CleverCancerCare

85% of children in High Income Countries (HICs) survive and thrive following a cancer diagnosis. This is in stark contrast to what happens to children in low- and middle-income countries (LMICs) where there is a 20% survival rate  (where over 80% of the 400,000 children who develop cancer each year live). Due to a complex range of poverty related limitations and markedly different levels of access to quality care more than 75% of these children will die of their disease. The lack of awareness of childhood cancer in LMICs has resulted in the disease to be a neglected disease causing many preventable deaths. In countries such as Tanzania where half of the 60 million population are below the age of 18 years old this disease is affecting a significant portion of the population. This social innovation aims to tackle two specific problems related to the high mortality rate of childhood cancer in LMICs:

1. The first problem we identified is that data from LMICs shows that systematic patient assessment is prone to error and rarely comprehensive. The resultant incorrect diagnosis and staging omissions have severe effects on patient health and reduce the chances of survival. Children often present to multiple treatment sites and referral information is seldom sufficient leading to repeat testing and unnecessary delays.

To ensure standarised patient cancer care across a nation it is essential to coordinate, monitor, and accurately record a patients’ information, treatment options and journey through the health service – either at a single hospital or across multiple site admissions. In order to do so a reliable and robust nationwide patient data network is required. 

To best serve the individual child with cancer a data network must systematically gather the correct patient information, leading to the correct diagnosis and staging in order to choose the correct comprehensive treatment including suggesting the correct treatment site and timing of response to treatment evaluations. This data must follow the child as they are referred between sites.

2. The second problem we found is that administration of chemotherapy at LMIC sites can be fraught with danger where protocol decisions are complex and prescriptions are almost always handwritten. With inadequate staffing capacity, prescribing errors are common and lead to unnecessary toxicity and treatment failures. Existing automated chemotherapy prescribing programmes are built for protocols used in High Income Countries, inadequately automated and prohibitively expensive.

TLM has created 2 powerful medical devices to dramatically modify these entirely unacceptable LMICs childhood cancer outcomes, with the potential of saving countless young lives. It is known as our suite of ‘CleverCancerCare’ Applications which consists of 2 synergistic web-based applications: CleverCharts and CleverChemo:

• CleverCharts:

Our CleverCharts Paediatric Oncology Data App is an Electronic Record Management System (ERMS) which has been custom built to incorporate all essential clinical data points related to childhood cancer. It has been built from the bedside to the cloud and is extremely user friendly while capturing a comprehensive dataset, including the limited data required by governments in the WHO Cancer Registries Initiative (CANREG5), simplifying mandated reporting. It will support medical personnel in choosing the correct comprehensive treatment. The application has helped to maintain the integrity of patient data and can be conveniently accessed by the different sites as patients move across the country using a unique but safe patient identifier.

• CleverChemo: 

An initial proof of concept Excel-based Automated Chemotherapy Prescription Platform (ACPP) has been implemented at Muhimbili National Hospital (MNH) in Tanzania. It has led to remarkable reduction in errors recorded over the last 4 years alongside an overwhelmingly positive reception from clinical staff using the excel-ACPP. Despite its incredible success, Excel-based programs are limited due to: security issues and ability of end-users to modify formulas; difficulty automating updates and reports; and complexity of building new treatment protocols.

CleverChemo, a custom web-based ACPP, is being developed to replace the excel-based platform to overcome the outlined limitations. We estimate that its unmatched automation and data verification features will remove more than 95% of all systematic prescribing errors, ensuring every child receives treatment faithfully according to protocol-directed calculations and requirements. It will transform the potentially error prone dangerous task of calculating chemotherapy to a safe, secure reliable process and will save countless lives.

CleverChemo has been built to either work independently or communicate with CleverCharts, allowing the hospital or health service flexibility in choosing one or both will ensure strict adherence to treatment protocols and minimize human errors in chemotherapy scheduling, calculations, and other protocol directed decisions application.

CleverCancerCare has the potential to help save the lives of 100,000s of children diagnosed with cancer in LMICs worldwide. To maximize our impact, we will distribute CleverCancerCare using either a free model or a tiered social enterprise model of distribution to overcome financial barriers to access. In developing and disseminating CleverCancerCare, this project aligns with the mission of MIT Solve to impact the lives of children with cancer and empower resource-limited countries by the built equitable health system to help cure childhood cancer.

