Oh good morning everyone. You're very welcome. Thanks very much for joining me this morning. A couple of things I want to talk about this morning and these are like most of the things I talk about heart loop related are relatable to the whole country and I know that protests are happening across the country against compulsory vaccination, vaccine passports, the Chinese social credit system that we're staring down the barrel of and one such protest took place in Hartlepool on the Saturday just gone which I attended and the first thing to say is to congratulate people who did go. It's good to see political engagement from people so well done to everyone who did go. There wasn't though to my knowledge any representative from the local council there certainly weren't any there's certainly the MP wasn't there and the MP isn't going to speak to these people, not even speak to these protesters and the reason for that is that she's a Tory and it's the Tories that are behind this but there wasn't anyone there from from local council as well to my knowledge. Karen King prior previous councillor for Britain was there protesting for the restoration of all the freedoms that we have lost and we have lost a lot of our we have lost our freedom and they would now got Nadim Zahawi the vaccines minister telling us that he will do all he can to prevent a fourth national lockdown. This is first of all the guy who told us that we would not need vaccine passports and then stood in the House of Commons saying that we were essentially that we do need vaccine passports. The language of these politicians since this began has been very sinister but now recognisable so when Nadim Zahawi says we'll do all we can to avoid a fourth national lockdown that means that a fourth national lockdown is looming and I didn't see this coming I didn't I didn't think they would even countenance even comprehend even begin to suggest of another lockdown another national lockdown but they are and this will be ramped up as we go on as kids go back to school for example expect to see more and more and more of this. One thing I do want to say to the people who were there protested on Saturday and something that occurred to me at the time and occurs to me whenever I go to these protests is are the people at this protest going to go and vote at the next election and if they do are they going to vote Labour or Tory? My guess is that large numbers won't vote at all and the ones who do are likely to vote Labour and Tory and yet will take to the streets to protest against the very against the things being done by the people that they vote for and if you voted for them prior to lockdown and vaccine passports that's hardly you can hardly be held responsible for that but we've got to we've got to stop voting for them and just a picture scenario what I would what I would envisage happening and that would change things in this town and again everything I say about this town is relatable to all towns and cities across this country. Let's say everyone at this protest got together and let's say all decided to stand against every Labour councillor and every Tory councillor and those who wanted to stand would stand would be the actual candidate and others who didn't want to stand would get behind them and lift it for them and knock on doors for them and make a big create an atmosphere locally that we are coming for Labour and the Tories the local people who are tired of being laughed at and making mugs of us and we create an atmosphere and this could be this could be create recreated all over the country there are local elections coming up again next May in parts of the country including here why don't we do that why don't we do it and then why don't we challenge them for parliamentary seats why aren't we doing it it's not an easy thing to do but it's the most effective thing to do and it's the only thing that's going to make any change you've got to go after Labour and Tory at the ballot box and if everyone at that protest the other day did that if we organised ourselves selected seats went after these two parties at the ballot box that's where changes if you don't want to stand yourself get behind someone who does get out there that's how we're going to change this that's how we're going to change the country back to sanity that's how we're going to get our freedom back everything everyone has a part to play in all this protests have an enormous part to play first out I met some people that I've already followed up with and we'll be seeing again but if you want to take your country back and you want to take your power back that's how to do it and it's not that difficult it's not easy but it's not enormously difficult either it's an it's a great experience anyone who's ever stood tell you it's a great experience that's how it's going to be that's how it's got to be done it's got to be done that way and I'm asking on this stream this morning asking people who were in attendance at that rally to contact me it was a great rally it was a great atmosphere um briefly stopped traffic which I thought was quite fun sitting in the sitting in a street on sort of a crossroads here at the center of the town and a circle of people sitting in the street blocking traffic that was great and it was only only the appearance of flashing blue lights that stopped people from doing that picked up a lot of literature a lot of leaflets and one in particular that is serious and and people are I think people who would not maybe wouldn't have otherwise got involved with this are now starting to sit up and take notice and that is the vaccination of children and wait there is a fourth lockdown looming I wouldn't have believed this two days ago but now that Nadim Zahawi has said there's no we're going to try no no no fourth lockdown no not another national lockdown the fact of the saying that tells me that there's another lockdown looming and I think that will bring more people make more people sit up and take notice but a newspaper I picked up at the protest on Saturday is it's the light paper the lights I'll just show you the I do like this paper and one of the reasons I like this paper is because they've interviewed me and that tells me that they actually practice what they preach when it comes to freedom of speech so there's an article in here which was a great deal of focus on at the protest on Saturday and that was as I say the vaccination of children so there's a letter that has been sent I'll just say just go through a little bit of this and this was a letter that was sent to Boris Johnson, Mark Drakeford, Arlene Foster, Chris Whitty, Frank Atherton, Michael McBridge, Sacha Javid, Elunid Morgan, the JCVI to the Joint Committee on Vaccination and Immunisation and the Medical and Healthcare Regulatory Authority, the MH or the Children's Commissioner and Children's Charities and we just read you a little bit of this letter this is really significant we are writing as professionals, medics, academics, parents, grandparents and members of the public to express our grave concerns about suggestions to extend the COVID-19 vaccination programme to children we believe this is a hasty step that is uncalled for under present circumstances you have been clear that society can reopen once the vulnerable have been offered vaccination against COVID-19 this has now been achieved all the highest risk groups have now been vaccinated and the government's own data confirms that 98% of over 60s have antibodies from either vaccination or infection that is really significant 98% of over 60s does basically all and this is of course the most high risk group the NHS has been protected and we no longer in a crisis situation whilst the very old and very frail will sadly always be at risk of serious illness our children or the future children's lives have been put on hold for over a year already at great cost to their physical and mental well-being and education we must not ask them to suffer further harm for the sake of adults thankfully the evidence shows that children and young people are minimally affected by COVID-19 vaccinating children then is of limited direct benefit to them but for the primary purpose of protecting adults however medical treatment cannot be justified if it poses a risk to the individual which is greater than it protects against that's another key point there is a risk here and if children don't suffer from COVID-19 unless they already have complex and serious conditions then where's the risk on that side whereas the risk on this side is higher because on say keep being among the government vaccine novel vaccines fast track to market let me start that again keep being of the government vaccine novel vaccines for yeah that is what it says but I didn't miss read it vaccine fast track to market have in the past caused devastating harm we draw your attention for example to the many children who no live with severe nervous system injuries caused by the swine flu vaccine which was given to children in 2009 2010 it goes on to give examples of dangers of risks and why are we taking that risk with healthy children okay what is effectively compulsory vaccination of children and what will be a compulsory vaccination of children regardless of the risks even though the NHS is no longer in this crisis it was supposed to have been in at times when doctors and nurses were dancing on TikTok NHS no longer in crisis remember that was the first request from the government stay home save lives protect the NHS we all remember that don't we and that's what it was all about at the time which was preventing the overwhelming of the NHS so that's no longer an issue up until next week or the week after 98% of over 60s now have antibodies either from vaccination or infection and it doesn't cause specific or particular harm to children so why vaccinate children and why are we now staring down the barrel of a fourth lockdown and we are there has to be a point when we come to the conclusion that this isn't necessarily about public health anymore I don't believe that everyone involved in this sees it as something senator something a targeted seizure of our freedoms and civil liberties I think a lot of well-intentioned people have done what what was asked of them when this started because a lot of well-intentioned people wouldn't believe that this could happen that every civil liberty we have could be taken away from us on a whim like this lied to and lied to and lied to over and over and over again people still wouldn't believe that our politicians would do this but they are doing it and by the looks of things they're going to do it again and if we are sent in now to another lockdown which is what we're being prepared for I sincerely sincerely hope that that will be the last straw for a lot of people this thing simply isn't the threat we were told it is we were told late that it is in the early days we Boris Johnson Chris Witty all the rest and told us this was a fairly insignificant disease even a small percentage and I quote him even a small percentage of over 80s only a small percentage of over 80s will actually be killed by this this is Chris Chris Witty back in the early stages of this since then we've had lockdown after lockdown compulsory masks school and university absolutely destroyed for young people no vaccine