Great post and insight into the art of the possible. As you say. much of this is already happening independently (in most cases). All that's needed is a more co-ordinated, collaborative approach.

I would certainly recommend keeping tabs on Josh Nesbit's work in Malawi (http://mobilesinmalawi.blogspot.com), where he seems to be blazing a trail with a well-executed model training and equipping "cellphone-wielding" community healthworkers (his words!).

I think 2009 is going to witness significant steps forward in the practical application of mobile technology in numerous fields, heath being one of them. Look out for my blog post in January! We have enough proven tools and highly capable and dedicated people working in the space right now - it's time we put it all to good, solid practical use.

Ken
www.kiwanja.net

Thanks for the comments! Dro, sunday morning sloppiness :), still thanks for your kind words and Ken, all I can say is keep up the great work.

Nate -- nice post!  We just wrote about UNICEF's work in Ethopia and Malawi preventing famine with rapid monitoring of feedinc center using RapidSMS, another mobile data collection and rapid reponse tool. See http://mobileactive.org/preventing-famine-mobile. 

It turns out that enterprise applications like RapidSMS are more scaleable than smaller, lower-end solutions like Frontline in delivering reliably larger amounts of data delivered via SMS, so for your scenario, a more scaleable, robust mobile/SMS reporting, monitoring and delivery platform is probably adviseable :)  For more software reviews such as RapidSMS (a finalists in the recent USAID Development 2.0 Challenge) and Frontline, among others, see http://mobileactive.org/wiki/Mobile_Tool_Reviews.

There are also numerous mobile data collection tools out there that we are reviewing.  There are many options - and for your forward-looking scenario, you'll need something that truly scales!

Wow, that is impressive.  I'd agree with your takeaways too, create a way to aggregate the data and then have a visual system on the other end to better plan and distribute around whatever findings you have.

New technology, improved organization and dedicated partnerships- 2011 is a year I can not wait for.  This is a blog of possibility. I think that patients having mobile phones (which will be very cheap by then) is a key component here- their observations will help with organization and medical adjustments.  This is hope at its best.

Good post!
If you are interested in following this topic, you should check out @MobilizeMRS on twitter, or http://is.gd/c1L2 (we're just getting started). We are working to connect FrontlineSMS and cellphones to a research equipped open source medical records system called OpenMRS (co-founded by Partners in Health, the organization founded in part by Paul Farmer, your pick and mine for top advisor to the department of development). I'll be spending next year in Burundi setting up OpenMRS, FrontlineSMS, and trying to connect the two with villagehealthworks.org.

cheers
Isaac

Everyone - thanks so much for your comments. Its great to hear from so many experience voices.

Katrin and Isaac, its great to hear about these related platforms you've all mentioned. If there's anything that the world of international development can teach us, it's that there is no one size fits all solution to anything and that its going to take iteration and experimentation.

I would imagine one of the major issues you're all dealing with is interoperability and data transport? For example, what happens when a cholera epidemic spreads from an area where people are working with FrontlineSMS to an area where RapidSMS is deployed? Or even more than that, what happens when CARE uses Ushahidi and MSF uses something similar by an entirely different group. It seems like a real opportunity to create cross-platform standards that could contribute to saved lives later on.

Isaac, its great to hear about your work - it sounds like a real step in this direction!

I really appreciate everyone's wisdom and work and I'm looking forward to hearing more.

Interoperability is a very important point Nate, I'm glad you mentioned it. One method of achieving the kind of scale you blogged about is a winner taka all approach - one very scalable product could become the standard over large regions of the world (as Katrin suggests in her comment on RapidSMS). The alternative (and in my opinion, more plausible) approach is interoperability, where it's not necessary for any one installation of anything to scale completely because data can move into or out of any system.

Mobile health stuff is so new that interoperability of medical data has hardly been considered, to my knowledge. With MobilizeMRS, one of the primary reasons we want to interface with medical records systems is that a huge amount of work has already been done to promote medical record interoperability with standards such as HL7. There is a lot of work to be done, but all the right processes are in place in the communities and organizations that promote electronic medical records - it would be a shame/impossible to re-create that for mobile phones.  OpenMRS, the system we will integrate with, is particularly strong in this area.

