ICT4Health CLIMBING NEW HEIGHTS: June 2007 Issue

V O L UME 2 | ISSUE 6 | JUNE 2007

A MONTHLY MAGAZINE ON ICT AND HEALTH

COVER STORY

BUILDING INFORMATION CAPACITY FOR BETTER HEALTH: US AND BEYOND INTERVIEW

GABE RIJPMA MICROSOFT: FACILITATING e-HEALTHCARE IN THE ASIA PACIFIC REGION FOCUS

MED-E-TEL 2007: AN INTERNATIONAL PLATFORM SHOWCASING e-HEALTH INSIGHT

A FRAMEWORK FOR THE PHILIPPINES’ PHR TECHNOLOGY

EMERGING TECHNOLOGIES FOR SUSTAINABLE RURAL e-HEALTH SPOTLIGHT

NATIONAL SEMINAR ON MEDICOLEGAL INFORMATICS www.ehealthonline.org

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w w w . e h e a l t h o n l i n e . o r g | volume 2 | issue 6 | June 2007

Cover story

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Building Information Capacity for Better Health: US and Beyond

Ticia Gerber

in conversation

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Microsoft: Facilitating e-Healthcare in the Asia Pacific Region

Interview with Gabe Rijpma, Director, Health and Human Services Industry, Microsoft Asia Pacific

insight

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A Framework for the Philippines’ PHR

Dr. Alvin B. Marcelo

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focus

Med-e-Tel 2007: An International Platform Showcasing e-Health 17 technology

Emerging Technologies for Sustainable Rural e-Health

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spotlight

National Seminar on Medico-Legal Informatics 38

NEWS REVIE W

world news

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india update 30

June 2007

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business news

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

We would like the contributors • Book reviews should include to follow the guidelines outlined details of the book like the below, while submitting their title, name of the author(s), material for publication: publisher, year of publication, price and number of • Articles/ case studies should 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,

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•

•

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

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

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

All contributions are subject to approval by the publisher.

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

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Volume 2 | Issue 6 | June 2007

president

Dr. M P Narayanan

EDITORIAL Can e-Health Reach Health?

editor-in-chief

Ravi Gupta sr. editor

G Kalyan Kumar Assista nt editor

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espite many odds, e-Health has come to stay. And it is set to change the face of tomorrow’s healthcare in an irrevocable way.

Though USA is taking the lead in e-Health measures, other countries of the developed world are also making commendable progress.

Yes, even in developing nations like Bangladesh, India, Kenya and Peru, there have been praiseworthy efforts in the form of some good e-Health projects, which are pregnant with development potential.

Seeing the potential of e-Health, many renowned foundations and major international funding agencies such as the United Nations (UN), World Health Organization, World Bank and the United States Agency for International Development have also made their forays into the global e-Health arena, as an integral part of their growing global health agenda.

In our Cover Story, written by the internationally renowned health information technology expert, Ticia Gerber from eHealth Initiative, the readers can get more information and insights about the progress of the deployment of health information technology in the US and beyond.

In the Indian context also, there have been many initiatives in e-Health in the recent times, fostered by a number of bodies; both public and private, ranging from large multinational conglomerates like Voxiva to researchers of academic institutions like IIT Chennai. But among them the Integrated Disease Surveillance Project, funded by World Bank, deserves a special mention.

We know that today Internet, coupled with the mushrooming of handy and technologically sleek devices like cellphones, PDAs and flash drives, is opening up possibilities of managing our own healthcare, and healthcare records. But as always, there is another side to this coin. May be electronic medical records, automated laboratory machines, and digital radiology equipment are going to be realities in India’s super-speciality hospitals of metros in the near future. But can we get rid of the reality of the images of malnourished babies and the news of rampant infant mortality? Can we relegate random incidents of people dying from highly curable diseases like malaria and cholera, into the domain of fiction?

The challenge ahead of India is how to apply the new developments in health information technology so that our teeming millions get benefited despite the country’s still largely underdeveloped healthcare infrastructure. We have to address this challenge urgently. Otherwise India would happily continue to live in different centuries...

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

June 2007

Ravi Gupta Ravi.Gupta@csdms.in

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C O V ER st o r y

Building Information

Capacity for Better

Health: US and Beyond Action in the United States sets the ball rolling The terms e-Health and health information technology (HIT) are used somewhat interchangeably in the United States. Both refer to the use of appropriate technologies related to computing, information, networking, and communications, in support of health, and the goals of the healthcare system. Abroad, e-Health often falls under a broader label, including any application of ICT for health in its ambit.

Ticia Gerber

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ountries around the world, including the United States, are becoming increasingly interested in using health information technology (HIT) to improve citizen health and to address pressing healthcare challenges, ranging from preventative care to pandemics. This article outlines key shifts in policy and practice on both the domestic and international fronts to integrate HIT into healthcare delivery, which in turn, can help people live longer, healthier lives.

Here I want to clarify a small point. The terms e-Health and health information technology (HIT) are used somewhat interchangeably in the United States. Both refer to the use of appropriate technologies related to computing, information, networking, and communications, in support of health, and the goals of the healthcare system. Abroad, e-Health often falls under a broader label, including any application of ICT for health in its ambit.

The Story of the US

American efforts to improve the healthcare experience and tackle the problem of continued increases in healthcare costs through HIT began in earnest in 2001, after the release of two government reports, which estimated that hospital medical errors resulted in 44,000 to 98,000 deaths per year. The reports called for a public-private sector effort to develop a national health information infrastructure that could support electronically-delivered healthcare services. In the aftermath of September 11, many early HIT initiatives in the USA focused on using information technology to strengthen coordinated and rapid public health communication ,and upgrading }

the nation’s capacity to deal with public health threats. With more than 90 percent of the estimated 30 billion healthcare transactions in the United States each year still conducted by phone, fax or mail, rapid change was sought to bolster realtime response capabilities.

Landmark public health and bio-terrorism preparedness legislation was signed into law in 2002 (P.L. 107-188).

Since this time, more than 20 bills related to HIT and better health have been introduced in Congress to address the biggest barriers preventing the use of HIT. They included the lack of interoperable electronic health record (eHR) systems that can talk to one another, ensuring that information in these systems is private and secure, and funding challenges and helping consumers and healthcare providers to employ these systems. Representatives of both national political parties-Democrats and Republicans – have worked together on the issues of improving healthcare through HIT, because they recognize that accomplishing this goal will benefit all Americans, young and old, sick and well. The year 2006 represented a watershed for action on HIT-related legislation.

Both the U.S. House of Representatives and the Senate approved HIT bills (S. 1418, H.R. 4157). However they were not conferenced and enacted into law.

Federal government health agencies responsible for Medicare, Medicaid and other programs have also acted boldly on issues related to HIT and better health, particularly since President George W. Bush said in his 2004 State of the Union remarks to the nation that our healthcare system is “in a time of change. Amazing medical technologies are improving and saving lives...” He called for the majority of Americans to have personal electronic medical records within 10 years. Since www.ehealthonline.org

this time, top U.S. health officials have declared this the Decade of Health Information Technology and supported moving to nationwide implementation of interoperable health information technology through increased leadership; funding needed research and demonstrations and soliciting input from the private sector. Multiple executive orders from the desk of the President have also been issued which encourage the federal government to use interoperable HIT and identify practices that promote high-quality healthcare.

Examples of bold actions by the U.S. federal government include founding the Office of the National Coordinator for Health Information Technology (ONC) in 2004 to harmonize the nation’s HIT efforts within the federal government, and the 17-member American Health Information Community (AHIC); created in 2005 to provide recommendations about how to make health records digital and interoperable, while assuring that the privacy and security of those records are protected. AHIC’s work is ongoing, but set to last no longer than five years. The Centers for Medicare and Medicaid Services (CMS) is also carrying out Medicare demonstration projects across the U.S., which are focused on testing innovative ways of paying for and delivering quality healthcare.

Adoption of HIT is a part of these experiments.

What do all of these seemingly arcane policy changes in Washington DC mean for the average American patient who just wants the best care possible? Quite a bit if the promise of the HIT decade is realized. Imagine a doctor visit where the facts about your medical history are available securely at the doctor’s fingertips, whether you are in Boca Roton or Barcelona. Picture the ability to sit at home and send monitoring information on chronic conditions such as diabetes or congestive heart failure to your healthcare provider conveniently on a daily basis, from the computer or TV set. Conceive of the ability to compare the quality of healthcare offered to you in different settings. These scenarios are possible with HIT, and the concerted endeavour by the U.S. Congress and administration are supporting a quicker path to this vision of system transformation, which is light years away from where the American healthcare system is today.

HIT in the US States, Regions and Communities

It needs a mention that action on HIT and better healthcare is no longer just a national issue in the United States. The issue is gaining great deal of currency at the state level too.

In 2005 and 2006 alone, legislatures in 24 U.S. states passed laws calling for recommendations and/or strategic action plans on adopting HIT to increase healthcare quality and pa-

devastating katrina

tient safety, and to curb rising healthcare costs. In the wake of Hurricane Katrina and the large-scale destruction it wrought on paper-based health records and effective healthcare delivery, states and communities began to think more seriously about the life-saving advantages of HIT and electronic health records systems.

The U.S. Department of Health and Human Services (HHS) Secretary Mike Leavitt observed that “there may not have been an experience that demonstrates, for me or the country, more powerfully the need for electronic health records than Katrina.” During Congressional testimony in late 2005, Department of Veterans’ Affairs (VA) officials contrasted the situation of the majority of hurricane survivors, moving to shelters and triage centers, lacking medical and prescription information, with patients of the New Orleans VA Medical Center. Although the VA Center flooded, medical records for all 50,000 patients were available within one day because they were electronic. Only a computer specialist had to be airlifted from New Orleans, carrying backup tapes of all the records, which by the next night had been re-entered into computers in Houston. Everything on the computers was saved.

Today, states in the Gulf Coast such as Louisiana, Alabama, Florida, Mississippi and Texas are real HIT innovation hubs, doing important work to strengthen Gulf Coast healthcare services and create a regional electronic health information infrastructure. However they are not alone. By current estimates, there are 280 state, regional and community-based collaboratives focused on improving quality through electronic health information exchange (HIE). Proving that all healthcare may indeed be local, these HIES represent the fo-

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360 Panorama of the ICT4D Spectrum Over 1200 Domain Specialists

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cover story

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Building information capacity for better heatlh: us and beyond

cused effort of multiple groups in the community such as doctors, hospitals, employers, health plans and public health agencies to mobilize information, and enable it to be available at the point-of-care, using interoperable electronic health information exchange systems. Although many are just getting off the ground, HIES are now in all the 50 states, Puerto Rico and the District of Columbia. medical diplomacy

The US is not only tackling health system transformation within its own borders, but across the globe. Two important new concepts – medical diplomacy and transformational diplomacy - have emerged that have turned traditional thinking about America’s responsibility in global health and IT’s role in it, on its head. Medical diplomacy is defined as exporting medical care, knowledge and personnel to help those most in need outside the U.S. That is patients in Africa, Asia,

the Middle East and elsewhere. American health leaders have urged that medical diplomacy be used in conjunction with existing foreign and defense policies to achieve progress and win the hearts and minds of people worldwide.

The medical diplomacy philosophy, as aptly stated by former HHS Secretary Tommy Thompson, is that “good medicine makes better neighbors.” An example of medical diplomacy efforts is ‘The Global Fund to Fight AIDS, Tuberculosis and Malaria’, created in 2001 as a partnership between government, civil society, the private sector and affected communities to dramatically boost the resources raised for addressing these diseases and directing resources in a strategic way. Since 2001, the Global Fund has attracted $4.7 billion in financing, and supports programs in 93 countries. A related movement is that of transformational diplomacy advanced by the US’ State Department Secretary, Condoleezza Rice, that seeks to reach beyond the borders of the traditional structures and move diplomats into the field, to partner in doing things with other people, not for them. Technology is a key component of this strategy, linking the US. and its foreign partners in real time and increasing information-sharing.

