Giving control back to the ailing

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Above: Kheston Walkins considers his Communicare software. Photo by Mark Lyndersay. Click to enlarge images.

Originally published in the Trinidad Guardian, November 02, 2017

Kheston Walkins has an odd little tell. Put a challenging question to him and his gaze will shift from you for a moment as he stares off into the distance, as if shaping the idea that will inform his words in response.

It lasts just a moment, but it happened often enough when we spoke at a coffee house in Chaguanas that it’s quite likely that it happens when he faces a challenge.

It’s just possible that he had a moment like that when he looked at the patient he’d volunteered to help a friend with, someone with a stroke who was growing increasingly frustrated because she had lost the mobility she was used to all her life and couldn’t communicate properly.

Her family was complaining that she wasn’t getting the attention she needed.

Out of that axis of problems came Communicare (communicarecc.com), the product that Walkins plans to launch on Friday, an app and cloud-based database that delivers an innovative link between patient need, caregiver notification and doctor’s supervision of the case.

“I’d been researching medical charts and how they are used in the hospital,” Walkins said.

“I saw that there needed to be more empirical measurement of the information that’s in play in the case.”

“Using Communicare, the patient can communicate information about their status, the caregiver can log the delivery of medication and their response, it’s all time logged so that comparison and following the progress of the treatment and patient response the doctors can put their notes into the system.”

The patient pain indicator console for the Communicare app is still under development and will be added in an update. Screenshot courtesy Communicare.

On the patient’s side, the app offers large buttons with bold graphics that explain what’s going to be communicated. If a patient wants food or water, the buttons will send that message to the caregiver and the request is logged and timestamped in the database.

Walkins demonstrates the app on a small eight-inch tablet, though it will run on a smartphone as well. The larger tablet version of the app offers a more visible and usable interface for weak or shaky fingers to target.

Caregivers log the administering of medication into the app and the collective dataset for each patient can be viewed by the doctor who has the option to filter for relevance to the case and can leave medical notes in the system.

The first user was logged into the system in July of 2016 and Communicare has been running with a test bed of 68 users who have had free access to the system in return for feedback on how it works and what each facet of the care process needs from the system.

The prime market for Communicare is patients with limited mobility and speech, patients with high dependencies and the elderly.

The other users are those who run outpatient clinics, or people who are out of the country and want to monitor their family’s care on a regular basis.

“The first challenge was development,” Walkins said.

“I learned a lot about user interface design, we were creating a product that was going to be used by people who don’t usually use smart devices.”

“Figuring out what you should put into it and leave out was critical, because you could end up slowing the development process working on features with little return.”

The app has been redesigned several times based on that feedback to make accessing the features easier for patients and adding filtering options for doctors examining the data.

“The biggest response was from family, who could establish a closer to real time connection with their loved ones. One big request was to be able to track consumption with inventory to be able to ensure that the medicine wasn’t going astray.”

The communications module of the Communicare app. Screenshot courtesy Communicare.

“We were told that nurses would resist, but they got the value immediately.  Clinicians have responded to the project because they can see the patient’s records. One clinician was getting patient updates via WhatsApp, but couldn’t correlate it with the patient’s history.”

“Doctors don’t want to know everything all the time, while family members want to know everything that’s happening. We are still working on the filtering of the mass of patient data to make it appropriate to each viewer.”

The response to the app has been stronger outside of T&T than inside it, with users in Paraguay and particularly in Cancun, Mexico expressing interest in its potential.

“Finances were definitely a problem,” Walkins recalls with a smile of the project’s development, “I had to eat less.”

Kheston Walkins dresses smartly and fashionably and has, as he describes it, with an interest in “health, entrepreneurship and youth.”

This gets an arched eyebrow from me.

“I mean us, you know,” the young developer says with a laugh, “I want people to understand that this brown boy from a barely middle-class home can pull it off.”

“We got resistance from Trinidad, but then when we got awards from outside, and we began to be taken more seriously.”

“There is a big push for inclusion globally, and this was an opportunity to include the elderly and to bring value, improving quality of life.”

The awards from the Inter-American Development Bank and the World Bank, among others, took interest in the project to another level.

“The people who took notice referred us to very helpful people. Then came distribution. We started with word of mouth, and it is one of the strongest ways to make a connection with customers and participants.”

Communicare will launch in limited terrorities in the Caribbean region with a focus on Barbados and Jamaica where there has been significant interest. Latin America, which has strong programmes supporting social entrepreneurship, is also likely to be another early market focus.

Walkins has a deep interest in the power of big data to inform and change the world, as he explained in his TedX PoS talk  and he is hoping that the raw data from Communicare, scrubbed of identity and massaged into useful shape, can inform palliative patient care.

“I’m just excited to explore and to see what we find,” Walkins said.

“Being able to track specific diseases, creating road maps for chronic illness, gathering information about the progress of disease based on biometrics. There are so many questions for which we don’t have answers. Communicare has the potential to be a smart health solution and not just a care management solution.”

  • Richard Hamel-Smith

    Recently, I came across a project called Open Data Kit https://opendatakit.org/ which allows building an app for collecting data. There are videos explaining how this is used in managing the treatment of HIV/AIDS patients in Africa. https://www.youtube.com/watch?v=pwPJ1F9EHZA.

    There are 3 elements
    an Android phone app
    data collection forms
    a web server with a database backend

    Building the forms in fairly simple. A spreadsheet with 3 worksheets is created. The .xls file is uploaded to a site which converts it to XML. The XML file is uploaded to a server which distributes the XML form to the phone and collects the data collected by the phone.

    The screens produced are not as “customer friendly” as the ones shown above. The goal of the ODK project may be different to the aims of Communicare, but it is definitely easier to create the forms.

    ODK also has the benefit of being open source, so it being used in several areas in different parts of the world. It can also be used for other things outside of the health industry. This project is over 10 years old and has been field tested extensively.

    Not to detract from the very laudable effort in producing Communicare, I think it might valuable to look at ODK in this sector as well.

    Richard

  • Dennise Demming

    This is the eye opener: “We got resistance from Trinidad, but then when we got awards from outside, and we began to be taken more seriously.” Why is it that great ideas have to be bathe in “foreign waters” before they are accepted locally? Having closely observed Kheston’s tenacity in the run up to TEDxPortofSpain 2016, I know he will be successful with this ap. Best wishes from the TEDxPortofspain team!