It is estimated that 400,000 children develop cancer annually in LMICs. In Tanzania, there are approximately 4000-4500 who suffer from the disease on annual basis. In a population of 60 million people that may seem like a small number but each and every one of these children deserve the dignity to live happy and healthy lives. Our organisation, Tumaini la Maisha, is the only organisation in the country who provides children with clinical and non-clinical cancer services free of charge. We believe our social innovation, CleverCancerCare, will serve a multitude of groups: 

1. The suite of applications, CleverCharts and CleverChemo, will drastically improve the workflow of medical personnel. CleverCharts will help staff to organise, manage, record and communicate patient data accurately and efficiently. At the moment all patient files are hand-written and paper-based. This can hinder the work of staff due human error and omission of  data. An ERM system will help staff to record the data with much more precision, retrieve data much quicker all the while ensuring that the data is robust. The patient's file will become more comprehensive as each hospital they visit will be able to record the data in the centralised system. CleverChemo will help medical staff to be confident in the prescription of chemotherapy. In Tanzania, like many LMICs there is a shortage of oncology specialists. While the application still requires a specialist to make a final decision, it can calculate the chemotherapy prescription for medical staff without these expertise.

 2. The children who suffer from cancer in Tanzania and in all low- to middle-income countries will also benefit from this innovation. CleverCharts will improve patient management and CleverChemo will ensure more robust chemotherapy prescription. As a result, the quality of treatment for paediatric oncology patients will improve. Once these products are rolled out, we want this product to support not only Tanzanian children but children in all LMICs. As we grow we hope to reach other paediatric oncology departments in Africa and across the globe to help them to adopt this technology to increase the survival rates. 

3. CleverCharts can also be adopted for adult oncology patient management. Thus, our social innovation has the potential to improve the treatment of this cohort of patients. 

4. In addition, by tackling childhood cancer in LMIC’s we have the opportunity to support governments to reach not only the Sustainable Development Goal 3 by 2030 but also to improve 1, 2, 4, 5, 6, 8, 10, 16, and 17.

The team has built a solution to real problems that they encountered every day caring for children with cancer. Each member is deeply committed and brings unique and crucial expertise to this venture. 

Dr. Trish Scanlan not only has over 20 years experience in Pediatric Oncology practice but also has phenomenally defeated breast cancer twice! This personal experience drives the grit and determination of this powerhouse to eradicate childhood cancer. She is the Director of the TLM Pediatric Oncology Programme in Tanzania where she oversees all operations at the Upendo Children’s Oncology ward, Ujasiri Family Hostel in Muhimbili National Hospital, MNH, and more recently the National children’s Cancer Network – supporting children’s cancer services at 11 sites all over Tanzania. Utilizing her tenure in Ireland and Africa to ensure a consistent transfer of resources and knowledge she has facilitated the partnership of the Department of Pediatrics at Muhimbili National Hospital with Children’s Health Ireland in Dublin. She has designed and supervised a master’s course in Pediatric Haaematology/ Oncology and a 10-week Intensive Pediatric Oncology Nursing certificate course based in Muhimbili University of Health and Allied Sciences, MUHAS. It was Dr. Scanlan’s ingenious desire to replace patient assessment paper files with an automated system that lead to the creation of the CleverCharts data collection system; and directly through challenges she witnessed on the ward that led to the excel-based Chemotherapy prescribing platform. She leads the team using this system and this led directly to the need to create CleverChemo to address the limitations with this first system.

Dr Jeremy Hassan (a medical resident in the US) and Mr Manuel Esther (a movement Science doctoral student) both are TLM volunteers for more than 4 years– initially in person and now remotely. They built the Excel based ACPP and advise on the CleverChemo design. They have never received any payment for their incredible support

Mr. David Sweeney is the Senior Chief Software Developer with more than 20 years experience working in industries such as, financial services, reward and recognition and medical. He has also worked as a Technical Logistician for Medicine Sans Frontiers. He previously worked for IBM in the Global Services and Microelectronics Divisions. He holds a first-class honours degree in Electronic Engineering from Dublin City University. He is driven to use his skills to serve the poor.

Mr. Mark Ashford is an IT consultant with more than 25years’ experience, specialising in the energy sector supporting extensive programmes in Africa, CIS and South America. He is founding board member of TLM UK and fully committed to supporting TLM with extensive experience in the area of data security. 

Dr Rehema Laiti is the Unit Lead on the children’s oncology ward in MNH. She has driven the clinical use of the TLM Excel based ACPP among all her local oncology colleagues.

