How to speed up the introduction of eHealth services in developing countries

Professor Leonid Androuchko Rapporteur ITU-D Sector, SG2, Q14-2/2 International University in Geneva 5 October 2009 ITU Telecom, Geneva

eHealth for Developing countries (1)

 

Why eHealth services in developing countries are not implemented as it could be? eHealth Master Plan Mobile eHealth services

eHealth for Developing countries (2)

January 1998, Mozambique. The first telemedicine project in Africa was implemented by ITU in Mozambique for teleradiology connecting the main hospital in Maputo, the capital, with regional hospital in Beira located about 1000 km away from Maputo.

Mozambique, 1998

The Prime Minister of Mozambique, H.E. Mr. Pascoal Mocumbi, inagurated the telemedicine project 30 January 1998. « Telemedicine will end isolation which has so far existed between health professionals in the country ».

eHealth for Developing countries (3)

After the project in Mozambique, during the last 10 years a big number of pilot eHealth projects were implemented in many developing countries led by international community in the majority of cases .

eHealth for Developing countries (4)

International Telecommunication Union was and is still active in eHealth field assisting developing countries to understand better the benefit of ICT for health care delivery.

ITU-D Study Group 2, Q-14

The main goal of the study is how to assist developing countries in the introduction of eHealth services and solutions, covering the technical part. This is the unique international study group in the ITU-D SG2, Q14 dealing with needs of developing countries.

ITU-D Study Group 2, Q-14

It was decided to prepare the questionnaire and ask the opinion of medical staff in developing countries about Telemedicine and eHealth. It was also a question asking participants about their view with regard to the implementation of eHealth services.

ITU-D Study Group 2, Q-14

The study was done in the following countries: Pakistan, Uganda, Bhutan, Sri Lanka, Saudi Arabia and recently in Mongolia.

ITU-D Study Group 2, Q-14
      

In favor of eHealth services Uganda – 96.6% Pakistan – 86.5% Bhutan – 87.5% Sri Lanka – 81% Saudi Arabia – 90.7% Mongolia – 77%

What is it nesessary to speed up the implementation?
Pakistan
40 35 30 25 20 15 10 5 0 38 30 22 10 Series1

%

more informaton on eHealth

training

good will of health administration

financial support

What is it nesessary to speed up the implementation?
Uganda
35 30 25 20 15 10 5 0 30.6 19.4 28.4 21.6 Series1

%

more informaton on eHealth

training

good will of health administration

financial support

Why eHealth services are not implemented?
  

Main obstacles: Lack of Government policy Lack of the knowledge of eHealth successful projects Lack of training at all levels

How can we help developing countries with eHealth introduction?

To provide assistance to countries in the preparation of eHealth Master Plan – strategic implementation plan based on local needs and existed infrastructure and showing clearly the potential benefit.

eHealth Master Plan

eHealth network has to meet priorities of the Ministry of Health. Proposed global structure of telemedicine network based on existed telecommunication infractructure Proposed list of possible eHealth services

eHealth Master Plan
 

Based on fixed and mobile networks Mobile eHealth has to use two solutions:

Mobile medical center connected via mobile network to nearby hospital/clinic Mobile phone/terminal

ITU-D Study Group 2, Q-14

Assist in the development of National eHealth Master Plan by providing information on the best technical solution taking into account the local telecommunication network.

ITU-D Study Group 2, Q-14

The introduction of eHealth services in developing countries requires multidisciplinary collaboration, with active participation of telecommunication operators and health care professionals.

International Telecommunication Union

Resolution 41 of ITU World Telecommunication Development Conference, which took place in 2002 in Istanbul, Turkey, recommended to all countries to create national eHealth Committees or Task Forces for such cooperation and coordination.

International Telecommunication Union

Experience demonstrates that there is no single solution that will work in all settings. The complexity of technologies and the complexity of needs and demands of healthcare suggests the gradual introduction, testing and refining of new technologies.

ITU and WHO

Effective governance of eHealth requires codes, regulations, and standards to ensure satisfactions of the consumers. Issues include legal liability, ethical standards, privacy protection, and cultural and social standards.

