e-Health in a Developing World: January 2007 Issue

A monthly magazine on ICT and Health

Vol. 2 No.1

January 2007

Rs. 75

www.ehealthonline.org Subscriber’s copy not for sale

e-Health in a Developing World

Focusing Equally on ‘E’ and Health

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Dr. Sundeep Sahay & Selamawit Molla Mekonnen

e-Health in Developing Countries

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Dr. Aradhana Srivastava

‘E’ for Excellence; ‘e’ for Health

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Interview : Prof. S.K. Mishra

6-8 February, 2007 Putrajaya International Convention Centre, Malaysia

Listen to the key decision makers, experts and thought leaders in e-Health, from Asia and beyond ...

Alvin B. Marcelo MD, University of the Philippines

Brenda Zulu Freelance Journalist, Zambia

Dr. Shashi Gogia President, Indian Medical Association, India

Eva Tanner Project Manager, DiploFoundation, Switzerland

Frank Lievens Managing Director of LIEVENS-LANCKMAN BVBA, Belgium

Jibananda Roy Institute for Planning Innovative Research, Appropriate Training and Extension , Kolkata, India

N. Parasuraman M.S. Swaminathan Research Foundation, Chennai, India

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

Santulan Chaubey Manager – Information Technology, Institute of Liver and Biliary Sciences, New Delhi, India

Sujay Deb IIT Kharagpur, India

Bruno von Niman ETSI TC Human Factor, Vice Chairman, Lead Expert, Vonniman Consulting, Sweden

Jagjit Singh Bhatia Director, Center for Development of Advanced Computing, Mohali, India

Mandeep Singh Randhawa Project Associate, Center for Development of Advanced Computing, Mohali, India

Sapiah Sulaiman Faculty, Universiti Teknologi Malaysia

Toms K Thomas Consultant, Evangelical Social Action Forum, Kerala, India

Organisers

knowledge for change

Host Organisations

Ministry of Energy, Water and Communications (MEWC) Government of Malaysia

Principal Sponsor

International Government Partners

MCMC

www.e-ASiA.org/ehealthasia.asp

Contents Cover Story

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Focusing Equally on ‘E’ and Health Case Studies from India and Ethiopia Dr. Sundeep Sahay, Selamawit Molla Mekonnen

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e-Health in Developing Countries Pitfalls, Challenges and Possibilities Dr. Aradhana Srivastava

Perspective

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Melinda G. Frost, Jay M. Bernhardt

Case Study

Interview for Excellence; ‘e’ for Health 36 ‘E’Interview with Prof. Saroj Kanta Mishra

CDC Fosters Global e-Health

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Synergizing Knowledge and Action AIDS Community of Solution Exchange Dr. Mohamed Essa Rafique, Rituu B. Nanda, Steve Glovinsky, Monica Raina

Report

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A Meet of Great Belief

News

25 31

Business World

January 2007 | www.eHealthonline.org

Project Showcase

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A Helping Hand

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Editorial Guidelines Contributions to eHealth magazine could be in the form of articles, case studies, book reviews, event report and news related to e-Health projects and initiatives, which are of immense value for practitioners, professionals, corporate and academicians.

We would like the contributors to follow these guidelines, while submitting their material for publication: • Articles/ case studies should not exceed 2500 words. For book reviews and event reports, the word limit is 800.

• An abstract of the article/case study not exceeding 200 words should be submitted along with the article/case study.

• All articles/ case studies should provide proper references. Authors should give in writing stating that the work is new and has not been published in any form so far.

• Book reviews should include details of the book like the title, name of the author(s), publisher, year of publication, price and number of pages and also have the cover photograph of the book in JPEG/TIFF (resolution 300 dpi).

• Book reviews of books on e-Health related themes, published from year 2002 onwards, are preferable.

In case of website, provide the URL. • The manuscripts should be typed in a standard printable font (Times New Roman 12 font size, titles in bold) and submitted either through mail or post.

• Relevant figures of adequate quality (300 dpi) should be submitted in JPEG/ TIFF format.

• A brief bio-data and passport size photograph(s) of the author(s) must be enclosed.

• All contributions are subject to approval by the publisher.

Log on to www.ehealthonline.org for goings-on in the world of eHealth 4

eHealth | January 2007

Editorial Vol. 2, Issue 1

January 2007

e-Health: An answer to the depressing healthcare scenario Welcome to a very happy new year of 2007. In this brand new year, we have a brand new news for you; in view of the overwhelming responses from our esteemed readers from e-health fraternity across the globe, we have been induced to change gears. From a bi-monthly mode, we have now progressed to a monthly mode.

Yes, from this issue onwards e-Health will be a monthly magazine, and that speaks volumes for the progress of e-Health as an idea whose time has come.

Simply put, e-Health is the synergy of ICT and medical science, which can not only facilitate, but revolutionize the healthcare of tomorrow. However, though the developed world has got familiar with the concept and practice of e-Health, the idea of e-Health is yet to take its root in the developing and underdeveloped nations of the world. This dismal fact is more true for a majority of the Asian countries, where poverty, ignorance and illiteracy rule the roost, and there is a predominant current of societal apathy towards use and application of new technologies. It is ironical, because the developing nations need the aid of e-Health much more than the western developed nations.

It is not only because the allocation for health budget in the developing countries is only 6 percent of their GDP on an average, compared to 11 percent in the developed countries, but also because of the by and large dilapidated rural healthcare infrastructure in the developing nations. At the same time, the prevalence of diseases is much more rampant in the developing nations than their developed counterparts.

We don’t have to go far to prove our point. Let’s take the example of India, where a large chunk of rural populace is having little or no access to quality healthcare. India spends only 1 percent of its GDP on health, and about 80 percent of its healthcare provision is concentrated in the urban areas.Besides, 85 percent of healthcare in India is channeled through private enterprise, and private healthcare is beyond the reach of majority of Indian populace. e-Health can give an effective solution to all these deep-rooted inequalities in India’s and other developing countries’ depressing healthcare scenario, by simply bridging the geographical distance between the doctor and the patient, which may not only enable the patient in a Haryana village to get medical care from the US specialists, but can also help the patient to avoid or at least markedly reduce the number of visits to the doctor, and thereby save him/her spiraling medical expenses.

However, it should be borne in mind that e-Health is a great idea needing a smart execution. At present, there are several lacunas towards executing a comprehensive e-Health infrastructure in the developing countries across the globe, but thankfully, the possibilities are also immense. We discuss some of these pertinent issues in our January issue of eHealth, raised by our expert panel of writers.

In this context, the importance of eHealth Asia 2007, which will be held during 6-8 February 2007 at Putrajaya International Convention Centre (PICC), Putrajaya, Malaysia, just cannot be overemphasized.

Ravi Gupta Ravi.Gupta@eHealthonline.org President Dr. M.P. Narayanan Editor-in-Chief Ravi Gupta Assistant Editor Swarnendu Biswas Sr. Sub Editor Prachi Shirur

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Cover Story

FOCUSING EQUALLY ON ‘E’ AND HEALTH Case Studies from India and Ethiopia

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he term e-Health can simply be defined as the application of information and communication technology (ICT) in the healthcare sector.

It includes telemedicine, electronic patient records system, the use of mobile devices like PDAs, and electronic health information reporting systems under its broad ambit. We argue, e-Health encompasses not only the ‘e’, (the technical) but also the ‘health’, which includes the organizational and institutional aspects. In this article, we focus on the issues of capacity building, one of the key factors that influences the implementation of e-Health projects.

Proposals and implementation plans around e-Health projects typically have a significant component of capacity building in their descriptions. While this emphasis is indeed welcome, the manner in which it is conceptualized and implemented is highly inadequate. In this article, we have attempted to analyse capacity development in the context of e-Health, in developing countries. While there is a universal recognition of the importance of this topic, approaches to address them are typically naïve and simplistic, focussing on the quantity of the efforts rather than its contents and structure.

Here we attempt to analyse the reasons for this inadequacy, and suggest some

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strategies to address them. Empirically, we draw upon the case of e-Health implementation in Ethiopia and India, in their ongoing attempts to implement electronic health information reporting and analysis tool called District Health Information Software (DHIS).

The implementation is part of the Health Information System Project (HISP) which started in 1994 in South Africa and is currently running in a number of developing countries in Africa and Asia.

This project is coordinated by the University of Oslo through the funding of NORAD and EU. In this regard there are two specific research questions.

One is how can the notion of capacity development be understood in a more holistic manner, and secondly what strategies can be adopted to practically approach capacity building from this expanded perspective?

Capacity building in Ehealth: Ethiopia and India (i) HISP India Health Information System Project (HISP) activities started in India in 2000, and initially the DHIS 1.3 (which is Microsoftbased) software was customized and deployed in the state of Andhra Pradesh through the efforts of a local development

Proposals and implementation plans around e-Health projects typically have a significant component of capacity building in their descriptions. While this emphasis is indeed welcome, the manner in which it is conceptualized and implemented is highly inadequate.

Dr. Sundeep Sahay Department of Informatics, University of Oslo, Norway sundeep.sahay@yahoo.com

Selamawit Molla Mekonnen Department of Informatics, University of Oslo, Norway selam_molla@yahoo.com

eHealth | January 2007

group. Initially the implementation efforts were carried out directly through Oslo faculty and students, and as the project grew, in 2003, an organization called HISP India was established as a not for profit NGO. Today, HISP India has about 35 full time and 80 contract staff, primarily coming from an informatics background. In 2005, the Kerala state government allowed HISP to conduct a pilot study, provided no license purchases were involved. Since this process broadly coincided with the development of DHIS 2.0, HISP India took the decision to pilot the same, even though it was not fully tested. The process of field implementation started in February 2006, and since then, HISP India has grappled with various capacity related issues.

An advantage of HISP India’s NGO structure is the autonomy and freedom it provides for the staff to conduct implementation activities, unconstrained by the bureaucracies of a university department. A disadvantage however is that the NGO does not have the independent capacity or mandate to run educational programs, and over time it is trying to address this limitation by developing tripartite linkages with other Indian educational institutions (Public Health and Informatics) together with University of Oslo.

During the initial stages in Andhra Pradesh, the HISP India team, because of the large scale availability of visual basic developers, created a strong capacity in DHIS 1.3, and independently developed various enhancements such as the incorporation of GIS functionality.

Through intensive capacity development efforts, significant gains have been achieved with the health staff now capable of independently conducting their monthly entry of routine data, generating the required reports, and its transfer from the PHCs to the districts.

However, a shortcoming of the entire effort has been the strong informatics bias at the expense of public health, and so topics such as the use of information have not been equally emphasized.

January 2007 | www.eHealthonline.org

Even though the DHIS 2.0 in its first version was untested and there was inadequate capacity in the team, HISP India decided to go ahead with the field implementation, so as to learn on the job, and gain feedback to help continually improve the application. The first version was tested on Linux environment with English language, and subsequently shifted to Windows as two more states (Jharkhand and Gujarat) were added on to the list of DHIS2 users with varying needs. This paved the way for the usage of local language, Hindi and Gujarati respectively.

scholarships from the Norwegian government, for their doctoral and masters studies at Oslo respectively. As the masters students graduated in 2005, a new batch of four students was further enrolled. The graduated students have since been employed by AAU through EU funding, and form the nucleus of HISP Ethiopia team. Subsequently, three other faculty members from AAU have also started their Phd studies.

Given the relatively decentralized political and governance structure of Ethiopia, and the lack of national level

In Addis Ababa, during the initial stages of implementation, capacity building efforts of the health services focused on data entry and report generation. With the accumulation of data and the consequent slowdown in system efficiency, HISP Ethiopia started to look for other more efficient software.

The translation was done successfully after extensive and ongoing discussions with the University of Oslo and Indian teams. With additional requirements being placed by the different states (for example, systems for logistics and budgets), there is a need for the team to better understand the core DHIS 2 knowledge, currently centered in Oslo.

These efforts are however constrained by the need for more development resources, and recruiting of experienced programmers at market rates, competitive with what is being paid by the thriving private sector.

(ii) HISP Ethiopia HISP Ethiopia was initiated in 2003, following the signing of a MOU between the University of Oslo and Addis Ababa University (AAU), which has guided the capacity building efforts. Initially, two faculty members from AAU and five graduate students (three in informatics and two in public health) were given

support for HISP, University of Oslo and AAU directly signed joint agreements with five regional health bureaus for the implementation. The starting point was Addis Ababa region using DHIS 1.3. A key feature in this process was the development of an additional Morbidity and Mortality Module that was based on recording disease patterns conforming to ICD (International Classification of Diseases) codes.

The aim of this relatively large-scale student enrollment was to develop capacity in public health informatics at the national university department, and also contribute to the field implementation activities as a part of their thesis, within an action research framework. Till date, both the research and practical outputs of the Phd students have remained marginal, with the students struggling to find the balance between research and action, with the latter suffering. Furthermore, since funds routed through the university are controlled by the administrators, the

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bureaucracies impede it from being easily available in the quantum and time as demanded by the rhythm of the field implementation.

