Notice F2: Shelf readiness with a focus on building local capacity and new teams.

Concept note from Everwell Health Solutions for F2 : A Tool for shelf readiness to enhance local capacity and uniformity

Two-sentence Overview: 

Everwell Health Solutions Pvt. Ltd. (“Everwell”) is thrilled to receive the opportunity to submit the technical application to Digital Square in support of Notice F2: Shelf readiness with a focus on building local capacity and new teams.

We propose to enhance our platform, the Everwell Hub, which not only digitizes a patient’s journey from awareness to recovery but also helps in monitoring patients’ treatment regime in terms of diagnosis and adherence. We want to develop Everwell Hub as an independent & open-sourced platform so that it enables more autonomy by users for setting up, managing, and customizing deployments.

While the platform is fully featured and in use in 15 countries supporting nearly 2.6 Million registrations per year, the Everwell team manages deployments and customizations centrally as per partners’ requests; this proposal outlines enhancements that will enable us to decentralize aspects of platform deployment and empower users to run deployments more independently.

Executive Summary: 

Everwell was founded in 2015 as a spin-out from Microsoft Research originally to champion innovations to support patient-centered adherence support and healthcare programs to monitor, visualize, and improve treatment for patients. Based on our initial work, we developed the Everwell Hub, an open-source module-based platform to digitize the cascade of care.

The Everwell Hub is an open-source platform that supports treatment recovery and programs management of healthcare domains such as Tuberculosis, HIV, COVID, mental health, and beyond. As a platform, the Hub aligns with data standards and is interoperable with external applications. The Hub has been deployed in 15 countries in partnerships with governments, NGOs, and hospitals and supports over 1 in 5 newly diagnosed active TB patients annually and has registered over 18 Million person episodes.

The platform digitizes the “cascade of care”, or patient recovery journey and is used by government decision makers, healthcare workers, and by patients themselves to support the best possible care. As the Everwell Hub grows in partnerships and deployments, the team customizes each deployment as per partner needs. While this provides a wholly customized and personal experience for partners, it means all new requests or customizations have to go through our team. In this proposal, we suggest a few key platform enhancements that will remove that dependency and better enable our community of users to set up, manage, and own their deployments for better sustainability. Enhancing our platform by empowering users is intended to increase the shelf readiness of the platform.

Consortium team: 

Everwell is leading the development of this concept note as a technical proposal for platform enhancement. We have active partnerships in several countries globally through which we would take partner feedback, suggestions, and ultimately demonstrate new features with. Some of our country deployments include India, Bangladesh, Myanmar, Vietnam, Philippines, Ukraine, Ethiopia, Uganda, Tanzania, Mozambique, Nigeria, DRC, South Africa where we do have local association and partnerships. As an open source toolkit, any developments to the core platform benefit all partners, and should this proposal go through we would select a few centers of excellence as demonstration sites for the new features.

At Everwell, our philosophy is that engineering, research and evaluation, and organizational capacity building in our users is the key to developing user-centric, reliable, scalable software systems to support healthcare practices globally. All of our work is open sourced; we release our code under the MIT license which is one of the most permissive licenses available. Both our approach to sustainability and our technical commitments to open source allow partners to customize and manage projects after Everwell’s initial involvement.

Project Description: 

Project Description

  • Background or problem statement: 

The Hub is currently deployed in various settings across different disease domains; while each environment relies on the same core infrastructure, there are customizations required for each environment. For example, all user registrations require the same basic demographic information. However, TB registration may request recent symptoms and a diagnostic result, while a PLHIV registration may ask for co-morbidities. Similarly, a research program may want a more exhaustive report section whereas a programmatic implementation may require top-line indicators. The platform was designed to handle these customizations, and we are proposing below several enhancements to help put those selections in the hands of users. As of now, our team manages most of these customizations at the outset of a new project. 

  • Objectives of the proposed Solution: 

In this proposal, we focus changes on three main interfaces to further improve our solution and provide a comprehensive easy to setup and use platform.

  1. Automating Deployment Setup - The current platform setup and launch time is close to 6-8 weeks depending on the partner’s need. While we can physically set up a new deployment in seconds, the real work is in understanding and customizing partner requests. These requests are mostly structured and therefore can be automated. We propose to upgrade our current offering to an off-the-shelf solution that is easy to set up, implement and adopt with little to no customization needed. The vision is to automate deployment setup along with options to choose from a list of available features and modules. For example, a user may want to use a local SMS vendor, or hide a module that is not relevant to their context. Through our enhanced module, they could make those changes in their own deployment. With just a few clicks our partners should be able to get their platform up and running. This process would ensure a lower setup cost and reduced time to launch. 

