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 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
Carnegie Mellon University’s Auton Lab, Professor Artur Dubrawski (RTBP research partner), was invited to a speak at the University of Peradeniya Computer Engineering Department. Doctrine on data mining and applications were presented focusing on the work related to the Real-Time Biosurveillance Program (RTBP) to an audience of faculty and students. Faculty members from the department Statistics and Computer Science were quite keen in the topic as they are working on similar applications. University of Peradeniya Department of Computer Engineering will be offering a course in statistical data mining beginning April/May 2010.
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.
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.
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.