)
Brazil 3 49
China 18 558
India 9 237
Nigeria 0.4 8
Pakistan 1 31
Russian Federation 11 303
Tanzania 0.1 3
WHO: "Heart disease, stroke and diabetes alone are estimated to reduce GDP between 1 to 5% per year in developing countries experiencing rapid economic growth"
(WH
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hro
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20
05
) Noncommunicable Diseases
Macro-economic Impact: Lost National Income
Source: WHOSource: WHO
Progress Is Not Uniform• Gaps in health between the rich and poor are as wide as
they were half a century ago and are becoming wider still
• Between 1975 and 1995, 16 countries with a combined population of 300 million experienced a decline in life expectancy
• By the year 2025, while life expectancy at birth in 26 By the year 2025, while life expectancy at birth in 26 countries will be above 80 years, in many low resource countries will be above 80 years, in many low resource countries it will be less than 55 yearscountries it will be less than 55 years
• Even more experienced a decline in DALE
A New Approach Needed
• the worsening indices of health status in the worsening indices of health status in developing countries demand a fresh look developing countries demand a fresh look at the way health systems are organizedat the way health systems are organized
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Water Education/ Training
Water resources protection
Waste management/ disposal
River development
Basic drinking water supply & sanitation
Water Policy/ Management
Water supply/ sanitation-large systems
Health Education
Health Training
Basic Nutrition
Family Planning
Medical Services
Medical Research
Basic Health Infrastructure
Reproductive Health Care
Basic Health Care
Health Policy/ Management
Infectious Disease Control
STD & HIV/ AIDS Control
Official Development Assistance for Health(2006, in US$ Billions, total is US$21 billion)
* O
DA
= O
ffic
ial D
evel
opm
ent
Ass
ista
nce
prov
ided
by
24 O
EC
D/D
AC
don
or c
ount
ries,
as
wel
l as
the
EC
Donors are not responding to requests for technical assistance
Health and Foreign PolicyHealth and Foreign Policy
Source: http://www.economist.com/printerfriendly.cfm?story_ID=693193
Shift from Foreign Aid to Sustainable Development
Source: http://www.economist.com/printerfriendly.cfm?story_ID=693193
The Technological Lag Advances in technology not applied to healthcare delivery in low
resource nations– Low public awareness of appropriate technology options (demand drives
supply)– absence of appropriate technology transfer and access to technological
advances
– Lack of infrastructure and expertise in new technological advances – Deficit in capacity building
– High cost of capital and limited organized private sector involvement in healthcare service
– Absence of favorable policies to support and attract investment in healthcare and mitigate against the risk
Misconceptions about Technology in Healthcare
Myth– Increase healthcare cost
– Widens inequalities
– Reduces access
– Does not improve quality of care
– Unaffordable
– Only fit for the western world
– TOO GOOD FOR THE DEVELOPING WORLD
Reality– Technology improves healthcare– Cost-effective/improves access
– Improves workflow efficiency– Improves patient information
management
– Improves reliability and patient safety
– Opportunity to extend quality care to rural settings
– Expand the reach of limited expertise
– Saves lives……..improves QOL….makes life better
Intervention Through Appropriate Technology Transfer
adapted from Chris Madu et. al
Identif y & ImplementAppropriate Technology
Capabilities
Needs & Objectiv es
Structural Factors(Culture Value
Sy stem)
Inf rastructure Resources
Success of Technology Transf ers
StableGov ernment &
Political Sy stem
Ef f ectiv eManagement
Educate & Train
R&D
Aquisition Factors
FactorsDetermined
by the Country
Figure 1. Critical Factors for Successful Technology Transfer
Madu CN: Long Range Planning, Vol 22(4), 115-24, 1989
Case Studies
• HIC• DOCS• EMS
OUR MODELHEART INSTITUTE OF THE CARIBBEAN
Our Model
• Smart, efficient and cost effective use of appropriate technology anchored on
knowledge and expertise.
• Leveraging advances in technology to improve access, quality and affordability
• Focus on training, research, development and innovation
Our Model: Niche Focus and DeliveryOur Model: Niche Focus and Delivery
• Organization and Strong Management TeamOrganization and Strong Management Team• Capital Formation and AccessCapital Formation and Access• Shift from Aid to Sustainable Development Shift from Aid to Sustainable Development
• Specialization and Economies of ScaleSpecialization and Economies of Scale• Innovative Use of Technology Innovative Use of Technology
• Strategic PartnershipsStrategic Partnerships• Internal Capacity DevelopmentInternal Capacity Development• Evolving Vision and Direction Evolving Vision and Direction
Jamaica 2005
• Population; 3 million
• #1 Cause of Death and Disability: CVD
• Access to CVD Care limited– No Cardiac Center of Excellence
– Few Cardiologists with limited availability– Waiting time for Stress Test 3-6 months
– Waiting Time for Echocardiograms 3-6 months
• The HIC SolutionThe HIC Solution
Our Model: Our Model: Making Technology Work
• Technology applications relevant to low resource economies
• Sustainable international partnerships rather than the current “dumping ground” approach
• Global Telemedical services to expand access to health care.
