scaling up ehealth in line with ict proliferation digital health for rural communities: potential,...
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Scaling up eHealth in line with ICT proliferation
Digital Health for rural communities: Potential, Trends and ChallengesITU, 17th Sept. 2010
Hani EskandarICT Applications and Cybersecurity DivisionITU Telecommunication Development Sector (ITU-D)
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Need for rapid eHealth proliferationNeed for rapid eHealth proliferation
o Proliferation rate of Tele-health services needs to race against disease incidence and prevalence rates in next decade.
o The economic burden of disease measured in disease-adjusted life years (DALY) translates to a loss of productivity to over $200 Trillion! in India.
o It is important to understand which Tele-Health services can be proliferated immediately with available infrastructure and which additional services can be added as the infrastructure is transformed.
o This will make it easier to decide on investment priorities for ICT adoption in Tele-Health
Methodology: identify which activities, transactions and information exchange events are achievable at various
levels of infrastructure maturity and computer interfaces at the user end.
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Typical activities/transactionsTypical activities/transactionswithin a Care process within a Care process
Care program management Surveillance
Preventive Care
|------------------------------------Patient Care Management-----------------------------| Patient care Support
Disaster Care ManagementActivities
Transactions
Source: ITU. Findings demonstrated in this presentation are based on a field survey of real-life application scenarios that was conducted covering over 26 Tele-Health initiatives from a mix of private, government and NGO managed care delivery organizations across India for the ITU by Dr. P.S. Ramkumar. The report will be published on the ITU website on: http://www.itu.int/ITU-D/cyb/app/e-health.html
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Activities, Transactions, Info. ExchangeActivities, Transactions, Info. ExchangeActivities Transactions Type of Information exchanged in the
transactionData type Data
SizeTransfer mode
Mobility
Preventive care intervention
Public education for preventive care
Information brochures TAVI M S M
Recorded Lectures AV L S M
Live shows AV L R P
Counselling AVT M R M
Announcements T S R M
Registration and cancellation forms, etc T M S P
Register patients into specific care programs
Patient demographic and referral notes T S S M
Photo , biometric I M S M
Family history, patient history T S S M
Conferencing AVT M R M
Data type Data Size Mode of transfer Mobility
Alphanumeric text – T
Image – I
Video – V
Waveform signal-S
Audio –A
< 160 Bytes- Tiny (T)
<32Kbytes – Small (S)
<1Mbytes – Medium (M)
<10Mbytes Large (L)
<100Mbytes - Very large (V)
>100Mbytes-Extremelylarge (E)
Real Time – R
Store and forward - S
Mobility – M
Portability - P
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SurveillanceSurveillance
o A large scale health care system will develop, deploy and manage care programs of relevance to the needs of citizens within their categories of focus (e.g. elderly population, disabled population, mother and child care, AIDs, Cancer, Malaria, etc.)
o It is important to form a surveillance network that gathers demographic and environmental information in regions of governance.
o Based on the analysis of such data the care program then identifies
prioritized target zones and needs of the disease management / living conditions to be addressed.
o The care program can then engage appropriate human resources such as health workers, nurses and doctors, trained according for timely intervention in regions of priority.
Fewer types of information exchanges are needed in surveillance phase than curative and palliative phases of
the care delivery process -> it is relatively cheaper, simpler and easier from a technical standpoint to induce ICT
transformation in this phase.
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SurveillanceSurveillance
Connectivity Care Activity
Care transaction type of Information exchanged
CDMA2000/ GPRS/ PSTN (<64Kbps)
Surveillance Register citizen for screening Citizen details
Conduct Screening tests ECG /PFT
Conduct Screening tests HR/BP/Temperature/weight/etc
Conduct Screening tests Screening reports
Conduct Screening tests Lifestyle issues
Trending of health indicators Regional, seasonal and sporadic disease incidence, morbidity-mortality reports, etc.
Environment monitoring Hygiene, pollution levels in air/water/food, industrial efflux, pests, insects, climatic change, etc.