The other reason to integrate with medical records systems is so that we can offer case level mobile decision support to community health workers - something you can't achieve with surveilence systems, but that's a different can of worms entirely.

cheers

Nathaniel -- Excellent comment. A few thoughts on what you wrote:

"I would imagine one of the major issues you're all dealing with is
interoperability and data transport?"

Many (but not all) of the data collection tools using mobiles utlize SMS as the main method of communicating data.  SMS is universal - the difference lies in the backend database receiving and parsing the incoming SMS, and the software used to send out SMS.  There are many of those, of course - both commercial and NGO-focused.  Your point about interoperability is a good one but it's nuanced and probably deserves a bit more of a a post, so bear with me! (will pick this up on the MobileActive.org blog as well)

First of all, as with much humanitarian relief and development work, the problem lies not so much in the integration of technology as with organizational turf - the human aspect of the work.  After all, a sql database or Excel spreadsheets that many of the mobile data collection tools utilize can be integrated with little effort. But relief managers and administrators of varying and often competing development and relief efforts are much harder to get on the same page.

Secondly, there are efforts under way to make the process of open sourcing promising tools and enabling technology integration easier -- most notably Open Rosa on the medical data collection side, and the Open Mobile Consortium, a consortium of organizations and tool developers committed to open sourcing their tools, and to collaborating. Led by Instedd, it incudes key people and leadership from Ushahidi and UNICEF's RapidSMS  -- both of which are open source applications, that is, the source code is shared and modifyable.  So far, despite repeated announcements that Frontline SMS would be open sourced as well last fall, this has not happened, though Ken is also part of the Open Mobile Consortium. Ken may shed light on when Frontline code is finally available.

Both the Open Mobile Consortium as a coordinated group working on knowledge-sharing, and collaborating to the greatest extent possible, and Open Rosa, aimed at developing a set of best practices and standards around mobile medical data collection, are steps in the right direction, that, even though they are just beginning, will inevitably increase as more mobile apps become available, and more significant deployments begin to happen.

I can say that this is where we like to see this going -- at least as long as we at MobileActive have anything to do with this field where we'll strive to convene and bring together the relevant people to advance coordination, and where appropriate, collaboration.

Thirdly, your comment "For example, what happens when a
cholera epidemic spreads from an area where people are working with FrontlineSMS to an area where RapidSMS is deployed? Or even more than that, what happens when CARE uses Ushahidi and MSF uses something similar by an entirely different group?" assumes that there is widespread deployment of these tools. This is not the case so far -- deployments are still mostly small pilot projects with very limited reach.  We found, for example, only very few in-the-field deployments of FrontlineSMS, despite a lot of downloads,  that, sum total, probably have not involved more than a few thousand individuals (and it is unclear whether there has been any impact at all in those projects as evaluations have not been done).  Similarly, RapidSMS has been deployed only twice so far late this year, with similar numbers and so far only anectotes about any impact.  Some other deployments focused on medical and public health data collection have been a bit larger as they have been going on longer, most notably in Uganda, South Africa and Southeast Asia, using different back-end applications and SMS -- but, bottom line is, deployments, in the scope of things (and needs) have been ridiculously small so far.  This field is just starting out -- a perfect time to bring people together, to collaborate on standards and tools, and to scale the work to really begin to make a difference.

Best,

Katrin

And I am with you, Isaac -- there should be a healthy ecosystem of mobile apps focused on different needs (as it's already developing).  What I think we'll see, though, is niche apps or highly modifiable and open apps that conform to certain standards, such as OpenMRS or standards around election monitoring, to take it out of the health field, etc, that can be tweaked for the particular locale and needs. 

This means that relevant tools have to be realtively open, modifyable, and that standards are agreed on.  I am actaully editing, as we speak, a review of data collection applications on MobileActive.org - stay tuned!

Thanks for the tweeting the discussion Katrina.  For me, this amazing initiative highlights how important it is for phones to become more tinkerable, by which I mean having more generic interfaces and operating systems that will open up innovation.  We don't think it is remarkable that PCs all have the same power cord or that all PCs and laptops have USB ports.  Yet USB ports have enabled a host of innovations on laptops and PCs alike.  Android is a good start as an Open OS for phones (although it still feels like bloatware for your average developing country phone).  Although I don't agree with Jonathan Zittrain's general thesis that the Internet is closing down, I think his argument applies very well to the mobile phone environment. Roll on OpenMoko!  Oh, and maybe go easy on the applause for Nokia et al.  Mobile manufacturers are very innovative but also clearly collude with mobile operators in their rent-seeking behaviour in developing countries.  How about a little openness Nokia?

