Embed Size (px)
Citation preview
mHealth, Patient Reported Outcomes, & Registries UICC Presentation
Bradford Hirsch, MD, MBA August 30th, 2012
New Cancer Diagnoses
0
5
10
15
20
25
1975 1985 2000 2008 2010 2015 2020 2025 2030
Mill
ions
Globally'
United'States'
Source:(GLOBOCAN(2008(
World(Cancer(Report(2008(
Doctors per 1000 Patients (2012)
0.6 0.6
1.1 1.3
1.7
2.2
3.3 3.5
3.8
India South Africa
China Brazil Turkey UK US Denmark Germany
Source:(Economist(Intelligent(Unit(
Penetration of Mobile Technology
Source:(ITU(World(TelecommunicaCon/ICT((Indicators(database(
0
1
2
3
4
5
6
7
2006 2007 2008 2009 2010 2011
Fixed Telephone Line Internet Users Mobile Subscriptions
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 Support
& Cancer Registries
Limited Patient
Engagement
Sophisticated PRO
Systems
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
H
Research Clinical Operations
& Quality
Clinician
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
! 2/3rds 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?
Adapted from slides
by Joel Selanikio
Create forms online and push to common mobile
phones�
Works with Android, Symbian, Blackberry,
SMS, and iPhone�Not just smartphones�
How does it work?
Adapted from slides
by Joel Selanikio
Data is secure, encrypted, password protected�
Data can be collected offline�
Data�Visualization�
More than 9000 users in more than 170 countries
Adapted from slides
by Joel Selanikio
Collection of Primary Data
Malaria surveillance in Malawi* Basic Patient Experience Data
*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
