Digital health Infrastructure for Africa

1. CHEST DISEASE CENTER AT
A Teaching Hospital of
Harvard Medical School
Building a Digital Health Ecosystem to
Transform Healthcare in Africa.
Jacques Kpodonu, MD
2/12/2017
Cape Town , South Africa
https://www.linkedin.com/in/
jacqueskpodonumd
@jacqueskpodonu

2. Burden of Cardiovascular Disease (CVD)
36% of all Deaths in
Canada
1 in 4 deaths in USA
1 in 3 global deaths
80% occur in LMIC
CVD is the leading cause of morbidity
and mortality globally

3. Burden of surgical disease
Global Surgery 2030
Lancet Commission on Global Surgery
Specialist surgical workforce density and maternal survival

4. Who knew healthcare could be difficult?
Partners HealthCare, New England’s
largest hospital network, lost $108
million; the Cleveland Clinic witnessed a
71% decline in operating income; and
MD Anderson, the nation’s largest
cancer center, dropped $266 million.

5. Strictly Confidential. Not for Further Distribution.
Digital records
Paper records
Patient Monitoring & AI
Evolution of global healthcare: going digital provides value.
Centralized care facilities increase costs exponentially. Digital health could enable the
hospitals of the future to transition to the connected home
“Beyond the revenue opportunity associated with digital health
technologies, potential systems savings represent a major
incentive to adoption – we peg the total savings opportunity
(TSO) at $305 billion.”

6. Patient monitoring savings opportunities using digital
health technology
Savings to hospitals via digital health adoption primarily arise with chronic disease management
Potential savings could amount to ca. $200bn, or 66% of the total savings opportunity
Frequent admissions from chronically-ill or recently released patients previously represented an additional revenue
stream, whereas now, hospitals are penalized if they must readmit a patient within 30-days
Case Report
Provider Organisation
Technology Outcome measures Number of patients Outcome
CHF patients
Brockton Hospital/Signature
Healthcare
Blood pressure cuff and scale
both linked via Bluetooth to
an iPad
Hospital readmission
medical expenses
25-30 per month
No readmissions
$216k in cost savings
Asthma patients
Multiple sites/studies
(12 studies)
Bluetooth enabled inhaler
sensor
Hospital admissions, ER
visits, pharmaceutical
costs
96,631 across all 12
studies
$2,101 less per year per
patient in total costs. 79%
reduction in rescue
inhaler use
Chronic Heart Failure
Germany
Daily measures weight, blood
pressure, ECG, thorax
impedance and breathing
rate, oxygen saturation
Patients measurement
self-management.
Reduce morbidity and
mortality
7,220 patients being
monitored across 7
projects
20% ⇩ mortality, 66%
⇩hospital stays, 21% ⇩
readmissions
Source: Third party research
Patient monitoring solutions savings carefully documented in numerous controlled randomized health economics studies:

7. Devlin, Kat. "Cell Phone Ownership Surges in Africa." Pew Research
Center's Global Attitudes Project. April 14, 2015. Accessed November 19,
2017. http://www.pewglobal.org/2015/04/15/cell-phones-in-africa-
communication-lifeline/africa-phones-7/.
Country Doctors per 1000
Population
Cell Phones per 1000
Population
Tanzania 0.03[1] 300[5]
Malawi 0.035[2] 100[6]
Liberia 0.03[3] 420[7]
Ethiopia 0.023[4] 170[8]
Mobile telephony in Africa : an opportunity to re-invent
healthcare.

8. Building a futuristic digital health platform
Users
Can we enable real time data exchange from hospital systems and patient home to predict and detect
life threatening medical conditions from your phone?
Devices
Mobile
AI / ML
capabilities Research
Healthcare
professionals
3rd party systems and
database

9. medopad
Towards an integrated healthcare ecosystem
Watch how it works https://vimeo.com/182692746
SpO2
Breathing
Watch
Body
positions
ECG
Location Heart rate
Activity
Skin
Temperature
Weights
BP
Source: Company information, BMI, Frost
Notes:
1. Includes: Diabetes, Pulmonary Disease, Orthopedics, Cancer, Cardiology, Transplant, Pain, Rare Diseases
2. Predictive analytics
3. Treatment optimasation
Patient
device
Medopad
app
Data
storage
Secure
HIPAA
databas
e
UI
UI
Patient
sensor
✓ Minimal setup
overheads ✓Real-time monitoring
and collection of data ✓ Readily integrable
with existing systems ✓
Capability to
integrate across
healthcare ecosystem
Healthcare
professiona
l

10. Connecting care through your phone
Adherence
reminders
Surveys,
AE reporting
6MWT in
PAH
Care team dashboards grant access
to detailed patient data, enable
remote consultation, and support the
early detection of deterioration
Patients receive treatment dosing
reminders, the opportunity to log
adverse events, monitor disease
progression, and to connect with their
care team
Patient view Care team view
medopad

11. medopad
Supported languages: English, German, Mandarin, Arabic, Danish, Spanish, Azerbaijani, Norwegian and more
Cancer
Diabetes
Diffuse Intrinsic Pontine
Glioma
Chronic Pain
Management
Cardiology
COPD
Splanchnic Venous
Thrombosis
Radiotherapy
Parkinson’s
Post-op
Deep Vein Thrombosis
Lysosomal Storage
Disorders
And many more…
Multiple Sclerosis Ophthalmology Leg Ulcer
Building disease-specific care plans
Chronic disease patient monitoring solutions, developed in collaboration with the
clinical leaders of each therapeutic area

