Pictured above: A health care worker in Bangladesh (right) uses the THINKMD app on a tablet while evaluating a child's health. (Photo: Jon Brack)

The growing shortage of health care workers seen in the U.S. is even greater in areas like sub-Saharan Africa, which according to the United States Agency for International Development (USAID), “faces a deficit of 2.4 million doctors and nurses” by 2030. Compounding that challenge is the fact that community health workers in the region lack the necessary training and skills to provide accurate assessments of patients’ health risks.

University of Vermont Professor of Pediatrics Barry Finette, M.D., Ph.D., had experienced this problem first-hand when providing health care in low- and middle-income countries. He was eager to find a solution, and with Professor of Pediatrics Emeritus Barry Heath, M.D., spent three years developing and testing a mobile app-based digital tool designed to bring physician-based knowledge to the hands of minimally skilled health workers. In 2014, they founded THINKMD™, a registered Vermont Benefit Corporation which offers what the organization calls “digital ‘clinical intelligence’ technology” that is affordable to all.

The THINKMD tool can be used anywhere – on or off-line – where there is a shortage of healthcare professionals and “allows the end user to perform a high-quality clinical evaluation of a patient and create appropriate care arrangements,” explains Finette. To date, the technology has been used in 11 countries, impacted a population of nearly 20 million people, and assessed roughly 300 clinical diseases and condition risks.

In the fall of 2021, THINKMD received a $2.3 million Bill and Melinda Gates Foundation grant. Titled “Development of a Globally Scalable Standardized Fast Healthcare Interoperability Resources (FHIR) Based Clinical Application Programming Interface (API),” the project focuses on the technical build-out of the technology – upgrading and standardizing clinical analytical tools/risk assessments and performing patient evaluations of people – and supporting interoperability between different systems.

“This work will allow us to distribute our clinical intelligence platform more broadly so that it can be placed within other health information system platforms,” says Finette. “Exchanging data can be very complicated (different languages, for example) so you need a universal data structure ‘language’. Gates is funding that too,” he adds.

More recently, THINKMD received a $1.5 million USAID Development in Innovations (DIV) grant to perform a randomized controlled clinical trial in Nigeria to test the technology at a higher scale and determine its ability to scale at a country or global level using a sustainable financial model.

“Currently there is an exponential increase in the shortage of health care providers globally,” says Finette. “You cannot replace these physicians by training more due to a lack of educational infrastructure or training facilities to meet the needs. To meet the needs, technology can help build a health care workforce capacity with increased skill sets and knowledge.”

The first phase of the research, says Finette, will be a “proof of principle.” The technology will be tested with minimally skilled community health care workers and nurses in public clinics to determine if it helps them provide a similar quality of care as physicians. Then, he explains, the team will take “the built tech that has demonstrated high value with the goal to test at a higher scale and determine its ability to scale at a country or global level via a sustainable financial model.” The clinical study will be conducted over the next two years.

Finette’s project team includes physicians from the University of Pennsylvania, global health economists at Yale University and World Bank, and implementation collaborators including Nigerian representatives of e-Health Africa and Innovations for Poverty Action.

If successful, the Nigeria study will provide evidence that THINKMDs technology cannot only save billions of dollars for countries, but help increase health care workforce capacity and quality and better utilize the existing physician workforce to ensure better care for citizens.