health

mHealth: Tending the garden of 1000 flowers Jon Tue, 11/30/2010 - 21:11

At #mHS10, we heard funders talking time and time again for letting "1000 flowers bloom" in mHealth pilots, and programs talking about pilots leading to more pilots. This was fine the first few times it came up, but by the last day, the syndromes of the pilot-itis pandemic were clear.

FlowerThis reeks of desperation. The funders are not finding clear winners in their projects, and the various implementers are casting about with local solutions that they either can't or won't scale, trying to find an idea so powerful that it will break through this lock.

We need to focus more energy on innovations which are dealing with core problems in health and in using mobiles for health, and thin out some of these 1000s of flowers. The soil is too fertile for this approach, and the many duplicated, repeated pilots will crowd out new, creative and gamechanging ideas. We need to move past these more basic mhealth applications - reminder messages for drug adherence, pre-natal checkups and so on are great - but simply using a new communications method to address an old problem. Let's replicate and scale those to more sub-sectors and keep them funded, but let's not dwell on them.

On scale -- this is not something that's eay to do. There are many barriers in mobile and in health, from cultural concerns to be dealt with which limit scaling of health projects, to many technical ones inhibiting good mobile projects from being re-implemented in other regions. There are many good meta-solutions to the technical side - open data standards and open source, both praised often at MHS10, are paving the way by creating a variety of tools which can work together.

We need more.

The platforms and networks need to become more open. Projects have been able to thrive where they rely on the lowest common denominators in phones - voice and SMS. Even still, a lack of global short-codes and improved cross-carrier and cross-border functionality hinders scaling. Beyond voice and SMS, it becomes a difficult maze of twisty passages dealing with the various featurephone systems, vendor lock-downs, and even more capable smartphones, which are even more locked down and difficult to get custom applications loaded.

The building blocks are there -- open source tools and open data standards abound; focusing on those is a big first step. Banding projects together, connecting at events like the mHealth summit, and increased best-practice sharing is another. Not being shy about where the real blockers are to scalable solutions is the elephant in the room. Do we need to engage the GSMA and ITU to work on better cross-connection solutions among the many global connectivity providers? Cell phone manufacturers to improve standardized access to their devices? These aren't the low-hanging fruits, but they might be the keys.

From #mHS10 to #mHS11: What we need for next year Jon Tue, 11/23/2010 - 09:43

Herein, a mix of quotidian tasks and big goals for us to prepare for a 2011 mHealth Summit. mHS10 was a great conference, and represents a seachange in the field compared to last year. It had a selection of amazing speakers, lots of academics and implementers, and overall just the right crowd.

Still, there remain some changes I'd love to see for the conference itself, and I'll follow up with some bigger challenges that the mHealth world needs to deal with, based on the themes from this year's conference.

First, keep the music if you must, but add lasers and a fog machine. If you were there, you know what I mean.

My top take-aways from #mHS10 , the mHealth Summit 2010 Jon Wed, 11/10/2010 - 13:53

As you might have guessed from my tongue-in-cheek #mHS10 drinking game (pilot=1 shot, 1k flowers=2, feature phone=3, "going global with sms phone support" = finish bottle), I got a bit tired of "Pilot-itis," which was finally called out as a problem on stage by Christopher Bailey of the WHO during the Wednesday morning plenary.

This pilot-itis was my biggest overall frustration with the discussions and presentations this year - a seemingly endless march of "new" pilot programs around (1) SMS for outreach/awareness (2) SMS and mobile for low-touch scheduled reminders and interaction or (3) Apps for various forms of monitoring. Perhaps it's my relative unfamiliarity with the health field, but do programs do controlled studies every time they plan to release a new paper, or put a PSA ad at bus stops? There is so much that can be done today, with a few hours of hacking, to advance at least #1 and #2 above, settle on a few solutions, and move on to more impactful territory. Take a page from Nike (who have one of the most successful fitness monitoring apps in the wild) and Just Do It.

