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v o l ume 2 | issue 4 | april 2007

a monthly magazine on ict and health

Rs. 75

EHCR

The Catalyst for Change?

covery story

advocacy for a common ehcr interview

Michael clarke, idrc: e-health is a facilitator not an alternative to conventional healthcare focus

baramati showcases e-health in its annual conclave health informatics

Towards Interoperability in ecg equipments development

the health initiatives and challenges in peru health awareness

a healthy beginning to spread healthcare info

www.ehealthonline.org


Click-start to an e-healthy journey ...

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w w w . e h e a l t h o n l i n e . o r g | volume 2 | issue 4 | April 2007

Cover story

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Advocacy for a Common EHCR

Santulan Chaubey

In conversation

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34

e-Health is a Facilitator Not an Alternative to Conventional Healthcare

Interview with Michael Clarke Director, ICT4D, IDRC, Canada

health informatics

Towards Interoperability in ECG Equipments 30 Qurat-ul-Ain Salim Khan, Hassaan Owais, Ammar Zaheer, Aleena Zahid Syed

focus

Baramati Event Showcases e-Health

12

Book Review

All about Undoing Delays in Healthcare

15

Health Awareness

A Healthy Beginning to Spread Healthcare Information

34

Development

The e-Health Initiatives and Challenges in Peru

36

Project Showcase

UK Biobank Project

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38

NEWS REV IEW

india update

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world news

23

April 2007

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business news

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Editorial Guidelines Contributions to eHealth magazine could be in the form of articles, case studies, book reviews, event report and news related to e-Health projects and initiatives, which are of immense value for practitioners, professionals, corporate and academicians. We would like the contributors to follow these guidelines, while submitting their material for publication: • Articles/ case studies should not exceed 2500 words. For book reviews and event reports, the word limit is 800. • An abstract of the article/

case study not exceeding 200 words should be submitted along with the article/case study. • All articles/ case studies should provide proper references. Authors should give in writing stating that the work is new and has not been published in any form so far. • Book reviews should include details of the book like the title, name of the author(s), publisher, year of publication, price and number of pages and also have the cover photograph of the book in JPEG/TIFF (resolution 300 dpi). • Book reviews of books on

e-Health related themes, published from year 2002 onwards, are preferable. In case of website, provide the URL. The manuscripts should be typed in a standard printable font (Times New Roman 12 font size, titles in bold) and submitted either through mail or post. Relevant figures of adequate quality (300 dpi) should be submitted in JPEG/ TIFF format. A brief bio-data and passport size photograph(s) of the author(s) must be enclosed. All contributions are subject to approval by the publisher.

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volume 2 | issue 4 | April 2007

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lectronic health records is an idea whose time has come, notwithstanding the continual barbs harping on patient anonymity being directed at it from sections of medical fraternity. If a potent idea has pitfalls, we should remove the pitfalls, not scrap the idea. The concept of EHR has been translated into a reality but its application is still in the nascent stages in the west. We should strive to develop a common low cost electronic healthcare records (EHCR) system in India. A common EHCR system will not only save money and hassles of the patient, but would also facilitate medical assistance to the patient in a big way. Among other things, electronic health records can also aid in the medical research through paving the way for analysis of various diseases and thereby facilitate development of a warning system, devised from trends of occurrence of diseases. There are positive ramifications for the health insurance and pharmaceutical sectors too. Of course there will be challenges in constituting a common EHCR, but the possibilities too are immense, which we have discussed in detail in our Cover Story. Ultimately it is more a question of political will than technological and financial bottlenecks. India should celebrate its progress on the highway of information technology and its positive impacts on the medical arena. One such recent indicator is the tie-up between Apollo Hospital Group and IBM to develop ‘Healthcare Super Highway’. The project aims to develop an online professional platform for doctors across the globe. The success of this project is expected to benefit more than 500,000 physicians across the globe by enabling them to interact and exchange their information, knowledge and expertise. We hope for the success of such innovative endeavours.

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April 2007




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C O V E R s t or y

Advocacy for a Common EHCR Architecture Role of electronic healthcare record for effective healthcare services Developing a common low cost electronic healthcare records (EHCR) system in India involves great challenge. There is a need to evolve a centralized system of storing, accessing and processing the medical records in electronic form, with all applicable standards and security support. The existing, so called EMRs are proprietary, with no interoperability, and are very costly. They mainly cater to the need of big hospitals in India. Santulan Chaubey

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he healthcare industry in India is undergoing significant growth. Quality healthcare is available in the country, at a much more affordable rate than in the west, which has resulted in a boom of sorts in medical tourism. However, at the same time there is a need to strengthen the public health services so as to make quality healthcare reach the socially and economically challenged population of the country. The primary health care (PHC) centers have to be empowered to reduce the load on secondary and referral healthcare centers. Presently there is a heavy load of patients on secondary and specialty healthcare centers due to non-efficient system of primary healthcare (PHC) centers. The power of information and communication technology can change the face of healthcare scenario in India, if the government takes up it as a mission mode project. National Health Policy-2002 (NHP) envisages an IEC policy, which maximizes the dissemination of information to those population groups, which cannot be effectively approached through only the mass media. However, the National Health Policy has not emphasized on taking technological advantage in the health sector, especially in public healthcare. The time is ripe to set the ball rolling and an effective answer to address the healthcare needs of India through the aid of ICT, lies in electronic healthcare record. Keeping medical record electronically at one place and accessing it electronically by healthcare centers may change the present way of health services in India. The role of electronic healthcare record (EHCR) is of great significance in terms of overall effectiveness of healthcare services in this country. If entire medical history of the patient is available at one place (even if consultation has been given in different hospitals), there will be less time required to provide medical assistance to the patient. Besides here are number of situations where patient is not able to collect the record and all tests, history, etc. has to be done again and again over a period of time. The }

EHCR will be saving hard earned money of patients if the lab tests are readily available for examination. In this regard, Indian health sector should take a leaf from the Indian stock and share market, where entire scripts are kept electronically in DEMAT form by the users in the stock exchange and trading worth of millions of rupees is done online, on a daily basis. A similar system has to be developed for health records that may be unique in the Indian health sector. However to develop a common low cost electronic healthcare records (EHCR) system in India involves great challenge. There is a need to evolve a centralized system of storing, accessing and processing the medical records in electronic form, with all applicable standards and security support. The existing, so called EMRs are proprietary, with no interoperability, and are very costly. They mainly cater to the need of big hospitals in India. The EHCR should be used right from the primary healthcare centers to private nursing homes. Like PAN card, a healthcare card should be issued to all, containing unique MRI (medical record Id) on it. To encourage the use of card, the card holders may be given additional benefits like priority in medical checkup, cost benefit in pathological testing, etc. Development of a common, low cost EHCR has potential opportunities of private-public partnership (PPP) in its implementation. Health insurance companies, pharmaceutical companies, medical equipment manufacturers, etc. can be involved in its implementation process, provided their involvement is ensured right from the planning stage of EHCR, in the Indian environment. Here we attempt to explore the possibilities of developing a low cost, common EHCR for India, consisting of all applicable international standards in Indian conditions. First of all let us examine what EHCR actually is and also the progression of EHCR from automated medical records. www.ehealthonline.org


The progression does comprise of the following levels:

1.The automated medical record is a paper-based record with some computer generated documents. 2.The computerized medical record (CMR) makes the document of level 1 electronically available. 3.The electronic medical record (EMR) restructures and optimizes the documents of the previous levels, ensuring interoperability of all documentation system. 4.The electronic patient record (EPR) is a patient-centric record with information from multiple institutions. 5.The electronic health record (EHR) adds general healthrelated information to the EPR that is not necessarily related to the diseases. The electronic health record shall broadly facilitate:

• Access of patient data by clinical staff at any given location • Building automated checks for drug and allergy interactions • Availability of clinical notes and prescriptions • Lab reports along with timeline analysis • Accurate and complete claims processing by insurance companies (this has potential for a business model through subsidising the implementation and operational cost involved in EHCR.) • Analysis of various diseases and development of a warning system, devised from trends of occurrence of diseases. • Planning and development of health facilities, depending on actual requirements • Research and development • Government would have database of citizens that could be used for other planning purpose. • Insurance companies may use this data for the purpose of authenticating fitness of customer. • Pharmaceutical companies may plan manufacturing of medicines as per the trends readily available to them. Challenges Ahead

However, there are manifold challenges in developing a low cost (here we refer to the cost to the user) EHCR on common architecture. They include interoperability with various hospital information and management systems (HIMS) in market, adding of legacy data (physical records like x-rays, MRI reports, prescriptions, etc.), adhering to various international standards of managing information like International Coding of Diseases (ICD – 10), Health Level (HL–7), etc. Then there is the thorny area involving privacy of health records, and the tangle of legal issues. Preservation of electronic records and maintaining security of patient record and the right to access can also pose challenges to the implementation of EHCR. Besides considering the present framework of health service, there will be lots of business process re-engineering required, which can prove to be another impediment April 2007

to the success of EHCR. Lastly it leaves room for duplicity in health record. A given patient with a health card may go to another place within the country and again get a new health card prepared. But the most daunting challenge is to create a common EHCR system, suiting to Indian conditions and acceptable to all kinds of medical service providers. There are already

Development of a common, low cost EHCR has potential opportunities of private-public partnership (PPP) in its implementation. Health insurance companies, pharmaceutical companies, medical equipment manufacturers, etc. can be involved in its implementation process, provided their involvement is ensured right from the planning stage of EHCR, in the Indian environment. international standards available for EHCR, but hardly followed even in developed countries. Interoperability in various EHCRs, available in different hospital information systems, is a big concern towards having a common EHCR. The Opportunities Involved

India is a fast growing country in the field of information technology. The National Informatics Center (NIC) has already setup its network up to the block level in India. The economy of India is booming with lots of business opportunities for medical as well as technical professionals. As mentioned earlier, healthcare industry, notwithstanding the lacunae, is also growing at a healthy pace. In the light of this present scenario, there are enough opportunities for insurance, pharmaceutical and medical equipment manufacturing companies to come forward with a business model to create a common EHCR system, which could be afforded by a healthcare center having minimal infrastructure. This EHCR system should become the integrated part of all HIMS and other applications. In IT terms, it should be like Transmission Control Protocol/Internet Protocol (TCP/IP) suite, without which no operating system can exist in the market. This is the right time to take the benefit of this evolution and connect health services of major hospitals / clinics / nursing centers to the block levels, all over the country. Though telemedicine is the easiest thing to start, but this does not serve the purpose in the absence of complete medical record of the patient. However, to implement EHCR successfully, we must understand the components involved in the EHCR system. There are three components involved in the EHCR system: 


cover story

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advocacy for a common ehcr architecture

1.Data Storage: We already have data centers available with NIC at state and district levels, with good security and access system. 2.Communication System: Fortunately, there is a very good communication network available all over India, up to block level, mainly through Bharat Sanchar Nigam Limited (BSNL) / Mahanagar Telephone Nigam Limited (MTNL) and many private players. Other private players are following this trend. 3.The Application System: Entire EHCR system has to evolve around the common architecture, to be developed and to be implemented in all HIMS regardless of operating system, environmental issues, health care standards, etc. An Approach to the Development of EHCR

A top to bottom approach will be required to develop a common electronic healthcare record system in India. The group of experts from medical administration, clinicians and information technology will have to contribute on a common platform to develop a low cost interoperable EHCR system. This EHCR should be integrated with all HIMS, as required

Preservation of electronic records and maintaining security of patient record and the right to access can also pose challenges to the implementation of EHCR. Besides considering the present framework of health service, there will be lots of business process re-engineering required, which can prove to be another impediment to the success of EHCR. Lastly it leaves room for duplicity in health record ... component. Involvement of various medical equipment companies will also be required to ensure the compliance of international standards of data exchange. A wide variety of data standards, medical terminologies and coding classification systems will play a major role in making electronic medical records systems interoperable. Same time, there is a need to evolve EHCR in local conditions and even in local language. Once the common standards are developed and frozen by the set of experts and supported by the government, there is high possibility of various business models including public-private-partnership (PPP). The IT companies involved in healthcare solutions will have to adopt common architecture in the HIMS. During the first time entry of a patient at PHC / hospital, etc. a plastic card should be issued to him / her containing the EMR Id, name, sex, age, blood group, allergies, etc. Updation and storage of medical data

However, if EMRs are not updated then its usefulness will be limited. Updating of the EHCR will also require lots of initia

tives from both government as well as the private sector. In its first phase, we should be updating everything except images as it may create problems in accessing the data for both retrieving as well as entering. In its first phase, data updating should be limited to non-image records. Once the feasibility of storing images becomes possible, we may think of storing images too. Daily updating should include births and deaths, medical testing reports, admission, discharge, etc. The escalation procedures should be inbuilt in the system to ensure the compliance. The exception reports should be automatically emailed to the concerned CMOs of districts on a daily or weekly basis, to ensure updating of data. Under data protection legislation, generally the onus of maintaining patient records (irrespective of the form they are kept in) is always with the creator and the custodian of the record; usually a healthcare practice or facility. In all hospitals, there is a separate medical record department (MRD) for this purpose. To store the EHCR, there is need to change the way we manage records today. The basic responsibility may remain with the creator of records, but the physical storage place may be shifted to NAS (Network Accessed Storage)/ SAN (Storage Area Network) in place of MRD. A storage area network (SAN) is a network designed to attach computer storage devices such as disk array controllers and tape libraries to servers. NAS is a disk array storage system that is attached directly to a network rather than to the network server (ie. host attached); it functions as a server in a client/server relationship, has a processor, an operating system or micro-kernel, and processes file I/O protocols such as SMB and NFS. The NIC may be entrusted with this responsibility of colocating the Storage Area Network (SAN) / Network Accessed Storage (NAS) at state / district level in India. The computerized system installed at various healthcare providers may access the required patient information directly from NIC, provided they have enough rights. Business Process Re-engineering and Implementation