passports followed by vaccine passport and this all started with three weeks to flatten the core remember but I followed this up on saturday I went to this protest and then I met somebody who told me about regular meetings on monday evenings so I went along to this meeting on monday evening and there was a speaker there and I don't know what his name was but he called himself the people's lawyer I'm not sure he was a lawyer but that's what he called himself and unfortunately because I had a live stream I wasn't able to stay for at all but a couple of observations on what I did here first of all it was very interesting what I was there for was very interesting and I would have liked to hear the rest of it what was the what how can I describe it so what observations going out there is a phrase I'll use to describe some of the stuff that was being said um and it's you know it's it's like I say it's interesting it's an interesting discussion it's an interesting debate but we have to remember something very important we are up against politicians this is this has been done to us by politicians they're the ones taken your rights away and if we do go into another lockdown it'll be the politicians who do it it's the politicians who are lying to you this is a political matter this is politics and in order to defeat the politicians in order to bring the politicians into line in order to stop the politicians destroying our lives we've got to challenge them politically and what I heard while it makes a great debate and a great discussion is not politically valid tangible saleable schools are effectively the word wasn't used but this is the sort of impression it creates in camps you know um schools should there should be not a thing is school um schools destroy children's self-confidence and they learn one of the things that was it was a children learn nothing in school I'm sorry and by the way I'm not we're not talking about the indoctrination camps that in neo-communist britain school has become it's school press a school in general and children learn nothing in school but I learned to read in school I learned to write in school I learned mathematics in school I was in school in the 80s which is a different completely different era I went to start a primary school in the 80s it was a different world but to say we learn nothing in school is simply not true you learn a lot of socialization in school you'll meet friends some of them will be friends for life um and importantly parents believe that they are doing the right thing sending their children to school so to be on such a radical to see to be to present such a radical framework to people that school per se is a problem and that children learn nothing in school is bad politics you're basically telling parents you've done the wrong thing by your children by sending them to school it's completely normal for us to go to school radical theories about how there is no such thing as transmissible illness this was another thing put forward it's simply that won't hold any water with anyone you're not going to win people over with radical theories like this and and and they are theories and radical ideas that turn everything that the parents and their children know to be normal on its head that almost place blame on parents for doing this to their children they're not going to listen to you they're not going to listen it's not politics and like i say it's a bit it's an interesting debate interesting discussion the nature of things but it's not politics and it's not how you're going to stop this this is what we're talking about this this this seizure of our humanity which is what it is it we're not we're at the very every movement for the last year and a bit it's been controlled by the state neo-communism if you want to stop that if we want to fight that and it's here it's right on our doorstep it's right in front of us then you're going to have to start meeting people where they are theoretical debate great winning people over politically it's not going to work it's not going to happen and that's what we originally needed to do so here's what i suggest whatever people's view on vaccination vaccination in general or this vaccination whether or not they trust the government still even after all of this i'm aware that some people actually want lockdowns and things i mean it's just absolutely bizarre but let's find something that we can all agree on and it's that something we can all agree on that you campaign politically on radical theories will lose people and they won't listen to the not so radical of what you're saying so if you tell people that schools are effectively torture camps you're sent your kids to this thing you look at you to teach you this is this leave it leave it like oh this is this it's it's brilliant theoretical debate for a specific area of interest fine leave the radical stuff out of the politics find what we all agree on or what the vast majority of us will agree on and talk about that make sure people understand over and over again that they're being lied to and they have been lied to so even whatever your view is on covid or vaccination know that Boris Johnson has been lying to you Nadim Zahawi has been lying to you they've all been lying to us and we can prove it we can prove it with objective evidence and facts and truth you don't need any radical theory to show people that they're being lied to and that they will continue to lie to us if we continue to vote for them that's not going to change not going to voluntarily give up the nastiness that they've been surviving and thriving on for years and then voluntarily give us back our freedoms and these things don't affect them the way they affect us i mean i look i promise you the politicians are not living their lives under the same restrictions that you are i promise it i mean you it's i mean they've been caught out in ireland for example it's absolutely caught with the jesus down in ireland more than once doing things to telling other people not to do what what we what can we all agree on what will most of us agree on even the most ardent pro lockdowner what will they agree on and that is that we should be told the truth there is no room for debate scientific debate in this political scenario we are not allowed the press politicians will not allow opposing or even differing views on these issues to be put forward if someone won't allow a debate to take place that someone has an interest in not allowing that debate to take place that someone has an interest in silencing other views why might that be something to hide none of this is far out there none of this is radical through this is just basic life that everyone everyone understands and everyone can get on board with we want the truth that's all for and for britain campaign for the truth as we always have if the truth is that this is the most dilliest virus and it's absolutely necessary the government's preventative and and immunization efforts are i mean absolutely necessary to save us if that's true then come as well but it isn't true and more importantly we've no way of knowing what's true because the powerful mainstream media mainstream politicians by the way it's my opinion that it isn't true but we don't know because mainstream politics and mainstream media i.e the most powerful in our society will not allow an open debate which may or may not is likely to but reveal the truth what is the actual truth an open debate is the most likely thing to get us to it a discussion with all sides represented of all opinions represented all scientists of the very very different opinions doctors of varying opinions the most likely way we're looking to get to the truth is through that open debate but the powerful won't allow that open debate we must have that open debate surely people on all sides of it can agree with that and if you want to speak to the public if you want to get the public on side if you want people to listen to you drop the radical theories and keep them for debate separate debate and discussion for interest's sake and meet people where they are meet people in a place we will all agree to meet which is surely that the best outcome the best both outcome and starting point for the future the starting point for going forward from here is to debate this openly and honestly no demonization no censorship and let's find out what the truth is and work moving into a future based upon that truth not censorship not propaganda not lies the truth that can only happen if we allow open discussion to take place that is the starting point politically and politically is what we have to do because this cannot i cannot emphasize the importance of this enough this is being done to us by politicians politicians it really i'm really i mean i am modern but i just want some loads of people really gonna let politicians take all your freedom away this should be your servant not the other way around this saturday there was a bit of chewing and froing on this i was invited i was speaking at a rally this saturday in darlington i was then informed that i was not allowed to speak um and ironically the poster for this event says it's time for the people of darlington to hear the truth and yeah anyway i so latest on this is that i am now allowed to speak so i'll be there and to finish i will put up the very poster uh on here i'm not entirely sure of the meeting place but darlington's not enormous and i'm sure um that meeting place will become more evident on the day north if you're in if you're in the north of england if you can make it to darlington this saturday please do and so the latest is that i will actually be speaking at this event on saturday and i'm really looking forward to it it's been a while but about a year since i spoke at an outdoor event okay not covid um thanks for watching do share do share this video and i will see you online i mean i'm a livestream monday even livestream as usual we're talking about the nhs this week um i do have a little bit of a cold going by the sounds of things and if i don't i'll see you on monday online unless of course i see you in darlington on saturday thanks everyone for watching take care


Hello, Columbia. On behalf of the City of Columbia, we would like to invite you to the 32nd annual Dr. Martin Luther King commemoration. The celebration will be held on Monday, January 20, 2020. The ceremony will begin at 4 p.m. and will be held at King Park, which is located at 2300 Green Street. For those who are seeking to attend the ceremony and looking for parking, additional parking will also be available in an overflow location as you can see on this current map. Once you're at the overflow parking site, shuttle service will be provided to King Park. Of course, after the ceremony, shuttle service will be provided back to your vehicles. We want to ensure that you have an easy flow to inform the ceremony and additional parking has been provided. If you would like additional details about this ceremony, please call 545-3100. Our parts and recreation department staff will assist you as needed. Again, our cordial invitation is extended to please join City of Columbia officials and community leaders for the 32nd annual Dr. Martin Luther King Jr. commemoration, January 20, 4 p.m. at King Park at 2300 Green Street. We hope to see you there.