Hi again, Nate

This is a fascinating conversation going on here. One of the most striking things for me, however, is how quickly it's become a discussion about technology. I don't think your initial post was coming at it from that angle at all - you just happened to mention two tools that *might* fit the task. A post about hope and a vision has turned into a debate about the merits of one tool over another. "Obsessing over the technology" seems alive and well in some quarters.

A final point from me is this. Let's not forget the users. An outsider reading elements of this discussion would likely see a bunch of white people arguing over what the best mobile health solution is for 'poor people'. Any technology which is brought in from the outside and forced onto a community of users is destined to fail. We know that, so let's not forget it. Tools with local ownership are key, and I don't just mean the hardware.

I think some of the cultural and human elements of my post last month on "mobile applications development" are very poignant here, and well worth re-visiting.

http://www.blogspot.kiwanja.net/2008/11/mobile-applications-development.html

Thanks for starting the discussion. Hopefully, by the end of it, we won't have lost sight of what really matters...

Ken

Argh - was leaving a comment and it kept growing, so here is a new blog post. In it I touch on what I see as gaps in the original article, the issues of scalability and interop, and pointers to the topic of data portability. Hope it adds to the dialogue, this is just my .02. I tried focusing on the big picture and the trends.

http://edjez.instedd.org/2008/12/phones-dont-change-world-people-do.html

Cheers!

I want to echo Ken's sentiments about the end users and the role of local innovation. I was moved to see the Cambodia lab team learning Ushahidi & FrontlineSMS, I know they could deploy them if needed, and contribute to their source in a future.
We all know the tech is the easy part...It is very early in the world of mobile apps with a social purpose, and as early contributors we have the imperative to lead by example on not just 'what', but 'how' and 'why' and ' by whom' things get built.

Hi again everyone. Fantastic discussion!

I wanted to highlight something in Ed's follow up post that he linked to above. He wrote:

"In my 2011, I hope that there are hybrid social-enterprise efforts that can make inroads to working with wireless providers and carriers. They need to evolve their offerings and provide the types of cost structures needed for health and social good to scale and not depend on infusion of donations to keep running OR pushing costs where they can’t be paid while willing customers cant spend their money. Even just helping providers make money differently would help a lot. Examples: toll-free-SMS?  Free-to-send? Free-to-receive? Mobile banking? Shared-costs billing? Provider-supplied location tracking of registered gov’t health staff? Anonimized tracking of random individuals for disease migration modeling? it goes on.. Providers could make more money (gasp!) and they don’t."

Coming from the perspective that I do with this blog, I think this issue is key. I do some basic work with refugee communities in Egypt and as I was trying to share some of these platforms with them this year, their response was simple: we can't use it if it costs us per SMS. The cost are simply too high. That's why Twitter's decision to stop sending SMS outside of a few countries was so devastating to the Egyptian activist community.

Also, to a point that was coming from many of you regarding returning people to the center of this equation. One of the things that open standards can/will/should do is enable the generations of young developers who are getting their first crack at re-creating their world to build into something that has real structure and opportunity.

For example, I know that Jon Gosier at Appfrica is mentoring a  number of Ugandan developers who are all tinkering with their own applications that could build off of these platforms. They're going to know the "market" better than anyone else, and are likely to build the game changer application if they're given the opportunity.

I've added a link to Eduardo's post in the main article. If anyone writes their own follow ups, I'm happy to link to you as well!

Very interesting comments, and great post, Ed!  I knew I was asking you for a reason -- thanks so much! 

I am elaborating more on why these pro-poor efforts commented upon and outlined above in the end are  not sustainable or maybe even desirable over at MobileActive.org: http://mobileactive.org/discussion-about-future-mobile-apps-hope-and-why-pro-poor-will-never-work.  Ken is right - geeking out on the details is nice and fine, but per-poor - those originating in poor communities by people in those communities --  efforts are elusive here.  All of the projects are by Northern white boys with nary an idea of user-centric and participatory design. Which probably explains that despite much digging, all of the Frontline, Ushahidi, RapidSMS (fill-in-the-blank) efforts lack any significant numbers of users despite serious investments -- once you start really looking.

