Information and Communication Technologies for Development

Intent

We are developing the process that would facilitate the use of mobile device to transport images taken by nurses at health care centers (point-of-care) in rural Zambia to a server in Lusaka where doctors can access the images in order to provide expert advice on cervical lesions. We would like to explore the use of this approach to facilitate a scalable national cervical cancer screening program. Finally, we would like to design a platform that would allow transfer of the images directly to an electronic medical record database for archiving.

Background

The Center for Infectious Disease Research in Zambia (CIDRZ) has been providing HIV prevention and treatment services since 2004. For this project, CIDRZ has partnered with Dimagi, an organization that provides technological solutions to problems in the developing world, to design and implement a national cervical cancer screening program. Cervical cancer is the leading cancer among women in developing countries including Zambia. Its rise in prevalence over the last decade is a direct consequence of the spread of HIV in the region. Transmission of the human papilloma viruses that cause cervical cancer is facilitated by the presence of HIV infection. In addition, progression of cervical dysplasia is accelerated by immunosuppression that results from an advancing HIV infection. As with most cancers, early detection is key for better treatment and management. Given that diagnostic and therapeutic expertise in cervical malignancy is scarce and localized in Lusaka, a nationwide screening using the traditional approach of performing Papnicolau smear is out of the question. The use of visual inspection with 4% acetic acid (VIA) and early treatment with cryotherapy by rural nurses is therefore trialled, with quality assurance provided by Lusaka-based specialists.

Current Landscape

CIDRZ currently has deployed the cervical cancer screening system just described in 4 clinics outside of Lusaka. Images are taken primarily for quality assurance and quality improvement purposes. Real-time decision support where indeterminate lesions can be reviewed by specialists is not available due to file size issues in GPRS emails. Also for this reason, quality assurance is provided by specialists who physically travel to the clinics once a week to review the images with the nurses. This process is not scalable given the resource constraints.

Aims and Key Deliverables

The aim is to develop an application that uses camera on device, captures image, resizes and transmits to an off-site specialist for decision support and QA/QI purposes. We plan on leveraging the JavaRosa project for Open Source mobile XForm development. This software is compatible with the pilot hardware, the Nokia E90 and provides a robust, flexible framework for rapid development of survey tools. The image is transmitted with basic patient and clinical information to the central server. We will design a platform for information management by the central server. This will likely be a modification of the open-source GATHER disease surveillance/monitoring/alerting framework. In this platform, the images and relevant clinical information is accessible in a realtime manner off a standard web browser via the internet. It shall provide capabilities for progress note entry by and communication between the nurses at the point-of-care and off-site specialists. Additional features of this web portal will include a personalized inbox for nurses and doctors to manage images under their care, a simple patient tracking system to allow for rapid retrieval of a patient’s image history, and a rich markup system to annotate relevant metadata on a patient’s image for retrieval at a later time. We will explore methods that will provide integration that would allow our application to support HL7, facilitating interface with other health information systems.

Research and Development Team
Andrés Monroy-Hernández, software engineer, client-side
Daniel Myers, software engineer, server-side
Leo Anthony Celi, medical consultant
Daniel Myung, project adviser
Gari Clifford, project adviser