Utilizing a simple user interface, the mobile telephone, MIDA provides a powerful back-end solution to improve medical information collection, processing and dissemination for in-field medical practitioners with limited resources. At the heart of MIDA is a secure, central data-hub that provides for the storage and retrieval of patient case data and medical diagnostic information via SMS (short message service) text-messaging. Data from the field is submitted by SMS text-message query in an initial message from the health worker, and a series of follow-up messages from the server. MIDA interprets and processes the incoming messages using business logic. Through the series of SMS exchanges, the application provides support in the medical diagnostic process by providing a structure and suggesting potential solutions. Fundamentally, MIDA is a tool to provide information. However, it has several other features. In addition to information exchange, MIDA collects large data sets on targeted populations and can route case information to specialists via email for consultation.


There are several benefits to using SMS text-messaging. SMS is supported by almost all handset types. Given the ubiquity of relatively inexpensive mobile phones with SMS capability in the developing world, most phones in existence today are already capable of supporting MIDA with no action, such as software installation, required on the part of the user.

 

Technology

SMS eliminates the need for handset software. Standardized mobile software platforms are typically available for expensive handsets, and inexpensive mobile phones tend to lack standardization, which makes software development difficult. MIDA circumvents this problem by centralizing the software on a server, and using the standard SMS text-messaging capability as the user interface. Additionally, upgrades and patches can be applied centrally without affecting handsets in the field.


SMS provides light-weight data transmission. Since mobile data service may not be available in many rural areas, SMS provides a way to transmit small, yet powerful, sets of data even when network signal strength is low. In addition, the SMS network is much less prone to be busy/engaged than that of voice or data transmissions.


MIDA also incorporates support for MMS (multimedia message service). Mobile phones with the capabilities to take and send pictures via MMS will be able to attach photographs to individual case files for diagnostic purposes if the case is forwarded to a specialist to review.


The diagnostic and mobile SMS-MMS exchange software is being created by the MIDA team and volunteer partners, though offers for partnerships with established software companies are currently being considered. MIDA is dedicated to providing the highest quality and most efficient diagnostic service that is tailored to address language and culture differences, as well as the varying medical needs and concerns in different regions of the world.

To maximize the effectiveness of each SMS and minimize the number of exchanges, query formatted SMS text-messages will be used to walk the in-field health worker through a simple, yet extensive, diagnostic structure with a reasonable number of exchanges in a short time interval. The concept of formatted queries is not new to users.  Simple functions such as "AND" and "OR" are used everyday on common internet search engines.


The initial query identifies the health worker and basic patient data using a delimited format. In addition, the MIDA format will support the use of keyword searches to help drive towards the most suitable line of questioning.

Example

About Queries

“Ken Banks (the creator of Frontline SMS) reminds us that there’s a huge gap between software

developers and practitioners.  People who develop mobile applications often don’t understand the context in which they’re going to be used. Tech people who write things requiring Nokia 95s (or iPhones)

really don’t understand that people in Uganda don’t walk around with

those kinds of phones.  It’s important to introduce developers to the people who

actually use these tools to  ensure they’re appropriately designed.”

- The Appropriate Infrastructure Development Group

  1. Working in a small, rural clinic more than six hours outside of the capital of a developing country, a health practitioner’s schedule is full with patients seeking care from a wide variety of ailments. Trained on how to cope with certain common diseases, the health practitioner knows how to handle the majority of cases that come in today. Despite her training, a handful of individuals come in with reoccurring or unusual symptoms. The health worker thinks she might have an idea of what to do, but she is not sure.


  3. In a memo from the health ministry, the health practitioner was provided with information about MIDA earlier in the week. This memo included instructions, a number to SMS text-message with a Health Post ID (16754372), and a User ID (879). Taking advantage of the new service, the health worker text-messages MIDA the patient’s sex, age, and a keyword to search for (MIDA supports the ability to search multiple keywords in the same message). The health worker waits a brief moment before she receives an incoming SMS text-message from MIDA. She is told the secure Patient ID number (88765562) and asked additional information. She can respond with yes or no to specific questions, numbers for multiple choice formated questions, or additional keywords.

  1. Over the course of a limited number of exchanges (estimated 4-8 SMS text-messages per average case), the health practitioner is provided additional methods of evaluation, potential related symptoms, potential diagnoses, and standard treatment for specific ailments. The total time of direct user interaction with the mobile phone is less than 5 minutes. The healthcare worker, satisfied with the additional information as it supports her original suspected diagnosis is confident in prescribing the patient a specific course of treatment.


  3. Later in the day, the health worker uses MIDA to address another case. This time, however, the patient’s skin rash is particularly unique and the health worker, though satisfied with the MIDA diagnosis, decided to contact a specialist. She takes a picture of the affected area with her mobile phone and sends it to MIDA. The MMS file is linked with the previous case-specific SMS text-message information sent and stored on the MIDA server.


  5. Upon the request of the health worker, the case is emailed to a government sponsored specialist for additional consultation. Over the next 24 hours, the specialist is able to respond via MIDA or can communicate directly with the health worker by calling the mobile number associated with the post and user ID. Satisfied with the specialist’s information, the health worker takes her new-found knowledge and applies it to her own diagnosis of future patients. The individual being diagnosed comes back to the clinic the next day for follow-up and potential new information from the specialist.


  7. Although MIDA is designed to limit the need for specialist consultation, the system can be used to help connect patients with specialists when necessary. Providing the patient with the option of contacting a specialist remotely for an improved and accurate diagnosis is an incredible and vastly superior improvement to the alternative of spending the resources to travel to the nearest major health center, or, worse, going without.


  9. The process of SMS text-message query and information dissemination is repeated by the health worker multiple times during the week. The other health workers at the clinic also use MIDA, as do most other health workers in the region. At the end of the week, the national health ministry reviews the large statistical set developed by MIDA and draws several conclusions about the status of public health in the region as it pertains to health worker knowledge and ability to diagnose unusual diseases. An international NGO providing health worker training is informed of the performance, and additional training relating to disease is requested. Later that month, MIDA is accessed by the national health ministry to use the collected mobile phone numbers to contact the health workers that have been using MIDA to survey for common public health statistics. Information is used to improve national statistics and inform policy.

Please contact the MIDA Team (mida.intl@gmail.com) with any questions regarding how MIDA works. Thank you.