Mr William Chimwege is an IT specialist employed at MNH and is playing an essential role in embedding the CleverCharts programme in the hospital server. He has supported TLM activities for over 5 years.

As our project is still in the early stages we are in need of strategic business development and technological support. We hope to develop the CleverCancerCare service into a social enterprise but need expert advice on how best to achieve this model. We believe the WFP Innovation Accelerator will provide the necessary developmental support. 

In addition, we currently do not have sufficient funds to progress the project at the pace which we feel it should be progressing so we are also in need of  financial support of which this prize offers. 

Our programme has the potential to save countless vulnerable lives and this opportunity provided by the Solve team can help make this a reality. The fact that Solve provides the dual opportunity of technical expertise and monetary support makes this programme ideal for the progression of our project. We would be thrilled to have the chance to collaborate with your team in order to effectively and efficiently eliminate suffering and deaths of children with cancer in not only Tanzania but in all LMICs. 

Electronic Management Record Systems (EMRS) and Automated Chemotherapy Prescribing Programs (ACPP), CleverCharts and CleverChemo respectively,  dramatically improves protocol compliance which in turn strengthens the capacity of medical personnel to provide high-quality and effective treatment. However, commercially available software is prohibitively expensive, inadequately automated and often tailored for High Income Countries.  

A recent systematic review of 37 commercially available ACPP systems concluded that ACPPs reduce medication errors and the time burden of prescribing treatment. There are also many commercially available EMR systems. If there are so many other options on the market what makes Clever Cancer Care novel? Below are the reasons CleverCancerCare is different and urgently needed.

• Distributed using a social enterprise model. All other programmes are commercial for-profit Apps and are prohibitively expensive for most LMICs 
• Specifically built with LMIC’s in mind (although equally able in HIC settings)
• Maximally automated to adhere to LMIC chemotherapy treatment protocols, minimising the need for expert decision making – if the decision is clearly outlined in the protocol then it will be fully automated by algorithms in CleverChemo

One of the most innovative features includes the fact that the user does not need to share any patient identifiers to use the CleverChemo ACPP and it will not store any information remotely, thereby maximizing web-based data security. In the complex and challenging world of medical technology this is a very simple solution to data safety. Instead, the information is stored on the CleverCharts programme which features best-practice data security measures.

2022-2023 Impact goals:  

- To ensure that no child in Tanzania dies unnecessarily from cancer 

- To deliver high-quality cancer treatment to call children suffering from cancer in Tanzania 

- All NCCN sites have access to the CleverCancerCare apps and are trained on its use 

- To improve the quality of childhood and adult oncology treatment across Tanzania

- Conducting rigorous M&E and impact evaluations to measure the impact of the app and to discern if changes need to be made to scale-up the service 

2022-2026 Impact goals: 

- To reduce the number of children dying from childhood cancer in LIMCs

- To improve the quality of childhood and adult oncology treatment across LMICs

- Use the revenue from the social enterprise to ensure that the provision of chemotherapy drugs, health insurance, transport services and nutritional programmes are sustained throughout the NCCN in Tanzania 

KPIs: 

Reduction in childhood mortality under 5 / under 18

Reduction in deaths due to non-communicable disease; cancer 

Reduction of errors in chemotherapy drug prescription 

Increased adherence to protocols for chemotherapy throughout entire treatment course 

Increased accuracy of disease identification 

Increased accuracy of patient data 

Increased number of sites in the NCCN using the CleverCancerCare Application 

Increased number of medical personnel trained on the usage of CleverCancerCare Application 

The CleverCancerCare applications, developed with the context of LMIC in mind, provide practitioners an easy-to-use, safe, secure and reliable product to firstly record and monitor patient data and secondly to accurately prescribe chemotherapy treatment. 

The activities that have taken / will take place to date include; the development of the applications, training staff on the usage of the applications and adoption of web-based applications on electronic devices in hospitals. These activities will allow for immediate outputs which will see the medical staff using the applications in their daily work routines. CleverCharts is an application where doctors and nurses can easily enter patients data into a database to communicate accurate and secure information between staff and different medical institutions. This information can be accessed by each medical institution the patient presents at. Most importantly, the application protects the data through a data restriction/ access feature. The CleverChemo application allows medical personnel to enter data such as standard patient specific details (age, weight, nutrition status, blood pressure, cardiac function etc), laboratory results and recent documented side effects. Then the application generates an automated personalised prescription for the patient's chemotherapy prescription minimising error, omission, or the need for senior support in the calculation process. Data will also be protected by a data restriction/ access feature. 

