Information and Communication Technologies for Development

There are numerous deliverables that we would like to produce before the end of term. Some of them will be essential for the 8 May presentation while some others are more relevant for use in the field. Our plan for the coming weeks are as follows:

**Now- 8 May**
Poster
Presentation slides
Programme improvements (to include sending out SMS message on positive analysis)
Addendum for consent forms
Demo video

**8 May - 15 May**
Final write up

**After 15 May**
Videos for: Vaccination clinic workers
Parents
Physicians

**On-going**
-Physicians' instruction sheets- protocol/ workflow, cellphone 101, important phone nos
-Vacciantion clinic workers' instruction sheets- sales pitch, legal matters, bracelet care, checklist of items to be explained
-Parents' index cards- pictorial instructions for bracelet care, important phone nos

It turned out that some important information with regards to the form of the RFID bracelet and social implementation had been gathered almost a year ago. Six focus group discussions were conducted with four female and two male groups in Lyari community during the month of May, 2006.

The main findings are as follows:

1) Males preferred cards but would accept a bracelet with black beads (which resemble beads that ward of the evil eye)
2) Females didn't not mind having the bracelet on for the first six months
3) Both men and women showed high concern for child safety and comfort when considering bracelet design
4) Important traits:
Soft (no wires)
Durable, beads won't come off
Waterproof
Prefer black beads to golden beads
Small thickness to minimise skin contact
Chip should be well-embedded in the bracelet so that a child cannot remove it even with his mouth
5) The community was familiar and comfortable with the card system but are concerned about the durability of the card
6) People reacted very well to monetary incentives such as grocery coupons

I spoke to Saira today and we discussed some of the socials concerns that we should address as we come up with ways to socially implement the RFID system. Here are some key points:

• Enrollment Concerns: Parents would like a good reason why their child should be wearing the special RFID bracelet--they don't want their child to stand out as "different" because they are participating in this study. (The fact that tabeez is commonly worn by people in Pakistan was one of the biggest reasons why that form factor was appealing.) Parents also want to make sure that the RFID tag will not have negative side effects on the child.

  What we can do about that:
  Have field workers wear some of these bracelets to prove that it's not harmful.
  Have health workers emphasize the greater goals of the pneumonia surveillance study.
  Emphasize the benefits of early detection and immediate response (as opposed to if the child didn't have the bracelet).

We have heard from Rachel and are now in the process of incorporating her feedback into our survey. We are very close to finishing it. The main changes are added questions for the physicans, and incoporating infrastructure questions into subgroup questionnaires instead of having a separate infrastructure questionnaire. This should help us determine the availability of cellphone reception, GPRS connection and electriciy at where it actually matters. The followings are the main features of our survey:

1) 3 separate questionnaires for parents, physicians and vaccination clinic staff
2) The questionnaire for parents asks about their habits of visiting physicians and preference of RFID tag
3) The questionnaire for physicians contains questions on energy and network availability in their clinic and work habit.
4) The questionnaire for vaccination clinic staff asks about energy and network availability in their workplace and gauges their ability to explain the project and obtain informed consent from the parents.

A week and a half ago we sent version 1 of our code to Pakistan to have them look at it and send back comments. We figured we were bug-free for the most part, and that we'd get back feature requests, etc. With some prodding, we just got a report back from the field. Sounds like I've got a bit of debugging to do before we can talk features. It's amazing how someone else's use of your software leads to bug discovery. Many of these comments aren't bugs per se - they are more so indications that our interface was not intuitive enough, and with slightly better error checking and a few hints, life would be better for our users.

Testing response email attached below:

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Really sorry for the delay. Here's what happened when I tested it on the Nokia 6131 NFC:

Here's what I noticed:

1. I had to close the entire application and restart it for a write to work. I could not do consecutive writes as it did not recognise the new id that I entered - perhaps the cache needs to be refreshed.
2. If I try scanning two RFID tags consecutively, with the 2nd scan, it reads it but below there is the following error:

By May 8, we would like to have a concrete idea and if possible, even some visual examples and finalized written drafts, of the following things. Below each of the groups of people involved in IRD, we've listed how we plan to accomplish those goals. These are subject to change, since we'll be talking to Saira (our HR contact on-site in Karachi), and discussing which of these will actually work and what would be the least disruptive and most effective way to socially install the technology.

For the IRD scientists & engineers:

• Technological & social explanation of the system.

Our proposal, diagrams, a video of our presentation and video demo of how to use the cell phone technology.

For the physicians:

• Reminders to look out for the bracelet and how to direct people with questions.

Illustrated posters and a brochure.