There should be a mandate from government to use common EHCR based information system only and it should be one of the prerequisites for registering nursing homes, laboratories, hospitals, etc. In the qualifying parameters to setup a healthcare facility, daily updating (if not online) of data should be made compulsory. Moreover, thanks to the reduction in cost of material, the cost of this health card should not exceed INR 2-5, so as to make it affordable to all and sundry. To encourage the use of this card, the card holders may also be given additional benefits like priority in medical checkup, cost benefit in pathological testing, etc. The EHCR implementation must follow the 80:20 rule; that is, 80 percent of the work of implementation must be spent on the issue of change management, while only 20 percent should be spent on technical issues related to technology itself. To test its feasibility, a pilot can be run involving state capital, one district and three four blocks of that district. The Government is to give necessary instructions and infrastrucwww.ehealthonline.org


ture for compulsory healthcare card on the pattern of voter Id Cards. This innovative system has potential of becoming a people’s application, which will get implemented on the public demand once its usefulness is understood by the public as it happened in railway / airline reservation. Having this facility in nursing homes will become a quality standard in the nursing homes / testing centers. Proposed Government Initiatives

Furthermore, the government should take the following initiatives with considerable urgency to give a momentum to the EHCR movement. Firstly it should develop low cost application for managing health services, based on an acceptable common architecture for primary healthcare centers. This software should take the advantage of broadband boom in India, to connect to the major hospitals as and when required. The software should not be proprietary in development and in its use. The primary EMR of a patient should be generated by this application only. This EMR should be shared by any referral hospital. The government should also develop data centers at state and national level for healthcare services, under National eGovernance Project (NeGP), to provide sharing of EMR across the country. However, the access to these data centers should not be limited only to government hospitals and dispensaries but should also be open to private hospitals and clinics. There is a possibility of having a business model for sharing the information. n References:

• Anjan Prakash: Medical Auditing, JAYPEE • GD Mogli, Medical Records – Organization and Management, JAYPEE Online References: • http://www.ibef.org/industry/healthcare.aspx • http://www.hl7.org/documentcenter/public/pressreleases/ CMeadV3Article_HIMSS_Winter_71_78.pdf • http://www.hl7.org/ • http://www.omg.org/news/releases/pr2005/03-08-05.htm • http://www.india.gov.in/outerwin.htm • http://www.iupac.org/symposia/conferences/ga05/posters/40_ lancashire.pdf#search=%22International%20Standards%20 on %20EMR%22 • http://www.healthdatamanagement.com/html/current/Current IssueStory.cfm • Medical Record Institute website: http://www.medrecinst.com/

Santulan Chaubey santulan@hotmail.com Manager, Information Technology, Institute of Liver and Biliary Sciences, New Delhi

April 2007

Interoperability is welcome but Privacy sacrosanct Competitiveness and Innovation Framework Programme (CIP), as part of the Framework 7, is going to provide a big fillip to e-Health, at the interoperability front also. Paul Timmers, the head of the European Commission’s eGovernment says work is underway on “interoperable platforms that can work… across borders”.Dr Gerard Comyn, head of the ICT for Health unit, confirms that the idea has progressed beyond the proposal stage and a largescale pilot involving six member states will be operational in the next 3 years, and real scale operations would be in place by 2012. European Commission’s ICT for Health unit calls for interoperability between European nations’ healthcare systems. Logic is that health, social care and other providers should no longer work in isolation, but need to collaborate as a team, if necessary beyond their national and linguistic borders. The member states will supply at least 60 percent of the funding, with the European Commission providing the rest. Observers say that the scheme can do wonders in situations. For example, suppose a British citizen fell ill while being in Switzerland, the doctors there can easily know what medication the patient should be taking or what were the conditions that patient had been experiencing before. US Scenario But the issue of invoking privacy regimes in the matter of health records is blowing hot and cold. In the U.S, a policy debate is raging over how much control patients should have over the transmission and sharing of their electronic healthcare records. Canada, the Netherlands and the United Kingdom are ahead of the U.S. in setting privacy policies in favour of patients exercising more control, and also about implementing systems that empower patients to restrict the flow of their information-both in whole and part. According to Joy Pritts, a privacy lawyer and Associate Professor at the Georgetown University Health Policy Institute, “Canada is using masking technology right now.” In Canada, Canada Health Infoway, the Federal IT Support Programme and the Pan-Canadian Privacy Framework works on privacy protection programmes in some of its provinces.There are hundreds of (IT) projects happening in Canada that are getting funding from Canada Health Infoway. To qualify, they have to comply with the federal privacy and security architecture and prove their systems can comply with and support the local privacy laws. In Canada, British Columbia’s PharmaNet project allows patients to mask their entire prescription record and only selected providers can see that record by sharing a password with them. In the U.K., the National Health Service is creating a central database for storing individual demographic data and health summaries called Summary Care Record, which will contain links to more detailed care records kept by providers.n




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in conversation

e-Health is a Facilitator Not an Alternative to Conventional Healthcare Time to Prove e-Health Investment is Lucrative than Investment in General Healthcare

Michael Clarke, Director, Information and Communication Technologies for Development (ICT4D) at IDRC, Canada is an internationally renowned figure for his contributions to ICT programmes in development and healthcare sectors. Clarke received his Ph.D in Parasitology from the University of Guelph, and also studied at York and Stanford Universities. He has held successive academic appointments at the universities of Guelph, Victoria, Western Ontario, and Ottawa. In the past 15 years, Clarke has held senior positions in several ICT programmes in the areas of curriculum development and medical education. As a founder of the Canadian health and clinical medicine journal, Open Medicine, he has done a remarkable service in introducing new thoughts to the healthcare sector.

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michael clarke : director, ICT4D, IDRC, Canada e-mail: mwclarke@gmail.com

Q

Even though lots of development has taken place in the field of medical science, majority of the people in the developing countries still do not have access to quality healthcare. What is your take on this widespread scenario?

A

I think universal state subsidized system of healthcare is the answer to this problem. Developing countries should look carefully into privatized healthcare systems. Though efficiencies are to be gained in terms of privatized healthcare systems; efficiencies in terms of accessing specialized forms of care, but that access is not universal. Only 10 }

Jaya Chittoor and Rumi Mallick from CSDMS caught up with Michael Clarke for an exhaustive interview during the eHealth Asia 2007 conference, held during 6-8 February 2007 at Putrajaya International Convention Centre (PICC), Putrajaya, Malaysia. The interaction threw light on a host of issues and focused more on the critical role being played by e-Health, in the healthcare sector.

those who can pay the steep healthcare costs of privatized care, or are within the health insurance net can access that system, for the vast majority state subsidized healthcare system is the answer. For example in Canada, we have a legal framework under which the health system operates, and that framework prevents to a large extent the introduction of privatized healthcare. Under the Canada Health Act, there is however some room to manoeuvre and introduce some healthcare services under privatized schemes, but they are very constrained. Do you think that in a country like

India, where the government simply doesn’t have the resources to translate the idea of universal healthcare access into a reality, and where obviously privatized healthcare is beyond the reach of its vast majority, can eHealth serve as an effective bridge to make international standards of healthcare accessible to its underserved people? I don’t think the application of ICT in healthcare is the solution in itself, as technology-based diagnostic systems can overlook some of the complexities of a typical case. The physician needs to understand not only the biological www.ehealthonline.org


context, which that patient presents, but also the socio-economic context that the patient brings with him. In my view, direct doctor-patient interaction is of paramount importance to quality healthcare. We should be circumspect about telemedicine applications, as they don’t necessarily include the element of personal touch. However, at the same time I must add that though not an alternative, eHealth has great potential to emerge as a facilitator to conventional healthcare through the provision of services to locations where conventional systems do not reach. For example, the management and follow-up of the patients through video conferencing is a very wise application of ICT, which can enable doctors to remotely monitor their patients. Internet-based web cam monitoring applications is also there. However, here also there is a catch; the patients concerned need access to these fairly high-end technologies. Then only e-Health will be a reality for them in the true sense. Do you think ICT can act as an effective interface, where there are no hospitals or healthcare centers? It can link up hospitals and specialists who are not willing to work in the rural areas but at the same time can volunteer some time to respond to queries. And what is the role of paramedical workers like medical practitioners in this regard? That is a great idea needing careful execution. ICT’s role as an effective interface between doctors and patients can be greatly facilitated through conduits like registered medical practitioners, which you have in India. These paramedical workers may have rudimentary medical knowledge and can deal with only very general cases, but they should be able to communicate what the patient is saying in a language that the doctor at the other geographical end can comprehend. Physicians will find it difficult, if not impossible, to communicate through, for example, telemedicine videoconferencing, with the patient, without the intervention of registered medical practitioners. Moreover, adequate training and expertise must also be provided to these people who would be handling April 2007

the technologies to interact with the doctors, on the behalf of the patients, which will help an effective transmission of medical knowledge to the grass roots level. Thus some investment in human resource is necessary to make ICT act as an effective interface. Human element must be maintained, and technology is not the driver, but can be the facilitator of healthcare. Could you cite some examples of ICTs helping in building capacity and technical skills upgradation of the paramedical workers, which is a continual requirement in the face of fast changing medical and technological scenario? In the project we are developing in Rwanda, based on a successful experience in Uganda, nurses will be using small PDA devices. These are used to capture patient data on a basic but very effective electronic medical record, which is then submitted over mobile telephone network to central server, where the data can be analyzed. Our role in the project will be to deliver back to these nurses accredited professional education, using the same technology infrastructure – PDAs and mobile telephony networks. This will enable them to upgrade their qualification, which in turn will help them to get promoted from one level to the next, and this promotion we hope, will also be reflected in their higher earnings. We are engaged in the development and delivery of certified curriculum from a bonafide nursing training institute in Kigali, the capital of Rwanda-which enables upgradation of the qualification of nurses, without having them to be displaced from their present locations. Do you think telemedicine can reach out to mass, or would it remain concentrated in the fringe areas? For example, we would also prefer to set up telemedicine centres in places where already some basic health infrastructure is available, and then we would optimize on that infrastructure. That leaves the possibility of setting up telemedicine centers in remote locations, where they are most needed, very bleak. What are your comments on this vicious circle of a situation?

The deployment of networking infrastructure in these remote locations would not happen as quickly as a training programme, instilling basic diagnostic and therapeutic skills. But that doesn’t undermine in any way the role of building up of new skill sets in different players in the delivery of healthcare, which remains a very effective strategy. ICT intervention in healthcare should actually happen through health informatics and health management systems. Do you think there is a direct correlation between investments in healthcare and economic development? If you are looking for a return on your investments, there is no better option than to put dollars into healthcare. They would yield multifold in terms of welfare, development and productivity. The returns or rewards from an effective healthcare system, simply results in development. Is there scope of lots of private investments in e-Health in the near future? Now the challenge is to show that a dollar invested in e-Health is more rewarding investment than a dollar invested in health in general. We are looking at centralizing specialized healthcare services in different parts of the world; certainly in Canada. We are also looking at regionalization of healthcare … and in all these developments ICT can play a major enabling role. Succinctly, we can say that efficiencies that are coming into our healthcare system wouldn’t have happened in the absence of e-Health.The possibilities of investments in e-Health are forthcoming across the globe. What is your take on our magazine eHealth, which has graduated to being a monthly from a bi-monthly mode from only its second issue? I would like to see this journal promoted as a medium for publication of primary research in a digestible form that could influence policy makers; essentially providing evidence for informed decision making. Its complementary online presence is also noteworthy and I would be happy to support its outreach to medical fraternity in the Americas.n 11


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focus

Baramati showcases e-health in ITS annual conclave Explores ICT Applications Towards Sustainable Health and Development

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he Seventh Annual Baramati Initiative on ICT and Development took place during 1517 March in Baramati, Maharashtra. This happened to be the seventh in a series of annual conferences, organized by Vidya Pratishthan’s Institute of Information Technology (VIIT) in Baramati. The basic concept behind this annual event is to highlight the enormous potential of digital technologies and the digital economy to help poor communities. Over the years, the Baramati Initiative has evolved to become one of the key platforms for people to exchange ideas and information on various innovative efforts in the field of ICT and development. This year, the conference focussed on the ICT applications in health and the theme of the conference was ‘The Potential of e-Health’. It endeavoured to showcase how ICT can be effectively deployed to provide sustainable growth impetus to the pharma and the healthcare sector. The event was co-organized by Vidya Pratishthan’s Institute of Technology (VIIT), Baramati and Intel Technology Pvt. Ltd.- a global leader in silicon innovation doing good work in Baramati- and YES BANK, India’s new age private sector Bank. YES BANK was also the knowledge partner of this knowledgecentric event. The conference aimed to explore avenues through which governments, NGOs, development agencies and corporate houses can successfully promote e-Health, to the benefit of the Indian populace. This year’s conference attracted a galaxy of dignitaries from a wide spectrum and included eminent people from the medical fraternity, academicians, development professionals, important players from the industry engaged in the ICT applications in healthcare, banking and finance, e-Health experts, senior bureaucrats and ministers, and thought leaders and CEOs/COOs of large super-specialty hospitals. The inaugural session commenced on 16 March 2007, with the opening remarks by Sharad Kulkarni, Chairman, Governing Council, VIIT. Rajiv Ratan Shah, the Member Secretary, Planning Commission, gave the inaugural address, which was followed by keynote addresses by Chris S. Thomas, Chief Strategist, World Ahead, Intel Corporation and Hardy Sekhon, Group Director Q& A, Infoway. Shah emphasized on the critical need for delivering of quality health services to the people by using ICT as an enabling tool. He also informed

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Sharad Kulkarni, who also moderated the valedictory session, spoke about the Baramati Initiative. He said, “We are privileged to be a part of this initiative to successfully promote e-Health for the benefit and upliftment of the rural economy, and we are happy that it continues to be a great success year after year.” He also informed the audience that “VIIT is ready to partner with all stakeholders in these developmental efforts.”

