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- Pages: 65
Jose Gomez-Marquez
1
IIH Global Health Device Development Model
APD provides a pathway to get the ideas to products.
Our community ecosystem is aimed at accelerating ideation and contributing distributed resources.
2
IIH Opportunity Sectors Vaccines Tech for disabilities
Mom and baby health Diagnostics
Therapy enhancements Surgical tools Personalized medical devices
Chronic conditions Appropriate Lab Instrumentation Information Systems
3
HLab IIH network of HLabs are an important part of our ability to produce world-‐
class medical technologies for developing world countries. Our access to rapid prototyping facilities, micro-‐machining, biomedical labs, software development clusters combined with the talented developers who run them make HLabs the new Menlo Park for Global Health.
MIT
Essential prototyping facilities 3 Machine Shops, 3-‐D Printers, Laser cutters, Machine Shops, Electronics,
Mobile technology
Outsource: partners, competitions, classes
Karachi Informatics, mobile technology, software
Managua
Laboratory testing and diagnostic co-‐development 2009 D-‐Lab Health impact 4
By the numbers 2 Years Old 12 collaborative country sites
Peru, Pakistan, Nicaragua, Guatemala, India, Ghana,
Nepal, Honduras, Tanzania, Venezuela, Ethiopia, Uganda
20+ PIs working across 7 fields 22 active technology projects 3 ongoing field trials
5
A Global Collaboration Footprint
6
80-‐90%
of all medical equipment in developing countries are secondhand
80%
fail in the first
6 months.
How We Measure the Impact Viability of our Solutions We have taken steps to identify the most important tensions that exist in appropriate biomedical technologies seen through the design lens. By mapping RESOURCE INVESTMENT and IMPACT along a X-Y spectrum, we can anticipate how appropriate our solution is against conventional approaches. We call this the Global Health Innovation Compass.
Resource Investment
Impact
Appropriate technology often requires a nuanced approach to design that combines simple solutions, elegant technologies and robust engineering to make technologies survive the rigors of the field. This often produces a highly tailored approach to each solution that is difficult to standardize across sectors and across individuals.
8
The Global Health Innovation Compass Affordable/ High Impact
Impact
Expensive/ High Impact
Investment & Resources
Affordable/ Low Appropriate Impact
Expensive/ Low Appropriate Impact 9
The Global Health Innovation Compass Affordable/ High Impact
Expensive/ High Impact
Our goal and strategy is to identify and work within catalyzing technologies (shown in purple arrows) that are able to take the capabilities of one paradigm state into the more Affordable and High Impact states. Sometimes, it may be a better mobile phone language that take the capabilities of a laptop computer into the portability of a mobile phone. Or perhaps, it may advanced digital microfluidics technology that takes the diagnostic capabilities only found into hospital, and transfers them to the field in a rugged, disposable device. Often it’s the combination of existing technologies that marry accuracy and portability into a distributed system.
Affordable/ Low Appropriate Impact
Expensive/ Low Appropriate Impact
A Focus on Applied Technology to get Products to Patients IIH provides researchers at MIT and other institutions to work on applied technology projects that have a real impact in the field. This requires a comprehensive look at the solution. The picture illustrates the value-chain of a microfluidic diagnostic product compared to the academic publishing opportunities. We recognize the opportunities to disseminate the research are important and we continue to pursue PRODUCT! those to advance the field. However, our group puts a premium on developing the concepts, prototypes, products, and dissemination strategy to get solutions to the healthcare arena. We accomplish this by working with stakeholders in the field on a daily basis. It keeps the timeline of our ideas aligned with the rapid pace of need in the field.
Source: LabChip, 2007, 7, 41–57 11
From Prototype to the Field IIH SafeTrial Through the IIH@ MIT SafeTrial program, we have the opportunity
to conduct clinical and engineering field trials in Tanzania, Nicaragua and Pakistan for member technologies. The IIH SafeTrial program allows the technology to be tested at a very low cost compared to traditional testing facilities under the direction of experienced public health professionals. This is an important distinction between IIH and other global health centers. Our ability to rapidly prototype concepts, take them to the field for data acquisition, and iterate provides a pathway in which we can show early results, adoption information, and market feasibility. This gets our designs closer to commercialization that our counterparts in other institutions. 12
Field Organizations for Technology Testing and Implementation Nicaragua (H-Lab Managua, MIT IIH)
Pakistan (H-Lab Karachi, MIT IIH)
13
Field Organizations for Technology Testing and Implementation Cambodia (Cambodian Health Committee): Siem-Riep Provincial Hospital Phnom Penh (2 sites: KSFH & Calmette) Takeo Provincial Hospital Svay Rieng Provincial Hospital
Indonesia (International Organization of Migration): Cut Nyak Dhien Hospital Community Clinics (Puskesmases)
14
Field Organizations for Technology Testing and Implementation Ethiopia (Global Health Committee): Addis Ababa
15
IIH Representative Technologies
16
Drug Delivery Aerovax The Aerovax System was designed as a go-anywhere inhalable drug and vaccine delivery technology designed for mass immunization of remote populations.
Diagnostics S.N.A.P
Simple Nucleic Acid Processing A field deployable DNA collection device. An IIH H-Lab team worked on a field deployable solution for Boston University researcher’s bench-based microfluidic sample collection tool that is now under further development by researchers MIT, Boston University, and designers in California and Ethiopia.
