H1N1 : A personal entry [ Wife & Daughter got it ]
As an American, I expect my government to have the H1N1 outbreak covered. And as you will see below, the CDC scores well. First lets dispense with some epidemiology. According to Slate.com which references the CDC, H1N1 is currently a outbreak and not an epidemic. The difference between the two lay in the morbidity rate (how many people die), once flu causes more than 7.7% of U.S. deaths, we have an epidemic. [the # changes from year to year]
Clearly H1N1 is an outbreak, and in my case, it broke right through my front door and infected my 2 year old daughter and pregnant wife (12 week). I then had an opportunity to see how good our online health information was.
What is H1N1?
First detected in the USA on April 2009, by June 11 the World Health Organization declared an H1N1 pandemic. Sometimes called Swine Flu due to the finding of genes common to North American Pigs, the flu was also found to have genes from flu viruses normally in Europe and Asia as well as bird (avian) and human genes.
Symptoms
- fever *
- cough
- sore throat
- runny or stuffy nose
- body aches
- headache
- chills
- fatigue
- sometimes diarrhea and vomiting
How does it spread?
- Air born transmission as a result of coughing and sneezing.
- Picking up the virus on hands (touching infected surfaces) and then touching mouth / eyes.
- People are contagious for 5 to 7 days after catching the flu.
High Risk Cases:
My wife & daughter were both high risk.
For the complete list of high risk cases go here: CDC LINK We focused on 2 specific cases:
- Children younger than 5, but especially children younger than 2 years old
- Pregnant women
We were particularly afraid of the repercussions for my wife. She is 12 weeks pregnant. This is precisely what we did: (http://www.cdc.gov/Features/PregnantH1N1Flu/#Treatment)
Treatment during Pregnancy
Oseltamivir (Tamiflu®) or zanamivir (Relenza®) can be used to treat 2009 H1N1 flu. To get these medicines, a doctor needs to write a prescription. These medicines fight against the flu by keeping flu viruses from making more viruses in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious health problems that can result from flu illness. At this time, Tamiflu® is the best medicine to treat pregnant women who have 2009 H1N1 flu.
Fever should be treated right away. It can cause problems for the pregnant woman and her unborn child. Acetaminophen (Tylenol®) is best for a pregnant woman to use to lower a fever.
Graphs by CDC
CDC
Look at the Hospitalization versus death chart (below). The consistent and near parabolic rise is particularly frightening.
Regional maps
Though there is more than enough information at the CDC site… the government has provided so much more…
Additional Sites
Each state has hot Lines and multi-media. See the interactive map. I live in TN.
TN State Hotline 1-877-252-3432
TN Media Content
- Simple Ways to Protect Yourself - Video
| Audio (MP3) - Stay Informed. Go to Flu.gov. - Video | Audio (MP3)
Broadcasting to Kids
The CDC has gotten involved with SID the Science Kid on PBS and instituted a “stop that flue” campaign.
They involved Sesame Street both in English & Spanish… Go Elmo.
Broadcasting to Teens / Adults: Celebrities Pitch In
Mark Anthony, Amy Ryan, Jackie Joyner-Kersee ___________________________
Health & Human Services PSA’s
http://www.flu.gov/psa/index.html
HHS Secretary Kathleen Sebelius announced a video PSA contest on flu prevention
Conclusion
If you have internet access, the CDC provides all the information you will likely need. I was pretty impressed. Too bad the vaccine didn’t come in time. That is where the government has faltered a bit, but there is information on how to find the shot…
If you can’t find that in your area, resort to what we did… Tamaflu http://www.tamiflu.com/
Healthcare 2.0 Sites (3) : Voxiva feature deep dive
Reach anyone anywhere anyhow.
Located in Washington D.C., Voxiva connects with patients using mobile devices (primarily).
Contact Information
- WEB: http://www.voxiva.com : Contact Info: http://www.voxiva.com/contactus.php
- Twitter: http://twitter.com/voxiva
- Facebook: LINK
Back Story
Founded in 2001, Voxiva focused on developing countries that often had poor infrastructure (land lines, internet connectivity, etc..) and latched on to what they did have: MOBILE PHONES.
By using mobile phones, Voxiva enables timely notification of medical alerts. Their platform known as mHealth supports a variety of communication channels. Though primarily focused on mobile phones, they also support normal web [ not just mobile ].
Voxiva has helped in various developing countries including Jakarta to broadcast information about H5N1 [ WSJ ]
They have presence in a number of developing countries.
