Innovative Low Cost mHealth tool kit

INDRA PRATAP SINGH

School of Telemedicine & Biomedical Informatics Lucknow, India [email protected]

, Sanjay Gandhi Post Graduate Institute of Medical Sciences

Content

• Background • Introduction • Material & Method • mHealth4U®: Integration of ICT & medical Equipments • Case Study: Telemedicine enabled specialty healthcare access for health emergencies • Discussion • Conclusion • Acknowledgement

Background

• Advances in mobile communications and medical technologies has facilitated development of innovative low cost portable tele-health tools • mHealth is the use of information and mobile communication technology to improve health systems performance • In India 506 million mobile phone subscribers with Growing approximatly 10 million per month • Mobile networks have now become country’s largest distribution platform, promising to deliver information and public services to the masses through innovative applications • Mobility as such brings in added value of continuous availability and timely information access • ICT based solutions for various types of customization and allowing support for a wider set of application requirements

Introduction

• Telemedicine is the use of medical information that is exchanged from one treatment site to another via electronic communications • It comprise videoconferencing, transmission of still medical images, document sharing, remote monitoring of vital signs • Evolution of wireless communication technologies have enabled telemedicine systems to operate in the remotest place for rural health practices, hence expanding telemedicine benefits, applications, and services • In India majority of the people are living in the rural and remote locations where even the basic facilities are not available for the society

Material & Method

• mHealth4U® a portable low cost mobile telemedicine kit was conceptualized, designed and prototype developed at the mHealth research laboratory, STBMI in the year 2008.

Two versions • mHealth4U-B ( Backpack ) • mHealth4U-S ( Suitcase )

Components of Low Cost Telemedicine Platform

1. Computer System 2. Communication Technology 3. Software based Video Conferencing System 4. Integrated Medical Equipments 5. Centralized Telemedicine Software

1. Computer System

• Low cost Atom based Processors for deploying large number of telemedicine terminals – Desktop – Notebook – Thin client & Cloud computing – Handheld Mobile tablet

2. Communication Technology

• Low cost communication facilities now be the alternative solution for transmitting the data, voice and video to the nearby telemedicine enabled service provider – ADSL broadband – Wireless broadband provided by various ISP in a form of HSB plug in

3. Software based Video Conferencing System

• Mobility and lowering cost of devices can only be achieved by replacing hardware with software based video conferencing system – People Link

mHealth4U

®

mHealth4U®: Integration of ICT & Medical Equipments

• mHealth4U® is a mobile tele-health solution designed, developed and validated by School of Telemedicine & Biomedical Informatics.

• Available both in Aluminium polycarbonate case (Aeroplane cabin bag size) & Standard Backback model.

• Consist atom processor based laptop with Windows vista platform & Microsoft Office, non-invasive blood pressure monitor, ECG, pulse oxymeter, Spirometer, Glucometer, Digital Thermometer, Digital Weighing Machine, Digital Stethescope.

• Mobile high speed broadband (HSB) data card is used to transmit data from remote rural area to teleconsultation center.

• All medical equipments are integrated with Curesoft® software.

• IP based video conference software is used for telemedicine interactive session

Integrated Medical Equipments PC Interface: USB & Bluetooth Wrist Clinic Spirometer Weighing Machine Common Interface Digital Glucometer Blood Pressure SPO 2 ECG Atom based Low Cost Laptop with Integrated Telemedicine Software Connectivity via High Speed Broadband (HSB)

Network Architecture

• All Software Servers are Installed at Data Center of School of Telemedicine & Biomedical Informatics

Screen Shot of Software based Video Conferencing

Screen Shot of Cure-Soft Software

Case Study: “Telemedicine enabled specialty healthcare access for health emergencies”

2009: Puri Rath Yatra @ Odihsa

• Telemedicine enabled specialty healthcare access for health emergencies during Lord Jagannath Rath Yatra at Puri was initiated by the School of Telemedicine & Biomedical Informatics (STBMI), SGPGIMS, Lucknow in collaboration with OTTET, Bhubaneswar and Govt. of Odisha • An enterprise based telemedicine network was set up connecting specialty hospitals at Bhubaneswar and Cuttack using wireless broadband IP network to exchange E.C.G. and carry out peoplelink® software based videoconference for tele-consultation

Technical Layout Diagram of Rath Yatra

2010: Field Deployment @ Gujarat, India

• Kit was deployed in Four Primary Health Center (PHC), one Community Health Center (CHC) and one state Hospital in the State of Gujarat, western India • Basic orientation, demonstration and hands-on-training programme was imparted to in-service paramedical, laboratory technician & nursing staff to give them first hand exposure on the kit • All five nodes were connected over mobile wireless internet with expert hospital located in the city. The electronic medical record was created using the Curesoft® telemedicine software and the input from integrated medical devices like ECG, NIBP; Spo2 etc were captured through USB 2.0 port into this software which was then exchanged between the nodes and videoconference session followed for tele-consultation after the successful transmission of the data to specialist.

Video Clip

Result

• The outcome of “Proof of concept” was satisfactory.

• The Doctors involved in the project was quit excited and found innovative solution for strengthening the healthcare services at their hospitals.

• Subsequently pilot deployment was started in a different environment. The patient data was transferred successfully between the expert doctors and remote end and videoconference could be possible even in low bandwidth.

• The doctors participating in the study suggested some minor changes in the software architecture like incorporating more graphics to represent body parts. Overall performance of the kit was acceptable to them.

Discussion

• The advancement of mHealth technology should be exploited in rural healthcare delivery setting in low resource countries where the mobile telecommunication network has already reached.

• mHealth or mobile health or efficient high-quality healthcare services for mobile citizens and u-Health or ubiquitous healthcare that focuses on eHealth applications that can provide healthcare to people anywhere at anytime using broadband and wireless mobile technologies.

• The tool kit has been developed keeping in mind the basic health care needs in remote villages in Indian setting, a situation akin to countries in developing world. Besides the local available technology and skill, cost factor has been taken into account. While field deployment has been successful in testing the local available mobile network, the human factors such as acceptability of the device and operational simplicity was also taken into consideration.

Discussion

• Evolving software solutions will help to further the growth, acceptance and adoption of telemedicine initiatives.

• Healthcare based on broadband and wireless mobile technologies can only reach to the door step. Although technology cannot take the place of a visit to the family doctor.

• Web and video conferencing are emerging as powerful components in telemedicine and telehealth initiatives worldwide. The integration of web based video conferencing has been able to help many patients, and has enabled doctors to communicate with specialists in order to make critical diagnoses faster.

• Software solutions like Peoplelink® will help to further the growth, acceptance and adoption of telemedicine initiatives.

• Keeping telemedicine costs low will enable providers to reach out to a broader audience, including those in rural regions and low-income patients who cannot afford to travel long distances for care.

Acknowledgement

• The authors would like to acknowledge the financial grant support received from Department of Information Technology, Ministry of Communications & Information Technology, Government of India under the Project” National Resource Center for Telemedicine & Biomedical Informatics”.

School of Telemedicine & Biomedical Informatics, SGPGI, Lucknow

Thank You

www.sgpgi-telemedicine.org

www.stbmi.ac.in

| www.telemedindia.org

| www.nrct.in