18
Diagnostics XoutTB
Patients who do not take their medications cost the American healthcare system $290 billion a year in increased medical spending. --- New England Healthcare Institute, August 2009
A Mobile-‐enabled diagnostic medication compliance platform A new penny-a-day test is ensuring adherence to Tuberculosis medications using a smart combination of mobile phones, diagnostics, and creative incentives.
19
Diagnostics XoutTB
Patients who do not take their medications cost the American healthcare system $290 billion a year in increased medical spending. --- New England Healthcare Institute, August 2009
A Mobile-‐enabled diagnostic medication compliance platform A new penny-a-day test is ensuring adherence to Tuberculosis medications using a smart combination of mobile phones, diagnostics, and creative incentives.
20
Diagnostics
Microfluidic System for Monitoring Sepsis at the Point-‐of-‐Care Dr. Catherine Klapperich, an Assistant Professor of Engineering at Boston University is an IIH affiliate and CIMIT-backed researcher. Need and Impact Sepsis is a systemic response to an infection that can be bacterial, viral, fungal or parasitic in origin and its diagnosis is based on patient’s history and presentationCurrent standard of care for sepsis require blood cultures that can take days to completeCurrent FDA approved “rapid tests” have reasonable sensitivity and specificity, but not the causative organism Solution and Innovation Develop rapid, point-of-care test to monitor sepsisQuantify nucleic acids in blood by combining novel microfluidic nucleic acid isolation with on-chip quantitative PCR Design assay to determine, in parallel, whether infection is bacterial (gram positive or gram negative) or fungal
21
Diagnostics
Microfluidic System for Monitoring Sepsis at the Point-‐of-‐Care
Jose Trevejo, MD, PhD, BIDMC and Preshious Rearden, PhD, Draper Need and ImpactTuberculosis (TB) remains a major public health problem worldwide with approximately 8 million new cases and >2 million deaths per yearMajor obstacle is the lack of point-of-care diagnostics for TB with high sensitivityNo real-time, reliable, inexpensive, portable detection deviceSolution and InnovationDevelop real-time volatile analysis system (breath analyzer) for TB detectionLeverage and apply novel differential mobility spectrometer that has a highly sensitive, portable gas sensors for detection at very low concentrationsWorld Healthcare Organization (WHO) supported ongoing clinical trials for TB
FAIMS Human Breath Tracing
22
Diagnostics
Microfluidic System for Monitoring Sepsis at the Point-‐of-‐Care Dr. Catherine Klapperich, an Assistant Professor of Engineering at Boston University is an IIH affiliate and CIMIT-backed researcher.
• Need and ImpactSepsis is a systemic response to an infection that can be bacterial, viral, fungal or parasitic in origin and its diagnosis is based on patient’s history and presentationCurrent standard of care for sepsis require blood cultures that can take days to completeCurrent FDA approved “rapid tests” have reasonable sensitivity and specificity, but not the causative organism Solution and Innovation Develop rapid, point-of-care test to monitor sepsisQuantify nucleic acids in blood by combining novel microfluidic nucleic acid isolation with on-chip quantitative PCR Design assay to determine, in parallel, whether infection is bacterial (gram positive or gram negative) or fungal
23
Maternal and Infant Health Car Parts Incubator Dr. Kristian Olson is the Program Leader for CIMIT’s Global Health Initiative and chief architect of the Car Parts Incubator project. Need and ImpactEach year over 4 million infants worldwide die within a month of birth due to pre-maturity, low birth weight and infectionConventional incubators designed for industrialized markets can cost over $30,00095% of donated medical equipment ends up broken within five years and unused due to lack of local training and repair Solution and InnovationBuild a lowcost, higher performing, safer and effective neonatal isolette for low-resource, rural settingsDesign and leverage readily locally available automotive partsDevelop and train to be operated, repaired and maintained with local human resource capacity
24
Cell-‐phone Based Vibrotactile Balance Visual Central Nervous System h"p://www.sensory-‐systems.ethz.ch
Ves=bular
h"p://www.infovisual.info/
Somatosensory
h"p://www.profeet.co.uk
Sensory Subs=tu=on
h"p://www.soulco.be
Vibrotac=le Electrotac=le Auditory 25
Cell-‐phone Based Vibrotactile Balance
Body motion is sensed and displayed to the user via vibrotactile cues to the torso Connect via Headphone Jack
External Tactors (Samsung)
iPhone features
- Tri-axial accelerometer - Visual display and Touch screen - Internal data storage - SDK development kit
Samsung smart phone Balance trainer with smart phone
- Support ubiquitous balance training device - Interface tactor driving hardware with 32 pin connector - Provide winCE operating system that enables to build embedded application software 26
Portable Biofeedback System
Battery Tactor (Samsung)
MCU
Main objectives
- Improve human motor function in patient populations with sensory and/or motor deficits - Support multiple patients via wireless or web-based manner - Provide clinical or motor learning tasks in physical therapy or sports training
6X5X3.5 cm 27
Global Health Design Research Noninvasive dehydration
detection
Approximates fluid loss on the order
of 1-‐2% dehydration by assessing radial pulse before and after supine to standing transition
Cell phone based maternal
health diagnostic platform Cell phone based patient symptom recognition and referral system
28
Portable Obstetrics Exam Table
James Bradshaw, Adam Gienapp, 29 Joseph Perosky, Rebecca Rabban
Traditional Male Circumcision Device
http://current.com/items/89197959/12yr_old_boy_circumcised_with_rusty_knife.htm
Decrease HIV transmission Increase safe outcomes of
circumcision
30
Kyle Lemmermen, Phillip Scott, Craig Spencer, Tom Van Wingen
Foldable Tricycle Attachment
31Tran Brian Holcomb, Alex Klonick, Michael Swift, and Michael
Fall 2009 Design Projects Low-‐cost mechanical CPAP machine
Water for the World integrated pump and water purification system Low-‐cost, low-‐tech blood pressure measurement device Surgical thoracotomy simulator Infant circumcision device Clean
32
IIH Design Strategies
33
How do we get there? Design Strategies
