Pakistan-U.S. Science and Technology Cooperation Program Annual Report Form

Transcription

1 Pakistan-U.S. Science and Technology Cooperation Program Annual Report Form Reports should be prepared jointly by the Pakistani and U.S. principal investigators and should cover all project-related activities carried out during the reporting period on both sides. Please expand the boxes below to accommodate all the information you need to include. Project Title: Capacity Building of Lady Health Workers in Rural Mardan, NWFP through the use of ICT based Tele-healthcare Pakistani Principal Investigator: Dr.Arshad Ali U.S. Principal Investigator: Dr. Rizwan Naeem Reporting Period: Feb 2009 to January 2010 Summary of Activities During Reporting Period: Our project aims to utilize voice, Short Text Messaging (SMS) and Multimedia Messaging (MMS) over mobile phones to quickly and efficiently extend medical advice to LHW in the field by connecting them to our network of specialists. This will enable LHW to provide better quality healthcare to the communities they serve. The specific objectives as per ISIF proposal are as follows: To provide immediate, sustainable, and affordable medical care to the needy in best possible way. To make use of innovative technologies including web and mobile technologies in extending healthcare services. Adding value to Mobile Network infrastructure in Pakistan. Capacity building of LHWs by connecting them to Health Centers and specialist through the use of ICT Telemedicine. Enhance the collaboration among APPNA, NUST-SEECS and UM-Trust on health care domain. To participate in initiatives of the Government and other relevant organizations regarding health care, population welfare, vaccination, emergency medical services, extension of health care education and the like. To develop an efficient healthcare model that can easily be replicated to various parts of Pakistan. While treating IDPs we realized that a live and visual representation of the patients shall be highly useful for various stakeholders aiming to provide better healthcare for Pakistan. So we have added following project objective:

2 To develop and deploy Pakistan's First Health Grid/Map that shall be integrated to our application to provide highly visual information representation of patient for correct analysis. Achievements with respect to the objectives: OpenEMR Record System: We have developed a customized OpenEMR (Electronic Management of Record) to store the record of patients. This software is developed by using open source technologies and is successfully tested and installed at the facility. Some of the highlighted features of OpenEMR include: Patient registration Patient appointment SOAP (records which is shared by doctors in U.S.A) Records attachments (ECG, Digital X-Rays) Search facility Medical Prescription Health Map There are some of features of the software and there are many more to it. Screen shots of the software are placed in annex for your reference. On average the 150 patients record is daily stored in our database and regular data analysis are carried out in order to make necessary decisions (sample results are referred in output section for your reference). The real data that is being gathered with the help of OpenEMR provides research opportunities for us as well as stakeholders involved in our project. For example: With the help of data analysis we came to know the most common diseases in the area, statistics of patients for each month, requirement of medicines, preventive measures for diseases etc. During the treatment of IDPs we learned the importance of tracking back the diseases such as hepatitis and HIV; we believe that identifying the disease origin can play a crucial role in healthcare. Currently our records collected by OpenEMR software showed that mostly people in Mardan are suffering from waterborne diseases due to unhygienic condition of environment and water. Our local sponsors provided us with water purification tablets which dramatically helped to reduce the percentage of waterborne diseases. There are many other examples where our software helped us in making beneficial decision for community. We have also shared the medical records of the patients with APPNA doctors in U.S.A using Open EMR. The diagnostics help the doctor at the facility to understand the medical case better. This exercise has been extremely successful and three to five cases per week are shared with APPNA doctors. Mobile Services using SMS/MMS We have developed a sustainable Tele-healthcare system that utilizes the mobile platform to