Katrin

Hi everyone,
I just posted a "manifesto" of sorts, about these issues, and especially about how mobile phones stand to revolutionize global capitalism and resource availability:
  How mobile phones can replace a broken economy  http://nxhx.org/thoughts/manifesto.html
Feel free to add it to the list above, and spread it far and wide!
--Joe

Links updated above. Also definitely wanted to point to Jonathan's work at Appfrica.net as an example (although very nascent) of trying to move beyond the "pro-poor" paradigm mentioned above.

What an interesting conversation going on here..

I read and read..

and the more words are crossing my eyes,
the more time spent,
the more I realize that every word is almost another unfortunate step in creation of a bigger gap...a knowledge gap. Innovation is in the hands of the connected ones..

This week I uploaded some airtime to the http://www.afrigadget.com grassroots reporters to be online via their phone to read Erik's welcome... Being online -for a little bit-….in South Africa it is like you’ve experienced in Egypt Nathaniel….to expensive …
The question I ask is: How do I get those bright “science and technology students in the township”– “the creators of the future” and “Africa’s future leaders” to be on top of things? How to get the current non-connected be part of the global conversation, be a contributor to innovation??! How to decrease the knowledge gap?

Tools and gadgets are great. And thank god there is Katrin and the mobile consortium to connect the stakeholders in the mobile (innovation) industry, connect and exchange knowledge in the process of invention.
Thank god there are people like Ken and Erik who get the conversation to the heart of matters, ask Africans what is needed in Africa…and involve the bright African minds into the process of development.  

I want us all to be aware of one thing…
we include and involve others in the creation of our own ingenuity
(asking somebody for his/her needs is different then having somebody be part of a global fest of knowledge sharing, resulting in the creation of great tools and gadgets)

And I ask the question: Does our current focus on tools and technology empower those bright non-connected kids here in the townships most?  

My dream for 2011: the current non-connected (Africans, South Americans, Indians,..) be the connected innovators. All of us tech-savvy knowledge sharing, connected innovators…focus more on implementation.

This would mean that our current focus on innovation and technology (the hunger for new tools and recognition) has to shift towards a more “bridging the gap” attitude.  

How to live a “bridging the gap” attitude? Some first thoughts.. - focus on getting governments involved in subsidizing mobile/internet use
- have internet/mobile commercial providers working together
- communicate what we know in a language understood by all…

I want every stakeholder in the mobile industry to realize that there is nobody BUT us with the knowledge we have got. It is our responsibility to make this knowledge available to the world, everybody included.

Hello,

It is a very cool technology indeed. I linked to the "Wired" article on TrackerNews (http://www.TrackerNews.net), which is an aggregator that groups stories by contextual relevance (There are four stories in the grouping, which is currently in the green bar banner, but will move into the left column tomorrow).

Tracker's beat - very broadly defined - covers health issues, humanitarian work and the technology that supports both. You might also be interested in the companion blog post that describes two other rapid diagnostic tests: http://tinyurl.com/6vv6rr

btw, Northwestern? That's my backyard! (in fact, i was the mastermind behind a theatre workshop class that developed a new musical based a series of children's storybooks about math - it's really good, too!) I would love to know more about the Center for Global Engagement.

cheers,

Janet Ginsburg

Whoops! that tinyurl may not work. Try http://trackerblog.instedd.org.

- janet

Hi there, great discussion. From my experience in the development aid sector there is a great challenge to evaluate the impact of projects. I imagine in this regard the use of mobile phones might make a great difference to collectively gather information from the field and to bring it transparently in the web. Or you can do it like Akvo.org, who work with mobile reporters in Africa (voicesofafrica.africanews.com/site/page/mobile_reporters ) to report from projects. I blogged a while ago about this potential (http://tinyurl.com/4ge2bp)

Imagine the potential to measure development projects from a grassroot level. Or to collect information about how many governmental services have arrived in villages. This could be possible by harnessing the wisdom of crowd. Using mobile phones to collect information.Present all information on a website with maps and databases.Use the website to connect the people who send information and aim to get more accurate information. Beneficiaries of projects could collect information in teams, send feedbacks to the platform and create their own map of development projects or their timeline with accurate information on how government services are fulfilling their duties. This kind of transparency should be an all-win-situation.

