Open Data Kit, A Solution Implementing a Mobile ...

IST-Africa 2013 Conference Proceedings Paul Cunningham and Miriam Cunningham (Eds) IIMC International Information Management Corporation, 2013 ISBN: 978-1-905824-38-0

Open Data Kit, A Solution Implementing a Mobile Health Information System To Enhance Data Management In Public Health Paul MACHARIA1, Eva MULUVE1 , John LIZCANO2 , Chuck CLELAND2 , Peter CHERUTICH1 , Ann KURTH2 1 National AIDS and STIs Control Programme, P.O Box 19361, Nairobi, 00202, Kenya Tel: + 254 722866753,+ 254 721617455,+ 254 736924030 , Email: [email protected], [email protected], [email protected], [email protected] 2 New York University College of Nursing Global, 726 Broadway Ave, 10th Floor, New York City, NY 10003, USA Tel: + 1-212-992-7096, + 1212- 992-9417, + 1212-998-5316 Email: [email protected], [email protected], [email protected] Abstract: A Reliable and accurate public health information system is essential for monitoring health and for evaluating and improving the delivery of health-care services and programmes. In Public health, decision-making is critically dependent on the timely availability of accurate and sound data. Open Data Kit (ODK) a free and open-source set of tools can be used by health organizations to author, field, and manage mobile data collection as a sustainable m-Health solution. m-Health encompasses health-related uses of telecommunication and multimedia technologies within health service delivery and public health systems in data collection and management to enhance data quality, reduce turn-around time and facilitate immediate feedback to health systems. This paper evaluates the implementation of ODK as an m-Health solution to enhance data management in public health. Keywords: Public health, m-Health, data management

1.

Introduction

In the developing world, lack of adequate resources and robust healthcare infrastructure makes collecting field information particularly difficult due to costs, logistics and access to remote sites [1] resulting in inaccurate data. A lack of accurate up-to-date patient data creates an environment in which policy makers and health care providers cannot accurately decide where and how to spend their most times limited resources improving medical care, planning and managing health systems [2, 3]. Collecting data where patients live is vital; the collected information can be updated and accessed on a real-time basis. The data collection process is more efficient and reliable if conducted via smartphones, Personal Digital Assistants, or mobile phones rather than paper-based surveys that must be submitted in person and manually entered into the central health database [4].Increased use of technology can help reduce health care costs by improving efficiencies in the health care systems [5], great benefit can also be derived from the recent and rapid appearance of mobile technology into low and middle-income Countries making mobile technology a reliable resource in the setup of sustainable mobile health information systems [6].

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1.1

General Background

Policymakers and health providers need accurate data in order to gauge the effectiveness of existing policies and programs in health care system and shape new ones in their endeavour to make health care in developing Countries accessible and reliable [2, 3]. Accuracy of data can be enhanced by proper data collection and management, the development, execution and supervision of plans, policies, programs and practices that control, protect, deliver accurate, relevant and up-to-date data in the shortest time [7]. m-Health is a term used in the practice of medicine and public health, supported by mobile devices. The term is used in reference to use of mobile communication devices such as mobile phones, tablet computers and Personal Digital Assistants for health services, information and data management [8]. The m-Health field operates on the premise that technology integration within the health sector has great potential to promote better health communication to achieve healthy lifestyles, improve decision-making by health professionals and enhance healthcare quality by improving access to medical and health information and facilitating instantaneous communication[9]. In the use of m-health, data collection and management has become an especially important aspect requiring portable software, mobile devices and the software that houses the collected information [10]. Open Data Kit (ODK) is a free and open-source set of tools that can help organizations author, field, and manage mobile data collection solutions. ODK is already being used to create decision support for clinicians and for building multimediarich nature mapping tools.

2.