Our immediate goals is for medical practitioner's processes to become much more efficient and effective. Clever Cancer Care will support doctors and nurses to carry out their work in a safer, more secure and quicker manner. In addition, we want to achieve higher rates of accurate chemotherapy treatment prescription. 

These immediate goals will link with our longer term goals which involves the reduction of childhood and adult deaths from cancer in Tanzania and in LMICs. It will also help to grow, integrate and improve the effectiveness of the NCCN and LMIC healthcare systems.  

There is ample evidence that these applications can drastically reduce errors, however, these products are typically used in high-income countries. Further, we built an excel-based proof of concept of the tool for automated chemotherapy prescription, which has been successfully used on one ward for over 2 years. 10 custom built excel sheets were rapidly adopted and reduced prescription errors by more than 90% almost over night. However, the limitations of the excel-based tool has revealed the need to develop the application 

We will test some of these links through regular reviews, meetings, consistent monitoring and evaluation. It will be important to take these reflections into consideration as each new site adopts the technology will need their specific context, resources and capacity appraised. 

Assumptions:

1. That medical staff will be prepared to change their behaviours when it comes to patient management and chemotherapy prescription. While this transition is simply a move from paper-based processes to electronic processes that will dramatically improve the staff's work, it may result in some pushback from staff uncomfortable with the shift. In order for all staff to feel they have ownership over the product we have been careful to include their feedback in the development of the product. This is crucial as they are end-users. It is also important to train all staff so the new technology enhances their workflow as opposed to intimidating or hindering their ability to work effectively. 

2. That Muhimbili National Hospital will be accepting of the restructuring of organisational processes. It is important when there is an update to systems that everyone is on board and trained on the product. 

3. The Tanzania government is accepting of cloud-based products. The Tanzanian government has implemented policy to support the Digital Transformation in the country.

CleverCharts 

This web-based system is housed on a HIPAA/GDPR compliant AWS cloud. International medical oncology coding systems have been used (ICD-10 and ICD-O) so that the data collected can be compared with any standardized data set. It is ready to be tested and launched nationwide. 

On the server side the system is created using Elixir and the relational database is postgres; the front end uses bootstrap and all the source code is managed via GitHub.

CleverChemo 

It will comprise of the following components: a background engine where a chemotherapy calculator operates; a library containing 3 sections (common paediatric oncology protocols; all possible disease staging systems; all common drug modification rules used to inform the chemotherapy calculator); and a user interfacing front-end for initial data entry and subsequent prescription generation. Adding a new protocol to this system would be simple and updates across all users would be possible instantly. The web-based app requires the prescribing doctor to input a limited number of simple patient and treatment-response related facts. These include: standard patient specific details (age, weight, nutrition status, blood pressure, cardiac function etc), laboratory results and recent documented side effects.

Our algorithm then automates the necessary complicated calculations minimising error, omission, or the need for senior onsite support in this process. Vital timed response-to-treatment-based alterations in management are generated and highlighted for specialist review and approval.  It is important to state that there will always be a need for sub-Specialist to confirm and provide final approval to any chemotherapy prescription, but this programme allows the possibility of offsite supervision for certain oncology treatments.

CleverChemo will not store any information remotely thereby simplifying all web-based security issues. It will act in the same way as a very specialized online calculator. It generates the chemotherapy prescription which is then stored by the end-user. In the complex and challenging world of medical technology this is a very simple solution to data safety.

As we are the frontline workers at Muhimbili National Hospital we collect the primary data to input into the CleverCancerCare suite of applications. It is our team of doctors and data clerks who are involved in the population of data. As we introduce the applications to our partner sites the medical and data management teams at these sites will also input the data from their paper files into the applications. 

The incentive for these teams to input data is to improve their everyday work practices and to improve the management of their patients. Our users have reported it to be practical and organised as it compiles the important details of a child's journey fighting cancer in a comprehensive way. By summarising the essential medical details of a patient's history, it allows them to make the best decisions possible for the patients. 

The most important aspect of these applications is to support medical personnel, not make their jobs more complicated. Once they have been  implemented and appropriate training as been provided, users see the impact and potential the applications have to support the reduction of mortality. 

