ICT Developments in Mobile Technology for Global Public Health: InSTEDD Collaboration Tools

Taha Kass-Hout, MD, MS Director, Global Public Health and Informatics ICT Developments in Mobile Technology for Global Public Health: InSTEDD Collaboration Tools Innovative Support to Emergencies, Diseases, and Disasters Photo credit: IRMA (Integrated Risk Management for Africa) Mekong Basin Disease Surveillance (MBDS) Information Communication and Technology Forum April 2 nd –3 rd , 2009 Mukdahan Province, Thailand Channe Suy, MCA Product Manager

Late Detection and Response DAY CASES Opportunity for control

Early Detection and Response DAY CASES Opportunity for control

Public Health Measures
Representativeness
Completeness
Predictive Value
Timeliness
Background

Public Health Measures 1000 Malaria infections (100%) 50 Malaria notifications (5%) Specificity / Reliability Sensitivity / Timeliness
Main attributes
Representativeness
Completeness
Predictive value positive
Get as close to the bottom of the pyramid as possible Urge frequent reporting: Weekly  daily  immediately

Public Health Measures Time
Main attributes
Timeliness
Health care hotline Signal as early as possible

One of four major initiatives of the UN Millennium Action Plan (2000)
mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World (2009)
Making Mobile Technologies Work for Health

Growth of Mobile Technologies Dzenowagi, WHO, 2005

Internet penetration levels among the population as a whole
India 5.2%
Malaysia 59.0%
Thailand 20.5%
Myanmar 0.1%
This compares to about 73.6% for North America
As we'd expect other countries in Asia are also shown to be high such as Japan, S. Korea, Taiwan and Hong Kong
Internet Penetration in Asia Pacific Countries Nigel Collier, BioCaster: http://biocaster.nii.ac.jp http://www.internetworldstats.com/stats3.htm#asia

UNCTAD Handbook of Statistics 2004 Urban – Rural Population, SE Asia (2002) Dzenowagi, WHO, 2005

Infrastructure
affordable, reliable, high-speed connectivity
Technology and tools
designed, developed and deployed
cheap and rugged access devices
people who can install and support them
Education
skills to find, use and manage information
Making Mobile Technologies Work for Health Dzenowagi, WHO, 2005

Policies and standards
for information representation and exchange
affordable rates, tariffs and services
Evaluation
evidence & experience to guide development
Coordination
vertical systems impede real progress
interaction: what is used in one place should work in another
Making Mobile Technologies Work for Health Dzenowagi, WHO, 2005

Costs of data transmitted over mobile phone are greater than voice costs
Language and illiteracy barriers
Patient privacy and security
Other challenges include
the physical components of a telephone (headset or network) are not isolated but are part of an entire business model that includes pricing plans and other incentives which can provide leverage employed by public health agencies and policymakers
Current Challenges Kaplan, Globalization and Health 2006, 2:9 doi:10.1186/1744-8603-2-9 , 2006

The InSTEDD TECHNOLOGY Platform
InSTEDD GeoChat: Take Decisive Action in Response
GeoChat lets you engage and coordinate with everyone who needs to be involved, linking headquarters, field, and the local community
InSTEDD Mesh4X: Share Data Across All Boundaries
Mesh4x lets you integrate applications, devices, and information into a shared, synchronized, distributed data mesh
InSTEDD Evolve: Synthesize Data into Actionable Information
Evolve lets you and your team monitor and collaborate around diverse data streams to detect, analyze, triage and track critical events as they unfold
Open source software for closing the global collaboration gap

How It Works – All Team Communication
A field team member sends a message… it reaches the entire team…

3 dead chickens Need supplies All is well Out of syringes Or… Field to HQ Communication

You Can Use GeoChat over Mobile Phone or Web

And these messages appear on a map… Messages : on the left panel are all of the messages coming into GeoChat from all the groups you have  , with the most recent at the top. Which group? At the bottom of each message, it tells you WHEN the message was sent and from which group it was sent. Filters : click here to show all the groups you are a member of.  the groups you want to view on the map.

