“If the technology delivers as promised,” Mr. Casey says, “then we believe that’s when we’ll move from sensors on people diagnosed with a disease to literally everybody.”

Professor Rogers is a co-founder of MC10, an electronics company in Cambridge, Mass., that is aiming to turn the epidermal monitor prototype into a commercial product in 2013. David A. Icke, MC10’s chief executive, said the company’s skinlike device consists of tiny components that are physically separated, like electronic “islands.” They are connected with squiggles he calls “serpentines,” which are designed to bend and absorb strain without breaking. The technology can theoretically be used both inside the body and on the skin.

Electronic monitoring of patients at home could significantly reduce medical costs. A study by the Department of Veterans Affairs and published in 2008 suggests possibilities for savings.

From 2003 to 2007, researchers tracked a large group of patients with serious conditions, including congestive heart failure and chronic obstructive pulmonary disease.

Full story.

Mr Gates, however, warned the participants not to celebrate too soon. Just because an m-health pilot scheme appears to work in some remote locale, he insisted, don’t “fool yourself” into thinking it really works unless it can be replicated at scale. Rafael Anta of the Inter-American Development Bank was even more cautious: “We know little about impact and nothing about business models.”

Happily, evidence of m-health’s usefulness is at last starting to trickle in. A study this week in the Lancet, a medical journal, shows that something as simple as sending text messages to remind Kenyan patients to take their HIV drugs properly improved adherence to the therapy by 12%. WellDoc, an American firm, found in a recent trial that an m-health scheme that relies on behavioural psychology to give diabetics advice on managing their ailment has more effect than putting them on the leading diabetes drug.

But that does not mean that he’s always right. Innovation comes when the situation is dire and other options are missing. So, it may be that Gates is not right here:

No doubt a dose of scepticism is warranted about m-health. But given the growing evidence of its usefulness and the new business models from emerging markets, there is reason for hope too. As Mr Gates pointed out this week, “Middle-income countries are where most innovation in health care is going to come from.”

The full article can be downloaded here or read below:

Sri Lanka has completed the trial of a mobile phone project which helps early detection of communicable diseases. The ‘Real-time Bio-surveillance Programme’ allows data on patients and symptoms of illnesses to be sent directly from hospital wards to the epidemiological centre through a web interface installed on mobile phones.  Under the present manual system, set up in the 19th century, it can take more than two weeks for information of outbreaks to reach the epidemiological centre in the capital. As a result, officials first learn about the outbreak through the media. The mobile system allows quick analysis to identify disease patterns to be made before the outbreak spreads.

-FutureGov Asia Pacific, October 2010, p. 47

Findings have also made to the Pakistani  media. Read the full article appearing in the The News, here.

Now if the same consortia can somehow figure out a surveillance program of bureaucratic inefficiencies, then the relevant governments of these countries may actually be able to respond well and respond fast, given that identification is just one component to controlling epidemics. Increasing the efficiency with which epidemics are identified is a step forward, but what comes after–implementation of crowd control, region-wide communications, and swift deployment of medical personnel–is the real test.

The detection of spread of respiratory tract infection in conjunction with a viral fever in Sri Lanka that caught the attention of the health departments and escalating diarrhoea cases in Tamil Nadu were detected in a matter of a day after the onset of the outbreaks. Through alert systems in the pilot project, such situations were communicated to the local community and health departments, who then publicised preventive measures and treatment. Potentially, the RTBP reduces the time to identify a potential disease outbreak to just a day.

- Mobiles on Health Calls, The Hindu Business Line, September 13, 2010

- Pilot study in using mobile technology for disease reporting shows promise, Thehindu.com, July 07, 2010

– Pilot study on epidemiological early disease warning system, Chennaionline.com, July 07, 2010

- New tech to keep tab on diseases, timesofindia.com, July 08,10

- Cellphone-based technology to build the arteries for healthcare, Livemint.com, Sep 03, 10

- Building mobile health, Thehindu.com , September 17,10

- New mobile technology can cut biosurveillance cost by 50%, Financialexpress.com, Aug 06, 2010

- Detecting disease-mobile way, expressbuzz.com, July 08,10

- Health on the Go, Voice and Data, September 2010

- Cell Phones to Track Diseases, Deccan Chronicle, July 07, 2010

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 0.50 (fifty cents).

We asked health workers as to how they came to know of any adverse health events (i.e. rise in cases of a disease or an outbreak) either in their own or neighboring jurisdictions. Most of them replied “through word-of-mouth” while some said they came to know through the main stream media (TV, Radio, News Papers). Ideally they should be receiving first hand information from the health system itself.

A summary of the RTBP conducted assessments are documented: field report for India and field report for Sri Lanka.