These developments, combined with the significant efforts of world’s leading philanthropist institutions such as the Bill

& Melinda Gates Foundation and the William J. Clinton Foundation based in America, to combat pressing threats in the developed and developing worlds, make the U.S. a leader in the global health arena. Information systems and electronic connectivity are at the very core of efforts to improve health worldwide. A panel of leading experts concluded at the 2006 Davos Economic Forum that “the great obstacle to serious progress towards global health goals remains the woeful state of the world’s public health infrastructure. Health information systems remain inadequate, making it impossible to monitor the delivery and coverage of interventions in a timely and effective way.”

Deployment of HIT to improve health is going forward on every continent. Individual nations such as England, Finland, Australia, Japan, India, Singapore, Mexico, South Africa and Kenya are tackling e-Health projects, large and small. Projects involve eHRS, hardware, software, PDAs, mobile phones and other technology, and are as diverse as the human imagination. Some examples include telemedicine networks in Bangladesh, e-pharmacy projects in Malaysia, low-cost, sustainable eHRs for HIV/AIDS patients in Kenya, transnational HIT infrastructure in Europe’s Baltic nations, diagnostic riverboats operating in the Amazon rainforest, web-based real time communication tools to decrease maternal and child deaths in Peru, and national efforts to create an eHR system in Australia (HealthConnect), and a single electronic healthcare record for every individual in the United Kingdom (National Programme for IT). Overall, nations are in earlier stages of HIT use, funding and development. Many existing collaborations to integrate HIT with the patient care experience are regional in nature, and are fuelled, in part, by private funding.

Nations are also instituting programs and policies that employ HIT to prepare for potential pandemics such as avian influenza. Experts estimate that a severe flu strain, similar to that seen in 1918, would result in 90 million illnesses worldwide, and nearly two million deaths. Moreover, the pandemic would spread around the globe in one month. IT is an essential part of any effective pandemic preparedness plan.

According to the Breakout Session Report of Pacific Health Summit 2006: Pandemic Preparedness, HIT and Policy (pg 1) “The speed, organization, and volumes of data that are necessary to monitor, prepare for, and react to a pandemic of any kind will necessarily require the creative use of information technology.”

A commonly held definition of global health is health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions. Foundations, non-governmental organizations, and major international agencies such as the United Nations (UN), World Health Organization, World Bank and the United States Agency for International Development are stepping into the global e-Health arena as part of their growing global health agenda. infoDev, coordinated by the World Bank, is developing a knowledge map project; charting role and use of ICT in the developing world. WHO reviewed and adopted Resolution WHA58.28 in May 2005, urging member-states to consider www.ehealthonline.org

developing long term strategic plans for developing and implementing e-Health services. The European Union also has an e-Health action plan in place to achieve a borderless transEuropean health information space by 2010, that will recognize the particular importance of interoperability and patient mobility, as well as strengthen disease prevention, healthcare personalization and patient involvement.

these initiatives achieve will only grow in the years ahead.

Meanwhile patients and consumers expecting better healthcare quality, safety and efficiency are awaiting. n References:

• Common Ground and Challenges

Countries around the world, which are improving health through HIT, represent a wide variance in terms of national population, geography, GDP, governance, health system structure, financing and disease burden. However, common challenges and ingredients to success are emerging.

Some common challenges include: maintaining HIT as a top item on the national agenda for shifting political and budgetary environments, antiquated laws and regulations, and project funding. Key success ingredients involve: • Knowledge transfer of best practices from those that have gone before; • Innovative use of low-cost technologies such as Palm Pilots, cell phones and simple computer systems; • Strong engagement from consumers and healthcare providers; • Active cooperation between governments & businesses; • The necessity of addressing data standards and interoperability issues, for enabling to exchange health information; and • Appropriately addressing privacy and security concerns at every step in the process.

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To Err is Human: Building a Safer Healthcare System, Institute of Medicine, November 1, 1999 Information for Health: A Strategy for Building the Ntional Healt Information Infrastructure, National Committee on Vital and Health Statistics, November 15, 2001 Michael Menduno, “apothecary.now,” Hospitals and Health Networks, July 1999, 35-36 President George W. Bush, State of the Union Remarks to the Nation, January 24, 2004 eHealth Initiative, States Getting Connected Issue Brief, August 2006 HHS Secretary Mike Leavitt, Comments to the Associated Press, September 12, 2005 eHealth Initiative, Improving the Quality of Healthcare Through Health Information Exchange, September 2006.

Former HHS Secretary Tommy Thompson, Public Speech, October 20, 2004 Global Governance Initiative - Third Annual Report, Davos World Economic Forum, January 2006 Global Connections: Requirements, Enablers and Roadblocks to Implementing HIT and Electronic Connectivity for Better Health Worldwide, Ticia Gerber, May 20, 2006 Emerging Collaborative Models for Implementing HIT, Stephen Solomon, MD, September 26, 2006 Pacific Health Summit 2006 Breakout Session Report: Pandemic Preparedness, HIT and Policy, pg 1

Summing Up

International dialogues reveal that countries are interested in developing a more strategic, coordinated global agenda, for funding e-Healthcare initiatives in and across countries.

This would facilitate government and industry working in tandem, and encourage national electronic medical record systems, that are developed to incorporate globally accepted data standards and interoperability protocols. While different views of healthcare, spread across national boundaries and cutting through the bureaucratic red tape are always challenges, the variety and intensity of efforts by nations around the globe to improve healthcare through HIT, electronic connectivity and a health information infrastructure is growing at an exciting pace. The health status and system improvements

About the Author: Ticia Gerber serves as the Vice President for International Programs and Public Policy at the eHealth Initiative (http://www.ehealthinitiative.org), a multi-stakeholder consortium whose mission is to drive improvement in the quality, safety, and efficiency of healthcare through information and information technology.

Ticia Gerber e-mail: ticia_gerber@hotmail.com VP, eHealth Initiative

Creativity Commitment Collaboration Impacting Millions of Lives Through ICT4D June 2007

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in conversation

Microsoft: Facilitating e-Healthcare in the Asia Pacific Region Driving Knowledge to Bring in a Healthy Change

In an exhaustive interview with Gabe Rijpma, Director, Health and Human Services Industry, Microsoft Asia Pacific, eHealth has attempted to probe the Microsoft’s vision for fostering e-Health in the Asia Pacific region and also its pragmatic corporate initiatives towards fruition of that vision. The interview can provide valuable information about Microsoft’s investments to NGOs and international development organizations which have great development potential, Microsoft’s proactive stance in disaster management, and the software giant’s approximate allocation in its annual budget for healthcare IT. The interview also explores Gabe’s candid and welcome views about India’s e-Healthcare scenario... gabe rijpma : Director, Health and Human Services Industry, Microsoft Asia Pacific e-mail: Gabe.Rijpma@microsoft.com

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indly elaborate on the various ways through which ICT can facilitate healthcare of developing countries in the Asia Pacific region -a region characterized by acute lack of basic healthcare infrastructure, and where the underprivileged populace are miles away from quality health.

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here are three key areas where I think ICT can play a profound role in helping developing countries in the Asia Pacific region. The first being information access. Through the use of Internet kiosks and community Internet centers, people in those regions today have far better and more up to date in10 }

formation regarding health issues than they have had ever before.

The second is in the area of providing remote tele-health services. This is about extending the geographical reach of health professionals through the use of technology. By leveraging technology such as web cams, electronic medical devices and the Internet, we can really make a difference in getting expertise to these often very remote areas in Asia Pacific. To provide an example of this, the work that we have been doing with partners such as Brilliance Informatics and the Ministry of Health in Malaysia can be very pertinent. The Teleprimary care project is all about extending

health services to remote areas, facilitated by technology.

The third area where I think ICT can play a big role is in improving health surveillance and getting to a point where we have almost real- time monitoring and indicators of what is happening with health related issues at a village or community level. With pervasiveness of mobile phones today, even at the village and community levels we have an amazing opportunity to use those mobile phones to report health issues in real time. Alerts as well as guidance and recommendations can then be easily sent back and forth from centralized areas. For example, we are doing work in www.ehealthonline.org

Indonesia with a partner called Voxiva, to do real-time monitoring of avian influenza in these rural communities. All through the use of SMS text messaging and combining that with portal and database technology for helping ministries get real time monitoring. This is incredibly powerful as many of these reports are still done on paper; sometimes taking several weeks for the outbreak information to reach the relevant authorities.

Making this more prompt allows us to react more quickly, and may be even save lives.

program is already active in 101 countries, with training that has equipped 2.5 million teachers and reached more than 57 million students across these countries. We also have made investments in multi- stakeholder programs such as the Pan Asia ICT R&D Grants Program, which was directly focused on enabling research organizations to do innovative work in the areas of health, education, governance and so forth. There we have been working with organizations such as IDRC, AMIC and UN and many others of similar standing.

What are Microsoft’s recent ICT innovations and programmes in the domain of healthcare?

Where do you think India stands as compared to other developing countries in the Asia Pacific region, in terms of ICT usage in private and public healthcare sectors? How does Microsoft view this country as a potential market for healthcare IT?

At Microsoft we started our dedicated health vertical in Asia Pacific, in July of 2006. We are very focused on delivering our vision of knowledge driven health in Asia Pacific and are taking a number of positive steps so that we can address not only underserved communities but entire populations in that area, through advancing the state of health ICT and its adoption. We are doing some really interesting work currently in the areas of building connected health systems.

We recently launched the Connected Health Framework (CHF), which provides documentation and guidance to health organizations looking at building out connected health systems. In addition to that, we also just launched an open source project for something we call the Health Connection Engine, which makes it much easier for people to take the guidance in the CHF and start making that a reality.

How Microsoft is partnering with government agencies and international development organisations in Asia Pacific region for research and project implementation in the healthcare sector?

We have an ongoing investment and commitment to research organizations and international development organizations. Through programmes such as Unlimited Potential we are investing with NGOs to broaden access, for reaching out to another one billion people by 2015. Our five-year, USD 250 million investment in its Partners in Learning June 2007

The great thing about India is there is such a passion and focus in everyone who I have met there, about solving issues in healthcare through effective use of IT. India has some unique challenges, but has an amazing abundance of brilliant people who I know will deliver the outcomes India needs through applying themselves. I think the market potential for e-Health applications in India will be vast. Right now we see a lot of research and development going on in India itself for doing this. As the market matures, I think we will see some broad consolidation of e-Health applications to foster even bigger and better outcomes.

On the one hand India is fast emerging as a hub for low-cost, high quality healthcare destination, giving fillip to health tourism. On the other hand, there is a rampant lack of even basic public healthcare infrastructure for millions of semi-urban and rural Indians. Is Microsoft planning to tap this gap for potential business benefits and also for adding social value?

The divide that exists between the people who can afford healthcare and those that cannot is a real concern for all of us around the world. I think ICT has a role to play but first and foremost we have to find ways of making healthcare more affordable as well as encouraging people to take up nursing and medicine. Today

we still have an acute shortage of doctors and nurses around the world, and that really limits access too. ICT role here is probably best placed in the area of learning, information sharing and improving access as I outlined earlier.

What is the approximate annual budget allocation and/or percentage of Microsoft R&D in healthcare IT? What are the expected welfare and economic dividends from this allocation, in the near future?

While we do not provide specific breakdowns, we do spend approximately US$7b in R&D every year. The healthcare segment is the largest segment of the world’s economy. And it is also one of the fastest growing. It’s an area in which information plays and will play an increasingly large role. The impact that information technology will make to the health sector will make an incredible difference to the users.

In the aftermath of the Asian tsunami, disaster management has assumed great importance in India.

Does Microsoft Asia Pacific have any plans to address the trauma-related issues among these victims through telemental health?

Microsoft is very committed to working with its partners and customers to find solutions to some of the most difficult issues facing us in situations like these.

