How to speed up the introduction

of eHealth services in developing

countries

Professor Leonid Androuchko

Rapporteur ITU-D Sector, SG2, Q14-2/2
International University in Geneva
5 October 2009
ITU Telecom, Geneva
 eHealth for Developing
countries (1)
 Why eHealth services in developing
countries are not implemented as it
could be?
 eHealth Master Plan
 Mobile eHealth services
eHealth for Developing
countries (2)
 January 1998, Mozambique. The first
telemedicine project in Africa was
implemented by ITU in Mozambique for
teleradiology connecting the main
hospital in Maputo, the capital, with
regional hospital in Beira located about
1000 km away from Maputo.
Mozambique, 1998
 The Prime Minister of Mozambique, H.E.
Mr. Pascoal Mocumbi, inagurated the
telemedicine project 30 January 1998.
 « Telemedicine will end isolation which
has so far existed between health
professionals in the country ».
eHealth for Developing
countries (3)
 After the project in Mozambique, during
the last 10 years a big number of pilot
eHealth projects were implemented in
many developing countries led by
international community in the majority
of cases .
eHealth for Developing
countries (4)
 International Telecommunication Union
was and is still active in eHealth field
assisting developing countries to
understand better the benefit of ICT for
health care delivery.
ITU-D Study Group 2, Q-14
 The main goal of the study is how to
assist developing countries in the
introduction of eHealth services and
solutions, covering the technical part.
 This is the unique international study
group in the ITU-D SG2, Q14 dealing
with needs of developing countries.
ITU-D Study Group 2, Q-14
 It was decided to prepare the
questionnaire and ask the opinion of
medical staff in developing countries
about Telemedicine and eHealth.
 It was also a question asking
participants about their view with
regard to the implementation of eHealth
services.
ITU-D Study Group 2, Q-14
 The study was done in the following
countries: Pakistan, Uganda, Bhutan, Sri
Lanka, Saudi Arabia and recently in
Mongolia.
ITU-D Study Group 2, Q-14
 In favor of eHealth services
 Uganda – 96.6%
 Pakistan – 86.5%
 Bhutan – 87.5%
 Sri Lanka – 81%
 Saudi Arabia – 90.7%
 Mongolia – 77%
What is it nesessary to speed
up the implementation?
Pakistan

38
40
35 30
30
25 22
20 Series1
%

15 10
10
5
0
informaton on

training

financial
administration

support
good will of

eHealth
health

more
What is it nesessary to speed
up the implementation?

Uganda

35 30.6
28.4
30
25 21.6
19.4
20
Series1
%

15
10
5
0
informaton on

training

financial
administration

support
good will of

eHealth
health

more
Why eHealth services are not
implemented?
 Main obstacles:
 Lack of Government policy
 Lack of the knowledge of eHealth
successful projects
 Lack of training at all levels
How can we help developing countries
with eHealth introduction?

 To provide assistance to countries in

the preparation of
eHealth Master Plan – strategic
implementation plan based on local
needs and existed infrastructure and
showing clearly the potential benefit.
eHealth Master Plan
 eHealth network has to meet priorities
of the Ministry of Health.
 Proposed global structure of
telemedicine network based on existed
telecommunication infractructure
 Proposed list of possible eHealth
services
eHealth Master Plan
 Based on fixed and mobile networks
 Mobile eHealth has to use two
solutions:
 Mobile medical center connected via mobile
network to nearby hospital/clinic
 Mobile phone/terminal
ITU-D Study Group 2, Q-14
 Assist in the development of National
eHealth Master Plan by providing
information on the best technical
solution taking into account the local
telecommunication network.
ITU-D Study Group 2, Q-14
 The introduction of eHealth services in
developing countries requires
multidisciplinary collaboration, with
active participation of
telecommunication operators and health
care professionals.
International
Telecommunication Union
 Resolution 41 of ITU World
Telecommunication Development
Conference, which took place in 2002
in Istanbul, Turkey, recommended to all
countries to create national eHealth
Committees or Task Forces for such
cooperation and coordination.
International
Telecommunication Union
 Experience demonstrates that there is
no single solution that will work in all
settings. The complexity of technologies
and the complexity of needs and
demands of healthcare suggests the
gradual introduction, testing and
refining of new technologies.
ITU and WHO
 Effective governance of eHealth
requires codes, regulations, and
standards to ensure satisfactions of the
consumers.
 Issues include legal liability, ethical
standards, privacy protection, and
cultural and social standards.
ITU and WHO
 Successful eHealth services require
more than just technology.
 For any eHealth system to work in
practice – in real clinical situation –
suitable, committed personnel are
essential.
Mobile eHealth
 There are two solutions:
 Mobile phone can be used for management
and consultations related to medical
services.
 Mobile eHealth care clinics/units traveling
in rural areas from one village to another
and connected to nearby hospital by
wireless communication for consultations.
 Developing countries have a better penetration
of mobile telephones vs land lines
 The mobile network allows reliable connectivity
in remote areas
 Primary medical care delivery systems in villages
and remote areas is relatively poor across all
developing countries
 Primarily due to shortage in trained doctors

