1. Evaluating a Real-Time Biosurveillance Program – a pilot project Overview - Suma Prashant

2. Background Given the context & established need, strengthen existing disease surveillance build a robust detection communication systems reduce latencies in detecting and communicating disease information set a standard interoperable protocol for disease information communication Can ICT Tools be employed for automated monitoring of information sources of potential value in detecting an emerging epidemic?

3. SNoPartnerRoles and Responsibilities 1.IITM’s Rural Technology and Business Incubator (RTBI), Chennai Technology Development (India and Sri Lanka) and Implementation in Tamil Nadu (India) 2.LIRNEasia, Colombo, Sri LankaOverall Monitoring of activities in India and Sri Lanka. Implementation in Sri Lanka (Sarvodaya) Budget Liaison with IDRC 3.National Center for Biological Sciences (NCBS), Bangalore Interface with Health Department in India Data analysis using the data gathered and provide scientific advisory for scaling and future intervention all over India 4.Deputy Directory of Health Services, Sivaganga district Ground-Level Facilitator for Implementation of Project Active Participation in Project-Scale 5.Carnegie Mellon University Auton Lab, Pennsylvania, USA Research Partner 6.University of Alberta (U-of-Alberta), Edmonton, Canada Research Partner 7.Post Graduate Institute of Medicine (PGIM), Colombo, Sri Lanka Research Partner 8.Lanka Jathika Shramadana Society (Sarvodaya), Moratuwa, Sri Lanka Research Partner 9.Respere (LSF), Sri LankaTechnology Partner Partners

4. Objectives 1. Evaluating the effectiveness of the m- Health RTBP for detecting and reporting outbreaks 2. Evaluating the benefits and efficiencies of communicating disease information 3. Contribution of community organization and gender participation 4. Develop a Toolkit for assessing m-Health RTBPs

5. Components 1. Digitization of patient health data through mHealthSurvey using mobile phone 2. Detection of unusual events using T-Cube Web Interface (TCWI) 3. Sahana Messaging and Alerting Situational Awareness For Communicable and Non-Communicable Diseases

6. Our pilot in India and Sri Lanka (July 2008 – June 2010) INDIA 24 Health Sub Center Village Nurses 4 Primary Health Center - Sector Health Nurses, Health Inspectors, and Data Entry Operators 1 Integrated Disease Surveillance Program Unit of the Deputy Director of Health Services Thirupathur Block, Sivagangai District, Tamil Nadu, India SRI LANKA 12 District/Base Hospitals and Clinics 15 Sarvodaya Suwadana Center Assistants 4 Medical Officer of Health divisions & 1 Regional Epidemiology Unit Kurunegala District, Wayamba Province, Sri Lanka

7. About Sivanganga – Project Location o One of the backward districts located in southern part of rural Tamil Nadu in India o More number of villages are remotely located with insufficient transport facilities o 47 PHCs each covering 20000 population and staffed by several paramedical staff and medical officers o 275 HSCs each covering 3000 to 5000 population and staffed by one village health nurse

8. Integrated Disease Surveillance Programme at district level Primary Health Centre Health Sub Centre Director of Public Health and Preventive Medicine at state level RTBP vs Present system in India Patients Form P (Weekly) Form S & Morbidity report (Weekly) Both Form P & S (Monthly) Form P (Weekly) District hospitals, Private Hospitals/Clinics, Taluk hospitals, Medical college and others Morbidity report (daily) OPD & Nominal Register (daily)

9. Black arrows: current manual paper/postal system for health data collection and reporting Red lines: RTBP mobile phone communication system for heath data collection and reporting Sri Lanka Epidemiology and RTBP overlay Reduce 15 - 30 day delays to Minutes

