On The Front Lines of Women’s Healthcare

In rural India, an expectant mother’s life is saved, along with that of her baby, by vital-sign monitoring that alerts doctors to the need for intervention.

A woman who lives alone in the United Kingdom battles cancer, supported by an app delivering virtual coaching and appointment reminders.

In Australia, an elderly woman takes a home medical consultation via a 3D image of her doctor transmitted in real time through holoportation (Holographic Mixed Reality).

These are three examples of how digital technologies are saving lives and transforming women’s healthcare worldwide. Home monitoring, telehealth, artificial intelligence – the groundswell of emerging technologies and use cases for them can be dizzying. Many are promising, some proven – but all can be problematic if not planned for and implemented mindfully.

Women’s health: a global emergency

Around the world, women face health challenges including cancer, reproductive health problems, maternal health complications, HIV, violence, disease, and depression. Every day, 830 women die from preventable causes related to pregnancy and childbirth more than 300,000 deaths a year, according to the World Health Organization (WHO). The stillbirth rate in sub-Saharan Africa is approximately 10 times that of developed countries 29 vs. three per 1,000 births, and the majority of stillbirths are preventable.

Untreated syphilis accounts for more than 200,000 stillbirths and early fetal deaths annually and approximately five million women younger than age 70 die every year from noncommunicable diseases. Global population growth expected to exceed 10 billion people by the end of the century – further magnifies stress on the evolving healthcare system.

Even as healthcare demand rises, supply is challenged by cost pressures and a growing workforce scarcity. Only half of all countries have the healthcare workers required to deliver quality care, according to the 2017 Global Burden of Disease Study by the Institute for Health Metrics and Evaluation. To healthcare providers and consumers, such data underlie an urgent call to action.

Digital innovation drives new models To help balance the demand/supply equation and solve longstanding problems in global healthcare for women, the healthcare industry is driving innovation through disruptive technologies new tools and techniques that so far surpass previous ones, they fundamentally change how healthcare is delivered and consumed.

At the front lines of these changes is Dr. Naila Siddiqui Kamal, a Fellow of the United Kingdom Royal College of Obstetricians, and a clinically active physician in the National Health Service (NHS) for 28 years. Dr. Kamal sees providers, patients, and promoters stakeholders including government health policy makers and technical solution developers – as coming together to create digital health ecosystems that leverage connected platforms to integrate across providers for improved patient outcomes. “We are almost into our fifth industrial revolution,” Dr. Kamal says. “The digital health ecosystem involves data sharing on smart platforms  electronic medical record systems with embedded clinical decision support, e-prescribing, e-radiology. Everything involved in patient care is on the platform.”

The fifth industrial revolution leverages artificial intelligence, robotics, and the convergence of humans and technology. Its enabling technologies include:

  • Blockchain: a shared record of transactions that enables secure data sharing.
  • Digital Reality: immersive technologies such as virtual reality (VR) and augmented reality (AR), along with the Internet of Things (IoT).
  • Cognitive Technologies: machine learning (ML), artificial neural networks (NNs), bots, neuro- linguistic programming (NLP), and robotic process automation (RPA).

In healthcare, these technologies enable a wide range of patient-facing digital solutions. The following cites a representative handful: wearable technologies such as activity trackers, health watches, and Bluetooth®-enabled devices gather data that can be transmitted to healthcare providers for diagnostic purposes or patient monitoring. “I saw a Bluetooth-enabled breast cup developed in Latin America that has sensors picking up the chances of breast cancer,” Dr. Kamal says. “These solutions are coming from all over the world.” Another example: In fertility diagnostics, an ovulation sensor bracelet and connected mobile app provide women with a detailed look into nine health parameters that can be measured to optimize or avoid conception. Using a finger prick that can be done at home, the test reveals fertility hormone levels, how many eggs a woman has, and other factors. healthcare apps deliver timely communications as well as gather data. A mobile app for expectant mothers includes an online scheduling platform; a task list for healthy nutrition, exercise, and other lifestyle choices; and other tips for new mothers. Furthermore, users receive a ‘Mommy Kit’ in the mail, with a connected device to measure weight and blood pressure. The information is sent to the user’s profile as real- time data for actionable insights.

Considering a uterine-cancer patient who needs constant support, Dr. Kamal envisions an app that could synchronize text alerts of the patient’s many appointments, aligned with a cancer-unit dashboard showing her position on the treatment pathway. remote interactions such as telehealth bring virtual services to patients where they are, including nursing, midwifery, or coaching support.

“I investigated one solution that uses watches and coaches, which is great because it can be a 24-hour patient companion,” Dr. Kamal says. “In the olden days, your grandmother or your elderly aunt would give you advice about your pregnancy. Now, you have something like that in the virtual service. It’s not an avatar, it’s a real live person there.” Dr. Kamal is particularly excited by the emergence of holoportation, which brings holographic practitioner consultations to patients in real time.

