Mobile Health Technology for Global Health in Action

Julian Wimbush, PhD

Research Fellow

CIDER, UC Berkeley

April 15, 2010

mHealth is…

…use of mobile communication devices for health services and (multimedia) information via:

• Mobile phones

• Smartphones

• Patient monitoring devices

• Mobile telemedicine/telecare devices

• MP3 players for mLearning

• Microcomputers

Information Flow

• Moving community and clinical health data between

• Practitioners

• Researchers

• Patients

• E.g.: real-time monitoring of patient vital signs,

• E.g.: direct provision of care (via mobile telemedicine)

UN Millennium Development Goals: 2001-2015

For health:

• Reduce child mortality by 2/3

• Improve maternal health

• Reduce mortality / morbidity by 3/4

• Combat HIV and AIDS, malaria, and other diseases

• Halt and begin to reverse the spread

MDG: Strategic Objectives

• Improvement of the access to emergency and general health services

• Improvement of the efficiency of health service delivery

• Improvement of the clinical practice for enhanced health outcomes

• The reduction of child and maternal mortality and morbidity in MVPs

Reality

• A child born in the developing world is 33 times as likely to die within the first 5 years of life

• Higher maternal mortality and morbidity rates (1M and 10M per year)

• High HIV infection rates (2.5M new cases)

• Prevalence of avoidable, communicable diseases (TB, malaria) due to preventable factors

• Shortfall of medical workers (Def = 2.4M)

IBM & World Bank, 2006

The Promise of Mobile Ubiquity

Developing World Context: Ripe for Growth

• 3 billion+ mobile phone users (64% in developing world)

• Biggest growth in Asia, Middle East, Africa

• Mobile phones (plus) as a leapfrog technology

• Bypassing fixed-line subscriptions

• 90% of the world now lives within a mobile reception area

• 2012: 50% of all remote populations will have mobile phones

Ease of Adoption: Low Cost

• Cost of deployment continues to decrease

• Cheaper infrastructure technologies (CDMA)

• Cheaper phones (e.g., Java phone $50-100)

• Availability of free and open-source software (FOSS) / apps

Ease of Adoption

• Breaking the literacy barrier

• Direct voice communication

• Communication and coordination with people in remote, rural areas

• Tracking migrant populations

Emerging trends in mHealth

• Emergency response systems

• Mobile synchronous (voice) and asynchronous (SMS) telemedicine diagnostic and decision support to remote clinicians

• Clinician-focused, evidence-based formulary, database and decision support information available at the point-of-care

• Clinical care and remote patient monitoring

• Health services monitoring and reporting

• Health-related mLearning for the general public

• Training and continuing professional development for health care workers

• Health promotion and community mobilization

• Support of long-term conditions

Distribution of mHealth Programs by Location and Application Area

Mobile Health

• Information as a provider

Decentralized Health Care Delivery

• screenshot

mHealth: Care Delivery

CommCare

Information Flow: Crowdsourcing Data

FrontLine SMS

• Screen shot

Frontline SMS

• enables users to send and receive text messages with large groups of people through mobile phones

• does not require an Internet connection

• works with existing plan on all GSM phones, modems and networks

FrontLine SMS

• Reminders / Adherence

• Coordination / Communication

• Simple SMS-based forms

Situational Awareness

• Communication (plus Geospatial Awareness?)

• Surveillance vs. Disaster Response

Situational Awareness

• Perception of:

• environmental elements in time and space

• comprehension of their meaning

• projection of their status in the near future

• Vital for emergency responders & surveillance

Situational Awareness: Haiti

How it works

1. Put word out that people on the ground can send [Name, location, status/message]

2. SMS submitted, with varying levels of structure/detail3. Enters database4. Passed to a mechanical turk-type outfit of volunteers

for structuring5. Message is structured in the database6. Gets passed off to orgs (via Sahana) that can do

something about the issue

4636 in Action

4636 in Action

Messaging Category Distribution Chart

Geospatial Situational Awareness

Geospatial Situational Awareness

• Geospatial presentation of situational data related to incidents and resources

• Real-time

• Can be viewed simultaneously or in layers

GeoChat

GeoChat

• Evolved from a simple concept

• Can I send an SMS message and see it on a map?

• Automated!

• Collaboration / communication platform designed to meet the needs of humanitarian aid, international health and disaster response workers

Situational Awareness: GeoChat

GeoChat Capabilities

• Create and join in chat groups.

• Translates location names sent by users to a position on a map

• Can broadcast one or more RSS feeds.

• Twitter-enabled.

• SMS gateway supported by 96% of the world’s mobile carriers.

Implementation Settings

• Mekong Basin Disease Surveillance network

• Laos, Thailand, Cambodia

• Thai Hospital Surveillance System

• Tied to national EHR system rollout in 600 public hospitals

Geospatial Situational Awareness (USHAHIDI)

Data Analytics: RIFF-Evolve

Combining Data: Data “Meshing” with Mesh4x

• Microsoft Access Database + Java XForms application + online Google spreadsheet.

• = Combined, then centralized

• Allows disparate orgs to share data while retaining local applications

Mesh4x

The Future?

• Bigger crowd + more media = better filters?

• Refined Data Acquisition and Analysis

• Predictive Analytics

• Automated Triaging

Thank you!

Questions?