A Data-Driven Approach to Healthcare in the Poorest Communities

PHOTO: It takes a community to run a health clinic, no matter how large or small the clinic. Members of Global Health Coalition preparing to deploy the electronic medical record system at the Jerusalem Clinic.

It takes a community to operate a health clinic. Members of Global Health Coalition preparing to deploy an electronic medical record system in Jerusalem Clinic, Haiti.

 

By Devin D. Mehta, MD

It was far too recent that your doctor recorded your medical history in a paper folder, barely able to read the chicken scratch left from the last visit. Patients bore the responsibility of maintaining their own records such as vaccinations and four-syllable medication names. This resulted in incomplete and inaccurate records, redundant prescriptions, and unnecessary anxiety. With paper medical records, there was a clear lack of continuity of care. Now take this problem and imagine healthcare delivery on the ground in developing countries in the aftermath of natural disasters. The lack of accessible patient health data would be a bottleneck in even the most sophisticated healthcare systems, let alone in rural villages. That is why I founded Global Health Coalition and believe deeply in our mission to bring modern health technologies to the poorest communities of our world using an end-to-end data driven approach to improving health outcomes. The first step in achieving our mission is the introduction of an electronic medical record (EMR) to a community off-the-grid.

Nearly 1.5 billion people live in developing nations. Due to the lack of infrastructure, these underserved populations are more susceptible to the fragmented healthcare system that follow a natural disaster or humanitarian crisis. Healthcare delivery in communities displaced by such events is challenged by the inability to maintain structured longitudinal data which helps impact physicians to provide thoughtful, high quality healthcare. As I experienced firsthand during my time in Haiti delivering care a couple years after the 2010 earthquake, the lack of accessible medical records led providers to always start from ground zero with each patient, so acute care took precedent over broad preventive health programs. This approach to healthcare in developing countries is short-sighted and creates unintended consequences years later when problems such as hypertension are only managed in a snapshot rather than over a duration of time. And this is where the EMR shines in developing countries.

With the support of our partners at Prominence Advisors, Global Health Coalition provides an end-to-end service model for a lightweight EMR system that can be deployed in the hardest-to-reach communities, often plagued by lack of power. The EMR is open-source and configured to match the workflow of a health clinics in rural communities. Our EMR system can function for 24 hours without the need for charging, making it perfect for use in resource-constrained environments. Global Health Coalition trains medical teams and clinic personnel, maintains the EMR, and provides access to the patient and population health data right back in the hands of our partners. Data from patients in the community are captured in the moment, seamlessly recorded by medical teams, unlocked to enable research studies, and a narrative of the community is more transparently painted for others to see (and fund). The long-ranging, positive effects of transitioning from paper records to an EMR was demonstrated by Global Health Coalition in a Haitian village, Jerusalem, located in Canaan.

Before it was declared an official village by the Haitian government, Jerusalem was a refugee community made up of those that had fled cities, such as Port-au-Prince, immediately after the catastrophic earthquake of 2010. It was a village built out of necessity but maintained out of lack of other options. With no money to rebuild homes elsewhere, families made due with make shift homes built with scrap metal and tarps. I arrived with a medical team from Rush University Medical Center in 2012 and quickly realized that a major factor limiting the quantity and quality of care we could provide was paper medical records. Without being able to see longitudinal patient data, there was no way to gauge the effectiveness of treatment. It was out of this frustration that the idea for Global Health Coalition coalesced and Jerusalem was a natural starting place to launch. After a little over a year of development, our EMR system was deployed in May 2016.

Less than one year later, healthcare has grown in sophistication in Jerusalem. Providers now order medications for patients through the EMR and the medications are ready for pick-up in a separate pharmacy. Lab data is stored and can be utilized to assess if testing is being used appropriately. Despite the unreliable diesel generators, the EMR system functions independently enabling data reports in real-time. In the back-end, Global Health Coalition maintains patient and community data in an intuitive format so non-technical individuals can access and explore the data. We moved beyond treating the individual; the powerful insights brought from data visualizations built by Global Health Coalition enables providers to follow trends in treatments and prevalence of diseases among the population. Beyond Jerusalem, Global Health Coalition’s goal is to operate in health clinics around the world. By providing health clinics and medical teams the option of sharing their de-identified data, researchers can compare seemingly disparate communities to leverage each other’s efficiencies so more meaningful healthcare can be delivered.

The Global Health Coalition’s introduction of an end-to-end data driven approach to healthcare solutions in Jerusalem validated a proof-of-concept. With that validation, a makeshift health clinic in an open-air church has evolved into a robust free-standing health clinic; it is clear that healthcare can spark an economy and engage stakeholders of health clinics to drive increased funding. Despite early achievements, Global Health Coalition sees a broader vision of success given the steadily increasing number of refugees across the world; success is deconstructing the silos of healthcare data in developing countries to enable high-powered research, designing of larger, more cohesive health interventions, and measurement of health outcomes to prove effectiveness of interventions.

Seventy nine percent of our world’s population live in developing nations with many lacking access to basic healthcare, clean water, and reliable electricity. As seen in recent months, when natural disasters or political upheaval destroys a community, people are displaced and they are the ones that suffer most. To invest smarter in our world’s poorest communities, we need to understand the healthcare challenges they face; data is crucial, but shared data is the solution.

Global Health Coalition is a 501(c)3 nonprofit providing end-to-end data driven healthcare solutions in our world’s poorest communities.