In Addis Ababa, during the initial stages of implementation, capacity building efforts of the health services focused on data entry and report generation. With the accumulation of data and the consequent slowdown in system efficiency, HISP Ethiopia started to look for other more efficient software.

After mulling over the options of moving to either DHIS 1.4 or 2.0, a decision was taken in favour of the latter, due to the technical problems of the previous versions.

Around July 2006, the capacity development efforts on the new software started when the University of Oslo’s master students (4 Ethiopians and one from Vietnam), together with their Professor, came to Ethiopia as a part of their study.

This team started to define the major functionalities needed in 2.0, based on the earlier 1.3 experience, including the Morbidity Mortality module and the customization of region-specific reports.

The Vietnamese student, who had been previously engaged in the core DHIS 2.0 development in Oslo, played a key role by teaching the Ethiopian team report customization through an approach of “learning by doing.”

While this process was useful, it created a dependency on the Vietnamese student, and the team’s capacity building activities primarily focused on report designing, and not on understanding the foundational DHIS 2.0 frameworks, required for integrating the Morbidity and Mortality module within the core DHIS 2.0.

The problem of low capacity in using DHIS2.0 was heightened due to the slow Internet connectivity in AAU, which made it very difficult to download new milestones and versions. Besides, the Ethiopians, who culturally prefer face-toface communication, also did not participate effectively in the electronic developer mailing lists, which contributed to their relative exclusion from direct access

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to DHIS 2.0 knowledge. While there was definite progress in the customization of the local reports, a solution could not be found to the morbidity and mortality module, which required knowledge about the core DHIS. In attempting to address this knowledge gap, two developers from University of Oslo came to Addis Ababa for 10 days, which was followed by a visit of an Ethiopian developer to South Africa, where he had the opportunity to interact with other DHIS 2.0 developers. These interactions, plus local efforts to learn Java, have helped the Ethiopian team to understand the broader architecture of DHIS 2.0. As compared to the earlier efforts, which were mechanically output-centered, these were largely capacity-centered and appeared to be more pragmatic and useful.

Strategies for capacity development in e-Health in developing countries The strategies for capacity development in e-Health in the developing countries involves two important facets. They are how to re-conceptualise capacity development; and what strategies can be developed to approach the capacity building challenge from this expanded perspective.

Re-conceptualizing capacity building for e-health On analysis, capacity building for e-Health involves three interrelated components, which are: technical capacity; public health domain; and the implementation and use context. In the Table( given on the page 9), we summarize these different components and types of capacity, and the guiding structural conditions that shape them, based on our case study. (i) Technical informatics capacity: This capacity works at two levels, one relating to Java application development and the other the capacity to customize reports, conduct software installation, and to make minor changes to the database such as the addition or deletion of data elements, data sets, and organizational units. Application

development skills are in short supply in both countries. Whereas in India the private sector demand pulls away the Java experts, in Ethiopia the university curriculum is ill-equipped to meet these demands. The HISP India team structurally has the advantage of having access to short-term Java courses offered by private institutions, something not available in Ethiopia.

To a certain extent, some of these skill shortages at both levels have been addressed in India through an approach of ‘learning by doing’; that is attempting to solve field problems locally as they arise, and taking the help of University of Oslo electronically in other cases. For example, even though the Indian team did not have the experience of working with Linux, they could learn about it through their everyday engagement with the field problems. This learning by doing approach was not adopted in Ethiopia because of their decision to delay field implementation till the application was complete and mature.

Furthermore, the poor Internet connectivity and also the difficulties in physically accessing the district installations made it difficult to use a more experimental approach. (ii) Public health domain : The higher level skills in this regard concerns epidemiology (modelling of disease patterns and causal factors) which is sadly absent in both the countries. Lower level skills here concerns understanding of concepts relating to indicators, coverage, and the capacity to conduct analysis pertaining to the use of information through Excel pivot tables. While the informatics skills are easily available in both the countries, the absence of doctors with an informatics orientation is a serious impediment. In Kerala, HISP India has an alliance with a local public healthcare institute, which has greatly helped to develop a public health orientation in the team.

In Ethiopia, it is difficult to forge such need-based alliances because of the AAU control. More recently, due to access to state funding, HISP India has been able to eHealth | January 2007

Capacity component

Types

Description

Guiding structures In India

Guiding structures In Ethiopia

Technical informatics

Software development related

Java programming, Java frameworks (eg Hibernate), database and server related; report customization

Private sector demands; local-Oslo relation; prior experience

University curriculum; local-Oslo relation; prior experience; poor electronic and physical infrastructure

Software implementation related

Report customization; software installation, adding/deleting data elements, datasets, organization units

Easy availability of system facilitators; learning by doing

Easy availability of system facilitators

Modelling disease patterns, and correlating with causal factors

Limited university curriculum

Limited university curriculum

Use of information

Indicators, coverage, analysis techniques

Weak availability of medical doctors with informatics skills; local alliances; funding access

Weak availability of medical doctors with informatics skills; AAU structure; limited funding

Work practices

How do staff collect, register, analyze and transmit data

NGO structure which allows on-site, on-job continuous engagement

Restrictive university bureaucracy

Organization structure, data flows

How the health department is organized

NGO structure which allows on-site, on-job continuous engagement

Restrictive university bureaucracy

Public health domain

Implementation and use context

v Epidemiology

hire two doctors as state coordinators, which should give an added impetus to the public health capacity. (iii) Implementation and use context: A higher level capacity here concerns the understanding of the work practices on how health staff collects, registers, analyses, and uses data. This understanding requires a deeper sociological orientation, and also continual engagement with the field realities. In both the countries, it can be argued that the involvement of the end-users (the users which are actually involved in healthcare service provision) have helped to develop the capacity.

January 2007 | www.eHealthonline.org

As there is a pressing need to develop a holistic perspective towards capacity development, and also to integrate these different components, we now arrive at the challenging question of how this can be done.

Strategies for integration of capacity development efforts Till date, the University of Oslo-AAU approach has been one of ‘tight integration’ where through university collaborations and joint Masters degrees between informatics and public health, the endeavour has been to try and develop individuals with integrated capacity

about informatics, public health and use context.

It can be argued that this approach, though ideologically praiseworthy, is very difficult to effectively implement, due to structural conditions such as the inert university bureaucracies, outdated curriculum which contribute to a weak supply of students with higher level skills such as related to Epidemiology and Java, and the poor salary structure within HISP, which cannot compete with the offerings from the private sector or international NGOs. These structural conditions are not only complex, but also subjected to slow

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change, and we argue that a more feasible approach may be one of a “loose integration� where the focus is to develop specializations within the respective disciplines (say public health and informatics), and then try to create mechanisms to encourage crosscommunication to the extent possible.

In this regard, we outline two key strategies. (i) Decoupling implementation and education/research: Two reasons contribute to this suggestion. One, in Ethiopia, the driving mechanism for implementation are the Phd and Masters students who are expected to contribute to their field activities within an action research framework. This level of integration is poorly understood, and students struggle to find the balance between action and research, and inevitably action suffers since the scholarships are seen to support research.

Two, universities’ bureaucracies and mandates are difficult to change. While the European funding is routed through universities, the universities do not see them as having their mandate to do implementation. They are primarily

HISP India : A training session in progress

contributes to a weakness on the education front, they are trying to address that by developing three way linkages

Application development skills are in short supply in both countries. Whereas in India the private sector demand pulls away the Java experts, in Ethiopia the university curriculum is ill-equipped to meet these demands.

engaged in research and academics. As a result, funding is not made available in the right quantity and time to support implementation activities, which ultimately suffers.

The Indian example shows the benefit of decoupling implementation and research (where the NGO structure is responsible primarily for implementation), and to have decision making autonomy; unconstrained by a university bureaucracy. While this of course

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between University of Oslo-local universities-and themselves. (ii) Let specialists be specialists: Developing higher level skills, such as in epidemiology and Java, requires specialist knowledge imparted through university education systems. Expecting informatics people to learn epidemiology or vice versa through casual interaction, is not a feasible task. Instead, domain specialists should remain that, and attempts should be made to encourage cross-communication

through small term and focussed workshops, rather than longer term education programs.

Such a decoupling is especially relevant in a country like India (as compared to Ethiopia) where individuals with such specialisations are already available through the university system, although attempts to develop such communication bridges are rare.

We can easily conclude that though there is an urgent need to develop a more holistic structure, it is acknowledged that there are tremendous challenges due to various prevailing structural conditions.

Strategies to try and develop this integration need to sensitively consider these structures, and also the requirements on the ground.

While trying to develop higher level research capacity through Phd students may be ideologically praiseworthy, it may be at a loss to improve the field level health conditions, which is such a pressing concern in developing countries like India and Ethiopia. eHealth | January 2007

Cover Story

E-HEALTH IN DEVELOPING COUNTRIES Pitfalls, Challenges and Possibilities

O

ne of the most significant impacts of the ongoing information revolution has been in the health sector. In the field of health care, ICTs have emerged as key instruments in solving many of the most pressing problems. ICT has helped to bridge the gap between the provider and seeker through telemedicine and remote consultations, enabled health knowledge management by institutions and agencies, and facilitated in the creation of networks between providers for exchange of information and experiences.

In fact, globally, the e-Health or health telematics sector is fast emerging as the third industrial pillar of the health sector after the pharmaceutical and the medical (imaging) devices industries. From a development perspective, ICTs are key instruments towards meeting the Millennium Development Goals (MDGs) related to health. In this respect, the increasing adoption of ICT in health care services of developing countries, by both public and private sectors, has been a welcome trend. All across the world, governments are pledging and pooling more and more of their resources towards developing ICT tools and systems with the ultimate aim of facilitating management, streamlining surveillance and improving health care through better delivery of preventive and curative services.

January 2007 | www.eHealthonline.org

e-Health scenario in developing countries Developing countries suffer from an extremely high incidence of virulent diseases, which comprises not only the prevalent contagious and communicable diseases, but also an increasing number of chronic diseases related to changes in lifestyle and consumption patterns. Much of the disease burden of low-income countries stems from a number of interrelated factors such as poverty, malnutrition, poor hygiene and living environment, along with gender and castebased discrimination. Overall, health budgets are extremely low in developing economies, though in terms of disease burden, some 93 percent is borne by them.

According to the World Bank figures, expenditure on health in developed countries is 11 percent of their GDP, as compared to just 6 percent on an average for developing countries. Given this depressing scenario, it is no surprise that the developing countries are woefully offtarget in meeting the MDGs pertaining to reduction in child and maternal mortality and in control of major communicable diseases like malaria and HIV/AIDS. In this context, ICT is playing a crucial role.

ICTs are increasingly playing an important role in improving the performance of health care system in developing countries,

The growing popularity of e-Health in India is a healthy indication that the country’s development sector has the potential and the necessary technical expertise to set in place such initiatives. India is among the top global exporters of IT products. In that sense, it is much better placed than other developing nations in the world, where the digital divide translates into technological as well as infrastructure divide.

Dr. Aradhana Srivastava UN World Food Programme

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Sadly, the answer still is an elusive one.

Key challenges

Telemedicine in the Indian scenario

specially in enabling equitable access to health services delivery, besides networking, coordinating research and knowledge management. A number of successful initiatives have been reported regarding innovative use of ICT in health.

Some of the major fields include internet based disease surveillance and monitoring systems, information exchange and capacity building of remote health workers at all levels, better programme implementation and supply management, disease prevention and emergency response facilitation, management of health institutions, capacity building of health functionaries and platforms for information dissemination and exchange.

In India, as in other developing countries initiatives such as Voxiva’s disease surveillance and reporting systems for state governments, Jiva’s teledoc initiative, the use of PDAs by ANMs in Nalgonda (sponsored by World Bank), and the Electronic Resource Centre for capacity building in HIV/AIDS set up by SAATHI – all point towards the growing usage of ICT in scaling major hurdles faced by the health sector in the country.

The growing popularity of e-Health in

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India is a healthy indication that the country’s development sector has the potential and the necessary technical expertise to set in place such initiatives.

India is among the top global exporters of IT products. In that sense, it is much better placed than other developing nations in the world, where the digital divide translates into technological as well as infrastructure divide. The gap in India is not so much in terms of lack of technical knowledge and expertise as in actual infrastructural availability and awareness at the users’ end. Thus we have several highly acclaimed initiatives, but are they in a position to survive and graduate from the status of ‘initiatives’ to viable programme strategies in themselves?

Listed below are some of the key challenges to the establishment of e-Health as the means for enhancing outcomes and system efficiency in the health sector of developing countries: 1. Lack of financial support and sustainability: With appreciably low health sector spending, poorer nations understandably do not have the same level of financial support to ICT in health as the richer nations. Several major innovative initiatives may die an unknown death for lack of fund support towards upscaling and mainstreaming.

