e-Healthcare in Africa endowed with the muscle of mobility: July 2007 Issue

v o l ume 2 | issue 7 | july 2007

a monthly magazine on ict and health ISSN 0973-8959

Rs. 75

e-Healthcare in Africa cover story

ambient wireless networks for subsaharan africa’s health system technology

rfid in healthcare: the emerging enabler development

telemedicine gets a human face event

microsoft public healthcare seminar case study

information ethics in paperless hospitals company profile

stalis serious on health data News review

world news Business news india update

www.ehealthonline.org

endowed with the muscle of mobility

www.ehealthonline.org your one-stop portal on healthcare ICTs

Catch Up With Latest News

Read Experts' Interviews

Access Magazine Archive

The pulse on Asia's e-Health

7

w w w . e h e a l t h o n l i n e . o r g | volume 2 | issue 7 | July 2007

Cover story

6

Ambient Wireless Networks for Sub-Saharan Africa’s Health System

13

Adesina Iluyemi

technology

10

RFID in Healthcare: The Emerging Enabler

A.U. Jai Ganesh, S. Srikrishna

case study

33

Information Ethics in Paperless Hospitals

Sapiah Binti Sulaiman, Rose Alinda Alias, Azizah Abd. Rahman

18

company profile

Stalis Serious on Healthcare Data

14

development

Telemedicine Gets a Human Face

16

event

Microsoft Public Healthcare Seminar

18

NEWS REVIE W

world news

23

•

business news

38

27

india update 30

July 2007

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

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

300 dpi).

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

•

•

•

•

published from year 2002 onwards, are preferable. In the case of website, provide the URL. The manuscripts should be typed in a standard printable font (Times New Roman 12 font size, titles in bold) and submitted either through mail or post.

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

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

All contributions are subject to approval by the publisher.

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

www.ehealthonline.org

Volume 2 | Issue 7 | July 2007

president

Dr. M P Narayanan

EDITORIAL Technology for Health is the Emerging Mantra

editor-in-chief

Ravi Gupta sr. editor

G Kalyan Kumar Assista nt editor

Swarnendu Biswas alliances & Advertisement

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

Bishwajeet Kumar Singh Om Prakash Thakur web

Zia Salahuddin circulation

Lipika Dutta (+91-9871481708) Manoj Kumar (+91-9210816901) editorial correspondence

eHealth G-4 Sector 39 NOIDA 201301, India tel: +91-120-2502180-85 fax: +91-120-2500060 email: info@ehealthonline.org printed by

Vinayak Print Media, Noida Gautam Buddha Nagar (U.P.) India does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. is not responsible or accountable for any loss incurred, directly or indirectly as a result of the

T

he world seems to be changing for the better, with ICT playing a crucial role in attempting to bridge the still yawning gap between the developed and the underdeveloped world; between the have and the have nots. Whether this will eventually lead to an egalitarian planet is a matter of debate, or perhaps die-hard optimism, but what is sure is that some significant inroads are being made.

Take the case of Sub-Saharan Africa. The region is reeling under poverty and unemployment on the one hand and HIV and AIDS on the other. In terms of healthcare, the region is faced with severe financial and logistical bottlenecks. But thanks to the burgeoning mobile/wireless network scenario in Africa, the hitherto hapless people of this region now have the potential of overcoming the centuries-old institutional deficiencies and reach a healthy e-age. The readers can get an insight into this scenario full of wonderful possibilities in our Cover Story.

Radio Frequency Identification(RFID) is another development in medical electronics having significant bearings on the health sector.

This automatic identification and data capture(AIDC)technology, which uses radio frequencies to transmit information, does have the potential to efficiently track hospital inventory, mobile medical equipments, medications and patients, and is a significant improvement over the barcode technology. We have also discussed the wide applications of RFID technology in healthcare and its catalytic role for healthcare service providers in this issue, through an interesting and engaging article by two e-Health experts.

However, despite the recent advances in ICT and electronics, which are going to shape the healthcare of tomorrow, possibly for the better, we must take into account of the ethical considerations that are rearing their heads in this emerging ICT-enabled medical environment. The case study on information ethics in paperless hospitals in Malaysia probes to find some pertinent solutions to this troubling scenario. Read it for a greater insight.

Though very much unwilling to do so, I have to end the above rosy picture on a maudlin note. V.K.Sarmaranayake, an ICT icon of sorts in our part of the world, is no longer with us. However, his quintessentially innovative spirit will help us strive to cross new frontiers and unlock new doors... His vision can make the developing world of Asia reach a truly ICT age in healthcare and other development domains.

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

July 2007

Ravi Gupta Ravi.Gupta@csdms.in

>

C O V E R s t or y

Ambient Wireless Networks for Sub-Saharan Africa’s Health System Tremendous promise despite myriad constraints There is a need to provide connectivity and access to the much needed and poorly distributed health knowledge and expertise within the health system in Sub-Saharan Africa. Connectivity and access through wireless networks could make possible communication between different levels of the health system, which in turn could ensure the coordination and cooperation between varied and distributed actors and infrastructure.

Adesina Iluyemi

T

he poor healthcare system in Sub-Saharan Africa (SSA) is a matter of numerous policies and fora discourses, but with limited commensurate actions or impacts. For example, the picture of the HIV/AIDS epidemic on the African continent is extremely alarming with about 40 million patients living with HIV and AIDS. This has impacted on all fabrics of society and health systems in SSA, with resultant loss of health personnel due to high mortality rate. This massive brain drain within the health systems is also compounded by the internal rural-urban and external local-international migration of qualified health personnel.

In addition, the severe financial and logistical constraints within the health system in SSA have also reinforced this poor state. These institutional deficiencies and limitations call for the need to explore alternative models of tackling and managing the health systems in SSA. The exploitation of the potentials inherent in the effective, appropriate and contextual applications of information and communication technologies (ICTs) could provide an alternative or complementary model for overcoming these systemic constraints in the health sector. The use of ICTs for health system support is in line with the numerous national, regional and global development frameworks for employing ICTs for health system development.

A major global or intergovernmental example is the World Health Organisation (WHO)’s e-Health initiatives. WHO, as far back as 1998, have promoted the use of ICTs for health system development and has since adopted the term e-Health in the document titled ‘Strategy 2004-2007 e-Health for }

Health Care Delivery’ (eHCD) in 2003. The use of e-Health for Primary Health Care (PHC), especially in low-resource countries from SSA, was a specific focus.

Subsequently the establishment of a Global Observatory for eHealth (Goe), which has on its plan to use e-Health for the development of the health system, mostly in the low and middle income countries as presented in the WHA 58.18 document, is a product of the WHO’s commitment. Two areas where e-Health can contribute to the health system in SSA are developing and building human health capacity, and in supporting and extending health services to the mostly rural, urban and geographically distributed population. The adoption and diffusion of e-Health within the health system in SSA could provide a means of maximising the skills and knowledge of the health workers located either locally within a country, region and internationally, and extend it to low level health workers situated in the rural and urban health centres.

In order to leverage the inherent potential of using e-Health to develop health human resources development and to improve and extend health service delivery, the existing wireless infrastructure should be employed. There is a need to provide connectivity and access to the much needed and poorly distributed health knowledge and expertise within the health system in SSA. Connectivity and access through wireless networks could make possible communication between different levels of the health system, which in turn could ensure the coordination and cooperation between varied and distributed actors and infrastructure. www.ehealthonline.org

Wireless/Mobile Network Scenario in Africa

The reality on ground in most SSA countries is the inevitability of the mobile/wireless technologies in providing communication access to millions of previously deprived and underserved people. This has led to the quiet acceptance of these ubiquitous technologies as the utopian answer to bridge the digital divide between the developed and developing countries. A very vivid manifestation of communication accessibility and connectivity of these technologies is explicit in the social democratisation and diffusion of GSM-based voice technologies.

For example, there are presently 2 billion GSM mobile phone subscribers in the world and the figure is rising. This figure is aside from other established mobile/wireless voice communication systems like satellite, CDMA and the emerging Voice Over Internet Protocol (VoIP) through wireless IP networks. This global trend has been replicated in the developing regions like SSA where as of November 2006; there were 177 million subscribers of GSM mobile telephony.

What’s more, some countries like South Africa and Nigeria have over 30 million users each, far outstripping the number of fixed telephones and even the mobile subscriber base in many European countries. In addition to this phenomenon is the sprouting of Community Internet Centres (CICs), also known as community telecentres or community access points, powered by the use of IP wireless networks such as GPRS, 3G, WiFi, VSATs, broadband satellite, DVB-RCS, and increasingly WiMax, for Internet access and connectivity.

This community shared access phenomenon is manifested as

the use of one GSM mobile phone by many people through familial, public and private access points. This trend challenges the established notion of using the subscriber base as a measure of connectivity with a shift towards measurement of access, which is a reflection of actual mobile telephony usage and penetration in SSA. The adoption and usage of mobile/wireless technologies in SSA and other developing countries has been driven mostly by voice communication, with data transmission limited only to SMS usage (and increasingly MMS) with GPRS already available in some SSA countries such as Uganda, South Africa and Nigeria. The use of voice and SMS communicationJuly 2007

based systems (notwithstanding their deficient data capacity) has transformed social networking in the SSA region, whose impacts are observed in building familial alliances, community mobilisation and enabling informal and formal business or commercial transactions. However, the lack of understanding or recognition of the potentials of the increasing bandwidth

A fully mobile community Internet access for community based home carers could be provided with WLAN enabled mobile devices that are in turn connected directly to community wireless networks on a real-time basis or ad-hoc basis, through mobile access points (MAPs) on bicycles or public buses, as in the DakNet project in India.

capacity of available and emerging wireless networks in SSA for leveraging the enterprise organisational processes of public and private institutions is retrogressive. The reasons for this might be but not limited to infrastructure scarcity, lack of knowledge, lack of coherent policy drivers, non-cooperative nature of telecom operators and lack of investment.

Wireless Enabled Integrated District Health Information System

The process and knowledge intensive nature of the health system demands a type of connectivity that has the capacity to carry large amounts of data and information from the distributed actors and structures within the health system, rather than voice-based communication only. As the district health system (DHS) is the unit of delivering PHC services in most of the SSA countries, there is a need to take an enterprise approach to the use of IP wireless networks for leveraging and supporting the organisational actors and structures.

Structures in this aspect could mean the physical entities of health facilities such as community health posts or district hospitals. Also, the structures could represent the different health information management systems (HIMS) of different vertical health programmes; electronic health records (EHRs) and web-based teleconsultation platforms such as iPath.

The actors represent the different cadres of health workers at the levels of the DHS. In the same vein, the integration and the interoperability of the different structures together could be achieved through the use of web tools and platforms. Web services are already matured for desktop applications, but the initiative of W3C in developing web tools for mobile devices especially for developing countries, is a pointer in the right direction and should be encouraged. Therefore, there is a need to recognise and identify the capacity and capability of these available IP wireless networks as a means of building an integrated district health information system (i-DHIS), as an appropriate means of providing the much needed connectiv

cover story

>

ambient wireless networks for sub-saharan africa’s health system

ity and access regardless of the geographical context. This proposition of an integrated health information system (HIS) is in line with the vision of WHO-led global plan of building a continent-wide district-based Public Health Information Network for African Health, known as ‘The African Health Infoway (AHI)’.

The use of the IP wireless network to enable the i-DHIS has the potential to provide the much needed access and connectivity to the Internet through different end-user devices, such as mobile phones, handheld computers, laptops and PCs; within and beyond health facilities.

Ambient Wireless Networks: A Proposed Model

The vision of the wireless IP enabled i-DHIS could be fully achieved through the concept of an ambient wireless network. This could be defined as the provision of Internet access through different types of wireless networks, regardless of your geographical context and nature of end-user device.

This integration and interoperability can be used to provide access and connectivity to the different cadres of health workers within the health system in SSA. This concept of ambient networks can either be classified as ad-hoc or continuous.

An ad-hoc ambient wireless network within an i-DHIS could involve a community-based health worker (CBHW) working within the community. He/She can be provided with Internet access through different types of fixed or mobile wireless shared access points. These can be used to provide either voice or data transmission in either store and forward or real-time modes. The use of Public or Private Call Offices (PCO), the Gremeen Bank concept of Village Pay Phone (VPP), Community Telecenters, the DakNet model of community information kiosks connected through wireless IP networks, are all proposed models of fixed wireless community access points.

For example, low-cost, store and forward data access platforms like SMS, MMS, and voice access through voicemails can be provided through GSM-based public or private community access points. These can be provided through the GSM-enabled ‘Shared Access To Data’ concept; a system of providing Internet access to multiple users from a single point either within the community or a health facility. In addition, the ‘Shared Access to Voice’ scheme; the deployment of a portable GSM-wireless box-phone, complete with solar charging accessories, to imitate a commercial public phone booth, can be adopted for voice communication. The deployment of these concepts through the Gremeen BankVPP model or CICs could provide an appropriate communication means for CBHWs in rural and urban regions of the developing countries. E-mails and web services can be accessed through shared PCs, located in the CICs or Community Access Centres (CACs) such as in the Nakaseke MTC model in Uganda. The provision of real-time voice communication for CBHWs can be provided through ‘Shared Access To Voice’ model or through VOIP in CICs. A mobile-fixed or semi-mobile concept could be equipping CBHWs with mobile devices such as mobile phones, PDAs and wireless smart cards or USB memory sticks. These can be

asynchronously connected to wireless access points, either within CICs as in the UHIN in Uganda concept, or community information kiosks, as in the DakNet model in India.

Connectivity can also be enabled by connecting the mobile devices through a wired connection to PCs via a secured website to a central repository within a health facility or community access points. Real-time multimedia and near real-time applications such as videoconferencing and instant messaging (IM) through the web can also be provided through PCs in the CICs for teleconsultation or interactive eLearning sessions, as in the iPath project. Public access points through community Internet digital screens, as in the Mindset Health programme in South Africa, can also be employed. The proposed ‘FonePlus’ concept from Microsoft can also be employed. This aims to make mobile phones to provide Internet access through connection to TVs that are widely available in most developing countries.

A fully mobile community Internet access for community based home carers could be provided with WLAN-enabled mobile devices that are in turn connected directly to community wireless networks on a real-time basis or ad-hoc basis, through mobile access points (MAPs) on bicycles or public buses, as in the DakNet project in India. These mobile devices could then provide data and voice access through IP networks. The use of low-cost mobile end user devices such as One Laptop Per Child project (OLPC) and Simputer could make this possible. Also a team of CBHWs on a community immunisation programme could employ the ‘Shared Access to Data’ model with an OLPC-like device for entering or accessing vaccination histories of patients on the field. The two shared access models could also be employed for use by a team of CBHWs, working together within a health post or health centre.

