SPICE Digital Health Platform

Despite advances in technology and medicine, the prevalence and death rates of preventable and curable health conditions remain high. And these rates are disproportionally high in low- and middle-income countries (LMICs). Non-communicable diseases (NCDs) account for 41 million (two-thirds of) global deaths every year and 66% of NCD-related deaths occur in LMICs. In 2021, nearly half of the world’s population was at risk of malaria with about 247 million cases of malaria worldwide. 95% of malaria cases and 96% of malaria deaths occurred in Africa. In addition, maternal mortality rates continue to be on the rise. In 2020, 800 women were dying daily—a maternal mortality ratio (MMR) of 223 maternal deaths per 100 000 livebirths and 95% of maternal deaths occurred in LMICs.  

Despite these persistently high disease burdens, LMICs lack the necessary funding to provide the health care needed to prevent and treat these diseases. Health services for screening, prevention, treatment and patient education are inaccessible to billions of people living in rural, remote and impoverished regions across LMICs.  The WHO has reported that over half the world’s population lacks access to the basic health services they need. While community health workers (CHWs) and digital health tools have been deployed in areas with low accessibility to health services, the combined effects of these interventions are not optimized for primary care management. At the community level, virtually all digital tools deployed are designed as simple ‘survey tools’ that operate independently from health facilities and the wider health system. As a result, these tools only capture point-in-time data rather than provide the longitudinal view that clinicians need to proactively manage the care of patients. There are no efficient communication channels between communities and facilities to ensure that patients stay engaged in the system to adhere to their treatment. At the facility level, staff lack useful data required to effectively prioritize their patients based on need and urgency. Most digital tools operate in disease silos by only collecting health data and providing health services for one disease vertical or a select group of symptoms. In effect, while digital investments have grown, we haven’t moved the needle on patient outcomes.  

Medtronic LABS started by developing a model to manage NCDs such as hypterension and diabetes. After initiall success, it is now building an integrated primary care model to manage conditions with the highest mortality rates such as TB, malaria, diabetes, hypertension and pregnancy and HIV. At the core of the model is a digital public good (DPG) called SPICE that is an open-source, interoperable digital platform for healthcare professionals at the community and facility level.  

 The model consists of four components: 

1. SPICE Core is an ‘offline first’, community-based platform for data-driven population health. It leverages clinical algorithms to screen, refer and manage patients based on clinical risk so that care delivery is proactive rather than reactive. For CHWs, SPICE serves as an easy-to-use mobile application to screen, refer, and manage patients based on risk. For facility level staff, SPICE incorporates risk-based algorithms to support provisional diagnoses and suggested care plans, decision support and longitudinal patient records to strengthen and standardize clinical care. Since both CHWs and clinicians are inputting and accessing data through SPICE, it establishes bi-directional communication between the community and the health system.
   
2. SPICE Engage is our patient engagement platform designed to drive patient interactions that generate results. It allows for targeted patient follow-up at every stage of the patient journey to ensure patients are getting the support they need for better health outcomes. SPICE Engage replaces health care workers’ current paper-based follow-up methods by prioritizing patients based on risk and time since missed follow-up visit to optimize workflows and health outcomes.  
3. SPICE Insights is our data analytics platform designed to deliver the right information to the right stakeholder at the right time. From clinical outcomes to operational KPIs, SPICE Insights is designed to make data useful at every level of the health system. Key features include data visualizations and dashboards for operational and clinical KPIs and MoH report downloads. 
   
4. Finally, SPICE Connect is at the core of model and represents the ongoing work Medtronic LABS is doing to create easy-to-implement and standards-based integrations so that SPICE can be interoperable with national level health reporting systems such as DHIS2 and EMRs.  

SPICE goes beyond data collection for individual conditions and enables actionable care management that looks at a patient holistically and integrates across different health conditions. Additionally, SPICE builds in clinical algorithms and logic models that allows community health workers and clinicians to refer and diagnose patients based on verified clinical guidelines. Finally, SPICE bi-directionally connects community health workers and health facilities so that patient health data is captured at all phases of the patient journey to build a patient’s longitudinal health record.