navigating the e-Health galaxy: August 2007 Issue

v o l u me 2 | issue 8 | August 2007

a monthly magazine on ict and health

ISSN 0973-8959

Rs. 75

navigating the e-Health galaxy

cover story

User-driven healthcare: a conceptual model cover feature

towards nano products in e-healthcare environment technology

telemedicine binds India and ethiopia development

ehealth: tangible lessons from canada power hospital

fortis flt. lt. rajan dhall hospital, new delhi profile

philips flexing muscles in diagnostic markets

A DI IN 007

News review

world news Business news india update

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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 8 | August 2007

Cover story

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User-Driven Healthcare: A Conceptual Model

Dr. Rakesh Biswas, Dr. Nupur Sarkar

Cover feature

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Towards Nano Products in e-Healthcare Environment

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GL Narasimha Murthy

technology

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Telemedicine Binds India and Ethiopia

J.S. Chhabra, T.K. Roy

development

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e-Health: Tangible Lessons from Canada

By Trevor Hodge

power hospital

Fortis Flt. Lt. Rajan Dhall Hospital

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profile : Philips

Flexing Muscles in Diagnostic Markets

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spotlight

Laboratory Information Systems: Coming to the Fore

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35

project showcase

The SOPARNO Project to Make an Impact

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News review

world news

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india update

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August 2007

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business news

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Editorial Guidelines Contributions to eHealth magawords should be submitted zine could be in the form of along with the article/case articles, case studies, book study. reviews, event report and news • All articles/ case studies related to e-Health projects and should provide proper referinitiatives, which are of imences. Authors should give in mense value for practitioners, writing stating that the work professionals, corporate and is new and has not been pubacademicians. lished in any form so far.

We would like the contributors • Book reviews should include to follow the guidelines outlined details of the book like the below, while submitting their title, name of the author(s), material for publication: publisher, year of publica• Articles/ case studies should tion, price and number of not exceed 2500 words. pages and also have the For book reviews and cover photograph of the event reports, the word book in JPEG/TIFF (resolution limit is 800.

300 dpi).

• An abstract of the article/ • Book reviews of books on case study not exceeding 200 e-Health related themes,

•

•

•

•

published from year 2002 onwards, are preferable. In the 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.

Log on to www.ehealthonline.org for goings-on in the worl d of e- health }

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Volume 2 | Issue 8 | August 2007

president

Dr. M P Narayanan

EDITORIAL Converting Challenges into Opportunities

editor-in-chief

Ravi Gupta sr. editor

G Kalyan Kumar Assista nt editor

Swarnendu Biswas alliances & Advertisement

Dipanjan Banerjee mob: +91-9968251626 email: dipanjan@csdms.in Debabrata Ray mob: +91-9899650692 email: debabrata@elets.in designed by

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hankfully, with the advent and progress of e-Health, healthcare is slowly but steadily becoming more patient-centric. One of the ways of making the health system more patient-centric is to make it userdriven. This will facilitate the application of e-Learning in healthcare in a more creative way, and eventually help to better address a specific singular problem of a given patient to an optimal extent, through mutual collaboration of knowledge and information dissemination among patients and health professionals.

An important movement that is showing signs of germination in the global healthcare scenario is the surfeit of embedded hand-hand mobile medical diagnostic equipments, which can help make quality health accessible to the multitudes, who have little or no access to medical support systems. This incoming technological revolution also holds immense possibility of making the healthcare system more patientcentric in the near future, to bridge the gap between the haves and havenots in terms of accessibility to health services. We have discussed both these issues in detail in our Cover Story and Cover Feature.

India and other developing countries from Asia as well as Africa should learn from Canada’s e-Health initiatives, spearheaded by Canada Health Infoway. This independent, not for profit corporation is playing a catalytic role in the progress of e-Health across Canada. We have covered an overview of Canada Health Infoway’s achievements and aspirations in an incisive article by one of its top-brass. We have to acknowledge that in India some private hospital chains have attained international standards of healthcare in the recent past. This calls for some added information and study, and to extrapolate on this, we are starting a new section titled ‘Power Hospital’ from this issue onwards.

It is common knowledge that Indian health sector is plagued with a number of problems, and it seems e-Health can serve as an effective solution to address the health problems of India, provided, its enormous potential is used with prudence. In this context, the relevance of organising of eHealth India 2007, as an integral part of eIndia 2007, can’t simply be overemphasized. The high-powered conference, which will attract a galaxy of internationally reputed medical professionals, academics and corporates, is sure to be a thought-provoking exercise on information and knowledge dissemination about the challenges and opportunities involved in navigating the e-Health highway. Let’s all hope for a healthier India...

is a publication of Centre for Science, Development and Media Studies (CSDMS, www.csdms.in). is marketed by elets Technomedia Pvt. Ltd. © Centre for Science, Development and Media Studies www.csdms.in

August 2007

Ravi Gupta Ravi.Gupta@csdms.in

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C O V E R s t or y

User-Driven Healthcare: A Conceptual Model Could pave way for a more patient-centric health system Learning, be it e-Learning or otherwise, is a cyclical process of reflective observation based on day to day concrete experiences, followed by abstract conceptualization and active experimentation at either individual or group levels.The present day evidence base in healthcare drives on active experimentation at a collective level and accumulates average patient data that may be difficult to correlate at an individual patient or health professional level. Web-based sharing of individual patient and health professional experiences through PC and mobile interfaces would make for better e-Learning in healthcare and could be easily incorporated into physician CME accreditation programmes.

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ser-driven healthcare is improved healthcare achieved with concerted collaborative learning between multiple users and stakeholders, primarily patients, health professionals and other actors in the care giving collaborative network across a web interface. User-driven healthcare may not be anything new as patients and health professionals, as health system users, have always been instrumental in driving the healthcare system. With the advent of the Internet however the term user driven has taken up a new meaning, as user here would denote patients and health professionals collaborating on the net. User-driven healthcare also needs to be differentiated from the presently more ubiquitous consumer-driven healthcare, which is essentially a strategy for users/consumers to decide how they may pay for their own healthcare through multiple stakeholders like employers who provide the money, and insurance companies who receive the premiums.

Present learning strategies in healthcare are mostly dependent on top-down structured content and non-structured bottom-up patient physician experiences are paid less importance. However, regular recording of day to day individual non-structured experiential data between patients and physicians may be a valuable adjunct to structured average patient data that presently exists in our information bases to promote patient-physician e-Learning in healthcare.

Learning, be it e-Learning or otherwise, is a cyclical process of reflective observation based on day to day concrete experiences, followed by abstract conceptualization and active experimentation at either individual or group levels (see figure 1). The present day evidence base in healthcare drives on active experimentation at a collective level and accumulates average patient data that may be difficult to correlate at an individual patient or health professional level. Web-based sharing of individual patient and health professional experi }

figure-1

ences through PC and mobile interfaces would make for better e-Learning in healthcare and could be easily incorporated into physician CME accreditation programmes. Collective wisdom in healthcare may be generated by diverse information needs in different individuals through a decentralized web -based adaptive system.

Medicine is a collaborative effort in problem solving between individual patients, health professionals and other bystanders (directly or indirectly related to the patient and health professionals, while patients’ relatives and physicians’ institutions provide the necessary support to the two primary collaborators). In the medieval past, medicine was a similar problem solving effort between patients and health professionals, but with time and globalization there have been major changes. www.ehealthonline.org

Each and every human has the capacity and likelihood of performing both roles of caregiver and care seeker (patient) in their lifetimes. From a localized expert physician opinion-driven approach in clinical decision-making (as a first step towards medical problem solving) the collaborative process has evolved to a global evidence-based approach that uses generalized information for the benefit of the individual patient.

As this information is to a substantial extent available on the Internet, patients and health professionals have rapidly learnt to use these Internet services to solve their clinical problems.

All these users and their information needs, drive present day healthcare to a considerable extent.

Often in day-to-day practice, both individual patients and health professionals are in situations where the information available is limited and difficult to apply to a given patient.

A gap between what is proved to be effective for selected groups of patients versus the infinitely complex clinical decisions required for individual patients has been recently recognized and termed as the inferential gap. The breadth of the inferential gap varies according to available knowledge, its relevance to clinical decisions, access to the knowledge (that is, what the physician actually knows at the time of a clinical decision), the variable ways in which knowledge is interpreted and translated into a decision, the patient’s needs and preferences, and a host of other factors. Clinicians are required to fill in where their knowledge (or knowledge itself) falls short. e-Learning in healthcare redefined

Average patient data, which occupies most of our present day information bases, is often unable to satisfy individual patient needs. In spite of the medical information base expanding unprecedentedly at present, we still do not have that quality of information to satisfy a complex clinical problem of an individual patient to an optimal extent.

They are often questions about both particular patients and different areas of medical knowledge, which may perplex medical practitioners. Here I will quote a BMJ Editor to elaborate on the complexity of the problem. Though this quote, is more than ten years old, it is very much relevant in todays so called fast changing medical age.

“In an octogenarian with anemia, angina, and a history of transient ischemic attacks, with a normal creatinine, iron, and mean corpuscular volume, who refuses a bone marrow exam, what diagnostic and therapeutic options are there?”

He presents in a single case, four different problems (including patient age) simply on clinical presentation alone, compounded by the fact that the patient doesn’t want the kind of investigative and therapeutic options present day modern medicine has to offer.

Furthermore, the need for information is often much more than a question about medical knowledge. People are looking for guidance, psychological support, affirmation, commiseration, sympathy, judgement, and feedback. This ‘information need’ is poorly explored, and yet it may well be the most important need and the biggest stumbling block to a technical August 2007

solution. Smith also mentions, “Most of the questions generated in consultations go unanswered.”

The moot question remains that how then do we account for the multidimensional information needs that every individual patient can generate? Can information technology offer an effective solution? There is no denying the fact that we need an information base that can seamlessly integrate information needs of all categories of certain individual medical learners, namely patients and medical students, who are also health professionals, with matching solutions offered by other individual medical learners; who have already gone through the particular experience the other group needs.

However, e-Learning environments can be creatively used to cater to the individual patient needs in a better way. Firstly, the access to life experience information of one patient

Most healthcare professionals/ individual patients can generate a lot more variety of beneficial examples in shared e-Logging in healthcare through regularly maintaining their own daily process logs, for which one may have time if it is done on the job. The information needs generated from these may be identified by web-based user-driven solutions. Ideally, after the physician enters the data into a PDA, it should be uploaded in the web portal of a given medical facility, which would in turn result in sharing and communicating of valuable patient data. This can eventually pave the way for a customized or a more interactive patient-centric care. that finds a match in another patient can itself act as a sort of narrative therapy for that patient. e-Learning can play a major role in facilitating this matching. Physicians should record e-Logs on their PDAs, preferably on a daily basis, which can facilitate to solve individual patient/health professional user needs in a more effective way. Most healthcare professionals/individual patients can generate a lot more variety of beneficial examples in shared e-Logging in healthcare through regularly maintaining their own daily process logs, for which one may have time if it is done on the job. The information needs generated from these may be identified by web-based user driven solutions. Ideally, after the physician enters the data into a PDA, it should be uploaded in the web portal of a given medical facility, which would in turn result in sharing and communicating of valuable patient data. This can eventually pave the way for a customized or a more interactive patient-centric care. All these together can offer a convenient local solution to improving hospital communication among in-house health professionals in a hospital, which is thankfully showing signs of evolving at present in many hospitals.

It should be recognized that medical students act as a vital force in e- Learning and improvement of patient care. This may sound contrary to popular opinion, but also happens to be true. The governments generally think that it spends

cover story

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user-driven healthcare: a conceptual model

a lot of money on undergraduate medical training, perhaps because these student doctors apparently do not serve while they learn. However, it is the medical student who has the time to listen in detail to their chosen individual patient (they do not have to see and are not responsible for all the ward patients unlike their overworked houseman/resident seniors).

Medical students’ e-Logs on their individual patients can be a vital source of detailed narrative data of individual patients, which their consultant might often enjoy reading and also benefit from, on a daily basis.

haps human to even want to cover up our errors (covering up is incidentally another word for privacy).

We advocate more transparency among patients and physicians so that both parties can benefit from continual learning from each other. Privacy (or covering up) may be a direct hindrance in this element of transparency, a fact we should seriously rethink in our definitions of privacy. Having said that, it would still be important to maintain patient anonymity and here we propose a method of anonymous information sharing, where patient identity would remain secure.

Individual patient learning and communicating from global experiences

Manner of usage of the proposed e-Health learning solution

In this article, we are proposing a global solution for all varieties of individual users. This solution can have wide ramifications in user-driven healthcare. For example, it can afford a diabetic patient in one part of the world to key in his

A web-based solution to integrate healthcare e-Learning needs could lie in a simpler forum model already in use at present in various web2.0 sites. Regular experiential informational input may be posted on to the forum, along with a copy to the individual user’s password protected web account that would function as an e-Portfolio if s/he were posting as a caregiver, and as a private personal health record if s/he is posting as a patient. The individual user could even do this through e-mail and every post made by mail could easily open a new post on to the forum.

However, this would still be confined to PC literate users and to bridge this digital divide, we, along with our collaborators in Intel Malaysia Innovation and Sunway College, are trying to develop a mobile SMS (short messaging system) portal for data entry into the web repository. An individual at his/her leisure or even while waiting in queue to meet his/her physician may SMS his/her thoughts, reflections and queries about his/her disease onto the forum, that could be responded to by anyone on the web.

All these information sharing could be optionally kept anonymous as user names could be made impersonal (again depending on user choice). SMSes to the web may display only the individual user’s mobile numbers. The illness experience posts would automatically generate related posts, depending on the keyword-tags that are being used to represent their posts, and this would enable every user posting his/her individual experiences to go through similar relevant live experiences of other individuals. In this way, any individual user feeding input into the net can receive automatic feedback that can grow, as individual users for this web-based solution grow; as they keep feeding their own data regularly.

Each and every individual is the author of his own destiny (as well as his own web log) that reflects his experiential life processes and decisions, which can in turn shape his future.

The present proposal is an attempt to help make those decisions. It is a proposal to document valuable individual experiences of patients, physicians and medical students in a practicably feasible manner that has till date regularly gone undocumented and has been lost to the medical literature that would have actually benefited from it.

