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InSTEDD Tools for Outbreak Epidemiology


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InSTEDD Tools for Outbreak Epidemiology

  1. 1. InSTEDD Tools for Outbreak Epidemiology Taha Kass-Hout, MD, MS and Eric Rasmussen, MD, MDM, FACP
  2. 2. 501c3 NGO
  3. 3. We create (or find) free and open-source software for collaboration toward collective action. We then teach other people how to create it for themselves Slide
  4. 4. Slide Questions in outbreak epidemiology What information isn’t getting to those who need it? Which groups should be making more decisions together ? What field reports and broadcast alerts should come faster ? Which systems need to share information? Collaboration… How much can we learn from what we already have ?
  5. 5. Slide Refugee trauma management Cholera outbreak Katrina response In our view, collaboration in outbreak epidemiology is THE critical task.
  6. 6. Slide <ul><li>Problem </li></ul><ul><ul><li>Agencies can’t (or won’t) communicate effectively in crisis </li></ul></ul><ul><li>Requirements for the technical problem </li></ul><ul><ul><li>Software that is effective, free, standards-based, easy to use, sustainable, and thoroughly interoperable </li></ul></ul><ul><li>Specifications </li></ul><ul><ul><li>Must have voices from WHO, US-CDC, UNICEF, MoH, OCHA, UNOSAT, ISDR, Relief Web, and many more involved in the design </li></ul></ul><ul><li>Development </li></ul><ul><ul><li>We’ve built four free and open-source tools as prototypes for improved collaboration in crisis. They address the gaps we identified. </li></ul></ul><ul><li>Implementation </li></ul><ul><ul><li>Field evaluation in progress with all four, plus a website now up </li></ul></ul><ul><ul><li>Educational model for introducing disruptive technologies </li></ul></ul>Collaboration pathway
  7. 7. What we need to see… <ul><li>A young village health worker on her rounds finds a bleeding mother and two children. The man is missing. </li></ul><ul><li>She sends an SMS with the location, an explanation, and the tag “bleeding”, then isolates the home </li></ul><ul><li>The SMS is received and triggers a cascade of events, including the dispatching of a Rapid Response Team and notification of both the Health Minister and the health worker’s nearest hospital. </li></ul><ul><li>The health worker receives an SMS telling her the message was received, and providing urgent management advice for suspected hemorrhagic viruses </li></ul><ul><li>The SMS from the health worker appears in a stream of messages that include recent monkey smuggling, and food insecurity leading to harvesting bushmeat. It is spotted by the surveillance software bots, combined with other information, and hypotheses are proposed. </li></ul><ul><li>A team of MDs, nurses, vets, logisticians, and others work together to plan and implement a response, entering information only once. </li></ul>Slide
  8. 8. The InSTEDD Collaboration Suite <ul><li>GeoChat </li></ul><ul><li>Mesh4x </li></ul><ul><li>Riff </li></ul><ul><li>( RNA ) </li></ul><ul><li> </li></ul><ul><li>Innovation Lab </li></ul>All free and open-source (and working names…)
  9. 9. When that village health worker finds a bleeding family… <ul><li>(GeoChat) She has to notify someone </li></ul><ul><ul><li>And others need to learn of the problem </li></ul></ul><ul><ul><li>The health worker needs to know she’s been heard </li></ul></ul><ul><li>(Mesh4x) Spreadsheets, maps, and databases need the information </li></ul><ul><ul><li>Synchronized as changes are made to ensure a common picture </li></ul></ul><ul><li>(Riff) A team needs to evaluate the significance, and they need context to sort it out </li></ul><ul><ul><li>They need to see each other and what else is known </li></ul></ul><ul><li>(RNA) Decision-makers need tools for event detection, hypothesis testing and planning </li></ul><ul><ul><li>Human and machine based decision support </li></ul></ul>
  10. 10. GeoChat <ul><li>Mobile-based reporting with (some) language support </li></ul><ul><li>Web-based mapping, mining, and chat </li></ul><ul><li>Vertical and horizontal alerts </li></ul><ul><ul><li>Multiple levels, multiple groups </li></ul></ul><ul><li>Geo-tagging and topic tagging </li></ul><ul><li>Any cell phone that can use SMS </li></ul><ul><li>96% of the world’s ISPs now supported </li></ul>Slide Joining a GeoChat group in Cambodia
  11. 11. GeoChat
  12. 12. GeoChat messages
