Big Ideas in Small Places

Big Ideas in Small Places

Jeffrey Tingle has glimpsed the future in the keypad of a cell phone. After years of developing software for medical applications, he has turned to an idea both bigger and smaller than any he has explored before: using mobile technology as an instrument to deliver healthcare. He has figured out ways to use the most basic phones to ask questions and generate answers about symptoms, dosing, and other issues, to offer medical assistance to those who otherwise might have to do without it or obtain it only at a sacrifice to their families—and livelihood.

Last summer, Tingle—a chemistry major from WPI’s Class of ’77, who also has an MS in geological sciences from Brown University—took a detour from the corporate path and volunteered on a project that placed cell phones in the hands of community health workers in rural Chiapas, Mexico. Now, he is considering not only how to expand this idea among the world’s most underserved populations, but also ways in which mobile phones can facilitate healthcare delivery here in the United States.

On a spring afternoon at his home in Harvard, Mass., Tingle describes himself as “very focused, very driven” in his dot-com days. Medical enterprises ranging from drug discovery to risk management benefited from his know-how and, in turn, he became highly informed about the intersecting fields of medicine and technology. A skilled climber and “fanatical” cross-country skier, Tingle exudes vigor, even while sitting on a wicker chair with a laptop nearby. He traces his enthusiasm for physical challenges to WPI, where he got hooked on the outdoors first at a winter session at Baxter State Park in Maine, and then as an avid member of the outing club. Thinking back on the allure of climbing, he asks, “Was it for the thrill or for the problem solving and management of risk?” He has concluded that it was the latter, and he believes these forces remain powerful motivations in his current, more alternative, exploits.

He calls up an image of a cell phone on his computer, with the word MicroEmulator in place of the brand name. In the cell’s window, three headings appear, in Spanish or English, depending on the user’s selection: pediatric dosing, adult epilepsy, and diarrhea in children. The emulator can furnish a sequence of questions and the corresponding answers for these problems and others confronted by a community worker administering healthcare in a remote location, far from a clinic or hospital.

This two-dimensional picture represents Tingle’s efforts as a volunteer for the initiative in Chiapas, supported by Partners in Health, a Boston-based nonprofit dedicated to providing medical care and social justice to some of the world’s destitute people. For this project, Tingle worked on software to be installed in the phones distributed to community care workers chosen to serve their villages. One worker per village received a phone, so that in this very poor and remote region, perhaps 5,000 people in a dozen villages could be aided by the software Tingle devised.

“I was updating clinical protocols, recoding the logical stream,” he explains. “They needed a way to help community health workers provide medication to children. They have a toolkit that contains about 10 different drugs. I worked with clinicians to build an application around the dosing protocols. Before, it was ad hoc. If they had a big kid, they might give him 3⁄4 of an adult dose. There is a diagnostic component as well. If the fever is this high and there is diarrhea, what is it? We’re not trying to treat more insidious diseases. The program is trying to take care of 80 percent of the people 80 percent of the time.”

But that improvement can significantly affect both the physical and the economic health of patients. “These are isolated villages,” Tingle says. “If a woman in harvest season has a sick child and has to walk two days to a clinic, that is an enormous economic hit.” If that woman, in turn, can be home picking crops with a child on the mend, the help extends to multiple individuals.

Tingle is an astute observer of high-tech trends. “If you’re going to survive in technology,” he says, “you’re going to have to reinvent yourself every three to five years.” And so he was primed to think of mobile devices as the next wave, especially after a case of undiagnosed low sodium sent his elderly mother on a circuitous journey through the U.S. healthcare system, while she experienced dementia, falls, mixed-up medication, and an assortment of other problems.

“It took some smart doctors a long time to figure out what was wrong,” he says. “Could we have shortened the cycle and made it less disruptive?” Tingle’s mother does not live in a remote Mexican village. She lives in Rhode Island with her husband. Tingle and his three younger brothers are all within an easy day’s drive. Nevertheless, the crisis got Tingle thinking about the potential for mobile technology as a healthcare tool even in a country where doctors are plentiful.

Tingle is certain that, just as a phone assisted in delivering better support to isolated villagers, a similar system could prove valuable in coordinating care for seniors. He imagines being able to combine a host of options within a single device. Along with a list of medications, there could be a way of checking that these were being taken, as well as guidelines regarding missed doses. A Twitter-style status update could simultaneously inform all family members about appointments and allow someone to sign up to accompany the patient to the next one. 

The software hasn’t been created yet, but Tingle is already reaching out to possible partners in this venture. At “meet-ups” in Cambridge’s Kendall Square, he and others consider what the product would be, how to bring it into existence, and then market it. “With any software development, people build upon the generations before,” Tingle says. In his hands, that process is continuing.

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