A tale of two disciplines: How Big IT and frontline health workers fix Ebola (and beyond)

Sitting at a morning meeting called Responding to the Global Health Crisis: Technology & Policy Innovation almost felt like attending two separate conferences. The first group spoke glowingly about how Big IT can solve health problems: high speed and cloud computing can provide enough infrastructure to produce high quality data analysis. The second group concentrated on the less flashy needs (technology and otherwise) of frontline health workers in Guinea, Sierra Leone and Liberia.

The meeting appeared to be organized to get the two groups to speak to each other. However, at this point, each faction certainly uses different language.

The lead government speaker (and the individual who did marry the two approaches), Steven VanRoeckel, chief innovation officer at USAID, said his team is worried about preventing the next Ebola crisis by solving this one the correct way. That means allowing the right technologies to tackle the problems it's best suited to solve. 70 percent of the landmass in Liberia does not have cellular network coverage, he said. So instead of worrying about cellular devices, USAID has invited tech firms try to solve basic problems like creating better PPEs for health workers, understanding what communication messages work and creating better burial procedures.

Network and resource issues in Sierra Leone and Liberia (and probably Guinea) have forced the international community to fight Ebola by leap frogging local capacity by importing the necessary tools for network and internet connections, equipment to beef up the electrical grid and also health workers to fight Ebola. These interventions certainly help out during the emergency phase of Ebola, says Farley Cleghorn of the Futures Group. But once this outbreak transitions to a different, more controlled phase, it will be necessary to bring local capacity up to speed, he said. That means training local health workers and technicians in the areas of disease prevention/diagnosis/control, technical methods like contact tracing, behavioral communications, etc. and even getting people to run and administer the power grid and internet network.

From the Big IT side of the house.

Justin Rattner, the President of the Intel Foundation said high performance computing allows technical teams to solve a lot of big problems and create tools that collect data, assess threats, model risks, predict spread. This work can be done in the Silicon Valley, Washington DC, or a garage just about anywhere in the developed world.

Simone Bianco, a staff member of IBM's Almaden Research Center, spoke about the open-source data visualization tools his team helped create to be able to track diseases and outbreaks. Here is the IBM webpage on spatial temporal analytics: http://researcher.watson.ibm.com/researcher/view_group.php?id=4152

Jason Paragas, the deputy director for innovation at the Lawrence Livermore National Laboratory, made a fascinating point that the US government provides free weather data (pre-competitive information in innovation parlance) so that various groups (many of them commercial organizations) leverage to create weather models. By making this data free and available, the US government helps business and innovation but also (by default) sets data standards.

This integrated weather model does not exist for biology or health. The FDA has their data and rules; so does the NIH and the various military health people. A lack of agreed-upon platform means groups like IBM and their competitors are kind of making up rules and standards as they go along. A chicken or egg argument broke out: A few in the audience say the government needs to step up to make various standards. The government people in the room say they can't make anything without consent of industry folks.

David Arney, from the Medical Device Plug and Play Interoperability Program, said this crisis has already pushed the FDA and other government agencies into rethinking their reluctance to move ahead with technological innovations in the health field. For example, the FDA blocked approval of wireless medical devices in ICUs because the agency felt they were not safe. Because Ebola treatment centers prove it's far safer for medical personnel to enter isolation units as few times as possible, the FDA is changing its mind.

Now, for the frontline health workers.

Jeremy Wacksman from Dimagi says tech firms must walk a fine line when working on the ground in this Ebola crisis. For one, network infrastructure is very limited, placing many technical solutions out of reach. Also, many of the skills necessary for community health workers are not technical in nature. Community health workers must also develop more understanding of behavioral change communication, he said. They must learn to better understand contact tracing, which takes very developed skills involving interviewing, case management and data storage. This was seconded by Lesley-Anne Long, from mPowering Frontline Health Workers, who said CHWs could use more training on how to collecting data.

This understanding of data can't be underestimated. Supercomputers create outbreak models and visualizations in various parts of the world, but they are wholly dependent on the veracity -- and completeness --  of data at the local level. Also, that data created by the high performance computers needs to be shared with the frontline health workers so they can make the correct decisions, says David Arney.

Moving directly to the needs of community health workers Lesley-Anne Long told a story of asking health workers in Kenya what they needed. "We could have given them laptops, iPads or mobile phones," she told the group. 'But what they really wanted was bicycles."   

“Technology made the health worker sexy because we can give them Ipads and such,” Allison Foster of IntraHealth International told the group. “But health workers have always been sexy.”

Photo from Wikipedia