Tag: mobile

Developing an Analytics Dashboard for Maternal Care

Over the last few months, alongside the protocol forms the Health Extension Workers (HEWs) are using to record maternal care patient encounters on their smartphones, we have been developing an analytics dashboard to allow HEWs, midwives, their supervisors and the local health bureaus to track the progress of pregnant mothers, their medical & pregnancy risk factors, and a range of key performance indicators.

Providing information back to HEWs and their supervisors about their performance, we hope will help to increase the number of ANC visits according to the recommended schedule, and provide information for local health bureaus to better prioritize resources and training. The current performance indicators include the percentage of ANC visits made on time, number of protocols submitted, PNC visit made on time and immunization records for both mother and baby.

Analytics Scorecard home page

For the HEWs, we can also provide information about the upcoming appointments, deliveries to assist them to plan their time better. Guidelines from the Ethiopian Ministry of Health encourage all pregnant mothers to give birth at local health centres, so we can use the ANC visit information to inform local midwives on expected delivery dates. Local health bureaus and HEW supervisors are able to compare the performance between different health posts or districts.

We are trying to be careful that this doesn’t become used as a EMRS (electronic medical records system) – there are already plenty of MRS’s available – rather we are looking at ways in which the HEWs can see advantages to recording their patient visits on their smartphones, by providing them with relevant, timely and easy to understand information about the patients in their area. In the future we may look at how to integrate with an MRS system (e.g. OpenMRS), but currently this is not the focus of what we’re trying to achieve.

For the technically minded, the analytics dashboard runs by accessing the ODK Aggregate database directly. We’ve looked at several different data collection tools (especially those focused on medical information collection), but all would require either direct database access (as we have done with ODK) or extraction of the data via an API (which would generally mean exporting to another database then accessing the dashboard from this). We’re still in the process of getting the HEWs and their supervisors up and running with accessing all this information via the web application and smartphone – we also still have some development work to do. Currently our researchers in Mekelle are printing regular reports to give to supervisors and HEWs, also, as this is a research project, it’s important that all the information (from protocols) can be stored as a hard-copy with the rest of the normal patient records at the health posts.

We’re currently developing an application so HEWs are able to access their task/performance information directly on the smartphones – which will work offline when there is no GPRS connection available, and update automatically when a connection is available (most likely using an HTML5 application, rather than a specific Android application)

Screen shots from prototype mobile browser version (personal data has been pixelated)

Using a smartphone platform to deliver this type of information is a good balance & compromise between other platform choices we could have made. Using PCs/laptops/netbooks would involve much more technical support, training and maintenance, and likely to have other issues such as access to electricity, portability etc. Smaller, low-spec phones would not allow us to present the information in such a clear and easy-to-use way.

For those interested the code for the analytics dashboard is available to download from GitHub at: https://github.com/alexlittle/Digital-Campus-Analytics

Mobile Developer Challenge

Win an HTC Hero smartphone by taking part in our Mobile Development Challenge

Create an Android application to maintain a task/appointment list for Health Extension Workers on their smartphones to help them manage their maternal care visits.

Closing date: Saturday 18th February 2012

Requirements:

  • Needs to work with Android v2.2 and above.
  • Stores the task data offline, connecting to the server to update the task list regularly. Update [20 Jan 2012]: Just to clarify, following a couple of queries, there is no requirement for the application to submit data back to the server, the task list is generated from information submitted by the HEws using OpenDataKit regarding their patient visits.
  • The task list will require a username and password (as get or post parameters) and will be provided by the server in JSON format. This is an example of the structure of the data that will be returned by the server, you can use this link to test your application – this is the format your application will be judged against.
  • Code must be released under an open source license and made available on a publicly accessible code sharing site (for example Sourceforge, GitHub, Google Code)

Criteria:

  • Your application must meet all the requirements to be eligible for the prize.
  • You must be an Ethiopian national, currently living in Ethiopia, to be eligible to enter.
  • Your mobile application will be judged on:
    • code structure, quality, error handling and commenting
    • user interface design
    • features available (for example: highlighting overdue tasks, grouping by task type etc)
  • All code submitted must be original and your own work.
  • The judges decision is final.

