Combining the power of the Web with the ubiquity and accuracy of mobile computing, InSTEDD helps teams and organizations communicate, share and analyze information more seamlessly, make better decisions, and take more effective action in the face of a public health threat or natural disaster. The In-STEDD Collaboration Suite consists of three open-source software tools that help public health users detect anomalies, visualize clusters of potential events, predict the rate and spread of a disease out-break and provide decision makers with tools, me-thodologies and processes to investigate the event. These software tools are: • InSTEDD Mesh4X is a light-weight synchroniza-tion platform based on cloud computing and peer-to-peer architectures. This integration platform al-lows teams to share critical information reliably, selectively, timely and securely, with anyone, using any device, regardless of network connection, sys-tems or services. Network connectivity is not a constant requirement, as Mesh4x can collect and distribute updates among users over SMS, Internet, or through other available means. • InSTEDD Evolve is a set of integrated services (analytic, collaborative and visualization) that helps to build and sustain a community of domain experts from the local to the international level. Evolve is equipped with a machine learning algo-rithm that augment users input and accurately classifies 7 syndromes, 10 transmission modes, over 100 infectious diseases, over 180 micro-organisms, over 140 symptoms, and over 50 chemicals. • InSTEDD GeoChat is a communications system that lets teams coordinate around events as they unfold, linking field, headquarters, and the local community in a unified effective response. Presently, these tools are being piloted in the Mekong Basin region of Southeast Asia (Cambodia, Thailand, Laos, and Cambodia), Ushahidi in Kenya, HIV clinics in rural Tanzania, Mongolia, Ghana, and Bangladesh. Use of mobile telephones for public health events detection and intervention in developing countries has tremendous potential due to low start-up cost and low bandwidth (e.g., SMS gateway). In 2002, mobile subscribers overtook fixed line subscribers worldwide and this occurred across geographic re-gions, socio-demographic criteria (gender, income, age) or economic criteria such as GDP per capita1. In much of sub-Saharan Africa, there are more mobile phones than fixed-line phones2 and the use of mobile phones in many Asian countries is on the rise. Addi-tionally, mobile telephone subscriptions have been growing rapidly since the 1980s in both developing and developed countries. Furthermore, the demand for mobile phones exists beyond reducing the waiting list for traditional wire-line phones 3. However, technical, financial and regulatory barriers remain great challenges to fully adopting mobile technology as a platform in developing countries. Using mobile phones for health data exchange in developing countries has not been demonstrated giv-en the costs of data transmitted over mobile phone are greater than voice costs 2, 4, language and illitera-cy barriers2, and privacy and security issues since SMS messages can leave a trail. Other challenges include the physical components of a telephone (headset or network) are not isolated but are part of an entire business model that includes pricing plans and other incentives which can provide leverage em-ployed by public health agencies and policymakers. References 1. Feldmann V: Mobile overtakes Internet: Implica-tions for Policy and Regulation. International Tele-commjunications Union 2003:1-39 [http://www.itu.int/osg/spu/ni/mobileovertakes/Resources/Mobileovertakes_Paper.pdf]. last accessed 13 March 2009. 2. Vodafone Policy Paper: Africa: The Impact of Mobile Phones. Vodafone Policy Paper Series Number 2 2005 [http://www.vodafone.com/assets/files/en/AIMP_09032005.pdf]. last accessed 13 March 2009. 3. Kundu A, Sarangi N: ICT and Human Develop-ment: Towards Bui

1. INTEGRATED GLOBAL EARLY WARNING AND RESPONSE Innovative Support to Emergencies, Diseases, and Disasters Photo credit: IRMA (Integrated Risk Management for Africa) AMIA Fall, 2009 Experiences and Challenges in Global Health Informatics Panel Nov 15 th , 2009, San Francisco, CA, USA Taha Kass-Hout, MD, MS