Objectives

Testing and Linkage to Care for Injecting Drug Users (TLC-IDU) is a study taking place in 4 sites in Nairobi and 6 sites in Coastal Mombasa including Malindi to help reduce infection and spread of HIV among people who are IDUs. The study is implemented by the National AIDS & STIs Control Programme (NASCOP) in the Government of Kenya’s Ministries of Health and New York University based in the United States of America. The baseline wave of the study was carried out from end of May to 30th November 2012. The TLC-IDU team setup ODK to evaluate its usability as an m-Health solution. ODK was used in the collection of eligibility, behavioural and part of Respondent Driven Sampling data from all participating IDUs.

3.

Methodology

To setup ODK as an m-health solution, 15 Samsung tablets were programmed to collect data from participating IDUs in the 10 sites. The collected data was uploaded to the remote Computer server over the Internet via available GSM and 3G networks in the respective remote locations.

4.

Technology Description

In setting up ODK, three components namely ODK Build, Aggregate and Collect are deployed. ODK Build is a HTML5 web application form designer with a drag-and-drop user interface; the web application enables the designer to add a new prompt by dragging the elements from the bottom of the screen onto the blank canvas. For each prompt, the designer can input the question(s) and modify its properties on the right portion of the screen. The finished form design is exported to XML format for use on a number of mobile and web-based applications. The ODK Aggregate Server is a ready-to-deploy server and data repository. The Aggregate Server can be deployed on Google's App Engine, enabling users to quickly get Copyright © 2013 The authors

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running without facing the complexities of setting up their own scalable web service. ODK Aggregate can also be deployed locally on a Tomcat server backed with a MySQL or PostgreSQL database server. The ODK Aggregate Server provides blank forms to ODK Collect, accept finalized forms from ODK Collect. Aggregate also provides a platform to manage collected data, visualize the collected data using maps and simple graphs, and export data as CSV files or other spreadsheet file format published to external systems. ODK Collect renders forms into a sequence of input prompts that apply form logic, entry constraints, and repeating sub-structures. Users work through the prompts and can save the submission at any point, finalized submissions are sent to the Aggregate server. Currently, ODK Collect uses the Android platform supporting a wide variety of prompts (text, number, location, multimedia, barcodes), and collects data without network connectivity.

5.

Developments

Using ODK Build, the TLC-IDU programming team designed the study’s eligibility, behavioural questionnaires and part of Respondent Driven Sampling data XML forms. Skip logics, validation checks and other security checks were also programmed into the data collection tools. The TLC-IDU team also setup an ODK Aggregate Server, the initial setup worked from the Google appspot but the free space and time quota quickly ran out. TLC-IDU opted to setup a stand-alone ODK Aggregate Server to access to unlimited storage space and access time. To setup ODK Collect, SIM Card enabled Samsung tablets running on Android operating system were procured. ODK Collect was installed in all the tablets and the ODK Aggregate Server credentials pre-set to allow downloading of new forms and uploading collected data. TLC-IDU relied on available GSM and 3G networks for data transmission over the Internet through an encrypted channel.

6.

Results

During the baseline wave, the quality of data collected from the 10 sites was very credible; of the 1947 IDU participants in the study there was no incomplete datasets neither were outliers found in this data. Throughout this phase of the study, the Research Assistants progressively spent less time in minutes collecting data as is reflected in figure 1 below. Time spent indicated the progressive familiarisation of this technology to both the staff and study participants. Working with IDUs, confidentiality was of great importance to this population. Use of tablets to collect behavioural data motivated the IDU participation based on assurances of safe storage of their confidential data in encrypted format compared to paper-based study tools. The research team was also able to progressively analyse study data, uploaded data could be exported to CSV file format which when downloaded can be instantly analysed on most statistical software. The CSV file needs no data cleaning, the collected data variables are predefined on ODK build during the programming stage of XML forms.

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Figure 1

7.