Hi and welcome to nursing school explained. Today we'll go over one of the most common pediatric respiratory disorder called bronchiolitis. And what that means is inflammation, it is of the bronchioles. So those are the smaller airways that we have in our upper chest. 50% of the cases the cause is RSV, respiratory sensational virus. And usually small children and infants are very prone to getting this. And usually they get it from contact with an older sibling or a parent, who might only have very mild upper respiratory infection symptoms, such as a little bit of a runny nose or throat cough, they might not really think much about it. But because the differences in the anatomy in small children, it can cause significant symptoms and also respiratory distress in these very small children. And it is highly contagious. So a lot of times parents, they don't know they just think they have a very minor cold, they go on about their business, they care for their child or infant as they would usually, they kiss them, they, you know, don't practice any particular infection control and all of a sudden this child gets really ill with the same virus that's not really causing any trouble in the adults or older siblings. But in small children, it can cause some significant problems. So signs and symptoms include nasal congestion, that's a big one. And because we know that small children are unable to clear their noses themselves, they can't blow their nose. And also, they mostly breathe through their noses. So if they have a lot of mucus build up, lots of nasal congestion, that is basically an airway obstruction and can lead to some really big problems. They might also be sneezing, have a lower temperature and anorexia, because we know that children, when they're ill, they just don't want to eat. Now later signs and symptoms. So in the initial phase, they might just have very mild symptoms, but then later on, they can develop some signs and symptoms of acute respiratory distress, such as tachypnea, tachycardia, they might have abnormal lung sounds. And that's mostly going to be Ronchi because that's all this mucus congestion that's causing the problems. And there might be underlying crackles or wheezing as well. The child might be cyanotic, or show signs of cyanosis, such as starting with sarcomaura, or maybe the extremities are a little bit cyanotic, that certainly can progress to some more significant whole body cyanosis. They might have all these other signs and symptoms of respiratory stress, flaring, retractions, difficulty feeding, sucking and swallowing, because they're working so hard to breathe that feeding really comes secondary. Plus keep in mind, if they are breastfed, and they're attempting to feed and they're attempting to breathe at the same time if the nose is congested, they're not going to be able to feed. Now, diagnostic test for bronchiolitis is a respiratory culture to really see what virus or bacteria might be causing the trouble and the signs and symptoms. And then maybe a chest x-ray, if there is a suspicion for some underlying adelectasis or pneumonia. So if this child is just not getting any better after several days of being ill or maybe hospitalized, and they're all too sad, it's not improving, then certainly a chest x-ray will be indicated. And treatment and nursing care, so if the symptoms are mild, the patient can be treated at home with supportive care. And that includes management of fever, making sure they're staying hydrated, making sure that infection control measures are being taken, that they're eating well, and all those good things that we teach our patients. Now, but if they're moderated to severe symptomatic, then they're going to have to be hospitalized. And treatments here because of this nasal congestion that's causing all this trouble in these children that breathe through their nose primarily, we want to make sure we get rid of that mucus. So on nasal pharyngeal suctioning is going to be of the utmost importance for these children. Cohumidified air will help moisturize any secretions as well as deal with the inflammation of the airways to really help decrease the edema and open their airways to breathe a little bit easier. Certainly, we want to elevate the head of the bed because all this congestion might feel like they're choking. So by elevating the head of the bed will let things just drain naturally. They might need IV fluids for hydration and certainly infection control measures. Now, the CDC only recommends contact precautions for RSV, but most hospitals nowadays will put the patient in contact and droplet precautions because it is so highly contagious. And then for preemies and children with chronic lung issues, so maybe they have asthma or they've had some congenital heart defect or any kind of other chronic illnesses, there is an RSV vaccination available. In summary, RSV is very common if you've been to pediatric clinical yet you know that children are hospitalized frequently for this for this illness. And because we have this nasal congestion and the mucus production, number one is to clear their airway. If you're thinking about your airway breathing circulation priorities, so that suctioning is going to be very important. Thank you for watching. Please also watch the other videos on pediatric respiratory disorders to help you distinguish between the differences. And I hope to see you again soon. Thank you for watching Nursing School Explained.


and welcome to Connecting Hawaii Business on Think Tech Hawaii. My name is Kathleen Lee and I am your host for this program. Today I am excited to have on the show the president of Chart Buddies, Shialito Mathias Schwartz. You go by CeCe. Is that correct? Ooh, I do. Yes. Hey, this is exciting. So welcome to the show, CeCe. Thanks for having me, Kathleen. I'm excited to be here. And I am excited to have you on. Tell our viewers about yourself. OK, like Kathleen said, I go by CeCe. And I was born and raised in Hawaii. I'm the daughter of a first generation immigrant parents from the Philippines. I have an older brother, a younger sister, but I'm married. And I have a son who is in college and a daughter in seventh grade just started middle school. And I have two dogs. That's awesome. Are they around? No, I put them away. OK. Especially for this specifically. Thank you. I know we talked about this earlier. So we met through a mutual friend, Marlon, who was just interviewed on the show. And he said he also had a hand in helping out with Chart Buddies. Is that correct? Yeah, he played a huge part, actually. He was the one who approached me. But I've known him for a very long time. He has his company, White Space Studios. And he actually developed our website for another company that me and my husband started a while ago. But that could be another show. He approached me because at the beginning of creating this Chart Buddy system, they were looking at who they could approach and how they could get this out. And I was newly elected as the president at the Philippine Nurses Association of Hawaii. And he thought maybe working with law and profits would be a good idea to introduce his product. And maybe the members would find it valuable. But in a first conversation, it just spiraled in a good way. And I started saying, hey, you know what you need to do? And then he just went on from there. And then he pulled me in. And I had a meeting. And I met the other co-founder and the developer of this system. His name is Manak. And another friend of theirs, Joe Nofo. So it's the four of us that really make up Chart Buddies. We're the team. They invited me on board. And kind of been a journey and been a wild ride ever since. It's fun. It's fun. Yeah. That's awesome. OK, so I was looking through your website. And I'm going by the description that you folks have when it comes to Chart Buddies. It's an efficient, electronic health records system. And it eliminates redundant data by previous bills and other forms. Tell us more about that. Like, what was the issue? I kind of stated it based on what you guys have. But what does that mean exactly? So let's talk about charting first. Like, what is charting? Oh, gosh, so charting. I mean, when people are nurses here that we're charting, whether you're in the hospital setting or in the community, it's gotten to a point where it consumes you and it takes up so much of your time where you're almost like not paying attention to your patient anymore. You're kind of moving away from that because there is so much documentation that you need to capture from that visit. And so it's almost moved away from really it being patient-centered because we're having to chart so much and document so much. And I'm not here to say that you're going to be eliminating that because that's really not realistic at all. However, with Chart Buddies, the whole goal was to cut charting time down to make a system that was a lot more efficient so that there's no redundancy. I mean, I'd worked on charting systems where I'd enter information and then I'd swipe to the next slide. And it's like I had to input the exact same information. Again, it didn't auto-populate. So those were the things that I would mention. And I would say it would be so good if you could do this. Or a problem I found with charting is this. And if we could address that, that would be amazing. And so it kind of kept evolving. And with the charting system, yeah, we really want to help people move away from paper charting, get on board with the digital type of charting, electronic, because it really does avoid duplication and really errors. We don't want errors in charting. And that's something that they hire auditors to do. Like a job that people do just to go through and audit. And so that was really one of the things that we had envisioned for when we created this. But keeps evolving because there's always things that we can add to it or it can make better. And that'll probably never end just as long as there's new things that are coming up that need to be captured, that need to be documented. But it's manageable. We try to capture a lot of the important data that we need and simplified it. So we only chart ones. And it auto-fills everything. So your description on the founders of the company is that it was designed by a registered nurse and a case manager. Is that you or those two different people? Actually, Marlon and Mac. Mac is an RN that is really focused in IT. And he codes. So I think that's where his wheelhouse is. And then when I came on board, I'm an RN case manager. But yeah, I've been in the home and community-based setting. I've been in manager care. And so I've seen and I've tried different types of charting. And I was even charting by paper if I'm dating myself. But yeah, back when I first started nursing, I was still charting with 10. Yeah. Let's go back to that. So tell us more about your background as in the nursing industry. How did you get into it? Oh, my gosh. So it runs in my family. And so I'm a Filipino nurse. So is my mom. And so is my sister. You've ever watched Jocoy follow me? But no, my mom. Yeah, she's now retired. But she was a nurse at St. Francis in Liliha, which is no longer there. But she was a cardiac ICU nurse for years before she opened up her own case management agency before retiring. My younger sister, she is a, now she is a clinical nurse educator. But before that, she was a bedside nurse trauma orthopedic. And so, and then myself, I work as a care coordinator at Queens in the Noura Life Institute. And so case management is really like my love. I've done it in the Oregon community settings, where I'm working with people, with families. And then now in the acute setting, very different ways. But it's still very patient-centered. It's including the patient and their family and their support in trying to create a discharge plan that's safe for them once they discharge. And the beauty, I think, of having had been in the community and now in the acute is I see both sides and what the gap is. And so Hawaii is the island. We don't have an infinite amount of people. And so it's really difficult trying to find a place for them, which leads me to care homes. There's a lot of care homes in Hawaii. But believe it or not, we still have a hard time finding places for our patients who are discharging to go. And that was the reason why I also got into that. And I'm really close to getting my license to operate a care home. And it's kind of timely because while I was going through the application process, I saw the different forms that I needed to do and what would constitute a binder for all my clients. And pages and pages that have probably just been Xerox copies over and over, photocopied again and again. And so that really helped build chart buddies, too, because that's the clientele that we were targeting, the care home operators. And there are many of them. And as far as I know, the majority are doing the binder and the paper charting system. And so we have a large market out there to reach the chart buddies. Let me launch