PROPOSAL TEMPLATE. Proposal Name: Neglected Tropical Diseases Management Portal Epidemiological Watcher

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1 PROPOSAL TEMPLATE Proposal Name: Neglected Tropical Diseases Management Portal Epidemiological Watcher Submitted by: Health Insight LTD. Please provide a description of the proposal (up to 500 words): Develop and deploy a web-based platform/portal to improve the management of neglected tropical diseases and others. This portal is supposed to provide a three way information and knowledge management tools: collect health information and disease notification from local health assistants, provide real time clinical decision support for those and organize and maintain epidemiological dashboards to clinical control of on-going cases under surveillance (locally and centrally). Firstly, the local health provider will access, from a web-based accessory or cell phone, a portal and open/start a clinical case. Immediately he receives on-line instructions on how manage this patient (on-line formularies, pre-prepared prescriptions following best practices protocols, follow-up visit and next steps/ procedures). Meanwhile, the system is creating a virtual to-do-list for this subject, in which will figure the next steps he is supposed to perform for each of those cases he opens. So, this to-do-list is the health care calendar for that specific person, with the procedures, visits, medication supply, formularies control and close case goals for the population under his direct surveillance or his team. The last functionality is: once collected this information must be organized. There are two different instances for this control, local and central. Usually, local control and local management tools are neglected and not consistently supported. Locally the clinical control of on-going and not closed cases is fundamental to provide real time information to the local health team. This team has to have a clear view of those cases under their surveillance, cases without proper follow-up, medications in use in that population, missing patients in follow-up visits among others. More than that, the team will be up-to-dated with the last epidemiological control assessments, and the newest protocols available.

2 Centrally, the control is viewed in a different perspective, wider, larger. Centrally the numbers are more important than names of patients, drug use and stock is not for today, but for the future, clinical control is not for one single patient, but to control and monitor clinically important trends, not closed cases, out-of-control regions. The geographic treatment of the data is also important to create a clear overview, not only for epidemiological aspects, but also to management control. This project does not create a breakthrough in this aspect, but creates a more fine control with more information and more detailed view of the surveillance. From the actual epidemiological snapshots to a new platform; dynamic, longitudinal view to follow those cases. The project proposed here is to develop and deploy this Neglected Tropical Diseases Management Portal Epidemiological Watcher, enabling World Health Organization to improve the local and central control of tropical diseases and other important clinical issues in developing regions. This Project might not be restricted to manage tropical and non-developed countries clinical problems, but can create a framework in which different clinical cases might be controlled. This framework is really a complement for that monitor WHO develop and maintain in the: site. Describe and justify the potential public health impact 1 of the proposal: As described by Baker MC, et al, 2010, in a series of papers published in The Lancet, mapping and monitoring are key aspects in clinical control in an epidemiological perspective. More than 3.4 billion people are exposed to tropical diseases and the control of this critical situation is not clear. As known, there are more death in this group of diseases for lack of control and management as well as lack of coverture for medicines supply than really would be carried out for the pathology it self. It must be highlighted that not always the patient is seen by a health professional, but often is seen by someone trained to collect information and provide treatment, and it creates an unequal health care. Since this project is the actual provider of the treatment choices and protocols, it enables equal access to knowledge. The so called: knowledge management enables to health professionals provide clinical protocols and best practice clinical care wherever they are and theirs back ground. In another hand, this project provides a central real time actualization of a clinical epidemiological view and on-going treatments. Improving this framework and empowering the management tool, the central 1 Principally CEWG criterion 1 but others may be relevant e.g. Equity/distributive effect including on availability and affordability of products and impact on access and delivery. 2

