The best thing about FrontlineSMS:Medic is that it gives physicians and healthworkers in geographically challenged areas the ability to create a closed communications system with their patients, with virtually no installation costs. The only thing required that cannot be purchased off-the-shelf is a working GSM wireless network. Happily, these are proliferating now.

FrontlineSMS:Medic It is an extension of the open source messaging platform pioneered by Ken Banks back in 2005, called FrontlineSMS.   Ken built FrontlineSMS with developing countries in mind, where Internet access is poor, so that aid workers and volunteers could do things like monitor elections or circulate news independently off of mobile networks, which are comparatively abundant. Since 2005, Banks' platform has be used in Nigeria, Zimbabwe, Iraq, Cambodia, El Salvador and more. Aid workers in Afghanistan use it currently to alert each other of Taliban attacks. The work helped Banks win support from Stanford University, and a 2007 MacArthur grant. 

There in Palo Alto, a Stanford student named Josh Nesbit heard Banks speak. Inspired, Nesbit and three friends customized Ken's source code to create FrontlineSMS:Medic. 

Here's how it works. Simply download and install Banks' software, plug in your phone to your PC, input the cellphone numbers of the people you want to reach--such as patients or nursing staff--craft your message, and hit 'send.' You now own your own text messaging system. The software is free, but users do need to pay carriers for the text messages.

The system is two-way, so recipients can reply to senders and ask questions, an especially important function for communication between doctors and patients. Banks notes that workers have also used the original FrontlineSMS to run surveys. This also could be a powerful way to extend healthcare research or polling for projects like the Dartmouth Atlas to remote areas. We have in mind those areas managed by the Indian Health Service in Alaska, Arizona, and New Mexico. We mentioned FrontlineSMS:Medic to a doctor at IHS recently: He went nuts about it.

While barely a year old, FrontlineSMS:Medic has some powerful anecdotal outcomes data. In a six-month pilot in Namitete, Malawi, doctors saved approximately six hours of travel time each day by no longer needing to leave their clinic to do basic follow-up rounds in the field. They used the time to double the number of TB patients they see in the clinic.

In the U.S., rural physicians, or primary care doctors on a budget, could use this to communicate with patients (take your meds!) or with colleagues (did you receive the patient's film?). It requires GSM, but if you're within these AT&T or T-Mobile coverage areas, you're good to go.

We like FrontlineSMS:Medic most because it allows physicians who might otherwise be reluctant to experiment with a new technology, a chance to do so on the cheap -- no $40,000 government subsidy needed for this improvement tool. If they have the gear, all they need to pay for are the text messages themselves. With a good plan, that's not even a four-digit annual investment, and less than $100 a month.

"That’s the beauty of the software. It gives people the ability to play and to learn at very low-cost where the barrier[s] to entry are usually too high," says Banks.

He encourages doctors to download the software and experiment with it. Why not? It's practically free. 

"Just pick 50 [patients], and ask them if they’d like to be part of a trial in the clinic. Once you decide SMS is good, then you can go invest $10,000. No one in their right mind wants to go and invest  $10,000 in a new technology to find out that it doesn’t work." Indeed.

Banks is now busy extending the original messaging platform with an applications development platform. Of course it will be open, so developers can customize tools for themselves. FrontlineSMS:Medic is working on a few applications, including: Patient View, a PHR application; OpenMRS, an EMR platform that will run across mobile phones; and CelloPhone, which will allow health workers to do diagnose Malaria, TB, and also conduct Complete Blood Count and CD4 T Lymphocyte counts with a camera phone. FrontlineSMS:Medic says the application will cost less that $1 per test. (Results will be fed into Patient View and OpenMRS (diagram below). A device to run CelloPhone is also in development, at UCLA. They hope it will cost as little as $10.

Stay tuned, we'll be sure to write about these promising innovations when they're ready.