“Holoportation is my dream, and it’s already happening in care of the elderly in some units in America and in Australia,” Dr. Kamal says. “It’s almost like ‘Star Trek’ when Captain Kirk would say, ‘Beam me up, Scotty.’ It’s a lifelike way to have face-to-face interaction with remote patients.” In addition to transforming how patients interact with care providers, digital technologies are being used to improve diagnostic capabilities and clinical workflows. clinical decision support systems and virtual cognitive assistants filter huge volumes of clinical data to find the critical information that helps practitioners make the best decisions. In addition to driving efficiency, such tools help maintain high standards of care.  “Healthcare workers don’t suddenly jump to their expert level; they have to go through that learning curve from novice to expert,” Dr. Kamal says. “How do we ensure the high level of care delivery at all levels?” artificial intelligence and machine learning enable predictive medicine, leveraging Big Data analytics. One area of study is using machine learning to predict postpartum complications.

“Sensors can capture patient data and move on to produce algorithms when using big data and machine learning for robots or precision medicine,” Dr. Kamal says. “We talk about precision medicine and predictive medicine in this day and age, and not just medicine.” Digital innovation can impact any aspect of the healthcare industry: research, outreach, prevention, education, diagnosis, and treatment, Dr. Kamal notes.

“How we speak to patients, how we hear patients, how we deliver care – it’s totally different,” she says. “On top of that, the governance model must address how we maintain quality, cost effectiveness, safety, security, efficiency, and outcomes. The digital solution must address all of this, but the payoff is a much more efficient, streamlined solution.”

The WONDER project: saving women’s lives

As Dr. Kamal explores the many elements of disruptive change, her colleague, Dr. Narmadha Kuppuswami, has focused on a particular challenge: reducing maternal mortality worldwide.

Dr. Kuppuswami, an obstetrician and gynecologist with nearly 40 years of clinical experience, is affiliated with Advocate Good Samaritan Hospital in Downers Grove, Ill. She also is founder and project coordinator of the Women’s Obstetrical Neonatal Death Evaluation & Reduction (WONDER) project, an initiative that began in India and aims to expand globally.

WHO research shows that the vast majority of maternal fatalities are avoidable, Dr. Kuppuswami says. Poor women and rural women are at highest risk, due to lack of facilities, delays in providing emergency care, and knowledge gaps.

The key to preventing these deaths is to intervene quickly as soon as a woman’s vital signs – pulse rate, blood pressure, temperature – show signs of distress. To this end, the WONDER project created an electronic health record (EHR) system featuring a color-coded vital signs chart that displays white for normal, yellow for warnings, and red for danger. The system sounds an alarm for red values, and gives a possible diagnosis with treatment guidelines. Next, the WONDER team devised a means to leverage Internet of Things (IoT) technologies to feed patient vital signs into the EHR. In remote areas, healthcare workers meet patients in the field, collect data, and store it until a network connection is available.  In care facilities, Bluetooth-enabled wearable biometric devices send data into the WONDER EHR, so busy caregivers can react on the spot.

The technology serves as a form of electronic triage. “With 40 patients in labor, the doctor knows these are the two who require closer attention, so they can directly treat those patients who need it most.  WONDER leveraged HP technologies including desktop and tablet PCs, displays, and printers to launch the program, described in greater detail in an HP Case Study.

Next, Dr. Kuppuswami envisions spanning the globe with electronic birthing centers modeled after electronic intensive care units. Hospital labor wards connected to primary health centers via two- way communication would receive WONDER EHR data for highly trained obstetricians to guide skilled care in remote areas. In addition, expectant mothers at high risk for complications could be monitored remotely during their third trimesters and postpartum.

“I want to take this globally,” Dr. Kuppuswami says. “The health center could be in a remote village in Africa. Because this is cloud- based, the data will be visible to the general hospital within eight seconds. Experienced clinicians can direct care and even arrange to airlift patients if necessary. Our goal and dream is to ensure that mothers in remote corners of the globe receive skilled obstetric care. That is my vision.”

From potential to program: how to start It takes a visionary like Dr. Kuppuswami to imagine solving difficult problems like maternal mortality rates. To turn those visions into effective programs takes thoughtful planning and collaboration. Fortunately, 80% of clinicians are ready to try, and 70% of consumers reportedly prefer digital healthcare solutions.