sharad pawar at the Baramati conclave

that the Planning Commission was gearing up with various charters to tackle this challenging task. Chris S. Thomas was very animated about the World Ahead initiative, which is doing wonders for Baramati’s healthcare development. According to him, “As part of our World Ahead initiatives, Intel continues to drive accessibility of computing to every person in every country.” He viewed that technology should be perceived as a tool to bring about healthcare improvements, as it has done so for other industries. “Intel offers its expertise to enable the healthcare industry to effectively incorporate IT, and hence fully realize the value that technology can bring in transforming lives,” he added. The sessions on 16 March were ‘Potential Impact of e-Health Initiatives & Policies on Rural Health’, ‘Corporate Initiatives in Rural Healthcare- a Public Private Partnership’, ‘Healthcare Insurance-Driving ICT Adoption’, and ‘ICT in Medical Education-Lacunas and Research Perspective.’ They were followed by three video conferencing sessions. The following day opened with a high-powered session, carrying a mouthful title. It was ‘Demonstrating Successful Use of Technology in Healthcare, Improving Operational Efficiency, Patient Safety and Satisfaction.’ It was followed by a session on ‘Innovative Good Practices in Healthcare’, and a panel discussion on ‘Measuring the

Economic Benefits of Digitialized Hospitals’ The last session before the valedictory session was on ‘Government Efforts on the Use of ICT in Health and Family Welfare’, which was moderated by Mrs. Chandra Iyengar, Secretary Health, Government of Maharashtra. The influence of the government machinery in the conference was very much evident in the valedictory session too. The valedictory session had the presence of two heavyweight ministers - Dr. Anubumani Ramadoss, the Union Minister for Health and Family Welfare and Sharad Pawar, the Union Minister for Agriculture, Food & Civil Supplies, Consumer Affairs and Public Distribution. Both of them extolled the virtues of e-Health as a solution to India’s healthcare problems. Other speakers at the valedictory session were Somak Ghosh, President - Corporate Finance & Development Banking of YES BANK, Dr. Sivakumar Ramamurthy, Managing Director, Intel Technology India Pvt. Ltd. and Sharad Kulkarni. Sharad Pawar, along with Dr. Anubumani Ramadoss, presided over the concluding plenary session on ‘The Future of e-Health’. There Pawar emphasized on the role of ICT as an effective enabler which can support and improve the livelihoods of agrarian families. “We should have full integration of biotechnology with food and agricultural systems. e-Health, like e-Agri, is a fundamental need for the empowerment of rural India and therefore planning and implementation go hand in hand. I am glad to see that some efforts in this direction have been flagged, and we will fully assist them in taking this effort forward,” he expressed. Dr. Ramadoss also said that the union government was “seeking to increase the number of public-private partnerships to augment the provision of healthcare in the country.” He acknowledged IT’s potential in improving the access of healthcare in the remote India, and called for using this technology for disease surveillance and telemedicine programmes.

www.eHealthonline.org


He affirmed, “The enabling role of the government with knowledge-based financial institutions to create robust PPP mechanisms will be crucial towards the success of such initiatives and the government will actively work towards achieving this goal.” The Union Minister for Health and Family Welfare also released the YES BANK knowledge report on ‘e-Health - Opportunities and Challenges in India,’ which focusses on the benefits of ICTs in healthcare delivery systems. The report covers some initiatives taken by the Indian stakeholders in the delivery of quality healthcare at an affordable price, to traditionally underserved populations. Besides it also covers the international initiatives implemented by various governments in order to leverage the advancement of information and communication technology in healthcare, and the need to implement this on a sustainable basis using Public-Private Partnerships (PPP). The second YES BANK knowledge report titled ‘Health and Healthcare in India’ was

released by Dr. Anbumani Ramadoss, which highlighted the trends covering infrastructure and hospital resources along with the key achievements and shortcomings of rural healthcare. Sharad Kulkarni, who also moderated the valedictory session, spoke about the Baramati Initiative. He said, “We are privileged to be a part of this initiative to successfully promote e-Health for the benefit and upliftment of the rural economy, and we are happy that it con-

April 2007

tinues to be a great success year after year.” He also informed the audience that “VIIT is ready to partner with all stakeholders in these developmental efforts.” Ramamurthy asserted that, “Through the World Ahead Program we remain focused on accelerating access to technology in addition to improving education and increasing Internet connectivity.” He informed that as part of this World Ahead Program, Intel has “equipped the government hospital in Baramati with computers, medical equipments, design expertise of solution special-

The Union Minister for Health and Family Welfare, A. Ramadoss also released the YES BANK knowledge report on ‘e-HealthOpportunities and Challenges in India,’ which focusses on the benefits of ICTs in healthcare delivery systems. The report covers some initiatives taken by the Indian stakeholders in the delivery of quality healthcare at an affordable price to traditionally underserved populations. Besides it also covers the international initiatives implemented by various governments in order to leverage the advancement of information and communication technology in healthcare.

ists, and has also engaged with the solution delivery expertise of third party service providers.” Some of the other important speakers who graced the conference included the likes of Dr. K. Ganapathy, an eminent neurosurgeon who happens to be the Head of Apollo Telemedicine Networking Foundation, Alok Gupta, Country Head, Lifesciences & Technology, YES BANK, Dr. S.V. Krishnan, COO, MediCiti Hospital, Dr. Ajit Babu, Director, Center for Digital

Health, Amrita Institute of Medical Sciences, Dr. Neeraj Raj, Managing Director, MedRC Edu Tech Ltd., Amit Kumar, CIO, Max New York Life Insurance Co., Dr. Nayan Shah, President, Reliance Industries Limited, Dr. Ashwin Naik from Vatsalaya Healthcare Solution Pvt. Ltd. Madhava Murthy, Executive Director & CEO, SN Informatics Private Limited, Pamela Rao, Associate Director, Social & Scientific Systems Inc., V. Thulasiraj(through video conferencing), Director, IT & Systems, Aravind Eye Hospital, Bomi Bhote, CEO, Ruby Hall Hospital, Dr. S.K. Mishra from SGPGIMS, Lucknow(through video conferencing), Dr. Seema Gupta, a Senior Consultant at Wipro and Dr. D.V.S. Sastry, Director General(R&D), IRDA. Overall, the conference showcased the enriching and often divergent views of a crosssection of experts, who shared their opinions, expertise and visions on the various parameters of e-Health, which are going through evolution. The Baramati Initiative provided a platform of exchange of ideas that facilitated awareness about many lesser known e-Health applications, that are beginning to deliver on the expected benefits of improved patient outcomes, better patient safety and cost-effective delivery. The cumulative endeavours of the esteemed speakers during the two-day long presentations and discussions (the sessions began on 16 March) helped in understanding of the enormous potential and intricacies of eHealth and also made us aware of the myriad challenges involved in its successful or optimal implementation. The pointed and pertinent questions by the delegates during the interactive Q& A phase, which followed each brainstorming sessions, further helped to unveil the maze of complexities, potential, impediments, and inherent dichotomies involved in the application of ICT technology, in the fast evolving field of healthcare. Events of such magnitude and focus are necessary for the emergence of an e-healthy educated nation. We welcome more of such initiatives. n 13


18-20 April 2007 THE INTERNATIONAL EDUCATIONAL AND NETWORKING FORUM FOR eHEALTH, TELEMEDICINE AND HEALTH ICT eHealth and Telemedicine applications worldwide are at a critical growth phase. Med-e-Tel offers unmatched opportunities to meet and network with qualified buyers, specialists, users, researchers, policy makers, and payers/insurers from 50 countries around the world. Med-e-Tel provides visitors with hands-on experience and an opportunity to discover and evaluate new products, systems and technologies and to hear about the latest eHealth/Telemedicine news and trends. Med-e-Tel features an extensive educational and conference program with more than 120 presentations and workshops on topics that matter to your daily business, research and care activities. Topics will include a.o.: - personal and in-home monitoring - use of ICTs in independent living for the ageing and disabled - disease management and medication compliance - maximizing the potential of ehealth in developing countries - funding opportunities for ehealth programs and projects - interoperability and standardization - wireless and broadband applications - satellite communication - and more … Additional events being planned in conjunction with Med-e-Tel 2007, include meetings and workshops by some of the following organizations: - International Society for Telemedicine & eHealth - International Association of Homes and Services for the Ageing / Center for Aging Services Technologies - European Commission & European eHealth Projects - World Health Organization - European Telecommunications Standards Institute - Telemedicine and Advanced Technology Research Center - World Academy of Biomedical Technologies - United Nations Office for Outer Space Affairs - Centre de Recherche Public – Santé

For registration, exhibition and sponsorship applications, conference program, hotel and travel information, newsletter subscription and more, go to: www.medetel.lu Supported by

Venue

www.medetel.lu


>

book review

all about

undoing delays in healthcare Patient Flow: Reducing Delay in Healthcare Delivery Series: International Series in Operations Research & Management Science , Vol. 91 Hall, Randolph W. (Ed.) 2006, XIII, 458 p., 91 illus., Hardcover ISBN: 978-0-387-33635-0

‘P

ATIENT FLOW: Reducing Delay in Healthcare Delivery’ probes the delays in healthcare delivery to patients and explicates some methods to cut possible delays normally experienced by patients. The book talks about improving the flow of patients, and the need to avoid unnecessary waits in the course of their flow through a healthcare system. Providing a hands-on discussion, the book looks at methods for solving a variety of problems that inhibit prompt and swift health care delivery. Taking into account the highly interdisciplinary and practitioner nature of this book, the chapters have been appropriately written by doctors, nurses, industrial engineers, system engineers and geographers whose perspectives have succeeded in providing a comprehensive view for addressing the lacunae of ‘patient delay.’ The book targets an audience of the researchers in healthcare, practitioners and administrators by trying to familiarize a set of techniques and strategies to motivate clinicians and administrators, thereby making them try out initiatives that can substantially reduce delays in healthcare delivery. A significant aspect highlighted in the book is about ensuring services that are closely synchronized with patterns of patient demand. Another notable aspect is about ensuring ancillary services, such as housekeeping and transportation; fully coordinated with direct patient care. Effective management of healthcare delays can produce dramatic improvements in medical outcomes, patient satisfaction, and access

April 2007

Presenting queueing theory as a general method for modeling patient waits in healthcare, the book dwells on the topic of rapid delivery of medication in a catastrophic event, such as a pandemic or terrorist attack. The importance of optimizing care when patients transit from one care setting to the next care setting is duly emphasized by tracking the good results in clinical outcomes and the business side.

to service and reduce the cost of healthcare. With this objective in mind, a slew of breakthrough strategies is discussed in the book that use ‘real-time’ monitoring systems for continuous improvement, with techniques for scheduling staff to match the patterns in patient demand. This reduces predictable delays. It utilizes simulation-modeling techniques for both healthcare design and process improvement and provides methods for forecasting the demand for healthcare on a regionwide basis. Presenting queueing theory as a general method for modeling patient waits in healthcare, the book dwells on the topic of rapid delivery of medication in a catastrophic event, such as a pandemic or terrorist attack. The importance of optimizing care when patients transit from one care setting to the next care setting is duly emphasized by tracking the good results in clinical outcomes and the business side. The book also provides project management tools to guide the implementation of patient flow projects. It may not be out of place to say that this may be the first book having sole focus on reduction in patient delay, and showcasing the brewing aspirations among hospitals towards positive changes. The book can be an eye-opener in facilitating healthcare.n

Reducing Treatment Delay Among Patients An estimated 13 million people in the United States have coronary heart disease (CHD), peripheral vascular disease, or cerebrovascular disease. The risk for subsequent myocardial infarction (MI) and death in these patients is fivefolds to sevenfolds higher than for the general population. Many effective therapies are now available for patients with unstable angina, acute myocardial infarction (AMI), potentially fatal arrhythmias, and cardiogenic shock if they seek and receive care expeditiously. However, delays in accessing and receiving care are a continuing problem, threatening the effectiveness of available treatments. Patients with previously diagnosed CHD, including a previous MI, have the same or greater delay times as those without prior MI or CHD. Because of the high-risk status of these patients, combined with the problem of delay in seeking care, the working group of the National Heart Attack Alert Program Coordinating Committee advises physicians and other healthcare providers of their important role in reducing treatment delay in these patients. The working group recommends that primary care clinicians in the office and in inpatient settings provide these patients and their family members or significant others with contingency counseling about actions, to take in response to symptoms of an AMI. The counseling should address the emotional aspects (e.g., fear and denial) that patients and those around them may experience, as well as barriers that may be associated with the healthcare delivery system. Assistance from other healthcare providers (e.g., nurses) should be solicited to initiate, reinforce, and supplement the counseling. A patient advisory form is offered as an aid to providers in counseling their high-risk patients about these issues. Other materials and aids should be considered as well. Physicians’ offices and clinics should devise a system to triage patients rapidly when they call or walk in; seeking advice for possible AMI symptoms. Further research is needed to learn more about effective counseling strategies; symptom manifestation in high-risk groups, and healthcare delivery systems that enhance access to timely care for patients, with prior CHD or other clinical atherosclerotic disease. n

15


lR;eso t;rs

Ministry of Health and Family Welfare Govt. of India

National Health Summit

Enhancing Corporate Health The Global Perspective Tuesday,17th April 2007, 9.30 am, Hotel Oberoi, Zakir Hussain Marg,New Delhi Co-Organizers: Sir Ganga Ram Hospital, Moolchand Medcity, All India Institute of Medical Sciences

Knowledge Partner: PriceWaterhouseCoopers

Sponsors: Videocon Group of Companies, Nicholas Piramal India Ltd.

Co-Sponsors: VLCC, VHB Life Sciences Inc.

