Frontida Records Electronic Health Record System

The number of forcibly displaced people has continued to rise dramatically to over 100 million in 2022 with 74% being hosted in low- and middle-income countries. As of October 2022, 8 million Ukrainians have fled their home country and have taken refuge in neighboring countries (www.unrefugees.org) while another 6 million people have been internally displaced within Ukraine. For example, Romania reported hosting over 106,000 Ukrainian refugees in January 2023—a number that only continues to grow. The public health imperative of addressing the medical needs of Ukrainian refugees is weighed down by the lack of retrievable refugee medical records and accurate medical supply inventories due to overwhelmed and disrupted healthcare systems affected by the war. The health records are either unavailable for refugees fleeing a war zone or misplaced when paper records are lost and/or destroyed. When moving from place to place, refugees need access to their health information in order to receive medical care and treatments in a foreign land. Furthermore, a lack of accurate, real-time inventory logs for medical supplies can lead to inefficient allocation of resources. Unfortunately, in Ukraine, many of the logistic systems within pharmacies and medical clinics have been severely damaged and disrupted by the war. Without the proper documentation, patients are at risk of misdiagnosis, errors in treatment, and fragmented care while lack of adequate clinical inventory management can lead to the risk of inaccessible resources and delays in healthcare services. The financial burden for healthcare is great both for host nations and for non-government organizations (NGO) that are trying to provide aid to refugees. Such realities are common among refugees, as well as people living in low-resource and underserved settings. Refugees, as well as people living in low-resource and underserved settings, need data to make informed clinical and public health decisions. Our solution is an affordable electronic health record that can rapidly adapt to the needs of clinics regarding managing and treating refugees in low-resource and crisis situations.

We build easy-to-use, scalable, customizable electronic health record (EHR) systems for NGOs, clinics, and hospitals that treat mobile refugee populations amidst humanitarian crises. The purpose of our EHR system is to preserve a patient’s medical history and data in a crisis environment. The data is securely stored in the cloud so patient data can be accessed by providers anywhere, providing a continuity of care. We built our EHR system in collaboration with staff at Refugee Camp Moria and have scaled up to provide EHR support to refugees in Greece, Jordan, Malawi, Ukraine, Poland, and Romania. 

Human-centered design lies at the core of our technology: we adapt our platforms to the language, culture, and clinical workflows of healthcare teams in their unique environments. We use a novel low-code system that builds off of pre-made templates, enabling our software engineers to rapidly customize the EHR systems to the needs of the end-users. The value of low code was evident during the evacuation of Afghan refugees from Afghanistan. In two days, Frontida Records was able to develop patient databases requested by the Transit Initiative, an NGO assisting Afghans to evacuate during a fluid and tense war. Our low-code EHR system was also tasked to preserve and track the health status, birth records, and visa data of people fleeing this war zone. 

For this challenge, our goal is to provide an EHR for refugees on the move by preserving their medical documentation and health histories. We hope that refugees will receive optimal care from healthcare teams who will have access to their medical histories. In addition, we are creating a medical supply and tracking system to help manage the logistics of sending and receiving medical supplies in humanitarian crises. Without data-sharing between healthcare teams on-the-ground and suppliers, healthcare teams are unable to request needed items nor know what medical supplies are coming. As a result, unhelpful and redundant resources are sent and even lost in transit. With our system, we provide up-to-date medical supply inventories to help suppliers send the correct resources and track shipments.

For this MIT Solve Challenge, the Frontida solution will serve Ukrainian refugees who need access to their medical histories as they migrate to new destinations as well as providing in-need clinics with inventory systems to help with clinical management and ensuring a higher quality of care. 

