We at Medic are committed to developing rigorous monitoring and evaluation structures with all of our partners in order to validate the impact of our tools.  To demonstrate this commitment, data on the outcomes from our first field site in Malawi were recently published in the Journal of Technology and Health Care.  The paper provides a treatment of the communication challenges that were faced at St. Gabriel’s Hospital, the manner in which FrontlineSMS:Medic tools were employed to address these obstacles, and a discussion of the outcome metrics from the six-month pilot.

To read the paper, follow the link below to the PubMed NCBI listing:

Technol Health Care. 2010 Jan;18(2):137-44.

A text message-based intervention to bridge the healthcare communication gap in the rural developing world.

Mahmud N, Rodriguez J, Nesbit J.

Or, for off-print requests, kindly direct an email to nadim@medic.frontlinesms.com.

Cheers,
Nadim

PatientView

Ideal for hard-to-reach hospitals and clinics, PatientView organizes text messages and mobile forms to create searchable patient and health worker profiles.The module creates a new user interface within FrontlineSMS – one screen where staff at a central computer can view all relevant data relevant. Health workers can sort, update, and add new records from the central computer. The plug-in also introduces login security, new search features, simpler messaging to patients’ health workers, and an upcoming  ‘flag’ system to alert clinical staff to certain information, and new reporting capabilities. Watch the demo video here.

Surveys

The Surveys module was developed to efficiently and accurately send structured information via plain text SMS available on the lowest-common-denominator handsets in low-resource settings. It provides a simple syntax and enables structured data collection with the robustness and scalability of SMS through plain text, yes/no, multiple choice, and checklist responses. Use cases include dynamic stock reporting and resource mapping, landmine victim care tracking, and maternal health vital event reporting.  We are collaborating with Google to enable Surveys to update information about health facilities in Resource Finder, a tool Google has developed to help disseminate updated information about which services various health facilities offer in a disaster area.  Surveys will allow relief workers to update a given facility’s available bed status, which types of specialists are on staff, etc, all via SMS.

Surveys screenshot

Google's Resource Finder

The OpenMRS Messaging Module

FrontlineSMS:Medic has built a messaging platform for OpenMRS, a web-based, open-source medical records system. This messaging module will allow large clinics to extend patient records outside clinic walls, e.g. giving remote health workers the ability to update patients’ records via SMS, allowing clinicians to set appointment reminders, messaging CHWs about patient test results and treatment instructions, etc. Learn more about the messaging module here.

FrontlineSMS:Medic aims to implement three national-scale and over ten regional-scale programs by the end of 2012. Target countries include Malawi, Kenya, Mali, Bangladesh, Haiti and Colombia.  Through these deployments, we expect to increase our number of end users to at least 15,000 health workers.

The need is loud and clear – large gaps exist in health systems. The disconnect between health centers and peripheral communities means that adherence rates suffer, clinicians are unaware of patient statuses, immobile patients cannot receive emergency care, remote health workers lack support, new illnesses are not identified, and drug stock-outs are too common. We believe that FrontlineSMS:Medic’s tools can help create health systems that are connected, coordinated, and save more lives.

The Singing Geeks of OpenMRS 2010 from Isaac Holeman on Vimeo.

One of the several open source software platforms we work with is called OpenMRS – it’s an electronic medical records system designed for managing patient information in treatment programs (such as HIV or TB), as well as primary care. Generally the niche for OpenMRS is with larger scale, more well resourced programs (in contrast with PatientView, which has more limited features and is much easier to use for minimally resourced projects). Although OpenMRS is used all over the world, it’s design emphasizes the needs of health care workers in the regions where we work – especially Africa.

Dieterich and I (Isaac) recently attended the annual OpenMRS meeting and it was great. Dieterich has been working very hard on a messaging module that will enable health workers to send SMS and other types of messages via OpenMRS, and his demo was very well received. I had a great time brainstorming with friends and mentors from all over the world, particularly including Zeshan Rajput who has played an instrumental leadership role in our messaging module project, Paul Biondich who is a key member of our board of advisors, and too many others to count.

One of the key elements of this meeting was the sense of community, and the clear agreement that the meeting itself wasn’t just about understanding our software application, it was about building relationships and a collegial atmosphere that will keep this good work moving forward despite many inevitable challenges. As Burke said, it’s more like camp than like a conference.