Hybridization Vintage Technologies + Smart Design/Tech = New Solutions Taking the improvisation and engineering solutions Bottom up observation Be trendsetting, not trendy Context shifting Distributed Systems Crowdsourcing 34
A little of the old, a little of the new
35
Hybridization Hybridization
+
Context Shifting
Vintage Technologies + Smart Design
Improvisation Design Coca Cola Spacer for Asthma Inhalers
A Rich Community
microfluidics
Collaboration and Diversity Tools Microfluidics Solar
Windows Mobile
Neonatal
J2MEE
Tuberculosis Pulse Ox
40
Our Community By the Numbers Nursing; 6% Public Health; 4% Industrial Design; 6% Biomedical Engineering; 6%
Physicians; 27%
Biomedical Research; 6% Business; 14% Electrical Engineering; 9%
Policy; 10%
Mechanical Engineering; 12%
41
IIH Global Health Technology: Healthcare Challenges Our Research Direction Collaboration Opportunities 42
IIH Global Health Technology: Healthcare Challenges Our Research Direction Collaboration Opportunities 43
The Next Challenges in Global Health Technology Oncology Diabetes
Diagnostics Imaging Solutions
Telemedicine Medical Simulation Rehabilitation and Personalized Orthodics
44
Oncology | Challenges Cancer now kills more people in developing
countries than HIV, TB and malaria combined.
Key Drivers:
Longer life expectancy -‐-‐ cancer risks rises
as one ages
Adoption of modern lifestyles (smoking,
drinking, sedentary lifestyles couples with diets high in fast and sugar)
Lack of early detection for cancers related
to infection, such as human papillomavirus (HPV), which is linked to cervical and colourectal tumours 45
Oncology | Opportunities
There is a clear opportunity for applications for early diagnosis, treatment, and palliative care of cancer in the developing world. In addition to research opportunities, the field is largely untapped as a business opportunity since most cancer patients constitute the driving force, the working professional class, of developing world economies. The lack of adequate treatments fosters regional medical tourism afforded only to the wealthy.
Area of Care
Radiotherapy
Imaging
Opportunity
Technological Drivers
The Programme of Action for Cancer Therapy is rapidly expanding conventional radiation treatment and imaging devices to select pilot sites in the developing world. More than 75% of cancer patients in low and middle income countries have Development of smaller, portable radiotherapy units could decentralize access to radiotherapy access to radiotherapy treatment and make it available in more remote geographies. Advances such as ion-‐induced nuclear radiotherapy could prove pivotal is combined with appropriate technological design . According to the World Health Organization, two thirds of the world's population has little or no access to basic diagnostic X-‐ray services. This has a major impact in early detection of cancers which could improve survival outcomes.
The Programme of Action for Cancer Therapy is rapidly expanding conventional radiation treatment and imaging devices to select pilot sites in the developing world. Development of smaller, portable radiotherapy units could decentralize access to radiotherapy and make it available in more remote geographies. Advances such as ion-‐induced nuclear radiotherapy could prove pivotal is combined with appropriate technological design.
46
Diabetes | Challenges
WHO predicts that developing countries will bear the brunt of this epidemic in the 21st century, with 80% of all new cases of diabetes expected to appear in the developing countries by 2025.
Diabetes is increasing faster in the world's developing economies than in developed countries. Seven out of ten countries with the highest number of people living with diabetes are in the developing world. With an estimated 35 million people with diabetes, India has the world's largest diabetes population.
Diabetes is a silent epidemic that claims as many lives each year as HIV/AIDS. In 2007, diabetes will cause 3.5 million deaths globally.
If present trends persist, by 2025 the majority of people with diabetes in the developing countries will be in the 45-64 age group.
47
Diabetes | Opportunities
Diabetes is a multi-sided healthcare burden that offers many opportunities for impact. Although prevention is ideal, treatment is needed for those who have already developed this chronic condition. We see opportunities in affordable management and monitoring, insulin delivery systems, and secondary disease management (diabetic wound care, prosthesis, eye care).
Area of Care
Management and Monitoring
Insulin Delivery Systems
Opportunity
Technological Drivers
We have opted to pursue colormetric based assays for collerating Traditional glucometers fail to gain traction in glucose levels. They are more affordable that traditional electrochemical glucose readers and offer tigher integration with developing world markets because the mobile phone technology. Futhermore, we see opportunities in business model is not adequate. Patients community based testing stations simliar to ATM machines. IIH is cannot afford the test strips even if the exploring one such design called the Glucovend that encapsulates all glucometer is given freely to them. the testing and diagnostic technology in a credit-‐card size form factor. IIH has designed a series of affordable nebulization and inhalation devices that could bridge the gap between developing world According to the British Medical Jounal, only populations and novel inhalable therapeutics such as aerosol insulin. about 36% of small towns in the developing Options like these are already in the field such as Oralyn insulin being delivered through oral inhalation in Ecuador (not IIH affiliated). world have reliable access to insulin. Furthermore, syringes remain the preferred choice for insulin delivery, but provide many downsides to public health (80% of all syringes in the developing world are misused leading to 2.5 MM Hepatitis cases and up 250,000 cases of HIV infection)
48
Imaging | Challenges
According to the World Health Organization, two thirds of the world's population has little or no access to basic diagnostic X-ray services. Additionally, the World Health Organization estimates that there is a need for one diagnostic imaging system for every 50,000 people. Medical imaging services are needed for the diagnosis and management of medical conditions such as trauma, chest disease (including tuberculosis), and abdominal ailments.