Because there is a lack of broad communication between healthcare systems across different countries, it hinders access to individual patient information regarding health history and previous care. A connected system of health data is vital to integrate patients who are migrating to a new destination, especially in the case of refugees. Since these systems of communication do not exist, refugee patients are often left to attempt to recall their medical histories and are often unable to access treatments and receive continuity of care. Furthermore, according to the WHO, refugees who are arriving at their new destinations will either have incomplete records or paper records which makes it hard for “tracking, assimilating, reporting and transferring health information.” Preserving refugee medical data on the cloud will ensure that refugees will be safely treated because their medical history and medication lists will be available to medical providers to make informed treatment decisions. The medical data will travel with the refugee patient as they are transferred to different medical facilities or migrate to new destinations. In addition, it will support clinic providers who are treating Ukrainian refugees, help coordinate care between different medical clinics, and provide rapid feedback of changing medical needs to the clinic’s sponsors. By eliminating misinformation, our EHR also helps reduce the potential for errors and misdiagnoses. We demonstrated that LMIC medical outcomes improved with stronger communication between medical providers (whether long or short term). 

Furthermore, we aim to improve the productivity of clinics and hospitals in Ukraine and other low-resource areas that rely on donated medical supplies amid humanitarian crises. Unfortunately, supply chains and communication channels are often disrupted resulting in health care teams burdened by inadequate supplies. It is difficult to coordinate medical relief efforts without information and knowledge of the needs of healthcare teams on-the-ground, including inventories of available supplies. Furthermore, healthcare teams are often required to send proof in specific formats to show what donations were received and how they were used in order to continue receiving medical supplies from funding and resource agencies. We hope to build into our EHR system the ability to track and send this information to suppliers and donors to build trust and transparency.

Our team is well-positioned to build and operate an EHR in crisis regions because of our extensive background experience, team-focused approach, and human-centered design in working together with the clinic providers and refugee patient populations we serve.

Our team lead has experience working and volunteering in refugee camps and LMICs, especially with their most vulnerable populations (women, children, etc.), and always works closely with the local healthcare teams on the ground. Our team is committed and will provide the highest level of service to those who seek our help. The team is diverse as we have members who come from different countries, cultures, and professional backgrounds ranging from technology, business, healthcare, and nonprofit work. The multi-ethnic composition of our team, combined with our vast and concerted effort to learn about the communities we serve (including their native language and cultural customs), allows us to successfully plan and execute our EHR in a culturally-sensitive manner.

Our commitment to those we serve has fostered a strong partnership with the communities we work with as we are able to meaningfully incorporate their ideas and feedback into the EHR. This process includes product demonstrations, conducting needs assessments with our partners on the ground to assess their needs, understanding language and cultural barriers, designing the EHR system together, and beta testing and launching it in our client’s team on the ground. We are unique in asking, listening, and incorporating our partner’s feedback at every step of the way ensuring that their needs are met and their voices are heard. The goal of Frontida Records is not just to provide equal access to medical records, but also to connect with and improve upon the communities that we work with.

Currently, we serve more than 20,000 people in 7 countries: Greece, Panama, Poland, Romania, Ukraine, Malawi, and Afghanistan. We have also organized over 3,500 shipments of medical supplies to Ukraine through our medical inventory logistics system.

We hope the MIT SOLVE Challenge will enable Frontida Records to provide EHR support in crisis-responding areas, specifically in Ukraine and its bordering countries that are in desperate need of healthcare. 

We have already developed our EHR for use in Poland, Romania, and Ukraine with various partners ranging from EHR system implementation to inventory management. But we lack the funds that would allow us to further scale our systems. The Frontida Records team needs the MIT SOLVE technical and financial support to build a medical supply logistics and reporting system that can be adapted to the specific needs of medical teams in crisis-responding areas. We also want our EHR and medical supply system to be scalable and usable by any health providers in humanitarian crises. Furthermore, we want to ensure that our system is accessible to our patient population to ensure continuity of care as they migrate. Our work in Ukraine will mature our technology and team to serve and care for the displaced in the many years to come. 

As we expand our solution to new regions in need of our services, we want to meet and work with trusted, vetted partners of MIT SOLVE. It can be difficult to navigate cultures, partnerships, and government relations with limited knowledge of countries' communities and frameworks, so we want to get coaching and strategic advice from people already working in these regions. We, too, hope to expand into a few African countries in late 2023, so we want to meet and learn from people working in or are from these regions. 