We have been working diligently to figure out how we can leverage ICT to improve response times, to ensure people get the right help as well as ensuring that all the amazing organizations that respond in difficult times like these can use ICT to better share and coordinate information with each other.

For instance, during the relief efforts for Hurricane Katrina, Microsoft Office Groove- a collaboration software program that helps teams work together dynamically and effectively, even if team members work for different organizations, work remotely, or work offline- that is part of the Microsoft Office system, was widely used to allow collaboration among rescue and relief organizations working across different infrastructure, in adverse and unpredictable conditions. n 11

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Insight

A Framework for the Philippines’ PHR Health information systems taking deeper roots When patients are more involved in their own healthcare, including the management of their personal health data, they become active participants in their healthcare and become more responsible. Providing a platform for personal health records may yet become the foundations for an effective and efficient healthcare system, that is oriented more to the welfare of the client. The Philippine National Health Information Infrastructure plays a crucial role in making personal health records happen in the Philippines.

Personal health record systems may be the impetus that will spur facilities to digitize their operations and allow clients to have electronic copies of their health records.

Dr. Alvin B. Marcelo

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he advent of Internet technology has made it easier for consumers to participate in the management of their own health records. Add to this the proliferation of person-based devices that allow consumers to hold on to electronic copies of their health data (e.g., in their cellphones, PDAs, flash drives), and the situation seems full of possibilities. Traditionally, health records are maintained in hospitals, and patients could only access them on a per request basis (often in the form of a photocopy of the original).

But the new emerging technologies (Internet, eXtensible Markup Language or XML, flash memory, mobile computing, etc) are already enabling consumers to store copies of their own CT/MRI scans and laboratory results in their personal storage devices, which they can bring with them as they transfer from one facility to another. As more modalities automate the digitization of health data and make these portable, the more we foresee consumers demanding access to their personal records and asserting their rights to manage their own data themselves. We would attempt to examine them further in the following paras.

A Present with Possibilities

The twenty-first century has been called the information age, and it promises to revolutionize the health sector. With the lowering cost of hardware and the advent of open systems interfaces, it is now possible for individuals to participate more actively in transactions that concern their private information. In no other domain is this participation more relevant than in health, where intimate and personal data need to be exchanged with providers and healthcare facilities, to 12 }

effect the most cost-effective approach to the solution of any health issue.

Even today, conventional health record management in the Philippines mostly follows a facility-centric or provider-centric model, where the data are stored in paper records in the clinic or in the hospital. This system essentially constrains patients into returning to the same provider every time, because their data is most complete in that facility. If they decide to transfer to another facility, they have to request for a photocopy of their record from the provider. This photocopy is often incomplete; and for health data that are not text-based such as radiology and pathology images, the second facility usually requests for repeat examinations, so they can have a copy of their own. This results in greater medical expense for the patient.

However, recent developments in health information technology are changing all these. All of them increase the ability of patients/consumers to participate in the management of their health data. First is the wide availability of personbased computing devices, such as cellphones or any device, with flash-based memory. These devices have matured to the point that their storage and computing power give them as much capability as desktop computers. Aside from cellphones, there are flash-based memory devices (such as Universal serial bus [USB] thumb drives), which can store volumes of digital information. The USB port specification has opened numerous possibilities for health data capture. The USB drives enable patients to have portable copies of their own health data, text-based or multimedia-based, that they can bring to any healthcare provider or facility.

Second is the increasing digitization of health data. With the advent of electronic medical records, automated laboratowww.ehealthonline.org

ry machines, and digital radiology equipment, much of what used to be written only on paper or printed in imaging plates, are now also being made available in digital format. These digital files can be transferred from one facility to the other, without any degradation of quality. With such data, it is possible to have an examination done in one healthcare facility and viewed in another, regardless of the second healthcare facility’s infrastructure.

Third is the increasing availability of Internet connectivity. The Internet allows for the low-cost exchange of data between facilities, and between patients and facilities in a seamless manner. It is essentially possible for patient data to be in various places of the Internet and to be consolidated into one comprehensive record in a provider’s clinic.

Here in this article we propose a framework for the design and implementation of a state-of-the-art personal health record systems in the Philippines. This framework allows policy makers to manage the transition from conventional to electronic health records in a secure yet cost-effective way; using a patient-centric approach. If the bottomline is greater participation of patients in their own care, a thorough analysis of the strengths and weaknesses of personal health records must be made to facilitate the inevitable shift from providerand facility-centric care to one that revolves around the one who truly counts .... the patient.

However, before we analyze further, we must clearly understand what a personal health record entails. Contrary to common belief, the PHR does not contain all of a patient’s health data. Rather it is a subset of data that can give healthcare providers a more comprehensive and longitudinal perspective of the patient’s care. The ASTM International (formerly American Society for Testing and Materials) has published Standard E 2369 Continuity of Care Record (CCR), which might throw some light in this context. It reads, “The standard provides a core data set of the most relevant administrative, demographic, and clinical information facts about a patient’s healthcare, covering one or more healthcare encounters. The CCR data set includes a summary of the patient’s health status (e.g., problems, medications, allergies) and basic information about insurance, advance directives, care documentation, and the patient’s care plan.”

In Search of a Comprehensive PHR for the Philippines

Rising social concerns in the Philippines

The Issues to Reflect Upon

Certainly, there are numerous issues that accompany such a dramatic shift from the conventional healthcare, which we must dwell in, before going in raptures over these innovations. Foremost would be the security and integrity of the data as they are stored in media, that are prone to tampering.

Another would be the issue of identification and authentication, both of the patient and of the provider, who would be accessing the data. Resistance from providers is also expected as personal health records would require them to invest heavily on technology infrastructure. Last but not the least, integration of the health records, parts of which may be in different facilities aside from the patient, remain a serious challenge to personal health record systems.

The Electronic Commerce Act of 2000 provides much of the policy framework for electronic-based transactions in the Philippines and would include electronic health records.

From the recent Electronic Health Records Philippines 2006 conference, we can find several applications which had some components of an electronic health record. The Community Health Information Tracking System (CHITS) is a Philippines government health center-based information system designed to manage the administrative and clinical tasks of a local health center. The Integrated Surgical Information System (ISIS) is a hospital-based patient registry that manages data about surgical patients at the Philippine General Hospital. The Blood Bank Information Management Package (BLIMP) manages the donor information system and transfusion services at the UP-PGH Blood Bank. At the Riverside Medical Center in Bacolod, Philippines, a pharmacy information system called HYSYPTO has been deployed, where prescriptions are filled up by the pharmacy right after doctor’s

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orders are scanned on the floor. However, none of these systems may be called personal health records since all of these are facility-based and do not share any information to the patients. Based on the author’s review of healthcare literature and of the local environment, there is no end-to-end model right now for personal health records in the Philippines. An end-to-end model allows for the transferring and viewing of health data seamlessly and securely, from one facility to another, with patients serving as the bearers of the data.

In radiology, a few imaging facilities have procured DICOM -compliant equipment, which could output digital data. Upon request, these facilities have provided their patients CD-ROMs of their images, which patients can view on a personal computer.

Laboratories on the other hand often give out test results in paper printout format. Having no actual system to receive electronic data from laboratories, only a few facilities provide electronic data to their patients in the Philippines. For the few who are able to output electronic data, they often deliver results to providers via fax or via e-mail, in portable document format (PDF). Others allow patients to print out their lab results through a web interface. Presently, there is no laboratory facility that offers electronic data to patients in the raw. The issue foremost among the operators of lab facilities is the integrity of the data once they are in the hands of patients. And there is no agreed upon way of assuring that the laboratory data would not be tampered, after transferring it to the patient.

As a matter of conventional practice, health facilities, especially providers’ clinics, do not give electronic data, in whole or in part, to their patients. Most of the time, the data are in paper format and they comply with a certain template such as clinical abstracts or medical certificates. Rarely will a provider supply a full medical record to a patient. More comprehensive and complex documents such as operative records and surgical techniques can only be obtained from hospitals, where the procedures have been performed.

At the policy side, a partnership between the Department of Health, Department of Science and Technology, Philippine Health Insurance Corporation, University of the Philippines Manila, and the Philippine Medical Informatics Society was formalized on 10 October 2005. The partnership, called the Philippine National Health Information Infrastructure or PNHII, aimed to consolidate the standards for health information in the Philippines. The PNHII focuses on four key areas: capability-building, standards and interoperability, connectivity, and test beds.

Succinctly, we can assert that the technological infrastructure to support personal health records seem to be in place already in the Philippines, but the awareness of consumers and openness of providers to the portability of data leaves much to be desired. The issues involved are multi-faceted and needs multi-stakeholder involvement.

The Role of Stakeholders (i) The Health Consumers

Currently, most Filipino patients are not aware that it is their 14

right to have copies of their health data and that they own the data even if they are in paper format, and even if the paper is being managed by hospitals or clinics. This knowledge is crucial in involving patients/consumers in the care of their own health data. Without an acknowledgement of this right, patients will default the care of their health records to health facilities, who serve as caretakers of their personal health data. Unless consumers realize that they can manage their own health data, the concept of personal health record systems will not prosper in the Philippines. (ii) Providers and Facilities

The healthcare providers and facilities must accept that the patient owns the digital data, but at the same time they are compelled to retain and manage copies of the data internally.

They should also accept that the data must be supplied to the patient when demanded. In effect the provider/facility manages the data, but it is the patient who owns the data within. These concepts must be made clear to all parties for personal health records, to be accepted by all involved stakeholders.

However, current local practice puts the control and power over health records to healthcare providers and facilities.

Shifting the current systems from manual to electronic within a facility itself is formidable; stiffer resistance is expected for transformation to electronic personal health records. Most of the resistance will be encountered from healthcare providers who will require additional equipment to view data from personal health records. On the other hand, it is also possible for a consumer-led trend towards personal health records to push the health facilities to invest on infrastructure. It will depend on generating a critical mass of end users and the establishment of a sustainable ecosystem to make the transition as seamless as possible.

Security Issues

Since personal health records entail strict privacy due to the potentially sensitive nature of their data, there are substantial security issues that need to be addressed in order to have successful personal health record systems in the country. If stakeholders do not trust the integrity of a personal health record, its utility and value decrease. There are four security components that must be addressed by a trustworthy personal health record system. First is the clear identification of the stakeholders (that the system can identify external actors [persons, other systems] before interaction). All parties involved in the accrual of digital health data must be unambiguously identified – the patient, the facility, the technician, the examining physician, the requesting physician, to name a few. This means a persistent (central or distributed) mechanism for storing authoritative identifiable data must be kept in an accessible place.

A second security component dependent on unambiguous identification is authentication. Authentication is the process by which a previously identified entity is validated to be who the identified person really is. In conventional health record systems, the authenticating process is performed by medical www.ehealthonline.org

records staff who keep the paper-based records. These personnel are presently in charge of identifying and authenticating their patients correctly.

A third security feature is non-repudiation (extent by which an application makes it impossible for an actor to deny that

A partnership between the Department of Health, Department of Science and Technology, Philippine Health Insurance Corporation, University of the Philippines Manila, and the Philippine Medical Informatics Society was formalized on 10 October 2005. The partnership, called the Philippine National Health Information Infrastructure or PNHII, aimed to consolidate the standards for health information in the Philippines.

a transaction has taken place). This follows the principle that disallows an entity that has previously participated in an electronic transaction, to refute the transaction. Current advanced devices have already integrated this into their system by using Write Once Read Many (WORM) hard drives.

Software based non-repudiation techniques are also available and may be the most practical solutions when data needs to be transferred from one facility to the next. Authorization refers to the access and user privileges for authenticated users/applications.

This security component ascertains whether an entity has the privilege to view the electronic health record. Assigning authority is primarily a social issue but once established, it can be implemented into security systems.

drive, any alterations of the file will be detected, and any authorized user will be informed of such.

