International Journal of Computational Intelligence and Information Security, February 2012 Vol. 3, No.

A Data Mining Based Prototype Model for Improving Health Care System in Rur al Areas or in Developing Countr ies
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Amnesh Goel, 2Sukanya Ray, 3Piyali Ganguly, 4Nidhi Chandr a

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Amity School of Engineering and Technology, Amity University, Noida, Uttar Pradesh, India Amity School of Engineering and Technology, Amity University, Noida, Uttar Pradesh, India 3 Amity Institute of Biotechnology, Amity University, Noida, Uttar Pradesh, India 4 Amity School of Engineering and Technology, Amity University, Noida, Uttar Pradesh, India amneshgoel7@gmail.com sukanyaray007@gmail.com 3 gangulypiyali7@gmail.com 4 nsrivastava5@amity.edu
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Abstract
In developing countries there is always a lack of proper health care especially in the rural areas because of less availability of medical staff. In this paper a prototype model of medical decision support system is designed for inexperienced doctors and medical staffs to provide medical treatment and assistance to those patients who are suffering from fatal disease and when no other medical help is possible and absence of medical assistance can lead to death. This prototype model will help doctors in disease identification, disease assessment, and disease management for the identification, prevention and proper cure of the disease immediately. Keywords: Data Mining, Health Care System Improvement, Data Set.

1. Introduction
Various surveys are showing that health care problem is a major issue for developing countries and this problem is due to shortage of funds, lack of expertise and lack of proper infrastructure. In rural areas there may be only one health care point is present for a whole village or sometimes there is a single health care point for more than one villages; and the doctor present there might not have enough expertise about all diseases.[1] As a result, identification of various fatal diseases takes a lot of time and the patient moves towards a no cure state. For proper treatment, often the patient have to come to the city and in the process of commuting from village to city, it is often seen that the patient expires on the way to the hospital in the city without getting any treatment. This problem can also occur the other way round. For example a person from a city paying visit to his house or any relatives house in village unfortunately he fell sick and due to the lack of proper medical facility in village he did not get proper treatment or his disease did not get proper identification. Now he has to travel back to a nearby city for proper treatment and if he has got some disease like heart attack or brain stroke then he might lose his life on the way which might not have happened if he was in his city home. It might also happen that a person in rural area is suffering from some type of cancer or any other fatal disease and due to inexperience the Doctors and medical staffs present there could not diagnose or even identify it properly. By the time the disease gets detected it might be too late and even after getting treatment at that time the patient might lose his/her life. But if the disease had been detected at an early stage it might happen that the patient could get cured. This is the main motivation behind this research idea. For a developing country this is definitely a major area of concern and proper care must be taken as World Health Organization (WHO) has already stated in the year 2000 Health for all.[2] So, to meet this standard such negligence of health care in rural areas is not acceptable. As this problem is mainly due to lack of expertise and infrastructure, so if some expert help can be provided to the doctors and medical staffs in form of information through videos, documents then the problem can be handled to some extent. Now a day almost every hospital or nursing home keeps a record of the patients treated there and also the list of medicines they were provided during the course of the treatment.

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A good prediction system for various diseases especially for heart disease, strokes, cancer can greatly help the health care centers and clinics where there is a lack of medical expertise. If there is a document present containing various case studies of a particular disease having detail of what were the symptoms that lead to the identification of the disease, at what stage of the disease did it get detected from those symptoms, what were the medication provided and how the patient responded to those medications and also what is the mortality rate of that disease then the doctors can go through these documents or videos; and Doctors can gain some knowledge that if this symptom occurs then it might be this disease and this what is the emergency medication that must be provided. Often it is seen that, there is a lack of infrastructure availability in rural areas and due to which all diseases cannot be treated there, patients have to visit city hospitals for treatment, but some disease needs immediate medication else the patient might expire. In those cases by going through these documents or videos the medical staffs of the health care in rural areas can give some immediate medication, so that the patient survives long enough to reach a city hospital. For example a patient is having a heart attack or a brain stroke then if he/she is rushed to city there is a high probability that he/she will expire on the way to the city hospital but if the rural health care staffs have knowledge then at least they can inject some medicine so that the patient can reach the city hospital without losing his/her life. Cancer is a very fatal disease and detecting it at an early stage is very important as it gives some opportunity for recovery if detected early. The rural health care might not have infrastructure to provide chemotherapy to cancer patients but if they can detect the disease at an early stage then the patient can reach the proper hospital in time for further treatment and hence the mortality rate will decrease to some extent. Our main aim in this paper is to design a prototype model which will help the health care centers in rural areas to have expert knowledge about various diseases with the help of various documents containing case studies of various patients who had those diseases and what approaches were taken in diagnosing them and how they reacted to the medication. This paper is divided into 5 sections. Second section focuses on the Current Medical Scenario. Third section focus on the existing approaches in field of prototype design in medical domain for various diseases. Fourth section focus on the proposed method and fifth section is for further scope of research in this domain.

