Mobile Pictographs for Alerting and Incident Reporting on the way

We have been working on the idea of using pictographs to empower the linguistically challenged with communicating disaster information for several years. The concept was first presented at the 2013 Common Alerting Protocol Implementation Workshop. Later the Federation of Internet Alerting considered our work in their efforts to communicate pictograph-enabled warnings through their online Ad Spaces.

Spot-On as a Service Provider to the Sahana Software Foundation (Sahana) is providing expertise in emergency communication. This is in part of a project Sahana is leading on realizing the concept of Mobile Pictographs in support of Linguistically Challenged.  The project is made possible through the Humanitarian Innovation Fund of ELRHA.

Real-Time Biosurveillance Pilot - Technical Report

The Real-Time Biosurveillance Program (RTBP) was a multi-partner initiative to study the potential for new Information and Communication Technologies (ICTs) to improve early detection and notification of disease outbreaks in selected regions of Sri Lanka and India. Experts in the field of biosurveillance and health informatics have argued that improvements in disease detection and notification can be achieved by introducing more efficient means of gathering, analyzing, and reporting on data from multiple locations. New ICTs are regarded as an important means to achieve these efficiency gains. The primary research objective of RTBP was to examine these claims more closely by producing evidence to indicate in what ways and to what extent the introduction of new ICTs might achieve efficiency gains when integrated with existing disease surveillance and detection systems.

The project achieved a number of key objectives at the outset, including the development of a Java-based application for collecting patient data using low cost mobile phones; the successful implementation of Auton Lab’s analytic software and T-Cube Web Interface for analyzing patient records and near real-time prediction of disease outbreaks; and the adoption and implementation of Common Alerting Protocol for multi-channel health alerting. Moreover, the project team successfully integrated each of these three key components into an operational system that collected individual patient records, over 330,000 in Sri Lanka and over 130,000 in India, over a 15 month course of study. Over the life of the project, the system identified over a dozen instances of potential disease outbreaks, with four of those (Chicken Pox, Acute Diarrheal Disease, Respiratory Tract Infection, and Mumps) being confirmed by health authorities. The project demonstrated that new ICTs can dramatically reduce turnaround time for outbreak detection and alerting, from current period of weeks to a matter of days or even hours. The project also demonstrated the feasibility of using low cost mobile phones and existing commercial cellular infrastructure and services to enable affordable, real-time reporting of patient records from frontline health centers.

Overall results from our work demonstrate the feasibility of introducing an RTBP from a technical and operational standpoint. Initial findings show significant efficiency gains in terms of disease reporting, outbreak detection, and health alerting; with cost savings over 35% in both countries when compared to the existing systems. However, further research is needed to better understand the challenges associated with scaling such a system up to a regional or national level of implementation. In particular, further work needs to be done to optimize data entry over low cost mobile devices, to address usability and training requirements for the analytics platform, and to continue to enhance and integrate health alerting into national and regional systems and practices. Moreover, extensive stakeholder consultation will be necessary to ensure the various policy, legal, and operational implications of a national or regional RTBP are better understood, addressed, and effectively managed in the future.

It was a tiring and exciting experience but helped towards change adaptation whereby health professionals in the respective pilot countries were exposed to new ways of public health maintenance. I am delighted to have developed the proposal, gotten funding, and directed the project in achieving in terms of important empirical findings on the usefulness of this type of system, as well as achieving impressive outcomes around the greater adoption of the RTBP.

This project was made possible through a grant from the International Development Research Center of Canada. This project recently ended in December of 2010. This blog is to share the final technical report with researchers and practitioners.

Click to view the Real-Time Biosurveillance Program Final Technical Report.

mobiles in support of Sentinel Site Surveillance

Sentinel Site Surveillance procedures are a popular public health practice in many countries, including Sri Lanka. Priority health data communication, case site investigations, and statical reporting are the key preliminary operations. The present day paper based procedures do not provide the much needed timeliness in completing these tasks.
The Real-Time Biosurveillance Program (RTBP) is a pilot project designed and lead by LIRNEasia. The pilot which ends in December 2010 showed promising results to the extent that the Wayamba Provincial Director of Health Services (PDHS) has expressed interest in scaling the project from a dozen hospitals to all fifty hospitals in the pilot district, with the aim of nationalizing after studying and rectifying the scalability issue. The mobile health software developed for the project was a simple application that digitized the optimal set of outpatient and inward data: case date/time, location, gender, age-group, disease, and syndrome. However, it was not designed to address the standard operating procedures of the legally mandated surveillance and notification.

