Archive for the 'health care' Category

First Meeting of the FrontlineSMS:Medic team in Palo Alto

Published
by
Isaac Holeman
on March 7, 2009
in global, health care and stuff in my life
. 0 Comments

First Team Meeting

I just returned from a long weekend in Palo Alto, my first face to face meeting with most of the FrontlineSMS:Medic team. It was fun! If you’re surprised that we hadn’t met in person before, you might be interested in how we learned about each other and decided to work together.

  1. Spring 2007: Josh Nesbit, an undergraduate at Stanford University, meets Ken Banks.
  2. Summer 2008: Josh begins using FrontlineSMS at St. Gabriels Hospital in Namitete, Malawi.
  3. Summer 2008: Lucky Gunasekara is working as a researcher in mobile and web media for a consulting company in Tokyo, Japan. In his free time reads about mobile phone penetration in developing countries and begins to dream of connecting community health workers and patients to electronic health records via SMS on mobile phones.
  4. Early Fall 2008: Isaac Holeman plans to work with a friend at a clinic in East Africa after he graduates from Lewis and Clark the following May. Having no clinical training but some tech experience, he begins planning to integrate OpenMRS into mobile phones using SMS.
  5. November 2008: Dr. Wayne Centrone of Health Bridges International wants to set up a health records system at their clinic in Peru and contacts Daniel Bachhuber (who has more tech experience) to ask for help.
  6. Daniel and Isaac are friends; they randomly share their ideas and decide to join forces under the name MobilizeMRS and apply for the NetSquared USAID Development Challenge. Their proposal is to merge FrontlineSMS with OpenMRS. Their project becomes a finalist.
  7. Early 2009: Through a series of emails and phone calls, Josh, Daniel, and Isaac team up.
  8. Josh meets, by chance at lunch, Lucky, who now studies at Stanford Medical School. Lucky joins the team, and invites his friend Nadim Mahmud to join on and help develop a 500,000 patient mHealth impact study in Bangladesh for the summer of 2010.
  9. Lucky is selected as one of 10 featured announcements out of 700 student commitments at the 2009 Clinton Global Initiative University. At CGIU, Lucky meets Ken Banks and pitches connecting FrontlineSMS, OpenMRS, and a revolutionary cell phone-based diagnostic technology, developed at UCLA. Ken agrees to formally give his support and former President Bill Clinton makes the announcement.
  10. February 23rd: They relaunch the venture as FrontlineSMS:Medic. The Medic team is currently beginning software development and already have firm implementation plans with over 15 partner clinics in Africa, Asia, and Latin America

Daniel and I both flew down from Oregon to Palo Alto on Friday, and got to know Josh, Nadim, and Lucky at a noodle bar down town. The real work began Saturday morning with a massive 11 hour team meeting. The five of us spent a lot of the morning working on our application for the Dell Social Innovation Challenge. That application is now posted, so we’d appreciate your feedback and your votes!

After a short break for burritos, we met with a handful of other Stanford med students to discuss our plans for the next year. We’re still working out the details about who will help set up where, and we decided it was useful to place the various upcoming implementations of FrontlineSMS:Medic into three categories.

Research Studies: These sites will conduct randomized controlled trials or prospective impact studies on a stable, accepted build of medic.

Innovation Pilots: These sites will innovate, experiment, and provide feedback on the latest features as soon as possible.

Implementer Partners: These sites will receive tech support, may receive hardware, and will have a FrontlineSMS:Medic team member on site for a short time or not at all.

We definitely have our work cut out for us with all these sites. We’ll introduce you to each project individually as things progress.

Technical details absorbed the next chunk of our meeting. Every exchange was good-natured, and yet the rapid back and forth was so intense it felt almost like an argument. For hours upon hours. I thought many times of something Clay Shirky recently said about innovation: “Don’t look at crowds and don’t look at individuals, look at small groups of smart people arguing with each other.”

Our discussion of features and interfaces led us to be empathetically and anthropologically about the community we hope to serve, and it exposed a truth that had quietly undergirded many of our earlier conversations. We are taking a grass roots approach to scalability. Many people will read the word “scalability,” and think of massive, efficient hospitals serving many hundreds of thousands of patients. They might think of organizations that have a large, university trained technical team to work on medical informatics. That’s scale, right? In contrast, by focusing on grass roots scalability we are thinking first and foremost about the small or medium sized clinic or hospital where perhaps no one has an awful lot of training with technology. Most of them will find one computer and some phones a lot less daunting than complex computer networks, servers, and complicated software installation. These organizations probably have just one person to work on medical informatics, and chances are this person is doubling as a TB officer, nurse, or janitor. If our project achieves significant scale, it will be first because we expand our simple approach to many resource constrained organizations, and secondarily because any one organization may implement FrontlineSMS:Medic at significant scale.

We’ll post more about the fruits of this discussion soon. In the mean time why don’t you check out Nadim’s post about the visit he and Lucky made to UCLA to discuss integrating FrontlineSMS:Medic with Professor Ozcan’s LUCAS technology.

Cross-posted at the FrontlineSMS:Medic team blog.

