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

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

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

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

  2. 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...

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

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

  5. 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

  6. Global Health Puzzle Is Mexico healthier than Canada?

  7. Older populations are less healthy!

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

  9. Global Health

  10. Simple Story $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ Life expectancy: 78 years Infant mortality: 5 per 1,000 births Maternal mortality: 8 per 100K births Life expectancy: 45 years $ Infant mortality: 95 per 1,000 births Maternal mortality: 500-1000 per 100K

  11. Simple Story $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$ $$$$

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

  13. 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

  14. 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.

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

  16. AIDS Treatment in Rural Rwanda One year later

  17. Improving Health Systems One year later

  18. Infrastructure One year later

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

  20. Patient Monitoring

  21. Unsuccessful Report

  22. Successful Report

  23. Unsuccessful Report

  24. OpenMRS • Open source framework for medical record systems • www.openmrs.org

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

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

  27. Rural Dispensary in Tanzania

  28. Standardized Care (IMCI)

  29. Standardized Care (IMCI)

  30. Standardized Care (IMCI)

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

  32. 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

  33. How Automate IMCI?

  34. Why Automate IMCI?

  35. Why Automate IMCI? • Improve adherence • Improve supervision • Easier to update • More sophisticated protocols • Reduced training

  36. Field Work Results to be published in CHI’08

  37. Viral Training

  38. Adherence Results

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

  40. Thank you! neal@equalarea.com

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