In other words, my theory is: Cheating (on a systematic level) happens because students try to get an edge over their peers/competitors. Even top-notch students cheat, in order to ensure a perfect grade. Fighting cheating is not something that professors can do well in the long run, and it is counterproductive by itself. By channeling this competitive energy into creative activities, in which you cannot cheat, everyone is better off.

Panos Ipeirotis — Why I will never pursue cheating again. A computer scientist teaching in a business school details a year of trying to combat cheating on assignments. Overall, he spent 45 hours addressing the problem during a 32 hour lecture course, and 22 of 108 enrolled students admitted cheating. Solutions could include:

• Public projects – All of the work ends up public, so embarrassment is the deterring factor.
• Peer review – Students have to present their work in class, and are judged by others.
• Competitions – Grades are performance-based (e.g. students build websites to attract the greatest number of unique visitors).

Takeaway: If plagiarism is your biggest worry, you’re doing it wrong.

Infographic by Lauren Rabaino, updated April 18th

In preparation for a roundtable discussion this weekend about the Knight Foundation’s commission on the information needs of communities, a few of us decided to survey past News Challenge grantees. A big thanks to Chris Amico, Will Mitchell, Max Linsky, and Lauren Rabaino for helping out with various parts. We wanted to pull together data like how many of the projects are still active, whether the grantees started their projects before receiving funds, and whether the amount they received was sufficient to achieve their objectives. On a program-wide scale, we wanted to know the percentage breakdown of content vs. education vs. software projects, the average lifespan of a project, and what type of institutions typically received funding. Some of this we were successful in collecting; some, not so much. All of our data is available as a Google Spreadsheet.

Since 2007, the Knight Foundation has awarded about $21.9 million to a total of 63 projects (40 of which responded to our survey). The largest, at $5 million, went to MIT’s Media Lab. The smallest, at $10,000, went to Joe Boydston’s CMS Upload Utility.

Of the 40 respondents:

• 31 (77.5%) are still actively working on their projects
• 19 (47.5%) started their projects before applying to the News Challenge
• 14 (35.0%) said they received sufficient funding, 8 (20.0%) said they didn’t receive enough money to achieve their goals, and 12 (30.0%) didn’t report because they are still working on their projects

According to our classification system, of all 63 projects:

• 14 (22.2%, $5,214,000) were non-profit, 15 (23.8%, $8,790,400) were schools, and 29 (46.0%, $7,267,100) were for-profits
• 14 (22.2%, $9,820,500) were startup projects, 22 (34.9%, $7,692,400) expanded an existing project, and 27 (42.9%, $4,431,600) were side projects
• 27 (42.9%, $5,073,400) focused on content production, 10 (15.9%, $7,606,000) focused on education, and 28 (44.4%, $9,265,100) built software

The following are a collection of responses we received to the survey’s open-ended questions.

1. How were you successful with your project?

“Readers played the games and, we think, gained an increased understanding of these issues and enjoyed themselves doing it. The games remain on our site and continue to attract traffic and interest.”

“Overall, I considered the project success. We designed a new newsroom for The Chronicle, the student paper at Duke University, designed to leverage a long-term view of where media is heading. Beyond that, the goal of the project was also to identify broader lessons that other news organizations could apply.”

“Our code is also open source and has been used by several other projects (goJournalism.ca, YouCommNews.com and others). While these projects have not been wildly successful it has shown that there is a real interest in this model. Other projects like SpotUs.it, YouCapital.It, Emphas.is and others show that there has been a cultural change inviting more crowdfunding projects.”

“At this point we’ve completed the initial integration of PRX Story Exchange with Spot.us via APIs and collaborative coding – which is one of the principal goals of the project. We are just now rolling out the first pilot instance of Story Exchange with Louisville Public Media, and then plan to offer it more broadly in partnership with local public radio stations and producers.”

“Yes, in the sense that we used a suite of free, simple tools to build a site and a forum for online community. No, in the sense that the hoped-for community never coalesced around the tools we’d created.”