If only all our daily processes were documented along with the anecdotes generated from them, they may yet be a valuable form of evidence. It may not be an impossible dream in this electronic information age. Web-based sharing of indi-

Often in day-to-day practice, both individual patients and health professionals are in situations where the information available is limited and difficult to apply to a given patient. A gap between what is proved to be effective for selected groups of patients versus the infinitely complex clinical decisions required for individual patients has been recently recognized and termed as the inferential gap. The breadth of the inferential gap varies according to available knowledge, its relevance to clinical decisions, access to the knowledge (that is, what the physician actually knows at the time of a clinical decision), the variable ways in which knowledge is interpreted and translated into a decision, the patient’s needs and preferences, and a host of other factors.

concerns about his own foot ulcer and find a match with his symptoms for another diabetic patient languishing with similar symptoms in another part of the globe. The former can drop in a word of sympathy to the latter and perhaps (through exchange of e-notes) can learn better sugar control from each other. Perhaps another person in another part of the world could become aware of the importance of a DNR from his dying father with end stage disease. Perhaps another diabetic with mild foot ulcer could become aware of the need for better sugar control in his own situation, by reading our first diabetic’s notes, and may remind his physician about his increasing sugar intake. We are not suggesting that the third diabetic’s physician is not knowledgeable about the importance of controlling blood sugars in foot ulcers but perhaps it is sometimes human for physicians to make errors of omission (especially under pressure), and unfortunately it is per

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vidual patient and health professional experiences through PCs and mobile interfaces would make for better e-Learning in healthcare and could be easily incorporated into physician CME accreditation programmes. SERMO is one web-based US company which has already made considerable headway in this direction, using a similar forum model (see figure 2) that’s at present only restricted to the US physicians.

James Surowiecki in his book, ‘The wisdom of crowds,’ mentions four key qualities that make for collective wisdom.

It needs to be diverse, so that people are bringing different pieces of information to the table. It needs to be decentralized, so that no one at the top is dictating the crowd’s answer.

It needs a way of summarizing people’s opinions into one collective verdict. And the people in the crowd need to be independent, so that they pay attention mostly to their own

figure-2—source: http://www.sermo.com/about

information, and not worrying about what everyone around them thinks.

How individual medical learners utilize their answered information needs would be the beginning of another process in continued bottom-up development in healthcare, positively complimenting the present day pedagogic top-down approach that dominates current medical learning. They can take a leaf from Surowiecki.

Acknowledgements:

The first author holds complete responsibility for the views expressed in the article, and also acknowledges the significant stimuli from various online discussion groups, particularly the Evidence Based health, Complexity in Primary Care, HIFA and Indian Association of Medical Informatics discussion fora.

• Experiential learning theory: previous research and new directions.

Kolb, D. A., Boyatzis, R., & Mainemelis, C., 2000, Prepared for R. J. Sternberg and L. F. Zhang (Eds.), Perspectives on cognitive learning, and thinking styles • Surowiecki J, Wisdom of the crowds, Random House, 2004 • Biswas R, Customizing health information in e-age. http://www. ehealthonline.org/articles/article-details.asp?articleid=1017&typ=Healt h%20Informatics • Smith R, What clinical information do doctors need? BMJ 1996; 313:1062-1068 • Tan J, Ed. (2005). E-health care information systems, Jossey-Bass: Wiley Imprint

India’s Healthcare Ripe for Big investments With the demand for healthcare services set to more than double in the next five to ten years, the Indian healthcare industry appears ripe for investment.

New Country Industry Forecasts from the Frost & Sullivan Economic Research and Analytics team addressing the Indian healthcare industry has revealed that opportunities exist in the pharmaceutical and medical tourism sectors of the industry. Frost and Sullivan is a global consulting company of international repute. According to the report, India’s recognition of pharmaceutical product patents and establishment of new regulatory bodies are likely to draw more foreign investors, seeking outsourcing opportunities in the country. Additionally, the creation of a suitable infrastructure coupled with an increase in healthcare as well as drug and pharmaceutical R&D expenditures will attract new drug development projects.

The report also noted that India was also all set to modernize its healthcare system through greater collaboration with the healthcare industry. Specifically, the country hopes to provide innovative drugs, expand healthcare insurance, as well as provide modern medical equipments and better services. The Indian government endeavours to revolutionize the delivery of healthcare services using information and communication technology with its implementation of telemedicine. According to the Frost and Sullivan’s analysis, healthcare-related programmes such as e-Health and the government’s encouragement of public-private partnerships, have improved the accessibility, standard and quality of medical services. n

Dr. Rakesh Biswas Associate Professor from the Department of Medicine Manipal University, Melaka Manipal Medical College, Melaka, Malaysia rakesh7biswas@gmail.com

References:

• Biswas R, Always a medical student, Student BMJ Feb 2003; 11:41 • Stewart WF, Shah NR, Selna MJ, Bridging The Inferential Gap: The Electronic Health Record and Clinical Evidence, Health Affairs, March/ April 2007; 26(2): w181-w191 August 2007

Dr. Nupur Sarkar Associate Professor from the Department of Paediatrics Manipal University, Melaka Manipal Medical College, Melaka, Malaysia nupursarkar@gmail.com

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cover feature

Towards Nano Products in e-Healthcare Environment Embedded mobile devices are to be the future Hospitals are also moving away from purchasing point solutions and toward buying equipments from different vendors that are interoperable, and that have a uniform user interface. Hospitals are developing internal networks that connect all diagnostic equipments, which feed all patient information over a network to data storage servers, for instant access.

GL Narasimha Murthy

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ajority of the population needs common diagnostic services to monitor their health data for common diseases of the world. Primary medical diagnostics will be (i) height, weight of the body, (ii) heart beat, (iii) blood pressure, (iv) blood test, (v) body fluid tests, (vi) cholesterol test and (vii) body temperature. Presently medical diagnostics equipments are entering the market as digital embedded equipments, resulting in good accuracy in diagnostic process.

Reduced size and display features are making these products flexible, which is facilitating the common men to use them with ease.

Introduction

The galloping development of the computer and of information technology has made it possible to gather, store, and analyze huge amounts of data, thereby profoundly transforming research in numerous fields. Emergence of mobile cellular phones and embedded hardware has made miniaturization a happening reality.

Lakhs of rural villages in the world have no access to any medical support systems to save their life—despite emerging technologies this is happening due to yawning disparities of income levels and other societal issues. But now 10 }

healthcare accessibility to remote areas can become possible due to advent of mobile cellular wireless communication.

Embedded hand-held mobile medical diagnostics tool will facilitate medical diagnostic need at remote places; for the aged population, and would contribute to reduction of individual medical expenditure. Furthermore, there is no denying the fact that the global healthcare market is influenced by a number of demographic trends, including the following: • Growing and Ageing Population: The U.S. Census Bureau predicts that the majority of the U.S. ‘baby boom’ population (28 percent of the total U.S. population) will begin to turn 65 between 2010 and 2020; • Consumer expectations for improved healthcare are increasing in both developed and developing countries.

• The above market projections are also a cause for introduction of innovative medical tools into the healthcare industry.

Emerging Trend of e-Diagnosis

In the next ten years, the healthcare market will focus on early diagnosisdigitized patient information that can

be accessed from numerous locations, and ‘total solution’ selling that contributes to healthcare productivity gains.

Early diagnosis and prevention is enabled by emerging diagnostic technologies. A ‘paperless’ hospital is another emerging trend. Digital patient records enable doctors to access patients’ records—wherever the doctor is. In a digitized hospital, healthcare providers do not have to wait days for an X-ray to ‘come back from the lab’ because the X-ray machine is digital and the image is instantly available.

Hospitals are also moving away from purchasing point solutions and toward buying equipments from different vendors that are interoperable, and that have a uniform user interface. Hospitals are developing internal networks that connect all diagnostic equipments, which feed all patient information over a network to data storage servers, for instant access. This drives medical equipment vendors to develop interoperable equipments, which have a uniform user interface. In effect, vendors are beginning to sell complete solutions that include not only the diagnostic equipments, but also the data storage servers as well as the interface software.

All these trends are leading to an increase in healthcare productivity—this means more patients can be put through the healthcare system by using better, www.ehealthonline.org

faster diagnostic equipments, which leads to early diagnosis of ailments and subsequent treatment. When the paperless hospital becomes a reality, productivity would be further enhanced because of instant patient test results and records access. Here in this article, we attempt to give a conceptual idea for a hand-held mobile diagnostics tool, which will integrate all medical testing features in a single equipment, along with integration of mobile communication, for a speedy suggestion from a doctor. The market for these types of products is doubling every year with an inclusion of various features in a single system.

Product Specification and Pre-generation

Concept I

main display will act as a man- machine interface with all the alarms and status signals, along with measured/monitored data. Concept I has dependency on external supplier for the purchase of building blocks. The module will occupy more space and will be costly for usage.

Risks in realization of Concept I as a product:

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Finance: For releasing this product in the market huge design and developmental resources should be used, drawn from different areas of electronics domain. This can be developed from governmental sponsorship as the product can be advantageous for the rural areas. • Availability of digital meters with needed interfaces • Integration issues for different instruments The risks have mitigation plan, once the total concept architecture is planned with a dedicated resource for implementation.

Instead of dedicated centralized processor, a desktop PC can be used with its standard interface selection, through a pluggable card for the system. PC/laptop can be connected with wireless network for an instantaneous remote health data monitoring.

Concept II

(i) Component Overview-Concept I

Concept I is about integration of all available digital equipment modules into a single system. The integration will be done with a SBC /Controller based PCB which is integrated with a LCD screen to monitor the displayed data. The centralized SBC will process the total incoming data through various interfaces, and in turn calibrate and display the required values on to the display according to the customized MMI interface.

The displayed data can be accessed through a cell phone and can be transmitted to the predefined receiver; the doctor will use this data and reply back with a medical transcription according to diagnosis results received through wireless transmission. This implementation requires purchase of available components as separate entities and finding interface possibility of different equipments. This diagnostics tool is not suitable for usage as a personnel utility. This can be installed as a system similar to ATM machines at villages or at public places with flexible medical utilities for diagnosis. The August 2007

(ii) Concept II-Diagnostics Tool Integrated with Cell Phone

To realise this mobile equipment, we require miniaturization of all the processes used for diagnosis, which will be costlier at the preliminary design stages. Any electronic costing depends on the volume of production. This proposed product sure has greater market scope and hence it can be safely expected that the cost of each internal component will be reduced within five years of the first release of the product. The second concept is looking at miniaturization and in11

cover feature

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towards nano products in e-healthcare environment

tegration of the entire gamut of medical diagnostic tools into a mobile phone. The purpose is to introduce an innovative medical product into the market with more usefulness to the mobile cell phone user.

Common medical diagnosis can be achieved with smart sensors, which can convert medical inputs into electrical signals and transmit them through a pluggable cable to the multichannel analog input, placed inside the mobile phone.

Processor will digitize the incoming data and process according to the required commands received from cell phone keypad and menu. The processed data can be stored into the memory with date wise file and can be transmitted to the corresponding consulting doctor as a data file, using address book of the cell phone.

However, we must remember that to integrate all equipments into mobile phones requires permissions from medical agencies and doctors, along with calibration certificates from various agencies according to the market geography.

Risks involved in implementation of this system will be• Costs to translate the system from concept to reality; • Complexity of miniaturization; • Complexity of inclusion of BP machine inside the mobile phone; • Probes and interface selection and integration; • Power supply dependencies due to increase in complexity of normal phone function; • Mixed signal design with RF integration.

Examples of Miniaturized Realisations of Some Medical Diagnosis Equipments (i) Blood Glucose Tester

Of the two types of test methods used in meters today—electrochemical and light-reflectance—the more commonly used method is the light-reflectance method. With this method, the blood sample reacts with a substance on a test strip so either there’s a colour change based on blood glucose content or it will exhibit certain properties when illuminated by a specific wavelength of light.

In meters using the light-reflectance method, the test strip is illuminated by a light source in the meter, usually an LED emitting in the visible range. The intensity of the light reflected back from the test strip is read by an optical detector, amplified, and converted before being fed to a microcontroller for processing. Great care is being taken to limit the amount of ambient light seen by the detector, since any ambient light is considered noise and reduces the meter’s accuracy.

The desired measurement depends on how the test strip’s chemistry is designed to react with the blood sample. You might want the reflectance of a particular wavelength of light, which can be achieved by either limiting the light source to only that wavelength or by filtering the sensor to see only the wavelength of interest. There are advantages and disadvantages to both of these approaches. Limiting the wavelength means that more is spent on the LEDs to get a particular wavelength output, but it allows you to use a general-purpose detector. Filtering the sensor lets you use a less expen12

sive light source and spend more on a filtered detector, such as the TSLR257, TSLG257, and TSLB257 from TAOS, which are light-to-voltage converters with integrated red, green, or blue filters, respectively.

If you require spectral information from the strip, the approach is to use LEDs tuned for specific wavelengths with tight tolerances.

The drawback is that the LEDs may be more costly and there must be a separate LED for each wavelength Fig 3: Use of individual photodiodes with of interest. If you red, green, and blue filters, respectively want to measure a change of colour in the strip, then you can measure the intensity of one or all of its tri-stimulus RGB colour components. If only one colour component is needed, then a light-to-voltage converter with an integrated colour filter for red, green, or blue, respectively, would be the best. In most cases, it is desirable to measure the intensity of all three RGB components. Traditionally, this has been done using photodiodes with RGB filters and discrete components (see Figure 3).

The colour-filtered photodiode outputs are fed to a multiplexer for selection of the red, green, or blue light-intensity data.

