Sunday, March 8, 2009 at 6:21PM Specialized hardware vs SMS, you be the judge
The Neurosynatpic ReMeDi MDAU (Multi-parameter Data Acquisition Unit) telemedicine tool assesses critical diagnostic services measurements and prepares them for transmission back to a clinic or hospital. The diagnoses provided are:
- Electro-Cardiogram (ECG)
- Blood pressure
- Oximeter (your blood's oxygen saturation level)
- Auscultation (what a stethoscope tells you)
- Temperature
- Heart rate
ReMeDi, the basic version, is designed for use, at least theoretically, in village kiosks such as those provided by nLogue. Cost is about US $250. ReMeDi, plugged into an n-Logue computer or someone else's hardware, is probeware.
By delivering diagnostic services in villages that don't have doctors, ReMeDi at least potentially saves villagers the costs and lost opportunities of traveling to towns or cities when they need to see doctors. (And if you're making the benchmark, $2 per day, you would: a) like to work as many days as possible; b) prefer not spending money when you don't need to.) So ReMeDi has some potential to improve morbidity rates (e.g., general health-related suffering) and cut end-user healthcare costs. ReMeDi also has the potential to increase revenues among early-adopter physicians and, of equal importance, deliver a bit of a revenue stream to the n-Logue. (Prof. Ashok JhunJhunwala, god-father of n-Logue, is also among the guiding lights of NeuroSynaptic.)
Now, I tend to argue that there's room for all kinds of solutions in the big tent of technology-for-development. (I mean, technology covers a lot, from pencils I suppose to robotic arms.) But in keeping with a flurry of information about telemedicine, it's interesting to compare the NeuroSynaptic approach to the effective use of SMS (Short Messaging Service) by healthcare-related NGOs in Africa, India and elsewhere.
SMS supports cheap one-way and two-way communication among healthcare providers and patients. It's been used to build HIV/AIDS awareness, (Text to Change, Uganda),
support and track drug-regimen compliance (the SIMpill medical adherence system is one among many), as well as to support diagnostic-and-treatment programs.
ReMeDi is low-cost, but the ability of Neurosynaptic to continue to offer the product requires 10s of 1,000s of kiosk operators and other providers of rural Internet access to offer the product and service and, critically, make money by doing so. (it's a bit hard for me to grasp the means by which kiosk operators connect to providers of diagnoses and medicines.) ReMeDi is state of the art, but it's only as effective as the training that the kiosk operator receives and his (her) ability to market the ReMeDi service. (In the pilot test supported by IDRC, an initial stream of users shrank to a trickle, possibly because the kiosk operators failed to operate the ReMeDi device effectively.)
ReMeDi, in its state-of-the-art-ness and its robustness, creates challenges in relation to training, asymmetrical partnership-building, and supply chain. (If the patient has to travel to get the prescription, her initial savings in avoiding a doctor visit are lost.)
SMS creates challenges based on the simplicity of the communication medium. Short text, no media. There's a bit of work involved in establishing broad- or narrow-cast message dissemination (although organizations like Frontline SMS are striving to reduce the work involved).
Most critically, ReMeDi requires several layers of inter-mediation, most noticeably by Neurosynaptic, by the kiosk-operating organization (n-Logue) and by the all-too-critical-and-all-too-unlikely-to-be-effective kiosk operator at the village level.
Again, it's not that these variant approaches exclude each other. But if I had a few dollars to support a scalable, sustainable, effective tool for reducing morbidity and/or mortality rates across a rural region, I would see what I could make happen with SMS and leave the more complex solutions for another player.
If I were prescription-drug manufacturer Rambaxi, however, I might look into ReMeDi as _part_ of a solution that included druggist-to-villager delivery of my products. That is, if someone else would fund hardware and connection for Internet access.
