Can e-health technologies be used to respond to the medical needs of vulnerable populations?

Can e-health technologies be used to respond to the medical needs of vulnerable populations?

Refugees use their mobile phones as their primary means of obtaining information. Smart phones have a unique potential for sharing health information, collecting data and conducting interventions.

(AFP/Elvis Barukcic)

Digital and communications technologies are increasingly transforming healthcare models. The World Health Organization defines e-health as “the cost-effective and secure use of information and communications technologies in support of health and health-related fields, including healthcare services, health surveillance, health literature, and health education, knowledge and research”. The European Commission elaborates on the concept by focusing on how e-health meets the needs of citizens, patients, health professionals, healthcare providers and policymakers.

The Covid-19 pandemic caused a worldwide shift to remote activities, from working to interacting with public administration to attending doctor appointments. “The pandemic has undoubtedly accelerated a wide range of possibilities that were already being developed over the last decade, but which required a major cultural shift for both professionals and patients to adopt them,” explains Dr. Sandra García Armesto, executive director of the Aragón Health Sciences Institute (IACS) in Spain.

“If we think of healthcare processes as a continuum focused on informing and empowering patients, the key is to provide the right combination of in-person and remote (synchronous and asynchronous) services, two-way information and support channels that allow patients to obtain and provide relevant information for their own care,” García Armesto continues.

‘Liquid centres’ and life-improving innovations

The development of the Internet of Things (IoT), linked both to devices specific to medical technology (telediagnosis, telemonitoring, etc.) as well as to increasingly ubiquitous applications in everyday devices (from smartphones and tablets to wearable technology), capable of collecting physiological and behavioural parameters, allows us to rethink the logic of healthcare and bridge the gap between healthcare centres and patients.

“In Aragón, we refer to this as ‘liquid centres’, the virtuous hybridisation of aspects that require in-person encounters between healthcare workers and patients, and those aspects for which the use of digital and communications technologies can be more effective, including follow-up and monitoring,” explains García Armesto. “I believe that we are about to witness the blossoming of a range of digital health services that will ultimately be normalised and integrated into the portfolio of every health system,” she adds.

García Armesto highlights two additional potentially positive results of this transformation. On the one hand, it will exponentially multiply exploitable and integrable data that can be converted into relevant clinical information for specific patient care. On the other hand, it will increase the capacity to generate new scientific knowledge and promote innovation and new approaches to disease management, which will increase the effectiveness and quality of care, as well as the efficiency and equity of the healthcare system.

Europe’s Remote Rehabilitation Service for Isolated Areas (ROSIA) is a project focused on developing a telerehabilitation model for patients who have suffered from strokes, heart attacks, chronic obstructive pulmonary disease, joint replacement and Covid-19, among other conditions, and who live in remote, often rural areas, where distances to specialised referral centres constitute a barrier to follow-up care and treatment. Such patients stand to benefit from extensive personalised rehabilitation plans, which technology has made much more accessible.

“One of the most interesting aspects of the project is that in the six sites chosen for its development, as well as in Aragón (Spain), Coimbra (Portugal) and Dublin (Ireland) where it was piloted, these new telerehabilitation services have become a link between local health services and community assets on the one hand, and highly specialised referral hospitals on the other, ensuring that these patients benefit from a quality integrated care plan,” says García Armesto.

Such services also improve patient rehabilitation by providing local support that keeps them motivated and allows them to closely monitor results.

Against a backdrop of rapidly evolving technology, another key feature of ROSIA, which will be launched in 2024, is the continuous integration of new solutions (such as devices, technologies and applications). Once tested, they will be included in the available catalogue so that healthcare professionals can recommend them to their patients.

Using mobile apps to improve health in the midst of humanitarian crises

According to the World Migration Report, the flagship publication of the International Organization for Migration, there were around 281 million international migrants in the world in 2020, equating to 3.6 per cent of the global population. But what happens when patients don’t know their rights or speak the language of their host country? Can technology help remove barriers and save lives?

“We know that when you flee from your home without anything to a foreign country where you don’t have a job and don’t speak the language, it’s hard to prioritise healthcare. But vaccinations are a cornerstone of healthcare and should always come first,” says Aral Sürmeli, a medical doctor specialising in digital and mobile health solutions in the context of humanitarian crises, and a PhD candidate in public health at the Johns Hopkins Bloomberg School of Public Health in the United States.

Following the Syrian refugee crisis, the largest of its kind since the Second World War, Sürmeli became involved in providing healthcare in Istanbul and other Turkish cities near the Syrian border through local non-profit Medical Rescue Association (MEDAK). “We realised that refugees use their mobile phones as their primary means of obtaining information. Mobile phones are not a luxury but a necessity for them to stay connected with their families and friends around the world.” Sürmeli saw the unique potential of mobile phones for sharing health information, collecting data and conducting interventions. Thus, HERA was born.

HERA is a mobile phone application designed to connect refugees, specifically women and children, to health services available in Turkey. Although Turkey provides healthcare free of charge, the four million refugees it has taken in have strained the capacity of all services provided, especially healthcare.

How does it work? The user downloads the application and registers her details. If the user is pregnant, she is asked questions about previous and current pregnancies, as well as her last day of menstruation. Using this information, the app automatically calculates the dates of her prenatal check-ups (the Turkish Ministry of Health recommends four during pregnancy). The app then reminds the user about her appointments. Similarly, users enter their children’s date of birth into the application, which automatically calculates whether and when the child is eligible for vaccination according to Turkey’s vaccination schedule.

“The reason we focus on women and children is because with quality healthcare, the issues they face are mostly preventable. In the area of public health, vaccination and prenatal care are two of the most effective and lifesaving interventions we have,” says Sürmeli, who is also the co-founder and CEO of HERA Inc.

In addition to behavioural interventions such as reminders, the application provides other functions developed with the specific needs of refugees in mind. For example, users can call an ambulance or find their way to the nearest hospital. They can also use the app to store their medical records so they don’t have to carry them around on paper.

“They can read about their health rights and topics of concern [such as breastfeeding]. In addition, we designed HERA to be modular so we can add new features very quickly if needed. For example, during the Covid-19 [pandemic], we implemented a symptom surveillance feature that asks the user every two weeks whether they have any symptoms of Covid-19,” says Sürmeli.

HERA was designed as a tool for organisations to use in humanitarian crises and is thus open source and free to use and replicate. In Turkey, in addition to several grassroots organisations, international organisations such as Doctors Without Borders have already expressed interest in replicating it.

“We are also in talks with other countries, Greece, Iraq and Nigeria being the most promising. We are working to adapt HERA’s features to the specific needs of their populations. It doesn’t need to be Syrian refugees, any migrant population can benefit from HERA,” says Ayse Kasikirik, HERA coordinator since March 2021 and a specialist in gender equality, women’s rights and social policy.

“This is also true for high income countries such as the United States. We have been working with several hospitals that take care of Mexican seasonal migrant farm workers to see how HERA can be used there,” says Kasikirik.

This article has been translated from Spanish.