Much of the innovative thinking in mHealth is coming from programs that target populations outside the United States, often in developing countries. Now in a twist of fate, the innovations emerging from the developing world could prove to be a significant springboard for innovation in the developed world.

Here’s a short list of some of the applications folks are using. They are not intended to run on smartphones; they are generally developed to run on low-end cell phones. It’s amazing – for patients and public health initiatives…

TRACNet (in Rwanda) a dynamic information technology system designed to collect, store, retrieve, display and disseminate critical program information, as well as to manage drug distribution and patient information related to the care and treatment of HIV/AIDS. This system enables practitioners involved in anti-retroviral (ARV) treatment programs to submit reports electronically and have timely access to vital information. By dialing 3456, a toll free number, or logging onto a bilingual website (English and French), health center staffers can submit or receive program results on HIV/AIDS patients as soon as they are processed. TRACnet uses solar energy chargeable mobile phones, which can be used in the most remote parts of the country.

PatientView is a simple and easy-to-use electronic medical record system (EMR) targeting small clinics or single departments that have little support from professional IT staff. Many of these clinics are currently using paper medical records and would benefit from the improved efficiency and reliability of an EMR, but do not have the technical staff to maintain a large, complex EMR. To address this problem, PatientView was designed to be easy to set up, easy to maintain, and easy to use. Beyond simplicity and usability, PatientView has many mobile features that are useful when working with health workers in the field, like the ability to coordinate SMS to and from the workers, accept forms submitted on mobile phones, and more.

CelloPhone is a revolutionary diagnostic tool that will be able to perform basic diagnostics such as Complete Blood Count, diagnosis of Malaria and TB, and CD4 T Lymphocyte count on the back of a camera phone. The device utilizes a new imaging technique called LUCAS that can take cellular-level images of blood or other liquids without complex lens systems or microscope hardware. An algorithm then analyzes cell morphology to automatically produce a diagnostic result. The diagnostic results will be communicated from the device to a central location using FrontlineSMS, and viewed with our Patient View module and/or sent to OpenMRS with our medical records module. The Ozcan lab at UCLA is developing this device, and we aim to pioneer its use in the developing world.

For a long weekend bonus, I thought I’d include a TED Talk too that take a look at what a difference technology (mobile and other) is making in health and the health care industry…

This paper will explain the economic and societal gains enabled by broadband, and describe how different rural service providers and the communities they serve have embraced the challenges and opportunities of new technology.

They take a look at Education, Health Care, Agriculture, Electronic Government, Public Safety, Utilities and the Consumer’s Home. Each chapter includes a statement of need (generally backed up with statistics and citations), some specifics on what communities and providers ought to be thinking about moving forward and a couple of case studies taken from real rural communities.

I think this report can be used to compel a community to take a closer look at broadband. It could offer some advice on goals. And, as it’s been developed by the NTCA and therefore uses examples from local telecommunications providers, I think this could be used to engage local provider through examples of success approaches by counterparts in similar areas.

I would like to pull out two Minnesota examples used in the report – both highlight best practices in Education…

Halstad MN – Discovery Education Drives Use

Based in Halstad, Minn., independent telecommunications cooperative Halstad Telephone Co. (HTC) maintains an Ethernet, fiber‐based network that provides broadband service to each of the four K–12 schools in its territory. HTC is part of the Northwest Minnesota Special Access, a consortium of 18 rural telephone companies that connects 126 schools and 43 libraries in the state. Students often use a remote video connection to take advanced placement, foreign language and other specialty courses from a teacher located in another facility. The network is linked to the University of Minnesota, Crookston, enabling high school students to enroll in college courses via a video conferencing application.

Although the network has been in place for many years, HTC recently observed an exponential increase in online activity. In 2010, HTC arranged provision of Discovery Education service to its four local K–12 schools at the company’s expense for one year. Under the terms of the arrangement, instructors and students have access to Discovery Education’s multimedia and interactive content within the school building. Content includes audio files, images and videos, as well as interactive elements such as online quizzes, educational games, and math and science lab simulations. The rural communications provider reports that the various school systems engaged in this endeavor each have a 6 Mbps to 30 Mbps symmetrical connection, and due to the popularity of multimedia content, the various capacities are maxed out at least once per day. HTC also stated that combined with the increasing use of tablets, it expects many schools to double their broadband speed requirements within the next two years.

Spring Grove MN – Devices Drive Use

Headquartered in Spring Grove, Minn., rural provider Spring Grove Communications (SGC) enables its citizens to learn on cutting‐edge technology devices. SGC partnered with its local school district to outfit students with the latest laptops and tablets. Apple iPads are used in all of the elementary classrooms, and every seventh through 12th grader has an Apple MacBook Air available to him during the school day. If a student wishes to take home a MacBook Air, he has the option of renting one for $15 a month. Many of the families renting laptops have never had a computer in their home. The program engages students on a dynamic, digital online platform, providing for learning anytime and anywhere. It also is educating students and teachers alike about how to use this technology and the importance of broadband in today’s economy.

