The surprising seeds of a big-data revolution in healthcare
-
0:01 - 0:02There's an old joke about a cop
-
0:02 - 0:04who's walking his beat
in the middle of the night, -
0:04 - 0:07and he comes across a guy
under a street lamp -
0:07 - 0:09who's looking at the ground
and moving from side to side, -
0:09 - 0:11and the cop asks him what he's doing.
-
0:11 - 0:13The guys says he's looking for his keys.
-
0:13 - 0:15So the cop takes his time
-
0:15 - 0:17and looks over and kind of
makes a little matrix -
0:17 - 0:19and looks for about two, three minutes.
-
0:19 - 0:20No keys.
-
0:20 - 0:23The cop says, "Are you sure?
-
0:23 - 0:25Hey buddy, are you sure
you lost your keys here?" -
0:25 - 0:27And the guy says,
"No, actually I lost them -
0:27 - 0:29down at the other end of the street,
-
0:29 - 0:30but the light is better here."
-
0:30 - 0:33(Laughter)
-
0:34 - 0:37There's a concept that people talk
about nowadays called "big data." -
0:37 - 0:40And what they're talking
about is all of the information -
0:40 - 0:42that we're generating
through our interaction -
0:42 - 0:43with and over the Internet,
-
0:43 - 0:45everything from Facebook and Twitter
-
0:45 - 0:49to music downloads, movies,
streaming, all this kind of stuff, -
0:49 - 0:50the live streaming of TED.
-
0:50 - 0:53And the folks who work
with big data, for them, -
0:53 - 0:55they talk about that their biggest problem
-
0:55 - 0:57is we have so much information.
-
0:57 - 1:00The biggest problem is: how do we
organize all that information? -
1:01 - 1:03I can tell you that,
working in global health, -
1:03 - 1:05that is not our biggest problem.
-
1:06 - 1:09Because for us, even though
the light is better on the Internet, -
1:10 - 1:14the data that would help us solve
the problems we're trying to solve -
1:14 - 1:16is not actually present on the Internet.
-
1:16 - 1:17So we don't know, for example,
-
1:18 - 1:21how many people right now
are being affected by disasters -
1:21 - 1:23or by conflict situations.
-
1:23 - 1:27We don't know for, really,
basically, any of the clinics -
1:27 - 1:28in the developing world,
-
1:28 - 1:30which ones have medicines
and which ones don't. -
1:30 - 1:34We have no idea of what
the supply chain is for those clinics. -
1:34 - 1:37We don't know -- and this is really
amazing to me -- we don't know -
1:37 - 1:41how many children were born --
or how many children there are -- -
1:41 - 1:45in Bolivia or Botswana or Bhutan.
-
1:46 - 1:48We don't know how many kids died last week
-
1:48 - 1:49in any of those countries.
-
1:49 - 1:52We don't know the needs
of the elderly, the mentally ill. -
1:52 - 1:55For all of these different
critically important problems -
1:55 - 1:58or critically important areas
that we want to solve problems in, -
1:59 - 2:01we basically know nothing at all.
-
2:03 - 2:06And part of the reason
why we don't know anything at all -
2:06 - 2:10is that the information technology systems
that we use in global health -
2:10 - 2:15to find the data to solve
these problems is what you see here. -
2:15 - 2:17This is about a 5,000-year-old technology.
-
2:17 - 2:19Some of you may have used it before.
-
2:19 - 2:20It's kind of on its way out now,
-
2:20 - 2:23but we still use it
for 99 percent of our stuff. -
2:23 - 2:25This is a paper form.
-
2:26 - 2:28And what you're looking at is a paper form
-
2:28 - 2:31in the hand of a Ministry of Health
nurse in Indonesia, -
2:31 - 2:33who is tramping out across the countryside
-
2:33 - 2:37in Indonesia on, I'm sure,
a very hot and humid day, -
2:37 - 2:39and she is going to be knocking
on thousands of doors -
2:39 - 2:41over a period of weeks or months,
-
2:42 - 2:43knocking on the doors and saying,
-
2:43 - 2:46"Excuse me, we'd like to ask
you some questions. -
2:46 - 2:49Do you have any children?
