Hikma Health

Continuous access to a patient’s data story is critical for the reliable and effective clinical care of displaced populations. Consider Hisham, for example, a 10-year-old Syrian refugee living in Jordan, who nearly died from a diabetic crisis because his clinicians could not piece together the correct diagnosis. The Jordan camp clinicians did not know his historic diagnosis and symptomatic progression with type 1 diabetes due to a total lack of medical records and limited patient education. Fortunately, in Hisham’s case, he was brought to an emergency department where the diagnosis was made and his life was saved, leading to a 2017 feature in the New York Times. However, for thousands of families in camps, the lack of patient data leads to a tragic end.

Hisham is one of 110 million people who are forcibly displaced worldwide as a result of persecution, conflict, violence, human rights violations, or events seriously disturbing public order (UNHCR, 2023). Refugees like Hisham face the dual challenges of limited care for typical conditions and additional clinical risks for metabolic, infectious, and psychiatric conditions. A study by Doctors of the World found that 63% of clinical visits by refugees in the Mediterranean region were directly related to camp living conditions like sanitation (Daynes, 2016). Providing healthcare to these individuals is an enormous undertaking; clinical care is provided by a patchwork of organizations, including international NGOs, local hospitals, clinics, and informal caregivers. These providers, however, often struggle with challenges like limited resources, staff turnover, and intermittent patient contact. Many clinics still rely on paper records - or no records at all - leading to gaps in patient information. Managing chronic conditions requires continual data collection to monitor patient progress.

Electronic Health Record (EHR) systems are often not designed for low-resource settings, limiting their utility for the refugee use case. A traditional EHR may require 10+ minutes of provider time to document a typical visit, in a setting where clinicians have 5 minutes with each patient. These EHRs have minimal mobile and offline functionality, which renders them unusable in most refugee and migrant care settings.

To meet these unique challenges, we collaborated with underserved community representatives and the clinicians who serve them to develop an innovative mobile EHR that can operate fully offline, sync to any cloud infrastructure when needed, and smoothly integrate with existing systems. Our goal is to support clinics in swiftly delivering personalized healthcare to refugees, ensuring quality care is accessible whenever and wherever needed. We ultimately aim to empower patients like Hisham with the personalized healthcare they deserve for healthier outcomes.

The Hikma Health System (HHS) is the world’s first free, open-source mobile health data system for physicians and clinics serving refugees and migrants. HHS is a completely customizable system designed to work for both a single clinician and at scale.

The system includes a mobile application and an administrator dashboard, which work together to support health data collection, reporting, and customization. HHS is designed for displaced populations and for low-resource clinics, with offline functionality specific for internet-limited settings. All data is safely stored in a sandboxed environment on the user’s device and can be synced when needed for other clinicians to access. This unique design allows clinicians to operate even when there is no network connectivity, while still being able to provide continuous and informed patient care. You can find more about our solution here: https://www.youtube.com/watch?v=P_8Z9qW2VTg

Any health organization, hospital, or clinician interested in implementing HHS does so on their cloud infrastructure, with specifications that fit the needs of their clinics and adhere to local data laws. The system’s code and documentation can be found on GitHub: https://github.com/hikmahealth.

Currently, HHS is implemented by organizations in ten countries, serving over 500,000 patients, with a particular focus on regions experiencing complex humanitarian emergencies and limited healthcare access. Our solution is community-driven by default; we partner with clinical organizations around the world providing free healthcare to thousands of refugees, migrants, and low-income patients. Our customizable EHR system is designed to streamline data collection, increase the capacity of the healthcare workforce, and improve health services for medically underserved populations. As an open-source platform, we welcome contributions from developers around the world to continually improve our offering.

Our software solution empowers patients, clinicians, and communities.

Patients: Underserved populations such as refugees benefit from continuous, high-quality health data that enables clinicians to make more informed decisions. This population faces significant challenges in accessing quality healthcare due to limited resources, ongoing displacement, and inadequate healthcare infrastructure. Given that many clinics in these settings operate without health records, or with paper-only records, patient health is often compromised due to the lack of data continuity. We’re committed to supporting patients like Hisham by providing them with access to comprehensive healthcare services, including accurate and up-to-date medical records, personalized treatment plans, and ongoing monitoring of chronic conditions. By addressing the specific needs of this underserved population and leveraging technology to overcome existing barriers, our solution will significantly improve the health outcomes and overall well-being of refugees who currently struggle to access the care they desperately need.

