Taha Kass-Hout, MD, MSDirector, Global Public Health and Informatics

Innovative Support to Emergencies, Diseases, and Disasters

ICT Developments in Mobile Technology FOR Global Public Health:

InSTEDD Collaboration Tools

Photo credit: IRMA (Integrated Risk Management for Africa)

Mekong Basin Disease Surveillance (MBDS) Information Communication and Technology Forum

April 2nd–3rd, 2009Mukdahan Province, Thailand

Channe Suy, MCAProduct Manager

DAY

CA

SE

S

Opportunity for control

Late Detection and Response

DAY

CA

SE

S

Opportunity for control

Early Detection and Response

Public Health Measures

• Representativeness

• Completeness

• Predictive Value

• Timeliness

Background

Public Health Measures

1000 Malaria infections (100%)

50 Malaria notifications (5%)

Get as close to the bottom of the pyramid

as possible

Urge frequent reporting: Weekly daily immediately

Specificity / Reliability

Sensitivity / Timeliness • Main attributes

o Representativenesso Completenesso Predictive value positive

Signal as early

as possible

Time

• Main attributeso Timeliness

Public Health Measures

Health care hotline

One of four major initiatives of the UN Millennium Action Plan (2000)

mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World (2009)

Making Mobile Technologies Work for Health

Growth of Mobile Technologies

Dzenowagi, WHO, 2005

Internet penetration levels among the population as a whole

India 5.2%

Malaysia 59.0%

Thailand 20.5%

Myanmar 0.1%

This compares to about 73.6% for North America

As we'd expect other countries in Asia are also shown to be high such as Japan, S. Korea, Taiwan and Hong Kong

Internet Penetration in Asia Pacific Countries

Nigel Collier, BioCaster: http://biocaster.nii.ac.jp http://www.internetworldstats.com/stats3.htm#asia

UNCTAD Handbook of Statistics 2004

Urban – Rural Population, SE Asia (2002)

Dzenowagi, WHO, 2005

Infrastructure

affordable, reliable, high-speed connectivity

Technology and tools

designed, developed and deployed

cheap and rugged access devices

people who can install and support them

Education

skills to find, use and manage information

Making Mobile Technologies Work for Health

Dzenowagi, WHO, 2005

Policies and standards

for information representation and exchange

affordable rates, tariffs and services

Evaluation

evidence & experience to guide development

Coordination

vertical systems impede real progress

interaction: what is used in one place should work in another

Making Mobile Technologies Work for Health

Dzenowagi, WHO, 2005

Costs of data transmitted over mobile phone are greater than voice costs

Language and illiteracy barriers

Patient privacy and security

Other challenges include

the physical components of a telephone (headset or network) are not isolated but are part of an entire business model that includes pricing plans and other incentives which can provide leverage employed by public health agencies and policymakers

Current Challenges

Kaplan, Globalization and Health 2006, 2:9 doi:10.1186/1744-8603-2-9, 2006

Open source software for closing the global collaboration gap

The InSTEDD TECHNOLOGY Platform

InSTEDD GeoChat: Take Decisive Action in Response

GeoChat lets you engage and coordinate with everyone who needs to be involved, linking headquarters, field, and the local community

InSTEDD Mesh4X: Share Data Across All Boundaries

Mesh4x lets you integrate applications, devices, and information into a shared, synchronized, distributed data mesh

InSTEDD Evolve: Synthesize Data into Actionable Information

Evolve lets you and your team monitor and collaborate around diverse data streams to detect, analyze, triage and track critical events as they unfold

How It Works – All Team Communication

A field team member sends a message… it reaches the entire team…

3 dead chickens

Need supplies

All is well

Out of syringes

Or… Field to HQ Communication

You Can Use GeoChat over Mobile Phone or Web

And these messages appear on a map…

Filters: click here to show all the groups you are a member of. the groups you want to view on the map.

Messages: on the left panel are all of the messages coming into GeoChat from all the groups you have , with the most recent at the top.

Which group? At the bottom of each message, it tells you WHEN the message was sent and from which group it was sent.

(A) Click on a message or an icon and a conversation bubble will appear.

(B) From here you communicate to an individual or to the entire team.

You can view the messages from one person by clicking on their message on the left panel (A) or by clicking on their icon on the map (B).

