Joel Selanikio: The surprising seeds of a big-data revolution in healthcare


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

79 Replies to “Joel Selanikio: The surprising seeds of a big-data revolution in healthcare”

  1. Save yourself some time and start watching at 9:00, the first half of this presentation is just common sense that you already know.

  2. What I don't like about this is this can be applied to pretty much everything, and that's the direction we're heading in. Data about everything you do will be stored, and without the proper safeguards, that can accessed and abused by governments searching for dissent and activists or insurance companies raising rates on customers who they think are unhealthy or are somehow at risk for whatever they have insurance for. I just want the right people to use all this data for the right purposes.

  3. Only our inputs though, kind of like keystrokes but hands free. Technology is available but will take some time to execute. But hey if my government wants to track my input for the better, it doesn't bother me at all.

  4. It's very good that he took the time to put things into perspective how fast things changed over time in the profession that he is in. Also, I did not know that people went from door to door to collect data.

  5. This is all pretty much common sense stuff, and he didn't really elaborate on HOW keeping track of how many babies are born is saving lives. I assume it has to do with distribution of vaccines, but he didn't really elaborate on that point.

  6. If every country was a first world country we would be a stronger world but we are still in are early stages

  7. You don't know Hawaii the medical system here is like fascist , judgmental, assumption its in your head until your tumor metastasized and blew my ovary up. Then they say oh your not in pain you just want to get high off the pain meds. Um really ok dr I didn't know you could feel inside my body thank you for judging me and being biases here is the tumor pic do you believe me yet?

  8. How do you know they'll be tracking your input for the better? Authoritarian governments, of which there are many in the world, including our own if things continue in the direction they're heading in, will use their tracking capabilities to search for political advocacy to silence in order to keep the power they have. This tracking technology needs to controlled or it'll get abused.

  9. I don't know for sure, but it's always a bet whether or not to trust someone. If my government is clearly not doing well and greed and corruption is apparent, people will speak up and a new government will arise. But it's not like the NA government isn't monitoring our internet activities already. The technology is just a convenient way for input, hands free style so nothing to worry about my friend.

  10. It's not a bet a to trust someone if you're smart enough to realize what kind of person – or government – they are, then you're sure whether or not they're trustworthy.

  11. "If my government is clearly not doing well and greed and corruption is apparent, people will speak up and a new government will arise."

    This reeks of naivety. There are MANY countries where greed and corruption is apparent, but the people DO NOT speak up because getting large portions of the population to speak up at once is extremely difficult to do, requiring very specific sets of circumstances.

  12. "If my government is clearly not doing well and greed and corruption is apparent, people will speak up and a new government will arise."

    Even if the people do speak up and something actually comes out from it, new governments DO NOT magically arise. There may be small changes or a shift in leadership, but for significant change to occur there needs to time. Almost always, broken governments have problems too deeply seeded to be fixed by a simple change of leaders.

  13. "The technology is just a convenient way for input, hands free style so nothing to worry about my friend."

    I'm sorry, what? Nothing to worry about? Even if the government won't do anything significantly wrong with this today, what's to stop them from abusing this power years down the line? To use this data to seek out and silence political activists? The ability to see into all electronic communications is fundamentally WRONG because it gives them broad, unwarranted powers they don't need.

  14. I like how you inject attitude and conspiracy theories into a calm talk about new technology. Way to kill it.

  15. Will not we loose our morals if we continue to use "BIG DATA" as a template for managing others; especially for the lackluster of an experience?

  16. It's not a theory, nor is it a conspiracy. A conspiracy is when two or more entities plot to do something illegal, usually for political benefit. I'm just raising the problem that, just like pretty much anything else in the world, this can be abused without any sort of oversight. Currently, there isn't any oversight.

  17. Government and Tech company conspiring to use new tech to obtain and abuse power. That to me sounds like a conspiracy theory. Anyway, the members of the government are subject to the law as much as anyone else and their actions are largely transparent so corruption is pretty hard to go unnoticed. At least that's the case where I live. And as much as the government is monitoring their citizens, we also have a combined effort in monitoring our government.

  18. I guess the sketch of the old situation is to make us feel what a huge organizational change has taken place.

  19. 1) I never said tech companies were involved, only the government. And as I've explained it's not a conspiracy since it's technically not illegal, although that doesn't make what they do right. Whether or not it sounds like a conspiracy theory to you doesn't matter, you're wrong.

    2) Where do you live? I'm speaking within the context of the US.

  20. 3) They have a MUCH greater ability to monitor us than we do to monitor them. They can read our emails, listen to our phone calls, and track us online. Don't believe me? Read about the recent Prism scandal and the documents Snowden leaked, they prove the NSA is recording us digitally.

    4) We cannot monitor them to the degree they do to us. We can't hear their phone calls, read their emails, or listen in on what they talk about in their private meetings. In fact, our government can be very opaque

  21. The idea behind this is a powerful tool that will help analyze fields that need this information in order to make their logistics more efficient. On another note, all this paranoid bullshit makes sick. Nobody gives a flying fuck about your pathetic lives and your moronic activities.

