The role of hand-held computers (PDAs)

Transcription

1 HIFA2015 Summary September 2008 The role of hand-held computers (PDAs) Note: Discussion is ongoing and further comments are welcome. Please send your messages to: and/or This summary will be updated as the discussion proceeds. This discussion took place on HIFA2015 throughout There were 14 messages from 5 contributors: United Kingdom (1 contributor), Malaysia (1) and USA (3). Contents: 1. THE CALL FOR HAND-HELD COMPUTERS 2. EXPERIENCES OF USING HAND-HELD COMPUTERS 3. OPPORTUNITIES AND CHALLENGES 4. WAYS FORWARD 5. LIST OF CONTRIBUTORS 1. THE CALL FOR HAND-HELD COMPUTERS This thread began with one post in January 2007 and the topic was picked up again in November This section outlines the call for hand-held computers, or PDAs (Personal Digital Assistant). Adesina Iluyemi, UK (January 2007): Based on the background of our recent discussions on the presentation of relevant and appropriate health information and knowledge to health workers in developing countries. It was higlighted in the discussions that the provision of contextural information to health workers at the primary and community levels has been known to be non-existent or chaotic. As a solution, a case was made for the provision of medical books for the digest of information by health workers. However, major limitations highlighted for this approach were lack of library facilities, low reading culture, lack of time to study due to workload and others in many developing countries especially Sub Sahara Africa The use of wireless and mobile technologies should be explored for overcoming these difficulties because of the potentials of providing information in a low-cost and easily accessible format and enables embedding medical knowledge within the workflow and daily activities of health workers. Bill Ward, USA (November 2007): I have a friend in Southern Zambia who also wants print materials for his staff. With the "Green" movement worldwide, what is the possibility of using

2 low cost PDAs. 2. EXPERIENCES OF USING HAND-HELD COMPUTERS Leela McCullough, USA: AED-SATELLIFE has been using low-cost PDAs in our Uganda Health Information Project for data collection and information dissemination for the past 3 years (see Stakeholders identified diarrhea, malaria, and neumonia as key diseases to focus on initially and later added other topics such as HIV/AIDS, Maternal and child health, TB, etc. Content broadcasts are sent to health workers in 5 rural districts via the wireless network that we created in Uganda which piggy-backs on the cellular network. Sources of content include local clinical and treatment guidelines, selected WHO content, and relevant content from health and medical journals. Our team in Uganda converts the content into html format that can be read in a browser application that is loaded on the PDA. Training in the use of PDAs is also provided by the team. Health workers (nurses, nursing assistants, clinical officers, community health workers) enjoy using the devices and rely on them for clinical management of patients and public health work in the community. We have also used Mobipocket Reader and have converted content into e- books which can be read in this application. Conversion of content into html format does take a bit of time but is very doable. Adesina Iluyemi, UK: It might be nice to look at the work of Tapan S. Parikh in using mobile phones for copying and transmitting documents in rural India. Here is a link to his website: 3. OPPORTUNITIES AND CHALLENGES Leela McCullough, USA: I am curious about reading documents on the small screen of the mobile phone. The size of the document is an important issue. PDA screens are small too but one can read text fairly well -- tables and charts are not so easy. If you move up to a smartphone that has the capabilities of a mobile phone and PDA, the screen is bigger which does help. But, the smartphone is more expensive. Microfinance applications, data collection, emergency health calls, health alerts, medication reminders, etc. are all quite doable on the mobile phone. Adesina Iluyemi, UK: I think the time has come to shift attention to low-cost laptops with multi-wireless capabilities and with low-power consumption. The OLPC[*] has blazed this trail and the big boys are joining in. I will predict that in the next five years this will be going for $100-$150, the cost for some smartphones or PDAs now. [*OLPC = One Laptop Per Child ( Neil PW, HIFA2015 co-moderator] Rakesh Biswas, Malaysia: The advantage of *mobilephones* lies in their present population penetration which is substantial. Also the general population may not appreciate switching from more portable to less portable devices. In all probability the future mobile phone shall develop present day laptop functionality (PDA etc are approximations that are inching closer). Adesina Iluyemi, UK: Other projects are also emerging; the Asus Minibooks