Despite decades of efforts aimed at addressing the problem of limited access to diagnostic imaging, little progress has been made. A key reason for this has been the lack of coordination in efforts and funding for sustainable deployment of the affordable technology that exists. Infrastructure needs to be created to include support for these critical components, while utilizing more modern and advanced imaging technology.
http://www.healthcareitnews.com/news/new-partnership-give-developing-countries-access-diagnostic-imaging-systems World Health Imaging Alliance Society for Imaging Informatics in Medicine
49
Imaging | Opportunities
There is a clear opportunity for applications for early diagnosis, treatment, and palliative care of cancer in the developing world. In addition to research opportunities, the field is largely untapped as a business opportunity since most cancer patients constitute the driving force, the working professional class, of developing world economies. The lack of adequate treatments fosters regional medical tourism afforded only to the wealthy.
Area of Care
Opportunity
Technological Drivers
X-‐Rays
More than 75% of cancer patients in low and middle income countries have access to radiotherapy treatment
Digital X-‐Ray technology is currently being developed by researchers with endurance, multi-‐ purpose, and affordability in mind.
Ultrasound
Ultrasound imaging offers major benefit in antenatal care. Thorough studies at a global scale have never been completed. Qualitative data with field partners and select publications point to the imaging approach as a
New technologies, such as the M-‐Turbo system developed by Sonosite in Seattle, can help improve access to ultrasound services. Ultrasound images and data are stored on a USB flash memory stick and can later be exported to a computer or server.
Specialty practitioners such as radiologists, cardiologists and Diagnostic Telemedicine pathologists are largely unavailable in rural areas due to “internal brain drain”
The growing availability of broadband mobile connections, cached data links, and distributed data connectivity provides a solid platform for telemedical consults. IIH companies such as ClickDiagnostics and Moca Mobile are providing important telemedicine services to bridge the gap between rural patients and knowledagable specilaists in eye care, dermatology, oncology, and maternal health.
50
IIH Global Health Technology: Healthcare Challenges Our Research Direction Collaboration Opportunities 51
Click Diagnostics
52
Cough Tracker
53
RFID Symptom/Disease Navigator
54
Lab-‐in-‐a-‐Box
55
BioMagnetic Diagnostics
56
Mobile Health | Population Counting Signs of life
Can roll out in specific numbers of “Grids” and then improve confidence of statistical estimation. 57
Mobile Health | Population Counting
58
Mobile Health | Diagnostic Accessories
59
Rural Health Informatics Large health inequity seen in
Latin America Rural
poor are 5x more likely to die before 60 than non-poor1 Financing of rural health systems has decreased proportionally
Technology can be implemented and
improve health care in rural settings Partners
In Health (Peru,2 Rwanda, …)
Villages Project (10 countries) Public HIV and TB programs in Brasil3 Millenium
1. Casas JA et al Health Disparities in Latin American and the Caribbean, PAHO, 2001 2. Fraser HSF et al Evaluating the impact and costs of deploying an electronic medical record system to support TB treatment in Peru, Proc. AMIA, 2006 3. Costa AL, de Oliveira MM, Machado Rde O. An information system for drug prescription and distribution in a public hospital. Int J Med Inform, 2004 Courtesy of Partners In Health 60
Medical Informatics| Rural Outreach OpenMRS, web-based open source
EMR platform Implemented
in over 17 countries
Sponsored
by Google, WHO, Rockefeller Foundation, Harvard Specially designed for rural settings Works with or without internet Easily installed and modified Incorporated as part of larger training and development initiative
GPRS
CommCare phone based system for providing care Implements clinical algorithms and forms Can connect remote health workers to health center Cell
61
IIH Global Health Technology: Healthcare Challenges Our Research Direction Collaboration Opportunities 62
IIH is an Ecosystem of Collaboration with MIT as a Host
Our members are embedded in world class organizations willing to collaborate and provide field insight 63
Collaboration Opportunities • D-‐Lab sponsorship opportunities • Academic and scholarly exchanges • Conference and Lecture opportunities
• Support MIT students and investigators in deploying, designing, and testing new medical device technologies for global health
• Engage Samsung engineers and designers to engage IIH researchers and their students to integrate Samsung technologies into current and future projects. • Firmware assistance • Korean fabrication opportunities
Research Fellowships
Academics
• Map current IIH initiatives against Samsung research, business, and corporate social responsibility directions • Provide appropriate technology analysis to Samsung ideas and projects
• Investigate field opportunities and demand for joint projects through our network of collaborators in developing countries • Launch engineering field trials for products
Research Alignment
Field R&D and Deployment
64
More Information Jose Gomez-Marquez
Program Director
[email protected]
617.674.7516
MIT
32 Carlton Street, Building e34
Cambridge, MA
65
1
IIH Global Health Device Development Model
APD provides a pathway to get the ideas to products.