We want to raise awareness about our nonprofit work through MIT Solve’s media, network, and conferences. While we have a dedicated team working to ensure we are spreading awareness about our work, we would love the opportunity to have mentorship as well as the network that SOLVE provides to increase our reach via branding and social media. MIT Solve is a well-known and respected initiative and we understand that being associated with and promoted by MIT Solve will only foster further trust and greater outreach that would further catalyze our work.

The ingenuity of our digital technology solution lies in its customizability, affordability, and rapid development. Our applications are built on low-code which enables us to tailor health applications in days instead of months at little to no cost. Since Frontida's applications are made up of a series of forms and modules, clinics can choose the most suitable forms and request new features tailored to their individual needs. Frontida can also modify existing features, forms, dropdown menus, and workflows to adapt to new and pressing public health crises. In our EHR system for Refugee Camp Moria, we integrated national refugee health surveys from the Greek Ministry of Health with questions specific to refugee culture and health risks; public health officials then utilized our data for policy-making and COVID-19 monitoring. Furthermore, we can adapt our application to different language preferences. Our system’s offline capability is also imperative for the remote areas that we work in, such as Bocas Del Toro, Panama, where doctors and physicians spend hours or even days without any internet connection and upload patient data later to the cloud. We strongly believe in human-centered design, ensuring that Frontida’s applications work for local populations and their unique and challenging environments. 

We believe our solution would catalyze a culture of inclusivity in the health-tech space. Current health documentation technologies, like EPIC and Cerner, are expensive and have westernized, “one-size-fits-all” methods of documenting care (Gates Foundation). Existing EHR and health application companies create fully-coded and inflexible systems that are built for insurance/billing purposes, have confusing interfaces, require time-consuming data entries, are overly expensive to modify, and have limited language capabilities. Low-resource and crisis-responding healthcare teams are not asking for these extraneous documentation systems and find it time-consuming and ineffective to use. Consequently, these communities are left behind when only using paper records. Frontida can solve this issue by creating technology responsive to the rapidly evolving needs of a humanitarian crisis.

Our core mission is to create and distribute accessible electronic health record systems to empower medical providers and improve the quality of healthcare in underserved communities around the globe. To achieve this mission, we defined our one-year goals to include fundraising, hiring additional staff, establishing a country-specific Board of Advisors, and launching the 3.0 Version of our technology that expands our database size.

This year, we are expanding operations into Ukraine and its neighboring countries (i.e., Romania, Poland, and Moldova), expanding our current work in Central America, and launching pilots in African countries. Frontida Records has been selected as a United Nations Digital X Solution (https://digitalx.undp.org/frontida-records_1.html), which means that the United Nations country offices are aware and able to partner with us as we apply for funding together. This UN partnership enabled Frontida Records to start our partnerships with the UNDP and Ministries of Health in African countries. We are currently applying for grants from the UN, WHO, and NIH to support this endeavor.  

In five years, we aim to document records of over 2.5 million patients in the following three regions: Central America, Eastern Europe, and Africa. We plan to expand beyond these regions as resources and staff increase. Currently, we have partners and/or pilot programs set up in these three regions. We aim to scale up our capacity to provide EHR services to National hospital systems with our NGO, government, and UN partnerships. We also want to expand our team by hiring local refugees from the places we serve to lead Frontida Records operations. One of our goals is to build up socially-minded leaders. We want to empower the communities we serve by investing in leaders with the technical and business skills to lead Frontida Records and similar projects. 

Our primary company metrics include the total number of patients served, health visits documented, medical supply items delivered, and users on our systems. To measure success and improve Frontida Records' work, methodical program evaluation practices will be deployed in monitoring the impact of Frontida Records, which includes collecting feedback from providers and patients through Likert scales to assess ease of use, reliability, effectiveness, and plans to continue the use of the system. Additionally, other target indicators to assess impact evaluation include an increase in patient visits and clinical efficiency and decreases in patient charting times and healthcare worker burnout. During the launch of our system in Panama with the Floating Doctors health organization, our EHR saved 2.65 hours of documentation and transcription time by the staff at Floating Doctors per day. Our analysis can be found in the links below: https://www.dropbox.com/s/w9clxxy8coqaf79/Floating%20Doctors%20Timekeeping%20Results%20%281%29.pdf?dl=0  and https://www.dropbox.com/s/228esr9sfgwqxik/Stratified%20Analyses_Timekeeping.pdf?dl=0

Goals: To use an EHR system to document healthcare for patients in low-resource and crisis-responding communities, improve continuity of care, and create medical supply systems to request, send, and track medical supplies in humanitarian crises.