off of that. So currently, who are the companies or even individuals who are using chart buddies? You already mentioned nursing homes. Are you able to disclose particular hospitals as well? No, we're not quite there yet. And I think because when we started with the care home operators, we knew that they were heavily relying on paper charting. And because I was just going through my own license and looking at the forms, I'm like, this is a good place to start. And we found out that, yeah, they're actually, the department of health was moving very soon to digital. And so we're like, I think this is a perfect opportunity. And in me going through this process, I joined an association. It's called ARCA for short, which is the Alliance for Residential Care Administrators. And once a year, they have a big education event. And they have vendors there and all their members come and get contact first, which is required. And so I reached out to the president and asked if chart buddies could come. And that was our first time really introducing our product and our service to a large audience. And so it was interesting because the very mixed crowd, a lot of them are nearing retirement age, if not already retirement past retirement age. But then there were some that were also very new at the care home business. So they were a bit younger. And so the feedback and how they received the product was, it was very vast. It was definitely, I mean, we got our first client from there. And so she saw some value in what we were presenting. And ever since then, over a year ago, she's been one of chart buddies. And I think what's amazing to hear is she's saying that it literally cut her charting time, and which is the goal, so yeah. How long does charting typically take? I know it's a case like, I wouldn't say something like, it's couldn't have. Can you give us an idea of how impactful that is? Is it like from like hours to an hour? Well, when I was working out in the field, and this is when I was working with a managed care system here, UnitedHealthcare, and I would do field visits. And when I would go see them, I'd take down all the data, and I'd type as much as I could, not feeling like I'm only treating my computer screen. I try to look at the patient too, of course. But I gather on my data, and it was about an hour and a half to two hour visit. And then when I go home, it's another two to three hours, just charting and getting everything. And that's just one setting. I can't speak for other people and how they're charting, depending on if they're a home health agency. And that takes time too, because I used to work with a home health agency, and the field nurses would be out there trying really hard to get through their charting quickly during that visit. But at the end of their shift, they're still taking their charting home, and that's less time with your family. And that's unfortunate. To that, it can't just be like, what do you work, and do the best you can, and once you're done, you're done. But it follows you home charting, follows you sometime. So let me, OK, I want to go off of that, right? So you're addressing this need for efficiency, which I think is wonderful, especially when it comes to the medical field. What are some challenges that you ran into when starting a business, especially here in Hawaii, and especially with a service or a product like yours that is innovative and might not be, like you mentioned, people aren't too familiar with that yet? Yeah. Well, I mean, starting a business in Hawaii has its own challenges, right, because we're our way in an island. And there couldn't be so many failure points, but it really comes down to, I think, the team and your support and the vision behind it. Some of the things that I feel have made it a little bit difficult was just reaching the people and getting our product and service in front of them. It's the marketing aspect, right? You could have this wonderful product, but you've got to find the people to present it to or to sell it to. And I think that's why it was critical for us when we were just starting to have this really nice package product and launch it out in front of a crowd of people who were like, ooh. But then again, like I said, that first time we did that, there were people who were probably digital immigrant. And then there were some who were digital native and the ones who were digital immigrant were like, what if we have trouble and it crashes and what do we do? So it was a very, it helped us really learn how to answer those kind of questions, because that's the reality of it, right? They're going to be a little bit scared of that innovation, even though they know that electronic charting is nothing new, but we were trying to present it in a way that's like, nothing's really changed the information, the questions are the same. We've even created it so that if you still want to print the forms out and you hit the button, it'll print out in the form that you're used to seeing that you've been using for years that the DOH actually provided to you. So when they saw that, they're like, oh, okay, it's familiar to them. But it's really a matter of like, you know, kind of feeling those questions answering it in a way that they understand. And I think it's just the comfort level, but we'll go to a class at LCC where they're taking the arch modules so that they can open their care home and they're a little bit younger and they've probably also been in the hospital setting used to charting electronically.  They know they need it and they know that it's gonna help them and they don't want to even start with making the binders and then transitioning over to an electronic health system. They're like, yeah, I know what that can do for me. And, you know, so I think it's catching on slowly, but, you know, I think at some point people will be like, wow, this is super helpful and that's really what we want to do. We want to help the industry in that way. Yeah.  That's the care home, right? And so there's still like the cluster homes and then there's all the other agencies. So there's a lot of people can still do that. We've got to kind of focus, you know, where we are right now for the people. Yeah. Yeah. You mentioned one benefit for some of your clients which is cutting, charting time in half. Are you able to share other success stories that you may have that stands out in your head when it comes to folks using chart buddies? Yeah, I think what they're just most impressed with is, you know, when somebody is willing to try it, right? They're moving and this is another client and she's not very tech savvy, but the more she started to use it and the more familiar she became with our system, the more confidence started to fill. So to me, I like those kind of success stories, you know, because then she feels like, you know, I can do it. And, you know, when somebody feels successful at something, it's always a win, right? And so those are the kind of things that we're also looking for too, you know, that's gonna be very different from somebody who's always, you know, very used to being on, you know, devices like that, but for somebody who is transitioning over from like paper charting for like years and years and then learning it step by step, you know, granted it was a learning curve, but then, you know, the more they did it, the more familiar they got with it and then, you know, they started to get more, they're quicker at it. And so I think they felt successful at it. So that's good, you know, we like that. They think that's awesome. Cece, what are some future plans or aspirations or goals that you may have for Chart Buddy since you are the president of the company current? How old are you? I don't know if I want to describe it, but I think that I'm gonna say like, you know, 1147s. And now if people watching this know what the 1147 is, it's like this functional assessment tool that we have to complete. And I do it in the hospital setting. I've done it in home and community base. I've done it, you know, in other settings. And it's just something that people have to do. It's this one form.  And sometimes if you're not saving all the time, then you lose your debt. And that's a real pain when you're like doing medications and you have to be tight certain things. Or, you know, once you submit it, you wait for approval. There's different ways that it's gonna be either like, you know, whether it's complete, submitted, in review, approved, so all these things. But you always have to go back and check the status. But unless it's on the forefront of your mind, you're not always gonna wanna go back or remember to do that. So I was telling Matt, like, wouldn't it be great if, you know, and I'm like, how might we have something where it's on our phone or some notification that says, hey, ding, it's like it's been submitted. Oh, it's incomplete. You need to go back and fix this. And how much quicker that process could be if people were alerted and then they could just go back and fix it and then submit it. And that would cut down on time. And, you know, I think that's something he's working on. But, you know, it's just my vision. And he's the tech guy.  We'll see. He's great. He's brilliant. And I know he can do it. So, yeah, we're hoping that we can, you know, launch that part of chart buddies. But there's so many things that, you know, we keep finding that we wanna keep prodding and we just wanna make sure that it's gonna be valued, you know, to the user. That's ultimately what we want. And we don't want to be overwhelmed anymore. Just get like, oh, it's too much for me. Enough. Right. Because that's all we're addressing, right? Yeah, we wanna say, you know, a simplification. Exactly. Well, Cece, what are some lessons that you learned during the process of building, starting and launching this business that you would like to share with folks out there that may wanna do something similar to what you folks have done? I, you know, a lot of it was just getting to that right ice point, yeah, for our service. Because when we're creating it and we know that this is so amazing and we're like, oh, wow, we could just make it, you know. But then really, we have to kind of go back to what we were trying to do. And, you know, at the curve that we wanna help people and we wanna make it accessible to as many people. So, you know, I think we've arrived at a price point that is very fair. And when people see that, you know, they're like, oh, wow, this is such a great party for that. And that kind of, that took a long time though to get to that point. So I think with any company or any business, you know, that something they probably have to go through, like figure out like, is this the right audience? Is this the right, you know, price point? You know, is this something that they're gonna receive and continue to, you know, be a loyal customer of because this is the price that we're offering it and the value that we're providing. Yeah, it hasn't been easy, that's for sure. But it's been fun and I have a great form to kind of keep, you know, bouncing ideas off of. And so I think that helps when you have like a supportive team that sees the vision also and willing to listen. And if they're not in agreement, like, yeah, let's talk it out and let's see how we can make this better. I think not looking at ourselves, if I kind of looking at what really is the goal of it going forward and what we wanna accomplish, would be huge, you know, with any business. Yeah. Well, what is there? Is there anything else that you would like to add that we haven't covered or that I haven't asked you about regarding chart buddies? Yeah, much else. Well, people can get started. Yeah, well, no, we, it's an installation fee of, you know, which includes the actual laptop that we give to them and then it's a subscription. Yeah, but the thing is that what's great about it is, you know, when people are like, you know, can you do this to it? And they take that feedback very seriously and they will make the updates and the changes if they know that it's gonna be a benefit to everybody and they will update the system so that everybody benefits. Like it was already getting it. Yeah, it's not just to that one person, for that one person. So that is, you know, wonderful. If people want to learn more about chart buddies, where do they go?  Chartbuddies.com. Chart buddies. Chart buddies, chart buddies. Yeah. Yeah, well, thank you, CC, for being on the show today. I'm very excited for Chart Buddies and EDI. I hope to see it launched according to the vision that you have for it. Yeah, well, thank you for having me. This has been fun. Of course. Again, you're welcome. So we've had Celie Tomatia Schwartz, president of Chart Buddies on this show today. Thank you again for being on here to talk more about the services and product. And we also want to thank ThinkTech, Kua'i, and J. Paidell for making shows like this possible. We had Mike and Hailey helping us out to have this show go on today. So thank you. And until next time, aloha. Bye.