Our community ecosystem is aimed at accelerating ideation and contributing distributed resources.
2
IIH Opportunity Sectors Vaccines Tech for disabilities
Mom and baby health Diagnostics
Therapy enhancements Surgical tools Personalized medical devices
Chronic conditions Appropriate Lab Instrumentation Information Systems
3
HLab IIH network of HLabs are an important part of our ability to produce world-‐
class medical technologies for developing world countries. Our access to rapid prototyping facilities, micro-‐machining, biomedical labs, software development clusters combined with the talented developers who run them make HLabs the new Menlo Park for Global Health.
MIT
Essential prototyping facilities 3 Machine Shops, 3-‐D Printers, Laser cutters, Machine Shops, Electronics,
Mobile technology
Outsource: partners, competitions, classes
Karachi Informatics, mobile technology, software
Managua
Laboratory testing and diagnostic co-‐development 2009 D-‐Lab Health impact 4
By the numbers 2 Years Old 12 collaborative country sites
Peru, Pakistan, Nicaragua, Guatemala, India, Ghana,
Nepal, Honduras, Tanzania, Venezuela, Ethiopia, Uganda
20+ PIs working across 7 fields 22 active technology projects 3 ongoing field trials
5
A Global Collaboration Footprint
6
80-‐90%
of all medical equipment in developing countries are secondhand
80%
fail in the first
6 months.
How We Measure the Impact Viability of our Solutions We have taken steps to identify the most important tensions that exist in appropriate biomedical technologies seen through the design lens. By mapping RESOURCE INVESTMENT and IMPACT along a X-Y spectrum, we can anticipate how appropriate our solution is against conventional approaches. We call this the Global Health Innovation Compass.
Resource Investment
Impact
Appropriate technology often requires a nuanced approach to design that combines simple solutions, elegant technologies and robust engineering to make technologies survive the rigors of the field. This often produces a highly tailored approach to each solution that is difficult to standardize across sectors and across individuals.
8
The Global Health Innovation Compass Affordable/ High Impact
Impact
Expensive/ High Impact
Investment & Resources
Affordable/ Low Appropriate Impact
Expensive/ Low Appropriate Impact 9
The Global Health Innovation Compass Affordable/ High Impact
Expensive/ High Impact
Our goal and strategy is to identify and work within catalyzing technologies (shown in purple arrows) that are able to take the capabilities of one paradigm state into the more Affordable and High Impact states. Sometimes, it may be a better mobile phone language that take the capabilities of a laptop computer into the portability of a mobile phone. Or perhaps, it may advanced digital microfluidics technology that takes the diagnostic capabilities only found into hospital, and transfers them to the field in a rugged, disposable device. Often it’s the combination of existing technologies that marry accuracy and portability into a distributed system.
Affordable/ Low Appropriate Impact
Expensive/ Low Appropriate Impact
A Focus on Applied Technology to get Products to Patients IIH provides researchers at MIT and other institutions to work on applied technology projects that have a real impact in the field. This requires a comprehensive look at the solution. The picture illustrates the value-chain of a microfluidic diagnostic product compared to the academic publishing opportunities. We recognize the opportunities to disseminate the research are important and we continue to pursue PRODUCT! those to advance the field. However, our group puts a premium on developing the concepts, prototypes, products, and dissemination strategy to get solutions to the healthcare arena. We accomplish this by working with stakeholders in the field on a daily basis. It keeps the timeline of our ideas aligned with the rapid pace of need in the field.
Source: LabChip, 2007, 7, 41–57 11
From Prototype to the Field IIH SafeTrial Through the IIH@ MIT SafeTrial program, we have the opportunity
to conduct clinical and engineering field trials in Tanzania, Nicaragua and Pakistan for member technologies. The IIH SafeTrial program allows the technology to be tested at a very low cost compared to traditional testing facilities under the direction of experienced public health professionals. This is an important distinction between IIH and other global health centers. Our ability to rapidly prototype concepts, take them to the field for data acquisition, and iterate provides a pathway in which we can show early results, adoption information, and market feasibility. This gets our designs closer to commercialization that our counterparts in other institutions. 12
Field Organizations for Technology Testing and Implementation Nicaragua (H-Lab Managua, MIT IIH)
Pakistan (H-Lab Karachi, MIT IIH)
13
Field Organizations for Technology Testing and Implementation Cambodia (Cambodian Health Committee): Siem-Riep Provincial Hospital Phnom Penh (2 sites: KSFH & Calmette) Takeo Provincial Hospital Svay Rieng Provincial Hospital
Indonesia (International Organization of Migration): Cut Nyak Dhien Hospital Community Clinics (Puskesmases)
14
Field Organizations for Technology Testing and Implementation Ethiopia (Global Health Committee): Addis Ababa
15
IIH Representative Technologies
16
Drug Delivery Aerovax The Aerovax System was designed as a go-anywhere inhalable drug and vaccine delivery technology designed for mass immunization of remote populations.
Diagnostics S.N.A.P
Simple Nucleic Acid Processing A field deployable DNA collection device. An IIH H-Lab team worked on a field deployable solution for Boston University researcher’s bench-based microfluidic sample collection tool that is now under further development by researchers MIT, Boston University, and designers in California and Ethiopia.
