Friday, December 12, 2008

Empowering Epidemiologists to Share Information, Anytime, Anywhere: Epi Info™ and Mesh4x

I’m leading a collaborative project with US CDC to establish a proof of concept demonstrating the potential to synchronize data in disparate Epi Info™ installations over the cloud and Short Message Service (SMS) text messages using the tools and libraries of the Mesh4X project. The Epi Info™ team includes: David Nitschke (lead), Roger Mir and Mark Berndt. The InSTEDD team includes: Juan Marcelo Tondato, Daniel Cazzulino, Pablo M. Cibraro, and Eduardo (Ed) Jezierski.

[The Epi Info™ team: Roger Mir (left) and David Nitschke (lead) (right)]

US CDC Epi Info™ is a suite of tools for use by public health professionals in conducting outbreak investigations, managing databases for public health surveillance, and general database and statistics applications. With Epi Info™, physicians, nurses, epidemiologists, and other public health and medical workers can rapidly develop a questionnaire, customize the data entry and validation process, enter and analyze data. Epi Info™ offers adaptability to changing requirements, growing demands, and innovative and scalable public health solutions. Its language and localization features make it portable for national and international missions and events. And, it’s FREE, so developing countries with limited resources can also employ its power. Epi Info™ is now available as an Open Source project [Please see Official US CDC MMWR release notice].

While Epi Info™ is widely used around the world, its implementations have been limited to discrete stand alone applications with no collaborative, peer-to-peer exchange of data or internet connectivity. Data are exported and sent as discrete packets (databases or spreadsheets) to collaborating centers where the data are merged and analyzed. This is a time consuming process and presents a significant limitation especially during an outbreak investigation. This was an opportunity for us to work collaboratively with the US CDC National Center for Public Health Informatics (or NCPHI), directed by Dr. Leslie (Les) Lenert, and demonstrate the value of Mesh4x to meet this challenge.

Mesh4X is a light-weight synchronization platform developed by InSTEDD which provides libraries, tools and applications to simplify interoperability of different applications and services. Ed just posted a blog on the progress of Mesh4x and its various and interesting properties. During this prototype, we developed an adapter for Epi Info™ enabling near real-time data synchronization using the fastest available technology (Internet, wireless Internet, satellite communication, SMS, or flash drive/pen drive) that we believe to be of significant value to the public health community at large.

An example scenario where Mesh4x would be useful is in an outbreak investigation. Many epidemiologists are familiar with the food borne outbreak in Oswego, New York, U.S.A. on April 18th, 1940. In this outbreak, 75 of the 80 people known to have been present at the pot-luck church supper. A survey was created and interviews were conducted with participants to determine the source of the contamination. While the Oswego study focused on a single region, the significant value of data synchronization can be seen by expanding this scenario to where interviews and data entry are conducted in different localities. Therefore, we recreated the outbreak as if the Oswego church supper was attended by residents of the Oswego county and four other neighboring counties: Jefferson, Lewis, Oneida, and Wayne. In this hypothesized scenario, we imagined two epidemiologists are investigating this outbreak; one investigating the outbreak in Oneida county and the other investigating the other counties. Prior to synchronization, Oneida county had inconclusive results on the cause of the outbreak (baked ham and Vanilla ice cream). After data synchronization, both investigators had a clear picture of the spread of the illness over space and time and concluded the actual source of the outbreak to be from the Vanilla Ice Cream prepared the night before the church supper on April the 18th. During this scenario, we also demonstrated synchronizing Google Earth maps between localities. We will be demonstrating the solution at the US CDC offices in Atlanta, GA next Thursday December 18th, I’ll keep you posted!

[Roger and David working on the User Interface]

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1 comment:

  1. Fascinating initiative, and reinvigoration of Oswego. This may be the first epidemic of slow staphylococcal toxin, still spreading after 69 years!