InSTEDD - Innovative Support to Emergencies Diseases and Disasters

Controlling your Privacy with Health Commons

2012-03-27T10:33:53-07:00

If you buy into the idea that information about your body is ‘owned’ by you, then it’s obvious you should get to have a say about what happens with that data once it leaves your body. Unfortunately, today there is no clear and easy way to express how you want people to use your data. In most cases, you never even get asked.

As a result I see many eHealth project implementers making cavalier decisions about data management that impact the rights and privacy of populations, patients and doctors alike. People grab, share, analyze information they may not have the rights to, sometimes even by accident. There are so many incentives to produce and move data freely: folks could use the data for the promise of big data analysis, research publications, commercial product improvement, for the sakes of efficiency, medical research, marketing, writing grants, or operations analysis. Violating rights and expectations is especially easy as these eHealth projects tend to have a bunch of players involved, each one with their own language, objectives and culture.

Unfortunately, there is a lack of frameworks and common language in which to have a discussion about rights to share and use health data. Academics do IRB reviews, but rarely understand licensing terms. Doctors use eHealth systems but are not information specialists, but typically don't go beyond clinical and public health use. Private systems may or may not have end user license agreements (EULAs), they impose a one-size-fits-all policy, and nobody reads the EULAs anyway because they are complicated, and each one so is different. Doctors in the USA mention HIPAA, and folks from other countries snicker. Governments roll out an eHealth HIV project and the data ends up in some intern’s laptop in California because he happened to help with the database system. And as you see this information flow rarely involves the consent and opt-in of the population and health providers in whom the population places their trust.

Imagine this situation: a mom shows up at a clinic and gets a diagnostic for her child. Who has which rights on the data? What about the kid? Her mom? What about the doctor who takes the test, the manufacturer of the diagnostics machine, the clinic where the doctor works, the NGO that implemented the diagnostic program, the funder that funded the NGO and bought the diagnostic machine, the government of the country, WHO?

I was recently a part of the annual AAAS Annual Meeting on a panel about Surveillance. It was a good chance to catch up with Nigel Collier from Biocaster and get to hear some poignant questions from Vint Cerf, one of the ‘fathers of the internet’. We had representatives of all sorts of surveillance work from anti-terrorism to meme propagation to infectious disease tracking; and there I presented a sketch of an idea:

What if we created a simple licensing framework that made it clear what rights and constraints go with different bits of your health data as it gets stored, aggregated, and analyzed?

If Creative Commons licensing helps a wide sharing of creative work under predictable terms that respect the intent of the creators; could a “Health Commons” do the same thing for health data? What can we learn from the evolution of sharing of information on the web and apply it to this critical space?

I would like to one day be able to share information about my health on some mobile app, a wellness site, or a diagnostic procedure, and specify that I am sharing it with the following restrictions:

Sometimes I would say it is OK to link the data to my other records, sometimes not: it all depends on the context and what it is that I am sharing. The important thing is that I am in control of data about my health.

Or, conversely, if I am participating in some survey, taking a diagnostic, or going to a new health care provider I would like to know if my data is going to be used with a forced license on it, so I can make an informed decision about whether to actually participate or not.

How would it work?

The idea roughly sketched would be to:

Treat personal information as data covered under copyright law, with the patient/originator as the original copyright holder.
Build a licensing scheme that grants explicit rights and restrictions to receivers of that data.
Make sure the rights and restrictions are termed right so that re-licensing and aggregation have clear and simple rules.
Embed licensing options into all relevant diagnostic and medical record platforms, as well as wellness websites, social networking sites, and so on.
Communicate & advocate the framework especially building conscience in the public.

I don’t know if the license example I invented for the example above (linking to other personal information, aggregating, and use for health, science, and commerce) are ‘the right ones’. I would love to hear more ideas for the sort of constraints and freedoms a simple license would allow.

Maybe other terms would be more important. Are there levels of anonymization I could specify for my data in aggregate form? Are there clauses for natural disasters or crisis that would allow me to temporarily bypass privacy concerns in order to help me reunite with my family? The nice thing about the model is that it provides a framework in which to resolve these questions.

The genius of Creative Commons was to choose a few simple rules that would be easy to understand for many, instead of trying to make it a comprehensive license for all cases and preferences; a Health Commons would have to emulate that approach. Each time you see the Creative Commons icon it carries beneath it a smart and legally sound set of terms and licenses.

Next Steps?

If anyone feels inclined to develop this further please let me know. The idea needs work from copyright attorneys, IP wonks, IRB data geeks, healthcare providers - and most importantly, anyone in the general population who would like to have a tool like this. I am especially interested in the licensing framework required for safe sharing of personal health information. I have seen "Health Commons" used to describe a knowledge commons with intellectual property such as genetic sequences, but I think much more focus is needed on the incoming tidal wave of integrated personal data from electronic records, sensors, and surveillance.

I think especially large funders and companies who are at the intersection of humanitarian field work and scientific investments need to improve their frameworks to make sure their programs have an ethical approach to protecting rights of their beneficiaries. In the meantime, maybe they should get into the mindset that they are just storing borrowed copyrighted information...

Please leave comments if you have an opinion on the topic.

More about Creative Commons

We use Creative Commons extensively in our work at InSTEDD. Most of our presentations are explicitly licensed under CC BY-NC-SA 3.0 (Attribution, Noncommercial, Share Alike), as is the material of this blog.

Like InSTEDD, Creative Commons is a non-profit organization that can always use your support: consider donating to them here.

National Health Systems as a Fabric of Services

2012-03-25T05:11:19-07:00

At InSTEDD right now we are involved on a wide spectrum of projects. Many of our projects are short and grassroots-driven, such as our recent work with UNICEF using aerial photography to map environmental vulnerabilities in the slums of Rio de Janiero (see blog from our iLab Latin America: Part 1 and Part 2). In addition, many of our projects are longer and more complex as we help Ministries of Health or large NGOs lay the technology foundation that helps them meet better serve their country over the long run, such as our work in Cambodia and Rwanda.

These latter projects require more patience to see the impact and are sometimes more difficult to work on due to the time lines and the large number of stakeholders and interests involved. But, when done right, the long-term impact can be transformational.

We are lucky to be involved with Jembi, Regenstrief Institute and others on implementing such a project in Rwanda, under the leadership of Dr. Richard Gakuba, who works for the Ministry of Health as the National eHealth Coordinator. Dr. Gakuba is leading the charge transforming Rwanda's Health Information System. A big part of this modernization is the implementation of shared health records, terminology services, and facility and provider registries. When this phase of the project is done, Rwanda will have a variety of independent, but interoperating, web services that implement these capabilities. It may sound like a 2002 buzzword to call it a “fabric”, but it evokes the right image: a supporting net of independent but inter-woven services.