2. Cur rent Medical Scenar io

Cardiovascular disease in India has increased by almost four folds in the last four decades and WHO has estimated that by 2020 approximately 60 percent of the cardiac patients will be Indians. The results of the researches carried out by the Escorts Heart Institute and Research Centre, New Delhi, India, predicts that rate of occurrences of the cardiovascular disease among urban people will be more than that among rural people. However still it will continuously increase and reach approximately 13.5 percent of the rural population in the age group of 60-69 years by 2015. Moreover, the pervasiveness rates among the age group of 40 and above are also likely to increase. In India almost 50 percent of cardiovascular disease related deaths occur among people aged below 70 years, while it is only 22 percent in the Western countries. [6] Most of the deaths from heart attacks are due to ventricular fibrillation of the heart which occurs before the heart attack victim can get any medical attention. Those patients who get medical attention have an excellent prognosis. The survival rate of a heart attack patient getting modern treatment facility in time should exceed 90%. The 1%-10% patients who die even after getting proper medical attention are those who have initially suffered major damage to the heart muscle. In case of heart attacks early diagnosis can save the life while a slight delay in getting medical attention can be vary fatal and even death can occur as delay in getting treatment can result in permanently reduced function of heart due to extensive damage to the heart muscles. Another reason of the occurrence of death due to heart attack can result from the sudden onset of arrhythmias such as ventricular fibrillation which is an abnormal irregular heart rhythm and very rapid uncoordinated fluttering contractions of the lower chambers of the heart result due to this. Although heart attacks can occur at any time, most heart attacks occur between 4:00 A.M. and 10:00 A.M. because during the morning hours the adrenaline glands release higher blood levels of adrenaline. India has a National Cancer Control Programme which was established in 197576. This has contributed to the development of Regional Cancer Centres (RCCs), oncology wings in medical colleges and support for purchase

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of teletherapy machines. [3] The District Cancer Control Programme was initiated but did not result in sustainable and productive activity. Diagnostic infrastructure in the country is limited. There are many districts in our country which does not have a pathology or cytology services, which are crucial for early diagnosing cancer. Financial and geographic constraints and lack of manpower have contributed to the urban concentration of facilities. An unestimated number of cancers diagnosed in the population are not treated. Untreated patients are likely to demand more resources from society. [4] If cancer can be detected early, treatment may be curative. The signs of the disease: lumps, sores that do not heal promptly, abnormal bleeding, and persistent indigestion or hoarseness. Cancers in accessible parts of the body like the oral cavity may be detected at an early stage or even in a precancerous stage through simple inspection and examination, which can be practised by a trained health care worker. Medical attention should be sought when these occur. Early diagnosis of cancers that are curable if detected early (cervix, breast, mouth) can be promoted in India using public education and training of primary health care workers. Treatment facilities are mostly limited in urban areas. There are no uniform protocols for treatment; the availability affordability of cancer treatment shows wide disparities. Treatments results are about 20% less than the similar conditions in more developed countries, mostly due to late diagnosis and inappropriate treatment. Oral morphine is the bastion for cancer pain relief. An essential list of cancer chemotherapeutic drugs will have to be prepared and availability of all drugs is essential. [5] According to the World Health Organisation (WHO), brain stroke is the third largest killer in India after heart attack and cancer. To explain it in a laymans language brain stoke occurs when blood circulation to the brain fails. Brain stops receiving oxygen and nutrients. There are two broad categories-a blockage of a blood vessel in the brain or neck called an ischemic stroke (80%) and bleeding into the brain or the spaces surrounding the brain causes the second type of stroke called hemorrhagic stroke.

3. Existing Methodology
Evidence Based Medicine (EBM): The data used here is the Public-data available on net. By studying various record sets the prediction is done and in this approach two algorithms are being used and their results are being compared for each disease for reaching the conclusion. The main drawback of this paper is that it requires both internal clinical experience as well as external clinical experience.[11] Predicating Breast Cancer Model: In this paper the researchers used SEER public database to study[9] the survivability rate of breast cancer patients between 1973 to 2000. The patients were grouped into two classes (survival and non survival) based on values present in SEER data sets. The drawback of this paper is that the data set did not have survival rate of each case and also the cause of death. Predicting Breast Cancer Survivability: In this study the above work is further extended and survivability rate and cause of death is added in the data set and some formula has been developed to calculate it. Here also the patients are grouped into two classes (survival and non survival) and the survival group consists of people who will survive for 60 months or 5 years. The drawback is that this paper does not consider the variables of Estrogen and Progesterone hormone therapy. [10] Adjuvant! Online[7] is a web based tool designed to guide Doctors, medical staffs and patients with detection of cancer at an early stage and also discusses the risks and benefits of getting additional therapy (chemotherapy, hormone therapy, or both) after surgery. The tool provides estimates of the reduction of risk after applying systemic adjuvant therapy. The estimates are given on printed sheets in simple graphical and text formats to be used for consultation. Cancer-Math.net[8] is another web based tool which provides doctors and medical staffs with web-based calculators for accurately predicting the clinical outcome for individual cancer patients, as well as for accurately estimating the impact of various treatment choices on that outcome. The main drawback of this prediction tool is that it provides no flexibility in storing, retrieving and editing patients data in a secured environment.