However, the concept of continuous ambient wireless network could provide a more integrated and seamless platform for the interconnectedness of the different actors and structures within the i-DHIS. This concept could ensure that the vision of the AHI becomes a reality within a relatively short www.ehealthonline.org

period of time. This could also ensure that Internet access and connectivity are provided to the actors within the levels of the DHS. For example, in the case of a CBHW illustrated above, instead of ad-hoc wireless Internet access, a CBHW empowered with a suitable mobile device such as OLPC can have Internet access through a WiFi network within the community health post. And the device can shift seamlessly to a GPRS/3G or long distance WiFi network, while working within the community during home-based care visits. This could provide an advantage of real time and instant access to the i-DHIS database.

From a different perspective, a continuous ambient wireless network could also enable a seamless integration of the structures within the i-DHIS, thereby ensuring that information is shared and updated on a timely basis. For example, the timely aggregation of data from EHR and HMIS would provide a timely access to information on matching health needs with logistical supply. Also, access to the i-DHIS can be provided through web services to a doctor, located at a district hospital, through a WiFi Local Area Network (WLAN)

The concept of continuous ambient wireless network could provide a more integrated and seamless platform for the interconnectedness of the different actors and structures within the district health information system (i-DHIS). This concept could ensure that the vision of the African Health Infoway (AHI) becomes a reality within a relatively short period of time. enabled PC, and the same access can be provided to a CBHW at the community level through WiFi/GPRS/3G enabled mobile devices like OLPC or Simputer. Hence, continuous ambient wireless networks could provide a means of using appropriate ICT tool to provide Internet access at different levels of the DHS. Taking this concept further, clusters of i-DHIS within each SSA country can further be interlinked and connected together with each other through the use of Wide Area Networks (WAN) like WiMax, WiFi, 3G and satellite technologies, either used singly or in combination. The interconnected i-DHIS could then provide a basis for building the continent-wide health network vision of AHI. This interconnection can then be achieved through the use of broadband satellite networks or through the ongoing New Partnership for Africa’s Development (NEPAD)’s fibre-optics broadband backbone presently under construction. Likewise, the India Space Research Organisation (ISRO) and the European Space Agency (ESA) have also indicated their intention to offer their satellite wireless networks to support the development of eHealth in Africa. The recently launched communication satellite by National Space Research and Development Agency (NASRDA) can also be employed towards this purpose.

Technically, this vision of continuous ambient wireless networks is feasible as the International Telecommunication July 2007

Union (ITU) under the Next Generation Networks (NGN) is already providing leadership on standardisation for interoperability and integration. ITU has also carried out some pilot studies in the use of IP wireless networks for e-Health purposes. Furthermore, the European Union (EU), through the Information Society and Technology (IST) programme, has developed protocols on how different wireless networks can be made to be interoperable so as to create a seamless and integrated information network for data and voice communication under the ambient network project.

Summing Up

The achievement of this vision could provide a means of building integrated health systems in Africa. In addition, the use of ambient wireless networks concept could provide a means of improving the health system through an integrated and networked health management information system.

Also, medical processes can be extended to rural and isolated regions of SSA through wireless telemedical and telehealth services. The recognition of this vision could provide a costeffective and appropriate means of achieving the WHO’s goal of ‘Africa Health Infoway.’ However, in order to achieve this vision of ambient wireless network enabled i-DHIS, there is a need to explore and exploit the Public-Private Partnership (PPP) clause of the target #18 of MDGs. Of particular importance is the need of the private wireless operators to be ready to share their infrastructure with public and community access networks. n Acknowledgement to Dr Jim Briggs of Centre for Healthcare Modelling and Informatics, University of Portsmouth, UK and Dr Patricia Mechael, mHealth Consultant to WHO for their valuable contributions to the structure of this article.

References:

1.http://whqlibdoc.who.int/hq/1998/WHO_DGO_98.1.pdf 2.http://www.who.int/entity/eht/en/eHealth_HCD.pdf 3.http://www.who.int/goe/en/ 4.4. http://telemed.ipath.ch/ipath/ 5.http://www.w3.org/2006/07/MWI-EC/cfp 6.http://www.gsdi.org/SDIA/docs2006/dec06links/health-infoway.pdf 7.http://www.grameenfoundation.org/what_we_do/technology_programs/ village_phone/ 8.http://www.firstmilesolutions.com/ 9.http://www.gsmworld.com/developmentfund/projects/index.shtml 10.http://www.cta.int/afagrict-l/telecentres.htm 11.http://pda.healthnet.org/ 12.http://www.mindset.co.za/

Adesina Iluyemi Centre for Healthcare Modelling & Informatics, University of Portsmouth, UK Adesina.Iluyemi@port.ac.uk

>

technology

RFID in Healthcare: The Emerging Enabler Facilitating the health industry to be more patient-centric RFID has the potential to become a catalyst for new efficiencies and enhanced services for healthcare service providers. Hospitals and medical facilities seeking competitive advantage can make use of RFID to optimize their workflows, improve productivity, reduce operating costs, and provide better patient care. RFID could help prevent patient identity mix-ups, medication errors, and also reduce thefts of expensive mobile medical equipments.

T

he rapid advances in medical electronics have brought about a revolution in the healthcare industry. In the recent times, radio frequency identification (RFID) has received considerable attention within both healthcare and pharmaceutical industries due to its potential to efficiently track hospital inventory, mobile medical equipments, medications, patients and personnel as well. Also RFID systems are being increasingly considered as an alternative to the existing barcode technology. The purpose of an RFID system is to enable data on the identity of an object and wirelessly transmit it using radio waves. As with any emerging technology, the deployment of RFID too seems to be fraught with potential uncertainties, including privacy and security concerns. Internationally accepted standards, guidelines for RFID technology and practices, coupled with lower deployment costs might hold the key for the widespread acceptance of RFID applications in healthcare.

An Overview of RFID

RFID is a form of automatic identification and data capture (AIDC) technology that uses radio frequencies to transmit information and can be used to identify many types of objects.

Every RFID system includes a radio frequency (RF) subsystem, composed of tags and readers. Each object that needs to be identified has a small RFID tag affixed to it or embedded within it. A RFID tag is a tiny radio device made of a microchip and an antenna, usually surrounded by some material.

The tags are of two types, active and passive. Active RFID tags are larger, battery-powered, generally rewritable and more expensive, whereas passive tags are relatively small, inexpensive and operate using power from the RFID transceiver. While active RFID tags offer a much better identification range, and allow updating, passive tags have lower range and typically store read-only data. The tags have a unique identifier and 10 }

may optionally hold additional information about the object.

Devices known as RFID readers wirelessly communicate with the tags to identify the item connected to each tag and possibly read or update additional information stored on the tag.

This communication can occur without optical line of sight and over greater distances than other AIDC technologies. Passive RFID tags require manual scanning to capture the identification data whereas an active RFID tag does automatic scanning and transmits the data to RFID-enabled devices. RFID technologies support a wide range of applications including asset management, tracking, access control and automated payment.

RFID vs Barcode

Though RFID and barcodes are perceived to be competitive technologies, both seem to complement each other. The distinct advantages of RFID system over barcodes could be summarized as follows: • It is sufficient for RFID tags to be within range of a reader to be ‘read’ or ‘scanned’ whereas barcodes have to be scanned at specific orientation to establish the line-ofsight.

• RFID tags are more durable than barcodes and can withstand harsh environments that would normally destroy barcode labels, thereby rendering them unreadable.

• Tags can be reprogrammed and reused whereas new data cannot be updated on barcodes, unless the user reprints the code.

• RFID tags can be read in bulk, resulting in a nearly simultaneous reading of contents, whereas barcodes must be read individually.

• A RFID reader can scan multiple items simultaneously and do not require any human intervention for data transmission unlike barcodes. www.ehealthonline.org

done on a wrong patient. In order to prevent these serious clinical errors, RFID-enabled patient identification and tracking systems are used, wherein the patients are given a wristband/bracelet with a RFID chip that stores the unique patient id and other relevant medical information. The caregiver uses a hand-held RFID reader or a PDA to access electronic patient records, cross-check the medication dosage prescribed, and update the record with observations and comments on diagnosis in real-time. Also patient identification and location assistance tools of RFID systems can be very useful for care providers, especially in cases of long-term care, mentally challenged patients, and newborns. (ii) Asset Tracking and Inventory Management

• RFID tag memory can be programmed, permanently locked, or erased to protect privacy.

Applications in Healthcare

RFID has the potential to become a catalyst for new efficiencies and enhanced services for healthcare service providers.

Hospitals and medical facilities seeking competitive advantage can make use of RFID to optimize their workflows, improve productivity, reduce operating costs, and provide better patient care. RFID could help prevent patient identity mix-ups, medication errors, and also reduce thefts of expensive mobile medical equipments. RFID systems, when used in combination with secure wireless networks such as WLANs, can enable a fully automated solution for information delivery at the point-of-care; thereby increasing efficiency in the care process and minimizing possibilities of human error.

RFID systems could help streamline the tracking and recording of the available inventory efficiently and accurately. This would facilitate hospitals to maintain optimal stock of medical inventory on a real-time basis and reduce the overall inventory cost by maximizing resource utilization and maintaining ‘just in time inventory’. RFID-enabled hospital equipments and wheel chairs could be easily identified and tracked. This could help trace misplaced equipment and also prevent thefts of mobile electronic devices throughout the facility. (iii) Laboratory Automation

RFID-enabled identification of specimen, blood samples and management of transfusion could help achieve significant improvement in preventing errors, during transfusion and laboratory processing, besides saving valuable time. (iv) RFID-enabled Remote Health Monitoring

Research initiatives are on to interface RFID tags with wireless microsensors that can monitor and store ECG, pulse rate, basal temperature, and other vital signs of patients noninvasively, and transmit them to the care providers’ database at predefined intervals. This could facilitate real-time health monitoring and provision of care for elderly, and people

While active RFID tags offer a much better identification range, and allow updating, passive tags have lower range and typically store read-only data. The tags have a unique identifier and may optionally hold additional information about the object. Devices known as RFID readers wirelessly communicate with the tags to identify the item connected to each tag and possibly read or update additional information stored on the tag.

Though the scope of RFID-enabled applications in healthcare is quite vast, they could be broadly categorized under the following: (i) Patient Identification and Tracking

Incorrect identification of patients gives scope for medication errors, mis-diagnoses and even having an invasive procedure July 2007

11

technology

>

rfid in healthcare: the emerging enabler

working in dangerous conditions like relief workers in disaster situations and soldiers on the battlefield. RFID-enabled wireless telemedicine applications could substantially reduce response time to medical emergencies and improve the accuracy of remote diagnosis. RFID-enabled sensors can collect and transmit information on environment such as temperature from time to time, and help monitor the shelf life of sensitive medical items and processes. (v) Pharmaceutical Applications

Pharmaceutical companies loose substantial revenue every year due to drug counterfeiting. Counterfeit drugs might pose serious health risks to patients due to the possible use of substandard and dangerous ingredients. Using RFID into packaging of prescription drugs can counter drug counterfeiting; identify fake, tampered, recalled or expired drugs.

This will enable verification of their authenticity throughout the supply chain, from the point of manufacture to the point of dispensing; thereby resulting in money savings for the industry and ensuring safe medication for the patients.

Challenges in RFID Adoption

Though the application space of RFID is growing and gaining popularity, its acceptance and adoption in healthcare is not without challenges. The key restraints include: (i) Cost

Though the costs of readers and tags are decreasing, implementation of RFID systems might still require substantial capital investments. This needs to be reduced for wider acceptance of RFID systems in the healthcare industry as potential adopters like hospitals with thin IT budget would not be keen to consider RFID systems, unless the investment is more affordable and offers better price-performance advantage.

In order to prevent these serious clinical errors, RFID-enabled patient identification and tracking systems are used, wherein the patients are given a wristband/bracelet with a RFID chip that stores the unique patient id and other relevant medical information. The caregiver uses a hand-held RFID reader or a PDA to access electronic patient records, cross-check the medication dosage prescribed, update the record with observations and comments on diagnosis in real-time. (ii) Environmental Limitations:

The reliability of RFID tags can be impacted by certain environment such as humidity, metal surfaces, etc. making it less ubiquitous than expected. For RFID systems to be widely used and accepted by the healthcare industry the products and solutions needs to be absolutely reliable.

12

(iii) Technology Incompatibilities and Standards:

Issues of compatibility between wireless devices and electromagnetic interference, needs to be addressed. Lack of established industry standards in RFID will force the adopters to incur high costs to ensure interoperability between readers and tags from multiple vendors. (iv) Security & Privacy:

The process of unique identification and authentication- the core competence of RFID systems- involves collecting large amounts of sensitive information that needs to be treated confidentially. There are serious security and privacy concerns relating to the use of RFID systems, especially when it comes to the tracking of patients and their medications. It is one thing to deploy RFID to track mobile equipments or consumables and quite another to monitor medications and activities of patients. It is difficult to achieve access control and data security in a highly mobile environment without the support of encryption features. But incorporation of basic security functionality tends to significantly increase the cost of tags. Imagine the logistical challenges and operational costs involved in performing some basic IT security controls such as setting unique passwords and changing them regularly for thousands or millions of tags!

Case Examples of RFID Implementations

Notwithstanding the challenges involved, there are some noteworthy examples of RFID implementations which we have elaborated here: (i) Wayne Memorial Hospital, Goldsboro, N.C., has saved more than $300,000 in expenses thanks to the active UHF RFID tags to track about 1,300 medical devices throughout the hospital. The hospital is using an RFIDbased real-time location system (RTLS) from RadarFind to keep tabs on infusion pumps, diagnostics machines, blood warmers, computers on wheels, wheelchairs and other equipments. The system indicates whether an asset is in use, needs cleaning or is ready for use, and also provides caregivers and administrators with simple map www.ehealthonline.org

views as well as sophisticated reporting functions to track maintenance, trend equipment utilization, make better planning and budgeting decisions. (ii The Bhagwan Mahaveer Jain (BMJ) Heart Center in Bangalore, India has been using passive UHF RFID tags from Aventyn, San Diego, California to help maintain patient records, monitor patient flow and care, and track assets throughout its outpatient department. With the web-based Clinical Information Processing Platform (CLIP) from Aventyn, the hospital tracks an average of 100 new patients a day, as well as returning patients, as they check into the facility’s outpatient department, the health records movement in the OPD, high-value items such as stents, pacemakers, wheelchairs and gurneys, as well as certain mobile equipments, such as those used in diagnostics labs. BMJ is also keen to expand the use of CLIP to track and manage processes very specific to patient care, in the inpatient and acute-care departments. (iii) The Masaryk Oncological Institute, operated by Masaryk University’s School of Medicine in Brno, Czech Republic, uses passive, HF tags to reduce the likelihood of theft and human error while handling chemotherapy medication, which are expensive and can cause severe harm if administered incorrectly. The RFID solution, implemented with help from IBM Global Technology Services and funding from the Czech Ministry for Education, uses nano-sized RFID tags from Tagsys to tag individual vial/ampoule of cytostatic drugs to identify patients and personnel, simplify and speed up the inventorying of high-cost medical supplies, and deter theft. The patient’s name and other basic information are printed on the label applied to RFID-tagged IV bag, while the pharmacist performing the work wears a ring-shaped passive tag on one finger. At a later phase of implementation, the institute plans to deploy RFID to validate administration of medication to the intended recipient, by reading the RFID tag worn by each patient and the RFID tag embedded in the ID badge of the nurse administering it. (iv) Hospital St. Louis, the largest hospital in Luxembourg, has opted for RFID system as an alternative to implanting electronic tracking tags among its dementia patients.