3 provision control might even provide real time availability of an specific drug to a specific treatment, about to be started, to the local clinical provider; enabling him to make this clinical decision ensuring that the patient is going to receive that drug throughout the treatment. This portal creates equity, providing knowledge management, and a clear view where and how deep the problems are in this exposed regions. Since it can be used to control vectors and collectives measures, such as the use of pesticides and direct control, it might become an important font for real practice preventive medicine. In terms of Tropical Diseases is well known and spread that traceability of the case is one of the difficult steps in management. Instead of doing active surveillance, as actually is done; this framework enables track the patient or vector moves trough the time and geographically, improving the time to the right response and cons-movement. Describe and justify the technical feasibility 1 of the proposal: This project is based in common technological resources. Nowadays, there are solutions that collect and respond messages in different ways and formats. The portal it self, is only for centralize the information, but communication is reached by a series of background process collecting and feeding information worldwide. A web-based platform might be accessed by a wide list of communication devices. From a single cell phone without internet that is broadly used and enables that all of this project goals can be achieved. Many papers published worldwide shows that mobile communication is sharply growing in all regions, and even illiteracy people can use cell phone. (Maxwell, M, 2008) The technology in which this project is based is able to receive information from a single SMS (which is the worst-case scenario) and also provide feedback in this simple way. For sure this is not the right or the best way to do it, but makes the range of the project much wider. The best way to use a platform like ours is from a web-based mobile device (smart phone, tablets and others) or a computer. If it is done from one of these devices, the information and feedback from the server is much more clear and effective. Even though, the cell signal coverture in India and in Africa are wide, but there might be one last option to receive information from health provides locally: to make notes in paper and send them to central sites where the computer and internet can be accessed. Administrative workers type those to the digital forms, and the information will be considered and managed. 1 Principally CEWG criterion 4 but others may be relevant e.g. Rational and equitable use of resources/efficiency considerations 3

4 In terms of local infrastructure, we do not expect to have servers or internet providers. We are in the cloud world now. The framework might be running in the internet, enabling every and each other simple computer access and manage information. Is not needed to have any improvement in local computer infrastructure. Regarding training processes, the health local team does not need to spend hours in classes to be able to use the system. We develop our systems using best practices for design and user interface, enabling everyone to be in touch and use it. In what concerns clinical care itself, the project does not need to create and maintain local professionals up-dating clinical protocols and best practices treatments. A professional group, with the knowledge and skills to deploy a proper protocol, does this centrally. Locally, this protocol might and should be adapted to fulfil specifics needs and provision issues, which might be done on demand from local teams to central level or even accessed and managed by them. This aspect highlights one more important issue: rational use of resources and installed capability. Describe and justify the financial feasibility 1 of the proposal: Described as above, technically this project does not create a new demand for infrastructure, and is based on existing platforms and widely used devices. The costs related to this project are related to developing and training issues, more than structural and expensive matters. The investments, in order to be more comprehensive, might be organized in: 1. Technological development and maintenance of the software and provision of central or local datacentres. Licencing third party software might be the case in some specific situations. 2. Training and up-dating professionals this is done through a e-learning platform, managed centrally. This does not increase local costs, but only single licences centrally. 3. Knowledge management creation and maintenance of a clinical group of experts to maintain the clinical protocols up-to-dated and localized for specific needs. 4. Acquisition of information Data will be sent from health professionals through SMS, data packages for cell phones and mobile devices or dial-up and broadband Internet connections. This cost is variable per local or country, but it is not wide. 1 Principally CEWG criterion 5 but others may be relevant e.g. Cost-effectiveness. 4

5 5. Clinical Decision Support to send information to the health professional, the mean utilized is the same as above. The necessary data can be transmitted and received for up to a few cents per transactions and there are not so many transactions in place. 6. Management platform the development and maintenance of the software and provision of the local or central datacentres are the investments involved in this phase. It is necessary to use skills already in place in WHO or other better-organized countries: Health Managers. This is profile that makes the difference, enable changes, creates future. This expertise already exists. One SMS or a few (kilobytes) kbs transmitted does not have any meaning when compared to the possibility of managing NTDs for real, in an effective way. The drugs are the main cost in this process, and might even be decreased, because of the use of best practices protocols. Evidences are widely available determining the cost-efficiency ratio of the use of the best knowledge in clinical practice. The population and the health care goes from an empirical approach, to a knowledge ruled new era. Describe in what way the proposal addresses cross-cutting issues 1 : The project proposed here have the capacity to address problems in many different areas in the present, and not accountable areas in the future. In what concerns the profiles of the caregiver, the project enables best practices clinical protocols be provided regardless the health professional responsible for the case. This creates a clear improvement in the way diseases are held nowadays, enabling not skilled professionals to address a clinical problem closer to the right way, regardless the region, the race, the gender, the literacy. Regarding knowledge management, the project creates a new formula. Instead of providing dozens of courses worldwide for health providers, up-dating them to best practices, we provide this knowledge centrally. This measure does not replace the previous method, with in class training. The project maintains a group of experts to up-date clinical protocols centrally, and works hard to localize them in order to fulfil specific and local issues. This localization is a fundamental aspect, looking into the diversity that we might me take care of. The availability of drugs, the distribution of clinical personnel, the literacy of the population, among others may interfere in the treatment choice for different areas. The framework is built to enable this localization feature, and the flexibility to manage work orders and workflows. 1 Cross-cutting Issues refers principally to CEWG criteria 7-12, if not addressed elsewhere in the submission e.g. Potential for delinking R&D costs and price of products. 5

