After using mobile technology to improve health care in some of the world’s poorest places, a local nonprofit program has turned its attention to rural Maine and launched a novel pilot project.

Harrington Family Health Center in Harrington, a small coastal community in Washington County, treats some of the state’s poorest and most at-risk populations for chronic health conditions.

Since July, nurses and physicians at the center have been using tablet computers loaded with dozens of medical-related apps that help them treat patients. The apps include searchable medical encyclopedias, a dosage calculator, a pill identifier and a symptom checker, which allows a nurse to input symptoms and immediately get a list of potential conditions. It also has an app that allows a health care provider to enter a patient’s medications and immediately get information on how those drugs interact and potentially dangerous combinations.

For health care providers who commonly see patients suffering from multiple conditions, the help is welcome, said Lee Umphrey, CEO of the health center, which last year treated roughly 3,500 patients over the course of 14,000 visits.

“While it’s a beautiful area, it has Maine’s poorest population and many of our people have the highest instances of diabetes, heart disease and cancer in the state. We also have the highest early death rate in the state,” Umphrey said. “This device is one more tool to give providers. It’s like having an electronic library at your fingertips.”

The tablets were provided by Health eVillages, a not-for-profit initiative created by Donato Tramuto, a successful Ogunquit businessman and serial entrepreneur. Tramuto is CEO of Massachusetts-based Physicians Interactive, which develops medical-related mobile apps and other technology.

The program was born from Tramuto’s frustration after the earthquakes in Haiti in 2010. At the time, Tramuto was on the board of Robert F. Kennedy Center for Justice and Human Rights and was troubled by reports of inadequate health care services in Haiti.

“I felt not enough was done to reach this population that even in the best of times struggled with medical resources and information that could help them improve care,” Tramuto said.

Building on what his company already did, he partnered with the human rights group to launch Health eVillages to leverage mobile technology for improving rural health care. The program has done projects in Haiti, East Africa and India. Its first project in the United States was on the Louisiana coast in the wake of the Deepwater Horizon oil disaster. And now Maine, which Tramuto calls home.

“I’ve been very eager to bring this to Maine,” said Tramuto, who also owns two restaurants and an inn in Ogunquit.

CUSTOMIZED CARE, UNTAPPED RESOURCE

A screen grab of a library of options on the app.

The basic tablets are loaded with fundamental apps, but can be tailored to a particular challenge. For example, the devices deployed in Lousiana were loaded with dermatology resources because of the prevalence of skin conditions due to the contaminated water, Tramuto said. In Harrington, the devices came loaded with apps specific to diabetes care.

Although the challenges in Harrington are likely not as dire as those in post-earthquake Haiti or a remote area of Kenya, Tramuto doesn’t believe they’re any less important.

“You’d be surprised in our country how technology is behind the eight ball in terms of health care,” he said.

Others in the industry agree.

Sara Donevant, a registered nurse who’s pursuing her Ph.D. in nursing science with a focus on fighting chronic illness using mobile technology, hadn’t heard of Health eVillages but said its project in Harrington sounded promising.

“Actually, (mobile apps are) not widely used anywhere, unfortunately,” she said. “It’s still a relatively untapped resource, if you will.”

Donevant, who’s doing her research at the University of South Carolina, said the challenge is that there are now thousands of medical-related apps, but no method to allow providers to easily determine the quality or integrity of a certain app.

“I know that as an ICU nurse I have downloaded apps to use at the bedside. For me, I wanted information and I wanted it fast,” she said. “But what I ran into was a problem with quality. For example, I used two critical care apps: One was not user-friendly – it had all the information I needed, I just couldn’t get to it. The other one was more user-friendly, but was missing important information. So it was kind of a Catch-22.”

The Harrington center is among the first to test the use of mobile technology in a health care setting, said Brock Slabach, senior vice president of member services for the National Rural Health Association, based in Kansas.

“I would say it’s part of a minority of providers that are entering into this kind of space,” he said.

KEY MONITORING OF CHRONIC CONDITIONS

Finding a better way to manage chronic conditions is going to be an imperative as baby boomers retire and use more health services, Slabach said.

“If we don’t change the way we deal with chronic disease … it will end up bankrupting the country,” he said.

Molly Boyd uses the Health eVillage tablet while she delivers care to patients in Harrington.
Whitney Hayward/Staff Photographer

The promise of mobile technology offers an excellent way to do that, he said. For instance, a diabetic patient can provide her physician with daily glucose levels from home through a mobile app, allowing her providers to better monitor her care and catch problems early.

“If you can prevent those peaks and valleys, then you’re preventing the need to have expensive interventions such as hospitalization for treatment,” said Slabach, who envisions a future in which hospitals are a community’s “nerve center” and monitor high-risk patients from a distance.

The Harrington center isn’t set up to manage patients’ chronic conditions like that now, but the project is laying the groundwork for that possibility, said Umphrey, the CEO.

“It’s the kind of thing, like any place, you bring in new technology and some of the people are going to be hesitant,” he said. “The providers are already overburdened by electronic medical records, but I think they’ve seen this as an enhancement, not as one more piece of technology preventing them from seeing patients.”

STOPPING MILLIONS OF EARLY DEATHS

The center’s workers are providing feedback to Health eVillages via monthly surveys on how they’re using the devices and what’s been valuable. Eventually, they also hope to tie the project to the local patient population’s health metrics.

Results have been measured elsewhere. Before Health eVillages delivered its tablets to the Lwala Community Hospital in Lwala, Kenya, in January 2012, the early infant mortality rate there was 60 out of every 1,000 live births, according to the hospital’s data. Over the next two years, the rate decreased to 31 out of every 1,000 live births, attributable in part to nurses using the tablets during prenatal visits to detect conditions such as pre-eclampsia.

“More babies are alive today because of our program,” Tramuto said.

But his vision is even greater.

“The problem I’m trying to solve is that in our lifetime 1 billion will go to their graves prematurely because they never had access to health care workers,” he said. “I don’t find that acceptable and that’s what Health eVillages is trying to do – make technology the vehicle to reduce that terrible statistic. If I can get it down to 700 million, that’s 300 million who are still alive.”