The Wi-Fi based active RFID system from AeroScout Inc. which is installed at the hospital, facilitates monitoring the movements of its high-risk dementia patients around the hospital. The system alerts the staff with real-time detection information if such patients move through doors or other designated ‘choke points’ unaccompanied. The hospital has plans to use RFID to track equipments such as infusion pumps and wheel chairs.

The Road Ahead

RFID applications in healthcare seem to present a vast scope of opportunities towards achieving improvements, in both supply chain productivity as well as patient care applications.

But this huge potential of RFID-based applications is being hindered by various issues like the economics in deployment, lack of established international standards, and concerns over July 2007

security and privacy. Once these are adequately resolved, we can expect the adoption of RFID technology to accelerate. A concerted effort towards the development of an international standard that guides the application of RFID in the healthcare industry might hold the key. n References:

•

•

• •

•

• • • •

Karygiannis, T.; Eydt, B.; Barber, G.; Bunn, L.; Phillips, T. Guidelines for Securing Radio Frequency Identification (RFID) Systems (Special Publication 800-98), National Institute of Standards and Technology (NIST), April 2007 Dighero, C.; Kellso, J.; Merizon, D.; Murphy-Hoye, M.: Tyo, R. “RFID: The Real and Integrated Story.” Intel Technology Journal. Volume 09, Issue 03 Published August 3, 2005; DOI: 10.1535/itj.0903 ”RFID in Healthcare - A Panacea for the Regulation and Issues Affecting the Industry” A UPS Supply Chain Solutions White Paper, 2005 Xiao, Y.; Shen, X.; Sun, B.; Cai, L. “Security and privacy in RFID and applications in telemedicine”, IEEE Communications Magazine, vol.

44, no. 4, pp. 64–72, 2006 “Ubiquitous Network Societies: The Case Of Radio Frequency Identification”, Background Paper, International Telecommunication Union (UNS/04: published April 2005) RFID Journal-http://www.rfidjournal.com “RFID White Paper Technology, Systems, and Applications” (BITKOM: published Dec 2005) “Wireless Opportunities In Healthcare” A Kalorama Information Market Intelligence Report (KLI1365761: published Jan 2007) “RFID in healthcare: Novelty or mass-market?” Datamonitor, (BFTC1095: published Oct 2004) A.U. Jai Ganesh Project Coordinator, Enterprise Healthcare Information Systems, Sri Sathya Sai Information Technology Centre, Prashanthi Nilayam, Andhra Pradesh jaiganesh.au@gmail.com S. Srikrishna Manager, Quality Control, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore,Karnataka krishy.b@gmail.com

13

>>

company profile

Stalis Serious on Healthcare Data For companies like Oxford-based Stalis, the competence in data migration is an USP in itself. Knowing that data cleansing is a huge market and the impending delivery of new national systems will be expanding the market, John Wiltshire, Sales and Marketing Director of Stalis Ltd. explains, “There are benefits ahead, and those can be improved business processes and cost benefits from the cleaned up data in their current systems.”

M

igration of patient data from myriad local systems to a national records system requires absolute data cleanliness and poses a technology challenge to the IT integration process in the healthcare sector. Changing policy regulations like Quality Assurance Programme (IQAP), embedded within the Connecting for Health (CfH) programme in the UK, in fact mandates the healthcare providers about improving and standardizing the data.

In the data solutions market, Stalis is one player, driven by the vision to be the leading provider of ‘end to end’ data and resource management solutions for the health industry, to improve the quality of information available to health providers. With this purpose, Stalis is providing an integrated platform, comprising software products and related services.

For companies like Oxford-based Stalis, the competence in data migration is an USP in itself. Knowing that data cleansing is a huge market, and the impending delivery of new national systems will be expanding the market, John Wiltshire, Sales and Marketing Director of Stalis Ltd. explains, “There are benefits ahead, and those can be improved business processes and cost benefits from the cleaned up data in their current systems.” Stalis has built up its business portfolio and product strategy by integrating advanced clinical systems, including image management, clinical portal, clinical decision support and business intelligence, and data warehousing.

Confers John Wiltshire, “Stalis CareXML suite of applications, methodologies and services are developed to help healthcare providers extract, manage 14 }

and benefit from the information they collect as a by-product of their clinical and administrative systems”.

Stalis has earned reputation in the market about its skills in data migration.

According to Wiltshire, “Good practice is essential in handling data migration.

Data migration may not be expensive as some might think, but it is indeed complex and it needs to be planned and executed properly.”

According to Wiltshire, “Stalis maintains the edge thanks to its complete end-to-end service. It gives the assurance that the migration will not go haywire. Otherwise there runs the risk of doing things by others yet not knowing what to look for. The risk of attaching the wrong record to the wrong patient is very much a possibility while integrating records from disparate systems. Trusts need to understand the impact of integrated records and plan to test for every eventuality.”

The twin challenges for the health service providers involve data cleanliness and readiness for migration to new systems. Often the data collected and stored, for decades, in local systems, may hamper their functionality.

In some systems, lack of utility to clinicians results in a haphazard collection process of the data. The lack of a uniform approach to clinical coding further compounds this problem at the data management front. There are institutions using ICD-10 stanadard, but many still rely on local codes.

Stalis has emerged as a specialist NHS Consultancy organization that supplies

information solutions and support a large number of healthcare organizations. Satlis has repositioned in the market, revising its business plans to coincide with the advent of the National Programme for eHealth in England.

Stalis has now moved to the domain of mission critical applications where the expertise of extracting, cleaning and translating healthcare data is in big demand. Stalis Ltd. hogged the limelight recently when it released CareXML® data migration, cleansing and reporting platform. CareXML® is the most advanced solution for extracting data from any legacy system, cleansing it and migrating that data to the Care Record Service (CRS). The new version of CareXML offers many new features.

The evolution of an ancillary-based system towards an integrated model with different types tie specific patientrelated data into a logical and temporal model. In fact, a database structure has evolved to support clinical needs for integration. A fully integrated model is capable of meeting traditional HIS needs.

Automated integration of patient records from disparate systems is a test for the configuration capability. The integration of patient records from different systems builds up an online patient record of all activity data for the patient, regardless of the system from which the data is derived.

Christine Whitehouse, Managing Director, Stalis avers, “CareXML has been extensively proven across the NHS in both acute and primary care trusts with whom we have worked collaboratively. This new release will ensure that we maintain the lead for CareXML® and fulfil our customer expectations for innovation.” n www.ehealthonline.org

>

insight

SNOMED CT: Making Successful Inroads in EHR Serious spadework is underway in the US

T

he U.S. Department of Health and Human Services (HHS) has announced recently that the Department will participate in an international effort to promote the rapid adoption of standard clinical terminology, for promoting the worldwide development of electronic health records.

This move will make the U.S. join the club comprising Australia, Canada, Denmark, Lithuania, the Netherlands, New Zealand, Sweden, and the United Kingdom, as members of the new International Health Terminology Standards Development Organization (IHTSDO), which has acquired Systemized Nomenclature of Medicine (SNOMED) Clinical Terms (SNOMED CT) from the College of American Pathologists (CAP).

SNOMED Clinical Terms (SNOMED CT) is a dynamic, scientifically validated clinical healthcare terminology and infrastructure that makes healthcare knowledge more usable and accessible. The SNOMED CT core terminology provides a common language that enables a consistent way of capturing, sharing and aggregating health data across specialties and sites of care.

Among the applications for SNOMED CT are electronic medical records, ICU monitoring, clinical decision support, medical research studies, clinical trials, computerized physician order entry, disease surveillance, image indexing and consumer health information services.

SNOMED CT is considered to be the most comprehensive, multilingual clinical healthcare terminology available in the world. When implemented in software applications, SNOMED CT represents clinically relevant information consistently, reliably and comprehensively as an integral part of producing electronic health records.

July 2007

International implementation of SNOMED CT is perceived as a serious effort in engaging nations to persuade towards electronic health records, and throw open new opportunities for international collaboration in research and public health surveillance. Says HHS Secretary Leavitt, “The use of a standard terminology will enable the use of health information across borders, facilitate public health surveillance and support evidence-based research.”

SNOMED CT is important as a ‘core terminology’ that provides a ‘common language’, enabling a consistent way of indexing, storing, retrieving, and aggregating clinical data across specialties and sites of care.

According to the SNOMED CT January 2007 fact sheet, the system has more than 3,08,000 active concepts with formal logic-based definitions organized into top-level hierarchies and more than 7,77,000 active English language descriptions for flexibility in expressing clinical concepts, and more than 9, 24,000 defining relationships to enable consistency of data retrieval and analysis. It is also available in Spanish and German language editions.

In an interesting development, the College of American Pathologists (CAP) is renaming its SNOMED International division. The division will now be called SNOMED Terminology Solutions and this follows the announcement of setting up of International Health Terminology Standards Development Organisation (IHTSDO) that acquired the intellectual property rights of SNOMED Clinical Terms® (SNOMED CT®) and its antecedents from the CAP. SNOMED Terminology Solutions focuses on education, training and consulting related to SNOMED CT, and its implementation. Education and train-

ing programmes include live and web teleconference education that detail SNOMED CT’s content and structure.

Consulting services include assistance in implementing SNOMED CT into systems; mapping code sets to SNOMED CT; building and maintaining SNOMED CT subsets and extensions; content development; validation; migration from earlier versions of SNOMED and project-specific coding.

Says CAP President Thomas Sodeman, MD, FCAP: “As global adoption of SNOMED CT continues to increase, the demand for its implementation into electronic health applications grows.

SNOMED Terminology Solutions assist in terminology implementation as well as educating the marketplace about SNOMED CT’s role in daily use of clinical terminology.” SNOMED Terminology Solutions will also own products not acquired by the IHTSDO, including the SNOMED CT Subset Editor Kit, the SNOMED-Encoded CAP Cancer Checklists and CAP Cancer Protocols.

It also will retain ownership of domainspecific subsets and cross mappings.

Adds Kevin Donnelly, SNOMED’s Vice President and General Manager: “SNOMED Terminology Solutions will leverage CAP’s 40 years of experience in the development of SNOMED to aid clients in meeting all of their healthcare terminology needs. We are already working with clients around the world to provide terminology solutions to enable semantically interoperable electronic healthcare records.”

With IHTSDO vested with the responsibility for SNOMED CT’s ongoing maintenance, development, quality assurance, and distribution, CAP SNOMED Terminology Solutions will now be doing so under a three-year contract with the IHTSDO. n 15

>

development

Telemedicine Gets a Human Face Remote Treating of Genetic Disorders in Sri Lanka This initiative of the ICT Agency of Sri Lanka endeavours to take the dividends of the highly specialized field of human genetics to rural communities through an ICT platform, and draws on the infrastructure facilities of the newest Nenasala at the Kurunegala Hospital and that of the Koslanda Nenasala.

T

he Information and Communication Technology Agency of Sri Lanka’s Nenasala Project has broken new ground when it opened its first Hospital Nenasala at the Kurunegala Teaching Hospital on 11 June 2007, under the patronage of the Sri Lanka’s Minister of Health Promotion and Disease Prevention and Kurunegala district’s MP, Jayarathna Herath. Kurunegala is a district of Sri Lanka.

Here it deserves a mention that the Information and Communication Technology Agency (ICTA) of Sri Lanka is the single apex body involved in ICT policy and direction for the nation. Wholly owned by the Government of Sri Lanka, ICTA is the implementing organization of the e-Sri Lanka Initiative. The e-Sri Lanka Initiative initiated by the Government of Sri Lanka, aims to provide access to diverse and unrestricted sources of information and means of communication to all the citizens of Sri Lanka.

One aspect of the e-Sri Lanka Initiative is that the ICTA will address the current ICT infrastructure deficiencies in rural areas of Sri Lanka. A key objective of this programme is to establish multi-service community information centres or Nenasalas (Nenasala in Sinhalese means global knowledge centres), which will provide access to Internet, telephones and other information services along with training, etc. to the public in rural communities.

Coming back to this new venture, the project has been made possible through 16 }

the partnership of the ICTA with the Human Genetics Unit of the Medical Faculty University of Colombo and the Kurunegala Teaching Hospital.

The Nenasala Project Nenasala Project is one of the projects implemented under the e-Sri Lanka Initiative. Formally known as the ‘Vishva Gnana Kendra Project (Nenasala)’, ICTA has incorporated it under the ‘Nenasala’ label to introduce several models of the telecentres or knowledge centres to be established in all parts of Sri Lanka; for spreading ICT services to the rural and semi-urban population of this island-nation.

The significance of this latest ICTA initiative is that it opens up new opportunities in healthcare for remote rural communities. For the poor and underserved in Sri Lanka, living in remote rural areas of the island nation,

access to quality healthcare is a challenge. One of the many ways in which ICT can facilitate healthcare is through remote consultation, diagnosis, and treatment through telemedicine, which is gaining currency in the Sri Lankan health scenario. An inconceivable phenomenon not too long ago, it is now a fast growing reality in Sri Lanka; now a patient in a remote rural area is able to obtain expert advice from a specialist in Colombo without having to move out of his local environment. Although this technological revolution is yet to bring a paradigm shift in the delivery of healthcare services, increasing sophistication in supporting technologies such as telecommunication, mobile monitoring devices, etc. has made telemedicine systems much more potent than ever before. This initiative of the ICT Agency of Sri Lanka endeavours to take the dividends of the highly specialized field of human genetics to rural communities through an ICT platform, and draws on the infrastructure facilities of the newest Nenasala at the Kurunegala Hospital and that of the Koslanda Nenasala.

There are thousands of disorders caused by genetic defects, some of which are very rare, while others such as Thalassaemia are common and affect a large number of people. Taken as a whole, the number of people affected by genetic disorders is quite significant and comprises a sizeable percentage of the population of Sri Lanka. Besides the human angle, as these conditions www.ehealthonline.org

cause long term disability, their effect on the economy of the country due to the drain on healthcare and social services is enormous.

