Dr. Brad Cohn (left) and Dr. Alex Blau (right) Photo Credit: ucsf.edu

An Apple app was released earlier this summer that translates medical history questions from English into other languages. The app, called MediBabble, was designed by doctors Alex Blau and Brad Cohn, a duo of physicians from San Francisco.

The idea for the app sprouted from a 2 a.m. conversation while the two were still in medical school. The conversation stemmed from frustrations over not being able to understand patients that did not speak English, and not having an immediate translating tool to help them out.

“Ninety percent of diagnoses come from the patient’s self-reported medical history, so the ability to communicate is critical,” Blau said. “Time is not an asset doctors or patients have. You need that information when you need it.”

MediBabble is currently being distributed for free on Apple’s iTunes, and has more than 8,000 downloads to date. The app has been lauded by several mHealth entities and has even won a few awards for its benefits to the medical world.

MediBabble was designed for Apple products with touch-screen software, such as the iPhone or iPad. The app allows health care providers to play medical history questions and instructions out loud, so far in five languages, to patients that don’t understand English. Currently, the available languages are Spanish, Mandarin, Cantonese, Russian and Haitian Creole.

The questions range from basic examination questions such as “Can you tell me your name?” to more specific inquiries like, “Do you get recurring lung infections?” The app has more than 2,500 exam questions in its arsenal to translate.

Photo Credit: itunes.apple.com

MediBabble’s interface is structured on a symptom-based approach already commonly used by medical practitioners worldwide. It starts by gathering information about the current complaint and then proceeds into social, family and medication histories; and a review of systems; all for over sixty common chief complaints across eleven organ systems.

According to Blau and Cohn, no medical translation app existed prior to theirs. Therefore, this is the first of its kind seen anywhere. A key feature is that the internet is not needed for full functionality. Once downloaded, the app can be utilized anywhere, at anytime as long as the mobile device has power.

This tool is currently paying dividends for health professionals in the developed world. However, MediBabble can easily be utilized by health processionals that encounter language barriers working on the ground in developing countries. The fifth language, Haitian Creole, was implemented for the earthquakes that struck Haiti in 2010. Therefore, it had already transcended the domestic boundaries.

After taking a look at its features, one realizes that the app is already acclimated for use in the developing world:

  • Once downloaded, it does not require an internet connection to deliver its service
  • it provides detailed examination instructions to the user
  • it has a self-guided tutorial that can teach someone like a community health worker or volunteer how to use it on the fly
  • it compensates for the deaf and/or noisy environments by having a mode that enables a full screen display in large letters

Utilizing MediBabble, health professionals from the developed world who go on aid missions around the world will worry less about language barriers. This may decrease the time it takes to examine a patient which means more patients can be examined and treated in the long run. The tool can change the way health workers interact with and treat citizens of the developing world. Therefore, aid agencies and NGO’s that deploy health professionals cannot overlook this tool.

Perhaps it won’t be long until MediBabble is used in the developing world. Blau and Cohn said the next five languages being introduced are German, French, Urdu, Hindi and Arabic. Four of those five tongues are predominantly spoken in certain developing countries.

Furthermore, Blau and Cohn intend to keep their app free. So far they have been able to do it with funding contributions from Apple, Google and Twitter. As long as the app is free, the tool will cost health professionals nothing, making it even more appealing for use in resource poor areas.

 

Photo Credit: geardiary.com

A new faction has joined in the war against malaria: graduate students. A group of students developed a malaria diagnostic tool that will be rolled out in India and Ethiopia this summer.  Called, the Lifelens project, the tool uses a micro lens on the camera of mobile phones that can ultimately test for and diagnose malaria.

Created by Harvard Business School student Cy Khormaee and UC Davis doctoral student Wilson To, the lifelens product attaches a $50 micro lens to the camera of a Windows 7 enabled smartphone.

With the camera in place, the phone can then capture high-resolution images of the cells in a drop of blood that is placed on the micro lens. Windows 7 software quickly analyzes the images, confirming the presence or absence of malaria. Once the images are analyzed, the results can be sent to public health workers and other health professionals via SMS for further assessment and data collection.