The video above is one of many examples (perhaps the silliest) of this community building. As the first vocalist, I sang “Cheek to Cheek” with spiced up lyrics. Next up is Dr. Paul Biondich, a cofounder/president of OpenMRS and director of the World Health Organization’s collaborating center on medical informatics singing a classic we all know and love. Third, a gentleman who I do not know… I hope people will let me know his name and the name of his song in the comments. Finally, the great instigator Chris Bailey of the knowledge management division at the World Health Organization, singing entirely new lyrics to a familiar tune that I can’t quite recall… can you help me name that tune?

You can read more about OpenMRS on their website, or follow them on twitter. Thanks to Burke Mamlin for filming our songs.

The deal for our clients:
We’ll continue to offer loads of free advice and software to anyone who will keep in touch about where, when, and how they are using it. This form is short – it should only take 10-15 minutes – and we want you to think of it both as a thank you to Medic and as a payment for our services.

Our ability to fundraise depends on having good data about our end users, so I’m serious when I say that completing this questionnaire is as important as providing payment for goods received. Nadim (Medic’s Research Director) and I have tried to make it brief and easy, so we hope you will be able to complete it quickly and painlessly.

Thank you in advance to everyone who takes the time to fill out this form! For those of you who are not actively working on a project, we appreciate your help reminding the rest of the community to check out the form.

cheers
Isaac

Find the form at http://medic.frontlinesms.com/implementations

PatientView login

Searching for a patient

Patient's record

PatientView administration

B is for Beta and for Bugs

We’re releasing PatientView as ‘Beta’ because it’s not yet ready for production use. We ask that you help us change that by reporting any bugs that you may find to bugs@medic.frontlinesms.com. Please tell us what you did just before the error, what you expected to happen, what happened instead, and describe any error messages that popped up. Additionally, if you have ideas for PatientView that aren’t bugs, but fall more in the ‘feature request’ category, then please send those in an email to ideas@medic.frontlinesms.com

How To Install & Run PatientView

1) Prerequisites – Make sure that you have at least Java 1.5 installed. If you don’t know for sure if you have Java or what version it is, you can execute the command ‘java -version’ in the terminal and it will tell you what you need to know. If you need to get Java, go here to download the Java Runtime Environment 6.0.

2) Go here and download the PatientView version that’s right for your computer. If you’re a Mac user, you’ll want the .dmg, if you’re a Windows user, you want the one labelled ‘Windows’, and if you’re a Linux user you should pick the version that matches your architecture (i686/ia64/x86_64). To find your processor architecture on Linux, execute the command ‘uname -p’ in the terminal.

3) If you’ve run FrontlineSMS in the past and want to continue running your old FrontlineSMS instance in the future then you should save your FrontlineSMS properties folder. This folder is located in your user directory/FrontlineSMS, and is called ‘properties’. Just rename it something that you’ll remember so that when you want to switch back, you can just re-rename it ‘properties’ again, and everything will be back to normal.

4) Run PatientView. There are slightly different instructions for each system:

Mac – It’s a .dmg, so it’s pretty straightforward. Just click on the FrontlineSMS icon inside the mounted .dmg folder.

Windows – unzip the folder and double click ‘FrontlineSMS.bat’.

Linux – unzip the folder and double click ‘FrontlineSMS.sh’

And that’s it! If you’re having trouble, please don’t hesitate to ask the implementer’s list by emailing your questions, what you’ve tried, and what errors you’re seeing to frontline-implementers@googlegroups.com.

By the way, we’re hiring

Software developers with enthusiasm for our cause should say hello and send a resume to jobs@medic.frontlinesms.com.

- Dieterich -

We are excited to announce that the Google Inc. Charitable Giving Fund of Tides Foundation is supporting FrontlineSMS:Medic’s innovation team with a $25,000 grant. This generous donation will fast-track development of new projects set to empower health workers and improve healthcare in low-resource settings around the world.

Stay tuned for updates!

Josh and the FrontlineSMS:Medic team

I write today with excellent news. We are thrilled to announce that The Mulago Foundation is supporting FrontlineSMS:Medic with a catalyst grant. Thanks to this support, I am now full time as Lead Developer, responsible for software design, development and testing. This is exciting because I’ve been chained to other activites for the past year or so and have been spoiling for a chance to really dig in to all the projects that Medic has going.