3 extend Tele-healthcare services in rural Mardan. This includes Short Messaging Service (SMS) and Multimedia Messaging Service (MMS). The system was developed using open source technologies such as Kannel and Mbuni. It is one of the most vital objectives of our project as we will be providing training to LHWs by unleashing the opportunities provided by mobile platform. As mentioned in our proposal that large population in Pakistan uses mobile and providing services through mobile is one of the best ways to reach to public in order to create health awareness. Following SMS based mobile services based mobile services are implemented: 1. Patient Registration in Jaroka Tele-Healthcare system (Jaroka System) 2. Submitting patient medical problems or conditions to the System 3. Assessment and plan of a patient 4. Definition of different diseases 5. Symptoms of different diseases 6. Registering a newly born or a baby for the vaccination alerts 7. Broadcast SMS from Jaroka System Following MMS based mobile services has been developed : 1. Patient Image Sending from Jaroka system to a mobile phone on request 2. Video sending using MMS from Jaroka System o the mobile phone upon request We have tested all of these services at the facility and they are continuously being evolved with the feedback from team. We are working on replicating the services at Love a Child (Haiti) and Meerabagwal (Pakistan) in coming months. Plz find the Jaroka System SMS Manual in Annex. Collaboration between APPNA, NUST-SEECS and UM-Healthcare Trust In order to foster the collaboration and exchange the knowledge about health issues and Tele healthcare, Ms Shamila keyani, Atif Mumtaz and Dr.Qasim attended 32nd APPNA Annual meeting. The five-day APPNA meeting was held at Downtown San Francisco from 1st July- 5th July Our team had an opportunity to present our Tele-healthcare project and comprehensively explained the uniqueness and innovation provided by the project in healthcare domain. APPNA is currently serving as one of our partner and is helping us in providing consultancy services and medical advices. APPNA has assisted us to sign MOU with Houston Shifa Services Foundation (HSSF). Volunteer doctors at HSSF shall help us in diagnosing the complex medical cases. Free Medical Camps UM-Healthcare Trust in collaboration with APPNA, NUST-SEECS and other NGOs organized various free medical camps in May and June Around thousands of patients and IDPs visited the facility and were provided with free medicine, treatments and expert

4 advice. It is to emphasize that UM-Healthcare Trust was the only facility active in supporting IDPs in the area of Rustum. Capacity building of Medical Doctor/Staff In order to exchange the knowledge and polish the skills of staff, regular training sessions for the staff and medical doctors are organized. Our Medical doctor, Dr.Qasim was sent to USA for two months training (July-September) in the field of Tele-healthcare. Our doctors are being trained to use ultrasound machines and other important test equipments (purchase under the funding of USAID) so that patients can get affordable medical tests right at the facility and the images/video files can easily be shared with doctors in USA via OpenEMR system. Regular trainings of Network administrator are conducted in order to have update Information and communication technology infrastructure at the facility. We strongly believe that involvement and training of local community is of utmost importance. In order to equip local community with basic knowledge a Basic Life Support (BLS) training session was organized by UM-Trust, NUST-SEECS,APPNA and Comprehensive Disaster Response Services (CDRS). The participants were from various background including medical staff, LHWs, students and professionals. The purpose was to recognize emergency procedure performed to sustain life that includes cardiopulmonary resuscitation, control of bleeding, treatment of shock, stabilization of injuries and wounds, and first aid. Capacity Building of LHWs This module requires some extra time and hence we request an extension for it. We require strong coordination from government health agencies in order to execute the training but due to the IDPs crisis the maximum LHWs were occupied to meet the emergency requirement. Hence the training has to be shifted in March. Currently our team is working in close collaboration with health agencies to formulate LHWs training material and curriculum. We are still in progress for this module and hopefully the training of LHWs will be carried out by mid of this month. We aim to train 50 LHWs. At UM-Healthcare Trust we have two female nurses who are also certified LHWs. They regularly use our SMS/MMS services to register and treat the patients. Their positive feedback is extremely helpful in making the system better and to design the curriculum for LHWs. Educational Impacts: Please provide information on the numbers of students and other junior collaborators (graduate and undergraduate students, healthcare workers, laboratory technicians, data collectors, etc.) involved in the projects, and discuss new courses or degree programs created (if any) or changes to existing course curricula as a result of your project. Regular capacity building trainings for Research Assistants (2), Network administrator (1)and Doctors (2) were held during the course.

