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Heidelberg University Hospital Partners with SAP to Improve the Health and Well-Being of Underprivileged Patients

First-of-Its-Kind Mobile App for Cancer Screening Developed with SAP Cloud Platform
by Lauren Bonneau, Managing Editor | insiderPROFILES, Volume 8, Issue 2

March 31, 2017

Every year, 500,000 women worldwide are newly diagnosed with cervical cancer.  To help prevent this disease, Heidelberg University Hospital developed a project using a biomarker that would help determine if a woman infected with HPV was at risk for developing cancer, enabling early, life-saving treatment for that woman. But reaching women in developing countries to screen them for cancer was a challenge. Learn how Heidelberg University Hospital, in conjunction with SAP’s Design and Co-Innovation Center, built a mobile app on SAP Cloud Platform that enabled the research group to test underprivileged women for cancer and, ultimately, save lives.  

 In the more industrially and technologically advanced countries of the western world, access to medical testing and treatment is not a major concern for most of the population. Residents live in relatively close proximity to doctors’ offices and hospitals, can easily obtain necessary medicines, and have regular appointments with health professionals. However, that is not the case for populations living in the world’s less-developed countries. There, the nearest local health center can often be more than a day’s journey by foot, the clinics’ staff have overwhelming caseloads with little time to devote to each patient, and the infrastructure is generally rudimentary and fragile.

One of the most common types of cancer in women worldwide is cervical cancer — with 500,000 new diagnoses each year. To date, nearly all instances of cervical cancer are a result of infections of the human papillomavirus (HPV). A vaccine has been developed to prevent HPV infection and is used frequently in the westernized countries; however, due to poor access to screening and treatment services, more than 90% of deaths from cervical cancer occur among women living in developing countries. In these areas of the world, it’s very difficult for medical personnel to identify and reach the people who need their attention.

To help overcome this disastrous situation, Heidelberg University Hospital — a prestigious medical center in Germany with a reputation based on excellent patient care, research, and teaching — discovered a way to determine which patients are at risk for cervical cancer. “A biomarker was developed a couple years ago, which is now in clinical trials for use in cervical cancer screening technologies, that allows us to identify — among these many women affected by HPV — exactly who are at risk of developing cancer as a consequence of that virus,” says Professor Magnus von Knebel Doeberitz, Medical Director, Department of Applied Tumor Biology, Institute of Pathology at the University of Heidelberg.

Even though HPV infections are widespread — the virus is so common that nearly all sexually active women will contract it at some point in their lives — only a small percentage of those infected will develop symptoms that a doctor will have to treat. Most of the infections simply clear by themselves, and the molecular changes that are required to trigger cancer development don’t happen. So the challenge is identifying exactly where the infections don’t go away and determining which women need immediate medical attention. Considering the enormous population of affected women living in the rural regions of the world, this is no small task.

“In the emerging world, particularly in Africa, the lack of infrastructure makes it difficult to defeat this type of cancer, so it is important to develop innovative screening technologies that we can apply in less privileged areas,” says von Knebel Doeberitz. “Once we had this biomarker that helped us to identify woman at risk, we started thinking about how to use technology to improve that situation where roughly nothing is available — no microscopes or laboratory facilities — so women living in those areas can benefit from the same high-tech medicine as the western world.”

The Emerging Technologies in Cervical Cancer Screening (ETiCCS) research project came about as a result, with the goal to promote global cervical cancer awareness and prevention through science, capacity building, and technology transfer. The pilot program was rolled out in Kenya, Africa — where the goal was to recruit women older than 25 years at health facilities for a cervical cancer screening study — and it was soon discovered that the screening process was rife with manual activities and a significant paper trail. As the project progressed, healthcare and IT experts from SAP joined forces with Heidelberg University Hospital to leverage IT solutions in ways that were not possible previously and to deliver medical technology to people who previously did not have access to it. “SAP is committed to improving peoples’ lives, and that’s why we see the ETiCCS project as a great opportunity for a close collaboration with Heidelberg University Hospital in the healthcare sector,” says Michael Byczkowski, ETiCCS Executive Sponsor and Vice President of Customer Design Experience at SAP. A series of iterative Design Thinking workshops and onsite user observations led to a first-of-its-kind mobile, cloud-based solution that significantly accelerated and simplified the screening approach. The mobile solution leveraged SAP Cloud Platform to provide study data online and in real time, so researchers can derive the most recent results out of the sample data without having to wait until the conclusion of the study for analysis.

“Using the biomarkers in the ETiCCS program, our digitized laboratory method can perform the cervical cancer test within a couple of days, but in Africa, it can be challenging to communicate with the lab analyzing the samples and inform the patients of the results,” says von Knebel Doeberitz. “That’s a major benefit of using SAP Cloud Platform to transfer that information back to the appropriate parties fast.”

