A Mobile eHealth Solution for Emerging Countries


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  • Good morning Ladies & Gentlemen, I am Yvonne representing the project, A Mobile eHealth Solution for Patients in Emerging Countries
  • Speaking of the contents of this presentation, we first brief you on the Background of the Sri Lankan Health Domain. Next, the Research Problem we identified and the Research Methodology we undertook in arriving at our solution.Next, the eHealth Solution followed by the Post Analysis Subsequently possible Future Enhancements and a ConclusionLast but not the least, the Acknowledgement
  • Which is, Developing an Optimal eHealth Solution to Sri Lanka,That encompasses, Health Care for patients; in Less time, with Less Cost, in a Less Distant with a better experience Improved Patient Medical Data StorageAnd the Consultant Time Management
  • So in solving this problem, first we thoroughly reviewed existing literature such as “Dr. Chapman’s Concept paper” which was a major reference for our solution and local eHealth Applications. Next, we researched on Human factors and legal implications associated with eHealth And, the required Infrastructure and the Financial Provisions in sustainably deploying an eHealth Solution All these factors contributed equally in coming up with our solution from which we gave birth to our evolutionary prototype; the famous “ViduSuwa” As a proof-of-concept we made ViduSuwa available at the Base Hospital, Marawila and District Hospital Dankotuwa.
  • So our solution consists of four major components: A web-based EMR model that would critically address the effective Patient Data Storage along with an mHealth Model to optimize the communication channel between the patient and the Health Care ProviderA Change Management Methodology to smoothly introduce the EMR and the mCommunication System into the manual system.And finally a Business Model that would specify the possibility of sustainably replicating the whole solution elsewhere to provide facilities for ePatients and eConsultantsAn eConsultant would be providing Consultation to patients from a location of his/her choice via internet. This location could be called as the eConsultation Center, and need not necessarily be a Health Institute. This could be even a specialized vehicle with the required resources to conduct the eConsultation Center.And the ePatient would be receiving eConsultation via internet at the presence of a General Medical Practitioner.
  • So, there were certain considerations we took in developing this system such as;Usage of existing technology and infrastructure to prevent the re-invention of the wheelMaintaining Simplicity to improve User-friendlinessGetting the end-user involved in the design phase, to make them feel of the ownership of the systemIntroducing ICT progressivelySuitability for the Developing WorldAnd most importantly to uplift the living standards of the society
  • So, let us look at the Business Model of this Solution that could be used to sustainably replicate the system elsewhere.
  • So, the model basically consists of two stages, the Background Analysis and the Sustainability’ Check.The Background Analysis basically identifies the applicability of this solution as an eClinic or as an eConsultation Center. Thus this will assess the possibility of a Health Institute functioning as an eClinic or an eConsultation Center. And the possibility of a Consultant Acting as an eConsultant.This assessment is performed for the selected Institution/Consultant and appropriate Stakeholders.In the Institution/Consultant category we assess the location and its infrastructure the draining area which defines the possible perimeter of land from which patients would visit this location. For an example, Draining Area of the Colombo National Hospital encompasses, Wellawattha, Kolpity, etc. And other health Institutes which could act as an eClinic or an eConsultation for this Health Institute.In terms of Stakeholders we assess, their organizational structure, Partner organizations and Private Institutes in close proximity .So the result of the Background Analysis would be the rough identification of the selected Health Institute/Consultant to act as an eConsultation Center or as an eClinic.So based on that the Selected entity would be thoroughly evaluated for the sustainability of the systemThe sustainability is assessed in terms of Technology, Economics, Legislations and Anthropology.Technology identifies the hardware, software and connectivity requirements to sustainably implement the systemEconomics identify the Financial Provisions in Acquiring and Maintaining the Required Hardware, Software and Connectivity.Legislations specify the Privacy Policy, Terms & Conditions and Disclaimers the Stakeholders should adhere to in using the system.And finally the Anthropological assessment of people committing to use the system.So the Sustainability Check identifies possibility of the Health Institute/Consultant sustainably incorporating the Health Solution which consists of the Web-base EMR and the mCommunication system. So to speak about the Web-base EMR I call upon Saatviga to continue with the Presentation