  13. 13. Mesh4x: Imagine an outbreak response in the field… <ul><li>Lots of information collected, working with many partners </li></ul><ul><li>Political and collegial will to share, but </li></ul><ul><ul><li>Different software applications between agencies </li></ul></ul><ul><ul><li>Little or no internet connectivity (many modes, very flexible) </li></ul></ul><ul><li>Mesh4x lets you: </li></ul><ul><ul><li>Choose the information to share </li></ul></ul><ul><ul><li>Identify the various applications holding it </li></ul></ul><ul><ul><li>Identify the various computers holding it </li></ul></ul><ul><ul><li>Synchronize it all, over multiple modes (even just SMS!) </li></ul></ul><ul><ul><ul><li>Excel, Google Earth, Access, ESRI ArcX, MySQL, etc. </li></ul></ul></ul>Over to Taha…
  14. 14. Hybrid Disease Surveillance Surveillance Systems Capture Filter Verify Identified risks Mandatory notification Laboratory surveillance Emerging risks Syndromic surveillance Mortality monitoring Healthcare activity monitoring Prescription monitoring Non healthcare based Veterinary surveillance Behavioral surveillance Environmental surveillance Poison centers Food safety/water supply … Domestic, NGOs Field Reports Open Media Surveillance <ul><li>Int’l Distribution lists </li></ul><ul><ul><li>ProMed (Regular, MBDS, Spanish, Russian, etc.) </li></ul></ul><ul><li>International agencies </li></ul><ul><ul><li>WHO, OIE, CDC </li></ul></ul><ul><ul><li>NASA (e.g., remote sensing, weather, population migration, bird migration, population density, plant, animal) </li></ul></ul><ul><li>Confidential/Limited </li></ul><ul><ul><li>ProMed (e.g., MBDS) </li></ul></ul><ul><ul><li>International health regulation agencies (WHO, OIE, CDC, NASA) </li></ul></ul><ul><ul><li>Threat bulletin (EWARN, ECDC) </li></ul></ul><ul><li>Public dissemination </li></ul><ul><ul><li>News, blogs, articles, </li></ul></ul><ul><ul><li>Health ministry press releases websites </li></ul></ul><ul><ul><li>Weekly releases </li></ul></ul><ul><ul><li>(Eurosurveillance) </li></ul></ul>Event Monitoring Indicator Based Event Based Collect Analyze Interpret Assess Disseminate Investigate Signal Control Alert
  15. 15. Hybrid Disease Surveillance Surveillance Systems Capture Filter Verify Event Monitoring Indicator Based Event Based Collect Analyze Interpret Feedback Feedback Detection Response Signal Control Alert
  16. 16. <ul><li>Riff is a next-generation information browser </li></ul><ul><ul><li>GeoChat messages show up there, with HealthMap (ProMED), Google News, email… </li></ul></ul><ul><li>When a concerning message appears, teams can join in </li></ul><ul><ul><li>Regional health officers, CDC, parasitologists, vets, HAZMAT teams </li></ul></ul><ul><li>Tools are included in Riff for letting teams enhance information </li></ul><ul><ul><li>Commentary, annotation, analysis, tagging, geocoding, reliability… </li></ul></ul><ul><ul><li>Cognitive analytics built in for collaborative decision support. (RNA) </li></ul></ul>Riff is a collaboration browser Riff
  17. 17. Slide Information streams… … with collaborative spaces … and cognitive analytics Seven syndromes and 10 transmission modes > 100 infectious diseases > 180 micro-organisms > 140 symptoms > 50 chemicals
  18. 18. Slide Timeliness, Representativeness, Completeness, Predictive Value, Quality, … <ul><li>Machine learning methods: </li></ul><ul><ul><li>Support Vector Machines </li></ul></ul><ul><ul><li>Clustering </li></ul></ul><ul><ul><li>Entity extraction </li></ul></ul><ul><ul><li>Neo-Bayesian analysis </li></ul></ul><ul><ul><li>Satisficing </li></ul></ul><ul><ul><li>Hypothesis testing (HMM) </li></ul></ul><ul><ul><li>Relationship suggestions </li></ul></ul>
  19. 19. Slide In Southeast Asia <ul><li>Invited by Mekong Basin Disease Surveillance Network (MBDS) to support technology for surveillance and response </li></ul><ul><li>Started in Cambodia with CDC because Cambodia is the technology lead. </li></ul><ul><li>Supporting the entire region. </li></ul>
  20. 20. Innovation Lab ( Physical space in Cambodia ) 400 hour workplan 125 hour curriculum Curriculum for ownership of InSTEDD tools and beyond Neutral space for academia, Ministry, local NGOs, more Dissolving silos – teaching as cross-functional teams Capacity enhancement for IHRs and MDGs Back to Eric…
  21. 21.
  22. 23. Open Mobile Consortium <ul><li>South Africa </li></ul><ul><li>UNICEF </li></ul><ul><li>Robert Kirkpatrick is Chair </li></ul><ul><ul><li>InSTEDD CTO </li></ul></ul><ul><li>~35 organizations </li></ul><ul><li>Standards and agreements </li></ul>Slide
  23. 24. Further Information Slide [email_address] [email_address] +1-650-353-4440