MiDoctor, personalized care and reminders using patients’ cell phones
This entry has been selected as a finalist in the
Innovations for Health: Solutions that Cross Borders competition.
MiDoctor improves patients' health through personalized care via their cell phones and lowers the costs of monitoring their health
About Your Organization
Chile, RM, Santiago
Country where this project is creating social impact
Chile, RM, Santiago
Is your organization a
How long has your organization been operating?
Has the organization received awards or honors? Please tell us about them
The mHealth Alliance and Rockefeller Foundation sponsored the Top 11 mHealth Innovations in 2011 (http://www.mhealthalliance.org/news/who-are-top-11-mobile-health-innovat...), of which our organization with MiDoctor was one of the Top 11 (http://healthunbound.org/top11_winners).
We were also selected by Startup-Chile (www.startupchile.org), a program by the Chilean government to sponsor entrepreneurship (http://thenextweb.com/la/2011/12/16/here-are-the-startups-who-will-get-u...) to receive a cash award and access to governments networks. We also won seed funding from another program within the Chilean Government to expand our system, MiDoctor, to a national level.
Finally, we were one of 3 companies selected to be part of the business accelerator of Movistar, one of the largest Telecommunications companies in Latin America (http://www.movistarinnova.cl/blog/noticias/noticias/movistar-innova-grad...). This program looks for organizations that have the potential for high scalability and impact, and accelerates them by providing access to the networks and marketing of Movistar.
References - Please provide two references with a two-sentence biography, email address, and phone number for each
Hamish Fraser, professor at Harvard Medical School, Director of Medical Informatics at the non-profit Partners In Health, and faculty advisor for Joaquin Blaya. He was one of the founding members of OpenMRS, a platform for clinical information systems for resource poor settings on which MiDoctor is based. Hamish_fraser@hms.harvard.edu, +1 857 222 6722
Pedro Pablo Muñoz is Chief Executive Officer (CEO) of Rezebra Technologies, one of the key players in the health informatics field in Chile. He has increased threefold the revenues of Rezebra since assuming as CEO. email@example.com, +56 (9) 7768-8226
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Select the stage that best applies to your solution
Growth (your pilot is up and running, and starting to expand)
How long have you been in operation?
Operating for 1‐5 years
Which of the following best describes the barrier(s) your innovation addresses? Choose up to two
The Need: What problem are you trying to solve?
Non-communicable chronic diseases, such as diabetes, hypertension, and respiratory diseases, kill over 1,300,000 people in Latin America annually. In most countries over 10% of the population has diabetes and 20% are hypertensive. Chile alone, spends USD504,000,000 annually on diabetes and its complications such as dialysis, vision loss, and amputations, most of which could be prevented.
Taking their medications, going to their controls, and changing eating and exercise routines are necessary if diabetics are going to have a higher quality and longer life. However, in Chile like most countries, most diabetics don’t know they have it or don’t control it well enough to avoid its catastrophic effects. A similar situation occurs with infectious chronic diseases such as Tuberculosis and HIV
The Solution: What is your solution? Be specific!
MiDoctor addresses the problems associated with non-communicable diseases (NCDs) in low resource settings. MiDoctor connects a patient's cell phone to an electronic medical record (EMR) to provide the continual care needed. It provides information and connects the patient to their health center via automated phone calls. The patient also receives tailored information via SMS. Finally, it gives the health center tools to manage these patients by alerting them of any responses that require attention to ensure patients receive appropriate care. This way it improves medication adherence, ensures patients go to their appointments, provides health centers with lists of patients that need intervention, and supports self-management support. All of this should reduce the catastrophic effects of these diseases.
MiDoctor is highly scalable because it works with any cell phone, it’s maintained by eHealth Systems hence there’s no need for health center technical staff, and uses web technologies.
The Model: Walk us through a specific example of how your solution makes a difference; include your primary activities
A health center (HC) contracts MiDoctor during the first week eHealth Systems customizes MiDoctor to the HC’s needs. The HC begins to use MiDoctor by entering their patients via MiDoctor’s web forms or by sending us the information. From there MiDoctor has all of the intelligence built in for when to call patients, when to send them SMS messages depending on their responses, and when to send email alerts to the HC. For example, if on an automated call the patient touches 1 on their keypad saying they forgot their medications, MiDoctor tells them they will receive an SMS every day for the next 7 days reminding them to take their medications. If the patient says they don’t know how to take their medications, MiDoctor sends an email alert to the HC and places them on a work list, so HC personnel can see all the patients they need to call about this particular issue. MiDoctor also calls patients before their appointment and asks them if they will attend, if the patient responds no, it alerts the HC so another patient can be seen.
In this way, MiDoctor connects patients to their HC ensuring they receive the appropriate care and don’t “fall through the cracks.” It motivates and educates patients in how to control their health, and alerts the HC when to assist patients, so that they provide the necessary care only when it is needed.
This strengthens the health system by reducing the no show rates and ensuring high quality treatment. MiDoctor also provides the foundation of an EMR without needing servers, thus taking the first step in placing other electronic tools in the HCs.
The Marketplace: Who are your peers and competitors? Identify others also working to address the needs you are and what differentiates you from them. What challenges could these players pose to your success or growth?
There are currently no systems with the same characteristics as MiDoctor in Chile. There are 2 experiences of SMS for appointment reminders, however, these only allow one way communication to the patient and don’t tell the health center if the patient is not coming, as does MiDoctor. Another system used nurses to call diabetics, however, this is too expensive and not scalable and therefore hasn’t expanded since it began in 2005. There are also SMS providers who can send messages to patients, however, they require the time, content and number for every SMS hence there is no automation.