If you’re a healthcare organization embarking on adoption of new technology, consider the following key success factors at the planning stage. decide how much development responsibility your organization is willing to take on. Some organizations simply wish to onboard technologies that already are tried and true. Others wish to be at the forefront, involved in development or even core design. The healthcare industry is served by many types of software providers and developers, all in various stages of maturity. For provider organizations that wish to participate early in the development cycle, groups such as the American Medical Association’s Physician Innovation Network provide channels to work closely with software developers on app/solution creation. How interested is your institution in that? Are they able to follow through?

clarify setup requirements for the new technologies. This has to do not only with the devices themselves and the software, but also the readiness of your organization, internal teams, and patients. Clarify your clinical pathways. If new types of data will be collected, who will manage that? At the back end, how will you receive and use the data? identify your use case(s). The potential use cases for connected technologies are countless, as Dr. Kamal explains. Look at your institution’s priority areas, especially where stakeholders bring passion for innovation. focus your scope. Too large a scope can become unachievable, or frustrating—with a timeline so long the project could get derailed by competing priorities. manage risk. Look into the low-hanging fruit of low risk, high gain programs. What solutions can integrate seamlessly into existing clinical workflows? Do you fully understand what that workflow is or do you need to pause and study it first? Do your development partners need to be educated about where their solutions might best fit? How will you ensure data security?

An innovation initiative will impact all of your organization’s stakeholders, including clinicians, IT staff, and patients. Let’s briefly consider some top considerations for each. clinicians: support, not complexity Clinician burnout is real. They work long hours and might be exhausted, with little time to explore and assimilate new technologies and workflows. Yet, their buy-in and engagement are essential. Any technology initiative must provide them with a means to serve their patients better, more efficiently, and with better outcomes. Solutions that align with established workflows and individual care plans can minimize the level of invasiveness and remove adoption barriers.

Staff training – and refresher training, when project timelines extend – builds the care team’s readiness and confidence. So does celebrating successes. Sharing lessons learned creates a learning environment for your teams.

The IT organization: partnering for success

Your internal IT team will be an important part of any technology initiative, so it’s important to consider their role and concerns. First, understand the difference between a proof-of-concept (POC) and a pilot project. In the POC phase, organizations typically don’t integrate directly into the EHR. They want data separation and the ability to digest lessons learned. Virtual Reality is a great example. Often, organizations start with standalone machines and expand later, after executive, clinical, and IT teams align to move forward.

When a program progresses beyond a POC into a pilot, that signals an intention to scale across the institution. However, it’s one thing to adopt a program for a cohort of 200 patients and quite another to roll it out for a million. The infrastructure and staffing capacity must be in place and adequate.

Another consideration is that connected care delivering care outside of the four walls of the clinical setting, perhaps placing technology in the hands of patients in their homes is not the IT organization’s traditional role. Their core focus is to keep enterprise facilities running, technology refreshed, and employees equipped with workflow tools. Asking them to scale a connected- health pilot can place a large burden on an already stretched department.

That’s where industry partnerships can help. Seek out global partners that bring the ability and expertise to facilitate solution configuration, deployment, and lifecycle management.

The patient’s point of view

It’s imperative to think about all of this from the patient’s perspective. We might think a program is wonderful, so why wouldn’t a patient want to participate? Many factors impact patient engagement with new technologies.

Culture is key. For example, many of the places where Dr. Kuppuswami took

the WONDER program were accessible only on foot; not even off-road vehicles could get there. Going into remote rural communities – whether in

India or Appalachia – it is critical to establish trust, to gain the support not just of the patient and, if possible, her family, but also of local leadership.

Also important are the patient’s social determinants of health. A bio-physical social management plan incorporates not just clinical interventions but other factors as well, such as smoking cessation or mental health counselling. If your patient works long hours, how might that impact her participation in a program that requires travel? If she lacks a supportive network, what organizations outside of your own might help?

Communication is vital. If you’re going to place a piece of technology into patients’ hands at home, how do you introduce it and educate them? What might be easy for one group
to adopt might be challenging for another. If your program is app-based, does your patient have a mobile device and reliable connectivity? Will your program use a Bring Your Own Device (BYOD) model? That might be cost-effective for you but problematic for participants on the wrong side of the digital divide. Or, will you supply fully configured solutions?

All of these questions have discoverable answers, and success stories abound. Consider the case of Johns Hopkins, whose Corrie Health program reduces cardiovascular disease in the Baltimore community right outside the hospital’s walls. Tune into the innovations Dr. Kamal introduces in the UK’s NHS. Watch as Dr. Kuppuswami takes WONDER global.

In summary: Tackle first the project that will make the most difference with the least upheaval. Include patients, clinicians, your technology staff and business partners in your program design. And remember, the health of women is an indicator of the social and economic wealth of nations.

Frances A. Ayalasomayajula, MPH,
MSMIS, PMP, is the head of Population Health, Worldwide at HP, Inc. An executive healthcare strategist and technologist,
Fran is dedicated to improving healthcare quality and access for populations around the world, and to increasing patients’ healthcare literacy and engagement.