Presently there is only one centre in Sri Lanka providing such clinical genetic services, and that is the Human Genetics Unit of the Faculty of Medicine, University of Colombo. It isn’t possible for everyone to come to Colombo to seek the advice of the geneticists of this faculty, especially because some of the people affected with genetic disorders are disabled and cannot travel long distances. However, the development of an island-wide network of Nenasalas equipped with ICT infrastructure and broadband connectivity has opened up an array of opportunities in the field of healthcare. The Human

Genetics Unit, Faculty of Medicine, Colombo can now be contacted online without the need to come to Colombo for a physical examination. This telegenetic project is aimed at giving the opportunity to remote and underserved communities of Sri Lanka to get the best genetic advice available in the country, which is on par with that of anywhere in the world, via videoconferencing with the clinical geneticists in the Human Genetics Unit of the Faculty of Medicine, at the University of Colombo. The pilot programme of this project involves online consultations with patients of the Kurunegala Teaching Hospital and the Koslanda District Hospital and will be coordinated through the Kurunegala Hospital Nenasala and the Koslanda Nenasala.n

V.K. Samaranayake: An Asian ICT Stalwart Departs

O

n 7 June 2007, the ICT industry of Sri Lanka suffered an emotional jolt when Professor V.K. Samaranayake passed away in Stockholm, where he had gone to attend a review of the Swedish government’s ICT development assistance programme. He was 68, which by modern standards is far behind the age of dying.

It is very true that death keeps no calendar. It is a grave loss to not only the ICT industry of Sri Lanka, but to the entire ICT fraternity of South-East Asia.

Prof. Samaranayake was the Chairman of the Information and Communication Technology Agency of Sri Lanka from 2004. He also held the esteemed chair of the Emeritus Professor of Computer Science of the University of Colombo. He was also the founder Director, University of Colombo School of Computing (UCSC) of the University of Colombo. In fact, he served the University of Colombo for a continuous period of 43 years since his first appointment in 1961, immediately following his graduation from the same university. Prof. Samaranayake also happened to be the founder of the Department of Statistics and Computer Science (DSCS) and the Institute of Computer Technology (ICT) of the University of Colombo.

These two institutions were merged as the UCSC in 2002.

He was a Fellow of the Harvard Information Infrastructure Project and the National Centre for Digital Government of the Kennedy School of Government, Harvard University.

In 2005, he was appointed as a Visiting Fellow of the Digital Vision Program of Stanford University, USA. There were many more feathers on his illustrious cap.

Prof. Samaranayake served the Council for Information Technology (CINTEC), the apex national agency for IT in Sri Lanka, as its Chairman, for a period of 12 years. In the field of IT he has pioneered work on IT policy, EDI/e-Commerce, security, Internet technology, computer awareness and IT education. Prof. Samaranayake was also actively

July 2007

involved in the development of multilingual web sites. This renowned academician was instrumental in facilitating the application of computers in many areas of Sri Lankan governance, including Sri Lankan national elections. He was also actively involved in introducing ICT to rural communities of Sri Lanka, and was engaged in developing multipurpose community telecentres. There’s more to his seemingly never ending achievements. The ICT pioneer was a member of the advisory panel of the Asia IT&C program of the European Commission. He chaired the national Y2K task force that coordinated the very successful crossover to the year 2000. More recently, he initiated the External Degree of Bachelor of Information Technology (BIT) of the University of Colombo, which in its very first year of operations has attracted 5000 registrations.

The Government of Sri Lanka has honoured Prof. Samaranayake for his contribution towards IT by the award of Vidya Prasadini in 1997, and the national honour Vidya Jyothi in 1998. The Japan International Cooperation Agency (JICA) has presented its President’s Award for International Cooperation to Prof. Samaranayake in 1996, in recognition of his contribution. At its convocation held in January 2005, the University of Colombo conferred on Prof.

Samaranayake the Degree of Doctor of Science ( Honouris Causa) for his outstanding contribution to the University.

On his passing away Reshan Dewapura, COO of ICTA, Sri Lanka said, “Everyone in the ICT industry in Sri Lanka has either met or worked with Professor Samaranayake. It was his sense of commitment towards ICT development in the country coupled with his boundless energy that set him apart and allowed him to make lasting alliances and friendships, both personally and professionally, around the world. There is no doubt that Prof’s tireless commitment to the ICT industry has made his contribution over the years remarkable. He will be greatly missed.” Dewapura couldn’t have been more correct. Professor Samaranayake would be missed, not only as an ICT pioneer of Sri Lanka, but as someone who infused human element in ICT to foster enduring development. n

17

>

event

Microsoft Public Healthcare Seminar: IT’s a Healthy Effort Dwelling on the potential of ICT applications in public healthcare

M

icrosoft Corporation and US Agency for International Development (USAID) recently came together to organise a seminar, focusing on the potential of IT in public healthcare. Titled ‘Enabling Public Healthcare’ – this day-long event held at The Oberoi, New Delhi, brought together representatives from central and state governments, international development agencies, healthcare industry and IT solution providers.

Opening the forum, Rohit Kumar, Country Head – Public Sector, Microsoft India, emphasized upon the immense potential of IT systems and communication technologies in revolutionising public healthcare standards.

Beth Hogan, Acting Mission Director, USAID-India reinforced USAID’s commitment to leverage public health in developing countries through the use of ICTs. While highlighting the need for ICT adoption in public health programs, Hogan brought forth some of the excellent instances of ICT-based rural health service delivery in India.

Aradhana Johri, Joint Secretary, Ministry of Health and Family Welfare, elaborated on the Government of India’s efforts in modernising public health systems in India. She delivered a presentation on IT integration plans of the Ministry and the challenges enroute to transforming public health service delivery.

Following the high-powered opening speakers, the session on ‘Experience and Potential of IT Interventions in Health’ had an inspiring presentation from Gabe Rijpma, Director - Health & Human Services Industry, Microsoft Asia Pacific, ending with a engrossing video clip of Microsoft’s vision of connected healthcare. While on the one hand, the session presented a blueprint for fu18 }

turistic hospitals, it did bring forth, in the same context, some of the ground realities and grassroot success stories through insightful deliberations from the Joint Secretary, Dept of Health, Govt. of Gujarat and Dr. K Ganapathy, Head, Apollo Telemedicine Networking Foundation. With an excellent moderation by Jonthan Kushner, Director, International Organisations, Microsoft, it turned out to be an highly informative session.

The session titled ‘Using IT in Health Programs’ explored opportunities and instances of ICT usage in national health programmes in India. Appropriately lined-up with eminent speakers from Pricewaterhouse Coopers (PwC); USAID ( Robert Clay, Director, Office of Population, Health & Nutrition); Ministry of Health and Family Welfare, GoI (Sanjeev Gupta, Deputy Director, Donor Coordination Division) and National Rural Health Mission ( P. K.

Aggarwal, Director, NRHM) and coordinated by Vijay Kapur, National Technology Officer, Microsoft, it turned out to be a highly insightful session.

The post-lunch session, titled ‘Implementation of Health Management Information Systems’, moderated by Robert Clay from USAID, began with an interesting presentation from Maneesh Gupta, CIO, Fortis Hopitals, who focussed on the overall IT integration framework and strategic plan of Fortis Hospitals in the context of long term returns and service improvement benchmarks of Fortis. The session also inlcuded presentations of Dr. Sumanth C. Raman, Advisor, Life Sciences & Healthcare Practise, TCS, on application of HIMS in disease survelliance systems and by Manish Sharma, Solution Specialist, Microsoft, on service quality improvement through integrated IT systems in hospitals.

The concluding session of the event, titled ‘Why Are We So Optimistic?

Innovation & Emerging Solutions’, chaired by Belinda Noakes, Microsoft Asia Pacific, put the spotlight on new and nascent areas of IT applications in healthcare. Dr. Hemant Kumar from Voxiva—a US-based health IT solution provider—gave a candid overview of some of the innovative solutions of the company for health program delivery management, disease survelliance and patient monitoring.

There was also the presentation by Dr. Ramani of Sankara Eye Hospital, demonstrating their initiatives in using telemedicine-based remote diagnosis for eye care in rural areas. The event culminated with Gabe Rijpma reiterating the pivotal role of IT and commnication technologies in revolutionising public healthcare in India and the developing world. n www.ehealthonline.org

3rd Annual ICT4D Conference and Exhibition

India's Premier ICT4D event 31 July - 03 August 2007 Hotel Taj Palace, New Delhi, India

7 Tracks 40 countries 75 thematic sessions 200 companies 1200 delegates

Organiser

Co-organisers

Department of Information Technology Government of India

knowledge for change

Knowledge Partner

Gold Sponsor

UN DP

Track Sponsors Learning Partner

Associate Sponsor

Silver Sponsors

Lanyard Sponsor

Dinner Sponsor

Gold Sponsors

eGovernance Solution Partner

Enterprise Solution Partner

Media Partners

Registration Counter Sponsor

ov Exclusive online partner

L CATION

Exhibitors a CL

www.eINDIA.net.in

Foreword R Chandrasekhar Additional Secretary, e-Governance, Ministry of Communication and Information Technology, Government of India

Subhas Khuntia Joint Secretary Minisry of HRD Government of India

In most cases abroad, the successful solutions in eGovernance and other sectors have been fueled by solutions created by Indian experts. However, such solutions are never found in India. One needs to understand why such absorption and evaluation is not happening in India. Several eGovernance conferences are happening in India. But in most cases, these are dominated by IT experts and there is genuine dearth of domain expertise. The eINDIA2007 conference is extremely well chosen in terms of domains. I look forward to effective knowledge and expertise sharing among the participants and all stakeholders.

The twenty-first century is a century of knowledge economy. ICT skills will contribute significantly to creation, dissemination, and application of knowledge in all spheres of life. To put in place a system which should enable this, there is a need for successful collaboration among Central Government, State Governments, academic institutions, industry, and civil society. In this context, the eINDIA2007 conference focusing on several key themes will be a valuable source of input to the Government and other stakeholders.

www.d

igitalL EARNIN G.in

on lin e.o rg

et vonline.n www.ego

ww w. eh ea lth

.ne line on .i4d w ww

t

Mapping ICT4D Knowledge

eINDIA2007- The location The venue of eINDIA2007, Hotel Taj Palace, New Delhiis a perfect embodiment of all qualities synonymous with the quality of Taj Hotels, Resorts & Palaces. Standing apart in service, its facilities, and of course, in its distinguished patronage, this hotel has played host to Heads of State, corporate moguls and high profile businessmen from across the world.

Nestled in six acres of lush greens in the exclusive Diplomatic Enclave of the city, the hotel Taj Palace is one of the best business hotels in Delhi. It is also recognized as the Convention Centre of the city and boasts of 13 halls including a special preview hall for private screenings to large halls, to accommodate seminars for 700 delegates and even a grand reception for 1000 guests. The environment is perfect for workshops, networking and recreation.

Listen to key decision-makers' needs eINDIA2007 gives you access to government IT decision-makers with the need, the authority, and the budget to buy your products and services.

Focused sessions for sponsors to position their solutions Sponsors could benefit from the key sessions, panel discussions and workshops, by participating in the discussions and presenting their solutions to the quality audience from around Asia-Pacific and beyond.

eINDIA2007 Website

Taj Palace Hotel Sardar Patel Marg, Diplomatic Enclave New Delhi, India -110 021, Tel: (+91-11) 2611 0202 Fax: (+91-11) 2611 0808, 2688 4848, Email: palace.delhi@tajhotels.com, Web: www.tajhotels.com

Top Reasons to Exhibit at eINDIA2007 Targeted audience eINDIA2007 brings the right mix of quality delegates unparalleled at any other INDIAN forum. Unlike many other general IT fairs, it addresses the need to bring region's top public sector buyers at one place thus saving time and resources of focused suppliers.

Visit the eINDIA2007 website (www. eINDIA.net.in), which will provide you all the latest information and updates, as well as all the necessary forms, making it easy for you to register online. www.eINDIA.net.in Constantly updated, the website keeps you abreast of all the latest developments as eINDIA2007 takes shape!

Registration fees Indian Delegates Pre Registration INR 5000

On Spot INR 7500

Foreign Delegates Pre Registration USD 200

On Spot USD 300

Valuable opportunity for face-to-face meetings eINDIA2007 maximises the face-to-face time exhibitors spend with key customers and prospects through informal meetings, structured appointments and many networking lunch and dinner receptions.

Fee Entitlements

Organisers

Contact Us

eINDIA2007 is organised by Centre for Science, Development and Media Studies (CSDMS), who have more than 10 years of experience in organizing niche events on ICTs for Development across continents along with several government partners.

Sushma Nautiyal (Tel: +91-9873757536)

The Delegate Registration entitles the individual to participate in all technical sessions, workshops, keynotes and plenary sessions, and social functions for all seven: egov India 2007, Digital Learning India 2007, Indian Telecentre Forum 2007, eHealth India 2007, mServe India 2007, e-Agriculture India 2007, and Community Radio India 2007 conferences.

eINDIA2007 Conference Secretariat: G-4 Sector 39, Noida, Uttar Pradesh, 201 301, India Ph.: +91 120 2502180 to 85 Fax: +91 120 2500060 Email: registration@eINDIA.net.in

Key Speakers at eINDIA2007 Ashis Sanyal

Aruna Sundararajan CEO, IL&FS

Aakash Sethi Executive Director, QUEST Alliance, International Youth Foundation

Astrid Dufborg Executive Director GeSCI

G Narendra Kumar Secretary, Department of Training & Technical Education and Higher Education, Government of NCT of Delhi

Senior Director, Department of IT, Ministry of Communications & Information Technology, Government of India

Amit Goel Advisor, Ministry of Panchayat Raj, Government of India

Arvind Kumar Director (BP&L), Ministry of Information & Broadcasting, Government of India

Ajay Madan CEO Essar Telecom Ltd.

Basheerhamad Shadrach

Deepinder Singh Bedi

Sr. Programme Officer telecentre.org/IDRC, India

Director, Tulip IT Services Ltd.

Joselyne Josiah

Capt K J S Brar

Advisor, Communication and Information for Asia, UNESCO

CEO Designmate India Pvt. Ltd.

K. K. Gupta General Manager, National Bank for Agriculture and Rural Development (NABARD)

Manish Gupta

Dr M C Pant

Vice President Aperto Networks

Chairman, National Open School

M Moni Michael Clarke Director, ICT4D IDRC, Canada

Maxine Olson United Nations Resident Coordinator and UNDP Resident Representative in India

Dr. P. L. Gautam Vice Chancellor G B Pant University of Agriculture and Technology

Deputy Director General , National Informatics Centre, Ministry of Communication & Information Technology, Government of India

M. Rajamani Joint Secretary, Ministry of Urban Development, Government of India

O Nabakishore Singh

Nancy L. Knowlton

Commissioner, Navodaya Vidyalaya Samiti, Government of India

President and Co-CEO Smart Technologies Inc.

Pravin Srivastava Director Ministry of Health & Family Welfare Government of India

R Chandrashekhar

Dr. Ravinder Singh

Additional Secretary, e-Governance, Ministry of Communication and Information Technology, Government of India

Director, Ministry of Health & Family Welfare, Government of India

Richard Alvarez CEO and President Canada Health Infoway

Ranjan Dwivedi National Professinal Officer (eHealth) WHO

S. Sadagopan Founder Director International Institute of Information Technology, Bangalore,

Shantanu Prakash Shashank Ojha

CEO Educomp Solutions Ltd.