This is one of the key reasons why very few IT projects in the development sector prove to be financially sustainable in the long run.

2. Poor quality of technology and infrastructure: IT is a technologically intensive sector requiring a heavy investment in infrastructure, including power supply, transport and Internet connectivity. However, most developing countries have insufficient and widely disparate levels of infrastructure development. Most of the African nations are facing this problem. Rapid technological growth is another feature of the IT sector, and the poorer nations may not be able to afford the innovations available in the market.

This makes the state of IT infrastructure more dated and often less efficient than the existing systems worldwide.

3. Lack of technically competent staff at all levels: IT is also a knowledgeintensive industry and the application

KARNATAKA TELEMEDICINE PROJECT The Indian Space Research Organisation (ISRO) has implemented the operational phase of the Karnataka Telemedicine Project, which will enable a significant section of the rural population of Karnataka to avail multi-specialty healthcare. TeleVital, an US and Bangalore based premier telemedicine company, is the telemedicine solution provider to this unique healthcare project. The multi-specialty network has a pool of specialty hospitals. Under this network, specialty hospitals for oncology, gynaecology, nephrology, etc. are providing telemedicine service to various district hospitals throughout the state of Karnataka. eHealth | January 2007

of IT tools require a basic level of technical competence among staff at all levels, ranging from top managers to the lowest field functionaries. However, an impressive base of such skilled human resource is not available in many of the developing nations, characterized by poor literacy levels. This is more true of sub-Saharan Africa. Also, the attrition rate of technically skilled persons is high, and such developing countries suffer from high levels of brain-drain as well. In the context of brain-drain in the IT sector, India deserves a special mention.

4. Lack of awareness, access and attitudinal problems among users: Perhaps one of the biggest impediments towards universal acceptance of ehealth in developing countries is the lack of awareness among its people in general, towards ICT innovations and methods. This is specially the problem with ICT initiatives in health information dissemination. People may not be aware of such initiatives, or they may not have access to computers or Internet. The attitudinal problem is another area of concern – it takes a long time to break the barriers of communication, which may thrive as a result of popular notions or cultural taboos.

5. Legal and policy issues: Another major problem in many of the developing nations is the lack of a clear policy direction towards ICT, coupled with lack of political commitment and ambiguous legal framework. A clearcut policy framework is essential for systematic and coordinated development of ICT initiatives.

Another problem in the developing countries is poor data management, which often leads to breaches in data security; one of the major deterrents to large-scale adoption of e-Health.

Especially in a sensitive field like health care, where the patients’ data is essentially private and sensitive in nature, this poses a major impediment towards smooth adoption of e-Health.

January 2007 | www.eHealthonline.org

The Indian story: A silver lining In the Indian context, the major problems include the poor reach of ICT services in rural areas, poor literacy levels leading to low awareness and utilisation levels, and insufficient infrastructure development.

More than sixty-six thousand villages and habitations in India with population above five hundred are yet to be connected by an all-weather approach road. Fifty-five thousand villages do not have a safe source of water supply. Over a hundred thousand villages in India are yet to be electrified. Even where there is electricity, the power supply is erratic and sparse in nature. More than three hundred and eighty million rural people in India are illiterate, of which 58.5 percent are women. These factors hinder the outreach of and access to ICTs in many of the remote backward regions. Centuries of ignorance, suppression, gender and caste discrimination have further erected strong cultural barriers to information sharing and dissemination. And yet we say that India lives in her villages. However, it is indeed heartening to note that India is among those developing nations where the progress in e-Health has been encouraging, despite the lacunas. While ICT ’s application in Indian health sector still

suffers from political apathy at regional and local levels, the positive factor is the commitment towards greater transparency, accountability and streamlining of programme implementation and management at the national level.

The union government also recognizes ICT as the most efficient enabling tool for achieving the said goals. This is having the desired trickle-down effect and several state governments have earnestly taken up e-Health monitoring and reporting systems for their public health programmes.

Disease surveillance systems under IDSP in Andhra Pradesh and Tamil Nadu, and ICDS surveillance system in Orissa are some examples of such initiatives. Publicprivate partnership has been successfully used to achieve a convergence of technical resources and personnel in the e-Health sector, for such projects. Funding and technical assistance has also been received from several external agencies such as the World Bank and WHO. Summing up, the task ahead is thus quite clear; more in the nature of creating an enabling environment, and involving each one of us as stakeholders. The universal application of e-health initiatives in all public health programmes in India is presently the need of the hour. e-Health can help us travel to a healthy India.

e-Health with a human face

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18-20 April 2007 THE INTERNATIONAL EDUCATIONAL AND NETWORKING FORUM FOR eHEALTH, TELEMEDICINE AND HEALTH ICT eHealth and Telemedicine applications worldwide are at a critical growth phase.

Med-e-Tel offers unmatched opportunities to meet and network with qualified buyers, specialists, users, researchers, policy makers, and payers/ insurers from 50 countries around the world.

Med-e-Tel provides visitors with hands-on experience and an opportunity to discover and evaluate new products, systems and technologies and to hear about the latest eHealth/ Telemedicine news and trends.

Med-e-Tel features an extensive educational and conference program with more than 120 presentations and workshops on topics that matter to your daily business, research and care activities.

Topics will include a.o.: - personal and in-home monitoring - use of ICTs in independent living for the ageing and disabled - disease management and medication compliance - maximizing the potential of ehealth in developing countries - funding opportunities for ehealth programs and projects - interoperability and standardization - wireless and broadband applications - satellite communication - and more …

Additional events being planned in conjunction with Med-e-Tel 2007, include meetings and workshops by some of the following organizations: - International Society for Telemedicine & eHealth - International Association of Homes and Services for the Ageing / Center for Aging Services Technologies - European Commission & European eHealth Projects - World Health Organization - European Telecommunications Standards Institute - Telemedicine and Advanced Technology Research Center - World Academy of Biomedical Technologies - United Nations Office for Outer Space Affairs - Centre de Recherche Public – Santé

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

Venue

www.medetel.lu

Perspective

CDC FOSTERS GLOBAL E-HEALTH D

espite the recent and rapid improvements in the domain of information and communication technology (ICT) across the globe, there are still yawning gaps in terms of access to healthcare services. Technological advances now provide wireless internet access to remote locations such as TimorLeste, yet there the child mortality rates are still ten times to those of in the US or UK. Short Message Service (SMS) use is ubiquitous in Nigerian cities, yet remnants of polio menace are still very much present in their rural areas. One mobile telephone call from Singapore to a coastal village in India saved thousands of lives during the 2004 tsunami, yet someone in India quietly dies every 30 seconds from Malaria – equaling a tsunami death toll in every 80 days! The statistics are startling but true.

Although ICT and increased real-time access to information are taken for granted in the US and other developed countries, their proliferation has yet to significantly and consistently impact the public health around the world. ICT sustains and facilitates to thrive global business and economic sectors and is readily employed by innovative educators, but their proliferation in public health and medicine is still nascent. Building on effective programs implemented in specific January 2007 | www.eHealthonline.org

geographic regions, it is critical that future efforts be both scalable and coordinated to bridge the gaps in ICT and global health disparities, to usher in a new era of effective e-Public Health.

CDC: A continually evolving information revolution The National Center for Health Marketing (NCHM) at the US Centers for Disease Control and Prevention (CDC) was established to leverage and harness the power of health communication, health marketing and partnerships, for improving health promotion and protection in the US and around the world. ICT plays a significant role in the work of NCHM and CDC and is a critical tool for presenting and receiving accessible, accurate, and timely health information to and from CDC’s partners and publics.

One ICT channel of interest is the CDC website (http://www.cdc.gov) and we are in the process of evolving the site from an online library of about 200,000 static pages of scientific text to an interactive, personalized health promotion tool that is both usable and effective. The percentage of international users of the CDC website has increased significantly in recent years with the enhancement in global Internet

Although ICT and increased real-time access to information are taken for granted in the US and other developed countries, their proliferation has yet to significantly and consistently impact the public health around the world.

Melinda G. Frost Team Lead, Global Communication National Center for Health Marketing Coordinating Center for Health Information and Service US Centers for Disease Control and Prevention

Jay M. Bernhardt Director, National Center for Health Marketing, US Centers for Disease Control and Prevention

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access, and thus we are taking effective steps to increase the accessibility and relevance of our health information for users across the globe.

eHealth week Berlin 2007 Berlin’s International Exhibition and Conference Centre will host the eHealth week Berlin 2007 during 16-20 April 2007. This European event pertaining to ICT in health is an integral part of the associated programme of the German EU Presidency 2007. All the leading events concerned with IT and telematics in the German health system will come under the ambit of eHealth week Berlin 2007. Telemed, eHealth Conference 2007, ITeG (International Forum for Healthcare IT), the KIS Conference, the IHE Connectathon and other international meetings relating to e-Health will also take place during the eHealth week Berlin 2007. Here it deserves a mention that Telemed is Germany’s oldest annual e-Health conference, founded in 1996 by the Professional Association of IT Practitioners in Medicine (BVMI) and the Free University of Berlin.

The meet will bring forth a galaxy of e-Health representatives across the globe, which will include policymakers, and users, suppliers, researchers and managers in the field of e-Health. eHealth week Berlin 2007 will provide a unique platform for exchange of views, information and experiences on e-Health, and thereby will surely give a fillip to the awareness about e-Health in Europe.

Coming of age of telemedicine

We also are moving beyond the text message to present CDC’s health information through multiple medias, including audio and video ‘podcasts’. This was launched earlier this year, and have already been accessed by thousands of users in the US and beyond.

Health access without boundaries In today’s world where diseases know no boundaries, contagious diseases leap from one continent to another on a half-day flight. Real-time and ongoing information exchange and message delivery are more important than ever for today’s public health care professionals. As part of a congressional-supported program called the Global Disease Detection Initiative, the CDC is developing and testing the potential of ICT to improve information collection, such as surveillance data and information delivery, and country-specific risk communication or health promotion messages and interventions.

The CDC/NCHM Global Communication Activity consists of several ICT projects, which are pilot-tested in selected regions and nations around the world. The goal of these projects is to deliver timely, accessible, targeted information to key audiences, especially during times of health

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emergencies.

The tests include a blended approach whereby the international public healthcare workforce can receive rapid technical guidance through ICT delivery, while the public they serve can receive targeted topic-specific health messages using unique e-Health and marketing approaches. The possible benefits of this blended approach include consistent recommendations and messages, received in a similar time frame by key audiences, and the establishment of critical networks that can be rapidly used during health emergencies.

As an example, CDC is developing infection control training for public health and hospital staff in Kenya. This training will be delivered via Internet and CDs, and will be delivered at the provincial and district levels. The training includes guidance on communicating infection control practices for home use among targeted patients. To complement the ICTbased training, hand hygiene and safe water systems materials and messages will be developed for the targeted public.

Public communication channels may include SMS, satellite educational radio, and regional radio PSAs. The planned evaluation will examine knowledge gained, behavioural changes in the

Doctor’s advice across seas

workplace and home, impacts on health and return on investment.

Here it deserves a mention that the approaches and core purpose of CDC’s e-Health pilot projects are in line with the UN World Summit on the 2005 Information Society plan of action for global eHealth. The projects focus on “collaborative efforts of governments, planners, health professionals, and other agencies… for creating reliable, timely, high-quality and affordable… health information systems” (See http:// www.worldsummit2005.org/ for more information.)

Note : The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. eHealth | January 2007

O pportunities for

D igital A sia 6-8 February, 2007 Putrajaya International Convention Centre, Malaysia

Organisers

knowledge for change

Host Organisations

Ministry of Energy, Water and Communications (MEWC) Government of Malaysia

Institutional Partners

Principal Sponsor

International Government Partners

MCMC

Knowledge Partners

Tourism Partners

Media Partners ov

L CATION

University of Malya

INTAN

Supporting Partners

www.e-ASiA.org

Asia's largest conference on ICT4D eASiA 2007 through its five seminal conferences, will focus on five emerging application domains of ICT for Development - eGovernment, ICT in Education, ICT and Rural Development, ICT enabled Health Services and Mobile Application and Services for Development

What?

