MobileActive.org

The sensitivity of health-care information and its accessibility via the Internet and mobile technology systems is a cause for concern in these modern times. The privacy, integrity and confidentiality of a patient’s data are key factors to be considered in the transmission of medical information for use by authorised health-care personnel.

Mobile communication has enabled medical consultancy, treatment, drug administration and the provision of laboratory results to take place outside the hospital. With the implementation of electronic patient records and the Internet and Intranets, medical information sharing amongst relevant health-care providers was made possible. But the vital issue in this method of information sharing is security: the patient’s privacy, as well as the confidentiality and integrity of the health-care information system, should not be compromised.

We examine various ways of ensuring the security and privacy of a patient’s electronic medical information in order to ensure the integrity and confidentiality of the information. The paper discusses modes of encryption, database security, the transformation from eHealth to mHealth, and the theoretical background for privacy and data protection. 

Background: Survey data are traditionally collected using pen-and-paper, with double data entry, comparison of entries and reconciliation of discrepancies before data cleaning can commence. We used Personal Digital Assistants (PDAs) for data entry at the point of collection, to save time and enhance the quality of data in a survey of over 21,000 scattered rural households in southern Tanzania.

Methods: Pendragon Forms 4.0 software was used to develop a modular questionnaire designed to record information on household residents, birth histories, child health and health-seeking behaviour. The questionnaire was loaded onto Palm m130 PDAs with 8 Mb RAM. One hundred and twenty interviewers, the vast majority with no more than four years of secondary education and very few with any prior computer experience, were trained to interview using the PDAs. Logical checks were performed and skip patterns taken care of at the time of data entry. Data records could not be edited after leaving each household, to ensure the integrity of the data from each interview. A small group of interviewees from the community, as well as supervisors and interviewers, were asked about their attitudes to the use of PDAs.

Results: Following two weeks of training and piloting, data were collected from 21,600 households (83,346 individuals) over a seven-week period in July-August 2004. No PDA-related problems or data loss were encountered. Fieldwork ended on 26 August 2004, the full dataset was available on a CD within 24 hours and the results of initial analyses were presented to district authorities on 28 August. Data completeness was over 99%. The PDAs were well accepted by both interviewees and interviewers.

Conclusion: The use of PDAs eliminated the usual time-consuming and error-prone process of data entry and validation. PDAs are a promising tool for field research in Africa.

In this paper, we present a phone-based application called CommCare which supports community health workers (CHWs) as they provide home-based care and social support to HIV+ and other chronic patients. We report on our experience developing and testing the application with five CHWs in Dar es salaam, Tanzania. We have developed a simple and easily useable system by rapidly prototyping CommCare with the community health workers, in quick iterations based on their feedback. The system guides the user through about 15 questions during each household visit. The CHWs answer the questions using the phone’s number pad, and the results are submitted over the cellular network to our server when the session is over.

We report on lessons learned from training and our initial deployment. We discuss the few hardware and software problems that arose during our initial piloting, most of which have been addressed. This use of CommCare has little effect on the time or efficiency of home visits, but results in much easier, much faster, and potentially more accurate reporting. In particular, it saves the CHWs approximately four hours per month spent on compiling reports in the paper system.

Finally, we conducted an initial qualitative assessment of the perception of the phone-based system by the clients of the CHWs who used it. We report on the findings below, which generally show a favorable impression of the system, including an appreciation that a phone can be more discreet than paper notebooks and that it can report data more quickly.