eCompliance system tracks every dose taken by every patient. This is a necessity because of the tedious and difficult regimen prescribed under the DOTS therapy in which a TB patient must take up to 75 doses under observation. This is the therapy prescribed by WHO and followed across the world.
eCompliance software is loaded on a seven inch tablet, which has a SIM card. This connects the tablet to a server through internet or text messages. The tablet updates the server every 20 minutes.
eCompliance tracks every activity required to deliver high quality TB treatment. It advises the health worker to carry out pre-treatment counselling. Simultaneously, the patient is also registered with her fingerprints in the eCompliance system. Then the first dose is dispensed. Thereafter, every time the patient has to take the medication, both counsellor and the patient have to give their fingerprints simultaneously. This generates irrevocable evidence that the meeting took place, every time, and the medicine was taken under observation.
If a dose is missed, eCompliance issues an alert to the patient, health worker and his supervisor. The health worker has to meet the patient within 24-48 hours, provide further counselling, 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 rolled out for nearly 9000 TB patients so far in India, Cambodia, Uganda, Dominican Republic and Kenya. It has already recorded over 400,000 transactions. Nearly 185 eCompliance units are now functional.
Discussions are continuing with many other organizations in half a dozen countries for replication of eCompliance and other technologies of Operation ASHA. eCompliance is designed to handle as many as 100,000 patients and can be expanded easily for millions of subjects spread across the world.
Replication of eCompliance in Uganda was done by Columbia University, Earth Institute, and the Millennium Villages. Results are “a staggering improvement” writes Professor Yanis Ben Amor (http://www.huffingtonpost.com/dr-yanis-ben-amor/harnessing-new-technologi_b_2940865.html). 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 as well as supervisors have found eComplinace extremely useful and friendly. Professor Amor made an interesting comment. “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”.
An exhaustive study of perception of all the stakeholders including health workers and supervisors was carried out in India by Operation ASHA and Microsoft Research. This study proves that eCompliance is easily accepted and has proved to be a win-win solution for everyone. The paper is available on http://research.microsoft.com/pubs/191182/thies-persuasive12.pdf .
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”
No wonder, Professor Amor is confident that eCompliance “means better TB care ….and TB follow up rates worldwide”, even in developed countries. He goes on, “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.”