Clinicians: The platform empowers clinicians in challenging environments by providing a flexible, offline-capable tool that enhances healthcare delivery. Designed for displaced populations and resource-limited clinics, it addresses unserved needs by streamlining data collection and enabling continuous care even without internet connectivity. The system's focus on customization ensures that it adapts to the specific workflows and requirements of healthcare providers, improving their efficiency and capacity to deliver quality care to vulnerable populations.

Communities: Our solution promotes health equity and empowers communities by increasing access to quality healthcare services and improving public health outcomes. By streamlining data collection and improving healthcare worker capacity, the system ensures better-informed treatment decisions and continuity of care, even in regions with limited resources.

Our team is uniquely positioned to deliver this solution because we have a deep understanding of the challenges faced by refugees, migrants, and low-income patients. We come from refugee and immigrant backgrounds ourselves, giving us a strong connection to the communities we aim to serve. Our Team Lead and members have direct experience working with refugees and have witnessed firsthand the barriers they encounter in accessing healthcare. As a team, we are representative of the communities we serve. Several of us have personal or familial experiences as refugees; all of us have worked closely with refugee populations on the ground. This proximity enables us to empathize with the unique needs and circumstances of refugees and migrants. We stay close to the communities we represent to ensure that our solution continues to meet their needs.

Throughout our design, development, and implementation process, we actively seek input from the refugee communities we serve. Our team visited refugee communities around the world to learn from patients and their clinicians about the pain points in their healthcare and how technology may unlock personalized care. Syrian refugees, including physicians, nurses, and allied health professionals, were involved from the earliest days of product design and development, which began with the MIT Media Lab’s Refugee Learning Accelerator. We continue to conduct extensive outreach and engagement efforts, collaborating closely with community leaders, healthcare providers, and individual refugees to gather insights, ideas, and feedback. This participatory approach has allowed us to co-create a solution that truly meets the needs and priorities of the target population.

The architecture of our solution also empowers local communities. The local nonprofit organization or its designees are the data owner and controller, without us having direct access to any data. Our use of the MIT license broadly empowers independent use by communities to suit their individual needs. As we grow, our team is committed to ongoing collaboration and partnership with local organizations and stakeholders in refugee-hosting communities. By fostering meaningful relationships and listening to the voices of those directly affected, we ensure that our solution is responsive, culturally sensitive, and aligned with the agendas of the communities we serve.

The Hikma Health System is an established solution actively used by 14 nonprofit clinical organizations in 10 countries, collectively serving over 500,000 patients annually. These organizations include MedGlobal, which launched Hikma Health in Bangladesh and is now scaling it globally.

The Hikma Health system is open-source and available for free global use under the MIT license; we have extensively tested and debugged the software. Any organization planning to implement an EHR system can create a separate branch of the open-source software available on the Hikma Health GitHub and develop their own deployment. Our team has developed detailed technical documentation to customize and deploy the system: https://docs.hikmahealth.org/.

Additionally, Hikma Health provides direct support to clinical organizations benefiting from funding and guidance on how to implement the system through our Care Innovation Grant program. Most recently, we supported eight nonprofit organizations with Year of Migrant Health Grants in 2022.

We are applying to Solve because we believe in the power of collaboration and collective action to address the global refugee health crisis. Solve's platform offers a unique opportunity to connect with a diverse network of scaling experts and resources that can help us overcome the multifaceted barriers we face in implementing our solution. Specifically, we believe Solve can assist us in overcoming financial, technical, and market barriers.

While we have made significant progress in developing our solution, securing adequate funding to scale our efforts to make a truly global impact remains a challenge. Solve's network will help us access the financial resources needed to further develop and deploy our solution effectively.

Additionally, Solve provides valuable technical expertise and support to enhance the functionality and scalability of our solution. We recognize the importance of leveraging cutting-edge technology and best practices to address the complex healthcare needs of refugee populations. We have benefited from advisors like Prof. Zak Kohane, a thought leader in interoperability of health data. We had significant additional learnings through the GLG Fellowship, through which we connected with architects of leading EHR systems. Solve's network will connect us with technical experts who can provide further guidance in this regard.

Furthermore, Solve's platform will help us navigate legal and cultural barriers that may arise in implementing our solution in diverse contexts. By connecting us with partners who have experience working in refugee-hosting communities and navigating regulatory frameworks such as GDPR, Solve can help us ensure that our solution is culturally sensitive, legally compliant, and effectively tailored to the needs of the communities we serve.

Overall, we see Solve as a valuable partner in advancing our solution and making a meaningful impact on the lives of refugees around the world. We are committed to leveraging Solve's resources and expertise to overcome barriers, drive innovation, and ultimately improve access to quality healthcare for vulnerable populations.