Current standard practices in malaria diagnosis involve administering a rapid diagnostic test (RDT). This method takes a blood sample, usually off of the finger of the patient, and then exposed to a cotton swab containing a solution that reacts with malaria antigens that may be in the blood. However, this method is inefficient and produces many false positives, with only a 40% accuracy rate.

Photo Credit: springwise.com

The lifelens tool acts as a powerful microscope and can easily be sterilized for further immediate usage. It is also more accurate than RDT since it detects malaria cells directly. To and Khormaee say that in the long run, the lifelens tool will be more cost effective than current RDT detection methods.

However, there are some obstacles. The lifelens tool only operates on a Windows 7 enabled smartphone. These phones cost hundreds of dollars and may be affordable in resource poor areas. Also, the lifelens tool is not the only novel technological tool in the malaria detection space. Disposable tests are already in wide use, and others are developing diagnosis technologies, including a DNA-based one that could, like Lifelens, test for malaria and other illnesses.

The lifelens project received an award in the Microsoft sponsored Imagine Cup competition that featured innovative technological tools that use Microsoft software. With this award in hand, To and Khormaee plan to roll out a testing phase for their tool in India and Ethiopia.

Virtually all deaths from malaria occur in the developing world with 90% occurring in Africa. Any advancement in malaria diagnosis is highly valued. The lifelens project is aiming to change the way infectious disease diagnosis is handled. “Malaria is just the beginning,” says To. “We’re building a platform.”

It was recently announced that an initiative called Mobiles Against Malaria will be launched in Bamako, Mali. The initiative will be executed using mothers who are community health workers in an effort to use mobile phones to prevent, diagnose and treat malaria in a more effective way than it has been.

The project is being funded by Akvo, a foundation created in 2008 that uses open source web and mobile software to attract funders to a spread of projects being done in the developing world.

CHW's at work. Photo Credit: Akvo

Mobile phones will be used by the mothers who were recruited as community health workers(CHW) to record data from neighborhoods on malaria. The CHW’s will visit each household in a particular neighborhood ready to ask pre-formulated questions.

The answers to the questions will be gathered on the mobile phones. For example, some of the questions asked may be ‘how many people live in the house’ and ‘how many people are ill’ and ‘what is the number of newborns’.

After gathering all of the necessary answers, the data will be sent via SMS to a central database located at a local hospital. It is hoped that NGO’s and local organizations will take advantage of the databases to analyze the trends and assist households in need of help. Officials hope the SMS data collection system will shed light on estimating how many insecticide-treated nets are needed in the poor areas in Bamako.

These community health workers will travel to malaria impacted areas around the capital city of Bamako to administer a revamped program. An older version was implemented using CHW’s who tested 2,796 children for malaria with a finger prick test after visiting nearly 100,000 households. That framework will be enriched by the introduction of the SMS-based frontline data collection.

The use of mothers as the CHW’s is a hallmark feature of this program. That along with using the SMS based frontline data collection sets this malaria detection program apart from other ones going on in Africa. Using mothers presents several advantages:

  • mothers are trusted in the community
  • they easily gain trust from other women from whom data is being collected
  • they can persuade women to visit hospitals using that established trust
  • they often have insider knowledge to the neighborhoods they work in
  • they ensure use of treated mosquito nets
  • they support treatment adherence

Along with attaining malaria specific data such as households using insecticide treated bednets, officials hope the program will create easier access to information on the burden. They also hope the cell phone-based application will improve patient management via a cell phone risk assessment and triaging tree, strengthen patient history documentation in the field, enable clinical communication (text, image, audio) between community health workers and clinics, and provide access to previously unrecorded health information.

The program aims to use mothers and cell phones to decrease costs of malaria detection and treatment while improving the access to treatment and treatment adherence. The program will train and utilize 50 CHW’s and 2 hospitals over the span of a year. It hopes that using mobile phones will build off of prior success.



Secretary of State Hillary Clinton and USAID Administrator Rajiv Shah. Photo Credit: USAID

The Saving Lives at Birth program held its DevelopmentXChange event last week in Washington DC. The event was hosted by Secretary of State Hillary Clinton and USAID Administrator Rajiv Shah and was sponsored by USAID, the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and The World Bank.