  • A Mobile eHealth Solution for Emerging Countries

    1. 1. A Mobile eHealth Solution for Patients in Emerging Countries<br />PRESENTED BY: <br />Dinusha Vatsalan, Saatviga Sudhahar, Yvonne Wickramsinghe, Dulindra Wijethilake<br />SUPERVISED BY:<br />Dr. S.M.K.D. Arunathilake<br />ADVISED BY: <br />Mr. G.P. Seneviratne, Dr. DilhariAatigala, Dr. PrathibaMahanamahewa, Dr. Keith Chapman, Mr. Kenneth Thilakaratne<br />1<br />
    2. 2. Contents <br />Background<br />Research Problem<br />Research Methodology<br />Solution<br />Post Analysis<br />Future Work<br />Conclusion <br />2<br />
    3. 3. Background<br />Resource Anomalies<br />35% of a Medical Consultant in Colombo<br />Issues In Rural Communities <br />Travel Distance<br />Travel Time<br />Travel Cost <br />Frustration<br />Issues In Urban Communities<br />Waiting Time<br />Frustration<br />Delayed Attendance<br />Ineffective Medical Data Storage<br />3<br />
    4. 4. Background<br />“There are <br />2.2 billion mobile phones in the developing world, <br />305 million computers <br />but only 11 million hospital beds”<br />4<br />Terry Kramer, the strategy director at British operator Vodafone has mentioned at the Mobile World Congress held in Barcelona<br />
    5. 5. Research Problem<br />“Developing an Optimal eHealth Solution to Sri Lanka”<br />Health Care for patients with<br />Less Time<br />Less Cost<br />Less Distance<br />Improved Comfort<br />Ubiquitous Patient Medical Data<br />Consultant Time Management <br />5<br />
    6. 6. Research Methodology<br />6<br />
    7. 7. Solution<br />7<br />Business Model<br />Change Management Methodology<br />Web-based EMR System<br />mCommunication System<br />ePatient<br />eConsultant<br />
    8. 8. Considerations…<br />Existing Technology and Infrastructure <br />Simplicity<br />User Centric Design <br />Gradual ICT Exposure<br />Suitability to Developing-world conditions<br />A conducive environment for the society <br />8<br />
    9. 9. The Project Scope<br />9<br />
    10. 10. Technical Solution<br />A Web based EMR system<br />Backend - EJB 3.0<br />Frontend- Struts Framework<br />Application Server - Jboss 4.2.3<br />Database – MySQL Community Edition<br />Mobile Communication System<br />Technology – Java<br />Connectivity – GSM Modem RS232 Serial Connection<br />Server Software – SMSLib<br />Consultation System<br />Connectivity – 3G Connection/ ADSL<br />Software – Skype/Ekiga/ VLC Player <br />10<br />
    11. 11. Web-based EMR System<br />11<br />
    12. 12. Web-based EMR Architecture<br />12<br />Client Machine<br />Web Server Machine<br />Internet<br />HTTP<br />HTTP<br />Web Browser<br />Application Server JBoss<br />Patient Management<br />Scheduling<br />Database Server Machine<br />User Mgmt<br />eConsultation<br />Database mySQL<br />Reporting<br />
    13. 13. Application Architecture<br />System<br />eConsultation<br />User Management<br />Patient Management <br />Scheduling <br />Reporting<br />13<br />
    14. 14. mCommunication System<br />14<br />
    15. 15. mCommunication Model<br />15<br />Health Workers<br />Patient<br />Mobile Service Provider<br />M-Communication System<br />Patient<br />Patient<br />Health Systems<br />EMRs, Other Databases<br />Patient<br />Internet<br />
    16. 16. mCommunication System Architecture<br />16<br />SMS Server<br />SMS Reminding Software <br />Phone – to – PC Data Cable<br />SMS Gateway<br />GSM Backbone Network<br />Database Server Machine<br />SMSC<br />Database mySQL<br />
    17. 17. Post Analysis<br />17<br />
    18. 18. eClinic Effectiveness<br />18<br />
    19. 19. Clinical Efficiency<br />Time-to-waite in the manual system = Tw<br />Time-to-consult in the manual system = Tc<br />Time-to-travel in the manual system = Tt<br />Time-to-waite in the eHealth system = T’w<br />Time-to-consult in the eHealth system = T’c<br />Time-to-travel in the eHealth system = T’t<br />19<br />(Tw &gt;&gt; T’w) AND (Tc &lt; T’c) AND (Tt &gt;&gt;&gt; T’t)<br /><br />(Tw + Tc + Tt ) &lt;&lt; (T’w + T’c + T’t)<br />
