A month ago, on my way home to San Francisco, I stopped in New York for the weekend to visit some good friends. While I was there, Aaron came across this post in one of his professor’s blogs, mentioning an interesting talk by Neal Lesh. I went, and now I’m finally getting around to posting up my notes.

Dr. Lesh’s background is related to my latest trip to the Congo: he’s a computer science researcher who went back to get his Masters degree in Public Health, and then developed several information systems for the delivery of medical care in the developing world. He was one of the early contributors to OpenMRS, the software I was piloting in Goma.

Since everyone was working during the day, on Monday, I decided to head uptown to Colombia (Natalie was going in at the same time anyway) and sit in. He spoke about the challenges and opportunities for applying information technologies for the well-being of people in countries like Rwanda and Bangladesh.

The question for me, going forward, is how I can also bring my resources to bear on the world’s problems, if only a person-sized piece of them. I have some ideas which will hopefully solidify as I continue my work (remotely) with the OpenMRS pilot in Goma.

I took some rough notes of the lecture; they’re after the jump.

Neal’s talk covered the following projects that he had worked on:

• Health records system and alerts on drug regimens/rules (Rwanda)
• Medical Algorithms (i.e. automated diagnosis) on PDAs (Somalia?)
• Health information over cell phones (Bangladesh)

Inequity: even “Cadillac” systems such as ones Neal has worked on only amount to $30/capita, which would mean less than 1% of the wealth of the top billion transferred to the bottom billion.

As a foreign “expert” it’s easy to jump in and start assigning tasks. Instead, it would be better to instill in people the “longing for the expanse of the sea” (Moby Dick?)

Not just how to produce the info, how to get it used. This is the “Appropriate tech” of reporting:

• Best workflow has been with one-patient-per-line summary sheets (as opposed to just the page-per-patient that you might get with western systems.) Dr. Vindu’s records looked like this, as well
• Missed-visit list (a form of alert, I guess) to actually go to people’s houses to get them to come in.

Challenges/Points for further development:

• Data quality: processes for cleaning up data. Point of care systems/Process iussues.
• Use of reports to improve decision making (I2I, “Inform to Improve”)
• Integration of lab and pharmacy components
• Detecting important trends (machine learning on aggregate data)
• Uptake: expense of training, dropoffs in usage over time, etc.

Misconcepctions:

• Positive: People’s excitement about learning: There is very little resistance to new technology, in places where Dr. Lesh has worked. People see the benefit immediately.
• Neg: “Activation potential” around problem solving. People often defer to authority, wait for solutions from above, are unwilling to tackle unfamiliar problems that are right in front of them.

Sucks that you missed OpenMRS Implementers 2007…

Cool UI on the Atomated IMCI (Integrated Management of Childhood Illness) system on a PDA: sequence of questions; answered questions scroll upwards, become summarized, grey out. Back/Next buttons. Like a Wizard, but with some context like a form.

Other ideas:

• Social Messaging Over Cell Phones (Listen and learn, answer questions, take to family and friends for free!)
• Mapping really needed for NGO work (resources, patients: where is everything?)
• SMS Surveys: paper form, string of SMS code to submit results. Bam, mobile computing platform for your survey takers.

Related Posts:

• OpenEMR and OpenMRS (September, 2007)
• Making Progress! (September, 2007)
• Bloody Effing Hell (September, 2007)
• William Kankwamba, Malawi Maker (July, 2007)
• John Robb’s “Dissipative Systems” (June, 2008)

This entry was posted on Tuesday, November 6th, 2007 at 7:29 am and is filed under goma, personal. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.