Now the RTBP project is looking for external funding to enhance the RTBP developed mHealthSurvey mobile phone software to adapt to the functional requirements of the Sentinel Site Surveillance program. This would require adding some logic in to the mHealthSurvey or other to capture the H544 attribute information if the patient record is a notifiable disease. One option we are looking at is using OpenRosa XForm technology to make this adjustment.

Knight Foundation selects Citizen Journalism via Mobile Services concept

Each year the Knight News Challenge Contest funds innovative projects that couple media with information communication technology that empowers local communities. The Mobile Service Platform (MSP) revenue share model for Citizen Journalism was selected for the second round to submit a proposal for the 2010 Knight News Challenge. The timing couldn't have been any better. I'm really excited in making this happen. The project partners are - Lanka Jathika Sarvodaya Society, Center for Policy Alternatives, Uniphore, Rural Technology and Business Incubator, Internews, and LIRNEasia.

Optimally transporting XML through SMS for CAP Messages - How can it be done?

While working on my presentation titled "Common Alerting Protocol" (CAP) for the ITU Workshop in Kedha, Malaysia and experimenting with the Sahana Messaging/Alerting Module in preperation for a demo for the workshop participants, I questioned, "is there a method already in place or how does one optimally send an XML file through the SMS transport. Of cause this is in relation to transporting a CAP message with the underlying XML data storage and transfer standard through the SMS transport technology.

One would say, "why bother with SMS just transport it through GPRS or any other advanced mobile data service platform transport layer. There are advantages that SMS offers and GPRS does not; a key advantage being SMS is always ready to receive messages (i.e. data can be pushed on to) provided the handset is turned on; where as GPRS must be user initiated where the data must be pulled. For the purpose of "alerting" SMS surpasses GPRS with the mentioned advantage. It is also possible to house a an applet that resides on the handset and uses GPRS to periodically fetch newly posted WAP alerts.


Obviousely all one needs to do is insert the XML formatted text including the tags, header, etc in an SMS text and send it to whomever they want. The dilemma is in the payload. The XML formated text in the image above has 520 characters with white space and 421 characters without white space. The 520 characters would fit in to four 8-bit encoded SMS pages. Cost of an SMS is proportional to the number of SMS pages; unlike GPRS which is billed by the number of bytes (or kilobytes). More so, the intent of CAP being mass alerting efficiency is compromized with the size of the payload. Hence the key question is "how do we minimize the payload of a CAP message transported througg SMS to maximize the efficiency and the effectiveness?"

For a targeted application such as one that would display a CAP message could be designed to include only the necessary and sufficient (tags), which are yet to be determined by experts and remain an open problem. Let us assume the CAP SMS text carries the <incident>, <scope>, <status>, <msgType>, <category>, <event>, <urgency>, <severity>, <certainty>, <areaDesc>, and <resourceDesc> tags. The mobile phone application would be designed to read these tags and display on an interactive mobile phone GUI. The GUI would give the recipient the option to change the predefined values such as the <msgType> from the received value of "Alert" to "Ack" and reply to the sender. Assuming the alert was issued through a software such as the Sahana Messaging Module, which has a feature to store replies and produce a consolidated report, sender could match those who had received and acknowledged the alert.

I anticipate the need to transfer XML files on to mobile phones will become a must with standardization and interoperability. The revers or the dual exists; thus XML encoding for SMS. Any one interested can find technical literature on IBM's developer works Tips.

Mobile platform revenue share model for citizen journalism in Sri Lanka

The research question is "can the mobile service platform revenue sharing model be catalyst to advocating a sustainable citizen journalism program in Sri Lanka?". The previous article on "audio content production and deliver is the first step to instigating citizen journalism" talked about the Sarvodaya initiative to build capacity in rural Sri Lanka for enabling a platform to hear the voices of the rural communities. Given the cost of mobilizing such an endeavor it is best to begin with audio productions.

I'm writing a research proposal that aims to use an Interactive Voice Response (IVR) system with touch tone and voice through a normal phone call and Podcasts through a website (specifically WAP enabled) over the GSM mobile service platform. IVR would work over the voice channel but the dilemma lies in the Podcasts over GPRS. Given the coverage strengths in Sri Lanka it is debatable whether the Podcasts would work.

As in most cases the emphasis in applied research (or action research), besides answering the system robustness question, is answering the sustainability question. As a result it is hypothesised that a revenue share scheme would advocate for such system to live long. The revenue share model over the content business value chains (Joader, 2007) establishes a proportionate sharing scheme between the content-creators, content-owners, aggregators, vendors, and the network-providers.

There are already aggregators such as Kongregate, Youtube, Digital Journal, etc that provide platforms for content-creators to cash in for their creativity. In Sri Lanka the mobile operators are apprehensive to sharing revenue with service providers. The research intends to partner with a mobile operator such as Dialog Telekom who has the largest mobile market share in Sri Lanka and is investigating ventures that will use their technologies such as delivery of the news paper Lankapuvath over SMS and IVR.

