Business unusual — innovating for health systems of the future

By John Sargent
Dec 14 2017

Op-Ed DevEx

On Dec. 12, 2012, the United Nations unanimously endorsed a historic resolution urging all countries to accelerate progress toward universal health coverage — a critical priority for international development.

UHC Day has been celebrated each year since on that day and spurs advocacy for the right of “all humans to have access to the health care they need without suffering financial hardship.” On Dec. 12, I was on a plane heading to Tokyo to attend the Universal Health Coverage Forum 2017, “Business Unusual: Innovating for Health Systems of the Future,” organized by the Government of Japan, the World Bank, the World Health Organization, UNICEF and UHC2030.

I joined heads of state, ministers of health and finance, and officials from donor and developing countries, as well as leaders from development agencies, the private sector, and academia — all in attendance to stimulate global and country-level progress towards UHC, including pandemic preparedness.

For UHC to become a reality, I believe the widespread adoption of innovative technology in the health care industry must become “business as usual.” The transformative power of technology empowers providers and payers of health care services to operate efficiently, generating the best possible health outcomes for the greatest number of people, in the most economical way possible.

Cloud and mobile technologies

For example, enhancements in cloud computing security make electronic health records accessible from decentralized, protected networks. Couple secure access with the ubiquity of mobile devices, and connected care health applications have the power to bring effective health care to more people, with applications ranging from mobile payment, symptom reporting, medication management, and telemedicine.

Engaging patients in their own care boosts prevention and symptom management for patients with diseases ranging from cancer to AIDS. According to the American Society of Clinical Oncology, electronic patient-reported outcomes, or ePROs, extend life while minimizing patient distress in cancer patients — the biggest driver of unnecessary costs such as ER visits and re-hospitalizations.

“Without an established health care infrastructure and entrenched practices built up over many decades, developing countries can innovate more nimbly and consequently bring health care to some of the world’s most marginalized populations.”

— John Sargent, co-founder, BroadReach

Dr. Khama Rogo, lead health section specialist at the World Bank and the head of the bank’s Health in Africa Initiative, recognizes the power of mobile technology to unlock inclusive health care for the heretofore-invisible poor. He credits the digital “health wallet,” accessible from cell phones, for removing barriers to universal access to care in Kenya, explaining how government funds transferred to citizens’ health wallet accounts enable people living in slums and remote villages to seek treatment in hospitals and clinics.

“Mobile technology is disrupting every layer of society at an unprecedented pace. The biggest social equalizer now in this part of the world [Africa], I believe, is a cell phone,” said Rogo.

Mobile technology facilitates electronic payment for services and monitoring of treatment adherence and fund availability.

Artificial intelligence

Digital technology focused on prevention at both the individual and the population level offers huge promise in the quest for UHC, as well. It is time for health care to move beyond dashboards and spot analytics that illustrate a point in time, derived from siloed data sets that relate to only one dimension of human health, accessible by one organization or ministry to make reactive decisions to situations after the fact.

At the individual level, artificial intelligence enables clinicians to keep up with the newest medical research, treatments, and trials — an otherwise impossible task — to best serve patients. Bernard J.Tyson, the chief executive officer of Kaiser Permanente, one of the largest not-for-profit health plans in the United States, serving close to 12 million members, emphasized the importance of AI, stating, “I don’t think any physician today should be practicing without artificial intelligence assisting in their practice. It’s just impossible otherwise to pick up on patterns, to pick up on trends, to really monitor care.”

AI must also drive decision making at the population level. For example, with AI-driven synthesis of data, governments have the insights to predict when and where communicable disease outbreaks will occur. They can identify populations with the greatest need for prophylactic treatment. And they can create staffing plans that match staff to highest-need areas and deliver best-practice workflows to standardize operations across distributed geographies.

Technology making a difference to combat HIV

“AI will continue to add value to the Vantage platform as AI technology becomes more powerful and pervasive — in the cloud as well as at the device level.”

— Ruan Viljoen, CTO, BroadReach

At BroadReach, we’ve been partnering with the U.S. Agency for International Development, the U.S. President’s Emergency Plan for AIDS Relief and provincial and district government across nine districts of South Africa to help gain control over the HIV epidemic, utilizing UNAIDS’  90-90-90 Challenge approach.

Our field workers fighting the HIV epidemic in five provinces across South Africa now rely on mobile device access to Vantage to capture daily activities and facility-level information, view trends, and retrieve analysis and recommendations to improve performance. Vantage toolkits are also accessible via mobile devices so that our health workers in all locations can implement best-practice workflows that address identified issues, such as appointment scheduling and community-based testing campaigns.

Using the performance tracking and AI analytics in the Vantage intelligent operating system platform, we can now prioritize resource allocation to the facilities with the greatest potential to improve district performance. Evidence-based insights combined with targeted HIV counseling, testing, and treatment protocols generated huge advances in the span of a year. Viral load completion rates jumped from 32 to 92 percent. Suppression rates rose from 57 to 81 percent and automating data collection and reporting saved 55-person years.

Technology supports health care to cross-border populations

Vantage has also been used when working with cross-border populations — including nomadic tribes, migrant laborers, refugees, and even transportation workers. They are perhaps the most challenging populations for UHC to reach and the USAID Regional Action through Data consortium partners are collaborating on a pilot of an innovative digital, cloud-based patient-tracking system in sub-Saharan Africa to ensure cross-border populations have continuity of health care. The project is funded by USAID’s Bureau for Africa and includes BroadReach and four other partners: the West African Health Organization, Intergovernmental Authority on Development, Duke University Innovations in Health Care, and Jembi Health Systems.

“We work for the day when the world’s most vulnerable populations lead the life they were meant to live — in good health, with access to education, decent work and compensation, and the ability to live peacefully and equitably in society.”  

— Ernest Darkoh, co-founder, BroadReach

Vantage is at the heart of the pilot and will enable evidence-driven decision making by regional organizations. With Vantage, RAD will use data across many sectors and leverage electronic patient record systems to create a new model of care, transforming the current policy-making environment by changing how and why data is collected, analyzed, and used to improve health.

#HealthforAll

Several flagship e-health applications that democratize health care hail from developing countries. Without an established health care infrastructure and entrenched practices built up over many decades, developing countries can innovate more nimbly and consequently bring health care to some of the world’s most marginalized populations.

Dec. 12 and every day forward is the time to galvanize the widespread adoption of technology to achieve UHC.

To learn more about, or see a demonstration of, the BroadReach Vantage intelligent operating system built specifically for the needs of the development industry, please contact Peter Graves.