Stanford students develop wearable device to help Ghanaian health care workers perform life-changing eye surgeries

Half of the seven million cases of blindness in Africa are due to cataracts, which can be cured with a 10-minute surgery. But in places without internet connection and rural areas, healthcare workers spend an average of one hour just collecting information on paper forms for a single patient – enough time for six life-changing surgeries.

That is now changing. Stanford University students worked with an eye care nonprofit to transform this patient data collection process using near-field communication – or NFC – bracelets and a companion app. The project, called Eye-dentify, originated from the Design for Extreme Affordability Program, a two-quarter graduate course and follow-on incubator program that is hosted by the Hasso Plattner Institute of Design (the d.school) and listed by the Graduate School of Business and the Department of Mechanical Engineering.

Through Design for Extreme Affordability, the students were paired with the Himalayan Cataract Project, a nonprofit global health organization that funds and operates high-volume cataract surgical outreach campaigns in Ghana and other African countries to cure preventable blindness. “They go to the remote areas where there isn’t as much healthcare infrastructure to perform hundreds of cataract surgeries a day to cure blindness in the villages,” said Manali Kulkarni, a master’s student in community health and prevention research at the Stanford School of Medicine and a member of the Eye-dentify team.

After need-finding in the class and discussions with their nonprofit collaborators, the students decided to focus on the problem of manual data collection, which is a bottleneck in the process of providing surgical interventions. Prototyping and small-scale user testing led them to their final bracelet and app design. Then, as fellows of the Social Entrepreneurship Lab – an opportunity that extends Design for Extreme Affordability projects – they facilitated a pilot test of their system in Ghana with the Himalayan Cataract Project staff in-country for 385 participants in June 2021.

The Eye-dentify team found that fully digitizing patient records off-the-grid has reduced patients’ treatment time and improved tracking of medical data. Compared with using paper forms, the team believes that use of the bracelets will result in an increase in patients attending their post-operation check-up care.

Information off-the-grid

Kulkarni, along with Radwa Hamed, a Knight-Hennessy scholar and graduate student in design impact who is starting at the Graduate School of Business this fall, and Aishwarya Venkatramani, a graduate of the master’s of engineering program in bioengineering, worked with their collaborators to increase the efficiency of their operations.

“We built an offline app where you can type in the patient information to mimic the paper form that the healthcare workers were using. The surgical intervention is built of four or five stations, so we needed a way of transmitting the data between stations without WiFi,” said Hamed. “We used super affordable – under one dollar – NFC bracelets, much like a hospital wristband, that the patient can wear.”

These wristbands use the same hardware that makes contactless payments with a credit card possible. By using this pre-existing technology, the team substantially cut down on costs. Many modern smartphones already have NFC readers built into them, thus making the NFC bracelets a clear choice for the Eye-dentify team.

“The NFC technology caters to a high-volume setting. There’s a lot of work that goes into encoding and decoding that data when putting patient information into the NFC bracelet, and it’s very unique in that it can work off the grid,” said Venkatramani.

The data on the bracelets include patient demographics, relevant history, pre-operation eye evaluation, surgery results and complications (if any), as well as post-operation checkup details. The data are encrypted for security but can be backed up to a cloud database when there is a hotspot or WiFi connection. Having an aggregate collection of patient data helps the team perform analysis on patient health and patterns in patient care, while also tracking different surgeons’ performance in terms of surgical outcomes and number of surgeries performed.

This analysis helped not only improve their collaborators’ efforts in Ghana but also demonstrated that this technology can advance medical care in a variety of contexts, said Hamed.

A digital revolution

In addition to increasing the attendance to follow-up appointments, the team received positive feedback from participants, physicians and their nonprofit collaborators. Bracelet wearers appreciated how easy the bracelets were to wear and use, allowing for better access to local referrals. Meanwhile, physicians were excited about the time they saved by using Eye-dentify, as were the members of the Himalayan Cataract Project, who found this to be a much more efficient way to gather and analyze data. Encouraged by the results, the Eye-dentify team applied for, and received, a provisional U.S. patent for their work.

“It was very rewarding to see testimonies from physicians who said that this is changing the way they’re doing things,” said Hamed. “Patients demonstrate 88% return on getting follow-up data the next day, which is much higher than with the original paper forms. The physicians we spoke to even suggested that we should be using this technology across the board in all governmental hospitals, and not just in their remote surgical interventions.”

As part of the Design for Extreme Affordability development process, the Eye-dentify team worked closely with their collaborators to develop their tool, paying particular attention to feedback from physicians and patients in the field to create a product that people will use and trust.

“Co-designing with the community was one of our main goals. We wanted to approach this work by connecting frequently with the community, earning their trust, and making sure their voice drives the design process. It has been very validating to hear their positive feedback and know that they’re participating in the design they want,” said Kulkarni.

The Eye-dentify team says their next step is to further refine their app based on the insights they received from their pilot test and the physicians and patients who used the tool. They also hope to pivot to the U.S. market, taking advantage of the already broad availability of NFC to expand the potential applications of their patient tracking and data collection tools. For the American market, they have chosen to pivot their product to patients, providers and researchers who have, treat or study autoimmune disorders, because tracking medical care related to these disorders can involve aggregating and organizing data from many different health care providers.

“The pandemic spurred a digital revolution in healthcare because everything had to be remote, so it’s been great working on Eye-dentify in that context,” said Kulkarni. “This is the direction that a lot of global health systems want to move towards, so it’s very motivating and feels like we were doing important work at the right time.”