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Meeting point to foster cooperation in ICT for Development in Asia

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Platform for consultative dialoguing, strategic planning and business partnering

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Comprehensive programme with keynotes from professionals, technical sessions and an exhibition

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Participation of high level speakers and experts on ICT from Asia and beyond

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Forum to address the issues of digital divide and explore opportunities for Digital Asia

Who? •

Ministry of Energy, Water and Communication, Government of Malaysia

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Malaysian Communications and Multimedia Commission, Malaysia

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Microsoft Corporation

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Swiss Agency for Development and Cooperation (SDC), Switzerland

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The Commission in Information and Communications Technology, Philippines

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The National Computer Center (NCC), Philippines

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Ministry of Information and Communication, Government of Korea

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The National University of Singapore (NUS), Singapore

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Universiti Teknologi Mara (UiTM), Malaysia

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International Development Research Centre (IDRC), Canada

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... And many more

Why? •

Meet key decision makers, experts, leaders and stakeholders in ICT arena at one platform

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Meet professional service providers, IT vendors, Telecom vendors, Satellite providers, Consulting firms, Government agencies and National-International development organisations in the domain of ICT

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Opportunity for potential business partners from Asia and beyond to meet and exchange ideas and needs

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Opportunities for cooperation in the field of ICT for development, education, governance and health among Asian countries

www.e-ASiA.org

6 - 8 February, 2007 Putrajaya International Convention Centre, Malaysia

The Venue The Putrajaya International Convention Centre or better known as PICC among the Putrajaya residents, is located on top of Taman Puncak Selatan in Precinct 5.

PICC takes its shape from the eye of the pending perak (a silver Malay royal belt buckle) with the main halls set in the eye of the pending perak.

Putrajaya International Convention Centre Dataran Gemilang, Precinct 5 Federal Government Administrative Centre 62000 Putrajaya, Malaysia Tel: +6-03-8887 6000 Fax: +6-03-8887 6499 E-mail: enquiry@pcc.gov.my Web: www.pcc.gov.my

Transportation and Accommodation Transportation

By Road: Putrajaya is 25 kms from Kuala Lumpur and 15 minutes drive from KLIA and F1 circuit in Sepang. It is the most accessible city in Malaysia. You can reach Putrajaya using expressways, urban highways and rail.

Prepaid Taxi: Delegates may take prepaid taxis from Airport to Putrajaya and/or from Kuala Lumpur to Putrajaya. Putrajaya International Convention Centre is approximately 30 min from KLIA and approximately 40 minutes from Kuala Lumpur city.

Shuttle Service by organisers during the conference period: The organisers will provide a shuttle service for delegates from the Putrajaya Station to Conference Venue and Conference Hospitality Partner Hotels in Putrajaya (and back) on hourly basis.

By Train: A high-speed train service either from Kuala Lumpur International Airport or KL Central (city), Kuala Lumpur, is the fastest way to reach Putrajaya.

Accommodation Organisers are pleased to announce Marriott Putrajaya as the Conference Partner Hotel for eASiA 2007. The hotel will offer the delegates room accommodation at a subsidised rate. Please visit the link www.e-asia.org/2007/accommodation.asp for more details and to book your room.

eASiA's Unique Value Proposition •

High level speakers and experts from Asia and beyond

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Right technology solutions and partners

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Opportunity to forge strategic partnerships with sellers and buyers

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Focussed session and target audience

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Face-to-face meeting with key customers and prospects

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Latest e-Solution services and initiatives from across Asia

6 - 8 February, 2007 Putrajaya International Convention Centre, Malaysia

Asia's largest conference on ICT4D

ASiA 2007

ASiA 2007

egov Asia 2007 will bring together some of the best minds from the highest echelons of government, industry, academia and civil society to discuss and deliberate on the key strategies for e-Government. The conference aims to create an invaluable Asian platform for consultative dialoguing, strategic planning, knowledge networking and business partnering in the field of e-Government.

Highlights: • National e-Government strategies • International and regional perspectives • Policy reforms for ICT-enabled governments • Models of e-Service delivery • Emerging technology solutions

Digital Learning Asia 2007 will bring some of the key drivers from the leading countries of technology-enabled education to deliberate on the pressing challenges of technology-enabled education from capacity building to reengineering pedagogy; change management to providing digital access.

Asian Telecentre Forum 2007 aims to bring the Asian practitioners on a platform for learning and sharing the experiences. Experts will be engaged in close assessment of issues relating to project monitoring steered by external financial support, from international development agencies & governments in Asia.

Highlights

Highlights • Telecentre movement in Asia: Road ahead • Partnerships for developing telecentre networks • Financing mechanism and sustainability factors of rural telecentres: A reality check • Service delivery and capacity building through telecentres

• National strategies on ICT in education • Localisation, customisation and content development • Educating the educators • Re-engineering pedagogy • e-Learning trend and practices • Education technology trends in Asia

Get Visibility through our Four Niche Magazines

ASiA 2007

Key Speakers

eHealth Asia 2007 aims to provide a platform to discuss the recent trends and emerging issues in the development of information & communications, science and technology and its integration in healthcare systems.

Conference will provide a knowledge sharing platform for deliberating on the opportunities and possibilities of ICT use for better health care delivery.

mServe Asia aims to discuss and showcase the different aspects of mobile services, technologies, implementation and implications, developments on the public administration and tie them to the existing and future m-Government, education, agriculture and other applications. The conference will provide a platform to promote networking and business opportunity development.

Highlights

Highlights • Enterprise mobile workforce management • Mobile infrastructure and connectivity issues • Next Generation 3G Network • mLearning • mServices • Emerging applications

• e-Health in developing countries • e-Health administration and management • Rural telemedicine • Emerging technologies in e-Health • Challenges and opportunities for collaborative action in e-Health

• Walter Fust, Swiss Agency for Development and Cooperation (SDC) • Richard Fuchs, International Development Research Centre (IDRC) • R. Chandrashekar, Additional Secretary, Ministry of Information, Communication and Technology, Government of India • Gerri Elliot, Corporate Vice President, Worldwide Public Sector, Microsoft

Host and Partner Organisations Host Organisation

Supporting Partners

Ministry of Energy, Water and Communications, Malaysia The Ministry is the key policy formulator and service regulator in Energy, Water and Communications sectors in Malaysia. The Ministry's main thrust is to facilitate and regulate the growth of industries in these sectors to ensure the availability of high quality, efficient and safe services at a reasonable price to consumers throughout the country. www.ktak.gov.my/

The Asia Foundation is a non-profit, nongovernmental organization that supports programs in Asia that help improve governance and law, economic reform and development, women's empowerment, and international relations. www.asiafoundation.org/

The Malaysian Communications and Multimedia Commission is the regulator for the converging communications and multimedia industry. The role of the MCMC Malaysian Communications and Multimedia Commission is to implement and promote the Government's national policy objectives for the communications and multimedia sector. www.cmc.gov.my

International Government Partners The Commission in Information and Communications Technology, Philippines, is the primary policy, planning, coordinating, implementing, regulating, and administrative entity of the executive branch of Government that promotes, develops, and regulates integrated and strategic ICT systems and reliable and cost-efficient communication facilities and services. www.cict.gov.ph The National Computer Center (NCC), Philippines, fundamental functions were to provide information bases for integrated planning and implementation of development programs and operational activities in the government. www.ncc.gov.ph

Knowledge Partner INTAN is a premier government institution of Malaysia providing world-class training and capacity building programmes for public sector organisations of the country. www.intanbk.intan.my

www.e-ASiA.org

ASiA 2007

ASiA 2007

Bellanet promotes and facilitates effective collaboration within the international community, especially through the use of ICTs. www.bellanet.org The Commonwealth is an association of 53 independent states consulting and co-operating in the common interests of their peoples and in the promotion of international understanding and world peace. www.thecommonwealth.org

telecentre.org is both a social investment program that supports grassroots telecentre networks and a loose family of organizations with a common commitment to helping the telecentre movement thrive. www.telecentre.org In India USAID is investing in economic growth, health, disaster management, environment and equity in India and in programs that focus on areas where help is needed most and people-level impact is high. www.usaid.gov in Warisan Global is a knowledge strategy company of Malaysia that is in the business of designing, developing and executing projects in the area of bridging the digital divide and grassroots entrepreneurhsip. www.warisanglobal.com

Institutional Partners The National University of Singapore (NUS) is a multicampus university of global standing, with distinctive strengths in education and research and an entrepreneurial dimension. www.nus.edu.sg

MobileMonday Malaysia is an open community of mobile professionals fostering cooperation and cross-border business development through virtual and live networking events that share ideas, best practices and trends from global markets. http://www.mobilemonday.com.my/

UiTM is Malaysia's premier institution of higher learning that has experienced a phenomenal growth since its inception in 1956. www.uitm.edu.my

Swiss Agency for Development and Cooperation (SDC) is Switzerland's international cooperation agency within the Swiss Foreign Ministry. www.sdc.admin.ch Southeast Asian Ministers of Education Organization (SEAMEO) was established on 30 November 1965 as a chartered international organization whose purpose is to promote cooperation in education, science and culture in the Southeast Asian region. www.seameo.org Sarvodaya is dedicated to making a positive difference to the lives of rural Sri Lankans. www.sarvodaya.org

University of Malya

Universiti Malaya is the first University of Malaysia, situated in the southwest of Kuala Lumpur - the capital city of Malaysia. www.um.edu.my

Conference Contacts Exhibition: Himanshu Kalra (himanshu@e-asia.org) Papers: Prachi Shirur (prachi@e-asia.org) Registration: Mukesh Sharma (mukesh@e-asia.org) General Information: Himanshu Kalra (himanshu@e-asia.org)

Asia's largest conference on ICT4D

eHealth Asia 2007: Exploring ICT's potential in Asian healthcare The innovative concept of e-Health has become the new buzzword of the health industry, as today the synergy of ICT and medicine is making new inroads in patient care, across the globe. Today e-Health systems serve the needs of citizens, patients, healthcare professionals, health service providers as well as policy makers. In fact, e-Health is today's tool for substantial productivity gains, while providing tomorrow's instrument for restructured, citizen-centric health care. Some countries have achieved advanced status in terms of applications of e-Health in one area or the other. Their successful e-Health developments are amply manifested in health information networks, electronic health records, telemedicine services, wearable and portable monitoring systems, and health portals.

However, till now we have tapped only a tiny proportion of the awesome potential of e-Health, more particularly in the Asian context. It is true that the developing countries of South Asia still have a long way to go in the field of application of e-Health.

Though in Asia, the scope, spread and growth of e-Health till now has been limited, but its potential is simply mind-boggling. eHealth can be instrumental in infusing health to the by and large depressing healthcare scenario of Asia in myriad ways, but most commonly and importantly, through transmitting medical advice and expertise from the developed world of the west to the by and large developing worlds of Asia by the technique of telemedicine. Thus a need for a platform to discuss and parley on the recent trends and emerging issues in the development of information & communication science and technology and its integration in healthcare systems with an Asian focus, just cannot be overestimated. And eHealth Asia 2007 is geared to cater to this urgent need of the Asian healthcare industry quite effectively. eHealth Asia 2007, which is being organised as a vital constituent of the eAsia 2007, will be held during 6-8 February 2007 at Putrajaya International Convention Centre (PICC), Putrajaya, Malaysia. The conference aims to share experiences on the utilization, efficiency and impact of e-Health applications and to explore how to best use the best practices within the Asian countries. The eHealth Asia 2007 conference will provide a wonderful opportunity for deliberation among e-Health experts and practitioners, ranging from bureaucracy to academia to industry, about the existing challenges, opportunities and possibilities in the field of eHealth, and would also explore the solutions for overcoming and harnessing them. Succinctly, it will provide a knowledge-sharing platform for deliberating on the ICT use for better healthcare delivery.

The three-day conference will have a wide variety of topics pertaining to e-Health under its ambit, but some of the focal areas of discussion will be: !

Global applications of e-Health

! Initiatives and developments in e-Health technologies- international perspectives and developments ! Current e-Health projects in Asia ! Developments in primary care and implementing IT at primary care level ! Engaging and empowering clinicians in IT ! Security and risk management in e-Health ! Challenges and opportunities of e-Health care in Asia ! Future of e-Health in Asia The conference will also have an exhibition area to showcase new strategies, tools and technologies; developed for healthcare delivery for technology users, buyers, vendors, healthcare providers and regulators.

The key sessions of the eHealth Asia 2007

www.e-ASiA.org

6 - 8 February, 2007 Putrajaya International Convention Centre, Malaysia conference will be: ! ICT Integration in National Health Policy ! Health Informatics Standards ! ICT Capacity Building for e-Health Implementation ! e-Health Applications in Asia ! Health IT Initiative: Country Case Studies ! Technology Innovations in Health Service Delivery ! Service Delivery Mechanisms for e-Health ! Opportunities & Challenges of e-Health Adoption The meet is organized by Centre for Science, Development and Media Studies(CSDMS) and GIS Development, who have more than a decade of experience of organizing niche events on ICT and geographic information systems across continents, along with several government partners.

The Ministry of Energy, Water and Communications (MEWC), Govt.of Malaysia, and The Malaysian Communications and Multimedia Commission are the official hosts of the eAsia 2007 conference, of which eHealth Asia 2007 is an integral part.

MEWC is the key policy formulator and service regulator in energy, water and communications sectors in Malaysia and its main thrust is to facilitate and regulate the growth of industries in these sectors to ensure the availability of high quality, efficient and safe services at a reasonable price, to consumers throughout Malaysia. The Ministry has provided leadership in the provision of infrastructure and services for the effective roll-out of e-Governance and eLearning.