World Bank

S Abbassi Joint Secretary, Ministry of HRD Government of India

Department of IT, Ministry of Communications & Information Technology, Government of India

Sajan Venniyoor

Shankar Nath Goswami

Trevor Hodge

Vaibhav Magow

Managing Director and Chief Executive Officer Media Lab Asia

Sr. VP Investment Strategy and Alliances Canada Health Infoway

Director, Marketing HughesNet Fusion Hughes Communications India Ltd.

Subhash Khuntia

Vishal Gandhi Vice-President Life Sciences & Technology, YES Bank

Wajahat Habibullah Chief Information Commissioner Central Information Commission Government of India

Solutions Exchange, UNDP

Where are you?

www.eINDIA.net.in/register

>

news review

T

WORLD

European Commission Gives a Fillip to Colon and Breast Cancer Diagnostics

he much talked about Colon and Breast Cancer Diagnostics (COBRED) project has received a whooping grant of EUR 2.9 million from the European Commission. The COBRED Project, which has been funded under the Sixth Framework Programme (FP6), endeavours to find new biomarkers for colon cancer and breast cancer. This project has the potential to herald new discoveries in cancer diagnostics.

COBRED aims at discovering colon cancer and breast cancer biomarkers for patient follow-up (monitoring markers) by exploiting the capacity of 3 state-of-theart high-throughput technolo-

gies in an integrated systems biology approach. This project has a time span of three years.

One of the goals of the project is to identify biomarker candidates (metabolites, proteins, PBL derived mRNAs) capable to detect and assess the status of minimal residual disease, metastases, and recurrence after surgery and chemotherapy. Designing a clinical protocol for prospective clinical breast cancer and colon cancer collections that fit the needs of the 3 high-throughput screening technologies usedtranscriptomics, proteomics and metabolomics- is another important goal of the project.

Developing a centralized da-

tabase to integrate the data generated by the 3 technology platforms with the anatomo-clinical information of the clinical collections; discovering biomarkers with better specificity and sensitivity using across-platform advanced data mining techniques on the combined data from the consolidated database; and validating the biological relevance and diagnostic potential of the identified biomarkers by testing their specificity on tissue arrays and in relevant preclinical models are some of the other goals of this project.

After three years, COBRED aims to deliver a set of biomarker/diagnostic candidates, veri-

Telemedicine Can Account for Huge Savings in the UK’s Health Costs

A

six-month pilot of cardiac telemedicine services within Cumbria & Lancashire of the UK has showcased the potential to save 90,000 accident and emergency(A&E) visits, 45,000 hospital admissions and hundreds of lives each year, in England. All these amounts to a great deal of savings in terms of healthcare costs. The pilot study showed how electrocardiogram (ECG) tests could be used to drastically reduce treatment times and healthcare costs for patients, afflicted with chest pains and heart problems.

The pilot’s results have also estimated that the minimum savings to the NHS from use of telemedical ECG tests are amounting to £46M per year, which can be attained simply by cutting unnecessary hospital admissions and A&E visits for symptoms of chest pain.

The advanced cardiac telemedicine solutions from Manchesterbased BroomWell Healthwatch has proved an outstanding success in the pilot. For the pilot, the NHS used BroomWell Healthwatch’s devices and call centres.

Broomwell’s advanced pocket-

July 2007

sized ECG devices and specialised cardiac monitoring centre support GPs in making diagnoses for their patients, in minutes. BroomWell Healthwatch offered its cardiac telemedicine solutions to 15 GP practices and two NHS walk-

in centres in Cumbria and Lancashire to ascertain the efficiency of ECG devices. The handheld ECG devices can scan a patient’s chest and send the report over telephone to call centres in 45 seconds flat. The report is usually returned within ten minutes.

Here it deserves a mention that a telemedicine ECG machine of BroomWell Healthwatch is similar to a standard ECG one, but rather than printing out the results, these machines transmit them to an external 24/7 clinical call centre. There, the results are interpreted and sent back over email or fax.

Data from the pilot showed 82 percent of patients receiving ECGs did not need to go to hospi-

tal (neither A&E nor outpatients) following the test—giving rapid reassurance, and reducing stress and anxiety.

The results of the pilot showed that access to ECG tests through this technology can save hundreds of lives each year by early detection of cardiac ailments.

Such early detection can facilitate in avoiding an irreversible heart damage.

A further benefit is that patients can be accurately diagnosed within local healthcare settings instead of having to travel to a hospital for testing, thereby saving the patients’ money and effort. BroomWell Healthwatch believes the savings to the NHS from using telemedicine ECGs on a wider scale would be around £250M per year. This includes cutting down outpatient appointments and waiting times, as GPs would not need to refer their patients for an ECG. The same telemedicine equipment can also be used to monitor a range of other conditions including arrhythmia, heart failure, congestive heart disease, and COPD. An evaluation of these is now underway. n

fied in preclinical studies, ready for large-scale clinical validation and further development for commercialisation. Furthermore, COBRED will seek to demonstrate the potential of exploring data from different high-throughput technologies and clinical profiles with advanced data mining technologies for enhanced biomarker discovery. The project has nine partners. They are Biosystems International, France, Biocrates, Austria, Ipsogen, France, Institut Curie, France, Institut GustaveRoussy, France, University of Debrecen, Hungary, University of Innsbruck, Austria, University of Tartu, Estonia and ARTTIC SA, France. n

Robots to Rescue in Future Wars

T

he U.S. researchers are in the process of developing a remote-controlled robot, which is designed to rescue injured or abducted soldiers, without opening a room for risk to their comrades’ lives or limbs. The prototype of the nearly 6-foot-tall, two-legged Battlefield Extraction-Assist Robot, very aptly called Bear, does pack in lots of raw power, along with a friendly appearance. This futuristic robot could lift nearly 135kgs with one arm. It is being developed by Vecna Technologies of College Park, Md. Bear is expected to be ready for field testing within five years.

The upcoming robot will be able to climb over rough terrain or scale up and down the stairs with a wounded soldier in its arm, while in a crouching or kneeling position. The robot is going to have wheels on its hips, feet and knees which will allow it to travel over smooth surfaces, while adopting a number of positions. There is more to this friendly robot. It will also be able to load trucks and carry equipments, functions which can carry immense utility in war zones. n 23

world News

>

Siemens’ Prototype of Simultaneous Imaging System arrives

R

ecently Siemens Medical Solutions showed results of a prototype for the world’s first fully-functioning imaging system, capable of performing simultaneously Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET). This innovative imaging system could herald a giant leap in the diagnosis and therapy for millions of patients, suffering from neurological diseases, stroke and cancer. The first in-vivo human brain simultaneous MR-PET images were acquired in the Siemens facilities in USA. Testing of this new prototype MR-PET will start before the end of 2007.

The first MR-PET images were acquired with support of Dr. David Townsend and Dr. Claude Nahmias, both from the University of Tennessee, USA, and Dr. Heinz-Peter Schlemmer, Dr. Claus Claussen and Dr. Bernd Pichler, all from the University Tübingen in Germany. MR-PET has the potential to become the imaging mo-

T

vageable after a stroke. In other rehabilitation settings, such as for patients with traumatic brain injury, the Siemens MR-PET approach would improve care and workflow. In that case, patients would be only scanned once instead of having to go to two different locations and get two subsequent scans. MR-PET images also hold great promise for stem cell therapy. Because the Siemens MR-PET approach allows simultaneous measurement of anatomy, functionality and biochemistry of the body’s tissues and cells, it may enable researchers to correlate MR and PET data in a way not previously possible before. This correlative approach will enable to get a much deeper understanding of track stem cell migration to damaged parts of the brain, determination over a prolonged period whether or not cells are still alive, and identification of how stem cells have been integrated into the body’s neurological network. n

Detecting Esophagus’ Reflux Through Wireless Monitoring

he doctors of the University of Texas Southwestern Medical Center and the engineers of University of Texas Arlington, have developed a wireless monitoring system. This wireless monitoring system uses electrical impulses to track esophageal reflux. Researchers have combined the Radio Frequency Identification (RFID) technology with another emerging applied science, namely impedance monitoring, which tracks reflux through electrical impulses, to arrive at this system.

The new system works by attaching a small, flexible RFID chip to the esophagus, and the chip remains there in that position, until it is removed by a physician.

The size of the chip is around two square centimeters, which tests electrical impulses that

24

dality of choice for neurological studies, certain forms of cancer, stroke, and the emerging study of stem cell therapy.

Researchers expect that MRPET images will open new doors in understanding the pathologies and progression of various neurological disorders like Alzheimer’s, Parkinson’s, epilepsy, depression and schizophrenia. For example, PET can currently differentiate mild cognitive impairment from early-stage Alzheimer’s, but cannot determine reduced brain volume caused by atrophy. By combining MR and PET, clinicians may be able to make a more sound determination of both cognitive impairment and atrophy. Furthermore, combining MR-PET and the new emerging neurological biomarkers, has the great potential to strengthen the assessment of the condition.

Similarly, in stroke patients, the technology holds the promise of allowing physicians to study which brain tissues might be sal-

signal acidic or nonacidic liquids moving through the esophagus. Thereafter its function is to transmit data to a wireless sensor, worn around the neck.

According to the researchers, as a result of a special plastic material used, the patients would hardly feel anything in their throat when the device is inserted.

However, this innovative device is still in the testing phase.

The researchers believe that this new device will herald an improvement over the current standard procedures, which require placing a flexible catheter tube through the nose and down into the esophagus.

The new wireless system does not require the catheter, so doctors are hopeful that the system will easily allow normal eating, drinking and activity patterns. The system includes the PillCam—a small pillsized wireless camera—which clicks photos as it passes through the digestive tract, and Bravo capsule, another wireless system that detects esophageal acids.

The sensor is tailored to detect the stomach acid, gas and water, so that doctors can determine whether the presence of those substances coincides with feelings of heartburn, the start of eating or other physiological activities. n

Asian forays in health to reap development dividends

T

here are some welcome news in the health sector from the Asian front, which ranged from the underdeveloped Afghanistan, to the almost developed Malaysia.

Recently on 20 June 2007, the first telemedicine system in Afghanistan was introduced; in its capital Kabul. The telemedicine system was being formally launched by the Afghan Minister for Communications, Amirzai Sangin.

The system is supported by Roshan—the leading cellphone operator of Afghanistan—and this development is expected to provide hospitals in Afghanistan with real-time access to specialist healthcare.

In the first phase, the telemedicine network would link the Kabul-based French Medical Institute for Children (FMIC) to Aga Khan University Hospital in Karachi, Pakistan. Subsequent phases will link Afghanistan’s major regional hospitals to the FMIC, which will in turn be connected with some medical institutions in Europe and North America. This will help Afghanistan patients access to world class healthcare in the near future.

In a completely unrelated development, the UN Refugee Agency (UNHCR), the Malaysian Medical Relief Society (MERCY Malaysia) and the Embassy of the Czech Republic have together signed an agreement, which entails initiating a nine-month long Mobile Healthcare Clinic Project for the refugees in Malaysia. This project endeavours to bring healthcare services to refugees in Malaysia, who are unable to make the journey to various clinics due to a number of factors.

MERCY Malaysia will implement the project, while the Czech Embassy will provide the funds for this project. UNHCR and the Czech Embassy will be jointly monitoring the project. n

www.ehealthonline.org

A Patient-Friendly Vision of PHR

V

isionTree, the leader in webbased patient-centered health record management and provider communication systems, has announced that its VisionTree Optimal Care™ (VTOC) is now reaching 100,000 patients in more than 40 sites.

The web-based system effectively standardizes personal health record documentation by applying the electronic clipboard at every point a patient needs to complete a form. Physician’s unique registration and history forms are administered through VTOC and personal health record fields are populated and tagged, giving healthcare consumers and physicians access to vital data when they need it. This has improved patient/provider communications, staff workflow efficiency and safety practices.

VTOC is a proven and secure patient health management system for collecting and storing medical and personal health records, as

F

well as consents, reminders, messaging, education material and outcomes data. This enterprisebased system has been adopted by numerous specialties, as well as for the self management of chronic diseases including hypertension and diabetes. The system empowers healthcare consumers to decide who will have access to their personal health record history, test results and other documentation.

VTOC has presence in 48 leading academic and community sites around the US which include UCLA Medical Center, Henry Ford Hospital, Partners Telemedicine, Scripps Green Hospital and Carolinas Medical Center. More than 200 new users on an average sign up for VTOC services through their provider each week.

“VTOC is a win-win for both healthcare consumers and their providers,” said Larry Khoo, M.D., Director of UCLA Medical Center’s Spine Institute. n

New South Wales Welcomes its New e-Health Records System

or the last four years, New South Wales(NSW) Health has been developing an online medical records system, which is termed as Healthelink. Healthelink brings together summaries of health information for individuals from different doctors, hospitals and health clinics and puts it into one secure computer record.

This muchtouted online medical records system is aimed at providing a central point of reference for the Australian state’s health professionals for accessing patient information and eliminating fragmented health records. NSW Health is presently testing Healthelink in parts of the state. The pilot is progressing well, with more than 9500 people using this

July 2007

application. Over the last five years, Healthelink has received more than 15.54 million USD through funding. The concept has been well received in New South Wales, as the opt out rate among people is less than five percent.

Every individual’s electronic health record is empty when they are first enrolled in Healthelink. Information is added to it over time, but no historical data is loaded except for community healthcare where related episodes to current care are also included.

As this is a pilot, not all facilities are taking part. The system will progressively expand within the pilot areas to include more healthcare facilities and doctors. n

L

LSU Healthcare Network enters the world of EHR

ouisiana State University has selected Medem’s iHealth to generate free health records for patients, who are included in its healthcare network. iHealth is a patients’ personal e-Health record. It is a web-based system, which carries the patients’ entire medical history. The system has the provision where each patient can update his/her medical records. Patients can go to the web and obtain their personal health records. LSU Healthcare Network also provides medical evacuation card to each patient who enters the system. The card enables patients to get medically prepared in case they have to evacuate their city. The medical evacuation card also has the patient’s iHealth record username and login and contains the contact information for the patient’s primary provider.

However, iHealth is not the only EHR initiative of LSU Healthcare Network. LSU has also purchased Allscripts’™ ehealth record system, which is a full-service, top-shelf electronic health record. Allscripts’ system offers the advantages of an e-prescription, or e-RX; a module that is free to the public.