Supporter: Fortis Flt.Lt. Rajan Dhall Hospital

Official Magazine: eHEALTH

Print Media Partner: Times Foundation

Media Partner: Zee Business

Focus Areas: Role of physical activity and exercises; Yoga practices and its health potential; Power of meditation and corporate health; Stress management; Abstinence of tobacco consumption and smoking ;Optimization of lifestyle & enhancing perfect corporate health; Need of health awareness through education in corporates; Corporate media and health professional integration; Spiritual practices in a scientific manner to enhance corporate health; Mental health and corporates; Public-private partnership in health care; Preventive healthcare; Corporate health and insurance; Heart fitness; Anger management; Need of preventive health check for corporates; Nutritional services for corporates; Women care and corporate health; Corporate and health fitness centers; Obesity care; Wellness promotion and corporate health; Holistic approach to corporate health; Hospital and corporate relationship; Youth care and corporate health

Target Participants: Central / state government officials; Multilateral agencies such as WHO, World Bank, USAID, DFID; Insurance Companies; Educational Institutions; Corporate - CEOs / VPs / Business Head / GMs / Administrators; IT / BPO professionals; Lawyers; Accountants; Banks and Financial Institutions; Pharma Companies; NGOs; Hospital Administrators; Developers- Real Estate; Manufacturers and Suppliers; Retailers

Secretariat Contacts Ms. Verginder Kaur – 9891463592; Mr. Vivek Tyagi – 9871367808 ASSOCHAM Corporate Office,1 Community Centre,Zamrudpur,Kailash Colony, New Delhi - 110048 Phone: 011- 46550555 (hunting line); Fax: 46536481 – 82 E-mail: ekta.malhotra@assocham.com; assocham@nic.in Website:www.assocham.org


>

news review

BUSINESS

A tie-up to boost the flow of telemedicine

O

klahoma State University Center for Health Sciences Telemedicine Center has selected Spacenet Inc. - a leading provider of high-performance satellite and hybrid terrestrial networking solutions for corporates, governments and home/small office customers in the United States and worldwide- to provide satellite network services for its new mobile telemedicine clinic. The Oklahoma State University Center for Health Sciences offers programs in osteopathic medicine, biomedical sciences and forensic sciences. The OSU College of Osteopathic Medicine has been nationally ranked by U.S. News & World Report as one of the top medical schools in the US for the past six years. The OSU Center for Health Sciences, its College of Osteopathic Medicine and affiliated teaching hospital support is one of the largest statewide tel medicine programs of the USA. OSU Telemedicine Cen-

ter is using Spacenet’s satellite network services with Cisco technology to sport its mobile medical facility. Spacenet’s advanced Connexstar satellite services with autoacquisition antenna technology can provide the ability to rapidly deploy communications solutions virtually anywhere in the United States, and serve as an ideal solution for emergency response. Connexstar services deliver high-performance satellite communications offered in fulltime and part-time usage based packages. OSU Telemedicine is utilizing Spacenet’s on-demand satellite services to support its data communications and Voice over IP (VoIP). for the mobile telemedicine clinic. Network Operations Manager for OSU’s Telemedicine Center, Jon Barnaby said, “The OSU Mobile Telemedicine Clinic will provide a valuable service for the state of Oklahoma by offering access to specialty medical

services throughout the region with an emphasis on rural areas. The use of Spacenet’s satellite services provides the flexibility and reliability that we need; to support the advanced communication requirements of a mobile telemedicine clinic. In addition, with the medical vehicle being on the road on a scheduled basis, Spacenet’s part-time satellite services are an ideal choice for us, providing a cost-effective way to meet our real-time data communications needs.” Spacenet President and COO Glenn Katz said, “Spacenet has applied its 25 years of experience in supporting mission-critical public and private sector networks to delivering advanced solutions for go-anywhere communications services. Our on-demand services, combined with transportable autoacquire antenna solutions make a perfect fit for the needs of users such as telemedicine, emergency response or first responder organizations.” n

Intel’s endeavour in Mobile Clinical care

I

ntel’s new mobile healthcare platform is designed specifically for clinicians. Intel has helped to pioneer a new solution to address the myriad challenges that healthcare professionals regularly face in dealing with patient histories and communications. Designed specifically for clinicians at the front lines of patient care, an exciting mobile point-ofcare platform called the mobile clinical assistant (MCA) facilitates overworked medical staff in performing a vast array of important tasks. The MCA can help reduce medication, dispensing errors and ease staff workloads so that clinicians can spend more time taking care of the patient, by providing up-to-date access to patient information where it’s most crucial—at the point of care. Intel has collaborated with Motion Computing—a long-time provider of mobility products in

April 2007

healthcare—to develop the first generation MCA product. Healthcare professionals now have ac-

cess to a portable system that can record, retrieve, identify, verify, and document-all at the point of care. To help the market get prepared for products based on the MCA platform, Intel has also

worked with leading industry suppliers, such as electronic medical records software vendors, to optimize their software to run on MCA platform. The unique ergonomic design of the MCA features an integrated handle and a spill and drop-tolerant enclosure, which can be easily cleaned with disinfectants. The ability to sanitize the casing may reduce the risk of contamination and limit the spread of infections as healthcare professionals move from patient to patient. A bar code scanning feature enables accurate patient identification, immediately matching the patient to treatment plans and records, and is intended to reduce medication-dispensing errors. In a nutshell, this advanced system has many integrated features that connect healthcare professionals with the information they need for enhancing patient care. n

Agfa HealthCare introduces enhancements to its IMPAX

R

ecently Agfa HealthCare has announced further enhancements to its web-enabled, persona-based IMPAX 6™ PACS (Picture Archiving and Communication System), thereby addressing the advanced visualization needs in diagnostic imaging. These new clinical applications are being developed for specialized areas such as virtual colonoscopy, nuclear medicine, registration and fusion and orthopaedics, and they further extend the clinical usability, productivity and efficiency strengths of IMPAX. Here it deserves a mention that IMPAX 6 is Agfa HealthCare’s web-enabled, persona-based, integrated PACS/RIS/reporting solution. IMPAX 6 facilitates the diagnostic reporting process, streamlines workflows and enables image and information management and increased collaboration departmentally, enterprise-wide or even beyond. Agfa HealthCare’s IMPAX Virtual Colonoscopy is a non-invasive procedure for visualization of endoscopic views of the colon and an extremely patient-friendly alternative to conventional endoscopy, as it does not require the use of a colonoscope. The IMPAX Nuclear Medicine review solution includes integrated MPR/MIP (multi-planar reformatting/maximum intensity projection) functions for volumetric data, calculation of SUV (standardized uptake values) and region of interest tools. Answering the need of reading radiologists to compare single modality as well as multi-modality images, IMPAX Registration & Fusion allows for multi-modality fusion of anatomical studies (CT/MR) or a combination of anatomical and physiological studies (tracers in PET images). The IMPAX Registration & Fusion solution is ideally suited for non-invasive diagnosis and surgical treatment and planning n 17


news review

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RTX Healthcare’s telehealth monitor makes life easy for chronically ill patients

D

enmark-based RTX Healthcare, which specializes in the development and manufacturing of wireless medical devices for remote monitoring, has launched the new RTX3370 Telehealth Monitor, which is designed specifically to improve the way of providing healthcare to patients suffering from chronic diseases such as heart failure, COPD, diabetes, etc. outside hospitals. “The RTX3370 Telehealth Monitor is targeting the disease management and home healthcare industry to monitor chronically ill patients at home,” said Bjarne Flou, Managing Director of RTX Healthcare. “The uniqueness of our product is that it is offered as a system device which interoperates directly with our clients’ clinical information systems. Our

Apollo and IBM to facilitate online medical knowledge dissemination

I

ndia’s Apollo Hospital Group has joined hands with IBM in an endeavour to develop an online professional platform for doctors across the globe. The proposed online platform is named as ‘Healthcare Super Highway’ and it will undergo phasewise implementation. What’s more, according to Apollo Hospital Group’s Chairman, C Pratap Reddy, Microsoft has also shown interest in partnering the project. However its entry is yet to be finalized. Healthcare Super Highway aims to provide access platform to 500,000-odd physicians across the globe, thereby enabling them to interact and exchange ideas, information and opinions pertaining to their profession. This will help the doctors on consulting over a difficult case or eliciting expert second opinion. Success of this project will open new windows of knowledge and learning opportunity for the Indian doctors. n 18

business model is based on hardware sales, compared to most other competing solutions in the industry, where the devices are tied up to a proprietary infrastructure and the business model are based on a monthly fee, fee per user and likewise,” he added.

Swiss Centre for Telemedicine Medgate, a provider of disease management and telehealth services, is among the first customers to integrate the RTX3370 into their portfolio of telehealth offerings. The RTX3370 engages the patients through personal-

ized daily interactions and questionnaires, while collecting vital signs. The vital signs, such as weight, blood pressure and blood glucose information, are transmitted seamlessly via Bluetooth, InfraRed or RS232 from industry standard wired or wireless peripheral biomedical devices to the RTX3370. All peripheral devices are standard of-the-shelf products from third party industry leading suppliers. Data are sent through the regular telephone systems and the global Internet, to the clients’ own clinical information system, using open standards such as Webservices and SSL128. Other unique features of the RTX3370 Telehealth Monitor include a large, easy to read colour display, simple buttons and speaker for vocalization of the patient dialogue. n

Locating patient data with a blink of an eye

N

early 100 million patient data sets in one database, combined with queries made by up to 1,000 concurrent users, have resulted in response times of less than a second. This is in summary the result of a weeklong test of the InterComponentWare Master Patient Index (ICW MPI) at the HewlettPackard European Performance and Benchmark Center in Böblingen, Germany. InterComponentWareAG (ICW) is a leading international eHealth specialist with locations in Germany, Austria, Switzerland, the USA and Bulgaria. Among other things, ICW develops and distributes software and hardware components for the healthcare IT infrastructure, for electronic health cards, the LifeSensor personal health record as well as networking solutions for hospitals and physicians’ offices. As part of the bIT4health consor-

tium, ICW provided important consulting services for the implementation of the electronic health card in Germany, is involved in the Austrian eCard project and has recently won the pilot project for the national health card in Bulgaria. The ICW MPI is a component of the ICW hospital connectivity solution, which links existing but previously isolated hospital information systems without

the need to replace the current software. It enables hospital doctors to access all medical information on their patients that is available in the whole hospital group at any time. Recently a customer project required the ICW MPI to prove how quickly and reliably it could

locate individual patient data from a sea of information, under extreme conditions. According to Thomas Breig, Managing Director of Healthcare Sales, HP Germany, “We subjected the ICW MPI to an extensive load test, at the HP European Performance Center. The software passed with flying colours, exceeding our expectations. The experts from ICW and HP were able to show how well the ICW MPI performs, as well as how stable and scaleable it is.” Alexander Ihls, Product Line Manager of ICW’s hospital connectivity solutions, summarized the test week, saying: “We first saved 15 million, and then 100 million patient data sets in one database, and in both cases we achieved stable response times of less than a second. The test results have proved that our solution is just as suitable for large hospital groups, as it is for the installation of regional and nationwide networks.”n

www.ehealthonline.org


India's Premier ICT4D event 30 July - 03 August, 2007 Pragati Maidan, New Delhi, India www.eINDIA.net.in

eINDIA2007 unites seven specialised conferences and exhibitions

ommun ty Rad o


The National eGovernance Plan (NeGP) launched by the Ministry of Communications and Information Technology is a comprehensive programme designed to leverage the capabilities of ICT to promote good governance across the country. The Indian economy is growing at a steady rate of 8-9%. For this growth to be sustainable there is a need to increase efficacy of business processes especially those directly controlled by the government. The eGov track of the eIndia2007 aims to bring together key stakeholders to forge the path to good governance for citizens and businesses in India, ensuring cross-pollination of information & knowledge across socio-economic and geographic boundaries.

INDIA

2007

While India has made huge strides and has been a key player in the Information technology revolution, vast digital divide still exists that inhibits a sustained all-inclusive growth for the society. India is bracing itself to catalyse the potential of ICTs in all spheres of development and creating opportunities for private investment and initiatives to supplement its development. In this immense growth environment, there is also a need for strategic planning, knowledge sharing and collaborative vision building between the government and the private sector to leverage the country’s growth potential and steer the country to lead the knowledge revolution. eINDIA 2007 is an inclusive, consultative and constructive ICT for Development forum – the largest and only one of its kind in India – promoting and propagating the use of ICT4D through its seven seminal conferences. Through its seven different but interrelated conferences namely, ● egovIndia2007, ● Digital Learning India 2007, ● Indian Telecentre Forum 2007, ● eHealth India 2007, ● mServe India 2007, ● Community Radio India 2007 and ● eAgriculture India 2007. The conference will address the issues of digital divide and identify and explore opportunities for Digital India.

India is trying to achieve the 'Education for All' goal in one hand and investing in building infrastructure and initiating programmes to build a world class human resource capacity on the other. The National Knowledge Commission has emphasised the need for extensive use of ICTs for 2007 research, collaboration and university networking for building ICT skills, sharing education resources and reaching the un-reached in higher education though distance learning. Digital Learning India 2007 will take on the existing debates and provide a platform for all stakeholders to deliberate on the issues of enabling and strengthening capacities to achieve the national goals of education.

INDIA

INDIA

2007

INDIA

2007

With the launch of a national programme, 100,000 Community Service Centres, the Indian telecentre movement is at a vibrant stage of development, with the key stakeholders representing government, private sector and civil society besides donors being engaged in fulfilling the aspirations of the grassroots community to join the knowledge economy. Second year in the series of annual consultations, the Indian Telecentre Forum 2007 will provide the platform to take stock of what has happened. The Forum will shape the way forward for the telecentre movement within India, and for creating an example for the world to learn from.

Telemedicine has been a technological takeaway for the developed countries. Defined as the use of communication networks for the exchange healthcare information to enable clinical care, it is increasingly being viewed as a tool for improving care and enhancing access to healthcare. Telemedicine helps to connect remote rural hospitals/health centres to super specialty hospitals located in the cities and helps patients in remote and rural areas to avail timely consultations from specialist doctors without the ordeal of travelling. eHealth India 2007 will deliberate on such initiatives and many other excellent though scattered efforts in this field and bring it together to form a conduit of critical information.

INDIA

2007

ommun ty Rad o

INDIA

2007

The Indian telecom sector after liberalisation has shown tremendous growth with its growth rate being one of the highest in the world. The mobile phones apart from bringing in the aspect of mobility in connectivity have an inherent ease in terms of usage unlike computer-based connectivity, which requires people to be literate and e-Literate at the same time. In a nation plagued by connectivity lapses, mobile technology may well emerge as the key to bridging the digital divide. mServe India 2007 will showcase the immense potential of mobile technology in the implementation of existing and future m-Government, m-education, m-agriculture and other applications.