The Malaysian Communications and Multimedia Commission is the regulator for the converging communications and multimedia industry in Malaysia. Its role is to promote the government's national policy objectives for the communications and multimedia sector.

The Commission in Information and Communications Technology, Govt. of Philippines and the National Computer Center (NCC) of Philippines are the international government partners of this eAsia

2007 event. The former is the primary policy, planning, coordinating, implementing, regulating and administrative entity of the executive branch of the Government of Philippines that promotes, develops and regulates integrated and strategic ICT systems and reliable, costefficient communication facilities and services. NCC, Philippines has the role of providing information bases for integrated planning and implementation of development programmes and operational activities in the government.

INTAN, a premier government institution of Malaysia providing world-class training and capacity building programmes for public sector organizations of Malaysia, has joined as the knowledge partner of eAsia 2007. Besides, several supporting partners are roped in to make this conference a great success. The supporting partners of this mega event are Bellanet International, Nepal, the Commonwealth, MobileMonday Malaysia, Sarvodaya, Swiss Agency for Development and Cooperation (SDC), the Southeast Asian Ministers of Education Organization (SEAMEO), telecentre.org, USAID India, The Asia Foundation and Warison Global. Furthermore, the National University of Singapore (NUS), UiTM and Universiti Malaya have joined as the institutional partners. The principal sponsor of this event is none other than Microsoft.

Med-e-Tel, the international educational and networking forum for eHealth, telemedicine and health ICT- is the media partner of this conference. The fifth annual edition of Med-eTel conference is to take place in Luxembourg, during 18-20 April 2007. For the last five years, every year Med-e-Tel has been attracting a highly qualified array of participants, which include industry representatives, bureaucracy, healthcare providers, payers/insurers and researchers from 50 countries.

With these important strategic networks, along with the huge potential of e-Health in Asia, eHealth Asia 2007 is destined to be a runway success story among the e-Health fraternity across the globe.

6 - 8 February, 2007 Malaysia

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Cancellations and Substitutions In case of any unforeseen or unprecedented occurrence beyond the hold of the conference secretariat, where the conference is called off, due to natural disasters, epidemics, man-made civil disturbances or other mishaps of large scale, there shall be no refund or reimbursement of any fees or commitments.

Cancellation and Substitution Policy !

In case a registered participant is unable to attend, s/he may send his substitute to attend the conference. S/he must inform the Secretariat by 6th January 2007.

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In case a registered participant is unable to attend and wants refund of registration fees, s/he may convey the same by 6th January 2007 and is liable to claim back 50% of the Registration Fee, subject to decision of the Secretariat. This does not hold for force majeure condition.

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eASiA 2007 Secretariat (Malaysia) GIS Development Sdn. Bhd., Suit 22.6, Level 22, Menara Genesis, 33 Jalan Sultan Ismail, Kuala Lumpur 50250, Malaysia Tel: +60166852201 Tel: +60166910129

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eASiA 2007 Secretariat (India) Centre for Science, Development and Media Studies G - 4, Sector-39, NOIDA - 201 301, India, Tel: +91-120-2502180 to 85 Fax: +91-120-2500060 Web: www.e-asia.org E-mail: info@e-asia.org

For any information/enquiry contact: Tel: +60166852201 (Malaysia) Tel: +919312907675 (India) Web: www.e-asia.org Email: info@e-asia.org

Business News Voice control solutions for better dental care TietoEnator, one of the largest IT services providers in Europe, specializes in consulting, developing and hosting its customers’ business operations in the digital economy. The company offers state-of-the-art ICT solutions and IT services for healthcare and welfare service providers. Now this Nordic IT giant has developed a voice control solution for recording dental findings in an electronic patient data record. The development work was carried out in cooperation with three Finnish joint municipal authorities, providing primary healthcare services.The purpose of voice control is to promote the efficiency and quality of oral healthcare.

“For dental professionals working alone, voice control means greater efficiency, more accurate information and improved hygiene at the workplace, as they can record their findings via microphone during the actual dental examination.

The dentist or hygienist no longer needs to make initial notes on paper or move back and forth between the computer and the customer,” says Jouko Kallio, Chief Dentist at the joint municipal authority for primary care in the KaarinaPiikkiö region.

The basic idea of voice control is to imitate, with vocal commands, the use of a mouse and keypad and to record any findings in the graphical dental picture, which is included in the patient records, in the Effica system. The application is based on the Speech Magic and Speed SDK solutions by Philips.

Results of a pilot project have shown that the application increases the efficiency of dental professionals working alone, as it omits the need for timeconsuming manual note-taking and recording.This also improves the quality of the treatment, as it reduces the room for errors. The more efficient workflow also results in significant cost savings January 2007 | www.eHealthonline.org

and better use of manpower.

Siemens takes ehealthcare to the Generation NeXt Siemens Medical Solutions, one of the world’s largest suppliers to the healthcare industry, has introduced ‘Generation NeXt’- which comprises two innovative ultrasound systems.They have the potential to give a big impetus to eHealth. The ultrasound systems, named as Acuson X300 and Acuson Antares, were both unveiled at a recent cardiology congress.

The Acuson X300, the latest member of the new Siemens X Class of Ultrasound systems, is an ultra-compact, performance-oriented system, which is uniquely positioned to become the goto system in busy settings such as emergency rooms. With an operatorfriendly console that helps to reduce arm and hand movement, and its small, lightweight transducers, the X300 takes the pain and pressure out of routine scanning. A flat panel display, height adjustable control panel and its light weight design enables a comfortable scanning position for the user, even in tight exam spaces such as the patient’s bedside. The system’s TGO (tissue grayscale optimization) technology delivers consistent image quality, while advanced Hanafy lens transducers enable improved image uniformity when scanning technically difficult-to-image patients.

With the introduction of shared service capabilities to the Acuson Antares ultrasound system, the benefits of a revolutionary design as well as the outstanding image quality and versatility will now also be available to the cardiologist. The Antares system, premium edition, 5.0 release is equipped with a high-resolution 19-inch flat panel display, mounted on an articulating arm for optimal viewing position. Other ergonomic design features include the natural and extended reach zone

concept that places controls and peripheral devices, so that they are easily accessible allowing for more comfortable patient exams, and improved examination and departmental workflow.

NHC, Singapore goes into e-Health mode in a big way Headquartered in Mortsel, Belgium,Agfa HealthCare is a leading name in healthcare across the globe. On 6 December 2006, it has signed a contract with National Heart Centre(NHC) of Singapore, the national referral centre for cardiovascular diseases, and part of the Singapore Health Services (SingHealth) public healthcare cluster.

NHC provides comprehensive preventive, diagnostic, therapeutic and rehabilitative cardiac services to local and overseas patients.

NHC will implement the Agfa HealthCare solution to manage adult cardiac catheterisation, echocardiology, and nuclear and vascular studies. The installation will include Agfa Heartlab Cardiovascular solution, a web-based cardiovascular information system comprised of image management, structured reporting and a web-based portal, and will also include a web-based scheduling module and the Heartlab clinical research tool for statistical data mining and reporting.

“SingHealth is extremely excited about the installation of the Agfa Heartlab Cardiovascular solution,” said Dr. Soo Teik Lim, Senior Consultant Cardiologist at NHC. “Agfa HealthCare’s solution will significantly enhance clinical workflow, resulting in a much improved working environment, that will ultimately increase the quality of patient care,” he added.

A phased implementation is expected to be completed by June 2007. When fully installed, the Agfa HealthCare solution will manage cardiology images and information, and create cardiology

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reports for more than 80,000 exams.

“Agfa HealthCare continues to build global momentum in the area of cardiology,” said Reid Losee, Global Cardiovascular Business Director for Agfa HealthCare.“We are pleased to add NHC to the list of world-class healthcare facilities that have chosen the Agfa HealthCare solution for cardiology image and information management,” he pointed out.

An Xpert’s help The US-based Thomson Corporation, a global leader in providing essential electronic workflow solutions to business and professional customers, has recently announced the launch of Thomson Clinical Xpert™ for PDAs(Personal Digital Assistants) . A powerful new medical reference and decision-support tool,Thomson Clinical Xpert puts authoritative drug, disease and laboratory information instantly into the hands of physicians and other prescribers, nurses, pharmacists, and clinical trainees, thereby facilitating them to make important decisions at the point of care, and reducing the chances of medical errors.

The launch of this new application, which will help address the quality and safety issues such as drug interactions, comes at a time when medical errors and patient safety continue to be a global concern and prove detrimental to more than 1.5 million patients a year.Whether in the hospital or a medical office, Thomson Clinical Xpert enhances healthcare professionals’ ability to make the right decisions quickly, helping to avoid errors and improve the quality of care.

Dr. Jerry Osheroff, Chief Clinical Informatics Officer at Thomson and lead author of the American Medical Informatics Association Roadmap for National Action on Clinical Decision Support, said Thomson Clinical Xpert will be a useful tool in efforts to improve the

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safety and quality of healthcare. “We know that clinicians are committed to eliminating errors and ensuring the most effective care for their patients,” he said.

“Thomson Clinical Xpert improves point-of-care access to consistent, authoritative medical knowledge for all those who play a direct role in patient care, reducing the risk of medical errors.

The ultimate beneficiary is, of course, the patient,” Osheroff added.

Thomson Clinical Xpert features premium content from Thomson Micromedex, one of the most respected providers of evidence-based clinical information. It also features drug interaction tools, convenient medical calculators and ‘Xpert Alerts’— electronic advisories regarding key drug changes or treatment studies delivered directly to users’ PDA, desktop or PDR net account.

Experienced physicians, pharmacists, toxicologists, nurses and other healthcare professionals at Micromedex has developed and reviewed Thomson Clinical Xpert content, giving clinicians information of unparalleled authority and accuracy, including: A searchable database of more than 4,000 drugs with comprehensive indications, dosage and interactions information; details on more than 400 laboratory tests and their interpretations; toxicology reports on more than 200 of the most common poisons and drug overdoses; a comprehensive disease database that offers differential diagnoses, therapeutics and evidence-based recommendation ratings; detailed information about alternative medicines.

IBM partners a patient-friendly healthcare model Geisinger Health System, one of the major fully integrated healthcare providers in the USA, serving more than two million residents throughout central and northeastern Pennsylvania, is one of the leading players in the US’

electronic health records movement.

Recently the organization entered upon a strategic partnership with IBM, with an objective to improve patient outcomes, and provide more personalized care and information that will facilitate patients and their doctors to make better and smarter decisions.

As part of the agreement, Geisinger Health System and IBM will collaborate to design and implement a first-of-its-kind Clinical Decision Intelligence System (CDIS) that leverages the health system’s rich reservoir of clinical data. The CDIS, which employs open standard based technology, will serve as the foundation for Geisinger’s integrated clinical, financial, operational, genomic and other medical data in a format that allows for rapid analysis and reporting of vital insights from a plethora of patient encounters.

Besides, the CDIS will create an environment that will enable physicians and medical researchers at Geisinger to identify important clinical trends, facilitate to ensure that patients receive all recommended care, support clinical trials, identify best practices and perform innovative health services research.

As part of the relationship, Geisinger will also collaborate with the IBM Research Healthcare and Life Sciences Institute on new projects that may involve innovative distribution channels in retail healthcare; remote patient monitoring; interoperable patient centric networks and translational research.

“Healthcare is at a critical juncture and innovation will play a major role in its transformation,” said Dan Pelino, General Manager, IBM Global Healthcare and Life Sciences. “By combining the technical and business expertise of IBM with Geisinger’s unique clinical and operational expertise, we have the potential to create a leading, patient centric care approach for the broader healthcare market,” he added. eHealth | January 2007

Case Study

SYNERGIZING KNOWLEDGE AND ACTION AIDS Community of Solution Exchange ‘And this gray spirit yearning in desire To follow knowledge like a sinking star, Beyond the utmost bound of human thought.’

-Lord Tennyson (from ULYSSES)

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he above lines aptly describe the concept of Solution Exchange.

Solution Exchange is an Internet based ‘Knowledge Management Partnership’ of the UN Country Team in India. It begun in early 2005 and has had good success in the Indian context.

Cutting across semantics, Solution Exchange is a new initiative of the United Nations Country Team in India that offers communities of development practitioners a UN-sponsored space where they can provide and benefit from each other’s solutions to the day-to-day challenges they face. It is an endeavour in connecting people who share similar concerns and interests, bringing them together virtually and face-to-face towards the common objective of problemsolving. The UN Country Team is playing a convening role, providing an impartial space for professionals from government, NGOs, policy and research institutions, donor partners and the private sector to constructively interact and take forward their common development agenda. This initiative is branded as ‘Solution Exchange’.