 Shortage in infrastructure and trained medical

personnel
 Comparison of mobile and
fixed phones (Source – ITU)
Mobile and fixed telephone line per
100 inhabitants

50
45
40
35
30
mobile
25
%

fix
20
15
10
5
0
Ky nia
na

Ta tan
M stan

an
Pa ia
bi

an
ha

ist
Ke
am

kis
y

rit
G

jik
rg
G

au
Mobile networks in selected
developing countries (Source – ITU )
Mobile Network Coverage and Telephone Penetration

100
90
80
70
60
Coverage
50
%

Penetration
40
30
20
10
0
i

da
nin

i
ea

go
da

l
bia
sh

n
dia

e
nd

aw

ga
ta

bw
an
uin

To
ge

an
Be

am
ru

bo

ne
kis
al

ba
Ug
Bu
la

w
G

Se
Pa
G
ng

m
Ca

Zi
Ba
 Medical professionals :
 Second opinion to doctors on primary diagnosis
 Enable trained medical personnel (nurse) to
provide quality primary care to patients
 Reduce errors in diagnosis across the healthcare
delivery system
 Patients :
 Access quality medical information on mobile
application
 Get diagnosis from signs and symptoms
 Understand their diseases and conditions better
 Act as a 24x7 medical advice system and
management of medical emergencies
Pakistan, Mobile Medical
Center
Pakistan
INDIA, Ophthalmology Car
 This car has VSAT connection to the
regional hospital

Tele-Ophthalmic Van – Shankara Nethralaya

Russia. Mobile Unit
Conclusion (1)
 Developing countries can not speed up the
implementation of badly needed eHealth
services without close cooperation with
telecom sector.
 Developing countries urgently need a
strategic document – eHealth Master Plan in
order to informed decision-makers in health
care sector about benefits of eHealth
technology.
Conclution (2)
 Developing countries heed technical
quidelines on how to use mobile and
fixed telecommmunication infrastructure
for the introduction of eHealth servies
 Developing countries need more
training and capacity building in this
field
 Thank you very much for
your attention.
Mobile phone/terminal
 Several useful applications developed

 Telemonitoring
 Intelligent diagnostic system
Telemonitoring. Telecardiology
 Cardio-vascular disease are the main
killer in every country. It is responsible
for more death than any other disease.
As an example, in the USA, 45% of
total mortality rate is contributed to
cardio-related disease. But it is possible
to reduce the number og death if a
patient gets the right treatment as soon
as possilbe.
Telemonitoring. Telecardiology
 For diagnosis of a person’s heart
condition it is important to get his
electro-cardiogram (ECG) data.
 Today with a small additional device in
your pocket wirelessly conected to your
mobile phone, you can send your ECG
to medical center and get doctor advice
immediatly.
Telemonitoring. Diabetes
 It is another very dangerous disease.
 You will get a small device, a glucose
monitor, which is wirelessy connected to your
mobile phone.
 Then the information is transmitted to the
medical center and you will get the
conclusion and the recommended treatment
from your doctor directly on your mobile
phone.
Telemonitoring
 Blood pressure monitoring
 Asthma control
 Fetal monitoring services
 Combination of emergency/alert
notification with required medical
services
Example: South Africa (1)
 The Dokoza system is an innovative
cost-effective interactive real-time
mobile system for fast-tracking and
improving medical services. It has been
developed in South Africa for use in
HIV/AIDS (specifically in respect of the
roll-out of anti-retroviral therapy) and
TB treatment.
Example: South Africa (2)
 This system involves the use of SMS
and mobile phone technology for
information management, transactional
exchange and personal communication.
Intelligent diagnostic system
 A software guided healthcare delivery system
revolutionize the delivery models across the
world.
 Bulk of patients handled by doctors can be
reduced considerably if a trained nurse with a
decision support system can attend to
patients in primary care centers
 Both healthcare professionals and educated
patients can use the system to identify the
diseases and get remedy tips
eClinician- artificially intelligent
diagnostic system (1)
 Developed in India. Similar system is
also developed in the United States.
 The system is being developed to suit mobile
platforms.
 The system will be available in two versions:
 Professional version for doctors and nurses
 Regular version for common man

