Continuing Medical Education on Stick (CMES)

Innovative technological solutions to deliver best-practice education to medical practitioners in remote areas.

Problem Statement: 
Medical practitioners in resource-challenged countries lack access to up-to-date Continuing Medical Education (CME). This is not from lack of initiative but due to financial and infrastructure constraints.

Interviews with medical practitioners worldwide indicate the main challenges to access CME as: mentor shortages; inadequate funds to buy CME programs; and lack of reliable electricity, up-to-date technology and Internet connectivity. This results in localized medical practices with great disparities between urban and rural areas, with certain patient population receiving sub-optimal treatment.

Our Solution: 
We eliminate the above barriers by designing innovative technological solutions to deliver free and high-quality CME content to practitioners such as community health providers, nurses, midwives, first-year interns, residents, and physicians.

We have developed two solutions, both allowing CME content to be downloaded at locations with intermittent electricity or Internet.

• Solution 1: CMES is a thumb-drive based application, enabling access to content on a charged device without the need for Internet.
• Solution 2, CMES-Pi is a raspberry-pi based offline server that provides real-time access to CME content at locations where it is installed. Practitioners access CME through their mobile phones or through web browser from a computer. This means that implementation is possible at rural health clinics, primary health care centers, hospital emergency rooms, and medical colleges.

The total cost of our solution is low. Initial set up at each site is $10 per thumb drive, and $80 per CMES-Pi. Additional costs include backend server expenses and travel to the site for installation.

The CME content, available in English and Spanish, provides a range of Emergency Medicine (EM) topics. EM is ideal because it covers primary to critical care medicine relevant to all practitioners. The CME is provided free by the distinguished, global faculty at Emergency Medicine Reviews and Perspectives (EM:RAP). It is available as mp3 podcasts and pdf files with quick reference bullet points.

Impact:  
We believe change is achieved, not in quantum leaps, but in smart incremental steps. Medical practitioners provided with quality CME access move forward professionally and personally to enriching their communities and themselves.

Practitioners improve their knowledge, skills, confidence, and performance which translates into improved patient care and health outcomes. This helps break down barriers of professional isolation for rural healthcare providers and maintain a sense of professional pride, distinction, and identity.

Starting in Nepal over two years ago, we have stepped from one continent to another by simple word-of-mouth as participants reached out to their global colleagues. Our project is currently active in 5 countries across 3 continents, including Nepal, Dominican Republic, Guatemala, St. Lucia, and Nigeria. There are 80 rural medical practitioners presently enrolled who serve a patient population base of 387,200. Expansion is scheduled to Ecuador, Uganda and Oceania during the second half of 2018. Our future goal is continued expansion to sub-Saharan Africa, Asia, Caribbean, Oceania, and Central America over the next 3 years and planned enrollment of 500+ practitioners.

Our solutions are innovative applications of technologies optimized for low resource settings:

• CMES thumb drive:
  • Allows the download of new content when Internet is available.
  • Once downloaded, content can be accessed without the need for Internet.
  • The interface is easy-to-use, and has a variety of features (sync, view, search, delete, etc.)
  • The footprint of the plug-and-play application is small (1.6MB). 
• CMES-Pi:
  • Provides point-of-care content access.
  • Has a custom designed build-in pdf viewer and mp3 player.
  • Is optimized to run on low-end mobile devices and computers.
  • Extends capabilities of CMES to mobile platforms.

Our solutions utilize multiple technologies:

• CMES thumb drive:
  • A self-contained OS-like application implemented using Java, Ant, and Maven.
  • Write-protected in viewing mode.
  • Automatic unlock/lock during update (for protecting intellectual property).
• CMES-Pi:
  • Low-cost Raspberry-pi for content management server.
  • Python based web front-end to interact with the Raspberry-pi.
  • iOS and Android apps are available for free download.
• Microsoft Azure Cloud Services:
  • Powershell scripts for automated ‘Push’ content delivery.
  • Storage containers for CME content, activity logging, and usage monitoring.
  • App services for website and blog hosting.
  • SQL Server Business Intelligence Stack for content management and user analytics.