    20. 20. Contribution to Patients<br />20<br />
    21. 21. Demonstration<br />21<br />
    22. 22. 22<br />
    23. 23. Conclusion<br />23<br />National Development Process<br />
    24. 24. Thank You !<br />24<br />
    25. 25. Future Work<br />Enforcing Industry Standards (Dicomm, HL7)<br />Voice Recognition (Dragon, FOSS)<br />Hand Writing Recognition<br />Localization<br />Mobile Access to the system<br />Rapid Development<br />Interfacing Medical Equipment (ECG Machine)<br />25<br />
    26. 26. A Participatory Action Research Approach<br />The need for a system<br /> Requirement Analysis<br />Changes to be done<br />How to manage<br />Technologies<br />Change Management<br />Researcher <br />Practitioner<br />Research Methodology<br />Adaptation of the Sustainable Model<br />Change Management <br />Specifics of the eHealth Solution<br />Pre Survey Analysis<br />Post Survey Analysis<br />26<br />
    27. 27. Web based EMR System<br />Value Chain Model for the EMR System<br />Administrative Functionalities<br />Integration with other systems<br />Support Value Processes<br />Knowledge Transfer<br />Clinical Research<br />Access to Patient information irrespective of time and place<br />Availability of specialists across a distance of eClinics<br />Easy Decision making with Holistic View of Patient information<br />Reduced cost and time<br />Primary Value Processes<br />27<br />
    28. 28. Actions Taken<br />Interviews<br />Medical Staff<br />Patients<br />Surveys<br />IT Awareness<br />Efficiency <br />Awareness Programs<br />System Launch & Press release<br />Brochures<br />Radio Programs<br />Training Programs<br />28<br />
    29. 29. Critical Analysis<br />No of Clinics carried out (8 weeks)<br />7 Surgical Clinic Sessions <br />9th July 2009 onwards <br />Every Thursday<br />1 Dermatology  Clinic Session <br />7th Aug 2009 <br />Once a Month<br />No of Patients Consulted<br />38 Patients<br />Avg Time-to-consult<br />Same as Direct Consultation (10 - 15 Mints. per patient) <br />Patients per day<br />38 / 8 = 5<br />
    30. 30. Challenges Faced<br />Technical & Economic Constraints<br />Handwriting Recognition <br />Speech Recognition<br />Automatic Scheduling<br />Relatively longer time taken for an eConsultation<br />Less utilization SMS feature<br />IT Health Policies & Legal Considerations<br />Privacy Policy<br />Patient Record Storage<br />Social Barriers<br />Lack of IT Knowledge & Infrastructure<br />Technology Phobia<br />Political Resistance<br />Professional issues<br />30<br />
    31. 31. Learning Outcomes<br />Health Standards<br />Effectiveness<br />Efficiency <br />Infrastructure<br />ADSL over VPN<br />Network & Hardware Maintenance<br />System Administration<br />Human<br />Participatory approach yield better results<br />Communication gap between Consultants and Doctors<br />User Training (Windows / Linux)<br />Outliers in the user survey<br />31<br />
    32. 32. Subject Matrix<br />32<br />
    33. 33. eHealth in Developed Countries<br />
    34. 34. eHealth in Developed Countries<br />Spain - Doctors & nurses transferring EMRs using <br />Tablet PCs on to mobile devices (PDAs) <br />Satellite Videoconferencing System<br />Online consultations <br />Specialized diagnosis (radiology, cardiology, surgery, dermatology)<br />Sweden & Denmark<br />90% of doctors using EMR <br />Electronic Participation of Chronically ill patients <br />Reduced visits by &gt;20% <br />Wireless devices <br />24 hour Wireless Ambulatory<br />Mobile & Remote Patient Monitoring<br />Diagnosis <br />Web-based Health Information Systems (Pubmed, Websurg,)<br />
    35. 35. eHealth in Developing Countries<br />Telemedicine in rural India<br />Personal computer <br />Customized medical software <br />Medical diagnostic instruments <br />Commercial VSAT at every location <br />Video-conferencing<br />Telemedicine Initiatives at SGPGIMS, Lucknow<br />Tele-education<br />Tele-consultation <br />Tele-follow up sessions <br />Tsilitwa , Africa – Rural Tele-consultations<br />Wireless network link <br />Uni-directional Video link<br />Sister-Doctor communication via a simple webcam<br />
    36. 36. mHealth in Developing Countries<br />Uganda <br />Mobile Devices for Health workers<br />Update from the field <br />South Africa - the SIMpill<br />A sensor-equipped pill bottle with a SIM <br />Informs doctors of patients<br />Tuberculosis medication for patients <br />The Amazonas state of Brazil <br />Surveys on Mobile phones<br />Marking incidents of dengue fever<br />Mexico<br />A medical hotline - MedicallHome<br />Patients’ medical questions via SMS<br />Diseases updates via SMS<br />