“We’ve continued the project well beyond the duration of Knight’s support, seeking other foundation funding and donations from individuals to allow us to support innovative new media efforts in different corners of the developing world.”

“Several stations are now using and contributing to the tools.”

“We got the concept, in it’s most basic form, built! And we did it with some money to spare.”

“Very modest goals were achieved.”

2. What challenges did you face with your project?

“The biggest challenge has been finding people with computer programming skills/backgrounds who are interested in studying journalism.”

“We were discouraged [by the Knight Foundation] from changing our focus from print to digital content while receiving grant funds. As a result, we had to wait until the end of our grant to do what our customers were asking us to do (allow them to publish to eReaders, the Kindle, mobile phones and tablet computers).”

“Time: If I thought the project would take X amount of time, it actually took about 100x.”

“Biggest failure to date is that we simply haven’t succeeded in sparking any sustained, large-scale public involvement/contribution. Exploring why that is and what we can do to change it is where we’re at right now.”

“A media partnership was difficult to forge due to the financial problems facing news companies.”

“Building partnerships with newspapers and publishers has been tough.”

“Learning curve [...] While I am grateful for the initial grant – one thing I’ve found is that the more funds you have, the more you need. Learning to keep your scope under control is tough. No amount of funds is enough to do everything you want. Just ask ProPublica.”

“The students did a terrific job coming up with the [project] concept in a four month time frame, but then the turmoil within the newspaper industry slowed considerably the progress of the [project] launch and contributed to its short duration.”

“The technological capacity of the organizations in Kenya whom we were encouraging to use our tech was lacking and therefore hindered adoption of [our project].”

“Not having programming background has been a real challenge. Not being able to devote two full-time brains to the business and product development had a definite impact.”

“Software built ‘for journalism,’ I’ve found, is rarely as efficient, timely, or useful as software built ‘for users.’”

“Changing content, not enough staff, exploding field.”

“We failed to invest in evaluation, documentation, and communications. We are dealing with a community that is slow to adopt change, and we lacked the resources to encourage them.”

“Insular community in small geographic locale meant focus on controversial topic was conversational non-starter online.”

3. What advice would you give to a younger you starting on the same project?

“Be willing to go a bit bigger.”

“Building partnerships with people in other countries is a really tough process. Track record matters – someone with an innovative idea is worth talking to, but it’s worth seeing whether that person has ever managed a project previously, gotten other efforts off the ground.”

“Don’t hire a tech firm. Interview people for CTO slots, give them an equity stake and name them publicly as a part of the project. Send them out to speak publicly on behalf of the project. Get their skin in the game.”

“If you haven’t met a few of the Knight judges in person prior to applying, you don’t stand a chance of winning. The Knight challenge is a great marketing tool for the Knight Foundation and the newspaper industry. If your project isn’t going to sound awesome in a NYTimes article about this year’s winners, it won’t be picked.”

“Have a clear understanding between editorial and technical staff about what the project should do and the technical limitations, and try to address these in a project design phase before the actual implementation process.”

“Release code frequently. While this isn’t something we necessarily learned in this project, it has been hugely helpful getting our code out there, getting eyes on it, and seeing how people use and react to it – while we’re still actively developing it.”

“Better understand the application process and what reviewers are looking for.”

“Go for a sustainable business idea rather than a grant-gaining idea.”

“Ask for less money up front; insist on the ability to change, morph and pivot like any other business; and create a product that people will pay for in some manner up front versus building something that may or may not attract advertising or investment. If you can create a sustainable and growing business right up front through ‘bootstrapping,’ you don’t need as much funding and you may not need any funding at all.”

“Insist on more support (mentorship, networking, guidance, collaboration) from the Knight Foundation. Many of us felt that some projects were Knight favorites and received exceptional attention. Looking back, I think that I would be more insistent on getting that support for my project.”

“Mobile phone technology is moving faster than you think. Don’t write code for yesterday’s platforms, even if they were the big thing when you started. Voice is in rapid decline, data is king, don’t be fooled that apps are the end game, see what is coming in your context a year or two down the line.”