18
Diagnostics XoutTB
Patients who do not take their medications cost the American healthcare system $290 billion a year in increased medical spending. --- New England Healthcare Institute, August 2009
A Mobile-‐enabled diagnostic medication compliance platform A new penny-a-day test is ensuring adherence to Tuberculosis medications using a smart combination of mobile phones, diagnostics, and creative incentives.
19
Diagnostics XoutTB
Patients who do not take their medications cost the American healthcare system $290 billion a year in increased medical spending. --- New England Healthcare Institute, August 2009
A Mobile-‐enabled diagnostic medication compliance platform A new penny-a-day test is ensuring adherence to Tuberculosis medications using a smart combination of mobile phones, diagnostics, and creative incentives.
20
Diagnostics
Microfluidic System for Monitoring Sepsis at the Point-‐of-‐Care Dr. Catherine Klapperich, an Assistant Professor of Engineering at Boston University is an IIH affiliate and CIMIT-backed researcher. Need and Impact Sepsis is a systemic response to an infection that can be bacterial, viral, fungal or parasitic in origin and its diagnosis is based on patient’s history and presentationCurrent standard of care for sepsis require blood cultures that can take days to completeCurrent FDA approved “rapid tests” have reasonable sensitivity and specificity, but not the causative organism Solution and Innovation Develop rapid, point-of-care test to monitor sepsisQuantify nucleic acids in blood by combining novel microfluidic nucleic acid isolation with on-chip quantitative PCR Design assay to determine, in parallel, whether infection is bacterial (gram positive or gram negative) or fungal
21
Diagnostics
Microfluidic System for Monitoring Sepsis at the Point-‐of-‐Care
Jose Trevejo, MD, PhD, BIDMC and Preshious Rearden, PhD, Draper Need and ImpactTuberculosis (TB) remains a major public health problem worldwide with approximately 8 million new cases and >2 million deaths per yearMajor obstacle is the lack of point-of-care diagnostics for TB with high sensitivityNo real-time, reliable, inexpensive, portable detection deviceSolution and InnovationDevelop real-time volatile analysis system (breath analyzer) for TB detectionLeverage and apply novel differential mobility spectrometer that has a highly sensitive, portable gas sensors for detection at very low concentrationsWorld Healthcare Organization (WHO) supported ongoing clinical trials for TB
FAIMS Human Breath Tracing
22
Diagnostics
Microfluidic System for Monitoring Sepsis at the Point-‐of-‐Care Dr. Catherine Klapperich, an Assistant Professor of Engineering at Boston University is an IIH affiliate and CIMIT-backed researcher.
• Need and ImpactSepsis is a systemic response to an infection that can be bacterial, viral, fungal or parasitic in origin and its diagnosis is based on patient’s history and presentationCurrent standard of care for sepsis require blood cultures that can take days to completeCurrent FDA approved “rapid tests” have reasonable sensitivity and specificity, but not the causative organism Solution and Innovation Develop rapid, point-of-care test to monitor sepsisQuantify nucleic acids in blood by combining novel microfluidic nucleic acid isolation with on-chip quantitative PCR Design assay to determine, in parallel, whether infection is bacterial (gram positive or gram negative) or fungal
23
Maternal and Infant Health Car Parts Incubator Dr. Kristian Olson is the Program Leader for CIMIT’s Global Health Initiative and chief architect of the Car Parts Incubator project. Need and ImpactEach year over 4 million infants worldwide die within a month of birth due to pre-maturity, low birth weight and infectionConventional incubators designed for industrialized markets can cost over $30,00095% of donated medical equipment ends up broken within five years and unused due to lack of local training and repair Solution and InnovationBuild a lowcost, higher performing, safer and effective neonatal isolette for low-resource, rural settingsDesign and leverage readily locally available automotive partsDevelop and train to be operated, repaired and maintained with local human resource capacity
24
Cell-‐phone Based Vibrotactile Balance Visual Central Nervous System h"p://www.sensory-‐systems.ethz.ch
Ves=bular
h"p://www.infovisual.info/
Somatosensory
h"p://www.profeet.co.uk
Sensory Subs=tu=on
h"p://www.soulco.be
Vibrotac=le Electrotac=le Auditory 25
Cell-‐phone Based Vibrotactile Balance
Body motion is sensed and displayed to the user via vibrotactile cues to the torso Connect via Headphone Jack
External Tactors (Samsung)
iPhone features
- Tri-axial accelerometer - Visual display and Touch screen - Internal data storage - SDK development kit
Samsung smart phone Balance trainer with smart phone
- Support ubiquitous balance training device - Interface tactor driving hardware with 32 pin connector - Provide winCE operating system that enables to build embedded application software 26
Portable Biofeedback System
Battery Tactor (Samsung)
MCU
Main objectives
- Improve human motor function in patient populations with sensory and/or motor deficits - Support multiple patients via wireless or web-based manner - Provide clinical or motor learning tasks in physical therapy or sports training
6X5X3.5 cm 27
Global Health Design Research Noninvasive dehydration
detection
Approximates fluid loss on the order
of 1-‐2% dehydration by assessing radial pulse before and after supine to standing transition
Cell phone based maternal
health diagnostic platform Cell phone based patient symptom recognition and referral system
28
Portable Obstetrics Exam Table
James Bradshaw, Adam Gienapp, 29 Joseph Perosky, Rebecca Rabban
Traditional Male Circumcision Device
http://current.com/items/89197959/12yr_old_boy_circumcised_with_rusty_knife.htm
Decrease HIV transmission Increase safe outcomes of
circumcision
30
Kyle Lemmermen, Phillip Scott, Craig Spencer, Tom Van Wingen
Foldable Tricycle Attachment
31Tran Brian Holcomb, Alex Klonick, Michael Swift, and Michael
Fall 2009 Design Projects Low-‐cost mechanical CPAP machine
Water for the World integrated pump and water purification system Low-‐cost, low-‐tech blood pressure measurement device Surgical thoracotomy simulator Infant circumcision device Clean
32
IIH Design Strategies
33
How do we get there? Design Strategies