Were your children vaccinated?" -
2:50 - 2:52Because the only way
we can actually find out -
2:52 - 2:55how many children were vaccinated
in the country of Indonesia, -
2:55 - 2:56what percentage were vaccinated,
-
2:56 - 3:01is actually not on the Internet,
but by going out and knocking on doors, -
3:01 - 3:03sometimes tens of thousands of doors.
-
3:03 - 3:07Sometimes it takes months to even years
to do something like this. -
3:07 - 3:09You know, a census of Indonesia
-
3:09 - 3:11would probably take
two years to accomplish. -
3:11 - 3:13And the problem, of course,
with all of this -
3:13 - 3:15is that, with all those paper forms --
-
3:15 - 3:18and I'm telling you, we have
paper forms for every possible thing: -
3:18 - 3:20We have paper forms
for vaccination surveys. -
3:20 - 3:24We have paper forms to track
people who come into clinics. -
3:24 - 3:28We have paper forms to track
drug supplies, blood supplies -- -
3:28 - 3:31all these different paper forms
for many different topics, -
3:31 - 3:33they all have a single, common endpoint,
-
3:33 - 3:36and the common endpoint
looks something like this. -
3:36 - 3:39And what we're looking
at here is a truckful of data. -
3:41 - 3:45This is the data from a single
vaccination coverage survey -
3:45 - 3:47in a single district
in the country of Zambia -
3:47 - 3:49from a few years ago,
that I participated in. -
3:49 - 3:52The only thing anyone
was trying to find out -
3:52 - 3:55is what percentage of Zambian
children are vaccinated, -
3:55 - 3:58and this is the data,
collected on paper over weeks, -
3:58 - 3:59from a single district,
-
3:59 - 4:02which is something like a county
in the United States. -
4:02 - 4:05You can imagine that,
for the entire country of Zambia, -
4:05 - 4:07answering just that single question ...
-
4:08 - 4:09looks something like this.
-
4:11 - 4:13Truck after truck after truck,
-
4:13 - 4:16filled with stack after stack
after stack of data. -
4:16 - 4:19And what makes it even worse
is that's just the beginning. -
4:19 - 4:21Because once you've collected
all that data, -
4:21 - 4:24of course, someone --
some unfortunate person -- -
4:24 - 4:26is going to have to type that
into a computer. -
4:26 - 4:28When I was a graduate student,
-
4:28 - 4:30I actually was that unfortunate
person sometimes. -
4:30 - 4:33I can tell you, I often wasn't
really paying attention. -
4:33 - 4:35I probably made a lot
of mistakes when I did it -
4:35 - 4:38that no one ever discovered,
so data quality goes down. -
4:38 - 4:41But eventually that data, hopefully,
gets typed into a computer, -
4:41 - 4:43and someone can begin to analyze it,
-
4:43 - 4:46and once they have
an analysis and a report, -
4:46 - 4:49hopefully, then you can take
the results of that data collection -
4:49 - 4:51and use it to vaccinate children better.
-
4:51 - 4:56Because if there's anything worse
in the field of global public health -- -
4:56 - 4:59I don't know what's worse
than allowing children on this planet -
4:59 - 5:01to die of vaccine-preventable diseases --
-
5:02 - 5:05diseases for which
the vaccine costs a dollar. -
5:05 - 5:09And millions of children die
of these diseases every year. -
5:09 - 5:12And the fact is, millions
is a gross estimate, -
5:12 - 5:15because we don't really know
how many kids die each year of this. -
5:15 - 5:19What makes it even more frustrating
is that the data-entry part, -
5:19 - 5:21the part that I used to do
as a grad student, -
5:21 - 5:22can take sometimes six months.
-
5:22 - 5:26Sometimes it can take two years
to type that information into a computer, -
5:26 - 5:28And sometimes, actually not infrequently,
-
5:28 - 5:30it actually never happens.
-
5:30 - 5:32Now try and wrap your head
around that for a second. -
5:32 - 5:35You just had teams of hundreds of people.
