ALFAIII JOINT PROJECT – SANANET - (CONCEPT NOTE- MAX 4 PP)
1. Relevance of the Action
Many regions in Latin America are characterised by (a) marked inequality in access to/ quality of health care
in rural areas (b) a high incidence of disease such as malaria, dengue, Chagas disease, parasitic illnesses,
diarrhoea and skin and respiratory illnesses and (c) a lack of trained health workers able to provide adequate
care in remote locations such as the Amazon.
A central issue is therefore the provision of accessible clinical support materials and training for health care
personnel in remote rural and under-resourced areas. Increasingly mobile, Open Source applications are
becoming important vehicles for supporting the training of health workers in the field to diagnose or respond
to these challenges. These needs need to be researched in more detail, taking account of remote contexts.
As novel vehicles for education in many cases, they also need new approaches to moderation, monitoring,
integration, accreditation and re-use through joint agreements.
In this proposal we focus on the healthcare curriculum, and the growing need for flexible standardised
multimedia content such as video-clips, low-resolution medical imaging, consultant notes, measurement
records, and other materials, which we call 'learning clips', which can be used flexibly from inexpensive
mobile devices to provide access to training for health care workers in remote and under-resourced areas.
For example, short ‘bite-sized’ video-clips are one means of providing training at a very basic level for those
providing care without access to more formal support. Video clips with didactic content, uploaded to services
such as YouTube and iTunes are increasingly being exploited as resources for teaching in Europe and Latin
America. While showing significant promise in transferring much needed skills and expertise to remote
practitioners, there are problems associated with more widespread adoption. Firstly these approaches are
not integrated into the traditional health / global health curriculum, leading to concerns about ensuring the
quality and appropriateness of materials accessed on the ground. Secondly, a lack of standards and 'best
practices' for content creation and curation significantly hinder more widespread penetration by impacting
variously on curriculum integration, quality, content discovery, interoperability and scaling. Also there are
issues with engaging and enlisted content providers, and brokering between content producers and content
consumers so that appropriate content can be made available in a timely fashion.
To achieve the maximum benefit from 'learning clips' the content needs to be trustworthy, interoperable, reusable and integrated with the more traditional curricula which it extends to meet the needs of more remote
and under-served populations. There also needs to be a clearer understanding of the barriers to scalable
implementation and the different implications (technical, socio-technical, organizational, economic etc) in the
European and the Latin American contexts. Standards and formats for the future of education for healthcare
workers at point of care are at a critical point in development in a discipline that is turning increasingly to
mobile, community-centred and open source infrastructure for provision. The interoperability of standards
and formats that are adopted will affect collaboration both between regions in Latin American, and between
the Latin American and the European Health Areas.
Much of the challenge now derives from the need to provide opportunities and incentives to
 engage in/ provide incentives the process of agreeing on formats/standards for developing and reusing resources from the partners, and their wider network
 design, pilot and explore the barriers in practice to use
 adopt an Open Science model1 for collating, sharing and curating contents using open-source
software applications within a collaboratory and disseminate using open access methods
 integrate these with the more traditional curriculum for health care personnel
Creating the infrastructure and shared formats for collating, curating and re-using these resources across
regions would benefit patients and local healthcare personnel in some of the most remote and underresourced areas in Latin America such as Cacuri and Mapire2
1
http://europa.eu/rapid/pressReleasesAction.do?reference=IP/10/1644&format=HTML&aged
1
It would also provide a stepping stone for designing further mobile and open source applications for
healthcare with European partners, with implications both for the infrastructure in place for provision, and for
the curriculum.
It also comes at a time when the curriculum in both continents is responding to new digital media and new
modes of delivery with new affordances, the proposal will contribute directly to the specific objectives of
ALFAIII in three regards in particular
1. improving the quality, relevance and accessibility of higher education for primary healthcare (and
clinical support) for staff in remote regions in LA, such as Cacuri in Amazonas (Add) and thus to
the economic and social development of the region in general
2. contributing to the development of interoperable standards and formats for telemedicine in the
Latin American region, at a point where trans-regional groupings such as AHCIET in Latin
America, and the Continua Alliance are raising these issues, and the standards that are adopted
in term of the curriculum (and technical standards given the dependence on digital technologies)
will determine the interoperability of programmes within LA and with the EU in future
3. contributing to the creation of a joint higher education area in both regions by supporting a
coordinated response to the challenges of providing a curriculum in a digital medium that requires
integration into the traditional healthcare curriculum, but also requires coordination in terms of
technical standards.