Having a fabric of services makes a lot of sense in this context, starting with the impact of this architecture pattern on human and organizational dynamics. Distributing the ownership, management and maintenance of different areas of data is appropriate when the organization itself is made of different departments with different workflows, incentives, and management styles. Centralizing all these processes and information into a monolithic block would cause a collapse as the only entity able to change things would rapidly become a bottleneck. Just the provisioning and maintenance of one big system can be an insurmountable obstacle. Modularity allows piecemeal evolution.

Benefits

Having a "fabric" of services has many advantages:

Creating an Ecosystem - services and their data can get used by others to create new "value-add services". For example, a facility registry could be extended with a call-in system to let immigrants get directions to nearby clinic in their own dialects. Enabling these value-add services (including mashups and client apps) allows the ecosystem of users (the general population, the local NGOs, the international ICT community, national and international private sector) to act like a gap-finder for better health services and businesses.

Potential for Big Data - Services provide a quantum leap over the traditional approach of keeping excel spreadsheets, access databases, and ad-hoc CSVs for research and retrospective data analysis. Data can be stored and versioned appropriately therefore simplifying future retrospective analysis. Taking advantage of these datasets comes with many challenges, however. For example, most countries do not have or enforce a framework where people opt-in to having their data stored, shared, and/or analyzed for research or commercial purposes. Rwanda has taken what I consider to be a great stance: All data that will be kept centrally about individuals has to be approved 'column by column' (using a relational metaphor). The data can be used only with scientific journal backed evidence that the information can be used to improve health outcomes within an actual project/program to do so. Notice this may turn some big data fans pale ("What, you are not saving everything centrally and then figuring out what to do with it?"), but I think it is a smarter place to start.

Steps to Open Government - While modest, the decision to have public data available as web services on the internet can be a milestone towards "open gov". Opening up government data increases accountability, trust, and feedback loops. Many governments would probably prefer to pay lip service to open data principles rather than embrace them; but there are so many benefits to doing so in the health sector that it may be a great place to start.

Example Services

What are the services that could exist in such a fabric? The theoretical list runs long but here are some examples of the services we are dealing with in the real world:

Facility Registry: A service to keep track of facilities, their admin information, the health services they provide, and data about their catchment population.
Vital Registration: Service to keep track of births, deaths and Health ID management for the population (Note that a different ID assignment authority is needed: the United State's practice of using a unified social security number for financial ID, health ID and immigration purposes is considered 'bad practice' by modern standards, and I am happy where we are working with people who are staying away from unified IDs).
Shared Health Record: Services that keep track of individual people's health data over time.
Provider Registry: A service that tracks the institutions and individuals who are licensed to work in the health system. This can be enormously important for HR, education, and performance-based-financing work. Having a current provider registry also is a foundation for maintaining privacy.
Terminology Registry: Services that collect, map and standardize the meaning of different words and fields. This makes it easier to see if the "blood pressure" field used in system A can be equated to "blood pressure" in system B (If the blood pressure is taken in different parts of the body in different conditions, the data semantics are different, regardless of the shared label).
mHealth SMS, Voice and USSD gateway: Having these help consolidate agreements with operators & aggregators and provide a simpler way to manage collections of mHealth initiatives.

Of course, having many services makes it necessary to have better federated authentication/authorization capabilities (unless you want users to forget 10 passwords instead of only one) and to have some external services that act as controllers/orchestrators for complex multi-step operations (for example, someone dying or moving may trigger a cascade of operations on all the services above).

Good neighbors

To be good citizens of the fabric, the services have to play well with each other. Here are some expectations:

Master vs Reference Data: Each service has clear ownership of master data versus what is reference, externally managed data which may be continuously updated from some external system.
Accommodating Dynamic Changes: Services-especially the registries and shared health record — have to accommodate dynamic changes in information schemas and uses over time; and provide a good long-term versioning strategy.
Updates and Queries: Services must expose a REST API or equivalent endpoints for state updates and queries, as well as expose a stream-of-events API (e.g. Atom/RSS feeds with some pingback/notification mechanism to allow other services to adjust themselves to the changes in real time or in batch mode).
Compatibility: Services share compatible approaches to authentication/authorization/auditing and other crosscutting aspects.

For the work we are doing, Rwanda has chosen use cases in maternal-child health as the 'red thread' that will drive priorities in the project. Part of their well thought out strategy is to keep governance over the technology but rely on local and international partners to help build the technology instead of having an in-house dev shop within the Ministry of health.

InSTEDD contributes the Facility Registry

Rwanda is currently evaluating good starting points for the services discussed above. For the Facility Registry services, Rwanda is evaluating Resource Map, an InSTEDD tool that was originally developed in 2009 by our iLab Southeast Asia.

Resource Map evolved to help people make better use of their data. Data that isn't used is stale, and stale data isn't used. We have seen lots of projects and facilities collect and forget about the data as soon as its reliability became suspect. Tens of thousands of dollars per country are spent every year on collecting information that could have simply received minor updates from previous versions.

Originally, we called the tool 'Dynamic Resource Map' to emphasize the dynamic nature of the tool. We wanted to ensure that the tool supported making the data operational, not obsolete. Some key aspects of the tool include the ability to define your own layers, with 'points' or resources or reports on those layers (which are shown as different fields). The tool also has query and update features that can be done through SMS and smartphones (using Open Data Kit). The tool is designed to manage a resource database that happens to have a 'geo' component to it which adds critical behaviors on top of the typical alternatives of having semantic-less spreadsheets or generic GIS tools.

A real-world example of the value of the tool is its ability to track stocks of supplies for Malaria treatment at the health center level. The simplicity of being able to just text in your current stock and have it automatically trigger an alert to the folks in the capital that will send you more medicines is invaluable.

Seeing the individual or clustered facilities with your own icons or alerts based on your rules can give you a real-time operational picture that otherwise would be impossible to visualize. Other uses include tracking of information about water quality measured periodically at different pumps, and also it is useful for project tracking and monitoring & evaluation (M&E) data gathering.

Data that isn't used is stale, and stale data isn't used.

As with any InSTEDD tool since 2007, we took the perspective of providing a cloud 'product' that is generic and usable worldwide, that each user can configure to their needs. For example, folks can add their own fields, manage their own user permissions, and have total freedom to import and export their own data, etc. And with the APIs and import/export features, people can move the data to spreadsheets or to more specific tools like ArcGIS or GeoCommons as needed.

As we work with the Rwanda Ministry of Health on their eHealth foundation, our Resource Map tool will evolve to incorporate the experiences and feedback from the people using the tools. We will use their stories to maximize the benefit to the global eHealth/ICT4D community as we develop new versions over the upcoming months. In addition, we have started engaging with other amazing implementation partners so that this work can be incorporated into the shared commons of technology. We are excited about the changes that this initiative is already bringing in the front of APIs as well.

