Technological Challenges and Approaches to Deploying Mobile Technologies for Public Health Information Systems Saptarshi Purkayastha, Director R &D, HISP India Brajesh Murari, Senior Software Developer, HISP India

mHealth applications are available for:  Subcenter reporting (SCDRT, included as part of DHIS Mobile)  PHC Monthly reporting (DHIS Mobile)  IDSP Weekly reporting (DHIS Mobile)  Patient-level information (NBITS Mobile)  Survey information (NBITS Mobile) All based on Free and Open-source applications (FOSS) Integral part of DHIS 2 (WHO recommended) Data warehouse approach of DHIS – Can communicate with other systems (proprietary or FOSS)

SMS-based Reporting for Facility-based Aggregate Data

Allows transmitting facility-level data from Sub- center using SMS Works on low cost phones (Rs ) Has been pilotted in 5 blocks in 5 different states and now scaling across 2 states Multi-language Low operating cost (2-3 SMS/month – Rs.5/month)

The SCDRT is now “DHIS Mobile” and is extended to report other formats like IDSP and PHC Monthly Dataset Using the same simple-to-use interface and using SMS, data can be sent rapidly for Disease Surveillance and Monthly reports from Primary Health Center Specially useful where internet/computers are not available at PHCs Cost of reporting is minimum (2-3 SMS/month i.e. Rs.5)

Mobile-Phone Interface

Field-level Access: NBITS Mobile allows the field-level health worker to access and update patient-level information from mobile phones Real-time and Online: The information is available real- time and accessed from anywhere across the state from the online NBITS application Migration/Facility Independent: The patient’s information can be viewed at from any of the facility and patient can be given treatment by any health worker from the state Alerts & Reminders: The patient can be reminded for medication, visits etc. The health worker can be sent alerts for visit or important cases that she has to attend

The health worker starts the application on her mobile phone. A login screen is displayed to identify the health worker and depending on her roles and privilege, she will be able to view patient information and different programs for the patient This authenticates the health worker on the server and displays the next screen

Login screen of NBITS. Here health worker can login and enter into the system. Each health worker will assigned with specific user name and password with specific user roll. This screen will authenticate use name and password and if it will pass the authentication process than user can see the next NBITS welcome page.

Search patients Create a new patient (Check for duplicates and verify) Download list of patients (cohort – for specific program) or (all - for her activity schedule) Download available forms for programs and program stages or surveys (made available to her) Upload collected data

Create, modify, search for a patient. Create, modify, and view patient attribute. Create, modify, and view patient attribute group. Create, modify, and view patient identifier type. Create, modify, and view relationship types. Create, modify, and view various programs.

A patient can be search using their patient identifier number or patient name The search for the patient can be done from the local list of patients already visiting or a new patient from the server

A patient can be search using their patient identifier number or patient name. Patient search can be done using any patient attribute available in NBITS. After search, system will show list of all patient available for specific associated organizationunit.

A retrieved Patient’s information Last encounter with the patient along with name and other demographic details New encounter for the patient will display the data elements from the program stage in the screen below Depending on the program stage of the patient, the elements are displayed

A patient data can be entered by selecting specific organization unit and specific program with specific program stage. Program stage history plan will indicate data entry of all the program stages with their due date status. After completing data entry, we can switch to other patient data entry by clicking on back to search button.

Upload the data that has been collected The data can be uploaded for  Set of patient visits  Single patient  Single survey form  Any other data that has been collected through the forms made available to the health worker The data can be uploaded to a offline machine through Bluetooth or even many SMSs to a computer with GSM modem

Photographs can be attached as part of forms and sent as well. These can be useful for special cases or nutrition days etc. (Phones with camera) GPS location of the health worker can be sent along. (requires phones with Location-based capabilities) Patient data can be viewed on maps (Maps in GIS should be available) These additional features require data connection (GPRS – Rs. 99/month) and a more expensive handset (Rs )