These data are converted from analog to digital and sent to a microcontroller. A next-generation colour sensor that converts light intensity directly to a pulse train with a frequency proportional to the intensity of the red, green, and blue components, is now available from TAOS. The output of the TCS230 can be fed di- Fig 4: Use of the TAOS TCS230, which converts rectly to a mi- light intensity directly to a pulse train crocontroller, eliminating the need for external amplifiers, multiplexers, and A/D converters (see Figure 4). (ii) Thermometer

Usage of DS18S20 or other temperature sensor in the probe will generate electrical signals, which can be interfaced with the microcontroller /processor module sitting inside the mobile equipment. (iii) BP Meter

It is based on a digital blood pressure meter concept, which uses an integrated pressure sensor, analog signal-conditioning circuitry. The sensing system reads the cuff pressure (CP) and extracts the pulses for analysis and determination of systolic and diastolic pressure. This design uses a 50 kPa www.ehealthonline.org

integrated pressure sensor (free scale semiconductor, Inc.P/ N: MPXV5050GP), yielding a pressure range of 0 mm Hg to 300 mm Hg. This method is employed by the majority of automated noninvasive devices. A limb and its vasculature are compressed by an encircling, inflatable compression cuff. The blood pressure reading for systolic and diastolic blood pressure values are read at the parameter identification point.

The simplified measurement principle of the oscillometric method is a measurement of the amplitude of pressure change in the cuff, as the cuff is inflated from above the systolic pressure. The amplitude suddenly grows larger as the pulse breaks through the occlusion. This is very close to systolic pressure. As the cuff pressure is further reduced, the pulsation increases in amplitude, reaching a maximum and then diminishing rapidly.

The index of diastolic pressure is taken where this rapid transition begins. Therefore, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) are obtained by identifying the region where there is a rapid increase and then decrease in the amplitude of the pulses respectively. Mean arterial pressure (MAP) is located at the point of maximum oscillation. Other medical diagnostic equipments can be realised similar to the above-mentioned given examples with needed sensors and calibration methods for analog signal conditioning circuitary. New diagnostics features also can be implemented due to integrated centralized monitoring display.

However, accuracies of sensors and size will drive the cost of the product.

Conclusion

The primary focus in the development of this tool is to deliver a system, which is configurable and flexible, along with saving of development and maintenance efforts.

This system would be useful for all age groups. Especially old aged people during travelling can have access with their consulting doctor, using their mobile diagnosis utility.

Implementation will take approximately one-and-a-halfyear time including integration of the overall system. In the ever increasing miniaturization of electronic equipments and the growing need for accurate and mobile devices, products similar to this integration will create new markets in the medical equipments’ sector.

References:

1.www.edn.com 2.http://www.sensorsmag.com/sensors/ 3.http://www.freescale.com/files/sensors/doc/app_note

GLNarasimha Murthy Assistant Consultant Tata Consultancy Services gl.murthy@tcs.com

August 2007

Intel’s Embedded Digital Solutions for Healthcare Intel’s Digital Health Group (DHG) aims to improve the health experiences of senior citizens while driving down cost by researching technology that can monitor patients’ health unobtrusively by various sensors embedded throughout the home.

The Technology Research for Independent Living (TRIL) centre, opened in Ireland in January, is part of this initiative and has already begun clinical trials of Intel’s healthcare technology.

“A global demographic tsunami is in the making as elderly citizens look set to reach two billion in the next few decades, according to Eric Dishman, senior official with Intel’s Innovation Centre in Leixslip, Europe. Already EU healthcare costs 30percent of the average GDP, and this is not sustainable.

Dishman says a paradigm shift in elderly healthcare is happening mainly through technological innovation that is mostly wireless and scaleable.

Drawing a parallel with the advent of the home computer, Dishman says this “shift left” strategy could be introduced to the healthcare sector by bringing monitoring equipment to the home. Rather than paying roughly 4,000 euros for an electrocardiogram (ECG) monitor for research purposes, universities and research centres can avail of Intel’s SHIMMER technology. Sensing Health with Intelligence, Modularity Mobility and Experimental Reusability (SHIMMER) ECGs are lightweight, Bluetoothenabled monitors.

They can track the motion and gait of patients in an effort to better understand and prevent falls, which often lead to rapid health deterioration among the elderly, and can be modified and applied to many areas of ageing research. With open source software and reusability, Intel has already run workshops for universities and TRIL is using its motion sensing technology to run a study of 600 patients in St. James Hospital, Ireland with 2.8m in funding from the Industrial Development Authority (IDA) and Intel combined.

DHG also hopes to create efficiency in the hospital environment by making paperwork and monitoring easier for nurses and doctors. The time spent on caring for patients is often taken up filling in and finding files. The Mobile Clinical Assistant (MCA) is one of the first technologies developed within the DHG. Designed by Intel and produced by Motion Computing, the MCA is waterproof and fall tolerant.

Launched in February this year, MCA is expected to be commercially available very soon. With Bluetooth technology, a built-in camera, RFID reader and software to track inventory and other electronic records, the MCA endeavours to add to workflow efficiency in a hospital environment. n

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Telemedicine Binds India and Ethiopia TCIL initiative set to enhance the reach of quality healthcare in Africa As there is generally no medical specialist in remote areas, there is a great need to provide specialized support for the betterment of health in these areas. In fact, the advantages are manifold; the patients do not have to travel to a super-specialty hospital from distant places, which results in saving his valuable time and money. It is extremely facilitating in getting specialist opinion on several tests done at the local health centre, where there is no expert available. Moreover, through telemedicine, medical experts at the superspecialty hospitals can also share their expert experiences and opinions on patients ...

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he ICT initiatives in various countries of Africa and other developing regions have contributed towards the speedy development in those areas in terms of various development parameters like education, healthcare, communication to rural areas, upliftment of women, equitable distribution of commerce, etc. The declining price of broadband communication and long distance connectivity has made communication affordable to evolve various kinds of services. The relentless efforts of various world bodies like IEEE, ITU, etc. in getting interoperable technologies have made it possible to improve key indicators such as life expectancy and infant mortality in widely disparate countries, through cost-effective use of ICT-based healthcare systems.

Telemedicine has been providing meaningful and affordable healthcare to people living in rural and distant areas.

Barriers due to distance vanishes when we provide online medical consultation for the benefit of people across the region, country, continents, etc. Already many hospitals in different parts of the country and in the world have adopted telemedicine, which is used for diagnosis of patients in distant, remote and unaccessible areas. Many corporate bodies have started thinking of providing telemedicine as corporate benefits.

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Employees of those companies who are stationed at remote sites can avail the medical facilities at par with employees in the headquarters of those corporate offices, which is usually located in a big city. Employees thus get confidence while working in remote areas, as they realise that their health would not be compromised just because of their geographic locations.

Telemedicine set up

The main welfare objective of the telemedicine services is to provide medical help to the people located in far-flung areas. Through DICOM compliant modalities, images such as X-ray, ECG, Ultrasound, etc. are transmitted to a medical expert, located at a distance.

The videoconferencing between doctors and patients, transmission of still images, patient records, remote monitoring of vital signs, continuing medical education may all be considered as part of telemedicine.

As there is generally no medical specialist in remote areas, there is a great need to provide specialized support for the betterment of health in these areas.

In fact, the advantages are manifold; the patients do not have to travel to a super-specialty hospital from distant

places, which results in saving his valuable time and money. It is extremely facilitating in getting specialist opinion on several tests done at the local health centre, where there is no expert available. Moreover, through telemedicine, medical experts at the super-specialty hospitals can also share their expert experiences and opinions on patients, cases and clinical information with the doctors at remote locations for the enrichment of their knowledge.

A telemedicine system consists of customized medical software integrated with computer hardware, along with medical diagnostic equipments connected to communication backbone, like leased line/PSTN/ISDN or VSAT. Normally, the medical record/history of the patient is sent to the specialist doctors, who will in turn study and provide diagnosis and treatment during live tele-interactions from the patient’s end.

The facility caters normally for transmission of patient’s medical images, records, output from medical devices, and sound files, besides live two-way audio and video. With the help of these, a specialist doctor could advise a doctor or a paramedic at the patient’s end online, saving critical time and resources.

Recently a telemedicine initiative has encouraged people in Ethiopia to get consultation from CARE Hospital, Hywww.ehealthonline.org

derabad. It is known as the Ethiopia Pilot project (funded

by Govt. of India). Under this project—the forerunner to the main Pan-African e-Network project of the Govt. of India— Telecommunications Consultants India Limited (TCIL) has established the fibre-optic based network between India and

Figure: A typical telemedicine set up

Ethiopia, to enable onine medical consultation and continuing medical education from the CARE Hospital, Hyderabad, India to Black Lion Teaching Hospital and Nekemte Hospital in Ethiopia.

TCIL was founded in 1978, with the main aim of spreading Indian telecom excellence in developing and underdeveloped countries. Today it has earned global recognition in this endeavour.

TCIL has earned its name in executing turnkey projects and rendering consultancy services in the fields of switching systems, transmission systems, access networks, optical fibre cable systems, dedicated networks, microwave system and even architectural design and civil works.

For meeting the fast changing telecom scenario, TCIL has expanded its activities by moving into areas of basic telephony, cellular mobile telephony, satellite telephony, OPGW, networking and e-Governance. Today it has a presence in a number of countries across the globe, and over the years, it has planned, guided and executed traditional wireline, hi-tech wireless satellite and IT projects in more than 55 countries.

Coming back to this project, telemedicine component of the Ethiopia Pilot Project has been designed to provide expert medical consultancy services from CARE Hospital, Hyderabad to Black Lion Teaching Hospital and Nekemte Hospital in Ethiopia.

These two hospitals in Ethiopia are provided and equipped with medical equipments such as X-Ray machine with digitizer, electrocardiogram (ECG), ultrasound machine, telepathology microscope, glucometer, defibrillator, blood pressure measuring instrument, urine analyzer and hot air oven.

Very critical and serious patients in ICU or those who have suffered cardiac ailments have benefited through the availability of expert consultation services through this telemedicine set up.

August 2007

Continuing Medical Education (CME) in Ethiopia

In fact, Ethiopia is making significant inroads in the field of telemedicine. Continuing Medical Education (CME) programme is being conducted for doctors in Ethiopia, which is helping them to gain knowledge on expert medical care and diagnosis. It is to be understood that doctors and nurses are required to expose themselves to various kinds of case studies, which enable them to get familiar with different kinds of medical complications and their remedies. CME sessions provide the opportunity to discuss case studies with the intention to share the experience among doctors/nurses at the other end in Ethiopia. Seeing the benefits of the CME programme, CARE Hospital is arranging regular sessions on various topics like adult cardiology, paediatric cardiology, radiology, pathology, neurology, dermatology, etc.

During the CME session, actual case studies along with medical reports and patient records are submitted to the audience through audio-video presentation. The presence of large number of audiences points to the importance of CME sessions that are serving their purpose. The technology set up for the CME is quite simple and affordable. Various solutions exist and depending upon the situation and requirements, the system can be implemented within a short time.n

It’s All About CARE Presently three hospitals that is Care Hospital in Hyderabad—a super-specialty hospital in southern India—Black Lion Teaching Hospital in Addis Ababa, and the Nekemte Hospital in the provincial town of Nekemte, are linked by this pilot project, which will eventually be rolled out all over Africa. India has not only provided technical support to this project, but the project has been set up through Indian aid. India will set up the project and run it free of charge for the first five years. The project was officially inaugurated recently by Pranab Mukherjee, the Foreign Minister of India, on his visit to Ethiopia, but even before the official inauguration, some 40 patients had benefited from this telemedicine tie up. The next step is to bring a total of 20 hospitals across Ethiopia into the ambit of this network, which will help rural Ethiopia to access international standard of medical care from the CARE Hospital in Hyderabad. This tie up will also enhance the knowledge and expertise of rural health workers in Ethiopia.

J. S. Chhabra Executive Director (Technical), TCIL jschhabra@tcil-india.com

T. K. Roy General Manager (TE), TCIL ztkroy@gmail.com

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development

e-Health: Tangible Lessons from Canada Canada Health Infoway makes significant inroads In response to strong public concern about wait times, Canada’s First Ministers committed to providing evidence-based wait time benchmarks for cancer, cardiac care, diagnostic imaging, joint replacement and sight restoration (cataract surgery). Moving forward, public attention on these benchmarks will be heightened each year as they look to see how the health system in their respective province/territory is progressing.

Trevor Hodge

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nformation is the lifeblood of Canada’s healthcare system. Yet each year, most of the patient data generated from approximately one billion healthcare encounters in Canada is captured predominantly on paper. Over 100 million physician exams, half a billion lab and radiology tests, and 382 million prescriptions – almost all are handwritten; many of them are illegible. This critical information lies scattered and buried in the filing rooms of forty thousand doctors’ offices, test centers, hospitals and clinics throughout the country. Fortunately, changes are afoot to modernize the Canadian healthcare system.

Canada’s approach to healthcare delivery

Canada’s healthcare system provides coverage to all Canadian citizens. It is publicly funded and administered on a provincial or territorial basis, within guidelines set by the federal government. Federal and provincial/territorial governments have shared accountability for healthcare delivery in Canada.

Where Canada’s federal government sets and administers national principles through legislation such as The Canada Health Act, the country’s thirteen provincial/territorial governments plan, finance, manage, and evaluate health services for their respective areas.

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The provinces/territories are responsible for more than 100 health authorities that coordinate care delivery over specific geographical areas. Within these health authorities, more than 900 hospitals manage care delivery. Approximately 400,000 healthcare professionals (60,000 physicians, 300,000 nurses and 26,000 pharmacists) deliver care through a variety of clinical settings.

Under the healthcare system, individual citizens are provided preventative care and medical treatments from primary care physicians as well as access to hospitals, dental surgery and additional medical services. All citizens qualify for health coverage regardless of medical

history, personal income, or standard of living.

Public sector spending still accounts for more than two-thirds of the total spending on healthcare. However, private sector expenditures (eg. out-ofpocket spending by individuals, spending by commercial and not-for-profit health insurance plans) are growing at a higher rate compared to public sector expenditures.

Pressures on the system

However all is not well with the healthcare system of the country. Canada’s www.ehealthonline.org

healthcare system is coming under continual cost and demand pressures – in large part driven by the country’s ageing population. By 2011, it is estimated that 1.3 million Canadians will be over the age of 80. Senior citizens will outnumber children in Canada in about a decade. The health status of the broadest demographic segment – the baby boomers – is declining as they age.