Back to Rwanda

Here is a video with Dr. Gakuba discussing the plans and context for the work. It contains many insights from a practitioner and leader that has to make the tough decisions every day. (Note, it is a bit long and the camera just focuses on the speaker, so it's hard to flip through it.)

He warns about making implementations of health programs revolve around evaluations (instead of make evaluations revolve around implementations) and gives an idea of the progress Rwanda has made in Maternal/Child Health, and how eHealth can help further MDG goals and health delivery.

He also reinforces the importance of starting small and working directly with your users as much as possible. Dr. Gakuba also recommends deploying simpler, smaller parts in a sequence versus going after large, complex technologies from the onset. Fortunately InSTEDD’s services-based approach is a perfect fit for that strategy, which allows the Ministry of Health to stay focused on priorities and gives a more iterative, agile frame to the project.

Our Modern Toolkit: Free and Open Source Tools for Social Impact

2012-03-14T17:09:52-07:00

At InSTEDD, we have been working to make the world a place where individuals, families and communities thrive, regardless of their geography, income levels or culture. We recognize that when dealing with issues around health, safety and development, there are many obstacles and challenges that we must overcome in order to make a meaningful social impact. That is why everything we do is based on a social-technical approach that involves users and local developers every step of the way. We focus on a human-centered design approach that involves listening openly to our partners, the final users, and experts in that particular issue area. We have the final users near us at every step so that we can learn fast, make changes quickly and work together towards developing an appropriate user-friendly solution.

Modern Toolkit of Free and Open Source Tools for Social Impact

With social impact being our primary goal, we are proud to share our powerful modern toolkit with the rest of the world. InSTEDD’s suite of open source tools is a collection of technologies that have been used to support our focus areas of maternal/child health, infectious diseases, emergency management and local innovation/leadership.

We believe that everything can be built in smaller, useful parts, delivering value in weeks, rather than years. Our highly skilled interdisciplinary team of public health experts, scientists, and software engineers works closely with our network of partners in Asia, Africa, Europe and the Americas. Through collaboration, we are able to maximize our resources and work faster, smarter and more cost effectively.

Powerful Tools Designed for Low Resource Communities (and they’re free, too!)

Developers at InSTEDD and in our iLabs around the world create platforms that are always free, reusable, interoperable, open source, and customizable. Designed for low resource settings, all of our tools are built based on knowledge from the real world where challenges are at every turn. Each tool has been designed, tested, and constantly improved by communities with little access to electricity, internet, expensive hardware, and technological literacy and by local leaders working with limited budget, often over stretched staff, and tremendous demands on their time. Whether the tool is used for natural disaster response in Haiti, preventing the spread of Dengue in Bangladesh, improving AIDS response in Rwanda, early detection of infectious disease outbreaks Cambodia, or organizing first responders in isolated communities in the USA, our tools are help communities to thrive.

Examples of InSTEDD Tools in Action

Remindem, our text messaging reminder tool, sends simple texts with to educate, advise, and remind parents and caregivers worldwide about childhood immunizations. (focus area: maternal / child health)

Verboice, our voice-based messaging tool, allows us to communicate clearly with oral communities, building a voice-based educational campaign with tailored messages from local opinion leaders to educate and engage parents and caregivers. (focus area: local innovation / leadership)

Resource Map, our collaborative mapping tool, lets us to see who has sufficient vaccination supplies and where they are, get alerts when supplies are too high or too low. (focus area: infectious diseases)

GeoChat helps teams of first responders, clinical staff, & public emergency response officials to stay in close contact during the aftermath of a disaster. Using this tool, they can keep each other informed about new disease cases, emergency situations, & critical resources in an area. Where problems arise, people on the scene can be immediately connected to a team that offers medical advice, arrives quickly with resources and transportation, or prepares to receive a patient. (focus area: emergency management)

Pollit, our mobile data collection tool, allows program leaders to assess, in an instant, community knowledge, attitudes, behaviors, needs and assets as they develop and evaluate projects. Using Pollit, the beneficiaries can be heard before and after a program or intervention, allowing program leaders to take the pulse of the people anytime and anywhere there is mobile phone service (focus area: local innovation / leadership )

Data Part 2: It’s not the technology, it’s about who uses it and how

2012-02-28T13:13:43-08:00

DATA PART 2:
IT’S NOT ABOUT THE TECHNOLOGY, IT’S ABOUT WHO USES IT AND HOW

Channe and Yon, from the iLab Southeast Asia, conducting usability tests with health care workers in a remote area outside Phnom Penh, Cambodia.

Last week, we blogged about some of the many lessons we’ve learned when it comes to working on projects that require some form of data collection. As a follow up to the post last week, we’ve added more of what we’ve learned in the hopes that it will help you better deal with similar situations. Below is a continued list of our lessons learned and how we have been able to work around the problems we’ve faced in the field.

Are you incorporating sensor information into your data sets?

The breadth of mobile coverage has opened many doors for data collection by humans — but what about sensor information? There are dozens of strategies to get more data automatically from remote places, especially as the costs and power requirements of Global Systems for Mobile (GSM) and wifi electronics plummet.

For instance, you can:

Use built-in smart phones sensors such as GPSs, accelerometers, cameras and/or touchscreens to automatically collect information on the go.
Extend the capability of a device with accessory gadgets and connect them via the device’s wires or bluetooth.
Hack devices to change their sensors or their inputs

Think what you can learn if you put sensors into portable vaccine fridges, or ambulances, water pumps or even prosthetic knees! Of course, this can be expensive. You can’t just outfit hundreds of thousands of water pumps with connected sensors to evaluate the quality and quantity of the water in the blink of an eye. But, in terms of the completeness-timeliness-quality trade off issue (see image below), the embedded and connected sensors can give very timely, high-quality data. Going back to our example, maybe if only 1% of well-chosen sentinel water pumps are outfitted with sensors, and you rotate them over time, you can get data leading to insights that otherwise would have been lost.

What are the motivations and incentives of the people who will use the tools?

Any good design process uncovers and adapts a solution to a large number of explicit and implicit motivations, incentive systems, fears and hopes experienced by the human users. We run into many researchers for which ‘data is king’ — and as they lead a data collection project they run into the reality that other people care about other things besides just collecting that data.

One useful tool we use at InSTEDD is a simplified approach to going through payoff matrices of the type used in game theory. We use this to evaluate the ‘payoff’ of people doing or not doing an intended or unintended action. The payoff matrices are just a guide for our dialogue to make sure we ask all the pertinent questions, such as:

Why would you do X instead of Y? or
Is it better for you to do A or B?

You can roughly quantify the answers and see what actions are more likely to happen. Sometimes this leads to discovering ways in which your users ‘game the system’ — which can be a slightly tense, humorous and often embarrassing moment.