• Cost effective and clever use of health care resources • Specialization and “niche” positioning for more efficient
service delivery
• Creating value at competitive price• Private-Public Sector Partnerships
Improving Healthcare through Improving Healthcare through TelemedicineTelemedicine
• Implementation of web based image management portal Implementation of web based image management portal and electronic medical reportingand electronic medical reporting
• Training of CV Techs for diagnostic studiesTraining of CV Techs for diagnostic studies• Engagement of Telecardiologists in different countriesEngagement of Telecardiologists in different countries
• Web based interpretation of cardiovascular diagnostic Web based interpretation of cardiovascular diagnostic studies to improve access and outcomesstudies to improve access and outcomes
• Rapid turn around time with improvement in healthcareRapid turn around time with improvement in healthcare
• Cost-effectiveCost-effective• Opportunity to extend quality care to rural settingsOpportunity to extend quality care to rural settings• Expand the reach of limited expertiseExpand the reach of limited expertise
Universal Access to Medical Expertise
Universal Access to Patient Information
andReporting
Just a click away
Impact of Technology in Healthcare
Jamaica 2005
– Echo waiting time: 3-6 months
– ETT waiting time: 3-6 months.
– Cardiology Consultation: 2-3 months
– Increased healthcare cost
– Wide inequality in care
– Reduced access to many
– Limited access to quality care
Jamaica 2012
– Echo waiting time; Same Day
– ETT waiting time: Same Day
– Cardiology Consultation: Same Day
– Reduced healthcare cost
– Equality of care and expertise
– Open access to many
– Opportunity to extend quality care widely and to rural settings
– Improved Quality of Life
NIGERIA 2012PROBLEM
– Limited access to timely healthcare or reliable health information
– Limited access to Specialist Opinion
– Absence of emergency medical response system
SOLUTION– Open access through 24
hour medical hotline (DOCS)
– DOCS Telemedicine Clinics
– Introduce EMS service run by medical professionals
Universal Access to Medical Advice and Healthcare Information
Looking to the FutureLooking to the FutureElectronic and Mobile Health PlatformsElectronic and Mobile Health Platforms
Launching July 2012• Access to Doctors 24/7 from anywhere• Medical advice, drug information, clinic and
hospital information• Internationally approved protocols• Aimed at improving access and reducing cost of
accessing healthcare – Physician and hospital visits– Transportation costs and Forgone earnings
• Earlier intervention = better outcomes• Invaluable “peace of mind” 24/7
DOCS Nigeria Medical Hotlines
• Innovative healthcare delivery model aimed at improving access– Will make widespread infrastructure accessible at low cost– Leverage 60-90 million unique mobile phone accounts to disseminate
healthcare services– Circumvents lacking infrastructure– Improves quality of care and will yield better outcomes– Will drastically reduce overall cost of healthcare by delivering accurate
information at the right time – Reduction in healthcare spending and productivity loss
Real World Examples – Call AnalysisTelehealth Service Ontario, Canada
• Data collected demonstrates that 43% of healthcare inquires can be resolved by self-administered care• 35% resulted in the need for physician consultation• An even smaller 16% resulted in the need for emergency care
DOCS TELEMEDICINE CLINICSDOCS TELEMEDICINE CLINICS• Real Time Audiovisual
Telemedicine • Direct connection to US
based Specialists• Virtual diagnosis and
treatment• VOIP based solution• Flexible access from
smart phones, tablets and laptops
• “an emergency medical service - contains 3 words that are critical;
1. It must be available and accessible in emergencies.2. It must be led by medical professionals.
3. It must be a service - integrated from the point of patient collection, to the nearest hospital with all the emergency care facilities i.e a fully functional surgical
theatre”– Source; http://www.nigeriahealthwatch.com/
• March 13, 2012
• “So far in 2012, 52 years after independence there is no functional "Emergency Medical Service" in Nigeria. Terms like ‘The Golden Hour’ and the ‘Platinum Ten Minutes’ that define Emergency Medical Services all over the world are practically irrelevant in Nigeria. EMS is an essential part of the overall healthcare system as it saves lives by providing care immediately”.– Source: http://www.nigeriahealthwatch.com/
• March 13, 2012
• Launching in Enugu, Nigeria, July 2012• Will be readily and widely available and accessible at minimal
cost• Led by experienced medical professionals with experience in
emergency medicine• Fully equipped EMS vehicles and trained personnel to
respond to emergencies• Will be integrated with key participating hospitals in Enugu• Model will be replicated in other cities nationwide
DOCS EMS PHONESDOCS EMS PHONES
SUSTAINABLE SOLUTIONS• Anticipate, adapt and respond
• Develop cost effective multidimensional technology transfer policy and action plan
• Build and maintain relevant infrastructure• Build internal capacity
• Open up access to capital• Bridge socio-economic inequalities• Embrace new and emerging technology
solutions
Take HomeTake Home
• Good healthcare is possible everywhere
• The Developing World can and should leapfrog using advances in technology