Another challenge was the existing infrastructure at the health facilities in Kenya. “Because all the communication had been paper-based and involved duplicating handwritten information, it was difficult to extract important data,” says Dr. Hermann Bussmann, ETiCCS Project Lead, Department of Applied Tumor Biology, Institute of Pathology at the University of Heidelberg. “The ETiCCS program can revolutionize how these facilities operate, even in the most remote areas.”

Identifying and Reaching Those in Need

This pilot of the ETiCCS project consisted of a one-year study, which is currently ongoing, involving two local health centers and the Moi Teaching and Referral Hospital in Eldoret, Kenya. The goal of the study is to recruit 800 women at these local health centers in Eldoret, which is a growing urban center where internet access and cellular phone use are more common than in the rural regions of Kenya. The digitized screening process involves a cloud-based tablet app that collects all relevant information and is accessible to different researchers globally. Once the women agree to participate in the study and cell samples are taken, the screening results are analyzed at a laboratory, sent to a doctor in the hospital for further review and management, and also shared with the lead researcher located in Heidelberg University Hospital. All the information gathered is accessible by the different roles of the research project — recruiter, nurse, lab technician, doctor, and researcher — and available via SAP Cloud Platform.

The three main sponsors and stakeholders from the medical side of the ETiCCS project (L to R): Professor Magnus von Knebel Doeberitz from Heidelberg University Hospital; Doctor Elkanah Omenge from Moi Teaching and Referral Hospital; and Doctor Hermann Bussmann from Heidelberg University Hospital.

With so many people in so many roles looking for one woman out of hundreds, it was more than just a question of technology. What the project team needed to consider was how these different perspectives and individual roles contribute to the whole process of saving lives. And when looking for technology, it was important to find a solution that would support these roles in their work rather than stand in the way.

Heidelberg University Hospital collaborated with the SAP Design and Co-Innovation Center to deliver a solution by leveraging the Design Thinking methodology, which is based on the cornerstones of “Discover, Design, and Deliver.” During the discovery portion of the project, a series of Design Thinking workshops were held in Germany with a diverse team of experts from both Heidelberg University Hospital and SAP. This group decided to take a user-centric design approach and to focus on the problem first and the technology second. To get to the bottom of the challenges, members of the project team traveled to Kenya to see the local area where the women lived, tour the health centers and hospitals, and interview the doctors, nurses, and participants to get a complete picture of the problem.

What this research uncovered was that the study participants were mostly living in rural areas and were key supporters of large families, so they couldn’t travel back and forth to the clinic every day. Same-day service was a requirement. The nurses each had an extremely high workload, approximately 50-100 patients per day, and did not have the time to also recruit patients eligible for the study. A separate role of recruiter would need to be established. Nurses and lab technicians documented their work with handwritten notes on paper that was then stored in binders — only one copy with no backup, confined to one location. Each health center was completely isolated in that there was no cross-location reporting or information sharing. Communication was fragmented, supported by paper and phones. A major necessity and focus of the project was easier information sharing among the various roles of the research as well as improved transparency into the status of the tests and study in general.

The team members returned to Germany armed with these important insights and ideas for Design Thinking that could optimize these processes. At this point, the technology came into play — and the project team began discussing how to create a user interface that was easily usable, ran on a mobile device, and resembled a paper form so that very little training would be required.

The SAP Custom Development team developed the solution so that each role could access the cloud application and see only information pertinent to that role. From a technology perspective, there were some challenges getting the mobile synchronization across all different locations. SAP Custom Development helped set up role-based apps implemented on a tablet as well as a web-based user interface. SAP Cloud Platform was selected as it would provide consistent access and a central database that performs all data security, authorizations, and backups. There would be no need for servers on site at the health centers. Rather, all the study data would be stored locally on the tablets, and anonymized data would be transferred via USB internet stick in the cloud and made available to researchers in Heidelberg so they could more closely monitor the study to see the current status of how many tests were performed or how many women had been recruited so far.

Recruiting and Screening Patients in the Cloud

Now that the ETiCCS mobile, cloud-based solution has been rolled out, there is a recruiter at the local health centers working alongside a nurse and informing patients in the waiting area about cervical cancer and prevention. The recruiter uses a mobile device, in the form of a tablet, and works offline, saving the recruiting information locally on the device. After conducting an initial discussion with the candidate, the recruiter gets informed consent from the her to participate in the study and performs intake to check all eligibility facts, with all information displayed on the tablet.

The mobile app, which is a simple, role-specific dashboard, shows the recruiter an opening screen displaying how many women were recruited so far that day as well as the total over time (see screenshots to the left). The recruiter can add new candidates to the study and see the latest participants recruited for the study. When the recruiter adds a candidate, the participant’s name and birthday are entered, and an internal number is assigned to that person so only anonymized data will be used thereafter for data security and privacy. Once the necessary questions are answered by the participant and entered into the tablet, the recruiter saves the information in the app and then transfers the data to the nurse’s device, who takes over the next step in the process.

