Operation ASHA’s eCompliance system is an innovative solution, allowing us to track every dose taken each of our 76,089 patients. This is the most essential tool we use to follow our patients through the difficult treatment regimen prescribed under DOTS. The DOTS TB regimen (as prescribed by the WHO) requires patients to take up to 75 scheduled doses under direct observation, and normally lasts six to eight months (MDR and XDR cases can last up to 27 months). With such a stringent and long term treatment regimen, there is no room for human error — that is where eCompliance helps Operation ASHA.
eCompliance software is loaded on a low-cost seven inch tablet equipped with a SIM card and fingerprint/iris scanner. The SIM card enables the tablet to sync to our servers in the cloud every twenty minutes. If there is not a reliable internet connection when the patient takes their dose, the system still records the information, syncing it to the cloud server as soon as possible.
The eCompliance app tracks every activity required to deliver high quality TB treatment. In order to register a patient into eCompliance, providers input the patient’s fingerprints, medical/TB history, other background information, and preferred schedule of treatment (Monday, Wednesday, Friday or Tuesday, Thursday, Saturday).
Once a patient is registered into the system with their fingerprints, eCompliance prompts the provider to carry out pre-treatment counselling and to administer the first dose of TB medications. For every dose a patient takes, both the provider and the patient must scan their finger into the app, generating irrevocable evidence that the meeting took place, every time, and the medicine was taken under observation.
If a dose is missed, eCompliance issues an SMS alert to the patient, health worker, and his supervisor. The health worker has to meet the patient within 24-48 hours, provide further counseling, deliver the dose and ensure that the patient re-joins the therapy. This meeting is also evidenced with a finger print. Thus, no fudging or manipulation can take place. This helps achieve a very high adherence and treatment success rate.
eCompliance has been implemented for 28,740 TB patients so far in India, Cambodia, Uganda, Dominican Republic and Kenya. It has already recorded over 776,112 transactions. 139 eCompliance units are now functional.
Discussions are continuing with many other organizations in half a dozen countries for replication of eCompliance and other Operation ASHA technologies. eCompliance is designed to handle as many as 100,000 patients and can be expanded easily for millions of subjects spread across the world.
Columbia University, Earth Institute, and the Millennium Villages replicated eCompliance in Uganda, resulting in “a staggering improvement” in patient treatment adherence according to Professor Yanis Ben Amor. In India also, the results are amazing, with reduction in default rate by 12 times compared to the figure reported by a WHO consultant in India.
Patients, community workers, and supervisors have found eCompliance extremely useful and user-friendly:
“The community and the patients are excited about the system. When the project was first implemented, the mother of one patient said she could not thank the eCompliance team enough for taking care of her son. She insisted that they take a few valuable pineapples as a gesture of her appreciation. Another health worker reported that community members told him how much they appreciated both him and the system. Now they can rely on him to always check on the health and treatment status of patients. In areas… where the system doesn’t yet reach, patients are asking when they will get the new technology.”
-Professor Amor, Columbia University
Operation ASHA and Microsoft Research conducted an exhaustive study on stakeholder perception of our technologies. The study proved that all stakeholders, including health workers and supervisors, easily accepted the technology.
The success of eCompliance (which was built with initial support from Microsoft Research) and EMR were tweeted by none other than Bill Gates in December 2012 (http://b-gat.es/VoMO2m). “.@MSFTResearch has teamed up with @Operation ASHA to fight #TB in India. Better data = better outcomes”
As Professor Amor observed, eCompliance “means better TB care ….and TB follow up rates worldwide”, even in developed countries. Yet, that is not all eCompliance has to offer:
“The benefit of eCompliance is not limited to tuberculosis alone. There are other medical issues where the largest challenge to success is ensuring patient follow-up, particularly in resource-scarce settings. Other opportunities include ensuring delivery of consistent antenatal care to pregnant women, recording childhood vaccinations, and aiding prevention of HIV transmission from mother to child. eCompliance may be just the assistant that overworked doctors and health workers in disadvantaged areas need to easily, efficiently, and successfully care for all of their at-risk patients, including in the United States.”
-Professor Amor, Columbia University
eCompliance has proven itself as an affordable, convenient, and reliable tool for Operation Asha and our partners as we continue to battle TB as well as other pressing issues in public health.