New Mobile App to Speed Sharing of Trachoma Data From the Field

 

Alex Pavluck is an epidemiologist and senior manager of research information technology at the International Trachoma Initiative and the Lymphatic Filariasis Support Center at the Task Force for Global Health. He worked in research for years, and prior to that was a software developer and systems engineer.  At the Task Force, he blends those skill sets to develop technical solutions to public health problems. Recently, he has been testing a mobile phone application that also works on electronic tablets to streamline data collection in the field and analysis in the office.

Trachoma Matters interviewed Alex about how the mobile phone app works and what it means for NTD control programs.

Q.  Today we’re going to talk about the new mobile phone app that, in our case, is being used to map trachoma. How would you describe it?

A.   The mobile phone application, called LINKS, is a tool based on the open source tool called Open Data Kit. By using open source we are able to take that tool and adapt it to our own purposes. It should take about 5 minutes of training in order to be able to use the tool. We’ve extended it to include a robust reporting backend so that the data can be sent via the cellular network or WiFi network to a web-based system that will automatically summarize, error check it and map it.  These backend tools are also built using free, open source applications, keeping the cost to implement this type of system low.

Q.  So, the mobile phone app works on a smart phone?

A.   Yes, the mobile phone application works on Android operating systems, which is a Google managed, but open source, operating system. It runs not only on cell phones but on tablets as well. We wanted to build it on something that would be able to be implemented on many different products. By using Android we are able to take advantage of the fact that there are many different handsets that run the Android operating system, giving us flexibility in terms of price as well as technology.

Q.    How does the mobile phone app change the way health workers will collect and report their findings?

A.   We’re hoping that use of this tool will make data collection faster and easier for teams doing difficult work in the field. We tried to take the technology out of the way and make it nearly transparent so the focus can be on the data. The data can be collected, transmitted immediately and summarized to the website instantaneously.

 

In Amuria, Uganda, healthcare workers collect data for Lymphatic Filariasis. At left, two workers enter demographic data into a cell phone. The same mobile app can be used to collect trachoma data. (Photo by Rebecca Mann for ITI)

Q.    Is it accurate to say this new technology is replacing paper and pencils, and that now health workers will record data in the mobile phones when they are in the field?

A.   Yes, its accurate to say the mobile phone is replacing paper, but it's a slow process to get there. Although wireless service in the United States is fairly ubiquitous and it’s becoming more ubiquitous throughout the world, we’re not quite there yet. But rather than waiting until we were there and trying to play catch-up, we’re trying to keep pace with technology as it advances. So we feel that this system is replacing paper and that trend will only increase.

Q.    Do you think this mobile app is a game-changer in terms of how health data will be collected in the field, then analyzed and reported?

A.    I do think this system is a game changer. The reason why is not necessarily this tool, but the more general ability to take the data from being stuck in some local electronic system or a stack of surveys on somebody’s desk or office in some remote location. It can be sent immediately to a central server that can make the data widely accessible to many people who can review the data as its being collected. This allows managers to manage projects off-site. This allows donors to see the progress of multiple projects around the world. This allows changes in strategy based on the data you are seeing as the data is being collected.

Q.   How do you know the mobile phone app will work?  Has it been pilot tested?

A.   We’ve deployed this for the last year to 19 different countries around the world. With partners as well as ourselves. We deployed it to 10 countries for a Gates Foundation grant to collect data on Lymphatic Filariasis. CDC has deployed it to five different locations under multiple leading departments, as well as deployed by Washington University at St. Louis.

Q.   How will it work if the health workers cannot get a cell phone signal when they are in the field?

A.    We’ve seen situations in which workers were not able to get cellular connections. This happened most recently on an island in Indonesia. The phone has a large amount of storage built into the device. It’s actually an external card to the device. If the device itself falls and breaks you can take that card out put it into another phone and all of the data still exists. That card has enough storage to allow for data collection for the entire project. If they are not able to send the data daily, or weekly or even monthly …the project can continue but without being able to send the data from the device that collected it. So there will be some lag in reporting for the people who are using the website to review the data, but the progress of the data collection itself will not be hindered by the lack of cellular connectivity

Q.   If a country wants to use this system, what is provided? Do you buy the phones for them as well as the cards?

A.    Typically, when we work with a country, we provide the equipment. It’s often as a loan for the duration of the project. The phones come preinstalled with the applications to collect the data as well as the surveys that they are going to be needing. The cellular service comes from whichever provider within country happens to provide the best access within the area where we are working. We work with the country to identify that provider.

Q.    Where will the mobile app be used first?

A.   For this project, the mobile app will be deployed to Ethiopia as part of a pilot test.

Q.   When do you expect to have the results back from that? How will you know if it worked?

A.   Well, one of the great things about this system is that we, as well as our partners around the world, will know if it worked after the first day of data collection. The data will come in, it will be summarized for that day’s activity and we’ll be able to review the data immediately from the central server.

Q.   So at any given time how many of these phones would be in the field. Let’s say when you do this in Ethiopia.

A.   That’s still to be determined. It will vary by the project size and the number of data collectors that project has. For example, we typically go into the field with 6 to 7 data collection teams. Each team has one phone.

Q.   So you feel pretty confident that this will work in the field.

A.   I have every confidence that it’s going to work in the field…the reason why I feel so confident about this is that it's a proven technology. We wouldn’t try to put some technology into the field unless we felt comfortable with it. We don’t want the frustration that will come with something that doesn’t work. We’ve kept things simple for the user. And by keeping things simple for the user, we feel that we’re going to keep the frustration of challenges that they might face to a minimum.