urban e-health project in rio de janeiro

URBAN E-HEALTH PROJECTSanta Marta Community, Rio de Janiero

BACKGROUND

BACKGROUND

• Low and middle-income countries are urbanizing rapidly• More processed foods, less exercise

• Shift from communicable disease to non-communicable diseases

• Communicable Diseases

• Malaria, TB, Hepatitis

• Non-Communicable Diseases ( Chronic )

• Long duration and not passed from individual to individual

• Cardiovascular, Cancer, Respiratory Diseases, and Diabetes

• In 2007, 72% of deaths in Brazil

STATISTICS

• 1980 – 2008, 10-year increase in life expectancy of every baby• At 2050, life expectancy of every baby in Brazil is 81

• In 2005, 15% of Brazil’s population were 65 years old and older• At 2050, they would be 55% of Brazil’s population

• Higher demand for health services

WHY RIO DE JANIERO?1. A rapid-aging population

• Highest ratio of elderly population

2. Changing dietary habits• Obesity also targeting the poor

• Chronic diseases on poor neighborhoods

3. Public heath-care that are adjusting

4. Rise of real-estate prices• For new hospitals

5. Prevalence of underprivileged urban areas • 22% or 1.4 Million, Little or no access to healthcare

WHY SANTA MARTA?• Transportation is a problem

• Slow and overcrowded cable car

• Nearest public hospital, 6 km from Sta. Marta

1. Pacification Program• To reduce high level of violence and crime

2. Saude Presente ( 2009 )• Expand health services to remote areas

• Currently, Santa Marta’s Family Clinic

• 1 doctor, 1 nurse, 1 nurse technician, 2 oral health teams, 6 community

heath agents ( INFOMEDIARIES )

SCOPE

SCOPE

• The Pilot Program

• Portable e-health kit for Santa Marta’s Family Clinic

• Measurements of blood pressure, glucose level, quickly and efficiently

• Backpack can be transported easily

• Can e-health technology reduce the cost of healthcare in a previously

underserved community?

• Does e-health technology help overcome barriers to healthcare in this type

of community?

SCOPE

• Directly addresses the gap in access

to public services

• Accelerates the process of health care

OBJECTIVES

OBJECTIVES

1. Address current and future health challenges affecting major emerging cities

2. Tackle the economic, social and physical barriers to healthcare for underserved communities

3. Develop a new economic model of healthcare

TASK FORCE MEMBERS

TASK FORCE MEMBERS

• The Pilot Project

1. City of Rio de Janeiro

2. Support of the Municipal Secretary of Health

3. GE

• Founding member of the New Cities Foundation

• Technology, strategic and financial support

4. Cisco

5. Department of Clinical Medicine at the State University of Rio

• Independent research team

TARGET POPULATION

TARGET POPULATION

• Elderly inhabitants of Santa Marta

1. Quality of Life

2. Good Nutrition

3. Physical Exercise

4. Rehabilitation

• 100 patients over the age of 60

• Data collection: 7 months

• August 2012 – March 2013

E-HEALTH BACKPACK

E-HEALTH BACKPACK

• Problem

• No equipment for blood analysis

• Chronic diseases cannot be detected

• Solution : E-Health Backpack

• Detect an average of 20 diseases in minutes

• Nurses can perform in-home visits

• Cost : USD $42,000 or Php 19 000 000.00

E-HEALTH BACKPACK

V-Scan

• Pocket-sized ultrasound device

for obstetric, abdominal and heart tests

E-HEALTH BACKPACK

Tuffsat pulse Oxymeter

• Blood oxygenation and heart rate

E-HEALTH BACKPACK

Electrocardiogram

• Electrical activity of the heart

Picture taken from : sanwinmed.pp.alibaba.com

E-HEALTH BACKPACK

Accutrend blood monitor

• Monitors glucose, cholesterol,

and triglycerides level

E-HEALTH BACKPACK

Tapemeasure

E-HEALTH BACKPACK

Scale

• Assess bioimpedance, weight,

fat, and hydration

• Bioimpedance – response to external

electric current ( blood flow, fat content )

E-HEALTH BACKPACK

Blood pressure monitor

E-HEALTH BACKPACK

Thermometer

TRAINING AND OUTREACH

TRAINING AND OUTREACH

• The Team

• 4 Doctors

• 1 Nurse manager

• 3 Nurses

• 3 Nurse technicians

• Doctors

• Trained to use the V-Scan

• Interpreting data collected from

the backpack

TRAINING AND OUTREACH

DATA COLLECTION

DATA COLLECTION

• 30 weeks of Data Collection

• 200 visits with backpack

• 6.6 visits per week

• To diversify the data pool, the study

included:

• Pregnant women

• Patients under 60

• Patients with disabilities

DATA COLLECTION

RESEARCH METHODOLOGY

RESEARCH METHODOLOGY

1. Is e-health cost effective from the public healthcare perspective?

• Economic Benefits

• Based on the avoided hospitalizations

• If patients condition can be prevented from advancing to the next stage

• Avoided clinical outcomes

RESEARCH METHODOLOGY

2. Does the pilot improve access to healthcare services for underserved populations?

• Clinical Impact

• Patients in the pilot VS a control group

• Difference in healthcare costs

RESEARCH METHODOLOGY

3. What is the end-user experience?

• End-user Satisfaction

• Patient’s and clinical staff’s satisfaction with the backpack

• A questionnaire was used to survey the users

RESULTS

RESULTS

Economic Impact

• Significant positive impact

• In-home visits were enhanced with the E-heath Backpacks

• Early detection of chronic diseases

• USD $200,000 per 100 patients per year

• Decrease severity of cardiovascular illness

• Reduction of 360 hospitalizations per 1000 patients

• USD $135,876 per 1000 patients per year

RESULTS

Clinical Impact

• Lower prevalence of clinical conditions VS historical control groups

RESULTS

Social Impact

• Majority of the patients and health workers : POSITIVE

• Reduction in time for medical results

RESULTS

Terrible

Poor

Neutral

Good

Excellent

Not Evaluated

RESULTS

Terrible

Poor

Neutral

Good

Excellent

Not Evaluated

RESULTS

Terrible

Poor

Neutral

Good

Excellent

Not Evaluated

CHALLENGES

CHALLENGES

1. Delays

• Authorization process

• Completion of the E-Health kit

2. Technical

• Need for a medical specialist to interpret images

3. Process

• Breaking the routine, using the backpack

4. Data Collection

• Slow at the early stage because of the 3 previous challenges

CONCLUSIONS AND RECOMMENDATIONS

CONCLUSIONS

CONCLUSIONS

1. E-Health kit benefits the patients as well as the healthcare professionals

2. Morbidity reduced for chronic disease suffering patients

3. The e-health project is worth the investment

4. High tech innovations can be used to improve healthcare in underserved communities

RECOMMENDATIONS

1. From m-health to e-health• Full potential of the backpack should be utilized

• Use wireless technology within the backpack

2. Expand the type and location of patients• Other communities with fewer health services

3. Extend the analysis of measurements taken• Cost saved for patients ( fare, etc. )

• Carbon emissions reduced

• Add another team member : social scientist

SOURCE

New Cities Foundation (2013), An Urban E-Health Project in Rio, [online] Available: http://www.newcitiesfoundation.org/wp-content/uploads/PDF/Research/New-Cities-

Foundation-E-HealthFull-Report.pdf

END