January 2007 | www.eHealthonline.org

Through Solution Exchange, community members interact on an ongoing basis, building familiarity and trust, thereby gaining in knowledge that helps them contribute more effectively to development challenges. There are ten communities of practice established by December 2006, with more than 7,000 participants; growing at over 100 members a week. Among other results are more than 200 synthesized responses to members’ issues, six face-to-face priority-setting workshops, nine ongoing examples of collective small-group work, and nine consultations on government policy documents.

Each community has a dedicated team of professionals to moderate the discussions. Solution Exchange foresaw support for development practitioners, concerned with HIV in India. The service would be hosted by UNAIDS as the secretariat to the ‘UN Theme Group on HIV’. Taking advantage of this opportunity to reach out through an UN-sponsored platform, the National AIDS Control Organization (NACO) requested UNAIDS to support civil society consultation through an e-consultation on the National AIDS Control Program Phase-III (NACP III). UNAIDS offered Solution Exchange as a platform to seek the views of the public; to contribute their

Solution Exchange has overcome the challenge of sharing undocumented experiential knowledge in a community, thereby solving the various issues caused by the epidemic that is spread across a large country like India.

Dr. Mohamed Essa Rafique Resource Person & Moderator, AIDS Community of Solution Exchange emohamed.rafique@undp.org

Rituu B. Nanda Research Associate, AIDS Community of Solution Exchange rituu.bnanda@undp.org Steve Glovinsky Global Advisor, Solution Exchange steve.glovinsky@undp.org Monica Raina National Coordinator, Solution Exchange monica.raina@undp.org

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insights into the working groups.

Echoing the excitement and interest generated in this pioneering effort, this econsultation received substantial press coverage, with headlines reading ‘You can help make AIDS policy’ (Asian Age, New Delhi), ‘e-Consultation to help the Government of India design its national AIDS policy’ (i4donline.com), and the likes. Through this e-consultation, the Indian Government has set an example for other countries, by seeking direct participation of the people at large in its efforts to design a National AIDS Control Programme. Responses received totaled over 300 in the three months of the consultation. A booklet named ‘Summary of the NACP III e-Consultation’ was also printed, as a product of this endeavour.

The final NACP III policy document is likely to roll out in March 2007. By

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capturing as wide a range of perspectives as possible, including those of People Living with HIV (PLHIV), the resulting programme will have a much better chance of meeting its goals and mitigating the spread of HIV in India.

The Solution Exchange for the AIDS Community in India then moved on to knowledge-sharing activities and other efforts intended to help ensure that members work more effectively, both individually and as a group. Solution Exchange has overcome the challenge of sharing undocumented experiential knowledge in a community, thereby solving the various issues caused by the epidemic that is spread across a large country like India.

The Solution Exchange service primarily functions in the following manner. When members of the AIDS

community come across a challenge and would like to have ideas from their peers, they put their query through an e-mail, and the moderator posts it to all community members. Members offer advice, experiences, contacts or other suggestions. In about ten days, the moderator posts a consolidated reply, which is a synopsis of responses to the mail group, including the original contributions as well as additional helpful resources and links.

The result of this Query-ResponseConsolidated Reply service is a comprehensive range of solutions, tailored to adapt to the local context. Compelling examples that influenced policy formulation include discussion on themes like stigma and discrimination, mandatory testing for HIV, training of trainers, section 377 and MSM, as well as registration for sex workers.

eHealth | January 2007

Since the launch of the Solution Exchange Service on 19 October 2005, forty-five queries have been posted. At present, this list has around 2500 members with largest membership from the NGOs (40.3 percent), followed by the UN and other inter-governmental organizations, which account for 24.1 percent. While the government agencies comprise 15.8 percent, the academicians are 12.9 percent and the private sector is the smallest group with 6.9 percent representation. Apart from the Query-Reply-Consolidated Reply services, Solution Exchange provides e-discussion, e-consultation, action groups and visioning workshop formats. Through

for the discussion.

3. FOR COMMENTS: Draft documents that network members or the public are asked to review and comment on within a specific period. Might be used, for example, by a member for a peer review, or for wide consultation on a draft policy document, program or project proposal.

Depending on the item, a consolidated reply could be prepared at the end of the period.

4. CONSOLIDATED REPLY: Provides a brief synthesis and analysis of the contributions received, as well as the list of contributors with their individual contributions. It also provides additional

When members of the AIDS community come across a challenge and would like to have ideas from their peers, they put their query through an email, and the moderator posts it to all community members. Members offer advice, experiences, contacts or other suggestions.

Solution Exchange, community members interact on an ongoing basis, building acquaintance and trust, gaining in knowledge that helps them contribute more effectively to the challenges of this epidemic.

Solution Exchange uses only six types of e-mail messages. Each type represents a different purpose for sending a message to the community through the mail list, so that the community members will know what to expect when opening it. The six standardized prefixes shown here in capitals help to distinguish the message types included in the subject heading: 1. QUERY: Indicates a request for solutions or information by a community member.

2. DISCUSSION: An open e-discussion on a particular topic with a structured format. The mail with this heading would: (i) introduce the topic for discussion, (ii) introduce the guest moderator(s) or conveners, if any, and (iii) provide details on the modalities January 2007 | www.eHealthonline.org

information regarding relevant resources and contacts. Consolidated replies have a standardized structure and format to make them easy to index and search for in the knowledge repository.

5. DISCUSSION/FOR COMMENTS INTERIM SUMMARY; DISCUSSION/FOR COMMENTS CONCLUSIONS : Works on the same principle as the consolidated reply. It provides the summary and analysis of the e-discussion or consultation, and may be prepared in collaboration with the guest moderator, where relevant.

Summaries are issued over the course of the discussion, and conclusions are issued at the close of the discussion.

6. FOR INFO: Announcements from the moderator about updates and newsletters issued, and from members sharing news or announcements. The latter are supply-driven messages, and as a rule should not be encouraged.

The preferred option is to include them

on the community’s website in the appropriate category.

Translating knowledge to action The Visioning Workshop uses a two-day format. The first day is devoted to three community ‘champions’ or members who commit to sponsoring ‘action groups.’ The champions present their cases and identify their respective action plans for taking a strategic priority forward. Examples of this from the AIDS Community Visioning Workshop were universal access, stigma and discrimination, and community response to HIV. The second half-day session is devoted to networking and to introducing a new knowledge-sharing technique that participants can use in their own environments. Now, participants do a ‘peer assist’; that is sharing their experiences in a face-to-face demonstration of the Solution Exchange Query-Response-Consolidated Reply format.

An e-discussion or consultation is a virtual brainstorming by members of a community of practice to address a broad topic of interest and provide a range of insights, conclusions or recommendations for the benefit of policy makers or for community members to take forward their work. It results in an ‘e-discussion summary’ paper that reflects the highlights of the discussions and the conclusions reached. E-discussions are posted on the community’s mail group and are moderated in the same manner as the Query-Consolidated Reply process. In an e-consultation, as we have seen in the singular example of the NACP-III consultation, the difference is that nonmember participation and anonymous postings are allowed. An example of ediscussion was the one on Universal Access, the summary of which was used in various National Stakeholder Consultation Workshops in various Asian countries.

Action Groups prepare high-value, strategic interventions that will take the community’s agenda forward. The

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intervention can be a program or project proposal, a study to fill a knowledge gap, a training package, policy recommendations, or anything that can be prepared within a 20-week period by a small team, including consultants. Action group topics are based on community priorities, identified in a visioning workshop, or because of a particularly compelling query that received a substantial number of responses.

The action group on stigma and discrimination completed a national work plan in the following way: An overwhelming response to a query on stigma and discrimination reiterated that it was the biggest problem faced by PLHIV. These contributions provided a convincing case on what can be accomplished through active, determined efforts. One member even suggested preparing a comprehensive programme of action at a national level.

So, an action group meeting was held, which led to the creation of AAROHII, an acronym for Action Advocacy Research on HIV in India. This coalition enabled the members to maximize their impact, both individually and collectively.

AAROHII has now drawn up its

queries or e-discussions that took place over the period, on announcements of events and new resources received from members during the period, and on lists of new members that have joined the community.

Updates are serially numbered and are particularly useful for managers and others, for reviewing queries and consolidated replies without having to review all the individual messages. The AIDS community has seen its eighth community update recently.

Among the main benefits of Solution Exchange are the following: • Enhanced knowledge on development issues. The learning gained by CoP members draws from both documented knowledge and undocumented experiences.

• Branding for the UN as a source of ideas. UN Agencies are the ‘convenors’ of the communities of practice, and play a highly visible role as knowledge brokers, both in the country and through the global linkages that UN agencies are in the best position to access.

during its maiden year from 19 October 2005 up to 18 October 2006.

The benefits of a knowledge management partnership and Solution Exchange have also been seen as replicable in other countries. In June, at the invitation of the India Country Team, representatives of 13 UN Country Teams across the world, along with agency headquarter and regional unit staff, participated in a consultation on how to adapt the Solution Exchange model for other Country Teams. Currently the India project team is pursuing several invitations to help set up similar initiatives.

The customer has the last word in confirming our role in policy formulation.

Jaffer Inamdar of Positive Lives Foundation, Goa wrote in: “After our discussions on ’Pre-marital Mandatory Testing for HIV’ and the public debate that was held, the Goa State Government has declared that pre-marital testing for HIV would be by ‘opt-in’ which is akin to voluntary. Therefore, for a long time we in Goa will remember this discussion more for its influential power than for its engrossing controversy.”

Creating Space for e-Health An e-discussion or consultation is a virtual brainstorming by members of a community of practice to address a broad topic of interest and provide a range of insights, conclusions or recommendations for the benefit of policy makers or for community members to take forward their work. constitution, objectives, a vision for India as the least stigmatizing country, and a project document that translates these objectives into activities, addressing stigma and discrimination.

Community updates provide community members with periodic news, information on the queries, and information on other community activities.

Information could be on ‘open’ queries and e-discussions for which replies and contributions are still expected, on closed

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• Team building within the UN. The close involvement and collaboration of the UN Heads of Agencies in this UNCT initiative have facilitated other team-based exercises such as the recent UNDAF preparation exercise.

The first annual compendium of the AIDS Community, Solution Exchange was released by Dr. Peter Piot, the Executive Director of UNAIDS, on 18 December 2006. This compendium contains the first thirty-six consolidated replies, issued

Space Hospitals, the Chennai-based telemedicine services provider, has some ambitious plans on the anvil. By the end of 2007, the healthcare chain, which works through an alliance of 14 major super- speciality hospitals in India, has endeavoured to enhance its existing telemedicine network across Tamil Nadu by adding 126 new telemedicine centers to its network.

Besides this, the organisation also aims to establish 38 satellite medical centres and nine regional association hospitals, which will improve its presence in the rural areas. Space Hospitals is engaged in talks with some major hospitals to join as its regional associate partners.

All total, Space Hospitals has aims of setting up 500 satellite medical centres, 40 regional associate hospitals and 800 telemedicine centres throughout the country during 2007.

eHealth | January 2007

World News Surgery in the US, watched in Pakistan The Higher Education Commission (HEC) of Pakistan has recently made successful inroads in the field of e-Health.

It has connected universities on the Pakistan Education and Research Network (PERN) with important universities of 14 countries, for an interactive video conferencing on health.

This has enabled medical students and faculty members in Pakistan to witness a live arthroscopic shoulder surgery being conducted in the US, and also exchange comments and discussion prior to the surgery with a cross-section of the academic fraternity from the Columbia University, McCormick Centre Chicago, Peking University, GDLN World Bank,Washington DC, Shanghai Jiaotong University, IIT New Delhi, Hong Kong University and University of Athens.

On 5 December 2006, the ‘Global Forum on Road Trauma’ became the first ever health event to be telecasted via video conferencing in Pakistan. It included live interactions with academicians and professionals from top universities and research institutions, which included University of Toronto, World Bank, Federal University of Rio de Janeiro, University of Vienna Medical School, Peking University, Shanghai Jiaotong University, India Institute of Technology, New Delhi, and McCormick Centre, Chicago.

Here it deserves a mention that by participating in this mega global conference on health, Pakistan formally joined a high-speed network named Internet2, that has links with over 200 top-of-the-line research institutions of the US.The network can now help many researchers to participate in collaborative experiments from thousands of miles apart, and also have access to high quality research material.

Of course, health researchers in Pakistan should avail of this opportunity, which can give a fillip to the e-Health scenario of our not so friendly neighbour.

January 2007 | www.eHealthonline.org

We wish them best of luck on the road to e-Health.

Presently Higher Education Commission’s video conferencing project has connected with nine universities in Pakistan through IP-based video conferencing system. This enables students of those universities to exchange ideas and views and gain knowledge and capabilities across vast distances.

A nose for cancer Dr. Hossam Haick, a 31-year-old Israeli researcher with the Israel Institute of Technology, has received a whooping grant of 1.73 million euro by the EU under its Marie Curie Excellence programme, for the development of an electronic nose, which can sniff and detect the growth of cancer at its earliest possible stages.

