Transcript A Unified Framework for Schedule and Storage Optimization

Improving Rural Healthcare Delivery
via Transparent Monitoring
Bill Thies
Microsoft Research India
In collaboration with Manish Bhardwaj1,2,
Sara Cinnamon2,3, Goutam Reddy2,3, Emma Brunskill1,2,
Somani Patnaik1,2, Seema Kacker1,2, Sourav Dey1,2 and Ajit Dash1,2
1Massachusetts
Institute of Technology
2Innovators In Health
3Abiogenix, Inc.
MEDITEL / December 20, 2008
Microsoft Research India
Established January, 2005
Seven research areas
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Algorithms
Cryptography, Security & Applied Math
Digital Geographics
Mobility, Networks, and Systems
Multilingual Systems
Rigorous Software Engineering
Technology for Emerging Markets
Contributions to Microsoft:
– MultiPoint, Netra, Virtual India
Currently ~55 full-time staff, growing
Collaborations with government,
academia, industry, and NGOs in India
http://research.microsoft.com/india
Microsoft Research India
Sadashivnagar, Bangalore
“Technology for Emerging Markets”
Research Group Goals
Understand potential technology
users in developing communities
Design and evaluate technology
and systems that contribute to
socio-economic development of
poor communities worldwide
Computer-skills camp in Nakalabande, Bangalore
(MSR India, Stree Jagruti Samiti, St. Joseph’s College)
Collaborate with developmentfocused organizations for
sustained, scaled impact
Multidisciplinary Research
Aishwarya Lakshmi Ratan
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Society
International Development
Public Administration and
Jonathan Donner
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Communications
Nimmi Rangaswamy
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Group
Social Anthropology
Indrani Medhi
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Design
David Hutchful
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Individual
Human Computer Interaction
Kentaro Toyama (Group Lead)
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Computer Science
Bill Thies
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Technology
Innovation
Computer science
Saurabh Panjwani
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Computer science
Rikin Gandhi
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Astrophysics
Sample
Projects
Microfinance & Technology
Microfinance
PC + mobile
Qualitative
studies
Business analysis
Research only
Potential of technology to
support microfinance
Kelsa+
IT and Microentrepreneurs
Microenterprise
PC + mobile
Mixed-method study
Research only
Information ecology of very
small businesses
Simultaneous Shared Access Featherweight Multimedia
Information access
PC
Qualitative study
Usage analysis
Pilot
Primary education
PC
HCI
User studies
Software SDK
General
education
Electronics
HCI
User studies
Prelim research
Free access PCs for lowincome office staff
Multi-user systems for
educational
Paper and cheap electronics
for low-cost multimedia
Text-Free UI
Warana Unwired
Digital Green
User interfaces
PC
Design
User studies
Guidelines
Text-free user interfaces for
non-literate users
Info systems
Mobile
Intervention
Rural kiosks
Pilot
Substitution of mobile phones
for rural PC kiosks
Agriculture
Video
Intervention
Control trials
Pilot
Video and mediated instruction
for agriculture extension
Drug Delivery: Last-Mile is Often Broken
Drug
Developers
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Distributors
Rural
Patients
Local
Clinics
TB treatment: 4 drugs, 6-8 months
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Worker supervises ingestion
3 times/week (DOT)
Courtesy PIH
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Courtesy PIH
Rural programs operate in the dark
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Interaction: Are workers reaching patients?
Adherence: Are patients taking medication?
Health: Are patients getting better?
Mission: Track Interaction, Adherence, Health
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The uBox: A Smart Pillbox
Developed by Abiogenix, MIT, and Innovators In Health
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The uBox monitors
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Delivery, by logging worker visits
Adherence, by logging pills dispensed
uBox impact
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uBox
uKey
(for patient)
(for worker)
Worker supervision and incentives
Timely and targeted intervention
Lowers adherence burden
Patients
Workers
Clinic
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The uPhone: Monitoring Patient Health
Worker
enters vital patient health
indicators into cell phone
Patient
lives in a remote area
Nurse
analyzes data,
identifies problems
Physician
sends advice to patients,
schedules field visits
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Is Technology Really the Answer?
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Often ignores systemic and societal issues
But, delivery is overwhelmingly about diligence
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Today: 2.4M doses/day, 187 countries, 77% reliability
Need: 7M doses/day, 100% reliability
FedEx: 7.5M shipments/day, 220 countries, 97.7% reliability
Our goal is to reduce the burden of diligence
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Change the culture: 85% is not enough
Need to respond to every failed transaction
Identify superstar workers early and replicate techniques
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uBox Training
Bihar, Spring 2008
By MIT and Innovators In Health
• Class was proficient in < 3 hours
• Overcame prototype shortcomings
• Gave very good suggestions
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uPhone Training
Bihar, Spring 2008
By MIT and Innovators In Health
• uPhone more challenging – literacy and
prior cell phone experience needed
• Lesson learned:
- Even with intensive training, many
errors on menu-based interface
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Evaluating the Accuracy of Mobile Data Collection
With Somani Patnaik and Emma Brunskill, to appear at the 2009 International Conference on ICTs and Development (ICTD 2009)
PDAs
Cell Phones
Malaria monitoring in Gambia (Forster et al.)
 Clinical study in Gabon (Missinou et al.)
 Tuberculosis records in Peru (Blaya & Fraser)
 Sexual behavior surveys in Peru (Bernabe-Ortiz et al.)
None?
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Published
error
rates
SATELLIFE (Groves et al.)
 DataDyne EpiSurveyor (Selanikio & Donna)
 EpiHandy (Engebretsen)
 Infant health in Tanzania (Shirima et al.)
 e-IMCI project in Tanzania (DeRenzi et al.)
 Respiratory health in Kenya (Diero et al.)
 Tobacco survey in India (Gupta)
 Ca:sh project in India (Anantraman et al.)
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Others
Cell-Life in South Africa (Fynn)
 Jiva TeleDoc in India (UN Publications)
 Pesinet in Mali (Balancing Act News)
 Malaria monitoring in Kenya (Nokia Newsletter)
 Voxiva Cell-PREVEN in Peru (Curioso et al.)
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1. Electronic Forms Interface
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2. SMS Interface
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3. Voice Interface
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User Study
Gujarat, Summer 2008
Conducted by Somani Patnaik, MIT
Evaluated three user interfaces:
- Electronic forms
- SMS
- Voice operator
Results:
- Forms error rate: 4.2%
- SMS error rate: 4.5%
- Voice error rate: 0.45%
Other benefits of voice:
- Easy to verify
- Easy to replicate
- Less expensive
These results caused us to change
our program to use a voice interface
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Conclusions
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Potential for simple technologies to offer large
benefits for improving rural healthcare delivery
Low-tech interfaces may be highest-impact
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uBox provides transparent interface
Operator-assisted reporting better than automated SMS, Forms
Most exciting aspects of work coming in next steps
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Can technology improve health outcomes in controlled trial?
Is operator interface effective in practice?
Seeking additional partners!
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Innovators In Health:
Ensuring Reliable Medication
Delivery in the Developing World
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Community Partner
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Prior Contributors
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The Prajnopaya Foundation
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Alex Krull
Oliver Venn
Jessica Leon
Nikhil Nadkarni
Catherine Dunn
Sponsors
… and many
generous individuals!
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