A Global Village
Issue 4 » iHealth

Health Care and the Economic Crisis - Can Technology Help?

Agnes Becker, Institute of Global Health Innovation, Imperial College London

Countries around the world are struggling to reform their healthcare systems in the midst of immense cost constraints. Safe, effective and accessible technologies could drive down costs globally, and help put patients at the heart of healthcare.

Cutting Edge yet Accessible Technologies
Chronic diseases are the leading cause of mortality in the world, representing 60% of all deaths1. Patients require regular monitoring, a process that is both inconvenient to the patient and costly for health care systems. With demographic changes associated with ageing populations, most Western countries are increasingly faced with age-related diseases and the political and economic ramifications that these introduce. This has motivated the development of pervasive sensing technologies using miniaturised wireless, low-power, wearable biosensors for key physiological indices to address the resource and cost implications of serving populations with increasing life expectancy and improved survival of chronic illness. They are also used to promote safe independent living, limit complications and expedite safe discharge.

Such devices are designed to be low cost, easy to use, yet technologically sophisticated to include context aware and autonomic sensing such that they are suitable for an untrained elderly population, often with decreasing perceptual and cognitive capabilities. The technical and design challenges faced by developed countries are, in fact, not dissimilar to those required for vital sign monitoring and point of care, lab-on-a-chip technologies in resource deprived countries where such services are not universally available. For once, there is a common ground for innovation where previously there was little incentive for manufacturers to develop devices solely for developing countries due to potential ethical issues surrounding differing standards and prohibitive engineering costs.

Western countries are
increasingly faced with
age-related diseases
and the political and
economic ramifications

At Imperial College’s Hamlyn Centre researchers are developing miniaturised sensors that could be used to remotely monitor patients with chronic and life-style related diseases. Packed with the latest technological advances, these sensors were designed to be used by elite athletes and those in resource poor countries alike. One example is the award winning e-AR sensor that is worn on a person’s ear to measure balance, body posture, activity level, and heart rate. This information is then transmitted wirelessly to a computer or other device where it can be viewed by the patient’s doctor or used by the patient to guide and manage the rehabilitation process. The e-AR sensor would allow health professionals to call patients into hospital when needed, rather than every few months for regular checkups. Minimal hospital visits would give patients better quality care and cut costs for the health service provider.

This reliance on wireless technology echoes mobile technologies that have transformed commerce, healthcare and social lives across the world – mobile subscriptions in Africa rose from 54 to almost 350 million between 2003 and 2008 – and heralded the establishment of a state-of-the-art communication infrastructure. This provides a unique opportunity to improve access to information by healthcare workers in these countries thus enabling safer and more effective care delivery.

Are Technologies Too Complicated?
Available technologies designed for industrialised markets are often inappropriately complex, and donations of these types of equipment to resource-poor countries can result in equipment left unused. The context within which a new technology is used, and the associated human errors that may result from its use, must be carefully assessed. Health workers globally must receive adequate training for new equipment.

Imperial College’s surgical education team have developed an inflatable surgical theatre that can be used to train staff from entry-level health workers to consultant surgeons. The theatre can be used for surgical simulations that give effective training for the technological apparatus used in surgery as well as team-working and appropriate regulatory and management procedures. The portable theatre can easily be taken to hospitals for training sessions. In the UK, around 850,000 errors occur annually in hospitals, contributing towards 40,000 deaths2. In England and Wales, 27% of inhospital reports of patients’ safety incidents were related to problems arising from medical devices or equipment3. Adequate training will result in fewer errors, thereby improving patient experience and cutting costs for the health care provider.

What about Resource-Poor Settings?
Inequality in access to technology and a general lack of appropriate technology designed for developing countries – with consideration of infrastructural gaps – is a problem. There is considerable need for safe, effective and accessible technologies that are tailored to the environment within which they will be used.

Point-of-care testing is an area where technology can have a significant impact in resource-poor countries. Imperial College’s CD4 Initiative is working to produce a simple, low cost, point-of-care test to aid treatment decisions for those living with HIV/AIDS in resource-poor countries. HIV infects and kills cells CD4 T cells, which are essential for a healthy immune system. In the developed world newly diagnosed patients are not always put on medication straight away; rather, antiretroviral therapy (ART) is only started when the number CD4 T cells in the blood fall to less than 350 cells/mm3, a threshold at which the patient is considered vulnerable to opportunistic infections. The traditional technology to count CD4 T cells is expensive and needs specialised laboratory and technical support that is beyond the scope of peripheral health centres in resource poor countries (where the majority of HIV patients access healthcare). Patients in developing countries must often travel many miles to their nearest HIV clinic and these may not offer CD4 counting. The decision to start life-saving ART is then based on whether the patient looks sick enough to start treatment. Alternatively, a blood sample is taken and sent to a centralised laboratory for testing. The patient will then have to come back to the clinic after four weeks to receive the result. Over 50% of patients do not return to collect their CD4 count results, perhaps because they are too ill to travel or partly due to distance from the clinic and an inability to afford transportation costs. These patients, many of whom will desperately need treatment, are effectively ‘lost’, potentially putting themselves and their community at risk. In addition, it is well established that patients who start treatment before demonstrably sick have better outcomes. The CD4 Initiative point-of-care test would offer an alternative scenario where patients could attend peripheral health centres and have an instant CD4 cell count (<30 minutes), ensuring sick patients are triaged for treatment immediately. These patients are then retained in the healthcare system and start ART before their immune system is severely damaged.

