Presentation on theme: "Agenda GramHealth UnReached People"— Presentation transcript:
0 ITU Workshop on "E-health services in low-resource settings: Requirements and ITU role” February 4-5, 2013, Tokyo, JapanGramHealth: An affordable and usable healthcare system for unreached communityAshir AhmedDirector, Global Communication Center Project, Grameen Communications, BangladeshAssociate Professor, Department of Advanced Information Technology, Kyushu University, Japan
1 Agenda GramHealth UnReached People Affordable and Usable Healthcare SystemPortable Clinic and GramHealth : Experimental Results and Comments(c) Ashir Ahmed, 2012
2 The Unreached Community Category3 billion people live on less than $2.50/dayPoverty1 billion people unable to readEducation1.5 million children die of diarrhea each yearHealth1.6 billion people live without electricityEnergy・・・How can we change these facts?
3 Muhammad Yunus Was awarded Nobel Peace Prize in 2006. Contributed to solve poverty issue.
4 Collaboration with Grameen Since 2007 Development of Technologies based on Social NeedsSocial Business to provided social services to the target community in a business wayHealthcare is a focused area of joint-research
5 Unreached: Beyond the BOP 100 M２ BillionSocio-economicLow income, Low skillsCompromised infrastructureUnder developed countriesNatural DisastersLow/high income, low/ high skillsBoth developed and developing countriesPoliticalLow/High income, Low/high skillsPurchase Power Parity (daily)$５4 Billion People69% of World PopulationBOP$２$１Commonality and VariabilityLast year, scientists revealed that it was in fact the chicken that came first, not the egg. And the same applies here: that it is the people that come first, not the technology. Regardless of how well-designed or technologically sound the tool, if people aren’t already using that tool then they won’t turn to it in a time of disaster. It is not just that people need to know of a technology, but they really need to have it already integrated into the way they communicate and share for adoption to take hold during a crisis.Charity:BusinessReverse Innovation
7 Low-resource setting Doctors don’t want to stay in villages Quality hospitals don’t sustain without a stable incomeTransportation cost is bigger than treatment cost
8 Bangladesh case: Health Consultancy over mobile phone since early 2000 GSM NetCenterCDRA patient calls a hotline number.The call is redirected to a call center doctor.The patient-doctor conversation starts.The doctor provides three types of services.The conversation is archived in CDRVoice only service
9 Two Case studies 789 Service Tele health 10600 Provider GrameenPhone 2-a) Remote Health consultancy over mobile phoneTwo Case studies789 ServiceTele health 10600ProviderGrameenPhone(a mobile phone operator)JBFH(a hospital)Calls per day15,000 calls500 callsCall center doctors200 doctors / three shifts10-15 doctors / three shiftsPrice5 cents per minuteFree for farmersCase-1: 789 Service by GrameenPhone (a mobile phone operator)15,000 calls per day, 200 doctors in 3 shifts5 cents per minuteCase-2: Tele health JBFH* (a hospital)500 calls per day (in 2009)Free for farmersSmall call center with 3-5 doctors/shift
10 Amazing Facts from Doctor-Patient conversation analysis 2-a) Remote Health Consultancy over mobile phone33% patients are females→ Solves another social prolem of femaleAmazing Facts from Doctor-Patient conversation analysisObserved ItemResults (n=400)(a) CallerPatient: 60%, Relatives: 40%(b) Age distribution of the patient0-10 years: 29%, years: 15% years:24%, years:17% years: 9%, 50+ years: 7 %(c) SexMale: 67%, Female: 33%(d) LocationRural: 30%, Urban: 70%(e) Call completionComplete: 68%, Incomplete: 32%(f) Time of callDay (8:00-15:30): 57 % Evening (15:30-23:00): 18% Night (23:00-8:00): 25%(g) Time occupancy of a single callIntroduction phase: 8%, Diagnosis phase: 27%, Advice phase: 67%(h) Consultancy aboutDisease related: 79%, Preventive healthcare related: 21%(i) Type of advicesPrescribed medicine: 54% , Advice: 28%, Referred to specialist/hospital: 17%,(j) PatientsFollow up: 17%, New: 83%(k) Major diseases consultedGastro-intestinal: 22%, Respiratory: 17%, Reproductive:10%, skin: 10%Data Source: Tele health (Case-2)Duration: December, 2009Total Records: 10000Selected Records: 40017% follow up patients→Popular !!!10