So you've got four presentations for quite different projects and they were selected really from dozens of applications that came in, because there's only forward to be quite a, quite a brief bit of time we can give to each of them. We have the expert lounge tomorrow morning, where hopefully we can continue discussion that emerges from them. So without further ado, I'm just going to introduce very briefly the four speakers, and I will leave them, I will leave them to present so we've got. First off, Dr. John Stelling and Julius Sujan. John is, I think as I mentioned in the plenary before. He's the co director of the WHO collaborating center for surveillance of anti microbial resistance in Boston, former medical office with the WHO and anti microbial resistance containment unit. He leads the development of his a software called who net, which has been the sort of global gold standard used by microbiology labs in over 130 countries. He's been working together with Julius Sujan. Some of us have known for quite a long time Julius is, is from Bangladesh. He's done a lot of interoperability work training work and the like with with his spin the air with his Bangladesh and director of the university of Oslo. So they'll be talking about AMR. We've got a presentation on open MRS connectivity with DHS to from Grace Popma, Pumail, Ratnayaki and Jaya Sanka with a singer. I think Jaya Sanka and Pumail will be presenting. I'm really excited to hear more about where we are, the DHS to connector. So I'm going to start off with a historian trickling, who is going to present again the story. I think if I have it right of individual level data from the, from the periphery towards the, the DHS to its central level. Interesting project from from Burkina Faso. And finally, but not least, we have Ranga, Ranga Rai, who's a PhD graduate from from the University of Oslo.  And he's the current custodian of the DHS to fire adapter and various innovations around that. So that's what we have ahead of us. I don't know if presenters are ready to go, but we wanted to start with John and Julius. Great. This is john, I can you hear me is the audio okay. We hear you great job. Perfect thank you so much everyone and we have a short period of time so I'll start directly. And the next topic is, I've already been introduced I'll just dive right in. The subject is surveillance of antimicrobial resistance and integration of our who not software, and the DHS to software and a pilot project in Bangladesh. And with my co presenter and collaborator to last to john. As you all know antimicrobials were one of the most important innovations of the 20th century for providing health, safe health care, curing infectious diseases, and we rely on them for so many things. But resistance is a growing threat and one of the main public health threats of the 21st century. The international surveillance activities, many of which do depend on the who not software at the local facility. National regional and global. Here are some of the regional and global activities, most of which have some dependence on who not. I do want to also highlight the first one from the United Nations, the UN interagency coordination group on AMR and the global leaders group like to point out that the co director the co chair of the global leaders group is in fact the DHS to Bangladesh, which also makes this another opera, another reason why Bangladesh is such an attractive pilot, as well as the very significant DHS to expertise there. The work I'm describing is funded by the UK Department of Health and Social Care through their Fleming fund initiative. I am part of two of the regional grants. People would like any further information about any of these activities. Feel free to contact us. There are other groups working with DHS to an AMR integration. And these are some that we are aware of. If other people are also active we would love to hear from you and seek opportunities for collaboration. University of Oslo and his India have been working on a tracker module find on an event program with the glass export glasses the WHO global anti recovery resistant surveillance system I mentioned that I showed it on the previous slide. This is an initiative in Senegal for using path tracker module for clinical reporting. And, of course, one of the standard WHO packages for DHS to, or DHS to packages for WHO is the tuberculosis project, which of course includes a module for DHS. There's also an initiative for Vietnam which started and then stopped. And one of the reasons they stopped stopped were because of limitations they found in DHS to, and I will come to a slide on that further in the presentation. This is a free software desktop software not a web software that our group has been developing. In fact, we go back to the 1960s with Dr. Tom O'Brien and, you know, the original dis diffusion, but we codified the name who net in 1989 as a desktop software that we've migrated over years. Currently we support over 3000 hospital food, animal health and no environmental labs in over 130 countries. The software is available in 29 languages. Primarily includes a laboratory configuration module so you can figure the software the way that you would need for your local purposes. data entry can be accomplished to either by manual data entry on a day to day basis by laboratory staff out of the notebooks, or through a data import module software. So if you have a lab information system and instrument database Excel. In most cases, it's possible to import those data, daily, weekly, monthly, yearly into who net to take advantage of the analytical features of who net. There's one example of interoperability. Bob gave some excellent points in those principles about the value of these and always coming down to the use the use case scenario how can we provide value. So people all over the world have live information systems with for clinical reporting purposes day to day operations, but without analytics. So that's where we come in to support analytics and data sharing data analysis I'll mention some examples and data exports. So who net is our, our software and we've integrated DH is two in three areas. One is exporting isolate level records into event program CSV files, or statistical aggregate statistics and analysis results into DH is to data set CSV files. When you export from who net it expects it exports along the associated required XML metadata files, so that you can import these into DH is to the exporter standardized all over the world. Well, once this is rolled out but whenever you export from who net it will always create the same set of UIDs. So if you are working with this in a variety of countries it facilitates the exchange of data among the DHS to databases, because the UIDs are all consistent across implementations. We've implemented the export in a set of predefined standard reports, click here that's the, that's the standard report you do this and then go to DHS to and you will always get the same thing with every instance. The really important one is the WHO glass export and you see in the lower right hand corner checkbox export to DH is to. You can also do interactive analysis with who net, you can output those results to the screen to excel to access or now DH is to below that it says configure output files where you would enter, for example, your high level organization unit, you ID. In the future we will also support Jason will work more closely with University of Oslo his India on their tracker module in integration, and with other people who would be interested in working together. We will also look at automated synchronization of the back ends. Right now, DHS to was new for us a year ago. So we're also it's a learning opportunity for us to take advantage of the richness of DHS to for bringing in our expertise and our international network on microbiology These are some examples of the output screens. You can do analysis of single antibiotics. Cross resistance with two antibiotics this is particularly useful for pharmacy studies about comparing drug a and drug be also quality control to these results make sense. Multi drug resistance tracking. This is very about we study resistance in part because of its public health importance and clinical importance, but antimicrobial resistance is also a useful epidemiological marker to facilitate strain tracking and outbreak detection. On this screen it's outbreak detection visually by looking at a graph. We have high I should alerts who net is showing you things that are clinical importance public health importance or quality control importance, suggesting a deficiency in laboratory practices. We also have statistical outbreak detection, we have integrated who net with the free sat scan software. You see an example here of Shigella in Argentina, and in red and outbreak that was confirmed initially by pulse field gel electrophoresis and later by whole genome sequencing. So it's very valuable again this interoperability. We have put the sat scan batch as a module within who net. So the user does not need to learn the other software. Also the glass export is an important one now as the temperature glass initiatives are getting out. So we did come across some limitations and we look forward to working with you to understand and address these. There's a lot of issues about duplicate counting if you have one patient in January one patient and that same patient in February. That's still one patient. So you should not be counting it multiply with data sets and events you end up with double counting with tracker you can facilitate you can count the number of people correctly. But it gets more complicated with antimicrobial resistance you want first isolate per patient per species for resistance pattern, perhaps per data stratification. So there are additional elements to how to do proper counting of events when we're looking for outbreaks, we're looking for outbreaks in a hospital setting on those isolates that are first isolates on hospital day three or later. There is some complexity there. People have often made mistakes in the interpretation of susceptibility test results. If you do it the easy way you'll get most things right, but there are a lot of complexities regarding hierarchies specimen type diseases, and it has to be maintained over time. So we're working collaboratively with CLSI in UCAS to make this plug and play as much as possible. There are human break points animal break points and also epidemiological cut off values, also known as microbiological break points. So for with DHS to we found a lot of wonderful things for the descriptive statistics and visualization, but for higher level