And from here you can communicate with the team

Geochat Training conducted by the InSTEDD Team Least and worst case pandemic scenario played by Dr. Sovann Ly, Deputy Dir., Cambodia MoH

GeoChat

Avian Influenza Exercise: Stung Treng Province, Cambodia, October 13-15, 2008

GeoChat

SE Asia Region (Source: Wikipedia)

The Komphun rural Health Center serves over 7000 population in the Stung Treng and neighboring provinces.

Avian Influenza Exercise: Stung Treng Province, Cambodia, October 13-15, 2008

Geochat Group n %Blue1 (simulated cross-border—Champasak) 4 7.5

Green1 (Kampot) 4 7.5Green2(Takeo) 2 3.8

Green3 (Kompong Speu) 2 3.8Green4 (Ratanakiri) 0 0

Green5 (Mondulkiri) 2 3.8Green6 (Kampong Cham) 3 5.7

Yellow1 (Rapid Response Team) 6 11.3Yellow2 (Provincial Health and Reference Hospital) 18 34

Yellow3 (Authorities) 7 13.2Yellow4 (Others) 5 9.4

Cell phone use during the Avian Influenza Exercise: Stung Treng Province, Cambodia, October 13-15, 2008

GeoChat

GeoChat Message Khmer Translation (using English characters)1. Does anyone have a car?2. We need medicine3. We need PPEs4. Who is the head of village?5. Family needs food6. I need mazut (gasoline)7. No gathering allowed at Pagoda8. Is market open?9. Is school open?10. I need an ambulance11. Can we help?12. What can we do to help?13. Do you have extra medicine?14. Yes, we have extra medicine15. Do you have enough medicine?16. No, we don’t have any medicine17. Can we get help with Quarantine

1. Teu nak na mean lan te?2. Yeun trov ka thnam3. Yeun trov ka PPE4. Nor na chea prathean phom?5. Cruosa trov ka aha6. Knhon trov ka mazut7. Men anugnat ouy mean ka choub chum nov wat8. Te phsa boeuk reu nov?9. Te sala boeuk reu nov?10. Knom trov ka lanpet11. Teu mean avey ouy yeung chhouy te?12. Ter yerng ach chuoy avey ban?13. Ter neak mean thnam bonthem te?14. Bat yerng mean thnam15. Ter neak mean thnam krob kran te?16. Te yerng khmean thnam te17. Ter yerng ach tor tuol chumnuoy pi Quarantine te?

Avian Influenza Exercise: Stung Treng Province, Cambodia, October 13-15, 2008

Total Messages (exercise only) Exchanged during the morning of the AI Simulation Exercise, October 15, 2008, Stung Treng, Cambodia

General messages exchanged among field workers, first responders, authorities, and government officials at CDC and provisional levels.

Connect a group of remote health centers

ongoing team communication

ask questions of each other

Monitor a public health problem

in a community with feedback from the field

Create a support network

for health issues, youth, women, etc.

Other ideas?

Examples Using GeoChat

Acknowledgements

Through funding from

Thank You!

InSTEDD400 Hamilton Avenue, Suite 120

Palo Alto, CA 94301

USA

+1.650.353.4440

+1.877.650.4440 (toll-free in the US)

info@instedd.org

Cambodia, Photo taken by Taha Kass-Hout, October 2008

“this pic says it all- our kids are all the same- they deserve the same”, Comment by Robert Gregg on Facebook, October 2008

BACK SLIDES

GeoChat

Features:

• Create, join, and participate in chat groups using SMS, email, or a web client on the surface of a map

• Location information in messages is automatically extracted, so that you can see who said what, when, and where

• International SMS gateway, Twitter gateway, and local gateway options

• Full SMS command line interface

• Public, private, and anonymous group configurations

• Broadcast alerts to the entire team

• Relay RSS/ATOM feeds of critical data over SMS

Gateway Settings

Setup RSS Feed

GeoChat Ideas for the Future

Features:

• Import additional data layers

– Upload your own KML layer and combine with GeoChat conversations [e.g., flooded areas, destroyed buildings]

– Sync structured data onto the map via HTTP or SMS

• Group management via SMS for field

• Gateway with plugged-in phone support for international characters /if the phone supports them/

• A US short code in summer (we cant promise dates)

GeoChat Ideas for the Future

Features:

• Offline client for disconnected operations

• Pluggable encryption

• Sensor integration

• PDA client

• Social Networking

• Integrated Analytics – tag clouds, machine learning, entity extraction, clustering, etc.

• Radio integration? Voice? Video?