Disease surveillance began in the 17th century with John Graunt’s “Natural and Political Observations Made Upon the Bills of Mortality.” His work was the first to perform basic epidemiological and demographic analysis on the causes of death in London. His statistics included some interesting and unfamiliar causes of death from itch to lethargy to consumption. While Graunt’s analysis was the first of its kind, he still faced many insurmountable challenges. Fortunately, we have made tremendous strides in health, science and communications technology since the days of John Graunt. The realm of current opportunities to collect, store and ultimately use data at each level of the health system is increasing exponentially.
One of the main drivers of this evolution is the use of mobile phones and other digital approaches. Time magazine recently published a story where they illustrated this dramatic change when they mentioned that “A kid in Africa has more technology at his disposal than the president of the United States did 15 years ago.” In a world with a current mobile penetration rate of nearly 90%, we are seeing an unprecedented opportunity to use this relatively new tool to improve the health and safety of billions.
There is a huge variety of innovative approaches for using mHealth/eHealth tools, as well as the frequently referenced “bone yard” of mHealth pilots. There are still a lot of small scale, independent, exploratory pilots that lack consideration for interoperability, reusability, scalability, and therefore sustainability. What is needed is more of a long term approach that takes into account the value of interconnectivity and interoperability. Basing ehealth and mhealth tools on open standards and exposing appropriate APIs allows them to be used locally and by other organizations in innovative ways as a platform for new social and humanitarian programs. This is precisely why all of InSTEDD’s tools use an open architecture and open source approach.
Despite some negative press, mHealth and eHealth persists as the more effective and scalable solutions are identified. A few of the current promising approaches include collecting data during frontline health workers service delivery to using social media and polls for event based surveillance.
Some examples of frontline health worker platforms being used in increasingly sophisticated ways to create routine interactions and empower frontline health workers worth mentioning are the MOTECH and CommCare platforms. The systems provide community health workers tools for scheduling, reminders, job aides, training materials, and they collect a variety of data around maternal and child health through these processes. Each of the two systems is focused on enhancing interactive service delivery as opposed to tools with a primary focus on data collection and research. (i.e. Episurveyor and OpenDataKit).
The use of web-based information using social media or news outlets is another rapidly growing area for disease surveillance. This enhanced type of event-based surveillance has been shown valuable in rapidly identifying disease dynamics in coordination with exisiting surveillance activities. There are some brilliant Digital Disease Detection Conference Videos from last year that are definitely worth a look in this area. These are just a couple of my favorites:
At InSTEDD, we continue to work towards Larry Brilliant’s founding vision for a global disease surveillance network that builds upon the knowledge and sensitivities of local communities. We are passionate about using data to surface meaningful insights and improve health outcomes at the community level. We believe that data from disparate systems can be used in an interoperable and interactive way to empower health workers and increase our understanding of local, regional and global disease dynamics. One of the ways we working to implement these concepts is through the use of GeoChat to support communication between disease surveillance teams and suspected outbreaks in Thailand. These interoperable and interactive tools are the next step to maximize disease surveillance activities and ensure appropriate response.