Phones don’t change the world, people do

posted on: December 22, 2008

CD4  counts, maybe someday (pic credit Dave Bullock, Wired)Inspired by the Wired article “Scientists Hack Cellphone to Analyze Blood, Detect Disease, Help Developing Nations” by Dave Bullock there has been a lot of activity under the change.org post “The Cellphone that could change the world” by Nathaniel Whittemore. 

Nate’s post takes on a ‘remember the future’ approach where he fast-forwards to 2011, and paints a scenario where mobile technologies are widely deployed and used. I really like that approach to visualizing possibility, and wished it was used more as a social activity. Strong Angel and Superstruct do this too, in a way. The realm of the imaginable could be further expanded by more science fiction about community and civilization resilience (This year I enjoyed reading Kim Stanely Robinson’s fiction books about the onset of sudden climate change and the response of a “fictionalized NSF” and a US govt that isn’t afraid to change). But I digress. I liked Nate’s post and the ideas there. The comments were riveting.

Katrin urged me to engage in the discussion at change.org. Reading through the original post and then through the comments (with a lot of  ‘strong players’ from the mobile applications community), a couple of thoughts emerged about the state of mobile technology applications for health and other social purposes. Here are some.

In the future…where are the business models?

today (pic credits Eduardo Jezierski, InSTEDD)

If you are curious, here is the reality today: In June the week before the elections I visited Zimbabwe. Here you can see a real, resilient, working Guava machine for CD4 counts on the outskirts of Harare. It uses microfluidic technology (for smaller blood samples and reactant costs) and if I recall correctly the operating principle is the same as the phone above which is a tested technology. The thing is solid, and the staff deemed it highly reliable. Calibration was not an issue. They were able to multiply the amount of CD4 lab counts manifold to 300+ per day. I was there discussing the possibility to link to the lab record system, but it wasn’t the highest priority.

A lot of the discussion did center around how disruptive it would be to have an open platform (open hardware, open software, open assays, open IP on the test methods, open reactant formulas and manufacturing) for these tests.

Just as a $99 iPhone is a red herring for the phone network costs you are going to pay every year, a cheaper test sensor that becomes widely deployed and relies on proprietary reactants has a hidden, more insidious cost.

I did not check what are the assays or lab system used by the LUCAS phone in the Wired article, and whether they are open. I just was surprised this dimension wasn’t part of the interview. I encourage Ozcan from UCLA to open-source the hardware specification to allow others to build on it!

Question: When you plug something in do you say “I’m using electricity” or “I’m using the wall socket”? Sometimes I feel the discussion about innovation in mobile tech sounds like a discussion of innovation in energy…where the discussion centers on the design of plugs & sockets. A phone is just a conduit to a network, and a powerful, sensor-rich, user-friendly device can be underused as a collaboration tool that help people work better together if network reliability and costs are not managed in unison.

In my 2011, I hope that there are hybrid social-enterprise efforts that can make inroads to working with wireless providers and carriers. They need to evolve their offerings and provide the types of cost structures needed for health and social good to scale and not depend on infusion of donations to keep running OR pushing costs where they can’t be paid while willing customers cant spend their money. Even just helping providers make money differently would help a lot. Examples: toll-free-SMS?  Free-to-send? Free-to-receive? Mobile banking? Shared-costs billing? Provider-supplied location tracking of registered gov’t health staff? Anonimized tracking of random individuals for disease migration modeling? it goes on.. Providers could make more money (gasp!) and they don’t.

Beyond 2011 I hope more effort gets put into creating connectivity approaches that would be disruptive to current wireless systems. And I mean the “system” of government spectrum licensing + carriers + wireless providers + device manufacturers. But who would fund this research? Sigh…we need smaller, personal, cheaper GSM ‘towers’ that can be linked up more than phones. What would happen if every smartphone could host a 802.13 ‘peer’ network?

Centralized or Distributed mobile apps? There are no ‘best’ practices…

There are only proven practices, in context.

When evaluating whether an approach fits a new situation, you have to consider the context in which other solutions succeeded or failed. I face this all the time in the discussion of ‘centralized’ versus ‘individual’ mobile solutions. Sometimes I get asked which approach is better and the answer is a) it depends b) you want both, not either/or.

Server side approaches work well with large scale requirements The centralized approach uses national or international-scale gateways, like Ushahidi with Clickatell, RapidSMS, InSTEDD GeoChat with Clickatell and BT, and so on. These are appropriate for national-scale programs, where reliability, performance security and availability of certain types are provided.

FrontlineSMS is an example of a personal solution FrontlineSMS is the archetypical individual or grassroots approach, where a phone attached to a computer acts as a gateway where you control costs, numbers, location, etc. – providing different types of reliability, performance, security and availability for different contexts. This type of ‘individual’ solution can even run in a smartphone, and FrontlineSMS and other projects are already proposing such a migration. For GeoChat, we put it on the backlog until we saw more demand for this approach from our Asia programs.

Approaches like RapidSMS which rely on an Asterisk server can also work on a laptop, or on a server, and can help span a ‘middle ground’ between other solutions.