In addition to the student aspect of education innovation, virtual learning is a driver of economic development for small, rural towns. Under the traditional education system, a teacher is limited to open positions within driving distance of her home. With virtual education, a teacher residing in a rural area is able to teach from home and reach students across the state, district lines or the globe.

In February, The Middle Class Tax Relief and Job Creation Act of 2012 was signed into law. It included a section that opened the door to the First Responder Network Authority (FirstNet).

Title VI – Public Safety Communications and Electromagnetic Spectrum Auctions

Sec. 6101-6703 – Spectrum Auction. This provision grants the FCC the authority to hold voluntary incentive auctions, allocates necessary spectrum for a nationwide interoperable broadband network for first responders, provides $7 billion for public safety broadband network build out, and provides up to $1.75 billion for relocation costs for broadcasters. This provision is estimated to raise $15 billion over the next eleven years.

The FirstNet plan is to build a broadband network for police, firefighters, emergency medical service professionals, and other public safety officials. FirstNet is really just getting going – but there are some plans. First plan is for FirstNet to work with state, local and tribal governments. A goal is to create an interoperable, cohesive, countrywide network. That being said, states can opt-out of FirstNet. Apparently the plan (and I’m gleaning this from the webcast) is for FirstNet to come to the states with an assessment of what the state has and what they need. And RFP will be created from these assessments.

The webcast included folks from all corners of the project (commercial, utilities, local governments (well NATAO – the National Association of Telecommunications Officers and Advisors). It was nice to hear each perspective. The need for a Public Safety Net was emphasized. I think many of us have heard the stories of different branches of first responders and/or first responders from different areas running into troubles communicating with each other because of technology. So change seemed to be welcome across the board – especially change that meant interoperability!

Sustainable was another theme. One thing that I always remember from the 700 Mhz Auctions in 2008 was that the Public Safety spectrum was the one auction that did not meet its minimum. No one wanted to build the public safety network back then. So what’s changed? I think it’s the greater opportunity for corporate carriers to ride on the network and the opportunities for commercial providers to take advantage of network sharing and roaming.

If sustainability is an issue, it makes sense to get the carriers involved. But I think it’s important to maintain an open source sort of network. One of the issues noted in the webcast was the failure of the current network is the proprietary nature of some many (or many portions) of the public safety network. Another point made by the utilities and local governments is that they have a lot of infrastructure in place already, suggesting that maybe that could help defray costs to build.

It sounds as if network will be 4G LTE. (I guess that would be more meaningful to be if there more stringent standards on what that meant.) One inherent issue they mentioned in the webcast was lack of voice capabilities on 4G LTE. However there is a budget for NIST (National Institute of Standards and Technology) to develop a solution and until there’s a solution, t-band spectrum (for voice) could be made available. (I should say someone asked about that – and the answer was that t-band availability would depend on NIST developments.)

So there’s movement forward. Some of the budget and spectrum are apparently still up in the air and will be based on the reverse auctions that are planned. (There is up to $7.3 billion in funding for network from future FCC incentive auctions but the NTIA can borrow $2 billion up front.) Also there’s a lot of discussion on who will be selected for the various FirstNet boards. With $7 billion dollars at stake and so many stakeholders in the game, those decisions will be critical to how FirstNet continues to move forward.

There are a couple other issues that I find intriguing – but will have to wait for another day: Text-to-911 and Commercial Mobile Alert System, which sounds like tapping into commercial cell phone carriers to broadcast “emergency broadcast system” type messages. (I think most readers will remember watching those as kids when the remote control was maybe a slow younger sibling.) I think the idea of “delivering geographically-targeted alerts to wireless consumers” could be lifesaving – but also opens the door to a lot of privacy concerns.

First I wanted to mention that I was delighted that this was featured as a Health segment, not a Technology segment. It indicates that broadband technology is integrating into various sectors and segment of everyday life. It’s fun to see what a different it has made for Ed Thelen in Cold Springs. Ed has Parkinson’s, Diabetes and depression; unfortunately what he doesn’t have is family nearby. The GrandCare systems helps the family keep an eye on his health…

GrandCare helps families remotely monitor daily activities with sensors that send notifications when pills are taken or when a door is opened. Thelen said, “I can take my blood pressure and that automatically goes onto the system. I can take my glucose.”

