Amrita Mobile Health Solution - A mobile healthcare solution for rural India

ABSTRACT
People in rural areas face some different health issues than people who live in towns and cities. Getting health care can be a problem when you live in a remote area. You might not be able to get to a hospital quickly in an emergency. You also might not want to travel long distances to get routine checkups and screenings. Rural areas often have fewer doctors and dentists, and certain specialists might not be available at all. Nearly 70% of all deaths, and 92% of deaths from communicable diseases, occurred among the poorest 20% of the population. Because it can be hard to get care, health problems in rural residents may be more serious by the time they are diagnosed. This research work aims to improve the health care facilities in the rural areas. It also aims at providing improved information and communication facilities between the health care officials and the rural population via various android applications. A mobile application has been developed which will help us monitor our blood pressure, sugar level, medicine intake pattern, provide us with proper notification at the time of medicine intake and assist in location based tracking of epidemics. A dedicated server program has been developed which will help medical officers to identify the possible candidate for a particular disease, send notifications and inform users at the time of vaccination schedule.

CONTENTS
List of figures.... i

List of tables.. ........ ... ii

Chapter 1

Introduction 1.1 Overview.... 1.2 Scope of the project 01 03

Chapter 2

Related Works

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Chapter 3

Amrita Mobile Health Solution 3.1 Overview.. 3.2 System Architecture. 3.3 Operating environment 07 10 11

Chapter 4

System Design 4.1 Logical Design. . . 4.2 Physical Design.... 4.3 Database Design. 14 17 20

4.3.1 Server side tables.. 21 4.3.2 Client side tables . 22

Chapter 5

Advantages of the System

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Chapter 6

Applicability of the System

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Chapter 7

Future enhancements

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Chapter 8

Conclusion

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References

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LIST OF FIGURES

1.1 Health infrastructure versus population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 1. 2 Access to physicians. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...2

3.1 System architecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

4.1 Context diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 4.2 Level 0 DFD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 4.3 Level 0 DFD - Server . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4.4 Level 0DFD - Server. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 4.5 Level 1 DFD - User. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 4.6 Consultational advice . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . .17 4.7 Monitoring medication pattern. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 4.8 Location based tracking of epidemics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 4.9 Personal details. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 4.10 Medical details. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 19 4.11 Childcare and notification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

LIST OF TABLES

1.1 Percentage of villages with access to various healthcares. . . . . . . . . . . . . . . . . . . . 2 1. 2 National Immunization Schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...2

CHAPTER 1 INTRODUCTION

1.1 Overview
India is the second most populous country of the world and has changing socio-political demographic and morbidity patterns that have been drawing global attention in recent years. Despite several growths orientated policies adopted by the government, the widening economic, regional and gender disparities are posing challenges for the health sector. About 75% of health infrastructure, medical man power and other health resources are concentrated in urban areas where 27% of the population lives. Contagious, infectious and waterborne diseases such as diarrhea, amoebiasis, typhoid, infectious hepatitis, worm infestations, measles, malaria, tuberculosis, whooping cough, respiratory infections, pneumonia and reproductive tract infections dominate the morbidity pattern, especially in rural areas. However, non-communicable diseases such as cancer, blindness, mental illness, hypertension, diabetes, HIV/AIDS, accidents and injuries are also on the rise. The health status of Indians, is still a cause for grave concern, especially that of the rural population. This is reflected in the life expectancy (63 years), infant mortality rate (80/1000 live births), maternal mortality rate (438/100 000 live births); however, over a period of time some progress has been made. To improve the prevailing situation, the problem of rural health is to be addressed both at macro (national and state) and micro (district and regional) levels. This is to be done in a holistic way, with a genuine effort to bring the poorest of the population to the centre of the fiscal policies. A paradigm shift from the current biomedical model to a sociocultural model, which should bridge the gaps and improve quality of rural life, is the current need. It is unfortunate that while the incidence of all diseases are twice higher in rural than in urban areas, the rural people are denied access to proper health care, as the systems and structures were built up mainly to serve the better off. While the
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urban middle class in India have ready access to health services that compare with the best in the world, even minimum health facilities are not available to at least 135 million of rural and tribal people, and wherever services are provided, they are inferior.