We will be working in 2 new countries, and 5 existing countries to help our participants gain access to enriched educational content.
Our plan includes:

• Scheduled clinical Installations at:
  • 2 hospitals in St. Lucia
  • 3 clinics in Ecuador
  • 24 Nepal district hospitals
  • 2 hospitals in Uganda
• Scheduled installation at 2 Nepal teaching hospitals in partnership with the Nepal Medical Council and government
• Offer additional content specific for primary care, nursing, and tropical medicine.
• Continue development of a usage tracking dashboard to evaluate effectiveness of the solution.
• Grow support base and financial stability.

Our five year plan focuses on 4 ways to scale our business and maximize impact.

• Use a data-driven approach to strategically ring map areas where our impact can be highest.  
• Actively grow participation through networking with global CME providers and nonprofit healthcare organizations.
• Roll out our “Mind the Gap” program allowing donors to choose a site they wish to support.
• Develop a robust evaluation approach to measure both effectiveness and impact, and use these findings to make evidence-base decisions.

We work with existing nonprofit medical organizations that provide clinic and supply support to their local partners in low-resource countries. We survey each potential participant to determine IT infrastructure available at their clinics/home to determine the best CME solution. Once determined, we visit the participants and provide instructions to user the thumb drive or CMES-Pi unit. If available, we include local IT staff at the clinics. We are available via email, Skype or WhatsApp to troubleshoot, visit the participants for follow-ups, and provide instructions for using the CMES thumb drive or CMES-Pi unit.

80 rural medical practitioners in aforementioned countries have either a thumb drive or downloaded the mobile app for the Raspberry-Pi device. Doctors and nurses download files when internet is available then listen offline to mp3 podcast or read the pdf file on a specific medical topic. They apply this knowledge to improve patient care, develop CME lectures for local staff, mentor and write procedure manuals.

323 medical practitioners in low-resource countries will be enrolled this year with either a thumb drive or CMES-Pi to access up-to-date emergency medicine CME.

Our goal for the next three years is placement of CMES-Pi units in all 75 Nepal district Hospitals; 3 Nepal teaching hospitals; and continue expansion by networking with present and new partners in sub-Saharan Africa, Caribbean and Central America.

CMES is a project of Techies Without Borders (TWB), a 501(c).3 nonprofit corporation based in US. Our team comprises of two academic researchers with deep experience in building technological solutions in low-resource settings, a retired EM doctor with experience serving rural areas, and technology specialists. We actively reach out to potential partners, and promote our solutions through international conferences and social media. CMES has received global attention through word-of-mouth, especially from medical practitioners working and volunteering in resource-constrained areas. For example, we just received an invitation to speak to the Sustainable Pacific Community (SPC) to expand the project to Oceania

We obtained 200 thumb drives and 30 raspberry-pis through grants. Backend operational cost provided by Microsoft Azure Grant expires at the end of 2018. Our revenue model relies on charitable donations through TWB to support our operational cost. 

We actively seek funding from philanthropic foundations, as well as service clubs such as Kiwanis, Lions and Rotary. We are on Amazon Smile and Google G Suite for Nonprofits. We charge For-Profit hospitals at-cost for participation. For future expansion, we are working to extend Azure grant for a sustainable long-term relationship with Microsoft.

Our exposure has mostly been through word-of-mouth. Solve’s network and media visibility can help us reach a wider audience and gain additional support from corporate foundations.

Our solution is deliverable and broadly scalable, and requires minimal technological support to sustain. Solve can provide expertise and guidance for impact evaluation of our solution.

• Understanding local needs of rural medical practitioners is challenging and require face-to-face interactions at the local site. We hope Solve community can provide input on how to best address this challenge.

• Lack of stable funding sources. Solve can guide us in developing a better financial model to support our operational cost.

• Solve can help us to find expertise in program evaluation, targeting the monitoring and evaluation of both outputs and impacts of the CME initiative.