SAM selects the target population on the following criteria:
Targeting vulnerability: SAM works with the poor and vulnerable communities who lack education, income, assets, status and access to healthcare.
Targeting pregnant, infants and children: SAM follows all pregnant women, infants and children under 5 years in the community.
Targeting reproductive age: For population stabilisation, SAM targets reproductive age group women and married couples between ages 18 and 49 years and adolescent girls from 10 to 19 years.
Targeting disease: SAM targets the families and contacts all TB patients, malnourished children and high-risk pregnant women.
SAM-ESP Innovation: SAM has developed a cost-effective platform for changing health behaviour ofa community. Health activists, in partnership with local public and private healthcare stakeholders, convert awareness to actionable knowledge. SAM has successfully used its Effective Social Persuasion Platform (SAM-ESP) in multiple locations. ESP relies on seven assumptions.
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Behaviour modification is the least expensive way to reduce disease burden.

Health is an individual and community responsibility; ownership of this responsibility empowers a community to demand healthcare rights. A campaign to push health information may improve awareness but is not sufficient by itself. Awareness is just one of many steps to change behaviour. Other essential steps include: a sustained, intensive, repetitive campaign without a predefined end time-point, encouraging peer to peer nudge and a methodical transfer of ownership to the community leaders.

Messages scripted by the community encourages their ownership. Trained volunteer activists can lead and sustain the ESP without external help.

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An established SAM-ESP platform can be used to address multiplehealth problems. SAM-ESP is not yetanother awareness building program. Awareness is often assumed to be equal to behaviour change. In practice, it is not true. Communication programs and prevalent awareness programs merely touch the surface without translating into significant behaviour change. SAM-ESP is a multi-step process, where awareness in just one of many steps for a sustainable behaviour change.

SAM promotes community ownership of both health and healthcare. SAM believes, that health is an individual and community responsibility and getting healthcare, as a right, has to be learned. SAM-ESP is a peoples’ program, which ensures that the health system is responsive and accountable.

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SAM trains volunteer health activists who lead the program and develops a cadre of social entrepreneurs, who sell contraceptives, sanitary pads and nutritional products. SAM field workers are from the community where they live and work. They are available 24/7 and take health to the doorstep of the recipients. The program sets no predetermined end date; repetitive training continues till SAM meets the objectives.

The following steps describe its execution:

Organize, create structure and build leadership capacity: SAM has well-trained field staff and managers;the voluntary directors of the organization are professionals from healthcare and management. Each district has a manager, trainers, and supervisors who are selected from the local population. They receive intensive training not only in health issues but also in motivational techniques, training methods and leadership.

Develop messages: SAM believes that a good message should be simple without technical jargon, short with less than five points, easy to understand without explanation and emotionally connected with a local need. For better retention, a message could be in the form of a story, song or a slogan. Some messages should be created by the community to feel ownership.

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Train health activists: Master trainers train volunteer health activists to be responsible for village health issues. Training is repetitive and intense.

Teach people: SAM organizes the village into a healthcare community. Field supervisors motivate and mobilize villagers and discuss each topic of healthcare with a specific training module. SAM uses local community resources to create training material and health leaders script their own songs and slogans. Activists meet villagers repeatedly to discuss best practices. Repetitive training of health activists and villagers is essential.

Cooperation with public and private health systems: SAM establishes linkage with the local private and public health system. Utilizing all available public health resources is an essential component of the program. Public health workers are invited to all meetings. This linkage creates awareness, which improves demand of healthcare and encourages accountability.

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Evaluation and improvement: Programs are monitored by community involvement and by participatory research action. Results lead tocourse correction.
Replicate: Solutions are validated and replicated in other locations.

Measuring impact: Each program starts with a baseline and finishes with an end-line evaluation. SAM defines objectives, activities, outputs and outcomes before the start of the program. They measure monthly progress against all these parameters.

Process of measuring impact is a four-step process:
Data Collection at community level: The field workers collect data during house visits and community meetings. They upload it on a smartphone.
Data review at block level: Field officers collate and review data every month at a block level. They validate it through client interaction.

Data validation at district level: SAM validates data through a monitor and evaluation protocol which includes field visits, focus groups and comparison with public health data. SAM compares outcomes and impact with similar programs run by the government and other private organisations.

External agency evaluation: Periodically, SAM engages external agencies to evaluate its work. The funding partners also send external evaluators to check the progress and impact.

Direct impact: Since inception, SAM has trained 37,000 volunteer health activists who live in the villages and are available to the community. SAM has directly impacted over 1,150,000 million people through maternal, child health, population stabilisation and TB control programs.