There is usually a complex web of incentives that shape the situation. Incentives related to money, power, social/professional hierarchy, geography or even a sense of righteousness are all common influencing factors. Attempting to analyze such an intertwined and complex web can be a fool’s errand. While we may never be able to fully understand all the factors at play, it’s important to investigate as much as possible so that we can design a solution that will be of value.

One of the greatest things about the InSTEDD iLabs are that they are made up of local staff who already have a deep understanding of the region, culture, language and many of the obstacles the users face within this context.

When some type of monetary reward is brought in as an incentive, payoff matrices rapidly become distorted. Many people approach InSTEDD with a design idea that will give the people who are using their technology a financial reward when certain data gets reported within a specific time frame. Unfortunately, I have yet to encounter any situation where providing money as a reward for data doesn’t skew the data beyond repair. Let’s say you give the health care workers who are reporting diseases some sort of cash bonus if they refer a tuberculosis patient that tests positive in a lab to treatment. By doing this, you’ve just created an incentive to have a health worker time the referrals to suit their own needs. The health worker may know of some tuberculosis patients in another village who need treatment, but the health worker may not refer them to treatment until it makes financial sense for him to do so. The sick patients can quickly become some sort of savings bank account or ATM for that individual health worker, as opposed to creating a collaborative “we’re all in this together because we are serving our community” incentive structure.

Many researchers like to think of themselves as objective and impartial as they focus on “the data”, but all too often these researchers unconsciously set incentive systems that distort the data they are helping to collect. They naively hope that if they pay for the data, then they will see the quality and consistency they desire. Unfortunately, many of the people who are in the field collecting data are focusing on other layers of Maslow’s hierarchy of needs and see the financial incentive as a great opportunity for them to take advantage of the system.

image from: http://life-engineering.com/1797/fulfillment-101-maslows-hierarchy-of-needs/

An interesting trend is the incorporation of “gamification” techniques which works by making technology more attractive and encouraging users to engage in desired behaviors by taking advantage of humans’ psychological predisposition to play games. Some examples of these gamification techniques include virtual currencies, hierarchy status, ranks, medals, titles, commendations, points and levels, just to name a few. These virtual incentives become truly valuable in the participant’s mind and they have been shown to dramatically change behaviors.

Military groups have long exploited gamification techniques and use video games as simulations for combat. Military groups have played off of human motivations and psychology for most of their history, and are now incorporating much of their techniques into social networks and virtual communities in order to increase the social exposure of participants. Just like someone can become a ‘Mayor’ in FourSquare, data collection users may be motivated by the opportunity to show off their ‘Perfectionist’ medals and ‘gold credits’ for doing things well. I have yet to see, however, better research in how these gamificiation patterns work for people who spend more time closer to real basic human needs (lower in the Maslow pyramid).

Does the data matter to your users?

One design approach to improving the quality of data that is collected is to ensure that the data being submitted actually matters and is useful to the user. This may take the form of responding with aggregate reports, comparative trends with neighboring areas, or some other piece of useful information that closes a feedback loop to the user. Some of the questions we’ve learned to keep asking are:

How does this data, or what happens to it, matter to the people doing the collection?
What could they do differently because of their connection to the data?
What do they aspire to do more of, or to do better?
How can the data they receive back be used to help them achieve it?

For example, community health workers sometimes enjoy a simple elevated ‘status’ because of their work. Sometimes, getting health information about what is going on in neighboring villages can help them maintain that status as it helps them stay ‘in the know’. The information sent back need not be useful in of itself, it just needs to make the receiver happy and somehow be derived from the data submitted by them in the first place.

Using a Suite of Tools: InSTEDD Technologies

Based on years of experience working with users within their own contexts, we’ve developed a suite of tools that help people turn data into action to support health, safety and development. We highly encourage you to browse through our free and open source “modern tool belt” to help you better collect, analyze and use data to achieve a maximum social impact.

click image to learn more about our technologies

Data Part 1: It’s not the technology, it’s about who uses it and how

2012-02-22T10:54:32-08:00

DATA PART 1:
IT’S NOT ABOUT THE TECHNOLOGY, IT’S ABOUT WHO USES IT AND HOW

Often times our work at InSTEDD revolves around projects that require some form of data collection. Typically we help people implement systems that facilitate work and use the relevant data to achieve a specific result. For example, we’ve worked on projects that help potential tuberculosis patients get tested earlier, HIV patients stay on track taking their medicines and tracking down sources of malaria to help eradicate it.

Over the course of working on a variety of projects that require data reporting, we’ve learned many valuable lessons. One such lesson is that the data collection system needs to be directly addressing the issue at hand, and often times the group running the project has to be coached up front in order to design the data collection system that deals with the real problem. In order to properly design a system for collecting data that is actionable, it’s important to understand the why, the who, the when and the context in which the data will be used.

Data for action, or data for data’s sake?

One of the first questions we ask is “why is this data important?” What will change in the world as a result of having it? Can we shift the design towards the outcome we want (the action) and not the means (the data itself)? Framing the discussion with these questions helps many of our partners shift their mindset so that they are better able to design an mHealth solution that supports the desired outcome: healthier people. The world is not Newtonian so bringing to existence a piece of data does not cause an equal corresponding reaction.

You want your data to be great, on time and with little resources

Any project manager with some experience is familiar with the ‘iron triangle’. If you want to deliver a project with certain quality, you can’t change time, scope and resources independently. Changing one will imply changes in the others. You can’t dictate that suddenly the project will deliver twice as much value, without changing the time and resources available.

In data collection a similar trade off happens: there is a tension between collecting data that is:

Timely — data is available quickly after a relevant event
Complete — data comes in from all relevant sources
High Quality — data tells you something happened when it did (it has good sensitivity) and that the data doesn’t tell you something happened when really it didn’t (it has good specificity)

However, there are some correlations worth exploiting when designing your solution as each particular problem set will have different needs and priorities. For example, infectious disease surveillance, polio eradication, reports of pregnant mothers with complications, street violence reports and post-disaster damage assessments all put different emphases on different ‘points’ of the triangle. The trade off is not a matter of the technologies themselves, but rather who uses them and how.

Additional hurdles need to be cleared when dealing with different technologies and their user experiences for collecting data. For example, filling out a 20-field form via SMS is painful. You also can’t send pictures as easily as you can do voice based messaging. Not everyone has a high-quality smartphone that lends itself to collecting highly structured data. People may not have the proper application, training or knowledge required to collect and/or share certain data. Filling in a form is can be a useful mechanism, but it’s important to be aware that the design of the form can influence the data in ways inexperienced people may not have predicted. Asking people the same question in different ways produce worse data. For example:

What symptoms do you have?
Do you have any of these symptoms?
Check all that apply: A, B,C
Do you have symptom A?
Do you have symptom B?
Do you have symptom C?”

We have learned that even a more advanced device which is capable of collecting richer data can produce worse data if the system isn’t designed properly.