For the IRD health-workers:

• An addendum to the consent form, which includes the issues involved with the RFID tag (the purpose of the study, plus the potential risks and causes, and benefits)

Here's what we've completed so far with respect to the social aspects of this project:

1. Made a video that describes how the physicians/clinicians can use the technology.
   Here is a link to the video: http://web.mit.edu/dytlaw/www/RMOV2387.AVI
   Currently it is in English, and the sound quality is not the best, but we plan to fix it in our final version. We will probably dub this in Urdu, add English subtitles, and do some video editing to better highlight certain technological features that we want to draw attention to.

2. Decided on the material and form of the bracelet.
   It shall be a bead encasing an RFID chip, on nylon thread. Exactly how the RFID tag is attached to the bracelet will depend on the form of the tag, once we get it (we've emailed Rich for resources). As for the thread, we decided on nylon because it has all the qualities that we have been looking for.

   We wanted the material to be:

   • long-lasting and comfortable (as the child would be wearing this RFID tag for at least six months)
   • small & sleek (out of the child's way and aesthetically pleasing)

Of course, the actual design will depend on the form of the chip that's available to us, but I just wanted to compile some websites that show different forms of tags that have already been created. (They already have a lot of cool things in China!)

• Different types of RFID tags:
  http://www.alibaba.com/product-gs/204531204/RFID_tags_and_iButtons/showi...
  I can see some of these as beads on a bracelet...
• Contactless cards that can be put on key chains:
  http://www.alibaba.com/product-gs/200338469/RFID_contactless_card.html
  These would be a good idea if our population in Karachi actually used key chains...
• Interesting collection of articles on RFID technology:
  http://www.rfidlowdown.com/implementation/index.html

In last week's presentation we showed our audience our cell phone interface iteration 1, bracelet design and distribution ideas and our needs assessment. Right now, we are waiting for feedback from the field for the interface and the bracelet ideas. For the needs assessment, we have got some very useful feedback from Rachel, especially about widening the scoop of our questions. We will incorporate her feedback into our survey and hopefully finalise it by next week. As our programming specialist does coding, the rest of us will be delving deeper into the bracelet design. We would like to obtain an actual RFID chip, as opposed to a card used in our demo, and start producing prototypes. At the same time, we will look into the costs and make sure that the bracelet is under USD 2.

Given the application has an easy and friendly interface, we do not expect any challenges for physicians interacting with it. We rather believe that most of the problems could be technical and come from the cell phone apparatus. Although is a robust cell phone, the Nokia 6131 NFC is going to be used to read the RFID tags, select the pneumonia status of patients and transmit the information over GPRS. The whole process entailed by our project is based on it. Without appropriate care and maintenance of the apparatus, the study results could be drastically affected. Hence, it is very important to keep the phones and its batteries in optimal conditions. At this point we do not know if exists technical support for this specific phone in the area where the study is conducted or if there will be in the future.

We have finished the first version of our proof-of-concept! Here is the email we sent to the IRD-PATH folks:

Hello everyone,

Our group has completed work on the first iteration of the cell phone
diagnosis interface.

You can find the .jar file, which can be copied to a Nokia 6131 NFC by
way of bluetooth and run from the gallery interface on the phone,
here:

http://people.csail.mit.edu/marcua/ict4d/pneumonia_interface/

In the same directory you will find a .zip file, which is a zip of my
eclipse project, containing all of the source code for the project.
If you unzip this file in your workspace, you can then import it as an
eclipse project.

When you run the program, you will be given three options:
1) Scan RFID - scan a Standard Mifare RFID card that has a "Patient
ID" written to it as per the instructions for "Write RFID Card" below.
After selecting this option, scan the card, which will identify the
patient.
2) Enter ID - in this situation, the doctor just knows the Patient's
ID number without having an RFID tag (or perhaps the RFID tag broke).
Enter any integer as the patient's ID after selecting this option.

Our goal is to have an end-to-end (though not feature-complete) implementation of our project by the end of this week. So far, we have the ability to:

1) Write a patient's ID to an RFID card,
2) Read the patient's ID from the RFID card,
3) Diagnose the patient (no pneumonia, mild pneumonia, or severe pneumonia).

All of this can be done on the Nokia 6131 NFC by way of a J2ME midlet. What remains to be done in order to have an end-to-end version is to get a GPRS connection to register the patient's diagnosis with a php script that will then take further action to alert the IRD-PATH folks if further patient contact is needed.

We're excited about the unique opportunity we have to practice iterative design. Traditionally, you meet with your client every 2 weeks or so and show them the current prototype in order to keep the design process true to the client's requirements. Because our clients are in Pakistan, we're iterating by way of e-mail - as soon as our prototype is complete, we'll send a .jar over e-mail to the engineers in Pakistan, which will run the application on their Nokia 6131 NFCs, and let us know how to proceed.