The research design will look at a sample of 10 governing districts in Sri Lanka and through a series of awareness campaigns recruit content-creators and subscribers. Thereafter, let the system determine the survival of the fittest; where the creative, interesting, subscriber centric content-creators will profit from the system and the weaker ones will disappear. The assessment will group the data on the urban/rural divide, language, religious preface, and gender. The publications will be categorized in to current affairs, culture, philosophy, education, and entertainment based on a probability measure distribution; where a publication on the topic of "child primary schooling" may fall into the categories of current affairs and education with a distribution of 0.70 and 0.30, respectively. Both a subjective and objective assessment schemes will be implement to qualitatively and qualitatively assess the evidence of the viability of the technology, human aspects, and policy implications.

Comments are welcome on any literature available in this area, research methodologies, and implementation schemes or even knowledge on other projects of similar nature.

Healthcare Worker based mobile Sensor Systems

The aim of the real time biosurveillance program is to mobilize Healthcare Workers in the rural settings with mobile phones to record and submit patient counts for the purpose of consolidating national health data for surveillance of unusual patterns (headsup). Problem that this real-time biosurveillance program (RTBP) promises to solve is to strengthen existing disease surveillance and detection communication systems, reduce latencies in detecting and communicating disease information, and set a stand interoperable protocol for sharing disease information with national and international health-related organizations in the region.

My role in the RTBP is working in the capacity of a Researcher and Project Director. The grant has been approved by IDRC but the administrative work remains to be completed before funds can be transfered and work can begin

RTBP shares many similarities with the small study working in (somewhat) rural Tanzania focus on guiding health care workers through medical algorithms, with the primary goal of improving care and the secondary goal of collecting data. In particular, it is automated with the IMCI protocols for classifying and treating childhood illness. If you are interested, an online paper titled "e-IMCI: Improving Pediatric Health Care in Low-Income Countries" describes the project and lessons learned.

The design of RTBP using mobile phones is in par with this abstract from the IEEE Internet Computing article titled - The Rise of People-Centric Sensing - "Technological advances in sensing, computation, storage, and communications will turn the near-ubiquitous mobile phone into a global mobile sensing device. People-centric sensing will help drive this trend by enabling a different way to sense, learn, visualize, and share information about ourselves, friends, communities, the way we live, and the world we live in. It juxtaposes the traditional view of mesh sensor networks with one in which people, carrying mobile devices, enable opportunistic sensing coverage. In the MetroSense Project's vision of people-centric sensing, users are the key architectural system component, enabling a host of new application areas such as personal, public, and social sensing."

QR Codes for Health Information Exchange

Yesterday night's skype meeting with Gordon Gow brought forth the idea of using QR codes to code and decode health information in relation to the next research in many aspects, a research him and I plan to start shortly; i.e. the RTBP. Refer to his blog for a note on QR Codes and application for mobile phones for emergency managers - Barcodes meet cellphones: intriguing possibilities.

The Real-Time Biosurveillance Program (RTBP) is a research that envisions pilot testing mobile phones for collecting health-related information and applying AutonLab's suite of statistical data mining algorithms for fetching anomalies in the health datasets. The Healthcare-Workers will be provided with mobile phones and a Java application, a rendition of openROSA suit of applications. Indian Institute of Technology - Madras will be developing the mobile applications.

The health information will be mostly patient counts with similar symptoms. We discussed the possibility of using QR codes during transport and storage of information:

1) the Healthcare-Worker recorded data on the mobile handhelds can be encoded as a QR Code prior to transmitting the information to central repository (database). Since the QR Codes use the Reed-Solomon error correction method the misinterpretation of health information during transport and storage is further reduced


2) Given, that a QR codes are already encoded in binary form, the possibility of increasing the speed of the statistical data mining algorithms are worth testing


3) encoding communicable diseases and other known diseases with symptoms in QR Code form printed as hard copy for Healthcare Workers to use for entering information by simply scanning the QR code with the mobile phone camera instead of typing the lengthy string with the possibility of misspelling


4) In the event the Java application residing on the handheld fails the Healthcare Workers can use the hard copy QR code version to scan predefined health information strings to record the information on the handheld, then use Email, MMS or SMS to transit the information over any technology that allows the standard Email, SMS, MMS applications, making it easier for the database to also decipher and parse the information before storing in the relevant attributes (fields)


5) The Healthcare Workers can store the patient information in QR Code form as a hardcopy as a backup. Since it is in a human unreadable form the possibility of an unauthorized random individual reading the confidential patient information is null


These are thoughts that came up during our discussion and look forward to testing the concepts with the RTBP.