Glimpsing the Future of E-Health Care From a Rio FavelaBy
Your doctor may not be the biggest fan of the coming electronic health care wave, but marrying mobile technologies with medical know-how has the potential to save lives, dramatically improve patient care, and slash significant costs, even in the poorest urban communities in the world, a new study finds.
Researchers at the New Cities Foundation, a nonprofit organization in Paris that seeks to tackle the most intractable issues facing the world’s fastest-growing cities, joined by a small team of health-care workers from Rio de Janeiro, recently concluded an 18-month trial in one of the poorest parts of the city, the favela of Santa Marta, a community of 8,000. Santa Marta was chosen for its unique geography and its remoteness—the rows of shanty homes appear to tumble down this hillside community where, until recently, there was no sewage, running water, or electricity to the upper reaches of this slum community, and access to even basic health care for the sick and elderly almost always involves an arduous slog downhill and up again.
The researchers went to Santa Marta to answer a fundamental question: Can the use of e-health technology bring cost savings to a public health-care system—in this case, a health-care system funded by the state—while improving access to health care in an underserved urban community? The answer surprised Hans Dohmann, municipal secretary of health of Rio de Janeiro.
“This trial really showed us a lot. We were able to follow these patients’ medical conditions better and make diagnoses earlier than before,” Dohmann says. “That has a huge impact on the health of the people and a huge impact on the entire health-care system.”
The study calculated annual cost savings for the city broken down by medical condition. For example, savings ranged from $4,000 (for those at risk of heart failure) to $200,000 (kidney dysfunction) per 100 elderly patients who participated in the e-health trial. The cost savings due to avoided hospitalizations of patients with cardiovascular diseases was roughly $136,000 per 1,000 patients. The researchers break down the full cost savings in their report (pdf).
Here’s how the trial worked: Equipped with a backpack of nine mobile medical devices, many of which were developed by General Electric, a New Cities Foundation backer, a team of 11 doctors, nurses, and nursing assistants climbed the winding streets of Santa Marta to conduct regular medical health checkups with 100 elderly patients. The patients suffer primarily from hypertension, diabetes, obesity, and heart disease, the kinds of chronic health-care disorders that affect the poor and elderly in most parts of the developed world, as well.
Inside the backpack was $42,000 worth of equipment, ranging from the high tech—GE’s V-Scan, a pocket-size ultrasound device to conduct abdominal and heart tests and, for younger women, obstetric readings, plus another GE device, the Tuffsat, a pulse oxygenation and heart rate oxymeter—to the everyday: a tape measure, stethoscope, and thermometer. Using the backpack, the e-health-care workers were able to detect among the patients 20 different diseases, such as hypertension and diabetes, within minutes. And underscoring the advantage of using mobile health-care technology, the e-health team was able to obtain blood tests on-site and have the results within three minutes, a procedure that can take as much as 15 days. Also, the test results were recorded and added to the patients’ existing medical file.
The researchers found that effectiveness of patient care improved dramatically, too, when compared with a control group that did not have access to the e-health care. For example, there was a 14.8 percent prevalence of hypertension complications for the control group, compared with 0.82 percent for patients in the e-health pilot. The gap was similarly wide for type II diabetes patients who participated in the e-health pilot.
One of the not-so-subtle findings of the research is how an investment in e-health technologies, even among the poorest communities, can lead to fewer bottlenecks at hospitals and significant cost savings, particularly in communities where state-funded health-care costs are skyrocketing, as is the case in Rio. The medical treatments, too, were for diseases as common in Rio as they are in Rochester, N.Y.
“We should not wait for this kind of innovation to slowly trickle down to the bottom of the pyramid,” says Mathieu Lefevre, executive director of the New Cities Foundation. “This study shows that we can and should start where better access to health care is needed most, and we should do so using the best available technology. We hope [this trial] will be replicated in other cities.”
Dohmann echos that, saying the city plans to expand the use of mobile e-health clinics like those first used in Santa Marta to other parts of Rio. “It will help us reduce the cost of health care,” he says.
The cost savings and rate of treatment effectiveness were two of the results GE, which markets many of the health-care devices used in the Santa Marta e-health initiative, is keen to highlight as well. Both points could be important selling attributes if the company is to succeed in persuading cash-strapped public health officials to invest in the latest e-health technologies to treat a rapidly aging population.