Over 50% of patients 
do not return to collect 
their CD4 count results

Technology can aid health research in remote rural areas, providing vital data and statistics to influence health policies. Developed at Imperial College’s Infectious Disease Epidemiology department and Bioinformatics Support Service, EpiCollect is a smartphone app and web application that can collect data from anywhere across the globe using mobile phones (Android and iPhone)4. EpiCollect is being used across Africa for studies of animal and human health. For example, the monitoring and evaluation of chemotherapeutic agents for the treatment of schistosomiasis and by Maasai vets for animal disease surveillance5.

Although EpiCollect uses mobile phones, a SIM card is not needed for the collection of data, making the devices cheap to use. Data, including photos, videos, sound clips and bar code scans, are entered into the mobile device, and can then be sent via 3G or wireless networks to a central computer server to be further analysed. The technology is simple, easy to use and portable and the website allows anyone to set up their own data gathering projects6. Researchers conducting surveys are able to take the mobile phones to remote areas and upload data directly, thereby cutting administrative costs.

Power to the People
EpiCollect could also revolutionise health care by giving power to the citizen. It is already being used in citizen science data gathering projects aimed at getting members of the public to contribute biodiversity data, but could be adapted to conduct national health surveys quickly and easily while cutting administrative and organisational costs.

The Dr Darzi Wellnote iPhone app, developed by Imperial College’s Centre for Health Policy, gives users the opportunity to rate hospitals and GP clinics, putting patients in the driving seat of improving healthcare and potentially cutting costs of expensive patient surveys.

Students tackle Global Health Challenges
A Global Village is a testament to Imperial College students’ drive to tackle global challenges. Student initiative has resulted in technologies that are being used across the world to benefit quality of life and better people’s health.

Lack of consistent electricity supply is a major factor hampering health care in many resource-poor settings. e.quinox, a charity set up by Imperial College engineering students, aims to bring sustainable electricity to rural areas. e.quinox have developed a portable battery pack that can be recharged using solar energy. In order to make the idea fully sustainable, local residents in each rural village staff the e.quinox energy kiosks. Villagers can use the kiosk to buy electrical equipment and recharge their batteries for a small fee. Already improving the quality of life of families in rural Rwanda, e.quinox’s sustainable energy supply could one day be transferred to clinics and hospitals. See page 28 for more on the e.quinox project.

Safe, affordable and 
easy to use technology 
can improve patient care
globally and at the same
time cut healthcare costs

Collaboration between Imperial College’s engineering students and the Royal College of Art’s design students has resulted in mywater, a portable home desalination unit that produces safe drinking water. The students formed their company InProgress to develop mywater which aims to provide people who have access to salt water and fossil fuels for cooking the opportunity to produce a significant amount of their daily water needs using the wasted energy created by the cooking process. By selling mywater at a premium to yacht owners, InProgress will be able to launch the product at a cheaper price in resource-poor settings, such as coastal areas of Bangladesh where high salt levels in drinking water has been shown to cause hypertension in pregnant women.

In both cases, students have developed products that fit the environment in which they will be used; they are simple and do not require vast training. They have ensured their business model is sustainable and will benefit the local community.

Technology can Better Patient Care and Cut Costs
Safe, affordable and easy to use technology can improve patient care globally and at the same time cut healthcare costs: as mobile phones dominate global communications, patients and citizens will be able to influence their health service; portable technology and body sensors will allow patients to be at the heart of health care delivery in both resource rich and poor settings; and efficient, sustainable products will continue to help curb the causes of disease. 

Institute of Global Health Innovation at Imperial College

www.imperial.ac.uk/global-health-innovation


Agnes Becker wrote this article as Communications Consultant for Imperial College’s Institute of Global Health Innovation. With a BSc Hons Natural Sciences and an MSc Science Media Production Agnes has worked in science communication at the Science Museum, on science TV programmes for BBC, Channel 4 and National Geographic, and as a freelancer producing short films, illustrations and publications.

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[1] WHO Chronic Diseases. (March 2011). http://www.who.int/topics/chronic_diseases/en/
[2] The Lancet (2006). WHO’s patient-safety checklist for surgery.
[3] Mytton O. T., Velazquez A., Banken R. et al. (2010). Introducing new technology safely. Quality and Safety in Health Care.
[4] Aanensen D. M., Huntley D.M. et al. (2009). EpiCollect: Linking smartphones to web applications for epidemiology, ecology and community data collection. PLoS ONE. 5 London International Development Centre. (March 2011). http://www.lidc.org.uk/news_detail.php?news_id=98 6 EpiCollect. (March 2011). http://www.epicollect.net