ITU and WHO

Successful eHealth services require more than just technology. For any eHealth system to work in practice – in real clinical situation – suitable, committed personnel are essential.

Mobile eHealth

There are two solutions:

Mobile phone can be used for management and consultations related to medical services. Mobile eHealth care clinics/units traveling in rural areas from one village to another and connected to nearby hospital by wireless communication for consultations.

  

Developing countries have a better penetration of mobile telephones vs land lines The mobile network allows reliable connectivity in remote areas Primary medical care delivery systems in villages and remote areas is relatively poor across all developing countries  Primarily due to shortage in trained doctors  Shortage in infrastructure and trained medical personnel

Comparison of mobile and fixed phones (Source – ITU)
Mobile and fixed telephone line per 100 inhabitants
50 45 40 35 30 25 20 15 10 5 0
G ha na G am bi a Ke Ky nia rg y M stan au rit an Pa ia kis Ta tan jik ist an

mobile fix

%

Mobile networks in selected developing countries (Source – ITU )
Mobile Network Coverage and Telephone Penetration
100 90 80 70 60 50 40 30 20 10 0
Ba ng la ge sh Bu ru nd i Ug an da Zi m ba bw e Be nin Ca m bo dia M al aw i Pa kis ta n R w an da Se ne ga l G uin ea G am bia To go

%

Coverage Penetration

Medical professionals :
 

Patients :
   

Second opinion to doctors on primary diagnosis Enable trained medical personnel (nurse) to provide quality primary care to patients Reduce errors in diagnosis across the healthcare delivery system Access quality medical information on mobile application Get diagnosis from signs and symptoms Understand their diseases and conditions better Act as a 24x7 medical advice system and management of medical emergencies

Pakistan, Mobile Medical Center

Pakistan

INDIA, Ophthalmology Car

This car has VSAT connection to the regional hospital

Tele-Ophthalmic Van – Shankara Nethralaya

Russia. Mobile Unit

Conclusion (1)

Developing countries can not speed up the implementation of badly needed eHealth services without close cooperation with telecom sector. Developing countries urgently need a strategic document – eHealth Master Plan in order to informed decision-makers in health care sector about benefits of eHealth technology.

Conclution (2)

Developing countries heed technical quidelines on how to use mobile and fixed telecommmunication infrastructure for the introduction of eHealth servies Developing countries need more training and capacity building in this field

Thank you very much for your attention.

Mobile phone/terminal

Several useful applications developed Telemonitoring  Intelligent diagnostic system

Telemonitoring. Telecardiology

Cardio-vascular disease are the main killer in every country. It is responsible for more death than any other disease. As an example, in the USA, 45% of total mortality rate is contributed to cardio-related disease. But it is possible to reduce the number og death if a patient gets the right treatment as soon as possilbe.

Telemonitoring. Telecardiology

For diagnosis of a person’s heart condition it is important to get his electro-cardiogram (ECG) data. Today with a small additional device in your pocket wirelessly conected to your mobile phone, you can send your ECG to medical center and get doctor advice immediatly.

Telemonitoring. Diabetes
 

It is another very dangerous disease. You will get a small device, a glucose monitor, which is wirelessy connected to your mobile phone. Then the information is transmitted to the medical center and you will get the conclusion and the recommended treatment from your doctor directly on your mobile phone.

Telemonitoring
   

Blood pressure monitoring Asthma control Fetal monitoring services Combination of emergency/alert notification with required medical services

Example: South Africa (1)

The Dokoza system is an innovative cost-effective interactive real-time mobile system for fast-tracking and improving medical services. It has been developed in South Africa for use in HIV/AIDS (specifically in respect of the roll-out of anti-retroviral therapy) and TB treatment.

Example: South Africa (2)

This system involves the use of SMS and mobile phone technology for information management, transactional exchange and personal communication.