Hi all

Janet and Christian, glad to have you join the conversation.

Janet, the Tracker project looks great. I've RSS'd the feed and will definitely be keeping better track (no pun intended).

Christian, your idea deserves a whole post. My single greatest excitement for mobile technology is new forms of impact assessment that actually collect information directly from the intended beneficiaries of programs.

Hi Nathanial....

Pun away with Tracker - it's just asking for it!

Although there an RSS for the blog (http://trackerblog.instedd.org), alas we don't have one yet for the website (it's on the list, along with formatting for hand-helds, tweaking search, etc - here's looking at v.2). The best way to hear about updates is actually to follow me on Twitter: http://twitter.com/TrackerNews.  I am pretty new to Twitter, but it's fast becoming one of my favorite things...

Also, we have a little Custom Tracker feature you might find kind of cool. It still needs work, but here's a sketch of one I roughed in for Ed Jezierski's Bar Camp Phnom Penh. http://www.trackernews.net/major_event/index.php?id=67

Essentially, these are DIY site maps for the collective knowledge or a group or event. Tracker was designed so the back end user interface is both wysiwyg and drag-n-drop. You can have as many categories, sub-categories and listings as you'd like (each with a tool tip, too!). I am hoping that in 2009 we'll be able to develop these further. They've got a lot of at-a-glance utility potential.

h'mmmm  - maybe we can meet at the Unicorn sometime. We'll have some Hoosier Mama pie and I'll show you how custom trackers work. (btw, the designer who produced the Hoosier Mama website, along with all the Metropolis Coffee graphics, designed TrackerNews. Small world...) 

 

This is a good idea.   It assumes that there is cell coverage in the area, or that the samples are sent to the lab later from an area where there is coverage or connectivity.  I would imagine that a camera that also has Wi-Fi in it would come in very handy in some places where there is Internet coverage but no GSM coverage.

A small technical detail - when photos are sent using GSM, it's not an SMS, but an MMS message that is being used.

How do you make sure the picture of the sample is matched with a particular patient?  Do you rename the picture?  What prevents typos?  Hopefully you using a naming system that includes a check digit or error detection scheme.

I knew we could find a real use for those devices!

Really cool idea.

The other day I stumbled over this news piece: “The phone that feels the flu before you do” – a company offers a service, where one can find out how intensive the level of flu is in their area. So, basically, you can get “Open Source Intelligence” via mobile phone. I find this quite fascinating because of the potential it entails for other usages as long as it is a public good.

This Data collection is amazing. We distribute Glucose Control teas and Drinks and are working on the same for our office in Accra. This data will help us to track the succes of our dsitribution efforts and plan better. Prediabetics are our main concern even in the US.

In the case of Africa, until we find a way to pay them for their products and natural resources, we are going to invent another "gift to the rich, among the poor" and save a few "destitutes" while the effects of poverty rages on.

What Africans need is real free trade, equal exchange, and truth in exchange.

Sounds like a scheme to get the whole wold addicted to Big Pharma's medication and our own broken "heath care system".  Just watch Sicko and you will see that more of the same broken system will not fix anything.

Take Coca-Cola out of our diet and out of the Africans' diet.  Replace it with clean water, and may illnesses will automatically go away.  The body will heal itself naturally with the proper nutrients. 

