Portable Health Clinic Packages for BoP Yasunobu Noharaa, Naoki Nakashimaa, Ashir Ahamedb, c , Masashiro Kurodad, Sozo Inouee, Partha Ghoshc, Rafiqul Islam Marufc, Tatsuo Hiramatsuf, Kunihisa Kobayashig, Toyoshi Inoguchif and Masaru Kitsuregawah a
b
Medical Information Center, Kyushu University Hospital, Fukuoka, Japan Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka Japan c Grameen Communications, Dhaka, Bangladesh d National Institute of Information and Communications Technology, Tokyo, Japan e Graduate School of Engineering, Kyushu Institute of Technology, Kitakyushu, Japan f Graduate School of Medical Sciences, Kyushu University, Fukuoka Japan g Fukuoka University Chikushi Hospital, Chikushino, Japan h Institute of Industrial Science, University of Tokyo, Tokyo Japan
Abstract and Objective In a developing county, its health/medical infrastructure has many problems. It is difficult for people in BoP (Base of Pyramid) especially lived in rural area to access a medical service. In this study, we propose a package for Portable Health Clinic (PHC) which provides telemedicine service for people in BoP. The package consists of major diagnostic tools and a tablet PC, and gathers measurements using medical Body Area Network (BAN) wirelessly and automatically. It can categorize patients into four groups depending on the priority of their treatment like a triage, and also sent these results to a doctor in a remote healthcare call center via mobile network. The package provides immediate consultation with the doctor over the Skype and doctor gives patients a prescription over the network. The package is easy to carry, easy to use, battery-driven and flexible against poor mobile network, and works even in a rural area. We are introducing the PHC packages in a health checkup program whose target is 15,000 subjects in Bangladesh, one of the BoP countries.
service. On the other hand, the mobile network spread rapidly in developing countries and Bangladesh, one of the poorest counties, is not an exception. In this study, we developed a package for an e-health service named “Portable Health Clinic (PHC)” consists of a set of sensor devices developed with international information standards like a IEEE802.15.6, also known as medical Body Area Network (BAN) in an attaché case, a data coordinator system including a tablet PC connected with a mobile network, data management application which is enough easy to be used by person who does not have high IT literacy, telemedicine by Skype with mobile network, and personal health record preservation. The package can categorize patients into four groups depending on the priority of their treatment like a triage, and also sent these results to a doctor in a remote healthcare call center via mobile network. The package provides immediate consultation with the doctor over the Skype and doctor gives patients a prescription over the network. We are introducing the PHC packages in a health checkup program whose target is 15,000 subjects in Bangladesh.
Keywords: Portable Health Clinic, BAN, IEEE802.15.6, BoP, Telemedicine
Description of the scientific demonstration
Introduction
In this section, we describe the PHC package which is used in the scientific demonstration.
The increase of non-communicable diseases (NCDs) such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes in developing countries will change the direction of health services to emphasize the role of preventive medicine. It is said that by the year 2020, non-communicable diseases will become seven out of every ten deaths in the developing regions [1]. Preventive medicine can reduce costs of the social medical/healthcare system not only in advanced countries but also in developing countries.
Attaché case type package of sensor devices and data coordinator in PHC
In a developing county, its health/medical infrastructure has many problems. Many people in BoP (Base of Pyramid), which is the largest, but poorest socio-economic group has never been measured even their weight. It is difficult for people in BoP especially lived in rural area to access a medical
Our PHC package consists of following items (See Figure 1 and Figure 2): Android tablet(s) as data coordinator Diagnosis tools and sensors Laptop PC as local sensor server Mobile printer with battery (optional) Mobile scanner
Body Area Networks – IEEE802.15.6
Figure 1 – Image of set of sensor devices in an attaché case
The IEEE802.15.6 standard is a candidate to collect measured data from different types of medical devices/sensors to a coordinator simultaneously. The coordinator automatically configures devices securely as a component of a Body Area Network (BAN) and the health-check provider needs not to manage the relationship between the coordinator and devices/sensors. The IEEE802.15.6 NB (=Narrow Band) supports several narrow band frequencies; 400MHz, 900MHz, 2.36GHz (2.36GHz (Only in US), 2.4GHz. 2.4GHz bands to follow the regulation of each country. The first BAN-enabled portal clinic uses 2.4GHz band and in near future we will switch to 400MHz or other medical bands with no modification to the application. The communication between a sensor and the coordinator requires less power consumption in data transfer and keeps data ordering among sensors involved in a BAN for future use. It, especially, expects less traffic from the coordinator to sensors, such as timing beacons, to reduce the receive-wait state on the sensor side. We have implemented a BAN requiring less traffic from the coordinator to sensors to reduce the receive-wait state in the sensor RF and which permits plug-in of sensors, such as a pulse oximeter, at the setup or a later time. These ensure order in the data coming from sensors using a beaconless time synchronization mechanism, and protect wireless communications from eavesdroppers and attacks [2]. The interface is defined on IEEE802.15.6 by the Quality-of-Life Sensing Network (QoL-SN) association [3]. Other short-range wireless communication, such as Bluetooth, is used for peer-to-peer services like hands-free voice communication and does not presume security and medical use. System Architecture
Figure 2 –BAN-enabled devices and android terminal for health checkup program We selected sensor devices by the viewpoints of international information standards and approval in Japanese government. If device did not have any standard transmission, we attached “Body Area Network” (BAN) interface on the sensor. Table 1 shows the type of sensors using our package.