Hikma Health's solution stands out with a unique approach to addressing the health data needs of displaced populations. By prioritizing mobility and accessibility, the Hikma Health system revolutionizes healthcare delivery through its mobile-first design, catering specifically to clinics serving refugees, migrants, and low-income patients. 

What makes our system truly groundbreaking compared to past EHR systems is its offline functionality, enabling clinicians to access and update patient data even in remote or internet-limited settings. This capability is vital in refugee camps and low-resource clinics where reliable internet access may be lacking. Additionally, Hikma Health offers unparalleled customizability and scalability, empowering healthcare organizations to tailor the solution to their unique needs and workflows. 

Our open-source model fosters collaboration and knowledge-sharing, encouraging developers worldwide to contribute to its improvement and adaptability. Through community-driven development, Hikma Health ensures that our solution remains responsive to the needs and priorities of the communities it serves, fostering trust and ownership among stakeholders. This inclusive approach not only enhances the effectiveness of the solution but also inspires similar initiatives, transforming the market landscape and ultimately improving health outcomes for millions of underserved individuals worldwide.

Hikma Health's solution aims to significantly impact the problem of healthcare access for displaced populations through a carefully constructed and rigorously tested theory of change. The team's activities involve developing and deploying the Hikma Health system across clinics serving refugees, migrants, and low-income patients, while actively engaging with these communities to ensure the solution remains responsive to their needs. The immediate outputs of this effort include the implementation of Hikma Health in clinical nonprofit organizations and the provision of user training and support to healthcare providers. These activities are expected to lead to intermediate outcomes such as improved healthcare delivery and increased efficiency in clinics. Over the long term, the Hikma Health system is anticipated to result in better health outcomes and increased health equity and empowerment among the target population.

Our theory of change is supported by evidence gathered from various sources. Community input from refugees, healthcare providers, and local organizations informs the development and refinement of the Hikma Health system, ensuring it meets the specific needs and priorities of the target population. Successful implementation of Hikma Health by 14 clinical nonprofit organizations serving displaced populations demonstrates its effectiveness in improving healthcare access and delivery. Ongoing monitoring and evaluation work will validate our theory of change with evidence of the solution's impact on health outcomes, efficiency, and empowerment within the target communities. 

Hikma Health has specifically addressed the requirements for clinicians caring for refugees in low-resource settings as we have described in past publications (Ashworth et al. 2022). While refugee-focused solutions have addressed specific crises, none have been scalable with an easily customizable interface for clinicians (Shrestha et al. 2022). Our user interviews for our feasibility study are underway in Nicaragua and Lebanon. One practice reported a 17% increase in efficiency as measured by per-provider patient volume after adopting the Hikma Health system. We work in collaboration with independent academic experts on refugee health monitoring and evaluation and will be publishing our findings in a peer-reviewed journal.

By addressing the root causes of healthcare disparities and empowering communities with our technology, Hikma Health's solution has the potential to create lasting positive change in the lives of refugees, migrants, and low-income patients worldwide.

Our primary goal is to measurably improve the health outcomes of refugee, migrant, and low-income populations worldwide. Our intermediate goal is to improve the efficiency of clinical practices serving these populations to extend their impact. We measure population health outcomes in collaboration with our nonprofit clinical partners and academic institutions under IRB approval and report the deidentified outcomes.

We are in the process of conducting a study to assess the feasibility of using the Hikma Health system for providing basic healthcare to diverse, displaced populations at Nueva Vida Clinic in Ciudad Sandino, Nicaragua and the Endless Medical Advantage mobile health clinics in Bekaa, Lebanon. Our team has conducted in-depth interviews to assess the acceptability, practicality, integration, and limited efficacy of the Hikma Health system in the care of the patient population at Nueva Vida Clinic and Endless Medical Advantage mobile clinics. In-depth interviews explored clinicians’ (physicians, nurses, other healthcare workers) experiences as well as administrative staff (hospital administration, intake staff) experiences. These interviews are now being used as the foundation for the construction of a Likert-based survey that will probe previously identified themes related to feasibility and will include a mix of qualitative and quantitative data. Finally, basic information regarding each clinic’s operational metrics (including resources available, e.g. internet and electricity, and available patient census data, etc.) are being collected and incorporated to provide context to the feasibility study’s outcomes. We will conclude and publish this study in 2024.

We intend to follow up this feasibility study with a larger effectiveness clinical study in 2025 involving more of our clinical nonprofit partners. In this study we will focus on metrics such as the prevalence and severity of chronic, infectious, and psychiatric illnesses. We hypothesize that the use of the Hikma Health system enables better continuity of care, which in turn reduces the severity of illness by effectively optimizing treatment.