-
5:35 - 5:38They went out into the field
to answer a particular question. -
5:38 - 5:40You probably spent hundreds
of thousands of dollars -
5:40 - 5:43on fuel and photocopying and per diem.
-
5:44 - 5:46And then for some reason, momentum is lost
-
5:46 - 5:47or there's no money left,
-
5:47 - 5:49and all of that comes to nothing,
-
5:49 - 5:52because no one actually types it
into the computer at all. -
5:52 - 5:53The process just stops.
-
5:53 - 5:55Happens all the time.
-
5:55 - 5:58This is what we base
our decisions on in global health: -
5:58 - 6:02little data, old data, no data.
-
6:03 - 6:05So back in 1995,
-
6:05 - 6:08I began to think about ways
in which we could improve this process. -
6:08 - 6:11Now 1995 -- obviously,
that was quite a long time ago. -
6:11 - 6:14It kind of frightens me to think
of how long ago that was. -
6:14 - 6:17The top movie of the year
was "Die Hard with a Vengeance." -
6:17 - 6:19As you can see, Bruce Willis
had a lot more hair back then. -
6:19 - 6:22I was working in the Centers
for Disease Control -
6:22 - 6:24and I had a lot more
hair back then as well. -
6:25 - 6:28But to me, the most significant
thing that I saw in 1995 -
6:28 - 6:29was this.
-
6:30 - 6:32Hard for us to imagine, but in 1995,
-
6:32 - 6:35this was the ultimate elite mobile device.
-
6:36 - 6:38It wasn't an iPhone.
It wasn't a Galaxy phone. -
6:38 - 6:40It was a PalmPilot.
-
6:40 - 6:43And when I saw the PalmPilot
for the first time, I thought, -
6:43 - 6:46"Why can't we put the forms
on these PalmPilots? -
6:46 - 6:49And go out into the field
just carrying one PalmPilot, -
6:49 - 6:53which can hold the capacity
of tens of thousands of paper forms? -
6:53 - 6:54Why don't we try to do that?
-
6:54 - 6:55Because if we can do that,
-
6:55 - 6:59if we can actually just collect
the data electronically, digitally, -
6:59 - 7:01from the very beginning,
-
7:01 - 7:04we can just put a shortcut right
through that whole process -
7:04 - 7:09of typing, of having somebody type
that stuff into the computer. -
7:09 - 7:11We can skip straight to the analysis
-
7:11 - 7:14and then straight to the use
of the data to actually save lives. -
7:14 - 7:17So that's what I began to do.
-
7:17 - 7:21Working at CDC, I began to travel
to different programs around the world -
7:21 - 7:25and to train them in using
PalmPilots to do data collection, -
7:25 - 7:27instead of using paper.
-
7:27 - 7:29And it actually worked great.
-
7:29 - 7:32It worked exactly as well
as anybody would have predicted. -
7:32 - 7:33What do you know?
-
7:33 - 7:37Digital data collection is actually
more efficient than collecting on paper. -
7:37 - 7:39While I was doing it, my business partner,
-
7:39 - 7:42Rose, who's here with her husband,
Matthew, here in the audience, -
7:42 - 7:45Rose was out doing similar stuff
for the American Red Cross. -
7:45 - 7:47The problem was,
after a few years of doing that, -
7:47 - 7:51I realized -- I had been to maybe
six or seven programs -- -
7:51 - 7:54and I thought, you know,
if I keep this up at this pace, -
7:54 - 7:55over my whole career,
-
7:55 - 7:58maybe I'm going to go
to maybe 20 or 30 programs. -
7:58 - 8:01But the problem is, 20 or 30 programs,
-
8:01 - 8:04like, training 20 or 30 programs
to use this technology, -
8:04 - 8:07that is a tiny drop in the bucket.
-
8:07 - 8:10The demand for this, the need
for data to run better programs -
8:10 - 8:13just within health -- not to mention
all of the other fields -
8:13 - 8:15in developing countries -- is enormous.