Upon reporting to the healthcare provider’s clinic, the patient supplies the USB drive to the provider. Using a PNHII supplied software or proprietary viewing software compliant with PNHII specifications, the provider is able to view the patient’s CT scans with full view of the digital signature of the facility from where the scans were made. Any alterations in the scans will be detected and the provider will be informed accordingly.

Electronic documents such as clinical abstracts or medical certificates may also be transferred to the patient’s USB drive as long as the security process is followed. Doubts about file integrity can be resolved by sending the file’s fingerprint to a central indexing system or to the originating facility, where it can be compared to a previous fingerprint in file.

The Proposal

Based on the current healthcare practices and available technology and capacity, I have recommended the following framework for personal health records development in the Philippines. All of the components of the framework should be overseen by the PNHII. At the semantic level, all messages exchanged between facilities must be consistent across systems. This means the ‘standards and interoperability’ component of the PNHII must take the lead in determining the vocabulary for the messages as well as the syntax. The messages must comply with the 3S, as listed in the figure below:

3S

-Standards compliant messages (XML)

-Secure (identification, authentication, non-repudiation, authorization) A Use Case Scenario for a Personal Health Record

Here I have conceived of a proposed case scenario for the use of a personal health record: Upon the request of his family physician, a patient goes to a radiology facility to have his CT scan taken. After the examination, the patient requests for a copy of his CT. Consent and waiver forms are signed and the patient’s USB drive is loaded into the healthcare facility’s personal computer. The patient’s digital CT scans are signed by the facility and transferred to the USB drive. Once the data is in the USB

Facility Facility A B

-Signed

PNHII Identifiers Certification authorities Test beds education

For syntax, the eXtensible Markup Language (XML) has become the lingua franca. It is platform-independent and has established itself as a neutral data format that is acceptable to many participating systems.

Once the messages can be constructed in a semantically and syntactically consistent manner, it must be wrapped within a security layer (similar to a secure envelope) prior to

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the transfer. This is where a certification authority using the public key infrastructure will play a role. The public key infrastructure employs a two-step authentication process which assures that messages exchanged between two trusting entities are protected from alteration. In addition, it also provides a framework for identifying and authenticating the sender and recipients of secure messages. Stakeholders involved in the transfer of the message (including the patient) will require a public and private key that they will use to sign the data.

Since most of the transfers will be from facility (radiology, laboratory or clinic) to patient, these healthcare entities are the ones who should obtain a key.

What is crucial at the facility level is the identification and authentication of the patient and the signing of the unaltered health data (CT, MRI, lab, etc) with the facility’s private key and the patient’s public key. Identifying and authenticating persons at the facility level may be done on a federated, distributed basis, by employing a web of trust.

Central to the adoption of personal health records will be the ease of viewing the data using freely available software.

The test beds component of the PNHII will make sure that free reference implementations are available for end users and developers.

Education and awareness campaigns must be undertaken to ensure smooth implementation. The shift from conventional health record systems to personal health records is a giant leap from current reality and is prone to failure unless deliberate attempts to bridge the gap slowly and in measured steps are made. An effective way to overcome resistance from the healthcare providers and facilities is to offer the benefits of automation in lowering the cost of operating the clinic or the facility. Focusing on patient empowerment also helps in convincing providers to make the necessary investments.

When patients are more involved in their own healthcare, including the management of their personal health data, they become active participants in their healthcare and become more responsible. Providing a platform for personal health records may yet become the foundations for an effective and efficient healthcare system, that is oriented more to the welfare of the clients.

The Philippine National Health Information Infrastructure plays a crucial role in making personal health records happen in the Philippines. Personal health record systems may be the impetus that will spur facilities to digitize their operations, and allow clients to have electronic copies of their health records. n

Dr. Alvin B. Marcelo alvin.marcelo@gmail.com

Dr. Alvin B. Marcelo is a general and trauma surgeon by training but has since diversified into health informatics. He is presently the Director of the National Telehealth Center of the University of the Philippines, Manila; and concurrently, the Node Manager for IOSN ASEAN+3 (International Open Source Network). He is also the Associate Professor of Surgery at the University of the Philippines.

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CancerGrid Project: Using ICT to Tackle Cancer According to the WHO estimates, Cancer affects 13 percent of people across the globe. It is one of the menacing threats afflicting the humanity. The recently launched CancerGrid project can provide a solution to this growing health concern.

The project is perhaps the first ever large scale application of computer grid technology for finding and developing new anti-cancer agents. It is a concerted effort by academia and industry to tackle one of the pressing medical challenges of our times.

The multidisciplinary research project is funded by the EU and is comprised of a 10-member, SME-led consortium. The partners of this ambitious project are AMRI Hungary, Inte: Ligand, Tallinn University of Technology from Estonia, GKI Economic Research Co. from Hungary,Computer and Automation Research Inst., Hungarian Academy of Sciences, University of Jerusalem from Israel, DAC from Italy, University of Bari from Italy and University Pompeu Fabra from Spain.

Here it deserves a mention that in the human genome, there is an estimated subset of approximately 3000 genes which encode proteins, including novel cancer-related targets, which could be regulated with drug-like molecules. The partners in the project will work towards developing specific chemical compound collections, which are also called chemical libraries, that will interact with these cancer proteins.

The project endeavours to develop and refine methods for the enrichment of molecular libraries for facilitating the discovery of potential anti-cancer agents. It will strive to amalgamate new technologies with biology to enrich molecular libraries and increase the likelihood of discovering potential cancer-curing drugs. The project will use the resources of grid computing to enable the researchers to tap into a potent network of interconnected workstations, which are able to process large chunks of data and reduce computational time.

Using grid-aided computer technology, the likelihood of finding innovative anti-cancer leads will substantially increase the translation of basic knowledge to application stage.

In particular, through the interaction with novel technologies and biology, the R&D consortium aims at developing focused libraries with a high content of anti-cancer leads; building models for prediction of disease-related cytotoxicity and of kinase/ HDAC/MMP and other enzyme (i.e. HSP90) inhibition or receptor antagonism using HTS results; developing a computer system based on grid technology, which helps to accelerate and automate the in silico design of libraries for drug discovery processes, and which is also suitable for future design of libraries for drug-discovery processes that have different biological targets (the result is a new marketable technology).

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Med-e-Tel 2007: An International Platform Showcasing e-Health A new introduction at Med-e-Tel was Estele, a robotics system for tele-echography, introduced by the French company named Robosoft. Estele is a tele-operated robotic system allowing any expert clinician to perform remotely ultrasound diagnosis as if he were “on site”. The system is based, on a light 4-axis ultrasound Probe Holder Robot (positioned on the patient by any medical assistant), and remotely controlled by a specialist. A bi-directional videoconferencing system allows the patient and the specialist to communicate as if they are in the same room, while the specialist can visualize the ultrasound images and see and talk with the patient.

O

n 18-20 April 2007, the Luxexpo Exhibition and Congress Centre in Luxembourg was once again host to the international Med-e-Tel conference. The international event focuses on telemedicine and e-Health. In its fifth edition, this annual event attracted some 400 participants from over 50 countries in Europe and other parts of the world.

In the opening session on April 18th, Dr. Mark Blatt, Director of Worldwide Healthcare Strategy for the Digital Health Group at Intel Corporation, provided an overview of how the emergence of new technologies and policies like broadband, VoIP, standardized remote monitoring use cases, and PHR expansion might effect the telemedicine environment in the near future. He showed how a paradigm shift is taking place within the healthcare ecosystem, empowering the end users (the citizen, the patient) to take control of their own health, and highlighted Intel’s involvement in the new Continua Health Alliance - a global consortium of medical and ICT companies and healthcare providers- who are aiming to develop and market interoperable health and wellness monitoring devices. e-Health Coordinator at the World Health Organization in Geneva, Dr. Yunkap Kwankam, gave an update on WHO’s current e-Health strategy, and an overview of its implementations around the world. After the WHO passed its eHealth Resolution in 2005, e-Health has been put firmly and per-

Dr. Mark blatt at the opening session

manently on the agenda of national governments and the WHO itself. The resolution urged member states to draw up a long-term strategic plan for developing and implementing e-Health services in the various areas of health sectors, including health administration.

In his presentation during the opening session, Dr. Michael Nerlich, President of the International Society for Telemedicine & eHealth (ISfTeH) and Dean of the Medical Faculty at the University of Regensburg (Germany), presented the eHCC (eHealth Competence Center)- a newly created e-Health research group- which aims to be part of the e-Health standardization. He also unveiled plans for an international e-Health

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med-e-tel 2007: an international platform showcasing e-Health

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master program. Prof. Krishnan Ganapathy, the Head of the Apollo Telemedicine Foundation in India, commented on the evolution, growth and development of the Apollo Foundation, and presented a demo of the world’s first VSAT-enabled village hospital.

Rolien de Jong, Head of Innovative Services at Dutch homecare provider Meavita, talked about their positive experiences with a telehealth platform that enables them to provide self-management services for their chronic care patients (elderly patients, patients with diabetes, etc.).The patient is considered to be responsible and capable to change his/her behaviour via the Meavita self-management program. Stepby-step knowledge and experience are built up by the interpretation of the data, which are gathered from the patient on a daily basis through the telehealth platform. The presentation actually showed how Dr. Blatt’s vision of the paradigm shift within the healthcare ecosystem is already taking place and empowering patients to take control of their own health.

Overall, the conference, with its enriching presentations and discussions, presented a wonderful educative and interactive experience for the e-Health practitioners and researchers across the globe. According to Frederic Lievens, International Coordinator for Med-e-Tel, “In short, Med-eTel offered unique opportunities to discover telemedicine and e-Health products, services and innovative technologies, to gather updated information through the extensive conference programs, to network with contacts from around the world, and to establish new partnerships.”

The themes of ageing and maintaining qualProf. k. ganapathy from india, at the ity of life for the elderly, opening session disabled and people with special needs through the use of telemedicine and e-Health tools and services, were high on the agenda at this year’s Med-e-Tel. According to Lievens, “With the rise in chronic conditions such as diabetes, heart failure or asthma, to name but a few, telemonitoring technologies offer tremendous opportunities to keep track of one’s health and physical wellbeing, allowing for timely interventions when things start deteriorating.” He asserted that, “We are proud that we were able to work together at this year’s Med-e-Tel with organizations such as the International Association of Homes and Services for the Ageing, and also the European Telecommunications Standards Institute, to provide an insight into how the use of technology can be a possible solution to the challenges facing patients/citizens, caregivers and governments in our ageing society.”

One of the best attended sessions at Med-e-Tel 2007 was the one on ‘Mobile eHealth Solutions’, in which the World Health Organization’s strategy for ‘mHealth’ was discussed.

18

The WHO is currently looking at what various donors, policymakers, and implementing partners are doing to support mobile e-Health activities throughout the world with a special focus on low resource settings and developing countries.

Some of the other sessions at Med-e-Tel included ‘eHealth for Developing Countries’, ‘Successes in Telecardiology’, ‘eHealth for Diabetes Management’, ‘Advanced Systems Strategies for eHospitals’, ‘Efficiency in eHealth’, ‘eHealth Support to Surgery and Traumatology’, ‘Mobile IT Solutions in Emergency Medicine’, ‘Optimizing Collaboration among eHealth Projects in Low Resource Settings’ among others.

Med-e-Tel also featured an exhibition, which provided a look at some of the practical developments that have been made in the area of e-Health, and the products and technologies that are available from companies such as A&D Medical, Aerotel Medical Systems, Alcatel-Lucent, AMD Telemedicine, Card Guard, Cisco, Hippocad, Honeywell HomMed, IBM, Impact Care, IRIS, ISIS, Omron, Robosoft, RTX Healthcare, t+ Medical, Viterion TeleHealthcare as well as many others.