Hybridization Vintage Technologies + Smart Design/Tech = New Solutions Taking the improvisation and engineering solutions Bottom up observation Be trendsetting, not trendy Context shifting Distributed Systems Crowdsourcing 34
A little of the old, a little of the new
35
Hybridization Hybridization
+
Context Shifting
Vintage Technologies + Smart Design
Improvisation Design Coca Cola Spacer for Asthma Inhalers
A Rich Community
microfluidics
Collaboration and Diversity Tools Microfluidics Solar
Windows Mobile
Neonatal
J2MEE
Tuberculosis Pulse Ox
40
Our Community By the Numbers Nursing; 6% Public Health; 4% Industrial Design; 6% Biomedical Engineering; 6%
Physicians; 27%
Biomedical Research; 6% Business; 14% Electrical Engineering; 9%
Policy; 10%
Mechanical Engineering; 12%
41
IIH Global Health Technology: Healthcare Challenges Our Research Direction Collaboration Opportunities 42
IIH Global Health Technology: Healthcare Challenges Our Research Direction Collaboration Opportunities 43
The Next Challenges in Global Health Technology Oncology Diabetes
Diagnostics Imaging Solutions
Telemedicine Medical Simulation Rehabilitation and Personalized Orthodics
44
Oncology | Challenges Cancer now kills more people in developing
countries than HIV, TB and malaria combined.
Key Drivers:
Longer life expectancy -‐-‐ cancer risks rises
as one ages
Adoption of modern lifestyles (smoking,
drinking, sedentary lifestyles couples with diets high in fast and sugar)
Lack of early detection for cancers related
to infection, such as human papillomavirus (HPV), which is linked to cervical and colourectal tumours 45
Oncology | Opportunities
There is a clear opportunity for applications for early diagnosis, treatment, and palliative care of cancer in the developing world. In addition to research opportunities, the field is largely untapped as a business opportunity since most cancer patients constitute the driving force, the working professional class, of developing world economies. The lack of adequate treatments fosters regional medical tourism afforded only to the wealthy.
Area of Care
Radiotherapy
Imaging
Opportunity
Technological Drivers
The Programme of Action for Cancer Therapy is rapidly expanding conventional radiation treatment and imaging devices to select pilot sites in the developing world. More than 75% of cancer patients in low and middle income countries have Development of smaller, portable radiotherapy units could decentralize access to radiotherapy access to radiotherapy treatment and make it available in more remote geographies. Advances such as ion-‐induced nuclear radiotherapy could prove pivotal is combined with appropriate technological design . According to the World Health Organization, two thirds of the world's population has little or no access to basic diagnostic X-‐ray services. This has a major impact in early detection of cancers which could improve survival outcomes.
The Programme of Action for Cancer Therapy is rapidly expanding conventional radiation treatment and imaging devices to select pilot sites in the developing world. Development of smaller, portable radiotherapy units could decentralize access to radiotherapy and make it available in more remote geographies. Advances such as ion-‐induced nuclear radiotherapy could prove pivotal is combined with appropriate technological design.
46
Diabetes | Challenges
WHO predicts that developing countries will bear the brunt of this epidemic in the 21st century, with 80% of all new cases of diabetes expected to appear in the developing countries by 2025.
Diabetes is increasing faster in the world's developing economies than in developed countries. Seven out of ten countries with the highest number of people living with diabetes are in the developing world. With an estimated 35 million people with diabetes, India has the world's largest diabetes population.
Diabetes is a silent epidemic that claims as many lives each year as HIV/AIDS. In 2007, diabetes will cause 3.5 million deaths globally.
If present trends persist, by 2025 the majority of people with diabetes in the developing countries will be in the 45-64 age group.
47
Diabetes | Opportunities
Diabetes is a multi-sided healthcare burden that offers many opportunities for impact. Although prevention is ideal, treatment is needed for those who have already developed this chronic condition. We see opportunities in affordable management and monitoring, insulin delivery systems, and secondary disease management (diabetic wound care, prosthesis, eye care).
Area of Care
Management and Monitoring
Insulin Delivery Systems
Opportunity
Technological Drivers
We have opted to pursue colormetric based assays for collerating Traditional glucometers fail to gain traction in glucose levels. They are more affordable that traditional electrochemical glucose readers and offer tigher integration with developing world markets because the mobile phone technology. Futhermore, we see opportunities in business model is not adequate. Patients community based testing stations simliar to ATM machines. IIH is cannot afford the test strips even if the exploring one such design called the Glucovend that encapsulates all glucometer is given freely to them. the testing and diagnostic technology in a credit-‐card size form factor. IIH has designed a series of affordable nebulization and inhalation devices that could bridge the gap between developing world According to the British Medical Jounal, only populations and novel inhalable therapeutics such as aerosol insulin. about 36% of small towns in the developing Options like these are already in the field such as Oralyn insulin being delivered through oral inhalation in Ecuador (not IIH affiliated). world have reliable access to insulin. Furthermore, syringes remain the preferred choice for insulin delivery, but provide many downsides to public health (80% of all syringes in the developing world are misused leading to 2.5 MM Hepatitis cases and up 250,000 cases of HIV infection)
48
Imaging | Challenges
According to the World Health Organization, two thirds of the world's population has little or no access to basic diagnostic X-ray services. Additionally, the World Health Organization estimates that there is a need for one diagnostic imaging system for every 50,000 people. Medical imaging services are needed for the diagnosis and management of medical conditions such as trauma, chest disease (including tuberculosis), and abdominal ailments.