I am not familiar with the Partners In Health software; I hope it can be linked to OpenVistA. I do know that OpenVistA is an open source and free version of the  health information software that runs the U.S. Veterans Administration hospitals (built under the intense opposition of the centalized computer systems office of the VA), the Indian Health Service, and in an older version, the entire U.S. military health system. It was also taken to Africa and adapted by people at OAU, a major university in Nigeria. The software was also taken to Mexico, and a cookie-cutter version of it was installed at over 100 hospitals for $10 million.
It was designed to the specifications of a decade-long study by the NIH on how to do health care informatics effectively. It was managed independently in each hospital but software evolution coordinated system-wide, and it is so easy to program that most of the particular procedures were written by the doctors and technicians who were doing the work. It has so many checks built into the system (for example to prevent giving the wrong drug to a patient) that the VA consistently leads in quality of care measures among large US hospital systems (we're not talking about unfunded mental health care now).
Since it runs the business systems and the medical imaging (which it pioneered) and more, it can be partially repurposed to other needs of a society. In other words, young people can learn its programming language, MUMPS, and apply that to any other infrastructure and business organizing their country needs. By the way, about 3000 trained admin and programming people are retiring from the VA in the next few years, and some could be recruited to teach MUMPS.
The version of MUMPS that is used by WorldVistA to provide OpenVistA is also used to handle over 60% of the world's major money market transactions -- it's bulletproof.
Someone has already successfully booted up OpenVistA on the XO laptop from OLPC.org. That machine could be readily modified (or the technology repurposed) to gather readings from miniaturized medical instruments via USB cable, and send them via its included world-class wireless mesh network to a server. The key to using these together is to add GPS and GIS to OpenVistA and the XO / clone and turn a hospital-based info system into a public health info system that supports outcomes research by passing along de-identified health records.
The benefit of that is you get to monitor the effectiveness of approaches such as nutrition, nutrients and herbs (in Naturopathy and other disciplines that use them), and compare that head to head against allopathic medicine for every condition and situation that occurs -- not just statistical samples! I know that American Western Life Insurance Company used Naturopaths to take all member health calls from a program for people that wanted this; they had 1/3 as many office visits and the cost per office visit was 1/3 as much -- multiply to get 1/9! That subsidized their larger allopathic practice until its escalating costs put them out of business anyway.

I would see using the above, with the GIS, to train health workers who live in villages (a la Partners in Health) to not only do health checks, but to get the nutrition of the crops and the foods made from them tested, and if there are deficiencies, find the nearest villages that have that nutrient in their food to trade with (probably in a different ecosystem, with different soil). All this goes into GIS and is displayed so people can plan health interventions. Same for malaria control, etc. Also, this kind of system can be connected to maps of ecosystems and expert information on solving agricultural problems with permaculture and biointensive gardening techniques, and specific plants that restore fertility, and protect crops during the dry season, to end hunger. In fact, the whole sustainability enterprise can be developed with this kind of information management power.
There is too much more info to put here; interest is welcome ,  .

Here is a bit from the WorldVistA home page:
Welcome to the WorldVistA homepage
WorldVistA was formed to extend and collaboratively improve the VistA electronic health record and health information system for use outside of its original setting. The system was originally developed by the U.S. Department of Veterans Affairs (VA) for use in its veterans hospitals, outpatient clinics, and nursing homes. WorldVistA has a number of development efforts aimed at adding new software modules such as pediatrics, obstetrics, and other functions not used in the veterans' healthcare setting.

WorldVistA seeks to help those who choose to adopt the VistA system to successfully master, install, and maintain the software for their own use. WorldVistA will strive to guide VistA adopters and programmers towards developing a community based on principles of open, collaborative, peer review software development and dissemination.

More along these lines; I just went to the WorldVistA site and found this press release. There are open standards in this field!
WorldVistA Receives 2007 Linux Medical News Freedom Award The WorldVistA organization was co-recipient of the 2007 Linux Medical News Freedom award for its work in getting WorldVistA EHR/VOE 1.0 certified by the Center For Certification of Health Information Technology (CCHIT). The award was presented to WorldVistA at the American Medical Informatics Association (AMIA) Fall conference: "WorldVistA's achievement was a true team effort and is a benchmark for what the Free and Open Source in medicine community can achieve. We are indebted to WorldVistA for keeping FOSS in medicine alive and competitive."  said Ignacio H. Valdes, MD, MS Founder and editor of Linux Medical News.

Here is a NY Times article on the topic, from the WV website:
http://www.nytimes.com/2007/05/30/opinion/30goetz.html?ex=1338177600&en=4b9b74b9874cad7f&ei=5124&partner=permalink&exprod=permalink
By THOMAS GOETZ
Published: May 30, 2007

SAN FRANCISCO

GO into almost any medical office, hospital or clinic in the United States and your records will still be handled the old-fashioned way — on paper. You can use a computer to pay your taxes, to program your TiVo or to read a message from your great-aunt, but your doctor has to practically level a forest just to examine your medical files. The cost, however, isn’t calculated in trees but in human lives: Electronic medical records would reduce the risk of medical errors and spare hospitals the expense of missing records and unnecessary treatment.

