FrontlineSMS:Medic becomes Medic Mobile

FrontlineSMS:Medic is now Medic Mobile. From the start, FrontlineSMS:Medic implemented and extended FrontlineSMS to bridge gaps in healthcare delivery systems. After a successful pilot, the FrontlineSMS software and community acted as a launchpad for an organization that uses open source software to support health services across the globe. The launch of a new name, Medic Mobile, reflects the growth and trajectory of that organization. Medic Mobile will continue to be one of the most emphatic champions of FrontlineSMS – contributing code, user experiences, and peer-reviewed research back to the community. Here, Isaac Holeman and Josh Nesbit, co-Founders of FrontlineSMS:Medic, walk us through the history of the project, and where they see Medic Mobile heading in the future.

The FrontlineSMS:Medic Story

Inception

FrontlineSMS:Medic was preceded by two independent projects, Mobiles in Malawi and MobilizeMRS. Josh Nesbit initiated Mobiles in Malawi in the summer of 2007, working at a rural Malawian hospital that serves 250,000 patients spread 100 miles in every direction. To reach remote patients, the hospital trained volunteer community health workers (CHWs) like Dickson Mtanga, a subsistence farmer. Dickson had to walk 35 miles to submit hand-written reports on 25 HIV-positive patients in his community. The hospital needed a simple means of communication, and in the summer of 2008 Josh returned to the hospital with mobile phones and a laptop running FrontlineSMS to provide it.

MobilizeMRS was born with a focus on electronic medical records, and the notion that the technology could be extended to engage CHWs in structured data collection. Isaac Holeman discovered Mobiles in Malawi and contacted Josh online, and in late 2008 they decided to join forces. Isaac brought the key characteristics of MobilizeMRS with him – a commitment to extending OpenMRS, the initiative to formalize their projects as a venture, insistence that the venture should have a distinct brand and leadership authority, and commitment to developing innovative software.

In February of 2009, Josh, Isaac, and a group of students from Stanford and Lewis & Clark founded FrontlineSMS:Medic together. The mission was to help health workers communicate, coordinate patient care, and provide diagnostics using low-cost, appropriate technology.

Impact

In six months, the pilot in Malawi using FrontlineSMS saved hospital staff 1200 hours of follow-up time and over $3,000 in motorbike fuel. Over 100 patients started tuberculosis treatment after their symptoms were noticed by CHWs and reported by text message. The SMS network brought the Home-Based Care unit to the homes of 130 patients who would not have otherwise received care, and texting saved 21 antiretroviral therapy (ART) monitors 900 hours of travel time, eliminating the need to hand deliver paper reports. You can read more about this pilot in the Journal of Technology and Health Care publication.

After the 2010 earthquake in Haiti, Josh reached out to FrontlineSMS users on the ground and connected with mobile operators. Soon after, FrontlineSMS:Medic helped coordinate The 4636 Project, an effort to create an emergency communications channel. Working with the Office of Innovation at the US Department of State, technology providers, Digicel, and Voila, a system was created to process text messages expressing urgent needs from the ground. Using crowd-sourced translation, categorization, and geo-tagging, reports were created for first responders within 5 minutes of receiving an SMS. Over 80,000 messages were received in the first five weeks of operation, focusing relief efforts for thousands of Haitians.

In less than one year, FrontlineSMS:Medic expanded from 75 to 1,500 end users linked to clinics serving approximately 3.5 million patients. Growing from the first pilot at a single hospital in Malawi, they established programs in 40% of Malawi’s district hospitals and implemented projects in nine other countries, including Honduras, Haiti, Uganda, Mali, Kenya, South Africa, Cameroon, India and Bangladesh.

A growing toolkit

In 2010, the FrontlineSMS:Medic team expanded and began creating new mobile tools. Software developers built on the FrontlineSMS platform to create a lightweight patient records system, PatientView, and a text-based information collection module, TextForms.

Developed by volunteers in less than two days, the initial 4636 system combined a number of technology platforms. Most recently, FrontlineSMS:Medic developers worked on a messaging module for OpenMRS, a project that had been in the works since the MobilizeMRS days prior to FrontlineSMS:Medic. It became clear to the team that building upon and implementing various open source tools was the best way to serve users and achieve impact.

Next Steps

FrontlineSMS acts as a catalyst for new projects – incubating ideas, teams, and software for legal systems, education, financial services, radio, and other fields. The model replicates FrontlineSMS:Medic’s sector-specific approach and builds on a community of users innovating every day

Medic Mobile continues FrontlineSMS:Medic’s team, values, and mission – using mobile tools to create connected, coordinated health systems that save more lives.

Hope meets phones.

It's been another landmark day in the short history of FrontlineSMS:Medic. For those of you who don't know, today saw the launch of their latest initiative - Hope Phones - which, generally speaking, encourages people to dig out their old phones and give them a new lease of life in the hands of a community health care worker (CHW) in a developing country.