5. Growth of Mobile Technologies Adapted from Dzenowagi, WHO, 2005

7. Urban – Rural Population, SE Asia UNCTAD Handbook of Statistics 2004 Adapted from Dzenowagi, WHO, 2005 Year: 2002

8. Making Mobile Tech Work for Health Avian Influenza: Stung Treng Province, Cambodia, October 13-15, 2008 SE Asia Region (Source: Wikipedia) The Komphun rural Health Center serves over 7000 population in the Stung Treng and neighboring provinces. Cell phone use during the Avian Influenza Exercise: Stung Treng Province, Cambodia, October 13-15, 2008

11. Architecture and Processes Best Poster Award for Improving Public Health Investigation and Response at the Seventh Annual ISDS Conference, 2008 http://kasshout.blogspot.com/2008/12/best-poster-award-for-improving-public.html

12. Architecture and Processes Feature extraction, reference and baseline information Tags Multiple Data Streams User-Generated and Machine Learning Metadata Comments Spatio-temporal Flags/Alerts/Bookmarks Evolve Bot Event Classification, Characterization and Detection Previous Event Training Data Previous Event Control Data Metadata extraction Machine learning Social network Professional feedback Anomaly detection Collaborative Spaces Hypotheses generationesting

13. Collaborative Surveillance Related items (e.g., News articles) are grouped into a thread. Threads are later associated with events (hypothesized or confirmed). Collaborative-centric semantic tags Expert-generated semantic tags Publish and Share Information Create a filter (by keyword, tag, topic, location, or time) and subscription (email, GeoRSS, SMS Text Messaging, Twitter, etc.) An event is monitored through a thread of items Data source: SE Asia Evolve Collaborative Workspace http://riff.instedd.org/space/ProMed-MBDS List view Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

14. Collaborative Surveillance Expert-centric auto-generated (machine-learning) semantic tags and related items Data source: SE Asia Evolve Collaborative Workspace http://riff.instedd.org/space/ProMed-MBDS Tags are semantically ranked (a statistical possibility match). Users can further train the classifier by rejecting a suggestion. Users can also train the geo-locator by rejecting or updating a location . Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

15. Collaborative Surveillance Map view Data source: SE Asia Collaborative Workspace http://riff.instedd.org/space/ProMed-MBDS Semantic map to monitor topic rise or decay over time Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

16. Collaborative Surveillance Filter feature which automatically filters content by topic of interest Filter content by radius Data source: SE Asia Collaborative Workspace http://riff.instedd.org/space/ProMed-MBDS Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

21. 2009 Novel Influenza A(H1N1) Data source: 2009 Novel Influenza A(H1N1) Collaborative Workspace http://riff.instedd.org/space/SwineFlu Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

22. 2009 Novel Influenza A(H1N1) Data source: 2009 Novel Influenza A(H1N1) Collaborative Workspace http://riff.instedd.org/space/SwineFlu Mid-March 2009 thru May 19 th 2009 Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

23. 2009 Novel Influenza A(H1N1) Data source: 2009 Novel Influenza A(H1N1) Collaborative Workspace http://riff.instedd.org/space/SwineFlu Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD Mid-March 2009 thru May 19 th 2009

24. 2009 Novel Influenza A(H1N1) Data source: 2009 Novel Influenza A(H1N1) Collaborative Workspace http://riff.instedd.org/space/SwineFlu Mid-March 2009 thru May 19 th 2009 Yin Myo Aye, MD: ProMED MBDS Taha Kass-Hout, MD, MS: InSTEDD

25. Avian Influenza: Egypt, 2009 Tracking the recent Avian Influenza Outbreak in Egypt (reports started to appear late January 2009). Data source: Africa Collaborative Workspace http://riff.instedd.org/space/AfricaAlerts

26. Worldwide Health Events, 2008 Data source: Early Detection and Response Collaborative Workspace http://riff.instedd.org/space/DEMOEventDetection

27. Acknowledgment

28. Through Funding from…

29. Thank You! In STEDD 400 Hamilton Avenue, Suite 120 Palo Alto, CA 94301, USA +1.650.353.4440 +1.877.650.4440 (toll-free in the US) [email_address] Cambodia, Photo taken by Taha Kass-Hout, October 2008 “ this pic says it all- our kids are all the same- they deserve the same ”, Comment by Robert Gregg on Facebook, October 2008