Maternal Concept Lab

A (Preliminary) Core Dataset for Community Antenatal mHealth Projects

Tue, 28 Aug 2012 13:52:26 -0400

Hi everyone,

I’m writing to update all of you on what the Maternal Concept Lab (MCL) has been doing this past year. We received funding from the mHealth Alliance to work with three Innovation Working Group projects that are all using mobile phones to facilitate community-based antenatal care: Dimagi in India, Grameen Foundation in Ghana, and the Government of Rwanda. Andy Kanter and the Columbia University International eHealth Laboratory (CIEL) is a close partner in this work, through the development of an interface terminology dictionary that has been implemented in many countries, including the Millennium Villages. Some of you may already be familiar with the MCL:Search tool (www.maternalconceptlab.org/search.php) which is used to search the CIEL dictionary. Also a big shout out to Liz Peloso who has done much of the terminology work in the Rwanda Health Enterprise Architecture project, including mapping to the CIEL dictionary.

We are using the content (e.g. xforms, reports, protocols) from these projects to create a core dataset of terminology and indicators that represents common practice for community-based antenatal mHealth projects. This is the starting point for making digital content like this more reusable, more interoperable, and more in line with best practices. It also enables projects to use common reports or dashboards, which can greatly simplify benchmarking and evaluation.

The 3 projects vary greatly, reflecting differences in the cadre of workers, infrastructure, funding, access to local expertise, culture, and design choices. Here’s a brief overview:

Dimagi – Dimagi supports 10+ implementations in different regions of India with World Vision, Save the Children, and other organizations. Non-clinical CHWs use CommCare Sense with images, audio and text to register pregnancies, provide counseling, and perform basic screening.
Grameen MOTECH – MoTeCH in Ghana uses text messages and integrated voice response (IVR) to remind clients and health workers of appointments and to automate counseling messages sent to pregnant women. CHWs and nurses use phones equipped with OpenXData to collect data and query patient data. Patient data is sent to OpenMRS for reporting.
Rwanda MoH – In Rwanda, CHWs use RapidSMS to register pregnant women in the community, record danger signs, track referrals, and encourage women to attend antenatal clinic visits. RapidSMS messages are sent to a shared electronic patient record (using OpenMRS) that sits at the district-level.

MCL’s goal in this project is to build a core dataset that is compatible with all 3 of the above projects to link it to reports and indicators. Everything that we do will be available publicly, and I’ve included links for everything that we’ve had time to put online so far. Here’s the process:

1. Collect content related to the community-based antenatal mHealth programs from all three projects. This resulted in about 15 xforms, 10 reports, and 2 data dictionaries. (Sorry, our content repository is not online yet, but hopefully coming soon!)

2. Map data elements from the above content to the CIEL/MVP terminology dictionary, creating new “concepts” where they do not exist. A concept is a procedure, drug, clinical finding, symptom, or even the questions and answers in an xform. All concepts were mapped to SNOMED or ICD-10 where applicable. In total, there were 300+ concepts, covering pregnancy and birth registration, mother’s pregnancy and health history, screening for danger signs, referral, and counseling. Much of the work that non-clinical CHWs perform in low-resource settings is not well represented in the major international reference terminologies. For example, creating concepts for community-based counseling from CHWs required that we make decisions based on the appropriate level of specificity (i.e. create one concept on “Counseling on the importance of seeking antenatal care” versus create multiple concepts for “counseling on frequency of antenatal visits”, “counseling on importance of antenatal physical exam”, “counseling on importance of antenatal lab testing”, etc.)

See the preliminary list of concepts here (this takes awhile to load!): Preliminary MCL-UNF Concept Mappings

3. Build the core dataset based on overlap and relationships between concepts, leveraging mappings to SNOMED and ICD-10. Keep in mind, that these 3 projects each use different types of workers and different technology, and each is providing different services, in a different country by different organizations. Despite all these differences, more than 30 concepts fit our inclusion criteria for the core dataset (an identical concept or matching SNOMED or ICD-10 code in at least 2 of the 3 projects).

See the list here: Preliminary Core Dataset

Some concepts are more specific versions of a related term (e.g. “third-stage postpartum hemorrhage” is narrower than “postpartum hemorrhage” which is narrower than “hemorrhage related to delivery of a fetus”). We are in the process of expanding the core dataset even further based on the relationships defined in SNOMED and ICD-10. This will also allow us to do some cool visualizations of the core datasets, which are useful once you’re dealing with hundreds or thousands of concepts, as all ministries of health are.

