m-Health Real-Time Biosurveillance Program (RTBP) interviewed Medical Officers in Kurunegal District in Sri Lanka and Sivagangai District in Tamil Nadu, India, during the months of September and October, 2009. These interactions revealed that outpatient health record entry in real-time by Medical Officers, using the mobile phone key pad is inefficient and the idea was rejected by them. The aim of the RTBP is to collect digitized patient disease, syndrome, and demographic information from the point of care to rapidly detect disease outbreaks. Village Health Nurses in Tamil Nadu examine at most 70 patients a week. Ninety percent of the Village Health Nurses opt to jot down the records on paper and later enter them leisurely after the day’s work is complete.
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.
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)
Village Health Nurses (VHN) are the last-mile health workers attending to the primary health care needs of the rural villagers in the state of Tamil Nadu; where the real-time biosruveillance program (RTBP) is being pilot tested in India. They work under harsh conditions. For instance transportation schedule is limited to a bus that leaves in the morning and returns in the afternoon. Baking and sweating in the hot sun in Sivaganga District of Tamil Nadu, they walk for several kilometers, carrying a heavy load of Registers, making house calls to give the much needed health care to the rural poor. During a recent workshop, in Tamil Nadu, a discussion around the accountability of submitting data revealed that the VHN sometimes cheat on the statistics they tediously record on large volumes of paper forms.
After showcasing our work at ICTD2009 (see poster), where our work: real-time biosurveillance program (RTBP) was highlighted along with Bill Gates in a Qatar media article, Prof. Artur Dubrawski (Director Auton Lab) and I returned to Sri Lanka to engage in work related to our pilot project: RTBP. Prof. Dubrawski’s visit included a workshop on T-Cube web interface in support ot the RTBP for the RTBP researchers at Sarvodaya head quarters in Moratuwa (see workshop program), a colloquium on Machine Learning in Support of Biomedical Security for the faculty and students at the University of Colombo School of Computing, and participating in the health worker m-HealthSurvey training program in Kuliyapitiya. The work under taken, April 21 – 25, is elaborated in the trip report.
Sixteen Sarovdaya Suwadana Center Volunteers working in the capacity of Research Assistants for the real-time biosurveillance program were trained in the use of the m-HealthSurvey mobile application. The training took place at the Sarvodaya Kuliyapitiya District Center, April 23 – 25, 2009. The three day program comprised lectures on disease surveillance and notification, use of mobile application for communicating patient data, and a field visit to understand the working environment. The Suwadana Center Volunteer training workshop report carries the full story.
“Leptospirosis is out and Dengue is in” – these are the words of the Sarvodaya Research Assistant – Pubudini weerakoon – working in Kurunegala District of Sri Lanka on the real-time biosurveillance program (RTBP). This report on Leptospirosis in Sri Lanka gives a full account of the past events. The aim of the RTBP is to gather patient case information through the m-Healthsurvey mobile application and subject that data to real time analysis for rapid detection of emerging health events. The automated analytic and detection is driven by the T-Cube software, developed by Carnegie Mellon Universities Auton Lab, based on data mining principles. We took the weekly epidemiological reports (WER) from the past two years and put T-Cube to the test.
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.
As a trial the State of Tamil Nadu, in India, is piloting the use of mobile phones with Village Health Nurses (VHN) to talk with the Deputy Director of Health Service (DDHS) and Public Health Center (PHC) staff as and when they need. Indian Institute of Technology in Madras (IITM) will add on a m-Health Survey application to add value to the mobile phones for the VHN to share patient disease and syndrome information. Besides digitizing health records, the VHN are eager to learn other communcation features such as SMS, WWW (GPRS), and Email. Team of Researchers from IITM’s Rural Technology and Buisness Incubator (RTBI) visited with the Thirupathur Block VHNs to outline the Real-Time Biosurveillance Program, a pilot project carried out in India and Sri Lanka. The meeting is documented in the “IITM VHN meeting report“.
Several of the pilot projects presented at the 2nd Pan Asian evidence-based e-Health adoptation and application (in short form – Panacea), were m-Health projects. One of the Panacea projects THIRRA and LIRNEasia lead RTBP share some aspects one being working on disease information communication in Sri Lanka; however, differs in the goals where THIRRA aims to digitize the H-544 health form at the Public Health Inspector’s point of service – at the patient’s home. On the other hand, RTBP will digitize minimal set of parameters: location (postal code), disease (ICD Code), symptom, sign, age, and gender collected from health provider facilities. Some of the other m-Health projects; especially in Philippines, involved Filipino rural community health care workers strictly using SMS with prearranged formatted strings for communicating field data to a central database. Prof.
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.
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.
This past week, our friends from the Rural Technology and Business Incubator (RTBI) of the Indian Institute of Technology showcased the Real-Time Biosurveillance Program (RTBP) at the Connect 2008 exhibition hosted in Chennai, India from September 11-13. The theme of this year’s event, which is the 8th episode, is – Global Competitiveness and Equitable Growth-Driven by Innovation”. The action research: Evaluating a real-time Biosurveillance program, being pilot tested in the state of Tamil Nadu, India and the District of Kurunegala, Sri Lanka over the next 2 years to come is an innovation emphasizing m-Health. The two ladies: Geetha G (left) and Suma Prashanth (right) in the news articel are managing the RTBP project in India, which includes developing the technology and piloting the ICT system with Village Health Nurses in rural Tamil Nadu. At present, the technology partners RTBI, Auton Lab (USA), and Lanka Software Foundation (Sri Lanka) are jointly working on developing the end-to-end disease surveillance and notification software applications.
A series of four meetings were held between 03-Aug-08 to 05-Aug-08 at the Indian Institute of Technology – Madras campus on defining the project design and goals in relation to the real-time biosurveillance program pilot. The program brought together partners from North America (University of Alberta and Carnegie Mellon University) who joined the meeting through skype; while the Indian and Sri Lankan partners met, face-to-face, at IIT-M’s Rural Technology and Business Incubator. The meeting coined this operations research initiative to be a “unique project”. You can access the RTBP partner meeting report v1 Set of presentations Disease surveillance program in Sri Lanka Mobile phones for public health intervention Auton Lab algorithms and data structures for rapid detection Sahana health and messaging modules Mobiles for data entry Sarvodaya community health program RTBP work plan