Richard AndersonRichard AndersonUniversity of Washington

Project examples from PATH and University of WashingtonPATH

H lth I f ti S t A hit t◦ Health Information System Architecture◦ Smart ConnectUniversity of WashingtonUniversity of Washington◦ Digital StudyHall◦ CAM◦ ComCare◦ Open Data Kit

Seattle based NGO working in health technologiesF d d 1977Founded 1977◦ Now working in 70

countriescountriesFormerly: Partners for Appropriate pp pTechnologies in Health

Our mission is to improve the phealth of people around the world by:by:◦Advancing technologiesSt th i t◦Strengthening systems ◦Encouraging healthy behaviors

Solutions for emerging and epidemic di lik AIDS t b l i d l idiseases, like AIDS, tuberculosis, and malaria.Health technologies designed for low-resource settings, by the people who will useresource settings, by the people who will use them.Safer childbirth and healthy children.H l h i f h ld’Health equity for women, among the world’s most vulnerable—and influential—populations.populations.The basic protection of vaccines for women and children around the world.

ICTG housed in Technology Solutions but consults to all field and global programs

Complex, crowded field; many donors; disease-f d M&E f i id i ffocused M&E; fragmentation; epidemic of indicatorsLack of comparability need for certification andLack of comparability, need for certification and application of common standards Weak analytical capacities; health poorly connected to statistics; Translation of health data into information for policy action; evidence based decision makingpolicy action; evidence-based decision makingParis Declaration on Aid Effectiveness; harmonization and alignmentg

Medicines supply systems: proposed model

REAGENT

HSS/EMP

E BFCE

UU FMCCC P GC G P

ESSENTIAL MEDICINES ARVs MALARIA TB OI ARVs

Ped

REAGENTBlood safety (+ HIV test)

VACCINES CONDOMS Contraceptives MEDICALDEVICES

GOVERNMENT

MULTILATERALDONOR

BILATERALDONOR

NGO/PRIVATE

CO

C DD Private G

MENTALHealth

Coordination mechanism: National needs / Funds

Source of

Funds

Procurement agent/body

Point of 1er

TAT

MMENTRALE

SAID

NICEF

NUAP

SF

DC

ICR

LINTON

EPFAR

DF

TB

AVI

SI

OLUMBIA

TP

AMIEN

FID

wholesalersTZ

CENTRAL MEDICAL STORES

CENTRAL MEDICAL STORES

Private wholesalers

Simplify and harmonize technical and financial procedures

Basket funds : Supply driven financingor Demand driven

Point of 1erwarehousing

Point of 2ndwarehousing

CENTRAL MEDICAL STORES Private wholesalers

Pharmacy

PATIENT

District hospital Teaching hospital

Primary health centre

Point of dispensation

REGIONAL STORES

Regional hospital

DISTRICT STORESPoint of 3thwarehousing

Private clinic

Reinforceand use

existing system

Measure the results

Health System Domain1 C it B d S i1.  Community Based Services2.  Facility Based Services3 Diagnostic Services3.  Diagnostic Services 4.  Commodities Supply Chain5.  Human Resources in Health6.  Environmental Services7.  Stewardship & Management8.  Finance Resources for Health9.  Knowledge and Information Resources 10 Infrastructure Resources10. Infrastructure Resources

Software Developer LeadPATH Lead

1 2 3 4

Design DeployDevelopAnalysis Design DeployDevelopAnalysis

• Architecture is grounded in user analysis, requirements and systems design grounded in the situational context.• Solutions (by design) will need to be scalable past discrete pilot projects and integrate with country HMIS.

17

Held in Tanzania with Health Care workersDetermine workflow around TB diagnosis and treatmentT d ½ d i S hili 1 ½ d iTwo days, ½ day in Swahili, 1 ½ days in EnglishParticipants working with paper artifactsParticipants working with paper artifacts proved very usefulSuccessfully generated activity diagrams ofSuccessfully generated activity diagrams of workflowDevelopers observed workshop

Last mile connection (digital dial tone)Device targeting occasional, low bandwidth communicationS l li iSample applications◦ Vaccine Refrigerator temperature monitoring

Status reports and alertsStatus reports and alerts◦ Updating stock informationDetermine feasibility for scaled deployment

Cell phone radioMicroprocessorDisplay and input deviceAttach to external power supply (refrigerator)Secure location (rural clinic)C i t b SMSCommunicate by SMS

4/2/2008ATLAS 25

4/2/200826 ATLAS

4/2/2008 27ATLAS

Record data from Micro Finance TransactionsKey Ideas◦ Mobile phone for data entry

Use bar codes to synchronize with forms◦ Use bar codes to synchronize with forms

Gaetano Borriello + Students

Removes social barriersCollects dataCollects data electronicallyContext follows course of visitEasier navigation with moremore attention to threshold casesBetter adherence (60 toBetter adherence (60 to 85%) ◦ Without extending visit time

Ifakara Health Research and Development Center, Mtwara, Tanzania

Must bring health care to peopleFirst line of defenseRoutine, regular home visitsKnow their communityEyes and ears for local healthP id d ti f b t tiProvide education for best practices

Little, if any, supervisionPaper-based forms – ad hoc designLong time-lag to usable dataLittle or no historical data

Standardization of data8

Rapid data aggregation and analysisSupervision of CHWsConnection to health recordsCHW + phone = Flexible, efficient platform for:for:◦ Better home care (checklists, protocols, etc.) ◦ New outreach programsp g◦ Outbreak detection◦ Improved disease surveillance

Open-source data collection tool kit ◦ Collaboration between Google & UWashington (prof +◦ Collaboration between Google & UWashington (prof +

interns)◦ Forms + GPS + Picture + Barcode + Audio + Video + …Initially targeted at public health t a y ta geted at pub c ea tapplications but also being used for forestation monitoring and other domainsCurrent deployments around the world with keystone efforts in Uganda, Kenya, Tanzania, and B il (Gh d ViBrazil (Ghana and Vietnamearly next year)

Collect – Android client for data entryS bmit m lti transport la er as nc data transfer

Available

Submit – multi-transport layer async data transferAggregate – App Engine server for data collectionManage – remote management tools for configVisualize – visualization of data on graphs/mapsDB – connect forms to existing DBs for browse/update

In progress/ p

Voice – make calls with spoken version of simple formsTasks – assignment of tasks to specific workersTasks assignment of tasks to specific workersSupervisor – supervisory dashboardSMS – communication/notification with community

Future

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Kenya HIV,300 CHWs300 CHWs

Tanzania e-IMCI, 5 clinicians

Richard Anderson◦ anderson@cs.washington.edu◦ cs.washington.edu/homes/andersonGaetano BorrielloGaetano Borriello◦ gaetano@cs.washington.edu◦ cs.washington.edu/homes/gaetano

change.washington.edu