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Government-funded study assessing iMOKO

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posted by Research Admin 1 on 25 February 2019



eHealthNews: 18 February, 2019

An independent study funded by the Ministry of Health and ACC is evaluating virtual health service iMOKO for efficiency and efficacy.

Developed by clinician Lance O’Sullivan, iMOKO enables trained teachers at participating kōhanga reo, early childhood centres and schools to securely send health information about students with common conditions such as head lice and strep throat to a digital health team working in Auckland.

These digital health assessors respond with a diagnosis and treatment plan and prescriptions are sent to the parents of caregivers via the iMOKO app.

Around 15,000 children are live on the service, with another 5000 consented and ready to load.

iMOKO's former chief executive Jodi Mitchell says the organisation is hoping to secure government funding for the service, as a consistent funding stream is needed to make it sustainable.

She says iMOKO fits closely with the government’s goals around improving Māori and child health as 86 per cent of the children registered with the service are Māori and Pasifika, and are often from impoverished areas around the country.

The independent study is being conducted by Dovetail Consulting. It began in June 2018 and runs until December 2019, and a preliminary findings report was submitted to ACC and the Ministry of Health at the end of last year.

Mitchell says the strong kaupapa Māori approach came through in preliminary results as a positive aspect of the service.

Dovetail director Adrian Field says the study is being done by a multidisciplinary team. The first phase of work looked at “to what extent are the foundations in place for iMOKO to deliver on its intentions?”.

This includes the organisation’s infrastructure, reach of the programme to target populations and recruitment of digital health workers.

Also being assessed is the extent to which clinical governance has been established, data is being collected and risks and unintended consequences are being monitored, he says.

The second phase is looking at outcomes, asking “to what extent is iMOKO making a difference and how?”.

This includes the impact of the programme on participating children and communities and the value to schools and the workforce involved.

 Field says the team is specifically looking at how the programme is benefitting Māori and Pasifika populations and improving access to healthcare and ACC-funded services. It is also assessing learnings to inform future implementations, scaling and development.

iMOKO tackling issue of inequitable access to healthcare

iMOKO describes itself as an “innovative, digitally enhanced healthcare programme developed to increase access to health services for children”. takes a closer look at the service and its future funding and roll-out plans.

While children under 14 get free healthcare from a GP, the costs associated with attending a clinic are still an issue for some families, as are cultural barriers due to the low number of Māori GPs.

Therefore, not all children under 14 are receiving free primary healthcare, and treatable conditions are going undetected within families and communities, leading to more serious health outcomes for those children.

Problem solving

Clinician and digital health entrepreneur Lance O’Sullivan aimed to tackle this issue with the development of a digital health service called iMOKO. 

iMOKO is used in a number of early childhood centres and te kōhanga reo, primary schools, four high schools and two free walk-in clinics.

It is set up to detect four non-acute conditions: sore throats, skin conditions, dental infections and head lice. There is also an ‘other’ category that is used mainly for things like respiratory, asthma and other common problems. 

There are around 1000 trained ‘digital health workers’ - volunteers such as teacher aides -who work in these organisations and want to be involved in improving children’s health. 

They are equipped with an iPad and take photos and ask questions about the child’s health. The information and images are then sent to a central digital health team.

The team currently gets around 60 cases a day, handled by four staff working at a time and one clinician who approves treatment plans. These plans and any prescriptions are sent to the parents or caregivers of the children via the iMOKO app.

“We teach them (digital health assessors) the pattern of disease and we have really good clinical guidelines, and the clinician at the end of the process approves their treatment plans,” explains iMOKO's former chief executive Jodi Mitchell.

Planning for the future

iMOKO has just rolled out clinical guidelines for both children and adults for another 20 conditions.

“The plan this year is to roll virtual healthcare out for adults, starting with iwi groups,” she says.

The iMOKO team also looks at other impacts on a child’s health, such as housing, and refers families to appropriate agencies where possible.

iMOKO has a contract with Northland DHB to prevent children developing rheumatic fever and has received seed funding from some other DHBs, as well as a donation from the Best Start Education Right Family Foundation.

Schools that want to participate pay a set-up fee then $2 per week for every enrolled child. For those that cannot pay, iMOKO seeks philanthropic sources of funding.

“We don’t have any shortage of demand,” Mitchell says. “We have a waiting list.”

The organisation is hoping to secure government funding for the service, as a consistent funding stream is needed to make it sustainable.

The government has set goals around improving Māori and child health and 86 per cent of the children registered with iMOKO are Māori and Pasifika, and are often from impoverished areas around the country. 

An independent study

The government is assessing the efficiency and efficacy of the virtual health service via an independent study conducted by Dovetail Consulting.

Dovetail director Adrian Field says the study involves analysing data and interviewing staff and participants in the programme.

After submitting a preliminary findings report to the Ministry of Health and ACC at the end of 2018, the study is moving into its second phase where it will be looking at iMOKO clinical data and seeing what patterns are evident, particularly in terms of the treatment of the main conditions the service is looking at.

“We’ll also be doing surveys and interviews of parents and whānau to get a broad sense of the experience and value iMOKO is offering,” says Field.

The team is also investigating how to assess the impact of iMOKO on the wider health system and health outcomes, such as hospital admissions.

“iMOKO being a very innovative approach and one that does, to some extent, challenge existing health services delivery approaches, that’s a question we will be looking at,” Field says.