TED Wish Update:

InSTEDD

Eric Rasmussen, MD, MDM, FACP2006 TED Wish CEO

Stanford BA 1987, MD 1990

Former US Navy Commander

Former Fleet Surgeon, Third Fleet, US Navy

Master’s in Disaster Medicine, WHO

Director, Strong Angel Demonstrations

Special Advisor, Humanitarian Informatics− US Office of the Secretary of Defense

DARPA Investigator of the Year - 2003

Chairman, Department of Medicine, Seattle

President and CEO, InSTEDD

Medical fieldwork in:Colombia, Korea, Iraq, Afghanistan, Bosnia, Zambia, Katrina, Kenya, Banda Aceh, Uganda, Turkey, Haiti…

Eric Rasmussen, MD, MDM, FACP

Larry Brilliant’s PRIZE Wish:

…that you will help build a global system to detect each new disease or disaster as quickly as it emerges…

INSTEDD OF A HIDDEN PANDEMIC, WE SEE NEW INFECTIOUS DISEASE THREATS AS SOON AS THEY APPEAR AND HELP AGENCIES COLLABORATE IN RESPONSE.

INSTEDD OF INDUSTRIAL ACCIDENTS LIKE BHOPAL SPREADING, UNNOTICED, WE SPOT THEM QUICKLY AND HELP AGENCIES COLLABORATE IN RESPONSE.

INSTEDD OF DROUGHT AND FAMINE REMAINING HIDDEN UNTIL IT IS TOO LATE, WE DETECT THE EARLY WARNING SIGNALS AND HELP AGENCIES COLLABORATE IN RESPONSE.

Offer help to those with existing responsibilities

Make useful tools freely available to anyone

Be available in as many languages as necessary

Be outside of any government

Be transparent in purpose and partnerships

Be international in scope and practice

was asked to:

We’ve talked with a lot of peopleUnited Nations Humanitarian Information SymposiumGeneva, November, 2007

A few disease reporting problems we’ve found:

1. Cultural acceptance

2. Geo-referenced imagery

3. Languages and translation

4. Unreliable communications

5. Minimal Essential Data Sets

6. Complex System Assessments

7. Epidemiology Decision Support

8. Rapid Assessment Consolidation

9. Emergent Strategic Collaboration

10. Consolidating Human-Animal-Environmental health impact

We’ve thought about it…

• Commercial models rely on competition to drive innovation.

• Their tools fail at the edge where there is no market to drive success.

• Non-profits know the “edge” challenges, but lack the resources for technical innovation

• We recognize our success will be measured by effective adoption at both the edge and the center. And it has to be open-source and free.

• We’ve decided to rely on environmental forces (rather than a market) to drive innovation. And it works.

Laptop fromLTC Susanna Roughton, RAMCPhysician-EpidemiologistBritish Royal ArmyAz Zubair, Iraq - 2003

Our environments are harsh.

Tough environmentsdrive innovation.

Not just harsh. Also REALLY disconnected…Savanakhet village, Laos, 2008

A related question for you…

The Greatest Foreseeable Threat to Global Security?(based on a recent NIC report)

1. Cancer radiotherapy2. Car antennas3. Peanut rust4. Lawns5. Glaciers6. Orphans7. Silurian phytoplankton8. Chickens9. Myanmar hookers10. Baywatch11. Groove, PGP, VSee and Skype

US National Intelligence Council 2020 Project: Mapping the Global Future

Chickens.Domestic fowl are the carriers of

H5N1 avian influenza.

120 million chickens died or were slaughtered in Asia in early 2004 to halt the spread of that virus. There have now been tens

of millions more culled through 2007.

It hasn’t worked.

147 out of 418 tigers now have died in Thai zoos from bird flu.

The Cambodian human case fatality rate is 100%

From the US National Intelligence Council Report, 2003

“A global pandemic is the greatest single threat to the global economy…

…and so to global security”

Emerging Infectious Diseases (EID)1940 – 2004

Nature 451, 990 - 993 (21 Feb 2008)

Hong Kong: A single person with SARS arriving in Toronto infected 483 people, killed 43, and cost Canada $763m.

Economic Impact of Recent Epidemics(12 listed, and all but one zoonotic)

Avian Flu, EU$500m

1996 1997 1998 1999 2000 2001 2002 2003

$50bn

$40bn

$30bn

$20bn

$10bn

Estim

ated

cos

ts

BSE, UK $10-13bn Foot & Mouth Disease

Taiwan, $5-8bn

1992 1993 1994 1995

Foot-and-Mouth DiseaseUK

$30bn

Avian FluAsia, US, Canada

$10bn (2004-now)

2004

BSE, US $3.5bn

BSE, Canada$1.5bn

Lyme diseaseUS $2.5bn

SARSChina, Hong Kong,

Singapore, Canada…$50bn+

Nipah, Malaysia$350-400m

Swine Flu, Netherlands

$2.3bn

BSE, Japan 1.5bn

• Predict and Prevent – developing the science – regional networks as springboards – awareness and mitigation – multiple continents

• southeast Asia and Africa this year

If you don’t go,

you don’t know.

A core thought for us…

The airfield in Banda Aceh: Infectious bacteria in the mud “off the scale”

After the tsunami in Banda Aceh: A city leveled, and no way to communicate the needs

Collaboration, in outbreak containmentand humanitarian action, is THE critical task

InSTEDD Field LabParticipatory ethnography meets natural selection

Our customers work in extreme conditions.

Our tools have to work where they work.

So…we go to the field.

We learn by failing fast and failing often.

In the end, our tools will be:

more robust, more reliable, and easier to use.