The program called for scholars, researchers, doctors, and entrepreneurs to develop innovative prevention and treatment approaches for pregnant women and newborns in rural, low resources setting around the time of birth. There were over 600 applications from around the world, and 77 finalists were chosen to attend this 3-day event held in Washington. At the end of the 3-day event, $14 million in grants were awarded to 25 of the 77 finalists.

The 77 ideas and projects fell into two categories: seed grant finalists and transition to scale finalists. The former were completely innovative and fresh ideas while the latter were already existing ideas that were calibrated to fit for maternal health purposes.

The projects and ideas highlighted gadgets, treatment schemes, prevention methods, health centers, strategic plans and a plethora of mobile phone related solutions. Finalists came from all over the United States and from over the world including Bangladesh, Kenya, India, Uganda, Pakistan, Switzerland and Australia.

Some of the 25 award nominees. Photo Credit: USAID

Many of the ideas that had mobile solution components used mobile phones as an ICT. One innovative project was from Kenya called mAfya which aimed to set up health specific kiosks that would offer basic medical services for free for maternal health issues. There was another project from Kenya that aimed to provide pregnant mothers vouchers to use towards health services through mBanking called Changamka.

Among the awardees, one project from Save the Children provided a mobile phone monitoring system for recording maternal and neonatal deaths. This, along with an electricity-free fetal heart rate monitoring component aims to give communities in Uganda better intra-partum response services. Another project originated from Healthpoint services in India that has already set up rural health clinics and provides water, and is looking to expand its maternal health services using an integrated telemedicine and mHealth system.

Saving Lives at Birth, the first program in a series of Grand Challenges for Development led by USAID. The Grand Challenges is an attempt to bring science, technology and innovation to the field of development, lowering the cost of helping the world’s poor and, in the process, saving lives, said USAID administrator Shah.

“Especially in these very difficult economic times … coming up with more innovative, more local and sustainable ways to make it cheaper and easier to help mothers survive child birth and help children survive the first 48 hours of life is what this program is all about,” added Shah.

Maternal and child health issues still need a lot of attention. A woman dies every two minutes in childbirth, and 99% of the deaths are in the developing world, according to the World Health Organization. Also, about 1.6 million neonatal deaths occur each year around the world. Additionally noteworthy is that only a handful of countries are set to meet Millennium Development Goal 5 of reducing maternal mortality by 2/3 by 2015.

Argusoft, a Fremont, CA start-up that’s combines video, instant messaging and Internet telephony in a platform for “e-health” programs in the developing world, is ready to implement a mobile phone application that will enable field workers to register HIV-positive mothers and provide regular updates on their care.

The application, called mAID, runs on any java-enabled phone and utilizes the SMS interface. It is designed primarily for health workers that go out into rural communities to inform citizens on different health issues.

Using the application in the field is simple. Cell phones are given to health workers who communicate through the phone to a central database. The health workers are sent daily instructions in the morning via SMS on where to go and which houses to visit. The health workers collect relevant data on HIV/AIDS prevalence and awareness and report the data back to the central database via SMS.

The new program is overseen by the Indian government with financing from the Global Fund, a nonprofit in Geneva that targets AIDS in developing countries. IL&FS, an infrastructure development conglomerate based in Mumbai, is handling logistics.

mAID underwent a pilot test where 35 health workers reached over 2500 patients using the application. The pilot phase ended last month, and based off its results, the Indian government wants to inject 3600 more health workers into the field with the mobile app for a nationwide scale up. There are even talks about using the application in Africa.

Argusoft's Ram Gopalan. Photo Credit: mercurynews.com

The CEO of Argusoft, Ram Gopalan has cited the difficulties of preventing HIV/AIDS as the impetus of his application. “It’s fully preventable, but one of the highest killers of children in the Third World,” Gopalan said.

Gopalan echoes the same sentiments of the Indian Government who have been working to prevent prenatal HIV transmission since 2002, using counseling and testing centers around the country. The Indian Government also cited issues with health worker capacity. Regarding that Gopalan said, “There was a lot of inefficiency, workers misinterpreting instructions, and paperwork getting lost.”