4. Select key indicators and measures that can be calculated using concepts in the core dataset. The core dataset represents current practice for community-based antenatal mHealth projects. In other words, these indicators are intended to be used today, rather than just the output of a hypothetical exercise. By combining indicators already used by the 3 projects with WHO guidelines, we have so far identified 15 indicators, including:

Proportion of pregnant women registered into the community-based antenatal program who are referred by CHW to an appropriate health provider for complications
Proportion of pregnant women registered into the community-based antenatal program who reported serious obstetrical events in post-partum follow up
Proportion of pregnant women in community-based program using IFA
Proportion of pregnancies registered within first 4 months of pregnancy

As this list expands, we will work with MNCH and evaluation experts to select indicators which can be used to most measure a mHealth program’s impact on care.

(Sorry, the indicator list is not yet available online, but we’re working on it!)

5. Create reports and dashboards to benchmark performance across projects. These reports will work with any set of data that is properly mapped to concepts in the core dataset, and will be used to report on the indicators we select. These will be compatible with RapidSMS, CommCare, and OpenXData. We’re really excited to get these out there, so stay tuned.

Pulling this all together…

Standardized terminology has many benefits—the ones we’re focused on are component reuse and the potential to simplify benchmarking and evaluation. There is still work to do, but we are close to completing the core dataset in are in the process of selecting compatible key indicators. The reports, dashboards, and study designs that we build for these projects can more easily be reused by projects that map to the same core dataset. All of our work will be available in a public repository (as soon as it is online) and a community of practice is being formed to support the use and adaptation of the tools in the repository. At the core of this is the CIEL interface terminology dictionary that provides a common vocabulary for the communication of maternal, newborn and child health information. Our hope is that the CIEL dictionary and the upcoming MCL repository, combined with the process for developing core datasets described above, will be the launching pad for a new community of practice that improves the tools that are used to deliver MCNH services.

We look forward to your questions and comments…

Cheers,

The MCL Team

(Jon, Maria, and Marianne)

Announcing the 2012 MCL Summer Fellows!

Mon, 06 Aug 2012 18:48:00 -0400

I am very excited to announce that Maria Freytsis CNM MPH and Marianne Muchura MD have joined the MCL team for the summer as the informatics and clinical fellows! Although there were many highly qualified candidates—and I look forward to being in touch with many of you in the future—Maria and Marianne both stood out for there strong clinical expertise and deep interest in mobile and global health. These fellowships are funded through a grant from the mHealth Alliance. The Columbia University International eHealth Laboratory (CIEL) is also playing a key role in dictionary management and concept mapping support.

Dr. Marianne Muchura, the MCL Clinical Fellow, is a member of the clinical faculty at Harvard Medical School and recently completed her residency in OBGYN at Beth Israel Deaconess Medical Center. She has worked clinically in several countries in East Africa and researched maternal health guidelines at the World Health Organization division of reproductive health.

Maria Freytsis, the MCL Informatics Fellow, brings a breadth of clinical experience both domestically and internationally, including midwifery training Peru, Guatemala, and post-war Kosovo, and maternal-child health needs assessment in post-tsunami Indonesia. She is passionate about finding creative solutions, such as leveraging mobile phones, to the challenges that midwives face across the globe.

See their full bios on the updated MCL Team page.

Maria and Marianne are leading MCL’s work this summer to analyze maternal-child mobile health content from Dimagi, Grameen Foundation, and the Government of Rwanda, to build a core dataset of MCH terminology and indicators, and to integrate our findings with international best practices.

We look forward to updating you on our progress in the coming months.

Summer Fellowship with MCL and PIH

Mon, 21 May 2012 10:09:00 -0400

We are very excited to offer a summer fellowship through MCL and Partners In Health. We’re ready to hire ASAP, so send over your resume or CV to me if interested. The job description is below, and feel free to forward widely. This is a great opportunity to apply public health skills to the real-world challenge of using ICTs to improve health in the developing world.

If you are interested in this type of work, but aren’t necessarily the right fit for this opportunity, send your info anyways and your interests, since we are hiring for other short-term positions as well.

Look forward to hearing for you!