Last year we gave the community a first taste of Patient View, our extension of FrontlineSMS that allows clinics to manage their remote workers and patients as well as the day-to-day operations at the clinic itself. Most recently, an alpha version of Patient View was on display at the Global Health Information Forum in Bangkok. While this was a good start, we have much, much more planned for this year, and I’d like to give you a rough outline of what the software devs have in store:

Release of Patient View

With a filled-out featureset including user interface improvements, internationalization,  lost-to-followup and adherence monitoring, improved charting, appointment scheduling, calendar tools, auto-topup, and much more, this year will definitely be a good one for Patient View. We are planning on releasing a beta version in February (in just a couple of weeks), and if you would like to participate in that beta testing, feel free to email me at dieterich@medic.frontlinesms.com. After the beta version, we will kickoff the Medic open source community by opening up the Patient View code.

FrontlineSMS & OpenMRS

While we think that Patient View is excellent, it isn’t right for everyone. There are large clinics with huge patient loads that need a solution that can handle their 60,000 patients and all the data that comes with them.  To that end we are working with OpenMRS (openmrs.org), an enterprise-level FOSS medical record, to develop several different featuresets including mobile data collection, SMS alerts, and more.

Mapping with Ushahidi

Ushahidi has created a wonderful platform for mapping, and has recently put their tech in a FrontlineSMS plugin. We plan to use this to add a wide range of mapping features to Patient View. This will allow users to map diseases, workers, resources, or anything that they wish so that they can better manage their time, fuel, and other resources.

Remote Diagnostics with CelloPhone

Andoyan Ozcan at UCLA (http://innovate.ee.ucla.edu/) has created a revolutionary system that allows cellular-level images blood to be taken using the camera sensor of a simple camera phone. These images can then be sent via MMS to a remote server where they are analyzed by pattern-matching algorithms, yielding important information like CD4 counts, disease diagnoses, and more. We plan to integrate this technology with Patient View, allowing doctors in the developing world to take full advantage of this incredible new technology. In the settings of many of our clinics, there are no labs to send tests off to, or if there are, getting results is expensive and time consuming. With this new technology, we can have diagnoses in seconds at the cost of an MMS. Now that’s what I call progress!

Personally, I’m super excited about this coming year. These projects all have the potential to change the state of  mHealth in a huge, positive way.

In closing, I’d like to emphasize that Medic is not solely focused on software; we are an organization committed to fostering an open-source software community and making sure these tools make it to those who need them most. With the beginning of our open source community, these plans have the potential to be yours just as much as they are ours. If you want to participate, email us and stay tuned because things are about to get really interesting, really quick.

Sometimes, people just pull through for one another. Less than one month ago, I flashed the designers’ bat signal with a meager attempt to draw out some use cases for FrontlineSMS:Medic. A team of talented artists stepped up to the plate and hit a home run:

Facilitated by Raina Kumra @ The Agency for Holistic Branding

They’re a wonderful team, and this is high-impact volunteering. As a nonprofit start-up, seemingly small tools/resources really matter. A nifty poster version of the graphic will be featured at the upcoming Global Health Information Forum in Bangkok and the art will immediately have a home in our team’s presentations.

1. Who are your target audience?
The Frontline Philosophy: To begin with, we’re focused on serving organizations that work to improve human health. And like Kiwanja.net and the core FrontlineSMS team, we focus on the “long tail.” This graph sums up the long tail idea well:

Our team differs from Kiwanja.net’s approach to the long tail in one important way. Ken Banks usually talks about where organizations sit on this graph. Instead, we look at where specific use cases or projects sit on the graph. If you’re a grassroots NGO with 2-3 people on staff, no tech experience, and a shoestring budget, then all of your projects and capabilities should fall in the green part of this graph. You might also be an international NGO with a multi-million dollar budget and a big IT team, but chances are you have some use cases or projects that your IT experts can’t contribute much time to, or where you need to stretch every dollar a very, very long way, or where you work in an impossibly remote and low infrastructure area whose needs are entirely different than other parts of your service area. These are what we’d call long tail use cases. Such organizations might find a rewarding cost/benefit equation for implementing expensive, complicated medical record systems at referral hospitals, perhaps even district hospitals. But for long tail use cases at remote health centers they will need a tool with a frontlines philosophy (whether or not they end up using FrontlineSMS).