A data coordinator gathers all measured data from medical devices wirelessly and securely using BAN (See Figure 3). The coordinator has a barcode reader for patient identification, and measured data is linked with the patient ID. Blood test and urinalysis are outside of the BAN configuration and these results are entered manually. Once data is collected in the coordinator, they are sent to a backend local PC for categorization and further remote diagnosis.
Table 1 – Type of sensors Sensor Name Weight scale
Values
Input Type
Weight, (BMI)
BAN
Sphygmomanometer
Blood pressure, Heart rate
BAN
Glucose meter
Blood Glucose
BAN / NFC
Body thermometer
Body temperature
BAN / NFC
Height scale or Tape measure
Height, (BMI)
BAN / Manual
Tape measure
Waist, Hip, (WaistHip ratio)
BAN
Pulse oximeter
SpO2
BAN
Urine test strip
Protein, Glucose and Urobilinogen
Manual
Figure 3 – Capture image of data coordinator using Android tablet A backend local server stores data from coordinators in local site via wireless-LAN and synchronize its data with the master sensor server (Master-SS) when the internet connection is available. Master-SS is placed in a data center and stores all sensors’ data and provides data to the Personal Health Record Sever and doctors in call center. The interface of the backend local
server is the same of that of the master-SS (transparency), therefore the sensor packages can directly connect to the master-SS only changing the configuration of the address of server. Operation of the system PHC is a healthcare service for the study including 1) health checkup by sensor devices, 2) data preservation in the data center, 3) provide health situation by paper and healthcare guidance according to situation of individuals, and 4) telemedicine by doctor in the medical call center.
if electricity is down, we develop battery-driven sensor packages. Laptop PC, Android terminal and mobile printer have its own Li-ion battery. Scanner and wireless router get their power from PC through USB. All sensors are powered by AA or AAA batteries that are sold even in a rural area. However, we use NiMH rechargeable batteries to reduce the total cost of the battery. Countermeasure for Internet connection problem In Bangladesh, the connection area of mobile networks covers about 98% of the whole country. But the network connection is unstable due to an electricity problem etc. We introduce local backend server and enable to continue checkup operation even if the network is down. After the network is recovered, measured results are sent automatically to the master sensor server and the system can provides telemedicine service immediately.
Conclusions In this study, we propose a package for Portable Health Clinic (PHC) which provides telemedicine service for people in BoP. The package is easy to carry, easy to use, battery-driven and flexible against poor mobile network, and works even in a rural area of developing country. Acknowledgments Figure 4- Work flow in a visit of the service In the first visit, a subject got an ID card with barcode after registration. After finished questionnaire, he/she was checked up by sensor devices so on. The data were preserved both in backend local server and main-SS in the data center, and automatically categorized into 4 grades according to the B-logic. “B-logic” (BoP logic) is risk stratification by international diagnosis standards to determine risk stratification into 4 grades, green (healthy), yellow (caution), orange (affected), and red (emergent) in results of each health checkup items. We provided telemedicine using Skype to orange and red subjects after health checkup by a doctor in a medical call center. Doctors can access to the results of subject’s health checkup, and provide advices for the disease, encourage visiting a clinic if possible and teleprescription for anti-hypertensive medicine by the network. Results were printed out and used for explanation to the subject by local staffs. Subjects who got teleprescription by the telemedicine should visit pharmacy in the village to purchase medicines.
Statement of innovation In order to use the package in various places, the package is equipped in attaché cases and easy to carry. Thanks to user friendly interface and automatic data input via BAN, it is easy to use for paramedic who does not have high IT literacy. The package also has solutions against two big problems in developing countries and is applicable to healthcare in disasterstricken area in advanced country. Countermeasure for electricity problem In Bangladesh, supply of electricity is always insufficient and blackout usually happens. In order to continue PHC work even
This research has been supported by Funding Program for World-Leading Innovative R&D on Science and Technology “Development of the fastest database engine for the era of very large database and experiment and evaluation of strategic social service enabled by the database engine”, and Health Labour Sciences Research Grant “Study of establishment and diffusion of standards needed for secondary utilization of electronic medical information”. The authors appreciate their supports.
References [1] World Health Organization, “Health Transition”, http://www.who.int/trade/glossary/story050/en/index.html [2] M. Kuroda, K. Takizawa, I. Kaneda, Y. Shibata, and O. Tochikubo, “Interoperable and Diligent Body Area Networks over IEEE802.15.6 for Real-time Monitoring,” pp. 2224-2227, IEEE EMBC 2008, Sep. 2011 [3] Quality-of-Life Sensing http://www.qolsn.org
Network
association,
Address for correspondence Yasunobu Nohara, PhD Medical Information Center, Kyushu University Hospital, Japan 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan E-mail;
[email protected]