Maternal Concept Lab-Partners In Health Fellowship

The Maternal Concept Lab (MCL) is looking for a qualified summer fellow to work with our partner organizations to analyze maternal-child health (MCH) content (e.g. clinical forms, protocols, reports, indicators, etc.), to build a core dataset of MCH terminology and indicators, and to compare to international best practices. The ideal candidate will have a clinical background—preferably OBGYN, midwifery or similar field—with an interest in standards of care and informatics.

This is a paid summer fellowship based in Boston, MA, although applicants based outside of Boston will be considered. Start date is as soon as possible. Send questions and resumes/CVs to info@maternalconceptlab.com.

Project Background

The Maternal Concept Lab (MCL) has partnered with the mHealth Alliance and Partners In Health to work with three Innovation Working Group (IWG) partners—Dimagi Inc., Grameen Foundation and the Rwanda Ministry of Health—to develop standardized terminologies that enable benchmarking and maximize the value of shared knowledge and components across several maternal-child health projects. These projects all utilize mobile health—or mhealth—to improve frontline worker (FLW) effectiveness in parts of Ghana, India and Rwanda and are being funded by IWG to scale regionally or nationally. MCL’s work will support project operations, bolster evaluation, and promote interoperability with national level systems.

About MCL

eHealth standards are important. Clinical best practices even more so. The Maternal Concept Lab is bringing standards and best practices together to make the world’s best maternal-child health content available in open, standards-based formats, leveraging IT and mobile devices where possible.

MCL was launched in 2010 in direct response to the need for standards and common tools to maximize the increased utilization of mHealth platforms to achieve Millennium Development Goals 4 and 5. MCL is (1) developing a standard terminology dictionary for maternal-child health, (2) building open-source tools to make standard terminology easy to use, (3) populating with content from implementers and best practices organizations, and (4) supporting a community of practice around the use of standards within maternal-child health. The dictionary has been adopted by Jembi, Millennium Villages Project, D-tree International, Rwanda Ministry of Health, Partners In Health, and several other organizations. MCL:Search is a web-based tool for searching standard concept dictionaries that is in use in more than 40 countries. MCL partnered with Columbia University International eHealth Laboratory to build a standard interface terminology dictionary for maternal, newborn and child health.

New MCL:Search Released!

Sat, 23 Apr 2011 09:37:00 -0400

The new version of MCL:Search has been released! In addition to finally creating a logo, there has been an almost complete re-write of the code to support a host of new features. Our goal remains to make concept dictionaries easier to use and to facilitate mapping ehealth tools to the shared MCL/CIEL dictionary. Some features, like batch searching, were created specifically to support hard core mapping work. Here’s the summary of new features, but also take a look at the updatedhelp 1-pager.

Search dictionaries, map sources, or concept lists - Now you can choose to search the MCL/CIEL dictionary or one of the 3 other dictionaries in our database, or select a subset of concepts from a mapping source (i.e. SNOMED or ICD) or a concept list (i.e. MCL Core)
Inline Operators - Use operators to find exactly what you’re looking for. For example, id:15 only matches a concept ID. map:15 only matches map codes. name:measles searches only in concept names while desc:measles searches only in concept descriptions. See MCL:Search Help for a complete list of operators.
Batch Queries - Perform multiple searches at once and compare the results by clicking on the plus icon in thesearch bar. Each individual search goes on its own line. See an Example.
Global Filters - Limit the search results that are returned by class and datatype, and specify whether to include retired concepts.
Inline Filters - For more complex searches, specify whether a search result is in or not-in a certain concept list. (I know, accessing lists by numeric id is a terrible idea…will be fixed soon!)
Link between MCL/CIEL, AMPATH, and PIH dictionaries - CIEL completed mapping the AMPATH and PIH dictionaries to the MCL/CIEL dictionary. You can now navigate between these dictionaries using map codes. This is a big step towards interoperability for those using any of these 3 dictionaries.

Enjoy the new tool and feel free to send feedback, bugs, feature requests, etc.

Jon

MCL:Search Screenshot

Fri, 22 Apr 2011 20:58:53 -0400

MCL:Search Screenshot

Welcome to the MCL Blog!

Thu, 14 Apr 2011 12:47:59 -0400

MCL is a cross-cutting project working to improve the delivery of maternal health services using technology by collaboratively making eHealth tools more reusable, evidence-based, and effective.

Visit us at our main site at www.maternalconceptlab.com.