analyses. That's where we find that integrating with who net can be of great value. And I'm talking about the who net, the core functionality of DHS to file sizes at one month of the data from a small hospital takes for us 140 kilobytes that same file in DHS to a 6.5 megabytes. And then records instead of 622 slow times and record limits. And these are some of the reasons why Vietnam stopped their DHS to that issues of performance flexibility. They did a lot of custom programming, and then they just went in a different direction. So this is important to keep in mind for further work. So I'm sorry just a warning you're on 10 minutes. Okay, great. Thank you. And I would now like to switch over to my colleague Jules. Thank you. This is Dr. Steling. Hello, my name is Jules. In collaboration with the communicable disease control department IDC and drug administration. We met a large number of public and private hospitals for engagement and initial assessment of laboratory for antimicrobial resistance surveillance in Bangladesh. Out of this we included 56 for on site assessments. We have provided training on who needs software over 140 microbiologist clinicians IT stuff and national Amr policymakers in Bangladesh who need has been installed in 31 laboratories thus far. We have been collecting three years of historical laboratory data from 41 governmental and private hospitals in eight divisions across the country. With a successful pilot. This will be sustained with prospective data collection and use as well as automation of file data processing. In terms of who need and he says to integration pilot in Bangladesh. We have a distance to pilot instance hosted in Amazon oil services for non confidential data with a successful pilot. In terms of development I mean DC assist will establish an Amr dedicated to server for both confidential and non confidential data with automated file transfers and synchronization of who need and he says to back in databases. Next slide. Next slide please. Julia sorry you're going to have to wrap up in about one minute so sorry. Yeah, sure. You need to jump straight to a summary. Okay, sure. We imported metadata data sets and events to decide to the necessary metadata available here you can see in the screen. Next place please. Next. Okay, this is the proposed architecture for the Amr data visualization platform in Bangladesh. And in summary, who need is widely used. Next please. Who need is widely used all the way to support local national regional and global Amr surveillance initiatives. On the other hand, this is widely used by national authorities for surveillance and program monitoring initiatives. So, this integration should support the development implementation monitoring and impact evaluation in near real time of national Amr contentment status is in Bangladesh. Next, please. Yeah, we would like to thank our government partners, especially Dr. Ron in the room and the program manager and Dr. Jackie days have you been a scientific officer ideas here. Thank you all for listening. Thanks very much Julius and thank you john. Sorry for rushing you through that that was really really fascinating. Lots of interesting questions particularly I think around the, the question of cohort counting versus head counting. We might get that theme might emerge again in some of the other presentations but otherwise we'll get the chance to take a few questions right at the end or in the expert lounge discussion tomorrow. Move on to next presentation, which is Jaya Sankar and Amal. I hope I'm pronouncing your name correctly. Yeah. Let me share my screen. Yep, we see it. Can he move. Okay, so thank you very much for the quick introduction. So I'm just a community developer at OpenMRS. I'm Puma and I'm also community at OpenMRS. So we are so happy to be a part of the digital DHS when working for us isn't it Puma. Yes, of course, yes, uncle. So we have developed a module at OpenMRS to integrate OpenMRS with DHS to without talking much, let's move into a quick demo. Let's assume that we have an OpenMRS instance in a hospital and we need to visualize COVID-19 patient data in DHS too. Okay, now I have set up a new data set using DHS to gather COVID-19 patient data. Yeah, I have patient counts based on gender and age. I have three age groups here. There are some affiliates, pardon me, just for the demo purpose. Also, I have created a new OpenMRS period indicator report to get the data that I need. So the data set is to gather monthly data. If I need to visualize this data, I have to run the report at the end of each month and copy those values one by one and paste them into DHS too. Pretty hard, huh? Here's the problem. If you have many complicated reports and numerous data sets, then the things get much worse. Here's the DHS to connect a module that comes to the picture. This module was initially developed by GenB, then it has migrated to the OpenMRS report. Had so of to GenB for developing this extremely useful module. Using this module, you can easily push data from OpenMRS to DHS too. Without talking much, let's move to the module. You can install this module from the module window of OpenMRS or just follow the setup instructions on the readme file. I'm going to connect the module with DHS to by adding the host, DHS to username and password. Before sending the data, we have to create a mapping. Mapping stores the relation between OpenMRS report and the DHS to data sets. We have to select the OpenMRS report from the left side and the DHS to data sets from the right side. This which will give you a nice drag and drop UI to do the mappings with the indicators of the report and the data elements and the category option of DHS too. Now I have created the mapping. Let's try to push some data. In the DHS to dashboard, I have generated some nice little charts for my data set. As you can see here, I don't have data for the month of September. Also, I can see on the data intuitive too. Now let's go back to the module's front report page. Select our report and the mapping. Select the relevant OpenMRS location and the DHS to open it. Select the month, in this case September. Also, notice the indicator changes according to the period type of the data set. We are ready to go. Let's click on the send button and wait for the response. Amazing! Seems we have done it correctly. Let's go to DHS to you and verify it. Now let's check back the month of September. Here we go. We have successfully pushed the data to DHS too. Let's see what happened to our charts. Before that, we need to do one thing. It's updating the analytics table. Okay, let's see how it looks. Now we can see data for the month of September here. Apart from that, the module has some nice set of features. You can manage these mapping, duplicate them or delete them. Also, you can export and re-import the mapping. Share them between the instance. Back up the DHS to API. Another nice feature that comes with the module is the schedule option. All you have to do is schedule in the report. The module will do the jobs for you. In that demo, you saw the things which can be done using the DHS connector module. Now these things are we are focusing on. You may notice that the user has to select the open MRS location and the DHS to organize into it when pushing data for DHS too. We thought to make it easier for the user. So we are going to implement a new feature called Automated Location Mapping. With this feature, users can save the matching location-organized sets for the future usage. And with the help of DHS to API, everything involving location-organized would be automated. Also, we are increasing the security of this module by implementing a user access control system. Here we introduce a new role-privilege-based access control system. So the open MRS admins can assign roles and privileges to the people who handle the module. In addition, this feature can greatly reduce the common mistakes made by the users. When it comes to UI UX, we keep improving the UI to provide a better user experience by making it simpler and easier. Also, we optimize the workflow of the DHS connector module to make the processes faster. Yes, uncle. So this module is also available in public. So you can easily download it by using open MRS identification. That's good news. As everything at open MRS, this is also an open source module. So you can contribute to this module to make it far better. Join open MRS talk today and let's continue the discussion there. If you have any questions, feel free to contact us in open MRS talk or DHS to community. Also, you can have a chat with us with the controllers as well. I hope you got an idea about the module. Thank you very much for listening. Thanks very much. Save lives. Thanks very much, guys. That was a really entertaining presentation. I like the musical interludes. It's really, really cool how you seem to have fixed all of the ugliness of the old DHS to connector module, the drag and drop interface and the like. It's exciting to see where it's got to. And I know there's a huge amount of interest in DHS to open MRS interoperability, more particularly again recently. So yeah, wish you all the best with, with, with the continued development diet. And thanks for sticking on time. Thank you very much, Bob. Now we have Florian. Florian, are you ready to roll? Okay, I'm ready. Thank you, Bob. Let me share my screen. Can you hear me? We hear you. Good. And can you see me now? It's okay. Can you see my screen? Yep, all good. Thanks. So hello, everyone. My name is Florian Triclin. And I'm really pleased to present Yeda, the digital health approach of TARDISOM. And it's complementarity with ENDOS and the HEALS data warehouse of Okinawa Faso, which is based on DHS to instance. In a few words, TARDISOM is the main organization for children in Switzerland. It is present in 35 countries around the world and had 4.8 million beneficiaries in 2020. TARDISOM is present in Mauritania, Senegal, Mali, Guinea, Okinawa Faso, Niger and Algeria in 3 main areas, which are access to justice, migration and health. In the health sector, TDH focuses mainly on 3 priorities. Maternal newborn and child health, strengthening of the health system. And digital health, which is transversal to the first two. In terms of digital health, TARDISOM has co-created since 2010 with the Ministry of Health in Okinawa Faso, a digital health approach whose primary objective is to improve the quality of care at the peripheral level. The first approach is based on four pillars. The first is a digital tool, which is called the REC for registre électronique de consultation in French, which is electronic consultation register, which I