The document discusses m-health solutions for rural healthcare in developing countries, focusing on a case study in India. It describes the disparities in healthcare access between urban and rural populations in India. It then summarizes the shift from traditional telemedicine using PCs to a mobile phone-based approach using customized handheld devices. The handheld devices are used by trained village health champions to register patients, record vitals, and facilitate consultations between patients and remote physicians to improve access to care in rural areas.

1. COST EFFECTIVE M-HEALTH SOLUTIONS FOR DEVELOPING COUNTRIES Case study CARE RURAL HEALTH INITIATIVE AP India Dr. Priyesh Tiwari

2. HEALTHCARE SECTOR IN INDIA STANDARD TELEMEDICINE EXPERIMENT SHIFT TO HANDHELD TECHNOLOGY INNOVATIVE APPLICATIONS Presentation contents

3. HEALTHCARE SCENARIO IN INDIA A country of wide contrasts

4. Private sector driven Urban areas and metros have world class medical facilities Many of the specialists trained in USA/UK with excellent clinical skills Use state of the art equipment High volume of cases, lower costs and manpower availability is attracting billions of dollars of overseas investment in the sector

5. Growing disparities ~ 70% of 1 billion people live in rural areas...

6. STANDARD TELEMEDICINE Using PC, broadband and video conferencing

7. Ongoing problems... Poor maintenance Heat, dust, rough handling Expensive Satellite driven broadband system is unsustainably expensive Poor electrical supply Variable voltage, available only for 3-6 hours per day) User training issues semiliterate population Lack of seamless connectivity to next level of care

8. SHIFT TO MOBILE PHONE Versatile, portable, user friendly

9. India is one of the fastest growing markets More than 100,000 new connections sold everyday Govt. Has made compulsory for connectivity providers to setup towers in rural areas Mobile phone can do almost all basic functions of a PC, in addition: It is rugged Easy to charge (3 hours charging lasts for day) Circumvents broadband connectivity (GPRS has become ubiquitous) Even semiliterate people are now expert mobile users

10. Level 1- Doctor on call Services are offered where people can call a toll free number and seek health advise... But: How do we know who is calling or who is answering? Are problems real, exaggerated or genuine? Who takes medico-legal responsibility? How does a prescription get signed? How do we ensure person gets the right drugs or correctly understands/follows advice

11. Level 2 - An intermediary introduced A Village Health Champion for each 200 families One person in the village is authorized to call She is trained and accredited for facilitation & providing paramedical services But still had many limitations like - Still a reactive care, no focus on prevention Cognitive skills of VHC span a limited range Prescription printing , delivery of medicines limited Lack of clinical data and tests limit clinical decision making Financial incentives not enough to be full time

12. CUSTOMIZED HANDHELD DEVICE Innovative Applications

13. Replaced mobile phone with customized integrated handheld device GPRS, WiFi, Broadband Biometric ID Smart card reader Built in printer Camera External physiological sensors TFT display Resistive touch screen Multi-lingual customizable soft keypad Built in speaker Standard Audio interface Two USB ports

14. Introduced CDSS Menu driven registration, history taking and vital signs recording Local triaging if the VHC should treat, call or transfer Logged transaction (GPS, time, date, ID stamped) enable quality control and process refinement

15. Example: Simple consult Patient goes to VHC Biometric ID validation VHC records Signs & Symptoms Information sent through GPRS to Web based server Physician in the city analyses and issues prescription/ referral / test advice Data sent to HHD VHC arranges logistics for further evaluation, medication & treatment Printing of Prescription at the village VHC provides OTC medicines & collects samples at site if needed

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