Simplicity has been made the cornerstone of WHP’s use of technology. This is because of the organisation’s focus on delivery of healthcare to rural and other underserved communities which inhabit areas of low resources and weak infrastructure. WHP designs its technologies so the simple frontend largely limits itself to collecting the diagnostic signals and data, which are transmitted for processing to the highly sophisticated systems in the backend. Since the human resource available in villages is sub-par, the technologies need to be kept simple and intuitive. Most of the village interface requires only numeric literacy since rural communities have difficulties in adopting systems that expect them to use text. WHP uses specially developed applications to compress data so they can be transmitted even when the connectivity is weak.
CENTRAL MEDICAL FACILITY
Doctors in cities can connect with village centres through special applications loaded on their laptop irrespective of where they are based.
The doctors use internet-based algorithms that standardise the processes and help them with computer-aided differential diagnosis. They use many dropdown menus of morbidities, diagnostic tests, and medicines to expedite consultations. A number of frequently used phrases are pre-loaded on the system which they can select quickly instead of writing them. These instructions can print in the local language on the prescriptions while they will be stored in English in the electronic medical records.
WHP’s Althea system has an innovative design. A specially developed application is loaded on a laptop or tablet, and is used as a platform to integrate commonly available, medically certified diagnostic devices. The system can be used by the village provider on her own for tasks, such as screening of patients or to communicate with city doctors. The system currently uses devices to measure blood pressure, pulse, temperature, blood sugar, blood count, foetal sounds and cardiac signals, with provision for adding otoscope for ear examination and dermascope for skin. The system can work in any digital environment ranging from 2G which is universally available to 3G, 4G and internet. (Better connectivity enables higher quality of services.) The village facilitator uses pre-coded checkboxes in English or in the local language so writing text—the biggest bugbear for semi-literate populations–is completely eliminated. An algorithm combines the symptoms registered by the village user with the basic vital parameters and patient history to generate a list of differential diagnosis for the doctor. The system also provides task lists for predictable services, such as estimation of gestational age, growth monitoring, and immunisation.
Each interaction is captured and stored in the internet cloud as an electronic medical record (EMR) under a unique patient identity which makes referrals easier. The EMRs also provide an opportunity for remote monitoring and pattern recognition through analytics.
The Althea system can transmit live videos and audio in real time with the bandwidth strength of 40 kbps making it suitable even in a 2G environment. Higher bandwidth will improve the quality of transmission, where the bandwidth strength is lower than 40 kbps, only still images and audio can be transmitted for these consultations.
MEDICAL DECISION SUPPORT SYSTEM FOR DOCTORS AND NURSES
Medical resources available to serve rural communities are vastly inadequate in almost all parts of the developing world. This brings huge pressure on the available doctors and nurses, especially those deployed in the public sector who often are the first point of contact for these communities. Any new solution will have to be sensitive to the time constraints these providers face. (The Indian government’s finance ministry uses four minutes per consultation for its cost calculations. In developed countries a general practitioner spends almost 20 minutes.)
WHP has developed tools for the backend to assist the medical personnel conduct expeditious and standardised consultations that are also of high quality. Task sharing and computer-aided diagnosis are an integral part of the design. Nurses and health assistants feed symptoms, vital parameters and family history into specially developed algorithms which generate differential diagnosis for the doctors. A global team of physicians assisted WHP’s team of doctors to develop the algorithms which were further refined over 208,000 consultations (as on July 15, 2018) WHP’s doctors have delivered digitally.
An interesting feature of the design is the automatic generation of a list of most probable investigations and medicines for each diagnosis which will enable the doctor to quickly select her choices and doses. In case the doctor wants to overrule the differential diagnosis suggested by the system, she can access the entire International Classification of Diseases’ latest version (ICD-10) of the World Health Organisation. Each selection from the 14,000 entries auto-generates probable investigations and medicines with quick synoptic notes and web links for further details.