Genetic and habitual risk profile known/unknown symptoms of genetic disorders, ethnic predisposition, habitual disorders, etc in target population
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SurveillanceSurveillanceReal-Time Bio-Surveillance Program(RTBP):
Directorate of Public Health and Preventive Medicine, Tamil Nadu, India
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Patient Care ManagementPatient Care Management
o Covers the curative and palliative care workflow delivered in hospitals, ambulances, clinics and homes of patients as needed.
o Citizens identified as patients may be referred to appropriate physicians where the patient’s case file can be provided electronically.
o Patients can be studied remotely and be prescribed specific medication, treatment or further detailed diagnostics/observations to assess the situation and plan treatment.
o Patients identified for emergency care get transferred to emergency management facilities immediately.
o In cases where hospitalization is not required, the treatment could be self-managed by training the patient or with assistance of health workers/nurses.
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Patient Care ManagementPatient Care Management
o In case patient goes through a surgery, the local doctor can seek guidance of remotely located experts. Such collaboration can electronically share patient history and data from monitoring apparatus, and discuss through audio/video conference before, during and after the operation.
o For Post hospitalization, the patient’s recovery can be remotely monitored in follow up consultations with the physician by sharing medication, treatment and symptomatic response data of the patient, as recorded by the health workers.
o In special situations, one can also employ patient monitors which can automatically track the specified symptoms/parameters within specified bounds and alert the care-taker/health-worker/patient when the parameters go out of bounds.
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Patient Care ManagementPatient Care ManagementConnectivity Care Activity Care transaction type of Information exchanged
CDMA2000/ GPRS/ PSTN (<64Kbps)
Patient care management
Consultation with Physician Patient history data analysis, patient risk quantification, genetic/ familial predispositions, allergies and adverse reactions to medication, medication history, Patient medical record
Consultation with Physician ConferencingPrescription Diagnostics, Medication, TreatmentDiagnostic (second opinion) Bio-chemical analysis of Blood, Urine, Stools reports, TMT, BP, Weight, Temperature,
etc.Diagnostic (second opinion) Summary reportsSpecialist Consultation Patient diagnostic data – Vital Specialist Consultation Specialist report on disease stage, assessment of complications for treatment,
prognostic classification, rarity of disease condition, etcMedication services Medication service order, prescription of diet and medication schedule , correlation of
symptom to schedule mismatchMedication services Schedule and dosage tracking reports, Symptom and complication capture and alerts
Medication services Inventory and door-to-door delivery scheduling.Therapy services Therapy service order, prescription of diet and schedule , correlation of symptom to
schedule mismatchTherapy services Therapy progress tracking formAmbulance services Real time patient data monitoringAdmission/Discharge/Transfer to hospital Bed booking, admission/ transfer form, discharge summary, legal forms
Surgery OT resource planningClinical-waste Management Waste inventory, disposal order and tracking formsPatient Monitoring Monitoring Configuration form, monitoring reportPatient Monitoring Recording of temperature, heart and respiration rate, BP, height ,weight ,urine, stools,
foetal heart rate, blood glucose, oxygen, etcPatient Monitoring Signals such as ECG/EEGPatient Monitoring Alert messages with critical informationCounselling Information brochures, FAQCounselling Tracker of Patient response to counsellingFinancial Assistance Telephonic support for education about insurance / other subsidy information
brochure/ FAQ listsFinancial Assistance Insurance/subsidy policy application forms, Claim forms, bills, claims processing
reportsFinancial Assistance Collection follow-up callsFinancial Assistance Claims audit reports
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Disaster Care ManagementDisaster Care Management
o Disasters may demand the system for large scale training, deployments and management of resources at very short notice in order to prevent/contain outbreak of diseases and casualty.
o From assessment of situation to planning, training, execution, tracking and steering the entire action plan, these activities may utilize services of Patient Care, Prevention, etc. but with independent, parallel governance and priorities.