Argusoft is no stranger to implementing eHealth initiatives. In the eastern Indian state of Tripura, Gopalan linked isolated villages with a hospital in the state capital where doctors can remotely diagnose simple but life-altering problems such as cataracts. This telemedicine project has provided eye care for more than 100,000 patients over the past five years.

In the future, Gopalan wishes to introduce a network of accredited family-care doctors from India who could be available 24/7 for live video chats with patients. This is similar to the meradoctor project which already exists in India. In the meantime, the HIV/AIDS burden in India needs some attention as it is the third highest burden in the world in terms of sheer numbers living with HIV.

Photo Credit: chinaview.cn

A research group led by scientists in Brazil has developed software that tracks outbreaks of dengue fever using the social media outlet twitter. This software was created thanks to coordination between two Brazilian National Institutes of Science and Technology, led by Wagner Meira, a computer scientist at the Federal University of Minas Gerais.

The software is designed to detect the word “dengue” in tweets and information about the sender’s location. The software analyzes the sentence structure and wording to determine if tweets are appropriate for dengue surveillance. Tweets that are deemed spurious or unrelated to dengue fever are filtered out.

During the testing phase, the researchers examined 2,447 tweets about dengue fever sent through the social networking portal between January and May 2009. They found a strong correlation between personal experience tweets about dengue and official data on outbreaks from the Brazilian Ministry of Health.

The research team now plans to analyze 181,845 tweets sent between December 2010 and April 2011, but are waiting for the ministry’s 2011 data before they do so. They also plan to incorporate other key words, mostly symptoms of dengue fever, into their detection scheme to gather more tweets.

Photo Credit: Twitter

This is the first time social media has been used for dengue fever surveillance, but it is not the first time social media has been used for real-time epidemic surveillance. Twitter was used to follow the 2009 swine flu pandemic. Furthermore, it is the first attempt to gather information on people tweeting about their personal experience of a disease.

Google also introduced Google Dengue Trends last month, which records spikes in web searches for dengue fever. Therefore, using social media for surveillance is not a new practice, and nor is tracking dengue using technology. However, Meira’s method is an innovative and efficient way to track dengue fever.

Dengue fever, which can cause hemorrhagic deaths, plagues Brazil ever year. Moreover, every year it emerges in different locations than before. Most Brazilians know how to control and even eradicate the disease, but the majority of citizens don’t take any precautions against it.

On top of that, outbreak notifications take several weeks to process and analyze which impedes officials from assisting citizens. Using Twitter messages could mean a much faster response, says Meira. “It isn’t predicting the future but the present,” he says. “This means we aren’t weeks behind like we used to be.”

The mHealth Working Group, a collaborative forum created in 2009 by K4Health, held a meeting yesterday that focused on the “Coordination of mHealth projects within and between organizations in the field.” The meeting brought together many experts from the field of mHealth in a meeting that was ripe with rich discussion and promising potential going forward in the field.

Representatives at the meeting came from a number of organizations including USAID, K4Health, John Snow Inc. (JSI), mHealth Alliance, and the UN foundation, just to name a few. Therefore, the meeting focused on mHealth implementation in the developing world rather than here at home where mHealth is much more sophisticated.

The overarching theme for the meeting was examining how to promote coordination amongst organizations that are active in mHealth. This is an important issue because of the lack of large scale mHealth efforts programs in the developing world and the dire lack of monitoring in existing mHealth programs.

The discussion began with the current status and perception of mHealth programs in the developing world. Michael Frost, an official from JSI, stated that mHealth is “exploding with a lot of new interest” but “needs to mature a little bit.” He also echoed claims found in the latest mHealth report, that “projects have a narrow focus, and they don’t have strong evaluation principles.”

Photo Credit: USAID

John Novak from USAID discussed the importance of external collaboration and USAID’s current efforts in structuring their standards for doing so. One of his take home messages here was that all parties involved with implementing mHealth projects, including the country government, ministry of Health, telecoms, NGO’s and medical professionals on the ground need to convene and join hands before implementing a project. One suggested way to accomplish this is creating “coordination groups” at the international and country levels that serve to bring the relevant players to the table.