Kitzhaber for Health Reform Czar

Published
by
Isaac Holeman
on February 5, 2009
in health care, politics and stuff in my life
. 0 Comments

Former Senate Majority Leader Tom Daschle recently withdrew his nomination to become the secretary of Health and Human Services and head of the White House Office of Health Reform, citing a controversy regarding unpaid taxes. President Obama now faces the dual challenge of finding a suitable replacement and restoring public confidence in his promise to run a more ethical and special interest-free administration. For reasons technical, political and personal, I believe former Oregon Gov. John Kitzhaber would be an excellent choice for either or both of these positions. Read more…

I invite you to read the rest of my recent opinion piece in the Oregonian. I would very much appreciate comments with your thoughts or support. I had hoped for a title that reflected Dr. Kitzhaber’s appropriateness for either HHS or the Health Reform Czar position, but I am nonetheless grateful to the editorial staff at the Oregonian for publishing my piece.

If you would like to make your voice heard in this process, I urge you to send a note of support for Dr. Kitzhaber to President Obama at Whitehouse.gov, or read a succinct background and use a letter writing form provided by OnwardOregon.

In Defense of Irrational Medicine

Published
by
Isaac Holeman
on January 13, 2009
in global and health care
. 13 Comments

A recent post at the change.org global health blog discusses a few global health programs that do not improve global health very much for how much they cost. Examples include Hospital ships and flying patients to the US for medical care. You could say that these programs use resources irrationally, Alanna goes so far as to say that such programs are immoral.

I think a key issue at the heart of some such of programs is the balance between long term effectiveness and the fierce urgency of now. I agree that the programs she describes would play a very small role in an ideal global health care service, but ultimately what we need more than any specific program is for people to give a damn. Some people have excess resources; we need them to care enough that they are willing to share some of those resources with the rest of the human family. If irrational programs will occasionally inspire people, perhaps they are worth the cost.

I’d like to discuss an example. The organization Partners in Health works in Haiti, and will occasionally fly patients to Boston to receive complex treatments that are not available in Haiti. They call it their Right To Health Care program. One recent patient was a young boy who needed to have a hole in his skull repaired. The flight and the procedure were admittedly expensive; the same amount of money might have purchased many bed nets or vaccines. But for the health care providers involved, the issue at stake was whether they were willing to treat this little boy like a beloved family member, whether they were willing to do whatever it would take to help him be healthy. In this instance PIH chose to respond to the fierce urgency of now.

PIH’s difficult work is possible in part because they have attracted very dedicated staff by telling controversial and emotionally charged stories, and following up with stories of hope and healing. Such acts are not purely metaphysical, they shape PIH programs. PIH has incredible, even enviable support in the communities where they work, in part because community members hear about stories like this little boy’s and they think, “wow, these people must really truly care about us an awful lot.” I also know individuals in the USA who have had the course of their lives changed by this brand of irrationally inspiring dedication. I’ve met people who heard a PIH story like this and decided that they were going to donate what they could to PIH every month from that point on - indefinitely. In my own case, I read of such efforts and decided that I too would become a doctor for the poor. I dare say my contributions to humanity will outweigh the cost of flying one needy child to Boston and performing a pro-bono surgery. I cannot emphasize enough how plausible it is that I might not have come to care, that I might have marched though life without being inspired.

Logistically, economically, such decisions do not make sense. They are irrational. And yet, a great many people ache for that kind of leadership, and to emulate such reckless devotion. I am forced to conclude that there are depths of the human soul which I do not yet understand.

Mobilizing Medical Records in Resource Poor Settings

Published
by
Isaac Holeman
on December 11, 2008
in health care
. 0 Comments

My good friend Daniel Bachhuber and I recently submitted an application to NetSquared/USAID’s Development 2.0 challenge. We wanted to let you know about the project, so this post is very similar to a post on Daniel’s blog. USAID is looking to give $10,000 dollars to a project using mobile technology (like SMS or phone-based applications) that “[maximizes] development impact in areas such as health, banking, education, agricultural trade, or other pressing development issues.” We think we’ve got just the idea.

We’d like to put together a bridge between mobile phones using phone software like FrontlineSMS or OpenRosa, and OpenMRS.  OpenMRS is a super neat medical records system that is gaining a lot of traction throughout the global south, thanks to an awesome community of developers and implementers, and institutional support from impressive organizations like, Partners In Health, the WHO, Google, and many others. Specifically, our project would enable community health workers in the field to access and interact with the medical records database. This would, for instance, allow them to instantly query the last time a tuberculosis patient had reported taking their treatment medicine. Daniel and I are also very interested in sorting together an OpenMRS module that would “watch” the data going in and out of the database. If a bit of data passed through tagged with, say, “#emergency”, it would go to whomever the on-call doctor was. This type of functionality, as far as we can tell, doesn’t already exist. We think it would be sweet if it did.

Now, most of this project is in the very preliminary stages. With your help, though, and funding from NetSquared/USAID, we can take it to the next step. Here’s the details:

  • Voting started on Monday and will run until Friday December 12th at 5:00 pm Pacific.
  • To vote on our application, you must first register.
  • Once you’ve registered, you then have one (1) ballot with up to five (5) votes. You have to vote at least three (3) times.

Our application is called “Mobilizing Medical Records In Resource Poor Settings“. We would be very much obliged if you took the time to vote for us and, if you do and leave a comment on this blog post, I’ll send you a personal thank you.

Also, if you don’t know who else to vote for, there were a few other projects which caught my eye:

Thanks for the support!