 The system shall include around 1000 diseases

covering more than 98% of regular diseases
eClinician- artificially intelligent
diagnostic system (2)
 The mobile ehealth solution shall be a small application (2-3mb)
downloaded to the mobile phone

 Once installed it will list out all possible symptoms in a easy to use
interface (symptoms will be in easy to understand language)

 The doctor has to choose these symptoms and ask the system for a
diagnosis

 The system will connect with the server and give the probable
diagnosis immediately ((There is also option to give diagnosis directly
from the application in mobile – internet will not be required)

 Additional information on these diseases: symptom list, causes,

treatment etc. can be downloaded as required.
FOR
TRAINED
MEDICAL
PROFESSIONALS
(DOCTORS,
NURSES
ETC…)












SYMPTOMS

INTERNET

eClinician

SYMPTOMS
TRAINED
MEDICAL
PROFESSIONALS
MOBILE
SERVER
•

eClinician
mobile
application
•

Symptoms
SERVER
•

Communicate
with
mobile
DOCTORS
•eClinician
Application
MOBILE DATABASE DATABASE
NURSE
eClinician •

Disease
information
REMEDY

COMPLAINTS

DIAGNOSIS
&
TIPS
DIAGNOSIS
&
TIPS
INTERNET

PATIENT
eClinician- artificially intelligent
diagnostic system (3)
 This software is capable of generating all
probable differential diagnoses from signs
and symptoms of the patient.
 The program is tailored to be used by health
workers with minimum or no computer
expertise and is flexible enough to be
adapted to suit the needs of different level of
practitioners – from general practitioners to
specialist.
FOR
PATIENTS
SYMPTOMS

SYMPTOMS INTERNET

eClinician

MOBILE
•

eClinician
mobile
application SERVER
•

Symptoms
SERVER
•

Communicate
with
users
mobile
•

eClinician
Application
DATABASE
PATIENT
•

Disease
information
MOBILE DATABASE
eClinician

DIAGNOSIS
&
TIPS
DIAGNOSIS
&
TIPS
INTERNET
eHealth/Telemedicine network
 It is a key platform for eHealth services
 It has to be based on existed fixed and
mobile telecommunication infrastructure
 Integrated modular approach
 It has to be designed and controled in
line with specific requirements for
medical applications: security and
reliability.
Wireless Enterprise Mobility
National and Regional Areas
GPS Coverage
GPS, GSM, GPRS
GSM Access Wireless Wide Area Networks

Backhaul Orthogonal

Redundant wireless WAN

Metropolitan Area
City Distribution Networks

Canopy/WiMax connectivity S
Si

S
Si
i

Wireless
Si
Si Switch
Si
Si

Si
Si

S
Sii

Wirelessly connect DCs, hospitals, buildings Wireless

Switch Wireless
Switch

Mobile RFID EHR

Readers Registries Data &
Services EHRS Locator
Data & Services
Data &

WiFi Tags
Services
In-Building WLAN Networks
Health Information
Data Warehouse
Wireless Access/Mesh
systems
Security
Mgmt Data Privacy
Configuration Data

WLAN/Canopy
Wireless
Switch

RFID Tags
Wirelessly extend coverage to health provider/physician,
Enterprise Edge pharmacist, radiologist, lab, field technician
eHealth Information Exchange
Infrastructure Pharmacy
System
Hospitals
& Physicians

Public Health
Services Network Resource
Svc Registrar
DNS, DHCP, WWW

Health Information
Data Warehouse
eHealth Information Healthcare
LDAP
Systems Infrastructure Provider
Dir
Networks
EHR, Registry Data,
Health Information MSP
GPRS Dial
GGSN

GSM

Network Operator Routed Network

IP/Switched Network

GSM MSC

Mobile Network SGSN Fixed Line Network

Managed/Hosted Health Mobility
Solutions
GSM PHONES, HI PROVIDER CORE APPLICATION
MOBILE COMPUTING
DEVICES, ADVANCED
DATA CAPTURE
DHCP, DNS, WWW, Apps, Content HTML, Web
& dBase Back-end
Directory Services