The mobile app, which is a simple, role-specific dashboard, shows the recruiter an opening screen displaying how many women were recruited so far that day as well as the total over time

The recruiter can add new candidates to the study and see the latest participants recruited for the study. When the recruiter adds a candidate, the woman’s name and birthday are entered, and an internal number is assigned so only anonymized data will be used thereafter for data security and privacy

The nurse sees a different individualized dashboard that shows how many new candidates were enrolled for the day, and can decide who to call up and examine. The nurse has a different set of questions displayed on the tablet to fill out that are specific to the examination, and also has access to check that the informed consent was signed and ensure that everything is in proper order. After the nurse performs the exam and collects the cell sample, he or she saves the appropriate information in the tablet and receives an on-screen confirmation, and all the data is updated in the app. The nurse can also send information about the samples to the lab technician right from the app as well as contact the participants to alert them when they have to come back to the local health center. For the purposes of consistency and data security, only the nurse uploads the patients’ data to the cloud. The process involves the nurse transferring the data from the tablet to SAP Cloud Platform via a USB internet stick twice daily, depending on internet availability, to sync the study data and provide transparency to those in the other roles.

The material samples are delivered to a specialized laboratory for examination and analysis where the biomarker testing and the HPV tests are then performed. The lab technician who physically analyzes the samples is connected to the cloud and has access to the same data through the app’s web-based user interface. After the technician performs the analysis, he or she then enters the results of the test in the ETiCCS app and sends them to a pathologist at the hospital for final interpretation. Those results are immediately available to the doctor, who then evaluates the results and decides whether the patient needs to be treated or if other follow-up measures are needed. Patients will be informed of the test results via a phone call from the nurse or by home visit when necessary. Once the doctor and the nurse save the pertinent information to the patient record in the app, the study results are updated so that the research lead back in Heidelberg University Hospital who is in charge of the study can look at the reporting across all the different activities recorded from all the various roles. And the researcher can review this information at any time to see the study progression, rather than having to wait to see results until after the study is concluded.

The pilot of the ETiCCS project consisted of a one-year study, which is currently ongoing, involving two local health centers and the Moi Teaching and Referral Hospital in Eldoret, Kenya.

Paving the Way for the Rest of the World

With the mobile solution also having an offline capability, recruiters and nurses can use the tablet to collect and enter data even when they are not connected to SAP Cloud Platform. This means they can travel far from the local health center to even the most remote villages to recruit harder-to-reach women. “Now our colleagues could also go into the remote communities in Africa to register women for cancer screening, collect test samples, deliver them to labs for testing, and then transmit results to the respective patient, together with any recommendation from the doctor,” says von Knebel Doeberitz. “And the fact that you can deliver that message through the cloud to the patient from whom the sample has been taken is a big advantage and will clearly improve the screening facilities in these areas.”

Other future enhancements to the project will include rolling it out beyond tablets to mobile phones. Self-sampling will also be implemented so women can forego the exam with the nurse and submit their own cell samples. This will help increase the number of samples by including women who might have been averse to the examination itself and by freeing up the nurses’ time so they can help even more patients.

Following its goal to prevent cervical cancer in underprivileged areas of the world, the ETiCCS project is well poised to reach other countries outside Kenya. The study has already expanded to include Gondar, Ethiopia, in addition to the recruitment in Eldoret. And the hope is to expand and reach areas beyond Africa. “This problem is on a global scale everywhere infrastructure has not been as well developed,” says von Knebel Doeberitz. “We are considering implementing the same technology and conducting similar trials in areas where no cervical center tests have been developed, such as in Latin America, Asia, and Eastern European countries.”

More sponsors will be needed to support the cost of setting up the infrastructure and reshaping the solution to localize it for different locations. While there is no single solution for the screening process for different countries since each country has its own specific requirements, the underlying technology makes the app functionality easy to duplicate. “There is no one-size-fits-all solution for cervical cancer screening, but our approach can easily be adapted to many different settings,” says von Knebel Doeberitz. “We can easily transfer this app to other underprivileged areas where cervical cancer is prevalent among women who play a vital social role in the overall development of their communities.”

The ETiCCS project received much well-deserved recognition for its success in 2016. It won a first-prize Design Value Award from the Design Management Institute for improving lives according to user-centered design principles; was awarded Bronze in the Spark Design Awards; was a finalist for a Mobile Excellence Award in the Humanitarian category; and achieved an SAP HANA Innovation Award honorable mention in the Next-Gen Apps category.

“We developed a simple, primary application using SAP Cloud Platform that has never existed before and will change the medical world,” says von Knebel Doeberitz. “This success will lead us into new phases of cloud-based application development, such as in the area of digitalized pathology and medical image analysis.” For example, nurses, doctors, or technicians could upload pictures of patients or samples from the app to the cloud. Global experts then would review those images, make recommendations, and transfer the results back to the local side. “Having these initial prototype projects like the ETiCCS program now running, we see how effective IT solutions can be and how we can make a huge impact addressing other illnesses and diseases affecting the world’s vulnerable populations,” he adds.

