Health IT

Hi Jessica,

Thank you for sharing information regarding this exciting new medication monitor with us! Interactive Research and Development (IRD) intends to share the status of mHealth initiatives for TB management and control with all existing and potential stakeholders in the field through the dissemination of our report entitled 'mHealth to Improve TB Care' (http://irdresearch.org/wp-content/uploads/2012/05/mHealth-to-Improve-TB-Care.pdf).
We would like to include Dr. Tom Moulding's innovation in the next version of the report, under the 'Treatment Compliance' theme. Please do let us know if your team is interested in being highlighted.

Best,
Jehan Ahmed
Research Associate
Interactive Research and Development

Dear Jehan,

I would like to share Operation ASHA's technology initiative with you, for
inclusion in your paper. Together with Microsoft Research, we have
developed the E-Compliance initiative, where each patient, on enrollment
has to give his fingerprints, which are 'saved' in the netbook at the DOTS
centre. each time the patient comes to take the medicine, he has to give
his fingerprint, the screen turns green in colour, and only then does the
provider give medication. At the end of the day, an SMS goes to the
concerned CHW in that area about those who have missed their dose. the CHW
then goes to the patients house and takes the fingerprint again, while
doing counselling and giving the medicines.

The best part of the technology is that a fingerprint cannot be fudged.
Manual entries can be fudged. Our workers cannot make false claims of
tracking patients, because the finger print is proof of visit. We have
brought default down to less then1.5% with this technology.

For more details, visit www.opasha.org or write to me at


Yours, in His work,
Shelly Batra, MD
President,
Operation ASHA


--

*Shelly Batra, MD*

President

Operation ASHA ...

Dear Jehan,

I would like to share Operation ASHA's technology initiative with you, for
inclusion in your paper. Together with Microsoft Research, we have
developed the E-Compliance initiative, where each patient, on enrollment
has to give his fingerprints, which are 'saved' in the netbook at the DOTS
centre. each time the patient comes to take the medicine, he has to give
his fingerprint, the screen turns green in colour, and only then does the
provider give medication. At the end of the day, an SMS goes to the
concerned CHW in that area about those who have missed their dose. the CHW
then goes to the patients house and takes the fingerprint again, while
doing counselling and giving the medicines.

The best part of the technology is that a fingerprint cannot be fudged.
Manual entries can be fudged. Our workers cannot make false claims of
tracking patients, because the finger print is proof of visit. We have
brought default down to less then1.5% with this technology.

For more details, visit www.opasha.org or write to me at


Yours, in His work,
Shelly Batra, MD
President,
Operation ASHA


--

*Shelly Batra, MD*

President

Operation ASHA

<http://www.opasha.org>


Like us on Facebook <http://www.facebook.com/operationasha> | Follow us on
Twitter <http://www.twitter.com/operationasha> | Join us on
Youtube<http://www.youtube.com/operationashaindia>


See the biometric eCompliance system in
action<http://www.youtube.com/watch?v=OUaNhdXtm-4>


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Dear Shelly,

Thank you for your message! We are happy to tell you that Operation ASHA is included in our report, which can be downloaded from http://irdresearch.org/wp-content/uploads/2012/05/mHealth-to-Improve-TB-Care.pdf

We strongly encourage all mHealth initiatives in TB management and control to contact the authors at to find out how to have their work included in the next version of the report.

Regards,
Jehan Ahmed
Research Associate
Interactive Research and Development

Shelly,
Could you let us know a little more about the project in India? Although defaults have dropped to 1.5% how effective has the biometrics been? Do you have any problems with unreadable entries or patients who cannot provide good fingerprints? There had been some concern that laborers, for example, might not be as reliable fingerprints. Who were your patients and where there any "failures" of the biometrics.

Could you provide more detail about the technology? What are you using for biometric readers and the EMR that the system dumps its log to?

Thanks for sharing!
Andy

Dear Andy,

I established Operation ASHA in 2005, and started TB education, active
case finding, DOTS expansion and default tracking, in 2006. We have
established a low cost, high impact scalable and replicable model,
empowering local communities to serve their needs. Now Operation ASHA
serves more than 6 million slum-dwellers and rural people in India and
Cambodia.