Discussions about the mHealth Summit that took place early last month in Cape Town also surfaced. One presenter mentioned a case study in Bangladesh that highlighted the fruitful impact of government taking control of the telecom industry to implement mHealth initiatives at no cost to citizens. The presenter expressed that governments need to take more active roles in coordinating programs; it is an effective way to get programs rolled out.

Photo Credit: Hub

The meeting produced more than lectures and discussions. Two mHealth resources were presented that are designed to make the process of collaboration and coordinating easier. Frost from JSI discussed their mHealth center whose primary roles are to create mHealth initiatives and assist existing ones by improving communication and information sharing methods within them. The mHealth alliance introduced a new knowledge resource website called Health Unbound (Hub) that aims to bring different stakeholders together to share, collect and produce information on the intersection of technology and health. Hub is planned to be unveiled to the public in about a month.

The core discussion never strayed away from the importance of coordination amongst organizations involved with mHealth initiatives. Nearly everyone seemed to agree that coordination in vital, and all parties involved in the process of creating mHealth programs must be represented in the planning process.

So the next question to ask is, how do you manage to get everyone to the table given each country has a distinct political and economic climate? How do you mediate between governments that want power, telecoms that want money and NGO’s that have ambitious goals? The answer, I learned, is multifaceted. Nonetheless I will attempt to discuss them over the next few posts with the information provided at the meeting. And even better, the answers will continue to be discussed over the next round of mHealth Working Group meetings.

The world of ICT is expanding into the health sector, and their interactions are garnering more and more attention by the day. Therefore, we must be mindful of the beginnings and demarcations of ICT usage in health. After all, we can’t know where we are going unless we know where we came from.

Current ICT for health news in the developing world is dominated by initiatives using mobile telephony; the bread and butter of mHealth. This is not a total shock since over 85% of the world now has mobile coverage. Moreover, there are over 5 billion people on Earth with a mobile phone, and 3.5 billion of them are in developing countries.  As a result, mHealth initiatives are booming in developing countries, especially in Africa and South Asia.

But what about other forms of ICTs that play a role in healthcare? What are they and how do they work? This crash course on the intersection between ICT and Health will explore the different avenues within that intersection and how to distinguish them from one another to prevent confusion.

Avenues of ICT and Health

Avenues are the different types of structured practices that implement ICTs in the health field. An avenue in the intersection of ICT and health will utilize old technologies, new technologies or a convergence of both in a structured and systematic way to achieve positive health outcomes. These are the different avenues:

eHealth: The term eHealth refers to the practice of using and being supported by electronics in healthcare. eHealth is the umbrella concept for many other avenues of ICT and health such as telemedicine and mHealth. The term is interchangeably used with health informatics by some experts. The term characterizes a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology. According to the World Health Organization (WHO), eHealth is the quintessential embodiment of the intersection of ICTs and health. Electronic health record systems, health information systems, mHealth and telemedicine all fall under the jurisdiction of eHealth.

Telemedicine: Technically, telemedicine has been around for decades, ever since doctors on one end of the phone have consulted patients on the other end of the phone. It pertains to providing remote clinical care through forms of telecommunication and information technologies. What distinguishes telemedicine from telehealth, since they are sometimes incorrectly used interchangeably, is that the former delivers clinical care while the latter offers clinical and non-clinical care such as health research and education. Telemedicine services include live patient consultation over phone or video, remote patient monitoring, medical and health information acquisition, and emergency telemedicine.

mHealth: Also called mobile health, mHealth is a form of eHealth that uses mobile devices such as mobile phones and PDA’s for health services. The Global Observatory for eHealth (GOe) defined mHealth as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices. mHealth capitalizes on mobile telecommunication services such as SMS, general packet radio service (GPRS),  third and fourth generation mobile telecommunications (3G and 4G systems), global positioning system (GPS), and Bluetooth technology.

Health Informatics: This is the field that aims to analyze the information needs of consumers, implement ways to disperse information to consumers and health professionals, and integrate consumer preferences into medical information systems. The field uses devices, resources and methods to store, obtain, retrieve, and disseminate information for healthcare purposes. Health informatics mostly uses computers but also takes advantage of clinical guidelines, advanced medical devices, and ICT services.