This grant can be seen as EU’s sustained endeavours to support and encourage young scientists.

If Dr. Haick’s research is successful, medical science will get a potent weapon to check any cancerous growth and eliminate this dangerous disease at its inception. Dr. Haick aims to create an instrument based on nanometer-sized sensors, that would not only be able to diagnose cancers at a very early stage, but would also ascertain as to what stage the disease is.

All odours comprise of molecules, and each of these molecules has a corresponding receptor in the human nose. When a specific receptor receives an odour molecule, it sends a signal to the brain and the brain identifies the specific odour of that particular molecule. The theor y behind the electronic noses is based on this basic physiological model, only in electronic noses, sensors are substituted for the

receptors. And instead of the brain, the sensors will transmit the signal to a program for processing.

A healthy charity Christmas eve can be the ideal time for some development work cloaked in charity, and the Australian Chamber of Commerce in Vietnam (AusCham) has wisely availed of this opportunity. The chamber, in association with the Australia and New Zealand Group (ANZ), organized a Christmas-time charity gala dinner for raising funds for an Internet health project at the National Hospital of Paediatrics in Ha Noi, Vietnam. The National Hospital of Paediatrics is an important centre for paediatric care in Vietnam.The charity dinner got support from heavyweight sponsors like Sofitel Plaza Ha Noi, Phillips Fox, Duografikmedia, Midway Metals, Cathay Pacific and Ha Noi Zakka.

The proceeds from the night were donated to the Hoc Mai Foundation, which has introduced a web-based communications link for doctors at the National Hospital of Paediatrics, in Ha Noi. Here it deserves a mention that the Hoc Mai Foundation, under the University of Sydney, runs an e-Health linkage project, which endeavours to have online case referrals between Vietnamese doctors at the National Hospital of Paediatrics in Ha Noi and medical practioners with the Royal North Shore Hospital and Children’s Hospital in Sydney, and the Royal Children’s Hospital in Melbourne. These links will help the Vietnamese doctors at the National Hospital of Paediatrics to able to refer cases on to hospitals in Australia for second opinions or expert advice, and as such we can say that the proceeds from this charity will go a long way in fostering to develop a strong eHealth link between these two countries.

An eye for e-Health Drishtee, which is engaged in creating and implementing a sustainable and scalable platform of entrepreneurship for

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enabling the development of rural economy and society in India with the use of ICT, has already made a name for itself in the field of e-governance. And in Dec 2006, it kick-started an e-Health initiative. Drishtee, along with its partners and its network of ICT kiosks, is proposing to take a major lead in taking quality health services to the rural populace. It proposes to involve leading players in the health care domain and synergize their competency and bind it with the strength and credibility of ICT entrepreneur to reach a broad based section of the community.

Though the present project is in the pilot stage, its potential reflects a bright future for rural e-Health in India. Under this project, Drishtee will set up kiosk cooperatives in villages, which will facilitate people in those villages to communicate with their health centers.

These health centers in turn will be connected to hospitals via Internet.

Doctors in hospitals will send their reports and prescriptions online.

Similarly, the kiosk centers will order medicines online as per the prescriptions.

Besides being an important conduit for medication, the health centers will also store important medical statistics, such as reports of blood pressure, pulse rates, etc. of regular patients. For this project, Drishtee has tied up with Bangalorebased Nerosynaptics, a local NGO named Janani, and a pharma company.

Here it deserves a mention that the World Economic Forum has selected 47 companies across the globe as ‘Technology Pioneers for 2007’, which also includes two Indian firms. One of them is Drishtee, and the other is Strand Lifesciences. The latter’s domain is into bio-informatics, and it applies algorithms and other computer-based technologies to facilitate innovation, discovery and development of new drugs. It seems that e-Health is the new buzzword in India’s technology.

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The heart of intelligent machines Telemedicine can now help you get cured of sleep apnea; a type of breathing disorder … while you are sleeping. If it sounds like fiction, then just remember the age-old saying. Yes for Christian Weigand, a computer scientist at the Fraunhofer Institute for Integrated Circuits in Erlangen, Germany, and his scientist colleagues, this is a scientific reality that they have achieved.

They have developed an innovative device which can be put in a box and strapped around the chest of the patient before he or she slips into slumber.With the aid of sensors, the said device can record vital data about the patient’s breathing rate, pulse, heartbeat, oxygen level in the blood, and sleeping position.

Now thanks to bluetooth technology, these data are now transmitted via shortrange radio to a base station (which incidentally is in the patient’s home), where the data is analysed and being send to the physician treating the patient.

Now its medical applications are no doubt, enormous. Besides breathing disorders, this futuristic technology can also aid the heart patients through remote monitoring, without making them bother to visit a hospital. Moreover, now the latest cardiac pacemakers and defibrillators are ‘intelligent’ enough to check themselves and send an email to the physician treating the patient, if they are not functioning properly, which facilitates their speedy ‘cure’ or replacement, thus saving lots of botheration for the patient. However, they can not only check themselves, but can also record changes in the heartbeat and heart rate of their ‘master’the patient!

Take the case of Health Manager, a device developed by the Stuttgart-based company Biocomfort. Presently it can measure weight, body fat, blood pressure, and blood sugar and its ability

to check heart rhythm is also on the anvil. That’s not all. The machine can transmit these medical data by radio to a personal computer or personal digital assistant, whose software makes a health assessment and gives warnings and health tips, as the case may be, through online. And what’s more, the machine is not at all unaffordable by international standards. Time to have a nice sleep ...

A fashion statement Eat healthy to stay healthy is an old notion. While that may still ring true, there is every likelihood that with the progress of the twenty-first century, the proposed and supposedly nutty dictum of “healthy clothing for a healthy life” can be taken with all seriousness. The European Commission has supported the development of intelligent biomedical clothes throughout its Fifth and Sixth Framework Programmes, and the Seventh Framework Programme provides for greater funding for research in this field, which makes intelligent fabrics an idea full of promise; all ready to make an impact in the world of health and fashion. Already some formative developments in this area by some of the FP6 projects are amply showing the huge potential. The garments developed in the WEALTHY and MYHEART projects deserve special mentions in this context.

Now what is the concept behind intelligent fabrics? They are smart fabrics with embedded sensors to monitor various aspects of human physiology. A patient wearing these clothes can be monitored over extended periods of time, which can greatly reduce the need for visits to doctor’s clinic and hospital.

The data collected from these wearable sensors can be transmitted to the telemedicine centers via communication networks(electronically, of course), and when the data reflects a need for concern, electronic systems show alarm or warning signs. Thus without the botheration of making an appointment and visiting a doctor after a long wait, eHealth | January 2007

the patient can stay connected with his doctor. These innovative form of clothing can not only intimate the doctors immediately about any emergency condition, but can also help in prevention and early detection of many diseases.

This innovation can be a great boon for the chronically ill patients who need constant monitoring, and for the elderly vulnerable people, who find it difficult to access traditional care due to their infirm conditions.

The muscle of e-Health Leading European researchers and doctors have come together in a newly launched ‘network of excellence’, to find cure for rare neuromuscular diseases.

This 10 million euro worth network is a first of its kind, and will provide the ideal marriage between ICT and medicine for neuromuscular research and treatment.

It has been funded by the EU. More than two lakh people in Europe suffer from neuromuscular diseases, which may lead to paralysis or even death. Muscular dystrophy and spinal muscular atrophy are only two of their fatal forms. The network named TREAT-NMD (Translational research in Europe Assessment and Treatment of Neuromuscular Diseases) comprises 21 partner organizations from 11 countries, and besides doctors and researchers, it brings together charities and public organizations working in neuromuscular diseases.

The network is not only concerned with exchange of ideas, research and invention of new drugs for neuromuscular diseases, but also with the logistics aspect. To ensure optimal efficiency in the progress of a drug from a laboratory to a medical shop, the network is establishing close linkages with the pharmaceutical companies. The network will develop clinical trials coordination center in Germany, which besides imparting advice on conducting trials of the highest standards, will offer training to participants in the network.

January 2007 | www.eHealthonline.org

The Power of MammoGrid In modern times, breast cancer has become the most common chimera among the women, across the globe.

According to statistics, it results in the death of one in 28 women in the EU and the US.Thus the importance behind its early and accurate detection just cannot be overestimated. Conventional Mammography can be the answer, though the probability of misdiagnosis involved in such a technique is quite high, largely due to the differences in tissue density among the patients, but also due to the differences in equipments and procedures. Here ICT can provide an effective solution as far as early detection and accuracy of diagnosis of breast cancer are concerned.

The European Information Society Technology (IST) project MammoGrid, which ended in August 2005, has explored the power of the grid to improve diagnosis. The software developed is already helping the hospitals, doctors, clinicians, radiologists and researchers.

The MammoGrid approach applies grid technologies for medical diagnosis and enables users to compare new mammograms with existing ones in the grid database. Already 30,000 images of over 3000 patients are stored in the

exhaustive, geographically distributed, grid-based database. Through this novel approach, the users can access mammograms from a variety of sources, as well as computer-aided detection algorithms; to detect tiny specks of calcium in the breast that could indicate cancer, and can also monitor breast density. Greater the tissue density in the breast, greater is the vulnerability of getting breast cancer.

The current version of the software also enables users to securely share the resources and patient data, without risking the anonymity of the patient.

However, the story doesn’t end here. A new consortium independent of IST funding has been set up to further develop the prototype and make it more in tune with the market needs. The new project team has set up four separate sites, to simulate the needs of four different hospitals and test the latest project developments.

The results from these tests have been evaluated by a panel of two IT experts and five clinicians from the hospitals in Spain’s Extremadura region. A precommercial release of the software (Mammogrid+ version 1.0) is scheduled in June 2007. Five hospitals are involved in this project, and the future plans include broadening the existing database across Europe.

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Report

A MEET OF GREAT BELIEF

T

he first European and Indian eInfrastructures conference was held at the Grand New Delhi, New Delhi, India during 14-15 December 2006, attracting over 250 research, industrial and academic delegates from ICT and its related domains. The august conference was organised by the BELIEF (Bringing Europe’s eLectronic Infrastructures to Expanding Frontiers) consortium. The BELIEF partners are from varied backgrounds and areas of expertise, spanning Europe, Asia, America and Latin America. The BELIEF Consortium possesses experience and expertise in community development, e-Infrastructure, networking connections and digital library development. The consortium shares complementary skills, international resources and links in the areas of e-Infrastructures.

The aim of this first of its kind event was to exchange information and views on how eInfrastructures are currently deployed in both Europe and India, with the objective of analysing how their increasing role is viewed in a business, educational, socio-political and scientific context. The two-day intensive discussions looked at promoting the sustained use of the EU-India link (Geant2 connectivity) and especially its use by new user communities.

The intellectually stimulating two-day programme was specifically targeted at industry and research experts and new users who wish to adopt eInfrastructures effectively within their workplace or research activities. The participants represented a rich mix of industry, government, research and academia, and

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The aim of this first of its kind event was to exchange information and views on how eInfrastructures are currently deployed in both Europe and India, with the objective of analysing how their increasing role is viewed in a business, educational, socio-political and scientific context. lll

NGOs. 14 EU-funded projects were showcased and there were key eInfrastructures stakeholders from Indian and European organisations. Though a majority of the delegates were from India, but there was sizeable representation of European and Latin American delegates too. The country breakdown of the participants showed that 78 percent were Indians, 19 percent were Europeans, and

3 percent were from Latin America and other countries.

Some of the speakers from Europe were representatives from CNRS-IN2P3 (France), Copenhagen Business School (Denmark), D-Grid (Germany), Eindhoven University of Technology (Netherlands), GEIE ERCIM (France), GRNET (Greece), INFN Cagliari (Italy), Infra Technologies (France), KTH eHealth | January 2007

(Sweden), Martel GmbH (United Kingdom), Poznan Supercomputing (Poland), RENATER (France) and University of Salerno (Italy). Additionally, officials of the European Commission and the European Union delegation to India were present to exchange information with the delegates, on opportunities for mutual and collaborative European funded programmes in R&D. Indian representations included members from the Ministry of IT, ERNET India, Avanade Inc, Sullivan University, C-DAC Noida, Centre for Science Development and Media Studies (the NGO was a media partner), DELNETDeveloping Library Network, IIIT Bangalore, IIT Bombay, Indian Institute of Statistics, Institute of Biomedical Technologies, National Informatics Centre, PlanetEDU Pvt.Ltd, etc.

The plenary and parallel sessions explored the concept of eInfrastructures with great introspection and detail. The topics discussed were: • Connectivity and sustainability - new user communities for eInfrastructures (services) between India and Europe;

• Government delivered services - the current case studies, future plans and visions in India and Europe in the field of eInfrastructures; • eHealth - the new opportunities for EUIndia e-health cooperation using eInfrastructures; • Scientific repositories - how can the EU best collaborate with India to create worldwide digital repositories; • Digital divide – the eInfrastructures’ role in reducing the digital divide; • Enabling business – what impact will eInfrastructures have on business in India; • Distance and eLearning – harnessing the power of eInfrastructures; • Mobile Grid - the convergence of eInfrastructures, mobile and grid technology.