“If your goal is to kick-start a project, give serious thought to the next step in funding. Partial funding can be worse than no funding. [...] Reach out to KNC staff often. They may not engage with you. [...] Use KNC connections wisely. In my case, who you know is more important that the quality of your code/idea.”

“Don’t be illiterate. When this project started, I really couldn’t code. I could not read the code I was paying for, or assess its quality. Since then, I’ve taken night school courses. My objective is not to become a coder but to become the World’s Worst Programmer — I want to be able to read the code I pay others to write, and I want to be able to fix bugs and add small features to my site without anyone’s assistance or permission.”

4. How did you modify the scope of your project over time (if at all)?

“There are lots of feature ideas we had in the beginning that never came to fruition – we cut them out in order to get something up and out the door [...] There are lots of features twe’ve built since that I hadn’t dreamed up when we first launched.”

“We expanded, both in terms of focus and in terms of diversifying our funding. Basically, KNC allowed us to undertake an experiment, and based on the success of that experiment, we made [the project] a permanent part of our newsroom and have scaled it up.”

5. In your opinion, what are the ways in which the Knight News Challenge has been successful?

“The Challenge has gotten all kinds of submissions. In a very strange way that is a form of success. They have convinced hundreds (thousands) of people to think about innovative ideas. It has been a cultural win for the journalism community. Before the Knight News Challenge – I don’t think there was an institution that really championed experimentation.”

“Knight built a high reputation of the contest right from the start – attracting top players and persons to the project (Sir Tim Berners-Lee etc.) and jury members, too. [...] KNC victory opens doors.”

“The News Challenge attracted technical talent into future-of-news efforts, and got people who, like me, had never applied for a grant or even considered applying for one before.”

“I love the Challenge’s openness to experiment and its willingness to take risks. These are precisely the traits that professional journalism has bred out of its practitioners over the last half-century. We need them and the Challenge has, I think, done a great deal to reinject them into the news bloodstream.”

“Bringing attention to the idea of innovation in news.”

“Great forum to share ideas, meet people, and a unique funding model for edgy ideas that would never get funding elsewhere (certainly true for Africa). A real commitment to journalism, democracy and development that comes through and inspires.”

“The KNC has resulted in some wonderful innovation in media efforts. We benefitted by being introduced to new partners and new ideas. We were able to hire development staff we never could’ve afforded otherwise.”

6. In your opinion, what are the ways does the Knight News Challenge need to be improved?

“Systems needed to be put in place to evaluate the open-source code generated through the News Challenge and identify ways to make it more widely deployed.”

“Capture more systematically the lessons of the challenge winners, and find additional ways to share the results of the projects.”

“Tracking the history of grants and providing the public with some metrics on their success would be a pleasant thing. I’m confident [the Knight Foundation does] this internally.”

“Shorten the application and decision process.”

“It would have been nice to get the $ right away instead of waiting for 4 months to get started.”

“Thus far, I think KNC has fallen a bit short in turning the various grantees into a community that works together and supports each other’s work. Perhaps that’s an unrealistic goal, but it seems like the field would benefit from regular collaboration and engagement between grant recipients.”

“Perhaps introducing grantees to other funders in a way to help sustain projects long-term would be useful.”

“Alone, the News Challenge is just a collection of projects. Taken together with all the people who applied for the News Challenge, you have the makings of a movement. To my knowledge, no effort has been made to keep the people who applied but were not funded together with those who were as an ongoing future-of-news community. A program like the News Challenge has to be careful, otherwise they risk encouraging a few dozen teams and discouraging thousands of others.”

“Knight needs to help News Challenge ideas turn into sustainable institutions.”

“Collaboration needs to be funded. We work in our own project silos. There was never enough attention given to drive collaboration between projects. The annual conference was not sufficient for group learning opportunities. Many of us suffered similar pains in isolation.”