Health care providers have been dreaming about electronic records for so long that the idea has begun to seem like vaporware, a never-to-be-realized fantasy similar to flying cars and jetpacks. But there is already a clear software standard, an open-source system that’s low-cost, easy to use and readily available. It could be the key to the health care system we ought to have already.

The program, WorldVistA, is based on the Veterans Affairs Department’s electronic-records system, called VistA (short for Veterans Health Information Systems and Technology Architecture — and yes, they beat Bill Gates to the name). VistA stands as perhaps the greatest success story for government-developed information technology since the Internet itself.

Using the VistA record system, the veterans department has managed to improve nearly every benchmark of quality in health care. In a decade, the department increased its pneumonia vaccination rate among at-risk patients to 94 percent from only 29 percent. That translates into 6,000 saved lives and $40 million saved each year from fewer pneumonia hospitalizations. On a host of other benchmarks — beta blocker use, cancer screening, cholesterol screening and so on — the department outperforms the nation’s best care.

Thanks to VistA, costs per patient at the Veterans Health Administration system are 32 percent lower, using inflation-adjusted dollars, than they were a decade ago. Over the same period, the medical consumer price index has increased 50 percent for the country as a whole.

The patients are happy, too. For the past eight years, the Veterans Health Administration has outscored private-sector health care in the independent American Customer Satisfaction Index. And because VistA is government-developed software, we all own it — it’s in the public domain. But while the government will mail you a copy, it won’t help install it or maintain it. The Department of Veterans Affairs is, in fact, prohibited by law to stray from its mission to serve veterans.

So in 2002, a group of former Veterans Affairs programmers and open-source advocates formed WorldVistA. They set about making a version of VistA that was simple for health care providers to use, and the fruit of their effort is now ready for market. Like VistA, WorldVistA is robust and fast. In April, the software was approved by the Certification Commission for Healthcare Information Technology. The certification means that WorldVistA is ready for broad adoption.

The effort to promote WorldVistA is supported by a grant from the Centers for Medicare and Medicaid Services, the agency that sets the prices for Medicare and Medicaid payments. The agency wants to provide clinics and public hospitals, especially those that serve uninsured and underserved patients, with an inexpensive system for electronic medical records. The agency was also just getting tired of seeing another year go by without a significant increase in the adoption of digital records. Right now, only a quarter of office-based doctors use them.

The problem isn’t a lack of software. There are hundreds of companies hawking electronic-records systems. But they don’t come cheap. The average cost is about $33,000 per doctor, plus another $1,500 a month per doctor for maintenance, according to a study published in the policy journal Health Affairs. For a small clinic with one or two doctors, that price is usually out of reach. For major hospitals, installing a new system can quickly become a multimillion-dollar experiment.

WorldVistA, thanks to its public-domain origins, costs about one-tenth of what a proprietary system does for a license fee and a support contract. And like any good open-source project, it’s constantly improving. A community of programmers fixes glitches and adds features, just as is done for the open-source Firefox browser and the Linux operating system.

And WorldVistA can be scaled up or down. It can work for neighborhood clinics, small-town hospitals, hospital systems, or, well, the Department of Veterans Affairs. WorldVistA’s big promise is that it can become the nationwide standard for electronic medical records, the backbone of a national network of health care. Your medical records could be read instantly and understood (perhaps less instantly) by any provider, anywhere.

Want to see the best knee surgeon in the country? If he’s using WorldVistA, he can check out your online records at his house or office. If you switch jobs and move to a new insurance plan, you won’t need to build a new medical history and FedEx old records around. With your permission, your files will be accessible to your new providers instantly. In this way, electronic medical records generate better care and lower costs.

WorldVistA isn’t perfect. It isn’t as customizable as some proprietary systems, and its graphical interface isn’t as intuitive or as polished. Worse, its back-office functions — staffing and billing — aren’t all that strong. Major hospitals and health maintenance organizations in search of a Cadillac are free to spend the dollars to buy one.

But for the vast majority of health care providers, WorldVistA is what they’ve been waiting for: a low-cost, simple-to-use system that makes it easier to provide quality health care. If only it could upgrade the waiting-room magazines, too.

Thomas Goetz is the deputy editor of Wired magazine and author of the blog Epidemix.
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This is a great idea and could certainly work for some things, but it is being promoted as an HIV detector at some websites, and that is one thing it most certainly is NOT. 