An ICT system for alerting and situational awareness, is what the RTBP is introducing to the health system in India and Sri Lanka. RTBP adopts a global standard called Common Alerting Protocol (CAP) for issuing standardized alerts and situational awareness messages. Besides structuring complete all-media all-hazards messages, CAP provides grounds for interoperability. The CAP guidelines and preliminary design was adopted from the USA Center for Disease Control Public Health Information Network CAP Guide.

The RTBP introduced technology and procedures are a paradigm shift from the present day surveillance and notification system. The new paradigm introduces situational awareness and alerting, giving the health officials advance notice to decide on the actions that would make a difference, opposed to an unproductive set of formalities that are not aimed towards saving lives but just for pushing statistics up the chain.

In the RTBP, when a health event of interest such as an increased number of common syndromes or diseases are identified through the T-Cube Web Interface, authorized health officials issue a message to the restricted recipients (i.e. health workers) in the effected as well as surrounding areas. Then health workers will be aware of the present danger and can mobilize to respond immediately or chose to be vigilant and observe the situation. For example, a health worker in the effected area would know that he/she needs to investigate the cases in their jurisdiction; while health workers in other neighboring areas may conduct awareness campaigns to educate the public.

The CAP messages designed for health alerts and situational awareness are delivered via SMS, Email, and Web. The single input multiple output software system was developed by Respere Lanka and is embedded in to the Sahana Messaging and Alerting Module. Sahana is a Free and Open Source Software specifically designed for managing disasters.

These health workers (few of them are in the photo with their backs to you) were given training and mobilized with the mHealthSurvey, mobile phone application, for submitting patient disease/syndrome data for the surveillance of epidemiological events. Data that used to take over 15 days to relay up to the paper chain, but was not subject to any detection analysis (i.e. just reporting), now takes several seconds. Moreover, the RTBP collects all communicable and non-communicable diseases along witht their syndrome opposed to a handful of diseases (i.e. Integrated Disease Surveillance Program S and P list of diseases). Each Primary Health Center sends over 100 patient records (probable, suspected, and confirmed cases) a day that is now subject to, RTBP introduced, real-time health event detection analysis. Although there were some errors due to misspelling at the begining, once they were asked to be cautious and were made aware of the consequences of the errors resulting in false statistics that may lead to false alarms of disease outbreaks, they have reduced the error rates to almost zero.

Dr. Ganesan M., (Senior Program Officer, RTBI – extreme left seated at head table, facing you, talking the Health Workers in the photo), present the paper titled: “Real-Time Bio-surveillance Program: Field Experience from Tamil Nadu, India” at the 7th Indian Association for Social Sciences and Health (IASSH) conference on Health, Poverty and Human Development held at Banaras Hindu University, Varanasi from 5th to 7th March 2010. Dr. Ganesan is part of the research team at the Indian Institute of Technology – Madras’s Rural Technology and Business Incubator (RTBI) conducting the RTBP action research in the state of Tamil Nadu, India.

View the conference presentation slides

Read a brief on the conference participation

Evaluation planning workshops took place in Karraikudi, Tamil Nadu and Kurunegala, Sri Lanka. This was to present the lessons to date and get a common consensus on the evaluation methodology. Participants were health officials and health workers (medical officers and nurses) belonging to the jurisdictions the project is being pilot tested. Besides the workshops, the researchers held meetings with health workers and officials to understand other elements towards evaluating the project.

Click to view the Indian Workshop report and Sri Lanka workshop report.

The medical officers in both countries agree that they cannot enter data while attending to 100 patients in a morning. The Real-Time Biosurveillance Program (RTBP) in India and Sri Lanka have, to date, collected 46,000+ and 76,000+ patient records since June 2009, respectively. This data comes from health facilities submitted through the m-HealthSurvey. Dr. M. Ganesan (Senior Project Officer, RTBI – Rural Technology and Business Incubator) discussed the progress of the data submission patterns and the associated shortcomings in the newly introduced process. While in India the challenge lies in getting the health workers to send data in real-time in Sri Lanka it is finding an incentive for the health workers submit reliable data. Analyst programmers: Vincy Pushpa Mary and Sheebha Ryer at RTBI are placed with the challenge of enhancing the mobile phone application: m-HealthSurvey to overcome the user induced challenges.

Prof. Artur Dubrawski (Director, Auton Lab) was able to show the workshop participants in both countries, live, real data subject to detection analysis through the T-Cube Web Interface. Although the data is quite noisy and somewhat unreliable signals of Acute Diarrheal Disease in India and Common Cold in Sri Lanka were detected, which were confirmed by Medical Officers attending the workshops. Karen Chen (Research Analyst, Auton Lab) mined the Sri Lanka Epidemiology Unit published Weekly Epidemiological Report data and exemplified propagation patterns of Dengue over a 6 month period; where the disease first started in Kandy District, then moved east to Ampara District, eventually moving south of the country at which time the disease in Kandy District seems to have been contained. Another set of analysis showed Dengue to emerge each year in the months of May (i.e. seasonal trend); however, an exceptional case of Dengue emerging in August;  illustrated in presentation slides (Dubrawski, 2009).

