Opinion, South Africa

Prof De Wet Swanepoel: On Designing mHealth Solutions That Solve Problems

Lead-inventor and Co-founder of hearScreen, Professor De Wet Swanepoel, talks about how his mHealth solution is addressing a global hearing loss crisis.

De Wet Swanepoel - EHN

Since its launch, hearScreen has won numerous awards and accolades as a ground breaking mHealth tool with clinical relevance. Lead-inventor and Co-founder, Professor De Wet Swanepoel, talks about how his innovative mHealth solution is addressing a global hearing loss crisis.

Tell us about your clinical background and how that led to hearScreen being developed.

As a Professor and a research audiologist at the University of Pretoria my interest has always been in how to make hearing health services more accessible to people, so I started looking at new models of early access to detection and linkage to care. From there my focus naturally transitioned into eHealth and telemedicine-based solutions after evaluating a number of alternative service-delivery models. When we realised that the burden of hearing loss globally is enormous, whilst the penetration of hearing healthcare providers is so low, the only real option for improving access to care was turning to the revolution in connectivity and technology – the mHealth sector.

That’s how this vision of utilising mHealth technologies to increase access to care was born. hearScreen was a collaborative effort between myself and an engineering colleague at the University of Pretoria, Dr Herman Myburgh. We put our vision together and brought in expertise from the hearing healthcare side and from the engineering side, which provided the synergy that we needed to realise the solutions we envisaged. We started on the hearScreen project in 2013 and launched a Beta version in 2015. At this stage, we are rolling out the solution on request from interested parties that can contribute to the Beta trial. On this basis, we currently have trials running locally and in several countries around the world.

Tell us about the need around addressing hearing loss.

The need is enormous – hearing loss is called the silent epidemic because it really is an epidemic. Globally there are more than 360 million people who live with permanent and disabling hearing loss. The majority of these people live in developing countries and we are seeing this number increase dramatically because of the ageing world population. The problem is that more than 80% of these people who suffer from hearing loss don’t have access to early detection. The key for effective intervention and quality of life outcomes is to have hearing loss detected early, and that’s where the hearScreen solution comes in. hearScreen is intended to bridge that gap by providing a cost-effective solution to detect hearing loss and to link them to their closest hearing healthcare providers. The solution then closes that loop with a cloud-based management and surveillance system.

A lot of the novelty around mHealth is the ability to roll out quickly. When do you plan to launch hearScreen commercially and what was the thinking around the length of your Beta version?

Our official commercial launch in South Africa is planned for the beginning of 2017. At this stage, it won’t be an end-user app but will function as a preloaded app running on an Android phone linked with a calibrated headphone.

Because it’s a university developed solution, our emphasis has always been on evidence-based innovation. It’s important for us to make sure that we can sufficiently demonstrate the accuracy and validity of hearScreen, and the impact the solution can have in real life test beds and that’s exactly what we’ve done. All our development is published in international peer-reviewed journals to ensure that we have academic backing. At the moment what we’re doing during the Beta launch is to refine and hone the solution to the needs of our end-users whilst testing as many use cases as possible.

We’ve been following hearScreen’s story for a couple of years now and know it has been the recipient of numerous accolades. Give us your take on how the solution has been received internationally.

Despite not advertising at all, there is a global interest in our solution and we literally receive requests for the solution on a daily basis. Part of our success thus far is the fact that we are an agile solution that can integrate with a number of other systems. For example, we’re currently working with the World Health Organisation (WHO) to evaluate the hearScreen solution in two different countries, and we are also partnering with a large NGO in the US that does ototoxicity monitoring for TB patients around the world. We are also integrated into the Guatemala National Disability Survey that is currently underway, where our solution has been translated and is being used within households to do a survey on disability across Guatemala. Those are just some examples to showcase the fact that if you have an agile solution that address a real need it can be integrated into other platforms to provide quality data that can feed into broader population data sets.

