1. INDRA PRATAP SINGH School of Telemedicine & Biomedical Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow, India singhip81@gmail.Com Innovative Low Cost mHealth tool kit

2. Background Introduction Material & Method mHealth4U®: Integration of ICT & medical Equipments Case Study: Telemedicine enabled specialty healthcare access for health emergencies Discussion Conclusion Acknowledgement Content

3. Advances in mobile communications and medical technologies has facilitated development of innovative low cost portable tele-health tools mHealth is the use of information and mobile communication technology to improve health systems performance In India 506 million mobile phone subscribers with Growing approximatly 10 million per month Mobile networks have now become country’s largest distribution platform, promising to deliver information and public services to the masses through innovative applications Mobility as such brings in added value of continuous availability and timely information access ICT based solutions for various types of customization and allowing support for a wider set of application requirements Background

4. Telemedicine is the use of medical information that is exchanged from one treatment site to another via electronic communications It comprise videoconferencing, transmission of still medical images, document sharing, remote monitoring of vital signs Evolution of wireless communication technologies have enabled telemedicine systems to operate in the remotest place for rural health practices, hence expanding telemedicine benefits, applications, and services In India majority of the people are living in the rural and remote locations where even the basic facilities are not available for the society Introduction

5. mHealth4U® a portable low cost mobile telemedicine kit was conceptualized, designed and prototype developed at the mHealth research laboratory, STBMI in the year 2008. Two versions mHealth4U-B (Backpack)Backpack mHealth4U-S (Suitcase)Suitcase Material & Method

6. mHealth4U-Backpack

7. mHealth4U- Suitcase

8. 1. Computer System 2. Communication Technology 3. Software based Video Conferencing System 4. Integrated Medical Equipments 5. Centralized Telemedicine Software Components of Low Cost Telemedicine Platform

9. Low cost Atom based Processors for deploying large number of telemedicine terminals –Desktop –Notebook –Thin client & Cloud computing –Handheld Mobile tablet 1. Computer System

10. Low cost communication facilities now be the alternative solution for transmitting the data, voice and video to the nearby telemedicine enabled service provider –ADSL broadband –Wireless broadband provided by various ISP in a form of HSB plug in 2. Communication Technology

11. Mobility and lowering cost of devices can only be achieved by replacing hardware with software based video conferencing system –People Link 3. Software based Video Conferencing System

12. mHealth4U ®

13. mHealth4U® is a mobile tele-health solution designed, developed and validated by School of Telemedicine & Biomedical Informatics. Available both in Aluminium polycarbonate case (Aeroplane cabin bag size) & Standard Backback model. Consist atom processor based laptop with Windows vista platform & Microsoft Office, non-invasive blood pressure monitor, ECG, pulse oxymeter, Spirometer, Glucometer, Digital Thermometer, Digital Weighing Machine, Digital Stethescope. Mobile high speed broadband (HSB) data card is used to transmit data from remote rural area to teleconsultation center. All medical equipments are integrated with Curesoft® software. IP based video conference software is used for telemedicine interactive session mHealth4U®: Integration of ICT & Medical Equipments

14. Integrated Medical Equipments PC Interface: USB & Bluetooth Atom based Low Cost Laptop with Integrated Telemedicine Software Connectivity via High Speed Broadband (HSB) Blood Pressure Digital Glucometer Common Interface Spirometer Wrist Clinic Weighing Machine SPO 2 ECG

15. All Software Servers are Installed at Data Center of School of Telemedicine & Biomedical Informatics Network Architecture

16. Screen Shot of Software based Video Conferencing

17. Screen Shot of Cure-Soft Software

18. Case Study: “Telemedicine enabled specialty healthcare access for health emergencies”

19. Telemedicine enabled specialty healthcare access for health emergencies during Lord Jagannath Rath Yatra at Puri was initiated by the School of Telemedicine & Biomedical Informatics (STBMI), SGPGIMS, Lucknow in collaboration with OTTET, Bhubaneswar and Govt. of Odisha An enterprise based telemedicine network was set up connecting specialty hospitals at Bhubaneswar and Cuttack using wireless broadband IP network to exchange E.C.G. and carry out peoplelink® software based videoconference for tele-consultation 2009: Puri Rath Yatra @ Odihsa

20. Technical Layout Diagram of Rath Yatra

21. Kit was deployed in Four Primary Health Center (PHC), one Community Health Center (CHC) and one state Hospital in the State of Gujarat, western India Basic orientation, demonstration and hands-on-training programme was imparted to in-service paramedical, laboratory technician & nursing staff to give them first hand exposure on the kit All five nodes were connected over mobile wireless internet with expert hospital located in the city. The electronic medical record was created using the Curesoft® telemedicine software and the input from integrated medical devices like ECG, NIBP; Spo2 etc were captured through USB 2.0 port into this software which was then exchanged between the nodes and videoconference session followed for tele-consultation after the successful transmission of the data to specialist. 2010: Field Deployment @ Gujarat, India

22. Video Clip

23. Result The outcome of “Proof of concept” was satisfactory. The Doctors involved in the project was quit excited and found innovative solution for strengthening the healthcare services at their hospitals. Subsequently pilot deployment was started in a different environment. The patient data was transferred successfully between the expert doctors and remote end and videoconference could be possible even in low bandwidth. The doctors participating in the study suggested some minor changes in the software architecture like incorporating more graphics to represent body parts. Overall performance of the kit was acceptable to them.

24. Discussion The advancement of mHealth technology should be exploited in rural healthcare delivery setting in low resource countries where the mobile telecommunication network has already reached. mHealth or mobile health or efficient high-quality healthcare services for mobile citizens and u-Health or ubiquitous healthcare that focuses on eHealth applications that can provide healthcare to people anywhere at anytime using broadband and wireless mobile technologies. The tool kit has been developed keeping in mind the basic health care needs in remote villages in Indian setting, a situation akin to countries in developing world. Besides the local available technology and skill, cost factor has been taken into account. While field deployment has been successful in testing the local available mobile network, the human factors such as acceptability of the device and operational simplicity was also taken into consideration.

25. Discussion Evolving software solutions will help to further the growth, acceptance and adoption of telemedicine initiatives. Healthcare based on broadband and wireless mobile technologies can only reach to the door step. Although technology cannot take the place of a visit to the family doctor. Web and video conferencing are emerging as powerful components in telemedicine and telehealth initiatives worldwide. The integration of web based video conferencing has been able to help many patients, and has enabled doctors to communicate with specialists in order to make critical diagnoses faster. Software solutions like Peoplelink® will help to further the growth, acceptance and adoption of telemedicine initiatives. Keeping telemedicine costs low will enable providers to reach out to a broader audience, including those in rural regions and low-income patients who cannot afford to travel long distances for care.

26. Acknowledgement The authors would like to acknowledge the financial grant support received from Department of Information Technology, Ministry of Communications & Information Technology, Government of India under the Project” National Resource Center for Telemedicine & Biomedical Informatics”.

27. School of Telemedicine & Biomedical Informatics, SGPGI, Lucknow www.sgpgi-telemedicine.orgwww.sgpgi-telemedicine.org | www.telemedindia.org www.stbmi.ac.in | www.nrct.inwww.telemedindia.org www.stbmi.ac.inwww.nrct.in www.sgpgi-telemedicine.orgwww.sgpgi-telemedicine.org | www.telemedindia.org www.stbmi.ac.in | www.nrct.inwww.telemedindia.org www.stbmi.ac.inwww.nrct.in Thank You