-
8:15 - 8:19There are millions and millions
and millions of programs, -
8:19 - 8:22millions of clinics
that need to track drugs, -
8:22 - 8:23millions of vaccine programs.
-
8:23 - 8:26There are schools
that need to track attendance. -
8:26 - 8:30There are all these different things
for us to get the data that we need to do. -
8:30 - 8:34And I realized if I kept up
the way that I was doing, -
8:34 - 8:37I was basically hardly
going to make any impact -
8:38 - 8:39by the end of my career.
-
8:39 - 8:41And so I began to rack my brain,
-
8:41 - 8:44trying to think about, what
was the process that I was doing? -
8:44 - 8:45How was I training folks,
-
8:45 - 8:49and what were the bottlenecks
and what were the obstacles -
8:49 - 8:51to doing it faster
and to doing it more efficiently? -
8:51 - 8:54And, unfortunately, after thinking
about this for some time, -
8:54 - 8:57I identified the main obstacle.
-
8:58 - 9:00And the main obstacle, it turned out --
-
9:00 - 9:02and this is a sad realization --
-
9:02 - 9:03the main obstacle was me.
-
9:04 - 9:05So what do I mean by that?
-
9:06 - 9:08I had developed a process
-
9:08 - 9:12whereby I was the center
of the universe of this technology. -
9:14 - 9:17If you wanted to use this technology,
you had to get in touch with me. -
9:17 - 9:19That means you had to know I existed.
-
9:19 - 9:22Then you had to find the money
to pay for me to fly out to your country -
9:22 - 9:26and the money to pay for my hotel
and my per diem and my daily rate. -
9:26 - 9:29So you could be talking
about 10- or 20- or 30,000 dollars, -
9:29 - 9:31if I actually had the time
or it fit my schedule -
9:31 - 9:33and I wasn't on vacation.
-
9:33 - 9:35The point is that anything,
-
9:35 - 9:37any system that depends
on a single human being -
9:37 - 9:39or two or three or five human beings --
-
9:39 - 9:41it just doesn't scale.
-
9:41 - 9:44And this is a problem for which
we need to scale this technology, -
9:44 - 9:46and we need to scale it now.
-
9:46 - 9:49And so I began to think of ways
in which I could basically -
9:49 - 9:51take myself out of the picture.
-
9:54 - 9:55And, you know, I was thinking,
-
9:55 - 9:57"How could I take myself
out of the picture?" -
9:57 - 9:59for quite some time.
-
9:59 - 10:02I'd been trained that the way
you distribute technology -
10:03 - 10:04within international development
-
10:04 - 10:06is always consultant-based.
-
10:06 - 10:09It's always guys
that look pretty much like me, -
10:09 - 10:11flying from countries
that look pretty much like this -
10:11 - 10:14to other countries
with people with darker skin. -
10:14 - 10:17And you go out there,
and you spend money on airfare -
10:17 - 10:20and you spend time and you spend per diem
-
10:20 - 10:22and you spend for a hotel
and all that stuff. -
10:22 - 10:26As far as I knew, that was the only way
you could distribute technology, -
10:26 - 10:28and I couldn't figure out a way around it.
-
10:28 - 10:30But the miracle that happened --
-
10:30 - 10:32I'm going to call it Hotmail for short.
-
10:33 - 10:35You may not think of Hotmail
as being miraculous, -
10:35 - 10:37but for me it was miraculous,
-
10:37 - 10:40because I noticed, just as I
was wrestling with this problem -- -
10:40 - 10:44I was working in sub-Saharan
Africa, mostly, at the time -- -
10:44 - 10:46I noticed that every sub-Saharan
African health worker -
10:46 - 10:49that I was working with
had a Hotmail account. -
10:51 - 10:54And it struck me: wait a minute --
-
10:54 - 10:58I know the Hotmail people surely didn't
fly to the Ministry of Health in Kenya -
10:58 - 11:00to train people in how to use Hotmail.
-
11:01 - 11:05So these guys are distributing technology,
getting software capacity out there, -
11:05 - 11:07but they're not actually
flying around the world. -
11:08 - 11:09I need to think about this more.