  22. "We can take a process that took two years and compress that down to the space of 5 minutes"
    But you couldn't do it for this talk?

  23. The first 12 minutes of this talk was pointless and could have been summed up with "So I made this website."

  24. Magpi runs on Java. This makes me wonder how many phones in sub-Saharan Africa have Java installed?

  25. Actually quite a few. Feature phones using JavaEE are very common in Africa. Landlines may not be available. But mobile phone networks and cheap featurephones are.

  26. I think the key is to make centralisation of power obsolete. History clearly shows that when you have too much power in one place, it eventually leads to disaster.

    That's where distributed systems can help us – early examples being Kickstarter, providing an alternative to bank loans, Kahn Academy, alternative to a degrading education system, eBay, Bitcoin, Wikipedia, and the blogosphere, the list goes on, and we will start to see more examples affecting real world change in our lives.

  27. Really? You're more likely to be shot by a cop than a private citizen. Government officials and corruption are synonymous. Congress passes laws repealing the ban on congress insider trading. Obama campaigns as an anti-Bush and becomes Bush on steroids. The IRS already targets groups based on political alignment. The NSA listens to EVERYTHING. And people have been shouting about all this for years. Why have people become so trusting of government? It's a gravity well for evil. Look up 'democide'.

  28. it might seem like such a mundane thing but it's actually pretty impressive. The fact that it already seems to be mundane might even make it more impressive. He started around '95. Now it's 18 years later and so much has changed. This might be one of the biggest changes in the entire history. And it's almost certainly one of the fastest.

  29. They only need to be able to send the forms to Magpi by text. Obviously you need a computer with Java installed to be able to access the data (something midwives and school teachers don't need to do).

  30. You'd be very surprised at how much mobile penetration there already is in Sub-Saharan Africa. It's a huge market. Meaning that people are literate enough to use the technology. You'd also be surprised at how far mobile coverage reaches over there now. People in rural areas do have and use cellphones in a lot of Sub-Sahara Africa.

  31. This would have been cool if I had watched it in 1995. I'm wondering why not send someone to vaccinate people AND collect data. Would that be too much for one person to handle? Also, we would not have to send a second person out to do the vaccinations. Having data is nice, but let's not forget why we are doing it.

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  33. The issue there is how do we define the "right" people and the "right" purposes. But in short it looks like you spelled out the problem right there.

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  35. US $5,000 / year or $500 / month – Included record uploads per year 10,000 / year

    kinda expensive for Africa isn't ?

  36. I made a website that collects data too, shows graphs and maps, and anyone can use it, along with 900 million other programs the same sort of thing, even in healthcare, all in the cloud (and, since you brought it up, let's stop calling it the cloud… it's the internet). What is new and groundbreaking here? I must have missed something.

  37. So should you waste millions of dollars bringing vaccines to people that have already been vaccinated? And how do you even know who should be vaccinated when you don't keep track of the number of people being born?

  38. Meanwhile, the U.S. Government still sends out an army of people every 10 years to do a head count of the entire country. No wonder we are trillions of dollars in debt.

  39. I am a civil engineer from germany. How can I help ?
    We use the net for structural design and training our engineers.

  40. This was nothing more than advertising his product masked as world saving tool :X shame on this guy. Why you put such stuff on TED??

  41. For example in google or in office you create forms for free without this limit of 500 entries that they have here or if you want to upgrade to PRO it costs only 10 000$… WTF?!

  42. I wondering why not send one team to collect data and meanwhile other team enter data into the computer .

  43. Of course digital is more efficient then paper, but this talk speaks about how this impacts developing countries in a big way.

  44. This is such a broad video. "if my government is clearly not doing well and greed and corruption is apparent, people will speak up and a new government will arise". is it even understood how the government works? that is something that will not happen. sure, there will be small changes that might come forth, but new governments do not just come out of the air. but, just for discussion, lets say one would. there is greed and corruption, people speak up and poof, new government. who is to say that this new gov't wouldn't have the same issues? what if this new gov't is actually a dictatorship who is going to be the head, the first to speak our of the ones who support them? there us always much more deep seeded issues that would need to be taken care of if you wanted to fix the broken gov't. then stating that "I just want the right people to use all this data for the right purposes". one more thing, that is never going to happen. it is ridiculous to think that the data will be used for the right purposes. the world and the information is not safe prom the predators or the people looking to do malicious things with what they find. it is a new world, and it revolves around needing to be more careful. they will not change, so we need to change our actions instead.

  45. About 4 years old but still relevant. People don't seem to understand that health decisions are constrained always by limited resources and lack of will. The collection of good data, easily and accessible, is the kind of advocacy that can make changes in how those limited resources are allocated or even higher level policy changes.

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