will come back after. The second pillar concerns the analysis and the exploitation of data resulting from the use of the tool. The third pillar, which is largely responsible for the success of the approach, is coaching at the peripheral level, which aims to improve the overall level of competence of health workers. The fourth pillar is e-learning through a platform that links health workers to training modules. In Okinawa Faso, the IMCI for children under five years of age was digitized in 2010 and implemented on the tablets made available in the Hill Centers. In this representation of the Okinawa Faso health system, we see that IEDA is now composed of several tools at the bottom of the slide. The IMCI, but also REC maternity composed of five forms, prenatal care, delivery, postnatal care, family planning, and post-abortion care. Two other tools complete the suite at the peripheral level, an EMR for those over five years of age, and a stock management tool. As we will see later, all these tools are fully integrated into the countries in IT infrastructure. The IMCI, the REC, let's say the REC for registre électronique de consultation, for IMCI within the IEDA approach is at scale in Okinawa Faso and currently covers nearly 85% of the country's Hill Centers. Full coverage will probably be reached by the end of this year or probably early next year. The REC records an average of 250,000 consultations per month. It contains more than 10 million consultations for five children, five million children, sorry. So this scale-up is leading to a transfer process that we are currently carrying out to the Ministry of Health and we hope to carry out equivalent scales up in India, Mali, and Niger, where we are currently conducting pilots. The diagnostic tool allows his workers to refine the analysis of symptoms and improve diagnosis and treatment through an algorithm that interacts with the his worker. The data is entered into the tool progressively by agents who are attentive to the patients. Regular checks are made on the data entered thanks to machine learning algorithms. These elements contribute to the capture of highly reliable data, not to mention the significant improvements in classification, in the case of the IMCI, and diagnosis that the tool has brought about. It's also worth noting the short-knit timeframe in which these data are made available. Indeed, the tablets containing the REC regularly synchronize their data with the central platform-based and com-care technology where 3G coverage exists. Statistics shows that more than 60% of PhDs upload their data in less than a week. This value increases to more than 97% in less than a month. So Yeda data is prompt and highly available. Finally, one last point regarding the Yeda data in the districts and PhDs where the Yeda approach is strongly applied. Almost all consultations are carried out with the tool. The data are therefore very complete. The fact that Yeda is at scale represents an additional incentive for district management teams and his workers to adopt the approach. The Yeda data are therefore highly available in a very short time and have a high level of completeness. I would now like to spend a few minutes on the process of aggregating and collecting the his data that we typically find in our healthcare settings. So in Burkina Faso, Burkina Faso is no exception to this rule. In general, consultations are recorded manually in a register kept in the health centers. This register is the source of the monthly reports prepared by the head nurses, which are then transmitted to the districts. In Burkina Faso, there is a decentralized data entry pilot in DHIS2. Thanks to the CAPTU application deployed on the Yeda tablets. Whether the data is entered in a paper report or in CAPTU, the aggregation operation in the register is manual, as is the data and trial. The data that reaches the district is then analyzed and validated by the district management team in DHIS2 to feed the country's decision making dashboards. Yeda's primary goal is to improve the quality of care. But it is clear that the value of such a system also lies in its ability to replace manual data and trial for monthly reporting by aggregating and transmitting the data collected during consultations in an automated manner. There is then very little to do for this aggregated data to be automatically transferred to the DHIS2. The Motec module performed this function by converting the com care forms into DHIS2 events. Through this association between Yeda and DHIS2, we quickly understand the complementarity of these two tools and the advantages of integrating a CDSA like Yeda from the design of a National Health Information System. CDSA data are exploited and constitute an extremely reliable prompt and complete source for the decision making tools used at the central level. His worker can focus on patient care. They save valuable time and his centers save money that they can reinvest in the medical equipment essential to their work. Yeda is a rare example of a digital health tool scaled up in West Africa that is fully integrated into the country's health infrastructure, improving the quality of patient care while improving the quality of the data that underpins the ministry's decisions. Thank you. The floor is yours, Bob. Thanks Florian. It was a really interesting presentation. I think there'd be lots of questions people might be interested to ask. Hopefully we'll have a little bit of time towards the end. I'm particularly interested in the handover process which you say is due to happen now in 2021. But yeah, let's move straight over to Ranga and let's see if we get a little bit of time at the end. Thank you, Florian. Thank you, Bob. I'm going to present on the work we've been doing with the DHIS to fire. I think you can see presentation, right? It's coming. Yeah, I see it. So basically, we're just going to talk a bit about DHIS to end fire and some of the progress that has been made within the community and implementing the DHIS to fire adapter, which is a very interesting component within this architecture. So I'll just get straight to the point. I've got many screens here. Can you see the next screen? Okay, so basically the background is this is kind of the architecture of the system if you want to think of it that way. So there's a set of Android applications that we developed. The first one we call register, which is basically for patient identifiable information. Then the second one is what we call freezing clinic app, which is basically the point of care system at the facility where clients are met. And the other one is internal referral for doing internal referrals or referrals from internal in an organization to other facilities that are outside than an external referral for referring clients inside. So that's kind of at least the user. What is interesting is that all these apps, they are basically customized on DHIS to then that's kind of the interoperability aspects of the apps themselves, DHIS to, but also in terms of sending data, we customize on DHIS to that means mental data is created on DHIS to, but we don't send data directly to DHIS to within our app. We now have to send the data to a file server. And also we have been implementing EpiFire, which is one of the largest fire implementations. So then this is kind of the picture, the Android app, which is freezing, which is basically a sort of apps.  And we have DHIS to fire adapting DHIS to. So initially when you log on, the system goes through and gets metadata from DHIS to set up phones, you know that on mobile phones, depending on which app you're using.  So basically, in terms of the Android apps and so that's a screenshot from from that. Basically, it's an Android, it's a native Android application. So it's, it's not really flexible to move to other platforms and we basically used native Android features and libraries. So that makes our system quite easy to set up on distribution platforms like Google Cloud and all that. And then it's full offline capabilities on the app. That means once you log in for the first time, you're offline also because it uses DHIS to or to, you don't need to enter a password again. So all transactions with the system throughout to then it's fire compliant, the Android app itself. So basically what it does, it takes DHIS metadata, then it converts it into a fire compliant format. Then it's the person who's entering data is basically entering fire compliant data. Then multi user support, you can have multiple users using the same device. Once you log in, you just need a pin. So you can have five, six users just entering the pins to log back into continue. And also because of offline capabilities and unavailability of the internet in some of these countries where Bluetooth exchange data offline. Then we have biometric referral system that you know, somebody can enter their fingerprint when you're referring the referral is created using a fingerprint then it's received on the other end using the fingerprint as well. So you cannot access the referral data if the person does not bring your fingerprints. So then, when you say interoperable with DHS to mean that we customize using DHS to checker. Then we also built on top of the DHS to authentication. They are so basically use DHS to auto authentication and even to authenticate to our file servers. Then what is critical is that we we also run the DHS to program rules on the app. So basically if you create program rules in DHS to on the app they will run on the system. Then also it's supposed to pretty large database because we are our client who we are currently working with there's maybe 8000 patients at a time so can be quite big in terms of amount of data that is accessible from the mobile device in an offline man. So, let me say that this is basically the mapping that we did from DHS to fire, what you call tracked entity type in DHS to it could be a resource and you know DHS to track entity types you never know what they are the person. It could be anything a world DHS to can track basically anything right. So in this case we have to specify what we're tracking. So in fireside we have to know that we're tracking a patient I was tracking a referral. I would check in something else so we have to specify. So in terms of the fields DHS to call them track entity attributes. On the fireside we specify we linked to the fireside using what's called fire part. So basically we decorate DHS to attributes with fire parts this compliant metadata so that we know that okay this name is actually a patient name or this field is actually a same name or this is a contact or this a phone number. So we do the mapping