According to Dr. Frank Opelka, CEO of the LSU Healthcare Network and Associate Dean for Clinical Affairs at LSU Health Sciences Center School of Medicine at New Orleans, LSU is also partnering with Medem in a Centers for Medicare & Medicaid (CMS)-sponsored pilot project, for providing Medicare patients with electronic health records. CMS has asked contractors such as Medem to develop pilot sites, which would register at least 100,000 patients. n

Chunghwa Telecom’s Successful Foray into Taiwan’s Mobile Medical Care

T

aiwan-based integrated telecommunications operator named Chunghwa Telecom is launching ‘Taiwan Mobile Healthcare Services’. To be launched at the Taipei Medical University Hospital, Tri-Service General Hospital and Taipei City-Wan Fang Hospital, this mobile healthcare service is part of the MTaiwan initiative, which is being piloted by Taiwan’s Ministry of Economic Affairs (MoEA).

The launch of this mobile healthcare services will greatly facilitate healthcare by enabling mobile medical care, using a Nortel WiMAX solution. This is the first time that a WiMAX healthcare network will be introduced in Taiwan.

The network will support emergency medical assistance and patient care services, outside the premises of a medical facility, as and when and wherever it is required.

Through WIMAX technology, which entails super-fast connectivity and high bandwidth, the health personnel can connect to critical medical resources.

Taiwan government is laying stress on fostering mobile access throughout the country and this will greatly transform Taiwan’s healthcare scenario for the better. Later on the government will launch mobile access services for finance, insurance, security, delivery, distribution and other related medical services. n 25

The world is talking. Are you listening?

Register Now

31 July - 03 August, 2007 Hotel Taj Palace, New Delhi, India www.eINDIA.net.in/CommunityRadio

Contact Details Jayalakshmi Chittoor (mob: 9811309160) email: jchittoor@csdms.in eINDIA 2007 Secretariat Centre for Science, Development and Media Studies (CSDMS) G-4, Sector 39, Noida, India - 201301 Tel. : +91-120-2502181- 85, Fax: +91-120-2500060

>

news review

BUSINESS

NaviMedix joins National e-Prescribing Patient Safety Initiative

N

aviMedix, Inc., a leading player in automating provider communications with health plans and care management has joined hands with Allscripts—the leading player in clinical software and information solutions— for providing the eRx NOW(SM) ePrescribing solution from Allscripts to NaviMedix’s nationwide network in the USA of about two lakh physician customers. eRx NOW will be offered at zero cost to the users of NaviNet® —NaviMedix’s free web-based provider communications solution.

NaviMedix offers automated information exchange, technology and services that deliver integrated business and clinical information from multiple health plans, and partners directly into the provider office.

The agreement also ensures the entry of NaviMedix to NEPSI coalition, comprising Naelters Kluwer Health; connectivity sponsor SureScripts; and search sponsor Google.

The companies have also announced plans to collaborate on additional services and integration to enhance the value and efficiency of each company’s solutions.

The NEPSI coalition was launched in January to address the public crisis surrounding preventable medication errors, which injure at least 1.5 million Americans and claim more than 7,000 lives each year, according to a July 2006 study by the federally-funded Institute of Medicine (IOM).

The IOM report called on all of the nation’s physicians to adopt electronic prescribing by

2010, yet acknowledged that many have been reluctant to use the technology because of a perception that it costs too much and requires too much time to learn and install. NEPSI addresses those barriers by providing physicians simple, safe and secure electronic prescribing at no cost.

Tim Hargarten, President and Chief Executive Officer of NaviMedix said, “We are very excited at joining the NEPSI coalition and supporting increased adoption of electronic

prescribing. We have the ability to accelerate adoption by giving healthcare providers across the country an easy and convenient way to access eRx NOW via our network of electronically linked physician offices and hospitals.”

He added, “Providing a comprehensive ePrescribing platform for free, to NaviNet, users will greatly expand the value of our solutions to our 190,000 providers as well as to our customers and partners who sponsor NaviNet.” The free NEPSI solution, eRx NOW, is a webbased software powered by the same engine that is used today by more than 20,000 phy-

sicians to write millions of electronic prescriptions each year. Designed to appeal to physicians in solo practice or small groups, eRx NOW is available for free to any healthcare provider in the USA, who have legal authority to prescribe medications, and requires no download, no new hardware, and minimal training.

The product can quickly generate secure electronic prescriptions and deliver them computer-to-computer or via electronic fax to nearly 70,000 retail pharmacies -- more than 95 percent of all U.S. pharmacies -- via SureScripts. All prescriptions are instantly checked for potentially harmful interactions with patients’ other medications, using a real-time complete medication database provided by Wolters Kluwer Health, as well as real-time notification of insurance formulary status from leading payers, plans and pharmacy benefit managers. Clinicians also can use eRx NOW to search and find targeted healthrelated information for themselves or patients, using the NEPSI Custom Search Engine from Google.

“We are excited to welcome NaviMedix to the NEPSI coalition and to provide eRx NOW to their network of physicians across the country,” said Glen Tullman, Co-Chair of NEPSI and Chief Executive Officer of Allscripts. He added, “Our partnership is another strong step towards fulfilling the NEPSI goal of enabling every physician in America to prescribe electronically for maximum patient safety.” n

Zix Launches E-Prescribing Business

Z

ix Corp (Zixi) is investing heavily in its emerging e-Prescribing business. e-Prescribing helps busy physicians to prescribe a patient script directly from a hand-held device to a pharmacy. There are numerous benefits claimed on this practice. The service saves time and money and minimizes the chance of prescribing errors. According to a company presentation, about 1.5 million medication errors happened last year, resulting in 7000 deaths.

Zix Corporation provides e-communication services that protect and deliver sensitive information to enterprises and consumers in the healthcare, finance, insurance, and government sectors, primarily in the United States. It operates through two segments, e-mail Encryption and e-Prescribing.

Tested in pilot programs throughout the United States, the programme has generated

July 2007

considerable interest in the managed care industry, and players like Aetna and Blue Cross/Blue Shield have promised the roll out of pilot programmes. The insurers have agreed to pay for the implementation, training and costs of the services for the physi-

cians. The insurers receive cost savings because the system highlights particular preferred and generic drugs that the physicians can prescribe. The pharmacy chains are also supportive.

They process all the scripts through SureScripts- a private LLC- formed by Wal-Mart,

Rite AID, Walgreens and CVS. ZIXI receives a small payment for each script, routed through this network. ZIXI has a major competitior in Allscripts, though both pursue two different markets.

The latter is looking for the bigger markets, primarily hospitals and large clinics. ZIXI is involved in the smaller markets, mostly clinics with 10 prescribers or less.

The overall U.S. e-Prescriptions market is estimated to be approximately $500 million, with the estimated number of prescribing physicians numbered at 2,25,000. ZIXI stands benefited from the managed care companies shouldering most of the initial roll-out costs.

The real challenge to the success of ZIXI, and e-Prescribing will be in physicians’ education, and convincing them that they understand the potential benefits of such a system. n

27

business news

>

I

IBM Contributes Software, Predicting the path of Infectious Diseases

BM has announced the development of an advanced software technology that helps prediction of transmission of diseases around the globe to the open source community. The tool will aid scientists and public health officials in understanding more efficient responses to health crises, ultimately providing new tools for protecting population health. The software, known as Spatiotemporal Epidemiological Modeler (STEM), is now available for use through the Eclipse Open Healthcare Framework Project (OHF), hosted at the Eclipse Foundation—the nonprofit foundation that guides the Eclipse open source community.

“STEM will allow public health officials to model the spread of a disease much like modeling a storm or hurricane -- it allows us to produce a public health ‘weather map’ for the spread of a particular disease,” said Joseph Jasinski, IBM’s Distinguished Engineer and Program Director, Healthcare and Life Sciences.

“Until now, it has been difficult to simulate health crisis scenarios on a global scale. STEM gives us the power to do that,” he added.

“We really view [STEM] as an experiment of building communities around disease preparedness,” Jansinski said. “This doesn’t go anywhere unless others use it. We’re really hoping to see a significant inertia in this and significant participation by academic researchers.”

STEM represents nearly three years of research spanning the globe with scientists from IBM’s Almaden, Haifa and Watson labs contributing to its creation. The technology is

designed to enable the rapid creation of epidemiological models for how an infectious disease, such as avian influenza or dengue fever, is likely to geographically spread over time. STEM, which runs on any operating system, creates a graphical representation of the spread of a disease based on a variety of parameters such as population, geographic and macro-economic data, roadmaps, airport locations, travel patterns and bird migratory routes around the world.

A basic epidemiological model framework will be provided to software developers, who can customize and configure the models based on their specific requirements. These models, which involve multiple populations and interactions between diseases, can help public health experts develop more effective preparedness plans. IBM’s donation is also intended to help facilitate collaboration between governments, scientific researchers and other players in the public health community. Users will have the ability to share the customized epidemiological models that

they create, in addition to the plug-ins they build using Eclipse.

STEM is one of the key technologies being utilized in the Global Pandemic Initiative, a collaborative effort formed by IBM and over twenty major worldwide public health institutions to help prevent the spread of infectious diseases. The tool is also compatible with the standards-based interoperable healthcare infrastructure developed by IBM and can query clinics, hospitals, lab systems and other information sources for anonymized data by disease, which enables a complete picture of the health of a population with real-time data.

“STEM is really a framework that has a model of the world in it ... and it allows anyone who can use a simple GUI to construct a model for the way they want to look at the world and the disease they want to study,” Jasinski said. “Ultimately, if you have real-time data during an outbreak, you can put that in [the model] and compare your scenarios to what is actually happening to see if you need to modify your scenarios,” added Jasinski.

According to him, until now, the only technology available for this type of modeling was proprietary and usually required users to have advanced computer skills.

Mike Milinkovich, Executive Director, Eclipse Foundation, said, “Eclipse is a community that promotes innovation and collaboration. We are thrilled to have IBM’s STEM technology contributed to Eclipse and look forward to fostering more innovation on this important technology”. n

Maurizio Vecchione is the new CEO of CompuMed, Inc

C

ompuMed, Inc (www.compumed.net), a leading player in medical informatics and advanced imaging technology, has appointed Maurizio Vecchione as its new President and CEO. Says Robert Stuckelman, Chairman of CompuMed, “Maurizio brings the ideal blend of experience and expertise to lead CompuMed’s ambitious growth efforts.” Commenting on his appointment, Vecchione said ,“CompuMed offers a compelling set of technologies that are poised to enjoy widespread adoption in the marketplace. It’s now time to translate that promise into ex28

ecution. We plan to focus on that fundamental execution in order to grow our revenue and reach profitability as soon as possible.

We believe we have the ingredients to position CompuMed as the leader in remote analytics and to leverage its bone analysis business to a position of peripheral bone density market leadership.

At the same time, our continued presence in ECG services should facilitate expansion opportunities in remote analysis markets, as well as the ability to add services to our bone business.”

CompuMed focuses on cardiovascular and musculoskeletal dis-

eases, as well as other diseases associated with ageing populations.

Its unique expertise in telemonitoring, imaging and analysis, facilitates the development of new solutions and services, designed to improve healthcare provider workflow and patient care, while reducing costs. CompuMed’s core products, the OsteoGram® and CardioGram(TM) systems, are cleared by the FDA and reimbursable by Medicare. The OsteoGram is an accurate and precise technology for osteoporosis testing.

The underlying OsteoGram technology has significant cost advantages over other technolo-

gies and will be applied to a suite of value-added applications, such as tracking the progression of arthritic disease and diagnosing vertebral fractures and scoliosis.

The CardioGram system is one of the first telecommunication networks designed to remotely interpret electrocardiograms, and is used by private practice, as well as government and corporate healthcare providers in north America. The CardioGram delivers online electrocardiogram interpretations within a short time and has the additional capability to automatically provide followup review by a cardiologist. n

www.ehealthonline.org

From now on, I'll connect... my own way

INDIA

2007 Discuss your stories at mServe India 2007 held along with eINDIA 2007 at Hotel Taj Palace, New Delhi from July 31 till August 3, 2007. Log on to www.eINDIA.net.in/mserve

>

news review

B

INDIA UPDATE

Srishti Software PACS IT with immense Health Potential

angalore-based Srishti Software, a leading provider of Healthcare Information Management System (HIMS), which received the Innovative Company of the Year Award from the President APJ Abdul Kalam in 2005, has earned another feather in its cap.

It has recently announced the successful implementation of Picture Archiving and Communication System (PACS) with HDTV production facility in the President’s Estate Clinic (PEC), the family wing of Rashtrapati Bhawan, New Delhi.

Using the Picture Archiving and Communication System (PACS), Srishti Software has linked the President’s Estate Clinic with CARE Hospital in Hyderabad, the military-run RR Hospital in Delhi and All India Institute of Medical Sciences (AIIMS). PACS helps to capture, store, distribute, and then display medical images. This eliminates the need to manually file, retrieve or transport film jackets or other media items. PACS

has the ability to deliver timely and efficient access to images, interpretations and related data and breaks down the physical and time barriers associated with traditional film based retrieval, distribution and display.

With the integration of all these hospitals with the President’s Estate Clinic, the entire medical records of the President’s Estate Clinic will now be visible to the specialists of all these three hospitals, which will facilitate them to give their expert opinions without delay.

Moreover, according to the CEO of Srishti Software Ajay Kumar Sharma, although the entire implementation would have cost around Rs 40 lakh, he did it for approximately Rs 10 lakh for Rashtrapati Bhavan. The reason?

The immense prestige associated with the project.

“We are pleased that we were able to work closely with the President’s Estate Clinic and implement PACS”, said Ajay Shankar Sharma, CEO, Srishti Software. n

Apollo sets up Health City in Hyderabad

T

he Apollo Hospitals Group launched Apollo Health City, the first functional health city of the Asian continent. This health city, located in Hyderabad’s Jubilee Hills, offers much more than the conventional curative care.

It offers comprehensive medical solutions, which include preventive care, holistic medicine, and medical research and education.

The focus here is not merely restricted to the cure of illness, but towards total wellness of being.

Besides conventional medication, alternative form of medicines will also be offered at this facility.

The Health City, spread over 33 acres of land, comprises of 300-bedded multi-specialty hospital, with over 50 specialties and super-specialties. Centres of excellence for cardiac diseases, cancer, orthopaedics and joint diseases, emergency, renal diseases, neurosciences, eye, minimally invasive surgery, trauma and cosmetic surgery are in the offing, which is likely to give this

A Low-cost Telemedicine Project Addressing Quality Healthcare

S

atguru Pratap Singh Apollo Hospital, Ludhiana has launched a low-cost e-telemedicine project, which enables the expert medical practitioners at Satguru Pratap Singh Apollo Hospital to view and monitor live ECG, TMT, etc. of patients of other medical institutes, and offer them on-the-spot expert advices. These advices to the patients are provided free of cost.

The whole process entails a minimal investment on the part of those medical institutes, who chose to establish a telemedicine network with Satguru Pratap Singh Apollo Hospital.