RTX Healthcare presented the new RTX3370 Telehealth Monitor at Med-e-Tel. It is an interactive and simple to use device, designed specifically to improve the way of providing healthcare to patients outside hospitals, suffering from chronic diseases such as heart failure, COPD, diabetes and other chronic diseases. “The RTX3370 Telehealth Monitor is targeting the disease management and home healthcare industry to monitor chronically ill patients at home,” says Bjarne Flou, Managing Director of RTX Healthcare. “The uniqueness of our product is that it is offered as a system device which interoperates directly with our clients clinical information systems. Our business model is based on hardware sales, compared to most other competing solutions in the industry, where the devices are tied up to a proprietary infrastructure and the business models are based on a monthly fee, fee per user and likewise,” he added.

Another new introduction at Med-e-Tel was Estele, a robotics system for tele-echography, introduced by the French company named Robosoft. Estele is a tele-operated robotic system, allowing any expert clinician to perform remotely ultrasound diagnosis as if he were “on site”. The system is based, on a light 4-axis ultrasound Probe Holder Robot (positioned on the patient by any medical assistant), and remotely controlled by a specialist. A bi-directional videoconferencing system allows the patient and the specialist to communicate as if they are in the same room, while the specialist can visualize both the ultrasound images and see and talk with the patient. Impact Care from The Netherlands presented its telehealth platform with embedded video telephony over the TV screen, which currently already allows elderly care organizations in The Netherlands to significantly reduce the number of home visits and to provide self-management services for chronic care patients. The same platform also allows for tele-education services among healthcare professionals.

Med-e-Tel also presented a media corner where information was provided about some 35 publications, magazines, journals, reports and online news and information services, in the fields of telemedicine and e-Health.n www.ehealthonline.org

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A Summit on the Nascent Domain of Behavioural Telehealth

T

he inaugural summit on Behavioral Telehealth: Technology for Behavior Change & Disease Management will take place at The Conference Center of Harvard Medical in Boston during 31May-1June 2007. The summit endeavours to discuss advances in behavioural telehealth, including applications to promote wellness, change behaviour and manage diseases. The programme will address the shift from traditional healthcare delivery to more consumer-driven approaches.

The target audience for the summit includes senior executives, clinical leaders, IT staff and clinicians from behavioural health companies, telemedicine companies,disease management companies, psychophysiological monitoring companies, medical device companies, pharmaceutical companies, e-Health companies, hospitals, home care agencies among others.

“Most of the lost productivity in the workplace is related to behavioral issues. This conference will examine how emerging information technologies can support the integration of behavioral health into primary care and chronic disease management. It

A Fillip to USA’s Rural Health, Thanks to USDA

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will explore how e-empowered health consumers can truly become partners in their own selfmanagement.

This timely event brings together leaders in behavioral health, disease management and telemedicine to celebrate the successes, tackle the challenges and advance the goal of integration,” said Dr. Steven Locke, Research Psychiatrist, Beth Israel Deaconess Medical Center, Associate Professor of Psychiatry, Harvard Medical School and Associate Professor of Health Sciences and Technology, MIT. He also happens to be the Program Chairperson of the summit.

The summit will include over 40 speakers participating in panel discussions, case studies

and keynote addresses. Topics to be covered include: computer-assisted behavioural assessment, screening and monitoring, online psychotherapy, treatment of depression and anxiety-related disorders, treatment of alcohol and substance disorders, tools for promoting patient adherence and for lifestyle and risk behaviour change, web-based tools for addressing behavioural issues, decision-support and educational tools, behavioural tools for enhancing self-management of medical conditions and much more. In addition, attendees will have the option of attending the workshop on ‘Technology tools for promoting patient self-management and shared decision-making.’ n

t seems the rural USA is going to get an impetus in eHealth. The US Department of Agriculture(USDA) has allocated $153 million for distance learning and telemedicine, for rural communities of the USA. This will facilitate the people living in the remote and rural USA to access international standard of healthcare services. Through telemedicine technology, rural residents can get access to medical specialists, which are not often available in remote areas.

However, USDA’s initiative in education and health is nothing new. In the past five years, USDA has already invested $166 million in distance learning and telemedicine programme. The department has enabled about 4000 rural educational facilities to expand their access to modern telecommunications technology and about 2000 healthcare institutions to develop technologies to enhance their local medical care. n

Bulgaria Gets its First Satellite-based Telemedicine Network ND SatCom, an SES ASTRA company and a leading global supplier of satellite-based broadband VSAT, broadcast, government and defence communication network and ground station solutions, has teamed up with its partner Interactive Technologies to implement Bulgaria’s first satellite-based telemedicine network based on ND SatCom’s core technology platform SkyWAN®. Bulgarian service provider Interactive Technologies provides the meshed VSAT network to the Bulgarian

Armed Forces for applications such as live video transmissions of operations, videoconferencing, teleconferencing and file transfer between military hospitals, etc.

According to Tzvetelina Dimitrova, CEO of Interactive Technologies, “ND SatCom’s SkyWAN® is a platform which supports the wide range of applications such as video conferencing, IP video and VoIP needed in this project. Due to its allocation on demand scheme, SkyWAN® offers our end customer an opti-

mized and dynamic bandwidth usage.” Dieter Dreizler, Director, Sales of ND SatCom, says, “ND SatCom’s SkyWAN® technology supports the network’s performance and offers unique redundancy features. Effectiveness and reliability are key factors in telemedicine communication. Given that parts of Bulgaria are earthquake endangered regions and terrestrial lines might fail, satellite communication is the best solution for providing independent and consistent telemedicine services.” n

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EMIS Introduces Safety Checks for Medications having Serious Side Effects

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gton Medical Information Systems Limited(EMIS) is the UK’s leading GP software supplier. EMIS is the supplier of IT systems to primary healthcare, providing the software that holds the medical records for 39 million NHS patients nationwide. Around 56 per cent of GPs in the UK currently use EMIS software. Recently EMIS has developed a proactive system of safety checks to help monitor patients who have been prescribed medication with potentially serious side effects.

Many of the drugs such as Azathioprine, Ciclosporin, Methotrexate, have potentially severe complications that can be identified early through regular monitoring of blood tests. The new system, known as medication monitoring, will enable GPs using EMIS’ PCS or LV systems to quickly identify patients who are overdue for tests, through daily searches. Doctors will also be alerted to missed tests on their computer screen, during consultations.

The software has significant potential benefits for patient safety. For example, patients taking Azathioprine for rheumatoid arthritis require regular full blood count checks for the potential life threatening complications of neutropenia (low white cell count) and/or thrombocytopenia (low platelet count).

Similarly, patients taking Ciclosporin (used to prevent transplant rejection) have a 50 percent risk of developing hypertension and require monthly blood pressure checks. The new safety alerts will enable practices to ensure that patients taking these and other drugs get optimal care and minimise the risks of severe side effects. n

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Pan-European Electronic Health Service in the offing

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U member-states and Iceland, Liechtenstein and Norway have adopted a common declaration on their commitment to pursue structured cooperation on cross-border electronic health services across Europe. The declaration was adopted at the eHealth Conference 2007 whose theme ‘From Strategies to Applications’ looked at the implementation of electronic health-service applications and infrastructures such as electronic prescriptions and electronic patient files, as well as future services available thanks to the electronic health card.

The eHealth Conference 2007 took place during 17-19 April at Messe Berlin - Berlin’s International Exhibition and Conference Centre, as part of the eHealth week Berlin 2007.

This high level conference is a joint project of the European Commission, the German Federal Ministry of Health, the Berlin regional government, and the Association for Social Security Policy and Research (GVG).The conference theme was appropriately titled ‘From Strategies to Applications’ and its primary aim was to provide a forum for those responsible for telematics in government, health insurance organisations, service providers and users’ organisations in Ger-

many and abroad. The eHealth Conference 2007 focussed on the implementation of applications and infrastructures, reflecting on the current situation in Europe and Germany, in parallel thematic tracks. Coming back to the declaration, it has the poten-

tial to make cross-border electronic health services in Europe a reality in the near future. “By adopting today’s declaration, we seek to ensure that, in the future, electronic health services for Europe’s citizens do not stop at national borders,” conferred Dr. Klaus Theo Schröder, the German State Secretary at the Federal Ministry of Health.“We want to give patients access to their medical records and patient summaries from everywhere within the EU. This not only serves the continuity of care but also affords

safety in an emergency,” he further explained.

The signatory countries share the view that national e-health infrastructures are a prerequisite for the development of European cross-border electronic health services. So, national e-health road maps should be taken into account when planning the content-wide infrastructures. The declaration also emphasised the need for more synergies between research and education, and called for a deployment strategy of new innovative e-Health services. The document also recommended that member-states should not only work on common European standards together with the e-Health industry to enable interoperability, but also open up new market opportunities in the field. The declaration then proposed that the European Commission launch large-scale pilot projects to test European cooperation in the application of improved patient summaries in different health contexts, such as medical emergencies or the dispensing of prescriptions.

The increased mobility of European citizens has brought the need for quality medical care to follow patients beyond their national and regional borders and health systems. n

A Partnership to Promote Remote Critical Care Across Pacific Rim

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BM has partnered with healthcare technology vendor, VISICU to wire a telemedicine network to provide remote critical care support to military hospitals along the Pacific Rim. The system includes IBM BladeCenter servers and VISICU’s eICU technology, which enables remote monitoring of intensive care units.

Tripler Army Medical Center, Honolulu will manage the remote monitoring and support system using VISICU’s eICU technology on IBM BladeCenter servers, in collaboration with the University of Hawaii. The eICU center, in colla boration with remote military hospitals, will provide an enhanced level of care to active-duty military personnel, their families and other beneficiaries.

VISICU’s eICU solution electronically connects military hospital throughout the Pacific Rim with

the remote eICU centre in Hawaii. This enables patients in these hospitals to get instantaneous access to critical care specialists, who are able to monitor patient status and directly speak with the bedside clinicians to channelize appropriate intervention.

Now the eICU specialists can support more than 300 patients across the Pacific Rim using the stateof-the art network and video technologies with device connectivity and smart alerts. Tripler Army Medical Center is supporting Joint Medical Operations with the U.S. Naval Hospital in Guam, four thousand miles away. In order to extend access to other hospitals along the Pacific Rim, a more flexible server platform was required. IBM BladeCenter servers and IBM system-storage technology can now allow the telemedicine network to support more than 300 patient connections, over 4,000 miles. n

www.ehealthonline.org

A Concerted Partnership to Tackle Cancer

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wo internationally acclaimed cancer centres have announced a partnership to achieve their shared vision of advancing world-class cancer care, that will ultimately reach well beyond the walls of their respective institutions. The two cancer centres are Toronto’s Princess Margaret Hospital (PMH) of the University Health Network (UHN), and the Centro Di Riferimento Oncologico (CRO-Oncological Referral Centre, National Cancer Institute), of Aviano, Italy.

The two centres signed a memorandum of understanding, establishing the principles and framework to pool their renowned cancer knowledge and

specialized expertise, support innovation in cancer education programs, promote e-Health initiatives, and create opportunities for joint ventures. Here it deserves a mention that Princess Margaret Hospital and its research arm, Ontario Cancer Institute, have achieved an international reputation as global leaders in the fight against cancer. PMH is a member of the University Health Network, which also includes Toronto General Hospital and Toronto Western Hospital. All three are hospitals affiliated with the

A Portal to Empower Kidney Patients in Ontario hanks to a new patient portal which is being developed by Grand River Hospital, Hamilton Health Sciences (both Ontariobased), University Health Network - which includes Princess Margaret Hospital, Toronto General Hospital, Toronto Western Hospital.and Canada Health Infoway, now patients suffering from chronic kidney ailments in Ontario, Canada will soon be empowered to selfmanage their illness.

This patient portal, which is scheduled to be launched in March 2008, will integrate with patients’ electronic health record, and provide self-management tools for tackling their chronic kidney ailments and improve communication interactions with their healthcare teams. Patients will be able to access the portal through a link found on both the Grand River Hospital and University Health Network websites, authenticating their identity through a secure login process.

This patient portal will enable patients to set personal goals for self care, monitor symptoms and side effects of their kidney disease, thereby facilitating to improve management of their chronic conditions and shrinking the room for unplanned visits to their doctors.

