 Changing against subject completely moving on to Who works for the ICT department? And I think he needs a chair as well. Do you think? Thank you Robin. Thank you everyone and Well, I'm glad to be here. Oh, by the way, hello Brussels. Hello mom So These days all of us rely on technology to get to the day So can you imagine working during the worst evil epidemic in history like this? In this day and age, we still have to see our clinicians collecting data on paper Then walking to the fence to show this information to someone else because they had to destroy the papers Afterwards to avoid risk of contagion This was not the best use of the limited time they could spend inside the high-risk zone And this way of working was prone to errors since it forces people to encode things twice And then one has to assume and the other person understood everything well, maybe asking to repeat it back to make sure And this data collection system failed to record information that is valuable information that we could use to better understand Ebola and find a way to treat the disease and This is how I one of the saw one of the few software engineers is still working in MSF Found a way to help those in the front line against Ebola So the aim of this this project alias, which is stands for Ebola link for emergency operational support was to replace the paper if not entirely at least partially To enable remote visibility to external clinicians into what's happening inside the high-risk zone of an Ebola management center EMC and To make things easier for the medical staff in the field because every meaning counts Especially when you have a critical situation with a large volume of patients and an overloaded staff a Situation like we saw in our three more. Oh, yeah. I feel completely overwhelmed. I feel Quite emotional because there's some really horrible situations in there I'm almost horrified by the scale of the center that we are constructing What we have here 120 beds? It's some it's horrible. It's horrible. What's the conditions inside what people are enduring? It's horrible. What the staff are having to do And you know the risk the heat everything To think that we're gonna double or triple this size triple this size So the project starts in September after bread the condition you saw in the video arrives in Brussels asking for help We assessed the different devices and systems and we contacted the medical staff in the field to have a better understanding About what information was required to be collected In October we started developing the software LAO's in-house and we outsourced development of the mobile application To a veteran company called the Z-test We deployed our system in November in our three and we decided to finish the pilot in March when we started the commission in LAO three So how does the system look like? Well on one hand you have the patients with Ebola who carry a bracelet inside the high-risk zone Over there and that's the bracelet with a barcode to be able to identify them We also have the the best inside the tents identified by using another barcode And finally the handheld devices used by clinicians in full personal protective equipment PPE to send and receive data via Wi-Fi Outside We have a server with a database which runs the backend software LAO's An application called MCL which allows the handheld devices connect to the server database via Wi-Fi We also have the laptops Accessing the server via Wi-Fi The laptops are used to display and enter data in different places such as triage nursing stations and so forth So now maybe you're wondering a PDA is anyone is still using them? Well, let me tell you why we identified the PDA is the best mobile device for this project It is a system to the current solution used in the EMC to disinfect It would sense a 1 meter immersion in water for 30 minutes, and it's totally protected against dust But also it was very easy to use while wearing the gloves Specified by the PPE directive because data can be entered either by touching the screen with the gloves or by using the buttons of the keypad And it's also a robust unreliable device which works in extreme weather conditions described by breath and Actually, you can also use it as a weapon So it is very resistant, so when we say resistant we really mean it So how does the system fit into the EMC workflow? First the patient arrives in triage, and he's given a bracelet with a unique identification by medical staff in full PPE The patient details are entered on a computer using the web application LAO's If the patient is confirmed Then he's transferred to the confirmed tent There a clinician can scan and confirm patient status and current location during each round using the PDA at the same time Naturally, the staff outside can organize the next round by consulting real-time data in LAO's On exit the patient outcome is also entered in LAO's so one of the biggest challenges of this project was actually to Make a decision about which data we wanted to collect which questions to ask on the PDA And I know we we love to think of ourselves as an organization without borders But when we when it comes to the scope of the projects we need to learn where to draw the line So we say to collect Or to ask questions for which the answers were useful in real time in other words We collected actionable data because it triggers follow-up actions for the different teams in the EMC For example a change of medical treatment or to request to have more staff going inside the tents Here we can see how the patient record looks like on the screen of the PDA There we have the patient details, which are practical to assure you have the right patient in front of you We also have the patient location given by tent and bed The series of information which are which helps the medics to assess the evolution of the patient And finally the last visit date and time important to avoid visiting the same patient twice during your round Here we have another screen. This is an screen an input screen on the PDA And as you can see it is an extremely simple data collection tool So it's worth noticing that the patient and location identification always shows on top The previous status ended