1. Global&challenges&[1&of&3]&
Increasing*healthcare*cost*and*leveling*of*health*impact*
1"
Healthcare)costs)spiral…)
…as)health)outcomes)plateau)
“Without"precise"
measurement"
innova3on"is"doomed"to"
be"rare"and"erra3c…""
With"it,"inven3on"
becomes"
commonplace”"
)
2013"Annual"Le?er"from"Bill"Gates"
(quo3ng"The$Most$Powerful$Idea$in$the$
World,"by"William"Rosen)"

2. Global&challenges&[2&of&3]&
There’s*huge*value*left*on*the*table…*
2"
Cost)of)NCDs)
US$47)trillion)
Cumula3ve"lost"
output"in"all"
developing"
countries"due"to"
NCD"2011L2025"
NCDs"were"the"second"ever"health"issue"addressed"at"a"special"mee3ng"of"the"
United"Na3ons"General"Assembly
Cost)to)fix)it)
US$170)billion)
Overall"cost"for"all"
developing"
countries"to"
implement"WHO"
"best"buy""
interven3ons"for"
NCD"2011L2025"

3. Global&challenges&[3&of&3]&
Data*innovation*today*is*very*siloed*
3"
Siloed&data&systems&cannot&talk&to&
each&other…&
!
1. Huge!complexity!for!buyers!
2. Market!cannot!put!a!price!to!a!
product!
3. Reinventing!the!wheel!
4. Increased!development!costs!!
5. Limited!market!size!
6. Limited!data!aggregation!
Results'
Uptake'
• >650,000&unique&patient&IDs&issued&in&Malawi&
• >6,000&patients&with&diabetes&
• Enthusiastic&clinicians&response&
&
Health'outcomes'
• Lower&patient&drop=out&and&death&rates&
• Reduction&of&drug&errors&
Scalability'
• Fully&open=source&system&
Additional'benefits'
• Automated&diabetes&registry,&enabling&
– More&accurate&government&drug&
forecasting&&
– Better&referral&and&planning&of&surgically&
necessary&treatments&(amputations,&foot&
ulcers&etc.)&
• Low=cost&power&backup&systems&&
• Hardware&for&information&storage&and&
transfer&
Background'
&
• Data&critical&for&high&quality&patient&care,&
programme&monitoring&and&evaluation,&
preventing&drug&stock=outs,&etc.&
• Manual&paper=based&aggregation&of&data&
and&compilation&of&reports&now&unfeasible&
Approach'
&
• User=friendly,&graphics=based&touchscreen&
incorporating&(in&one&shot):&
1. Basic&patient&medical&history&&
2. Clinician&alerts&and&decision&support&
3. Fully=automated&reports&for&M&E&
4. Data&collection&for&secondary&uses&
Examples'we’ve'explored:'Baobab&A'Harries'
11"
Source' &Douglas&GP,&Gadabu&OJ,&Joukes&S,&Mumba&S,&McKay&MV,&Ben=&Smith&A,&Jahn&A,&Schouten&EJ,&Lewis&ZL,&van&Oosterhout&JJ,&Allain&TJ,&Zachariah&R,&Berger&SD,&Harries&AD,&Chimbwandira&F&(2010=.&&
Using'Touchscreen'Electronic'Medical'Record'Systems'to'Support'and'Monitor'National'Scale?Up'of'Antiretroviral'Therapy'in'Malawi.'PLoS&One&Medicine,&August&2010,&Volume&7,&Issue&8&
&Allain&TJ,&van&Oosterhout&JJ,&Douglas&GP,&Joukes&S,&Gadabu&OJ,&Darts&C,&Kapur&A,&Harries&AD&(2011).&&Applying'lessons'learnt'from'the'‘DOTS’'Tuberculosis'Model'to'monitoring'and'evaluating'
persons'with'diabetes'mellitus'in'Blantyre,'Malawi.&&Tropical&Medicine&and&International&Health,&volume&16&no&9&pp&1077–1084&
Results'
Uptake'
• 13#centres#already#use#eHealth#
• System#consolidation#underway#for#others#
#
Health'outcomes'
• XX#
Scalability'
• XX#
Additional'benefits'
• XX#
Background'
• 24#centres#for#MCH/Diabetes#with#>200,000#
patients/year#attend#them#
#
#
Approach'
• Possibility#of#using#eHealth#to#monitor#
mother#and#child#care#and#take#more#
detailed#medical#records,#and#also#the#
organisation’s#desire#to#expand#the#services#
surrounding#diabetes#and#hypertension#
• Mobile#health#initiative##
Examples'we’ve'explored:'Jordan'A'Harries'
12#
Source' #XX#
Results'
Uptake'
• 94%$eligible$population$within$<18$months$
• >190,000$
$
Health'outcomes'
• Discovered$‘silent$killer’$risk$factors$
– 1/3$diabetes$=$11,000$
– 1/2$high$blood$pressure$=$27,000$
– 2/3$high$cholesterol$=$$
• 24%$increase$in$patient$engagement$with$care$
• 18%$increase$in$good$control$of$diabetes$
• 20%$increase$in$good$control$of$cholesterol$
Scalability'
• Fully$openKsource$system$
Additional'benefits'
• Secure$patient$access$web$portal$
• CloudKbased$
• Multimedia$(web,$call$centre,$mobile,$smartphone$
apps,$etc.)$
• Rockefeller$implementation$OpenHDD$
• Platform$Health$ITU$standard$(H.MEDX)$
Background'
$
• UAE$second$highest$prevalence$of$type$2$
diabetes$in$the$World$
• Comprehensive$health$reform$with$universal$
health$insurance$
Approach'
• Innovative,$lowKcost,$secure$eHealth$system$
(Shafafiya)$
• Pioneering$eHealthKenabled$population$NCD$
programme$(Weqaya)$
• Weqaya$logo$on$healthy$products$
• Open,$secure$mobile$Cloud$
• API$creates$market$for$Weqaya$apps$
• Disease$Management$Programme$market$
Examples'we’ve'explored:'Abu'Dhabi'O'Harrison'
13#
Source''Podolak$I,$Vetter$P,$and$Harrison$O$(2012).$$Measuring'Health'Data'Management'Maturity'in'Abu'Dhabi'Health'Policy'and'Technology.$$Health$Policy$and$Technology$
$Hajat$C,$Harrison$O,$Al$Siksek$Z$(2011).$Weqaya:'A'Whole'Population'Cardiovascular'Screening'Programme'in'Abu'Dhabi.$$AJPH$2011,$22$September$
$Hajat$C,$Harrison$O$(2010).$The'Abu'Dhabi'Cardiovascular'Program:'The'Continuation'of'Framingham.$$Prog.$Cardiovasc.$Dis.,$Vol$53,$Issue$1,$JulyKAugust$2010,$pp28K38$
$See$http://www.jointlearningnetwork.org/content/openhdd$and$http://www.jointlearningnetwork.org/content/dayKoneKsiteKvisitKabuKdhabi$
$Weqaya$materials$available$online$at$URL$www.weqaya.ae$$
Source!!Estrin!D,!Sim!I!(2010).!!Open!mHealth!Architecture:!An!Engine!for!Health!Care!Innovation.!!Science,!Vol!330,!pp759T760!