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Through maternal, child health and population stabilization programs, SAM has directly impacted: 530,000 women and over approximately 100,000 infants. SAM follows all (100%) pregnant women in the villages and has reduced maternal mortality by 90% and infant mortality by 60%. In some places, SAM has done even better. In the past 6 years, in 167 villages of Gadag, Karnataka; maternal mortality rate has decreased to 15.8 from 364 and the Infant mortality rate has decreased to 5 from 46.

Through population stabilizations program, the marriage of girls under 18 years of age has decreased to almost zero. Contraceptive use has increased from 28% to 62% and supplychain management has reduced the unmet need for contraception from 10.8 % to 2% been running in 700 villages. 287,042 people have participated in 14,552 community meetings. 13,973 people have had sputum tested. Sputum was positive for TB in 1329 people and 14 had multiple drug resistant TB. All received supervised treatment. SAM has directly helped with education and surveillance of 130,000 contacts of TB patients and helped another 317,000 community members with awareness program. TB detection rate has improved 3.7 times.

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Indirect impact: SAM estimates that approximately 0.9 to 1 million people, who did not actively participate in its programs, became aware of the benefits from those who attended our programs.

Women feel empowered, which has opened their minds to many choices in life. They express their opinions freely. Men and elderly women, who were suspicious and objected to their women attending public meetings, have mellowed their resistance and have even become enablers. Girls attend school more regularly and the number of girls attending college has increased. Adolescents participation has increased. Public health system and their workers are more responsive to public demand.Local elected politicians are responsive.

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Discussion: Multiple theories have attempted to explain the health behaviour of individuals. The most popular is the Health Belief Model (HBM), which was developed about 40 years back. It postulates that people make healthcare decisions based on perceived susceptibility to disease and consequences. The response is tempered by perceived benefits of action and with a belief that benefits outweigh risks. While this theory, like other theories, builds a plausible reference point to explain behaviour, it gives no guidance for modification of individual behaviour.

Theory of Planned Behaviour suggests that a person should be empowered with ability (self-efficacy) to change behaviour. The person should believe that the behaviour will improve his health and is socially approved. It has also been recommended that principles of marketing could be applied to a social cause, where the product to be sold is behaviour change.

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SAM model comes close to a hybrid variety of HBM, building self-efficacy and social marketing. SAM tries todevelop social efficacy through the agency of health activists by using techniques similar to social marketing. SAM Effective Social Persuasion is a people’s platform, which needs further elucidation and expansion. SAM is looking to use entertainment education or gamification for behaviour modification and use of technology in early detection of noncommunicable diseases. SAM seeks collaboration with others for mutual learning, sharing resources and scaling-up the program in vulnerable population.

About the author

Dr. Shiban Ganju is the Chairman of Atrimed Pharmaceuticals and Founder of Save A Mother Foundation, USA. He has dedicated his life to healthcare. Dr. Ganju graduated from AIIMS New Delhi and received advanced training in Internal Medicine and Gastroenterology both in India and USA. He is a consultant specializing in gastroenterology, liver disease and nutrition in hospitals in the greater Chicago area. His commitment to and understanding of how to drive improvements in health outcomes has benefitted big strata of society.

There is no doubt AI and IoT are big help in radiology and early diagnosis of cancer etc. but can never replace human intervention. India is also fast changing to adopt new technologies. As per a recent estimate, AI has potential of bringing $957 billion to the Indian economy by 2035. This may be the cause for luring young professionals to this new domain.

AI, as described by the domain experts – application of AI in healthcare, can be classified into Descriptive, Predictive, and Prescriptive. Our effort here is to learn and share newer knowledge by various initiatives taken by us through our annual conference, magazines, training programs, club meetings, webinars and the most recent delegation to Sweden under InnoBRIDGE 2019 to learn the best practices and explore synergies. On the request of our stakeholders, the next planned initiative is InnoBRIDGE USA 2020.

This issue is based on the theme of AI & IoT in Healthcare. The next one would be on Unmet Needs in Healthcare: Leading to Innovation. Do share your views and research for the benefit of all who believe in change through innovation. Let us think more on the basic issues of healthcare and how we can use technology to improve healthcare for common man at an optimum cost.

Ideate, Innovate and Incubate for the Bottom of Pyramid. Let us strive together to make India a developed economy from an emerging economy. The population of1.3 billion should be an asset and not a liability for the nation. A healthy India only can make wealthy India.

