m-Health


The end game in m health: medical monitors implanted in the body, wirelessly connected to doctors and nurses who can take remedial action. Not really something researched in Nuwan Waidyanatha’s m health projects, but still worth keeping an eye on: “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.
Bill Gates makes eminent sense, most of the time. One could not be both a college drop out and world’s richest man unless one is incredibly intelligent. In a recent report on the mHealth Summit, the Economist reports thus. 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.
LIRNEasia‘s m-health research pilot project has been  featured in the October 2010 issue of FutureGov Asia Pacific magazine. Led by Nuwan Waidyanatha, the project explores the  use of mobile phones for early detection of communicable diseases in selected cities in India and Sri Lanka. 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.
Findings from LIRNEasia‘s m-health pilot research on the use of mobiles for detection and dissemination of disease outbreaks, led by Mr. Nuwan Waidyanatha, was presented to key stakeholders at a workshop on 29 – 30 September 2010 in Islamabad, Pakistan. Participants consisted of key officials of the ministries of health and IT, public and private healthcare institutions, NGOs and academic institutions. The conference was co-funded by eHealth Association of Pakistan and International Development Research Centre, Canada. Findings have also made to the Pakistani  media.
The dissemination work done by Nuwan Waidyanatha in Colombo is yielding unexpected results. A nice write up in Fast Company. 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.
On the eve of Nuwan Waidyanatha’s big dissemination event in Colombo, it was nice to see very high profile coverage for his work in one of India’s leading newspapers, the Hindu: 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.
The “Evaluating a Real-Time Biosurveillance Program” (RTBP) research team meet in Chennai, July 6 – 7, 2010 to discuss the interim findings of the evaluation work (click to read workshop report) carried out in Tamil Nadu India. In addition to the workshop a news conference was organized to disseminate the pilot project findings. The links below are some of the news prints (click on the thumbnails to view news clippings) :: – 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.
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 literarcy rate in Tamil Nadu is above that of the national average. Health workers assisting in the Real-Time Biosurveillance Program (RTBP) in Tamil Nadu, all of whom are female, 68% have 10 years of education and the rest only 12 years of education. They have more than 10 years experience working in the field providing primary health care and reporting on relevant health statistics to the government. 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.
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 document describes the Standard Operating Procedures (SOPs) for data collection, data processing, data reporting, and database/system administration. 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
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.
A m-HealthSurvey Certification Exercise was carried out as part of the m-Health Real-Time Biosurveillance Program (RTBP) to measure the usability and adoptability of the m-HealthSurvey mobile application. The exercise was conducted with health workers in Sivagangai District, Tamil Nadu, India and in Kurunegala District, Sri Lanka. The final results of the exercise will be published in the near future. m-HealthSurvey is a mobile application developed by indian Institute of technology Madras’s Rural Technology and Business Incubator (RTBI) for collecting near real-time patient disease, syndrome, and demographic data for rapid detection of disease outbreaks. It is a J2ME midlet that allows users to select categorical data as well as type information to generate patient clinical records to be submitted via GPRS to a central database.