Pregnant woman on phone. Photo Credit: MOTECH

A new mobile phone service was recently launched in Ghana that provides free access to health information in ensuring safe pregnancies. The service, aptly named Mobile Midwife, offers text or voice messaging on maternal health to pregnant women.

Mobile Midwife was developed as part of the U.S. based Grameen Foundation’s MOTECH Ghana initiative, funded by the Bill & Melinda Gates Foundation. It is just one more result of rising donor attention to mHealth services. Its creation continues a trend of mHealth initiatives being churned out in Africa.

Educating women and making them aware of the maternal health risks associated with pregnancies are the cornerstone goals of the service. To make it convenient for the user, the service comes in several different languages, and is presented by text or voice via mobile phones. Additionally, the messages are time specific concurring with the woman’s stage of pregnancy.

When a pregnant woman registers for the service, they are asked to give the expected due date for delivery of the unborn child and their location. Then, periodically, the woman receives messages informing when appointments are due or overdue to remind them to visit the health clinic for check-ups.

The users also get reminders for specific treatments, information about milestones in fetal development, nutrition facts, tips on the benefits of breastfeeding and other pregnancy-related and prenatal health information. It also provides information that demystifies local pregnancy myths and helps users overcome the widespread fear of visiting doctors or health clinics.

MOTECH also rolled out a similar mobile health service earlier in the year that enables nurses in rural Ghanaian health facilities to automate much of their record keeping and reporting, which formerly took 4-6 days per month. The service is in the form of a java–based mobile phone application.

Both Mobile Midwife and the application mentioned above have made life easier for everyone involved in the process of delivering a baby.

One Ghanaian mother said to Grameen, “I would like to advise my pregnant friends to go to the hospital to enroll into MOTECH, to listen to the messages and also to practice what is said because it helps a lot…I used to be scared about pregnancy but now with the messages I am no longer scared and it has taken away my worries and that we feel ok and then the pregnancy is ok.”

This service is extremely pertinent since Africa exhibits some of the worst maternal health records in the world. Fourteen of the fifteen countries with the highest rates of maternal mortality in the world are in Africa. Furthermore, African countries are far behind in meeting Millennium Development Goals set for 2015; especially for those associated with maternal health. Perhaps services like this can lend a helping hand.

 

MIT researchers recently created a smartphone device designed to detect cataracts. Called Catra, the device uses “off -the-shelf components” as opposed to the highly expensive and highly space consuming technologies normally used to detect cataracts.

Using Catra device on smartphone. Photo Credit: EyeCatra

The research group is part of the MIT media lab that won the MIT Global Challenge competition back in May. Taking advantage of mobility through mobile phones and an inexpensive design, Catra was designed for use in the developing world.

The device, which attaches to the screen of a smartphone, costs about $2, whereas a slit lamp examination conventionally used to examine cataracts cost up to $5,000. And unlike conventional slit lamp examinations, Catra does not need a skilled human operator to administer the test and read the results, Catra does everything for the patient.

Catra utilizes a technique, which allows the user to respond to what they visually experience.  It scans the lens of the eye section by section. The user then sees projected patterns and presses a few buttons to map the light attenuation in each section of the eye.  This information is collected by the device creating an attenuation map of the entire lens.  This allows individuals to monitor the progression of the severity of the cataract on their phones.

Catra vs. Slit Lamp technology. Photo Credit: MIT

This is not the MIT media lab’s first project to improve the health of the eye. They are working on a series of projects involving eye care. They developed and released Netra, an application and smartphone attachment for eye exams via mobile phone, last year.

Cataract is a condition where clouding builds up in the lens of the eye. It is the leading cause of avoidable blindness worldwide. Furthermore, ophthalmologists, doctors that specialize on the eye, are scarce in the developing world with one ophthalmologist per million people in some areas. When cataract leads to vision loss, it prevents people from being productive citizens in their community. It leads to high levels of illiteracy and poverty, and can impair a society’s economic and health sectors.

Using mHealth to tackle cataract is a crucial development. However, smartphones are not ubiquitous in the developing world. And it’s for a reason. Even though the Catra device may be cheap, the phones on which they operate are much more expensive. This needs to be considered when implementing Catra on a wide scale in the field. However, with the potential of this kind of technology, it is likely that MIT media lab will find a way.

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