SMART Health India to fight chronic disease in West Godavari district

After the success of the pilot project that familiarized doctors and ASHA workers with a smartphone based clinical decision support system in 11 villages of West Godavari district, The George Institute for Global Health India, is now gearing up to launch a large-scale research project in 55 villages to bridge the implementation gap in blood pressure control in rural Andhra Pradesh.

The project which has been approved by the ethics committee and the Health Ministry screening committee, ICMR, Government of India will use the 'SMART Health India', an android-based app developed by The George Institute for Global Health in India with the support of Institute of Bio-Medical Engineering at Oxford University. The app records blood pressure, blood sugar levels and other heart disease risk factors like age, sex and smoking status, and analyses the data to indicate extent of cardiovascular disease (CVD) risk, based on which the person can consult a doctor for further treatment.

Part of the SMART Health project will kick off with a baseline study that will involve interviewers going from village to village and collecting data about the prevalence of cardiovascular diseases in 55 villages of the district. Over the past four days, these interviewers have been familiarizing themselves with the app so that they will be able to gather data on CVD risk for those who are above 40 years of age.

SMART Health is a low-cost high-quality healthcare delivery system that uses smartphone-based technologies, providing the healthcare worker with personalized clinical decision support to guide the Systematic Medical Appraisal Referral and Treatment (SMART) of individual patients," says Dr D Praveen, Senior Research Fellow, The George Institute India. In the pilot, we worked with Accredited Social Health Activists (ASHA) in villages who are familiar with the neighbourhood and who went from door to door, assessing their medical condition using the app. Based on the analysis and recommendations from the app, they refer patients to doctors or suggest precautionary measures," says Dr Praveen.

When the application was tested in 11 villages in the West Godavari district of the state, it not only tracked risk factors, but also addressed a mindset plaguing a large number of people - callousness towards health issues including even basic tests. "Before I was involved in the pilot, I did not know anything about diabetes or blood pressure control. Now I regularly get my blood pressure and sugar levels checked," says Marthamma, an ASHA worker from Ardhavanam village who is keen to participate in the larger research project.

The project has been funded by the National Health and Medical Research Council (NHMRC) through a call from Global Alliance for Chronic Diseases. "We are working out the modalities of the large-scale research project and we already have support from the Directorate of Public Health and Family Welfare of the Andhra Pradesh Government," said Kishor Mogulluru, Research Fellow, The George Institute India.

"This is an important program on non-communicable diseases and we welcome this development as this research output will be useful in the scaling up of NCD programs throughout the State and the country," mentioned in the letter of support issued by the State Nodal Officer, NCD programmes, Directorate of Public Health and Family Welfare.

The application follows a few simple processes. One key feature of the app is that the BP device is Bluetooth enabled and transfers readings to the app, which then calculates CVD risk, recommending lifestyle changes and alerting the patient for follow-up. Patient summary is also stored using the app for future reference. The app not only alerts the person for CVD risk over a 10-year period, but also has a risk projection meter, which presents a visual portrayal of the CVD risk depending on change in values of risk factors over time.

"The app also has a section recording lifestyle habits like smoking, alcohol consumption, extent of physical exercise etc. Whenever the history of smoking for a person who is being screened is recorded, the needle of the 'risk-meter' dial moves in an area marked orange and an automatic prompt to advice the participant on healthy lifestyle changes including smoking cessation is generated," said Dr Praveen, giving an example.

The way the app works, it will help save time of available doctors as the basic screening protocol has been conducted by the health worker, and the doctor does not have to record these basic heart health risks. "The information from the app is automatically transmitted to a remote server and then to the doctor in the nearest primary health center. If the app flashes a high risk sign, ASHA workers refers patient to the nearest primary health center for the doctor there to act. "We have trained ASHA workers who are married into the village so that they do not leave the village and are easily connected with locals," said M Ameer, Project Manager, The George Institute India who was involved in the training procedure.

Originally, SMART Health was developed for the management of cardiovascular disease, but now The George Institute is planning to branch out to include other chronic diseases such as diabetes and other illnesses such as kidney disease, respiratory disease, and tuberculosis.

"Our ultimate goal is to determine whether this approach will deliver meaningful reductions in death, disability and 'catastrophic' healthcare expenditure (ie healthcare costs that endanger the financial security of patients and their families) across a range of geographies and cultures. We believe that such evidence will provide a strong case for scale-up to all disadvantaged communities in the region and many other parts of the world, with implications for the health and wellbeing of billions of people," says Dr Praveen.