TABLE 1.1 Percentage Villages with Access to various Health Care FACILITIES ROUND THE YEAR (ACCESS BY TYPE OF FACILITY) Infrastructure/Services % Villages PHC Sub-centre Govt. Dispensary Govt. Hospital
Private Clinic Private Hospital
62.7 76.7

68.3 43.2 67.9 79.0

The basic nature of rural health problems is attributed also to lack of health literature and health consciousness, poor maternal and child health services and occupational hazards. The majority of rural deaths, which are preventable, are due to infections and communicable, parasitic and respiratory diseases. Infectious diseases dominate the morbidity pattern in rural areas (40% rural: 23.5% urban). Waterborne infections, which account for about 80% of sickness in India, make every fourth person dying of such diseases in the world, an Indian. Annually, 1.5 million deaths and loss of 73 million workdays are attributed to waterborne diseases. To improve the prevailing situation, the problem of rural health needs to be addressed in a very efficient manner. This research work focuses on this aspect [1][2][3].
Source: RCHS Round II, 2004.

1.2 Scope of the project

This research work aims to improve the health care facilities in the rural areas. It also aims at providing improved information and communication facilities between the health care officials and the rural population. This research work focuses on various aspects of health care facilities and it can be broadly classified into two areas: a) Personal health care b) Primary health care

The personal healthcare aspect focuses on the following areas: Consultational advice Reminders for medicine patterns Monitoring medication of elders Monitoring daily lifestyle

The primary healthcare aspect focuses on the following areas: Child and maternal care Early learning of outburst of epidemics Location based tracking of epidemics Identifying possible candidate for a particular disease Statistics and surveys

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CHAPTER 2 RELATED WORKS

Some firms have started using mobile technologies and smart networks to improve the quality of care, reduce costs, and contribute to a healthier world. American Telephone and Telegraph Company [AT&T]'s mHealth Solutions are a new set of IT solutions for healthcare that combine mobility technologies, devices, connectivity and applications to help drive down medical costs and deliver improved patient outcomes. AT&T Managed Tablets is a highly-secure, end-to-end management solution bundling software and services with certain tablets that is easy to purchase and deploy. AT&T mHealth Solutions presents DiabetesManager is an initiative between AT&T and WellDoc, which combines the DiabetesManager application and feedback engine with AT&T's highlysecure hosting environment, support and customer care [12].

Another venture is ashametrics which provides mobile health solutions and tools for a healthier life. Ashametrics enables patients and clinicians the ability to collect physiological data on a mobile phone and upload it to a medical record database. Ashametrics LifeBands are soft wearable textile bands that measure physiology and transmit data wirelessly to a mobile phone or nearby PC. Lifebands can also be used to record/log data internally and downloaded later via Bluetooth or USB. The AshaView software enables real-time monitoring and recording of physiological data. The mobile application supports simple plotting, real-time annotation, and the ability to configure all the settings on the Ashametrics LifeBands (such as sampling rate, date/time,and patient ID). Up to seven sensor bands can be connected simultaneously. Data can be downloaded to a PC via USB for post-processing. The basic version of the AshaView mobile application is available for FREE in the Andoid Market [15].

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CellTrust Corporation has created a secure mobile healthcare solution that turns the standard SMS into a powerful HIPAA-compliant tool. This enables healthcare organizations and vendors to communicate patient data via secure text messaging to clinicians and patients mobile device [11].

Grand Challenges Canada is a unique and independent non-profit organization dedicated to improve the health of people in developing countries. In rural Bangladesh most women do not seek care for breast cancer until it is too late and Grand Challenges will develop and test novel mobile phone tools for female Community Health Workers (CHWs) to case-find, refer, and encourage women to attend the breast centre; CHWs will learn new marketable skills which will make the system sustainable [13].

