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Potential of indigenously developed Telemedicine using Internet
- Local Solutions with Global Potential
Prof K Siddique-e RabbaniDepartment of Biomedical Physics & Technology
University of Dhaka Bangladesh
www.bmpt.du.ac.bd
Keynote lecture, bdNOG5, 11 April 2016
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What is Telemedicine? – medicine at a distance
Through a medium that connects patients in one location to doctors in another location. Doctor provides prescription through the connectivity medium
DoctorPatientHealth
Operator
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Telemedicine -History
Soon after its invention Telephone allowed tele-consultation with doctors.
The term ‘Telemedicine’ – coined in 1970s.
Modern ICT has increased the potential of Telemedicine widely
o Telephoneo Radioo Televisiono Mobile Telephoneo Internet
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Telemedicine –Iconic picture
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Telemedicine – in the West -1 Specialised consultation (even from a hospital)
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Telemedicine – in the West -2 Home patient care (for the aged)
o Using mobile unito Auto detection in normal
daily life Detectors in bed,
chairs, toilet seats, clothings
Auto alarm to nearest
healthcare centre
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Telemedicine in Low Resource Countries – a different perspective
• About 70% of total population lives in rural areas
• Country average: 3.6 doctors for 10,000 people
• Much much less in rural areas
In the West very few live in villages
Example: Healthcare scenario in rural Bangladesh
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1. District Hospitals: 642. Semi-rural (Upazilla) Health Complexes:
400 (Hospitals with X-ray, Pathology and other facilities).
3. 4000 Outpatient facilities with GPs (union based)
4. Rural (Ward) Community Clinics: 11,000 with 3 month trained med assistants, a few have midwifery.
Bangladesh: Govt Infrastructure
Govt finds it very difficult to retain specialist doctors in (1) and GPs at (2). Situation likely to continue for many years – depends on socio economic conditions
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Overall status of healthcare in rural Bangladesh• Most rural people consult village doctors or quacks or
pharmacists with little or no formal education or trainingo Leads to maltreatmento Abuse of drugs, antibiotics
• For emergencies – people go to hospitals – expensive, difficult logistics
• Females, children, old, disabled – mostly go without treatment at all.
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Solution ? - Telemedicine
Internet
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Telemedicine – in the Low Resource countries
FeverHeadacheAbdominal
painDiarrhoeaRespiratory
problemsEye & Ear
problemsEarly heart
problemsEarly
obstetrics & Gynecological problems
Pain at joints Skin problemsEarly DiabetesEtc…..
Primary and Secondary Healthcare- cover majority of medical problems
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Telemedicine – in the Low Resource countries
Limitations of Telemedicine: No emergencies, no surgical interventions
Patients need to know if specialised attention or hospitalisation is required or not.
Alternative: Go to a hospital in the town and find out – spending money, time of patient and attendant, logistics, harassment in overloaded hospitals
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Opportunity for TelemedicineInternet and mobile phone networks cover almost the whole of Bangladesh. Telemedicine can use both these media effectively.
Mobile phone coverage
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Dimensions of Telemedicine Audio Audio + Visual (Video conference) + diagnostic measurements
(Ultrasound scan, ECG, ear, eye images, stethoscope sounds, skin images, etc.)
Live and/or Store & forward
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How many rural TM centres do we need in Bangladesh? 4500 unions: population av: 250,000 11000 community clinics: population av: 10,000
At least 4500 telemedicine centres needed ( better 11000)
Considerations: Cost Suitability to our weather and power line Servicing and repair
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If foreign equipment used, situation?
Very expensive to procure Fails frequently under our weather and power line conditions Repair unrealistic, cost prohibitive
(purchasing a new one is more cost effective than repairing) Waste of resources
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If foreign equipment used, situation?Example:
Donated Medical equipment in low resource countries 70% are not in use – either out of order, or not appropriate Waste initial transfer and installation costs, hospital space
when dumped (cannot throw out, nor can use)(Bill Gentles, University of Toronto, Canada, at World Congress of Medical
Physics & Biomedical Engineering, 2015)
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If indigenously developed Lower cost Can be designed to suit local weather and power line
conditions at little extra cost User interface can be designed to suit local language, culture
and practices Repair ensured at low cost (local expertise, availability of
spares) Long usable life (decades) Saving of scarce resources
Desirable for deployment in large numbers
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Our efforts at Dhaka university, since 2010Dept of Biomedical Physics & Technology [BMPT-DU] with its background in the dept of Physics
Experience in design & development of IT enabled (computerised) medical equipment since 1986.
1988 2000 2014
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Our efforts at Dhaka university, since 2010Dept of Biomedical Physics & Technology [BMPT-DU] with its background in the dept of Physics
Learnt in 2010 - internet with video links in 400 Upazilla Health Complexes
Initiated the effort towards developing a PC based telemedicine system that uses internet.
Why PC?A PC gives a greater capability of data capture. Most rural centres can have PC. Besides we had more experience with a PC.
