Remote Patient Monitoring System
Remote Patient Monitoring System with Focus on Antenatal Care
This project is funded by the National ICT R&D fund, Government of Pakistan, over the period of 3 years (2008-2010). For further details, please visit: http://rpms.nexginrc.org/
Executive Summary
The primary objective of this project is to develop a reliable, efficient and easily deployable remote patient monitoring system that can play a vital role in providing basic health services to the remote village population of Pakistan at their door step. As a result, the patients no longer need to travel long distances to reach to the nearest basic health units and then just be examine by a mere GP. The project will identify the most important issues in the design of a remote health care monitoring system and will develop a low cost solution, which will be provided to the lady health workers (LHWs) for this purpose.
The goal of the project is to design a generic remote health care system with a focus on antenatal care. Our aim is to use advancements in Information and Communication Technology (ICT) to develop a monitoring system that could enhance the quality of health care provided by the lady health workers. Presently, the antenatal care is being provided by little-educated lady health visitors who perform all the steps of patient care manually. They take readings of patient’s physiological data using instruments which are difficult to handle and require manual tuning etc. Then, they record this data into printed forms manually. Finally, the collected forms are sent to a doctor who goes through all of them looking for any symptom of abnormality. The doctor then takes decision regarding the patient’s treatment.
Architecture of the System
The basic model consists of a data gathering module, a PDA, a remote server providing Clinical Decision Support System (described later) and electronic medical record keeping, and any web-enabled remote terminal (e.g. doctor’s laptop) which could be used to access services provided by the web-server.
The working of this basic model is as follows. The lady health worker is required to attach the data gathering module to the patient’s body using wearable straps etc. provided with the module. The module (consisting of medical sensors) will record the patient’s data and forward it to the PDA through a wired channel (e.g. USB or serial port). The PDA will contain an application for local monitoring of patient’s data that would display the current readings. When all the readings have been taken, the PDA will connect to a remote server and transfer the data to it. The remote server will process the data, invoke the Clinical Decision Support System to perform analysis of data, invoke the Electronic Medical Record service to record the readings in the patient’s history and provide feedback to the PDA screen notifying the decision given by the Clinical Decision Support System.
This model is realized by using intelligent wearable medical sensors controlled by a data gathering module. The sensor nodes are attached to the bodies of the patient and provide medical information to the data gathering module’s processor. The data gathering module is connected to the PDA through USB or serial port. The PDA is carried by the lady health visitor. It collects and forwards the data observed at sensors attached to the patient’s body to the main server typically located at a tertiary health care center. The communication between PDA and the main server is done through TCP/IP, GPRS or SMS/MMS (whichever is available in the area or the least costly in case of multiple services availability).
Working of Basic Model
The lady health worker is required to attach the data gathering module to the patient’s body using wearable straps etc. provided with the module. The module (consisting of medical sensors) will record the patient’s data and forward it to the PDA through a wired channel (e.g. USB or serial port). The PDA will contain an application for local monitoring of patient’s data that would display the current readings. When all the readings have been taken, the PDA will connect to a remote server and transfer the data to it. The remote server will process the data, invoke the Clinical Decision Support System to perform analysis of data, invoke the Electronic Medical Record service to record the readings in the patient’s history and provide feedback to the PDA screen notifying the decision given by the Clinical Decision Support System.
This model is realized by using intelligent wearable medical sensors controlled by a data gathering module. The sensor nodes are attached to the bodies of the patient and provide medical information to the data gathering module’s processor. Data gathering module consists of a central microprocessor controlling the operation of a number of medical sensor modules. The central microprocessor gathers data from the sensors and passes it on to the PDA through a serial to USB interface.
The PDA carried by the lady health worker acts as a base station for transmission of patient’s data to the main server in the hospital. Its software part consists of a device driver for detecting and handling data gathering layer, and a local application interface which displays the gathered data for local monitoring and sends it to the main server for medical analysis. The feedback from server is displayed on the PDA. The PDA also provides an interface for entering patient’s data manually or reading it automatically using the patient identification system.