    37. 37. Patient Management<br />New Patient<br />Search for Patients<br />Patient Profile<br />Audio/Video<br />Medical Images<br />Medical History<br />Demographics<br />Medical Clinic<br />Surgical Clinic<br />
    38. 38. Scheduling<br />New appointment<br />Search for appointment<br />Appointment<br />Rescheduling<br />Cancellation<br />Scheduling<br />Operation Dates<br />eClinic Appointments<br />
    39. 39. Mobile Communication<br />SMS to email<br />Sending SMS<br />Receiving SMS<br />Mobile Reminding<br />Medication for Patients<br />Vaccination Dates<br />Operation Dates<br />eClinic Appointments<br />Postponement/ Cancellation<br />Appointment/ Operation Reminder<br />
    40. 40. User Interface Design<br />
    41. 41. EMR Software Evaluation<br />
    42. 42. Mobile Communication Technologies Evaluation<br />
    43. 43. eConsultation Technologies Evaluation<br />
    44. 44. Background Analysis- Institution<br />44<br />
    45. 45. Background Analysis - Stakeholders<br />45<br />
    46. 46. Sustainability Check - Economics<br />46<br />
    47. 47. Sustainability Check - Technology<br />47<br />
    48. 48. Sustainability Check - Anthropology<br />48<br />
    49. 49. Sustainability Check - Legal<br />49<br />
    50. 50. Hardware Configurations<br />50<br />
    51. 51. Expenditure Incurred<br />51<br />
    52. 52. Pilot Surveys<br />52<br />
    53. 53. Comprehensive Survey<br />Stratified Sampling<br />4 Weeks<br />53<br />
    54. 54. Training & Awareness Schedule<br />54<br />
    55. 55. Training Schedule<br />55<br />
    56. 56. Training & Awareness Programs<br />
    57. 57. eClinic & eConsultation Sessions<br />57<br />
    58. 58. Benefits for Consultants<br />For Consultants<br />Virtual Presence of the Consultant and the Patient <br />24x7 Patient Information Access<br />Clarity of data<br />Compensation of lost Diagnostic cards due to <br />Patients Negligence<br />Natural Disasters<br />Easy decision making<br />Potential for Research<br />Less congestion of in-ward patients <br />
    59. 59. Benefits for Patients<br />Better Consultation<br />Less time<br />Less Cost<br />Less Distance<br />Less Frustration<br />Mobile Reminding<br />Prevents data loss <br />Misplaced Diagnostic cards<br />Staff errors<br />Patient Negligence <br />Natural Disasters<br />
    60. 60. Benefits for Rural Health Institutes<br />Access to Consultants<br />Knowledge Transfer to General Medical Practitioners<br />Reduced Cost <br />Patient transfer<br />Electronic Patient Health Records <br />Pro-active decisions on Resource Allocations <br />Pro-active decisions on Patient Care <br />Potential for Research<br />60<br />
    61. 61. Work Carried Out<br />
    62. 62. Terms & Conditions<br />We offer help problems regarding Non Critical Patients only in ViduSuwa. Patients referred by a respective consultant are allowed to register.<br />No record will be Deleted or Disclosed which are related to Medical History of a particular patient.<br />The service provided by this site is no substitute for a critical patient visiting a consultant a qualified, licensed health care professional. <br />This site would enable Officers in the medical field to share medical knowledge for research and academic purposes.<br />Prescribing medications online may contradict with to medical ethics. Thus our Consultant would be accompanied with another Government Qualified Medical Practitioner to assist the patient. <br />You may consult the Doctors through ViduSuwa:<br />If you are advised to do so by your Consultant<br />If you have any medical question or problem and want to consult the medical doctor<br />If you want to know the routine screening tests or immunizations to keep you healthy<br />If you want to know the second opinion of your medical condition or treatment<br />If you want to know the medical condition causing your symptoms<br />If you are not recovering with your current treatment<br />62<br />
    63. 63. Business Model<br />63<br />
    64. 64. Business Model<br />64<br />Background Analysis<br />Stakeholder(s)<br />Healthcare Provider<br />eClinic<br />eConsultation Center<br />Sustainability Check<br />Technology<br />Economy<br />Legislations<br />Anthropology<br />
    65. 65. Change Management Methodology<br />65<br />
    66. 66. Change Management<br />“It is not the strongest of the species that survive, <br />nor the most intelligent, <br />but the most responsive to change“<br />Charles Darwin R<br />Aspects of Change<br />McKinsey’s 7S model<br />66<br />
    67. 67. Change Management Strategy <br />67<br />
    68. 68. Acknowledgment <br />68<br />