3 ( ) that costs between ) is an example. A general observation of these devices is that they are mostly made for children in developed countries and with the OLPC in developing countries. But they still have the functionalities and capabilities of regular laptops. If health workers in developing countries are using PDAs and mobile phones effectively now, I believe then that they can use these low-cost laptops too. Another innovative contribution of the OLPC is the multiwireless communication capability of the device. With the peer-to-peer design, it is possible for health workers working within a facility or within a considerable geographic location to communicate with each other without the need for a public wireless network. This has advantage for telecommunication cost-savings especially in developing countries. Bob Pyke, USA: Cost for the rest of the world is still high, the iphone is still pricey, but prices are coming down, the Blackberry looks pretty good but adoption is spotty except in the business community. If and what role will the iphone play is debatable. The new forthcoming Windows based smart phones look pretty good and may offer an alternative. Also I see UTube playing a role in e-health/telehealth throughout the world? Rakesh Biswas, Malaysia: Just to add to the figures on OLPC costs the Indian HR Ministry had stated plans to make laptops at $10 for schoolchildren. Two designs submitted to the ministry from a final year engineering student of Vellore Institute of Technology and a researcher from the Indian Institute of Science, Bangalore reportedly describe a laptop that could be produced for "$47 per laptop" for even small volumes. No technical specifications or development timelines have been released. ticleshow/ cms. On the other hand NGOs have started piloting the OLPC in certain parts of India: I guess you are correctly focussing on the present (where mobile phone data communication leaves a lot more to be desired and OLPC comes in as a life saver) and I was just reflecting on the future (when mobile phones will have a PC functionality and at the same time be handled by people from all walks of life, the PC illiterates of today, most of who do carry a mobile phone). Adesina Iluyemi, UK: Thanks for your comments. Progress have been made with school children but how can we replicate this with rural health workers in developing countries? I think we need to start searching for answers. Rakesh Biswas, Malaysia: To begin with I believe education in health workers unlike in children has to be more bottom up and experiential (where learning is generated in a meaningful dialogue that coincides with one's own experience). The present scenario is unfortunately more pedagogic and top down where health workers are spoon fed information and treated like children (as children have been treated traditionally but even that is changing). Bill Ward, USA: Thanks for your comments. To tie this in with the subject heading, hand held computers would allow for distance communication or field communication while field data are collected for program planning... As you mentioned, education should be a two way process... Strategic planning and management courses are great ways for students to look at their own clinics, hospitals, private practices, and the like in applying planning and

4 management principles to improve them. Field courses in other cultures can be very useful although a bit more involved. Although frustrating, team business plan development points out how difficult such activities are in the real world. Most administrators don't want open transparency which makes getting strategic information from them a real challenge for students but that is simply an introduction to the reaction they will get in the real world, as well. Adesina Iluyemi, UK: Kindly watch this slide show with soundtrack, on the One Laptop Per Child trial in Africa. Please pay attention to the teacher in pink attire taking hold of one of the Laptops. This teacher could be a health worker in rural or even urban Africa. A food for thought.** Audio slideshow: Laptops for Africa. Nigerian pupils and teachers explain how the $100 laptop project has helped education in Africa**. /1/hi/in_depth/629/629/ stm 4. WAYS FORWARD Contributors to this discussion pointed to several key issues to be considered in the future of hand-held computers (PDAs) for health workers in developing countries, Leela McCullough, USA: I would like to highlight that while the PDAs provide a powerful mobile computer library and are very useful in environments without Internet access, one needs to keep in mind the need for the training of users, ongoing support in use of the technology, and troubleshooting support. Leela McCullough, USA: When it comes to creating a mobile library for health workers, especially in rural areas where Internet access is limited, we have to seriously consider the following: who is our audience, what are their information needs, language preferences, what are the available sources of information, copyright issues, conversion of content from print into electronic into PDA format, information delivery mechanisms, training, on-going support for technology and content, and evaluation. Rakesh Biswas, Malaysia: I agree on the power consumption front and perhaps the need is acute for devices that can be charged by human muscle power (as in the OLPC laptops that may be charged on hand crank or even pedalling). Rakesh Biswas, Malaysia: Health workers need something like adult active learning and experiential knowledge sharing has a lot to offer. Matching individual experiences (and the health information contained therein) is a challenge that ehealth has risen to answer in the coming future. Adesina Iluyemi, UK: Pilot studies are needed to evaluate low-cost laptops with rural and urban health workers in developing countries. Related topics on the HIFA2015 forum include Free healthcare information by mobile phone, Mobile phones for isolated health workers, Using laptops in remote areas, and ICTs for health in the developing world.

