Alex Little

Just posted on the Digital Campus blog:

Video demo of the patient management tools currently being used by Health Extension Workers on our project. This video shows the mobile protocols (using ODK), the mobile scorecard and analytics dashboard.

Since my camera broke the other day (I’m waiting for a new one to arrive), I used a flip camera for filming this, unfortunately it doesn’t focus well in close up, so the images of the mobile screen don’t show up well on this video, once my new camera arrives, I’ll refilm the video, to better capture the mobile screen.

For info I’ve just published the HEAT demo app up on Google Play for anyone who is interested in having a look.

Couple of notes…

• This is a work in progress so not everything may work as expected. Any feedback is welcome.
• To initially log in to the app, you’ll need to create an account on mQuiz. This is because any responses to the self assessment exercises are sent (if you are online) to be stored on mQuiz.
• The embedded videos won’t be available, the videos aren’t included in the app on Google Play, they’re stored separately on the phone SD card (to keep the apk file size down). Please contact me if you’d like details about the videos we’re using.

Here is a brief overview of how I created the Android application with the HEAT content. It is very much a demo/prototype application, so I’m sure there are many other ways this could be done (maybe in a more generic approach).

I used the plain zip download format of the HEAT modules (eg: http://labspace.open.ac.uk/blocks/formats/download_unit.php?id=6612) – which essentially provides a set of static webpages of all the module content. I noticed a couple of issues with these downloads, for example some had incorrect references to images, and the contents page wasn’t in quite the right order, but no big problems.

I then used the PhoneGap framework to turn this content into an Android application, just applying a revised stylesheet and adding a new header/footer for navigation. Initially I tried working with a whole HEAT module, but we found there was just too much text for anyone to be able to read comfortably, so we cut the content down to just the essential parts (introduction, learning outcomes, summary and SAQs). This was the part that probably took the most time, since it was a manual process to refactor the content in this way.

I’m sure there are ways this could be done in a more generic and less-manual way, perhaps using the OU XML to generate only these specific sections, but I suspect that we will always want to edit the content slightly for mobile devices, especially since we’ll be adding videos and perhaps some audio content too. Using the PhoneGap framework means that we should easily be able to transfer this application over to iPad/Blackberry/Windows Mobile applications with very little effort.

For embedding the videos, I used a PhoneGap extension to allow the embedding of local video content. The videos we’re testing out are from the Global Health Media Project, and are stored on the phone/tablet local SD card. We could include the videos directly in the Android apk package, but this is likely to make the apk quite large, plus we’ve not yet finalised which videos we’d like to embed.

The final part to all this is the interactive self assessment exercises. This is using a web app I have been developing over the last few weeks (mQuiz) and is designed to allow quizzes to be run offline. The quiz can be created then stored as a JSON object and a javascript library is then used to display the quiz to the user. If the user has an active internet connection then their responses are sent back to the mQuiz server, if they are working offline their responses are kept until a connection is available.

So we now have an Android application which can be run completely offline, with all the content, videos and quizzes pre-loaded onto the phone.

All of this is a work in progress, the code is up at: https://github.com/alexlittle/HEAT-Training-Android. I’m sure there are areas where improvements to this could be made – any suggestions welcome.

Here’s an updated video showing the OU HEAT content running on an Android smartphone and tablet showing embedded video content (videos stored locally on the device) and interactive self assessment exercises:

The video we’ve embedded is from the Global Health Media Project

Posting from Digital Campus blog:

We’ve recently been looking at how we can embed some of the Open University HEAT training content (for HEWs in Ethiopia) onto mobile phones and have these integrated alongside interactive self assessment questions (SAQs).

We restricted the content to just putting the introduction, learning outcomes, summary and SAQ for each of the study sections, otherwise there is far too much text content for users to comfortably read on screen – so this is designed to supplement (rather than replace) their existing course manuals.

The quizzes can be taken anytime, whether they have an internet (GRPS) connection or not, and results are submitted back to the mQuiz server (or stored for later upload if no connection is currently available). All the content and quizzes are stored directly on the phone. Users need an internet connection to initially log in, but once logged in they won’t need to re-enter their details (unless they log out or change their password).

Their SAQ results are stored on the phone, along with a ranking for how they have performed against others who have taken this assessment exercise.

Here is a quick demo video of this running on my mobile:

The next steps are to test embedding video and audio content.

Looking back at my recent blog postings I realise that most seem to be just holiday/travel photos, so to show I have really been doing some work too, here is some info on the latest updates I’ve been making to mQuiz.

The big change is that now I have an HTML5 version, so you can run the quizzes in your browser (either on your normal PC/laptop or on your smartphone). The quizzes and results are cached, so if you happen to be offline you’re still able to take quizzes. The mobile browser version (at: http://mquiz.org/m) supports all the same functionality as the Android application but will make the app available to more users (even those without smartphones). The browser version has a search feature and will suggest quizzes for you to take.

mQuiz running in Firefox on laptop

mQuiz running in Android emulator

The other change I’ve made is that the detailed list of results for a quiz are only available to the owner/creator of that quiz (previously these were available to anyone), although the overview results (average scores, average score by question) are still available to anyone who is signed in.