Click on a message or an icon and a conversation bubble will appear.
From here you communicate to an individual or to the entire team.
You can view the messages from one person by clicking on their message on the left panel (A) or by clicking on their icon on the map (B). And from here you can communicate with the team

GeoChat
Features :
Create, join, and participate in chat groups using SMS, email, or a web client on the surface of a map
Location information in messages is automatically extracted, so that you can see who said what, when, and where
International SMS gateway, Twitter gateway, and local gateway options
Full SMS command line interface
Public, private, and anonymous group configurations
Broadcast alerts to the entire team
Relay RSS/ATOM feeds of critical data over SMS
Gateway Settings Setup RSS Feed

GeoChat Ideas for the Future
Features:
Import additional data layers
Upload your own KML layer and combine with GeoChat conversations [e.g., flooded areas, destroyed buildings]
Sync structured data onto the map via HTTP or SMS
Group management via SMS for field
Gateway with plugged-in phone support for international characters /if the phone supports them/
A US short code in summer (we cant promise dates)

GeoChat Ideas for the Future
Features:
Offline client for disconnected operations
Pluggable encryption
Sensor integration
PDA client
Social Networking
Integrated Analytics – tag clouds, machine learning, entity extraction, clustering, etc.
Radio integration? Voice? Video?

GeoChat Avian Influenza Exercise: Stung Treng Province, Cambodia, October 13-15, 2008 Geochat Training conducted by the InSTEDD Team Least and worst case pandemic scenario played by Dr. Sovann Ly, Deputy Dir., Cambodia MoH

GeoChat Avian Influenza Exercise: Stung Treng Province, Cambodia, October 13-15, 2008 SE Asia Region (Source: Wikipedia) The Komphun rural Health Center serves over 7000 population in the Stung Treng and neighboring provinces. Geochat Group n % Blue1 ( simulated cross-border—Champasak) 4 7.5 Green1 (Kampot) 4 7.5 Green2(Takeo) 2 3.8 Green3 (Kompong Speu) 2 3.8 Green4 (Ratanakiri) 0 0 Green5 (Mondulkiri) 2 3.8 Green6 (Kampong Cham) 3 5.7 Yellow1 (Rapid Response Team) 6 11.3 Yellow2 (Provincial Health and Reference Hospital) 18 34 Yellow3 (Authorities) 7 13.2 Yellow4 (Others) 5 9.4 Cell phone use during the Avian Influenza Exercise: Stung Treng Province, Cambodia, October 13-15, 2008

GeoChat Avian Influenza Exercise: Stung Treng Province, Cambodia, October 13-15, 2008 General messages exchanged among field workers, first responders, authorities, and government officials at CDC and provisional levels. GeoChat Message Khmer Translation (using English characters)
Does anyone have a car?
We need medicine
We need PPEs
Who is the head of village?
Family needs food
I need mazut (gasoline)
No gathering allowed at Pagoda
Is market open?
Is school open?
I need an ambulance
Can we help?
What can we do to help?
Do you have extra medicine?
Yes, we have extra medicine
Do you have enough medicine?
No, we don’t have any medicine
Can we get help with Quarantine
Teu nak na mean lan te?
Yeun trov ka thnam
Yeun trov ka PPE
Nor na chea prathean phom?
Cruosa trov ka aha
Knhon trov ka mazut
Men anugnat ouy mean ka choub chum nov wat
Te phsa boeuk reu nov?
Te sala boeuk reu nov?
Knom trov ka lanpet
Teu mean avey ouy yeung chhouy te?
Ter yerng ach chuoy avey ban?
Ter neak mean thnam bonthem te?
Bat yerng mean thnam
Ter neak mean thnam krob kran te?
Te yerng khmean thnam te
Ter yerng ach tor tuol chumnuoy pi Quarantine te?
Total Messages (exercise only) Exchanged during the morning of the AI Simulation Exercise, October 15, 2008, Stung Treng, Cambodia

Connect a group of remote health centers
ongoing team communication
ask questions of each other
Monitor a public health problem
in a community with feedback from the field
Create a support network
for health issues, youth, women, etc.
Other ideas?
Examples Using GeoChat

FIELD SIMULATION EXERCISE

Signup to GeoChat Send SMS: Name*mcbt To 08 7723 1939

Signup to GeoChat: Join a Group GeoChat: 0877231939 Syntax: NAME*GROUP GeoChat group SMS to join a group MSGL Shang Gra La Field Surveillance Team Yang-Lee*MSGL Chan*MSGL MAFT Atlantis Field Surveillance Team Natsu*MAFT Zheng*MAFT MCBT Cross-Border Collaboration Team Yin*MCBT Kang*MCBT