4. Abu&Dhabi&was&an&ideal&market&for&
innovation&in&tackling&chronic&disease&
4"
2.6m"lives:"“Big"enough"to"ma?er,"small"
enough"to"manage…”"
Highly"strategic"government"with"broadL
based"popular"trust"
Extreme"pace"and"depth"of"socioLeconomic"
development"–"very"high"burden"of"NCDs"
Plural"and"diverse"payers"and"providers"
Rela3vely"wellLresourced"health"system"
enabling"innova3on"
Source )Weqaya,"Abu"Dhabi;"presented"in"public"at"the"IDF"World"Diabetes"Congress,"Dubai"2011"

5. “Closing&the&health&loop”&within&a&plural&
healthcare&market,&at&population&scale&
Baseline)assessment)
• Secure"ID"(NHS"number)"
• CVD"risk"(e.g.,"NHS"Health"Check)"
Clinical)care)
+)
SelfBcare)
Monitoring)
+)
evaluaFon)
Amendment)
to)treatment)
plan)
Reassess!
Shared)data)
5"

6. ClosedFloop&public&health&works&
Abu*Dhabi*case*example*
6"Source&&Weqaya,!Abu!Dhabi;!Presented!at!the!IDF!World!Diabetes!Congress,!Dubai!2011!
Everyone&can&know&their&numbers…&
M A M J J A S O N D J F M A M J J A S O N D J F
2008! 2009! 2010!
…&and&the&numbers&can&change&health&outcomes&
%&engaged&with&
care*&
%&with&HbA1c&<7.5%& %&with&LDL:HDL&ratio&
<3.5&
100%*=*±220,000* 94%$$
uptake$