Heidelberg University Hospital

Industry: Healthcare

Employees: 10,300 employees, including 1,500 professors and doctors

Hospital details (2015): 44 medical departments; 11 medical institutes; 3,600 medical students; 1,100,000 outpatient visits; 66,000 inpatient cases; 56,000 partial inpatient days; and 400 students earned their medical degrees

Websites:

SAP solutions: SAP Cloud Platform, utilizing SAP Design Thinking methodology

 

 

 

 

Emerging Technologies in Cervical Cancer Screening (ETiCCS) scoops award for improving women’s lives

About SAP / SAP Africa News Center


Februray 17, 2017 by Nteseng Maboe

East Africa, Kenya, Nairobi, 4 February, 2017SAP’s Design and Co-Innovation Center together with Heidelberg University Hospital has optimized a cervical cancer screening test that combines applied medical research with the power of innovative SAP cloud technology to improve quality of life amongst women in Africa. The digitized screening test, called “Emerging Technologies in Cervical Cancer Screening (ETiCCS)” scooped first prize of the dmi:Design Value Award* in 2016 for improving lives according to user-centered design principles.

Cervical cancer is the second most common cause of death for women worldwide and ranks #1 in Kenya. Although it is easily preventable, most eligible women have never been screened and have no access to healthcare resources. The cervical cancer screening test was piloted during a one-year study, and was tested on a total of 800 women at the Moi Teaching and Referral Hospital in Eldoret, Kenya.

At the UN Sustainable Development Summit 2015, 193 world leaders gathered to adopt 17 Sustainable Development Goals aimed at protecting the planet and ensuring prosperity for all by 2030. Projects like ETiCCS proof SAP’s mission how technology can effectively transform the healthcare industry and help medical professionals to address cancer diagnosis and treatment in fragile infrastructures which directly supports the UN’s top 3 goal of Good Health & Well-Being.

“This is a special award for SAP as it reinforces our vision and commitment to help the world run better and improve people’s lives, while supporting the 17 sustainable development goals of the United Nations (UN). The screening technology is the first to combine applied medical research with the power of cutting edge cloud technology and user-centered design principles for cervical cancer. SAP is very excited about this achievement as we continue to uncover the underlying challenges of cancer screening in Africa and other emerging countries,” commented Dr. Gilbert Saggia, Managing Director at SAP East Africa.

The screening in Kenya is ongoing and the plan is to include countrywide self-sampling and IoT scenarios (lab equipment integration), pattern recognition, deep learning, remote diagnostics support and validation. “SAP is looking for additional strategic partners with a passion for improving people’s lives and strengthening Africa’s healthcare systems. The aim for SAP East Africa is to collaborate towards a global 2030 vision for user-centered design and cloud technology to improve cancer screening and further uncover the underlying challenges of cancer screening in emerging countries,” adds Dr. Saggia.

With the help of technology such as SAP HANA Cloud Platform the user centered solution runs on a single platform across multiple roles which enables seamless communication between all parties, even in very remote areas and environments with unstable Internet connectivity. Thanks to role-specific data entry the solution is easy to use and access to patient data and test results are immediately available to the local hospital and to Heidelberg University Hospital in Germany.

Through the use of the technology, medical staff have now reduced paperwork meaning no duplication or opportunities for human error to affect test results. The medical records are safely stored in the cloud providing instant access to results. This enables labs to accelerate the screening process and empower medical staff through improved quality control embedded in the screening process. Real-time access to data and reporting, fully compliant with data privacy and security requirements, means labs can make informed diagnoses regardless of location or region.

“This project is another milestone in SAP`s attempt to address the challenge of adequately screening for and treating cancer. It is not only about building great software to help the world run better, but also creating a positive impact in society and improving people’s lives,” added Dr Saggia.

The project stands to transform healthcare screening services by combining user-centered design with on-site user research that enables healthcare professionals to uncover critical patient insights and adapt the solution to other screening processes and field research.

ETiCCS’ vision is to support the fight against cancer in fragile infrastructures. The solution sets new standards for bringing applied medical research to Africa, powered by the SAP HANA Cloud Platform. SAP Design projects such as these undoubtedly positions SAP in the lead with regards to design and innovation to influence the medical community. With this solution, hundreds of women in Kenya now have access to screening for cervical cancer during the first pilot phase

Prof. Magnus von Knebel Doeberitz, Medical Director, Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, said: “Through the ETiCCS program, we were able to complement applied medical research around biomarkers with the power of cutting edge cloud technology to bring co-innovation to Africa in a way which really helps to improve people’s lives.”