Are you putting all your eggs in one basket?

The best strategy is not to rely on a silver bullet approach, or pick the option with the least obvious problems. Rather, it is wiser to create a combination of approaches that create datasets that you can use together. Such as

Create a ‘hotline’ to get some information from the population directly via voice, or with SMS callbacks. For example, this could be a hotline set up for farmers who can report suspicious livestock deaths (which could be an early indicator of an H5N1 outbreak).
Develop a consistent reporting schedule so that those closest to the action on a daily basis are in the habit of regularly reporting what they see. For example, community health workers can report routine and occasional events with more detail, through an SMS or voice reporting system.
Equip a highly-trained team with knowledge and technology to use more advanced technologies to gather rich information from the field. For example, community outreach teams can use smartphones or tablets in the field while they do routine/surprise interviews or unplanned field investigations to that the information collected is sent back to headquarters in real time.
Correlate the field information collected to verified diagnostic reports from reference laboratories validating disease diagnostics. For example, you can relate the information gathered from the community health centers to a larger more complex system to help verify if the diagnosis was correct and the treatment appropriate.

As you see, each data set will be different. Balancing the timeliness, completeness and quality of each solution gives you an opportunity to use the data complement each other. When brought together in the right way, these different information sets create a better picture than each one could independently. The whole is much greater than the sum of its parts.

We have learned many valuable lessons from our work in the field and the above post is by no means an exhaustive list. Our hope is that by sharing some of our experiences from working directly with the ones using our tools, that we will be able to help others improve the quality of their work as well.

Stay tuned for part two of this blog next week…

Rio 2.0 Demo Alley Conference: Building Technologies for Social Impact

2012-02-10T12:03:02-08:00

Rio 2.0 Demo Alley Conference: Building Technologies for Social Impact

Early this month, InSTEDD was fortunate enough to have participated in the USRio+2.0 Demo Alley event held at the Stanford University, Graduate School of Business. Demo Alley, also known as “speed geeking,” follows a similar format as the well known “speed dating” concept where the purpose is to encourage participants to meet a large number of new people and be exposed to a variety of innovative ideas that help bridge the gap between technology and sustainable development. For this event, participants divided into small groups and each group gathered around a small cocktail-like table to view a short five minute presentation put on by a representative of the organization. After those five minutes, the facilitator rang a bell to signal the group rotation to the next table for another demonstration.

Below is the presentation that InSTEDD CEO, Dennis M Israelski, MD, gave during the Rio 2.0 Demo Ally Conference.

Rio 2.0 Demo Alley Presentation

View more presentations from InSTEDD

Below is the transcript from Dr. Israelski’s presentation:

Slide 1: Cover
RIO 2.0 DEMO ALLEY
Building Technologies for Social Impact

Dennis M. Israelski, MD
President & CEO, InSTEDD
Clinical Professor of Medicine, Stanford University School of Medicine
Feb 2, 2011

Slide 2: About InSTEDD
At InSTEDD we envision a world where communities everywhere continuously improve their health, safety and economic development. To achieve this vision we use a social technical strategy to design and build technologies that can lead to solutions for the most challenging problems of our times.

Slide 3: About InSTEDD iLabs featuring the iLab Southeast Asia
InSTEDD’s unique approach has led to the creation of regional Innovation Laboratories also known as iLabs. These are regional assets that support human-centered design and development of technology for long-term social impact. We believe this approach will lead to creative solutions that are locally owned and led. The successful iLab will achieve a triple bottom line of 1) building local capacity 2) maximizing social impact and 3) investing in economic sustainability.

InSTEDD’s iLab Southeast Asia, located in Phnom Penh, Cambodia, was started in 2008 to support the Mekong Basin Disease Surveillance (MBDS) Network; this is a diplomatic pact among 6 Ministries of Health to collaborate on surveillance and response in The Mekong Basin sub region of Southeast Asia—considered a “hot zone” for emerging diseases. InSTEDD’s work with the MBDS resulted in the development of a suite of collaboration tools for early detection, response to disease outbreaks. (e.g., Geochat, Nuntium, Veeglio).

Slide 4–6: Examples

One example of how the InSTEDD iLab Southeast Asia is supporting public health work is through the Malaria Day 0 project. This project represents a partnership of the Ministry of Health’s National Malaria Center, an NGO known as the Malaria Consortium, and the largest telecommunication company in Cambodia. The objective of the pilot project was to build a scalable system for the alerting of malaria infections at the time of diagnosis.

The iLab Southeast Asia team designed and built a system to host reliable data sharing among the key stakeholders to support activities required to meet the National goal for the elimination of Malaria in Cambodia by 2025. It all happens real-time with customized alert text messages being sent by health centers and village health workers simultaneously to the operational district malaria supervisor, the provincial health department and national malaria elimination program.

The system was designed and built by the iLab Southeast Asia staff in less than four months and is currently up and running in 4 operational districts (represents 40 villages and 52 health centers) . The system has completely met the requirements of a 17 step series of end user stories. The system is fully capable of being scaled nationally.

And there is more– Clear visualization of the terrain improves the follow-up of Day Zero infections and will make it possible to better carry out investigations focused on improving epidemiology and entomology.

Slide 7: InSTEDD’s Modern Toolkit
Based on years of experience in human design in some of the most remote and resource constrained places around the world, we have created a flexible, diverse and scalable suite of tools that can be used independently or can be fully integrated. In addition the functionality of these reusable and open source tools can all be extended to multiple problem areas within health (i.e. improvement in achieving the Millenium Development Goals 4, 5, and 6) and other domains to address some of the greatest challenges of our time.

Please see our website to see our suite of tools in more detail.

Slide 8: Closing

Here we have briefly overviewed InSTEDD’s approach to fostering local innovation that can lead to sustainable solutions that address some of the most vexing challenges in Global Health. It’s an exciting time in history where the power of technology can be used to address the greatest threats to communities everywhere. We stand ready and able to assist partners to meet that challenge. Our contact information and materials are available, so please reach out to us if you believe we can be of assistance.

One Man’s Trash is Another Man’s Catalyst for Innovation: How a simple toilet paper roll led to the creation of the Reporting Wheel

2012-02-06T20:08:09-08:00

One Man’s Trash is Another Man’s Catalyst for Innovation
How a simple toilet paper roll led to the creation of the Reporting Wheel

An important aspect of InSTEDD’s work is that we work with the people who will actually be using the tools we create every step of the way. We don’t build anything in isolation and we involve the end-users every step of the way. When we spoke to the people at these rural health centers, we encountered a number of issues that we had to find creative solutions to work around. For a detailed look into how we overcame these challenges to develop the Reporting Wheel, please read the blog post “IT without Software” here.