California Urban Search and Rescue

Task Force – 3

Collaboration Testing in the field

Thirsty? Here’s a firehose…Using agile design and early validation for linking people to help

GeoBloggingSMS Geo-Chat

Emergency Emergency Command Command CenterCenter

GeoChat GeoForms

Platform Development StrategyInnovate only where we must

Gather requirements in the field.

Solicit ideas from a wide audience.

Repurpose existing tools with potential for humanitarian use.

Partner with key public and private sector organizations.

Build wherever gaps remain.

Integrate into the InSTEDD Platform.

Iterate…

AgileDevelopmen

tProcess

Field Lab and Platform SynergyLearning at the edge, building for the future

EmergingRequirements

ComponentIntegration

DesignValidation

New Features& Services

Collaboration everywhere “Who’s doing what where” – January 2008

The Mekong Basin Disease Surveillance Consortium

Serious infectious disease hotspot.

Requirements from our MBDS countries

• Reliable

• Effective

• Sustainable

• Local relevance– The method of reporting is locally appropriate

– The local population derives benefit

• Regional Partnerships – shared technical capacity acceptable in MBDS

Cambodia

Cambodia and Lao encompass the set of problems we want to help address:

1.Challenging languages

2.Early stage of technical development

3.Reportable diseases are present, difficult, and worrisome

4.Helpful Ministry involvement

5.Strong relationships with both international agencies and neighboring countries

Health Information Flow in Lao and Cambodia

• Overland travel

• Some HF Radio• More mobile phones• Some land lines

• Few mobile phones• HF radio• Overland travel

• Some dial-up Internet• Land lines & Fax

• Broadband Internet

• Broadband Internet

Upward: slow and difficult Downward: slow and rare Horizontal: only ad hoc observed from the District level down

Some helpful methods are out there, waiting…

Some we’ll have to build

• Compact

• Reliable

• NGO discovery

• In use in Afghanistan

GATR Inflatable Satellite Communications

• Simultaneous IM translation• Instant messaging • 17 languages• Accuracy “modest”, but improving.

In use in Iraq and Afghanistan

Palantir Analytics Corp. Proprietary and Confidential. No distribution without prior PAC written authorization

Solid science is developing around indicators

200+ social disruption parameters developed by subject matter experts in:

Infectious diseases Medicine Public Health Sociology Cultural

Anthropology Disease History Disease Modeling

And around sensemaking in large data sets

Cell phone SMS messages show up on Google Earth Time, date, person, location, text Reply directly from your laptop See movements as paths over time The status display ages

SMS Microblogging (cell phone + Google Earth)

GeoChat

So, after learning all of that, what would REAL antiviral software

look like?

InSTEDD PlatformOpen source applications, services, and frameworks

Big project. Worthy goal.

And there is a good start already underway.

World Health Organization’s EWARN An Early Warning and Response Network

• 23 countries• WHO international standard• Paper ledgers to Microsoft Access.• Good reporting from a limited base• Excellent effort from very limited resources.• Well-accepted globally • Used in Cambodia and Lao PDR

But….• It is a stand-alone system with no network layer.• It has no collaboration or communication capacity. • WHO has asked for our help.

WHO-EWARN partnership

with InSTEDD

• Collaboration• Improved Analytics• Enhanced Visualization• Mesh Architecture• Bidirectional data flow• Horizontal data flow• SMS Reporting• SMS Alerting• SMS Synchronization• Standards-based interoperability• Multi-feed data fusion• Improved Usability

Riff

Siam Pang DistrictNorthern Cambodia

Siam Peng District in Steung Treng Province, CambodiaNo internet access, and a computer with EWARN only in the district capital

• Community health center workers routinely submit reports into the District EWARN via SMS

• EWARN, watching, detects an outbreak in progress

• EWARN broadcasts SMS alerts to all district community health workers

• Community health workers coordinate a response using group SMS

OUTBREAK

Steung Treng Province, CambodiaDistrict EWARN Sites, Diagnostics Lab in Provincial Capital

• EWARN database SYNCHRONIZES via SMS.

Cell phones to laptops.

• The outbreak, the lab confirmation, and the contact tracking, can all be done over SMS.

Steung Treng ProvinceNorthern Cambodia

• Moderated Lists, News Feeds, Articles, Blogs, Emails, wikis, Videos

• Human health, animal health, plant health, water quality, Internet traffic, utilities, intelligence, etc.

• SMS, SMS Geo-Chat

Risk Visualization and SimulationUser Alerts

Contact Tracing and Network Modeling

Signal

Time Series Visualization

Multiple data streams(structured and unstructured)

Data Visualization

Alert and Health Events Board

Asset Status and Readiness

Spatio-Temporal Analysis

Remote Sensing

Response

Early technical partners in our platform development

• Research Triangle International

• Harvard MIT – HealthMap

• NASA Goddard Space Flight Center

• IBM: Public Health Information Affinity Domain (PHIAD)

• ProMed Infectious Disease Reports

• Google.com, Google.org

Obvious risks

• Ignorance

• Arrogance

• Stupidity

• Seduction

• Distraction

• Complacency

• Passivity

• Misplaced Trust

• Evil, knowing or unknowing

John Francis, PhDUN Goodwill Ambassador on the EnvironmentPlanetwalker, and here at

Unusual consultant:

An Ethics Advisor, helping the focus

Minimizing Agendas

• Political

• Personal

• Academic

• Religious

• Corporate

• Social

You must take responsibility for what you know.John F. Kennedy, 1962

HumanitarianTechnology Review

This doesn’t exist yet.

We think it needs to.

We’re looking for sponsors.

There is a lot to do.And much at risk.

We’d love to tap the energy!

See us at our display in the Simulcast Lounge

www.InSTEDD.org