Moreover, the portal will also foster two-way communication between patients and healthcare providers by placing timely access to medication summaries and lab results, accompanied by useful information to help patients understand what the results entail. n

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University of Toronto. The Centro di Riferimento (CRO-Oncological Referral Centre, National Cancer Institute), of Aviano, Italy, is dedicated to clinical research with the aim of improving understanding of the causes and biology of malignant tumours, as well as identifying new means of prevention, diagnosis and treatment of cancer.

Signing on behalf of UHN were Dr. Robert Bell, President & CEO, and Dr. Mary Gospodarowicz, Medical Director of the Cancer Program at PMH/UHN. Signing on behalf of CRO was Dr. Paolo

De Paoli, Legal Representative.

According to Dr. Robert Bell, President & CEO of UHN, “Our fine institutions may be separated by an ocean but they are united by a common vision to promote and expand the dissemination of best practices in all aspects of cancer research and care. This is the way to achieve global impact and truly provide what we all strive to do every step along the way -- the best patient care.”

“We will collaborate to enhance the academic and research opportunities, and also share information about best practice in clinical trials, education, and patient care,” conferred Dr. Mary Gospodarowicz. n

A DVD to Make Breast Cancer Victims More Aware of the Surgery Options

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niversity Hospitals of Leicester NHS Trust comprises three acute hospitals based in Leicester, UK. They are Glenfield Hospital, Leicester General Hospital and Leicester Royal Infirmary.

The three hospitals merged to create UHL in 2000, to meet the increasing demands for providing better healthcare. The trust is one of the largest acute teaching hospitals in the United Kingdom, employing over 12,000 staff.

Now a new information DVD has been developed by the staff at Leicester Royal Infirmary, UK with the aim of helping breast cancer patients make decisions about breast reconstruction. The DVD, which is believed to be one of the first of its kind in the UK, includes computer animation, photographs of results and

interviews with patients who have had breast reconstruction surgery. Graham Offer, Consultant Plastic Surgeon at the Royal, said, “We decided to produce this DVD to give cancer patients who are considering reconstruction, a realistic idea of the different surgery options available and let them see for themselves the results that can be obtained. We hope the DVD will help alleviate some of the worry and anxiety that women naturally feel.”

The making and distribution of the DVD has been funded by the Crazy Hats charity, a fundraising committee set up by former breast cancer patient Glennis Hooper several years ago. To date, Glennis has raised £18,000 for the plastic surgery department at the Royal. n

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BUSINESS

Electronic Medical Records Get Another Fillip in the Healthcare Industry of usa

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aimonides Medical Center is a thriving non-profit, non-sectarian hospital that is the pre-eminent treatment facility and academic medical center in Brooklyn, and also among the best in the USA. Maimonides Medical Center is among the largest independent teaching hospitals in the USA. Recently Maimonides Medical Center turned to Verizon Business to design and deploy a high-capacity, resilient optical network, connecting the medical center’s main campus buildings and 24 remote locations throughout Brooklyn.

The new network, which Maimonides began to transition to in March, enables the secure and rapid transmission of electronic medical records, providing physicians at Maimonides and affiliated institutions with complete patient medical histories, including doctors’ orders, prescriptions, lab results and radiology films. By eliminating the cumbersome process of transferring paper records

between physicians and among various healthcare facilities, Maimonides hopes to reduce medical errors, eliminate duplicative testing and deliver improved patient care at a lower cost - providing critical, comprehensive clinical information directly at the point of care.

Verizon Business is a unit of Verizon Communications; is a leading provider of advanced communications and information technology (IT) solutions to large business and government customers worldwide.

It has impressive global network along with advanced technology and professional service capabilities, which enables Verizon Business to deliver innovative and seamless business solutions to customers around the world.

According to Walter Fahey, the Chief Information Officer at Maimonides, “Immediate access to electronic patient records can help enhance the speed and efficiency of health

care as we know it today.” He added, “Working with Verizon Business, we are on the road to making traditional clipboards and paper records obsolete. The new network supports our current requirements and provides a secure and scalable platform for our future initiatives.” Steve Young, the Senior Vice President of Corporate Markets for Verizon Business averred that “Verizon Business is helping Maimonides and other health care providers transform the way they do business, to provide better care for patients.”

The new Maimonides network will also serve as the foundation for the Brooklyn Health Information Exchange (BHIE), a regional healthcare network scheduled for launch in 2008. Designed to meet the federal call to action to transform the delivery of healthcare through regional collaboration, the BHIE will aid the development of electronic medical records and promote interconnectedness among Brooklyn-based clinicians. n

SCS’ Hospital Information System for Shanghai Gleneagles

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ingapore Computer Systems Limited (SCS), a leading information and communications technology service provider in Asia with its headquarters in Singapore, has completed the implementation of SCS integrated Hospital Information System (iHIS) for Shanghai Gleneagles International Medical and Surgical Center (Shanghai Gleneagles), which opened on 9 May 2007. Shanghai Gleneagles, part of Parkway Holdings Limited (Parkway), is a premium day surgery centre offering one-stop medical consultations and surgical treatments at a convenient and prestigious location in the heart of Shanghai. Parkway Holdings Limited is one of the largest healthcare groups in Asia with operations across Singapore,

Malaysia, India, Vietnam, Brunei, and China.

“SCS congratulates Parkway on the opening of Shanghai Gleneagles, a fully digital medical centre.

We are pleased that the implementation of SCS web-based dual language integrated Hospital Information System, iHIS,

for Shanghai Gleneagles was a success. The close collaboration between the SCS and Shanghai Gleneagles teams ensured that the implementation was well managed. SCS hopes to extend

our partnership with the Parkway Group and be the healthcare IT service provider of choice as they expand in China,” said SCS President and Chief Executive Officer, Tan Tong Hai. Dr Jonathan Seah, Chief Executive Officer of Shanghai Gleneagles and Group Vice President for Parkway Holdings North Asia, conferred, “We are pleased that SCS delivered a secure, reliable and scalable solution that enables Shanghai Gleneagles to better service our patients, whom we call our guests, in order to emphasise our focus on five-star service quality.” The high-speed telemedicine and videoconferencing network connects Gleneagles with doctors from the Parkway Group in Singapore, and other countries. n

W. Europe attracting best Doctors

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high demand for doctors across the EU, coupled with the extremely low wages paid to doctors in Romania, presents a new challenge -- the drain of much-needed doctors who are heading westward. Doctors in Western Europe earn almost ten times as much as their Romanian counterparts. More than 50% of Romanian doctors and 75% of medical specialists plan to leave the country and continue their practice in Western Europe, a survey by the Iasi County Medical College shows. The Iasi survey also shows that 61% of the doctors described the country’s healthcare system reform as stationary, and 21% thought that the reform will be ineffective. n

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Siemens Medical Solutions Ensures Remote Diagnosis of Medical Imaging Systems

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iemens Medical Solutions is perhaps one of the first manufacturers of medical systems worldwide to implement an internationally valid information security management system (ISMS) for the remote service of medical devices. This has been certified by TÜV Süd in Germany, according to the international standard ISO 27001.

When a red light flashes at the Siemens Medical Solutions Service Center in Erlangen,Germany, the customer service engineers know that somewhere in the world the X-ray tube in a computed tomography system needs to get replaced. Siemens is able to detect this situation through its Siemens Remote Service (SRS) platform. Worldwide, thousands of medical systems are connected to the Med SRS platform— primarily via VPN connections

(Virtual Private Networks), which are secure virtual data tunnels between two points.

Imaging systems in medical applications are subject to constant use, which subject them to wear and tear. To detect and prevent possible malfunctions in imaging systems as early as

possible, Siemens has developed its preventive ‘Remote Service’.

The task of Siemens Remote Service is to detect warning or problem messages from imaging systems as early as possible.

At present, experienced service specialists proactively monitor more than 15,000 systems daily and can immediately initiate corresponding measures.

As soon as the system is started at the customer site, it can automatically send messages to the service center via the secure Siemens Med remote platform.

As a result, potential deviations or incidents are detected early as ‘events’, thereby enabling malfunctions to be prevented.

Information and data security are crucial decision-making criteria for customers in the medical sector. With this certification, Siemens has shown that information security and data protection have top priority, when operating a highly-complex remote maintenance infrastructure Siemens demonstrated to the TÜV auditors an effective information security management system (ISMS) that meets all requirements with respect to availability, confidentiality, integrity, and connectivity. n

Philips and Misys in Partnership for Home Healthcare Solutions

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oyal Philips Electronics and Misys Healthcare Systems have announced a plan to join forces for providing a comprehensive solution for the homecare market. The companies intend to develop an integrated software platform that enables homecare agencies to provide high quality care to chronically ill patients, while benefiting from operational efficiencies in monitoring and managing their patients’ health status.

Through this nonexclusive agreement, the companies seek to combine Philips’ experience in telehealth and remote patient monitoring with Misys’ expertise as one of the leading providers of clinical and business software for the U.S. homecare market. Misys Healthcare Systems develops and supports reliable, easy-to-use software and services of exceptional quality that enable physicians and caregivers to more easily manage the complexities 28

of healthcare. Misys and Philips intend to work together to offer deeper integration of vital signs data and health status information into the patient record, providing a more comprehensive clinical review application than is currently available from telehealth providers today.

The goal is to provide a powerful solution that helps homecare agencies optimize care for patients most in need of clinical attention, in order to reduce hospital readmissions and healthcare costs associated with chronic disease. Philips offers wireless telemonitoring measurement

devices, robust clinical content —including patient education, validated health surveys and risk assessment tools—as well as wide-ranging service delivery support and innovative pricing models. Misys brings a fully integrated financial and clinical management solution, including point-of-care, to the homecare industry.

“Telemonitoring, in conjunction with early intervention and self-care education, can extend the reach of care and improve patients’ quality of life,” says Mike Lemnitzer, Senior Director, Philips Consumer Healthcare Solutions.

Jeneane Brian, Clinical Strategy Executive for Misys Healthcare Systems conferred, “Misys is focused on providing cost-effective solutions for the home healthcare market.” According to him Misys provides a better way to monitor and manage homebound patients and schedule clinical staff. n

Agfa HealthCare and ICW embarks on a collaborative effort to promote e-Health

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gfa HealthCare, a leading provider of IT enabled clinical workflow and diagnostic imaging solutions, and InterComponentWare AG (ICW), a leading international e-Health specialist with locations in Germany, the United States, Austria, Switzerland, and Bulgaria, have announced that they are intensifying their cooperation efforts. The non-exclusive agreement covers the development of seamless integration and interoperability between Agfa HealthCare’s hospital information system ORBIS™ and ICW’s eHealth Framework.

The ICW eHealth Framework is an open platform for the development of service-oriented solutions for the healthcare market.

It offers standardized interfaces for the integration of existing applications of other manufacturers with solutions from ICW. The eHealth Framework enables seamless integration, allowing different existing systems to be combined into one consistent solution. The many years of experience of ICW developing and using its own e-Health solutions have been incorporated into the eHealth Framework. It is the foundation for all product developments at ICW and is offered to interested partners for their own development purposes.

The non-exclusive agreement will strengthen Agfa HealthCare’s expanding position in the e-Health market. Agfa HealthCare’s ORBIS has currently been deployed in over 750 institutions across Europe with 4,50,000 daily users. n

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ONGC Launches a Telemedicine Endeavour in Mumbai

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he Oil & Natural Gas Corporation(ONGC) has recently inaugurated a pilot project of telemedicine network. The network extends from SLQ platform in Mumbai offshore to the Lilavati hospital, which is a famous hospital of India, located in northwest Mumbai.

