eMOCHA
TraBuK
We have enjoyed learning from this forum. We would like to speak a bit about our mHealth platform called eMOCHA (electronic Mobile Open-Source Comprehensive Health Application). We hope this will be of interest to many of you.
Regards,
Larry Chang
Director of Field Evaluations for eMOCHA
Assistant Professor of Medicine, Johns Hopkins School of Medicine
Miquel Sitjar
Lead Developer for eMOCHA
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eMOCHA (electronic Mobile Open-Source Comprehensive Health Application)
-Platform Overview-
eMOCHA is a secure, highly flexible and adaptable, open-source mHealth application developed by the Johns Hopkins Center for Clinical Global Health Education (www.ccghe.jhmi.edu) and the PEPFAR Uganda Distance Learning Initiative. eMOCHA is designed to leverage mobile phones to assist health programs, researchers, providers, and patients to improve communication, education, patient care, and data collection. eMOCHA synergizes mobile technology, Android-supported devices, video and audio files, and a server-based application to analyze and Geo-referentiate large amounts of data, implement interactive multimedia training, and streamline data collection and analyses.
-Key Facts and Features-
-Runs on all Android devices and versions
-Uses XML forms (X-Forms standardized by OpenROSA) to flexibly gather data in multiple formats (multiple choice answers, text entry, pictures, bar codes, audio, and video)
-Incorporates logic/branching within forms (skip patterns, parameter checks, etc...) and also between different forms, eMOCHA can store an unlimited number of forms and activate them for specific users or households using results stored on other forms or geo-spatial data as triggers, allowing flexibility and efficiency in data collection and Clinical Decision Support.
-Real-time/near real-time syncing with server via WiFi or cellular network
-Plays multimedia courses (MP4 format) linked to quizzes to test user knowledge and understanding. Quiz results can be submitted wirelessly for analysis.
-Includes a library section for viewing documents (PDF or HTML format) which can easily be updated from the backend.
-Household or individual versions: on the household eMOCHA, households act as containers for patients, geo-referentiating the household and not the user, it will then use core forms for the household that will be stored and visualized in the backend independently from the patients, and can condition the forms used for each patient.
-Security: Server incorporates 256 bits AES encryption. Data transferred from the phones uses 128 bits SSL encryption. Phone data storage is pushed from the SD card into the internal database for an extra layer of security, if necessary, the data could be encrypted in the MySQL lite database, but since eMOCHA stores a lot of data, encryption could slow the application over time.
-SMS and Web Integration: Uses smart phones as the main source of data, but data can also be entered (and viewed) directly through the web-based interface and through Toll Free SMS, a feature allowing data collection from regular cell phones (dumb phones). SMS can also be sent to phones from the backend.
-Flexible architecture: the platform is designed to work seamlessly under virtually any network scenario, as wide as a cloud service, keeping the backend on the Internet, or as local as having the backend running on a laptop sitting in a car and having the phones sending data with ad-hoc connections. In Uganda we are testing a group of phones that send the data to a server sitting in our office in Kampala connected to the operator's backbone using a VPN, the phones have a special APN that assigns the server as the gateway and then the server provides all the services needed, this way we are able to negotiate lower prices with the operator because we don't use their Internet gateway, and we achieve higher speeds while keeping the data in country.
-Field Experience, Active Piloting-
*Pilot of household-based HIV testing and targeted delivery of HIV prevention in Bushenyi district, Uganda
This ongoing pilot study (over half way through) targets 1,000 households in the Bushenyi district of southwestern Uganda, testing an estimated 4,000-6,000 adults (including 2,000 sexual partnerships). A questionnaire programmed in eMOCHA on the Google phone is administered to all consenting participants for HIV risk assessment. In addition to standard HIV prevention messaging, high-risk individuals will receive an individualized HIV “prevention prescription” based on HIV serostatus, risk factors, and risk behaviors. The prevention prescription will contain brief counseling message, follow-up questions, information about local resources, and a referral for appropriate HIV prevention services. Follow-up to assess uptake of HIV prevention services will be done.
-Field Experience, Active Deployment-
*Pilot of location-based monitoring of injection drug use in Baltimore, USA
This pilot uses location-based data and eMOCHA-built surveys on a smartphone to see if it is feasible to track drug-users activities in Baltimore. The idea is to then use location-based and drug user-specific data to target interventions to prevent drug use and improve engagement in health services.