Back in mid 2009, part of the InSTEDD team went to Southeast Asia to work with some rural community health workers in order to create a simple, fast and easy way for them to share information about disease instances at their health centers. Disease instances would include things such as the disease type, the age of the person who was sick, the date of when they fell ill and so on. The information needed to be shared in a somewhat structured way so that the health workers higher up the information hierarchy could easily be able to tell when there was a problem. We needed to help them find a way to “compare apples and apples”, not apples and mangoes.

Below is a short reflection by Adrian Romero, one of the developers who created one of the first prototypes for what later became the Reporting Wheel.

I took a trip to the iLab Southeast Asia in 2010 to help identify opportunities for technology to support public health workers in Southeast Asia. One of the projects I began working on was the Reporting Wheel. Now, when I think of technology, I tend to think of a physical electrical device. Unfortunately, the technology that I’m used to back home is not as prevalent and widely used in places like the remote villages of Thailand and Cambodia. With this in mind, I began to wonder what other types of devices could be used to encode a specific set of values, such as in disease reporting.

As I tossed this idea around to others at InSTEDD, we began to build some momentum behind designing a non-electrical device that could be used to help the health workers who had such limited access to technology. We knew that we needed to create some sort of device that:

1) can be made a home with common household materials

2) was small enough to be easily carried around by a person

3) was effective at encoding potentially lots of values

4) was extremely simple and easy to use

At home, later that evening, I was stuck by an idea. What if I could make a device from two concentric cylinders, where the outer cylinder would display values through a small windows so that you could see the codes labelled on the inner cylinder? People would rotate the outer cylinder in order to choose which data to report, revealing the code through the display windows.

The potential for this idea was tremendous. I got so excited that I rushed around my apartment trying to find materials to build the first protoype. Less than 10 minutes later with nothing more than a couple of empty toilet paper rolls, a pair of scissors and a pen, I was able to create the first prototype of what later evolved into the Reporting Wheel.

Although the Reporting Wheel 1.0 wasn’t very impressive to look at, it represented something much bigger than the sum of its parts. The most important thing about this experience was the fact that all you needed to create innovative solutions was a good idea and the willingness to try something unexpected. Ideas are easy to come by, but the iLabs provide a great way to try them out and see what works and what doesn’t faster than anything else we’ve seen.

To learn more about how InSTEDD developed the Reporting Wheel, please read this blog post.

To watch a short video on how to assemble your own Reporting Wheel, please watch here.

To get started making your own Reporting Wheel, please continue here.

Part 2: “If You Don’t Go, You Don’t Know”

2012-02-02T11:17:25-08:00

If You Don’t Go, You Don’t Know
What We’ve Learned and What We’re Doing About It

PART 2: The Journey

(For part one, click here)

How to Scale 10x Overnight

Part of the challenge of scaling technologies that use SMS text messaging is how quickly the costs adds up. With this in mind, we knew that in order to reach large numbers of people, we had to develop relationships with mobile operators that could help us keep our costs low. Reluctant at first, always business-savvy, and initially tough negotiators, we built strong relationships with supportive mobile operators. With the support of these mobile operators, InSTEDD could effectively scale from 5 to 500000 people overnight! This meant that with the proper system, you could share what you knew instantly, in real time with the right people who could then take action to mitigate the potential damages.

A New Approach to Working Together

By the time InSTEDD reached 2-years-old, we had accomplished more than anyone thought possible. We had a mature team that knew how to work together in an agile and efficient way and we had made deals with mobile operators and aggregators to help us scale. But most importantly, our iLabs had the full capacity to create, deploy and support a range of tools to help us achieve our mission. The entire team was deeply committed to cultivating a radical shift in how technologies were created. We believed that the design and development of technologies should happen in and by the communities they are meant to serve. Using this approach, the technology was lean, modular, simple, modern, and most importantly, useful. We would work the people who would actually be using the tools, in flexible and iterative ways that showed results in weeks instead of months or years. Yet with all its promise, this was a novel concept that was hard to grasp for people who were used to work in other ways. Many didn’t believe that we could deliver something so fast and cheaply… unless, of course, it wasn’t very good. Few people had the first-hand experience that the closer you are to the problem, the more focused the solution becomes.

Gaining Momentum

The proof that this method was working kept accumulating, and eventually a watershed movement happened as more and more government groups and NGOs approached InSTEDD with the belief that with good, local design, technology would help them achieve their social goals. Since the design was done bottom up, we had government users — not your typical first adopters — choosing to use tools despite them not being mandated officially to do so and without bogus financial incentives. They used the tools because they truly believed they were useful. Since we built things as modular and open source services, local developers stepped up, independently, to build new solutions for hospitals, NGOs and communities. They were able to develop something useful in a matter of weeks– with capabilities that high-income countries would spend millions of dollars on! Due of our relationship with mobile operators, we could aggregate business arrangements and rapidly scale tools from tens to thousands of users…with no extra work.

Haiti Earthquake of 2010

Another pivotal point for InSTEDD came right after the Haiti earthquake of 2010. Our modular architecture, ability to connect with mobile operators and scale quickly as well as our deep-held belief that data needs to flow through fundamental standards, allowed us to deploy an emergency information system to help the relief efforts. The Emergency Information System (EIS) that we developed for Thomson Reuters Foundation supported the flow of a million text messages that aided the relief efforts. As the Haitians were text messaging in their needs, that information was crowd sourced and visualized in other tools of the larger relief ecosystem to help identify what was needed and where. And to achieve even more impact, EIS was used to send messages back to the survivors with useful information to aid their recovery. You can read a project description on our website, watch a video or read a blog post for more information on our work in Haiti.

The Global Community

Since our tools are open source and can be used from any location, we saw that people from New York to Bahrain had discovered that when you design for a constrained environment, the result is simple enough that it’s applicable anywhere else, and ready to roll as soon as the need appears. We intentionally combined our humanitarian mission with smart business acumen so that we could set our first iLab on track to scale and become a financially independent social enterprise. You can read more about our iLabs and that trajectory here.

Today, new applications are designed every day in our two iLabs that help people treat, manage and prevent the spread of diseases such as HIV/AIDS, tuberculosis, malaria and more. Our tools support the rapid reporting of infectious diseases by sending alerts upwards, downwards, and horizontally, therefore stopping outbreaks before the rest of the world even hears about them. They are used to track information after earthquakes, manage scarce supplies in rural areas, and send disease specific reminders to patients to help them stay healthy. These applications are cost effective, scalable and can be rapidly assembled with the open toolkit we’ve been growing over the years. All of this is done with the context specific needs of the users leading every step of the way.

iLabs: Bridging the Gap Between Society and Technology

Part of the reason why many development projects ultimately fail is because there is a huge, constantly changing, gap between the needs of the people and what was created by the NGO. We knew the intersection between society’s needs and technology is was where the “rubber hit the road” and where we needed to be. With this socio-technical approach in mind, we went straight to the communities themselves and developed the concept for local innovation labs, aka iLabs.