Currently all personal records are kept in Kenya – only pseudonyms data is uploaded through the SAP mobile solution. The mobile solution creates a number based on the pseudonyms data and links to the patient test results. However, the mapping between the generated number and patient is done on site by a medical professional. The app will be made available through SAP to other interested countries in Africa as a custom development solution.

About SAP

As market leader in enterprise application software, SAP (NYSE: SAP) helps companies of all sizes and industries run better. From back office to boardroom, warehouse to storefront, desktop to mobile device – SAP empowers people and organizations to work together more efficiently and use business insight more effectively to stay ahead of the competition. SAP applications and services enable more than 335,000 business and public sector customers to operate profitably, adapt continuously, and grow sustainably. For more information, visit http://www.sap.com/africa .

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Nteseng Maboe, SAP Africa, +27 (11) 235 6000, Nteseng.maboe@sap.com

 

 

SAP Design and Heidelberg University Hospital join forces to fight cervical cancer

World Cancer Day


Date:  2 February 2017 to 9 February 2017

We are proud to support this year’s #WorldCancerDay. SAP Design and Heidelberg University Hospital are committed to support the UN’s global goal of good health and well being by improving research and treatment of cancer through the power of design, applied medical research and IT.

Cervical cancer is the second most common cause of death for women worldwide and ranks #1 in Kenya. Although it is easily preventable, most eligible women have never been screened and have no access to healthcare resources. Heidelberg University Hospital piloted the Emerging Technologies in Cervical Cancer Screening (ETiCCS) test during a one-year study with 800 women at the Moi Teaching and Referral Hospital in Eldoret Kenya. SAP Design joined the Heidelberg University Hospital to digitize the recruiting, screening and examination process of ETiCCS by applying Design Thinking and latest cloud technology.


First SAP mobile Cloud cervical cancer machine unveiled in Kenya // Dr. Gilbert Saggia, SAP East Africa Managing Director

BizNis Africa // February 2nd, 2017


SAP’s Design and Co-Innovation Center together with Heidelberg University Hospital has optimized a cervical cancer screening test that combines applied medical research with the power of innovative SAP cloud technology to improve quality of life amongst women in Africa.

Cervical cancer is the second most common cause of death for women worldwide and ranks number on in Kenya. Although it is easily preventable, most eligible women have never been screened and have no access to healthcare resources. The cervical cancer screening test was piloted during a one-year study, and was tested on a total of 800 women at the Moi Teaching and Referral Hospital in Eldoret, Kenya.At the UN Sustainable Development Summit 2015, 193 world leaders gathered to adopt 17 Sustainable Development Goals aimed at protecting the planet and ensuring prosperity for all by 2030. Projects like ETiCCS proof SAP’s mission how technology can effectively transform the healthcare industry and help medical professionals to address cancer diagnosis and treatment in fragile infrastructures which directly supports the UN’s top 3 goal of Good Health & Well-Being.“This is a special award for SAP as it reinforces our vision and commitment to help the world run better and improve people’s lives, while supporting the 17 sustainable development goals of the United Nations (UN). The screening technology is the first to combine applied medical research with the power of cutting edge cloud technology and user-centered design principles for cervical cancer. SAP is very excited about this achievement as we continue to uncover the underlying challenges of cancer screening in Africa and other emerging countries,” comments Dr Gilbert Saggia, SAP East Africa Managing Director.The screening in Kenya is ongoing and the plan is to include countrywide self-sampling and IoT scenarios (lab equipment integration), pattern recognition, deep learning, remote diagnostics support and validation. “SAP is looking for additional strategic partners with a passion for improving people’s lives and strengthening Africa’s healthcare systems. The aim for SAP East Africa is to collaborate towards a global 2030 vision for user-centered design and cloud technology to improve cancer screening and further uncover the underlying challenges of cancer screening in emerging countries,” adds Dr. Saggia.

With the help of technology such as SAP HANA Cloud Platform the user centered solution runs on a single platform across multiple roles which enables seamless communication between all parties, even in very remote areas and environments with unstable Internet connectivity. Thanks to role-specific data entry the solution is easy to use and access to patient data and test results are immediately available to the local hospital and to Heidelberg University Hospital in Germany.

Through the use of the technology, medical staff have now reduced paperwork meaning no duplication or opportunities for human error to affect test results. The medical records are safely stored in the cloud providing instant access to results. This enables labs to accelerate the screening process and empower medical staff through improved quality control embedded in the screening process. Real-time access to data and reporting, fully compliant with data privacy and security requirements, means labs can make informed diagnoses regardless of location or region.

“This project is another milestone in SAP`s attempt to address the challenge of adequately screening for and treating cancer. It is not only about building great software to help the world run better, but also creating a positive impact in society and improving people’s lives,” adds Dr Saggia.

The project stands to transform healthcare screening services by combining user-centered design with on-site user research that enables healthcare professionals to uncover critical patient insights and adapt the solution to other screening processes and field research.