But even more valuable, GrandCare is helping them keep in touch…

In his apartment in Cold Spring, Ed Thelen now has this magic window to a healthier world. As he touched a picture of a camera on his GrandCare touch screen he said, “My favorite things is merely touching this little thing and having all these beautiful people available to me.”

He’s talking about being able to talk to his three kids and six grandkids through a simple touch screen version of Skype. He said it has been beneficial to his emotional health.

The story is available on video – and worth a couple of minutes if you have time.

To learn more about the GrandCare system you can check out the complete description from their website…

The GrandCare System is connected to any dedicated Internet Connection and communicates with “wireless” sensors throughout the residence. Designated caregivers can log into the GrandCare Website to send communications to the Loved One, view Activity & Tele-wellness sensor information, and customize the automatic caregiver alerts. A caregiver may choose to receive a call, email or text message if specified conditions occur (medication noncompliance, unusual activity, door opens at unusual time, etc).

The Loved One may enjoy the socialization, entertainment and communication portion of the GrandCare System. Family can virtually send pictures, messages, emails, reminders, calendar appts, voice messages, family videos, music and more right to the GrandCare System (Interactive Touch & Non-interactive TV models available). The Loved One may also choose to play games, engage in brain benders, listen to favorite music, watch old film clips, view news & weather reports and more, right from their own GrandCare System.

(GrandCare is also working with Benton County as part of the Minnesota Intelligent Rural Communities – MIRC - initiative.)

Here are very abbreviated accounts of the case studies; I recommend folks check the report for more details.

1. Domestic Abuse Project, Minneapolis, MN – selectively open up their database to probation officers so that they can get the info they need in a timely fashion and staff can work on other things.
2. United Way of Olmsted County – created a community wide shared database for human service organizations to track information on clients and reduce duplicative efforts for staff and clients served. Less time on paperwork means more time with clients.
3. HOWA Family Center, Walker, MN – needing to reach high school kids and finding that the phone and email were no longer working, HOWA turns to text and Facebook.
4. Headway Emotional Health Services, Richfield, MN – moves field staff to smartphones so they can access calendars and case files as well as communicate in the field easily.
5. Greater Minneapolis Crisis Nursery, Golden Valley, MN – created a database to collect data to help prove the business case – that their services were protecting children and strengthening families.
6. Community Thread, Stillwater, MN – uses social media to attract new volunteers are keep all volunteers engaged. Efforts paid off last year when many volunteers were needed when the nearby St. Croix River flooded.
7. Minnesota Child Care Resource & Referral Network’s Eager-to-Learn Program, St. Paul, MN – developed online learning programs for childcare providers.
8. Lifetrack Resources, St. Paul, MN (Minnesota Hands and Voices Program) – archived closed-captioned webinars to provide just in time training to families with children who are deaf or hard of hearing, many of whom live in rural Minnesota.
9. Lifetrack Resources, St. Paul, MN (Customer Service Training Program) – incorporated opportunities for students in their customer service training to become guest bloggers as an opportunity to also pick up writing and social media skills.

1. Increased Public Health and Safety.
2. Enhanced/Expanded Educational Access.
3. Expanded Economic Development Potential for the Region.

While the project didn’t receive ARRA funding – the case is made effectively in the reports – and could be a helpful tool for a community looking at spearheading a broadband campaign. Here’s a snippet from the conclusion…

1. Increased Public Health and Safety. First responders will be able to obtain audio and visual instructions from hospitals during emergency situations. Police will be able to locate 911 cell phone calls and better communicate with other police and fire departments across the county and region during emergency situations. Residents will be able to obtain health care information from reliable sources such as Mayo Clinic or the Alzheimer’s Association.
2. Enhanced/Expanded Educational Access. Children will be able to take online courses to supplement K-12 curriculum. Teachers will be able to access professional development opportunities online. Adults and professionals will be able to obtain continuing education units and/or complete advanced BA, MA, MBA, and PHD degrees without having to travel, in some cases, more than 100 miles to gain access to their advisors and coursework.
3. Expanded Economic Development Potential for the Region. Homebased and manufacturing businesses will be able to produce products and services in this six-county region and ship them to customers around the world. Agribusinesses will be able to obtain information regarding government programs and download forms from departments such as USDA and have access to immediate alerts regarding the markets for their products. Tourism companies will be able to offer world-class businesses with employee development opportunities and linkages with their sites around the world. As more people mix work and play and find access to work while on vacation nonnegotiable, high-speed internet may also increase the tourism draw of the area. Funding of the CTC proposal would also bring construction and operations employment to the region at a time when the local economy is struggling.

Through a project called Enriching Lives, Country Manor in Sartell has been broadening the opportunities seniors have to communicate with family and friends, as well as, explore new horizons available via web-based education, entertainment and daily life enrichment.

