NB Health Care
Specialist Eye Care, Anywhere: Vula Mobile app enables rural health workers to conduct eye tests, consultations
Vula Mobile says that of the world’s 39 million blind people – most of whom are in the developing world – 30 million lost their sight unnecessarily; their blindness could have been prevented through basic health care and simple procedures like cataract operations. That’s why Dr. William Mapham, an ophthalmologist in South Africa, developed the Vula Mobile app, which enables health workers in remote areas to carry out eye tests and consult with specialists using a smartphone. In the Q&A below, Dylan Edwards (dylan
Kyle Poplin: Did Dr. William Mapham develop the Vula app specifically for low-income settings or was that a use recognized after the fact?
Dylan Edwards: Vula Mobile was designed to be used in low-income settings. Dr. Mapham was working in rural Swaziland when he first got the idea for the application. He was working in an eye clinic called Vula Amehlo, siSwati for “open your eyes,” which is where the inspiration for the name “Vula” came from.
Working in this setting, Dr. Mapham saw firsthand how difficult it was for patients to access specialist eye care. A lack of access to basic diagnostic tools and specialist skills and poor communication between hospitals and outlying clinics meant that often patients were not referred to the eye clinic when they should have been. Equally frustrating, many patients were referred when there was no need for specialist care, which created unnecessary costs both for the patient and for the clinic.
Today, Vula is used in low-income settings in both rural and urban environments.
KP: What phones can carry the app? Are there “competitors” and, if so, what makes Vula unique?
DE: Any Android or iOS phone with a camera. The closest thing to a direct competitor are chat services like WhatsApp. We have often come across places where WhatsApp is being used unofficially to transfer patient data. However, this is not secure or completely confidential. Vula has a built-in data security system whereby patient data is deleted from phones after the referral has taken place. The data is then stored on a secure server that can be accessed later if required.
(The app, shown in use at left, uses the phone’s light to test pupil reactions.)
There are some organizations that are doing really interesting things in building sophisticated diagnostic equipment that can be plugged into a smartphone, but we see these organizations as potential partners rather than competitors – their tech can help us to make better referrals. However, for the most part our main competitor is a combination of pen, paper and fax machine, which is still the way that most medical referrals are made in low-income settings.
What sets Vula apart is that we connect our users directly with specialists who can respond in real time. We think that while the Internet has done an amazing job of making information available to everybody, the real value still lies in helping people to access specialist skills.
KP: Is the app primarily used by health care workers in the field or in hospital or clinic settings?
DE: We have a little over 300 health professionals using the app at the moment. Most of these are nurses, community health workers or general doctors who use the app to make referrals, while about 30 of them are eye health specialists who use the app to receive referrals. Referrals are normally made from primary health facilities (in South Africa these are the thousands of small clinics found throughout the country that are normally the entry point for somebody accessing the public health system) or from mobile outreach clinics. Soon, we hope the app will be used to screen children in schools, too.
The specialists who receive the referrals are generally in a larger, more central hospital.
KP: What feedback are you getting from health care workers who use the app, and from eye specialists? How does it ease their burden?
DE: We’ll be publishing the results of a study that tackles this question soon. Having seen the preliminary data, I can say that the feedback has been really positive. Our users generally agree that using Vula Mobile saves them time and our non-specialist users say that it has increased their knowledge of eye health.
KP: Can you talk about how the app helps rural health care workers connect with eye specialists?
Dylan Edwards (right): When seeing a new patient, a health worker will capture their basic details in a short, simple form. The app will guide her through performing an eye test, and automatically assign a visual acuity score (a standard measure of clearness of vision). Once she has saved the patient’s details, she can tap on the “refer” button, which will bring up a list of the specialists at the hospital where she refers her eye health patients. She will be able to see which doctor is on call. Once she taps on the specialist’s name, she will be able to exchange text messages with that specialist through our built-in eyeMessage system. This allows the health care worker to ask clinical questions and allows the specialist to find out more about the patient in real time. Together, they can then decide what the best course of care for the patient is.
KP: What’s the business model for the app?
DE: Our model is to sell licenses to health system administrators. This would normally be a public department of health, whether municipal, provincial or national, but could also include large health-focused NGOs or even corporates with large workforces that manage their own health systems.
KP: What are your plans for expansion?
DE: We want to expand in two ways. First, we want to roll our existing eye health app out to new territories. We are already some way down the track to launching in Swaziland and Zambia, and there are still plenty of areas in South Africa where we would like to establish ourselves.
Second, we are looking to expand to areas of medical specialization other than eye health. We are talking to specialists in a wide range of areas of medicine (cardiology, neurology, dermatology, orthopaedics, paediatrics, among others) about how a mobile referral platform might be able to support their work. We also think that this will make our offering far more useful for health care workers who will be able to access specialist skills across a range of areas of medicine.