Frustrated at the lack of interest by the medical establishment in reducing the costs of diagnostic testing, and seeing almost no chance of getting the necessary research grants, Kanav Kahol, a member of Arizona State University’s department of biomedical informatics, returned home to New Delhi in 2011.
He had noted that despite the similarities between most medical devices in their computer displays and circuits, their packaging made them unduly complex and difficult for anyone but highly skilled practitioners to use. They were incredibly expensive — costing tens of thousands of dollars each. Kahol knew that the sensors in these devices were commonly available and inexpensive. He believed that he could connect these to a common computer platform and use commercially available computer tablets to display diagnostic information, thereby dramatically reducing the cost of the medical equipment. He also wanted to repackage the sensor data to make them intelligible to technicians with just basic medical training.
In March 2014, the government started a pilot of 4,250 Swasthya Slates in six underserved districts of Jammu and Kashmir, with a population of 2.1 million people. It is now being also used in Delhi, Uttar Pradesh, Bihar, Meghalaya and Gujarat and countries across the world. Abroad, countries, including Nigeria, Peru, Norway and Canada, have started using the device and a large number of other nations are booking orders.
Kahol and his Indian engineering team built a prototype of a device called the Swasthya Slate (which translates to “Health Tablet”) in less than three months, for a cost of $11,000. This used an off-the-shelf Android tablet and incorporated a four-lead ECG, medical thermometer, water-quality meter, and heart-rate monitor. They then enhanced this with a 12-lead ECG and sensors for blood pressure, blood sugar, heart rate, blood haemoglobin, and urine protein and glucose. In June 2012, they sent this device to 80 medical labs for testing, which reported that it was as accurate as the medical equipment they used. By January 2013, Kahol’s team had incorporated 33 diagnostic tests, including for HIV, syphilis, pulse oximetry, and troponin (relating to heart attack) into the Swasthya Slate and reduced its cost to $800 per unit. They also built a variety of artificial-intelligence– based apps for frontline health workers and started testing these in different parts of India. The proportion of the time that frontline health workers spent on administrative paperwork, recording data from tests and filling out forms, was reduced from 54 percent to 8 percent of their work day. Antenatal testing, which often took 14 days because mothers had to go from clinic to clinic for different diagnostic tests, could be done in 45 minutes in a single clinic.
A newer version of the Slate, called HealthCube, was tested last month by nine teams of physicians and technology, operations, and marketing experts at Peru’s leading hospital, Clinica Internacional. They tested its accuracy against the western equipment that they use, its durability in emergency room and clinical settings, the ability of minimally trained clinicians to use it in rural settings, and its acceptability to patients. According to Alvaro Chavez, tests were highly successful and “acceptance of the technology was amazingly high.” He sees this technology as a way of helping the millions of people in Africa, Asia, Latin America and other developing countries who lack access to quality diagnostics.
Rupandeep Kaur, 20 weeks pregnant, arrived at a medical clinic looking fatigued and ready to collapse. After being asked her name and address, she was taken to see a physician who reviewed her medical history, asked several questions, and ordered a series of tests including blood and urine. These tests revealed that her fetus was healthy but Kaur had dangerously low hemoglobin and blood pressure levels. The physician, Alka Choudhry, ordered an ambulance to take her to a nearby hospital. All of this, including the medical tests, happened in 15 minutes at the Peeragarhi Relief Camp in New Delhi. The entire process was automated — from check-in, to retrieval of medical ecords, to testing and analysis and ambulance dispatch. The hospital received Kaur’s medical records electronically There was no paperwork filled out, no bills sent to the patient or insurance company, no delay of any kind. It was all free. The facility, called the “mohalla” (or people’s) clinic, was opened in July 2015 by Delhi’s chief minister, Arvind Kejriwal. This is the first of 1,000 clinics that he announced would be opened in India’s capital for the millions of people in need. The Delhi government allocated an initial $790 million or 79 crores in this year’s budget for the clinics, after promising to improve healthcare and ease the burden on its ageing hospitals.
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