The network is named as Sagar Space Chikitsa, and it is geared to provide instant as well as critical healthcare to over 2500 personnel, who are stationed at 24 rigs and production platforms of ONGC. The telemedicine solution will enable transfer of medical data from Mumbai offshore to specialists at the super-specialty Lilavati Hospital, who can then analyze them and provide the necessary clinical advice. The same medical data is also stored in a centralized server simultaneously, for reviewing and reporting later. This newly inaugurated telemedicine system will provide medical information and consultation across a gamut of fields in medicine, which includes cardiology, orthopedics and surgical.

It is expected that the establishment of this network will facilitate timely intervention and recovery process of these ONGC personnel, especially during the time of medical emergencies.

The telemedicine network will also be instrumental in reducing critical healthcare delivery times for its customers/ patients. The pilot project will be operational for three months, after which the project will be extended to all installations, which are having living accommodation at ONGC Mumbai offshore. n

30 }

INDIA UPDATE

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Healthcare BPO Education: India Ventures into the NEXT Age

EXT, a premier training organization, that provides recruitment management services, and training in ITES, soft skills, communication and personality development, has recently announced the launch of India’s first healthcare BPO education and training course.

This training course has been aligned to the requirements of the healthcare BPO industry and aims to address a critical skill gap faced by professionals. The eligibility criteria include strong written English skills and a minimum qualification of the twelfth standard.

This certification course will span across 26 weeks and those eligible for the course can also apply for a loan from UTI bank, to be repaid through easy installment schemes.

The enrollments have begun with the first batch starting on 1 June 2007. Initially there are

F

plans to start full time batches, and in due course, also introduce a part time option.

The course structure would include imparting knowledge on medicine and its terminologies, international hospital work culture and practices, behavioural training to understand and work with American communication styles amongst others. There are specialized modules in the training on medical claims processing, medical transcription, medical billing and coding as well as managing hospital accounts receivables.

According to Manoj Pachisia, the CEO of NEXT, “Addressing the skill gap is of prime importance and it is this requirement that leads us to launching a targeted program. The training aims to provide a foundation program for BPOs engaged in telemedicine, clinical trials, medical transcription, billing and

coding, claims processing and accounts receivables.

Through this we hope to raise the quality of talent pool of the future generation coming into this industry.”

Organizations such as Spheris India, which is an important player in India’s healthcare BPO segment, view this as a step taken in the positive direction to address the skill shortage existing within the industry.

According to Suresh Nair, CEO, Spheris India, “Introduction of the certification course has led us to elevate our longstanding partnership with NEXT and offer a guaranteed job to candidates upon successful completion of this program. This partnership is an effective filter, one that would allow us to maintain the highest quality of manpower in the industry. We would be looking to hire about 60 people from NEXT every month.” n

Frost & Sullivan Plans medical summits in small towns

rost & Sullivan is hosting a one-day, multi-city summit titled ‘Emerging Healthcare Hotspots—Addressing Opportunities and Challenges.’ The multicity summit is being held on 21st July at Coimbatore, 8th August at Jalandhar, 25th August at Hyderabad and 6th October at Aurangabad.

The conclave aims to bring together all the key stakeholders, critical in the development of solutions for concerns emerging in the upcoming and future healthcare hubs, as well as providing a platform to leverage opportunities arising in these geographies. It will thus strive to bring together key decision makers from medical equipment companies, government regulatory bodies, corporate hospitals, mid-sized hospitals, and financial institutions to draw out a roadmap for combating the expected / arising challenges and allow for

a smoother transition of opportunity utilization for all.

The Indian healthcare industry is in a phase of impressive growth for some time now. Future investments of around US $2-3 billion are expected in the next three years, and a growing focus on the country is on making it a destination for cost optimization of healthcare value chain components like setting-up innovation centers, design centers, healthcare service facilities and manufacturing services.

All these make the industry one of the most happening sectors in the country today. Early entrants, recent market participants and fence sitters are keenly eyeing this market for developing, penetrating and leveraging the immense opportunity it offers.

Simultaneous triggers from end-user demand, aggressive expansion plans by providers of services and equipments, signifi-

cant initiatives through innovative reimbursement / insurance product launches by payers; and policy initiatives by the government are further aggravating the action in the health sector.

The most significant change is the evolution of Indian healthcare beyond metros and major cities to feed the growing need for standard / state-of-the-art healthcare across smaller cities and towns.

As infrastructure development plans spill over into these emerging healthcare hubs, they result in growth in the demand for technologies and trained manpower.

Consequently, issues pertaining to investment options; equipment operations and maintenance; growth, expansion and retention of trained talent are expected to follow suit as well; thus creating new challenges in the adoption of healthcare standards in the emerging healthcare hubs. n

www.ehealthonline.org

Sony’s foray in high definition video conferencing is expected to aid telemedicine

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ony India Pvt. Ltd. has made a foray in high definition videoconferencing in India, through its launching of a new range of visual communication equipment for the Indian market. The equipment named PCS-HG90, is equipped with a 3CCD camera, which will enable it in videoconferencing. PCS-HG90, the latest addition to Sony’s IPELA range of IP-based products, uses HD video compression format and a maximum of video transfer rate of 8Mb/s, achieved over IP network.

PCS-HG90 entails enhanced video and audio quality, in addition to safe and secure communication system within the country.

High definition videoconferencing through PCS-HG90 in turn will facilitate the telemedicine scenario in India in a big way.

Videoconferencing will aid the specialists from other corners of the developed world to interact with referral clinics in remote underserved areas of developing and underdeveloped world.n

A

AIIMS Extends Telemedicine Network to Africa

ll India Institute of Medical Sciences(AIIMS) has established its telemedicine network not only within India, but is also extending it overseas. Soon AIIMS will be extending its consultancy services to patients in Africa. The Ministry of External Affairs (MEA) will be installing telemedicine equipment at AIIMS, which will enable the institute to connect with various hospitals in the African continent. The MEA will soon provide a comprehensive network through satellite and fibre-optics and wireless links at AIIMS. The infrastructure is expected to be in place within two to three months.

The project endeavours to connect all 53 nations of Africa Union through a satellite and fibre-optic network. The network will connect five universities, 53 learning centres, 10 super-specialty hospitals and 53 remote hospitals in Africa.

Telemedicine to Get Academic Recognition

The African network, which will cover its 53 countries, will be VSAT-based star network and connect with India through under-sea cables. The network will provide tele-education and telemedicine, through tele-conferencing services.

A data centre to manage and maintain records, storage and back-up facility and retrieval mechanism for the medical facilities will be provided in the hospitals.

AIIMS will be connecting to its trauma centre, cancer hospital, cardio-neuro centre and few other important areas of medicine, which will give the doctors the freedom to give consultation without specially coming into the telemedicine room.

However, this teleconsultation facility will not entail emergency cases at the beginning.

The consultation for emergency cases may be extended gradually. n

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amil Nadu Dr. MGR Medical University will soon have the distinction to conduct the first formal telemedicine technology course for the doctors in Asia. The course will be launched at Tamil Nadu Dr. MGR University, in collaboration with Apollo Hospitals.

However, the introduction of this course will follow the establishment of a department of telemedicine in the said university.

Initially the telemedicine technology course would be in the form of a part-time certificate programme for doctors affiliated to Tamil Nadu Dr. MGR University, but later, according to the Vice Chancellor of Tamil Nadu Dr. MGR University, Dr. Meer Mustafa Hussain, there are chances of extending the course to a full two-year term.

The course is to be co-ordinated by Dr. K.Ganapathy, who heads the Apollo Telemedicine Networking Foundation and the faculty will comprise of technologists and engineers.

The classes would include field experience. n

Maharashtra Takes the Tele Route to Healthcare

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year ago the Maharashtra state government and Indian Space Research Organisation (ISRO) has entered upon an agreement to develop a telemedicine project, and by now impressive spade work has been done regarding this. The necessary equipments have been set up, and trials are being conducted, and now the project is expected to take off by June.

The project entails establishing ICT network between King Edward Memorial Hospital in Parel, Mumbai, which is a tertiary care superspeciality hospital, with hospitals in Latur, Sindhudurg and Nandurbar, and the VN Desai Hospital in suburban Mumbai. The latter

are patient nodes. This telemedicine link will enable specalists at King Edward Memorial Hospital to provide medical consultations to patients living in rural Maharashtra. Once this telemedicine system comes into place, the patients at these above-mentioned hospitals would not have to come all the way to Mumbai for some specialized treatment, surgery or consultation.

ISRO is providing the bandwidth and telemedicine equipments, which include dish antenna, server, computers, digital ECR,TV with video camera, and X-ray scanner, while the rest of the infrastructural support are

being provided by the Maharashtra government. According to S. Krishnamurthy, Director (Publications and Public Relations), ISRO, both INSAT and EDUSAT will be available for the project. However, initially, the compatibility, connectivity and effectiveness of telemedicine will be tested through a two-year pilot project. Based on the project results, the telemedicine network will then be extended across the state. Presently KEM officials are undergoing training to get acquainted with telemedicine machinery, so that they get familiarised with sending and recording information digitally. n

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technology

Emerging Technologies for Sustainable Rural e-Health Hardware is central to e-Health regimes The issue of rural e-Health software is a complex one. There are hundreds of open source Electronic Medical Record (EMR) systems supporting different platforms available around the world. These range from full-fledged hospital management solutions to community EMRs, to personal health records. The advantage of open-source applications is reduced costs, flexibility to customize, and sharing of knowledge with developer community and users.

Dr. Pushwaz Virk

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number of technologies are now emerging, which can create a sustainable ecosystem for rural e-Health. The well-demonstrated evidence about the benefits of rural eHealth has been bolstered by the support for comprehensive surveillance after the SARS and bird flu outbreaks in the recent times. Given the resource constrained environment, any successful rural e-Health project has to bring together enablers at the right time and with right incentives for widespread adoption and sustainability. Such systems need to be low cost, rugged, portable, convenient and interoperable. The four vital components of e-Health are mobile hardware, which can be taken into patient’s dwellings and has support for network access, software for accessing records with some decision support built in, reliable network which is low cost and connects mobile workers to the central base or a national grid, and most importantly the power source, for providing electricity in remote areas.

Some of the promising technologies which can have tremendous impact on these four e-Health components have been discussed here. These are either in pilot stage or in early launch phase. Some are not being explicitly promoted for eHealth applications, but their specifications make them ideal candidates for e-Health adoption.

The ICT developments in the hardware domain

Hardware is central to e-Health implementation. Over years, many large and small organizations have introduced mobile devices to enable their application in rural settings with varying degree of success. These devices can be used to access patient records at point of care, enter data during patient encounter and instantly make available to central databases.

One of the most visible educational technology projects in the world is the $100 usd laptop project. This project is June 2007

aimed at creating a low-cost laptop that would be used as an educational aid in developing countries. Recently renamed as ‘One Laptop Per Child (OLPC) project’, this MIT Media Lab design is a Linux-based system, manufactured by a Taiwanese company.

The multiple features of the laptop – low cost, rugged design, longer battery life, multiple network connectivity options, human power source, make it ideal for use in any setting in rural areas. It is expected to cost about $150 at its launch, which is expected to take place in late 2007.

Intel, the world’s largest CPU maker, has come up with ‘Classmate PC’, which is targeted at children. It supports Windows XP and a 900 Mhz Celeron CPU. There is no hard drive and it uses 1GB flash memory for data storage. The product is priced substantially higher than OLPC at $400. The design is very rugged, has extremely low power requirements and is considered to be the better alternative to OLPC. A couple of years back, an Indian company had launched ‘Simputer’, which was a Linux- based device and a cross between a PDA and a laptop. It failed to take off and was subsequently bought by a mobile application development company. Now another device called ‘Mobilis’ has seen the light of the day. It is a Linux- based tablet PC, and is one of the most advanced low-cost mobile computers from India.

However, it is yet to be deployed in any large project.

Apart from these, there have been some attempts to build low-cost laptops in Brazil and China. AsiaTotal.net attempted to distribute free PCs by subsidizing the costs from the sponsors who could have hotlinks on the keyboards, directing to their webportals. In 2004, AMD introduced the Personal Internet Communicator as part of its 50x15 program, but abandoned the project in 2006.

