Open Mobile News
Beware the Foreign Expert
As fair warning, this post is part rant, part confession, part promotion (see links below!), and part call to action for increased investment in local innovation in low- and middle- income countries.
I spend a good deal of my time raising money, working on budgets, and generally championing open source software designed to be used by health workers in low-income countries. Most of this ‘eHealth’ software ends up being developed by extremely talented and dedicated software developers from the United States and other wealthy countries. I spend a relatively small portion of my time trying support and strengthen local software development capacity.
For example, we’re working with a small, all Tanzanian innovation company called ITIDO. While equally talented and motivated, ITIDO’s staff has less training and, consequently, less expertise than those of the organizations I’m affiliated with. However, it’s hard to shake the feeling that in the long run, Tanzania needs successful ITIDOs more than it needs organizations I’ve helped create. It seems that a well-functioning ITIDO is more likely to build lasting, relevant, solutions that will actually be used in Tanzania.
A key challenge is time. We often feel the need to deliver results in a few months. And, indeed, there is no time to waste in developing and deploying technologies that have the potential to improve desperately needed healthcare. Given limited funds and the need to deliver quickly, the most efficient approach is almost always to go with highly experienced software developers. And this becomes more and more true once you start building software with one group of experts. The people who know the current software best are the ones who can most quickly extend it. Capacity building takes time.
One approach we advocate is establishing a “Coded in Country” (CIC) label for software, akin to a Fair Trade label for projects. There is ongoing discussion about the best definition of CIC, and if there should be an official certification process, but the original idea was that a software application or module is CIC if at least half of the money goes into local development. CIC nodes will provide capacity strengthening and opportunities for international exposure to talented local developers. The idea has generated a good deal of enthusiasm from many groups, especially those deploying eHealth software for use in Sub-Saharan countries in Africa.
Bringing Mobile to OpenMRS using Open Data Kit
From CommCare's support of community health workers to RapidSMS's ability to monitor childhood illnesses, a number of OMC technologies are being used to improve healthcare delivery in developing regions. As part of this effort, the OMC is also connecting these technologies to larger and more domain-specific systems like OpenMRS -- an open source medical record system used in over 20 developing countries.
Reasons to Bring Mobile to OpenMRS
In most deployments of OpenMRS, clinicians fill out a paper form with patient data. They place that form into the patient's folder and every few days, data clerks enter that information into the OpenMRS server. Once in the server, the data is available for clinical studies, administrative reports and sometimes printed patient summaries. While this is an improvement over a purely paper-based system, it also has a major flaw -- useful patient data (clinical alerts, lab tests, drug interactions) are not readily available to clinicians for decision making.
To address this issue, the Open Data Kit (ODK) team has been working with the OpenMRS and OpenXData communities to bring mobile phone connectivity using ODK to OpenMRS. Specifically, ODK now has OpenMRS form filling and patient record syncing -- two features that push patient data collection and observation to the mobile phone.
ODK and JavaRosa: Collaborating in Code
A few weeks ago, the Open Data Kit (ODK) team released an update to our mobile client, ODK Collect. ODK is a suite of tools to help organizations collect, aggregate and visualize their data. The goals of ODK are to make open-source and standards-based tools which are easy to try, easy to use, easy to modify, and easy to scale.
Some of the new features in the most recent release include barcode scanning, image/audio/video capture and playback and editing of saved data. We've also made location acquisition and form processing a lot faster, added a really cool way to review data entry and reworked the user interface to make training and use much easier. Of course, we still support question grouping, repeats, constraints, complex logic and multiple languages -- functionality that we inherited from JavaRosa, another Open Mobile Consortium data collection project. (For a video of some of the new features, see here.)
ODK and Java Rosa - The Obstacles to Working Together
The story of how the ODK and JavaRosa projects, two competitors in the mobile data collection space, came to work together is something we would like to share with the wider community. Both of our respective projects faced a number of challenges that illustrate how hard it is to work together to benefit our users. For us, this story demonstrates the importance of the Open Mobile Consortium in creating an organizational and technical framework to minimize the obstacles faced in collaboration.