“The News Challenge can improve its logistical support for journalism initiatives that lack professsional business expertise. If we want to support ‘informed, engaged communities’ then we need to recognize that most grassroots, community initiatives won’t be lead by people with conventional ‘corporate’ skills. Every effort should be made to support information operators who have never used a spreadsheet and those who have no idea what an elevator pitch or an executive summary is. It needs to demystify the process and eliminate barriers to entry. Red tape should be viewed as an existential enemy.”

“At times we would have appreciated more feedback and help from people at the Foundation. I was also a big fan of the listserve of recipients that functioned in the early days of the challenge and would like to see that renewed. IdeaLab does not offer the same kind of sharing and informal give and take the listserve did.”

“Though vagueness is useful on Knight’s side, better guidance on an annual basis as to what the News Challenge is truly committed to funding would be helpful for applicants. Some of the questions on the grant application form is confusing. The word limit is a great improvement over the characters limit!”

“The selection process my year was somewhat chaotic, and communication with me as an applicant was confusing — I almost didn’t get my grant because of a miscommunication between the Challenge leaders and me that led to one real misfire of a phone interview. (Happy ending, not complaining, but it was definitely a process breakdown.) [...] After the selection process, I’ve been surprised at the low level of communication with Knight — close to nil. I’m at a relatively advanced stage of my career and happy to dig my own trench; I don’t feel I’ve been hurt by this lack of communication. But if I were younger/less experienced I think it might be disappointing.”

“For each project awarded, include funding for evaluation and recommend someone to do the evaluation work as it takes away from the project focus for the grantee to start doing research and eval.”

“Recoup the innovation lost in projects not selected. Can we help non-winners with their project, outside of cash funding?”

A bit of background. Next weekend, David Cohn of Spot.us (not one of the trouble-makers) is bringing a couple dozen of us together for Hardly Strictly Young. It’s at the Reynolds Journalism Institute, sponsored by the Knight Foundation, and will be my first trip to Missouri. Over two full days, we’ll discuss facets of the Knight Foundation’s commission on the information needs of communities. Part of this, or at least what those of us running the survey think, is to help the Knight Foundation learn from the first four years of the News Challenge. It is arguably the most significant effort from news industry actors to inspire innovation within said industry. In other words, it’s been our only hope.

Unfortunately, there’s not much data for us to work with. Yet. The Knight Foundation has all of the winners listed on the News Challenge website, along with their project descriptions and amount granted, but very little information on outcomes. This is where you fit into our crowdsourced reporting project.

We have two sections on our survey form. The first asks for quantitative information on your project, and is intentionally required for you to submit the form. We want to know whether your project is still active, how much of you grant you actually spent, and whether you achieved your stated objectives. These responses will go on the big ol’ spreadsheet of data we’ll eventually release. The second (optional and/or anonymous) section asks for a qualitative perspective on your project, including how it was successful, what challenges you faced, and what you thought of your experience with the News Challenge. These questions are intentionally broad. If you decide to respond anonymously, we won’t publish the remarks with your name (if we choose to publish them).

This data is quite important. Thank you in advance for taking at least a few minutes to respond. To make things fun, we’ll be updating a public list of who has and hasn’t yet responded. So encourage your friends who haven’t yet replied to do so. I’d like to thank On The Media for the creative idea.

A search for my name currently looks something like this:

Ideally, the search functionality should support these requirements:

• Query across all of the content objects associated with the J-School’s primary website. These objects include posts, pages, events, blogs, databases, members, groups, and (coming soon) job opportunities. Eventually it would be nice to search attachments as well.
• Expand a query to include content from any of the 216 and counting websites within the network. Filter results to a specific site, or by author, publication date, categories, or tags.
• Highlight results based on matched keywords. If possible, show the sections of text matching the query.
• Log queries and (optionally) provide analytics on search trends.

As far as I can tell, the options on the table are Sphinx, Solr, and search as a service from IndexTank. Sphinx appears the lowest-hanging fruit; Solr takes a couple of weeks to set up and configure, and IndexTank costs money for anything over 500 queries/day.

For Sphinx, there’s a WordPress plugin making it easier to integrate the two. The author has reasonably detailed documentation for installing Sphinx via the admin, if you chose to do that.