- Argentina
- India
- Kenya
- Mexico
- Nigeria
- Peru
- Rwanda
- Tanzania
Platform Characteristics:
Multi-device access
Real-time data collection
Submitted data is stored in databases.
Analysis and Alerts
Data is transformed into information that can be visualized and actionable (e.g. alerts conditionally sent out)
SAAS (Software As A Service) Model
No hardware to buy or maintain, but based on #’s I’ve been given, the price isn’t cheap.
Integration with Existing systems (e.g. EMR)
Solutions:
HealthConnect:
Helps notify / prod people into living more healthy lives. They work with academics & industry partners to develp the content & programs, but they also provide custom solutions.
Health Connect Services:
- Smoking Cessation
- Pregnancy
- Diabetes
- HIV/AIDS
- Flu
- Immunization
Interaction with MHealth (creating, adding, editing & viewing information) happens through web forms.
HealthWatch: Disease Surveillance
A tool built for governments & public health agencies to detect outbreaks and get more timely information from the field.
- Disease Reporting
- Database Mining
- Outbreak Detection and Analysis
- Alerts on Health Events
- Case Investigation
- Outbreak Management
HealthNet: Health Management Information System
HealthNet is a scalable and secure Health Management Information System (HMIS) designed to support real-time collection, analysis, and exchange of critical health data. Example, tracking anti-viral treatment in Rwanda: [Link]
- Real-Time Data Collection
- Management Dashboard, Data Mapping and Analysis
- Automated Notification
- Information Services
- Field Support
Custom Solutions: Leveraging mHealth
Voxiva leverages mHealth to provide solutions deployed in geographically diverse regions.
Partners: Varied
See their [LINK]
Health Organizations
- Rockefeller Foundation
- HHS
- CDC Foundation
- CDC
- CARSO Health Institute
- UN Foundation
- PEPFAR
- SCMS
- HMHB
Industry Partners:
- Grey Healthcare Group
- Johnson & Johnson
- WPP
- Quinnian Health
- Accenture
Academic & Research Partners:
- Columbia University
- University of Cayetano, Peru
- KIST
- Tulane University
- George Washington University
Technology & Telecom:
- Motorola
- MTN
- Verisign
- Microsoft
- GSM Association
- Telcel
- America Movil
Voxiva / Mobile Health in USA
CTIA.org has an article that indicates eight in ten Americans (78%) expressed interest in mHealth (or mobile health) solutions and more than one in ten (15%) said they were extremely/very interested in learning more about it. Interest in mHealth service options was so strong that nearly 1 in 5 (19%) people surveyed said they would upgrade their existing wireless plan to participate and 11% said they would even consider switching wireless providers to receive mobile healthcare services.
- 1 IN 5 (19%) indicated tey would upgrade their mobile service to get healthcare news on their mobile phones.
100% Mobile Phone penetration in USA by 2013
Engadget indicates 100% penetration is imminent [ 2007 ]
According to [ weblog.cenriqueortiz.com ] With 88% penetration in 2008 and 104% penetration by 2014 in the United States. The above numbers for the US matches the penetration numbers reported by CTIA for 2008 of 88%.
According to [ pr-usa.net ] By 2012, the percentage of U.S. physicians using smartphones will increase to 81%. The current rate of penetration is 64%.
Given such strong presence of mobile phones, Voxiva would seem a natural candidate, but given the penetration of smart phones (IPhone, Android, etc..) SMS may be less important. But having a platform that can service anyone anywhere anytime is a powerful offering.
In an blog entry found here: http://histalk2.com/2009/11/11/histalk-interviews-paul-meyer/, Voxiva co-founder Paul Meyer said this in regards to USA adoption of mobile health:
We focus on trying to leverage and define innovative solutions for solving important problems. We believe if we can do that, we’ll get paid for it and make money at it.
Henry Ford had a pretty good line on this — a company whose only purpose is making money has no reason for being.
In the rest of the world, in emerging market countries, there was no alternative. There was no Internet to reach those people. Necessity being the mother of invention, people went right to mobile.
Secondly, the U.S. is the only country in the world where you actually pay to receive text messaging on cell phones. That’s also been a barrier to the adoption. Not just to health applications, but mobile applications in general.
…
the real reason that the U.S. is behind on mobile is because we have the Web.
…
I think obviously the U.S. is waking up to this. Secretary Sebelius last week gave a great speech… One of the things I was really gratified to hear in her speech last week was that the importance she attaches to mobile phones as a tool for really informing and engaging your power in patients, seeing the mobile phone as the obvious extender of electronic health records.