for the patient during the last round is shown as a dot next to the option and also if you Press the number corresponding to the option on the keypad. It has the same effect as tapping it with the fingers on the screen We only allow users to select one option or select multiple options per screen So no typing or writing which means less errors or less stress while being on PPE and This is the part I think I like the most because this is when I get to show you the application. I developed Eleos And here we can see a screenshot of one of the dashboards That the clinicians used to check the current location and status of each patient in the emcee And what are the bigger successes of this project? Well, what is the improvement in the time that pays that the clinician spent entering patient data? It was also very easy for users to learn how to use the system Especially the barcodes which were of great value getting information into the system quickly And we deploy the system very fast and at a very low cost And what are the things we would like to improve in a future deployment? Well, we need to escape people in the field to support the IT infrastructure But the kind of profile is hard to find during an Ebola break Also, we experienced the connectivity issues between the PDA and the server and for that We used a buffer to store the information locally so we could send it later on whenever the connection was available again But then you lose the advantage of the real-time information And also as a data collection tool clinicians constantly change what data they want to collect and that is not a clear agreement about the patient information Essential to collect an Ebola break And finally we must be aware that the situation evolves very fast Because they're well you we are having less patience than we said to do clinical trials So in that sense it's important to do a constant follow-up with the field To make sure to prevent that the information you are collecting becomes a absolute for them for the clinical setting So the next steps in this project include the use of other mobile devices such as smartphones and tablets and we can do this Without the costly and time-consuming developing because we used a technology called MCL Which allows building the mobile application regardless of the operating system and then the Alliance hardware platform In we also source the the mobile software to another company But we are planning to lend the technology in-house So we can have more control over the software and react faster to the needs of our users and This project was conceived for Ebola, but we are exploring the possibility to use the the system in other types of emergencies With alleles we learned that usually the simplest ideas have the biggest impact So I strongly believe that the use of mobile devices in MSF operations And maybe for any healthcare setting can make patient care management simpler faster more reliable and more efficient And this in a situation like we saw in West Africa can make the difference. Thank you very much Thank you very much, Manny. So we move to some questions and we're gonna go to our online audience first I have a question from MSF Zimbabwe who are asking and what is the backup plan? And for example, do you still use paper? Copies of information. Yeah, they're like a bumblebee to go back to the paper collection system And when we were actually piloting the system, we had a sometimes is still using the paper and others using the PDA Thank you very much Okay question at the back there on the left-hand side, please stand up and state your name and Maths and student nurse at Kate Kings College And it's just a quick one of my placements was actually in the TB team here in London And one of the things that they were struggling with was dealing with the paperwork of having to test basically a school 300 kids in about three weeks and an awful lot of paperwork was involved in that Would you be it's possible you could work with other organizations that have that do similar things just to Make that process more efficient This looks all really good. Oh heck, I would have loved to not see through 300 plus sheets of paper So you ask essentially is it the role of MSF to As it can it could it could could other organizations be involved and used similar come the similar processes and ideas that you're coming up with More general question. Could the technology be used? Elsewhere so the question is more Could the technology that you use to get rid of the paper system in the field be used for any other Paper type system potentially. Well, of course, you know, this is what what we are actually planning out to do in Brussels We could use it for core outbreaks for my nutrition emergencies for TV HIV Yeah, the sky's the limit. I mean It's also a matter of getting together with the clinicians understanding that there needs with the I think the most difficult part and then Trying to to respond to the need with with a mobile device, which I think it would definitely improve the operations Thank you very much any other questions Yeah Hi, it's real as we from MSF. Sorry, I don't have a voice Thanks for the presentation I think this is very needed and it's been very useful But how much will will the presence of a developer be needed once once the once it's adapted to other Or Ebola or non Ebola how much will there be an absolute need for a developer in case? it's an emergency where we can't get hold of a developer immediately or You know the developers busy with something else and we want to get project up and running How much of it is easy to adapt? Well, I think first of all mobile the applications are something we can definitely afford to do in MSF in-house because they are Relatively simple and then like I said, we can respond faster to a change of requirements that if we outsource the application Now the time that we're considering here is Days I will say maybe even hours because of this platform that we are using that really allows us to have this application running on an Android on a PDA on a Windows mobile on Tablet, so it's really independent of the device and that makes actually the development cycle really really short Thank you very much