on the DHS to side. And of course in terms of clinical decision support in the DHS to side with program rules in terms of fire. We talk about clinical quality language this is a direction that we're going now but we haven't fully implemented secure. So in DHS to your own the program the fireside map that program into what's called a K plan. And of course what you call an event in DHS to is an activity in the K plan on fire data what you call it data element in DHS who can directly mapped to a questionnaire response on the fireside. But also that's just a generic approach to customization. There are many ways in which to dig deep into by standards and so on and so forth. And then of course indicator in DHS to is what's called a measure in fire. So in terms of how you specify DHS to system you probably need to have a data indicator dictionary of some sort in fire use what to call profiles so we've done all this mapping in the background. So the system just connects from one side to that. And I would say that our current application application of the system is the sex work program in Zimbabwe which is 80,000 either mobile clients across border is that the spelling border, not sure. But cross border, you know, they travel a lot and you need to track their many legacy systems for the client we've been working with and, for example, what's called coconut they've also been using all decay. They basically integrated all those different system into one system which is fire and DHS to compliant. And of course we've conducted the piloting and we fixed the bugs reported in the pilots. And now they just find the data to make sure because it's been quite a lot of legacy information. So that's that side of things and the DHS to fire that place working moving data from between DHS to and fire as you can see. We have a company called the migrator which basically takes data from their pre existing systems into the highest to into a happy fire then from a fire through the adapter to DHS to. So, I mean, we want to we've been, we've been using questionnaires a lot because they map easily to DHS to kind of questionnaires, but also want to go deeper into us that was using other types of resources started using other resources on fire. So that's called service request and we're basically developing the DHS to fire adapted to accommodate more resources, which are for compliance. And of course we've also been participating and working with a team in WHO, which has been working on what they call computer or care guidelines. So in this forum, we're participating in the project to develop what's called an Android Fire SDK, which will limit because originally we wrote our own fire SDK within our Android apps. So the teams Google and other stakeholders are inviting a new fire SDK which can be used across different Android apps and is by default compliant fire. So that's what we're using and also it's easy for you to receive what I call computer bouquet the guidelines, which will be distributed by double HL which will just run on the Android app. Then you have a five compliance implementation by just doing that. Of course we're also working and improving the DHS to fire doctor there's a lot of work to be done there. So so far is we're using it as it is, but the main ideas in terms of how to automate it how to make it easier to use a lot of people try to use the fire doctor, and coming to us and facing some challenges and maybe giving up along the way so hopefully in the process we improve that applicability of that fire adapter on the DHS to site. And of course we're working on integration on secure between. So basically once we start using the Android fire SDK, which is under development, secure is built in so we won't necessarily need, for example, to run the DHS to program is engine within our system. So I mean, basically, so the different partners that have been participating in this project, it's invested also, we've also been supported by innovation knowing session is my way has been key stakeholder in terms of development and requirements. And of course, we like we say we're participating in the computable key guidelines working groups, which have Google and the way we're developing was participating in the development of standards and distributable fire. guidelines basically then of course the team within our own company. So, I mean, there's a lot in terms of the fire system but I can just one minute show you exit a little bit. So this is what it looks like on the fire side of the background. And these are these are K plan like you said the program in DHS to then you have about a minute or two. Okay, okay. So, basically, if let me just slide floating meeting controls in. So you can look, for example, on the DHS to side if you look at a program it looks something like this right where you can add stages, for example, in this case you can add demographic details so on and so forth. Then in this case if you look at the same design on the fireside it's what's called K plan. So basically, each stage in the HHS to be like an activity. So this is a planned activity for the clients who for example this demographic details and other activities so this is what it looks like on the fireside. Then on the. On the Android side. This is what for example the system. So the device looked. So, for example, that's the device and basically the program is customizing the test tool. But that's what it looks like your program will support from the test tool. And into basically this entire customizations and DHS to. So you can enter whatever data section whatever it is that you're collecting in the field. So this, thanks for that. I think we're going to have to wrap up. Yeah, I think I'm done. So that's basically it in terms of the system that we've been working on in basically it builds on top of the DHS to fire that and we're developing and improving the documentation on these cases. Thank you, Bob. Excellent. Thanks. That was really, really fascinating. I mean, two things. I think, first of all, the, the work that's been done now on the resource mapping and moving moving beyond questionnaire questionnaire response to more than strongly typed mapping of resources. I think that's a huge advance. And it goes really interested to see what's going to happen with the CQL work and whether there can be any way of linking that with program rules and stuff in DHS to. But thanks for the presentation. And again, thanks. Thanks for being on time. Because everybody's been so disciplined, we've actually got, I think, five minutes to field one or two questions to any of the presenters before we get kicked out of here. I don't know how it goes. We'll be kicked out in five minutes. If we kicked out in six, seven, eight minutes, definitely we have another session starting here. So that's six, seven minutes. If anybody got a question they want to pose to the, to any one of the four presenters. Fire now. We fish from the chat. Just reading up. We have Richard Mitchell asking Ranga. That was interesting. They do you have it. You say you've set up three fire resources so far. How many more do you anticipate map. I mean, we are not using three fire resources we're using. Let me just look at the fire one organization location media episode of care patients. We have a question and response service request. One, two, three, four, five, six, seven, eight, eight fire resources. We use service request for the federal system. We use media because we have a fingerprint system. So we're using the media resource to store some, some, some cryptid based the fingerprint data for the clients. For an encounter when you enter facilities in episode of case or whatever in romance you get an episode of care. So it's seven eight resources and we're planning to use them. Does anybody have a question for one of the earlier Zen has I've just been working up through the chat. I'm sure we'll have them on the community of practice. If somebody wants to say something in the chat here we'll get it. Otherwise, what I will say you know we have the experts lounge tomorrow morning noon I think it is around interoperability and hopefully the presenters from this session, as well as as others will be available in there as well for any additional clarifications and discussions. I feel bad I rushed everybody along and we now have three minutes to go. Well, you had a question on the end of a process I think. Right. Yeah, yeah, I'm interested to know how. When is that going to happen and how has the preparation been and how do you see that going because the handover process is is always fraught with difficulty. Yeah, it's a long journey for this and over process and we are present in 85% as I said in the of the PhDs in booking FSO so the whole we are transferring the whole approach so I mean, the tool, of course, but also coaching processes. Data analyze. He learning, etc. So this is a long journey of two years, let's say, and it's not finished. The main difficulties is to try to to be sure that there is, of course, competencies in booking FSO but also and more organization for to receive this. There is an infrastructure that that can host come care instance and data and so on. So there is no really technical issue regarding that, but more organization of the agency that is hosting this platform and all the processes of coaching that we have developed. To be sure that the tool is well used, because we know that if there is no the whole approach and the whole process around the usage of the tool. There is no usage of the tool and can make a cross on the other so. Yes, this is a really complicated process but we are sure that we will keep a link with the DHS to this is a set. We are sure of that. We look forward to watching it. I'm sure the his WCA people are probably more familiar with that particular project. The DHS to implement missions typically we've tried to avoid this notion of of can turn key projects with a hand over because they are so far the difficulty. And tend to try to evolve, I guess the eventual system owners from the very, very beginnings of the system implementation and design, so that the transition is kind of less traumatic. It's good to hear that you have at least the technical parts of infrastructure support and like under control. That's a big one. I think I might have to wrap up so you can prepare the next presentations. Okay, so we have to wrap up here. Thanks very much. First of all to the presenters excellent presentations really interesting. Thanks a lot everybody for attending. And let's hope towards maybe we'll have a bigger interoperability webinar or something towards the end of the year we can have a little bit more time.