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Typical Scene in a Rural Health CenterTypical Scene in a Rural Health Center
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Introduction| CHITS: Community Health InformationTracking System
Community Health Information Tracking System (Community Health Information Tracking System (CHITSCHITS) is a system that stores ) is a system that stores records in a database from various vertical programs in the local health center. records in a database from various vertical programs in the local health center.
CHITS
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CHITS Setup
SERVERSERVERROUTERROUTER
WORKSTATIONSWORKSTATIONS
CHITS: Community Health InformationTracking System
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CHITS: Community Health InformationTracking System
STEP 1: ARRIVALSTEP 1: ARRIVAL
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CHITS: Community Health InformationTracking System
STEP2: STEP2: CONSULTATIONCONSULTATION
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CHITS: Community Health InformationTracking System
STEP3: DEPARTURESTEP3: DEPARTURE
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Problems
CHITS: Community Health InformationTracking System
Target based approachTarget based approachMidwives pad and modify their data to meet their quota which is Midwives pad and modify their data to meet their quota which is encouraged by the “pen and paper” approachencouraged by the “pen and paper” approach
All-or-nothing phenomenonAll-or-nothing phenomenonReports from the lower layers are not passed to the higher levels Reports from the lower layers are not passed to the higher levels until the records are completeduntil the records are completed
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Introduction| miCHITS: Mobile Interface for CHITS
miCHITS (Mobile Interface for CHITS) miCHITS (Mobile Interface for CHITS) Recently developed to provide some answers Recently developed to provide some answers to these problems by incorporating a mobile to these problems by incorporating a mobile component to the system. component to the system.
The database from the server is downloaded The database from the server is downloaded to the phone and the health worker can now to the phone and the health worker can now encode the data into the phone and update encode the data into the phone and update the database later when he visits the centerthe database later when he visits the center
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miCHITS Setup
miCHITS: Mobile Interface for CHITS
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miCHITS: Mobile Interface for CHITS
STEP1: FIELD CONSULTATIONSTEP1: FIELD CONSULTATION
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miCHITS: Mobile Interface for CHITS
STEP2: RETURNSTEP2: RETURN
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miCHITS: Mobile Interface for CHITS
STEP3: SYNC/RESOLVE DATABASESTEP3: SYNC/RESOLVE DATABASE
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Target based approachTarget based approachThe “pen and paper” approach would be replaced by the mobile The “pen and paper” approach would be replaced by the mobile component and there will be no more manual encoding since the component and there will be no more manual encoding since the database file is transferred directly to the server thus preventing database file is transferred directly to the server thus preventing the modification of data.the modification of data.
All-or-nothing phenomenonAll-or-nothing phenomenonRecords could still not be sent in real-time due to certain Records could still not be sent in real-time due to certain circumstances circumstances Examples:Examples:
Health worker could not return to the health centerHealth worker could not return to the health centerHealth worker lost the phoneHealth worker lost the phone
miCHITS: Mobile Interface for CHITS
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Problem All-or-nothing phenomenonAll-or-nothing phenomenon
Problem
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Goal
SERVERSERVER ROUTERROUTER
WORKSTATIONSWORKSTATIONS
CHITS SETUPCHITS SETUP
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Goal
MOBILE APPLICATIONMOBILE APPLICATION
miCHITS SetupmiCHITS Setup
WEB APPLICATIONWEB APPLICATION
CHITS SetupCHITS Setup
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miCHITS SetupmiCHITS Setup
Health worker Health worker after field workafter field work
DB transfer via data DB transfer via data cable/bluetoothcable/bluetooth
CHITS SetupCHITS Setup
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DB transfer via data DB transfer via data cable/bluetoothcable/bluetooth
No remote No remote connectionconnection
Health worker Health worker on field workon field work
miCHITS SetupmiCHITS Setup
CHITS SetupCHITS Setup
Inside health center
Inside health center
Remote patients’ houses
Remote patients’ houses
Health worker Health worker after field workafter field work
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Goal
… … to improve the current setup of miCHITS by integrating a to improve the current setup of miCHITS by integrating a cost-efficient and effective remote data connection cost-efficient and effective remote data connection between CHITS and miCHITS through the SMS functionality between CHITS and miCHITS through the SMS functionality of mobile phonesof mobile phones
Our Goal is…
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Impact |Mobile Phones on Telehealth
Africa – Uganda Health Information Network*Africa – Uganda Health Information Network*– 24% savings per unit24% savings per unit– Improvement in weekly surveillance reportingImprovement in weekly surveillance reporting• 100% compliance rate (before: 63%)100% compliance rate (before: 63%)
– SMS reminding TB patients to take their pillsSMS reminding TB patients to take their pills(although there are stills problems on this)(although there are stills problems on this)
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Impact |Mobile Phones on Telehealth
““CHITS web-based application comprises only 5% CHITS web-based application comprises only 5% of the first-hand data collection, the remaining of the first-hand data collection, the remaining 95% will be compensated by the mobile 95% will be compensated by the mobile componentcomponent.”.”
