IT Innovation Contest

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Tablet-based internet/email access and international travel safety management utilizing microSIMs and local mobile telephone networks

Proposal Status: 

Project description. This project has two parts:  (a) In many foreign countries, internet and email access can be slow, expensive, unreliable, or unavailable but can be critical to project success or traveler safety.  However, GSM cellular telephone networks are ubiquitous, and the installation of an inexpensive microSIM (µSIM ) for a local network in a GSM iPad or other tablet provides the user with contract-free mobile internet and email, enabling ready access to web-based resources, expert advice, and emergency communications (e.g., iJet notfications). No special tools are needed to install a µSIM – the tray holding it can be opened using a paperclip.  A 1 GB µSIM costs about as much as one day of hotel internet access, but can provide email access (depending on usage) for up to a month. All iPads with wireless connectivity sold by Apple in the US are not locked or tied to a particular carrier (µSIM access in GSM Android tablets is certainly possible, but will not be addressed in detail to keep the scope of this short project manageable).  The primary barriers to wider adoption of µSIM tablet internet & email appear to be lack of awareness that this can be done and how to do it, and one goal of this project is to make a non-technical audience aware of the availability of this technology and how easily it can be implemented. (b) The tablet can also be used to store or access key travel, safety and academic documents, such as scanned passport pages (critical for rapid replacement of a lost passport), travel insurance documentation, emergency contact and credit card numbers, scanned drug & vision prescriptions, immunization records, student goal sheets/work logs, and so on, creating an invaluable travel resource in a small highly portable package that has a long battery life.  This enables the traveler to avoid having to carry a laptop computer and its associated gear, and/or to avoid having to use a phone interface for long or complex messages. 

Deliverables(a) A non-technical explanation of how and why this works, a short glossary of technical terms, a comparison showing the costs and limitations of other ways to obtain internet and email access abroad (e.g., international 3G plans), assurance that installing a new µSIM does not void the tablet warranty, basic troubleshooting instructions, and similar documents addressing other user concerns. (b) A how-to manual (both online and digital versions) consisting of contact information for network providers that  offer µSIMs provisioned for iPads in various countries, instructions (how to identify a GSM iPad, check network coverage, install and test a µSIM in an iPad, estimate usage over time, turn connectivity off & on, reset the  iPad, and so on).  (c) A package of digital travel links, including those on the Risk Management (RM) website http://www.rmis.ucsf.edu/RMISDetails.aspx?Panel=9 and the SOM Study Abroad (SA) website http://medschool.ucsf.edu/intlprograms/Programs/Study_Abroad.aspx as well as instructions on creating personalized resources, e.g., a scanned version of essential passport pages.  A sample (redacted) set of such resources will be developed. (d) A list of useful free & low-cost tablet travel resources, such as Google Maps/Earth/Translate, SmugMug (offline picture storage app), and OffMaps2 (offline city maps).  All deliverables will be linked or housed on GHS, SA & RM webpages.  Proof of concept has been independently demonstrated by two project team members, and we hope to be able to test and evaluate µSIM iPad access in Mexico, Central America, and Kenya this coming September (and if so, the travelers involved will provide structured evaluation and feedback on the deliverables – we’d also like to try out sending iPad photos for medical consultation as well as VoIP connections with the iPad).

Impact on UCSF’s mission and community.  This project would directly support UCSF’s vision of Advancing Health Worldwide, and could facilitate inter-professional provision of health care.  Any member of the UCSF community who is travelling outside the US for rotations, research, and/or academic business – particularly, but not limited to, students, faculty and staff in Global Health Sciences (GHS) - in an area with GSM mobile phone service would potentially benefit from this project.  By providing electronic communication 24/7, it would contribute to their safety, security, and mentorship, could enable distance consultation, and might also result in significant cost savings for internet access.

Team members (all will be users/project evaluators): Chris Cullander, Institutional Research, SAA – visionary, subject matter expert/content provision, utilization evaluation; Andrew Sinclair, Risk Management & Insurance Services –subject matter expert/content provision; Scott Barter, ITS- network and phone technologist;  Teresa Moeller, CTSI & GHS – subject matter expert/content provision, dissemination; Mylo Schaaf, Pathways Explore Global Health Advisor - subject matter expert/content provision, supervision of students abroad, utilization evaluation.

Estimated time devoted by each team member   CC – project lead, ~50% time on evenings and weekends (non-worktime), all deliverables.   AS – travel safety management resources, ~10% time, primarily deliverable c. SB – technical advice & explanations,~10% time, evenings, primarily deliverable a.  TM - GHS & CTSI web resources, ~15% time, primarily deliverable c and review of a & b. MS - supervision of students abroad, ~15% time, primarily deliverable c & traveler evaluations, if accomplished.