11 Advantages and Technical Challenges Social and Business AspectFemale patients can stay anonymous for female diseases. Amazing Privacy!!Access to basic healthcare by millions of unreached patientsTechnical ChallengesBad quality of communications. Incomplete calls.Doctors cannot see to past records for repeated patientsDoctors can not make a good clinical decision, no diagnostic tools at the patient side to provide health data
12 Our response to the technical challenges Solutions by Portable Clinic(a health check up box)a. Diagnostic tools(one set for one community)b. Broadband Internet (Not GSM)Portable ClinicChallengesa. No diagnostic toolsb. Bad quality of communicationsc. No Patient ID management mechanismd. Difficulties to access to past clinical recordsDifficulties to access to past clinical recordsSolution by GramHealth(a Web based PHR)c. Unique patient ID and Phone numberd. Universal access to PHRGramHealthPHR: Personal Health Record
13 Grameen and KU: Towards One Community One Clinic 3,000 USDAffordable?
14 Can we make it more efficient? Portable? Rural PatientsCell PhoneDiagnostic ToolsInterfaces(a) $3000 “Clinic Booth” with existing devicesUrban doctor(b) FHRProposed $300 “Portable Clinic”Patients visitclinicClinic visitspatients(c) FHR Application Server(d) FHRViewerPhase 1: System design of a clinic booth using traditional devices and SW toolsPhase 2: Develop a cost effective portable clinic
16 The prototype used in field Low cost vs. AccuracyBarcode readerPaperand penName cardswith barcodeMeasure(Height, Waist, Hip)Pulse oximeter(Oxygen in blood)Blood sugar meterThermometerUrine tester tape（protein, sugar）Blood pressureButteryMobile modemWeight scaleAndroid terminal
17 Accuracy of the sensors: Concept of Triage to convince the patient SafeRiskyGreenYellowOrangeRedBlood Pressure (mmHg)<140 mmHg140≦ <160 mmHg160≦ <180180≦<90 mmHg90≦ <100 mmHg100≦ <110110≦Blood Sugar<100mg/dl100≦ <126mg/dl126≦ < 200mg/dl≧200mg/dlPostprandial Blood Sugar<140mg/dl140≦ <200mg/dl200≦ < 300mg/dl≧300mg/dlUrine test…SpO2≧96%93≦ <96%90≦ <93%<90%
19 PHR collection for preventive healthcare Patients’ Advantages:-Access to quality healthcare from home-Saves travel time and costHealth Care GuidelineTriagePatients in VillageDoctors in Urban AreaInternet2. Healthcheckup1. Registration3. TeleConsultancy4. Prescription & SuggestionDoctors’ Advantages:-Saves (>70%) doctor-time Can see more patients-Immediate access to health records Better clinical decision
20 Portable Clinic in KU-Grameen FHRInternetLady HealthWorkerEnergy and communication problemSimilar to disconnected (due to natural disasters) areas?
21 Nomadic and Portable GramHealth Village-1 Internet Village-2 Village-3 (c) Ashir Ahmed, 2012
22 BigData in GramHealth 15,000 records by March, 2013 Conversation Data GramHealth DBVital DataClinical DataConversation DataPrescription DataTriageHealth care Guideline1. Registration2. HealthcheckupTriage3. TeleConsultancy4. Prescription & Suggestion15,000 records by March, 2013Collaborator: N. Nakashima, Kyushu University
23 Data Variability and Trends 4. What’s next? Healthcare BigData?Data Variability and TrendsStructuredPHRSemi-StructuredPrescriptionAnalysis of BigData will produce Trending-Disease pattern-Geographical distribution-Cohort characteristicsUn-StructuredConversationGramHealth DBBigDataInvaluable resource for the Data mining researchers