The cell phone is excellent of course - But COCA COLA a savior!!!
Everywhere it has gone disease has followed drinking contaminated sugar water - is this a Clinton idea ? does he own stocks - this is as bad as having cigarette companies deliver lung cancer drugs. 
Talk about Orwellian corporate mind twist - ugg- just when you think your heard the last of the dregs . . .

UC Berkeley Human Rights Center will host a major conference on technology and human rights May 4-5 in Berkeley, CA, USA. Including a "mobile challange" in partnership with TechSoup Global.

See hrc.berkeley.edu for more details soon. BG

The cell phone is NOT excellent.  By focusing on technology, we're heading towards the cliff's edge.  What about the growing number of people who get ill from the electromagnetic radiation from cell phones, WiFi and cell towers?  Must we plaster the planet with those ugly metal towers planted everywhere? Will no place be safe from electromagnetic smog? Please remember that humans, along with many other creatures are bio-electric beings. Just because we can't see the radiation or the movement of bio-electricity does not mean it does not exist.

The majority of comments made on this blog are by technological experts, not health experts.  People that are technologically savvy probably like to think that their chosen field will be the solution to many of the health problems the world faces. There is a good comment made above about adding more applications to the broken Western Medical Model.  There are way to many toxins in our environment, not to mention the unnecessary evil of increasing electromagnetic smog over the planet.  THere are a plethora of studies that show this to be harming biological systems.  Politics and money will cover and filter any progress to be made by this cellphone based system, not even counting the detriment made by the excess EMF.

I would like to politely add that some of the health problems people suffer from are created or worsened by the human bodies interaction with certain frequencies on the electromagnetic spectrum, which is necessary (at least so far) to the cellular technology discussed above to report health problems.  I feel it is important to share this information as it is relevant to the initial topic written about the cellular phone and public health.  It is important to make great strides towards improving the health of large groups of people.  But a large aspect of this technology AS IT RELATES TO HEALTH is being overlooked.   Read the works of Dr.s Robert Becker(Nobel prize nominee), Henry Lai, Neil Cherry, or go to www.bioinitiative.org for up to date information on wireless technology (with specific frequencies) on specific body systems i.e. nervous, endocrine, cardiovascular, etc.  Glucose levels can rise in certain fields,(50-60Hz) and histamine responses are shown to occur under the skin in animal studies (who are not known for psychosomatic reporting..) Histamine response occurs in allergic responses and can  feel like you have the flu.  Constant stress on the system from  certain EMF make one vulnerable to incoming pathogens like influenza.  One of the ways I have recently read that HIV makes the system vulnerable to immuno-compromise is by having the body produce excess cortisol.  Cortisol levels are also elevated in the presence of EMF fields. Usually these fields are endured by the body without respite. Wireless tech is always ON.  Melatonin, an anti-tumor hormone with many other functions in the body is not produced as well while in a radio-frequency environment.  This can explain one of the reasons why breast cancer is thriving today.  Microwaves need not be "ionizing" to cause disruption to the human body.  We are a finely tuned bio-electric system. Our brain waves operate on Hertz.  Our hearts rely on electrical signaling.  The electrolytes in our bodies rely on a healthy electromagnetic environment to work. Calcium is not regulated properly in cellular function while in certain wireless environments.  Don't just listen to me, read more.  Read Dr. Becker-- Nobel Prize nominee and his books "Cross Currents" or "The Body Electric", look at www.bioinitiative.org/report. Ask the Russians who have studies these frequencies for decades. Technology is great, but we should not give every technological idea carte blanche until carefully studied and carefully implemented. Thank you.

This is a fascinating use of technology.  My group is developing project-based participatory learning programs between groups of US and Chinese students.  I'll follow this conversation thread with interest.  If anyone has any ideas for mobile learning applications, let me know.

Stephen, have you seen this? http://www.innovationsforlearning.org/html/index.html

Great article Nathaniel. Cellphones can change the developing world. We use them in remote and dangerous locations in Afghanistan and Somalia to be able to meet the huge needs in constructing water and sanitation infrastructure. We bring representatives from communities together in District capitals, train them and send them back to their communities to monitor their projects. During the course of their projects they send us photos of the progress for our database. When the security situation eases up we randomly select a few projects and go and physically verify. Our donors (ECHO and BPRM) seem to be happy with the process.

Brian
http://www.watersanitationhygiene.org