Despite decades of efforts aimed at addressing the problem of limited access to diagnostic imaging, little progress has been made. A key reason for this has been the lack of coordination in efforts and funding for sustainable deployment of the affordable technology that exists. Infrastructure needs to be created to include support for these critical components, while utilizing more modern and advanced imaging technology.
http://www.healthcareitnews.com/news/new-partnership-give-developing-countries-access-diagnostic-imaging-systems World Health Imaging Alliance Society for Imaging Informatics in Medicine
49
Imaging | Opportunities
There is a clear opportunity for applications for early diagnosis, treatment, and palliative care of cancer in the developing world. In addition to research opportunities, the field is largely untapped as a business opportunity since most cancer patients constitute the driving force, the working professional class, of developing world economies. The lack of adequate treatments fosters regional medical tourism afforded only to the wealthy.
Area of Care
Opportunity
Technological Drivers
X-‐Rays
More than 75% of cancer patients in low and middle income countries have access to radiotherapy treatment
Digital X-‐Ray technology is currently being developed by researchers with endurance, multi-‐ purpose, and affordability in mind.
Ultrasound
Ultrasound imaging offers major benefit in antenatal care. Thorough studies at a global scale have never been completed. Qualitative data with field partners and select publications point to the imaging approach as a
New technologies, such as the M-‐Turbo system developed by Sonosite in Seattle, can help improve access to ultrasound services. Ultrasound images and data are stored on a USB flash memory stick and can later be exported to a computer or server.
Specialty practitioners such as radiologists, cardiologists and Diagnostic Telemedicine pathologists are largely unavailable in rural areas due to “internal brain drain”
The growing availability of broadband mobile connections, cached data links, and distributed data connectivity provides a solid platform for telemedical consults. IIH companies such as ClickDiagnostics and Moca Mobile are providing important telemedicine services to bridge the gap between rural patients and knowledagable specilaists in eye care, dermatology, oncology, and maternal health.
50
IIH Global Health Technology: Healthcare Challenges Our Research Direction Collaboration Opportunities 51
Click Diagnostics
52
Cough Tracker
53
RFID Symptom/Disease Navigator
54
Lab-‐in-‐a-‐Box
55
BioMagnetic Diagnostics
56
Mobile Health | Population Counting Signs of life
Can roll out in specific numbers of “Grids” and then improve confidence of statistical estimation. 57
Mobile Health | Population Counting
58
Mobile Health | Diagnostic Accessories
59
Rural Health Informatics Large health inequity seen in
Latin America Rural
poor are 5x more likely to die before 60 than non-poor1 Financing of rural health systems has decreased proportionally
Technology can be implemented and
improve health care in rural settings Partners
In Health (Peru,2 Rwanda, …)
Villages Project (10 countries) Public HIV and TB programs in Brasil3 Millenium
1. Casas JA et al Health Disparities in Latin American and the Caribbean, PAHO, 2001 2. Fraser HSF et al Evaluating the impact and costs of deploying an electronic medical record system to support TB treatment in Peru, Proc. AMIA, 2006 3. Costa AL, de Oliveira MM, Machado Rde O. An information system for drug prescription and distribution in a public hospital. Int J Med Inform, 2004 Courtesy of Partners In Health 60
Medical Informatics| Rural Outreach OpenMRS, web-based open source
EMR platform Implemented
in over 17 countries
Sponsored
by Google, WHO, Rockefeller Foundation, Harvard Specially designed for rural settings Works with or without internet Easily installed and modified Incorporated as part of larger training and development initiative
GPRS
CommCare phone based system for providing care Implements clinical algorithms and forms Can connect remote health workers to health center Cell
61
IIH Global Health Technology: Healthcare Challenges Our Research Direction Collaboration Opportunities 62
IIH is an Ecosystem of Collaboration with MIT as a Host
Our members are embedded in world class organizations willing to collaborate and provide field insight 63
Collaboration Opportunities • D-‐Lab sponsorship opportunities • Academic and scholarly exchanges • Conference and Lecture opportunities
• Support MIT students and investigators in deploying, designing, and testing new medical device technologies for global health
• Engage Samsung engineers and designers to engage IIH researchers and their students to integrate Samsung technologies into current and future projects. • Firmware assistance • Korean fabrication opportunities
Research Fellowships
Academics
• Map current IIH initiatives against Samsung research, business, and corporate social responsibility directions • Provide appropriate technology analysis to Samsung ideas and projects
• Investigate field opportunities and demand for joint projects through our network of collaborators in developing countries • Launch engineering field trials for products
Research Alignment
Field R&D and Deployment
64
More Information Jose Gomez-Marquez
Program Director
[email protected]
617.674.7516
MIT
32 Carlton Street, Building e34
Cambridge, MA
65
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