To kick off the project Country Manor applied for and received funding from Living Connected in Benton County to install six “hotspot” wireless locations across their campus and to purchase seven iPads. This project is enabling their tenants and residents to learn about new technology, to set up email accounts that allow them to stay in touch with family and is providing gaming and reading options for tenants who are introverted.

“We have positive response from our dementia community. Tenants enjoy the wonderful simplicity and vast world of the internet. Emailing to family is part of their weekly program,” said Anthony Fenstad, Director of Housing and Community Services. Fenstad goes on to say, “The biggest impact has been an appreciation for technology and a reduction in fear of the technology.” Fenstad also indicated that the tenants now have a greater interest in purchasing their own hardware to use at their leisure.

Country Manor Campus provides innovative health services and advanced medical care while remaining steadfast to it’s mission of enriching lives. For more information about Country Manor Campus call 320-529-9000 or visit www.countrymanorcampus.org.

Living Connected in Benton County www.bentoncountyconnected.org is a project partner in the Minnesota Intelligent Rural Communities Initiative (MIRC). MIRC is a coalition of 19 statewide partners and 11 demonstration communities funded in large part through an American Recovery and Reinvestment Act grant. The work of the coalition focuses on bringing the full promise of broadband technologies to rural Minnesota communities, businesses and people. Blandin Foundation serves as the project administrator. More about MIRC is available at www.blandinfoundation.org.

Earlier this week the Star Tribune ran an article on a virtual ICU programs – programs that allow healthcare professionals to remotely monitor and support critically ill patients to support efforts of on-site staff. The idea is that the remote monitor can be a highly specialized or skilled provider and extra set of eyes and expertise…

McQuillan, 30, is one of a team of doctors and nurses helping to transform the way the VA cares for patients in its intensive care units by tracking them remotely from a new Tele-ICU center in the Minneapolis hospital.

Ordinarily, nurses have their hands full trying to manage two critically ill patients at once. McQuillan can juggle 35, in six cities, without even leaving her desk. From a bank of computers in Minneapolis, McQuillan can tell if someone in the Iowa City VA is having trouble breathing, someone in Omaha has an irregular heartbeat, or someone in Spokane is going into kidney failure.

In the Twin Cities the Veterans Affairs Medical Center in Minneapolis (VA) started offering virtual ICU services last summer; they were the first in the area and they serve seven regional hospitals. The plan isn’t to replace existing staff, but to supplement them. Apparently the idea has been successful in other areas…

Already, some studies suggest virtual ICUs may save both lives and money. In Green Bay, Wis., Bellin Memorial Hospital saw a 34 percent drop in the death rate of ICU patients after it started working with a virtual ICU, said Erin Green, of Froedtert Health, which runs the program. From 2007 to 2008, it also cut the number of ICU patient days by 29 percent.

It’s heartening to see Minnesota take advantage of innovation that can save lives and save money. I’m hoping that the following story will help inspire Minnesota to want to do even more.

According to CivSource (and thanks to Ann Higgins for the heads up)…

Ohio is launching the first ever state-led initiative to provide a statewide 100 Gigabits (Gbps) per second broadband network. The state wants to leverage its existing medical research and university network to bring companies and funding into the state in order to create jobs and grow the economy.

Apparently they will be investing about $10 million to upgrade their existing 10 Gbps network. The plan is to become the place for medical research and hopefully the place for medical research investment. There are opportunities for the public and private sector. So often I hear that we don’t have money. We need to come up with plans that don’t require investment – so I’m hopeful when I read stories from people who are investing now.

Principal Paul Karelis is excited for what the prospect of a nursing course could provide to students at Worthington High School.
Several students will begin a newly designed nursing course in the fourth quarter, which will earn them college credits for three pre-requisite classes into a college nursing program.

In collaboration with Minnesota West Community and Technical College, the school district has spent months tweaking the upcoming course.

Apparently the class will include the following…

Students will spend the first portion of the course learning medical terminology with high school and college instructor, Craig Kroger.

Once they’ve completed the class, they will devote two and a half weeks training for first aid and CPR-AED certification with District 518 school nurse Wendy Donkersloot.
…

The final class focuses specifically on introduction to nursing assistance.

“Topics include child care, reporting procedures, and hospice care,” he added.

Additionally, students will also be exposed to supervised lab activities at Sanford Regional Hospital, Worthington.

It will give students insight into a prospective career, for students who are drawn in, having the college credits will give them an advantage is a very competitive field. It will be fun to see what other classes the high school is able to offer through the ITV options and their partnership with the Southwest/West Central Service Cooperative.

“The whole thing involved a lot of compassionate people,” Sherack said. … “Something like this could only happen in a small community and we are all thankful.”

It might take a small community – but a little high tech support and broadband help too.