This innovative, cost-effective software, developed by Satguru Pratap Singh Apollo Hospital, is finding its customers in small towns where quality health-

30 }

care is hard to get. Earlier, doctors used to get only a facsimile copy of ECG, which gave only the static status of the patients’ heart, but now, thanks to the new software in this e-telemedi-

cine project, doctors at Apollo can monitor live ECG and tap on to the change in modulations occuring in seconds, which helps to get a more accurate picture of the patient’s condition. In other words, through this telemedicine software, the doctors can

now view live diagnosis. The software employed by this hospital is a marked improvement over the V-sat method, which is generally used in telemedicine consultation.

A normal telemedicine installation requires an investment to the tune of Rs. 60 lakh, whereas this technique requires just an Internet broadband connection and a digital ECG machine. Presently the hospital has entered into a tie-up with Sachdeva Hospital and Jassi Hospital in Fazilka- a little town in the Ferozpur district of Punjab. Talks are on with other hospitals in Punjab.

It is believed that this telemedicine endeavour will facilitate delivery of quality healthcare to the small towns and rural areas in the near future. n

world class integrated healthcare facility an added appeal across the globe.

Apollo Health City has given due importance to the increasing interconnectedness between ICT and healthcare. According to Prathap C Reddy, Chairman, Apollo Hospitals Group, Apollo Health City has a number of initiatives, which include Health Street—medical BPO services for offshore customers, and Medvarsity—an online education programme for medical professionals. Apollo Health City will also have the academic and technical thrust. It will have institutes of PG education for doctors and nursing school and college. Sections on medical informatics, emergency medicine and paramedics will also be introduced.

The Apollo Group wants this health city to have a special economic zone (SEZ) status and has plans to apply for the same. This health city does have the potential to make an indelible impact in India’s healthcare scenario. n

DFID grant to facilitate healthcare access

T

he Department for International Development (DFID) from UK has announced a grant of £250 million to India for improving the access to healthcare services among the poor and the marginalised sections of India, and also for achieving the Millennium Development Goals.

Funds will be allocated for the Reproductive and Child Health (RCH)-II programme, the National Aids Control Programme (NACP)III, and other schemes that are being run at the state-level for improving women’s health.

Of this whooping amount, INR 816 million has been earmarked for NACP-III to deal with HIV/ AIDS infection in India between 2007 and 2012. This grant would facilitate healthcare in India. n

www.ehealthonline.org

Electronic Cardiac evaluation in India

C

ardiac patients in Dar es Salaam, Tanzania can undergo electronic cardiac evaluation, conducted by the medical experts at the world famous Narayana Hrudalaya Heart Institute, Bangalore, India, without moving out of their city. The ICT network between Regency Medical Centre in Tanzania and the Bangalore-based Narayana Heart Institute has enabled this telemedicine service, or more precisely the videoconferencing link, between the two hospitals.

As a result of this telemedicine linkage, the heart specialists at Narayana Hrudalaya Heart Institute can read the results pertaining to the cardiac patients of the Regency Medical Centre through computer, and send in their expert electrocardiograph and electrocardiogram reports along with prescriptions, within minutes. n

I

C

Asian Heart Institute to Give Space to Telemedicine

hennai-based Space Hospitals has entered upon a three-year deal with Bandrabased Asian Heart Institute, under which the former will provide the Asian Heart Institute with technical support for transmitting medical expertise to the remote corners of Maharasthra and the rest of India. The medium will of course be satellite-based communication. This telemedicine project will entail diagnosis,medical consultation, medication and treatment to remote and underserved patients of the country, by the expert medical practitioners at Asian Heart Institute.

However, here it deserves a mention that Asian Heart Institute is not entirely new to telemedicine. The hospital already has a telemedicine infrastruc-

ture which facilitates communication between the hospital and its doctors’ residences, but now with the technical support of Space Hospitals, this set up will undergo expansion. The Space Hospitals’ technical support include a ‘black box’, which will enable teleconsultation and telediagnosis between referral centres and a major hospital, through videoconferencing. With the advent of this videoconferencing link, direct conversations between cardiac specialists at Asian Heart Institute and the patients in some remote village will be a welcome norm. The technology and softwares used will make real-time transmission of ECGs, angiographs and information regarding other vital health parameters a reality.

ISRO working on portable Telemedicine Kit

SRO is out to revolutionise telemedicine by making it more user friendly. It is contemplating to develop a miniature model of the telemedicine kit, which can be packed into a suitcase. The actualisation of this innovative idea could usher in a new era in telemedicine technology, by endowing telecare with the added muscle of mobility. This handy telemedicine kit can administer emergency care to travellers falling suddenly sick, on board a moving train or an aircraft. Through this proposed kit, a sick person on board a moving train or aircraft, or his relatives/friends/ co-passengers, can immediately contact one of the leading hospitals in the network, and get expert advice.

However, such a welcome reality is still in the conceptual-

July 2007

ization stage. According to ISRO’s Chairman Madhavan Nair, presently ISRO is studying a proposal from Air India, which has asked the space agency to supply it with compact telemedicine kits.

At the same time, there are lots of challenges and impediments involved in realisation of this techno-revolution of sorts. One of them, according to Nair, is to “make the antenna and other equipment extremely compact.”

ISRO is going to have the K-band system, where, according to Nair, “the antenna’s size will be significantly reduced.”

This will further enable the packing of all the requisite medical equipments—ECG, stethoscope,etc. Then only the conception of a miniature model of telemedicine kit can result in a successful reality. n

I

The sophisticated videconferencing that this telemedicine project will provide would greatly facilitate cardiac care to the poor, remote and rural patients, as through this technology doctors will even be able to see the extent of blockage in the arteries.

This would greatly facilitate their decisions. The project is expected to take-off by the beginning of July 2007, as work on testing the equipment and facilities is going on.

This project, and the ISRObacked KEM hospital telemedicine project, are together geared to change the telemedicine scenario of the state of Maharashtra, by facilitating its underserved population to access quality healthcare in the near future. n

Polio in India raising concerns of slapping of Travel Advisory

ndia is faced with a looming However, Ramadoss acknowlthreat of travel advisory in the edged that India has made signear future, if it fails in eradicat- nificant progress in curbing the ing the disease of polio. Dr. Rama- menace of polio, but at the same doss, the Union Minister of Health time, he fervently urged in the and Family Welfare, while ad- meeting to completely eradicate dressing a review meeting of the polio from India, and show it to health ministers of Indian states the world. affected by polio, exIt is to be noted pressed concern over that about 193 couna resolution that was tries at the WHA recently introduced wanted such a resoat the World Health lution to be on. The Assembly, held at spread of polio to Geneva, where it was countries, which are stated that anyone free from this disDr. Ramadoss travelling to and from ease, can lead to seIndia must have a vere economic and mandatory polio immunisation. human resource loss for these Ramadoss informed that though countries, and thus in a way they concerted efforts avoided im- were not entirely unjustified in posing the resolution on India, their claims. the threat of travel advisory is Dr Ramadoss said India constill there, until and unless India vinced the WHA that the governattains success in completely ment was committed to eradicate eradicating polio. This resolution polio, and for this purpose the if effective, would have augured country has earmarked Rs 1300 serious negative effects on India’s crore for the polio eradication economic growth. project alone. n 31

The World has Changed! is Here...

Your Window to ICT in e-Healthcare Read, Update and Stay Ahead...

Subscription Order Card

subscribe Now!

Subscribe to Magazine...

Every Month & Get e-Mpowered!

Duration Issues Subscription (Year) USD

1 12 100

2 24 150

3 36 250

Newsstand Price INR

900 1800 2700

Subscription Price INR

Savings

900 -1500 Rs. 300 2000 Rs. 700

*Please make cheque/dd in favour of CSDMS, payable at New Delhi

Three easy ways to subscribe: Web : Log on to http://www.ehealthonline.org/subscribe.asp and submit the subscription form online.

Fax : Complete the information on the back of this card and fax it to +91-120-2500060 Post : Mail the form along with the cheque to : eHealth magazine Centre for Science, Development & Media Studies (CSDMS)

G-4 Sector-39, Noida 201 301, U.P. India Tel +91-120-250 2180 to 85 Fax +91-120-2500060 e-mail : info@ehealthonline.org, Web. : www.ehealthonline.org

I/We would like to subscribe to monthly eHealth

magazine!

Please fill this form in Capital Letters First Name..................................................................... ........................................... Last Name Designation/Profession . ................................................ Organisation .......................................

Mailing address .........................................................................................................................

City .............................................................................. Postal code .........................................

State . ........................................................................... Country ..............................................

Telephone...................................................................... Fax .....................................................

Email ............................................................................ Website ..............................................

I/We would like to subscribe for

1

2

3

Years

6/,5%Ă&#x; Ă&#x;Ă&#x;\Ă&#x;)

335%Ă&#x; Ă&#x;\Ă&#x;*5.

I am enclosing a cheque/DD No. ............................ Drawn on ...................... (Specify Bank)

%Ă&#x;

!Ă&#x;-/.

4(,9Ă&#x;!'!:)

.%Ă&#x;/.

Ă&#x;)#4Ă&#x;!. $Ă&#x;(%!

,4(

2S Ă&#x;

Dated ......................................................... in favour of CSDMS, payable at New Delhi. #/6%

For Rs./USD ................................................................................................................... only Subscription Terms & Conditions: Payments for mailed subscriptions are only accepted via cheque or demand draft • Cash payments may be made in person • Please add Rs. 50 for outstation cheque • Allow four weeks for processing of your subscription • International subscription is inclusive of postal charges

2Ă&#x;34/

"5), 29 #!0!$).' (%! #)49 Ă&#x;).& ,4( Ă&#x;&/2 /2Ă&#x;53Ă&#x;! Ă&#x;"%4 !4)/ ).4%2 6)%7 .$Ă&#x;" 4%2Ă&#x; .Ă&#x; '!"% %9/.

-)#2 Ă&#x;2)*0$ E (%! /3/&4 !Ă&#x;

0!#)& ,4(# Ă&#x;&!#) )#Ă&#x;2%'!2%Ă&#x;) ,)4!4 &/#53 )/. .Ă&#x;4(% ).'Ă&#x;Ă&#x; Ă&#x;!3)! Ă&#x;Ă&#x; -%$ ).4%2 % 4%, Ă&#x; 3(/7 .!4)/ Ă&#x;!.Ă&#x; #!3). .!,Ă&#x;0 ).3)'( 'Ă&#x;E ( ,!4&/ %!,4( 2-Ă&#x; 4 !Ă&#x;&2!

0(),) -%7/ 00).% 2+Ă&#x;&/ 3´Ă&#x;0(2 2Ă&#x;4(% 4%#(. Ă&#x; /,/'9 %-%2 3534! ').' ).!" Ă&#x;4%#( ,%Ă&#x;25 ./,/ 30/4, 2!,Ă&#x;E ')%3Ă&#x;& )'(4 (%!, /2Ă&#x; .!4)/ 4( ,%'!, .!,Ă&#x;3 Ă&#x;).&/ %-).

2-!4 !2Ă&#x;/.

WWW )#3 Ă&#x;-%$) EHEA #/ LTHON LINE O RG

)#4 ( #,)- EALTH .%7 ").'Ă&#x; Ă&#x;(%)' (43

>

Case Study

Information Ethics in Paperless Hospitals To play a crucial role in the emerging e-Healthcare scenario While paperless hospitals are being introduced in Malaysia and all over the globe, there is lack of a holistic code of ethics, specifically for handling massive computer-based information in these hospitals. Healthcare professionals such as medical practitioners and nurses in these paperless hospitals now need to have two codes of ethics to follow, namely, medical ethics and computer ethics. These medical professionals not only should handle patient’s information; at the same time they also have to be proficient in handling computerized systems to ensure the security of the information. However, at the moment, there are no written guidelines, which can be followed by the healthcare professionals in Malaysian paperless hospitals.

T

he use of computers in today’s business decisions has both revolutionized and benefited business. Yet, misuse of computers and unethical behaviour related to computer application systems have resulted in serious losses to business and society. Information technology (IT) provides organizations the opportunity to have almost instantaneous access to vast amounts of critical information about customers, competitors, employees, and suppliers. Unfortunately, recent incidents involving software piracy, computer viruses, data theft, system espionage and employee monitoring have emphasized the potential for unethical behaviour associated with the use of IT. Medicine always aims to promote health, prevent and cure diseases. With the advancement of technology today, many innovative methods of cure are being introduced. However, several methods are rather controversial in nature i.e. assisted conception. Here medical ethics can play a role. Medical ethics is applied to keep track of what is right and what is wrong in different areas of healthcare.

Information Ethics in Healthcare in an e-age

There is a great need for some form of regulation concerning the collection, processing, storage and communication of medical data, including images such as x-rays and eye scan.

There must be strict control over this sensitive information.

Patients’ information can be used for any unethical purposes, such as insurance companies may use the information to ask the patients’ family to buy their insurance, and irresponsible people may humiliate the patient among their neighbours, officemates, relatives and friends.

Patients have a right to expect that information systems are secure and will not in any way violate their privacy. Hence July 2007

the method must ensure that the confidentiality of the medical data or information is always preserved, particularly when it involves the movement of information from one location to another, electronically.

It is ethically inappropriate to carry on providing the services if the system fails to safeguard the confidentiality of the patient information that is of a sensitive nature. Disclosure of these information is a betrayal of trust.

Therefore measures must be taken to ensure that unauthorized interception can be prevented. Even if the transmitted information is intercepted, it shouldn’t be read. A comprehensive legal and ethical framework is necessary for the protection of the patients’ rights. In Malaysia, Ministry of Health (MOH) has a code of conduct for medical officers and nurses.

This code of conduct guides them to be good practitioners, while performing their duty. It includes guidelines on behaviours of medical practitioners with patients, visitors, and also among themselves.

Even in other countries, hospitals are focusing more on the patient’s care, but only part of the code of ethics focuses on the patient’s information handling. In fact, oaths and codes for medical practitioners vary from one country to another and even within countries, and they have many common features, including promises that physicians will consider the interests of their patients above their own, will not discriminate against patients on the basis of race, religion or other human rights grounds, will protect the confidentiality of patient information and will provide emergency care to anyone in need. But, sadly it still only focuses on the way they interact with patients directly, not through the computer system. Medical ethics in an ICT age is the need of the hour for every country, which has entered or about to enter the e-age.

33

case study

>

I n f o r m a t i o n E t h i c s i n P a pe r l e s s H o s pi t a l s

Malaysian Paperless Hospital

The Malaysian Government is the major provider of healthcare for its people. Other important providers contributing to the health of the population in Malaysia include the private sector and non-government organizations (NGOs).

In the Seventh Malaysian Plan, it was stated that there will be 33 paperless public hospitals in Malaysia. There will be 8 hospitals using total hospital information system (THIS), while the other 25 smaller hospitals will use the hospital information system (HIS). But due to the economic crisis in 1998, those projects were put on hold, and were expected to be implemented during the Eighth Malaysian Plan.

The ethical framework describes to the practitioners what is expected of them, whilst performing their duty.

This way the role of the practitioner is clearly put in perspective. Patients can be confident that they will receive quality care and their rights will not be violated in anyway. Without such a framework, it will be difficult to determine the moral obligation of the practitioner towards the patient.