Clearly, these demographic shifts will continue to put pressure on the system – both in terms of levels of usage and costs. In 2005, Canada spent an estimated $142 billion on healthcare, or $4,411 per person. After inflation was taken into account, that was almost three times what was spent in 1975.

Despite increased expenditures on healthcare, concerns about growing wait times for major procedures has been a focal point for public debate and remains one of the Canadians’ top concerns. In response to strong public concern about wait times, Canada’s First Ministers committed to providing evidence-based wait time benchmarks for cancer, cardiac care, diagnostic imaging, joint replacement and sight restoration (cataract surgery). Moving forward, public attention on these benchmarks will be heightened each year as they look to see how the health system in their respective province/territory is progressing.

Another challenge in striving to deliver a consistent level of healthcare in Canada stems from the size of the country and the number of people who live outside urban centres.

As the second largest country in the world in terms of land mass, and a population of only 31.6 million people, Canada’s population density is among the lowest in the world.

Consider Canada’s three northern territories: Yukon Territory, the Northwest Territories and Nunavut together encompasses more than a third of Canada’s territory (which makes them larger in area than most countries, including Mexico and India), but only have a population of just over 101,000 residents.

Spanning over two million square kilometres, Nunavut consists of 26 communities ranging in size from tiny Bathurst Inlet (population 25) to Iqaluit, the capital (population almost 6,000). Grise Fiord, the northernmost settlement, lies at 78 degrees North. None of these communities are accessible by road or rail; everything, from people to fuel to food, arrives by plane or sealift. Delivering healthcare services to remote centres such as those in Canada’s north is proving particularly challenging.

change in transforming a 19th century paper system into a safer, 21st century system, that is able to exchange important clinical information for the benefit of all Canadians.

Reporting to its members – Canada’s 14 federal, provincial and territorial Deputy Ministers of Health – Infoway invests with public sector partners across Canada to implement and reuse compatible health information systems that support a safer, more efficient healthcare system.

To accomplish this, Infoway has adopted a unique model – that of strategic investor – working in partnership with health ministries, regional authorities, other healthcare organizations and information system vendors to best align Infoway’s investments with jurisdictional plans and to leverage existing solutions.

Infoway is currently working with its public sector partners on projects in ten targeted investment areas: Registries, Diagnostic Imaging Systems, Drug Information Systems, Laboratory Information Systems, Interoperable Electronic Health Record, Telehealth, Public Health Surveillance, Patient Access, Innovation and Adoption, and Infostructure.

Once investment decisions are made, our public sector partners lead the development, implementation and use of the electronic health record, telehealth and public health surveillance solutions. Infoway provides leadership by establishing a strategic direction for e-Health implementation throughout Canada, in collaboration with the provinces and territories.

Infoway was given federal funding of $1.6 billion ($CDN) to get the job started. Infoway invests three quarters of the cost of a provincial/territorial project; the province/territory invests the remaining 25 percent of the project costs.

With 227 e-Health projects currently completed or underway from coast to coast, all provinces and territories are aggressively pursuing what needs to be done – from developing telehealth services in remote regions, to providing chronic kidney patients with online portals to better manage their ‘wellness.’

Furthermore, jurisdictions are pursuing their plans within a common architecture and standards so that best practices and successful interoperable systems in one region can be shared or replicated in another, thereby reducing risks and development costs, and speeding up progress.

The great news is that all the 13 provinces and territories of the country have embraced this innovative model of collaboration. They have established 3-5 year roadmaps to implement the common e-Health systems they need.

Time for change upon us Much remains to be done

A number of studies commissioned over the past five years by the federal government concluded that Canada urgently needs a foundation of proven information technologies to manage and exchange healthcare information, as part of a solution to effectively address many of the pressures/challenges facing the healthcare system.

As a starting point, Canada’s First Ministers launched an independent, not-for-profit corporation – Canada Health Infoway (Infoway) – to serve as the catalyst for collaborative August 2007

Unfortunately, many key areas that should be tackled, lie beyond the scope of our current mandate. For example, by 2012, when all our seed money is invested, half of all Canadians will still not have a complete, individual electronic health record.

The vast majority of doctors’ offices in Canada will still not have the automated clinical systems for electronic ordering of prescriptions that alert them to dangerous drug interactions 17

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e-health: tangible lessons from canada

and inappropriate dosages. Without these tools, doctors’ ability to effectively manage their patients’ chronic disease is limited, whether it’s diabetes, arthritis, respiratory or heart disease. All this at a time when chronic disease already demands three quarters of Canada’s public and private healthcare budgets.

And reducing wait times, so fundamental to every government across Canada, will continue to be handicapped by the absence of a better information technology foundation that can automatically match waiting patients with available operating rooms, surgeons and cancer treatment centers.

Canada’s First Ministers launched an independent, not-for-profit corporation — Canada Health Infoway (Infoway) — to serve as the catalyst for collaborative change in transforming a 19th century paper system into a safer, 21st century system, that is able to exchange important clinical information for the benefit of all Canadians.

Two recent studies estimate that $350 per person, spread over ten years, is needed to complete our work in Canada – compared with the $40 per Canadian invested so far.

The promising news is that these same studies confirm that once in place, these new clinical systems will deliver a six-fold return on investment, saving $6 to 7 billion ($CDN) each year. This money can be more productively re-invested in other priorities, whether it’s healthcare, education, innovation or infrastructure. This is particularly important as healthcare costs today consume more than 30 percent of provincial budgets in most instances.

Global collaboration is the key success factor

While the context in which we are operating is uniquely Canadian, we have already learned a great deal from e-Health leaders from around the world, from healthcare technology vendors and from countries who are entering into the eHealth space anew. Collaboration not only with our partners in Canada, but with other countries from around the globe is crucial to our success. Meanwhile, in Canada, we are at crossroads. We have established strong momentum and a solid track record. We have a good idea about what needs to be done, but we are also very keen to explore how other countries are tackling similar problems in creative ways.n

By Trevor Hodge Senior Vice-President, Investment Strategy and Alliances, Canada Health Infoway e-mail: thodge@infoway-inforoute.ca

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Canada’s THINK Mulls Faster Clinical Care Under Tech. Alliance THINK—Transforming Health Care into Integrated Networks of Knowledge—has been launched in Canada at the Trillium Healthcare Centre, Ontario. The project of 100 million Canadian dollars seeks to harness products and services from eight global technology giants to connect patients and healthcare professionals in a seamless continuum of care.

Under this initiative, the procedures upon admission to Trillium Health Care Centre, apparently after a heart attack, will be as follows. In a few minutes, the emergency team will electronically search and retrieve all the healthcare records of that patient from multiple sources—pharmacist, cardiologist and family doctor. These assorted records can be accessed on a variety of devices like laptops, PDAs, desktops, to enable the physician on duty to assess risks and administer timely treatment to save that patient’s life.

This leads to faster clinical decisions that can save a life.

Claims Ken White, Trillium’s CEO, “This is an entirely new model in healthcare and keeps the patient at the centre. This signals the reversal of the current practices of keeping the doctor’s office at the centre, where all the medical decisions are made, records kept, tests done, and diagnoses conducted.” Trillium selected the partners through a bidding process. The eight technology vendors were selected to participate in the THINK Alliance. IBM Canada Ltd. is the overall program and project manager, which offers consulting and systems integration expertise.

Eclipsys is for providing clinical information system for the integrated patient health record; Cognos for business intelligence (BI) toTrillium decision makers through web, e-mail and wireless technologies; Agfa for the shift from film to digital-based diagnostic imaging; IMS Maxims for applications that manage illness and disease beyond the hospital walls and across the community. Sybase is chosen for transactional and hierarchical database and transactional management systems for operational data; EMC supplies advanced storage technology; Courtyard integrates the systems and adds to the interfacing support.

Says Ganderton, leader of the Canadian National Healthcare Industry Group at IBM Business Consulting Services, “THINK will defenitely change the way the community sees its hospitals—not simply as buildings, but as a network of medical and healthcare expertise and knowledge, integrated with community and family networks.”

Unconnected parts of the healthcare system has been driving up costs and driving down efficiency. Several key reports had recognized and recommended changes.

The Romanow Commission report in 2002 had called electronic health records as one of the keys to modernizing Canada’s health system. In 2003, Senator Kirby’s report called for a pressing need to seriously upgrade IT, and recently Canada Health Council report said “wiring the country was essential for healthcare reform.” n

www.ehealthonline.org

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power hospital

Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi Embedding health solutions with an ICT angle All the departments in the hospital are having workstations and they are connected to the Hospital Local Area Network for accessing information from different servers and also updating the information immediately to the servers, as to have an upto date information. Networked PCs ensure the fast exchange of information between various departments, thus resulting in the efficient operation of the hospital and fast services to the patients.

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he Fortis Flt. Lt. Rajan Dhall Hospital is located at Vasant Kunj, New Delhi. The hospital employs cuttingedge technology to provide medical care of internationally accepted standards.

The hospital reflects the aspirations of international standards in healthcare, by the Fortis group—whose growing network is bringing a wealth of medical expertise, world-class infrastructural facilities and compassionate care, thereby enhancing the value of patient care across the country.

The major focus of this healthcare facility is on ‘high incidence health problems’ in India, such as heart, kidney, respiratory and diabetic conditions, especially since there are linkages among these. The facility also focuses on the treatment of complex joint problems, a prevalent condition among the senior citizens. Specialized departments for each of the five super-specialties have been set up such as The Fortis Heart Institute, Fortis Institute for Renal Sciences, Fortis Specialty Centre for Joints, Fortis Lung Centre and Fortis Centre for Diabetes. The medical faculty of Fortis Flt. Lt. Rajan Dhall Hospital comprises some of the most eminent doctors in the key specialties.

Equipped with 200 beds and spread over an area of 1,50,000 sq. ft., Fortis Flt. Lt. Rajan Dhall Hospital talks of an impressive list of infrastructural facilities, such as ultra modern operaAugust 2007

tion theatres, laminar flow in the OTs to eliminate chances of infection, stateof-art 64 slice CT scan machine, fully automated blood bank facilities (to be operational shortly), round-the-clock emergency and trauma care, 24-hour pharmacy, critical care, laboratory services, radiology and imaging services.

Enhanced by the warmth and care of the professionally trained nurses and house-keeping staff, Fortis Hospital at Vasant Kunj recreates the comfortable ambience of home within its four walls.

A wide range of patient rooms, a multicuisine cafeteria and other conveniences complement the quality experience at this Fortis facility.

Fortis Flt. Lt. Rajan Dhall Hospital has been very serious about inducting

ICT in its healthcare and as such has an impressive IT infrastructure. It comprises of: 1. Local Area Network: At Fortis Vasant Kunj, there is a local area network of 100 Mbps speed with Gigabit Ethernet Backbone. For the local area network, structured cabling has been done in the facility by using AMP Jack Panels,CAT 5E and CAT 6E cables, information outlets and faceplates. The hospital is using Cisco 3750 Gigabit Switch in core and Cisco 296010/100/1000 switches at edge. The network is based on Microsoft 2003 Active Directory Domain.

2. WAN and Internet: All the hospitals of Fortis chain are interconnected with 128 Kbps Airtel IP VPNs or MPLS for smooth and fast interchange of informa19

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tion. The Fortis Flt. Lt. Rajan Dhall Hospital is also having 256 Kbps Internet link for the Internet browsing.

3. Servers: 6 HP Proliant ML 350 G4 servers with Intel Pentium 3.0 Ghz, 4 GB RAM with RAID 5 for different applications like HIS having Sql 2000 database, Exchange 2003 Server for messaging, Windows 2003 AD, Trend Micro Neat Suite for Antivirus Protection, ISA 2000 server for Proxy and Fire wall, SMS ( Short Messaging Service) server and Fortislife Intranet.

4. PCs: The hospital is also having a network integrated around 200 HP and DELL workstations, having Windows XP Professional as the operating system. All the departments in the hospital are having workstations and they are connected to the Hospital Local Area Network for accessing information from different servers and also updating the information immediately to the servers, as to have an upto date information. Networked PCs ensure the fast exchange of information between various departments, thus resulting in the efficient operation of the hospital and faster services to the patients.

5.Printers and Scanners:The hospital is having HP LaserJet, DeskJet, EPSON Dot Matrix and Thermal Printers for fulfilling the different printing requirements. It also has HP Scanners for scanning official and patient documents, and Zebra Card Printers for printing OPD Patient Registration Cards, that are given to the patients who come to the hospital for the first time for an OPD consultation. Networked as well as personal printers are installed at various departments according to the functional requirements and keeping in mind the continuous service to the patients.

6. Applications:The hospital boasts of an in-house developed full-fledged hospital information system, covering front office (OPD&IPD),billing, stores ( pharmacy and general), wards, doctors’ scheduling, appointments, and discharge summary.

HIS is developed using Visual Basic and SQL 2000 database.

All the nursing stations in all the wards, ICUs, OTs, and front offices are having HIS module installed in the PCs and indents are made there and then. HIS is integrated with the lab management system (LMS) for ordering the pathological tests. MS Exchange Server 2003 is installed for providing mailing services, that is for sending e-mails between internal as well as external users, for fast and efficient communication. Trend Micro Net suite is installed for the virus protection. This anti-virus server scans all the PCs and servers on the network for any virus activity and eliminates that if it occurs. This antivirus server is connected to the Trend’s online update center and downloads latest virus pattern files and fixes to the server, and server in turn updates the clients automatically. This ensures that all the machines on the network are always with the latest virus definition files and fixes.

The specialty also have SMS (Short Messaging Service) server integrated with the HIS server, that is configured for sending some specific information to the relevant users on their mobiles. This information includes occupancy, revenue, patient admission and other relevant information. Fortis Life Intranet server provides basic information about the hospital departments and services, important numbers, extension list, weekly menu for the canteen and special web-based MIS reports that are very important for the hospital management, to 20 }

Specialties at Fortis Flt. Lt. Rajan Dhall Hospital SUPER-SPECIALTY Cardiac services Renal sciences Diabetes& metabolism Thoracic-Pulmonary Disease Joint Replacements MULTI-SPECIALTY Internal Medicine Gen. Surgery ENT Ophthalmology Paediatrics Dermatology Preventive Health Check-up Dental Lifestyle Management Emergency Medicine Cosmetic & Plastic Surgery

Physiotherapy Gynecology TERTIARY CARE Cardiac: Invasive and Non-invasive Joint Replacements Thoracic Surgeries Urological: All Procedures Renal Procedures Other Medical Facilities Blood Transfusion Services Pathology Lab Emergency Services Physiotherapy 64 - Slice Volume CT Heart Scan Radiology Department Nuclear Medicine Department Telemedicine

track the operations of the hospital and take necessary strategic decisions. This Intranet application is connected to the HIS database and produces latest information with Bar, Line and Pie Graphs.