  2. Patient Interface – Currently we provide 2 interfaces: one for researchers (with hidden PII) and the other for staff. The primary goal of these interfaces is mediated care, where the user is a healthcare worker or researcher. It supports the entire cascade of care from registration, diagnostics, follow up, digital payments, virtual care and engagement, and digital adherence technologies. Each stage models a stage in the patient’s recovery journey. We would like to develop and deploy a companion application to citizens and patients via an Android App interface using which they can learn about their symptoms, assess their personal risk, view their treatment details, receive reminders to take medications at home, and monitor the status of their government-issued benefits.  This tool would further empower citizens and patients to engage with the healthcare system directly through their smartphones. While we have started development of such an application, it is highly context specific and has not been globally deployed.

  3. Customizable Dashboard view - Currently, we provide preset reports and data to our partners. In addition to these default reports, we would like to provide customized dashboard views and reports that are relevant to stakeholders and will be built over the data collected vide staff / patient interfaces or data can be imported (as per the specified format) from external applications as well. It will allow for a panoramic, as well as a detailed view and allow users to customize what data is exported. Data will be structured in dedicated data marts in virtualized semantic layers, which are business-focused, trustworthy, and faster than an on-premise warehouse backend. The platform would help leverage insights pertaining to custom queries, unexpected duplicates, erroneous, extreme, or fictional data values, irregular transaction volumes, time-series data patterns and geographical location anomalies. Security restrictions can be managed for users’ and objects’ access. In short, the platform captures large amounts of data and we want to build a better front end to empower users’ better control over accessing their data.

  • Deliverables & Schedule with Estimated Budget:

Activities

Description

Planned Timeline (Months)

Planned Deliverables

Estimated Budget 

(in $)

Automated Deployment Setup

This module shall be enhanced and allow deployment owners (i.e. Government stakeholders, researchers or NGO project leaders) to customize their deployment of the platform

4

Module webpage,  & screen in the app as per the requirements 

40,000

Beneficiary interface to their health portfolio

Our  platform shall be  developed as beneficiary centric (i.e. citizen, patient) application so they can access their health details, information, resulting to encouragement  and better adherence while on treatment

2

Companion application (Android) available for beneficiaries in select geographies


 

30,000

Customizable dashboard view

This enhancement would extend our current static dashboards, reports, and visualizations to give more power to administraters and super users for how to view the data

3

Backend architecture to combine databases into a near real-time data warehouse, and accompanying dashboard (webpage)

35,000

Compliance with OpenHIE standards

Ensuring the Hub's compliance with global standards.

2

Completion of compliance with standards

25,000

Creation of training materials (static and interactive) in multiple languages

Designing training material for users of the new modules, including interactive tutorials/ guides.

0.5

Completion of training materials (available in public domain)

10,000

Implementation demonstration with at least one partner

Deployment of the new modules with at least one of our existing modules for rapid feedback and testing, and to seed uptake.

1

Live deployment in at least one environment

10,000

Total Estimated budget 

$150,000

We estimate that we can complete the overall objectives in 9 months, subject to the final requirements for each module. Some activities can happen in parallel, but the core engineering developments would happen sequentially. 

We create training and scaffolding tools to enhance local capacity. We will use a combination of audiovisual materials explaining each module, alongside interactive tutorials in the web and app to walk new users through workflows.

  • Risk Mitigation: 

The Everwell Quality Assurance (QA) team ensures that all features shipped have gone through rigorous manual and automated testing. Our team follows technical releases on fixed days, whereby any newly developed code is first deployed on a beta server to allow for robust testing and quality assurance. We have a suite of automated tests that cover basic workflows and ensure scalability and uptime of releases, as well as manual workflow testing. Code releases are only pushed into production environments when all QA processes and testing are passed.

Everwell is an ISO 27001 Certified organization and maintains the good practice framework as per ISO 27001 protocols for establishing, implementing, operating, monitoring, reviewing, maintaining and improving an information security and management system (ISMS). We implement best practices in data security and privacy, and take extreme precautions to protect data captured on the platform. We also rely heavily on our partner network for guidance and feedback on feature development, and would take their feedback for any proposed designs.

Application Status: 
Approved – Contingent on Funding

Comments

In the full application:
- Please explain further how you are planning on aligning with Instant OpenHIE architecture. 
- The Patient Interface appears to be too specific for this application, how is it adaptable to other programs?