Comments

Why a specific focus on iPads? My understanding is that Apple hardware is hard to service or replace in many developing nations, where Android tablets are often more accessible and often bundled with local mobile data plans. Examples: http://it-depot.net/pages/tablets and http://trak.in/tags/business/2012/04/24/top-4-cheap-value-money-android-...

Hello Anirvan - Thanks for your comment. We wrote with a focus on iPads since this is intended for members of the UCSF community, that's what most folks at UCSF seem to have, but as we noted in the proposal, this could work for other GSM tablets as well. With respect to ease of repair, the question is how often a tablet requires service (very rarely) - and in fact that may be another reason to travel with a tablet rather than a laptop. I would NOT advise anyone to purchase a tablet with a data plan abroad, since they are often locked to a particular carrier, and availability of repair may be an issue in the US - but as one of the links in your message makes clear, GSM microSIMs are available in India. Thanks, Chris

A very imaginative use of existing resources and technologies to assist in traveling abroad. This has obvious applicability outside of UCSF community, as I don't see any UCSF specific requirements. I hope this is available the next time I travel abroad! As an iPad owner, I can see the benefits of utilizing this resource.

Thanks, Enrique!

I agree with Anirvan, expand the project to include other tablets, although the iPAD is most common among faculty (especially those who want functionality out of the box). It seems that not all tablets are unlocked, and short of asking people to jailbreak their equipment, we need a short "how to identify if your tablet can do this", as well as an infographic on swapping in a SIM. (for each tablet). I had no idea that the iPAD had this functionality, and I agree that tablets are going to be more broadly adopted in constrained settings as communications devices for diagnostics and epi data collection tools. I am already aware of many faculty who have given up toting their laptops. Giving the tablet increased functionality while abroad, while tailoring some of the UCSF safety and communication information to their format makes sense.

Hi Teresa - Thanks for your comments. Although this should work with any GSM tablet, we intentionally limited the scope of this project to iPads for the reasons given in the response to Anirvan's comments (see below) and so that the project could be completed within the time span specified. All iPads obtained from Apple in the United States that have wireless mobile connectivity (original, iPad2, iPad3) are not locked and not tied to a particular carrier. GSM iPads can be easily identified by their serial number on the back of the device. A short 'how to' about doing this is a good idea, as is an infographic on swapping microSIMs (this would be an improvement on the text description that we anticipated providing). I think we'll also add a short troubleshooting guide (cleaning a microSIM, how to do soft and hard iPad resets, etc.) - Chris

Nice work Chris and colleagues. I do think this project has great potential for supporting a range of interprofessional learning and teaching activities, as the use of this technology allows students and faculty from the different professions to engage with one another and share health care information and insights across countries and time zones. This project is also extremely timely - the use of informatics for enhancing interprofessional education and collaboration is only beginning to emerge in the interprofessional field. This is occurring as the shift moves away from single professional use (e.g. medical informatics) to a focus on how technology can be employed to promote effective synchronous and asynchronous interprofessional interaction.

Thanks, Scott! I like your point about how this technology could facilitate inter-professional provision of health care, and will try to include that in the revised proposal.

This will be an extremely useful innovation for students and trainees doing global health work! I have a few questions/comments: 1. Can this innovation also be used for consultation on difficult diagnostic cases since there is a camera on the iPad? Trainees frequently wish for sub-specialty contact with faculty back at UCSF, for management or diagnostic issues. What would be the cost, for example, for sending several (non-identifiable pictures) with case history back by email from east Africa? Or perhaps a real-time consultation. This would expand the benefit of the innovation, allowing UCSF another way to give back to many of the international sites. 2. How safe is it to store the emergency documents (like passports) on iPad? 3. Could we include student journals/goal sheets on the iPads, with the goal of improving real-time mentoring as UCSF faculty could share the unfolding student projects. 4. Could we test the feasibility of 1 & 3 in the next 2 months, since we have students going to Mexico and Central America? And although I've been writing about medical students, clearly this system could benefit the mentorship of students in any school. Mylo Schaaf Pathways Explore Global Health Advisor