7. Patient Monitoring System: Patient Monitoring System has been installed in the hospital to monitor the vital statistics of the patients in critical care or ICUs. This statistics can be viewed using the Internet Explorer on any networked PC within the hospital or in any hospital that is connected through WAN. 8.Patient Calling System: Patient Calling System has been installed in front of all the OPD chambers that is used to call the patients. This system is integrated with the HIS system and when a patient takes an appointment with an OPD doctor, a patient call number is assigned to the patient and printed on the OPD receipt. Doctor sitting in the OPD chamber logs on to the HIS and gets the list of all the patients he has to see. He selects one patient and click call, and the digital display outside his OPD room displays the patient call number.

9. EPABX: The hospital is having top-of-the-line Alcatel OmnPCX 4400 Enterprise EPABX System that is connected with the Airtel PRI of 30 channels for telecommunication. EPABX is also integrated with the Hospital PA system of BOSCH for the announcement of CODE Blue and any other emergency announcements from any extension.

10. Telemedicine: The hospital is also employing telemedicine. Its specialist doctors receive the medical records and images, dioganise the patients, and provide advise to the treating doctors situated far away through telemedicine.

11. Technological Partners: HP and DELL are the hospital’s partners for hardware solutions. Fortis Flt. Lt. Rajan Dhall Hospital also have corporate tie-up with AIRTEL for any mobility, fixed line telecommunication and data communication solutions. Microsoft is its partner in business and other application solutions.n www.ehealthonline.org

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Philips Flexing Muscles in Diagnostic & Imaging Markets P

hilips is one of the leading players in healthcare, mainly in the markets of medical diagnostics and patient monitoring systems that include X-Ray, general ultrasound, computed tomography (CT) scanning and magnetic resonance imaging (MRI).

With strong credentials in lighting and electronics markets, Philips is positioning itself in the healthcare market as a player of ‘substance’. With its clinical IT services and solutions, Philips has been able to target physicians and surgeons for their departmental needs and workflow management and implementation of new technology, new solutions in clinical data capture and retrieval.

Of late, Philips has gone in for a paradigm change in its offerings. The new products blend ergonomics and technology together and there is very much a concern to accommodate the patient’s point of view. The recent example is Ambient Experience Cath Lab. It reflects a thinking of going ‘beyond the system’, while combining the design elements with smart technologies.

The Ambient Experience Cath Lab’s unique design eliminates many unwanted physical barriers in the imaging suite to facilitate better patient and staff interaction, reduced clutter and enhanced workflow. Many patients experience significant stress during interventional procedures as in a Cath Lab. A pleasant environment with personalized lights, themes and music as well as technology will make the surroundings more natural and facilitate patient relaxation and cooperation with the clinical staff. The iU22 ultrasound system is another product doing well in the market. Meant to help clinicians in shortening exam times, expanding the clinical utility of volumetric imaging and for providing new tools for interventional procedures, the product is working under the principle that cus22 }

tomizable protocol-driven exams would clinically reduce ultrasound exam times by as much as 30 percent and improve exam consistency and accuracy across the departments.

In iSLICE, intelligent slicing technology is used for volumetric datasets, for providing progressive views of anatomy with one sweep; quickly generating the best views for diagnoses. These new image enhancements are optimizing needle visualization for faster, less invasive biopsy procedures, making the iU22 a comprehensive solution to assist in planning, guiding and assessing liver tumour ablations.

Among the ICT-oriented products, mention must be made of Philips Xcelera cardiovascular information solution. Xcelera R2.1 integrates examination results from across the cardiology sub-specialties and allow cardiologists to access images and patient information all across the cardiac care cycle at one location. Positron Emission Tomography (PET) and Computed Tomography (CT) hybrid scanners with the new GEMINI TF 64-channel configuration are already a hit. Here the benefits of time-of-flight can be seen by the enhanced small lesion detectability,

shortening scan times, reduced patient dose and exceptional image quality in oncology, cardiology, neurology and molecular imaging.

GEMINI TF raises the effective image sensitivity by 10 times over conventional PET, and shortens image acquisition to less than 10 minutes for a whole-body PET scan. Consistent with all GEMINI PET/CT systems, GEMINI TF also features Philips’ patented OpenView gantry design, allowing for increased patient comfort. In India, Philips has a wider exposure. Nearly 50 percent of cardiac examinations in India are done on Philips equipment. In the specialized area of surgical X-ray, Philips’ innovation in the mobile c-arm for intra operating imaging has been positively acclaimed.

With substantial market shares in High field MR, Cardiac CT, Cath Lab and Monitoring Systems, Philips (Medical Division) in India is present in measurement (patient monitoring systems and cardiology equipments) and electro physiological therapy systems like Automatic External Defibrillators and Point of Care Diagnostics.

The acquisition of Stentor Inc. in 2005 signalled its new focus on imaging and molecular imaging. The company, rechristened now as Philips Healthcare Informatics, provides extensive radiology image-archiving systems.

Philips Healthcare Informatics makes picture archiving and communications systems or PACS, used in diagnostic imaging centers to review, store and share radiology and cardiology images, such as X-rays and related images.

Imaging market too is responding well to this new aggression of Philips. Sales have improved in Europe, Asia-Pacific region and South America. Buoyed by this growth, Philips has now aggregated cardiology imaging and related services to the former Stentor business.n G. Kalyan Kumar, kalyan@csdms.in

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WORLD

news review

Ghana to get a healthy fillip

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ecently the government of Ghana received an approval of funding from the World Bank Board, amounting 40 million USD. This funding will finance two health sector projects (i) Health Insurance Project—US$15 million and (ii) Nutrition and Malaria Control for Child Survival Project—US$25 million. Here it deserves a mention that despite Ghana’s health sector’s general improvement over the past two decades, boosted particularly by the introduction of the National Health Insurance Scheme (NHIS), there are still challenges galore.

World Bank assistance to Ghana’s health sector, through its concessionary finance affiliate— the International Development Association (IDA)—has increased over the past 10 years, and more than USD160 million has already been disbursed for various health related projects including HIV/AIDS. The beneficiaries of the Health Insurance Project include (i) the

National Health Insurance Council which will have improved processes for management oversight of the National Health Insurance Scheme and, therefore, greater control over the finances of the Scheme; (ii) the District Mutual Health Insurance Schemes which will have streamlined mechanisms for local level administration; (iii) the provider network including relevant institutions under the Ministry of Health and other quasi-governmental organizations and private providers which will have improved financial management and administrative mechanisms to improve management performance; and (iv) the Ghana Institute for Management and Public Administration, the Kofi Annan Centre for Information Technology and other training centers that will provide training in executive leadership, management and information technology.

The main objectives of the Nutrition and Malaria Control

for Child Survival Project are i) to improve utilization of selected community-based health and nutrition services for children under the age of two, and pregnant women in the selected districts; ii) to strengthen institutional capacity of relevant institutions to deliver services at all levels; iii) to create demand for and expand community-based delivery of selected health and nutrition services; and iv) promote the utilization of insecticide-treated nets for malaria prevention. This project will focus on outcomes with known links to child survival such as nutrition and malarial prevention and scaling up of strategies of community mobilization and communication as a means of building capacity for basic health and nutrition service delivery at the community level.

It can be safely said that both these projects can together play a strategic role towards the realization of Ghana’s health sector’s objectives. n

South Australia to upgrade patient management systems South Australia’s Department of Health has recently been given a whooping $11.5 million funding to initiate the upgrading of its patient management systems, which has been long overdue. The entire operations is expected to incur an investment of $70 million. The funding was allocated to the South Australian state budget of 2007-08.This $11.5 million would be used to replace several IT systems, which include the patient administration platform, which has undergone undue ageing. However, patient administration system would have a gestation period of six to eight years, as it will run parallel with a number of other computer projects. The PAS project is part of a 10-year, information and communications technology capital investment program worth $650 million, that has been developed by the South Australia’s health department’s IT division. n

Three healthcare technology giants to pilot Motion C5 Mobile Clinical Assistant platform

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group of healthcare technology providers - Intel, Oracle and Orion Health - have announced plans to pilot the use of the new Motion C5 Mobile Clinical Assistant (MCA) platform at the Hospital Universitario Son Dureta, in Palma de Mallorca, Spain. Here it deserves a mention that Hospital Universitario Son Dureta is the largest healthcare facility in Spain’s Balearic Islands.

Using RFID technology, integrated into the MCA, to read patient wristbands, the doctor or nurse will be able to access patient information such as demographics and clinical results (e.g. blood tests, scans, etc). The deployment of Orion Health’s clinical software onto the Motion C5 MCA will enable patient data to be available at the point of decision regardless of whether the

August 2007

patient is in a bed, on a stretcher, or being moved in a wheelchair.

The healthcare professional will be able to validate the data by sharing it directly with the patient. The Motion C5 is based on the Intel mobile clinical assistant platform and was designed following Intel’s extensive research with clinicians around the globe.

“Hospital Son Dureta has made enormous progress in supporting clinicians with information technology in the past couple of years,” said Joan Marques, CIO at Hospital Son Dureta. “The next logical step is to make these information tools mobile so clinicians can access patient data wherever they happen to be

in the hospital. We are excited about the potential of mobile devices such as Intel’s MCA to improve clinical practice and deliver safer care to patients,”he added.

Orion Health and Oracle technologies are already implemented at Son Dureta Hospital, bringing together clinical data from multiple systems across the facility. The OracleOrion Health solution comprises a clinical web portal, a central repository for clinical data, and an electronic whiteboard for the accident and emergency department.

These systems were implemented in 2006, in partnership with Fujitsu Services.

Son Dureta uses Oracle Healthcare Transaction Base (HTB) as a centralised, standards-based repository for clinical data. Relevant data from the hospital’s various existing systems is fed into Oracle HTB via Orion Health’s Rhapsody Integration Engine, where it is normalised to allow for automated clinical decision support and important clinical comparisons. Clinical information stored and maintained in Oracle HTB at Son Dureta Hospital includes clinical orders, lab test results and patient demographics.

Data stored in Oracle HTB is available for immediate recall and viewing by authorised clinicians via Orion Health’s Concerto Medical Applications Portal. Concerto presents the HTB data in an on-screen format that is easy to read and act upon. n

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world News

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Smart clothing for an e-age health

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e are fast entering the world of smart clothing.

Researchers from the University of South Australia have already made some significant inroads in this direction. They have developed a garment with integrated electronic technology, which enables it to monitor the wearer’s cardiac and respiratory functions, without the tangle of any wires.

That’s not all. These garments are able to download the monitored data onto a computer in the wardrobe; a wardrobe where these smart garments are being kept, after they are being placed on electronic hangers. This does way with the apprehension of losing data while the smart garment is being cleaned and washed. After cleaning, these smart clothes can be recharged for wearing again.

This technological innovation may pave in for revolution in cardiac care and eventually replace the expensive heart monitoring equipments, for the infrastructure needed for operating these smart clothes is minimal. n

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Study tracking European physicians’ IT usage

US-based healthcare marketing information and services firm named Manhattan Research has unearthed some emerging trends pertaining to ICT adoption and integration in the practices among European physicians, located across Germany, France, Spain, Italy and the United Kingdom.

This country-specific data are based on a telephonic research study titled Taking the Pulse® Europe v5.0.It s a syndicated multi-client study and advisory service covering 1000 practicing physicians in the UK, Germany, France, Spain and Italy.

The primary focus of the study is technology adoption and integration in physician practices across Europe, and the objectives are to identify and analyze the behaviour, attitudes and demographics of the physician population which is using technology and the Internet for professional purposes. Taking the Pulse®

Europe explores topics such as the Internet usage and experience by location and frequency, e-mail communication, PDA, physician websites, portals and search engine usage, electronic medical records (EMR), personal health records (PHR), electronic prescribing (e-prescribing), web-based sampling (e-sampling), electronic detailing (eDetailing), and online medical education (or eCME).

The segments of European physicians covered in this survey include cardiologists, dermatologists, family medicine/ general practitioners, hematologists, oncologists, infectious disease experts, OB/GYN, paediatricians, psychiatrists, rheumatologists, and surgeons.

Besides a solid country-wise analysis, the technology and information seeking preferences of European specialist physicians can also be immediately accessed by the subscribing clients. n

Dubai to host the 2nd Annual Global Health Care Expansion Congress

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ubai will host the 2nd Annual Global Health Care Expansion Congress during 5-6 September 2007. The venue will be the Hyatt Regency hotel in Dubai. The congress will give the opportunity to buyers in charge of sourcing medical equipments and solutions to meet global industry suppliers as well as to increase their knowledge about the hottest topics and issues facing the fast evolving healthcare industry. Essential to the event are the educational sessions, which will be delivered in a case-study format by experts on the talked-about and important topics and issues facing the industry.

The two-day executive congress would feature the most distinguished names in the field of e-Health, hospital architecture 24

and design and medical imaging.

The event is designed to provide an effective platform for exchanging health experiences and expertise, and networking and forging of new business partnerships in a unique business-driven environment.

This event, which is to be sponsored by Misys Healthcare Systems, Cerner Corporation, Avaya, Oracle, Phillips, Ellerbe Becket and Cambio Healthcare Systems, is a

part of the ongoing educational mission of naseba group’s ‘Knowledge Expansion Series.’ naseba is a world renowned event organizing firm based in France. The congress is organized by naseba, in partnership with names like AME Info, ArabMedicare, DPM News Agency, Dubai Health & News, International Society for Telemedicine & e-Health, Middle East Health, Hindawi Publishing Corporation, Hospital Post, eHealth News EU, The Medicine Publishing Company, Healthcare IT News Europe among others. Holistically speaking, this mega event has the potential to provide a platform to the leading healthcare professionals from all across the globe to brainstorm on the challenges facing the health industry in the nearest future. n

Canada makes inroads in e-Health

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he future of healthcare in Canada is evolving. Implementation of electronic health records across Canada is creating unprecedented efficiencies throughout the country’s healthcare system. According to Richard Alvarez, President and CEO, Canada Health Infoway (Infoway),the Canadian patients are benefiting from a 39 per cent enhancement in electronic health initiatives

that are modernizing the way clinicians deliver healthcare.