Amongst all the broadcasting media in India radio has the highest penetration and thus makes it the media which can reach the rural and remote areas servicing even the unlettered and illiterates. Realising its potential in November 2006, after seven long years INDIA of lobbying by groups like the Community Radio Forum, that the government finally 2007 accepted to make changes in the Community Radio Policy, to allow community based groups to set up their own radio stations. Community Radio India 2007 will bring together key stakeholders on a common platform to take the community radio movement in India to the next level.

e-Agriculture India 2007 will explore the opportunities of how ICTs can be used to improve the lives of the rural communities. Timely information on weather, disasters, improved agricultural practices, commodity prices and market information would greatly benefit farmers directly to minimize the risks and provide opportunities for enhanced incomes while cutting out high debt servicing costs, and taking informed decisions. The impact is felt directly with improved incomes and savings, access to services and valuable connections with stakeholders. The Universities, policy makers, industry leaders, development specialists and NGOs working for the farmers’ interests would explore the current developments and scalability of experiments.

www.eINDiA.net.in


i4d Film Festival “A picture speaks a thousand words”… The audio-visual medium is obviously an extremely powerful tool that can change the way global dialogues take place.

first ICT4D film festival. The film festival will cater to all sections of the ICT4D domain.

The first attempt of its kind in this arena, CSDMS will bring together over 50 films at the upcoming eIndia2007 forum. The features, long and short, will be gathered from around the world through the well-established networks that we already foster. Grassroots representation from not only India but around the world in the various cinematic forms will constitute the world's

Interested persons are requested to visit our website at http://www.eINDIA.net.in/films to download the application form and guidelines. All submissions will be reviewed by the festival committee. Please be advised that we do not return VHS tapes or DVDs. We will contact those film-makers whose films/videos are accepted to participate in the festival.

Potential Participation International Development Agencies: ! ! ! ! ! ! ! ! ! ! ! !

Swiss Agency for Development and Cooperation (SDC) telecentre.org International Development Research Centre (IDRC) Swedish International Development Agency (Sida) United Nations Development Programme (UNDP) United Nations International Children’s Education Fund (UNICEF) Unted States Agency for International Development United Nations Educational, Scientific and Cultural Organisation (UNESCO) World Bank Asian Development Bank (ADB) International Finance Corporation (IFC)

Indian Government Organisations: ! ! ! ! ! ! !

Ministry of Communications and Information Technology, Government of India Ministry of Human Resources Development, Govt. of India Ministry of Rural Development, Govt. of India Ministry of Health, Govt. of India National Informatics Centre, Government of India National Institute for Smart Government, India Department of Telecommunications, Government of India

! ! ! !

Department of Posts, Government of India National Rural Health Mission, India Planning Commission, India State IT and Education Departments

Research & Academic Institutions: ! ! ! ! ! ! ! !

Delhi University, India Centre for Good Governance, India Jawaharlal Nehru University, India National Council for Educational Research and Training IGNOU, Government of India Kendriya Vidhyala Sangathan, India University Grants Commission, Government of India IITs

National and International Networking Thematic Programmes: ! ! ! ! ! ! !

Mission 2007 Med-e-tel Euro India ICT Cooperation Commonwealth Human Rights Initiative (CHRI) Asian E-learning Network (AEN), Japan Global e-Schools and Communities Initiative South East Asian Ministers of Education Organisation

Past Sponsors and Exhibitors

empowering education... enabling careers

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Centre for Science, Development and Media Studies (CSDMS), G-4, Sector - 39, Noida, Uttar Pradesh - 201301 Phones: +91-120-2502180-85 Fax: 91-120-2500060 For any information/enquiry contact Sulakshana Bhattacharya Tel: +91-9811925253 email: sulakshana@eINDIA.net.in

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WORLD

news review

ICT deployment in hospitals can cut operating costs

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nce hospitals exceed a certain tipping point in its IT investments, they see a reduction in operating costs, improved efficiencies, and a slight drop in patient mortality rates, according to a new report by PricewaterhouseCoopers. The study of 2,000 US acute care hospitals found that about 60 percent so far are near or have reached the tipping point, in which investments in IT have begun to pay off. In total, there are about 6,000 acute care hospitals in the US. The tipping point is slightly different for forprofit versus non-profit hospitals. However, to reach the tipping point, a hospital needed to make pretty significant investments in IT, based on the complex scoring system PwC, used to evaluate the hospitals. The scoring system rated hospitals on their investments, in about 40 different applications. n

Involving patient in healthcare through IT

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n 12 March 2007 The Scarborough Hospital (TSH) and Canada Health Infoway (Infoway) have announced a new initiative to improve emergency room service. Through kiosks in the emergency waiting rooms at both hospital campuses, patients will be able to enter information in seven different languages, thereby facilitating more effective triage. Here it deserves a mention The Scarborough Hospital is Canada’s largest urban community hospital, involved in delivering innovative, high quality patient care. It advocates community’s health and wellness issues, and is a leader in research, teaching and learning. Affiliated with the University of Toronto, TSH is also a referral centre for vascular surgery, pacemakers and corneal implants. Canada Health Infoway is an independent not-for-profit organization that invests with public sector partners across Canada to implement and reuse compatible health information systems,

which support a safer, more efficient healthcare system. Coming back to this joint initiative, which is Called Enhancing Emergency Services: A Patient-Centred Approach (EES), it aims to better support nurses and physicians with smart tools so that they can work more efficiently and effectively to enhance patient flow and improve patient care. These patient-centric information systems will assist patients in communicating their status to ER staff and physicians as they wait in emergency waiting rooms. An alert will pop-up on the nurses’ screen each time a patient updates information. According to Dr. Hugh Scott, President and CEO, TSH, “Patients now have the option to play even more of an active role in their care process during unavoidable waiting time.” Also, the new e-triage tool will assist staff with the patient reassessment process and reprioritization of care as needed.” The system is designed to enhance

Boost for electronic health records

Investment in MiddleEast Healthcare to Triple

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bill introduced on 1 March 2007 by the US Representative Patrik Kennedy, a Democrat based in Rhode Island, will give US doctors an incentive to sign patients to use electronic health record systems. According to the terms of this bill, titled Personalised Health Information Act, US doctors will get US$3 for every patient that they sign up to use electronic health record, over a period of next three years. The bill entails US Secretary of Health and Human Services to create an incentive program for doctors, to encourage their patients to use an electronic health record system. The bill is a proactive step to facilitate USA’s adoption of electronic health records, which in turn can contribute greatly towards reduction of healthcare costs, and elimination of medical errors. The successful passing

April 2007

various aspects of ER service for patients without increasing staff or enlarging facilities. The user-friendly kiosks are available in English, but will also feature interfaces in seven different languages including English, French, Chinese (Cantonese and Mandarin), Tamil, Punjabi, Farsi, Hindi and Urdu. Patients are asked a number of questions in their native language and can choose answers from a comprehensive list. The system then translates the information into English for use by the care providers. Infoway is investing $1.5 million dollars in this pilot project, approximately half of the project’s total cost. The new technology will capture more detailed data from patients, process that information and provide it to the nurses and physicians. The Centre for Global e-Health Innovation, University of Toronto Healthcare Resource Modelling Laboratory, the University of Alberta eTRIAGE Solution and Medisolve, are also partners in this project. n

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and execution of this proposed bill is estimated to save to the tune of $70-$80 billion a year for the healthcare industry, in terms of efficiency alone. The e-health records would allow healthcare providers to send important messages to patients, such as reminders about a check-up or the due date of vaccination, etc. According to Kennedy, the bill would

empower patients by making them better informed and would also improve communication exchange between patients and their healthcare providers. Several companies, which include Microsoft, e-health record vendor Allscripts and the American Heart Association, have endorsed this bill, which endows it with an added corporate muscle. n

he Mideast is set for a substantial increase in spending on its healthcare infrastructure, according to virtually all local news sources. In the UAE alone, estimates suggest that there is shortage of over 2,000 hospital beds. As a result, numerous private hospital development groups have been drawn to the region, explained Ottmar Schmidt, Director of Marketing at Welcare World. The change is expected, among other things, to reverse the trend of affluent Middle Easterners seeking healthcare abroad in such places as the U.S. or Europe. The forecast predicts that the Middle East will be one of the four emerging markets, along with China, Russia and India, whose healthcare investment will rise from $1 billion to $3 billion. n 23


news review

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Telemedicine in the sub-Saharan Africa

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European task force on telemedicine, which met at Gaborone, Botswana, on 1 March 2007, reviewed the ICT applications for health in the sub-Saharan region. The task force concluded that ICT through satellite solutions could facilitate the improvement of health in sub-Saharan Africa. To translate this idea into reality, some shortterm actions have been chalked out in a pilot projects proposal. The suggested actions focuses on increasing the numbers, improving performance and quality of the health workforce of sub-Saharan Africa, increasing the coverage of health services in the area, by reaching remote, isolated areas, and strengthening the intelligence gathering capacity of the area’s health systems and their ability to use in-

formation for decision making. All total three pilot projects were proposed under the eHealth initiative, as part of a European Union’s strategy to enhance interconnectivity in Africa through ICT. According to Telemedicine Task Force, by complementing terrestrial infrastructure with satellite communications, better communications coverage for the sub-Saharan region can be achieved. However, the proposed pilot projects should concretely demonstrate the feasibility of this approach. These demonstration projects will be used to inform and to help develop a framework for extending eHealth. One of the key goals of this European task force is to develop a complete scenario of telemedicine opportunities in the sub-Saharan region, and to

formulate recommendations for future action. Here it deserves a mention that this was the third meeting of the telemedicine task force, which is composed of the main relevant African organisations, the World Health Organization, the European Commission and the European Space Agency. This task force is constituted after a Brussels workshop in January 2006, that highlighted the potential of satellite telecommunication technology to support health systems in Africa. The task force has been set up to define a framework of appropriate actions for a telemedicine programme in the sub-Saharan Africa to support the definition of a cost-benefit study; to evaluate the relevance of a pan-African network for telemedicine. n

Using bioinformatics to tackle avian flu

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esearchers at the University of California, San Diego (UCSD) and the University of Hawaii will use bioinformatics, grid computing and networking infrastructure, as well as collaborative ties with the Asian institutions to learn more about avian flu. “We will use modern highthroughput biology to annotate the biological structures of different subtypes of the avian influenza virus, at the same time as we study their variations,” said Principal Investigator Peter Arzberger, Director of Life Science Initiatives at UCSD. “We will also construct a grid infrastructure to support avian flu research - an infrastructure that could one day handle research on other infectious diseases as well,” he added. According to him, “Fighting a pandemic will also be easier if we put in place the infrastructure to replicate data, support medical informatics, and even assist in remote diagnosis.” University of California, San Diego will lead the one-year proj24

ect, with more than $350,000 in funding from the Telemedicine and Advanced Technology Research Center (TATRC), a part of the U.S. Army Medical Research and Material Command (USAMRMC). TATRC invests in telemedicine and advanced medical technologies in order to deliver world-class healthcare to military personnel. Institutions in three Asian nations will leverage TATRC’s investment by funding their own researchers to work with their counterparts in California and Hawaii, as part of their ongoing collaboration in the National Science Foundation-funded Pacific Rim Applications and Grid Middleware Assembly (PRAGMA). Pacific Rim institutions collaborate in PRAGMA to develop grid-enabled applications and coordinate deployment of the needed infrastructure throughout the Pacific region to allow data, computing, and other resource sharing. Five non-U.S. partners have pledged to fund collaboration on

the avian flu virus project. They are Japan’s National Institute for Advanced Industrial Science and Technology (AIST); China’s Jilin University (JLU) and Computer Network Information Center (CNIC); as well as the Korea Institute for Science and Technology Information (KISTI) and Konkuk University (KU). Significantly, Malaysia’s Universiti Sains Malaysia (USM) has pledged new funding for the collaborative project at the PRAGMA 12 workshop. The focus of this research is on the use of reverse genetics techniques to combat emerging bird flu pandemic threats. The researchers intend to characterize the function of the influenza viruses using a structure-based approach, develop simulations of the molecular dynamics involving interactions among major factors that may determine the virulence of a virus, and test whether the multinational collaboration can establish a successful, largescale, distributed computational data grid. n

Fight against Aids in Africa gets mobile power

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he recently held 3GSM World Congress in Barcelona was the platform for announcing a significant inroad in the e-Health sector. Here it was announced that the mobile phones could be used to combat the prevalence of HIV/AIDS, which is threatening to take epidemic proportions in the African continent.

