Improvement of Cancer Screening Process
Globally, cervical cancer is the second most common cause of death for women, but in Kenya it is the number one cause of death (Source: http://www.who.int/mediacentre/factsheets/fs380/en/). Although this cancer is easily preventable, most of the eligible women have never been screened. With the risk of cervical cancer being 6 to 20 times higher for HIV-infected women, it is critical to act fast in order to prevent a dramatic impact on families and even entire societies.
To improve this situation in Kenya, new methods for cancer screening are desperately required. That´s why the University Clinic Heidelberg runs a first pilot of the Emerging Technologies in Cervical Cancer Screening (ETiCCS) project in Kenya. This pilot is being funded by the German Federal Ministry of Education and Research. The project tests a specific method to detect an infection with the Human Papilloma Virus (HPV), which can cause cervical cancer via specific biomarkers. These biomarkers have a higher sensitivity and the test evaluation can be trained easily. Women who are infected with HPV and at risk to develop cervical cancer can now be identified more easily and can be treated in order to not develop cancer as a consequence of this very early screening. The University Clinic then reached out to find industry partners to digitalize the paper-based process.
SAP’s Design & Co-Innovation Center (DCC) team joined ETiCCS as an experienced partner in delivering cloud-based software solutions, while convincing Intel, a SAP Global Technology Partner, to sponsor 10 Fujitsu Tablet PCs for the project.
Hermann Bussmann (Medical Director, ETiCCS Project Lead, Institute of Pathology of the University Hospital of Heidelberg) is extremely positive about the outlook:
This approach can really revolutionize the work that healthcare facilities are doing, particularly in remote areas in Africa.–
Applying User-Centric Design in Kenya
The initial focus of ETiCCS is a one-year cervical cancer study with 800 women performed by the Moi Teaching and Referral Hospital in Eldoret, Kenya. Subsequently it is planned to offer a self-sampling test in a larger, more rural area with the ultimate goal to screen eligible women across the entire country.
The basis for the first prototype were several design thinking workshops with the DCC team in the SAP AppHaus Heidelberg. During those workshops, the respective experts from the University Hospital Heidelberg, together with SAP employees focused on uncovering the underlying challenges of cancer screening in emerging countries today. The challenges included incomplete communication, accessibility and availability of patient data. The SAP team consisted of designers, experts from the HANA Cloud Platform department, Healthcare product and solution management, Corporate Social Responsibility, and Custom Development, who developed and implemented the mobile prototype to allow local data entry and easy access to patient data. A target process was defined to collect valid data for the study: a woman would be recruited in a local health center, a nurse examines that woman, takes a sample, sends it to a laboratory, receives the results and contacts the woman for follow-up such as further treatment.
These efforts were complemented by on-site research in Eldoret to interview end-users like nurses and also understand the activities and challenges of the various people involved in the process. These results influenced the further agile development which led to splitting the role of recruitment and examination, as having a 40 minute recruitment process proved to be not feasible for nurses who have to cope with fifty to a hundred patients every day. To implement this efficiently, the different roles have to collect and exchange data through an easy-to-use system, fitting into their very busy and challenging workday.
The user-centered solution enables seamless communication between physician, laboratory and patient even in very remote areas making early cancer detection programs feasible.
Applied Medical Science in the Cloud
To ensure that the solution works in an environment with unstable Internet connectivity, the local part of the touchpad solution runs in an offline mode and can be synchronized to the cloud via an internet USB stick twice a day. By using a cloud-based approach the results can be monitored remotely from the University Clinic Heidelberg. The data will be available for stochastic analysis after initial studies are finished, creating a unified knowledge base for medical analysis and communication in practical medicine.
Based on the extensive user research, a single process across multiple roles was established that is still optimized for each of these roles in order to simplify screening significantly. In parallel, important research information is captured and made available globally, wherever it is needed.
The next step for ETiCCS will be to bring the entire solution closer to the patients, so that women don’t have to travel many hours to the next health center. It is also envisioned to further simplify the process and support smartphones for full mobility.
Looking further ahead, this software solution can easily be applied to screen other diseases, or be extended to improve diagnostic procedures.
The Cervical Cancer Screening project in Kenya powered by the SAP HANA Cloud Platform has received a HANA Innovation Award Honorable Mention in the category of Next Gen Apps, and has won the first prize of the dmi:Design Value Award 2016!
Through the ETiCCS program, we were able to complement applied medical research around biomarkers with the power of cutting edge cloud technology to bring co-innovation to Africa in a way, which really helps to improve people’s lives.– Magnus von Knebel Doeberitz (Medical Director, Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg)