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Health systems & teams: co-design offline tools—no WiFi needed

Designing Liver Care Systems That Work in the Real World

Clinician-led digital tools and system designs developed to address real-world failures in liver disease care. Built from frontline practice. Used globally.

We work with health systems, providers, and organisations to design tools and pathways that still function when time, connectivity, or manpower is limited.

Who This is For

This work is designed for organisations responsible for delivering liver care under real-world constraints.

  • Health systems and providers

  • Commissioners and service designers

  • NGOs and global health organisations

  • Digital health and implementation teams

Problems organisations ask us to help with

  • Missed follow-up and silent pathway failure

  • Workforce overload and cognitive burden

  • Digital tools that fail offline or under pressure

  • Inconsistent guideline implementation

  • Fragile data capture across care pathways

How we work with organisations

Digital health implementation for liver disease programmes using offline-first tools, WHO-aligned protocols, and evidence-based design.

  • Pathway and systems review under real-world constraints

  • Advisory input on digital and operational resilience

  • Licensing or adaptation of existing tools and frameworks

✓ Gilead & BSG collaborations

✓ 27,000+ users validated

✓ Offline-capable deployment

✓ Pilot programmes & partnerships

If you’re exploring how to reduce system friction or risk, we can have a brief, non-obligatory conversation.

Start with a conversation? Schedule a brief, confidential discussion

Enterprise Case Studies

Case study 1 — Rwanda hepatitis programme with WHO

Challenge
National hepatitis services required visual simple educational resources for consistent screening, linkage to care, and data capture across sites with variable connectivity and workforce capacity.

Intervention
Co-designed an offline-first hepatitis care platform aligned to WHO guidance, enabling screening workflows, patient tracking, and educational tools for national training of hepatitis care workers.

Implementation timeline
Discovery and co-design (8 weeks) → pilot deployment (12 weeks) → scale-up readiness assessment.

Outcomes
Deployed across [Country-wide]; supported [Staff managing hepatitis]; improved competence of staff [Feedback received]; reduced reliance on WiFi in low-connectivity settings.

Partner role
Technical collaboration with WHO country team and Ministry of Health stakeholders.

Reference
WHO Rwanda hepatitis programme (reference available on request).

Case study 2 — Endoscopy reporting pilot with BSG

Challenge

Endoscopy services required structured reporting to improve data quality, audit readiness, and research outputs without increasing clinician burden.

Intervention

Delivered an offline-capable endoscopy reporting platform with structured datasets and audit-ready outputs, piloted within BSG-aligned workflows to centres in Nigeria & Zambia.

Implementation timeline

Clinical requirements (8 weeks) → pilot build (12 weeks) → live pilot and evaluation (8 weeks).

Outcomes

Early deployments produced positive user feedback and measurable workflow benefits: Nigeria reported improved reporting efficiency and automation; Zambia used the system for approximately 100 patients during the initial phase. 

Partner role

The BSG International Committee funded and governed the collaboration; Dr Ladep led technical and clinical implementation; local teams managed recruitment and integration. Feedback is being used to refine the app, expand training, and prepare formal evaluation reporting for wider roll‑out.

Reference

BritisBritish Society of Gastroenterology. BSG International Endoscopy Services in Africa — project report / news item.

Case study 3 — Hepatitis Care Companion (Gilead Medical Fellowship)

Challenge

Hepatitis care in the trial region suffered from poor continuity, low adherence to surveillance and treatment pathways, and frequent loss to follow‑up in settings with intermittent connectivity and limited specialist access.

Intervention

Developed and trialled an offline‑first Hepatitis Care Companion under the Gilead Medical Fellowship. The app combined automated reminders, patient education aligned to WHO guidance, medication and appointment tracking, and clinician‑facing reports to support local care teams and task‑sharing models.

Implementation timeline

Design and ethics approvals → local adaptation and training (6 weeks) → trial deployment in low internet connectivity setting (12 weeks) → data collection and evaluation (6 weeks).

Outcomes

Outcomes are reported in the published abstract: see Gut (BMJ), Supplement 1, abstract A4.1 for the trial results and measured impacts.

Partner role

Gilead Medical Fellowship provided sponsorship and clinical trial oversight; local clinical teams led recruitment, adaptation, and delivery; academic collaborators supported evaluation and reporting.

Reference

Published abstract: Gut (BMJ), Supplement 1, abstract A4.1 (Gilead Medical Fellowship Hepatitis Care Companion trial).

NEW PROFESSIONAL RESOURCE

Offline-First Digital Health Toolkit

Implementation lessons from deploying digital health tools to 12,900+ patients and healthcare workers across 120+ countries.
Includes real budgets, templates, and frameworks for building systems that work beyond ideal conditions.

For programme managers, NGOs, and digital health developers

Tools as Proof

Reference implementations, not products

These tools are reference implementations. They demonstrate how we design for continuity of care, monitoring, and adherence when real-world constraints apply.
Some are used directly. Others are adapted, embedded, or licensed within organisational systems.

 

They exist to prove one thing:
the thinking works outside ideal conditions.

Hepatitis Care Companion

Supports continuity of hepatitis care in settings where specialist access, reliable connectivity, or workforce capacity is limited.

→ How organisations use this

LiverCheck

Enables structured monitoring and preparation between appointments, reducing missed follow-up and information loss across care pathways.

→ How organisations use this

Liver Nutrition App

Demonstrates how personalised lifestyle guidance can be delivered safely and consistently at scale, without increasing clinician workload.

→ How organisations use this

Note

Demonstrates how personalised lifestyle guidance can be delivered safely and consistently at scale, without increasing clinician workload.

If you are exploring how similar capability could be adapted for your system, a brief, confidential conversation may be useful.

Start with a conversation

Frequently asked questions

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The following clarifies how these tools are intended to be used within real-world care pathways.

dr nimzing ladep image

Dr. Nimzing Ladep, MBBS, FRCP, PhD

National Clinical Director for Gastroenterology, CHEC
Healthcare Systems Designer

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I design and advise on healthcare systems that must function under constraint. My work focuses on reducing silent failure in liver disease pathways through offline-first tools, governance-aware design, and real-world implementation.

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  • 27,000+ patients supported globally

  • 20+ years in liver disease & systems design

  • 6+ evidence-based digital health tools

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If you’re exploring how to reduce system friction or risk in liver care, we can have a brief, confidential conversation.

27,000+

Patients Empowered Worldwide

20+

Years Clinical & Systems Design Experience

6+

Evidence-Based Mobile Apps 

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