instedd: tools for outbreak epidemiology

Presentation prepared for the 2nd International Conference on

Global Health Applications of Handheld Computing Devices Atlanta, Georgia, USA – November 24-25, 2008

InSTEDD Tools for Outbreak Epidemiology

Taha Kass-Hout, MD, MSand

Eric Rasmussen, MD, MDM, FACP

2nd International Conference on Mobile Computing Devices November 24-25, 2008, Atlanta, Georgia, USA501c3 NGO

2nd International Conference on Mobile Computing Devices November 24-25, 2008, Atlanta, Georgia, USA

Slide 3

We create (or find) free and open-source software

for collaboration toward collective action.

We then teach other people how to create it for themselves


Slide 4

Questions in outbreak epidemiology

What information

isn’t getting to

those who need it?

Which groups should be making more decisions

together?

What field reports and broadcast alerts should come faster?

Which systems

need to share

information?

Collaboration…

How much can we learn from

what we already have?


Slide 5

Refugee trauma management

Cholera outbreak

Katrina response

In our view, collaboration in outbreak epidemiologyis THE critical task.


Slide 6

1. Problem

– Agencies can’t (or won’t) communicate effectively in crisis

• Requirements for the technical problem

– Software that is effective, free, standards-based, easy to use, sustainable, and thoroughly interoperable

• Specifications

– Must have voices from WHO, US-CDC, UNICEF, MoH, OCHA, UNOSAT, ISDR, Relief Web, and many more involved in the design

4. Development

– We’ve built four free and open-source tools as prototypes for improved collaboration in crisis. They address the gaps we identified.

• Implementation

– Field evaluation in progress with all four, plus a website now up

– Educational model for introducing disruptive technologies

Collaboration pathway

What we need to see… A young village health worker on her rounds finds a bleeding mother and

two children. The man is missing.

She sends an SMS with the location, an explanation, and the tag “bleeding”, then isolates the home

The SMS is received and triggers a cascade of events, including the dispatching of a Rapid Response Team and notification of both the Health Minister and the health worker’s nearest hospital.

The health worker receives an SMS telling her the message was received, and providing urgent management advice for suspected hemorrhagic viruses

The SMS from the health worker appears in a stream of messages that include recent monkey smuggling, and food insecurity leading to harvesting bushmeat. It is spotted by the surveillance software bots, combined with other information, and hypotheses are proposed.

A team of MDs, nurses, vets, logisticians, and others work together to plan and implement a response, entering information only once.

Slide 7


The InSTEDD Collaboration Suite

1. GeoChat

2. Mesh4x

3. Riff

4. ( RNA )

5. www.TrackerNews.net

6. Innovation Lab

All free andopen-source(and working names…)


When that village health worker finds a bleeding family…

• (GeoChat) She has to notify someone

– And others need to learn of the problem

– The health worker needs to know she’s been heard

• (Mesh4x) Spreadsheets, maps, and databases need the information

– Synchronized as changes are made to ensure a common picture

• (Riff) A team needs to evaluate the significance, and they need context to sort it out

– They need to see each other and what else is known

• (RNA) Decision-makers need tools for event detection, hypothesis testing and planning

– Human and machine based decision support


GeoChat

Mobile-based reporting with (some) language support

Web-based mapping, mining, and chat

Vertical and horizontal alerts

– Multiple levels, multiple groups

Geo-tagging and topic tagging

Any cell phone that can use SMS

96% of the world’s ISPs now supported

Slide 10

Joining a GeoChat group in Cambodia


GeoChat


GeoChatmessages


Mesh4x:Imagine an outbreak response in the field…

Lots of information collected, working with many partners

Political and collegial will to share, but

– Different software applications between agencies

– Little or no internet connectivity (many modes, very flexible)

Mesh4x lets you:

– Choose the information to share

– Identify the various applications holding it

– Identify the various computers holding it

– Synchronize it all, over multiple modes (even just SMS!)

− Excel, Google Earth, Access, ESRI ArcX, MySQL, etc.

Over to Taha…


Hybrid Disease Surveillance

Surveillance Systems

CaptureFilterVerify

Identified risksMandatory notification

Laboratory surveillanceEmerging risks

Syndromic surveillanceMortality monitoringHealthcare activity

monitoringPrescription monitoring

Non healthcare basedVeterinary surveillanceBehavioral surveillance

Environmental surveillancePoison centers

Food safety/water supply…

Domestic, NGOsField ReportsOpen Media SurveillanceInt’l Distribution lists

ProMed (Regular, MBDS, Spanish, Russian, etc.)

International agencies WHO, OIE, CDCNASA (e.g., remote sensing, weather, population migration, bird migration, population density, plant, animal)

Confidential/LimitedProMed (e.g., MBDS)International health regulation agencies (WHO, OIE, CDC, NASA)Threat bulletin (EWARN, ECDC)

Public disseminationNews, blogs, articles, Health ministry press releases websitesWeekly releases (Eurosurveillance)

Event MonitoringIndicator Based Event Based

CollectAnalyze

Interpret

Signal

Assess

Control

Disseminate

Alert

Investigate


Hybrid Disease Surveillance

Surveillance Systems

CaptureFilterVerify

Event MonitoringIndicator Based Event Based

CollectAnalyzeInterpret

Signal

Control

Alert

Feedback Feedback

Det

ectio

nR

esp

onse


• Riff is a next-generation information browser

• GeoChat messages show up there, with HealthMap (ProMED), Google News, email…

• When a concerning message appears, teams can join in

• Regional health officers, CDC, parasitologists, vets, HAZMAT teams

• Tools are included in Riff for letting teams enhance information

• Commentary, annotation, analysis, tagging, geocoding, reliability…

• Cognitive analytics built in for collaborative decision support. (RNA)

RiffRiff is a collaboration browser


Slide 17

Information streams……with collaborativespaces…and cognitiveanalytics

Seven syndromes and 10 transmission modes> 100 infectious diseases> 180 micro-organisms> 140 symptoms> 50 chemicals

Timeliness, Representativeness, Completeness, Predictive Value, Quality, …

Machine learning methods:

• Support Vector Machines

• Clustering

• Entity extraction

• Neo-Bayesian analysis

• Satisficing

• Hypothesis testing (HMM)

• Relationship suggestions


Slide 19

In Southeast Asia

Invited by Mekong Basin Disease Surveillance Network (MBDS) to support technology for surveillance and response

Started in Cambodia with CDC because Cambodia is the technology lead.

Supporting the entire region.


Innovation Lab( Physical space in Cambodia )

400 hour workplan

125 hour curriculum

Curriculum for ownership of InSTEDD tools and beyond

Neutral space for academia, Ministry, local NGOs, more

Dissolving silos – teaching as cross-functional teams

Capacity enhancement for IHRs and MDGs

Back to Eric…


TrackerNews.net


Open Mobile Consortium

South Africa

UNICEF

Robert Kirkpatrick is Chair

– InSTEDD CTO

~35 organizations

Standards and agreements

Slide 23


Slide 24

Further Information

[email protected]

[email protected]

+1-650-353-4440www.TrackerNews.net

taha.instedd.org

instedd: tools for outbreak epidemiology

Technology

mobile computing devices

health minister

health workers

young village health

improved collaboration

outbreak epidemiologyis

opensource tools

instedd tools