Dr. Alvin MarceloDr. Alvin MarceloDirector, National Telehealth CenterDirector, National Telehealth Center
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Health worker Health worker on field workon field work
miCHITS SetupmiCHITS Setup
CHITS SetupCHITS Setup
Health worker Health worker after field workafter field work
SERVER PHONESERVER PHONE
Inside health center
Inside health center
Remote patients’ houses
Remote patients’ housesData transfer via SMSData transfer via SMS
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Java MEJava MEMIDP 2.0MIDP 2.0CLDC 1.1CLDC 1.1
Compatible with most Compatible with most mid-class phonesmid-class phones
ModulesModules Personal informationPersonal information Vital signsVital signs VaccinationVaccination Maternal careMaternal care
Mobile Interface
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J2EEJ2EE Spring Framework 2.5Spring Framework 2.5 Apache Tomcat 6.0.18Apache Tomcat 6.0.18 MySQL ServerMySQL Server
Web Interface Data compatibility and Data compatibility and synchronization of the phone's synchronization of the phone's local database and temporary local database and temporary databasedatabase
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Java SEJava SE
Desktop Interface
Used to process incoming messages and respond to Used to process incoming messages and respond to the requestthe request Connected to a phone which receives the messagesConnected to a phone which receives the messages
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System Architecture
SMS Reliability Protocol
Only ninety-five percent of the SMS sent reach the target phone. Only ninety-five percent of the SMS sent reach the target phone. The other five percent are either delayed or lost. The other five percent are either delayed or lost.
A modified selective repeat protocol was designed to factor in the A modified selective repeat protocol was designed to factor in the constraints of implementing it over SMS and on a mobile constraints of implementing it over SMS and on a mobile platform.platform.
• Best effortBest effort• Stop-and-wait per sessionStop-and-wait per session• Session – s bit ID, at most m messagesSession – s bit ID, at most m messages
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SMS Reliability Protocol
Selective Repeat ProtocolSelective Repeat Protocol
SenderSender
ReceiverReceiver
Acknowledgements (ACKS)Acknowledgements (ACKS)
Data being transmittedData being transmitted
Methodology |SMS Reliability Protocol
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SMS Reliability Protocol
Selective Repeat ProtocolSelective Repeat Protocol
SenderSender
ReceiverReceiver
Acknowledgements (ACKS)Acknowledgements (ACKS)
SenderSender
Data being transmittedData being transmitted Data being transmittedData being transmitted
Designed ProtocolDesigned Protocol
ReceiverReceiver
ACK VectorACK Vector
Methodology |SMS Reliability Protocol
11011101
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CompressionDeflate AlgorithmDeflate AlgorithmTo lessen the amount of messages sent, the deflate compression To lessen the amount of messages sent, the deflate compression algorithm will be used algorithm will be used
OperationsOperations Operations usually take the length of ½ to 1 message (Ex. Operations usually take the length of ½ to 1 message (Ex. Adding a patient)Adding a patient)
5 operations = about 373 characters5 operations = about 373 characters Compressed = about 234 characters ~ 38% reducedCompressed = about 234 characters ~ 38% reduced
Compression of data
SMS Messages are received by server phone
Decompression of data
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Temporary DatabaseFor conflicts in remote updates to be resolved, a For conflicts in remote updates to be resolved, a temporary database was used to save the old states of the temporary database was used to save the old states of the records being changed.records being changed.
The web interface handles the resolving of conflicts.The web interface handles the resolving of conflicts.
CHITS DB TEMP DB
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STEP1: FIELD CONSULTATIONSTEP1: FIELD CONSULTATION
MOBILE APPLICATION
REMOTE ACCESS TO
SERVER
RETRIEVERECORDS
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STEP2: SYNC REAL TIMESTEP2: SYNC REAL TIME
SYNCREMOTELY
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STEP3: RESOLVE REMOTE CONFLICTSSTEP3: RESOLVE REMOTE CONFLICTS
WEB APPLICATION
CHECK FOR CONFLICTS AND
RESOLVE
CHITS DB
TEMP DB
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Duration in Server
0
50
100
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350
1 2 3 4 5 6 7 8 9 10
Number of messages
Time (s)
Designed protocol
Selective Repeat
Go-Back-N
Stop-and-Wait
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Comparison
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Duration in Phone
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1 2 3 4 5 6 7 8 9 10
Number of messages
Time (s)Designed protocol
Selective Repeat
Go-Back-N
Stop-and-Wait
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Protocol: Protocol: Bandwidth: 1400 bytes/111 secsBandwidth: 1400 bytes/111 secs
~1 message/12 secs~1 message/12 secs
Compression:Compression: UncoUncompressedmpressed
20 records = 1506 characters = 1318 bytes 20 records = 1506 characters = 1318 bytes ~ 10 messages~ 10 messages
Compressed Compressed 682 characters = 597 bytes (55% reduced) 682 characters = 597 bytes (55% reduced) ~ 5 messages (50% reduced) ~ 5 messages (50% reduced)
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Impact |
chitSMS
chitSMS
The presence of a remote connection for updating the CHITS The presence of a remote connection for updating the CHITS system promises to be a useful tool. system promises to be a useful tool.
Instead of travelling back to the health center to update the Instead of travelling back to the health center to update the database, the health worker could easily update and view the database, the health worker could easily update and view the patient records. In effect, he saves time and money, which he can patient records. In effect, he saves time and money, which he can use to do other useful work.use to do other useful work.
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SMS Reliability ProtocolImpact |
SMS Reliability Protocol
Any system that needs a reliability protocol where SMS can be Any system that needs a reliability protocol where SMS can be used can use with our SMS reliability protocol.used can use with our SMS reliability protocol.
Example:Example:Election Automation SystemElection Automation System
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Conclusion
The presence of a remote connection for updating the CHITS The presence of a remote connection for updating the CHITS database promises to be a useful tool in providing telehealth database promises to be a useful tool in providing telehealth services or other systems over SMS.services or other systems over SMS.
The project utilizes the key feature of mobile phones which is The project utilizes the key feature of mobile phones which is SMS, in transmitting data from the mobile phone to the server to SMS, in transmitting data from the mobile phone to the server to update patients records in a close to real-time manner.update patients records in a close to real-time manner.
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