Intelligent diagnostic system

A software guided healthcare delivery system revolutionize the delivery models across the world. Bulk of patients handled by doctors can be reduced considerably if a trained nurse with a decision support system can attend to patients in primary care centers Both healthcare professionals and educated patients can use the system to identify the diseases and get remedy tips

eClinician- artificially intelligent diagnostic system (1)

Developed in India. Similar system is also developed in the United States.
The system is being developed to suit mobile platforms. The system will be available in two versions:
 

Professional version for doctors and nurses Regular version for common man

The system shall include around 1000 diseases covering more than 98% of regular diseases

eClinician- artificially intelligent diagnostic system (2)

The mobile ehealth solution shall be a small application (2-3mb) downloaded to the mobile phone Once installed it will list out all possible symptoms in a easy to use interface (symptoms will be in easy to understand language) The doctor has to choose these symptoms and ask the system for a diagnosis The system will connect with the server and give the probable diagnosis immediately ((There is also option to give diagnosis directly from the application in mobile – internet will not be required) Additional information on these diseases: symptom list, causes, treatment etc. can be downloaded as required.

FOR
TRAINED
MEDICAL
PROFESSIONALS
(DOCTORS,
NURSES
ETC…)












SYMPTOMS

INTERNET eClinician
TRAINED
MEDICAL PROFESSIONALS
SYMPTOMS

DOCTORS NURSE
COMPLAINTS

MOBILE eClinician

MOBILE •

eClinician
mobile
application •

Symptoms SERVER •

Communicate
with
mobile •eClinician
Application DATABASE •

Disease
information

SERVER

DATABASE

REMEDY

DIAGNOSIS
&
TIPS

DIAGNOSIS
&
TIPS

INTERNET

PATIENT

eClinician- artificially intelligent diagnostic system (3)

This software is capable of generating all probable differential diagnoses from signs and symptoms of the patient. The program is tailored to be used by health workers with minimum or no computer expertise and is flexible enough to be adapted to suit the needs of different level of practitioners – from general practitioners to specialist.

FOR
PATIENTS
SYMPTOMS

INTERNET
SYMPTOMS

eClinician

PATIENT

MOBILE eClinician

MOBILE •

eClinician
mobile
application •

Symptoms SERVER •

Communicate
with
users
mobile •

eClinician
Application DATABASE •

Disease
information

SERVER

DATABASE

DIAGNOSIS
&
TIPS

DIAGNOSIS
&
TIPS

INTERNET

eHealth/Telemedicine network
 

 

It is a key platform for eHealth services It has to be based on existed fixed and mobile telecommunication infrastructure Integrated modular approach It has to be designed and controled in line with specific requirements for medical applications: security and reliability.

Wireless Enterprise Mobility
GPS Coverage GSM Access National and Regional Areas

GPS, GSM, GPRS Wireless Wide Area Networks
Backhaul Orthogonal

Redundant wireless WAN

City Distribution Networks
Canopy/WiMax connectivity

Metropolitan Area

Si Si

Si Si

Si Si

Wireless Switch
Si Si
Si Si

Si Si

Wirelessly connect DCs, hospitals, buildings

Wireless Switch

Wireless Switch

Mobile RFID Readers

Registries Data & Services

EHR Data & Services

WiFi Tags

EHRS Locator Data & Services Health Information Data Warehouse systems

In-Building WLAN Networks
Wireless Access/Mesh WLAN/Canopy
Wirelessly extend coverage to health provider/physician, pharmacist, radiologist, lab, field technician

Security Mgmt Data Configuration

Privacy Data

Wireless Switch

Enterprise Edge

RFID Tags

eHealth Information Exchange Infrastructure
Pharmacy System Hospitals & Physicians Public Health Services
Network Resource Svc Registrar
DNS, DHCP, WWW

Health Information Data Warehouse
LDAP Dir EHR, Registry Data, Health Information

eHealth Information Systems Infrastructure
MSP

Healthcare Provider Networks

GPRS GGSN

Dial GSM

Network Operator
IP/Switched Network

Routed Network

GSM

MSC SGSN

Mobile Network

Fixed Line Network

Managed/Hosted Health Mobility Solutions
GSM PHONES, MOBILE COMPUTING DEVICES, ADVANCED DATA CAPTURE HI PROVIDER CORE
DHCP, DNS, WWW, Apps, Content Directory Services Security Services Billing & Account Services

APPLICATION

HTML, Web & dBase Back-end

BTS BSC

Health Information Provider IP Network

BTS

Health Information Data Warehouse
EHR, Registries, Ancillary Svcs Hospital, Clinic, Field Hospital, Public Health Systems Intranet

Dial-in NAS
BTS

MSCs

Service Provider IP Core
PSTN/ISDN

Mobile Device Apps
Internet

BSC

BTS

Thailand, Bangkok (1)

Bumrungrad international hospital is the largest hospital in Southeast Asia and one of the world’s most popular destinations for medical tourism. Hospital initiated implementation of a stateof-the-art wireless infrastructure project that will provide the backbone for delivering world-class healthcare services to its patients.