Inputs: 

1. Frontida EHR.

2. Healthcare team on-site being trained on and using the EHR.

3. Hardware at medical clinics (computer, cellphone, tablets) and connectivity at the headquarters (cloud-based vs. satellite internet vs. stand-alone versions).

4. Frontida Records team that works to develop and adapt the EHR to low-resource, refugee, and crisis-responding communities and their health providers. The team works with NGO clinics via Zoom or on-site to understand the site needs, design the technology, deploy beta versions, collect feedback, launch final products, conduct onsite training of health providers, analyze how the EHR is used, and identify problems for software improvements.

 Actions and Activities:

1. Eliminate paper records and poor documentation systems by deploying Frontida’s EHR tailored for low-resource and crisis-responding communities with a medical supply tracking module. Our technology is built from a core platform that can be quickly transformed to adapt to client needs and to share data among providers, NGOs, suppliers, funding agencies, and governments. 

2. Add a medical supply inventory and tracking system.

3. Adopt EHR systems in clinics, hospitals, and health NGOs.

4. Store and share data on the cloud and/or on-site servers.

5. Compile and clean data for data analysis and reporting to partners.

Outputs for Challenge

1. Use EHR with medical supply tracking module at pilot sites in Ukraine and its bordering countries for three months with minimal errors.

2. Create, launch, and collect feedback on database inventories and tracking systems of healthcare supplies in order to monitor requests, supplies, and shipments.

3. Scale up EHR solutions to serve other healthcare teams in humanitarian crises and low-resource regions.

Outcomes:

1. Provide accurate, legible, up-to-date, and complete information about patients at patient visits.

2. Enhance clinical efficiency, coordination, management, workflow, and data analysis of health organizations serving refugee and low-resource populations.

3. Save time documenting, searching, and analyzing data.

4. Reduce medical errors.

5. Reduce costs from decreased paperwork and duplication of testing and treatments.

6. Enable healthcare teams to request needed healthcare supplies and improve resource allocation.

7. Use data for research and reporting to funding agencies, governments, site clinics, and local communities to demonstrate the clinical efficiency, impact, and allocation of funding and resources.

8. Provide data to public health officials to understand community health needs and current status to make informed health policy decisions.

Beneficiaries and Stakeholders: 

1. Patients receive improved medical care because their medical records provide continuity of information and care.

2. Health providers at clinics, hospitals, and health NGOs use our software to make informed clinical decisions, reduce errors, and improve patient outcomes.

3. Public health agencies have medical data to make meaningful government decisions.

4. Suppliers and funding agencies receive data reports that inform them how funds and resources were allocated and what impact was made.

Frontida Records’ core technology is based on low-code development for faster and cheaper development. We leverage low-code development platforms to rapidly customize our template health applications to the language, culture, and clinical workflows of our clients. By using low-code tools, we ensure that we can implement all of our customer’s needs at a fraction of the cost compared to traditional development agencies. Thus, we can develop our solutions rapidly, in a manner of days, which also enables our applications to respond to emergency crises in Afghanistan and Ukraine. Thus, our solution is also scalable as we can create region- and crisis-specific applications. All information will be stored in the cloud so that data can travel with the patient regardless of their destinations. Additionally, our software saves data in Excel spreadsheet format for queries and data analysis.

To ensure Frontida’s data security, the software was developed in consultation with data security agencies (Vanta, Google, AWS) and is continuously tested to provide data security feedback to our software engineers. We also partnered with O'Melveny & Myers data security lawyers to create our data security policies. 