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4. Proposed Methodology
Proposed concept is motivated from the need of such system in todays scenario when technology in medical domain has advanced to a noticeable point. Concept of proposed method can be understood by using architecture shown in Figure 3.1.

Figure 3.1 3-Tier Architecture of proposed system This is a 3-Tier architecture where top tier of this architecture is user or view level, middle tier is data mining engine and lower tier is database or data set which will gather data from medical domains to give efficient results. User can use this system either from the desktop software as like other system software or by an internet connection as a web application; architecture in both the case will remain same as flow of logic is same. As we have discussed in introduction part of this paper, proposed concept will help to new doctors to give services to patients even when they dont know have in depth knowledge of that diseases. To understand the flow of this architecture lets consider one example. Suppose any patient walks in into the hospital suffering from serious problem which is not a normal problem like fever, cough, cold etc. and which needs doctors attention immediate and the Doctor on duty is also not experienced enough to diagnose the disease, in that case on duty doctor can take help of this system by entering the symptoms of patient. Disease like brain stroking, heart attack etc could be possible which need doctor's attention immediately else the patient might lose his/her life. So, according to prototype Phase I, Doctor first need to examine the patient, then the Doctor will enter the symptoms of patient into the system (either in desktop software or web based). There will be more option which doctor can opt for like patient back records (history) if any, current medical treatment under progress if any and medicine detail if provided by either patient or care taker. In this way, Phase I will enable doctor to enter all information related to patient enabling system to search for that kind of problem; more specifications in the problem statement will lead to more accurate result. In the Phase II, symptoms entered by doctor will go to data mining engine. Data mining engine is equipped with different data mining algorithms like C4.0, C4.5, Apriori, Fast Apriori, k-means etc. which will quickly find the frequent item set for those symptoms. The data mining engine will run all these algorithms in parallel to each other and will give the result from each algorithm. Usually it may happen that two algorithms will lead to same frequent item set for a particular query; and more number of times same frequent item set will result for same query will lead to more effective result. This data mining engine will not wait for to finish execution of all algorithms; as soon as it will get the result from algorithms; it will give the result back to Doctor. This is because of reason that two algorithm can have different time complexity. Data mining engine is attached with database to find the frequent item sets. This database consists of data sets of several life loss diseases. Dataset will be compiled by data of as much as possible; because only then data

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mining engine can give better results. This can be understood like if treatment given to patient p for disease D can either be a good treatment for him or a bad treatment. Similarly same treatment for same kind of patients can either be good or bad; because treatment is depend on other factors also like internal body system, heredity etc. So, a large data set can guide about the most commonly opt treatment for a particular type of disease. Hence, algorithms mentioned in Phase II will work on these data sets and will give result back to the Doctors. Doctors can customize their search by refining their search criteria. In this way, a Doctor on duty in a very rural area and who is inexperienced or a young Doctor can also treat the patient who is suffering from a life loss disease. So, such Doctor can also find the treatment from the prototype model and by giving an appropriate treatment to patient can save a life; and further that patient can be referred to next hospital which is equipped with more experienced specialized Doctors and instruments. Treatment given by doctor will be able to make patient life live for next hours; and in these hours patient can commute to referred hospital. Same kind of prototype model can also be implemented into the ambulances where sometimes life loss come into picture when patient commute towards hospital and medical representatives present in the ambulance are not that well trained.

5. Conclusion
This paper focused on the medical requirement into the rural areas and using the medical man power very efficiently in rural areas to avoid the death ratio. This paper further proposed a prototype system from which doctors can take help to give immediate solution for life loss diseases like heart attack and brain stroking etc. Proposed model considers data mining result from more than one data mining algorithm which ensure to give fast and efficient results. In the further extension of this work, this prototype model can be implemented by implementing these algorithms under one umbrella.

References
[1] 2000 [2] Prof. J. K. Choudhury, "Technology and Status of Health Care Delivery in Third World With Special Reference to India", Proc. 14th Annual Int. Conf. of the IEEE Eng. in Medicine & Biology Society, Paris, pp2869-2870, 1992 [3] National Cancer Registry Programme. Two year report of the Population-based Cancer Registries 19971998. Incidence and distribution of cancer. New Delhi: Indian Council of Medical Research; 2002. [4] National cancer control programmes; policies and managerial guidelines. 2nd ed. World Health Organization; 2002. [5] [6] http://www.medterms.com/script/main/art.asp?articlekey=2580 http://whoindia.org/en/index.htm M. Refaee, Prof. M. A. Fayed HEALTH CARE TECHNOLOGY FOR DEVELOPING COUNTRIES IEEE

[7] Adjuvant! Online, Decision making tools for health care professionals. www.adjuvantonline.com. [8] [9] Cancer Math. Web based decision support system for oncologist. www.cancermath.net Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) Public-Use Data (19732005). [10] Abdelghani Bellaachia, Erhan Guven. Predicting Breast Cancer Survivability Using Data Mining Techniques. [11] Ir CATH Tee, Ali H. Gazala A Novel Breast Cancer Prediction System IEEE 2011 978-1-61284-922-5/11.

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