Here it deserves a mention that Canada Health Infoway (Infoway) is a federally-funded, not-for-profit organization that is leading the development of electronic health records across Canada.

The organisation works with the provinces and territories across Canada to develop electronic health records,that is paving the way towards a safer and more efficient healthcare system than the healthcare system based on paper records.

In 2006-07, Canada Health Infoway approved investments of $518.9 million in EHR initiatives across Canada, surpassing its target of $335 million. In the last one year, there has been tremendous growth in the number of electronic health record initiatives.n

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Hospital in the US wins wired healthcare system award

or the third consecutive year, the Memorial Hermann system in Houston, USA has been named as the nation’s most wired healthcare system. According to the Most Wired Survey and Benchmarking Study 2007, released by Hospitals & Health Networks magazine, “The Most Wired Survey is conducted annually by Hospitals & Health Networks magazine, which uses the results to name the 100 most wired hospitals and health systems. It focuses on how the nation’s hospitals use information technologies for quality, customer service, public health and safety, business processes and workforce issues”.

Since 1999, the publication has named the 100 most wired hospitals and health systems. The selected institutions show better outcomes in four key areas: mortality rates, patient safety measures, core measures and average length of stay. Based on the

analysis of the ninth annual Most Wired Survey and Benchmarking Study, hospitals are graded on how they use information technology to address five key areas: safety and quality, customer service, business processes, workforce, and public health and safety. In the past year, Memorial Hermann opened three new hospitals with technological innovations including an advanced Electronic Medical Record (EMR) system, paperless check-in using tablet PCs, positive patient ID using arm-band scanning, and OR tracking that enables physicians, staff and families to privately follow a patient’s surgical progress using large display screens in waiting rooms, ORs and postop/pre-op areas. Nurses and staff wear hands-free, wireless communication devices that enable them to connect with each other instantly. Patient diagnosis is also enhanced with a new 3-Tesla magnetic resonance imaging

(MRI) scanner. This 3-Tesla MRI is twice as strong as conventional units, providing unsurpassed imaging and diagnostic capabilities.

“Memorial Hermann has made a tremendous commitment to using information technology to enable top-quality patient care,” said Chief Information Officer, David Bradshaw. He added, “The opportunity to design and build three new hospitals gave us the opportunity to incorporate the very latest, state-of-the-art technology, as well as infrastructure for future growth. Our new hospitals utilize the best technology throughout our system and are piloting some innovations for upcoming rollout to other facilities.”

Hospitals investing in quality are also investing in IT. “The Most Wired hospitals are focused on quality,” said Alden Solovy, Executive Editor of Hospitals & Health Networks. Hospitals & Health Networks conducted the survey in cooperation with Accenture. n

Genetic screening may impede pregnancy

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he credibility of genetic screening, which is being thought of as a panacea for the older women opting for in-vitro fertilization (IVF) treatment to have a child, is now under threat.

Recently a controlled clinical trial of 408 women has sprung a surprise revelation that genetic screening is not only ineffective, but plays a role in reducing pregnancy rates. Genetic screening involves studying the genetic make-up of the embryos, before their transfer to the womb, to ensure those embryos’ health and increasing their likelihood of survival. However, this healthy concept couldn’t withstand the heat of a recent emperical test, conducted by of a group of Dutch researchers. However just one experiment cannot write off the potential of genetic screening as there may be many medical factors influencing the result. n

A partnership to develop a patient and family-centric health system

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CW America (ICW), a leading international e-Health specialist with locations across Germany, Austria, Switzerland, the USA, and Bulgaria, and the Warren Alpert Medical School of Brown University’s Center for Primary Care and Prevention (the Center) at Memorial Hospital of Rhode Island, have reached an agreement to enter into a strategic collaboration to ‘develop and test a 21st century patient-centered, e-Health model of care.’Here it deserves a mention that Brown University in USA is an internationally known Ivy League institution with a distinctive undergraduate academic curriculum, outstanding faculty, state-of-the-art research facilities, and a tradition of innovative and rigorous multidisciplinary study, and Memorial Hospital of Rhode Island is a 294-bed community hospital serving the Blackstone Valley of Rhode Island and Southeastern Massachusetts, USA. The key objective of this strategic collaboration is to show evidence of improvement in quality of care and patient safety by linking, and in this case, actually integrating a patient owned and controlled personal health

August 2007

record (PHR) to their provider’s electronic medical record (EMR). The collaboration will present the opportunity for a demonstration project that will support, promote and illustrate the value of ICW’s integrated LifeSensor® PHR. When integrated, LifeSensor becomes a trusted source of patient health information for providers, and serves as the patient’s ‘source system’.

Jeremy P. Coote, CEO of ICW America stated, “ICW has been very impressed with the environment of quality improvement supported

by Brown and Memorial at the Center. Equally impressive is their record of accomplishment in research and innovation, including clear leadership in embracing health information technology. The Center’s orientation toward improving the patientphysician relationship and fully involving the patient and the patient’s family in clinical care closely matches ICW’s vision.”

Dr. Charles Eaton, M.D. M.S., a Professor of Family Medicine at the Warren Alpert Medi-

cal School of Brown University and Director of the Center, is spearheading this initiative.

“LifeSensor, as an integrated PHR, fully supports the concept that healthcare providers and patients are equal partners in monitoring and managing patients’ health. The model we envision creating with ICW will enable and empower patients to take more responsibility for their health. With our program design, we believe that we may actually prevent illness or certainly lessen the seriousness and impact of diseases.”

Eaton further stated that an integrated PHR-EMR will foster better patient-doctor communications and promote better health outcomes between doctor visits. “Using LifeSensor in this program is not meant to replace the traditional doctor’s office practice but rather enhance and improve upon it.”

In addition to the integration of the PHREMR within the initial programme objectives, the collaboration will also set up the foundational capabilities to enable connectivity for a broader, multi-stakeholder and interoperable regional health inform­ation exchange. n

25

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news review

BUSINESS

CSW acquires software assets of H2HCare

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SW Group Ltd, a leading provider of standards-based e-records products for healthcare and knowledge management in the UK, have acquired the software assets of H2HCare, a health IT company, which specialises in the ‘business of healthcare’. H2HCare provides web-based billing, contracting and financial management capabilities to support effective patient care for public and private healthcare organisations. Here it deserves a mention that CSW has combined in-depth knowledge of the requirements of clinical users with advanced web and XML technology, in its Case Notes product suite, to deliver a new generation of solutions for shared care, health records management.

As a result of this acquisition, H2HCare products will be incorporated into CSW’s Case Notes product suite, extending it from

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product offering will be unique in offering a fully integrated enterprise solution for both clinical and administrative users, and will ultimately improve the patient experience.”

Case Notes Enterprise Booking allows GPs to refer and book patients indirectly—automating the patient booking and scheduling process throughout the hospital and other health or social care settings.

Case Notes Financials is an integrated suite of web-based components which support each stage of the revenue lifecycle from patient access, to billing and claims processing. According to John Chelsom, Managing Director of CSW Group, “The new added features and functionality make Case Notes one of the most comprehensive web-based electronic health records systems on the market.” n

RSLSTEEPER opts for doc@Home for addressing its telehealth solutions

SLSTEEPER, an important supplier of prosthetic and orthotic patient care services in the UK, has teamed up with Docobo—a UK healthcare solutions provider which is involved in the management and prevention of Long Term Conditions (LTCs also known as chronic diseases)—to provide clients with doc@HOME. doc@HOME is an integrated telehealth solution for the remote management of patients with a range of Long Term Conditions (also known as chronic diseases). It is the means for the collection and analysis of essential patient related data, permitting effective management through efficient interaction between clinicians and patients at home.

The doc@HOME service is designed to provide a systematic approach to the management of chronic disease in the home and other locations, which are

August 2007

an electronic health record for cross-agency shared care into a complete service management system for scheduling care delivery and meeting the extended contract quality challenges in the new commissioning environment.

The new software will be released this autumn in Case Notes v5.2 as the Case Notes Financials, Patient Administration and Enterprise Booking modules. CSW is in discussion with former customers of H2HCare in Ireland on upgrades to the new Case Notes versions of the product.

Eamonn Furniss, former Chief Executive, H2HCare said, “I am delighted to see our software incorporated into CSW’s Case Notes. CSW and H2HCare have worked as partners in the past and have very complementary product offerings for private and public healthcare. The combined

remote from the clinicians’ office. Patient-clinician interaction is typically via the Docobo HealthHub, a fit for purpose, robust, hand-held data collection unit which connects through a standard telephone line at the patients home to secure server.

The Docobo HealthHUB portable home monitor allows patients to record vital signs, symptoms, lifestyle and quality of life measures around the clock from any location. Healthcare professional interaction with the doc@ HOME service is via secure web access, using standard browsers,

enabling patient management at a range of locations.

Changes in patient trends can be identified and notified to the authorised user. An authorised clinician can access the patient record on demand and send messages directly to the patient, for example, a request to visit the surgery or to change the frequency and/ or volume of medication.

Andrew Thornton, Managing Director of RSLSTEEPER,said, “We chose doc@HOME because it has several benefits, not least the fact that it has been developed and widely tested successfully in the UK. It has great functionality which makes it ideal for patients with different long term conditions, not just one single disease.

The price of the unit is also very attractive. As well as having low cost, there are no hidden extras that you find with other telehealth solutions.” n

System C expands its ambit into the healthcare market

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ystem C Healthcare plc (‘System C’) has announced a significant strategic step into the private healthcare market with the acquisition of IQ Systems Services Ltd. Here it deserves a mention that System C Healthcare Plc specialises in the provision of information systems and solutions to the healthcare sector. System C Healthcare plc is an independent British company specialising in the provision of clinical information systems and services to the healthcare sector. These services include the implementation of electronic patient record (EPR) systems and patient administration systems (PAS), and a range of associated services including data migration, systems interfacing and training.

IQ Systems Services Ltd is a leading supplier of patient management and clinical software solutions for private treatment centres and hospitals. Its IQUtopia product is highly regarded in the private healthcare marketplace and has been deployed at a number of prestigious private sector treatment centres in the UK. IQUtopia complements System C’s MedWay Patient Administration and Electronic Patient Record (EPR) software. The acquisition of IQ will accelerate System C’s expansion into the private healthcare market as well as strengthen its product portfolio. IQ has a number of major private healthcare customers.

System C’s Chief Executive, Ian Denley commented on this acquisition while stating that, “We are delighted that IQ has chosen to become a fully integrated part of the System C business.”

He further added, “We will work closely with IQ to enhance IQUtopia, strengthen the professional services available to IQ customers, and further expand the strategic relationship with their clients.” n 27

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news review

INDIA UPDATE

AIIMS’ step to ensure faster cure of cancers

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ll India Institute of Medical Sciences(AIIMS) is going to install a new machine imported from the UK, which can help in combating many kinds of cancer in a much better manner. This machine will use an innovative technology called Image Guided Radiotherapy(IGRT), which will concentrate the incidence of radiation directly on the affected tumour and minimise the radiation exposure to the healthy tissues in close proximity to the tumour.

In radiotherapy through the conventional radiotherapy machines, more areas around the tumour are exposed to radiation, thereby affecting the healthy tissues. Through IGRT technology, however, the area around the tumour exposed to radiation will be much less. IGRT technology ensures instant location of the tumour, and concentration of bombardment of radiation directly to the tumour, leaving the surrounding areas relatively harmless. This not only will facilitate a faster and more effective

way of eliminating the tumour, but at the same time will reduce the number of complications that have the risk of rearing up during the course of cancer treatment through radiotherapy.

The IGRT technology is especially crucial for the treatment of moving tumours, and can be very much successful in the treatment of prostate cancer, gynaecological tumours, brain tumours, tumours in the head and abdomen, and breast and lung cancer.

IGRT technology is already in usage in many other countries, but in India this technology’s introduction has been a nascent one. However, in India too AIIMS is not the first player to induct this technology for carcinogenic remedies; already some private hospitals in the country are using this technology. But AIIMS will be the first government hospital in the country to introduce this technology. IGRT technology will be in use in AIIMS from sometimes in the later half of this year. n

A partnership to tackle the AIDS menace

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IDS has become one of the most critical problems plaguing the Indian healthcare scenario. The Department of Biotechnology (DBT) of the Ministry of Science & Technology and the International AIDS Vaccine Initiative (IAVI) have recently signed an agreement to design candidate vaccines for bringing out neutralising antibodies against HIV. A new Indian medicinal chemistry programme, co-sponsored and co-funded by IAVI and the DBT, will be set up. It will be comprising top-notch Indian and US scientists who would be striving with the objective of quickening the pace of discovery of the AIDS vaccine and developing innovative concepts for the next generation of AIDS vaccines.

This new partnership is expected to give a fillip to the ongoing efforts in India to find an AIDS vaccine. The Indian programme will complement the work of IAVI’s Neutralising Antibody Consortium (NAC), which comprises a team of internationally recognised scientists, who are tirelessly working on finding the neutralising antibody to AIDS.n

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Awake CABG comes in rural India

ecently St. Gregorios CardioVascular Centre in Parumala, which is possibly the first rural cardiology centre in India, achieved the distinction of conducting two awake heart surgeries on two 65-year-old aged patients. Awake heart surgery is a rare surgical feat by any standards, and can serve as a great inspiration to the development of healthcare in rural India. The four member team of doctors, led by Dr. Pankaj Kumar Srivastava, carried out Coronary Artery Bypass Grafting (CABG) on the patients, while the patients were awake and chatting. One of the operations was five-hour

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long, while the other extended to four hours.