7. Sustainable&business&models&distribute&risk&of&
future&health&costs&and&align&incentives&for&health&
7"
Range&of&Disease&
Management&Providers&
&
!
!
!
Consent&for&data&
Pay&for&health&
Tariff*set*as*a*
proportion*of*the*
avoidable*cost*of*
complications*
Range&of&Apps&
and&services&

8. Significant&Health&IT&innovation&in&a&wide&range&
of&countries&
8"
• UNRWA,!
Jordan!
• Baobab,!
Malawi!
• Text!for!
Change,!
Uganda!
Low* Medium*
Low*
Income&
Previous&
eHealth&
capability&
High*
• Arogya,!india!Medium*
• Weqaya,!Abu!
Dhabi!
• Text!to!Quit,!
New!Zealand!
High*
• SHINTNY,!New!
York!
• FoodSwitch,!
Australia!
• Text4Baby,!
USA!

9. Data&innovation&remains&siloed&
9"
Siloed&data&systems&cannot&talk&to&
each&other…&
!
1. Huge!complexity!for!buyers!
2. Market!cannot!put!a!price!to!a!
product!
3. Reinventing!the!wheel!
4. Increased!development!costs!!
5. Limited!market!size!
6. Limited!data!aggregation!
Results'
Uptake'
• >650,000&unique&patient&IDs&issued&in&Malawi&
• >6,000&patients&with&diabetes&
• Enthusiastic&clinicians&response&
&
Health'outcomes'
• Lower&patient&drop=out&and&death&rates&
• Reduction&of&drug&errors&
Scalability'
• Fully&open=source&system&
Additional'benefits'
• Automated&diabetes&registry,&enabling&
– More&accurate&government&drug&
forecasting&&
– Better&referral&and&planning&of&surgically&
necessary&treatments&(amputations,&foot&
ulcers&etc.)&
• Low=cost&power&backup&systems&&
• Hardware&for&information&storage&and&
transfer&
Background'
&
• Data&critical&for&high&quality&patient&care,&
programme&monitoring&and&evaluation,&
preventing&drug&stock=outs,&etc.&
• Manual&paper=based&aggregation&of&data&
and&compilation&of&reports&now&unfeasible&
Approach'
&
• User=friendly,&graphics=based&touchscreen&
incorporating&(in&one&shot):&
1. Basic&patient&medical&history&&
2. Clinician&alerts&and&decision&support&
3. Fully=automated&reports&for&M&E&
4. Data&collection&for&secondary&uses&
Examples'we’ve'explored:'Baobab&A'Harries'
11"
Source' &Douglas&GP,&Gadabu&OJ,&Joukes&S,&Mumba&S,&McKay&MV,&Ben=&Smith&A,&Jahn&A,&Schouten&EJ,&Lewis&ZL,&van&Oosterhout&JJ,&Allain&TJ,&Zachariah&R,&Berger&SD,&Harries&AD,&Chimbwandira&F&(2010=.&&
Using'Touchscreen'Electronic'Medical'Record'Systems'to'Support'and'Monitor'National'Scale?Up'of'Antiretroviral'Therapy'in'Malawi.'PLoS&One&Medicine,&August&2010,&Volume&7,&Issue&8&
&Allain&TJ,&van&Oosterhout&JJ,&Douglas&GP,&Joukes&S,&Gadabu&OJ,&Darts&C,&Kapur&A,&Harries&AD&(2011).&&Applying'lessons'learnt'from'the'‘DOTS’'Tuberculosis'Model'to'monitoring'and'evaluating'
persons'with'diabetes'mellitus'in'Blantyre,'Malawi.&&Tropical&Medicine&and&International&Health,&volume&16&no&9&pp&1077–1084&
Results'
Uptake'
• 13#centres#already#use#eHealth#
• System#consolidation#underway#for#others#
#
Health'outcomes'
• XX#
Scalability'
• XX#
Additional'benefits'
• XX#
Background'
• 24#centres#for#MCH/Diabetes#with#>200,000#
patients/year#attend#them#
#
#
Approach'
• Possibility#of#using#eHealth#to#monitor#
mother#and#child#care#and#take#more#
detailed#medical#records,#and#also#the#
organisation’s#desire#to#expand#the#services#
surrounding#diabetes#and#hypertension#
• Mobile#health#initiative##
Examples'we’ve'explored:'Jordan'A'Harries'
12#
Source' #XX#
Results'
Uptake'
• 94%$eligible$population$within$<18$months$
• >190,000$
$
Health'outcomes'
• Discovered$‘silent$killer’$risk$factors$
– 1/3$diabetes$=$11,000$
– 1/2$high$blood$pressure$=$27,000$
– 2/3$high$cholesterol$=$$
• 24%$increase$in$patient$engagement$with$care$
• 18%$increase$in$good$control$of$diabetes$
• 20%$increase$in$good$control$of$cholesterol$
Scalability'
• Fully$openKsource$system$
Additional'benefits'
• Secure$patient$access$web$portal$
• CloudKbased$
• Multimedia$(web,$call$centre,$mobile,$smartphone$
apps,$etc.)$
• Rockefeller$implementation$OpenHDD$
• Platform$Health$ITU$standard$(H.MEDX)$
Background'
$
• UAE$second$highest$prevalence$of$type$2$
diabetes$in$the$World$
• Comprehensive$health$reform$with$universal$
health$insurance$
Approach'
• Innovative,$lowKcost,$secure$eHealth$system$
(Shafafiya)$
• Pioneering$eHealthKenabled$population$NCD$
programme$(Weqaya)$
• Weqaya$logo$on$healthy$products$
• Open,$secure$mobile$Cloud$
• API$creates$market$for$Weqaya$apps$
• Disease$Management$Programme$market$
Examples'we’ve'explored:'Abu'Dhabi'O'Harrison'
13#
Source''Podolak$I,$Vetter$P,$and$Harrison$O$(2012).$$Measuring'Health'Data'Management'Maturity'in'Abu'Dhabi'Health'Policy'and'Technology.$$Health$Policy$and$Technology$
$Hajat$C,$Harrison$O,$Al$Siksek$Z$(2011).$Weqaya:'A'Whole'Population'Cardiovascular'Screening'Programme'in'Abu'Dhabi.$$AJPH$2011,$22$September$
$Hajat$C,$Harrison$O$(2010).$The'Abu'Dhabi'Cardiovascular'Program:'The'Continuation'of'Framingham.$$Prog.$Cardiovasc.$Dis.,$Vol$53,$Issue$1,$JulyKAugust$2010,$pp28K38$
$See$http://www.jointlearningnetwork.org/content/openhdd$and$http://www.jointlearningnetwork.org/content/dayKoneKsiteKvisitKabuKdhabi$
$Weqaya$materials$available$online$at$URL$www.weqaya.ae$$
Source!!Estrin!D,!Sim!I!(2010).!!Open!mHealth!Architecture:!An!Engine!for!Health!Care!Innovation.!!Science,!Vol!330,!pp759T760!