A public-private alliance between the US government and five member groups from the mobile phone industry has taken an initiative called ‘Phone for Health’ for this purpose. The $10 Million ‘Phone for Health’ project aims to use mobile phone to cater to health systems in ten African countries. Firms working on this project include the US President’s Emergency Plan for AIDS Relief, Motorola, the GSM Association, Voxiva, and Accenture. The scheme expedites the real time collection of data from healthcare staff and field workers and holds structured two-way intercommunication to enhance supervision and feedback. According to Paul Meyer, Chairman, Voxiva, “Health workers will also be able to use the system to order medicine, send alerts, download treatment guidelines, training materials and access other appropriate information.” Presently, more than 60 percent of the African populace lives in regions where there is mobile phone coverage. This is projected to escalate to 85 percent by 2010.n

www.ehealthonline.org


Singapore to consolidate its patient medical records

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he Singapore government is endeavouring to consolidate patient medical records in a common IT system so as to enable sharing of health information between doctors in Singapore, coming from both the public and private sectors, in a secured manner. However, according to Singapore’s Health Minister Khaw Boon Wan, some sensitive data pertaining to issues like HIV and sexual diseases will never be shared, and will be kept highly confidential. This centralized database has the potential to transform the healthcare of Singapore. With the advent of consolidated medical records, now a patient will not have to repeat his/her tests and scans, if he changes his/her doctor, or visits a different doctor than his/her usual one. This will lead to savings in his/her medical costs. Khaw also said that Singapore would “gradually” graduate to an EMR system. Already some progress has been made in this direction. Several issues, which include data protection, regulation and audit, need to be considered first before moving over to such a system, and Singapore government is naturally introspecting on these. n

A deserving award for Raytel and tele-health

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rost & Sullivan, a global growth consulting company, which has been partnering with its clients to support the development of innovative strategies for more than forty years, has selected Raytel Cardiac Services as the recipient of the 2007 U.S. Cardiovascular Enabling Technology of the Year Award for its dedicated efforts in the remote monitoring in cardiac rhythm diseases. Each year Frost & Sullivan presents this award to a company that has developed a technology that can benefit or revolutionize the industry. “Any refinement of procedures or devices that are able to expedite the time a doctor is able to allot for a patient, without sacrificing accuracy or thoroughness, will be seen as a significant advancement,” said Frost & Sullivan’s Research Analyst Venkat Rajan. “Raytel’s advanced remote home monitoring technologies and reporting services are aiding this market,” he added. Here it deserves a mention that Raytel is one of the most experienced telemedicine providers in the US healthcare industry. Its technicians and report data are available to patients and clinicians 24/7, all year round. The company’s highly experienced

technical staff supports the monitoring service, provides comprehensive and relevant test reports, supports physician emergency notification requirements, works with patients to ensure test compliance with their physician’s prescribed frequency, and also offers guidance and training to both clinicians and patients. This comprehensive monitoring service allows the clinician to spend limited clinical resources on more acute patient needs without sacrificing quality of care. This remote monitoring system can greatly aid the patients who live in remote or rural locations, without immediate access to their cardiologist. Not only can the device alert the cardiologist of unstable arrhythmias, but they can also monitor device function, battery power, and identify if cardiac leads have become disconnected. “Raytel’s technology and services also represent significant future savings for reimbursement payers. Being able to monitor patients on a frequent and consistent basis reduces the necessity of office visits, and even can pre-warn healthcare providers about delineating conditions that could lead to an acute emergency,” noted Rajan.n

NASA scientists to make inroads in the domain of space medicine

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ASA scientists are studying ways to improve space medicine for tackling space travel’s medical challenges. One effort is to develop ‘image fusion.’ In this process, clear, sharp x-rays and other high-resolution, scanned images of astronauts taken on earth will be combined with less sharp sonograms taken onboard spacecraft to enhance those images. These improved images will enable doctors to better see the condition of major organs in astronauts. Sonogram scanners use non-invasive sound waves to take pictures of organs and features inside the body. Doctors also use sonograms to view and monitor unborn babies. Because sonogram scanners often are lighter and use less power than other kinds of scanners, they are better suited for space travel. “We want to be able to detect any changes (in astronaut) organ

April 2007

structure and function during spaceflight,” said Richard Boyle, a scientist and neurology expert at NASA Ames Research Center in California’s Silicon Valley. He added, “This would allow us to provide early intervention to resolve medical problems before they become more serious. There will be very limited diagnostic tools available to the astronauts, and this image fusion may provide a way to help astronauts maintain their health.” “In order to investigate any potential changes that may occur during long-term space travel, we have selected the human heart and kidneys as our initial study subjects,” Boyle observed. According to Xander Twombly, a colleague of Boyle’s, “We’re working on development of a digital model of the human heart and kidneys. This is a computer model of the heart that can be used to

predict changes in heart function under different gravitational conditions.” According to Twombly, computerized topography, which are commonly known as CT scans, will be used to “take pictures of the beating heart on earth prior to spaceflight.” These x-rays provide significantly higher-resolution pictures of the heart as compared to those provided by an ultrasound scanner. “We will take ultrasounds (of the heart) on the earth as well, before spaceflight, and then we’ll combine the ultrasound and the CT images to make an enhanced picture of the heart,” Twombly explained. According to researchers, they are using the power of computers to tie x-ray details to lower-resolution ultrasound scans, so that when ultrasounds are taken during space travel, they will be sharper and show more detail.

NASA has teamed up with doctors to develop image fusion for sonograms. Collaborations also aid in the spin-off of new technologies, like image fusion. NASA has entered into a collaboration with Salinas Valley Memorial Healthcare System (SVMHS), with whom NASA has a Space Act Agreement. “They provide all the imaging and medical expertise, and NASA provides the computer science know-how and systems to develop image fusion technology. Our group has had close interactions with SVMHS Sam Downing, President/CEO, the doctors and staff at Salinas for at least eight years to develop a wide variety of medical imaging technologies,” Boyle added. Dr. Richard Villalobos is the principal investigator at Salinas Valley Memorial Hospital, working with Boyle and Twombly. n 25


The world is talking. Are you listening?

Submit your abstract online at www.eINDIA.net.in/communityradio

Important Dates: 30 July - 03 August, 2007 Pragati Maidan, New Delhi, India www.eINDIA.net.in/cr

Abstract Submission: 25 - 05 - 2007 Abstract Acceptance: 06 - 06 - 2007 Full Paper Submission: 30 June 2007

Contact Details eIndia 2007 Secretariat Centre for Science, Development and Media Studies (CSDMS) G-4, Sector 39, Noida, India - 201301 Tel. : +91-120-2502181- 85, Fax: +91-120-2500060


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2007 Discuss your stories at mServe India 2007 held along with eINDIA 2007 at Pragati Maidan from July 30 till August 3, 2007. Log on to 'www.eIndia.net.in/mserve' to send your papers.


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news review

INDIA UPDATE

India gets a radio station on disaster management

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he country’s first radio station on disaster management was launched on 23 February 2007, in Chennai. The radio station would help in the preparedness for impending disasters for the population of the infamous, tsunamiscarred district of Nagapattinam, Tamil Nadu. The station will operate from Vizhundhamavadi, a nondecript village of the given district. Known as Kalanjiyam, the community radio station was a product of financial assistance of United Nations Development Programme to the Maduraibased Dhan Foundation. The local people have also pitched in with their active assistance. The Dhan Foundation has already trained radio volunteers

Mapping Healthcare Needs of Malappuram

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edia Lab Asia, a non-profit R&D organization, which is functioning under DIT of Government of India, has undertaken an ambitious project to map the healthcare needs of Malappuram district of Kerala. The project would use ICT for collecting information on prevalent diseases in Malappuram, and also on the available treatments. This project is a collaborative effort between Media Lab Asia and the state government’s e-literacy program called Akshya. The Medialab would also be collaborating with the Center for Development of Advanced Computing (CDAC) and a host of non-governmental organizations for the purpose. The field agents will record medical data of the people of the district on their personal digital assistants(PDAs) and the data would be sent to a central database. These data will act as as an yardstick of medical history and of the present development in the health sector of the given district, and will also be used as a record for ready reference, for research and development purposes. n

April 2007

among the local youngsters, of which, many of them were victims of tsunami. The radio station would work as a warning system, and will aim to inform the local populace of Nagapattinam on how to cope with disasters. Initially the daily broadcast will be of half-an-hour duration, which later will be increased to an hour. Following the granting of license by the Union Government to the foundation, the broadcast will go up to six hours a day. Initially, the radio station’s broadcasting range would cover a radius of around two kilometers through narrow casting, but later when the station graduates to a fully broadcast mode, it would cover a radius of up to 20-kilometers.n

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Concern over delay in telemedicine standards

hough three years have passed since the framing of the path-breaking draft report by the Department of Information Technology (DIT), which defined standards for telemedicine in India, they are still not notified. This is impeding the growth of telemedicine in India, which undoubtedly has huge potential. According to Rajeeva Ratna Shah, the Member-Secretary, Planning Commission, “a large number of telemedicine projects have been initiated in the country by both private and public players but they are scattered and based on different software protocols.” A uniform standard would help different systems to network

with each other. However it is expected that these standards would graduate from paper to practice by the end of the 11th plan, where, the senior bureaucrat assured, there are substantial allocations for e-Health. However, simply funding is not enough, the focus and direction of the funding is equally important. Shah very pragmatically opined that the growth of telemedicine would depend on the availability of appropriate bandwidth, protocols of time-sharing and conceptualization and execution of suitable business models. These are other infrastructral lacunae, preventing the growth of telemedicine in India. n

Pune to go the telemedicine way

une district of Maharashtra will have an ambitious telemedicine project in the near future. The union government has decided to connect all the community health centers (CHCs) in the Pune district with super-specialty hospitals, through telemedicine and telecounselling. Talks are already on with the super-speciality hospitals like Ruby Hall Clinic and Aundh Chest Hospital. With the help of computing infrastructure and medical equipment, the CHCs across the Pune district will send medical reports like ECG, images of scans, etc. to specialists in the super-specialty hospitals. The specialists will then diagnose the patients remotely, on the basis of those inputs, and suitably advise the doctors at the CHCs on the treatment. However, this ambitious pilot project is inspired by the telemedicine initiatives of the Grameen Rugnalaya Centre in Baramati. Baramati, a quaint town of Maharashtra located 120 km from Pune, is a recent success story in development. Thanks to Intel (which has conceptualized this initiative, and is providing

the technology and consultancy services for this initiative) a pilot project was introduced in the Baramati’s community health center, in November 2006. Baramati CHC has been connected with Bangalore-based Narayana

welfare of the people in Baramati. So far more than 2000 people have addressed their problems through tele-diagnostics, from this Baramati CHC. This union government funded project for the Pune district has

Hrudyalaya and Madurai-based Aravind Eye Hospital through IT. In Baramati, through the help of ICT, the patients have availed the expertise of specialists from Arvind Eye Hospital in Madurai and Narayana Hridayalaya in Bangalore. This tele-diagnostics in ophthalmology and cardiology has immensely contributed to the

an estimated cost of Rs. 10 lakh per center. The implementation of this pilot project is expected to take place in the next six to nine months. This telemedicine project will also facilitate the maintenance of electronic record of the patient’s medical history and bring transparency in the supply chain of drugs and vaccines. n 29


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Health informatics

Towards Interoperability in ECG Equipments Standardization of e-Communication in Healthcare A prerequisite for interoperability is standardization of message formats, protocols and storage. But different manufacturers use different standards with different scopes and standardization philosophies. This raises the disparity between existing equipments. In order to promote a multi-vendor environment, a standard format for digital ECG storage and data exchange is desirable. Currently the market has heterogeneous hardware and software platforms, which are generally integrated to some extent using costly and cumbersome propriety interfaces, which will soon become obsolete as technology advances. Thus a better method to exchange data would be eagerly welcomed.

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ue to the lack of standardization in electronic communication throughout the field of medicine, there is potential to provide homology and automation in many essential systems to improve patient care. This is especially true in cardiology, where electrocardiograms (ECGs) are used to evaluate cardiac abnormalities such as arrhythmias and heart valve defects. Whilst different standards like SCP-ECG, HL7 and DICOM, etc. for ECG representation have been established in medical institutes, there is no recognized body to adjudicate conformity to a standard. Almost all facilities make use of different criteria to accommodate their storage, viewing and printing conveniences; hence, to facilitate consistency, a standard format for digital ECG storage and data exchange would be a pragmatic step for ensuring effective intercommunication of cardiology results. Here we will be exploring the existing standards of ECG format and the viability of introducing a single standard, which can be followed universally. Interoperability between medical devices and host systems is a key requirement to ensure standardized, readily transferable, patient medical records. A prerequisite for interoperability is standardization of message formats, protocols and storage. But different manufacturers use different standards with different scopes and standardization philosophies. This raises the disparity between existing equipments. In order to promote a multi-vendor environment, a standard format for digital ECG storage and data exchange is desirable. Currently the market has heterogeneous hardware and software platforms, which are generally integrated to some extent using costly and cumbersome propriety interfaces, which will soon become obsolete as technology advances. Thus a better method to exchange data would be eagerly welcomed. Here we discuss three main ECG standards, which are implemented extensively in electrocardiography. The stan30 }

dards are analyzed to determine a ‘general purpose’ standard that fulfils the most common needs, such as reliable storage and transfer mechanisms as well as integration into the existing medical infrastructure. Each standard is thus, evaluated on the basis of the following parameters: a) data storage, b) data acquisition, c) data compression, d) transmission and e) ease of implementation. In the end, a standard is proposed, keeping in mind the advantages and disadvantages of the discussed standards.