According to our timeline, we are supposed to meet up with people from the Nokia lab this week. However, after talking to the course instructors, it was agreed that we do not have solid questions in mind and hence a meeting with Nokia will not be very useful apart from letting them know we are working with Nokia phones.

Yesterday our team had a meeting to devise the needs assessment which is one of the final deliverables of the course. A needs assessment aims to find out whether the proposed project is actually needed in the target community and if so, how it should be implemented. When we started our project, a lot of the details were already given to us and our job was more about developing the system given the background than shaping the project. As a result, when writing the needs assessment, we had to pretend not knowing about the outcome. Even so, I feel that having our decisions already made for us might have adversely affected the quality of our needs assessment. There is a risk that the questions we drafted were geared to produce the answers that would lead to the decisions that were already made. Also, the coverage of the questions may not be wide enough. For example, we have decided to use RFID bracelets and/or barcode ID card. As a result, it is easy to come up with questions that gauge what people think about using these two things but do not explore other options. Hence, we added a question that asks family members what they usually bring with them when they leave home in an attempt to find out what their habits are, and from there work out what form the RFID tag can take so that people will carry it with them most of the time.

We met our IRD contact today. Aamir Khan took us to lunch, and we discussed the project, as well as ICT for health in general. We had a lot of interesting discussions about how to get funding for such projects in general. Aamir Khan is of the opinion that the best way to get funding is to figure out the problem you want to solve (Multi-drug Resistant TB, for example), and propose a solution based on that, which specifies some new technologies you will develop along the way. He hasn't seen funding for core technologies just based on their merits - the best way to get funding is to do so by solving a tangible problem.

We aim to create a technological solution that helps decrease infant mortality in Karachi, Pakistan. In developing countries, lung infection kills more children (under age 5) than aids, malaria and measles combined!. Pneumonia is the number one killer of those children. Of course preventive measures such as vaccinations, adequate nutrition and reducing indoor air pollution or overcrowding are very important. Nevertheless, when a patient already has pneumonia, it is imperative to take the appropriate steps to better address the problem. Under staff and under equipped conditions in the poorest areas, makes it difficult to deliver care promptly. This is one of the reasons why, regions like South Asia and Sub-Saharan Africa, have the highest rates of mortality due to pneumonia.
A mobile alert system that becomes part of the general practitioners workflow in Karachi, without adding more burden to their busy schedule, would help IRD-PATH study the impact of vaccination in reducing pneumonia and thus infant mortality.

The project continues to progress; this week we not only started to identify individual tasks but also realized how to enhance our workflow. We should overlap our work. Hence, I am planning to work near Adam to define the medical terminology we should use in the application, and together with Sony to create the required informed consent. Denise and Sony are going to work on the bracelet design and Denise is going to crunch some numbers according to our budget.
Also, this week the group in Karachi sent us information about the “plastic seals” they are planning to use as the bracelet in the infant’s ankle. We were not sure if the proposed device is harmless, thus we are going to look more into that. In addition, they insisted on using active RFID devices. As we learn last week, the FDA apparently does not approve active devices for medical purposes. We talked about this matter with Rich, and we agree on working with passive devices.
Today we received the GSM modem and a pretty cool phone (although not the one we need for our project) to start performing some tests and initiate the coding phase. I will hopefully start learning J2ME and PostgreSQL from Adam.

A big issue with our project going forward is a lack of foresight into what the final patient identification module will be. We are considering everything from active RFID to automatically detect a study participant, to a passive RFID reader connected by bluetooth to the doctor's phone, to a very simple passive RFID or barcode card that the parent carries with them (and hopefully doesn't forget). Because of this, modularity is key - the functionality of the phone after the patient identified is the same, so our goal is to abstract away how exactly the patient will be identified. We'll provide several identification modules as proofs of concept, to ensure that we aren't making assumptions about how identification works in later steps of the interaction.

In preparation of the initial write-up, this week our team started looking at how ideas work together on a more technical level. After exchanging emails with our contact in Pakistan and meeting with our supervisor, we found out/ came up with the following:

- The viability of incorporating a passive RFID chip in a traditional bracelet has been tested by our contact in Pakistan. They have successfuly made a working prototype and have evaluated the social impact. Dialogues with parents and grandparents reflected that this idea should be applicable.

This eliminates a lot of our initial concerns regarding tempering with religious accessories. The next step will be looking into the details of the bracelet such as formally drafting designs and considering manufacturing aspects.

- Our contact has expressed that an active battery operated RFID chip will be preferred but there are constraints such as size, cost, and the fact that active RFID is not approved by the FDA for use in medical records due to security reasons. This will be one of the main issues that we hope to resolve asap.