10. WHOBITU)Joint)
IniFaFve)in)mHealth)
Developing!the!technology,!
delivering!the!promise!
10"
Brings!eight!countries!that!
may!implement!Open!
Health!Platforms!to!help!
refine!the!approach!and!
technology!

11. Open&Health&Platforms&joinsFup&silos&whilst&
maintaining&security&and&commercial&boundaries&
11"
Transformative&
change!
1. Unification!of!effort!
2. Clarity!for!buyers!!
3. Open!market!for!
devices,!Apps!and!
services!
4. Scalability!(national!
and!transnational)!
5. (A)!scalable!
business!model(s)!
Source&&Estrin!D,!Sim!I!(2010).!!Open!mHealth!Architecture:!An!Engine!for!Health!Care!Innovation.!!Science,!Vol!330,!pages!759T760!

12. Taking&the&first&steps&
1. Interoperability!standards:!
- How*to*exchange*data:!HL7,!ITUTT!H.810!(Continua!Health!Alliance)!
- Which*data*to*exchange:!ITUTT!H.MEDX!(Platform!Health)!
2. PopulationTscale!demonstrators!(“early!adopters”)!
3. Dissemination!of!best!practice!
- Implementation!toolkits!
- WriteTups!
- Informed!commissioners!
- Private!Sector!incentives!for!growth!
12"

13. Transforming&healthcare&delivery:&
Success&stories&
&&
Abu*Dhabi*and*WHOKITU*mHealth*Joint*Initiative*
Wednesday,!26!February!2014!