Another sys admin has written a three part series on extending WordPress search with Sphinx.

Extending search sources to custom fields is apparently as simple as adding to the select query.

The best way to dynamically add new blogs to the index for WordPress multisite is by editing the .conf file, although I’ll need to develop a way to add a unique index for every piece of content.

I intend to get Sphinx working on the development environment first, document the steps it took, then implement on production.

Startup Equity Distribution

Notice that I used the word allocation above. Allocated means not vested. In my mind all founders stock should have either a milestone or time based (or some mixture of the two) vesting schedule. If you want to know why find someone to tell you a story about a cofounder who walked away from the company and is still holding a 25% ownership stake. Trust me. It creates problems. Personally I prefer 25% one year cliff vesting with 6.25% quarterly vesting thereafter combined with individual milestones.

It’s all about K.I.S.S. Lance argues against equal equity distribution and for dividing it based on contributions of time and expertise. One approach is to determine the valuation of the company, and then use a function of proposed wages and time contributed to divide up ownership.

Equity distribution amongst startup co-founders?

Technically, equity distribution is proportional to the “value contribution” by each stake holder. In general, tangible contributions (investment, land, resources) are considered much more important than intangible contributions like experience/expertise.

The options seem to be 50/50 or distribution as a function of contributed value. People answering the question lean more towards the latter and offer some suggestions as to how to do it best.

Calculating Partnership Equity Splits

Potential formula for equity distribution: break down money to be invested, time to be invested, and experience of partner into percentages, and then determine percentage contributions of each partner. This breakdown then determines overall split of shares.

How do I survive when starting a business without a paycheck?

There are very creative ways to live cheaply if you’re dedicated. The best response in my opinion is to live out of your car and buy a gym membership for exercise and showering.

Equity-Split Results, Part 1: When Do Teams Split Equally?

Interesting chart comparing different situations. An equal split is more likely amongst smaller teams coming from similar backgrounds that divide equity at the start of the project or company.

Dividing equity between founders

One thing I’ve also noticed is people tend to overvalue past contributions (coming up with the idea, spending time developing it, building a prototype, etc) and undervalue future contributions. Remember that an equity grant is typically for the next 4 years of work (hence 4 years of vesting). Imagine yourself 2 years from now after working day and night, and ask yourself in that situation if the split still seems fair. Another consideration is if one founder has had greater career success and will therefore significantly improve the odds of getting financed at an attractive valuation. One way to figure out how much this is worth is to estimate how much having that founder increases your valuation at the next financing and then, say, split the difference. So if having her means you can raise $2M by giving away 30% of your company instead of 40% of your company, let that founder have an extra 5%.

Variables to potentially consider include: past and future contributions, career success, and who had the big ideas (and whether those ideas have any technology or intellectual property associated with them).

Brain and note taking dump ahead.

The clinic has an EMR at the moment which is very limited. It was developed by a local programmer they still have good relations with and, every time they want expanded functionality, they just ask he (or she) to build it. Furthermore, the clinic staff has been talking over the last year about different ways to expand the tools. At the moment, it captures data about the patient, vital signs, and has a free text area for diagnoses. Continuing development on this software will require significant money, of course, which is why OpenMRS is probably a better long term option. Writing software for a pretty common use case doesn’t make much sense when there are customizable open source options available. Thanks to a relatively fast internet connection today, I was able to upload a HD walkthrough of their current EMR:

Tour of the clinic’s custom EMR from Daniel Bachhuber on Vimeo.

One fairly significant problem we faced Thursday morning, however, was trying to convince the clinic staff of the merits of OpenMRS without a full featured online demo or video tutorials. I personally haven’t experimented with the software very much, nor do I know all of the useful components of a medical records system, so I couldn’t necessarily sell the software with my salesmanship.

Wayne, being proactive, took the conversation from step zero so that Lilia and Maris would be able to help assess the merits and demerits of their current system:

Basic needs of a Medical Records System from Daniel Bachhuber on Vimeo.

