An e-health application intended to help astronauts provide healthcare for each other during space flight could end up being a major advantage to community health workers who are often the only care providers to millions of people around the world.
GuideView is a software framework that uses a mix of text, audio, images and video to provide easy-to-understand healthcare instructions for healthcare workers in remote communities who may not always comprehend the language or nuances of clinical guidelines.
The software runs on a number of different devices, but the mobile phone is the primary platform for community health workers, who are the backbone of global health, according to Sriram Iyengar, assistant professor of health information sciences at the University of Texas Science Center at Houston.
Community workers can have error rates as high as 60 percent using paperbased healthcare guidelines, leading to significant morbidity and mortality. But studies by Iyengar and his students show that the use of GuideView on mobile phones can cut the mean error rate by more than 30 percent.
Some of the reasons they found the paper-based systems prone to errors were that those documents were not interactive; they didn't fit easily into the workflow of the community workers; and the documents weren't customizable. Terms and language usage in the paper documents also were not necessarily given at the right educational level of the community worker, Lyengar said.
GuideView, on the other hand, allows people to create more flexible and targeted guidelines using text, audio and video to build a rich view of situations the community worker may face, without complex programming.
When they need to examine an infant for signs of convulsions, for example, GuideView not only provides text instructions but also a video example of such an encounter. Another is recognizing the severity of lesions; GuideView will provide pictures and video to help with that.
None of this requires that phones be connected to a cell network as treatment guidelines are stored on microSD flash memory cards that are now commonly used in mobile phones. When available, however, connectivity adds a powerful dimension to GuideView's feature set. A common problem with community workers is a failure to refer their patients to a hospital for further examination and treatment. But GuideView phones can be programmed to automatically send details of an encounter to a hospital physician.
Cell as computer
Another feature that Iyengar and his group have been working on is adding a Global Positioning System (GPS) app which would allow managers to track community health workers' movements to make sure they are where they are supposed to be.
All of the encounters the health workers deal with also can be recorded on the phone, for later analysis.
The fact that all this happens using a mobile phone is key to the system's use by community health workers, Iyengar believes, something that came from his own observations during a scientific study of the use of GuideView earlier this year in Medellin, Columbia.
Whereas he and his students considered the device to be more computer than phone, Iyengar said the perception among community workers was that it was a phone first, and computational device second.
The distinction is important. Computers were viewed by the workers as formidable devices that required a lot of training to use, he said, whereas mobile phones are seen as "sweet, nice devices." So the workers immediately see the phone, with its GuideView guidelines, as something that's very acceptable and useful to them.
The authoring system is being debugged and the final features tuned with an eye to the University of Texas offering a general release of the GuideView system by early 2010, Iyengar said.Iyengar's co-collaborator in the GuideView research was Jose Florez- Arango, who is now on the faculty of medicine at the University of Antioquiain Columbia. Support was also provided by Microsoft Research, the state of Texas, NASA and US Army's Telemedicine & Advanced Technology Research Center, which is heavily involved in development of health care applications using mobile phones.