According to Dr. Srivastava, heart surgery assumes increasing complication for patients having other diseases like lung ailments and thyroid problems, and thus for those patents Awake Heart Surgery is the preferred option, rather than going in for general anaesthesia or a heart-lung machine. In awake heart surgery, high thoracic epidural anaesthesia (TEA) is being used. Now this milestone in tertiary care has at last been achieved. Just a few hours after the surgery, patients were sipping coffee. n

A course to Address the acute shortage of CVR professionals

he Asian Heart Institute(AHI) from Mumbai, in collaboration with Chester University from the UK, will start a part time postgraduate certification programme in cardiovascular rehabilitation.

The duration of the course will be of six months. The course will not only impart knowledge and research about the latest methods and techniques in cardiovascular rehabilitation prevalent at international level, but would also provide practical experience about their usage. The course is open for doctors, senior nurses, physiotherapists and. occupational therapists.

Commencing on Sept 2007, the course will be conducted within the AHI premises only, but the faculty will comprise of experts from India and the UK. After successful completion of the course,

the students will be awarded a certificate in Cardiovascular Rehabilitation from the University of Chester, UK, an accreditation certificate from the Royal College of Physicians, London and membership of the British Association of Cardiac Rehabilitation. This is the first of its kind of course in India, and would help in the creation of professional CVR practitioners in India in much greater numbers, which is a crying need in the Indian healthcare scenario.

The certificate course comprises three eight-week modules on cardiovascular diseases, treatment and rehabilitation; functional anatomy and physiology of the cardiovascular system; exercise testing, prescription and programming in CVR. Each module will be evaluated by a 5,000-word handwritten assignment. n

ISRO to extend its telemedicine ambit in the public sector

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he Indian Space Research Organisation (ISRO) is envisaging to bring more government hospitals across the country, under the ambit of its telemedicine programme. ISRO’s telemedicine programme aims at connecting the rural and district hospitals in the country with the super-specialty hospitals in the cities through INSAT. Under this satellite network, while ISRO provides the software, hardware and communication equipments as well as satellite bandwidth, the specialty hospitals provide the infrastructure and human resource, and also maintain the system. Presently this telemedicine programme of ISRO covers 165 hospitals - 132 district/rural hospitals, which are connected to 33 superspecialty hospitals. ISRO has also established Village Resource Centres in association with NGOs, trusts, and state and central agencies, and has also developed eight mobile healthcare units. Four of them are in Tamil Nadu, while two each are in Kerala and Karnataka. n

August 2007

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s p o t li g h t

Laboratory Information Systems: Coming to the Fore Hitherto overlooked LIS is finally rising to prominence LIS can ensure quicker availability of test results and analysis in ICUs, operating rooms or emergency room settings. The faster turnaround times by reducing the time to report can save invaluable patient lives. LIS can be integrated with point of care diagnostic devices at these locations for information management. The value of providing detailed results to clinicians in real time cannot be undermined.

Dr. Pushwaz Virk

A

majority of the initiatives advocating the use of information technology in hospitals or clinical practices, focus on electronic medical record systems. While the advantages of EMR systems have been substantially proven, an often-overlooked aspect of healthcare delivery automation is the use of information technology in clinical laboratories.

Imaging services are leading the technology adoption curve in healthcare while the laboratory information systems lag quite behind. Imaging tools are closely integrated with computerized systems for display and communication of data, so there is relatively no process disruption by the introduction of radiology information systems. Similarly, the need to track inventory has propelled pharmacies as one of the drivers to adopt information systems, which are now being linked to EMRs for e-Prescriptions. However, laboratories have been using paper-based systems. Here the automation has been patchy and the lack of widely accepted standards and protocols for data communication has impeded the concerted effort to make the laboratory systems talk.

Laboratory investigations consume a small proportion of the healthcare budget, but influences a great percentage of clinical decisions. In a study, it was indicated that the laboratory tests comprised 3-5 percent of the hospital’s budget, but influenced about 60-70 percent of the decisions about admitting patients, ordering medications or discharges. Both ‘Laboratory Information Management Systems (LIMS)’ and ‘Laboratory Information Systems (LIS)’ refer to the software systems used in laboratories, however, in a hospital setting, LIS is more prevalent.

Laboratory Information System

Laboratory Information System is a generic term used to denote the computer systems in a clinical or research laboratory. LIS has multiple modules for data collection, tracking, 30 }

analyzing, reporting or delivery of results. The data can be related to patients, lab employees, samples, results, instruments, consumables or reagents, etc. LIS can also be used for workflow management, accounts and control of instruments if integrated with the system. The LIS is interfaced with Electronic Medical Record (EMR) or Hospital Information System (HIS) for exchange of data, and faster access of laboratory results at the patients’ bedside. LIS can support various subspecialties of a pathology laboratory including hematology, chemistry, immunology, blood bank, surgical pathology, anatomical pathology, flow cytometry and microbiology. The inputs into a LIS are a uniquely identifiable physician order and a matching patient sample. These are then matched with the patient record and the order is processed. The outcome of the test is then manually or electronically added to the patient record for access by the physician.

LIS can generate bar-codes or a unique identifier for the samples. This helps in easier, faster and error free tracking of samples. If the testing instrument is automated, which is in most cases, samples are uploaded in batches and the analyzing instruments match the results and relay them directly to the LIS system. In case of manual systems, a technician matches the results with the samples and the patient, and enters the data into the system. These are either printed on the lab report or sent to the hospital medical record system.

LIS also stores the demographic information of the patients, tests orders, and results for retrieval. Furthermore, LIS collects the data from multiple testing departments, instruments or locations into a single report and database. A very useful purpose of LIS is to support the ordering clinician with various options of tests that he or she could choose from with indicators for each patient. These systems could be standalone or be operated by a clinical pathologist for advance decision support. In some hospitals, such systems have been piloted and the physicians are increasingly turning to expert advice for laboratory investigation selection and also interpretation www.ehealthonline.org

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laboratory information systems: coming to the Fore

advise to increase the quality of care, reduce medical errors and decrease the cost of care.

Standards

In order to ensure interoperability and seamless exchange of clinical information, global standards have emerged, which enable the adoption of LIS technology without worrying about interfaces. SNOMED (Systematized Nomenclature of Medicine Clinical Terminology) is the industry standard for representation of medical terminology in electronic systems.

It harmonizes the collection, encoding, storage, sharing and transmission of clinical data, including disease nomenclature, procedures, pathogens, pharmaceuticals, etc. The standardization helps healthcare providers working across countries, healthcare systems and dialects to effectively communicate, report and make transactions, thereby facilitating in seamless and accurate exchange and aggregation of laboratory results.

Using Health Level 7 (HL7) standards, guidelines, and methodologies, LIS are able to exchange data with electronic health records, ensuring interoperability across various healthcare networks. HL7 is the standard for interfacing clinical data in Health Information Systems.

The Area Committee on Automation and Informatics of the Clinical and Laboratory Standards Institute (CLSI) identifies, manages and coordinates the development of standards and guidelines for the design and integration of automated clinical laboratory. Logical Observation Identifiers Names and Codes (LOINC) is the standard for identifying laboratory or clinical observations, test names and outcomes in transactions between hospitals, laboratories, laboratory testing instruments and public health authorities.

can provide surveillance data to public health agencies, using the accepted standards, and these data could be about reportable disease, infections, tumour registries, etc.

LIS can also facilitate evidence-based medicine. The systems can be used for trend analysis, tracking of disease profiles and conducting research studies. Laboratories generate a lot of data, running into millions of test outcomes everyday. These data can be matched with the appropriate clinical records to determine outcomes, which could dynamically influence the treatment plan. In a study, about 25 percent of primary care physicians found the expectations of care beyond the scope of their knowledge.. The physicians will be well served with a LIS which helps to provide interpretations to ordering physicians that are specific to patients’ needs and conditions.

LIS also helps to ensure better quality of care by providing comprehensive interpretation of tests; decision support during ordering and earlier detection of adverse events. Increasingly, the general practitioners feel that the clinical information is growing too fast for them to keep track of. So a

LISt of Benefits

Laboratory Information Systems provide a number of benefits, which undeniably provide a great incentive towards their adoption. Some of the benefits that healthcare organizations can derive from such systems are elucidated here.

LIS can ensure quicker availability of test results and analysis in ICUs, operating rooms or emergency room settings.

The faster turnaround times by reducing the time to report can save invaluable patient lives. LIS can be integrated with point of care diagnostic devices at these locations for information management. The value of providing detailed results to clinicians in real time cannot be undermined. In a study conducted at Massachusetts General Hospital, the clinicians’ improved accuracy in 70-80 percent of the cases using expert opinions of pathologists were facilitated by LIS. The concerned pathologist used a LIS with clinical decision support to provide narrative interpretation with every lab result to cohort of clinicians.

Disease surveillance for earlier detection of epidemics is another important benefit. LIS systems can be connected with a central monitoring system, which picks up subtle changes in trends. Such a system is being set up under the World Bank funded Integrated Disease Surveillance Project in India. LIS 32

LIS with decision support can be usefully integrated with the Computerized Physician Order Entry System (CPOE). Just as CPOE systems have been very successful in the selection of appropriate medications, use of similar systems for laboratory test selection will improve the patient safety and quality of care. In another study, a decision support system was put in place to assist the physician with ordering tests. The study indicated that the physicians who used this system, ordered lesser number of tests, leading to reduced sample collection and costs. LIS can lead to inventory management without the use of bar-code systems or radio frequency IDs. Automation in the laboratories will provide the same benefits as any retail or service industry.

Another potential benefit is the error reduction in labelling and interpreting by automating the process of sample collection, testing and reporting. Using unique identifiers for physician orders, patients and samples, potentially dangerwww.ehealthonline.org

ous mistakes can be avoided. Studies have shown improvement in patient safety with the use of information technology tools. There can be improved communication between departments by connecting LIS with the Hospital Information System, which can result in cost savings and increase in productivity. The laboratory diagnostic tools are becoming complex. Emergence of molecular diagnostics will further increase the dependence on information technologies for interpretation and management of test results. Increase in utilization and testing options frequently puts uncertainty among the ordering clinicians choice of investigations, resulting in inappropriate ordering in some cases.

Regulatory compliance by incorporating checks and alerts in the laboratory management workflow is another possible benefit. Laboratory requirements can be programmed into the systems so as to generate alerts for warnings or for deviations from protocols. These are of immense help in QA activities and in ensuring compliance with government and regulatory compliance. Easier and quicker billing by integration with hospital accounting systems can prevent much undue hassles.

physicians in the selection and interpretation of tests, but the ongoing developments in evidence-based practice of medicine have been very encouraging.

The problem so far has been the complexity of such decisions.

Currently, there is no widely acceptable algorithm-driven test selection and interpretation software. However, in the future, with the adoption of sophisticated biomarker-based diagnostic tools, data warehousing studies on patient registries and use of search engine technologies on large patient databases, such applications are possible.n References

1.

2.

3.

4.

Current issues

However, notwithstanding the potential benefits of LIS, Laboratory Information Systems have to cover some ground before they become ubiquitous. Some of the issues in LIS are around: Integration with EMR systems of the hospitals. Even though standards for exchange of patient information exist, sometimes it becomes a challenge to integrate with legacy EMR systems.

Paucity of intervention free, intelligent and reliable decision support to the ordering physicians. Due to the complexity of clinical practice, a same test may not be ordered for two different patients, maybe because the family history is different or patients can’t afford it. The LIS have not become sophisticated enough to consider all practical permutations.

General poor state of automation of clinical laboratories resulting in barrier to adoption. In a resource-starved setting, introduction of LIS can be considered an overkill.

Appropriate training of lab techs in information technology tools is also the need of the hour.

HIPAA and privacy issues around sample management needs a concern. Electronic information has the potential of abuse, but with wider adoption of EMR systems, these concerns have subsided.

5.

6.

7.

8.

9.

10.

11.

12.

13.

Conclusion

Laboratory Information Systems have come a long way, but are poised for even greater growth as complex medical investigations become more pervasive. With increasing use of molecular diagnostics, biomarker-driven testing tools and genomic technology in clinical practice, the LIS will become indispensable. A lot of work still needs to be done for algorithm development and decision analysis to fully support the August 2007

Forsman RW. Why is the laboratory an afterthought for managed care organizations? Clin Chem 1996;42:813-816 Laposata M. Patient-specific narrative interpretations of complex clinical laboratory evaluations: who is competent to provide them?.

Clin Chem 2004;50:471–472 Health data standards: The Players. (http://faculty.washington. edu/ocarroll/infrmatc/database/data/players.htm. Accessed July 15, 2007) Clinical and Laboratory Standards Institute, Area Committee on Automation and Informatics (http://www.nccls.org/source/custom/ comm_aut.cfm?Section=Area_Committee_on_Automation_and_Informatics. Accessed July 15, 2007) Laposata ME, Laposata M, Van Cott EM, Buchner DS, Kashalo MS, Dighe AS. Physician survey of a laboratory medicine interpretive service and evaluation of the influence of interpretations on laboratory test ordering. Arch Pathol Lab Med. 2004;128:1424-1427 The World Bank, Integrated Disease Surveillance Project. (http://web. worldbank.org/external/projects/main?pagePK=104231&piPK=732 30&theSitePK=40941&menuPK=228424&Projectid=P073651. Accessed July 15, 2007) St. Peter FR, Reed MC, Kemper P, Blumenthal D. Changes in the scope of care provided by primary care physicians. N Engl J Med 1999;341:1980-1985 Teich JM, Merchia PR, Schmiz JL, et al. Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000;160:2741-2747 Smith BJ, McNeely MDD. The influence of an expert system for test ordering and interpretation on laboratory investigations. Clin Chem.

1999;45(8 pt 1):1168-1175 Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med 2003;348:2526–2534 Berwick DM. A primer on leading the improvement of systems. BMJ 1996;312:619–622 Green ML, Ciampi MA, Ellis PJ. Residents’ medical information needs in clinic: are they being met?. Am J Med 2000;109:218–223 Dighe AS, Soderberg BL, Laposata M. Narrative interpretations for clinical laboratory evaluations: an overview. Am J Clin Pathol 2001;116 (suppl). :S123–S128

Dr. Pushwaz Virk.