In 2007, InSTEDD launched the first iLab in Phnom Penh, Cambodia to target issues affecting the Mekong Basin region. Since its inception, we’ve worked with the Cambodian Communicable Disease Control to strengthen the agency’s internal communications, we’ve worked with the National Center for HIV/AIDS, Dermatology and STD (NCHADS) to develop an appointment reminder system as an extension to their current patient information system.

In April of 2011, we officially launched our second innovation lab. The iLab Latin America was born from our partnership with Manas, a Buenos Aires-based software development and consulting firm that we had already been working with on InSTEDD projects all over the world. Their goal would be to create a center for technological innovation tailored to the Latin American region’s unique needs.

Currently, we are helping the design of our third iLab. What’s even more exciting than opening more iLabs is that parts of our model are being applied all over the world. From Kenya to Liberia and beyond, people are taking action towards creating this sort of innovative environment. The magic of the iLabs can be seen in the faces of those that work there, those that support them, and more importantly those that benefit from their work.

It turned out that by exploring what technologies would help “early detection and early response”, we discovered something much larger. We found a way to continuously evolve, create, recombine and scale the impact of our tools while staying true to the need and keeping our costs low. Metaphorically speaking, we had set out to find gold, and ended up with an alchemist’s recipe, crucible, and lab for producing it. Yet, despite our important discoveries, there is no magic solution.

The challenge is still out there. Millions of dollars are wasted every year on technologies don’t solve the problems at hand, are isolated into silos and keep important data away from the people that really need it. Still today, tools are built with an inherent design that empowers its administrators to fulfill their own needs– at the expense of the needs of the communities. The media will continue to highlight and repeat the flashy, sensational development stories, making it that much harder for the work to tell what’s really making an impact. We are committed to having an real social impact and are creating a team to focus exclusively on research and evaluation. The intent is to have better research that will help discover what has worked and discard what hasn’t based on evidence. Since InSTEDD really helps other groups and agencies do their work; we will have to work with the willing — sometimes folks are too eager to dismiss or hype up the impact of technology based on belief.

A Better World

We all want this world to be better — for ourselves, our families and that rapidly translates to everyone. The evidence is all around us that digital technology is the facilitator of a new ‘age’ — just as stone and iron facilitated new ages, not that long ago. We have just taken our first primitive steps down this new road.

This task is larger than any single organization can achieve. The good news is that each and everyone of us can play a role in ‘changing the world’. If you are reading this there is a high chance you are engaged and can offer support moving forward. Help us in bringing the power of digital technologies to where they make the most difference. We envision a world where people are healthy, productive, kind and creative. We strive to ensure that they are safe when the unexpected strikes or as an unknown future slowly thunders their way. We seek to support the development of a smarter and compassionate future, with well-designed technology that serves the ones in need.

Part 1: “If You Don’t Go, You Don’t Know”

2012-01-24T16:30:04-08:00

If You Don’t Go, You Don’t Know
What We’ve Learned and What We’re Doing About It

PART 1: The Realization

Our TED Prize Beginnings
InSTEDD was created from a TED prize with a single vision. In his acceptance speech, Larry Brilliant said:

“My TED wish is for you to help build a global system,an early-warning system, to protect us against humanity’s worst nightmares. So instead of a hidden pandemic of bird flu, we find it and immediately contain it. Instead of industrial accidents like oil spills or the catastrophe in Bhopal, we find them, and we respond to them. Instead of famine, hidden until it is too late, we detect it, and we respond. And instead of a system, which is owned by a government and hidden in the bowels of government, let’s build an early detection system that’s freely available to anyone in the world in their own language.“ (full talk here)

The “early warning/early response” mantra that Dr. Brilliant repeated throughout his speech was the core idea that InSTEDD was built upon. In order to really save lives and keep people healthy, we needed to act as a global community to advance our thinking on how to create a system that taps into both the importance of local knowledge and the power of technology.

The founder build an experienced, world-class team to move InSTEDD forward. The world of bio surveillance and disease detection was no mystery to this team. Whether it was simple data reports or complex phylogenetic analysis, InSTEDD’s experts knew how it all fit together. Yet there was still a huge missing piece that had to be found.

Water Water Everywhere, But Not a Drop to Drink
There were already many early warning systems out there, but the warnings still weren’t coming early enough. There were many analyst groups with powerful tools and lots of information, yet they seemed to be cut off from what was being experienced across the globe in the communities that were suffering. There was something more that needed to happen, and it wasn’t about adding more dots on maps.

Experience had taught us an important lesson — if you don’t go, you don’t know. While going to the source is important, individual knowledge is not enough. Everyone at InSTEDD had extensive careers and had developed domain expertise as they worked around the world, but what was really needed was to look at things from a unified, not just domain specific, perspective. The world had to be experienced through social and technical lenses simultaneously. There were plenty of data reporting technologies that people didn’t use — and didn’t want to use. Why? There were plenty of lives to save if the right people shared what they knew, at the right time, and acted together. What was getting in the way? That was the first problem we needed to explore.

A New Approach to Technology
While we were striving to understand the behavior patterns and real motivations of people living in vulnerable communities, a wide variety of seemingly helpful technologies continued to pop up all around us. At first, many of these new technologies seemed to avoid the obstacles we were observing in the field, yet after time all of them ended up in failure. Why did this keep happening? Was the big issue putting forms on phones? Maybe, yet, not really. Was the final solution recording information on to a map for the connected world to see? Well, not quite, the communities we worked in kept telling us again and again. There was something subtle yet critical just under the surface. Early warning and response, and its outcome — healthier people– would never be possible without a cross disciplinary course of action.

Our diversified global team was not just spending time in the communities we were hoping to serve, but were born out of them. It was the local experience that taught us a clear lesson again and again. Technology could serve people and their health, but something had to be changed about the way it was being developed. We knew that a new approach was necessary. And that was exactly what we set out to create.

Making Information Actionable
A wise man once said “teaching is reminding people of what they already know”, and that message instantly resonated with us. The challenge was to identify what people already knew and use the power of technology to bring that information together to make it tangible, operational, workable and most importantly, actionable.

Focusing on this would be a departure from the “early warning, early response” founding idea, but we were willing to expand our vision to strive towards creating a precedent for using technologies to best serve our global community. The challenge seemed huge, but we knew this was the value that InSTEDD needed to strive for.

Change is never easy, and our change in course was no exception. One of the most critical issues was the complexity of working as a non-profit and being dependent on the traditional structure of grants. Few grant makers are thrilled when their grant recipients don’t do exactly what was assumed up front. Fortunately for us, we had allies at Google.org, the Rockefeller Foundation and more who with an appropriate balance of skepticism and optimism gave us free reign to act on our intuitions and observations. That gave us both the motivation and flexibility to reach out to the most remote places where people had never even heard the word “Google” or “TED”. let alone know how to use the technologies we take for granted in the developed world. We knew had it in us to deliver results, but this was a tall order. There was nothing else to do but hit the ground running.