5 Project Infrastructure Development: Project Design: Our project consists of five major modules in terms of implementation: 1) Electronic Management of records 2) Mobile Services (SMS/MMS) 3) Sharing the patient medical records with APPNA doctors for expert advice. 4) Capacity building of LHWs 5) Health Grid Module Fig 1: Model of Jaroka project and its modules-source Jaroka Tele-Healthcare

6 Technologies Implemented: Electronic Health Record System (OpenEMR) (Module 1) Customized version of OpenEMR is successfully developed in Open Source is deployed at UM-Healthcare Trust Mardan. SMS/MMS Module: (Module 2) Kannel is used as an SMS gateway for implementing SMS services used in the Jaroka Telehealthcare project. It is installed on our Jaroka computing server and a GSM modem is connected to the server. The GSM modem receives SMS messages from Lady Health workers (LHWs) requesting different SMS services and passes the SMS requests to Kannel, which triggers our web based application. The web based application then processes the requests and forwards the requested information to Lady Health worker (LHW). For instance, when a LHW registers a patient using our SMS based registration service; it sends an SMS with a particular format GSM modem. The GSM modem receives the SMS, passes it onto Kannel and in turn to the web based application. The web based application parses the SMS, retrieves the particulars of the patient from the SMS and stores the patient record to our patient database. The web based application then sends a reply SMS which contains the patient ID assigned to the patient by the Jaroka Tele-healthcare system, from now on referred to as Jaroka system, to the LHW. The LHW keeps track of the patient using the replied patient ID from the system. When the patient is registered, a Doctor present in the hospital facility can view the patient using the Jaroka system. It can see the patient, his/her medical problems, diagnoses the disease and then prescribes the medication needed. When the doctor has entered the prescription into the Jaroka system, the system automatically sends a notification about the medical prescription and dosage information to the LHW, who registered the patient. Following SMS based mobile services have been implemented and being tested. Patient Registration in Jaroka Tele-Healthcare system (Jaroka System) Submitting patient medical problems or conditions to the System Assessment and plan of a patient Definition of different diseases Symptoms of different diseases Registering a newly born or a baby for the vaccination alerts Broadcast SMS from Jaroka System Mbuni MMS gateway is configured to provide MMS based services in Jaroka System. The Lady Health Workers (LHWs) send requests to the Jaroka System via SMS to retrieves training videos, healthcare related videos, images of patients and other diagnostic materials like x-rays ECGs etc. This service not only helps the LHWs but doctors, clinicians and specialists to retrieve patient s uploaded videos and other diagnostic related images.

7 Publications: Following are the publications and Technical reports published for the project: Affordable and Accessible Tele-healthcare to rural areas of Pakistan through web and mobile based technologies, presented at High Capacity Optical Networks and Enabling Technologies (HONET 2009) at Parosh University Egypt. (Paper is submitted for IEEE publication). "Diseases surveillance in rural Mardan", Dr. Asif Sardar and Mr. Atif Mumtaz. Tele-Healthcare Model for rural Pakistan, Presented at APPNA U.S.A platform by Dr.Qasim Nasar and Atif Mumtaz. Conferences to attend : Mr.Atif Mumtaz is likely to attend the following two conferences: 7th International Conference on E-Governance at IIM-B, on April 22-24, 2010 International Conference on Information and Communication Technologies and Development (ICT4D) at Royal Holloway, University of London on 13th-16 th December Ms. Shamila will be attending the following conference: Women Deliver 2010, Washington DC (U.S.A) from June 5 th to 9 th. Additional Funding: Currently our project is being sponsored by two major funding bodies namely, ISIF ASIA and USAID. To make our project sustainable we charge minimal free (Pak Rupee 30=0.40 cents) from our patients who can afford to pay. This amount helps to cover the operational cost for the project. With the strong credibility of UM-Healthcare Trust and innovation in project, we are attracting more patients to hospital. Soon we will be starting the medical test including ultrasound tests at our facility. These tests will cost some money (inexpensive as compared to other private hospitals) which will also help the project to be sustainable after the project duration is complete. Linkages with Government or Private Industry: Partnerships and their role in achieving project objectives APPNA: APPNA provides the expert medical advice and opinions for the medical cases over the Internet to treat patients. They are also helping the project by arranging the training sessions and free medical camps. With due guidance and support from APPNA platform Dr.Qasim (serving at UM-Healthcare Trust) had an opportunity to get tele-healthcare and other medical related training from U.S.A.