Help to get started:
If you are new to developing applications for Android, here are some links to help get you started:

How to submit your application:
When you have completed your application, email the application package (.apk) file to alex@digital-campus.org with the following information:

  • Your name
  • Your employment/educational status (where do you work/study)
  • Contact details (email, phone/skype, website, address)
  • Url to where you have published your code.

For more information please contact: alex@digital-campus.org

Download a poster for the challenge to display in your organisation.

Health Extension Worker technical training

Last week I spent several days visiting the training Araya and Florida are running to show the groups of Health Extension Workers how they can use smartphones for data collection.

We first visited a group in Adi Gudem (about 30km south of Mekelle), they’ve had the phones for several weeks now, so are already familiar with them. The training revolved around them using an updated client application (we’ve also changed the server software to use OpenDataKit, but this ought to be invisible to the end users) and the new ante-natal care protocols that we’ve developed over the last few weeks. For the second group in Wukro (about 40km north of Mekelle), this was their first training session, so they’d not used the phones at all before.

All seemed to go well, we had a couple of technical issues that I need to look at this week – but this is to be expected given that we’re still in the technical feasibility stage, we won’t be starting the intervention study until early next year. One of the issues we’re still finding is the level of English of the HEWs – it seems likely that we’ll need to provide the protocol questions in both English and Tigrinyan.

Some photos from the training sessions (plus a few other pics):

OpenDataKit – entering dates in Ethiopian format

Some of the feedback we had from the initial HEW training last week was that some of the HEWs had difficulty in using the Gregorian calendar. Ethiopia has it’s own calendar which is the normal calendar used for the vast majority of Ethiopians (Ethiopian calendar entry on Wikipedia). Given that we’re asking the HEWs to collect date information, we need to make this as easy and understandable for them as possible – for example, to enter appointment dates a few weeks or months in advance. So over the past couple of days I’ve been looking at creating a date picker widget for integration into ODK Collect that will allow dates to be entered using the Ethiopian calendar format, but will store the date in the database as Gregorian. This transformation is hidden from the user and storing Gregorian dates in the database means we can manipulate and compare dates for reporting purposes, which we’d be unable to do storing Ethiopian dates as strings in the database (we can transform the dates back into Ethiopian calendar for final display).

It ended up being much more straightforward than I though it would be, especially with much help from the ODK Community and with the Joda Time java library already built into ODK Collect. I’ve got a first version ready for testing, so if anyone else is interested in having a look you can download the .apk file for installation on your Android phone.

To see the Ethiopian date picker working you’ll need to load up a form which specifies data picker. You can connect to our ODK Aggregate server at: http://hew-datacollect.appspot.com and download the EthioDateTestV1.5 form. Or you can download the original form XML to put on your own server.

This is only a first version, so any feedback is very welcome – or if you’d like the source code then please feel free to contact me (will put it up somewhere once I’ve tested it a bit more). [Update 19-Aug-11: I’ve now put all the code up as a clone on Google Code at https://code.google.com/r/alextlittle-dc-odk/, so you can see the full changes I’ve made.]

Finally, here are a couple of screenshots of the Ethiopian date picker running in my Android emulator:

Initial HEW training with smartphones

I just posted this up on our Digital Campus blog:

Last weekend Araya and Florida ran the first training course for Health Extensions Workers (HEWs) who will participate in our feasibility study. We are starting with a very small group of HEWs – just 5 in this first training session – and the 2 day training consisted of:

  • the basic functions of the HTC hero phones, contacts, making calls, messaging and switching between Amharic and English keyboard layouts
  • charging the phones using the solar lamps and chargers we provided – as most of the HEWs do not have electricity in their Health Posts
  • using the EpiSurveyor client application for entering and sending data, plus using the GPS
  • practice completing and sending the Ante Natal Care protocol forms set up in EpiSurveyor

This first training is simply to get the HEWs used to using the phones, find out what problems and issues they may have, especially with battery life, recharging, completing forms etc – at this stage we’re not looking to collect real data – though we hope they can practise using the forms with real patients.

