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.
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.
The Canadian Broadcasting Corporation’s show – The National “Lifelines” – did a news program on the Real-Time Biosurveillance Program carried out in India and Sri Lanka; watch the clip here.
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.
Auton Lab is a technology partner developing the T-Cube software for the Real-Time Biosurveillance Program. Prof. Artur Dubrawski (Director of Carnegie Mellon Universities Auton Lab) presented the paper: TCube Web Interface for Real-time Biosurveillance in Sri Lanka at the Eight Annual International Society for Disease Surveillance (ISDS) 2009 in Las Vegas, USA, Dec 03-04. The presentation shows some examples of events detected by the T-Cube analysis on synthetic data set produced using the Sri Lanka Ministry of Health and Nutrition’s Epidemiology Unit published Weekly Epidemiological Report as a basis.
Prof. K. Vijayraghavan, Director of the National Center for Biological Sciences, in Bangalore is one of five recipients of this year’s Infosys Science Foundation prize, given to world-class researchers in social science in India. Along with our friends from the Indian Institute of Technology Madras’s – Rural Technology and Business Incubator, Prof. Vijayraghavan is one of the Investigators of the Real-Time Biosurveillance Program (RTBP) carried out in the state of Tamil Nadu in India and Sri Lanka.
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.
The objective of this document: Guidelines for Evaluating RTBP v0.4 is to outline the evaluation methodology for assessing the upstream communication: data collection, data processing: event detection, and downstream communication: alerting/reporting stages (verticals in Figure 1) on the aspects of social, content, application, and technology of a RealTime Biosurveillance Program (RTBP). The blue arrows across the verticals and the horizontals indicate the interoperability between elements.
The main problem, identified by India and Sri Lanka health workers, with the Rural technology and Business Incubator (RTBI) developed m-HealthSurvey mobile application, was in the look up content. The application allows for the user to search for a disease name by typing a few characters of the name. Upon selection predefined symptoms and signs are auto-displayed, giving the user the option to edit those values, if needed. The Health Workers using the application to send patient case information, expressed the need for full list of all possible symptoms and signs, associated with each disease; then all they have to do is delete and not enter. Entering is cumbersome for those user; especially in Sri Lanka, who are not familiar with the spelling of symptom and signs.
Press Release 2009 from Brown Lloyd James. ICTD2009 highlights new developments in technology for developing countries “Dr. Artur Dubrawski, Director of the AutonLab at Carnegie Mellon University and Mr. Nuwan Waidyanatha, Senior Researcher and Project Director of LIRNEasia in Sri Lanka, are presenting their collaborative project using mobile telephony. The project uses the T-Cube Web Interface, a tool developed by Carnegie Mellon University to visualize and manipulate large scale multivariate time series datasets, to support real-time bio-surveillance.
The intention of this blog is to share the user requirements captured during the business analysis phase of the real time biosurveillance program. The state of Tamil Nadu and Sri Lankan business cases are documented in the report. Any changes can be discussed in this blog itself.
The village Health Nurse (VHN) is a rural last mile primary health care worker – duties ranging from holding medical camps in schools to running a Health Service Center (HSC) in the village providing primary health care to walking door-to-door providing antenatal and post natal care. These mobile services require proper documentation; the paper work is later converted to statistics that is reviewed by the district and state Health Officials. An idea Sir Gee is to replace the 2 heavy bags with a 100gram mobile phone with built in applets to capture the same data. The Real Time Biosurveillance Program, an m-Health pilot carried out by Indian Institute of Technology Madras’s Rural Technology and Business Incubator in the Thirupathur block, to begin with, will be field testing the mobile concept of capturing the necessary and sufficient morbidity data for aggregate reports and disease surveillance. Lessons from this pilot will provide enough insight to develop the remaining applets to replace the heavy bags.
The Sarvodaya Suwadana Center Volunteers (Community Healthcare Workers) assembled at the Medical Officer of Health office in Kuliyapitya (Kurunegala District, Sri Lanka). This was a workshop organized by Sarvodaya and LIRNEasia as part of the Real-Time Biosurveillance Program (RTBP), launched in July this year – evidence based healthcare research aiming to evaluate the use of mobile phones for collecting health data and applying statistical data mining software programs for detecting emerging diseases outbreaks. This initiative is to complement the existing national disease surveillance and notification system.