Title: Improving Rural Healthcare Delivery via Transparent Monitoring Bill Thies Microsoft Research India
1Improving Rural Healthcare Deliveryvia
Transparent MonitoringBill ThiesMicrosoft
Research India
- In collaboration with Manish Bhardwaj1,2,
- Sara Cinnamon2,3, Goutam Reddy2,3, Emma
Brunskill1,2, - Somani Patnaik1,2, Seema Kacker1,2, Sourav Dey1,2
and Ajit Dash1,2 - 1Massachusetts Institute of Technology
- 2Innovators In Health
- 3Abiogenix, Inc.
- MEDITEL / December 20, 2008
2Microsoft Research India
- Established January, 2005
- Seven research areas
- Algorithms
- Cryptography, Security Applied Math
- Digital Geographics
- Mobility, Networks, and Systems
- Multilingual Systems
- Rigorous Software Engineering
- Technology for Emerging Markets
- Contributions to Microsoft
- MultiPoint, Netra, Virtual India
- Currently 55 full-time staff, growing
- Collaborations with government, academia,
industry, and NGOs in India
Microsoft Research India Sadashivnagar, Bangalore
http//research.microsoft.com/india
3Technology for Emerging Markets
Research Group Goals
- Understand potential technology users in
developing communities - Design and evaluate technology and systems that
contribute to socio-economic development of poor
communities worldwide - Collaborate with development-focused
organizations for sustained, scaled impact
Computer-skills camp in Nakalabande,
Bangalore (MSR India, Stree Jagruti Samiti, St.
Josephs College)
4Multidisciplinary Research
Society
Society
Group
Group
Impact
Impact
Understanding
Understanding
Individual
Individual
Bill Thies - Computer
science Saurabh Panjwani -
Computer science
Technology
Technology
Innovation
Innovation
5Microfinance Technology
IT and Microentrepreneurs
Sample Projects
Microfinance PC mobile Qualitative
studies Business analysis Research only
Microenterprise PC mobile Mixed-method
study Research only
Information ecology of very small businesses
Potential of technology to support microfinance
Kelsa
Featherweight Multimedia
Simultaneous Shared Access
Information access PC Qualitative study Usage
analysis Pilot
General education Electronics HCI User
studies Prelim research
Primary education PC HCI User studies Software SDK
Free access PCs for low-income office staff
Multi-user systems for educational
Paper and cheap electronics for low-cost
multimedia
Text-Free UI
Warana Unwired
Digital Green
Info systems Mobile Intervention Rural
kiosks Pilot
AgricultureVideo Intervention Control
trials Pilot
User interfaces PC Design User studies Guidelines
Video and mediated instruction for agriculture
extension
Substitution of mobile phones for rural PC kiosks
Text-free user interfaces for non-literate users
6Drug Delivery Last-Mile is Often Broken
?
DrugDevelopers
Distributors
Rural Patients
Local Clinics
- TB treatment 4 drugs, 6-8 months
- Worker supervises ingestion3 times/week (DOT)
- Rural programs operate in the dark
- Interaction Are workers reaching patients?
- Adherence Are patients taking medication?
- Health Are patients getting better?
Courtesy PIH
Courtesy PIH
Mission Track Interaction, Adherence, Health
7The uBox A Smart PillboxDeveloped by
Abiogenix, MIT, and Innovators In Health
- The uBox monitors
- Delivery, by logging worker visits
- Adherence, by logging pills dispensed
- uBox impact
- Worker supervision and incentives
- Timely and targeted intervention
- Lowers adherence burden
uKey (for worker)
uBox(for patient)
Patients
Workers
Clinic
8The uPhone Monitoring Patient Health
Worker enters vital patient health indicators
into cell phone
Nurseanalyzes data,identifies problems
Physician sends advice to patients,
schedules field visits
Patient lives in a remote area
9Is Technology Really the Answer?
- Often ignores systemic and societal issues
- But, delivery is overwhelmingly about diligence
- Today 2.4M doses/day, 187 countries, 77
reliability - Need 7M doses/day, 100 reliability
- FedEx 7.5M shipments/day, 220 countries, 97.7
reliability - Our goal is to reduce the burden of diligence
- Change the culture 85 is not enough
- Need to respond to every failed transaction
- Identify superstar workers early and replicate
techniques
10uBox Training
Bihar, Spring 2008 By MIT and Innovators In Health
- Class was proficient in lt 3 hours
- Overcame prototype shortcomings
- Gave very good suggestions
11uPhone Training
Bihar, Spring 2008 By MIT and Innovators In Health
- uPhone more challenging literacy and prior
cell phone experience needed - Lesson learned
- - Even with intensive training, many
errors on menu-based interface
12Evaluating the Accuracy of Mobile Data
CollectionWith Somani Patnaik and Emma
Brunskill, to appear at the 2009 International
Conference on ICTs and Development (ICTD 2009)
131. Electronic Forms Interface
142. SMS Interface
153. Voice Interface
16User Study
Gujarat, Summer 2008 Conducted by Somani Patnaik,
MIT
Evaluated three user interfaces - Electronic
forms - SMS - Voice operator Results -
Forms error rate 4.2 - SMS error rate
4.5 - Voice error rate 0.45 Other
benefits of voice - Easy to verify - Easy to
replicate - Less expensive These results
caused us to changeour program to use a voice
interface
17Conclusions
- Potential for simple technologies to offer
largebenefits for improving rural healthcare
delivery - Low-tech interfaces may be highest-impact
- uBox provides transparent interface
- Operator-assisted reporting better than automated
SMS, Forms - Most exciting aspects of work coming in next
steps - Can technology improve health outcomes in
controlled trial? - Is operator interface effective in practice?
Seeking additional partners!
18Innovators In HealthEnsuring Reliable
MedicationDelivery in the Developing World
- Community Partner
- Sponsors
- Prior Contributors
- Alex Krull
- Oliver Venn
- Jessica Leon
- Nikhil Nadkarni
- Catherine Dunn
The Prajnopaya Foundation
and manygenerous individuals!