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Telemedicine through rural centres
Internet
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‘Dhaka University Telemedicine Programme’ Address: www.telemedbd.net
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Basic Telemedicine Network
CLOUDServer
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Initial development of devices for Telemedicine, PC based
• ECG, 12 lead, full diagnostic
• Stethoscope
• Lungs ventilation monitor / Respiration Monitor
• Improvised Microscope
• Multipurpose imaging camera on flexible stand (for
X-Ray film, Skin images, old reports)
• Digital Colposcope (for cervical cancer
investigation)
• Palpation (conceptual innovation - ours)
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Basic equipment – commercially available ones- manually typed in results
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Basic Scheme of the System at Rural Telemedicine Centres
Loca
l PC
Digital Stethoscope
Digital Microscope
Digital X-ray viewer
Digital Colposcope
Digital ECG, 12 lead
Sound input jack of PC
USB port of PC
USB port of PC
USB port of PC
USB port of PC
Display
Report generation
Audio system with extra bass sensitivity
Archiving and printing
Typed data entry through PC keyboard
Earphone with extra bass sensitivity
Internet link
Video conferencing link
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Basic Scheme of the System at the Doctor’s end
Loca
l PC
Display
Report generation
Audio system with extra bass sensitivity
Data Base, Archiving and printing
Earphone with extra bass sensitivity
Internet link
Video conferencing link
Typed data entry through PC keyboard
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Computerised ECG, our own design Single Channel, 12 lead: for telemedicine, or for stand-alone use
Hand crafted aluminium cabinet Hand crafted Leather bag for Tablet model Compact size
Branded:BANGLAMED
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BANGLAMED ECG allows live data transmission through internet
Internet
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Combined ECG traces. May be sent to Cardiologist via website or email
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Certification for ECG equipmentObtained through DG Health, Bangladesh Govt.
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PC based Stethoscope
Microphone connected to stethoscope head Needs low frequency response for heart & lung
sounds (30Hz to 2kHz) Live transmission of sound desired
Problem: Skype or Google talk do not
provide the low frequency response needed
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Stethoscope – our solution: store & forward
Use ‘Skype’ first. Doctor guides operator to position the stethoscope head properly
Then use ‘Audacity’ to record 5 to 10 seconds of data and save file.
Send file through Skype
Doctor listens to recorded sound, of good quality
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Multipurpose Imaging camera with flexible arm
2 Mpixel camera, Carl Zeiss Glass Lens, software zoom
Possible use:1. Patient’s
appearance2. Dermatology3. Film X-Ray digitiser4. Ultrasound scan
image grabbing5. Written record
digitiser (scanning)
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Improvised Digital Microscope
Much cheaper than imported ones.
Good quality camera, 2MPixel, glass lens,
video and sound
Good for teaching schools,
medical college
Rural health centre has technicians, but not
pathologists
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Electrical Impedance based (our indigenous design)
Focused Impedance Method (FIM - our innovation)
Localised Lungs Ventilation & Respiration rate monitor
VI
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Localised Lungs ventilation & Respiration Rate Monitor using Electrical Impedance
0.0 0.5 1.0 1.5 2.0 2.5 3.00 30 60 90 120 150 180
Frequency, HzRate per min
FFT
Ampl
itude
Time, Sec Am
plitu
de
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Challenge: baby should not cry!!
Pneumonia detection in children Needs accurate respiration rate
We innovated a soft palm-worn electrode.Mother wears it and places on child’s thorax.Result - Success ! Babies did not cry!!
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Digital Colposcope for detection of Cervical Cancer
Improvised from a binocular
Digital Image of cervix taken using this Colposcope
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Prescription generation
With database for medicines, advices, etc.
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Dhaka University Telemedicine Programme
Chronology:2010-12: R&D started, few equipment made
2013: Field trial (through an NGO)
2015: Support by A2I, success of field trial
2015: Permission from DG Health for DU
2015: DU approves use of its name
2015: Grant from ISIF-Asia to develop a mobile phone based system
2016 (April): 9 rural centres running
2016: Monthly patient: 500 (av)
2017: reach out to other countries
Organised by Dept of Biomedical Physics & Technology
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Affordable Sustained (repair and maintenance is ensured) User friendly (designed to suit local customs,
culture and psychological traits)
Telemedicine using homegrown technology
If we can install these for all 4500 unions, it will bring a revolution in healthcare in the rural areas.
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Dissemination (Field Trial)Challenges:• Technical
(Bandwidth – video conferencing, Ultrasound image streaming)
• Self sustaining model• Doctor/operator – training, quality• Marketing (competing threats)• Monitoring
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Rural Healthcare through Telemedicine
Financial Support by
Farm Fresh (initial, in 2011)
Beximco Pharma (2014-16)
A2I (PMO-GOB) (2015)
ISIF-Asia (Australia based) (2015-16)
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Sky is the limit
…… Thank You