2. Description of the action and its effectiveness
Collaboration between the partners as part of pan American networks, conferences and activities on the use
of ICT in both healthcare and society, such as the recent AHCIET Conferences.3, and their participation in
EU fora on the use of ICT in health with a Latin American strand, such as Inforsalud4, Med-e-Tel and ICT4D
highlighted the need for scalable, interoperable approaches to the use of ICT in health, and as a vehicle for
wider social and economic development through the provision of training for under-served groups.
Recent videoconferences and workshops over the past year with the Venezuelan and Scottish partners
highlighted the development of collaborating teams with shared interests, and a move towards identifying
key topics where collaboration would be of mutual interest as digital and social media reshape curricula in LA
and EU http://telemed.wikipsaces.com/Workshop_March
Proposed Objectives, Actions, Outcomes (2012-2014
Overall Objectives
1. Agree shared standards/formats/accreditation for use of mobile content as part of training for health
care workers in remote areas, to facilitate the development of a bank of reusable resources that can
provide a scalable, sustainable resource for the healthcare curriculum (a) in remote areas (b) across
the European and Latin American curriculum
2. Identify barriers (and opportunities) afforded by this approach, both in the field, and in terms of
developing pan – Latin American and pan-European resources.
Achieving this requires the coordination of activities to
 identify what health workers, clinical support teams and nursing/ curriculum specialists feel (a) is
required (b) are the barriers
 agree /adopt shared technical, formatting and curricular approaches and accreditation
 provide a wiki based collaboratory for sharing materials with applications for curating, managing
attributions and agreements for use, and for initiating the accreditation process.
 pilot materials in the field
2
Mapire: http://www.youtube.com/user/TheSOStelemedicina#p/c/6114A4428262E9C6/4/I0NfG1mB2VE
Cacurí: http://www.youtube.com/user/TheSOStelemedicina#p/c/6114A4428262E9C6/3/zsvmFT0S8m0
AHCIET Conference http://www1.ahciet.net/agenda/ponencias/default.aspx
4
http://events.emagister.co.uk/congresses/inforsalud_2011__congreso_nacional_de_informatica_de_la_salud/38409
3
2



evaluate the experience of users/ support teams (clinical support staff; curriculum developers in the
specific nursing/health education team)
report on needs, implications for service and curriculum development, barriers to use, opportunities
ensure that these activities are aligned with emerging standards and formats for accreditation in the
curriculum, and emerging mobile standards.
Roles
For most activities each partner would have a similar role, with a researcher costed in to help carry out a
country specific process of: (1) Identifying requirements through interviews with (a) the people who would be using the material
on the ground in a specific site, and (b) with curriculum developers, IT staff and data managers,
librarians, for discussion in local workshops and reporting to the joint meetings.
 (2) Evaluating a pilot of the materials developed after joint agreements about common formats,
standards, topics using qualitative research as before, and pre-agreed metrics reflecting joint and
separate objectives.
 (3) Developing the platform, portal and the wiki, including an application to initiate (a) acquisition of
basic metadata (b) assignation of attributions and agreements for use and re-use (c) initiate online
management of the accreditation process. Standardisation, alignment with international standards.
 (4) Designing a link to patient records, using the mobile Open Source software developed by
Sanamobile as an example, as this is not just an educational, but also potentially a diagnostic aid,
that might be accessed for either purpose from a mobile phone. (Letters of support have been
requested from a representative of HL7, and from Sana Mobile www.sanamobile.org
The partners in Chile, Ecuador, Mexico and Venezuela will have a greater role in the field work, in remote
sites where they already do this kind of work, in collaboration with hospitals and in tandem with the nursing
curriculum in the University. The partners in Venezuela would host the platform, and have the infrastructure
in place to do so with confidence. Scotland and Spain provide particular expertise in standards in software
design and clinical standards such as HL7, but also drawing on existing work in their own remote regions.