Our vision is to ensure that no child is left behind in the fight against cancer. This means that regardless of sex, race, religion, tribal or cultural affiliation we will provide our clinical and non-clinical services to those in need. This mission to provide high-quality cancer treatment to Tanzanian children from all walks of life underpins the philosophy of our organisation. This means equality is a core value at TLM. Diversity in our team is particularly important in an organisation that works with groups from varied backgrounds. We are aware that diversity enables the incorporation of different perspectives which are crucial when dealing with complex issues such as childhood cancer. This empowers us to be a a stronger tea m and more innovative. 

We also want to ensure that we offer members from different groups equal opportunity to work with us. It is important to give all people a fair chance to join a team irrespective of their context. There is a vibrant volunteer programme at our organisation that works with local, national, regional and international people. Involving volunteers into our team creates a dynamic environment which creates diverse insights. This always adds value to our work and reaching the ultimate goal of eradicating childhood cancer. Our HR team have established a strong basis to be as welcoming and encouraging as possible to all of our current staff, new staff and our patients. We want to make sure that everyone feels heard, valued and respected.

TLM is dependent on effective partnerships as we work alongside our colleagues’ at Muhimbili National Hospital. Therefore, placing emphasis on diversity, equity, and inclusivity into our organisational structure is imperative to ensure we are a sustainable organisation and that our staff and patients feel respected, dignified and valued. In addition, as we continue to expand the National Children's Cancer Network, NCCN, across the country, we will ensure to respect and value each individual as we continue to integrate new sites into our NCCN. 

These principles will also be incorporated as we launch the CleverCancerCare App. We will ensure that as we grow the service to ensure that we integrate a strong, clearly defined and thoroughly understood diversity, equity and inclusivity action plan

Our business model will be a social enterprise with a focus on a low- to middle-income client. The aim is to provide medical technology to low-income medical institutions that would otherwise be unable to afford it.This model will help us to achieve a high social impact in terms of improved healthcare and reduction in childhood mortality in Tanzania and in all LMICs. Our customers will predominantly be governments and medical institutions which in turn will principally benefit children with cancer. We will provide our customers with a set-up stage where we implement the product in their institution and train them on how to use the product. We will also provide ongoing maintenance and technical support. This application will be attractive to our clients as other programmes are unaffordable, built with high-income countries contexts in mind, assume senior expertise is on hand so none of the products are commercially available or maximally automated.

Target Market: 

1.   Market 1: Tanzania (free)

a.     Test at Muhimbili National Hospital

b.     Expansion to 30+ centres in Tanzanian National Children’s Cancer Network (NCCN)

2.   Market 2: Expansion in Africa (Level 1 pricing for LMIC)

3.   Market 3: Expansion Globally (Different pricing depending on site)

4. Market 4: Adult Oncology (Different pricing depending on site)

As this is a social enterprise, we would like to use grants and donors to cover the costs of the development. Products will be paid by end-users. Costs will be kept to a minimum to follow a simple revenue model to sustain product maintenance and future development. The service will be provided on a graded basis to sustain product maintenance and future development.

Variations to our CLEVER Chemo APP essential for distribution outside of Tanzania include:

• Compliance with patient data privacy laws in different countries.
• Translation to different languages

Revenue will be realized through invoicing product units:

Unit 1: Single Initiation fee: Standard CleverCancerCare Apps (standard access to CleverCharts data collecting tool; and standard library of CleverChemo automated treatment protocols and reports); training and implementation.

Unit 2: Annual Licensing fee - software and treatment guideline updates; technical support

Unit 3: Customized services including requests to:

•  Programme and upload locally required treatment protocols to the CleverChemo App.  
• Generate customized reports

Unit 4: Licensing fee for access to anonymised data from centralized cloud-server

Our units are priced to cover operating and development costs with a small margin:

Unit 1 and 2 Price: ongoing scheduled maintenance +development costs: training, server, technical support, updates. Patient volume may also be considered.

Unit 3 and 4 Price: Depends on scope of product customization/complexity of data and # of licenses sold.

This project is in the pilot stages of development, so we have not raised funds as of yet. All of the progress achieved so far is the result of volunteer work from specialist business strategists and software developers. 

However, our organisation as been in operation since 2011 and we have a successful record of raising funds and acquiring donations. You can review our financial reports on our website: https://www.wearetlm.org. And our 10 year summary of successes: https://www.wearetlm.org/our-s...Therefore, as stated we will generate funds initially from grants and donations. Once the product is fully developed and implemented we will sustain revenue through the installation of the product, licensing fees and customised services.