6 Addressing drugs and its rational use, the project enables a new way of managing it. When a specific drug x is available in the central level, the information that comes from the clinical formularies from the field, gives the right distribution perspective. This drug will be distributed respecting the exact need for different regions, fulfilling their need. When the drug is not going to be available until the end of some treatment, the front-end personnel might be advised to use a different protocol; when a specific item in the supply chain is out of stock, the central level of control may be warned to start some measure This framework has centrally a business intelligence platform, which is the right way to reuse and create knowledge. This regards to localization of knowledge as well. When the information in every clinical visit is up-loaded to the central server, this information comes in metadata, and might be used to run bio inspired algorithms over it, showing trends, comparing results of different drugs or patient profile. What comes from this approach is knowledge localized for that specific region and group of users, capitalizing the results as real life trials results. This scientific approach has great statistical relevance. When the coverture of the project is wide like the proposed, the access of information from the health assistants locally creates the possible equity needed to justify the investment in localizing protocols. This is a new breakthrough proposed and clearly reachable in this type of technological framework. When the discussion is about technological use and implementation of something, there are two more aspects that should be addressed: the investment done lasts for a long time and the knowledge create from that is for a long time. This is not a punctual investment neither short term impact. The impact of a project like this, lasts for a long time if not forever. This proposed project and the system developed from it is to be held in the perspective of this funding process. Once the framework is developed, the source code belongs to WHO, and this institution is free to deploy regardless the developers team. If needed, the proposing company, under new contract, might provide a contract of maintenance of the code or services. The WHO is able to maintain, create, deploy and up-dated clinical protocols, formularies and others on its own base. Identify key steps necessary to begin implementation and key issues to be resolved for implementation to begin: For the complexity involved in this project, we defined the following steps to reach the cruise level: 1. Development phase: Once approved the project, the system has to be finished. 6

7 2. Implementation phase: a. The framework must be deployed for internal use for at least a few months, enabling assurance of technological errors will be corrected. b. In parallel, the clinical group might work in the writing phase of the clinical protocols and localization for the first region of pilot project. c. The region decided to be the first to receive the system is implemented. Is strongly suggested that this first implementation the development is still on control from the proposer, to adapt for specific needs. 3. Wider implementation phase a. With the aspects learned in the first implementation, the e-learning platform is fed with the right approach and courses. 4. Business analysis and maintenance phase a. A continuous business analysis is important to grow the knowledge, increase the clinical response capacity and improve processes. b. To maintain the project, is important to have epidemiologic analysts mining numbers, collecting the juice they can provide. Provide the evidence base for the proposal including literature references and other relevant information: M C Baker, E Mathieu, F M Fleming, M Deming, J D King, A Garba, J B Koroma, M Bockarie, A Kabore, D P Sankara, D H Molyneux. Mapping, monitoring, and surveillance of neglected tropical diseases: towards a policy framework. Lancet 2010; 375: Molyneux DH, Hotez PJ, Fenwick A. Rapid-impact interventions : how a policy of integrated control for Africa s neglected tropical diseases could benefit the poor. PLoS Med 2005; 2: e336. Amazigo U, Okeibunor J, Matovu V, Zouré H, Bump J, Seketeli A. Performance of predictors: evaluating sustainability in community-directed treatment projects of the African programme for onchocerciasis control. Soc Sci Med 2007; 64: Gonzalez RJ, Cruz-Ortiz N, Rizzo N, et al. Successful interruption of transmission of Onchocera vlovulus in the Escuintla-Guatemala focus, Guatemala. PLoS Negl Trop Dis 2009; 3: e404. King JD, Eigege A, Richards F, et al. Integrating NTD mapping protocols. Can 7

8 surveys for trachoma and urinary schistosomiasis be done simultaneously? Am J Trop Med Hyg 2009; in press. UNICEF. Multiple Indicator Cluster Survey. statistics/index_24302.html (accessed March 26, 2009). Measure DHS. Demographic Health Surveys. measuredhs.com/aboutsurveys/dhs/start.cfm (accessed March 26, 2009). Memória da vigilância sanitária/ History of health surveillance. Agência Nacional de Vigilância Sanitária. Rev. Saúde Pública 40(1): , ND Feb. Vigilância em saúde e controle de doenças na Organização Pan-americana de saúde e a globalização.prata, Aluízio. Rev. Soc. Bras. Med. Trop. 40(1): 94-95, Feb. 8

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