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Using Microsoft technology to help heal more smiles

The father paces anxiously as his 7-month-old daughter is being prepped for an operation that would change her life forever, setting his little girl on a path that he had as a child hoped for himself.

Like his daughter, Nguyen Thi Hanh, Nguyen Van Dinh, 42, was born with a cleft lip and palate. He still carries memories of a childhood marred by cruel taunting because of his facial deformity. It wasn’t until he was 22 that he received an operation that corrected the defect and enabled him for the first time to speak clearly and be understood by others.

“Having my own surgery was like being born a second time. Before, I would get bullied and teased by other children at school who would call me awful names. And no one could understand me when I spoke,” Dinh recalls.

Like so many others in Vietnam who grew up with cleft, Dinh’s family was too poor to afford the much-needed operation. That all changed when Operation Smile repaired his deformity. Now, two decades later, the nonprofit organization will do the same for his daughter.

“It changed my life and I’m glad my daughter will not have to go through the same experience I went through growing up,” Dinh says.

Each year, Operation Smile performs an average of 180 international missions, including the one held on the grounds of the Vietnam-Cuba Friendship Hospital in Hanoi, where Dinh’s daughter was treated. Some 100 volunteers participated in the Hanoi mission last month, including medical specialists, nurses, anesthetists and dentists. On average, between 100 and 150 patients are operated on during each mission.

Patients in Hanoi
Patients in Hanoi waiting to see Operation Smile physicians.

In 32 years of bringing help to those in need, Operation Smile has treated hundreds of thousands of patients and seen many others, collecting data about the children they treat and the environments in which they live. Despite this wealth of information, however, the organization and others like it have yet to determine the root cause of the facial deformity.

Operation Smile is pinning its hopes on Microsoft technology to uncover the answers, while helping it grow the operation worldwide by digitizing its systems and hosting the data in the cloud.

During its recent Hanoi mission, the organization rolled out a digital patient assessment process for the first time. All data was collected using a new electronic medical records system.

Patients in Hanoi are screened
Patients in Hanoi are screened using a new electronic medical records system from partner Slainte Healthcare and 2-in-1 devices running Windows 8 donated by ASUS.

Images of cleft lips and cleft palates were captured and uploaded, along with weight, hemoglobin level and other health-related information needed to assess the patient’s suitability to undergo surgery. Patient data to support surgical prioritization was entered into Asus Transformer 2-in-1 tablets carried by Operation Smile’s medical volunteers onsite and will be uploaded to the cloud for archival and future analysis.

“Our dream is to get the complete story so that we are learning from our patients how to prevent this deformity and take better care of them and of more people in the future,” says Dr. Ruben Ayala, senior vice president of medical affairs for Operation Smile. “Technology is a great tool enabling us to do things more efficiently so we can help more children. We tried to connect the dots before but it was too difficult. We couldn’t get to where we wanted to be until Microsoft came into the picture.”

Dr. Ruben Ayala
Dr. Ruben Ayala checks on a patient after surgery.

All of this would not have been possible if not for a chance meeting between Microsoft executive Paul Smolke and Operation Smile’s founders Dr. Bill Magee and his wife Kathleen Magee four years ago — several thousand feet above ground.

The three met on a flight from Beijing to Seattle. At the time Magee was wrestling with how Operation Smile could use technology to improve its processes and productivity. Smolke, who is Microsoft’s industry managing director of Worldwide Health, and has 30 years of experience in healthcare technology, found himself in the right place at the right time to offer help.

“I was intrigued by Operation Smile because they have to apply technology in very difficult situations and very often do not operate out of fixed locations,” he says. “They’re constantly shifting equipment and operating where it is challenging to efficiently capture data.”

The task: Automate record-keeping processes that had previously been done by hand, and do so in a way that requires little or no training, so Operation Smile volunteers can learn the technology quickly.

Smolke and his team worked tirelessly to evaluate the organization’s workflow and bottlenecks, and put together a business case consisting of three phases. First, Microsoft provided the organization with Office 365, which was deployed to address Operation Smile’s productivity issues.

The organization is using Office 365 OneDrive for Business for document storage and sharing, which allows their staff to spend less time worrying about maintaining and backing up data, or rolling out updates manually. In time, Operation Smile will use Microsoft Azure for image archiving as well as new, innovative line of business applications with global availability.

Medical volunteers and Operation Smile Founder Dr. Bill Magee
Medical volunteers and Operation Smile Founder Dr. Bill Magee (right), review patient records before surgery.

The second phase involved shifting to electronic medical records. Microsoft’s partner Slainte Healthcare stepped up to provide the software and services for this move.  The live deployment on a mega-mission such as the one to Vietnam marked an important milestone in the initiative, putting in place the foundation needed to support the third, and most important, phase: data analytics.

“What Dr. Magee is really interested in is importing all the history they’ve collected in the last 32 years since Operation Smile was founded and applying analytics to it.  We’ve been working with health customers on some very interesting projects leveraging analytics in the cloud using Azure,” says Smolke.

“With the data analysis, for instance, we can potentially identify genetic and environmental correlations with incidents of cleft.  We can look at different sets of data, bring the data together and create some interesting insights,” he adds. Once the data is digitized, it’s going to be interesting to see what we can gain from it.”

For Operation Smile, electronic health records are the vital link between past, present and future patients.  “Capturing data on patient demographics as well as difficulties encountered during surgery could shed some light, for instance, on medications, procedures or conditions involving a higher risk of complication for specific groups so we can better prepare for surgery,” Ayala explains.

The data could also help identify key barriers to patients getting necessary care and which of them are more likely to experience complications during surgery. It would also enable Operation Smile to monitor patients who were unable to receive treatment during a mission due to malnutrition, for example, and provide the necessary advice to help improve their condition. With their information properly recorded, these patients can then be contacted for future missions where they can be assessed again for surgery.

“We have some of the data, but we need to find more, and with technology, we can speed up the process,” Ayala says.

Patient medical records are viewed in real time
Patient medical records are viewed in real time during the recent Operation Smile Hanoi mission.

With medical records digitized, Operation Smile is ready to scale up deployment so it can run more missions and reach more patients worldwide.

According to Chris Bryant, Operation Smile’s senior vice president of enterprise applications and technology, the organization treats some 20,000 patients a year and aims to increase that to 60,000. To achieve this number, it will need to grow its network of medical volunteers. Bryant hopes to do this by re-engineering its recruitment system.

“With a more efficient system in place, we can provide enough notification so our volunteers can schedule time away from their jobs to give them more opportunity to participate,” he explains, noting that the organization’s volunteer management system, the Medical Volunteer Action Center, currently runs on several databases.

“Our plan is to consolidate this into a centralized database with the necessary algorithms to automate mission staffing. In the end, we will be able to map qualified and available volunteers with required slots for an optimal mix based on their medical specialty and experience,” Bryant says.

As Operation Smile expands its understanding of the causes of cleft lip and palate deformities and its scope to be able to provide more frequent missions, the organization aims to treat more patients as early as possible so they never have to experience hurtful teasing.

Nguyen Van Dinh and his daughter, Nguyen Thi Hanh
Nguyen Van Dinh and his daughter, Nguyen Thi Hanh, after her surgery in Hanoi.

Asked how he felt now that his daughter would have a chance to grow up without the difficulty he endured, Dinh was too overcome to respond. Regaining his composure, but with tears in his eyes, he says, “I want to thank Operation Smile … I don’t know why they would do this and help so many of us, but I’m very thankful, touched and happy.”


Photos by: Zute Lightfoot, Operation Smile