ETiCCS’ vision is to support the fight against cancer in fragile infrastructures. The solution sets new standards for bringing applied medical research to Africa, powered by the SAP HANA Cloud Platform. SAP Design projects such as these undoubtedly positions SAP in the lead with regards to design and innovation to influence the medical community. With this solution, hundreds of women in Kenya now have access to screening for cervical cancer during the first pilot phase.

“Through the ETiCCS program, we were able to complement applied medical research around biomarkers with the power of cutting edge cloud technology to bring co-innovation to Africa in a way which really helps to improve people’s lives,” Prof Magnus von Knebel Doeberitz, Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital Medical Director.

Currently all personal records are kept in Kenya – only pseudonyms data is uploaded through the SAP mobile solution. The mobile solution creates a number based on the pseudonyms data and links to the patient test results. However, the mapping between the generated number and patient is done on site by a medical professional. The app will be made available through SAP to other interested countries in Africa as a custom development solution.

Watch the webinar with Prof. Magnus von Knebel Doeberitz of Department of Molecular Pathology of Heidelberg University Hospitals

Healthcare and IT joined forces to significantly accelerate and simplify the screening approach in fragile infrastructures. The first project started with a cervical cancer screening study in Eldoret, Kenya.

Get in touch! dcc@sap.com and check out http://spr.ly/605783MPF

German academics tackle cervical cancer in Africa with SAP HANA

diginomica


By Jessica Twentyman, November 20, 2015

Almost nine out of ten cervical cancer deaths worldwide occur in the developing world. Researchers from the University of Heidelberg are rolling out screening to women most at risk.

Screen Shot 2015-11-19 at 15.33.11In the developed world, regular screening, early detection and rapid treatment have led to positive long-term outcomes for women diagnosed with cervical cancer. In the developing world, the disease is still a killer.

In Western Europe or Australia/New Zealand, for example, for every 100,000 women diagnosed with the disease, fewer than two will die from it, according to figures from the UN’s World Health Organisation (WHO). In East Africa, it’s closer to 30 (27.6). There, few women will ever be screened. For many of those diagnosed, treatment comes to late.

In fact, almost nine out of ten (87%) of cervical cancer deaths occur in less developed regions. And since the disease is particularly prevalent in women in their thirties, many victims leave dependent children behind. Of the twenty countries worldwide with the highest incidence of the disease, sixteen are in Africa, says the World Cancer Research Fund International.

But the screening processes that have proved so successful in the developed world, based on annual or three-yearly Pap smear tests, are difficult to implement elsewhere, explains Dr Magnus von Knebel Doeberitz, a professor of molecular oncology and microbiology at the University of Heidelberg in Germany. There are considerable costs involved, he explains, not least to train pathology technicians in the cytology skills needed to analyse Pap smear test results.

Although this test has undoubtedly saved the lives of many millions of women in the developed world, it has its weaknesses, among them ‘false positive’ findings, sometimes leading to unnecessary biopsies, and more seriously, ‘false negative’ findings, where malignant cell changes go undetected. So, in the developed world, skilled analysis and repeat testing of women is still required.

In Africa, by contrast, the infrastructure challenges involved in getting women to regular screenings, let alone to make subsequent repeat visits and undergo treatment, are immense. Paper-based medical record systems only slow responses down further.

A few years ago, his research work in molecular biology led Dr von Knebel-Doeberitz to develop a technology that makes Pap smear tests more accurate, by highlighting cells particularly liable to become cancerous when exposed to the HPV virus responsible for cervical cancer. He later spun this off as a company, MTM Technologies, that was acquired by Swiss pharmaceutical giant Roche in 2011. He says:

So my personal dream has always been to implement these tests in Africa, because that’s where the real suffering happens.

In the absence of a commercially viable market in Africa, however, it’s been difficult to bring that dream to fruition – until a few of his investors came forward with backing for a trial of the test in that region. And even then, there was still the hurdle to cross of making screening available to women, especially those in rural areas, and tracking and communicating their results.

Enter HANA

It’s at this point a friend of Dr von Knebel-Doeberitz comes into the picture, who is an employee of SAP:

He suggested SAP could help us in this respect. We could establish a system using cloud-based technology, available through mobile phones, to transmit information to patients, physicians and local healthcare workers in the villages.

The initial focus of Dr von Knebel-Doeberitz’s Emerging Technologies in Cervical Cancer Screening (ETiCCS) project is currently a one-year study involving 800 women, delivered by the Moi Teaching and Referral Hospital in Eldoret, Kenya and funded by the German Federal Ministry of Education and Research. Much of the technology involved was provided for free by SAP and Intel. Roche, meanwhile, has provided the test kits.

