mHealth, Patient Reported Outcomes, & Registries UICC Presentation Bradford Hirsch, MD, MBA August 30 th , 2012
New Cancer Diagnoses 25 Globally' 20 15 Millions 10 5 United'States' 0 1975 1985 2000 2008 2010 2015 2020 2025 2030 Source:(GLOBOCAN(2008( World(Cancer(Report(2008(
Doctors per 1000 Patients (2012) 3.8 3.5 3.3 2.2 1.7 1.3 1.1 0.6 0.6 India South China Brazil Turkey UK US Denmark Germany Africa Source:(Economist(Intelligent(Unit(
Penetration of Mobile Technology 7 Fixed Telephone Line Internet Users Mobile Subscriptions 6 5 4 3 2 1 0 2006 2007 2008 2009 2010 2011 Source:(ITU(World(TelecommunicaCon/ICT(( Indicators(database(
Need Creative Solutions ! LMCs represent the majority of the worldwide cancer burden – 7.6 million deaths from cancer in 2008 – 64% in LMCs ! Must understand cancer burden ! Must augment workforce to address specific needs ! Must create unique ways to engage providers and patients in order identify and monitor cancer diagnoses, pursue treatment, and conduct surveillance ! mHealth tools are positioned to address these issues Source:(GLOBOCAN(2008( World(Cancer(Report(2008(
Spectrum of mHealth Tools Workforce Limited Sophisticated Support Patient PRO & Engagement Systems Cancer Registries
Duke Center for Learning Health Care ! ePRO = prototype system for collection of patient information & analysis ! On-the-ground, real-time mechanism to gather data on: � Diagnosis & patient history � Symptoms � Quality of life � Medication use and compliance � Patient satisfaction � “Value” of treatment
Collection Methods
Validated Questionnaires Available
Interface
7 Clinician Clinical Operations & Quality Research H
Evolution ! Improve visualization ! Trigger interventions & education ! Provide scorecards ! Enable rapid learning clinic ! Embed randomization
Evidence Based Medicine: A Paradigm Shift African CRs monitor 11% of the population, the Costa Rican registry covers 90%, U.S. and Madras cancer registries reach 96%. In the “validity” domain the key criterion was pathologic diagnosis confirmation. Most LMC CRs are not pathology-based. CRs in wealthier settings like Hong Kong report histological confirmation in >85% of cases. In the “timeliness” domain standards for timely data reporting are largely undocumented. First'steps'
Creative solutions for LMCs No need to wait for greater technology adoption by clinics as mHealth can be used to circumvent the system ! Must understand cancer burden – EpiSurveyor in Tanzania ! Must augment workforce – Education for providers and patients in India and China
Registries in LMCs ! 2/3 rds of global cancer burden occurs in LMCs ! Registries only monitor 11% of the African population vs 96% of the U.S. population ! Infrastructure to identify and monitor diagnoses, treatment, and surveillance is the cornerstone of clinical and research oncology ! WHO, among other organizations, has advocated for the creation of standardized cancer registries in LMCs Source:(GLOBOCAN(2008( World(Cancer(Report(2008(
Episurveyor - What does it do? Adapted from slides by Joel Selanikio
How does it work? Create forms online and push to common mobile phones � Works with Android, Not just smartphones � Symbian, Blackberry, SMS, and iPhone � Adapted from slides by Joel Selanikio
How does it work? Data � Visualization � Data is secure, encrypted, Data can be collected password protected � offline � Adapted from slides by Joel Selanikio
More than 9000 users in more than 170 countries Adapted from slides by Joel Selanikio
Collection of Primary Data Malaria surveillance Basic Patient Experience Data in Malawi* *Applying or Integrating Mobile-based Episurveyor Technology into Malawi Malaria Supervision – episurveyor.com
India & China ! Augmenting workforce – Implementation of limited PROs, adapted for literacy and technologic capabilities – Basic education
Creative solutions for LMCs ! Many complex and targeted mHealth platforms, but don’t forget about basic solutions with great flexibility ! Goal is to – provide patients and populations what they need in their communities – provide open, creative solutions – avoid waiting for traditional infrastructure to be built
Contact Information Bradford Hirsch, MD, MBA Bradford.Hirsch@duke.edu +1 - 214 - 707 - 2790
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