These organizations present a challenge only in that they can provide a lower cost alternative with less functionality, however, they have been around for years and few organizations use their services.
This Entry is about (Issues)
Founding Story: We want to hear about your "Aha!" moment. Share the story of where and when the founder(s) saw this solution's potential to change the world.
My partner and I had two different moments. She’s a Chilean clinician with experience in both the private and public health sectors. Her moment came when we started designing the initial system for two health centers and she realized that this type of system could fill the current void in the care of chronic patients which occurs because it’s so hard to have continual communication with them between visits or to know what specific support or intervention the patient requires.
For me, it came when I realized that we could empower the patient and provide them with information they wanted through any cell phone, independent of how technologically savvy they were, and with no additional work for the patient. Many chronic disease systems either increase the digital divide because they require Internet or knowledge of how to use computers or aren’t used because they require too much effort from the patient.
Please describe the goal of your initiative; outline what you are trying to achieve
1. Improve chronic disease care by a) ensuring they have their clinical appointments, b) alerting their clinician of risk factors or problems the patient reports, c) providing a history of problems or questions the patient has had to improve their doctor's visit
2. Optimize the management and resources of the health center by a) confirming patients will go to their appointments and if they won't alerting the center to see another patient, b) providing indicators to improve management.
3. Motivate patients to improve their self-care and improve their satisfaction by a) helping them remember their medications and change their lifestyle, b) educating them through personalized SMS and automated phone calls, c) allowing them to provide or request information when they would like.
What has been the impact of your solution to date?
The first project was when we designed MiDoctor and implemented it in 2 health centers in Feb., 2010 for a study. This study concludes March, 2011 and the results of MiDoctor's impact should be known by June. The evaluators have found many patients commenting that they find this system useful and that patients who answer the first call, tend to continue with the program. The larger impact was to iron out the details of the system. This included adding functionality not originally planned, finding voice and SMS providers that worked with Chilean cell phones, and tuning the clinical workflow within MiDoctor.
The second project, in a rural hospital in the south of Chile, was for MiDoctor-Reminders. To date, 185 patients have been called, of which 29% confirmed their appointment, 6% responded they were not going, and 11% called MiDoctor back. Since the project occurred at the same time as the first the same technical issues were resolved, so we now expect the response rate to increase.
What is your projected impact over the next five years?
In 5 years, we expect to have implemented at least one module of MiDoctor (Diabetes, Reminders, or Hypertension) in 60% of Chilean public health centers, and in 300 centers in Latin American and the world. Through this reduce no-show rates by 50%, foot amputations by 30%, and delay the start of dialysis by an average of 1 year. This is in Chile will save over US$58 million annually at a cost of US$6.5 million.
At a national level, we will have implemented this two way communication model in the Chilean national health hotline “Salud Responde” and shown demonstration of systems that communicate to each other to promote a national network where information is shared between any health center where the patient goes.
What barriers might hinder the success of your project? How do you plan to overcome them?
An initial barrier is how to enter information into MiDoctor since many health centers have an electronic system which we can't access, and they will not want to enter data again into MiDoctor. For this we've designed MiDoctor to require as little data as possible, for all of that data to be loaded only when the patient is first entered and not continuously, and for MiDoctor to collect any additional information from the patient themselves during one of the automated phone calls.
Another barrier is how to market this to the thousands of health centers in Chile and Latin America. For this, we have signed an agreement with Movistar, one of the largest telecomms in Latin American and the one that has over 90% of health institutions in Chile as clients, for them to be resellers of MiDoctor.
Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact
Have implemented this system in at least 10 health centers and have shown that it reduces no shows rates.
Identify three major tasks you will have to complete to reach your six-month milestone
Define how Movistar will use their sales force for our product
Automate the installation as much as possible
Have signed at least 1 of the top 3 private clinics in Chile
Now think bigger! Identify your 12-month impact milestone
Have implemented this system in at least 40 health centers and have shown that it increases medication adherence
Identify three major tasks you will have to complete to reach your 12-month milestone
Have implemented system in at least 1 clinic outside of Chile
Have created a second module for MiDoctor for Hypertension
eHealth Systems should count with its own infrastructure and not count on our partners for it
Tell us about your partnerships
An eHealth Systems partner is founder and CEO of a radiology software company with an income of US1 million annually and over 400 installations in Latin America. We are using their project implementation, software development, and service provision.
We are defining the mechanism to use the sales force of Movistar, the 2nd largest Telecomm in Chile. They provide internet and phone to the entire public health system.
Joaquin is on the Board of Directors of OpenMRS, an electronic medical record with implementations in 49 countries.
Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?
We are planning on a step-wise expansion of MiDoctor to include hypertension, respiratory problems, tuberculosis, and mental disorders. This will include new patient populations.
Further, we plan to expand the markets of MiDoctor first to other countries where our partners, Lebox and Movistar, work. This includes all but 3 countries in Latin America. Then through the OpenMRS network expand to countries beyond Latin America. We’ve already started conversations with organizations in the Philippines and Pakistan for example.
What type of operating environment and internal organizational factors make your innovation successful?
We believe our most important value is improving society, specifically its health system. This ethos has led us to find collaborators, not just employees. For example, our lawyer entered our board of directors instead of payment, and has become a trusted advisor. The idea of social enterprise, relatively new in Chile and Latin America, is key to having an innovative and enjoyable workplace.
Secondly, the combination of the skills of the three partners, clinical, technical, and commercial, is a mix rarely found in health informatics companies, and something which no company in Chile possesses.
Finally, MiDoctor is a platform for other innovative solutions. Since it connects the health center and the patient, additional services such as home rapid tests, can easily be added.
Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list
We don't have additional categories of support.