Dr von Knebel-Doeberitz and his team worked with staff at the Design & Co-Innovation Centre team at SAP’s AppHaus Heidelberg centre, to design a mobile app that would work for the project, based on the company’s HANA Cloud Platform. This is designed to accelerate study recruitment and provision of cancer test results. SAP has produced a video showing the app at work.

All patient data entered locally, along with test results, can be monitored remotely by staff at the Heidelberg University Hospital and, to ensure that the solution works in areas with patchy Internet connectivity, the local part of the tablet-based app can run in offline mode and be synchronised to the cloud via an Internet ‘dongle’ several times a day. Says Dr von Knebel-Doeberitz:

It’s slowly developing, but we need more public interest. We hope we can get more funding because, right now, we have enough for about two years, but after that, we’re not sure. What we do know is that we would like to be rolling out this kind of screening on a broader basis to other countries too, such as Tanzania.

We need to show industry that there’s a market here for them. Without that, it would be incredibly naive to imagine that big pharmaceutical companies will get involved. But with the help of SAP, we’re now able to give them a glimpse of that market – and get better outcomes for patients and their families, too.

Krebsvorsorge in Kenia: Neues Screening-Konzept erreicht Frauen zuhause

Universitätsklinikum Heidelberg, Deutsches Krebsforschungszentrum (DKFZ) und SAP starten Testphase zur Früherkennung von Gebärmutterhalskrebs in Kenia / Gemeinsam entwickelte Software, neues Konzept und leicht auszuwertender Test erlauben flächendeckendes Screening in medizinisch unterversorgten Ländern

Gebärmutterhalskrebs ist in vielen Ländern Afrikas kaum zu behandeln, es mangelt an Medizintechnik und entsprechend ausgebildeten Ärzten. Umso wichtiger ist die Vorsorge. Wissenschaftler des Universitätsklinikums Heidelberg und des Deutschen Krebsforschunsgzentrums (DKFZ) haben gemeinsam mit IT-Spezialisten der SAP SE ein auf die Verhältnisse vor Ort zugeschnittenes Konzept entwickelt: Eine von SAP entwickelte Software und das Internet – in Afrika über das Mobilfunknetz verfügbar – sowie ein leicht auszuwertender Test erlauben ein flächendeckendes Screening auch in wenig erschlossenen Gebieten. Krankenschwestern besuchen die Frauen in ihren Dörfern, nehmen Abstriche der Gebärmutterschleimhaut und verschicken die Proben an ein Zentrallabor. Die für die Patientenakten erhobenen Daten werden auf einer speziellen Cloud Plattform gespeichert. Hier hinterlegt das Zentrallabor auch die Testergebnisse, so dass die Krankenschwestern vor Ort die Frauen zeitnah informieren können. Das Projekt ist nun im Rahmen einer Studie in Zusammenarbeit mit dem Moi Teaching and Referral Hospital in Eldoret, Kenia, gestartet worden.

“Wir möchten mit diesem gemeinsamen Projekt Unternehmen der Gesundheitsbranche zeigen, dass es sich lohnen kann, in Gesundheitsprojekte in ärmeren Ländern zu investieren. Es gibt dort einen enormen Bedarf z.B. an innovativen Vorsorge-Programmen”, erläutert Dr. Miriam Reuschenbach, Klinischen Kooperationseinheit Angewandte Tumorbiologie des Pathologischen Instituts am Universitätsklinikum Heidelberg und am DKFZ: Sie ist die Projektleiterin einer vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Pilotmaßnahme, aus der die Zusammenarbeit mit der SAP SE initiiert wurde.

“Nur durch die Zusammenarbeit von Wissenschaft und Wirtschaft können die Probleme vor Ort sinnvoll und nachhaltig gelöst werden”, sagt Professor Dr. Magnus von Knebel Doeberitz, Ärztlicher Direktor Abteilung Angewandte Tumorbiologie, Pathologisches Institut am Universitätsklinikum Heidelberg und Leiter der Klinischen Kooperationseinheit mit dem DKFZ. “Mit der SAP SE mit Sitz in Walldorf haben wir einen kompetenten und innovativen Partner gefunden, um trotz schwacher Infrastruktur eine lückenlose Kommunikation zwischen den Frauen, Labor, Ärzten und Krankenschwestern sicherzustellen.”

