Using mobiles for data collection is increasingly common, particularly in the area of mobile health and with a focus on community health workers. eMOCHA is a program using a smartphone Android application for storing and transmitting data easily.
Developed by the Johns Hopkins Center for Clinical Global Health Education, eMOCHA (which stands for “Electronic Mobile Open-source Comprehensive Health Application”) uses video, audio, touchscreen quizzes, GPS and SMS to collect and analyze large amounts of data. Larry William Chang, director of field evaluations for eMOCHA, explains in an interview with MobileActive.org that the inspiration for developing the tool came out of researchers’ experiences in the field and their desire to build solutions to gaps in health care data collection systems.
Fellow team members include Miquel Sitjar, lead developer for eMOCHA, and Robert Bollinger, director of the Johns Hopkins Center for Clinical Global Health Education. Chang says, “We all had these public health problems and these education and training problems that we were looking to solve, and we wanted to build a mobile-based platform that could address all the different challenges we were facing. So we designed eMOCHA to address some of the public health and patient care problems that we were seeing with our other work.” eMOCHA’s first deployment began in October of 2010, and new pilots have been announced for 2011.
Development and Implementation
eMOCHA is an open-source Android application, and runs on all current versions of Android phones. Chang says that at the time the team began building the application, choosing Android was a risky move. He explains, “When we first started there was essentially just one phone, the G1 phone, released for Android. And we knew it would be a bit of a risk, but we also felt that Android had the best potential for scaling up in the near future and also for being the most cost effective eventually in low- and middle-income countries, which were our target.” Built with a PHP backend, the application uses a MySQL database and X-forms for its interface.
One of the most important features that eMOCHA offers is increased security – the servers and data sent from the phones are encrypted, and data stored on the phones is password protected and stored in the phones’ internal databases. The interactive nature of eMOCHA means that community health workers and researchers can use it not only as a means of data collection, but also for educational purposes. The multimedia forms allow workers to show videos, host quizzes, and also train patients and other CHWs. Chang says, “[The Johns Hopkins Center for Clinical Global Health Education] is focused on delivering training and capacity building to low and middle-income countries. So we wanted a platform that could deliver multimedia content, which eMOCHA can do, and we wanted users to interact, for example taking quizzes before and after they view educational content. So I think our emphasis on building this as an educational platform and the training features make it relatively unique.”
Another key feature of eMOCHA is its integration with SMS. Chang explains that although the usual method of using eMOCHA in the field is for a community health worker to use the provided smartphone as a demonstration tool, the team realized they also needed to be able to communicate with larger, non-smartphone owning populations. The eMOCHA team added the ability for the application to receive SMSs from patients and to send out SMSs in order to directly target large numbers of users. Chang says that incorporating SMS capabilities into the application “gives us the flexibility to implement more comprehensive and somewhat more complex programs and services."
Deployment in the Field and Challenges
So far, the application is either running or set to launch in three locations. In Uganda, a pilot project launched in October of 2010 in which community health workers use eMOCHA to provide HIV awareness and prevention information with rural residents. Community health workers are targeting 1000 households in the Bushenyi district of Uganda, sending out prevention messages and questionnaires about sexual behavior to assess each respondent’s risk. The pilot is set to continue until August 2011. In Baltimore, eMOCHA has been adapted by a currently running project that monitors the habits of injection drug users. The project there had been using PDAs, but wanted to switch to more secure and more accessible technology so they switched to eMOCHA-equipped smartphones. In Afghanistan, a pilot monitoring HIV risk among sex workers has been in development since January and is set to officially launch in June 2011.
In the course of the development and deployment of eMOCHA, the team encountered several challenges. One of the main issues was that eMOCHA, as a smartphone application, requires a higher level of technology knowledge than a program for basic phones. Chang says, “I think one of the honest disadvantages of eMOCHA is that it still requires at this point in time a relatively high threshold of IT support. We're certainly working on making it more and more accessible but we're still, in some ways, early in the process. So working with people on the ground who may not have a lot of tech savvy has been a bit challenging, getting phones set up, and when things go wrong, getting the appropriate feedback.” He also added that, “The fact that we don't always have 100% real-time syncing can be a little bit challenging.” However, although coverage in some pilot areas varies, eMOCHA can store the data on the phone, so it doesn't need access to the cloud at all times and can sync when the user gets somewhere with network coverage.
A Different Perspective
Because eMOCHA was designed within a university setting, that academic perspective influenced the development of the application. Chang explains, “We tried to leverage our strengths, and some of our strengths are that we're in academia. So we're focused on not just implementing the programs but also evaluating their impact. And we're drawn to opportunities where people are looking not just to implement a service but also to rigorously evaluate it."
With that approach, the group built eMOCHA to improve clinical care outcomes and improve patient care in a variety of settings, to handle large amounts of data collection, and also to provide training and education to community health workers. Chang concludes, “We're constantly looking for ways to make things easier and more intuitive."
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