I’ll still be maintaining the Android specific app for mQuiz, but will probably spend more time focussing on the HTML5 version for now.

I’m sure there are still some kinks to work out and I have lots of ideas for functionality I’d like to add so will be working on these over the coming weeks. Any feedback welcome if you find something not working correctly. In the meantime test your knowledge of the periodic table.

From Digital Campus blog:

Thanks to all of you who took part in our Mobile Developer Challenge, we’ve spent that last couple of days reviewing the applications and we were very pleased with the standard of all the entries. The winning application was by Daniel Tareke, so congratulations to Daniel. A screenshot of his application is below and you can download his application from Sourceforge.

There’s only until next Saturday (18th February) to get your entries in for our mobile developer challenge. More details on how to enter.

Copy of a posting I made on the Digital Campus blog yesterday:

Over the last few months, alongside the protocol forms the Health Extension Workers (HEWs) are using to record maternal care patient encounters on their smartphones, we have been developing an analytics dashboard to allow HEWs, midwives, their supervisors and the local health bureaus to track the progress of pregnant mothers, their medical & pregnancy risk factors, and a range of key performance indicators.

Providing information back to HEWs and their supervisors about their performance, we hope will help to increase the number of ANC visits according to the recommended schedule, and provide information for local health bureaus to better prioritize resources and training. The current performance indicators include the percentage of ANC visits made on time, number of protocols submitted, PNC visit made on time and immunization records for both mother and baby.

Analytics Scorecard home page

For the HEWs, we can also provide information about the upcoming appointments, deliveries to assist them to plan their time better. Guidelines from the Ethiopian Ministry of Health encourage all pregnant mothers to give birth at local health centres, so we can use the ANC visit information to inform local midwives on expected delivery dates. Local health bureaus and HEW supervisors are able to compare the performance between different health posts or districts.

We are trying to be careful that this doesn’t become used as a EMRS (electronic medical records system) – there are already plenty of MRS’s available – rather we are looking at ways in which the HEWs can see advantages to recording their patient visits on their smartphones, by providing them with relevant, timely and easy to understand information about the patients in their area. In the future we may look at how to integrate with an MRS system (e.g. OpenMRS), but currently this is not the focus of what we’re trying to achieve.

For the technically minded, the analytics dashboard runs by accessing the ODK Aggregate database directly. We’ve looked at several different data collection tools (especially those focused on medical information collection), but all would require either direct database access (as we have done with ODK) or extraction of the data via an API (which would generally mean exporting to another database then accessing the dashboard from this). We’re still in the process of getting the HEWs and their supervisors up and running with accessing all this information via the web application and smartphone – we also still have some development work to do. Currently our researchers in Mekelle are printing regular reports to give to supervisors and HEWs, also, as this is a research project, it’s important that all the information (from protocols) can be stored as a hard-copy with the rest of the normal patient records at the health posts.

We’re currently developing an application so HEWs are able to access their task/performance information directly on the smartphones – which will work offline when there is no GPRS connection available, and update automatically when a connection is available (most likely using an HTML5 application, rather than a specific Android application)

Screen shots from prototype mobile browser version (personal data has been pixelated)

Using a smartphone platform to deliver this type of information is a good balance & compromise between other platform choices we could have made. Using PCs/laptops/netbooks would involve much more technical support, training and maintenance, and likely to have other issues such as access to electricity, portability etc. Smaller, low-spec phones would not allow us to present the information in such a clear and easy-to-use way.

For those interested the code for the analytics dashboard is available to download from GitHub at: https://github.com/alexlittle/Digital-Campus-Analytics

Following a few comments regarding being unable to send SMSs in Amharic with the Ge’ez keyboard installed I thought I’d have a better look into this. Also we’re looking to involve the volunteer community health workers (VCHWs) in our maternal care project and they are likley to need any text messages to be Tigrinyan or Amharic rather than English.

It seems that this isn’t only an issue with Amharic, others have had issues sending ‘ñ’ or accented characters using Android, so I can pretty much rule out that this is an issue with the Ge’ez keyboard.

Much like debugging language/font issues with database driven websites, with Unicode SMSs there are a number of places where a problem can prevent the message being encoded correctly – both of the phone handsets need to have the right font installed and be capable of sending unicode SMS, plus both the network operators need to have their networks configured correctly to send unicode text messages. There’s little we can probably do if network operators aren’t set up to send/receive unicode SMSs and from what I’ve read (e.g. here, here and here) most issues seem to be with US mobile operators.

Using my Spanish sim card (on an HTC Hero with the Ge’ez keyboard installed) I was able to send and receive messages in Amharic with my UK sim card:

My colleague Araya has also been testing sending unicode SMSs in Ethiopia, between an HTC hero phone and one of the (Ethiopian assembled) Tana mobiles – and this has been working fine.

So the main issue that we’ve had so far is with sending between some phones in the US – for some reason one phone will receive unicode SMS fine, but is unable to send – I’m guessing this has something to do with the the network operator settings rather than the phones themselves.

For reference:
GSM alphabet – which should work on all operators