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Disaster Care ManagementDisaster Care Management
Connectivity Care Activity Care transaction Type of Information exchanged
CDMA2000/ GPRS/ PSTN (<64Kbps)
Disaster care management
Emergency response Real time vital signs of patients
Emergency response Abnormality alerts from monitoring
Emergency response Emergency admission forms
Triage Disaster assessment form, disaster management protocol, resource allocation form
Emergency care Emergency treatment plan, health Insurance /subsidy information form, specialist notes
Emergency care Patient tagging, patient vital signs and other medical parameters monitor
First aid Primary symptoms capture
Disaster Care ManagementDisaster Care ManagementDisaster management and Proactive care in Tele-Health Network – Amrita
Institute of Medical Sciences(AIMS), Kerala, India
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Broadband & eHealthBroadband & eHealth
Connectivity Care Activity Care transaction type of Information exchanged
ISDN/DSL/ EDGE (<256Kbps)
Surveillance Conduct Screening tests Biochemistry lab imagesConduct Screening tests Microbiology imagesConduct Screening tests Heart Sound, AudiogramConduct Screening tests Ophthalmology testsConduct Screening tests Endoscope, otoscope, dermoscope
Patient care management
Diagnostic (second opinion) ECG, PFT, EEG, etcDiagnostic (second opinion) Heart Sound, AudiogramDiagnostic (second opinion) Angiogram, Otoscope, DermoscopeDiagnostic (second opinion) Microbiology, ECHO, Otoscope, endoscope,
Dermoscope videoSpecialist Consultation Patient diagnostic data – generalSpecialist Consultation Patient diagnostic data – RadiologyMedication services Follow up with patient for counselling and tracking of
medicationTherapy services Patient training information (live/recorded)Ambulance services ConferencingAmbulance services Fleet management, other logistics supportPost-hospitalization follow up consultation ConferencingPost-hospitalization follow up consultation Patient records, patient health trend report, progress
notesCounselling ConferencingFinancial Assistance Patient medical records
Disaster care management
Emergency response Conferencing from emergency siteTriage Conferencing for TriageTriage Live video of affected areaTriage Emergency training, counselling, consultingTriage Environmental surveillance reportsFirst aid real time counselling and preventive care guidance
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Broadband & eHealthBroadband & eHealth
Connectivity Care Activity Care transaction type of Information exchanged
VDSL/ CABLE/ EV-DO (<10Mbps)
Patient care management
Diagnostic (second opinion) Ultrasound, Mammogram, X-ray, CT, MRI imaging, Ophthalmoscope and slit-lamp
Specialist Consultation Patient diagnostic data - Pathology
Diagnostic (second opinion) Pathology imaging
VSAT/ HDSL/ XWIFI (<1Mbps)
Care program management
Education and training for site staff Live shows
Preventive care intervention
Public education for preventive care Live shows
Patient care management
Surgery Sharing prior information with remote experts
Surgery Conferencing during surgery with fail over channel
Surgery Live local and remote monitoring of apparatus & patient during surgery with failover channel
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ConclusionsConclusions
It is observed that 25% to 60% of the information exchange in 95% of the transactions falls in the ‘small’ data size category. Only in a couple of cases such as full-slide pathology reporting, etc. extremely high data size is observed.
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ConclusionsConclusions
Over 85% of the transactions can employ store and forward methods ranging between 35% to 100% of information exchanges within the transactions. About 45% of the transactions can be completely handled using store forward methods.
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ConclusionsConclusions
o Several proof points of benefits have been demonstrated in terms savings in travel time, expense and effort of patients; timely intervention and containment of disease outbreaks and emergency; proactive care delivery; reduced human error and misplacement of patient data, etc.
o SMS and Web-based routine data capture for demographic, environmental surveillance and patient monitoring have been demonstrated using basic cell phones.
o Mobile Vans with various functionalities from screening to minor OT have been deployed routinely to reach out to remote rural areas.
o Transmission of vital signs and video conferencing data have been demonstrated at 64 Kbps links. o Most of the transactions that are needed in surveillance and preventive care are possible with existing infrastructure.
o Employing surveillance to identify the disease outbreaks in its early stages and delivering timely preventive cure requires lesser expenditure and infrastructure than curative and palliative stages.
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ConclusionsConclusions
There is no need to wait for new infrastructure, many
ICT enabled care services can be designed around existing infrastructure which needs to be done with
utmost urgency, to save DALY losses.