Hope Phones will make use of the nearly 450,000 cell phones discarded every day in the United States, and allows donors to print a free shipping label and send their old phone in to The Wireless Source, a global leader in wireless device recycling. The phone’s value allows FrontlineSMS:Medic to purchase usable, recycled cell phones for  health care workers. According to Josh Nesbit:

Hope Phones lets you give your old cell phone new life on the frontline of global health. That's powerful. Just one, old Blackberry will allow us to purchase three to five cell phones for health care workers, bringing another 250 families onto the health grid via SMS. Old phones can help save lives

Why it's not about the phones

What really excites me isn't the simplicity of the idea, or the great execution, or the branding (more kudos to our good friends at Wieden+Kennedy), wonderful as all those things are. It's not even the number of retired phones this could rejuvenate, or the impact that all of this could have on the ground, incredible as it promises to be.

No. It's all about mobilisation. To take and adapt a phrase:

Never doubt that a small group of thoughtful, committed students can change the world. Indeed, it's the only thing that ever has

FrontlineSMS:Medic, and Hope Phones, has come out of nowhere, and it's challenging our perceptions of what's possible. Sure, global health is a seriously big beast to deal with, and few of us - if any - will ever have the muscle needed to tackle that particular monster. But that doesn't mean we shouldn't do anything. Indeed, there is a lot we can do.

Talk is cheap

While large multinational donors and governments battle it out, dotting the i's and crossing the t's, people need help. Every day. These people can't wait. And people like Josh, who have spent time on the ground understanding how rural hospitals tick, know all-too-well the impact that a simple cellphone can have in the hands of a committed CHW. With little more than passion, drive and an amazing ability to mobilise and motivate, Josh has pulled together an incredible team of equally committed individuals - students - from universities all across the United States. While adults generally critique and find reasons not to do things, they've gone out and done.

We all know what we can't change. The real challenge therefore is not only figuring out what we can, but acting on it. Talk, like politics, is cheap. Lives are not.

It's about time we challenged old models. And that time is now.

Mobilising around FrontlineSMS:Medic

Today sees the launch of an exciting new initiative - FrontlineSMS:Medic - by a growing team of students mobilising around the practical application of mobile technology in global healthcare delivery. FrontlineSMS:Medic combines Josh Nesbit's pioneering work on "Mobiles in Malawi" with a mobile version of OpenMRS - an open source medical records system - and an exciting new remote diagnosis tool. In this guest blog post, Josh Nesbit and Lucky Gunasekara talk about the origins of the project, and their plans in the coming months.

Josh: I should be heading off to class, right about now. I'll go, but not without telling a story, first. A convergence of ideas and people marks the launch of FrontlineSMS:Medic and the team's embarkation on a quest to do mHealth the right way.

Many of you are familiar with the role FrontlineSMS, a donated laptop, and a bag of recycled cell phones have played in connecting community health workers (CHWs) in Malawi to a rural hospital and its resources. Text messaging is now an integral component of the hospital's infrastructure. FrontlineSMS has proven intuitively easy to use with strong user buy-in. The program is horizontally scalable, and incredibly cheap to run, matched with indisputable savings in time and costs. Enter Lucky.

Lucky: I am the bewildered South Asian guy in the photo. Back in 2008, I was sitting in an office in Tokyo reading about cellphone penetration in developing countries, wondering if mobiles couldn't also be used for boosting healthcare delivery in resource poor settings. When I wasn't wearing a suit and riding to work in a packed Tokyo subway car, I was wearing a t-shirt and khakis and working in clinics in Sri Lanka - accepting an offer to attend  Stanford Med, this year. I worked out that SMS could be used in tandem with an open source electronic medical records system called OpenMRS, allowing for continuity in patient care from the community health workers to the clinic.  Meanwhile, Josh was sweating it out in Malawi, actually learning this the hard way. Just to prove that good ideas are obvious, Isaac Holeman and Daniel Bachhuber, two students at Lewis & Clark, had the same realization and began working on a project called MobilizeMRS to get this underway.

Josh: Long story short, we're all working together now. Lucky is pictured on stage with Bill Clinton, as his CGI U commitment is announced on the group's behalf.

Lucky: The commitment is, briefly:

To build on kiwanja's CGI commitment of an Ambassadors Program within FrontlineSMS, by developing a new version of FrontlineSMS - FrontlineSMS:Medic - for use in clinics in developing countries. That Medic will have end to end of continuity of electronic medical records by fusing FrontlineSMS with OpenMRS in a modular click-to-add format. I will be taking a year off from medical school (a decision infinitely popular with my folks) to work on this system and develop new partners on the ground with Josh, and do research on a new breakthrough medical diagnostic system at UCLA, that we feel will be the "Killer App" of FrontlineSMS:Medic. More on that to come. We're also going to be fully open source with wiki user manuals and off-the-shelf healthcare packages for download, so setting up a DOTS-TB program doesn't have to be any harder than buying a song on iTunes... OK, maybe a little bit harder... but not by much.

Josh: We're planning to pull this off within a year, operating in more than 25 pilot study and partner clinics by the summer of 2010. The system will be free and so will the hardware. Check http://medic.frontlinesms.com regularly to learn more and get involved.