According to the doctor, the basic needs of a medical records system are three-fold:

1. Documentation – an EMR should have the ability to take notes and capture information on labs, Rx, Dx imaging, etc. Most importantly, this information should be searchable.
2. Networking -  an EMR should lend accessible communication, both internally (within the clinic) and externally.
3. Decision support – an EMR should be intelligent, and assist the clinic staff in identifying high-risk patients, etc.

Once we had these criteria established, we started talking about the pros and cons of using their current system.

The pros of their system are:

• Easy implementation – the software is already installed on the computer and they know how to use it.
• Design specific to clinic – they can choose how they want the software to operate because they direct the development of it.
• Know[n] commodity - they know what they’re dealing with.
• Personal sw. provider – the developer is local and can come to the clinic to provide support, etc.
• Economically speaking + impact – Cheap for what it does.

The cons of their system are:

• Design specific – the design of the software is tied very much to the needs of their clinic today, and not five years in the future.
• Expandability – uncertain as to how difficult it is to extend the system.
• $ for upgrades – have to pay to have the developer build every single upgrade. Also, only the developer knows how to build or maintain the system.
• Don’t really know “OpenMRS” – don’t have the proper education materials to illustrate the power and flexibility of OpenMRS.

The unfortunate thing is that their current system doesn’t match up to the needs of an EMR very well. As it stands, it’s not much more than a data storage tool. They use it to house basic information about the patient, symptoms, and diagnosis, but it isn’t very useful as a tool to manipulate the information. On top of that, the networking support (connecting computers in the reception with those in the doctor’s rooms and farmacia), has yet to be built and decision support is cost ineffective.

The clinic is interested in OpenMRS, however. On Monday or Tuesday, Wayne will be showing Lilia and Maris a demonstration of the EMR he uses back in the States. This will ideally convince them of the practicality of having a robust EMR. We’d also like to get them to a clinic in Peru that has a working demo of OpenMRS soon. If this proves feasible, then we might be able to send the programmer they have to an implementer’s training with PIH.

A thought on bringing the programmer into the fold: this might actually be an economic enterprise for him or her. My thinking is that there are a number of clinics in Arequipa still using paper records, so if the clinic HBI works with becomes a local model for using OpenMRS, then that might get the other clinics interested in medical records and incentivize the developer to get to know OpenMRS better.

In the interim, though, the clinic will still put a bit more money into the system they already have.

On the note of SMS, we discussed the possibility of how mobile might be useful to increase clinic efficiency:

Day seven, Arequipa from Daniel Bachhuber on Vimeo.

The idea wasn’t very well received, though, because the assumption is that the demographic that the clinic serves most likely will not have cell phones, and the clinic staff couldn’t really understand how the technology could be useful. Anecdotally, however, a doctor said the penetration of mobiles in this market is near or over 90%, a statistic which doesn’t seem too unrealistic to me. Furthermore, I think that mobiles could play a significant role in improving the efficiency of the clinic.

We’ve got an experiment cooking too. Building upon the pediatric idea briefly outlined in my previous post, we’d like to have a control group, an experimental group which receives a reminder for their appointment, and another experiment where the group receives a unique code for a discount on their appointment. In preparation, the clinic will start collecting cellphone numbers at registration. Ideally, this experiment will be later this spring or early in the summer.

One last thought on efficiency: we’d also like to run a two week experiment (probably in February) where patients receive a time-stamp upon checking in to the clinic, and another one when the doctor takes them for their appointment. I think mobile could a tremendous impact on the clinic’s ability to efficiently deliver healthcare (the concept of being on-time for appointments is nearly zero), but baseline numbers will be really important to calculate impact.

A little background. The catchment area for the clinic in Alta Cayma includes 30,000 to 35,000 people. From this population, the clinic saw 22,000 visits in the past year, with between 15,000 and 17,000 unique patients. Recorded number of visits to the clinic is increasing at a rate of 4,000/year. The clinic is pretty well resourced, according to Wayne of HBI, with a team of physicians (rotating 5, not all full time), dentists (2), nurses (9, not all full time), pharmacy (4), management (2), and two specialists, a psychologist and opthamologist. Essential medications are provided through a Catholic charity program and they can get most others through donations. Where the clinic lacks is primarily in specialization, health education, and patient care advocates.