Simba Hybrid Pillow

Simba hybrid pillow is a perfect combination of technology and material. It contributes not only to the best night’s sleep but also increases the benefits of sleep for the body and mind. The uniqueness of this pillow lies in the choice of the material with which it is made. The material or filling used is Outlast based on Nanotube technology and is made of memory foam tubes designed to adapt to each sleeper. Each pillow comes with hundreds of nanotubes that can be added or removed to alter the height and firmness of the pillow. This small laser-cut, cylindrical tubes are made from super-soft memory foam which molds to the shape of your head giving one utmost comfort. The pillow can be customized to be made soft, medium firm or firm by the addition or deletion of nanotubes. Each nanotube adapts to your sleeping position, supporting the complex structures of the head, neck, and spine. To keep the body temperature regulated outlast draws the heat away, trapping it within its fibers and as one cools down it releases the warmth back out. On the reverse side of the pillow is a combination of smart microfiber and premium 300 thread count jacquard cotton. This side is extremely soft, lightweight, breathable and highly durable. Thus, this pillow has the advantages of thermal regulation and height alteration which no other pillow has offered till date. This seems to be the future of comfortable sleeping.

Source: www.inshorts.com

First Ever FDA Approved Augmented Reality Presurgical Imaging Tool

Novarad HoloLens have collaborated to launch an OpenSight AR system which is the first ever FDA approved Augmented Reality pre-surgical imaging tool. The OpenSight runs on AR technology to give 2D, 3D and 4D patient images which can help doctors plan the surgery ahead more thoroughly as it gives dual side by side image, both of the patient as it is and their internals. Doctors can now use Microsoft HoloLens for specific, pre-operative purposes. The technology is going to be transformative as it will allow the doctors to have a full brief of the patients’ internals before they make the first incision. Novarad has also released the teaching version of OpenSight AR system to ease the medical students into the future. Students or other surgery attendees can witness the AR preparation first-hand since the HoloLens experience can be shared among multiple headsets. No doubt FDA recognized Novarad’s efforts by clearing the OpenSight system for use. It is a complete medical package, designed to improve the precision and utility of medical practice.

Source: www.healthimaging.com

Top 5 Latest Healthcare Innovations for the month of June 2019

Evaluation–Diagnosis–Treatment. This is the traditional and generally accepted method of a medical procedure. However, the healthcare sector has evolved over the last couple of years. Today’s healthcare is using a new, digital companion to determine how patients feel based on much more than their present medical condition. Healthcare information technology or healthcare IT is widely used by doctors, surgeons, and pharmacists to understand the medical information of patients and improve communication between doctors and patients.

What is the use of Healthcare IT?

The major advantage of the healthcare IT is that it reduces the communication gap between a patient and a doctor as the healthcare IT collects and converts the patient’s information from paper records and medical charts to electronic data. This migration provides direct access to patient’s information to doctors irrespective of their location and enables to share knowledge with other doctors than the current medication providers. Moreover, the doctor-recommended prescriptions can be transmitted electronically owing to the healthcare IT, which has improved efficiency and reduced the valuable time.

Healthcare IT is much more than just an electronic version of paper medical records. It includes previous maintained medical images by radiology departments and opinions of specialists on a certain method of treatment. In addition, the digital messages including emails, healthcare tips, chat logs, the day-to-day medical progress of a patient, and financial factors such as scheduling and billing fall under the sky of healthcare IT. However, these records must be stored and maintained carefully to prevent invasion of privacy. On the other hand, technological advancements and easily accessible facilities fuel the demand for healthcare IT. Roughly, two-thirds Americans have instant access to the internet, which eliminates a patient’s restrictions with medical consultants. The tech giants such as Microsoft, Apple, and other new start-ups are developing up-to-the-minute opportunities in the healthcare IT market by improving access to digital applications and providing efficient security features. This has increased demand for healthcare IT services, boosting the growth of the healthcare information technology market. According to a report published by Allied Market Research, the market is expected to register a CAGR of 13.2 % in the period 2014–2022.

Healthcare generates job opportunities

The growth of healthcare IT has created a surge in job opportunities in the IT sector. According to the U.S. Bureau of Labor Statistics, by the end of 2024, the need for healthcare and medical managers will boost by about 17 percent. The healthcare IT management jobs oversee the entire system process and its day-to-day operations. Healthcare providers are finding hard to pick employees for job positions such as development, analytics, coding, and research. Moreover, just the collection of healthcare data is not enough. Once that data is received, it needs to be analyzed by skilled professionals and constantly updated and improved. Therefore, coding experts are extremely essential to smoothly transfer the individual records of patients to a central hub, by changing the codes that could otherwise interrupt the transfer of information. It is estimated that the requirement of such new codes is nearly 130,000. Moreover, the IT specialists assist healthcare service providers to obey the federal guidelines for records, a collection of data and share to protect a patient’s privacy. Due to such requirements, there are ample IT companies and even start-ups that are launching new platforms to develop a sustainable healthcare IT department.

Recently, Javara Inc., a clinical research service organization, launched a platform that is focused on compelling innovative research partnerships, service, and technology to healthcare systems. Jennifer Byrne, the co-founder, and CEO of Javara stated that the new healthcare IT platform will bring better outcomes for patient-centered care, better economic results, and easier research delivery model to the biopharmaceutical sector.