Activities
Semi-structured interviews /Qualitative
research for Needs Anal & Evaluation
(a)
(b)
(c)
(d)
Start
Jan
2012
End
Oct.
2014
with users (rural healthcare workers
clinical support staff
curriculum developers
IT support staff
Looking at needs and perceived barriers
(Face to face where practical, and by Video
Conference, Skype, or phone)
Meetings
(real and virtual)for Requirements Analysis
based on
a) User needs: interviews with users on
the ground in each region
b) Alignment with current/emerging
standards: joint meetings with Univ.
Curriculum specialists and advisers
from standards bodies such as HL7
(Medical) Continua Alliance
(Commercial/Technical standards for
Healthcare equipment)
Platform/Tool Development + Exploration
of Technical Barriers
Wiki collaboratory for uploading materials,
with online tools and standard formats for
those developing materials, including basic
metadata
Resources
1 researcher*
at each site(6)
+ travel /equip
costs
Outcomes
Requirements analyses
(per country)
Qualitative Evaluations
(per country)
Report + recommendations
Journal submission
Jan
2012
Jan
2014
6 regional
workshops
3 international
meetings(one
at AHCIET,
one at MedTel)
Jan.
2012
Jan
2014
Technical Report
-Open Access Journal
Paper
White Paper/Position
Paper with WHO
recommendations
VC meetings
Workshops/ Workshop
Reports
1 software
engineer (or
two part-time –
one in
Venezuela ,
one in
Wiki
Linked OS mobile
applications
Hosted platform + Content
3
Scotland
Links to other Open Source applications
used by partners such as Moodle and
Sanamobile
Roadmap of Issues in
relation to Scalability,
Standards
Application for initiating the process of
accreditation and assignment of agreements
for attribution, use, and re-use
Staff/Student Exchange
Given the lack of specialist expertise in
particular areas, it is seen as necessary to
allow for a site researcher to have some
mobility as required.
The School of Informatics (the lead
applicant) also runs a very popular Masters
programme, with group projects run over the
summer. There will be one or two projects
related to this proposal run each summer.
This would leverage expertise at no extra
cost, and facilitate the building of transregional networks as part of the curriculum.
Dissemination
Project Portal: content creation tools,
standard formats, content
Open-access articles and reports
Reputable Conferences (AHCIET/TICS y
Sociedad ; Med-e-Tel; ICT4D, ACM SIGHIT
International Health Informatics Symposium,
Oct.
2012
Jan
2013
Option for
movement of
researchers*
between sites
for 6 months
periods
Transfer of expertise
Summer
School
Local evaluation (Phase b)
Strengthening/extension of
network
Local requirements
analysis (Phase a)
Local Workshops x 6
Oct,
2010
Ongo
ing
n/a
Project portal
Journal Papers
Conference Papers and
Presentations
General public involvement
of other regions in sharing
/contributing materials
3. Sustainability of the action and possible risks
Sustainability
This will simply enhance the an already sustainable process, by providing (a) focussed expertise (b)vehicles
for collaboration at a technical, social and academic level (c) critical mass in terms of content and adoption of
standards, the aggregation and re-use of content, at a timely moment for both regions.
There is a real demand for material in a reliable and re-usable form that is accessible in remote/rural
locations, and can be curated, re-used and incorporated into the nursing and medical curriculum by the
partner Universities and incorporated into other programmes. This builds on innovative work already
underway by the partners with their associated medical and nursing Schools.
Risks
The sites are not subject to extreme events, but delays are possible in case of flooding or problems with
transport, however there are a number of sites which could be used /exchanged. Changes in the value of the
currency might affect costings, though this would affect the speed and scope of activities, rather than the
achievement of the outcomes themselves.
Other standards may develop in other regions such as Africa, India where these materials are gaining
popularity as an approach to video-based education in such communities (See www.digitalgreen.org). We
have associate groups supporting the proposal who will provide an advisory role, and who have an interest
in adopting these standards/ having access to these materials is made more widely available.
The biggest risk is allowing different standards and incompatible formats to prevent future cooperation,
scaling and inter-operability between regions and Health areas, with significant implications for the most
vulnerable groups that effective use of ICT can support.
4