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A Mobile eHealth Solution for Emerging Countries
This document presents a mobile eHealth solution for patients in emerging countries. It discusses background issues like resource anomalies in rural/urban communities and proposes developing an optimal eHealth solution for Sri Lanka. The research methodology, technical solution including a web-based EMR system and mCommunication system, and post-analysis of clinical efficiency and contribution to patients are described. Future work areas like enforcing industry standards and rapid development are also outlined.
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A Mobile eHealth Solution for Emerging Countries
- 1. A Mobile eHealthSolution for Patients in Emerging CountriesPRESENTED BY: Dinusha Vatsalan, Saatviga Sudhahar, Yvonne Wickramsinghe, Dulindra WijethilakeSUPERVISED BY:Dr. S.M.K.D. ArunathilakeADVISED BY: Mr. G.P. Seneviratne, Dr. DilhariAatigala, Dr. PrathibaMahanamahewa, Dr. Keith Chapman, Mr. Kenneth Thilakaratne1
- 2. Contents BackgroundResearch ProblemResearch MethodologySolutionPostAnalysisFuture WorkConclusion 2
- 3. BackgroundResource Anomalies35% of a Medical Consultant in ColomboIssues In Rural Communities Travel DistanceTravel TimeTravel Cost FrustrationIssues In Urban CommunitiesWaiting TimeFrustrationDelayed AttendanceIneffective Medical Data Storage3
- 4. Background“There are 2.2billion mobile phones in the developing world, 305 million computers but only 11 million hospital beds”4Terry Kramer, the strategy director at British operator Vodafone has mentioned at the Mobile World Congress held in Barcelona
- 5. Research Problem“Developing anOptimal eHealth Solution to Sri Lanka”Health Care for patients withLess TimeLess CostLess DistanceImproved ComfortUbiquitous Patient Medical DataConsultant Time Management 5
- 6.
- 7. Solution7Business ModelChange Management MethodologyWeb-based EMR SystemmCommunication SystemePatienteConsultant
- 8. Considerations…Existing Technology andInfrastructure SimplicityUser Centric Design Gradual ICT ExposureSuitability to Developing-world conditionsA conducive environment for the society 8
- 9.
- 10. Technical SolutionA Webbased EMR systemBackend - EJB 3.0Frontend- Struts FrameworkApplication Server - Jboss 4.2.3Database – MySQL Community EditionMobile Communication SystemTechnology – JavaConnectivity – GSM Modem RS232 Serial ConnectionServer Software – SMSLibConsultation SystemConnectivity – 3G Connection/ ADSLSoftware – Skype/Ekiga/ VLC Player 10
- 11.
- 12. Web-based EMR Architecture12ClientMachineWeb Server MachineInternetHTTPHTTPWeb BrowserApplication Server JBossPatient ManagementSchedulingDatabase Server MachineUser MgmteConsultationDatabase mySQLReporting
- 13. Application ArchitectureSystemeConsultationUser ManagementPatientManagement Scheduling Reporting13
- 14.
- 15. mCommunication Model15Health WorkersPatientMobileService ProviderM-Communication SystemPatientPatientHealth SystemsEMRs, Other DatabasesPatientInternet
- 16. mCommunication System Architecture16SMSServerSMS Reminding Software Phone – to – PC Data CableSMS GatewayGSM Backbone NetworkDatabase Server MachineSMSCDatabase mySQL
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- 19. Clinical EfficiencyTime-to-waite inthe manual system = TwTime-to-consult in the manual system = TcTime-to-travel in the manual system = TtTime-to-waite in the eHealth system = T’wTime-to-consult in the eHealth system = T’cTime-to-travel in the eHealth system = T’t19(Tw >> T’w) AND (Tc < T’c) AND (Tt >>> T’t)(Tw + Tc + Tt ) << (T’w + T’c + T’t)
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- 25. Future WorkEnforcing IndustryStandards (Dicomm, HL7)Voice Recognition (Dragon, FOSS)Hand Writing RecognitionLocalizationMobile Access to the systemRapid DevelopmentInterfacing Medical Equipment (ECG Machine)25
- 26. A Participatory ActionResearch ApproachThe need for a system Requirement AnalysisChanges to be doneHow to manageTechnologiesChange ManagementResearcher PractitionerResearch MethodologyAdaptation of the Sustainable ModelChange Management Specifics of the eHealth SolutionPre Survey AnalysisPost Survey Analysis26
- 27. Web based EMRSystemValue Chain Model for the EMR SystemAdministrative FunctionalitiesIntegration with other systemsSupport Value ProcessesKnowledge TransferClinical ResearchAccess to Patient information irrespective of time and placeAvailability of specialists across a distance of eClinicsEasy Decision making with Holistic View of Patient informationReduced cost and timePrimary Value Processes27
- 28. Actions TakenInterviewsMedical StaffPatientsSurveysITAwarenessEfficiency Awareness ProgramsSystem Launch & Press releaseBrochuresRadio ProgramsTraining Programs28
- 29. Critical AnalysisNo ofClinics carried out (8 weeks)7 Surgical Clinic Sessions 9th July 2009 onwards Every Thursday1 Dermatology Clinic Session 7th Aug 2009 Once a MonthNo of Patients Consulted38 PatientsAvg Time-to-consultSame as Direct Consultation (10 - 15 Mints. per patient) Patients per day38 / 8 = 5
- 30. Challenges FacedTechnical &Economic ConstraintsHandwriting Recognition Speech RecognitionAutomatic SchedulingRelatively longer time taken for an eConsultationLess utilization SMS featureIT Health Policies & Legal ConsiderationsPrivacy PolicyPatient Record StorageSocial BarriersLack of IT Knowledge & InfrastructureTechnology PhobiaPolitical ResistanceProfessional issues30
- 31. Learning OutcomesHealth StandardsEffectivenessEfficiencyInfrastructureADSL over VPNNetwork & Hardware MaintenanceSystem AdministrationHumanParticipatory approach yield better resultsCommunication gap between Consultants and DoctorsUser Training (Windows / Linux)Outliers in the user survey31
- 32.