The Importance of Personal Design in the Mobile Technology Revolution
Mobile technologies present an unprecedented opportunity to improve health, safety and development. We are living in a world where nearly everyone alive has access to a mobile phone. In fact, more people in the world have access to cell phones than they do toothbrushes. Within this context, the global communication possibilities are endless.

While access to personal technologies such as the mobile phone is moving in the right direction, we must not forget how important the design aspect is in making these tools valuable and supportive of a healthier world. Personal technology requires personalized design; and no mobile health solution we had come across was approaching design from this angle, especially in the developing world. We found the skeletons of multiple tools in old PCs around rural clinics. Even more disturbingly, we saw example after example of tools used only under perverse incentive schemes, including paying individuals each time they used the system. These Frankensteins on life support were the best experience many of the people we talked to had with technology, which explained why we kept being turned away. We heard things like “You mean you can have something up and running in weeks? Impossible!” or “There is no way our rural users will send these reports. The last project paid every user fifty cents every time they send something, so they sent gibberish daily. If you want better information, you need to pay them better!” We talked to the people who would be using the tools to find out what would incentivize them to report data. We found out who was the data for and how would it help them? We learned how information was flowing so we could know when these rural health workers would find out if a neighboring village was getting sick. We knew progress could be made only if we put these people at the center of our world, and started creating technology with them, not just for them.

We knew we were fighting an uphill battle. We also knew that if we could engage people with incentives more meaningful than just money, then the impact of this work would be huge. So we stayed the course.

Continue on to Part 2 here.

2011 Reflections: Technologies, iLabs and Accolades

2012-01-02T17:07:30-08:00

It has been quite the year for our team here at InSTEDD and our Innovation Labs in Southeast Asia and Latin America. As we prepare to enter the year ahead we wanted to take a moment to look back over a few of our highlights from 2011.

Presented: TEDx Phnom Penh

In February, Channe Suy, Product Manager at iLab Southeast Asia gave an inspiring talk at TEDx Phnom Penh about how we can create sustainable solutions to improve our future by building the capacity of local communities through knowledge sharing. This is one of our guiding principles and Channe was able to share about our work in capacity building in Southeast Asia though the iLab.

Launched: iLab Latin America

A few months later in April we officially launched our second innovation lab! iLab Latin America was born from our partnership with Manas, a Buenos Aires-based software development and consulting firm that we had already been working with on InSTEDD projects all over the world. Their goal would be to create a center for technological innovation tailored to the region’s unique needs.

Eliminating Malaria: Malaria Day Zero Collaboration

August was a busy month for iLab Southeast Asia. First came the trainings for health care workers in the Kampot province of Cambodia on the Malaria Day Zero web application with SMS text messaging for reporting of malaria cases. Village health care workers were also trained on the system and provided with a solar cell and mobile phone in order to employ the reporting system. Also in August, iLab Southeast Asia set out to cut down on the current time of 1–2 weeks for obtaining TB test results. And thus the Lab Result Alert System was developed.

Watchfire: A Collaboration with The Red Cross and Cisco

As October rolled around, we were awarded a seed grant from Cisco Systems for the development of a program to support shared safety, self reliance and situational awareness during a public crisis in the Bay Area. For this project, we worked with the Red Cross to design, develop and test an emergency response team assembly tool called Watchfire.

Winner: TrueBites wins the Ashoka Changemakers Citizen Media Competition

In November we were honored to be chosen as a finalist in the Ashoka Changemakers Citizen Media competition. The iLab Latin America’s idea was for a new kind of news where information is broken into small bites and then all those bites are brought together to create a multi-perspective story. Thanks to all those who supported us with their votes, the idea for TrueBites was one of four winners!

Released: New Free and Open Source Tools

Throughout 2011, we released several new technologies. They are all not only free and open source but also can be combined with our other technologies to develop integrated systems and individualized programs to support a multitude of global health initiatives.

Pollit is a real-time feedback tool that lets you collect status updates, opinions and more all via mobile phones.

Remindem lets you set up a schedule of tips, reminders or messages that will be sent via SMS messages to list subscribers. Like all of our tools, they can be used individually or paired with other tools to create more complete solutions.

Verboice, which transcends language and literacy barriers because it allows anyone to create and run applications that interact via voice. This allows your users to listen and record messages in their own language and dialect. Verboice was also the system that Baby Monitor- a mobile application that we developed for the Population Council.

Verboice is also the foundation for Watchfire, the emergency response team assembly tool we developed for the Bay Area Red Cross with funding from Cisco.

These are just a few of our technologies and highlights from 2011. But we couldn’t have done it without our community’s continued support. Thank you from all of us for supporting us this past year with your donations, your enthusiasm and your kind words in blogs, articles and social media. We are looking forward to the challenges and triumphs that await us all in 2012 and to moving closer to our vision of a world where communities everywhere design and use technology to continuously improve their health, safety and development.

InSTEDD - Innovative Support to Emergencies Diseases and Disasters

Controlling your Privacy with Health Commons

National Health Systems as a Fabric of Services

Benefits

Example Services

Good neighbors

InSTEDD contributes the Facility Registry

Back to Rwanda

Our Modern Toolkit: Free and Open Source Tools for Social Impact

Data Part 2: It’s not the technology, it’s about who uses it and how

Are you incorporating sensor information into your data sets?

What are the motivations and incentives of the people who will use the tools?

Does the data matter to your users?

Using a Suite of Tools: InSTEDD Technologies

Data Part 1: It’s not the technology, it’s about who uses it and how

Data for action, or data for data’s sake?

You want your data to be great, on time and with little resources

Are you putting all your eggs in one basket?

Rio 2.0 Demo Alley Conference: Building Technologies for Social Impact

Below is the transcript from Dr. Israelski’s presentation:

One Man’s Trash is Another Man’s Catalyst for Innovation: How a simple toilet paper roll led to the creation of the Reporting Wheel

Part 2: “If You Don’t Go, You Don’t Know”

If You Don’t Go, You Don’t KnowWhat We’ve Learned and What We’re Doing About It

PART 2: The Journey

How to Scale 10x Overnight

A New Approach to Working Together

Gaining Momentum

Haiti Earthquake of 2010

The Global Community

iLabs: Bridging the Gap Between Society and Technology

A Better World

Part 1: “If You Don’t Go, You Don’t Know”

If You Don’t Go, You Don’t KnowWhat We’ve Learned and What We’re Doing About It

PART 1: The Realization

2011 Reflections: Technologies, iLabs and Accolades

If You Don’t Go, You Don’t Know
What We’ve Learned and What We’re Doing About It

If You Don’t Go, You Don’t Know
What We’ve Learned and What We’re Doing About It