Harvard University Health Services, Cambridge, MA Pvirk@uhs.harvard.edu

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perspective

Healthcare in India: Problems and Prospects Will e-Health be the answer to the ongoing scenario ?

By the application of e-Health, knowledge or information pertaining to a quality and sophisticated healthcare system can be made accessible to remote corners of India, where only rudimentary health infrastructure is available. For example, a team of medical experts sitting in London or the USA can impart their diagnostic skills or prescribe appropriate medication to a critically ill patient in rural Bihar, through the help of effective information technology networks. Telemedicine can also help in training of medical personnel across the country, and thereby India can improve its human resource in health sector, by making them abreast of the current developments in the field of medicine.

D

espite all the recent hypes about India’s perceived emergence as a knowledge superpower, which are bandied by the popular media with tacit support from the establishment, with uncommon enthusiasm, there is no denying the fact that India as a country, even after six decades of its political independence, is still failing miserably to address the basic needs of its multitude of teeming millions. And it is common economic wisdom that without sustained development measures, knowledge can’t flourish in a society. At best it can remain confined to the elite echelons of the society, who have their eyes set on the Silicon Valley.

Perhaps one of the most basic of these basic development parameters is the need for basic healthcare to its population.

Health is a very neglected sector in India. In the past decade, the average expenditure of the Union Government on health and related areas has been around 0.35 per cent of GDP, and in the 2007-08 budget, the budgetary allocation for health was only a dismal 0.2 percent of India’s GDP. This is abysmally low by global standards.

A Lopsided Story

The WHO recommendation for spending in health is 5 percent of the state’s GDP; a target which needs enormous political will for India to reach in the near future. However, this meagre spending on health is also not evenly distributed; a major chunk of the public healthcare spending is concentrated in the metros. Ironically 80 percent of health allocation in India is in urban areas, though 74 percent of India’s population lives in rural areas. It doesn’t take a statistician to gauge that rural India of 2007 has very limited access to quality healthcare. The unequal true story doesn’t end here. About 85 percent of healthcare in India is channeled through pri34 }

vate enterprises, and private healthcare is beyond the reach of majority of Indian populace. Though India boasts of a few super-specialty hospital chains like Apollo, Fortis and Max, etc. and they do offer medical services at par with global standards, but their prohibitive costs are beyond the reach of the vast majority of Indian populace. The fact that majority in India is outside the safety net of medical insurance, further compounds the problem. Thus there is a yawning gap between the privileged, and the not so privileged, and the underprivileged class in India, in terms of access to quality healthcare, both in terms of medical and human resources.

While India has 30,000 MBBS graduates coming out of its colleges every year, the entire rural health system of more than 750 million people never has more than 26,000 doctors.

Moreover, the better skilled and educated among them always naturally opt for greener pastures in metros and foreign countries, leaving rural India reeling under an acute paucity of high level medical specialists.

Amidst the backdrop of such a sordid scenario, it comes as no wonder that in India, annually, on an average, 22 lakh infants and children die from preventable illnesses and about one lakh mothers succumb to death during child birth. India has an unhealthy infant mortality ratio of 57 per 1000 live births, which is even higher than that of the less developed nations like Bangladesh and Namibia, and the maternal mortality ratio of the country; even as late as 2006, stood at a shameless 540 for every 100,000 live births. In rural areas this figure was 619. What’s more, according to UNICEF, India also has the dubious distinction of accounting for 20 percent of the world’s maternal mortality cases. It is alarming that there are 2.5 million HIV/AIDS victims in India, but what is more alarming is that lakhs of people die in this country through tuberculosis every year, which is easily curable by today’s medicine. www.ehealthonline.org

At the very outset, we have to acknowledge that the main problem in India’s health sector is not the unavailability of medicine and human resources, but their proper accessibility and distribution. Like in everything else, the health sector in India is plagued more by the distribution lacunae than the production bottlenecks.

Unless we take care to make a decent health system accessible to the multitude of our population(accessible in terms of cost, demographics and geography), many such tragic incidents like that of Sarita’s would continue to hog newspaper headlines and stream through audiovisual bytes. Sarita is a seven-year-old girl suffering from complete renal failure, a daughter of a vegetable vendor, who was recently thrown into the river by her hapless father, who couldn’t carry her medical expenses. She was luckily rescued by some fishermen, but her future, and the future of Indian healthcare, remains a big question mark. I have a nagging suspicion that for every Sarita gaining media attention, there are hundreds of such ‘Saritas’ suffering in oblivion.

Silver Linings

By rattling off the above statistics, I am here not implying that nothing has been done to improve India’s healthcare. There have been developments in the recent years, but much more needs to be done to address this mammoth problem. The fact that the Union Government has proposed to increase the allocation of the National Rural Health Mission(NRHM) from

The Integrated Disease Surveillance Project of the Ministry of Health and Family Welfare, and the Department of Information Technology’s initiatives of networking the district hospitals in Mizoram and Sikkim with Apollo Hospital, Delhi, and its development of Teleoncology network in Kerala and Tamil Nadu, are noteworthy e-Healthy achievements in the public sector.

Furthermore, ISRO’s telemedicine programme aims at connecting the rural and district hospitals in the country with the superspecialty hospitals in the cities through INSAT. Under this satellite network, while ISRO provides the software, hardware and communication equipments as well as satellite bandwidth, the specialty hospitals provide the infrastructure and human resource, and also maintain the system.

Rs.8207 crore in the 2006-07 budget to Rs.9947 crore in the 2007-08 budget reflects the present government’s concern about the country’s appalling healthcare. Overall, the Finance Minister has enhanced the expenditure on health and family welfare by 21.9 percent in the current fiscal, as compared August 2007

to that of the previous fiscal year. The Finance Minister has also expressed the present government’s determination and resolve to achieve zero level growth of HIV/AIDS in his recent budget. The provision for the AIDS Control Programme has also been proposed to be stepped up in the current budget to Rs.969 crore. But all said and done, these are small steps...we need some revolution of sorts to make any significant difference to our healthcare system.

IT can be a Healthy Solution

In this depressing scenario, e-Health or electronically enabled healthcare can provide the much-needed silver lining and bridge the gaps in healthcare access that is prevalent in the Indian society. In fact, India and many other developing countries need e-Health more than the developed world, because conventional healthcare has failed to reach the former group’s large sections of underserved population.

By application of e-Health, knowledge or information pertaining to a quality and sophisticated healthcare system can be made accessible to remote corners of India, where only rudimentary health infrastructure is available. For example, a team of medical experts sitting in London or the USA can impart their diagnostic skills or prescribe appropriate medication to a critically ill patient in rural Bihar, through the help of effective information technology networks. Telemedicine can also help in training of medical personnel across the country, and thereby India can improve its human resource in health sector, by making them abreast of the current developments in the field of medicine. However, before all things, the government and the private players have to collectively ensure that the cost to incur the benefits of e-Health are within the reach of the majority of India; otherwise the entire exercise will be a futile one from a development perspective, though reflecting mercenary dividends.

Besides ensuring a more equitable access to healthcare delivery, e-Health in India, among myriad other welfare-ori35

perspective

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healthcare in india: problems and prospects

ented aspects, can also ensure knowledge management in healthcare industry and facilitate a more optimal utilization of limited medical resources.The example of the former is an electronic data base of patients’ history and other basic health performance indicators such as sterilisation, birth attendance, and immunisation rates in a given district. Electronic health records can ensure easy access to patient’s information across the globe, minus the clinical errors. Another example of optimal allocation of limited healthcare resources can be the proper allocation of healthcare centers across the geographic ambit of a given district, achieved through geographic mapping systems.

Inches Achieved, Miles to go

There are some significant initiatives by the public as well as the private sector to increase e-Health’s incidence in the health sector. The Integrated Disease Surveillance Project of the Ministry of Health and Family Welfare, and the Department of Information Technology’s initiatives of networking the district hospitals in Mizoram and Sikkim with Apollo Hospital, Delhi, and its development of Teleoncology network in Kerala and Tamil Nadu, are noteworthy e-Healthy achievements in the public sector.

ISRO’s telemedicine programme aims at connecting the rural and district hospitals in the country with the super-specialty hospitals in the cities through INSAT. Under this satellite network, while ISRO provides the software, hardware and communication equipments as well as satellite bandwidth, the specialty hospitals provide the infrastructure and human

cal Sciences(SGPGIMS) in Lucknow. In the private sphere, Apollo Telemedicine Networking Foundation(ATNF) is doing a yeomen service to facilitate the progress of telemedicine across India, and has even established overseas telemedicine units in Colombo, Dhaka, Maldives and Lagos among others.

With over 17,000 teleconsultations, ATNF has emerged as

Sarita is a seven-year-old girl suffering from complete renal failure, a daughter of a vegetable vendor, who was recently thrown into the river by her hapless father, who couldn’t carry her medical expenses. She was luckily rescued by some fishermen, but her future, and the future of Indian healthcare, remains a big question mark. I have a nagging suspicion that for every Sarita gaining media attention, there are hundreds of such ‘Saritas’ suffering in oblivion. possibly the largest multi-specialty telemedicine network in South Asia. However, though Apollo may be the first player to enter the field of telemedicine, when it started its telemedicine network in the Aragonda village of Andhra Pradesh way back in 1999, but lately there have been many other private players making noteworthy inroads in the e-Health domain.

The names of Narayana Hrudayalaya, Bangalore and Aravind Eye Hospital based in Madurai, must deserve special mentions in this regard.

Handle With Care

resource, and also maintain the system. Presently ISRO’s telemedicine network covers 165 hospitals, which include 132 district/rural hospitals and 33 super-specialty hospitals.

What’s more, the Indian Space Research Organisation (ISRO) is envisaging to bring more government hospitals across the country, under the ambit of its telemedicine programme.

Other important players and institutions furthering the cause of e-Health in the country include the names of AIIMS, C-DAC and Sanjay Gandhi Postgraduate Institute of Medi36

However, all said and done, we have taken only a few fumbling forays towards realising the seemingly enormous potential of e-Health in our healthcare scenario, and there are miles to go. For this, only talks and seminars wouldn’t do.

We need proactive action to translate the idea of e-Health into a welcome reality. We need to pull up our socks as far as adoption of ICT in medicine in India is concerned. At present the penetration of e-Health in the Indian context leaves much to be desired. An average mid-sized hospital in India(which are mostly concentrated in cities) spends less than 1.5 percent of its turnover on IT (new investments plus the annual maintenance) while a large hospital spends only around two percent of its turnover on IT, which by any standards is not a noteworthy achievement.

At the same time, we should not throw caution to winds and celebrate the adoption of this amalgamation of ICT and medicine without circumspection. e-Health’s usage must be very prudent, and care should be taken to see that the benefits of ICT revolution helps to transmit the benefits of medical knowledge effectively to the underserved sections of the population of India, without compromising on their privacy, which may be revealed through insensitive dissemination of sensitive electronic health records among other things.n Swarnendu Biswas, swarnendu@csdms.in

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project showcase

The SOPARNO Project Set to Make an Impact Empowering the ageing population in Europe

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OPRANO stands for ‘Service-oriented Programmable Smart Environments for Older Europeans’ and it is an integrated project in the European Commission’s 6th Framework Programme (IST Priority 6th Call on Ambient Assisted Living or AAL). The SOPRANO project sets out to develop and provide highly innovative ambient assistance to a range of living situations. The objective of the SOPRANO project is to develop affordable, smart ICT-based assisted living services with interfaces, which are easy to use for older people and are familiar in their home environment. The Soparno project was started in January 2007, and will have a duration of 40 months.

The societal trends SOPRANO is responding to are the rise in the proportion of older citizens in the population due to demographic change, which is a particularly prevalent phenomenon in Europe, the scale and type of needs of older citizens which societies must plan to meet, the rejection of current ICT-based services by many older citizens, the steady deterioration of non-ICT-based service provision in the information society, the poverty of offer of ICT-based services usable by older citizens, and the difficulty of designing ICT-based services usable by older citizens. At the same time, research has shown that a large segment of the growing number of older people in Europe can be offered AAL services, which can radically improve their quality of life, provided usability of ICT systems can be radically improved.

The opportunity to do this is given by recent developments in ambient intelligence and new abilities of software systems to communicate with users in something approaching natural human 38 }

to human interaction. The new European Commission’s Programme on AAL, of which SOPRANO is a part, was launched against a background of this accelerating demographic ageing across Europe. The EC research is to show how technologies such as computers, the Internet and mobile communications— which are already pervading many aspects of everyday life—can be used to tackle emerging health problems and in

particular contribute to improved quality of life for older people.

SOPRANO develops and adapts to normal home environments a sophisticated range of suitably unobtrusive ambient intelligence components, seamlessly linked to external service provision. A major objective of SOPRANO is to take a leap forward in the way users can interact with and take charge of their living environment and in the way professional care personnel can support them when called on to do so.

SOPRANO AAL systems are not only to help users deal with their home environment - its lights, heating, door security, etc. - in comfort and safety, but

www.soprano-ip.org

also to give them improved access to the world outside home, including general online services and new forms of eCare, utilizing ICT-based support from care professionals.

SOPRANO, to be installed in homes, aims to enable provision of flexible, individualised supportive services and healthcare; to promote continued ability to live independently; to help integrate people with functional impairments into social life so as to maximise their independence and help them retain their dignity. Involvement of the community, as well as an older person’s family, neighbours and friends in service provision is part of the approach.

Assisted living already serves a broad range of elderly people and provides a bridge between active retirement living and care in a nursing facility.

Three strands of research and development are to be integrated. They are: • Stand alone assistive technology: products designed to compensate for motor, sensory and cognitive difficulties frequently experienced by older adults; • Smart home technology: networking of ICT in the home environment, with the integration of appliances and devices to provide control of the entire living space; • Telecare services: applications addressing care-related needs prevalent among older people, with ICT utilised to enable support from professionals and informal carers.

The SOPRANO consortium of enterprises, public bodies and research institutes comprises over 20 partners from seven European countries, namely Greece, Germany, the UK, the Netherlands, Spain, Slovenia and Ireland, headed by EXODUS (Greece).n www.ehealthonline.org

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