Open Source Telemedicine

Sana is a smartphone application written for the Android operating system that allows health workers to collect medical data (photo, video, audio, free text, and rich data such as x-ray, ultrasound, and ECG), and send this data using the cellular network to an electronic medical record system. A doctor in an urban hospital who participates in the Sana referral network logs into the online medical record system using his or her browser, reviews the case, and enters the diagnosis and treatment recommendation, which are then sent back to the health worker's cell phone so that the care can be delivered.

Will it make a difference?

Sana can minimize and potentially eliminate the time to diagnosis and close the loop of patient presentation with an illness to delivery of care. Minimizing this cycle reduces the high rate of loss to follow-up that is common in remote areas where the patient must travel long distances and sacrifice daily income to seek care. By providing either preventive care or care early on in the stage of illness, total cost of treatment is lowered, and health outcomes improve. Sana's software has been specifically designed to meet these needs, and overcome the constraints of poor cellular connectivity during data transfer.

Is it being implemented in the field?

We have active projects in Brazil, two sites in India, two sites in the Philippines, and project partners implementing the system in Haiti, Kenya, and Greece. I am project manager for the Philippines, where we are customizing Sana to help community health workers operating clinics for two large microfinance institutions identify and manage patients with hypertension.

Tell us more about your project in the Philippines

Cardiovascular diseases are a leading cause of mortality and morbidity in the Philippines, and our partners identified these health problems as top priorities for improving the health of their clients. We hope to identify and treat patients in the long-term who will benefit from reduced acute hypertensive episodes and minimize the risk of debilitating strokes. Our challenge is to leverage local resources to drive achievement of milestones and sustainability. To this goal, we coach our partners in the value of locally led, data-driven accomplishments, and are working closely with our own counterparts in the Philippines: a local technical consultancy who has raised grant funding to spearhead management of the cell phones and servers; hospitals and local doctors to provide diagnosis and treatment recommendations; and we are working with the Department of Health as well as local universities to sustain continued implementation, research, and evaluation of the program. Once the project is evaluated and we make a decision whether or not to scale, we plan on integrating diabetes management tools as the next high priority disorder to tackle to improve the health of Filipinos.

Are you collaborating with others?

We are constantly mentoring other research groups and organizations in the process of identifying, implementing, and evaluating mHealth projects. A completely novel offering in the mHealth space is a new course we are teaching at MIT called HST.184: Health Information Systems to Improve Quality of Care in Resource-Poor Settings.