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Mobile software reinventing healthcare in developing world

EpiSurveyor is now the most widely adopted open source mobile health software in the world, technology that is not only saving lives, but also changing the face of the public health system worldwide.

Merging Dr. Joel Selanikio's expertise in the areas of computer science, medicine and public health with his business partner's background in technology spurred the development of a sustainable mobile software tool to aid in disease surveillance and the collection of public health data in developing nations. EpiSurveyor has been officially established as an electronic data collection standard by the World Health Organization.

"Unfortunately, until now very few people have looked at cell phones as a capable computing platform, and so the advance on the computing side hasn't been as dramatic as that on the communications side," Dr. Selanikio said.

"For the purpose of public health data collection and analysis and reporting (for which you could read ?public health knowing what the heck is actually going on with the health of the population'), we aim to change that by using mobiles as the computers they truly are: allowing mobile data collection, wireless data transfer, instantaneous analysis and reporting, and many other features that will increase the speed and the accuracy of the systems by which the healthcare system provides for distribution of lifesaving medications, training of health workers, reporting of diseases, investigation of outbreaks and many other things," he said.

Public health, like any large-scale enterprise, depends on good data to operate effectively: decision makers need to know what problems affect the population (e.g., what percentage of the population is infected with HIV?), how well their solutions are working (e.g., what percentage of children were actually vaccinated last year?), and how their system is operating (e.g., what percentage of clinics have run out of essential medications each month?).

All of that information must be collected systematically by means of surveys, usually on paper.

EpiSurveyor has so far done one thing very well: It allows public health workers to more efficiently collect that data.

Before EpiSurveyor, you had two choices for data collection: collect it slowly and inefficiently, but cheaply, on paper, or collect it rapidly and efficiently on mobile devices, after spending tens or hundreds of thousands of dollars on consultants and programmers to manage the process.

"With EpiSurveyor, we eliminate the consultants and programmers, allowing any public health worker to easily create efficient data collection systems," Dr. Selianikio said. "The terrible choice between paper and expensive computing has been replaced by the ability to use computers inexpensively and effectively."

EpiSurveyor is a free, open source software package that enables health workers to quickly and easily create data collection systems on mobile devices.

Health workers in Kenya were the first to be trained in EpiSurveyor; in 2008 the Kenyan Ministry of Health budgeted more than $100,000 towards the purchase of PDAs and the training of nearly every health officer in the ministry.

The Lemelson-MIT Program has named Dr. Selanikio as the recipient of the 2009 $100,000 Lemelson-MIT Award for Sustainability in recognition of his accomplishments in public health and international development.

Dr. Selanikio, co-founder of DataDyne and assistant professor of pediatrics at Georgetown University Hospital in Washington, DC, will accept the award and present his innovation to the public at Massachusetts Institute of Technology (MIT) during the Lemelson-MIT Program's third-annual EurekaFest, a multi-day celebration of the inventive spirit, on June 24-27.

Improving methods of data collection
Dr. Selanikio became devoted to improving data collection in public health while working as a U.S. Public Health Service officer at the Centers for Disease Control and Prevention.

He found that existing means of data collection for disease surveillance and immunization programs were inefficient -- health workers carried hundreds of thousands of sheets of paper to the field, a process that was inconvenient, expensive and environmentally unsound.

Moreover, after the paper forms were filled out, the data would need to be manually entered into a computer system for analysis, which could take more than a year; this paper-based system severely hampered the ability for health organizations to evaluate the success of their programs and move quickly in battling disease outbreaks.

With the proliferation of mobile phones and personal digital assistants, Dr. Selanikio recognized the potential of handheld computers in dramatically improving the data collection process.

He set out to develop software that was extremely simple to use; taking the skills, expertise and capacity that previously came with hiring a consultant and instead, put the necessary tools into the hands of the actual public health officer, nurse or physician.

Dr. Selanikio was determined to make the software both free and open source so as not to raise barriers to data collection.

Lowering the barriers to high-quality data
It is uncommon for most citizens in developing countries to own desktop or laptop computers, but the use of mobile technology continues to grow, with 64 percent of all mobile users living in developing nations.

Dr. Selanikio and his partner, technologist Rose Donna, formerly of the American Red Cross, co-founded DataDyne, a nonprofit devoted to information and communication technologies for public health and development, to capitalize on the prevalence of this hardware as the platform for EpiSurveyor.

This free software package, which can be downloaded onto handheld mobile devices, lets health workers become fully self-sufficient in programming, designing and deploying health surveys, eliminating the need for costly outside consultants, paper and manual data entry.

EpiSurveyor enables full cycle data collection from surveillance of diseases affecting populations, to evaluating treatments, to monitoring the success of treatments in preventing outbreaks and improving health.

In Africa and across the globe, EpiSurveyor is enabling thousands of public health officials to have a clearer knowledge of priorities, successes, problems and the future path of public health, according to the Centers for Disease Control and Prevention.

Revolutionizing global public health
It was once unheard-of for developing countries to collect their own national-level health statistics.
This process is now becoming routine and economical thanks to the EpiSurveyor technology.

In partnership with the World Health Organization and participating ministries of health, DataDyne and the United Nations Foundation and Vodafone Foundation Technology Partnership are currently training and equipping health workers in more than 20 sub-Saharan African countries with the tools to make smart decisions about critical public health issues, making it easier to combat deadly diseases and save lives.

Already, EpiSurveyor has had an enormous impact in Africa; playing a role in the hugely successful Measles Initiative for measles vaccination, which has helped reduce measles deaths by nearly 90 percent in Africa since 2000.

In Zambia and Kenya, the EpiSurveyor software has streamlined the inoculation of children against measles, provided new information on HIV and even helped to contain a polio outbreak.

EpiSurveyor is currently being used in Kenya, Ethiopia, Ghana, Senegal, Zambia, Burkina Faso, Sierra Leone, Uganda, Cameroon, Benin, Madagascar, Rwanda, DRC.

Heathcare workers are being trained over the course of 2009 in Togo, Mali, Cote d'Ivoire, Liberia, Gabon, Burundi, Botswana and Swaziland.

"Wireless/mobile technology, which is still in its infancy, is transforming the healthcare industry," Dr. Selanikio said. "But more than that, it is providing a general revolution in access to information that I believe will rival that created by the printing press."

Until now only a very small percentage of the world's population has had access to the world's knowledgebase, or to communications tools to allow them to speak to one another over distance, or to computing power to allow them to create and disseminate their own information.

"The mobile phone combined with the Internet is changing that in ways that we can only begin to appreciate -- just as no one watching Gutenberg demonstrate the printing press in 1440 could have been expected to understand the world-changing impact that that device would have on mass literacy, mass democracy and social change," Dr. Selanikio said.