*HIV surveillance in Afghanistan
This pilot is simply using eMOCHA to conduce HIV surveillance surveys in the challenging setting of Afghanistan.
-In Development-
We have additional projects under development for Central America, India, Bangladesh, Zambia and Ethiopia. These diverse projects include community and home based strategies to optimize HIV counseling and testing, HIV treatment adherence, TB diagnosis and treatment, malaria prevention and treatment, maternal and child health, management of chronic diseases, and prevention of domestic violence.
-eMOCHA Niche-
We are clearly learning about quite a variety of different ICT-based solutions in this forum. We think there are currently some great mHealth tools already out there. With eMOCHA we are trying to address some specific issues we have come up against in our mission to improve health care and education. eMOCHA emphasizes security which has been very important to us as we transmit lots of sensitive data. eMOCHA incorporates significant learning features such as multimedia presentations and quizzes as we are targeting health care workers in particular with this application. Our paradigm focuses heavily on smartphones, but we recognize the critical role of feature phones, which we have integrated into our platform.
Thanks for your time. We look forward to any comments and will be happy to answer any questions.
Mark Spohr
Is there more information available on this project? Is the software available for review?
Regards
Mark Spohr
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Mark Spohr, MD
Nachiket Mor
I am a member of the Board of Directors of the IKP Centre for Technologies in Public Health (www.ictph.org.in). As a part of their action-research programme they now have a few papers that they would be keen to present to other researchers with an interest in this work so that they can get critical feedback and suggestions for improvements. They would also be similarly keen to invite researchers to their project site in Thanjavur to present their work to a the ICTPH team based there. If you think there would be an interest at your institution for such an interaction please do let me know. If there are other institutions that you feel would be interested please feel free to forward this email to them and / or share their names with me so that I can request the ICTPH team lead by Dr. Zeena Johar to be in touch with them directly.
Some of the papers that are ready are listed below:
§ Health Systems and Health Financing: These two papers detail the ICTPH Health Systems Approach and its four elements essential - Human Resource, Infrastructure, Technology, and Financing. The two Rural Micro Health Centres of Sughavazhvu (a Thanjavur based health care organisation) serving a population of 10,000 people each, function as per our defined model: (a) ICTPH Health Systems Approach - http://ictph.org.in/blog/from-the-president-zeenas-note/ictph-health-system-approach/ and (b) Financing Health Systems - http://ictph.org.in/blog/from-the-president-zeenas-note/financing-health-systems/
§ ICTPH Population based Individual Screening Protocol (PISP): http://ictph.org.in/blog/from-the-president-zeenas-note/population-based-%e2%80%93-individual-screening-protocol-for-rural-indian-populations/
§ ICTPH Health Extension Workers: The health extension worker model as adapted by ICTPH primarily provisions screening, follow-up care and intervention implementation to her catchment population of a 1,000 people, along with clinical practice modules for her career progression ensuring her long term sustenance within a health system. We now have a working paper detailing the village based selection methodology, the four phase training paper will follow shortly. Selection Tool for Health Extension Workers in Rural India: http://ictph.org.in/blog/ictph-guides/selection-tool-for-clinical-health-workers-in-rural-india/
§ ICTPH Health Management Information Systems (HMIS): We will also be releasing a technical note detailing our web-based HMIS, currently being implemented through Sughavazvhu’s Rural Micro Health Centres. Various features have seen a seamless integration in our HMIS in the recent past, most notably PISP analysis and report generation, SOAP methodology based patient assessment, mobile device integration for data collection, drug distribution and supply chain management. A number of features under development include nurse-patient protocol integration, disease protocol integration and diagnostic laboratory management including bar-coded sample movement.
§ ICTPH Interventions: As a part of our comprehensive intervention design which includes CVD, Cancer, Diabetes, Oral Hygiene, we are close to initiating our iron supplementation intervention for the 6 month – 24 month old infants in our catchment populations using iron sprinkles in one of the RMHCs of Sughavazhvu. Evaluating a Delivery Model to Ensure Feasible and Effective Reduction of Childhood Anaemia: http://ictph.org.in/blog/research/evaluating-a-delivery-model-to-ensure-feasible-and-effective-reduction-of-childhood-anaemia/
Nachiket Mor, Ph.D.