-
11:09 - 11:11While I was thinking about it,
-
11:11 - 11:14people started using even more
things like this, just as we were. -
11:14 - 11:17They started using LinkedIn and Flickr
and Gmail and Google Maps -- -
11:17 - 11:18all these things.
-
11:18 - 11:21Of course, all of these things
are cloud based -
11:21 - 11:23and don't require any training.
-
11:23 - 11:25They don't require any programmers.
-
11:25 - 11:26They don't require consultants.
-
11:26 - 11:29Because the business model
for all these businesses -
11:29 - 11:32requires that something be so simple
we can use it ourselves, -
11:32 - 11:33with little or no training.
-
11:33 - 11:36You just have to hear about it
and go to the website. -
11:36 - 11:40And so I thought, what would happen
if we built software -
11:40 - 11:42to do what I'd been consulting in?
-
11:42 - 11:46Instead of training people
how to put forms onto mobile devices, -
11:46 - 11:49let's create software that lets them
do it themselves with no training -
11:49 - 11:51and without me being involved.
-
11:51 - 11:52And that's exactly what we did.
-
11:52 - 11:58So we created software called Magpi,
which has an online form creator. -
11:58 - 11:59No one has to speak to me,
-
11:59 - 12:02you just have to hear about it
and go to the website. -
12:02 - 12:04You can create forms,
and once you've created the forms, -
12:04 - 12:07you push them to a variety
of common mobile phones. -
12:07 - 12:10Obviously, nowadays, we've moved
past PalmPilots to mobile phones. -
12:10 - 12:14And it doesn't have to be a smartphone,
it can be a basic phone, -
12:14 - 12:16like the phone on the right,
the basic Symbian phone -
12:16 - 12:18that's very common
in developing countries. -
12:18 - 12:22And the great part about this
is it's just like Hotmail. -
12:22 - 12:23It's cloud based,
-
12:23 - 12:26and it doesn't require any training,
programming, consultants. -
12:26 - 12:29But there are some
additional benefits as well. -
12:29 - 12:31Now we knew when we built this system,
-
12:31 - 12:33the whole point of it,
just like with the PalmPilots, -
12:33 - 12:36was that you'd be able to collect the data
-
12:36 - 12:39and immediately upload
the data and get your data set. -
12:39 - 12:42But what we found, of course,
since it's already on a computer, -
12:42 - 12:44we can deliver instant maps
and analysis and graphing. -
12:44 - 12:46We can take a process that took two years
-
12:46 - 12:49and compress that
down to the space of five minutes. -
12:50 - 12:52Unbelievable improvements in efficiency.
-
12:52 - 12:56Cloud based, no training,
no consultants, no me. -
12:57 - 12:59And I told you that in the first few years
-
12:59 - 13:01of trying to do this
the old-fashioned way, -
13:01 - 13:03going out to each country,
-
13:03 - 13:07we probably trained about 1,000 people.
-
13:07 - 13:09What happened after we did this?
-
13:09 - 13:11In the second three years,
-
13:11 - 13:13we had 14,000 people find the website,
-
13:13 - 13:15sign up and start using it
to collect data: -
13:15 - 13:17data for disaster response,
-
13:17 - 13:21Canadian pig farmers
tracking pig disease and pig herds, -
13:21 - 13:23people tracking drug supplies.
-
13:24 - 13:27One of my favorite examples, the IRC,
International Rescue Committee, -
13:27 - 13:30they have a program
where semi-literate midwives, -
13:30 - 13:33using $10 mobile phones,
-
13:33 - 13:36send a text message
using our software, once a week, -
13:36 - 13:39with the number of births
and the number of deaths, -
13:39 - 13:42which gives IRC something that no one
in global health has ever had: -
13:42 - 13:46a near-real-time system
of counting babies, -
13:46 - 13:47of knowing how many kids are born,
-
13:47 - 13:50of knowing how many children
there are in Sierra Leone, -
13:50 - 13:52which is the country
where this is happening, -
13:52 - 13:54and knowing how many children die.