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CHAPTER 3 AMRITA MOBILE HEALTH SOLUTION

3.1 Overview
Amrita Mobile Health Solution [AMHS] focuses on two main aspects of healthcare, personal healthcare and primary healthcare. The personal healthcare aspect focuses on the following areas: a) Consultational advice the user will be provided with an interface in his mobile in which he can enter the readings of pressure and sugar level and it will be stored in the users database. If a similar pattern of information is entered for 3 or more days, then the mobile can show a message indicating whether to consult the doctor or whether his values are normal or not. Here the mobile will be acting as a knowledge base. b) Reminders for medicine patterns Alarms can be set on the time when the medicine has to be taken. It will display which medicine has to be taken and also its dosage. c) Monitoring medication of elders An UI can be created in which the user has to tap the button after he had taken a particular medicine. It can be set as on tapping the button the information that he had taken a particular medicine will be sent to the intended person and also the information will be stored in the users database. d) Monitoring daily lifestyle It focus on recording the persons pressure and sugar level, intake of medicines etc on a daily basis and by analyzing these data the medical officer can monitor the lifestyle of the person and can advice on improvements if needed.
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The primary healthcare aspect focuses on the following areas: a) Child and maternal care It focuses on maternal and childcare. Our main focus is to help prevent various diseases like tuberculosis, diphtheria, pertusis, tetanus, polio and measles in children by timely alerting the parents about the date and time of vaccination via mobile. The information whether the vaccine has been given or not will be recorded in the users as well as healthcare offices database so that it can prove useful in future. It also focuses on maternal care. The details regarding the pregnant women will be stored in the healthcare offices database and they will be alerted regarding the various injections and vaccines to be taken during the maternity period.

Age Birth 6 weeks

TABLE 1.2 NATIONAL IMMUNIZATION SCHEDULE Vaccines BCG, OPV0 DTwP1, OPV1, Hep B1$, Hib1$ (BCG if not given at birth)

10 weeks

DTwP2, OPV2, Hep B2, Hib2 DTwP3, OPV3, HepB3, Hib3 Measles DTwP B1, OPV4, MMR$ DT TT TT TT1 (early in pregnancy) TT2 (1 month later) TT booster (if vaccinated in past 3 years)

14 weeks 9-12 months 16-24 months 5-6 years 10 years 16 years Pregnant women

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$HepB,

MMR and Hib are available in some districts only

b) Early learning of outburst of epidemics By monitoring the data received from the people, the medical officer can detect the outburst of any epidemics at a very early stage. c) Location based tracking of epidemics By monitoring the data received from the people, the medical officer can find out in which area a particular disease is getting spread. d) Identifying possible candidate for a particular disease By monitoring the lifestyle of a person the medical officer can detect the chances of any disease in future. e) Awareness messages This module provides with the message sending facility to all the registered users informing them about medical camps, health tips and other health care related information. The server side focuses on patients personal details as well as medical history. It focuses on the following aspects: a) Patient registration b) Record updating c) Record deletion d) Information retrieval e) Report generation

The server also receives all the medical information sent from various users via android mobiles and stores them in the database for future references. It is the server that calculates the dates based on immunization schedule and sends SMS to the intended persons mobile informing them about the date of vaccination.

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3.2 System Architecture

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3.3 Operating Environment

The Amrita Mobile Health Solution is developed using the latest mobile technology android. Android is a free, open source mobile platform. It includes operating system, middleware and key applications. It is developed by Google and Open Handset Alliance in 2007. Android is built on the open Linux Kernel. Furthermore, it utilizes a custom virtual machine that has been designed to optimize memory and hardware resources in a mobile environment. Android is an open source; it can be liberally extended to incorporate new cutting edge technologies as they emerge. The platform will continue to evolve as the developer community works together to build innovative mobile applications. The various characteristics of android are: Data transmission using Wi-Fi, GSM, EDGE, CDMA, EV-DO and UMTS. It has a rich set of libraries for audio, video and image files. Dalvik Virtual Machine SQ-Lite for data storage. IPC message passing facilities. Integrated browser Comprehensive libraries for 2D and 3D graphics. Have features for video camera, touch screens, GPS etc.

The advantages of android include: Its an open platform. This means that its code is available for people We can switch from one application to another with minimal changes. Android allows third parties to make applications for the phone that can be installed by anyone. An Android phone is guaranteed to work with Google products. to look at.

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 Android platform will work on notebook and computers. This means that you could have device that share the same platform giving you the ability to purchase applications that will work on all devices. Multitasking Android gives better notification. Application freedom is guaranteed. Android allows customization of home page and use of widgets.

To develop android applications the following software needs to be installed on our system: Java Development Kit [ JDK] A compatible Java IDE [ Eclipse] Android SDK tools and documentation Android Development Tools[ ADT] plug-in for Eclipse

The healthcare office system i.e., the server is coded using the popular programming language java. Java is a general-purpose, concurrent, class-based, object-oriented language that is specifically designed to have as few implementation dependencies as possible. It is intended to let application developers "write once, run anywhere" (WORA), meaning that code that runs on one platform does not need to be recompiled to run on another. Java is currently one of the most popular programming languages in use, particularly for client-server web applications.