Security

BTS
Health Information Services

BSC Provider IP Network Billing & Account

Services Health
Information Data
Warehouse
BTS

Dial-in EHR, Registries,

NAS Ancillary Svcs

BTS Hospital, Clinic, Field Hospital,

MSCs Public Health Systems Intranet
Service Provider
IP Core Mobile Device
Apps
PSTN/ISDN Internet
BSC

BTS
Thailand, Bangkok (1)
 Bumrungrad international hospital is the
largest hospital in Southeast Asia and one of
the world’s most popular destinations for
medical tourism.
 Hospital initiated implementation of a state-
of-the-art wireless infrastructure project that
will provide the backbone for delivering
world-class healthcare services to its patients.
Thailand, Bangkok (2)
 The solution is design for scalability and
will allow hospital to deploy Wi-Fi and
RFID services through one switching
platform.
 This integrated approach will reduce the
total cost of ownership and simplify
management of multiple wireless
infrastructure technologies.
Building a Better Health/Hospital
Information System
• Improving healthcare
• Define building blocks of accuracy, coverage, quality
HITS infrastructure for and safety
healthcare

• Enlist Independent
• Providing an open standards
software vendors to
and best of breed HIT
develop mobile ehealth
framework
applications

• Deploy backbone
infrastructure & wireless • Strong support for eHealth
connectivity development of best
practices & initiatives
 Health Information Systems Evolutionary Strategy
Phase I Phase II Phase III

Improved Communications Advanced Health Data Synch

Public Health Services Reporting,
Outbreak Mgmt, Shared Health Records,
Connectivity – enables Integrated Networks – Drug and Health Information
access to health deploy an adaptive
Compliance & Tracking Electronic
Electronic Health Health – Data
Records
information and providing architecture that supports Allows extended
Instant update visibility
of medical records,
visibility by leveraging a health information and
Patient real-time
ID and vital data,point ofService Care
Point of
existing communications service care, disease
technologies, backbone with integrated
eHealth Value

outbreak management, and

Health Systems
infrastructures& eHealth Information Information Distributed Peer-to-Peer Networks
extended electronic health,
applications Systems to capture, move, medical,
Integrated Public and patient
Health provider systems,
store, organize and cross-Lab & Drug information,
Hospital, records access
clinics and physicians
Advanced Network Access
referenceHealth
extended ehealth Systems Infrastructure
Information
eHealth Data Access
information Integrated Health information Infrastructure,
Server Based Facilities Access & Connectivity
Basic Access
Web-based links to Doc Mgt,
Mobile Data Access Patient History, and data
Email, PIM

TIME
 Health Information Systems Evolution

Improved Communications Advanced Health Data Synch

Public Health Services Reporting,
Outbreak Mgmt, Shared Health Records,
Drug and Health Information

Compliance & Tracking Electronic Health Records Data

eHealth Value

Instant update of medical records,

Patient ID and vital data, Point of Service Care

eHealth Information Systems Distributed Peer-to-Peer Networks

Integrated Public Health provider systems,
Hospital, Lab & Drug information, clinics and physicians
Advanced Network Access
Health Information Systems Infrastructure
eHealth Data Access Integrated Health information Infrastructure,

Server Based Facilities Access & Connectivity

Basic Access
Web-based links to Doc Mgt,
Mobile Data Access Patient History, and data
Email, PIM

TIME
 Wireless Inside and Out

Backhaul Layer
Data Center
Point-to-Point Wireless Bridges Line Of Business Applications

Wireless Network Design and Management

(ERP, CRM, Supply Chain, Fin, PIM, Collaboration)

All Wireless

Network and Device Security

Distribution Layer
Mobile Wireless Point-to-Multipoint
CELLULAR

Lower Cost
Access Layer
Simplified WLAN

Mesh WLAN
More Secure PMP
Mesh Outdoor

Client Devices
Rugged/Std Laptops
VoWLAN phones
Mobile Computers
Vehicles
Cameras

HQ Branch Store DC

Indoor Outdoor Fixed Outdoor Mobile

WHO
 The World Health Assembly in May
2005 officially recognized eHealth and
adopted Resolution WHA 58.28
establishing eHealth Strategy for the
World Health Organization.
WHO
 It was recommended to establish
eHealth Strategy « …stressing that
eHealth is the cost-effective and secure
use of information and communication
technologies in support of health and
health-related fields… »
INDONESIA
INDONESIA