8 NUST-SEECS: This institute is providing all the research and development support in order to implement the project. The development in terms of technologies so far is carried out in High Performance Computing lab (HPC) in NUST-SEECS. The students and the faculty of NUST-SEECS have voluntarily participated in arranging the free medical camps, training of the staff and IDPs crisis. UM-Healthcare Trust: The project is physically implemented in UM-Healthcare Trust, Mardan. Till date we have treated 50,000 plus patients including IDPs and conducted free medical camps. Problems Encountered: Delay in Training Module The Lady Health workers module needs an extension and has been shifted to the month of March. Due to the IDPs crisis our team and the government of Pakistan was busy in providing the assistance and support in healthcare services. We are in process of developing the manuals and training kits for the LHWS. Delay in Equipment purchasing Due to the long term procedural methods for purchasing of equipment, we have faced the problem of delay in the equipments being made available. We have requested the higher authorities to speed the process up at the delay in equipment purchasing process is causing problems for doctors working our Facility. Plans for Activities During the Coming Year: Following points explain the impact of the project to date and for future: Affordable and accessible healthcare to under-served (surviving on less than $1 a day earning) community. It is worth mentioning that Mardan has the maternal and infant mortality rate higher than the national average. Innovative solution (SMS/MMS and OpenEMR) for the resource deprived rural areas of Pakistan where there is hardly any doctor or medical facility. First time the rural community in this area has a reach to doctors in U.S.A. With the help of regular data and statistics, the diseases are being tracked and relevant preventive measures are taken. Collaboration with APPNA, UM-Trust, NUST, and many other non-profit organizations.

9 Value added to existing mobile technology infrastructure. Employment opportunities generated. Volunteering opportunities generated under this project (e.g. medical camps and IDPs assistance) With the help of Health Grid, Healthcare professionals and other stake holder can easily visualize the information with respect to gender, area, age etc. This module is expected to bring revolution in the area of health-care in Pakistan. For example, through this module diseases like chronic disease can be traced back to the origin. Empowerment of women. Through this project we are reaching and educating the women who have seen the doctors and medical facilities first time in their life. Awareness to women on hygienic and contraceptive issues. Involvement and cooperation of local community to this project. Opportunities generated for team members of the project (e.g doctor training from U.S.A,, conference attended, workshops attended, fellowships and essay competition won by team members) Supplementary Information: Awards and Achievements Along with all the technological achievements, our project and team members won following awards and fellowships ITU Cyber-security and ICT Application Essay Competition Internship Program- Ms.Hina Mushtaq Paragon Asia 100 Fellow- Foundation of Youth Social Entrepreneurship (FYSE)- Ms.Shamila Keyani Atlas Service Corps Fellowship (U.S.A) Shamila Keyani Scholarship to Attend Women Deliver 2010 U.S.A Shamila Keyani Indicators Reporting Period: 1. Number of higher education partnerships between Pakistani and U.S. institutions (see note below) 2. Number of journal articles, technical reports, books, or book chapters (published or accepted for publication) 1 2 research papers, 4 technical reports,

10 resulting from your project during the reporting period 12 Monthly Progress Reports 3. Number conference presentations resulting from your 2 project during the reporting period 4. Number of training events (courses, workshops, seminars, 6 conferences, stakeholders meetings) conducted on your project during the reporting period 5. Total number of Pakistanis making exchange visits on 3 your project during the reporting period Number of women 1 Number of men 2 6. Total number of Americans making exchange visits on 2 your project during the reporting period Number of women - Number of men 2 7. Total number of exchange visits overall during the 4 reporting period 8. Total number of Pakistani PhD students involved in the N/A project Number of women Number of men 9. Total number of American PhD students involved in the N/A project Number of women Number of men 10. Total number of all other Pakistanis not listed above who participated in your project during the reporting period 20 students (Include in this total those who were involved as researchers, MS or undergraduate students, technicians, or data collectors, as well as those who received formal training in workshops or courses or participated in conferences or stakeholders meetings organized as part of the project.) Number of women 7 Number of men Total number of all other Americans not listed above who - participated in your project during the reporting period (Include in this total those who were involved as researchers, MS or undergraduate students, technicians, or data collectors, as well as those who received formal training in workshops or courses or participated in conferences or stakeholders meetings organized as part of the project.) Number of women - Number of men - Note on Question 1: For the number of higher education partnerships, please count the partnership between your institution and your Pakistani counterpart s institution as one. If your project also involves collaboration with other Pakistani institutions / US institutions (universities, research institutes, government agencies, or non-governmental organizations), please add each such additional institution to your total.