1. Caring for the world; one handheld at a time Low Cost Computing for Rural Health Care: From the Lab to the Real World Vish Anantraman, MD, MS

2. Caring for the world; one handheld at a time Who are we Boston based global Healthcare Informatics company Spin-off from MIT-Media Lab –Advised by Professor Sandy Pentland Founded in 2002 with seed capital from ConceptLabs Inc, CA People –Unique expertise in both healthcare and informatics –Pioneers in creating & executing appropriate health technology in rural India and South Africa –Passion to innovatively apply advanced technology to solve rural health problems

3. Caring for the world; one handheld at a time Vision Use cutting edge IT to solve the BIG problems of our times: »HIV/AIDS »Diabetes »Mental Illness Discover  Develop  Deploy Estimated number of adults and children living with HIV/AIDS, From 2001 to 2001 Source: UNAIDS/WHO/UNICEF September 2002

4. Caring for the world; one handheld at a time Genesis of a problem Over 300,000 healthcare workers Go door to door delivering primary healthcare Can we use technology to improve healthcare delivery in some of the poorest communities in the world ?

5. Caring for the world; one handheld at a time The Ca:sh project Ca:sh –Disease case management system for health workers in rural India Linux handhelds Population over 80,000 Over one and half years in operation Antenatal care, Immunization, Census records Ca:sh

6. Caring for the world; one handheld at a time Engineering for low cost Ca:sh – Palm OS version SD Card for HIPPA compliant patient data storage Additional drug order entry system Low-cost devices Robust database backend Ca:sh

7. Caring for the world; one handheld at a time Partnering locally for HIV/AIDS Counseling centers Africa Center 16 community based counseling centers 25,000 population resident adults to be tested in one year Cohort for HIV surveillance HIV Confidant ™

8. Caring for the world; one handheld at a time Sizing the problem HIV blood test results need to be stored confidentially Only patients to have access to results Obviate the necessity for re-testing Rapid, low-cost deployment Distributed nature of the counseling centers HIV Confidant ™

9. Caring for the world; one handheld at a time Our solution PatientsHIV counselor Africa Center – test results in SQL server Private Key Public Key HIV Confidant ™

10. Caring for the world; one handheld at a time Our solution Blood Collected for testing Patient assigned an ID (public key) and a password (private key) Encrypted result stored in database on server Encrypted result transferred to handheld Result given to patient by counselor HIV Confidant ™

11. Caring for the world; one handheld at a time The Technology Palm OS™ based devices. Data stored in a RSA public private key encrypted format Database synchronization to a SQL server HIV Confidant ™

12. Caring for the world; one handheld at a time Other Applications for rural health Medical guidelines engine for Palm OS™ – IMCI guidelines Field based survey toolkit GPS based patient tracking system for Palm OS™

13. Caring for the world; one handheld at a time Other activities of Dimagi DiabetNet™ –Wireless PDA based gaming for increasing disease compliance in Type I diabetics HiRoller –Wireless cell phone based voice analysis and measurement of impulsivity in Bipolar Disorder

14. Caring for the world; one handheld at a time Acknowledgments Media Lab Asia The Africa Center for Health and Population Studies All India Institute of Medical Sciences