Blue-skying Mobile Apps: Common Forms Jon Tue, 05/05/2009 - 12:05

I missed the recent Technology Salon on Mobiles for Development (I was kind of busy with Global Youth Service Day), and was already scheduled to make it to the Mobile Active m4Change unconference the next week.

A prime outcome of the Tech Salon was a challenge from Vodafone's Terry Kramer:

Mobile network operators (MNO) want increase revenues and market share by expanding into rural areas, and see partnerships with the development community as a key market entry strategy. Specifically, Vodafone is looking to the development community for key applications that solve a common need for many and can be scaled into commercial activities.

Here's my response, an idea that's been rattling around in my head for quite some time.

A common "form" application to send out encoded questions and receive back answers via SMS.

The core would be an agreed-upon encoding/compression format for sending form questions and receiving the answers via SMS.

This standard could be coded to using existing outreach tools like EpiSurveyor, FrontlineSMS, RapidSMS, and the like. It would have a "server-side" component where you could set up a form, specify the answer types (y/n (or t/f), multiple choice, very-short-answer?) and compose the SMS messages to send.

The key (and the hard part) is having this app as common as a calculator tool on deployed phones. The app would capture the coded SMS form, present it as a user-friendly form, and take the answers and reply (again via SMS) using as few outbound messages as possible.

Anyone with an SMS-sending tool could code questions and use their tool to distribute them; and any phone with this (pre-installed) app could "decrypt" the compacted form and present it to the user.

This would make data collection much smoother, eliminate distribution of questionnaires and codesheets prior to each new questionnaire, and improve data quality.

I see immediate applications in election obersvation, human rights monitoring, and health field-worker reporting, not to mention census, and even for-profit ventures for immediate customer satisfaction surveys, more complex SMS-voting (imagine what BravoTV would do with this were it widely deployed!)

Another path forward for the One Laptop Per Child Project

I've long been an advocate for selling the XO commercially or at least following a Grameen Village Phone style approach to create OLPC XO-centric small business models. Or simply just enable smaller pilot projects to spread the XO technology. I still believe any or all of these offer amazing benefits to expanding the scale of the OLPC XO, re-establishing the XO as the dominant player in the low-cost, rugged, low-infrastructure-requirements laptop, ideal for education projects around the world.

This doesn't seem to be getting much traction, despite apparent interest. Let me propose a different path forward, closer to the original "we sell laptops in batches of 1 million or more to governments" idea: Drop education.

Don't get me wrong - education is absolutely key to development, and the OLPC XO can be a great tool for education. But education systems also need to invest in teacher training, school infrastructure (from simple, double-ventilated pit latrines all the way to electricity and computers).

But there are so many other areas where something like the XO could help. Anywhere that cell phones are established as data-reporting tools is a potential place to introduce an XO. The laptop is barely more resource-hungry than a cell phone in terms of power, and can work "off-grid" with solar or car batteries just as well. It can deploy without any central communications grid (unlike a cell phone), given enough XOs or mesh extending devices to maintain an active peer-to-peer mesh network, and add one satellite uplink or cell-modem into the system and you're online. More importantly, if the cell network is down, a mesh network still can pass along messages within a small area.

Even a simple OLPC can still provide a much more rich data reporting toolset than coding long strings of data into a 160 character SMS, not to mention the ability to add in encryption for personal security and not relying (necessarily) on a central network which could be compromised.

What are some areas that such a device could provide valuable tools? Crisis response would be one obvious win, but also health reporting and/or managing reports being filed, human rights violations, election reporting, and even something like agricultural data exchange, enabling farmers to "pull" and explore information on long-term weather forecasts, disease risks, and market prices.

Combine an XO with FrontLineSMS and you have a portable, solar-powered SMS communications hub, which I can see being valuable in a few tough situations if you had some manual encryption schemes set up with your constituents.

Accepted, the XO is more expensive and would require more training than a simple cell phone. It could not -- and should not -- replace cell phone deployments, as a cell phone can go longer without power and is less "flashy" than an XO. But hybrid systems involving OLPC XOs as well as cell phones, or using XOs as portable SMS-messaging hubs, or simply to quickly deploy a local area wifi mesh network are all clear needs that an OLPC XO could help with.