- 33. eHealth in DevelopedCountries
- 34. eHealth in DevelopedCountriesSpain - Doctors & nurses transferring EMRs using Tablet PCs on to mobile devices (PDAs) Satellite Videoconferencing SystemOnline consultations Specialized diagnosis (radiology, cardiology, surgery, dermatology)Sweden & Denmark90% of doctors using EMR Electronic Participation of Chronically ill patients Reduced visits by >20% Wireless devices 24 hour Wireless AmbulatoryMobile & Remote Patient MonitoringDiagnosis Web-based Health Information Systems (Pubmed, Websurg,)
- 35. eHealth in DevelopingCountriesTelemedicine in rural IndiaPersonal computer Customized medical software Medical diagnostic instruments Commercial VSAT at every location Video-conferencingTelemedicine Initiatives at SGPGIMS, LucknowTele-educationTele-consultation Tele-follow up sessions Tsilitwa , Africa – Rural Tele-consultationsWireless network link Uni-directional Video linkSister-Doctor communication via a simple webcam
- 36. mHealth in DevelopingCountriesUganda Mobile Devices for Health workersUpdate from the field South Africa - the SIMpillA sensor-equipped pill bottle with a SIM Informs doctors of patientsTuberculosis medication for patients The Amazonas state of Brazil Surveys on Mobile phonesMarking incidents of dengue feverMexicoA medical hotline - MedicallHomePatients’ medical questions via SMSDiseases updates via SMS
- 37. Patient ManagementNew PatientSearchfor PatientsPatient ProfileAudio/VideoMedical ImagesMedical HistoryDemographicsMedical ClinicSurgical Clinic
- 38. SchedulingNew appointmentSearch forappointmentAppointmentReschedulingCancellationSchedulingOperation DateseClinic Appointments
- 39. Mobile CommunicationSMS toemailSending SMSReceiving SMSMobile RemindingMedication for PatientsVaccination DatesOperation DateseClinic AppointmentsPostponement/ CancellationAppointment/ Operation Reminder
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- 42. Mobile Communication TechnologiesEvaluation
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- 45. Background Analysis -Stakeholders45
- 46. Sustainability Check -Economics46
- 47. Sustainability Check -Technology47
- 48. Sustainability Check -Anthropology48
- 49. Sustainability Check -Legal49
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- 54. Training & AwarenessSchedule54
- 55.
- 56. Training & AwarenessPrograms
- 57. eClinic & eConsultationSessions57
- 58. Benefits for ConsultantsForConsultantsVirtual Presence of the Consultant and the Patient 24x7 Patient Information AccessClarity of dataCompensation of lost Diagnostic cards due to Patients NegligenceNatural DisastersEasy decision makingPotential for ResearchLess congestion of in-ward patients
- 59. Benefits for PatientsBetterConsultationLess timeLess CostLess DistanceLess FrustrationMobile RemindingPrevents data loss Misplaced Diagnostic cardsStaff errorsPatient Negligence Natural Disasters
- 60. Benefits for RuralHealth InstitutesAccess to ConsultantsKnowledge Transfer to General Medical PractitionersReduced Cost Patient transferElectronic Patient Health Records Pro-active decisions on Resource Allocations Pro-active decisions on Patient Care Potential for Research60
- 61.
- 62. Terms & ConditionsWeoffer help problems regarding Non Critical Patients only in ViduSuwa. Patients referred by a respective consultant are allowed to register.No record will be Deleted or Disclosed which are related to Medical History of a particular patient.The service provided by this site is no substitute for a critical patient visiting a consultant a qualified, licensed health care professional. This site would enable Officers in the medical field to share medical knowledge for research and academic purposes.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. You may consult the Doctors through ViduSuwa:If you are advised to do so by your ConsultantIf you have any medical question or problem and want to consult the medical doctorIf you want to know the routine screening tests or immunizations to keep you healthyIf you want to know the second opinion of your medical condition or treatmentIf you want to know the medical condition causing your symptomsIf you are not recovering with your current treatment62
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- 64. Business Model64Background AnalysisStakeholder(s)HealthcareProvidereCliniceConsultation CenterSustainability CheckTechnologyEconomyLegislationsAnthropology
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- 66. Change Management“It isnot the strongest of the species that survive, nor the most intelligent, but the most responsive to change“Charles Darwin RAspects of ChangeMcKinsey’s 7S model66
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Editor's Notes
- #2 Good morning Ladies & Gentlemen, I am Yvonne representing the project, A Mobile eHealth Solution for Patients in Emerging Countries
- #3 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
- #6 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
- #7 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.
- #8 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.
- #9 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
- #64 So, let us look at the Business Model of this Solution that could be used to sustainably replicate the system elsewhere.
- #65 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