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To send and receive SMS text messages to cell phones from a JAVA application the Ozeki JAVA SMS SDK is used. It was designed to be used in JAVA applications that have a GUI or that operate as a background service. The SMS technology was created to provide an infrastructure for the transportation of short messages containing a maximum of 140 bytes (8 bit objects) of useful data in mobile telecommunication networks. The transportation is done in the GSM signaling path in traditional GSM networks, and as GPRS packets in GPRS networks. Messages are composed using the PDU specification. An SMS is a binary string containing all the necessary information to form the message header needed for transportation and the message body containing the payload. The basic addressing scheme of SMS messages are mobile telephone numbers called MSISDN. Ozeki has released the Java SMS SDK to add SMS functionality to JAVA applications in a very efficient way. This SDK communicates with the Ozeki NG SMS Gateway, through a TCP/IP socket. The socket is always connected, which makes it possible, to receive SMS delivery reports and incoming SMS messages instantly. The Ozeki Java SMS SDK implements the TCP/IP communication and provides methods calls and events you can implement to achieve the desired functionality. Using this SDK very fast and efficient SMS solutions can be developed. To be able to use this SDK, you need to install Ozeki NG SMS Gateway into your corporate network. Ozeki NG SMS Gateway will be responsible for attaching your system to the mobile network. It will receive the TCP/IP connections from the JAVA SMS SDK and it well send and receive SMS messages through the configured communication method [14].

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CHAPTER 4 SYSTEM DESIGN

The system design is to deliver the requirements as specified in the feasibility report. The main objectives of the design are practicality, efficiency, cost, flexibility and security. The system design contains logical design and physical design.

4.1 Logical design

The logical design of a system pertains to an abstract representation of the data flows, input and output of the system. This is often conducted via modeling which involves a simplistic representation of an actual system. Here modeling is done using Data Flow Diagram [DFD]. DFD is a hierarchical graphical model of the system that shows the different processing activities or the functions that the system performs and the data interchange between these functions. The DFD which is the top level view of the Information System is called context diagram [16].

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4.2 Physical design

The physical design relates to the actual input and output processes of the system. This is laid down in terms of how data is inputted into the system, how it is verified/authenticated, how it is processed, how it is displayed as output [16].

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4.3 Database design

A database is a set of logically related files organized to facilitate access by one or more application programs and to minimize data redundancy. The most important aspect of building an application is the design of tables or the database schema. The overall objective in the process of table design has been to treat data as an organizational resource and as an integrated whole [16].

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4.3.1 Server side tables

TABLE 1: VACCINEDETAILS FIELD ID USERID OPV1 OPV2 OPV3 MEASLES OPV4 DT TT1 TT2 DESCRIPTION Automatically generated Unique id of the user 1st vaccination date 2nd vaccination date 3rd vaccination date 4th vaccination date 5th vaccination date 6th vaccination date 7th vaccination date 8th vaccination date DATA TYPE INTEGER TEXT TEXT TEXT TEXT TEXT TEXT TEXT TEXT TEXT

TABLE 2: MEDICALDETAILS FIELD PID PNAME MEDIDATA DESCRIPTION Unique id of the user Name of the user Medical data DATA TYPE INTEGER TEXT TEXT

TABLE 3: PERSONALDETAILS FIELD PID PNAME AGE SEX ADDRESS PHONE DESCRIPTION Unique id of the user Name of the user Age of the user Sex of the user Address of the user Mobile number of the user DATA TYPE INTEGER TEXT TEXT TEXT TEXT INTEGER

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TABLE 4: MEDINTAKEDETLS FIELD ID USERID DAY MEDICINE INTAKESTATUS DESCRIPTION Automatically generated Unique id of the user Current date Name of the medicine Medicine intake status DATA TYPE INTEGER TEXT TEXT TEXT TEXT

TABLE 5: SYMPTOMS FIELD ID USERID SYMPTOM LOCATION DATE DESCRIPTION Automatically generated Unique id of the user Symptoms shown by the ser GPS data Current date DATA TYPE INTEGER TEXT TEXT TEXT TEXT