-
13:55 - 13:56Physicians for Human Rights --
-
13:56 - 13:59this is moving a little bit
outside the health field -- -
13:59 - 14:04they're basically training people
to do rape exams in Congo, -
14:04 - 14:05where this is an epidemic,
-
14:05 - 14:07a horrible epidemic,
-
14:07 - 14:10and they're using our software
to document the evidence they find, -
14:10 - 14:12including photographically,
-
14:12 - 14:15so that they can bring
the perpetrators to justice. -
14:16 - 14:20Camfed, another charity
based out of the UK -- -
14:20 - 14:23Camfed pays girls' families
to keep them in school. -
14:24 - 14:27They understand this is the most
significant intervention they can make. -
14:27 - 14:31They used to track the disbursements,
the attendance, the grades, on paper. -
14:31 - 14:34The turnaround time between a teacher
writing down grades or attendance -
14:34 - 14:37and getting that into a report
was about two to three years. -
14:37 - 14:38Now it's real time.
-
14:38 - 14:42And because this is such a low-cost
system and based in the cloud, -
14:42 - 14:46it costs, for the entire five countries
that Camfed runs this in, -
14:46 - 14:48with tens of thousands of girls,
-
14:48 - 14:50the whole cost combined
is 10,000 dollars a year. -
14:51 - 14:53That's less than I used to get
-
14:53 - 14:56just traveling out for two weeks
to do a consultation. -
14:58 - 15:01So I told you before that when
we were doing it the old-fashioned way, -
15:01 - 15:05I realized all of our work was really
adding up to just a drop in the bucket -- -
15:05 - 15:0710, 20, 30 different programs.
-
15:08 - 15:09We've made a lot of progress,
-
15:09 - 15:11but I recognize that right now,
-
15:11 - 15:14even the work that we've done
with 14,000 people using this -
15:14 - 15:15is still a drop in the bucket.
-
15:15 - 15:18But something's changed,
and I think it should be obvious. -
15:18 - 15:20What's changed now is,
-
15:20 - 15:24instead of having a program
in which we're scaling at such a slow rate -
15:24 - 15:27that we can never reach
all the people who need us, -
15:27 - 15:31we've made it unnecessary
for people to get reached by us. -
15:31 - 15:36We've created a tool
that lets programs keep kids in school, -
15:36 - 15:40track the number of babies that are born
and the number of babies that die, -
15:40 - 15:43catch criminals and successfully
prosecute them -- -
15:43 - 15:48to do all these different things
to learn more about what's going on, -
15:48 - 15:49to understand more,
-
15:49 - 15:51to see more ...
-
15:51 - 15:53and to save lives and improve lives.
-
15:55 - 15:57Thank you.
-
15:57 - 16:01(Applause)
- Title:
- The surprising seeds of a big-data revolution in healthcare
- Speaker:
- Joel Selanikio
- Description:
-
Collecting global health data was an imperfect science: Workers tramped through villages to knock on doors and ask questions, wrote the answers on paper forms, then input the data -- and from this gappy information, countries would make huge decisions. Data geek Joel Selanikio talks through the sea change in collecting health data in the past decade -- starting with the Palm Pilot and Hotmail, and now moving into the cloud. (Filmed at TEDxAustin.)
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 16:18
Brian Greene edited English subtitles for The surprising seeds of a big-data revolution in healthcare | ||
Krystian Aparta commented on English subtitles for The surprising seeds of a big-data revolution in healthcare | ||
Krystian Aparta edited English subtitles for The surprising seeds of a big-data revolution in healthcare | ||
Krystian Aparta edited English subtitles for The surprising seeds of a big-data revolution in healthcare | ||
Krystian Aparta edited English subtitles for The surprising seeds of a big-data revolution in healthcare | ||
Krystian Aparta edited English subtitles for The surprising seeds of a big-data revolution in healthcare | ||
Thu-Huong Ha edited English subtitles for The surprising seeds of a big-data revolution in healthcare | ||
Thu-Huong Ha approved English subtitles for The surprising seeds of a big-data revolution in healthcare |
Krystian Aparta
The English transcript was updated on 1/11/2016.