Scalability is important, but, I see discussions of scalability center around numbers of messages and numbers of registered users which is for most cases profoundly irrelevant. Again, scalability is context-specific; and measured by how well you grow with your users’ needs.

phone in rural cambodia with structured data. Photo Eduardo Jezierski (InSTEDD) I know a chap –I consider him a hero- who spends most of his month travelling rural Cambodia supporting a national program to send data via SMS using plugged-phone installations. Imagine it: phones with locked enclosures get forced and misused, SIM cards swapped, chargers that burn out, USB drivers that fail, phones that lock up…Support costs of a site are his scalability denominator. For GeoChat, for example, our main scalability metric is latency of roundtrip messages under sustained use (like twitter, responses have to come out fast) across all channels (SMS, email, twitter) under large number of group users and groups.

But why one approach or the other?

Some applications support both centralized and decentralized models (like GeoChat) but as we start working together in this budding mobile community it makes sense to pool efforts and re-use each others’ technologies. I don’t see why InSTEDD for example should build yet-another-phone-detection-and-driver layer if other “social good” applications have it. For example, FrontlineSMS can forward messages on to Ushahidi (acting as a local gateway). We will take a similar approach with InSTEDD and should be emulated by the rest of the community. By working on common protocols all our apps could forward messages to each other as required (see this example as a working draft from the Open Mobile Consortium Katrin mentioned) (And Ken, if you are reading this, contributing to FrontlineSMS source was on my last years’ resolutions, and now that we got access to the source code we can really start work on integrating/implementing it with GeoChat, Mesh4x, etc… I’m optimistic about ‘09)!

rough sketch of whewre it is all going (in terms of message exchange topology, at a very high level)

The goal is to be able to pick the right tool for the context, and all the applications mentioned above are already working on protocols that would let you have a hybrid deployment that would allow you to scale up or out as needed. As contexts change, having freedom to evolve your app and not be locked into one or another is key.

Once you are moving messages around, how do you make sure different applications interpret the information in similar ways?

Shared formats for data exchange

To achieve interoperability, and reuse the human capital of having trained users, mobile apps should also share conventions on what gets put IN the messages. There is a huge gap in defining what gets put on SMS messages for diverse uses:

  • Free text, with specified language
  • Free text with explicit tags
  • Locations (lat/long, place names, village PCodes etc)
  • Delimited data (e.g. Ed, Jezierski, Cambodia)
  • Self Describing Data (e.g. firstn:Ed|lastn=Jez|city=Seattle
  • Multi-Message batching, sequenced or order-agnostic
  • Message batch retries
  • Compression
  • and the list goes on…

The community of builders of mobile apps for social purposes has to start catching up in this space. I suggest re-using the leadership of twitter and other services in evolving some conventions (eg @user, #tag) in common ways where applicable. I would also like e.g. Nokia’s data gathering solutions and other industry players e.g. Google to participate in the open forum, too.

For example, In the Cambodian Avian Influenza hotline pilot we implement batching and self-describing data over SMS. We should get together with RapidSMS, and define a common approach. This would let the Cambodian government switch out InSTEDDs backend and put RapidSMS transparently, if they chose to do so.

One example of this is GeoChat + JavaROSA. We want to support JavaROSA front ends to send structured data to GeoChat, and if we documented the format well, other clients (like Nokia’s?) or servers could be used interchangeably.

JavaROSA is an excellent open source project, great technology and well run. We have contributed the ability to do 2-way sync between phones and between a phone and a server, already.

Even with these agreements interoperability can also lead to a shallow openness, where applications work with others… as long as they can continue to hoard the data and lock-in users. You can see this happening over the last year in the space of social networking technologies, where many announcements of open approaches veil an underlying strategy of trying to become the ‘hub’ or the ‘one stop shop’.

Do the benefited populations really gain much if folks can collect more data, but we they can’t move it around?

Sharing Data

We all know the limits to sharing data are political or incentive-based, more than technical. But technology makes a fine excuse for not sharing information.

In the field one faces many silos – NGOs with different mandates, Government agencies with different domains (animal health, human health), research programs funded by different ivy league universities, not to mention ethnic, language and country borders.

This is an area where InSTEDD has been doing a lot of work as part of the Mesh4x project, which basically allows data to be shared two-ways between disparate systems.

Here are some latest updates

Leslie (Les) Lenert, Director, National Center for Public Health Informatics, US CDC, puts forward technologies they believe are disruptive. Better devices, data collection, and data sharing:

CDC Slideby Les Lenert, photo credit Taha Kass Hout (InSTEDD)

The goal: An Open & Sustainable Platform for the end users

Ken uses the \o/ logo for FrontlineSMS, a gesture of empowerment. I smile every time I see it.

We can’t forget that all these technology efforts are trying to empower individuals and organizations, and simplify the work of caring for one’s own community or for others.

All the teams mentioned here are working together already in different capacities towards this end goal. Resources, timelines, tools are always an issue, but over time things will be more integrated.

All the technologies mentioned here are converging towards a shared architecture –a platform for data exchange and collaboration built around mobile users in the harshest environments. A platform that can start small and grow transparently, or start large and continue running even if the centralized networks are unavailable. Because of this shared architecture, the end portfolio will be stronger, dollars spent on technology will go further, and users will have a simpler entry point to learn what are the right tools for their context.

So when a new phone comes out with a CD4 blood cell sensor, its users will know that it can send its data and “it just works”…and then go change the world one CD4 test at a time!

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