Existing Standards I. DICOM 3.0 Supplement 30 Digital Imaging and Communications in Medicine (DICOM) is a comprehensive set of standards for handling, storing, printing, and transmitting information in medical imaging, made by ACR/NEMA organization. DICOM developed the Waveform Standard (DICOM 3.0 Supplement 30), which addressed the robust interchange of waveforms. This includes ECG, electrophysiological and hemodynamic curve data, such as pressure flow signals; independent from sampling frequency, amplitude and system sensitivity. Furthermore, audio signals such as voice comments can be entered. (i) Data storage In DICOM, information is stored as DICOM file-sets. Each DICOM file represents a separate class of information. These files in the file set contain a collection of data elements known as the data set. Internally these data sets are maintained in a tree structure. Each data set contains elements, which comprise of a) a tag, b) a value length and c) a value field. Besides this core data, additional Meta information is stored. The waveform object carries the raw waveform sample data only; it does not specify how the waveforms are to be displayed. www.ehealthonline.org


(ii) Data acquisition In order to identify a DICOM file-set and facilitate accessing the information stored in the DICOM files of the file-set, the DICOM standard has defined the Basic Directory IOD (Information Object Definition). A DICOM file-set contains one or more DICOM files. One of the files contained in the file-set is the DICOMDIR file, which contains information about other files in the file-set. Supplement 30 has defined three waveform classes: 12-lead, Resting ECG and Exercise ECG. This waveform data is organized into channels. (iii) Data compression DICOM uses the deflated transfer syntax, to apply a lossless ZIP compression to all data. Transfer syntax is a part of the DICOM Presentation Context, which specifies a set of encoding rules that allow applications to unambiguously negotiate the encoding techniques that they are able to support, thereby allowing these applications to communicate. It also provides a mechanism for supporting the use of Run Length Encoding (RLE) compression, which is a byte-oriented lossless compression scheme through the encapsulated format. (iv) Transmission Its communication protocol is an application protocol that uses Transmission Control Protocol / Internet Protocol (TCP/ IP) to communicate between systems. Its Transport Layer Secure (TLS) protocol provides a means of adding security to DICOM communication. The security added, targets three main areas. They pertain to authentication, confidentiality and data integrity. Authentication is carried out using a series of challenges and responses between the ‘client’ and the ‘server’. Confidentiality is achieved by encrypting the data sent over the communication channel. Data integrity is maintained by using message authentication codes for each packet, sent across a DICOM network. (v) Implementation The implementation of DICOM waveforms is possible using an existing DICOM toolkit. It is an open source toolkit named ‘The OFFIS DICOM conformance testing tool.’ In summary, DICOM supports a good variety of waveform data and allows the integration of further types. II. Standard Communication Protocol for Computer-Assisted Electrocardiography (SCP-ECG) SCP-ECG is a standard that specifies the interchange format and a messaging procedure for standardized transmission of ECGs between various computer systems and electrocardiographs. It is a project of OpenECG. (i) Data storage Here all ECG files are stored in a record format. This record is divided into different sections, which in turn are divided into two parts a) ID header and b) data part. Global fields in the data structure are CRC checksum, size of record, pointer to the record, header, ECG data and various types of processing results. This format allows for a rather large number of options to store and format the ECG data. (ii) Data acquisition In SCP, information is stored in a record format, which has a built-in self-identification mechanism. Its pointer section gives an overview of what is within the whole record, with April 2007

Figure 1: Message structure for ecg data exchange

information from the header of each section. This information can determine the possible options for the information content of that section, and locate and access the required information from the required data field. (iii) Data compression SCP employs Huffman tables for entropy-dependent encoding to achieve data compression. This type of encoding allows the transmission of the original ECG data by dense bit packing. It provides a well-assessed support for lossless and lossy ECG compression and achieves compression ratios up to 20:1. It ensures that the errors in the reconstructed signal are maintained within thresholds described in the standard itself, sufficient to guarantee a correct reinterpretation of the ECG signal. (iv) Transmission It uses an enhanced XMODEM data transport protocol. It is an error free file transfer protocol. It breaks up the original data into a series of packets that are sent to the receiver, along with additional information, allowing the receiver to determine whether that packet was correctly received. It uses checksum method for error checking. It has disadvantages in

Whilst different standards like SCPECG, HL7 and DICOM, etc. for ECG representation have been established in medical institutes, there is no recognized body to adjudicate conformity to a standard. Almost all facilities make use of different criteria to accommodate their storage, viewing and printing conveniences; hence, to facilitate consistency, a standard format for digital ECG storage and data exchange would be a pragmatic step for ensuring effective intercommunication of cardiology results.

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Towards interoperability in ecg equipments

health informatics

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segments, separated into several messages. (v) Implementation HL7 V3 standards are developed as syntax-independent models. The current preferred implementation technology is XML.

Proposed Standard

figure 2: internal structure of a data set or module

Based on the storage, acquisition, encoding, transmission and implementation of the prominent market standards, a ‘general purpose’ standard has been proposed. Thus, in order to develop an effective data storage format for efficient data interchange, a hybrid design is required. For data storage, a merger of the qualities of a SCP Record and a DICOM file-set is advised. The basic message can be taken in four parts; a)

terms of speed, performance and recovery functionalities. A physical link between the systems involved in the file transfer is necessary. (v) Implementation For the implementation of SCPECG, detailed implementation guides are available. OpenECG portal is one source for easy and free access to these guides. III. Health Level 7 (HL7) Version 3 HL7 is currently the selected standard for the interfacing of clinical data in most institutions. For waveform data, only ECG is integrated into HL7 V3. The ECG is called aECG or Annotated ECG. (i) Data Storage It defines very simple data structures and messages for exchanging waveform data. The data acquired is stored as a collection of digital information; represented as sequence sets of numbers, using xml coding. Annotations are added. The waveform samples are organized into channels, and codes are used to identify concepts such as channel or measurement units. (ii) Data acquisition It defines a kind of standard format for information exchange. Many value fields inside the segments are optional. It uses OIDs (Object Identifiers). OIDS are strings of numbers separated by dots. Each number indicates a branch in a tree of identifiers. It makes use of a self-identifying and self-delimiting encoding scheme, thus each data value can be identified, extracted and decoded individually, without knowing the structure of the message. (iii) Data compression HL7 does not compress waveforms. Thus it does not employ any compression techniques, and transmits and operates on raw ECG data. (iv) Transmission HL7 uses the TCP/IP protocol for information interchange. It defines the LLP (Lower Level Protocol), which allows the exchange of messages in less robust communications such as over a RS-232 connection. The LLP defines the protocol to fragment a message and methods to prevent data loss. An HL7 message is composed of different segments. For transferring waveforms, HL7 combines OBX (observation/result) 32

Figure 3: secure transmission of ecg message on a reliable tcp/ip connection

CRC checksum field; b) pointer section; c) version number and d) file set (see figure 1). The checksum field is reserved as the first field of the message format. This Cyclic Redundancy Check (CRC) using the checksum bits in this field is a simple and effective error detection technique. The second field is reserved for the pointer section. This is a useful means to identify what the contents of a transmitted message will be. The pointers will highlight the file headers of the files in the file set. This will make it easier for the manufacturer to access the information contained in these files. The rest of the message is comprised of a file-set – as in the DICOM message. The DICOMDIR file, as in the DICOM, is replaced with the pointer section for ease of access, to the supposed table of contents of the message. The third field is reserved for keeping the version number of the standard being implemented. This is necessary because all standards must evolve, as the applications they support change too. In recognition of this, the standard should include a field for its version ID in all messages. New transactions or data elements will be added to operational environments of the standard, as a result of changes in the standard or due to changes in the local implementation as permitted within the standard. It is important that these changes are implemented at a site without requiring all communicating www.ehealthonline.org


applications to upgrade simultaneously. This way, new fields can easily be added first to the sending or source system, and the receiving system will ignore the new fields until it has been updated to use them. This file-set feature of the DICOM message can be used to allow for inclusion of multiple classes, i.e. one file for each class. This is beneficial when working with different ECGs. The SCP format however does not allow for different types of ECGs. Each file in the file set will contain a file ID in its header section. This will be used as a reference to that file in the pointer section. The file would comprise of modules, which in turn will maintain data elements in a tree structure as in the DICOM message. Each data element will comprise of an identifier value (or tag), a value length field and a value field (see figure 2). This hierarchical structure facilitates with the implementation. For data compression and encoding of the ECG waveform, SCP-ECGs’ data compression technique seems like the best option available, since it provides high compression ratios and data integrity is being kept intact. If optimized Huffman tables are used, depending on the noise spectrum, they can result in only marginal compression effects and much higher compression ratios. For safe and secure transmission of data, HL7’s transfer protocol should be ideally used for file transfer over a network, as it uses the 7th layer (application layer) of the OSI model, using TCP/IP protocol. The application level deals primarily with the semantics or data-content specification of the transaction set or message. It uses LLP for secure transmission over less robust connections. The TCP/IP protocol has features to help with error, flow and congestion control. It also helps ensure the data integrity, confidentiality and authenticity of the packet being interchanged (see figure 3).

Qurat-ul-Ain Salim Khan National University of Sciences and Technology, Rawalpindi,

Conclusion: The existing prominent market standards have high flexibility with too many manufacturer specific implementation options and some ambiguity within the text. Many implementation details are left to the ingenuity and innovation of manufacturers, who must take into account of their knowledge of the clinical environment and effective user interfaces. This gives rise to differences in understanding and also results in a difIn order to develop an effective data storage format for efficient data interchange, a hybrid design is required. For data storage, a merger of the qualities of a SCP Record and a DICOM file-set is advised. ference in implementation. It results in decreased interoperability amongst the different manufacturers, even when using the same standard. One solution, as proposed in this article, is the implementation of a single ECG waveform standard in medical institutes universally. This can only happen if a recognized medical body takes up the challenge to strictly implement one ECG standard worldwide. Currently manufacturers affirm their compliance with a particular standard, without describing their respective level of conformance in the conformance statement. We do realize that the main obstacle to the implementation of this standard is the market leader companies whose main aim is the protection of their own market and creation of a more extended market for their ECG management system. Secondly the conversion of the large number of existing ECG devices and ECG management systems to cover a different file format and protocol, entails a high cost. It is necessary to take into account of these obstacles if we really wish to promote standardization in the ECG file format and data exchange.n

Pakistan anniesalim@gmail.com

Hassaan Owais National University of Sciences and Technology, Rawalpindi, Pakistan hasx4@hotmail.com

Ammar Zaheer National University of Sciences and Technology, Rawalpindi, Pakistan 8.ammar@gmail.com

Aleena Zahid Syed National University of Sciences and Technology, Rawalpindi, Pakistan syedaleena1@hotmail.com

April 2007

References [1] http://www.leadtools.com/SDK/Medical/Medical-DICOM-DataSet.htm [2] Michael Onken, et al. Standardized exchange of medical signals using DICOM waveforms OFFIS, Oldenburg, Germany [3] Chr. Zywietz, R. Fischer/ February 2003. How to implement SCP (Part I & II), Version of the document 1.3, Hannover. [4] F Chiarugi, et al. Developing Manufacturer-Independent Components for ECG Viewing and for Data Exchange with ECG devices: Can the SCP-ECG Standard Help? In: CMI-HTA, Institute of Computer Science - FORTH, Heraklion, Crete, Greece. [5] http://www.openecg.net [6] Barry Smith, Werner Ceuster/August 2006, Studies in Health Technology and Informatics, 2006; 124: 133–138 Presented at Medical Informatics Europe, Maastricht [7] C Zywietz, et al. Communication and Storage of Compressed Resting and Exercise ECGs Using the Revised SCP-ECG Standards: In: Biosignal Processing, Medical School Hannover, Germany.n 33


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health awareness

A Healthy Beginning to Spread Healthcare Information Improved Information Flow will Prevent Death and Suffering The lack of safe and effective healthcare in the rural India is the primary reason behind India’s loss of 50,000 children, on an average, every month from diarrhoea, pneumonia and other common illnesses - a silent ongoing tragedy that does not make the headlines of our newspapers. Most of these deaths could have been avoided by very simple treatments. Most of these remedies can be given at home or at the level of a primary health facility. And a major factor in these deaths is that the caregiver or health worker simply did not know what to do or when to seek help (WHO World Health Report 2006, p21). Dr. Neil Pakenham-Walsh

L

ike all health professionals, each one of India’s health workforce has basic needs in order to deliver safe, effective care. Each one needs appropriate skills; diagnostic and treatment equipments; relevant and reliable healthcare information; infrastructural support; access to essential medicines; motivating incentives; and communication facilities to make referrals, seek advice, and arrange transport. Too many of India’s health professionals - and especially those working in rural areas - are not having these basic needs met. As a result, too many of India’s people - and especially the poor and disadvantaged in rural areas - are not getting safe, effective healthcare. The lack of safe and effective healthcare in the rural India is the primary reason behind India’s loss of 50,000 children, on an average, every month from diarrhoea, pneumonia and other common illnesses - a silent ongoing tragedy that does not make the headlines of our newspapers. Most of these deaths could have been avoided by very simple treatments. Most of these remedies can be given at home or at the level of a primary healthcare facility. And a major factor in these deaths is that the caregiver or health worker simply did not know what to do or when to seek help (WHO World Health Report 2006, p21). About 50,000 deaths a month! Compare this with two recent calamitous events. On July 2006, India lost over 200 people in the Mumbai bombings; in December 2004, over 10,000 of its population perished in the tsunami. Both were unprecedented disasters that shocked the world and catalysed global action. We are still, rightly, talking about these two events. But we are still, wrongly, silent on the larger death toll associated with poverty and lack of access to healthcare. Many of these deaths could be avoided by ensuring that all healthcare 34 }

workers have the requisite information they need; to learn, to diagnose, and to save lives. Death Cloaked in Ignorance

Diarrhoea is just one of the many illnesses that kill large numbers of people,and what is more alarming is that it is easily treatable. Diarrhoea kills 1.6 million babies every year - most of these deaths are due to dehydration and would have been prevented if the carer had simply given the baby extra drinks to replace the fluids lost. But a recent study in rural India found that 4 in 10 mothers believe they should withhold fluids if their baby develops diarrhoea. Tragically they are unknowingly contributing to the deaths of their children! For example, 80 per cent of caregivers in the developing world do not know the two key symptoms of pneumonia - fast

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and difficult breathing - which indicate the child should be treated immediately. Only half of the children with pneumonia receive appropriate medical care, and less than 20 percent receive antibiotics. (Wardow T et al. Pneumonia: the leading killer of children.’ Lancet 2006;368:1048-50). A preliminary literature review by the Global Healthcare Information Network indicates similar deficiencies in knowledge and practice across all aspects of primary and district care, associated with lack of relevant and reliable healthcare information. Furthermore, there is little evidence that caregivers and health workers at the primary and district levels, are any better informed than they were in 1994 (Fiona Godlee, Neil Pakenham-Walsh et al. Can we achieve health information for all by 2015? Lancet 2004;364:295-300). This lack of progress is directly attributable to ineffective coordination and communication among the many stakeholder groups involved at international, national and local levels. As a result, widespread and preventable loss of life and suffering continue, jeopardizing the achievement of the Millennium Development Goals. Improving the availability of information will prevent death and suffering, and will promote more appropriate and timely referral to secondary and tertiary care. It will improve the cost-effectiveness of drug prescribing and use of diagnostic and other facilities, thereby increasing the efficiency of health systems and bringing social and economic benefits for communities and countries. The potential benefits for India in particular are huge in this regard. An effective platform to facilitate healthcare