Thailand, Bangkok (2)

The solution is design for scalability and will allow hospital to deploy Wi-Fi and RFID services through one switching platform. This integrated approach will reduce the total cost of ownership and simplify management of multiple wireless infrastructure technologies.

Building a Better Health/Hospital Information System
• Define building blocks of HITS infrastructure for healthcare • Enlist Independent software vendors to develop mobile ehealth applications • Deploy backbone infrastructure & wireless connectivity • Improving healthcare accuracy, coverage, quality and safety • Providing an open standards and best of breed HIT framework • Strong support for eHealth development of best practices & initiatives

Health Information Systems Evolutionary Strategy
Phase I Phase II
Improved Communications

Phase III
Advanced Health Data Synch
Public Health Services Reporting, Outbreak Mgmt, Shared Health Records, Drug and Health Information

Connectivity – enables

access to health deploy an adaptive Electronic Health – Compliance & Tracking Electronic Health Records Data information and providing Allows extended visibility architecture that supports Instant update of medical records, visibility by leveraging and real-time point of a health information Patient ID and vital data, Point of Service Care existing communications service care, disease backbone with integrated technologies, outbreak management, and Health Information Distributed Peer-to-Peer Networks infrastructures& eHealth Information Systems extended electronic health, Systems to capture, move, applications Integrated Public Health providerpatient medical, and systems, store, organize and cross- & Drug information,access physicians Hospital, Lab records clinics and Advanced Network Access reference extended ehealth Systems Infrastructure Health Information information Integrated Health information Infrastructure, eHealth Data Access
Basic Access Mobile Data Access
Email, PIM

Integrated Networks –

eHealth Value

Server Based
Web-based links to Doc Mgt, Patient History, and data

Facilities Access & Connectivity

TIME

Health Information Systems Evolution
Improved Communications Advanced Health Data Synch
Public Health Services Reporting, Outbreak Mgmt, Shared Health Records, Drug and Health Information

Compliance & Tracking

Electronic Health Records Data
Instant update of medical records, Patient ID and vital data, Point of Service Care

eHealth Value

eHealth Information Systems

Distributed Peer-to-Peer Networks
Integrated Public Health provider systems, Hospital, Lab & Drug information, clinics and physicians

Advanced Network Access eHealth Data Access Basic Access Mobile Data Access
Email, PIM

Health Information Systems Infrastructure
Integrated Health information Infrastructure, Facilities Access & Connectivity

Server Based
Web-based links to Doc Mgt, Patient History, and data

TIME

Wireless Inside and Out
Backhaul Layer
Point-to-Point Wireless Bridges Data Center
(ERP, CRM, Supply Chain, Fin, PIM, Collaboration)

Distribution Layer
CELLULAR

Wireless Point-to-Multipoint

Access Layer
Mesh WLAN PMP Mesh Outdoor

WLAN

Client Devices
Rugged/Std Laptops VoWLAN phones Mobile Computers Vehicles Cameras
HQ Branch Store DC

Indoor

Outdoor Fixed

Outdoor Mobile

Network and Device Security

All Wireless Mobile Lower Cost Simplified More Secure

Wireless Network Design and Management

Line Of Business Applications

WHO

The World Health Assembly in May 2005 officially recognized eHealth and adopted Resolution WHA 58.28 establishing eHealth Strategy for the World Health Organization.

WHO

It was recommended to establish eHealth Strategy « …stressing that eHealth is the cost-effective and secure use of information and communication technologies in support of health and health-related fields… »

INDONESIA

INDONESIA

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