MHealth


The “mobiles in support of Sentinel Site Surveillance (mS-cube)” project, following the success of the Real-Time Biosurveillance Program (RTBP), investigated the scalability and institutionalization issues. The mS-cube project was carried out in the Wayamba Province of Sri Lanka. The Infectious Disease Control (IDC) nurses, in the province, were given training on the “mHealthSurvey” mobile application and provided with mobile phones for submitting digitized all outpatient and inpatient health records. The findings are that the relatively older IDC nurses find it difficult to enter data with the mobile keypad and do not have an incentive to submit all patient records (i.e.
“Often, most cases are suspected cases, with fewer confirmed cases. Patients with symptoms are asked to go for further tests, and this takes time. By the time a good number of confirmed cases are collected, the disease has spread rapidly. From a public health perspective, this is just not good enough. We need to catch it at the out-patient care level, restrict spread to clusters and deliver a cure before it grows into a wider geographical spread.
Fidelity of digitized data in the Real-Time Biosurveillance Program (RTBP) was not promising; especially with the personnel in Sri Lanka with no medical knowledge but technically capable were producing up to 45% noisy data (second stacked graph). On the contrary the medically trained but less fluent in mobile phone usage Indian nurses were less prone to producing noisy data. The Indian health workers had an incentive because the erroneous data would produce false alarms, and they would need to respond to these false alarms or it would portray a bad image of the health situation in their area; while the Sri Lanka data digitizing personnel had no incentive besides picking up a paycheck for the data entry work they did. The data was submitted through the mHealthSurvey mobile software that works on less expensive Java-enabled hand-helds. The RTBP envisions that hospital data is submitted each day; thus, the real-time expectations.
Findings from the Real-Time Biosurveillance Program was presented in the poster session at the mHealth Summit 2010 (Fig 1). Our partners from Auton Lab were creative in affixing an iPad to the poster to show a video of the working solution. Thanks to the marketing abilities of our friends from Auton Lab, our work caught the special attention of delegates from the Bill & Melinda Gates Foundation, Rockefeller Foundation, UN Foundation and several other global development agencies. The Gates Foundation’s video crew made an exclusive appearance to capture our poster content and interviewed Prof. Arutur Dubrawski, which made all others presenting their work a bit jealous.
Not just eHealth but in any national innovation, finding a champion to own, operate, and promote the new intervention is crucial. We found ours in Sri Lanka to take the Real-Time Biosurveillance Program (RTBP) to the next level; our champion is Dr. R.M.S.
The Real-Time Biosurveillance Program (RTBP) held a news conference in Colombo, Sri Lanka on September 14, 2010 at the Cinnamon Lake Side Hotel. This is list of the articles published in the News papers:
The Director of Carnegie Mellon University’s Auton Lab – Prof Artur Dubrawski – delivered a keynote speech at the Health Informatics Society of Sri Lanka organized eHealth Sri Lanka 2010 conference, 15-16 September, 2010. His talk titled – Detection of Informative Disjunctive Patterns in Support of Clinical Informatics (click to view slides) – has synergies with the Real-Time Biosurveillance Program (RTBP) we are piloting in India and Sri Lanka. RTBP specifically integrates a data mining and probability testing tool called the T-Cube Web Interface. In addition to the keynote, Chamindu Sampath, LIRNEasia Research Assistant, presented a paper titled the “T-Cube web tool for rapid detection of disease outbreaks in India and Sri Lanka” (click to view the slides) and a poster. Several interesting issues regarding data quality needed for event monitoring was discussed by the audience during the session: public health informatics.
A public lecture entitled, “From euphoria to pragmatism: The experience and the potentials of eHealth in Asia” is to be held at the Sri Lanka Medical Association, Colombo 7, on 14 September 2010 from 1500Hrs to 1730Hrs. The new paradigm, called eHealth, is being adapted widely, from primary to tertiary health care in many countries. However, looking at the current literature on the subject, the reviews have been mixed. For every successful and sustainable initiative that has been adopted several have fallen on the wayside. This lecture will look into the experiences of eHealth in Asia.
I was in Lyon, France presenting our mHealth paper – Real-Time Biosurveillance pilot in India and Sri Lanka – at the IEEE-HealthCom conference, which took place 01-03, July 2010 (click to view the slides). I spent an extra day in France to travel down to Grenoble, accompanied by my friend and research partner – Artur Dubrawski – an ex-scholar from Grenoble,  in search of a Joseph Fourier’s statue for a photo opportunity. Why? Jean Baptist Joseph Fourier (21 Mar 1768 to 16 May 1830) was a French mathematician and physicist best known for the “Fourier series” – a way of writing a function as a sum of frequency components; i.e.
Recently I presented a paper titled – Robustness of the mHealthSurvey Midlet for a Real-Time Biosurveillance program at the 2010 International Symposium on Medical Informatics and Communications Technology – in Taipei, Taiwan. The main focus was on mobile computing; especially surrounding Body Area Networks (BAN) that is in the working mills of the IEEE 802 standardization process under the auspices of Task Group 6. The present day challenges that countries like Taiwan and Japan face, also propagating in to other Asian countries, are increase in chronic illnesses, aging population, and need for convenience. Within this frame, researchers are realizing the growing need for remote sensing and maintenance of health; such remote maintenance ICT based services would reduce patient admissions (or inward patients), which countries like India, Sri Lanka, Taiwan, etc, fully subsidize and can be drastically reduced. The mHealthSurvey has proven the capability to transport digitized data compressed to ~ 2KB over GPRS-10 and higher networks in rural India and Sri Lanka.