The feedback we have received is that the training went very well, the HEWs seem very and eager to learn how to use the phones and soon became quite comfortable using them. Over the coming months we’ll introduce the phones to another couple of small groups of HEWs and we’ll find out what challenges may exist and the feasibility for using smartphones for protocol and data collection in this environment.

Installing Ge’ez Virtual Keyboard on Android Devices

Update (2-Jan-2012): more up to date instructions can be found here: http://alexlittle.net/blog/2011/06/03/installing-geez-virtual-keyboard-on-android-devices/

Instructions for installing a Ge’ez Virtual Keyboard on Android:

  1. Root your device – exactly how this is done will depend on your device and you’ll need to look up on Google how to do this – note that rooting is not the same as unlocking your phone, rooting means you get administrative privileges to update system files, such as the font files we’ll update below.
  2. Download the files DroidSans.ttf and RootExplorer-v2.15.apk and copy these onto the phone’s SD card (or equivalent)
  3. Install and run the RootExplorer application and go to the sdcard folder
  4. In rootexplorer, find the DroidSans.ttf file and copy it
  5. Go to the /system/fonts folder and push the button marked “mount R/W”, the button will the change to be marked “mount R/O”
  6. Paste the DroidSans.ttf file into this folder – replacing the existing DroidSans.ttf file. Leave all the other font files as they are. It’s probably a good idea to make a backup of the original DroidSans.ttf file first, before you overwrite it. Just rename the original file to (something like) DroidSans.ttf.bak.
  7. Now restart the phone and the new font will be installed
  8. Now to install the keyboard, download the keyboard apk file
  9. Copy this to your phones SD card and install the application
  10. You should now be able to switch between the standard and Ge’ez keyboards. You may need to enable the keyboard by going to: Settings -> Language & Keyboard then select check the box to enable the new keyboard
  11. To find out how to switch between keyboards, watch our video:

We have tested this installation procedure on a few different phone models, though obviously we can’t cover every possible phone type and can’t guarantee it will work for every device. If you have any problems/issues then please post a comment. We’d also be very happy to hear that it did work for you!

Data Collection using Smart Phones

InterviewGathering data from remote locations can be very time consuming, using paper based collection methods may mean it takes a long time for the data to reach those who are going to use or analyse it. Collecting accurate medical and epidemiological data is essential to get a true picture of the health of the inhabitants for resource planning and research. With the growth in availability and decline in cost of smartphones, these seem an ideal technology to help to improve the accuracy of data collected and vastly reduce the time taken for the data to reach those who need it.

Interviewing rural health workers

Key Facts

  • 64 rural health workers interviewed
  • Symbian and Android smartphones tested
  • better than expected GPRS coverage

Digital Campus is testing a variety of technologies for the collection of public health data to help determine which may be most suitable for application in the field. Working with PhD students in maternal health care an initial study to discover the possible challenges and options for using mobile technologies has already been completed. Over 39 health posts in 3 districts of Tigray (northern Ethiopian) were visited to interview the Health Extension Workers (HEWs) based there.

They were interviewed to try to determine their knowledge, training and experience in maternal health with a view to identifying any gaps in their knowledge and designing a programme to help fill these. Additionally, and crucially if a technology based solution is to be implemented, information regarding their technology experience and the infrastructure facilities (such as mobile reception and electricity access) was collected.