The Frontida Records team believes in and supports the MIT and SOLVE mission statement on diversity, equity, and inclusion.

Diversity: We appreciate and leverage the many differences of SOLVE staff and SOLVE’s larger community, and we involve and reflect the various communities we serve through partnership and open innovation. We believe that “everyone should have a seat at the problem-solving table,” as MIT President Reif states. Of our 30-person team, we are proud that over 75% are people of color, and over half are women. We also build up field advisors who are locals from the communities we serve. They are essential in understanding and communicating with on-the-ground stakeholders and helping us design Frontida’s technology to meet the needs of their communities.

Equity: We design our policies, practices, and resources with the goal of providing people of all backgrounds, circumstances, or statuses with a genuine and fair opportunity to thrive. 

Inclusion: We strive to create an environment in which everyone feels valued and respected. Solve specifically seeks to support social entrepreneurs who use human-centered, inclusive technologies to solve world challenges. We know that when solutions are designed with the most underserved populations in mind, they benefit everyone. That’s why we tailor our platform to uniquely serve each community we work with. We work together with locals to gain their input and collect data that is relevant to them.

CLICK HERE for our business model:

https://docs.google.com/presentation/d/1SUFXTufUg-cI-mlqGqqqbdDActXCu0ANyDYQrPzDOWU/edit#slide=id.p

We have dedicated business and funding teams who push us to strive to be a fully sustainable nonprofit. From our teams, we are able to work through multiple streams of revenue including licensing fees, custom development fees, grants, and donations. We also collect donations to empower our work and are applying for grants from the United Nations, the World Bank, and various funding agencies to support our work. 

We have already onboarded our first paid client Floating Doctors who currently pays $875/month ($10,500 annually) for our services. We are working to serve 10 clinics by the end of year 2023, 25 clinics by year 2024, and 75 by 2025 with each clinic paying personalized costs. Currently, we aim to raise $300,000 in donations/prizes/grants to hire full-time staff and support our 2023 operations. These funds will support our beta-testing, operations, and staff as we grow to sustainable scale. Frontida will continue to compete in pitch and grant competitions, and has already won over $100,000 in 2022.

Participating in several accelerators and competitions, we have gained incredible mentorship and resources to push our organization toward a self-sustainable future. In 2020, Frontida received $5,000 from Blackstone/TechStar Investment Company, a fellowship committed to inspiring entrepreneurship globally; and $10,000 from the Iovine and Young Academy Social Impact Prize Competition, a USC competition showcasing innovations to improve society or revolutionize an industry. In 2021, we were granted $5,000 in legal fees from the Maseeh Engineering Prize Competition, a USC competition for engineers addressing challenges in energy, health, safety, education, and our environment. In 2022, we were awarded $40,000 from the Westly Prize Competition, a competition for social innovators in California; and $16,500 from the New Venture Seed Competition, USC's largest venture competition. We also won a competition by the National Academy of Engineering (NAE), which gave winners access to NAE members for mentorship and National Science Foundation workshops for product development. Our team has also won awards and recognition from the Lloyd Greif Center for Entrepreneurial Studies at the USC Marshall School of Business. Lastly, we were selected as a United Nations Digital X Solution. Of the 4,000 worldwide applications, only 100 solutions were accepted by the United Nations Development Programme (UNDP). (https://digitalx.undp.org/frontida-records_1.html)

In terms of technology, we established corporate partners with Google which subsidizes our software development costs. Our partners at Oracle/NetSuite assist us with providing our business and accounting software under their social impact program. Additionally, our sponsorship with Vanta provides Frontida with critical data security services.

Moreover, Frontida benefits from the guidance of a professional board of directors and advisors composed of CEOs, physicians, researchers, lawyers, engineers, and business consultants with extensive experience in their respective fields from reputable firms such as USC, UCLA, PwC, EY, and Deloitte.

Finally, Frontida Records has hired a new director who teaches innovation and entrepreneurship at USC and has helped startups obtain adequate funding to develop into larger and more sustainable companies.