Integration of Artificial Intelligence in Healthcare IT

It is no secret that the healthcare sector holds a humongous amount of data; if incorporated with artificial intelligence (AI), it will open innumerable opportunities in the future. Microsoft, one of the largest information technology companies, has been working on several healthcare-related projects. Recently, Microsoft made clear its exact intentions behind developing a Microsoft healthcare team. The company aims to create a cloud-based patients’ profile, push doctors to use more cloud-based services, and eventually develop an AI to analyze the huge data. Microsoft hired two industry past masters: Jim Weinstein and Joshua Mandel to help achieve this goal. Jim Weinstein, the former CEO of Dartmouth-Hitchcock Health System, will help the migration of healthcare data to the cloud. Joshua Mandel, ex-Google employee, will assist in building open cloud architecture for all healthcare service providers.

The prime motive behind the project is to find a way to shift healthcare data to the cloud without jeopardizing its confidentiality. This new team will be a part of Microsoft’s AI research division. Peter Lee, the head of Microsoft healthcare, explained, at Microsoft, we’re confident that many aspects of the IT foundations for healthcare will move from on-premise doctors’ offices and clinics to live in the cloud. We are taking concrete steps with an initial blueprint intended to standardize the process for the complaint, privacy-preserving movement of a patient’s personal health information to the cloud and the automated tracking of its exposure to machine learning and data science. The company wants to pave the way to create an open architecture that eventually helps doctors, nurses and healthcare service providers, and to allow more time for patients to spend face-to-face with the doctors. The new platform will open new opportunities for healthcare data to be shared and to protect its privacy. Such innovative projects and huge investments in healthcare AI proves that the incorporation of AI in healthcare IT will be a fruitful investment for the healthcare providers, and no doubt it will be a key to the bright future of healthcare sector.

About the author

Nikhil Bhusare is an Executive with Allied Market Research.

Authors share, Intentional or unintentional – frequent use of medical and healthcare services have led the way towards the design of an integrated approach in healthcare management

Health systems worldwide are challenged by the increasing demand for services while operating within limited fiscal resources to meet growing patient demand. There is an increasing recognition that small segments of the population are accessing health services very frequently due to multi-co morbidities and very complex health needs.  In one Canadian province, it has been documented that just 5% of the 13 million citizens consume and account for 67% of health system service resources (Wodchis, 2013). This population is an important priority patient group in the region, known as the ’frequent user’.  The majority of these individuals have multiple co-morbidities and are confronted with navigating numerous, complex health services across a number of different programs, medical specialties and locations which are often isolated and disconnected from each other and focused on a single disease management approach. The frequent user population has expressed many challenges and significant dissatisfaction with accessing current health services that are neither integrated nor connected in a meaningful way.

This lack of integration and coordination leads to gaps in care, frequent use of emergency department services, and hospitalizations when their health deteriorates. 1% of the province’s ‘frequent user’ population consumes 34%, and the top 5% consume 67% of health system expenditures in the provincial health system. There is an impressive opportunity to implement an innovation strategy to re-design health services to more adequately meet the needs of these complex patients, and in doing so, reduce health system costs through a more coordinated and integrated model of care, focused on health and wellness that enhances quality of life.

A collaboration team for research is currently underway to design and implement an integrated health services strategy for patients identified as ‘frequent users’ across one provincial region.  The research team is examining the impact of this integrated model of care that leverages innovative technology to identify the frequent users in real time as they access health services.  A case management solution designed by the clinical team is implemented to engage patients and their families as partners in managing their own care, and focus on meeting the health goals identified by the patient and family rather than disease management goals determined by clinicians.  Results of the pilot phase of the research demonstrated that patients’ utilization of services decreased dramatically over a six-month period after the integrated model of health services was implemented.  Outcomes measured included the patient’s self-report of perceived wellness, satisfaction with the new model, ease of accessing primary care services and health services utilization (emergency visits, hospitalizations, length of stay).

Preliminary Findings Over a 6-month Period:

Frequent Users require integrated care led by primary care teams that engage specialists only when required, self-identified health goals focused on quality of life and maintaining their independence in the community, reported high levels of perceived wellness and readily engaged in self-management, with the support of their primary care team and a case manager as well. Clinicians reported working collaboratively to achieve integrated services focused on patient health and wellness across primary and specialist care. Health service utilization data for this population demonstrated 40% reduction in hospital days, reduced emergency department visits, and reduced length of hospital stay.

Both – the collaborative approach to integrated care and building an innovative eco-system strategy into the region to influence system change – are key conditions affiliated with the success of the integrated model of care in this pilot phase of the study. Phase II of the study continues with approximately 300 ‘frequent users’ being followed for 12 months to determine the impact of this integrated approach to care over time.

 
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