After meeting with Rich earlier this week, a lot of our group's confusion was clarified, and now we have a better idea of what our project involves. Making the best use of our skills, each of us has also been able to carve out a niche on the team so that we can all contribute to the development of the project in each of our various directions.

My role on the team will be to assess the ergonomics of the system we will be proposing, so I've started to think about some of the features we should make sure our system has: for a start, it should minimally affect the workflow at the clinic and be really simple to use and troubleshoot. While the second factor will become a more important thing to keep in mind when we actually start designing the system, the first idea is something we have been keeping in mind since the beginning of the project.

First of all, I'm super-excited about this project because it seems very applicable and possible. Our supervisors have been readily available and responsive so far, and I think we have a wonderfully cohesive team. Almost the perfect recipe for a successful project.

In my opinion, what we have to work on at this stage is the communication aspect of the project, and figure out what we actually need to do and/or what we can do. After speaking with Dr.Khan and meeting with Rich this past week, I think we understand the general, overall plan of how the RFID system is supposed to fit into the medical visits. We even have a decent idea of what population we're working with and what challenges and limitations we should foresee. However, it's still unclear how much of the project has already been done, how much has been tested, and how much still needs to be figured out. Basically, how much freedom do we have in molding the project and designing the system? For instance, for the past week, we had been coming up with the set up for the system and its course of action, but apparently that has already been done.

Our conference call and subsequent emails with our lead contact in Pakistan (Dr. Aamir Khan) have made one thing clear - the goal of our project is to design a system which collects accurate statistics about clinical visits and pneumonia occurrences in the 7500 participating infants. The first assumption is that you can't trust unincentivized participants (doctor or patients) to change their workflow to accomodate data collection. If you do, then you will inevitably lose data points to people who are already to busy or worried about their health to add to a checklist.

After a conference call with Aamir Khan and a couple of meetings among ourselves, we have started to understand the different facets of the IRD/PATH project. It is interesting to see how the limitations that are paramount to the success of this project can seem so trivial. The system has to be as passive as possible so that medical staff will not have to put in extra effort; the infant should be scanned upon arrival at the clinic so that the physician will not have to get out of his chair to scan him while he sees him; instead of using a barcode on an ID card, a passive RFID trabeez/ traditional bracelet must be worn by the infant and expected to survive the elements and the passage of time. While these points are all sensible and applicable, it has become glaringly obvious that the participants and stakeholders in this project do not have a lot of incentive and hence will not be willingly to take on any responsibility.

I am very enthusiastic about participating in the IRD/PATH project. Applying radio-frequency technology in health care is not only novel but also very promising. Our goal is to utilize this technology for patient identification, enabling the health system to provide improved patient care, follow up and treatment. One of my roles in this project will be to act as a medical consultant, focusing on potential problems that might arise from this technology.

I am a second-year graduate student at CSAIL, where I am part of the Database group and the Haystack project. My advisors are Sam Madden and David Karger. Before coming to MIT, I received my B.S. in 2006 in Computer Science and Mathematics at Rensselaer Polytechnic Institute (RPI).

I was born in Israel and moved to America when I was five years old. While I'm heavily involved in technology, I look forward to putting it into a social context this semester as we do more than develop technology for technology's sake.

Hi! I'm Sony. I'm a senior who's majoring in Brain & Cognitive Science and concentrating in Linguistics. I've been pre-med since high school, so most of my background is in Bio and chem, but despite this soft science facade, I actually like math and computational/technical stuff more--in fact, I'm a techie at heart, which I discovered this past summer. This summer I participated in a Public Service Center fellowship project in New Delhi, India, where worked with NGOs. As a part of my project, I had to design a computer application in MS Access that stored and analyzed patient data. This was such an amazing experience that I decided to take this interest seriously and not to be pre-med anymore. So, after declaring my freedom, I signed up for this course and now I'm trying to get more involved in ICT4D!

Hello I'm Denise and I'm an exchange student who reads manufacturing engineering in the University of Cambridge. In MIT I'm a junior in mechanical engineering and management. I was born in Hong Kong and went to highschool and university in the UK. I enjoy travelling, reading and pistol. I have always been interested in development work and after going to India with D-Lab 1 during IAP, I would like to look at what we can do from a more technical perspective. I hope to use my general techonology background and knowledge in busniess and economics, and be involved in a company that disseminates appropriate technology.

I am a National Library of Medicine Fellow pursuing a masters degree in Biomedical Informatics in the Harvard-MIT Health Sciences and Technology Division. I am originally from Buenos Aires, Argentina and relocated to the US for further training shortly after receiving my medical degree. Since then I have been working in molecular research and surgery. I am interested in information systems and new technologies to improve and personalize health care delivery.