We have taken TB treatment to the doorsteps of slum dwellers, so no patient
has to miss work or wages in order to get the medicine. DOTS centers are
open early morning and late night, in temples, shops and clinics of quacks,
near major bus-stops or factory areas. Local people who live here are
working as DOTS Providers. For 2 DOTS centres, I have a full time worker,
the Counselor, who belongs to the community he serves. He is responsible
for case finding, giving education to families , facilitating the process
of testing at Microscopy centres, and most important, if any patient misses
a single dose, the counselor has to track the patient in his home, repeat
the counselling and bring the patient back into the system. For this, he
gets a cash incentive.

My concern was this. Are the counselors actually going to ...

Dear Andy,

I established Operation ASHA in 2005, and started TB education, active
case finding, DOTS expansion and default tracking, in 2006. We have
established a low cost, high impact scalable and replicable model,
empowering local communities to serve their needs. Now Operation ASHA
serves more than 6 million slum-dwellers and rural people in India and
Cambodia.

We have taken TB treatment to the doorsteps of slum dwellers, so no patient
has to miss work or wages in order to get the medicine. DOTS centers are
open early morning and late night, in temples, shops and clinics of quacks,
near major bus-stops or factory areas. Local people who live here are
working as DOTS Providers. For 2 DOTS centres, I have a full time worker,
the Counselor, who belongs to the community he serves. He is responsible
for case finding, giving education to families , facilitating the process
of testing at Microscopy centres, and most important, if any patient misses
a single dose, the counselor has to track the patient in his home, repeat
the counselling and bring the patient back into the system. For this, he
gets a cash incentive.

My concern was this. Are the counselors actually going to patient's houses
or not? are they simply declaring they have done so, in order to get cash
incentives? To solve this issue, we collaborated with Microsoft Research
and developed the e-compliance initiative, which is a biometric terminal.
The terminal has 3 off-the-shelf components, a netbook, a fingerprint
reader and a modem to send messages. E-compliance terminals are kept both
in the DOTS centres and carried by counselors. When a new patient is
enrolled, he has to give his fingerprints, which are saved. At the time of
swallowing medicine in the presence of a provider, the patient again has to
give the fingerprint, and this is irrefutable proof of visit. At the end of
the day, a text message goes to the concerned counselor and his senior
about all missed doses, and also all data is downloaded in the SQL server
into the back-end EMR. At the time of default tracking again the counselor
has to carry the terminal to the patients home and take his finger print,
repeat the counselling and give medication. So finger print prevents
fudging of data,ensures accuracy, prevents MDR-TB, and reaffirms patient's
belief in the governments DOTs program.

We had initial computational problems and algorithms had to be re-written.
Also, some workers were scared of losing or damaging the device. Others had
a fear that they would be replaced by computers. Recognition ability of
fingerprints was ensured by taking prints of both index fingers. The
netbook compares fingerprints of all patinets registered in that terminal,
not in the entire program which makes it easy. Sometimes patients develop
cuts or callosities on one finger. In this case, the second finger is used
for identifying patient. If this fails as well, then the finger print is
matched against a unique ASHA ID, an alpha-numeric number given to each
patient at the time of enrollment. Another point is that it is robust
system, and can survive very well at high temperatures, dust and humidity.

I hope this answers your questions. If you have any further questions,
please feel free to ask. You, and all members of this forum, are welcome
to visit our DOTS centres in India and see the biometrics in action. Please
write to me directly on for more info.

Yours, in His work,
Shelly Batra, MD

--

*Shelly Batra, MD*

President

Operation ASHA

<http://www.opasha.org>


Like us on Facebook <http://www.facebook.com/operationasha> | Follow us on
Twitter <http://www.twitter.com/operationasha> | Join us on
Youtube<http://www.youtube.com/operationashaindia>


See the biometric eCompliance system in
action<http://www.youtube.com/watch?v=OUaNhdXtm-4>


This email and any attachments to it may be confidential and are intended
solely for the use of the individual to whom they are addressed. Views or
opinions expressed therein do not necessarily represent those of Operation
ASHA. If you are not the intended recipient of this email, you must
neither take any action based upon its contents, nor copy or show it to
anyone. We apologize if you have received this email in error.