4.3.1 Client side tables

TABLE 1: PRESSUREDATA FIELD _ID USERID PRESSURE DATE DESCRIPTION Automatically generated Unique id of the user Pressure level of the user Current date DATA TYPE INTEGER TEXT TEXT TEXT

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TABLE 2: SUGARDATA FIELD ID USERID SUGARLEVEL DATE DESCRIPTION Automatically generated Unique id of the user Sugar level of the user Current date DATA TYPE INTEGER TEXT TEXT TEXT

TABLE 3: MEDICINEDETAILS FIELD _ID MEDICINE DOSAGE TIME DESCRIPTION Automatically generated Name of the medicine Dosage pattern Time to take the medicine DATA TYPE INTEGER TEXT TEXT TEXT

TABLE 4: INTAKEDETAILS FIELD _ID USERID DATE MEDICINE STATUS DESCRIPTION Automatically generated Unique id of the user Current date Name of the medicine Medicine intake status DATA TYPE INTEGER TEXT TEXT TEXT TEXT

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CHAPTER 5 ADVANTAGES OF THE SYSTEM

The proposed system is user-friendly. The system does not require any extra hardware and hence the system is cheap. The user does not require any extra knowledge to operate the application installed in his/her android based smart phone. The application developed support all smart phones with android version 2.3.3 and above. The proposed system is portable and low cost and it makes it a system for the common man. The system is reliable and robust.

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CHAPTER 6 APPLICABILITY OF THE SYSTEM

The system can be implemented in any rural area for healthcare assistance. Though the system is designed for rural population, it can also be used in urban areas as well. The server system can be implemented in the National Rural Health Mission [NRHM] health centre. The system can be implemented not only in NRHM centre but also in other medical care offices to keep track of the medical records of the people in that locality as well as give medical assistance in times of need. The application developed is very user friendly that it can be implemented in any android smart phone and the common man can use it with ease.

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CHAPTER 7 FUTURE ENHANCEMENTS

As the progress in life is advanced from known to known, the future of any software package lies in its ability to progress from the specified to the general. The basic structure of AMHS was designed in such a way that the incorporation of additional utilities and function could be accomplished very easily without any change in the basic design. The system can be enhanced by adding mew modules and giving more server side capabilities. One module that can be added is statistics and surveys i.e., instead of going to each door and collecting information, can send a SMS with an attached survey form which the user can use to fill in the details and send back through SMS and the healthcare officer can store the data in the offices database. In this work, a dedicated server is being used, instead a framework can be developed which will allow users to communicate with any Hospital Information System using their android mobile.

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CHAPTER 8 CONCLUSION

A mobile health application has been developed. This application can be used by any end user to manage his health as well as communicate with the rural healthcare centre and avail healthcare notifications. The application is developed for android mobiles. It is expected to live up to the objectives for which it was designed. There is a hope that this task management application will be utilized to its maximum and will do a good job in the long run.

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REFERENCES

[1]

Ashok Vikhe Patil, K. V. Somasundaram and R. C. Goyal, Current health scenario in rural India Banerjee A., Esther C. Duflo, and Angus Deaton (2004). Healthcare Delivery in rural Rajasthan, Economic and Political Weekly, 39(9), pp. 944949, Mumbai. Laveesh Bhandari and Siddhartha Dutta, Health infrastructure in rural India Marvin Gore and John W Stubbe, Elements of system analysis Talk with Dr. Priya V C, Medical Officer, NHRM, Kulasekharapuram, Karunagappally, Kollam

[2]

[3] [4] [5]

[6] [7] [8] [9]

Talk with Mr. Sinoop, PRO, Community Health Centre, Oachira, Alappuzha. http://www.nlm.nih.gov/medlineplus/ruralhealthconcerns.html http://www.ruralcenter.org/about http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-aboutrural-health-care

[10] [11] [12] [13] [14] [15] [16] [17] [18] [19]

arogyakeralam.gov.in http://developer.android.com http://www.celltrust.com/solutions/healthcare/celltrust-solutions-healthcare.html http://www.att.com/gen/press-room?pid=18708 http://www.grandchallenges.ca http://www.ozeki.com http://www.ashametrics.com/software http://www.stackoverflow.com http://javatechniques.com http://groups.google.com/group/android-developers

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