Neal Lesh Computer science applications to improve health delivery in low-income countries.

My Story Mid-thirties computer researcher seeks more fulfilling career. Goes back to school then off to Africa. Discovers things are more simple and more complex than he originally imagined. Can't imagine doing anything else...

Thesis It is increasingly possible to apply computer innovation to improve health care delivery in low-income countries.

Who are you? It is increasingly possible to apply computer innovation to improve health care delivery in low-income countries.

What’s in this for you? Taste of global health Confidence that information can help Two examples Patient record systems for AIDS treatment Medical algorithms on handhelds Cautionary cartoon

Global Health Puzzle CanadaMexico Deaths per 1000 per year (2003 est.) Is Mexico healthier than Canada?

Older populations are less healthy!

Risk Factor for surviving the Titanic. % survived Poverty as a

Global Health

Simple Story $$$$$$$$$$$$$$$$ $ Infant mortality: 5 per 1,000 births Maternal mortality: 8 per 100K births Life expectancy: 78 years Infant mortality: 95 per 1,000 births Maternal mortality: per 100K Life expectancy: 45 years

Simple Story $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$ $$$$

Simple Story “We are the first generation that can end poverty.” - Eveline Herfkens, UN Millennium Campaign

Complexity Corruption, careerism, tax write-offs 5-star poverty alleviation meetings Unintended consequences, e.g., paying volunteers Imperialism & foreign experts “If you want to build a ship, don't drum up people to collect wood and don't assign them tasks and work, but rather teach them to long for the endless immensity of the sea.” – Antoine de Saint-Exupery

Information as Care Study: rigorous application of standard treatment protocols reduced in-hospital mortality in children’s malaria cases by 50% Clinician’s complaint: where are my lab results?! Patient Knowledge Example: five danger signs for seeking care during and after labor.

Roadmap Taste of global health Confidence that information can help Two examples Patient record systems for AIDS treatment Medical algorithms on handhelds Cautionary cartoon

One year later AIDS Treatment in Rural Rwanda

One year later Improving Health Systems

One year later Infrastructure

Electronic Medical Record (EMR) Patient Monitoring Reports Clinicians & Patients Managers EMR Staff Paper forms Program Monitoring Reports Funder & government reports $ Re-allocate resources

Patient Monitoring

Unsuccessful Report

Successful Report

Unsuccessful Report

OpenMRS Open source framework for medical record systems

Data Quality Mistyped IDs Missing & conflicting data Backlog Potential solution: point-of-care systems

Roadmap Taste of global health Confidence that information can help Two examples Patient record systems for AIDS treatment Medical algorithms on handhelds Cautionary cartoon

Rural Dispensary in Tanzania

Standardized Care (IMCI)

Tanzania: underfive mortality was 13% lower in the two IMCI districts Source: Schellenberg J et al Full IMCI in HF End of study 13% difference 95% CI: -7%, 30% Significant impact on stunting

Deploying IMCI IMCI – Shown to reduce mortality and morbidity – Adopted by ~100 countries But uptake not as good as hoped – Training expensive – Correct use tapers off over time – Supervision challenging

How Automate IMCI?

Why Automate IMCI?

Improve adherence Improve supervision Easier to update More sophisticated protocols Reduced training

Field Work Results to be published in CHI’08

Viral Training

Adherence Results Investigation Current practice adherence e-IMCI adherence p-value Vomiting66.7% (n=24)85.7% (n=28)- Chest indrawing75% (n=20)94.4% (n=18)- Blood in stool71.4% (n=7)100% (n=3)- Measles in the last 3 months 55.6% (n=9)95.2% (n=21)< 0.05 Tender ear0% (n=1)100% (n=5)- All61% (n=299)84.7% (n=359)< 0.01

What are we going to do today, Brain? The same thing we do every day, Pinky…. Make a plan to TAKE OVER THE WORLD!!!!!

Thank you!