 

Krebsvorstufen in Kenia noch gut zu behandeln

Weltweit erkranken jährlich mehr als eine halbe Million Frauen an Gebärmutterhalskrebs, rund eine Viertel Million stirbt jedes Jahr daran. In den ärmeren Ländern der Welt haben Frauen mit fortgeschrittenen Krebsstadien nur selten Zugang zu einer Therapie, eine umfassende Behandlung mit Chemotherapie und Bestrahlung ist von den Krankenhäusern vor Ort kaum zu leisten. “Für die Frauen in vielen Ländern Afrikas bedeutet ein bereits in tiefere Gewebeschichten eingewachsener Tumor meist den sicheren Tod – ohne Schmerzmittel zudem einen sehr leidvollen Tod”, sagt Dr. Hermann Bussmann, Projektkoordinator des ETiCCS-Programms in der Abteilung für Angewandte Tumorbiologie. Die hohe Sterblichkeitsrate ist außerdem speziell in Entwicklungsländern ein großes sozioökonomisches Problem, da die Erkrankung häufig Mütter und Frauen im arbeitsfähigen Alter trifft. Dazu kommt, dass HIV-positive Frauen – in Kenia sind rund acht Prozent der Bevölkerung betroffen – ein erhöhtes Risiko tragen, an Gebärmutterhalskrebs zu erkranken. Programme zur Früherkennung, die auch Frauen außerhalb der Städte erreichen, könnten viele Todesfälle verhindern. Die Vorstufen des Gebärmutterhalskrebses lassen sich in der Regel auch in ärmeren Ländern gut behandeln.

Bei der Konzeption und Einführung entsprechender Screening-Programme gibt es drei große Probleme: Der bisher zuverlässigste Test auf Krebsvorstufen in der Gebärmutterschleimhaut, der auch in Deutschland zum Einsatz kommt, ist nur mit geschultem Blick auszuwerten. Andere Tests sind wenig aussagekräftig. Die Frauen leben größtenteils nicht in der Nähe einer Klinik oder eines niedergelassenen Frauenarztes. Und die wenigen Kliniken wären mit dem Zulauf im Rahmen eines routinemäßigen Screenings hoffnungslos überfordert.

 

Über Cloud Plattform erreichen Testergebnisse alle Probandinnen

Alle diese Punkte sind im Projekt ETICCS (Emerging Technologies in Cervical Cancer Screening) berücksichtigt. Zur Anwendung kommt ein Krebstest, den das Team um von Knebel Doeberitz entwickelt hat und dessen Genauigkeit in mehreren Studien belegt wurde. Ein spezielles Färbeverfahren markiert veränderte Zellen mit einem hohen Risiko, sich zu einer Krebsvorstufe weiterzuentwickeln. Das Ergebnis ist entweder positiv oder negativ, es gibt keine Zwischenstufen und keinen Spielraum für Fehlinterpretationen. Die Gewebeproben können von Krankenschwestern in den Ortschaften mit Hilfe von sterilen Einweg-Sets entnommen, sofort fixiert, codiert und anschließend an das zuständige Labor verschickt werden. Studienrelevante Daten verwalten die Krankenschwestern an Notebooks über eine spezielle Software, die das Team von SAP in enger Abstimmung mit Ärzten um Professor von Knebel Doeberitz entwickelte. Die zehn in der Studie verwendeten Notebooks sind eine Spende der Firma Intel.

Die Software lässt sich intuitiv bedienen und lädt die pseudonymisierte Patientenakte, sobald eine Internet-Verbindung hergestellt werden kann, automatisch auf die SAP HANA Cloud Plattform. Nachdem die Labormitarbeiter die Testergebnisse in dieser virtuellen Patientenakte hinterlegt haben, holt die Software sie wiederum automatisch auf die Notebooks, sobald Zugang zum Internet besteht. Auf diese Weise können die Krankenschwestern Frauen mit auffälligem Ergebnis zeitnah informieren und sie zur weiteren Abklärung an die nächste Klinik verweisen. Die Mehrbelastung der Kliniken bleibt überschaubar.

In einem nächsten Schritt wäre auch der Einbezug von Mobiltelefonen und Smartphones denkbar, die in Kenia weit verbreitet sind. Mit ihrer Hilfe könnte man die Frauen direkt über ein bevorstehendes Screening informieren, über die Erkrankung aufklären oder Testergebnisse übermitteln. “ETICCS ist ein Modell für einen wichtigen Aspekt der Gesundheitsversorgung in ärmeren Ländern. Es lässt sich problemlos auf andere Länder und auch andere Erkrankungen übertragen”, ist sich Professor von Knebel Doeberitz sicher. Die erste Projektphase wird von der in New York City ansässigen Ladenburg-Foundation gefördert.

 

Kontakt Medien

Doris Rübsam-Brodkorb
Pressesprecherin
Leiterin Ukom
Tel.: 06221 56-5052
Fax: 06221 56-4544
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Julia Bird
Stellvertretende Pressesprecherin
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weitere Informationen

Prof. Dr. Magnus von Knebel Doeberitz
Ärztlicher Direktor Abteilung für Angewandte Tumorbiologie
Pathologisches Institut des Univ.-Klinikums und Klinische Kooperationseinheit des Deutschen Krebsforschungszentrums
Telefon: 06221-564221
E-Mail

Dr. Hermann Bussmann
Abteilung für Angewandte Tumorbiologie am
Pathologisches Institut des Univ.-Klinikums und Klinische Kooperationseinheit des Deutschen Krebsforschungszentrums
Telefon: 06221-564221
E-Mail