1.
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

2.
Late Detection and Response DAY CASES Opportunity for control

3.
Early Detection and Response DAY CASES Opportunity for control

4.
Public Health Measures <ul><li>Representativeness </li></ul><ul><li>Completeness </li></ul><ul><li>Predictive Value </li></ul><ul><li>Timeliness </li></ul>Background

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

6.
Public Health Measures Time <ul><ul><li>Main attributes </li></ul></ul><ul><ul><ul><li>Timeliness </li></ul></ul></ul>Health care hotline Signal as early as possible

7.
<ul><li>One of four major initiatives of the UN Millennium Action Plan (2000) </li></ul><ul><ul><li>mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World (2009) </li></ul></ul>Making Mobile Technologies Work for Health

8.
Growth of Mobile Technologies Dzenowagi, WHO, 2005

9.
<ul><ul><li>Internet penetration levels among the population as a whole </li></ul></ul><ul><ul><ul><li>India 5.2% </li></ul></ul></ul><ul><ul><ul><li>Malaysia 59.0% </li></ul></ul></ul><ul><ul><ul><li>Thailand 20.5% </li></ul></ul></ul><ul><ul><ul><li>Myanmar 0.1% </li></ul></ul></ul><ul><ul><li>This compares to about 73.6% for North America </li></ul></ul><ul><ul><li>As we'd expect other countries in Asia are also shown to be high such as Japan, S. Korea, Taiwan and Hong Kong </li></ul></ul>Internet Penetration in Asia Pacific Countries Nigel Collier, BioCaster: http://biocaster.nii.ac.jp http://www.internetworldstats.com/stats3.htm#asia

10.
UNCTAD Handbook of Statistics 2004 Urban – Rural Population, SE Asia (2002) Dzenowagi, WHO, 2005

11.
<ul><li>Infrastructure </li></ul><ul><ul><li>affordable, reliable, high-speed connectivity </li></ul></ul><ul><li>Technology and tools </li></ul><ul><ul><li>designed, developed and deployed </li></ul></ul><ul><ul><li>cheap and rugged access devices </li></ul></ul><ul><ul><li>people who can install and support them </li></ul></ul><ul><li>Education </li></ul><ul><ul><li>skills to find, use and manage information </li></ul></ul>Making Mobile Technologies Work for Health Dzenowagi, WHO, 2005

12.
<ul><li>Policies and standards </li></ul><ul><ul><li>for information representation and exchange </li></ul></ul><ul><ul><li>affordable rates, tariffs and services </li></ul></ul><ul><li>Evaluation </li></ul><ul><ul><li>evidence & experience to guide development </li></ul></ul><ul><li>Coordination </li></ul><ul><ul><li>vertical systems impede real progress </li></ul></ul><ul><ul><li>interaction: what is used in one place should work in another </li></ul></ul>Making Mobile Technologies Work for Health Dzenowagi, WHO, 2005

13.
<ul><ul><li>Costs of data transmitted over mobile phone are greater than voice costs </li></ul></ul><ul><ul><li>Language and illiteracy barriers </li></ul></ul><ul><ul><li>Patient privacy and security </li></ul></ul><ul><ul><li>Other challenges include </li></ul></ul><ul><ul><li>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 </li></ul></ul>Current Challenges Kaplan, Globalization and Health 2006, 2:9 doi:10.1186/1744-8603-2-9 , 2006

14.
The InSTEDD TECHNOLOGY Platform <ul><li>InSTEDD GeoChat: Take Decisive Action in Response </li></ul><ul><ul><li>GeoChat lets you engage and coordinate with everyone who needs to be involved, linking headquarters, field, and the local community </li></ul></ul><ul><li>InSTEDD Mesh4X: Share Data Across All Boundaries </li></ul><ul><ul><li>Mesh4x lets you integrate applications, devices, and information into a shared, synchronized, distributed data mesh </li></ul></ul><ul><li>InSTEDD Evolve: Synthesize Data into Actionable Information </li></ul><ul><ul><li>Evolve lets you and your team monitor and collaborate around diverse data streams to detect, analyze, triage and track critical events as they unfold </li></ul></ul>Open source software for closing the global collaboration gap

15.
How It Works – All Team Communication <ul><li>A field team member sends a message… it reaches the entire team… </li></ul>

16.
3 dead chickens Need supplies All is well Out of syringes Or… Field to HQ Communication

17.
You Can Use GeoChat over Mobile Phone or Web

18.
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.

19.
<ul><li>Click on a message or an icon and a conversation bubble will appear. </li></ul><ul><li>From here you communicate to an individual or to the entire team. </li></ul>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

20.
GeoChat <ul><li>Features : </li></ul><ul><li>Create, join, and participate in chat groups using SMS, email, or a web client on the surface of a map </li></ul><ul><li>Location information in messages is automatically extracted, so that you can see who said what, when, and where </li></ul><ul><li>International SMS gateway, Twitter gateway, and local gateway options </li></ul><ul><li>Full SMS command line interface </li></ul><ul><li>Public, private, and anonymous group configurations </li></ul><ul><li>Broadcast alerts to the entire team </li></ul><ul><li>Relay RSS/ATOM feeds of critical data over SMS </li></ul>Gateway Settings Setup RSS Feed