5 4. LIST OF CONTRIBUTORS Rakesh Biswas is Associate professor, Department of Medicine, Melaka-Manipal Medical College, Melaka, Malaysia. He is a physician academic trying to merge two worlds, the developing and developed in his day to day practice. He has worked in India, Nepal and Malaysia. His interests include Medical problem solving, education and evidence based telemedicine. rakesh7biswas AT gmail.com Adesina Iluyemi is a dentist by profession with Masters degree and postgraduate Royal College of Surgeons, England diploma in Dental Public Health. He is presently a PhD candidate at the Centre for Healthcare Modelling and Informatics, University of Portsmouth, UK studying Mobile Health Information System (Telehealth) in developing countries context and focussing on the use of mobile technologies to support community health workers. He is also interested in the use of mobile technologies for the management of chronic disease patients especially HIV/AIDS. adeiluyemi AT yahoo.co.uk Leela McCullough is Director of Information Services at the AED-SATELLIFE Center for Health Information and Technology, an international not-for-profit organization based in the US. AED- SATELLIFE serves the urgent health information needs of the world's poorest countries through the innovative use of information technology. Information services developed by AED-SATELLIFE include global discussion groups and electronic publications comprised of abstracts and selected full-text articles from leading medical journals and international organizations. These services are available free of charge to health professionals in the developing world only. For information and subscription details, send an message to hnet@healthnet.org. Web site lmccullough AT aed.org Bob Pyke is a pediatric nurse practitioner, and a technical consultant with experience in healthcare management. His interests include Ambulatory Care, Chronic Care, Home Health Care and Case Management, Managed Care, Pediatrics, Health Informatics, E-Health, Distance Education, International Health, Humanization Relief and International Pediatrics. Bob is coadministrator of the Telehealth Professional Discussion List serve and the E-Health Professional Discussion List serve. He is also the assistant editor of the TelehealthNews Letter, and a constant observer and writer focused on the use of technology in health care today. In real life he is adoptive father of a son from Korea and a daughter from Nepal. In his spare time, he tries to travel back to Asia to escort children to spend time with their families. He is also a professional clown and is AKA, Dr. Denton Fender. repyke AT infi.net Bill Ward has been involved in maternal and child health in developing countries for the last 4 decades (Middle East, West Africa, and the Caribbean primarily). He is a faculty member in the Department of Health Policy and Measurement at the University of South Florida College of Public Health and he teaches distance courses in international health management. He also teaches a graduate course In global primary health care strategies, and directed a primary health care and community development program on the Palestinian West Bank that provided 125,000 visits annually to 50 villages. He is a doctorally trained health educator with a focus on community health, primary health care, and health care planning and evaluation. wward AT hsc.usf.edu Summary prepared by Clare Chandler, HIFA2015 expert advisory panel & London School of Hygiene and Tropical Medicine