These needs tie into the intra-clinic collaboration. On Monday and Tuesday, Health Bridges International and Medical Ministry International will be holding a conference in downtown Arequipa to bring together as many players in private, public-sector health care as possible and hold a discussion on how to improve the efficacy of healthcare delivery by cooperation. According to Wayne, there is no central record keeping of healthcare in Arequipa. There are, however, four-ish different methods of delivery:

• MINSA: through the Ministry of Health, and this is the primary source for most Peruvians
• Es Salud: if you work in the formal sector and get taxes withdrawn from your pay, then you are eligible
• Military and police hospitals
• private clinics (including for-profit and non-profit) – ballpark of around 500 to 700 of varying sizes in Arequipa

About 50 or so of these private clinics, along with government officials, have been invited to the conference at the beginning of the week. At the end of the first day, we’ll pass out a survey [Google Doc] asking questions to try and establish both the type of information to be shared and best medium to share the information through.

In any regard, this little project was the first reason I was destined to come to Arequipa. The second is a project Isaac Holeman and I are working on called MobilizeMRS. The concept is to bridge the gap between SMS (short message service, or text messages) and MRS (medical records system). The first step in the process, or in Peru at least, was going to be to introduce the clinic to FrontlineSMS and see if we could find an experiment to use it on. If they don’t already have one, getting the clinic on an electronic medical records system is a bit more difficult of a process.

Most immediate issue: this clinic implements primary care, unlike most of the use cases I’ve found for FrontlineSMS thus far.

This means that instead of focusing treatment on HIV/AIDS and Tuberculosis, they deal with “Western diseases,” or  obesity, diabetes, etc. This also means that the only “community health worker” they have is Maria, who is more of a social worker than anything else. It’s not a huge hang-up, but has made the questions I came down here with (i.e. how many community health workers are there in the network, how far do they travel, etc.) mostly obsolete, and means we’ll have to experiment with how SMS might be useful.

We have an idea, however.

Peruvian patients are notoriously tardy. It’s just not really a cultural expectation to be “on time.” In a clinical setting, this means you have to run at less than optimal efficiency, because you really don’t know for sure who is going to show up when. You also don’t know when you’re using your resources to their fullest potential.

The idea is to change this by incentivizing “on time” behavior. We’re considering doing a trial run with pediatric patients because the clinic needs to do follow-up appointments with about 150 kids. To experiment with this, we could assign 50 kids to three different morning sessions. Session one is the control, meaning we would just tell the parents that they should bring in their children between hour X and hour Y on Tuesday morning. For session two on Wednesday morning, we would send a blast text message out to the parents on one of the days preceding that they could get 50% the consultation fee (which is 3 soles, or about a dollar), if they showed up within an hour of hour X. They would each have a unique confirmation code to reveal in order to get the discount. Session three might have the opportunity to receive priority treatment if they showed up promptly. In short, I think the plan is to create an experiment like this and see what the ROI of improved communication with patients might be.

An important note about establishing ROI: it’s really, really important to have baseline numbers. This is particularly hard to do in the Alta Cayma clinic, as I imagine in many clinics, because so much data is left untracked. On top of that, all of the records right now are paper, which makes tabulation a pain. There are a few simple data points I’d like to start tracking as soon as possible: average length of time spent in line to see the doctor, number of patients that leave before seeing a doctor, and number of patients per hour by the day. These should be as easy as marking the time the patient was checked in and was seen by a doctor on their chart.

A couple of final questions about using FrontlineSMS:

• Has FrontlineSMS been implemented in other primary care settings?
• What are some ways FrontlineSMS can be applicable to primary care?

OpenMRS is going to be a whole other beast, I think. I’m heartened to learn that they’ve already been thinking about electronic medical records significantly, though, and plan on including me in a few hour meeting on Thursday to discuss potential options and ideas.