Business Benefits

In a paper-based survey, cost of paper, printing of questionnaires and transportation from remote sites to the data management office of completed study tools takes up a considerable part of the budget. In the TLC-IDU study, the only data collection budget included the onetime purchase of tablets and the purchase of Internet bundles on a monthly basis. Data storage both on the Aggregate server and in the tablets is in encrypted format making IDU confidential data very secure; the ODK Aggregate Server has restricted Users rights also enhancing security of stored data. Retrieval of data from the ODK Aggregate server is easy and fast compared to paper-based study tools that are bulky and require a large storage space. Turn-around time from data collection to analysis is greatly reduced, the inbuilt skip logics, validation checks and other data security features ensure that datasets uploaded to the ODK Aggregate server have minimal or no errors. The uploaded data is exportable to a CSV format file, a format compatible with most data analysis software.

8.

Conclusions

m-Health solutions can enhance the productivity of mobile health workers and improve the quality, cost, and efficiency of care [11]. This use of technology can reduce healthcare costs and increase the overall quality of patient care by providing access to current, comprehensive healthcare information for both patients and healthcare providers across public and private healthcare settings [12]. Equally important to the cost-effectiveness and scalability of m-Health is its ability to provide an effective tool for addressing emerging health needs [4]. Mobile technology can also enable much-needed, thoroughgoing change in healthcare systems worldwide and in turn bring significant social and economic benefits [13]. Turn-around time in data collection, analysis and putting to use successful study findings can be greatly reduced. Health workers have also reported increased job satisfaction due to the greater efficiency and flexibility provided by technology [4]. Copyright © 2013 The authors

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ODK is an open source application, collaborative development between projects using this open source application and those planning to use electronic data collection tools have a great potential to improve the quality of software and reduce costs of setting up sustainable mobile systems that enhance data management in public health and other research disciplines [14]. NASCOP spearheads the Ministry of Health's interventions on the fight against HIV/AIDS and contributes to the bulk of the implementation of the Kenya National HIV and AIDS Strategic Plan III (KNASP III) [15, 16]. One of the programmes at NASCOP is HIV Testing and Counselling (HTC) serving as the entry point to HIV prevention, care, treatment and support services through provision of quality HIV testing and counselling to the Kenyan population. To achieve HTCs vision of “Universal knowledge of HIV status”, collaboration between NASCOP, mobile service providers, Android-based smartphone manufactures and funding agencies to implement an ODK m-Health solution at Voluntary Counselling and Testing (VCT) sites would be of great benefit. This m-health solution could enhance data collection quality using an electronic HIV TESTING AND COUNSELING (HTC) LAB REGISTER MOH362 and other relevant registers administered at VCTs nationally to inform development of policies and guidelines required for proper implementation of HIV testing and counselling services.

Acknowledgment We would like to acknowledge the funders of this study, The National Institutes of Health (NIH) in the United States of America, participant IDUs, staff and management of the study sites and all TLC-IDU staff, the Head of NASCOP and all relevant Government agencies that have made the study a success.

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11. using mhealth to work smarter: increasing efficiency for clinicians and health workers http://www.intel.com/content/dam/www/public/us/en/documents/white-papers/usemhealth-to-work-smarter-paper.pdf 12. How Providers Can Lower Costs and Improve Patient Care Using Evidence Based Medicine July 2009 Chequeta Allen, Lewis Carr 13. Emerging mHealth: Paths for growth http://www.pwc.com/en_GX/gx/healthcare/mhealth/assets/pwc-emerging-mhealthfull.pdf 14. Implementing electronic medical record systems in developing countries Hamish SF Fraser ,Paul Biondich , Deshen Moodley , Sharon Choi, Burke W Mamlin, Peter Szolovits 15. http://www.nacc.or.ke/attachments/article/112/CLICK%20HERE%20TO%20DOWNL OAD%20KNASP%20III%20DOCUMENT.pdf 16. http://www.nacc.or.ke/attachments/article/112/CLICK%20HERE%20TO%20DOWNL OAD%20KNASP%20III%20SUPPORTING%20DOCUMENTS.pdf

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