October 23, 2014
By Mark Hagland
What does “giving back” mean, in the context of healthcare IT development? In the case of the folks at Vecna Cares, it means leveraging a turnkey vendor solution to help clinicians achieve better patient care delivery in developing countries. Vecna Cares, a non-profit organization, was created by executives at the Cambridge, Mass.-based Vecna Technologies, a provider of solutions around patient registration, including patient pre-registration, express check-in, appointment scheduling, insurance verification, forms completely, bill payment management, and clinical intake.
Deborah Theobald, co-founder of Vecna Technologies, and executive director of Vecna Cares, has been working to bring the opportunity of improved health and healthcare delivery in several countries recently, most notably in Haiti. Theobald and her colleagues at Vecna Cares have created the Camp Coq Clinic in the small town of Camp Coq, about 45 minutes from Cap-Haïtien, Haiti’s second-largest city, and there, have established a pilot to support resource-constrained clinicians, who can now electronically record and report data on a patient’s visit, diagnosis, and prescriptions, through laptops and tablets. The mHealth solution they’ve developed there has enabled clinicians at the clinic to make better-informed on-the-spot healthcare delivery decisions through a portable unit.
Recently, HCI Editor-in-Chief Mark Hagland spoke with Theobald about her and her colleagues’ work in that area. Below are excerpts from that interview.
Tell me about the origins and history of Vecna Cares?
Vecna Technologies and VecnaCares go hand in hand. Vecna Technologies was started in 1989 by myself and my husband. And we started with HIT applying the Internet to healthcare. And it’s been great to be in the right place at the right time for improving and automating care and access to care. Our main products have been focused on taking these large health systems with their multiple information systems and confusing pathways and integrating their systems on the back end so people on the front end can have a much more pleasant and actionable experience. So we have kiosks and online platforms. We also apply this to work by clinicians. And eventually, we’ve done this by robots, too, run through our PCbot. So that’s Vecna Technologies.
Meanwhile, in 2009, I became aware of global health programs, and started working with people working in rural areas and developing countries on medical missions. And I saw that their state of health IT was so poor. Even trying to teach people basic computer skills. And decision-making was being based on a very inaccurate and ad hoc data process.
So I saw a huge need for really good information, to connect them for better continuum of care. That’s why Vecna Cares was born in 2009, to adapt our technologies and make them accessible to people. We did the same thing for computer literacy for caregivers. And Haiti, we discovered this group called Care To Communities—they take 40-foot containers and outfit them as clinics. They become permanent. And they’re easy to set up. But they need information systems for care, for tracking costs and so on. They’re trying to keep up with heavy demand from local communities.
Is that organization basically supported by donations from the U.S?
They have funders and individual funding. That’s given them the initial capital investment, but they are working towards a sustainable business model.
They provide fee-for-service care, essentially?
Absolutely. There is a contingent within global health that has proven that even poor people will pay for health services, and they’re trying to meet that need at the right price point. So we need to provide FFS at the right price point.
How big is their volume of care?
At the Camp Coqu Clinic, which is about 45 minutes outside Cap-Haïtien in northern Haiti, they’ve got one physician seeing about 35 patients a day.
When did that clinic go live?
That clinic went live in April. They had been operating with paper for a year before that, but we went live with our clinical information system, to make them fully digital, in April. Our CliniPack is basically a box with everything you need—power management, server, and wireless, all at the touch of one button. They plug it into a car battery for backup, and their generator. It can run for two days off the car battery. And then the wireless network goes throughout the clinic area. It’s two containers and a registration pavilion. It’s probably around a 350-foot radius. Small location. So each of the registration people and caregivers use tablets that connect with this wireless system, to register a patient, put them in a cue, for care.
Is there any kind of established healthcare delivery system in Haiti?
They do have a public health commission, but it’s very disjointed. They’re in dire need of other methods of receiving care.
How has it been working, tech-wise?
Actually, it’s been performing beyond our expectations. We went down there for an initial setup and got things moving, and then actually didn’t hear from them for several weeks. Fortunately, they were able to divert their attention to all the other things they needed to do as a clinic; the technology as working well! And now, we’re doing data analytics. So as far as people coming in, getting the consults, going home to their community or families, getting money to cover care… We’re also seeing multiple visits. These things are a lot easier to track in an electronic system. And sometimes, they just have a chronic condition like diabetes, and they just come in to check in on their blood pressure. People in Haiti have some of the same situations as people in the US and will go and see caregivers. They’re very invested in that. We have a 72-year-old woman and her husband—they come frequently just to get their blood pressure checked.
Is there replicability in this model of care delivery?
Absolutely? One of the biggest issues in providing care is just developing a space for care, for trusted care. We’ve been working with one clinic in Kenya that’s been under construction for years. There’s been promise of things coming, but it just hasn’t come, they’ve been having to make do with whatever they have. Some clinics do end up closing. So having that consistent standard of care, even though it might not be on a big scale, just building consistency, helps you begin to build a culture of healthcare, of care within these communities. And having the clinics that have the facilities and resources, all those things are informed by having resources in the community. So we’re trying to figure out how to tailor services to individual clinics, so they can meet the primary care needs of their communities, and also being a conduit for more specialized care. What they’re putting in place here is wonderful.
You’re providing this technology at cost?
All the intellectual property of Vecna is available to VecnaCares. And as customers purchase our services in our for-profit, we very much have a voice in that. We are able to provide these tools at a much lower cost to our partners and organizations working in these areas. So we definitely work to make it affordable and available. We don’t give it away, but we do provide it at low cost. And Vecna employees devote up to four hours a week to VecnaCares. So some of the product and project development is done at Vecna.