Recording Health of TB Patients via a Cell Phone
The uPhone allows collecting detailed health information, while the uMessage is a basic version used to record dosage.
Health Recording (uPhone)
The uPhone is an ordinary cell phone with software that allows workers to record health indicators. Rural treatment programs today have poor knowledge of the evolving health of their patients, who are spread over a wide area. This leads to inefficient use of physicians, who are scarce to begin with in such settings. Physicians may spend hours getting to a village, when a different one had a more pressing need. Furthermore, the lack of medical history (especially treatment history in TB) affects outcomes. The uPhone was developed to mitigate these difficulties.
How It Works
The uPhone has a custom menu in the local language (and optionally English) that allows community workers with basic training to check off indicators related to TB. The uPhone may be used for both detecting new cases and periodically checking up on patients undergoing treatment. Programs can intervene, for instance, if side effects interfere with therapy, or if the patient continues to be symptomatic despite treatment.
Progress
The uPhone has been successfully tested in three user studies in Bihar, India, in collaboration with the Prajnopaya Foundation, and is currently in its third revision. The phone can use both SMS and data (GPRS) to transfer records.
Dosage Recording (uMessage)
The simplest way to use uNotify is by recording doses using a basic cell phone with no custom software (uMessage). While uMessage provides limited authentication, it is cost-effective in communities where providers serve only a few patients every year, e.g., sparse rural areas. In such settings, equipment costs are hard to amortize.
How It Works
All treatment providers are given a cell phone that can send and receive text messages (SMS). Providers text the patient ID to the uNotify system when dispensing the dose. At the end of each day, the system generates a list of all patients who did not receive their dose, and sends it to program personnel for follow up.
Two mechanisms are used to provide a measure of authentication. First, the uNotify system responds to a provider text with a random 4-digit acknowledgment code. The provider copies the code on a coupon and hands it to the patient. Periodic checks discourage false reporting. Second, the system occasionally alerts managers when dose notifications are received. Managers can then call providers and ask to speak with the patient.
Progress
The uMessage messaging system is currently under development, and a trial is planned in Bihar in 2010. In preparation, we have conducted extensive coverage and reliability testing of the cellular infrastructure in target communities (in collaboration with the Birla Institute of Technology, Patna).