The Emerging Role of Cellphones; Resource-friendly healthcareExisting Technology & InfrastructureWhat is changing?Why particularly cellphones?An example: Cervical cancer screeningPeri-urban and rural health careWhat can cellphones do to help?Usage ScenarioFuture directions: Decision supportModality of useConclusionsSummary – why can this work where before it was difficult?Reading ListReferencesMIT OpenCourseWarehttp://ocw.mit.edu MAS.965 / 6.976 / SP.716 NextLab I: Designing Mobile Technologies for the Next Billion Users�� Fall 2008 For information about citing these materials or our Terms of Use, visit: http://ocw.mit.edu/terms.The Emerging Role of Cellphones;Resource-friendly healthcareGari Clifford, PhDPrincipal Research Scientist, HSThttp://www.mit.edu/~gari6.976 / MAS.965 / SP.716 - Nextlab IExisting Technology & Infrastructure• Old legacy hardware & instruments• Generally paper notes, static information• Poor communication channels• Poor drug storage and supplyImages © Gari Clifford, Creative Commons License - http://creativecommons.org/licenses/by-nc-nd/3.0/us/• Poor waste disposal• Poor transport• Intermittent electricity• Information shortage• Skills shortagesWhat is changing?• Over 80% of humans live within range of a cellphone tower• Over 2 billion cellphone subscriptions worldwide• Cellphone usage increasing up to 30% annually*• Cost per flop dropping analogous to Moore’s law• Integrated peripherals increasing every year (Camera, Video, Accelerometer, GPS, larger screens)• Battery storage technology improving every year • Cost per kilobyte dropping every year• Cost of hardware dropping every year* (India, 2007)Map removed due to copyright restrictions.Tigo’s GSM coverage in Guatemala.http://www.tigo.com.gt/seccion/mapa-de-cobertura-gsm-y-35gWhy particularly cellphones?• Don’t think of it as a phone – it’s a mobile hand-held computer with integrated communication and sensors.• What’s unique about this hardware for medical care?– Multi-functional and self-contained: but parts are no use for other devices;user will not strip it for battery or other uses. – Easy to charge even when no grid electricity available (can even use wind-up generators), – Easy to hide, disguise and keep safe (in pocket), – Interchangeable & standardized,– Easy to replace – plenty of supply,– No proprietary cabling to replace (wireless communication)– Significant computational power in one device! – A.I.?– Humans want (need) to communicate – they will ensure that the device is always working and are highly motivated to have it repaired quickly if it is their primary method of communication!An example: Cervical cancer screeningIssues:• Skills to read images of cancer are limited (e.g. menopause is difficult to differentiate from cancer)• 2ndopinion requires a multi-step process to send image & receive feedback• Patient may have left clinic (and never return) by time diagnosis arrives• Images can be out of focus over/under-exposed or contain lighting artifactsImage removed due to copyright restrictions.hree stages in development of cervical cancer, from http://www.preventcervicalcancer.ie/what_causes_it.asp.TPeri-urban and rural health care• ~5 minutes per patient! • Rapid & accurate evaluation and information retrieval neededImages © Rachel Hall Clifford, Creative Commons License - http://creativecommons.org/licenses/by-nc-nd/3.0/us/What can cellphones do to help?• Replace existing cameras for taking and storing images• Provide instant transmission of images for remote diagnosis• Archive data for follow-up and quality audits• Provide training for automated classifiers:– Artificial Intelligence (AI) can be thought of as the mimicry of complex human task, such as medical diagnosis, by a computer.– AI can be achieved through computer algorithms that have been trained on data labeled by humans– AI algorithms that have been trained on data labeled by human experts can often be taught to classify similar data as well as the human experts themselves (in less time, and more consistently)[Balas 2001, Phinjaroenphan et al 2004, Tulpule et al 2005,Zimmerman et al 2006, Luck et al 20 6, Gordon et al 2007]0Usage Scenario• Standard Smartphone with built-in 5MP+ camera and flash.• Transmit data to remote website/database• Multiple experts label images (and parts of images) • Consensus of experts decides on real classification• SMS diagnosis and treatment back to doctor• Patient treated immediately – not lost!Future directions: Decision support• After data is labeled, software is trained and downloaded to phone• On-board software will:– present image to on-board classification software – upload image to remote server with meta-data– provide feedback to user• Feedback from user to improve data set after expert consultation• Automated back-up of data, classification accuracy assessment and treatment efficacy tracking• Users can be encouraged to improve data collection at the source; if the algorithm isn’t sure, or thinks the image is out of focus or at strange angle, it can ask user to take another pictureModality of use• AI can provide instant classification in most cases• In dubious cases, images can be retaken with software guiding user; in this way, user is trained to take better photos.• If still unclear, image is referred to multiple experts. • Expert classifications are folded back into training set and phone software is updated automatically.• Database can cross-validate in background and detect if changes are occurring in population – Is the disease manifesting in a previously unknown manner? Software can adapt to changes in population overtime.• Software can show user where it suspects the cancerous region may be and provide an explanation of why it is cancerous (“large dark mass”) or not (“patient is post-menopausal”)Conclusions• Potential of mobile computing is enormous• Can provide expert diagnosisin an instant• Will provide a large databaseof cases to continue improvements of diagnosis, and of allow doctors to track patient’s recovery over time• Low costand easily maintained technology.• Very few points of failure(no cables, local hard disks or electricity supply problems)• System can train local talentand improve local expertise• Secure Integrated Electronic Medical Recordwill allow users to keep control of their
View Full Document