The campaign was launched in Mombasa, Kenya, in October 2006. HIFA2015 brings together over 600 professionals and organisations from over 80 countries across the globe, which comprises of health workers, trainers, publishers, librarians, researchers - all committed to improve the availability of relevant, reliable healthcare information. As Dr Tikki Pang (Director of Research Cooperation at the World Health Organization) has said, “HIFA2015 is an ambitious goal, but it can be achieved if all stakeholders work together.” HIFA2015 is supported by an increasing number of leading organisations, including the British Medical Association, International Federation of Medical Students Association, International Medical Corps, and Royal College of Nursing - among others. HIFA2015 facilitates a global e-mail space for dialogue about how to meet the healthcare information needs of isolated health workers and disadvantaged people around the world. We identify cost-effective solutions to tackle the menace of poverty in healthcare information, and also provide a meeting place to explore new ideas. And the ideas are many, leading to a rich online confluence of discussion and dissemination of knowledge, information and opinions with a Only half of the children with pneumonia receive appropriate medical care, and less than 20 percent receive antibiotics. (Wardow T et al. Pneumonia: the leading killer of children.’ Lancet 2006;368:1048-50). A preliminary literature review by the Global Healthcare Information Network indicates similar deficiencies in knowledge and practice across all aspects of primary and district care, associated with lack of relevant and reliable healthcare information. sharp pragmatic focus. From India itself, many interesting new ideas to explore ICT for enriching healthcare information are emerging. An ENT surgeon from Kolkata is planning a project using mobile phones to deliver health information; a public health consultant from Delhi is looking at ways to expand and improve the training of rural health workers; and a journalist from Noida is reviewing the impact and potential of cutting-edge technologies on health information access. And there are many more; unknown soldiers of a very known war. Things are moving in the right direction... though the road is long, but our will has strong legs!n For further information visit: www.hifa2015.org

However, this colossal human tragedy is not singular to India but is very much prevalent among the less developed and developing countries to a greater or lesser degree. In this context, Healthcare Information For All by 2015 can serve as a ray of hope. Healthcare Information For All by 2015 is a global campaign with a specific goal. The goal is simple, challenging and inspiring. It aims that by 2015, every person worldwide will have access to an informed healthcare provider. We are working for a world where people will no longer suffer or die due to lack of basic knowledge of healthcare. April 2007

Dr. Neil Pakenham-Walsh is coordinator of the Global Healthcare Information Network, a non-profit organization that supports the goal of ‘Healthcare Information For All by 2015’ (www.hifa2015.org). He has a special interest in the availability and use of relevant, reliable healthcare information in developing countries, especially at primary and district levels. e-mail: neil.pakenham-walsh@ghi-net.org

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development

The e-Health Initiatives and Challenges in Peru e-Health is Essential in Latin America

T

he revolution in science and technology has caused deep changes in human development and its values, with positive and negative impacts on all spheres of society, particularly on human health. Latin America is faced with several development challenges, chief among them are public health epidemics, environmental degradation, vulnerability of rampant poverty, geopolitical climate, impediments towards expansion of education and social services, and limited trade competitiveness. The value of ICTs, particularly in addressing these challenges, as well as improving access to information required for decision making, research and production, is now well recognized as governments continue supporting them as powerful change agents throughout the Latin America region. Peru presents a potential for ICT applications in social sectors, education, health, and political participation.

In Peru it has been heartening to see the establishment of strategic alliances between public institutions and civil society organizations, through the various collaboration methods using ICTs. The community effect is reflected in the promotion of greater familiarization with the use of the Internet, and assisting medical team’s involvement and access with the activities of the community. Today the threat of infectious diseases like pneumonia, tuberculosis, diarrhoeal diseases, malaria, measles and HIV/AIDS have assumed global proportions and is threatening hardwon gains in health and life expectancy. The threat is hanging over the civilization like a Damocles Sword. Contagious diseases like AIDS are now the world’s biggest killer of children and young adults.

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They account for more than 13 million deaths a year, that is one in two deaths in developing countries. For tackling them, ICT can be an effective weapon. Now ICTs have proven to be a powerful tool in improving the

In Peru it has been heartening to see the establishment of strategic alliances between public institutions and civil society organizations, through the various collaboration methods using ICTs. The community effect is reflected in the promotion of greater familiarization with the use of the Internet, and assisting medical team’s involvement and access with the activities of the community. Improving access to remote areas, and maintaining a presence in these areas is also one of the priorities of this collaborative approach. However, the language and cultural barriers, local geographic conditions and the inability of many poor people to pay for the access of Internet services are some of the impediments towards the fruition of those objectives.

Objectives: quality of healthcare for people globally, and only an improved healthcare on a sustained basis can root out the incidence of contagious diseases in the long run. There are also many information society healthcare technologies, which can improve patient care, while others can make health systems more efficient and responsive. ICT for Health (also known as e-Health) describes the application of information and communications technologies across the whole range of functions that affect the healthcare sector, from the doctors to the hospital managers, via nurses, data processing specialists, social security administrators and of course, the patients themselves, and local communities. e-Health is very much needed in Latin America, where about 220 million people languish in poverty, with little access to conventional healthcare. In the Latin American context, Alexander von Humboldt Institute of Tropical Medicine – Universidad Peruana Cayetano Heredia (www.upch.edu. pe/ tropicales) and multidisciplinary teams (Codesi, EHAS, Minsa, Voxiva, INICTEL, Concytec, DiploFoundation, E-Health Lab, PUCP) working in Latin America have played a crucial role in the application of ICT in the healthcare.

To create a demand for information and services, and promote those services for the promotion and maintenance of health and well-being. • It is essential to build human networks, with the support of ICT, that motivate and harness, in dynamic and systematic form, the interaction between people, thereby strengthening the generation, dissemination and exchange of information and knowledge based on their professional, institutional and social objectives. • To create knowledge, to learn and to share knowledge on inter-sectorial societies, and ICT innovations in health and education for human development. • To share successful experiences that have been implemented in Peru, to generate strategic alliances with companies, universities and ministries for articulating efforts and to exchange lessons learnt. • To urge and enable the academia in ICT, and to grant technical and pedagogical endorsement to them. In a nutshell, it is urgent to have proper public health policies and aggressive actions, yet it must be attentive to the availability in the ac-

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Healthcare issues may haunt Latin America : A Study

D cess of ICTs, and must assure its effective use. It is also essential to conform and follow natural human communication networks, with the support of ICTs, that can motivate and harness the dynamics and the systematic form of communication, which would normally be created. Over the years, in the developing countries, the application of ICTs in health sector has shown to provide powerful and practical tools in healthcare for doctors, patients, and other healthcare providers, in addition to assisting family members and communities at large. One sees with capacity building activities through knowledge and experience sharing plus skills building of relevant healthcare personnel, the quality of proper and trusted healthcare for all those living in developing countries is reinforced. ICTs can be of much help and the axis of e-Health is the greater power acquiring the patient or user. Health information technology is transforming and will continue to transform health and healthcare in Latin America. n

Lady Murrugarra: IMT AVH UPCH WorkGroup Telemedicine – E-learning Alexander von Humboldt Institute of Tropical Medicine - UPCH www.upch.edu.pe/tropicales, ladym@upch.edu.pe Marco Canales: IMT AVH UPCH marcan@upch.edu.pe Eva Tanner: Diplofoundation – Switzerland evat@diplomacy.edu Francesco Salizzoni: E-Health Lab – Brasil francescosalizzoni@gmail.com Diego López de Castilla: IMT AVH UPCH dlopecako@yahoo.com Stacy Gildenston: WOWEM sgildenston@gmail.com

April 2007

espite Latin America’s economic growth of 5 percent in the last three years and significant progress in reducing poverty in the recent years, a World Bank report launched to mark the World Health Day, warns that illness, accidents, and normal life-cycle events such as old age can jeopardize people’s health and throw their households and families into poverty. The report—’Beyond Survival: Protecting Households from Health Shocks in Latin America’—is based on six case studies in: Argentina, Chile, Colombia, Ecuador, Honduras, and Mexico, and argues that applying a classical insurance system could better protect Latin American households which are overburdened with out-of-pocket spending and lack sufficient access to instruments with which to pool risks. “With total health expenditures accounting for 6.4 percent of gross domestic product, Latin America and the Caribbean are the highest-expending regions in the world after the countries of the Organization for Economic Cooperation and Development,” said Cristian Baeza, a World Bank’s Acting Director of Health and co-author of this report. “Public expenditures on health care are low in most countries in the region, but private spending on health – particularly spending out of pocket paid when services are needed - is correspondingly high,” added Truman Packard, World Bank’s Senior Economist and co-author of the report.

The report carries four main messages for policy makers in the Latin American and Caribbean (LAC) region: Health out-of-pocket payments—and loss of income as a consequence of illness —can impoverish households and plunge already poor people into a transgenerational cycle of abject poverty. People need protection from the potentially ruinous costs of healthcare and loss of income due to illness. The costs rival losses of income from unemployment as a cause of poverty.

Risk pooling in LAC has mostly benefited formally employed salaried workers who are covered by mandatory public and quasi-public risk pooling mechanisms. Extending risk pooling to the large and growing informal labour sector is a priority in LAC. This means inventing contribution mechanisms for non-poor households to participate in risk pooling that are not linked to workplace or labour status. “Despite nearly two decades of bold reforms in the health sector, households in the Latin America and the Caribbean region are still overexposed to health shocks that can force them to cut consumption of other basic services and goods and even result in destitution,” said Guillermo Perry, World Bank’s Chief Economist for the Latin America and the Caribbean Region. “Around the world, including in Latin America, health care costs are rising,” Perry added. “Beyond Survival breaks new ground in the ongoing debate about health finance and financial protection from the costs of health care,” said Keith Hansen, World Bank’s Sector Manager for Health in the Latin America and the Caribbean Region. “This book reviews existing and new evidence on the mechanisms and magnitude of impoverishing effects of health events and the importance of public policy to prevent such impoverishment,” Hansen added. n (Courtesy: World Bank)

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Project showcase

UK Biobank Project Tracking a Healthy Future Ahead Through a Public Health Initiative

U

K Biobank Project reflects the awesome potential that electronic and ICT applications in health sector can imply in terms of welfare, for the tomorrow’s brave new world... The UK Biobank project is sure to create a healthcare model for the world to follow in the near future. Hosted by the University of Manchester, UK Biobank Project is one of the biggest and most detailed public health research initiatives of our time. It will provide a valuable resource for research into a wide range of diseases including cancer, heart disease, diabetes, dementia, mental illness, Parkinson’s disease, joint and dental disease and many other life-threatening and debilitating conditions. Here it deserves a mention that UK Biobank is a major UK medical research initiative, and a registered charity in its own right, with the aim of improving the prevention, diagnosis and treatment of a wide range of serious and lifethreatening illnesses, including cancer, heart diseases, diabetes, arthritis and forms of dementia. The UK Biobank project is huge in size, vision and potential. This multi-million pound medical project endeavours to recruit 500,000 people aged 40-69 across Britain and track their health over the course of next three decades or more. This will help facilitate the cure of many life threatening and debilitating diseases. The project already took off in Manchester, on 21 March 2007. In the first phase of a fouryear recruitment process, about 10,000 letters asking people to take part in the UK Biobank project were being sent. Tens of thousands more invitations will be sent throughout the course of the year to people across Manchester, asking them to join this exciting project. A successful pilot study to check the feasibility of this huge undertaking took place in Altrincham (south Manchester)

38 }

last year. UK Biobank will recruit in Manchester for about one year. People who receive letters asking them to participate will be offered an appointment time and date. However, if they found the timing inconvenient, they can change it. People in Manchester who agree to take part in the UK Biobank project will attend a 90 min-

ute assessment at a special centre in Hulme, south Manchester. They will be asked to allow UK Biobank to follow them through routine health records over many years. The assessment centre will open in April 2007. Participants will be asked about their current health and lifestyle and will have a number of measurements taken, such as blood pressure, weight, lung function and bone density. They will also be asked to give small samples of blood and urine. Though not a health check, participants will leave with a list of personalhealthrelated measurementsand some indication of how they compare to standard values. However, here it deserves a mention that taking part in the UK Biobank project is entirely voluntary and participants can withdraw at any time should they wish to do so.

The UK Biobank project is huge in size, vision and potential. This multi-million pound medical project endeavours to recruit 500,000 people aged 4069 across Britain and track their health over the course of next three decades or more. This will help facilitate the cure of many life threatening and debilitating diseases. The project already took off in Manchester, on 21 March 2007.

According to Dr. Tim Peakman, UK Biobank’s Executive Director, “At the assessment centre we will obtain the consent of people who want to join UK Biobank and collect what we call baseline information about their health and well being. Along with the blood and urine samples, this will provide important data for scientists of the future when they are trying to work out what causes some people, and not others, to develop a particular disease.” He added, “The UK Biobank resource will help untangle the complex interplay of nature (that is, genes) and nurture (such as lifestyle) in the development of many different diseases. Its goal is not to focus on genes alone, which may be better done through other sorts of study.” This project is geared to benefit the future generations and not

the present generation, a sample of whom(the participants) would be health-monitored during the project. According to Peakman, “Though UK Biobank may not directly benefit those who take part, it will help our children and our children’s children to live longer, healthier lives. A willingness to help others in this altruistic way will, I hope, be a powerful motivation for many people to take part.” It is aimed that if this project attains success, around 15 million blood and urine samples will eventually be stored for decades in specially designed laboratories near Manchester, at temperatures down to about -200°C. These vital samples, along with the crucial medical records, will serve as keys to futuristic healthcare, and may help in unravelling the cure of many now uncured diseases. Mike Farrar, Chief Executive of National Health Service North West, UK said, “NHS North West fully supports the work of UK Biobank and its role in improving the health of people living in the region. This medical project highlights some of the excellent initiatives that are taking place to transform public health.” The UK Biobank project is funded by the Wellcome Trust, the Medical Research Council, the Department of Health, the Scottish Executive and the Northwest Regional Development Agency. It is hosted by the University of Manchester, and has the support of the National Health Service (NHS). The project is a collaborative effort between 22 UK universities. n

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EHCR The Catalyst for Change?: April 2007 Issue: April 2007 Issue  

[ www.ehealthonline.org ] eHEALTH is Asia's first and only monthly magazine on healthcare ICT's, medical technologies and applications. Th...

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