I just received my copy of the book: Biosruveillance methods and case studies edited by Taha Kass-Hout and Xiaohui Zhang. I first met Taha in cyberspace when he was with InSTEDD, we had started a Google group: Biosurveillance, which we use as a knowledge-base. Their approach to disease surveillance was through “event-based surveillance” and our approach was through “indicator-based surveillance” but both converging at finding signals for timely public health alerts that would advocate early control measures. We had contributed three chapters in the context of the Real-Time Biosurveillance Program pilot (RTBP) – Chapter 9: “The role of Data Aggregation in Public Health and Food Safety Surveillance” – Artur Dubrawski Chapter 13: “User Requirements towards a Real-Time Biosurveillance Program” – Nuwan Waidyanatha and Suma Prashant Chapter 14: “Using Common Alerting Protocol to Support a Real-Time Biosurveillance Program in India and Sri Lanka” – Gordon A. Gow and Nuwan Waidyanatha.
The present day disease surveillance and notification system in Sri Lanka, confined to a handful of diseases, known as Notifiable disease, and reporting large numbers of common cases, is what the British introduced in 1897 as part of the quarantine and prevention of diseases ordinance. This paper based surveillance and reporting system has its shortcomings that the health professionals themselves have voiced. The Real-Time Biosurveillance Program (RTBP) pilot, during the first week of April, interviewed health workers and health officials in Kurunegala District to study the notification and response policy and procedures. These interviews revealed that in some occasions by the time health officials receive the notification to inspect the patient, with the infectious disease, at the patient’s residence, the patient had already died; health workers literally pull their hair trying to decipher the illegible handwriting on the paper forms; they also mentioned that they have to travel long distance from their villages to the Medical Officer of Health (MOH) office to pickup the paper forms with the patient’s information. These inefficiencies and excessive costs can be drastically reduced with ICT; with a technique as simple as a communicating the information via SMS text messages that costs Rupees 0.
The Sivagangai District (Tamil Nadu, India) Deputy Director of Health Services (DDHS), Dr. Raghupathy, compared the Real-Time Biosurveillance Program (RTBP) to a comprehensive machine with multiple flavors that can give the required surveillance results with the touch of a button. Kurunegala RE (Region Epidemiologist, Sri Lanka), Dr. Hemachandra’s words were “RTBP will give a booster to surveillance in our region”. Evaluation planning workshops took place in Karraikudi, Tamil Nadu and Kurunegala, Sri Lanka.
The Real-Time Biosurveillance Program (RTBP) information communication system comprises an upstream health data submission by last-mile health workers, data processing by epidemiologist, and downstream alerting by health officials.There are four components to the RTBP software: mobile phone application, desktop web application, database, T-Cube analytic tools, and Common Alerting Protocol messaging. The individual components are to be developed by Rural Technology and Business Incubator, Respere (Private) Limited, and Auton Lab. Following are the four software requirement specification documents – 1) Sahana biosurveillance module (database and desktop web application) 2) Mobile J2ME application (data collection) 3) T-Cube web interface (analysis and event detection) 4) Sahana Common Alerting Protocol Messaging Module (publishing SMS/Email/Web alerts)
The design of the Real-Time Biosurveillance Program pilot (termed as the m-Health project) and findings from the Last-Mile Hazard Information Dissemination pilot (termed as the HazInfo projects) involvoing the Common Alerting Protocol (CAP) were presented, yesterday, at the CAP Implementers Workshop organized by the World Meteorological Organization (WMO). First Talk – The m-Health RTBP will be evaluating CAP or EDXL (Emergency Data Exchange Language) as means for disseminating health risk information to local health officials and community health care workers. Currently, the National Epidemiology Unit, in Sri Lanka, publishes a “Weekly Epidemiological Report” on the world wide web, a pdf file that can only be viewed on a personal computer. Paper copies of the same are delivered via postal mail to the relevant health officials. The latency in gathering the epidemiological data, analyzing, publishing, and disseminating is delayed as much as up to 3 weeks.
I was invited by the International Telecommunication Union (ITU-D) to present and overview of the Common Alerting Protocol and lessons learned in the Sri Lankan experience in relations to the HazInfo project and the work in progress on the RTBP m-Health project. Further demonstrated the use of the Sahana Messaging Moudule CAP Template engine for generating CAP messages and the SMS/Email Multicasting engine for issuing alerts. Dialog Telekom is the only Sri Lankan organization that has adopted CAP and has embedded CAP in to their Disaster and Emergency Warning Network (DEWN) for communicating disasters. The DEWN solution in being implemented as means for the Disaster Management Center of Sri Lanka to communicate hazard information to their District level disaster centers and local first responders. CAP surfaced as a standard in 2005 fairly new and unheard of by most in the disaster communication arena in the developing world.