21.
GeoChat Ideas for the Future <ul><li>Features: </li></ul><ul><li>Import additional data layers </li></ul><ul><ul><li>Upload your own KML layer and combine with GeoChat conversations [e.g., flooded areas, destroyed buildings] </li></ul></ul><ul><ul><li>Sync structured data onto the map via HTTP or SMS </li></ul></ul><ul><li>Group management via SMS for field </li></ul><ul><li>Gateway with plugged-in phone support for international characters /if the phone supports them/ </li></ul><ul><li>A US short code in summer (we cant promise dates) </li></ul>

22.
GeoChat Ideas for the Future <ul><li>Features: </li></ul><ul><li>Offline client for disconnected operations </li></ul><ul><li>Pluggable encryption </li></ul><ul><li>Sensor integration </li></ul><ul><li>PDA client </li></ul><ul><li>Social Networking </li></ul><ul><li>Integrated Analytics – tag clouds, machine learning, entity extraction, clustering, etc. </li></ul><ul><li>Radio integration? Voice? Video? </li></ul>

23.
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

24.
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

25.
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) <ul><li>Does anyone have a car? </li></ul><ul><li>We need medicine </li></ul><ul><li>We need PPEs </li></ul><ul><li>Who is the head of village? </li></ul><ul><li>Family needs food </li></ul><ul><li>I need mazut (gasoline) </li></ul><ul><li>No gathering allowed at Pagoda </li></ul><ul><li>Is market open? </li></ul><ul><li>Is school open? </li></ul><ul><li>I need an ambulance </li></ul><ul><li>Can we help? </li></ul><ul><li>What can we do to help? </li></ul><ul><li>Do you have extra medicine? </li></ul><ul><li>Yes, we have extra medicine </li></ul><ul><li>Do you have enough medicine? </li></ul><ul><li>No, we don’t have any medicine </li></ul><ul><li>Can we get help with Quarantine </li></ul><ul><li>Teu nak na mean lan te? </li></ul><ul><li>Yeun trov ka thnam </li></ul><ul><li>Yeun trov ka PPE </li></ul><ul><li>Nor na chea prathean phom? </li></ul><ul><li>Cruosa trov ka aha </li></ul><ul><li>Knhon trov ka mazut </li></ul><ul><li>Men anugnat ouy mean ka choub chum nov wat </li></ul><ul><li>Te phsa boeuk reu nov? </li></ul><ul><li>Te sala boeuk reu nov? </li></ul><ul><li>Knom trov ka lanpet </li></ul><ul><li>Teu mean avey ouy yeung chhouy te? </li></ul><ul><li>Ter yerng ach chuoy avey ban? </li></ul><ul><li>Ter neak mean thnam bonthem te? </li></ul><ul><li>Bat yerng mean thnam </li></ul><ul><li>Ter neak mean thnam krob kran te? </li></ul><ul><li>Te yerng khmean thnam te </li></ul><ul><li>Ter yerng ach tor tuol chumnuoy pi Quarantine te? </li></ul>Total Messages (exercise only) Exchanged during the morning of the AI Simulation Exercise, October 15, 2008, Stung Treng, Cambodia

26.
<ul><ul><li>Connect a group of remote health centers </li></ul></ul><ul><ul><li>ongoing team communication </li></ul></ul><ul><ul><li>ask questions of each other </li></ul></ul><ul><ul><li>Monitor a public health problem </li></ul></ul><ul><ul><li>in a community with feedback from the field </li></ul></ul><ul><ul><li>Create a support network </li></ul></ul><ul><ul><li>for health issues, youth, women, etc. </li></ul></ul><ul><ul><li>Other ideas? </li></ul></ul>Examples Using GeoChat

27.
FIELD SIMULATION EXERCISE

28.
Signup to GeoChat Send SMS: Name*mcbt To 08 7723 1939

29.
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

30.
Chan Yang-Lee Natsu Zheng Dr. Yin Dr. Kang Cross-Border Collaboration Shang Gra La Field Team Atlantis Field Team

31.
SHANG GRA LA FIELD TEAM <ul><li>The Shang Gra La field surveillance team uncovers an AI outbreak in various villages along the Dancing River in Shang Gra La </li></ul>

32.
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)

33.
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)

34.
<ul><li>The Shang Gra La field surveillance team lead escalates the situation to the Cross-Border Collaboration Team </li></ul>ESCALATING THE SITUATION

35.
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)

36.
<ul><li>The Cross-Border Collaboration Team alerts Atlantis about the situation in Shang Gra La </li></ul>CROSS-BORDER COLLABORATION

37.
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)

38.
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)

39.
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)

40.
<ul><li>The Atlantis field surveillance team uncovers an AI outbreak in various villages along the Dancing River in Atlantis </li></ul>ATLANTIS FIELD TEAM

41.
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)

42.
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)

43.
<ul><li>The Atlantis field surveillance team lead escalates the situation to the Cross-Border Collaboration Team </li></ul>ESCALATING THE SITUATION

44.
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)

45.
<ul><li>The Cross-Border Collaboration Team Evaluates the overall situation in Shang Gra La and Atlantis and alerts the MBDS Executive board </li></ul>CROSS-BORDER COLLABORATION

46.
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)

47.
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)

48.
Acknowledgements

49.
Through funding from

50.
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