Chairman, Sughavazhvu Healthcare, Thanjavur
Website: www.sughavazhvu.co.in; www.ictph.org.in
Email: nach...@nachiketmor.net
Primary Health: http://ictph.org.in/blog/?cat=28
Jonathan Jackson
-Runs on all Android devices and versions
-Uses XML forms (X-Forms standardized by OpenROSA) to flexibly gather data in multiple formats (multiple choice answers, text entry, pictures, bar codes, audio, and video)
-Incorporates logic/branching within forms (skip patterns, parameter checks, etc...) and also between different forms, eMOCHA can store an unlimited number of forms and activate them for specific users or households using results stored on other forms or geo-spatial data as triggers, allowing flexibility and efficiency in data collection and Clinical Decision Support.
-Real-time/near real-time syncing with server via WiFi or cellular network
-Plays multimedia courses (MP4 format) linked to quizzes to test user knowledge and understanding. Quiz results can be submitted wirelessly for analysis.
-Includes a library section for viewing documents (PDF or HTML format) which can easily be updated from the backend.
-Household or individual versions: on the household eMOCHA, households act as containers for patients, geo-referentiating the household and not the user, it will then use core forms for the household that will be stored and visualized in the backend independently from the patients, and can condition the forms used for each patient.
-Security: Server incorporates 256 bits AES encryption. Data transferred from the phones uses 128 bits SSL encryption. Phone data storage is pushed from the SD card into the internal database for an extra layer of security, if necessary, the data could be encrypted in the MySQL lite database, but since eMOCHA stores a lot of data, encryption could slow the application over time.
-Field Experience, Active Deployment-
*Pilot of location-based monitoring of injection drug use in Baltimore, USA
This pilot uses location-based data and eMOCHA-built surveys on a smartphone to see if it is feasible to track drug-users activities in Baltimore. The idea is to then use location-based and drug user-specific data to target interventions to prevent drug use and improve engagement in health services.
Larry William Chang
Miquel and I will tag team some of these questions.
We should have provided our webpage, www.emocha.org, for some more
info. It's not as up to date as we'd like it to be, and we are also
happy to discuss eMOCHA one-on-one or arrange for demos. Please email
us privately if interested.
Regarding the multimedia and library functions. We have primarily just
done some formative work with these features among community health
workers in Uganda and Nepal. This primarily qualitative data
(interviews and focus groups) is being actively analyzed, but they
seem to indicate that these are welcome additions (by supervising
staff and chws) to the other features of the application and
acceptable and feasible to implement. We are still looking for a
suitable demo project that focuses more closely on these education/
training features.
Regarding Baltimore and HIPAA. This is a research study with
deidentified data collected primarily for research purposes after
participants give written informed consent, so it does not fall under
the category of HIPAA per se. However, I believe that eMOCHA, because
it is 1) Password protected 2) Can encrypt data on transfer, server-
side, and on the phone, is HIPAA compliant if all these features are
activated.
Hope this answers some of these questions.
Cheers,
Larry
TraBuK
Jonathan, great to hear from you again!
-We forked ODK a while ago (we call it eMOCHA-ODK, it has to be downloaded separately from eMOCHA, we like to make sure they always get credit for it), although we haven't had time to organize our code and share it with the ODK team, but I promised Gaetano I would... and will be doing so soon.
We made many modifications, like the way data gets stored and organized (we had to do so for the household version) and we also created a visual "grid" to the "answers" options so that we can actually show a jpg with 4 pills and ask the chw something like "touch the pill the patient is taking..." or "touch the skin rash that looks more like the patient's" we also use that for the quizzes, making it visual makes it much easier.
I can get a list of improvements together if you are interested, as I said, the idea is to share the code but we've been extremely busy and shorthanded.
-I see Larry already answered this two questions...
-The backend is built on the KohanaPHP framework but it has been entirely programmed in-house, we use Google Maps when in cloud and MapServer with ESRI maps when we don't have access to the cloud and need mapping, we also decided to license the backend under an Open Source license.
-Yes, the data is encrypted at rest in the server, although we are mostly encrypting patient identifiers and GPS data, and so far our server is handling very well, but in the next version of the backend, we want incorporate a semi-encrypted cache (that would only be used for the duration of the calculations and then deleted) for doing statistical analysis on large amounts of data, in that case, we will use PostGIS instead of MySQL.
I hope this answers all your questions.
Best,
Miquel Sitjar