Chan Yang-Lee Natsu Zheng Dr. Yin Dr. Kang Cross-Border Collaboration Shang Gra La Field Team Atlantis Field Team

SHANG GRA LA FIELD TEAM
The Shang Gra La field surveillance team uncovers an AI outbreak in various villages along the Dancing River in Shang Gra La

Yang-Lee Message 4 dead chicken in Curry village Belongs to Shang Gra La Field Surveillance Team (MSGL) Sends Message to Shang Gra La Field Surveillance Team (MSGL)

Chan (SGL lead) Message 3 dead chicken in Jasmine and Rose villages Belongs to Shang Gra La Field Surveillance Team (MSGL) Cross-Border Collaboration Team (MCBT) Sends Message to Shang Gra La Field Surveillance Team (MSGL)

The Shang Gra La field surveillance team lead escalates the situation to the Cross-Border Collaboration Team
ESCALATING THE SITUATION

Chan (SGL lead) Message Several dead chicken in Jasmine, Curry and Rose villages Belongs to Shang Gra La Field Surveillance Team (MSGL) Cross-Border Collaboration Team (MCBT) Sends Message to Cross-Border Collaboration Team (MCBT)

The Cross-Border Collaboration Team alerts Atlantis about the situation in Shang Gra La
CROSS-BORDER COLLABORATION

Dr. Kang Message Suspect AI in Jasmine, Curry and Rose villages Belongs to Cross-Border Collaboration Team (MCBT) Sends Message to Cross-Border Collaboration Team (MCBT)

Dr. Yin Message AFT team lead, please report any dead chicken in Atlantis Belongs to Cross-Border Collaboration Team (MCBT) Sends Message to Cross-Border Collaboration Team (MCBT)

Natsu (AFT lead) Message We will investigate immediately Belongs to Atlantis Field Surveillance Team (MAFT) Cross-Border Collaboration Team (MCBT) Sends Message to Cross-Border Collaboration Team (MCBT)

The Atlantis field surveillance team uncovers an AI outbreak in various villages along the Dancing River in Atlantis
ATLANTIS FIELD TEAM

Natsu (AFT lead) Message AFT Team, please report any dead chicken Belongs to Atlantis Field Surveillance Team (MAFT) Cross-Border Collaboration Team (MCBT) Sends Message to Atlantis Field Surveillance Team (MAFT)

Zheng Message 10 dead chicken in Durian village and 12 in Coconut village Belongs to Atlantis Field Surveillance Team (MAFT) Sends Message to Atlantis Field Surveillance Team (MAFT)

The Atlantis field surveillance team lead escalates the situation to the Cross-Border Collaboration Team
ESCALATING THE SITUATION

Natsu (AFT lead) Message Many dead chicken in Coconut and Durian villages Belongs to Atlantis Field Surveillance Team (MAFT) Cross-Border Collaboration Team (MCBT) Sends Message to Cross-Border Collaboration Team (MCBT)

The Cross-Border Collaboration Team Evaluates the overall situation in Shang Gra La and Atlantis and alerts the MBDS Executive board
CROSS-BORDER COLLABORATION

Dr. Kang Message Suspect AI outbreak in Jasmine, Curry, Rose, Coconut and Durian villages Belongs to Cross-Border Collaboration Team (MCBT) Sends Message to Cross-Border Collaboration Team (MCBT)

Dr. Yin Message I am going to alert MBDS immediately Belongs to Cross-Border Collaboration Team (MCBT) Sends Message to Cross-Border Collaboration Team (MCBT)

Acknowledgements

Through funding from

Thank You! InSTEDD 400 Hamilton Avenue, Suite 120 Palo Alto, CA 94301 USA +1.650.353.4440 +1.877.650.4440 (toll-free in the US) [email_address] Cambodia, Photo taken by Taha Kass-Hout, October 2008 “ this pic says it all- our kids are all the same- they deserve the same ”, Comment by Robert Gregg on Facebook, October 2008

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ICT Developments in Mobile Technology for Global Public Health: InSTEDD Collaboration Tools

by Taha Kass-Hout, MD, MS

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