Hello friends,

I write today with excellent news. We are thrilled to announce that The Mulago Foundation is supporting FrontlineSMS:Medic with a catalyst grant. Thanks to this support, I am now full time as Lead Developer, responsible for software design, development and testing. This is exciting because I’ve been chained to other activites for the past year or so and have been spoiling for a chance to really dig in to all the projects that Medic has going.

Last year we gave the community a first taste of Patient View, our extension of FrontlineSMS that allows clinics to manage their remote workers and patients as well as the day-to-day operations at the clinic itself. Most recently, an alpha version of Patient View was on display at the Global Health Information Forum in Bangkok. While this was a good start, we have much, much more planned for this year, and I’d like to give you a rough outline of what the software devs have in store:

Release of Patient View

With a filled-out featureset including user interface improvements, internationalization,  lost-to-followup and adherence monitoring, improved charting, appointment scheduling, calendar tools, auto-topup, and much more, this year will definitely be a good one for Patient View. We are planning on releasing a beta version in February (in just a couple of weeks), and if you would like to participate in that beta testing, feel free to email me at dieterich@medic.frontlinesms.com. After the beta version, we will kickoff the Medic open source community by opening up the Patient View code.

FrontlineSMS & OpenMRS

While we think that Patient View is excellent, it isn’t right for everyone. There are large clinics with huge patient loads that need a solution that can handle their 60,000 patients and all the data that comes with them.  To that end we are working with OpenMRS (openmrs.org), an enterprise-level FOSS medical record, to develop several different featuresets including mobile data collection, SMS alerts, and more.

Mapping with Ushahidi

Ushahidi has created a wonderful platform for mapping, and has recently put their tech in a FrontlineSMS plugin. We plan to use this to add a wide range of mapping features to Patient View. This will allow users to map diseases, workers, resources, or anything that they wish so that they can better manage their time, fuel, and other resources.

Remote Diagnostics with CelloPhone

Andoyan Ozcan at UCLA (http://innovate.ee.ucla.edu/) has created a revolutionary system that allows cellular-level images blood to be taken using the camera sensor of a simple camera phone. These images can then be sent via MMS to a remote server where they are analyzed by pattern-matching algorithms, yielding important information like CD4 counts, disease diagnoses, and more. We plan to integrate this technology with Patient View, allowing doctors in the developing world to take full advantage of this incredible new technology. In the settings of many of our clinics, there are no labs to send tests off to, or if there are, getting results is expensive and time consuming. With this new technology, we can have diagnoses in seconds at the cost of an MMS. Now that’s what I call progress!

Personally, I’m super excited about this coming year. These projects all have the potential to change the state of  mHealth in a huge, positive way.

In closing, I’d like to emphasize that Medic is not solely focused on software; we are an organization committed to fostering an open-source software community and making sure these tools make it to those who need them most. With the beginning of our open source community, these plans have the potential to be yours just as much as they are ours. If you want to participate, email us and stay tuned because things are about to get really interesting, really quick.

This was originally posted at jopsa.org.

Sometimes, people just pull through for one another. Less than one month ago, I flashed the designers’ bat signal with a meager attempt to draw out some use cases for FrontlineSMS:Medic. A team of talented artists stepped up to the plate and hit a home run:

Facilitated by Raina Kumra @ The Agency for Holistic Branding

They’re a wonderful team, and this is high-impact volunteering. As a nonprofit start-up, seemingly small tools/resources really matter. A nifty poster version of the graphic will be featured at the upcoming Global Health Information Forum in Bangkok and the art will immediately have a home in our team’s presentations.

Ken Banks recently wrote on kiwanja.net about the philosophy and niche of the core FrontlineSMS platform. He addressed five issues that are central to our field, and he called the post a social mobile line in the sand. While we work closely with the core FrontlineSMS team and share much of their philosophy, our motivation for forming our spin-off health oriented community was that we wanted to focus on a slightly different niche. Hopefully this post will help you understand how were are similar to and different from the core FrontlineSMS team, and every other mobile tool out there.

1. Who are your target audience?
The Frontline Philosophy: To begin with, we’re focused on serving organizations that work to improve human health. And like Kiwanja.net and the core FrontlineSMS team, we focus on the “long tail.” This graph sums up the long tail idea well:

Our team differs from Kiwanja.net’s approach to the long tail in one important way. Ken Banks usually talks about where organizations sit on this graph. Instead, we look at where specific use cases or projects sit on the graph. If you’re a grassroots NGO with 2-3 people on staff, no tech experience, and a shoestring budget, then all of your projects and capabilities should fall in the green part of this graph. You might also be an international NGO with a multi-million dollar budget and a big IT team, but chances are you have some use cases or projects that your IT experts can’t contribute much time to, or where you need to stretch every dollar a very, very long way, or where you work in an impossibly remote and low infrastructure area whose needs are entirely different than other parts of your service area. These are what we’d call long tail use cases. Such organizations might find a rewarding cost/benefit equation for implementing expensive, complicated medical record systems at referral hospitals, perhaps even district hospitals. But for long tail use cases at remote health centers they will need a tool with a frontlines philosophy (whether or not they end up using FrontlineSMS).

2. What is your position on scaling?
Like Kiwanja.net, we focus on horizontal scale, rather than vertical scale. For a generic example of horizontal scale, think of ten independently managed platforms serving 10,000 people each, as opposed to a single centrally managed platform serving 100,000 people. We choose the horizontal, modular approach because we do not want to centralize:

knowledge transfer, learning, and the empowerment that comes from a job well done.
use of gathered data
user ownership and enthusiasm
decision making authority
funding requirements (and potential for failure if they aren’t met)

We also like it when end users can make their own technology decisions (rather than having to defer to an official who will never actually use the tool directly), and we like it when ambitious groups can charge ahead without having to wait for their entire country/district/the domain of any vertically scaled system to catch up.

We do, however, find it absolutely essential to be able to centralize one thing: data. For a huge number of reasons, from pharmacy and supplies procurement, to fund-raising, to disease outbreak management, to research. Exchanging data, of course, can be achieved by representing data in agreed upon formats and transferring via a variety of channels – from Internet, to SMS, to USB sticks carried by bicycle.

3. How does it replicate and grow?
Kiwanja.net couldn’t have said it better: “growth is based on patience, and a “pull” rather than “push” approach, i.e. awareness-raising and then letting NGOs decide if they want to try out the tool or not. Those that do then go and request it from the website. Everything is driven by the end user.”
At the request of partner organizations, we do have a core team of experts that manage a small number of implementations. The majority of implementations, however, only rely on us for the free software and a lot of advice and support (mostly via email). As an organization, we have plenty of growing up left to do, and we’re still figuring out how to portray to the public that we don’t want to (and frankly can’t) manage or direct most implementations of FrontlineSMS and associated tools in health care settings.
We recently decided to start using the term reference implementations to describe the small number of programs that our core team of experts oversees directly. Moving forward, reference implementations will be selected because they pioneer a new piece of software, an important new use case or methodology, or in some way contribute substantially to the larger Frontline community. All other projects are community implementations, and we are pleased to support them with free software, direct email with our team, and upcoming public email lists and a wiki-based field guide. Hat tip to the OpenMRS community for the framing of reference and community implementations.

4. What is your position on open sourcing?
In addition to sharing source code, we strive to live up to principles that are common among community developed projects, such as openness and transparency, bias towards collaboration rather than reinventing the wheel, and sharing the fruits of our labors as freely and widely as possible. That said, we prioritize impact for our users, and we are realistic about the substantial resources required to collaborate – to license code and make sure it’s commented and documented thoroughly enough to support developer collaboration. We sympathize with the many young and low resourced open source projects that are so busy supporting users that they leave something to be desired for strict open source advocates. We’re still in the process of working out licensing of PatientView and setting up our wiki and public mailing lists. We hope you’ll give us the benefit of the doubt and (collegially) hold us accountable in this regard.

5. Does access to “the cloud” matter?
Yes, the cloud matters; it is the future, but not the present on the frontlines of global health. I mean this more as an observation than as an opinion – the cloud simply cannot be accessed with any regularity in the vast majority of places where we work. We want everything we do to accelerate movement towards sophisticated use of low cost, easily accessible cloud based apps, but starting with apps that work exclusively in the cloud or even rely on the Internet just isn’t the best way to do this. Paper based societies need to get their feet in the door with tools that work NOW, but have been designed to point the way to cloudville. How can an SMS platform built on disconnected laptops point the way to cloudville? Under the “scaling” section we hinted at the importance of data standards and platform interoperability. We’re making sure FrontlineSMS plays nice with various cloud based apps. We may even start working in the cloud ourselves someday, but not just yet.

So, that’s our line in the sand. If anyone else has a mobile tool – or is working on a mobile tool – I’d encourage them to clear up any possible confusion and write a post outlining their thinking in these five areas.

Pop!Tech has published the presentations from this year’s Social Innovation Fellows, and I thought I’d share the 5-minute talk on FrontlineSMS:Medic and the Hope Phones campaign. The fellowship program challenged us to rethink our presentations, impact models, financial sustainability, and media strategy — making sure we left with a ‘way forward’ and a community of support.

PopTech 2009 Social Innovation Fellow Josh Nesbit from PopTech on Vimeo.

Be sure to check out the other fellows’ amazing work here.