12. medopad
Cardiology
Adherence
Reminders
Surveys 6MWT
Post-Op Care
Activities Active task
post op
Treatment
tracker
Learn
Building disease-specific patient monitoring modules

13. oncology case studies
Royal Free Hospital
• Medopad SVT solution initially deployed in a 6-month trial programme
• Solution was tested with 30 patients, all enrolled within first several weeks of
deployment
• Positive feedback received from leading haematologists
• Two meetings with Medopad and Patient Study Groups (>15 patients per
group)
• High-level outcomes from trial were presented at British Haematology Society
Conference (Mar-2017)
• Director of Haematology at Royal Free decided that Medopad’s SVT solution
will be considered as a standard care from 4Q2017
• Royal Free is a centre of excellence for SVT, and are now seeking to enforce
Medopad’s SVT solution as a standard of care at the National level
HCA Group
• Initial study deployment of Medopad’s cancer paediatric patient monitoring
solution at the Harley Street Clinic with world leading oncologist in 3Q2016
• Positive response from both patients and family members across entire study
population
• Study leader oncologist decided to prescribe a configured version of
Medopad’s solution for all DIPG (diffuse intrinsic pontine glioma) patients as of
Q2 2017, currently signing at a rate of 1 patient per week
• Study site at Harley Street Clinic is the global centre for treating DIPG
medopad

14. 1 in 5 of the 735,000 Americans who survived an MI
are readmitted within 30 days.
Hospital Penalties Increased Utilization Adverse Events
▪ Injury or death
▪ Hospital Acquired
▪ Medical Error
Source: Centers for Medicare and Medicaid Services 2015
Heart Disease and Stroke Statistics – 2015 Update: A report from the American Heart Association. Circulation 2015 131 (4):e29-322.
Can we re-engineer heart care through
technology?

15. • 1st cardiology app on Apple’s CareKit
• Clinically tested at Johns Hopkins Hospital
• Re-engineering heart attack discharge & recovery
• Undergoing clinical testing
Cardiology case study : reducing readmission
after heart attacks

16. A digital healthcare transformation model for
hospital discharge: preliminary results from
Myocardial infarction COmbined device Recovery
Enhancement (MiCORE) Pilot Study
Armstrong Institute for Patient Safety and
Quality
TM
DISCHARGE study
Diagnosing Systemic failures, Complexities and Harm in
Geriatric discharges
1. Poor Understanding of Plan
2. Inconsistent Content
3. Last Minute Delivery / Timing
4. Lack Key Elements of Transitional Care
5. Follow-up inconsistent

17. Day 1
Day 3
Day 2
Day 4
Day 5
Discharge
Papers
5PM
Day 1 - 5
MiCORE model for pre-discharge patient empowerment
and skill building
TM

18. MiCORE Results
19%
3%
Johns Hopkins
Hospital
(N=200)
30-DayReadmissionRate(%)
P<0.001
25%
20%
15%
10%
5%
0%
TM
Corrie
Users
(N=67)
Corrie participants are diverse:
• Mean age 58 w/ range of 32-76 years (every
generation represented)
• 30% women, 32% non-white
• Lower income patients included through
iShare program:
• 19% w/ medical assistance for
insurance
Building the future of research through digital

19. Pioneering technologies for the phone/tablet as a healthcare tool.
pacemaker accelerometer
stethoscope HD camera acts as
scope
High resolution
screen acts
ultrasound
Anatomy Of A Handheld Hospital

20. Smartphone test reader &
real-time monitoring AI
app
HS Cardiac OTC test
Cassette + Biomarker
Combo
Machine Learning to predict
patients risk factors
Phone as a lab device: can my phone diagnose a heart
attack at home?

21. Phone as a heart monitor: leveraging smart devices, machine
learning tools and BIG DATA
Wireless EKG/Oxygen
sat device
EKG recordingPhone app

22. Phone as an ultrasound device: revolutionizing structural
heart disease care in Africa.
Uni-body magnesium shell
Drop safe construction
No moving parts
Bluetooth pairing
Wi-Fi Direct (Hotspot)
Wi-Fi Network
iOS and Android Compatible with
Phone or Tablet
App based update
Permission-based access anywhere
in the world.
Share exams for remote consults.

23. Connecting the dots: preparing for the fourth industrial revolution
(a fusion of technologies that is blurring the lines between the physical, digital, and biological spheres,” could
significantly improve the quality of life for billions around the world) Irving Wladawsky-Berger
Immersive Reality

24. Connecting the dots:building a scalable global cardiac surgery delivery
platform
Patient imaging /
digital health data
from‘Anywhere’
Data is
transmitted
through secured
health cloud
Data is processed and care
plan generated
Data and reports sent to
Center of Excellence.
The relevant images and
report are sent to the
customer site.
Cloud Computing Replaces
Hardware; Automated Image Guided
Surgical Protocols Could Be Made
Available to emerging economies.
Virtualized surgery
A heart surgeon in the US, for example, could use Internet-
controlled devices to virtualize an operation in Africa. While
the practical application of this approach remains in the
future, there have already been demonstration trials.
medopad

25. medopad
The Cape Town Declaration calls for a global cardiac umbrella organization built from existing
societies to oversee cardiac care development in LMICs.
Expedites information sharing
and service coordination to
create a practical pathway for
the delivery of cardiac care in
developing countries.
Creates a coalition of
stakeholders: cardio-thoracic
surgeons, cardiologists,
industry, and donors
The Medopad platform could connect
cardiac specialists from all over the
world through a collaborative platform
for training, research, education, patient
care, and global surgery.
Bridging the North-South divide with an integrated
healthcare platform