The core technology underlying the Hikma Health system that enables offline native functionality has been available for several years and has been applied to other applications such as finance, communications, and gaming. However, it has never been successfully applied to a health data system due to challenges with conflict resolution and offline data provisioning on mobile devices. This limitation meant that historically only clinics with reliable internet access broadly adopted EHR systems. A new database architecture would be needed to enable an offline-first health data system.

We created this new database architecture with SQLite that powers our offline-first approach, allowing for highly performant local queries and mutations that can get synced with the server whenever the user has network availability. With this architecture, the server is responsible for conflict resolution, and determining what changes each client needs to have during a sync event. Our system enables a flexible approach that uniquely works for clinics that have no, low, or variable access to the internet. You can learn more about our technical approach to offline sync here: https://docs.hikmahealth.org/docs/offline-and-sync. 

15

1 full-time staff, 2 contractors, 12 volunteers.

6 years

At Hikma Health, our commitment to Diversity, Equity, and Inclusion (DEI) is woven into the fabric of our organization given our dedication to serving immigrant and refugee populations globally. This commitment is influenced significantly by our founding team, which consists of 3 immigrants including a woman of color. This founding vision reflects our dedication to ensuring that every member of Hikma Health receives respectful and equitable treatment, regardless of their background, identity, or circumstances.

We are proud that 87% of our team comes from minority backgrounds, which greatly enriches our understanding and responsiveness to the diverse needs of the communities we serve. Our team speaks twelve languages, which enables us to relate to and connect with the communities we serve. We are committed to fostering a diverse workplace by continuing to recruit, retain, and promote individuals from varied demographics, including different races, ethnicities, genders, ages, religions, disabilities, and sexual orientations.

Equity remains central to our mission. We strive to dismantle barriers to health services by tailoring our programs to address the unique challenges faced by underserved and marginalized populations. This commitment extends beyond service delivery to empowering these communities to lead the development and use of Hikma Health.

Inclusion is essential in our work environment. We endeavor to create an inclusive culture where all employees feel valued and respected, and where their contributions are recognized and celebrated. Through ongoing education and open dialogue, we continually deepen our understanding of DEI principles and integrate them seamlessly into every aspect of our operations.

Hikma Health operates with a hybrid business model that aims to deliver value to the populations it serves while ensuring sustainability through revenue generation. At its core, Hikma Health prioritizes impact by providing significant value to its primary beneficiaries, including refugees, migrants, and low-income patients. Through its innovative mobile health data system, Hikma Health empowers patients by offering continuous access to their medical records and personalized treatment plans, particularly critical in resource-limited or displaced settings. By streamlining data collection and enhancing healthcare delivery, Hikma Health enables clinics to provide more efficient and effective care to underserved populations, ultimately improving overall well-being and health equity.

In parallel, Hikma Health implements revenue-generating strategies to sustain its operations and further its mission. These strategies primarily include offering customization and implementation services to healthcare organizations interested in adopting the Hikma Health platform. By tailoring the system to fit the specific needs and workflows of each organization, providing training and support to healthcare providers, and assisting with seamless integration, Hikma Health generates revenue while ensuring effective deployment and utilization of its solution.

Additionally, Hikma Health provides ongoing consulting and support services to its customers, including technical assistance, troubleshooting, and guidance on best practices in healthcare data management. These services help customers optimize the use of Hikma Health, address any challenges or issues that may arise, and stay updated on the latest developments in healthcare technology. Through its consulting and support offerings, Hikma Health continues to deliver value to its customers while generating additional revenue to sustain its operations and further its impact.

Overall, Hikma Health's business model is designed to balance impact and sustainability, aiming to create lasting positive change in the lives of underserved populations worldwide while ensuring the organization's long-term viability and growth.

We have earned an average of $150K annually over the last four years from a combination of grants and private donations including the HBS New Ventures Competition, the MIT $100K Competition Audience Choice Award, Google.org, and the Robert Wood Johnson Foundation. The Sall Family Foundation is also a major supporter and Dr. English Sall is on our board. We are now shifting to a self-sustaining model in the next 2 years so that all future grants and donations will be used for product enhancements rather than core services of supporting clinical nonprofits. In the coming year, we will be providing customization and cloud hosting services to larger nonprofit organizations with $1M+ annual budgets. These customers will each pay us on the order of $24K/year at a gross margin of 30%. We aim to scale to serving 12 such organizations by the end of 2025 and 50 such organizations by the end of 2026. This will yield $1.2M in revenue and $400K in profit that will immediately be used to further improve our solution and directly support its deployment by smaller nonprofits with budgets under $100K annually. At this point, Hikma Health will be a self-sustaining organization. MIT Solve will be catalytic to our expansion as we scale this open-source customization business model.