We then took some of the Pew Research data and looked at the Internet vs. cell phone penetration among the sub-populations with the highest infant mortality. There was just a 20-30% gap between broadband Internet and cell phone penetration in the population that we’re trying to reach.
African-Americans and Hispanics are disproportionately much higher users of SMS and other mobile data services because they have a relatively lower level of internet access. If one is looking at how to extend and improve health services and extend healthcare to under-served and low-income populations, the mobile phone is an even more indispensable tool.
We’ve done a lot of work in improving adherence and compliance in HIV/AIDS care treatment. There have been some really, some good studies showing improved efficacy of weight loss programs when enhanced by a mobile service. It’s still early, but I think there are some good initial studies showing the improved health outcomes in these kinds of interventions.
Given Widespread adoption of Mobile Phones…
Healthcare 2.0 would do well to focus on the prevalence of mobile phones in the market place. The ability to engage patients over various media can only strengthen a platform. Though computer penetration will increase, it will undoubtedly lag mobile adoption. A platform that can transmit important health information over various channels will be at a significant advantage.
Ideal ubiquitous broadcast medium:
- Web & Mobile web
- Smart Phone Applications (providing rich user experiences)
- SMS (texting) servies
- Email notifications
- Social Media (Twitter, Facebook, etc…)
- Fax
- Mail Merge (snail mail – postal service)
- IVR (telephony)
Conclusion:
Voxiva is in a good position to provide healthcare information to Americans (USA) and most every other person on earth.
Healthcare 2.0 Sites (2) : Keas technical reveal
The previous post went over features of Keas, now let’s look under the covers and see if we can figure out how they do this. There are no technical documents I could find describing the architecture, so I’ll do what i can.
Integration w/ Services (Google, HealthVault, Quest)
Quest:
Integration with Quest is through an API as far as I can tell. The integration is well done – no redirects.
Google Health
Integration is through redirects:
Health Vault:
Integration is a hybrid b/w the well integrated Quest form and the blatant (unco-branded) redirect of Google Health.
Authentication / Verification & Cert:
Sign-up and an email is sent to your email account, click on the link and you’re ready to go.
https://www.keas.com/confirm-account-creation.html?pid=[VERY LONG ID]
HTTPS Certificate is from Go Daddy SCA
HTML / CSS Quality & Validation:
Keas is kind enough to support IE6 – no small commitment:
><!--[if IE 6]>
<style type="text/css">.iepngfix { behavior: url('/ui/owrap/css/iepngfix.htc?vid=22399') }</style>
<script type="text/javascript">var IEPNGFix = window.IEPNGFix || {}; IEPNGFix.blankImg = '/ui/owrap/images/blank.gif?vid=22399';</script><![endif]-->
First let do some basic validation of the home page: (This isn’t a big deal, but it is interesting)
- HTML Fail
- CSS Failed
JavaScript: JQuery 1.3.2 (current release)
Let’s see what they write / use.
They use JQuery but not any of the CDN (Content Delivery Networks) like Google. They are using the latest release of JQuery 1.3.2
/ui/js/jquery/jquery-1.3.2.min.js
Layout & Feeds (CSS Layout)
Primarily there are two ways to layout content on a page, using <Table …/> tags w/ rows & columns, or using <DIV..> and CSS. See Table versus CSS Style Layout ( google search ). Basically this just indicates that we have a CSS purest behind the UI.
The Feeds are coming from various news sites: (Guardian & NYTimes). They look to be hand entered
NYTIMES : http://feeds.nytimes.com/click.phdo?i=7f118af1361b2825fe30eac626a4d54a
Guardian : http://www.guardian.co.uk/lifeandstyle/2009/oct/25/obesity-rights-discrimination-nhs-cost
Lacking Content Delivery Networks
Like the JQuery libraries, Keas’ images don’t use CDN’s either – which is an indication that these guys are focusing on core features before trying to achieve scale that may not be warranted (yet). Smart.
Web Server / Proxy [ NGINX ]
Based on the LB (Load Balancing) Cookie, the web server they use looks to be http://nginx.net/
nginx [engine x] is a HTTP server and mail proxy server written by me (Igor Sysoev).
Cookie:
| NAME | LB-Persistence-mc-alpha-nginx-80 |
| VALUE | AMAKBOKM |
| DOMAIN | keas.com |
| PATH | / |
| EXPIRES | 10/28/2009 20:48 |
RSS / Plan Form & Subscription
Plans look to be subscriptions to RSS feeds that are integrated into your Keas Home Page Live Feed:
