One cool program here at IHME is the field placements for our Post-Bachelors Fellows. This is a roughly 6 week stint during the summer of their second year here where they travel from Seattle to some distant place, to see where the numbers we’ve been crunching come from. Kyle Foreman is in Sri Lanka doing this now, and here is a guest post he’s written about an ICT4D challenge he’s seeing that he wants your ideas on:
I’m spending this summer in Sri Lanka working with the Ministry of Health and the community health department of the University of Peradeniya, observing how Sri Lanka’s medical record keeping and vital statistics system works. They’d like for me to make some suggestions on how it could be improved, so I was hoping to get some feedback on how to make this work.
Here’s the problem: keeping track of something as simple as the number of people who die each year is very difficult here. Patient records are kept at each hospital, then they are tabulated and sent to a regional office, then tabulated at a district office, ad nauseam, until they finally reach the national level. It takes literally years (they just finished the 2006 returns), is full of errors (because they do it all by hand), and is very incomplete (because every step along the way there’s further tabulation which strips away valuable data). They thus have difficulty identifying problems (especially outbreaks), targeting resources, and assessing the outcomes of their efforts.
Yet in every hospital I’ve been to, even the most remote, there’s a computer. I asked the MoH why they don’t use an electronic database for their records. It seems that even though most hospitals have internet access, they don’t want to implement something that not all hospitals can use. It’s smart for them to keep everything standardized, but I’ll bet there’s a way to make a system that’ll work across the board.
My first source of inspiration was Google Gears (which I guess is now being subsumed by Google’s HTML5 frameworks?). I use it all the time to compose messages in Gmail on the bus and then send them opportunistically when I find some wifi. The basic technology there – an application that uses a remote database when it’s accessible and a local database when it’s not – sounds exactly like what they need here.
But how to sync those local databases with the primary server where they don’t have wifi? Well, one thing that really surprised me here is their great cellular broadband coverage; I’ve yet to find a place where the 3G usb modem I purchased can’t find at least some signal (take that, ATT!). They’re too expensive for each hospital to have one, but what if each province had a couple that could be shared amongst the hospitals? Even if each hospital had access to a modem just once or twice a year, that’d be enough for them to sync the database and get national results sooner than 4 years after the fact.
Or maybe just add a feature to save the database to disk and the hospitals without internet can mail them in to be synced at the provincial registrar? And should there be paper backups that can easily be scanned in for hospitals with no computer (or in case their one PC fails)? Am I overthinking this – are bubblesheets like the SAT the best way?
My first thought is that moving from paper to computers is a great idea, and this sounds like a nice application area for the new noSQL databases that are designed to be “eventually consistent”. But my second thought is that I’m always making things too complicated, so I should think about it more before choosing precisely which new gadget is needed.