Project came to learn of two main use cases for detection analysis that both health departments (DDHS Sivagangai and RE Kurunegala) require: 1) investigate the temporal scan and spatial scan of a suspected disease outbreak 2) regularly monitor the Group A, Group B, Sentential disease in Sri Lanka (i.e. what’s reported through H-544) and S-form and P-form diseases, part of the Integrated Disease Surveillance Program (IDSP), in India. While, the full fledged T-Cube with all functions remain available, the team at Auton Lab will reduce the present TCWI to a minimal set of functions to fit the requirements (i.e. two use cases) suggested by the health departments in Tamil Nadu and Sri Lanka; instead of going through the tedious process of setting of parameters to run the statistical methods and estimations. The process will be automated to a single push of a button.

Users of T-Cube agreed to participating in the frequent periodic on-line assessment on utilization, usability, effectiveness. Moreover, the project is interested in assessing the Receiver Operation Characteristics (ROC), Activity Monitoring Operating Characteristics (AMOC), and RECALL (commonly known as sensitivity). For this, the project will, periodically, submit a set of high probability events (disease outbreaks) detected through T-Cube to the health departments. They will tell us whether those alerts were true or false, as well as tell us those events that were not detected by T-Cube.

The Sahana Messaging/Alerting Module with CAP messaging was presented. In an alert message, the Medical Officers in Tamil Nadu want to know the disease name, effective date, when, where, and what to do. This would transforms to receiving the Common Alerting Protocol (CAP) elements: info.event, info.description (disease names), info.effective, info.onset, area.area description, via SMS. However, the full CAP message will be posted on the web and the xml file emailed as an attachment with the short CAP message in the body. The users are interested in both upstream and downstream alerting.

Data collection involves

• Setting up of the Biosurveillance Module (BSM) initial information (i.e. implement database) through the web application and direct Database Administration (DBA) functions
• Installing, configuring, and maintaining the m-HealthSurvey mobile application
• Health worker expected practices in submitting data
• Documenting and reporting problems associated with the BSM and m-HealthSurvey

Data processing involves

• Installing, configuring, and maintaining the T-Cube Web Interface (TCWI) analytical tool
• Installing, , configuring, and maintaining the detection algorithms
• Health Officials (epidemiologist) expected practices in analyzing the health data
• Defining priority levels for particular diseases
• Documenting events of interest
• Documenting and reporting problems associated with TCWI and detection algorithms

Data reporting involves

• Installing, configuring, and maintaining the Sahana Alerting and Messaging Module (MAM)
• Initializing the MAM contact lists, jurisdictions, geographical areas, message templates
• Verification and Authorization procedures for issuing health alerts

Infosys Prize for five researchers, B.S. Satish Kumar, The Hindu –> FULL ARTICLE

“BANGALORE: The Infosys Science Foundation, a non-profit trust set up by Infosys Technologies, on Monday announced the Infosys Prize 2009 for five eminent researchers in four categories for their outstanding contributions to scientific research.

The winners are: Thanu Padmanabhan of the Inter-University Centre for Astronomy and Astrophysics, Pune (Physical Sciences); Ashoke Sen of the Harish Chandra Research Institute, Allahabad (Mathematical Sciences); K. VijayRaghavan of the National Centre of Biological Sciences, Bangalore (Life Sciences); and Abhijit Vinayak Banerjee of the Massachusetts Institute of Technology & Upinder Singh of the University of Delhi (the award is shared in the Social Sciences and Economics category).”

]]> http://lirneasia.net/2009/12/vijay-infosys-prize-2009/feed/ 0 http://lirneasia.net/2009/11/rtb-e-asia2009/ http://lirneasia.net/2009/11/rtb-e-asia2009/#comments Wed, 25 Nov 2009 17:24:14 +0000 Nuwan Waidyanatha http://lirneasia.net/?p=5964 The health departments and health workers involved in the Real-Time Biosruveillance Program (RTBP) pilot see the benefits in the m­-HealthSurvey for real­-time data collection, T­Cube Web Interface for near­-real­-time outbreak detection, and Sahana Alerting Module for real­-time health risk information dissemination. Preliminary lessons to date indicate the need for more robust mobile application for data collection with complete standardized content in disease­-syndrome for reduction of noise and increase of reliability in the datasets. More rigorous capacity building and frequent use is required for health officials to take advantage of the full potential of TCWI. Further exercises need to be carried out with the Sahana Alerting Module to understand its shortcomings. Given that the system has been in preliminary use for less than six months, it is anticipated that the usability issues will subside in time to come.

These concluding remarks are from the paper titled- “Real-TIme Biosurveillance Pilot in India and Sri Lanka“, which I shall be presenting at the e-Asia 2009 Conference to be held December 02 – 04, 2009 in Colombo, Sri Lanka.

For the Slides Click Here