Conference Highlights: EU-IndiaGrid Project Session: The EUIndiaGrid (www.euindiagrid.org) Project Session discussed priorities for training and interoperability between EGEE (Enabling Grids for E-sciencE) and Indian Grid infrastructures; and explored possibilities

of pilot applications for this new infrastructure support project.

Belief Conference Promotional Zone: This promotional zone displayed highly relevant documentation, published by the European Commission and ERNET. The focus of this promotional area was innovative Grid-enabled technologies and e-Infrastructures, developed or being developed by Europe and India; national and international initiatives aimed at facilitating the adoption of these new, more powerful resources, and intensifying collaboration between the two regions and spurring innovation for mutual benefit.

Get In Touch Sessions: BELIEF offered all delegates the chance to participate actively in the conference and learn about the activities of various projects as well as FP7 opportunties. Each session comprised a series of 10-minutes presentations, focusing on project activities and ideas for eInfrastructure funding under FP7. The EuroIndia-IT project was on hand to offer expert advice on future opportunities under FP7, to foster further collaboration between India and Europe.

- Prachi Shirur

World Health Care Congress Europe 2007 The third annual edition of the World Health Care Congress Europe 2007 will be held during 26-28 March 2007 at the Fira Palace Hotel in Barcelona, Spain. It is presented with the lead underwriting support from Capgemini. Here it deserves a mention that Capgemini, which is headquartered in Paris and is a global leader in consulting, technology, outsourcing, and local professional services; working in partnership with clients to develop business strategies and technologies tailored to their unique requirements, has become the premier sponsor and the host of World Health Care Congress Europe 2007 for the third consecutive year.

Organised under the high patronage of the European Commission, the World January 2007 | www.eHealthonline.org

Health Care Congress Europe is a major international forum which is expected to attract over 500 health leaders, who will share their best practices and successful initiatives for improved delivery and outcomes in Europe. The event is expected to attract the participation of an impressive array of thought leaders across the globe, which include health ministers, leading government officials, hospital directors, IT innovators, decision makers from public and private insurance funds, pharmaceutical and medical device companies, and health care industry suppliers.

The event will have four focused summits, which are: • Chronic Disease Management and Patient Empowerment • Implementing IT Systems

• Paying for Performance • From Electronic Health Records to Personalised Healthcare As a two-day networking opportunity, the event will feature visionary keynote addresses, controversial debates, dynamic panel discussions, and case studies. By attending the four summits, delegates will have a great opportunity to discuss pertinent issues in-depth and to determine actionable plans with healthcare leaders from around the world. It can be said that among other areas of the health sector, the mega event has the potential to generate greater awareness and initiatives in the field of eHealth too. The second World Health Care Congress Europe took place in Chantilly during 29-31 March 2006, and the event was a huge success.

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Viewpoint

‘E’ FOR EXCELLENCE; ‘E’ FOR HEALTH During the recently held BELIEF (Bringing Europe’s eLectronic Infrastructures to Expanding Frontiers) eInfrastructures Conference, which was held during 14-15 December 2006 at the Grand New Delhi Hotel, Swarnendu Biswas, Assistant Editor of eHealth, had a fruitful conversation with Prof.

Saroj Kanta Mishra, the Head of the Department of Endocrine Surgery at the Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow. Here is an excerpt of an interview with him as presented below: What is the ambit of e-Health in India? e-Health is not only about telemedicine.

One needs to clear the air about the popular but mistaken notion of connecting e-Health only with telemedicine.

Besides telemedicine, in India the ambit of e-Health comprises an array of services, including hospital information management system, customer service through Internet, medical transcription, and health awareness through portals.

How do you gauge the potential of e-Health in India?

India has awesome potential in the field of e-Health. Presently India already has 400 hospitals with telemedicine facilities, with many more to come. Commendable work has been done by ISRO, C-DAC, AIIMS,

36

and of course, by SGPGIMS, in furthering the network of e-Health across India.

Today ISRO’s telemedicine network covers 165 hospitals, which include 132 district/rural hospitals and 33 super-specialty hospitals.

Kindly elaborate on some of the other prominent e-Health initiatives taken in the recent times by the government.

There are myriad e-Health initiatives by the Department of Information Technology, which includes among other measures, the development of Teleoncology network in Kerala and Tamil Nadu, and networking of district hospitals of Mizoram and Sikkim with Apollo Hospital, Delhi. Presently the DIT telemedicine network covers 75 nodes. The Integrated

Disease Surveillance Project, and the All India Regional Cancer Network-oncoNET India- of the Ministry of Health and Family Welfare also deserves a mention in this context. e-Health is still by and large an elite concept, and its penetration in the rural India is still negligible. What are your comments regarding this.

I agree that e-Health’s penetration in the village level has still been far from satisfactory. However, one should not get unusually disturbed over this, for we have to remember that in India the concept and practice of e-health is still in its nascent stage. Gradually its benefits are percolating down from the research institutions to the district and village levels with a top-down approach. eHealth | January 2007

Kindly elaborate on the problems, which are impeding the spread of eHealth in India.

The major problem is of developing a costeffective satellite infrastructure. However, with the introduction of WIMAX technology, there would be an exponential growth in telemedicine across India, as it will enable to bring the districts and villages within a cost-effective ‘e’ network.

But in the same breath, I must say that satellite connectivity will not alone ensure the growth and spread of e-Health network in the Indian interiors.

Besides the age-old inhibitions and prejudices, which impede the adoption of an innovative technology, it is also difficult for the poor people in the rural areas to borne the consultation charges of the specialists in Indian metros or abroad.

In fact, cost is a major inhibitor to world class medical care, and telemedicine is unlikely to change the equations overnight.

Then there is the acute lack of skilled and technical manpower to man the referral clinics, which compounds the problem in the percolation of e-Health. After all, e-Health in itself is not a magic wand, which will solve all the health problems of India; we have to give adequate ascent to the issues of health infrastructure also to ensure the success of e-Health network in India.

Furthermore, the tangle of legal and licensing issues are other thorny factors, that may threaten the smooth progress of e-Health in India. Suppose a doctor from USA prescribes a particular medication to a doctor/health worker associated with a district-level referral clinic or hospital, and if something unfortunate happens to the patient; then who is to be held accountable? Of course, if there is some blunder being committed in the execution stage, then the said health worker/doctor in the referral clinic is accountable, but if wrong medication is administered across thousands of miles, then how on earth can we hold the US doctor accountable without comprehensive regulations?

January 2007 | www.eHealthonline.org

What are the achievements of Sanjay Gandhi Postgraduate Institute of Medical Sciences in the field of e-Health?

Commendable work is being carried out

by Sanjay Gandhi Postgraduate Institute of Medical Sciences. The institute happens to be the first tertiary care hospital in public healthcare sector in India to adopt information technology (IT) for healthcare delivery. The institution joined the digital revolution in 1998, when it introduced the Hospital Information System (HIS) for the purpose of recording, storing, processing and retrieving health related data of its patients.

What’s more, the software was developed in-house, in collaboration with Center for Development of Advanced Computing (C- DAC), Pune. In 1999, telemedicine was introduced at the institute, and in 2001, a comprehensive telemedicine infrastructure was in place. The HIS database, which is managed through Oracle, boasted patient records of 2,47,201 patients till 31 March 2005, and every day, 250 new registrations are done on the system, on an average. e-Health scenario in India is characterised by acute paucity of skilled manpower. What is SGPGIMS doing to address this issue?

At Sanjay Gandhi Postgraduate Institute of Medical Sciences, we give considerable ascent on training of skilled manpower for e-Health. Doctors of other medical colleges and community centers are also being educated about the tele-healthcare and tele-educational services at SGPGIMS. For the last seven years, we are also involved in the application-oriented research in telemedicine; research works which are in tune with the Indian context. In this regard, the institute’s endeavour to set up the School of Telemedicine & Biomedical Informatics deserves a special mention. The school is expected to do a yeomen service to the healthcare industry by imparting training for all kinds of ICT applications in healthcare. Overall, these telemedicine

awareness activities of SGPGIMS for healthcare providers and other stake holders will definitely help in catering to the extreme paucity of trained human resource in the field of e-Health, in India.

Has the institute established telemedicine networks with other medical institutions of India? What are the e-Health activities the institute is presently engaged in?

Over the years, the gamut of work done by SGPGIMS in the field of e-Health has been impressive to say the least. The institute has established telemedicine networks with reputed medical institutions across India, which include among others, AIIMS, PGI Chandigarh, AIMS Kochi and SRMC Chennai.

Tele-consultation and distant education in medicine, tele-mentoring, research and product development in tele-health, in collaboration with industry are only some of the productive e-Health activities that SGPGIMS is presently engaged in.

Besides, we are also doing consultancy, project planning and implementation of telemedicine network in the states of Orissa, Uttaranchal, Uttar Pradesh and the North-East states.

One of the recent feathers in the cap of SGPGIMS is the innovative usage of telemedicine infrastructure to effectively monitor the health problems cropping up among the people in the makeshift townships of the recently held Khumbh Mela. We established exhaustive telemedicine networks, connecting State Administration Health Secretariat at Lucknow, the field hospitals at the makeshift townships, and the nearest hospital from the mela site.

This ensured that devotees thronging to the Khumbh Mela got a decent medical care, at par with a resident in Lucknow.

By achieving success in this regard, we proved that like timeless faith, timely care too doesn’t believe in distance. Specially if you are ever willing to walk that extra mile.

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Project Showcase

A HELPING HAND

T

he Defence Advanced Research Projects Agency (DARPA) of the USA has initiated its efforts to revolutionize prosthetic devices for amputee soldiers. These initiatives are in response to the casualties suffered by the defence personnel during the conflicts in Afganistan and Iraq. Presently DARPA has two projects of this nature. One is a two-year-long project titled ‘ Prosthesis 2007’ which will incorporate the best possible technologies and the most revolutionary short-term developments into a highly advanced, neurally interfaced prosthetic arm. The arm would be likely to be ready for clinical trials within two years. The research is expected to yield a limb that will allow the user to control his/her shoulder, elbow, wrist and hand simultaneously.

The project has been awarded to Deka Research and Development Corporation, Manchester, which received an 18.1 million USD funding from DARPA to this effect. However, it is not a solo endeavour of Deka as the institute will be working with researchers and clinicians at Rehabilitation Institute of Chicago (a leading rehabilitation hospital in the US), Chicago PT, LLC (a private firm having expertise in human/machine physical interaction), Good Imaging Technologies, and Institute of Biomedical Engineering, University of New Brunswick. The Institute of Biomedical Engineering will develop the embedded computer that interprets the muscle activity of the user, and relays control information to the prosthesis.

In this project, researchers will focus on some of the more difficult mechanical

38

aspects of providing near-human strength in a prosthetic limb and would create customizable method of manufacturing a cosmetic covering that would allow the amputee a prosthetic arm, which is not only functional, but is similar in appearance to the amputee’s native limb.

The Applied Physics Laboratory of John Hopkins University has been awarded the other project. Revolutionizing Prosthetics 2009 program has a four-year gestation period and a budget of 30.4 million USD. Under this project, over the next four years, the researchers are expected to create a mechanical arm with the properties of a biological limb. With this new prosthetic, an upper extremity amputee would be able to feel and manipulate objects as he/she could do with his natural hand.

Researchers will focus mainly on advanced neural control strategies to allow the user to operate the prosthetic arm in a near-biological manner. Besides that, the program would develop new power,

actuation and robotic control technologies and fabricate advanced sensors.

According to Dr. Kevin Englehart, Associate Director, Biomedical Engineering of the Institute of Biomedical Engineering, University of Brunswick, “The diverse APL team brings together some of the most respected scientific researchers in their fields and commercial leaders from the prosthetics industry, including investigators from Arizona State University, the BioSTAR Group, California Institute of Technology, Johns Hopkins University, National Rehabilitation Hospital, New World Associates, Northwestern University and the Northwestern University Prosthetics Research Laboratory, Oak Ridge National Laboratories, Otto Bock Health Care (Austria), Rehabilitation Institute of Chicago, Umea University (Sweden), University of Michigan, University of Rochester, University of California, Irvine, University of Southern California, University of Utah and Vanderbilt University.”

Besides activities and deliverables similar to the Prosthesis 2007 project, the Institute of Biomedical Engineering’s role in this innovative initiative also involves working in tandem with other partners in signal processing of the peripheral nerve and brain signals.

The successes of these pionerring research works have the potential to give a great respite to the amputees, and thereby providing a fillip to the thriving e-Health scenario across the globe.

For more details visit: http:// www.unb.ca/biomed/ research_proj_prosthesis07.php eHealth | January 2007

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