However, until the early stage of the Ninth Malaysian Plan, only two hospitals are formally known as paperless hospitals, while implementation of other proposed hospitals are still on hold. Testing of the computerised systems have been given as reasons that contribute to this delay.

At the moment, these two hospitals do not have any code of ethics in handling patients’ computer-based information system. All healthcare professionals (the physicians, the IT department staff and the record department staff) only practice their own department’s policy or code of conduct.

However, in order to make them understand more about the system they are using, it might be better if there is one universal standard code, which can be read and practiced by all healthcare professionals across the country.

followed by the healthcare professionals in Malaysian paperless hospitals. They are usually only given verbal guidelines on ethics in the early stages of their training. Lessons on the computerized systems are usually given by senior staff in the wards.

As stated before, currently, there are two fully operational paperless hospitals in Malaysia. These hospitals fully rely on computer information systems to improve their operations efficiency. Here we describe the design of an ethical framework for healthcare professionals involved in handling computer-based information in these hospitals.

The design began with a draft framework of code of ethics for healthcare professionals, derived from a literature review on ethics related to them. The draft framework was incorporated in questionnaires, distributed randomly to healthcare professionals. The respondents were interviewed after completing the survey and many of their comments were directed to specific items in the survey. The research identified five major code of ethics, namely confidentiality, information protection, password management, computer usage and Internet usage. It is hoped that this ethical framework will guide healthcare professionals to act in an ethical manner, while using the medical information system in paperless hospitals. It is also important in their interactions with patients, colleagues and authorities, as well as in the conduct of medical research.

Ethics among hospitals’ staff is important in order to make sure the success of these healthcare institutions and to earn customers’ trust. Research shows that there have been cas-

Figure 1: Research Design Document

Review

Literature

Phase 1 Develop Draft Framework of Code of Ethics

Conduct Exploratory Study Verification of Draft of Code of Ethics

Interview

Phase 2

Develop Instrument for Data Collection The Ambit and Role of Ethics

Here in this article, we focus on the information ethics in the paperless hospitals of Malaysia. While paperless hospitals are being introduced in Malaysia and all over the globe, there is lack of a holistic code of ethics, specifically for handling massive computer-based information in these hospitals. Healthcare professionals such as medical practitioners and nurses in these paperless hospitals now have two codes of ethics to follow, namely, medical ethics and computer ethics. These professionals not only handle patient’s information; at the same time they also have to be proficient in handling computerized systems to ensure the security of the information. However, at the moment, there are no written guidelines, which can be 34

Data Collecting Survey Questionnaire

Interview

Phase 3

Analyze Data Collected Based on the Multiple Perspective Framework Revise Draft Framework of Code of Ethics Produce Final Framework of Code of Ethics

www.ehealthonline.org

Phase 4

es of healthcare professionals facing ethical dilemma while handling their patients’ information. If these problems are not taken care of, the concerned hospitals can receive a bad reputation.

However, here it deserves a mention that ethics is not about rules but about ‘codes of conduct’. Ethics can be defined as the system of moral principles that have graduated to become standards for professional conduct. Ethics is about behaviour and about ways of thinking, especially in situations where our choice can affect the dignity and well being of others. Because ethical behaviour implies free choice, it cannot be captured or condensed in a rule. This involves the challenge in its implementation. It is impossible to force adherence to an ethical standard: the notion of coercion itself is foreign to it.

But individually we can make a promise to abide by them.

Final Code of Ethics Framework I.Confidentiality A practitioner must…

1. ensure that ONLY authorized individuals have access to the patient’s information system.

2. maintain confidentiality of privileged information and use discretion in sharing information among the practitioners.

3. not disclose identifiable information about patient’s health status, medical condition, diagnosis, prognosis and treatment, and all other information of a personal kind, even after the patient has died. Exceptionally, the patient’s relatives may have a right of access to information that would inform them of their health risks.

4. not disclose information about a patient, except to other practitioners who are involved with the given patient’s care.

5. not disseminate, or provide misleading patient’s information 6. ONLY disclose confidential information if the patient gives explicit consent, or if it is expressly required by law, provided that the requirement is authenticated.

II.Data Protection

The research identified five major code of ethics, namely confidentiality, information protection, password management, computer usage and Internet usage. It is hoped that this ethical framework will guide healthcare professionals to act in an ethical manner, while using the medical information system in paperless hospitals. It is also important in their interactions with patients, colleagues and authorities, as well as in the conduct of medical research.

A practitioner must…

1. process patient’s information fairly and lawfully.

2. obtain patient’s information ONLY for official purposes such as for education and any medical work, with the permission from the person in charge.

3. keep and up to date the patient’s information.

4. prevent unauthorized creation, alteration, or destruction of patient’s information.

5. keep the patient’s information secure.

6. consider carefully the content to be entered into the computer system III.Password Management A practitioner must…

1. have user-ID account and password to access the computer system.

2. memorise his/her user-ID account and password and not write down and leave it in a place, where unauthorized persons might discover them.

3. change the password whenever an unauthorized party has compromised the system.

Methodology

4. change the password regularly, at least once every four months, to avoid other

Figure 1 shows how the research was being conducted. The research process consists of four phases. First, a comprehensive literature search was conducted to compile codes recommended by several organizations, as well as those suggested in various articles and publications. Then, those codes were compiled into a questionnaire form where respondents validated the codes by indicating whether it was accepted and can be applied in their working area. An exploratory study was conducted to ensure that the questionnaire was as clear as possible and would be able to measure what it was supposed to measure. Besides improving the questionnaire, the feedback and the data collected were used to provide some initial view of codes needed in the hospitals.

Second, hospitals using computer-based information system in handling their patients’ information were identified.

The finalized questionnaire was distributed to the healthcare professionals in those hospitals. The research uses a Multiple Perspective Method by Linstone (1993) to get multiple views of the codes from three ‘lenses’- technical view, organization view, and personal view of ethics. There is personal ethics, technical ethics and organization ethics in an organization.

But, there is no code that can be used by these three groups.

So, the research combined all codes which can be practiced by these groups. Figure 2 (in page 36) will show the relationship between the ethics and the practitioners.

5. brief the importance of user-ID account and password to other staff, and the man-

people using it to access the computer system.

July 2007

ner in which they are to be used and protected 6. keep his/her user-ID account and password confidential and not share it with other staff.

IV. Computer Use A practitioner must…

1. not use the computer system for non-official purposes such as playing games, chatting, or sending an email which is not related to work.

2. make sure that the patient’s information system has been logged out, before leaving the computer 3. have access to ONLY specific patient’s information for specific purpose 4. not download any software into the system without permission 5. ONLY use or install licensed copyright protected materials in the system with the permission of the person in charge.

6. not copy any patient’s information from the computer system without permission.

V. Internet Use A practitioner must…

1. not use personal e-mail (such as TMNet and Jaring) for official matters unless with the permission of the person in charge.

2. ONLY surf or browse information through World Wide Web (WWW) that is related to his/her job.

In the figure, the physicians include the medical officer, medical assistant, nurses, and attendants. Here administra35

case study

>

I n f o r m a t i o n E t h i c s i n P a pe r l e s s H o s pi t a l s

Figure 2: Multiple Perspectives Model of Medical Information Code of Ethics

tion of the practitioner towards the patient. The framework is to ensure that the quality of care is not compromised, and hence can facilitate to improve clinical effectiveness, which is one of the aims of any health authority.

Conclusion

tive include the staff in record department and the IT personnel are those who work in the IT department.

The Ethical Framework

The chart in page 35 represents the final code of ethics framework, which resulted from this study. The hospitals’ analysis of the data and information from the interviews resulted in the elimination of three codes. Several codes were combined

An exploratory study was conducted to ensure that the questionnaire was as clear as possible and would be able to measure what it was supposed to measure. Besides improving the questionnaire, the feedback and the data collected were used to provide some initial view of codes needed in the hospitals. because they addressed the same issues and were related to each other. The final outcome is a list of 26 codes that are essential to guide the ethical manner of handling patients’ computer-based information system. This code may assist other organizations to come out with their code of ethics in handling computer-based information in paperless hospitals.

Suggestions

Since Malaysia is moving towards paperless hospitals, this research endeavours to come out with an effective framework of code of ethics for practitioners, for handling patients’ information system. Linstone’s Multiple Perspective Method was used to analyse the code as it is useful for organizing a description, to aid in understanding of all points of views.

The ethical framework describes to the practitioners what is expected of them, whilst performing their duty. This way the role of the practitioner is clearly put in perspective. Patients can be confident that they will receive quality care and their rights will not be violated in anyway. Without such a framework, it will be difficult to determine the moral obliga36

Medical information is considered confidential because it is related to people’s life. No matter who are the patients, whether they are artists, ministers, or students, disclosure of sensitive health information can influence their lifestyles, and other people’s perceptions about them. That is why the ethical framework is very important in preventing the revealing of confidential medical information.

It is hoped that this proposed ethical framework can be used to let the practitioners act in a manner which recognize their responsibilities towards society. The framework also demands that the healthcare personnel display great professional ethics, and also entails that a mechanism exists to protect society from those healthcare personnel who do not, or cannot, live up to these responsibilities. n References:

1. Dato’ Seri Dr. Mahathir Mohamed. “Malaysia-The Way Forward”. Paper presented at the Inaugural Meeting of the Malaysian Business Council on 28 February 1991.

2. Hayden Wetzel, Malaysia Country Commercial Guide FY 2003: Leading Sectors, http://strategis.ic.gc.ca/epic/internet/inimr-ri.nsf/en/gr109345e html. Accessed January 16, 2006.

3. Dr. David Seth Preston and Uma Devi Kanagaratnam, University of East London, http://itch.uvic.ca/itch2000/PRESTON/PRESTON.HTM. Accessed February 28, 2006.

4. Code of Professional Conduct , 1971, Ministry of Health, Malaysia 5. Code of Conduct for Nurses, 1998, Ministry of Health, Malaysia 6. Medical Ethics Manual, 2005. World Medical Association (WMA) 7. Ethical Principles for Medical Research Involving Human Subjects, 2004.

World Medical Association Declaration of Helsinki 8. John S. Ash, Paul N. Gorman, Mary Lavelle, and Jason Lyman. Multiple Perspective on Physician Order System.

Sapiah Binti Sulaiman sapiahsulaiman@yahoo.com Faculty of Computer Science & Information Systems Universiti Teknologi Malaysia

Rose Alinda Alias alinda@utm.my Faculty of Computer Science & Information Systems Universiti Teknologi Malaysia

Azizah Abd. Rahman azizahar@utm.my Faculty of Computer Science & Information Systems Universiti Teknologi Malaysia

www.ehealthonline.org

>

project showcase

Health-e-Child Project Towards an Integrated Healthcare Platform for European Paediatrics

T

he vision for the Health-e-Child system hinges on becoming the universal biomedical knowledge repository and communication conduit for the future. Perhaps it is emerging as a common vehicle by which all clinicians will access, analyze, evaluate, enhance, and exchange biomedical information of all forms. It is tailored to be an indispensable tool in their daily clinical practice, decision making, and research. It will be readily accessible at any time and from anywhere, and will offer a friendly, multi-modal, efficient, and effective interaction and exploration environment.

There is a compelling demand for the integration and exploitation of heterogeneous biomedical information for improved clinical practice, medical research, and personalised healthcare for the citizens of the European Union. This demand can be catered in a big way by the Health-e-Child project.

Any effort towards this vision requires significant change in the biomedical information management strategies of the past, with respect to functionality, operational environment, and other aspects. Pivotal to this outlook are recent Health-e- Child’s breakthroughs in personalised medicine through integrated disease modelling, knowledge discovery and decision support.

The Health-e-Child project aims at developing an integrated healthcare platform for European paediatrics, providing seamless integration of traditional and emerging sources of biomedical information. The long-term goal of the project is to provide uninhibited access to universal biomedical knowledge repositories for personalised and preventive healthcare, large-scale information-based biomedical research and training, and informed policy making.

The project has manifold objectives.

They include among others, gaining a comprehensive view of a child’s health by vertically integrating biomedical 38 }

data, information, and knowledge, that spans the entire spectrum from genetic to clinical to epidemiological; to develop a biomedical information platform, supported by sophisticated and robust search, optimisation, and matching techniques for heterogeneous information, empowered by the grid; and to build enabling tools and services on top of the Health-e-Child platform, that will lead to innovative and better healthcare solutions in Europe.

With respect to medical applications, Health-e-Child focuses on paediatrics,

particularly on some carefully selected representative diseases in three different categories: paediatric heart diseases, inflammatory diseases, and brain tumours.

The focus of this project is on individualised disease prevention, screening, early diagnosis, therapy and follow-up of paediatric heart diseases, inflammatory diseases, and brain tumours. The project will build a grid-enabled European network of leading clinical centres that will share and annotate biomedical data, validate systems clinically, and diffuse clinical excellence across Europe by setting up new technologies, clinical workflows, and standard.

In a nutshell, the focal point of the Health-e-Child project is in the establishment of multi-site, vertical, and longitudinal integration of biomedical data, information and knowledge delivered via a Gridbased platform, and supported by robust tools for search,

optimisation and matching processes.

The project is partnered by heavyweight corporate bodies and prestigious academic institutions and research bodies, which include names like Siemens, European Organisation for Nuclear Research-CERN, University of the West of England-Bristol,UK, University of Genoa, Italy, French National Institute for Research in Computer Science and Control ( INRIA) among others.

Health-e-Child emphasises on building the enabling tools and services which will improve the quality of healthcare and reduce its cost by increasing efficiency. The project is working to achieve this objective through integrated disease models, database-guided biomedical decision support systems, and cross modality and longitudinal information fusion and data mining for biomedical knowledge discovery.

The Health-e-Child project is expected to enhance the level and quality of medical services offered in Europe and significantly advance medical research.

It is also expected to improve the competitiveness in the area of medical service and facilitate the adoption of new health policies in the EU member-states.

It is also expected to bring forward information-based medical technology and integration of mostly separate areas i.e. vertical information integration, advanced medical querying, Grid infrastructures, disease modelling, medical imaging, knowledge discovery and data mining, and decision support.

Furthermore, the project is expected to improve the success rate in resolving challenging medical cases, and thereby contribute towards saving children’s lives. Such improved medical decision making would often result in lowering medical cost and/or treatment duration.

To ensure its impact, the Health-e-Child will carry out various networking activities, beyond the provision of the system and its underlying research. n www.ehealthonline.org

INDIA

2007 31 July - 03 August 2007 Hotel Taj Palace, New Delhi

Does IT Sound Healthy?

Showcasing India's e-Healthcare...

...of Today and Tomorrows!

Make your Presence Felt, Voice Heard, Vision Shared...

In The LARGEST e-Health Conference & Exhibition in INDIA Join and get involved!

www.eINDIA.net.in/eHealth