Fast and accurate data dissemination

All the data collected during the interviews was recorded on a smartphone using a questionnaire created using the episurveyor web application (a propietary but nice platform so far). Using the client software (installed on the actual phone), responses to the survey are recorded on the phone, as soon as an area with GPRS signal is reached, the data is automatically uploaded to the EpiSurveyor server, making it available to anyone (with the right permissions) around the world. Each record uploaded is automatically time and location (with GPS) stamped, making it possible it pinpoint exactly where and when the interview took place.

Rural health postOne of our initial concerns was that the GPRS coverage would be limited, perhaps only to large towns/cities, but in fact almost all the Health Posts had good GPRS coverage, even those where the villages didn’t have reliable electricity provision. Only a handful of very remote posts had no mobile coverage at all.

We used Symbian and Android based smartphones to collect the data, but in fact the EpiSurveyor client software will run on almost any java enabled phone. We are also currently setting up a more sophisticated platform based on the Sana community-based development MIT project, with the intention of developing it as a more powerful open-source mobile health platform , that will allow us not only to gather epidemiological data, but to use it for electronic clinical records, telediagnostic applications, decision support systems and posgraduate training

We are in the process of writing a detailed technical paper, describing in more detail the survey results and technology used, along with the main challenges and possible solutions to using smartphone technologies in this environment.

Next steps

Over the coming months we will provide a small group of Health Extension Workers with smartphones to determine what (if any) issues and challenges they face in using these and also to gain a clearer picture of how this technology could be used to improve their skills, training, data collection and reporting methods. Once the results from this pre-implementation phase are known, we will be in a position to design a larger scale programme.

Visiting Rural Health Posts

I have spent the past 4 days visiting rural Health Posts with my colleague Araya. His phd is looking at the gaps of the Health Extension Workers (HEWs), specifically related to maternal health. Once the gaps are known, the next stage will be to design a programme to fill the hole in knowledge/skills, possibly using technology to help deliver the training.

Altogether he’ll interview 150 HEWs at over 100 Health Posts in 3 districts in Tigray. Over the 4 days I’ve been out with him, he managed to interview 18 HEWs at 14 health posts. Each day has been long – leaving Wukro around 7 am and not returning until after 7pm, so 12 hours to conduct about 5 interviews, each interview lasting about an hour or more.

I’ve been helping with the technology support and will be helping look at what could be appropriate to use in this context. Not all the concerns I mentioned in my earlier post have been realised.

The GPRS coverage has been far better than I’d expected, out of the 13 posts we visited, only one had no mobile or GPRS coverage. A couple had patchy coverage – but it was working for some of the time during our approx 2 hour visits. This is really positive from the point of view of the technology we might like to use in the future.

However, none of the posts had an electricity supply. A couple had electricity poles running very close to the building, but they weren’t connected up. In most cases there wasn’t any electricity supply to the village at all.

My phone battery got to be a real problem for me, despite having wireless and bluetooth turned off, I found that battery was only lasting for about 8-9 hours. I was using the GPS quite a lot, but even on the first couple of days when I was only briefly turning the GPS on (to get the coordinates for the posts), this only gave me a couple of extra hours battery life.

All except one of the HEWs we met had a mobile phone. The reason for the one exception was that she worked at the post with no mobile coverage, so she’d given her phone to a relative. Which for me than raised the question of how they charge the phones given there’s limited power supply. The answer to this was that they must travel to the town to charge their phones (this could be a 2-3 hour walk), or they send the phones with someone else going to town.

The HEWs have very limited English (although much better than my Tigrinya), so delivery of any training materials must be in either Amharic or Tigrinya to have any chance of being effective. One of Araya’s questions is about their use of text messaging, many don’t use text messaging simply because they don’t know the latin alphabet well enough.


What I’ve seen over the past few days is only a small proportion of all the posts that Araya will eventually be covering, but it’s likely that the further interviews will reinforce what we’ve already found out – rather than raising any new issues or significantly altering the results to date.

Over the coming months (after some more of the interview have been conducted), we’d like to get the results from the technology aspects written up into a paper.

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