Hello Mylo – Thank you for your comments and questions. Taking them in order: 1. Using the iPad camera for remote real-time or asynchronous medical consultation. Certainly possible, with the major consideration being the amount of data transmitted and the data limit of the particular microSIM purchased (they come in different sizes). Emails typically are 10-100 kB, and one iPad2 photo (using the 0.9 megapixel back camera) is about 300-400 kB, however photos with the 5 megapixel iPad3 back camera will be much larger unless they were compressed before sending them. You’d need to experiment to find what an acceptable image quality was. In other words, you can send lots of short emails, but transmitting big picture files would reach the data limit on the microSIM more quickly. Video represents a huge datastream, and videoconferencing would probably be impractical. There are several voice-over-Internet-Protocol (VoIP) apps for the iPad (e.g., iCall, MobileVOIP, etc.), but I haven’t used any of them. Voice data is a relatively thin stream, but would still gradually deplete the chip data allocation (far more slowly than videoconferencing would), however this might be worth it in some circumstances – definitely worth a try! There are presentation apps (such as Fuze Meeting iPad) that might be useful for consultation as well (without using its video features). Given the time difference between Nairobi and San Francisco (10 am here is 8 pm there), real-time interactions would be challenging but are do-able. 2. iPad data security. iPads have very good security features, including a device passcode, hardware-based encryption for emails, and secure network access, and this would probably be sufficient. For more information, see http://www.apple.com/ipad/business/integration/. If you want to secure individual documents, there are apps such as Stash, GoodReader for iPad, and WatchDoc, among others. 3. Student journals/goal sheets. Sure. Beyond just using email for this, there are collaboration apps ranging from whiteboards to fairly sophisticated ones such as Huddle (see http://www.huddle.com/this-is-huddle/collaboration-apps/). Some are free, others not – pretty much depends on what you need. 4. Testing feasibility with UCSF students in Latin America. Great idea! From their webpages, it appears that two of the three GSM telecommunications providers in Mexico provide microSIMs for iPads – the next questions are whether either provides coverage in the area that the students will be in, and whether one of the students (or someone accompanying them) has a GSM iPad and is willing to try this out. One of the Mexican providers has network access agreements with several Central American companies, but that probably comes at a price – if you’ll let me know which countries the students are traveling to, I’ll look into GSM networks there. You mentioned East Africa in your first question - Kenya (for example) has two GSM networks, and the providers supply iPad microSIMs as well. And yes, this setup could be used for mentoring students in any program who are doing research or training far away from San Francisco – thanks for pointing this out!

Using the SIM card within the iPAD can provide more comprehensive access to email while traveling. Since the iJET alerts are sent by email, it is invaluable to have email access while in rural areas where much of our research takes place. In addition, when a situation escalates, as determined by iJet, UCSF contacts registered travelers to ensure they are aware of the escalation.(many examples- Ebola this week!) This is also done PRIMARILY through email, although we typically have several routes of recourse if we cannot get hold of one of our people. If we enable people to use their devices cheaply and easily while they are traveling, they maintain their pattern of use, and we have a more predictable communication stream.

Thanks, Teresa. This points out how email access, which we tend to take for granted, can become of critical concern when it's hard to obtain.

I think this would be a convenient and reliable way to communicate with students who are at our remote externship sites in California too. Great idea. Dorothy Perry

Thanks, Dorothy. Just took a look at the Dentistry webpages - I wasn't aware that your School operated so many rural and/or remote clinics!

Chris, Thanks for letting me know about this innovative project. I imagine that it would be an extremely useful tool for our students working abroad to communicate both with their advisers back in the US and with each other as well. I know that it would be especially well received by our graduate programs in Global Health Sciences, Medical Anthropology, and History of Health Sciences, who regularly have students living and working outside the US. Liz

Thanks for your comments, Liz. Glad to hear that this would be useful for graduate academic students as well as those in the health sciences.

Faculty in Family Health Care Nursing agree this project has great potential benefit for students within our programs involved in distance learning within and outside the US. We would welcome the opportunity to expand such offerings to student and this project would facilitate our ability to do so.

Thanks, Linda - glad to hear that there is Nursing interest in this project!

This is a very well-timed proposal, Chris. Faculty and students in the School of Pharmacy working on global projects would find this particularly useful and it would allow for stronger collaborations with our global partners. We currently have a student working in Uganda during this Ebola outbreak and although she is safe, I think access to this kind of resource would certainly have helped with communications. Because I personally do a lot of work in subSaharan Africa, I am keen to see this advance. I can also say that Apple's change in policy re: the need for a credit card on iTunes has meant that my local partners have been able to embrace these devices to a greater extent as well.

Tina, thanks for your comments, and pleased that this resource would be useful to Pharmacy. Glad to hear that your student is safe!

A critical component should be clear and simple instructions on what to do in case of an emergency while traveling for work related activities. This should include the telephone numbers to our evacuation insurance (and a list of the services they provide such as medical advice), who to contact back home (key numbers in your department as well as at the campus level), and how to access iJet travel advisories.

Absolutely - this information will be part of deliverable (c). Thanks for commenting!

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