10. Main Outcomes - Quantitative SN o ComponentsLaunch Date Status – INDIALaunch DateStatus – SRI LANKA 1patient health data through mHealthSurvey May 200987,700 recordsJan 20092,49,000 2T-Cube Web Interface (TCWI) Dec 2009Synthetic Injection - 3Dec 2009Replication Study with Data (2007- June 2009) 3Sahana Messaging and Alerting Dec 2009Exercise Conducted for 23 Health Workers Dec 2009Exercise Conducted for 19 Volunteers

11. Main Outcome - Qualitative 1. Digitization of patient health data through mHealthSurvey using mobile phone Mobile as a data collection device – usability and user preferences Quality of incoming data - error 2. Detection of unusual events using T-Cube Web Interface (TCWI) Web interface for real-time tracking of unusual events? Statistical Tools – Expertise Usability – “no usage” 3. SAHANA Messaging and Alerting Situational Awareness Alerting module for dissemination Authenticity Other delivery methods

12. Sl. No. TitlePeriod 1.Health workers meet in ThiruppathurNovember 24, 2008 2.Technology training workshop for Village health nurses/sector health nurses, Sivaganga district, Tamil Nadu, India May 4 & 5, 2009 3.Health event notification workshop for DDHS and PHC officials June 19 & 20, 2009 4.Certification exercise and demonstration of T- Cube Web Interface (TCWI) and Messaging/Alerting workshop September 29 to October 1, 2009 5.Evaluation planning workshop for deputy director of health services, Sivaganga district, Tamil Nadu, India December 18, 2009 6.Sahana Common Alerting Protocol (CAP) Messaging/Alerting exercise April 5 th to 9 th, 2010 Training workshops conducted so far – to update

13. List of paper presentations/participations in Conferences/Symposia 1. Nuwan Waidyanatha, Ganesan M, Pubudini Weerakoon, Gordon Gow, Maheshkumar Sabhnani and Artur Dubrawski, Real-Time Biosurveillance Pilot in India and Sri Lanka, Asia's Premier ICT Event - 2-4 December 2009, Bandaranaike Memorial International Conference Hall, Colombo, Sri Lanka, December 2 – 4, 2009. 2. M. Ganesan, Suma Prashant, N. Janakiraman and Nuwan Waidyanatha, Real-Time Bio-Surveillance Program: Field Experiences from Tamil Nadu, India, Seventh Conference of IASSH on Health, Poverty and Human Development, Banaras Hindu University, Uttarpradesh, India March 5 – 7, 2010. 3. Gordon A. Gow, Vincy. P and Nuwan Waidyanatha, Using Mobile Phones in a Real-time Biosurveillance Program: Lessons from the frontlines in Sri Lanka and India, 2010 IEEE International Symposium on Technology and Society (ISTAS ’10), Wollongong, New South Wales, Australia. 2010. 4. Nuwan Waidyanatha, T. Kannan, R. Sheebha, Vincy Pushpa Mary, Effectiveness of the m-HealthSurvey Midlet for Real-Time Biosurveillance, The 4th International Symposium on Medical Information and Communication Technology, Taipei, Taiwan, March 22 – 25, 2010. 5. M. Ganesan, Suma Prashant, Vincy Pushpa Mary and N. Janakiraman, Digitizing Patient Health Information using Mobile Phone in Rural Areas, 2nd Indian Youth Science Congress, SRM University, Chennai, India, June 26 – 28, 2010 6. S. Prashant and N. Waidyanatha (2010). User requirements towards a biosurveillance program, Kass-Hout, T. & Zhang, X. (Eds.). Biosurveillance: Methods and Case Studies. Boca Raton, FL: Taylor & Francis, Chapter 13, pp.240-263. 7. G. Gow and N. Waidyanatha (2010). Using Common Alerting Protocol To Support A Real-Time Biosurveillance Program In Sri Lanka And India, Kass-Hout, T. & Zhang, X. (Eds.). Biosurveillance: Methods and Case Studies. Boca Raton, FL: Taylor & Francis, Chapter 14, pp 268-288.

14. Thank you. suma@rtbi.in