INTEGRATED GLOBAL EARLY WARNING AND RESPONSE Innovative Support to Emergencies, Diseases, and Disasters Photo credit: IRMA (Integrated Risk Management for Africa) AMIA Fall, 2009 Experiences and Challenges in Global Health Informatics Panel Nov 15 th , 2009, San Francisco, CA, USA Taha Kass-Hout, MD, MS

The Team Eduardo (Ed) Jezierski Nicolas di Tada Dennis Israelski, MD Eric D. Rasmussen, MD, MDM, FACP

Eduardo (Ed) Jezierski

Nicolas di Tada

Dennis Israelski, MD

Eric D. Rasmussen, MD, MDM, FACP

Overview Infectious disease events represent substantial morbidity , mortality , and socio-economic impact

Infectious disease events represent substantial morbidity , mortality , and socio-economic impact

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 Tech Work for Health Photo Source: UN Foundation Photo Source: Nellie Bristol, Are Cell Phones Leading the mHealth Revolution, the Global Health Magazine, 2009.

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)

Growth of Mobile Technologies Adapted from 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 Some countries in Asia are also shown to be high such as Japan, S. Korea, Taiwan and Hong Kong Internet Penetration in Asia Pacific Nigel Collier, BioCaster: http://biocaster.nii.ac.jp Data Source: http://www.internetworldstats.com/stats3.htm#asia

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

Some countries in Asia are also shown to be high such as Japan, S. Korea, Taiwan and Hong Kong

Urban – Rural Population, SE Asia UNCTAD Handbook of Statistics 2004 Adapted from Dzenowagi, WHO, 2005 Year: 2002

Making Mobile Tech Work for Health Avian Influenza: 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. Cell phone use during the Avian Influenza Exercise: Stung Treng Province, Cambodia, October 13-15, 2008

Our Approach Hybrid human and machine-based Collaborative and cross-disciplinary Web 2.0, Light-weight and open source

Hybrid human and machine-based

Collaborative and cross-disciplinary

Web 2.0, Light-weight and open source

Information Sources Event-based ad-hoc unstructured reports issued by formal or informal sources Indicator-based (number of cases, rates, proportion of strains…) Timeliness, Representativeness, Completeness, Predictive Value, Quality, …

Event-based ad-hoc unstructured reports issued by formal or informal sources

Indicator-based (number of cases, rates, proportion of strains…)

Architecture and Processes Best Poster Award for Improving Public Health Investigation and Response at the Seventh Annual ISDS Conference, 2008 http://kasshout.blogspot.com/2008/12/best-poster-award-for-improving-public.html

Architecture and Processes Feature extraction, reference and baseline information Tags Multiple Data Streams User-Generated and Machine Learning Metadata Comments Spatio-temporal Flags/Alerts/Bookmarks Evolve Bot Event Classification, Characterization and Detection Previous Event Training Data Previous Event Control Data Metadata extraction Machine learning Social network Professional feedback Anomaly detection Collaborative Spaces Hypotheses generation esting

Collaborative Surveillance Related items (e.g., News articles) are grouped into a thread. Threads are later associated with events (hypothesized or confirmed). Collaborative-centric semantic tags Expert-generated semantic tags Publish and Share Information Create a filter (by keyword, tag, topic, location, or time) and subscription (email, GeoRSS, SMS Text Messaging, Twitter, etc.) An event is monitored through a thread of items Data source: SE Asia Evolve Collaborative Workspace http://riff.instedd.org/space/ProMed-MBDS List view Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

Collaborative Surveillance Expert-centric auto-generated (machine-learning) semantic tags and related items Data source: SE Asia Evolve Collaborative Workspace http://riff.instedd.org/space/ProMed-MBDS Tags are semantically ranked (a statistical possibility match). Users can further train the classifier by rejecting a suggestion. Users can also train the geo-locator by rejecting or updating a location . Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

Collaborative Surveillance Map view Data source: SE Asia Collaborative Workspace http://riff.instedd.org/space/ProMed-MBDS Semantic map to monitor topic rise or decay over time Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

Collaborative Surveillance Filter feature which automatically filters content by topic of interest Filter content by radius Data source: SE Asia Collaborative Workspace http://riff.instedd.org/space/ProMed-MBDS Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

Automatic Classification Current classification includes: 7 syndromes 10 transmission modes > 100 infectious diseases > 180 micro-organisms > 140 symptoms > 50 chemicals

Current classification includes:

7 syndromes

10 transmission modes

> 100 infectious diseases

> 180 micro-organisms

> 140 symptoms

> 50 chemicals

Indicators and Insights Approximations of Epidemiological Features Response Local Public Community Reaction (Public and Responders) Infrastructure Infectious Disease Disaster

Approximations of Epidemiological Features

Response

Local Public Community Reaction (Public and Responders)

Infrastructure

Infectious Disease Disaster

Snapshot: SE Asia, 2008-2009 From September 1, 2008 to February 27, 2009 998 near real-time reports on 46 infectious diseases that effect humans or animals Myanmar, Thailand, Laos, Cambodia, and Vietnam 220 provinces, 239 districts, and 14 cities Data source: SE Asia Evolve Collaborative Workspace http://riff.instedd.org/space/ProMed-MBDS

From September 1, 2008 to February 27, 2009

998 near real-time reports on

46 infectious diseases that effect humans or animals

Myanmar, Thailand, Laos, Cambodia, and Vietnam

220 provinces, 239 districts, and 14 cities

Snapshot: SE Asia, 2008-2009 From September 1, 2008 to February 27, 2009 The infectious disease event reporting in SE Asia was of: Low socioeconomic disruption (83%), High socioeconomic disruption (17%); with indicators of: potential sociological crisis (16.4%), and disaster (0.6%) Data source: SE Asia Evolve Collaborative Workspace http://riff.instedd.org/space/ProMed-MBDS

From September 1, 2008 to February 27, 2009

The infectious disease event reporting in SE Asia was of:

Low socioeconomic disruption (83%),

High socioeconomic disruption (17%); with indicators of:

potential sociological crisis (16.4%), and

disaster (0.6%)

2009 Novel Influenza A(H1N1) Data source: 2009 Novel Influenza A(H1N1) Collaborative Workspace http://riff.instedd.org/space/SwineFlu Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

2009 Novel Influenza A(H1N1) Data source: 2009 Novel Influenza A(H1N1) Collaborative Workspace http://riff.instedd.org/space/SwineFlu Mid-March 2009 thru May 19 th 2009 Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

2009 Novel Influenza A(H1N1) Data source: 2009 Novel Influenza A(H1N1) Collaborative Workspace http://riff.instedd.org/space/SwineFlu Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD Mid-March 2009 thru May 19 th 2009

2009 Novel Influenza A(H1N1) Data source: 2009 Novel Influenza A(H1N1) Collaborative Workspace http://riff.instedd.org/space/SwineFlu Mid-March 2009 thru May 19 th 2009 Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

Avian Influenza: Egypt, 2009 Tracking the recent Avian Influenza Outbreak in Egypt (reports started to appear late January 2009). Data source: Africa Collaborative Workspace http://riff.instedd.org/space/AfricaAlerts

Worldwide Health Events, 2008 Data source: Early Detection and Response Collaborative Workspace http://riff.instedd.org/space/DEMOEventDetection

Acknowledgment

Through Funding from…

Thank You! In STEDD 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