HP also experimented with mobile computers, targeted at developing countries, before discontinuing any more investments in the project. However, these devices were 33

technology

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Emerging Technologies for sustainable rural e-health

too generic to address the requirements of any single sector comprehensively.

Rural e-Health Software

The issue of rural e-Health software is a complex one. There are hundreds of open source Electronic Medical Record (EMR) systems supporting different platforms available around the world. These range from full-fledged hospital management solutions to community EMRs, to personal health records.

The advantage of open-source applications is reduced costs, flexibility to customize, and sharing of knowledge with developer community and users.

One of the oldest and most widely used open source EMR is VistA, which was developed by Veterans Affairs health system in the US. It includes more than 50 separate but integrated modules, and different development groups have added pediatric, obstetric and other hospital applications on to the base system. The system has a track record of supporting a large variety of clinical settings and medical delivery systems, and it can be customized for Indian deployment. VistA is developed in Mumps (M language) but some of the other available open source EMRs are developed on contemporary platforms, and are easier to install and manage.

Challenges of Reliable Network Connectivity

The network connectivity is a major component of rural eHealth setup. So far it has been the most difficult and expensive to manage. In a sparsely populated area, it becomes very

The four vital components of e-Health are mobile hardware, which can be taken into patient’s dwellings and has support for network access, software for accessing records with some decision support built in, reliable network which is low cost and connects mobile workers to the central base or a national grid, and most importantly the power source, for providing electricity in remote areas.

expensive to use wireline technologies, and cellular phone companies cannot recoup their investments. However, global R&D is producing some innovative technologies which can address these pressing issues.

Intel and University of California, Berkeley are working together to provide Internet access, using steerable antennas with range of hundreds of kilometers. These antennas with range of hundreds of kilometers are connected on the 34

one end to the urban centers and are ‘daisy chained’ to each other. At the other end, they can be connected to a local wifi system. The antennas can auto-calibrate and can run on solar power or other conventional power source. They can be deployed in a mesh-network system and can provide variations of 802.11 and 802.16 wireless protocols; optimized for remote locations.

A tele-ophthalmology project is already being run with this system in South India. In test runs, up to 1 mbps bandwidth was obtained at a distance of 200 km. Drishtee, a social enterprise supported by Acumen Fund, is collaborating with rural entrepreneurs in India to set up e-kiosks that will provide a large variety of healthrelated services like preventive checkups, health information, hospitalization insurance and medicines.

There are more encouraging examples in the Indian context. Voxiva is piloting projects in India, after successful deployment in Peru and other developing countries. They are promoting the use of phones instead of PCs to enter healthcare information at remote rural sites.

This system can be used to enter basic patient information or any disease outbreak warnings by just calling-in.

Researchers at IIT Chennai are working towards deploying Internet kiosks in villages. A combination of wireline and wireless systems would enable connectivity with central servers and data storage. Using thin clients, users can access a central server and provide connectivity to business applications, Internet and e-mail. The project would involve local entrepreneurs to operate and manage these kiosks and earn profit over services delivered through them. A similar model has been successfully demonstrated by ITC’s e-choupal project.

International Telecommunication Union (ITU), which is a specialized agency of United Nations established to standardize and regulate international radio and telecommunications, has a number of projects to provide wireless network access to rural areas. One of these is UMTS Forum Project which aims to make lower frequencies available for mobile phone networks, based on open standards, harmonized frequency bands and global deployment.

In another ITU project, which is codenamed Enclusion, the GSM networks are extended to wider population, using VHF radio transmitters. People can connect to this low bandwidth network using mobile phones, computers or special devices and access predominantly text only information.

A very innovative model is being promoted by a UK based organization named Aleutia, which markets hand-held devices with inbuilt wireless transmitters and receivers. Aleutia is piloting this technology in East Africa, starting with Rwanda.

So far, they do not have any plans to launch it in Asia, but this novel idea can be easily implemented by interested agencies in India.

Each device has a range of about 7 km and can communicate with other devices and also with the base stations, within a range of 34 km. The interesting concept is that the local www.ehealthonline.org

technology

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Emerging Technologies for sustainable rural e-health

transport buses act as the data carriers. The mobile device closest to the bus stop is the last one in the mesh of mobile device network.

It aggregates all the outbound e-mails from mobile devices and exchanges e-mails with the mobile device in the buses, when the local buses passes through that village. As buses travel through remote areas, they exchange data with devices in their range and the devices subsequently share the data with others distributed. This mesh network is a self-contained solution and any node can be linked to a GPRS-based device or an Internet network.

However, all said and done, one of the most important initiatives to create an e-Health network in India is the Integrated Disease Surveillance Project, funded by World Bank.

Currently in the process of roll out, it has a central disease surveillance unit linked with district hospitals, medical hospitals, community health centers and peripheral health centers. The local units monitor case reports, verify lab reports and report to district surveillance unit, which is connected to central database.

The aim is to generate warning signals for epidemics and monitor progress of ongoing disease control programs. The nodes across the nation are connected through 45 mbps satellite link, provided by ISRO. Powering Change

Lack of reliable and quality electricity is an infrastructural bottleneck in rural areas of developing economies like India.

Every technology deployment has to address the power requirements before it can be made sustainable. The problem is acute for mobile devices since they are unable to utilize many of the available alternative energy sources. Also, the options have to be cost effective to be successful. Both solar power and fuel cells could be ruled out for this reason. Some concepts that are available include: Hand crank on the side of laptop: This was the original design of OLPC, but has been discontinued in favour of human-powered generator with string mechanism.

Potenco has designed a hand-pulled string powered model for OLPC. The string can be pulled by hand or leg to generate power. About one minute of pulling generates power for 10 minutes of use of OLPC. The target price for the generator is $10usd. A special kind of batteries in the OLPC keep the machine running for about eight hours on a single charge.

A foot-powered energy source is being sold by Freeplay. It is currently retailing for about $200usd per unit.

The Last Word

There are many technologies that are either in research stage or pilot testing phase, which can address any of the four components for rural e-Health in emerging economies.

Any integrator who could bring these technologies together around an e-Health application would not only be able to provide quality healthcare delivery to millions of people, but 36

would also lay the foundation of a medical communication network. This requires high initial capital investment, collaboration with multiple agencies, clear ROI assumptions and measurable project outcomes. It is right to assume that with the limited healthcare-IT deployment in urban centers, it is very difficult to push it in the rural centers. But the fact is the potential benefit of e-Health in a medically underserved area is much greater, so as to justify the investment. n

Dr. Pushwaz Virk Harvard University Health Services, Cambridge, MA

Helping Older People to Help Themselves The number of elderly people is increasing significantly and rapidly in all EU countries, thereby creating substantial problems in terms of resources needed for assisting them.

Specially their healthcare needs are a cause of concern in many EU states, as many of the old people live alone, with not enough money at their disposal to afford private carers. Thus with the increase in elderly population in EU, the relative public burden on healthcare in EU states is also rising. The OLDES project is an honest endeavour to address the healthcare needs of the elderly population of EU, through the help of ICT. The OLDES project is aiming to offer new technological solutions for improving the quality of life of older people.

To go into more detail, the project aims to plan and develop a technological, cheap and easy to use platform for tele-assistance and tele-company, thanks to the joint work of 11 EU partners.

OLDES project, which has a scheduled time-span of 36 months(from 1 January 2007- 31 December 2009), is working to plan and implement an innovative low cost and easy to use technological platform, which will be able to provide a wider range of health services to a higher number of elderly people. The platform will be tested by 100 elderly people in Italy (10 of them affected by heart disease) and a sample of diabetics in Prague. In a nutshell, OLDES’ objectives are to develop a cost optimised technical solution; to define the profile of ‘elderly people’; to define a standardised procedure for tele-care interaction; and to develop a programme for results evaluation. The success of the OLDES project will make the older people in EU access to e-Healthcare services from their homes.

OLDES puts older people at the centre and makes their needs the main priority in all developments. This will be achieved through the use of modeling and animation tools to create scenarios designed to elicit responses from older people, their carers and service providers. Animation and simulation will help to ensure that developments are, at all stages, grounded in the realities of social and healthcare, the cultures and economies of the specific pilot contexts, and has as wide a range as possible of other European public service contexts. n

www.ehealthonline.org

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spotlight

National Seminar on Medico-Legal Informatics Rising role of ICT in the medico-legal arena The seminar covered the topics of ‘Medico-Legal Informatics & Law, ‘Accessing Medico-Legal Information’ and ‘Electronic Medical Record Management—Legal Viewpoint’. All the sessions attracted eminent speakers.

Organizers were successful in bringing over 200 domain experts from medical, legal and informatics field to deliberate and brain-storm on issues of common interest on one platform. The seminar deliberated that the justice delivery system can be accelerated if we can achieve a seamless integration of information flow between legal and medical professionals, employing information communication technologies.

E

merging technologies have brought into focus the manner in which medical and legal experts will manage their business in tomorrows. However, to make adoption of such technologies simple, there is a need to create a forum to translate the emerging technology trends, or more specifically ICT trends, in a language which medical and legal professionals are used to.

In this regard, the national seminar on Medico-Legal Informatics, organized by Indian Legal Information Institute (INDLII), in association with Indian Association for Medical Informatics (IAMI), on 29 April 2007 at the premises of Sharda Group of Institutions in Greater Noida assumes great significance. This seminar was hosted by Sharda Hospital & Hindustan Institute of Medical Science & Research, Greater Noida.

This was perhaps the first time in India when three institutions with diversified interests, but with a common objective, joined hands to organize a seminar on multi-disciplinary subjects to discuss how best to employ information communication technology judiciously for the benefit of common citizens. The objective of this seminar was to bring domain experts in the fields of medical, legal and informatics on one platform to: Discuss seamless integration of information flow between these two fields, employing information com38 }

munication technologies to accelerate the justice delivery system; create a forum to increase the undertaking of the emerging legal issues and technologies; and provide legal information to the professionals in all fields.

The seminar was inaugurated by Chief Guest, Justice J. S. Verma, the former Chief Justice of India and former Chairman of National Human Rights Commission. The inaugural function was chaired by Justice M.B. Shah, Chairman of National Consumer Disputes Redressal Commission, and former Judge, Supreme Court of India. Justice Shah delivered the keynote address. Other notable participants were Dr S.B. Gogia, President, IAMI, and Adeesh Aggarwala, President, INDLII. The seminar covered the topics of ‘Medico-Legal Informatics & Law, ‘Accessing Medico-Legal Information’ and ‘Electronic Medical Record Management – Legal Viewpoint’. All the sessions attracted eminent speakers.

Organizers were successful in bringing over 200 domain experts from medical, legal and informatics field to deliberate and brain-storm on issues of common interest on one platform.

The seminar deliberated that the justice delivery system can be accelerated if we can achieve a seamless integration of information flow between legal and medical professionals, employing information communication technolo-

gies. At the seminar, pertinent examples were provided as to how the IT has revolutionized Karkardooma courts in East Delhi.

Overall IT has aided the average case closure rate, which had shot up remarkably due to the infusion of IT. Talwant Singh, Additional District and Sessions Judge, Delhi, during his presentation on ‘ICT in Courts’ in the seminar, conferred that this could be even more if other departments including forensics could also incorporate IT and its associated efficiency in its day-to-day working. From the seminar, a expectation emerged that soon IT would spread to the entire legal system of our country and energise it.

A full session was devoted to electronic medical records, where it was emphasized to make them legally tenable and secure. While it was well known that issues of privacy and ethic, especially those pertaining to patients are important, the participants at the seminar showed that there were enough means to overcome such and other problems of similar nature. There was another event of great e-Health potential at the seminar. Professor Sneh Bhargava, a Padma Shri awardee, and the former Director of All India Institute of Medical Sciences, inaugurated the online course of Indian Association for Medical Informatics on healthcare informatics. n www.ehealthonline.org

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