2. What is your position on scaling?
Like Kiwanja.net, we focus on horizontal scale, rather than vertical scale. For a generic example of horizontal scale, think of ten independently managed platforms serving 10,000 people each, as opposed to a single centrally managed platform serving 100,000 people. We choose the horizontal, modular approach because we do not want to centralize:

knowledge transfer, learning, and the empowerment that comes from a job well done.
use of gathered data
user ownership and enthusiasm
decision making authority
funding requirements (and potential for failure if they aren’t met)

We also like it when end users can make their own technology decisions (rather than having to defer to an official who will never actually use the tool directly), and we like it when ambitious groups can charge ahead without having to wait for their entire country/district/the domain of any vertically scaled system to catch up.

We do, however, find it absolutely essential to be able to centralize one thing: data. For a huge number of reasons, from pharmacy and supplies procurement, to fund-raising, to disease outbreak management, to research. Exchanging data, of course, can be achieved by representing data in agreed upon formats and transferring via a variety of channels – from Internet, to SMS, to USB sticks carried by bicycle.

3. How does it replicate and grow?
Kiwanja.net couldn’t have said it better: “growth is based on patience, and a “pull” rather than “push” approach, i.e. awareness-raising and then letting NGOs decide if they want to try out the tool or not. Those that do then go and request it from the website. Everything is driven by the end user.”
At the request of partner organizations, we do have a core team of experts that manage a small number of implementations. The majority of implementations, however, only rely on us for the free software and a lot of advice and support (mostly via email). As an organization, we have plenty of growing up left to do, and we’re still figuring out how to portray to the public that we don’t want to (and frankly can’t) manage or direct most implementations of FrontlineSMS and associated tools in health care settings.
We recently decided to start using the term reference implementations to describe the small number of programs that our core team of experts oversees directly. Moving forward, reference implementations will be selected because they pioneer a new piece of software, an important new use case or methodology, or in some way contribute substantially to the larger Frontline community. All other projects are community implementations, and we are pleased to support them with free software, direct email with our team, and upcoming public email lists and a wiki-based field guide. Hat tip to the OpenMRS community for the framing of reference and community implementations.

4. What is your position on open sourcing?
In addition to sharing source code, we strive to live up to principles that are common among community developed projects, such as openness and transparency, bias towards collaboration rather than reinventing the wheel, and sharing the fruits of our labors as freely and widely as possible. That said, we prioritize impact for our users, and we are realistic about the substantial resources required to collaborate – to license code and make sure it’s commented and documented thoroughly enough to support developer collaboration. We sympathize with the many young and low resourced open source projects that are so busy supporting users that they leave something to be desired for strict open source advocates. We’re still in the process of working out licensing of PatientView and setting up our wiki and public mailing lists. We hope you’ll give us the benefit of the doubt and (collegially) hold us accountable in this regard.

5. Does access to “the cloud” matter?
Yes, the cloud matters; it is the future, but not the present on the frontlines of global health. I mean this more as an observation than as an opinion – the cloud simply cannot be accessed with any regularity in the vast majority of places where we work. We want everything we do to accelerate movement towards sophisticated use of low cost, easily accessible cloud based apps, but starting with apps that work exclusively in the cloud or even rely on the Internet just isn’t the best way to do this. Paper based societies need to get their feet in the door with tools that work NOW, but have been designed to point the way to cloudville. How can an SMS platform built on disconnected laptops point the way to cloudville? Under the “scaling” section we hinted at the importance of data standards and platform interoperability. We’re making sure FrontlineSMS plays nice with various cloud based apps. We may even start working in the cloud ourselves someday, but not just yet.

So, that’s our line in the sand. If anyone else has a mobile tool – or is working on a mobile tool – I’d encourage them to clear up any possible confusion and write a post outlining their thinking in these five areas.

PopTech 2009 Social Innovation Fellow Josh Nesbit from PopTech on Vimeo.

Be sure to check out the other fellows’ amazing work here.