Let’s talk about HearZA, your free hear screening app that you launched in March this year. Can you share with us the impact that the app and supporting campaign have had on hearing health nationally?

Our first and main aim with the HearZA campaign is to raise public awareness of the importance of healthy hearing. Secondly, we want to detect hearing loss and then link those patients to their closest hearing health providers. We are really excited about the fact that we recently won MTN’s App of the Year Awards in the Enterprise Developer category, but we’re even more excited to see the impact that the app is having. At this stage over 16,000 people have done the test on their mobile phones, and we are seeing that about 25% of those people are failing the hearing test. It therefore looks like the people who are taking the hearing test are people who suspect that they may have a hearing problem.

The HearZA App is designed to not only detect the hearing problem, but also to link patients to either our private or public practice referral database of hearing healthcare providers. People are referred to their closest hearing healthcare provider, and the provider then needs to provide feedback on whether they contacted the patient or not. If they haven’t, then the referral moves on to the next closest hearing healthcare provider. In that way we are trying to incentivise providers to follow up with patients.

By way of sponsorship we’re able to help patients who can’t afford with interventions such as hearing aids. We recently fitted three patients with hearing aids who were identified through the HearZA campaign but couldn’t afford the devices. We fitted them here in our department at the University of Pretoria with brand new hearing aids sponsored by Sivantos. We’re putting together a short documentary about it to showcase the importance of detecting hearing loss, following through on the intervention and finding out what impact it has on the lives of individuals, and the difference better hearing makes to their daily functioning.

We realise that something like a national hearing test that’s on an app takes a continual public awareness campaign and effort to keep people engaging with the app and downloading it. We are therefore working on marketing campaigns all the time to see how we can engage in a way that elevates hearing loss awareness in the public sphere and not just to a small segment. We’re aiming to dispel the myth that hearing loss is just for the elderly. Last year the WHO issued a warning that the widespread use of mp3 players and phones poses a major public health risk for hearing loss in young people. HearZA aims to increase awareness of this and have young people monitor their hearing over time. Users are given a personal hearing score, and the idea is that they can monitor it on regular intervals to make sure that there are no changes for the worse in their hearing ability.

Are there any developments in hearScreen’s pipeline that you want to share?

There are number of exciting new things that we are working on. One is that we’ve partnered with a UK-developed solution, called Peek Vision, which resembles our solution but for eye health. It was also developed by an academic institution and has been validated on hundreds of thousands of patients. We have integrated their solution as an option in hearScreen and are now running trials to conduct both hearing and vision screening using the same mobile phone.

We’re also developing an otoscope – a device that you use to look into the ear canal of a patient – which can be connected to the same phone. We have developed a decision tree and are now expanding that to an artificial neural network that allows us to diagnose the five most common ear conditions in patients in an automated diagnostic fashion. We’ve published our first findings in one of the Lancet journals showing that we have an accuracy that exceeds 80% in our diagnosis, which is better than many general practitioners.

What advice would you offer other mHealth solution providers and entrepreneurs who are trying to have an impact on the health of individuals?  

From our experience, it takes a diverse team to build a solution that is relevant and that can make an impact. We’ve found that the synergy between clinical, engineering and commercial experts is where the magic of innovation lies. That’s been critical in our development, especially for a point-of-care diagnostic solution like hearScreen. We’ve been fortunate enough to have this evidence-based academic background as well; the solution was developed in a university setting and it’s now being rolled out with a tech transfer into a private company. We’ve also managed to get an entrepreneur on-board, Nic Klopper (hearScreen, CEO), who has a real vision and who’s driving the expansion process with a view to an international footprint.

One of the other important pieces of advice is that from the very start, all our iterations have been tested on the ground with the people who we were hoping to have the biggest impact with. Without that we would have gotten entirely lost with the application of the solution and testimony to anyone in this space that first and foremost, your solution must be designed to help patients.

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