The main server in hospital will run a web server to provide the services of clinical decision support system and electronic medical record system to the requests from PDAs carried by the lady health workers. The web server will also handle requests from doctor’s terminal and provide reports about the patients’ situation. An electronic medical record system will be used to store the incoming data to the patient’s record. The clinical decision support system will provide automated analysis of data and assist the doctor in decision making process. The applications will be developed with ease of use in mind. To train the personnel using the application, help system and tutorials will be designed and distributed. Presentations will also be given on the use of software and installation of hardware.
The whole system cannot be efficiently developed without its deployment in a practical scenario. This practical deployment will also help in regular evaluation of the system and will lead to its further improvement. For this specific purpose, a controlled population group of pregnant ladies will be setup along with the expert advice of doctors from a teaching hospital. For this purpose, the evaluation framework has a setup based on following two organizations: Human Development Fund (HDF) and Rawalpindi General Hospital (RGH).
To evaluate the performance of the proposed system, some performance indicators have been defined. The evaluation framework will evaluate the system deployed in the controlled population group on the basis of these indicators. These performance indicators include increase in lady health workers’ capacity, number of correct referrals, reduction in complexities in birth process through timely preventive measures, amount of correct information available during emergency cases; and ultimately reduction in infant and maternal mortality ratios in the controlled population group.
The whole project is a 28 month effort culminating in the release of a remote patient monitoring system after practical deployment and testing in the real world environment. With focus on antenatal care, the success of this project means better child and maternal health care. Maternal care is not associated with an exclusive segment of society. It is an issue of all households. So, better maternal care will ultimately result in the creation of a better society that has progressive trends.
Benefits of the Project
Direct Customers / Beneficiaries of the Project
The majority of Pakistan’s population lives in rural areas with nonexistent health infrastructure. These people shall be the primary beneficiaries of this project. These people form a majority of population as well as are the main sustainers of the agricultural sector ofthe country. The quality of life of theses people shall improve as a result of this project as health care services will be provided to them at their doorsteps.
With focus on antenatal care, the success of this project means better child and maternal health care. Maternal care is not associated with an exclusive segment of society. It is an issue of all households. So, better maternal care will ultimately result in the creation of a better society that has progressive trends.
The primary customers of this system will be the Health Care Organizations and hospitals. They will be able to deploy this low cost and highly reliable infrastructure in the areas where there is none at present. This would result in an increase in the quantity as well as quality of service of the overall health service being provided in the country. By taking advantage of this newly designed system based on technological revolutions in the field of communications and embedded systems, the government of Pakistan would be able to realize its vision of providing medical facilities to all of its citizens in a cost efficient manner. This would naturally lead to an improvement in the current catastrophic situation in the health sector.
Outputs Expected from the Project
This project, being the first of its kind, will bring about a technological revolution in the health sector by introducing infrastructure based on modern technology and communication advancements. This would initiate a wave of interest in the research field (especially Bio-Engineering which is nearly non-existent at present) in the country. New research will result in new advancements and thus the field of Bio-Engineering which has been ignored for so long, will come to academia/industry spotlight.
The Health Sector will benefit from the advancements in communication technology and will be able to improve the quality of health service in the country by providing health care at the customer’s doorstep. Collaboration of Academia, Information Technology sector and the Health sector will result in increased use of Information and Communication Technology (ICT) in the field of Bio medical engineering. This project will also empower the lady health workers by providing them training in the use of modern and technologically advanced equipment.
On National level, this would result in an increase in the coverage of health facilities across the country. This project will enable the government to fulfil its dream of providing basic medical facilities to all its citizens especially those living in remote areas. As a result of this project, the people living in remote areas will be delivered with a better quality health service.
Organizational / HRD Outcomes Expected
Expertise development is an important part of this project. A trained and well-groomed team of expert developers will emerge from this project. This team would be capable of handling further development projects and shall prove an important and productive asset of our nation. The project involves collaboration of engineers and researchers with doctors, a sociologist, lady health workers and patients. So the project would nurture research oriented ties between the representatives of different professional fields. The project will result in an increase in the quality and quantity of research work going on in the concerned research organizations. By inducting student researchers into the project and providing them financial support, the project will initiate the research culture in the organization’s students and lessen the burden of their fees and other expenditures. The project will encourage and promote an increased use of technological advancements in the daily record maintenance by hospital staff and decision making process by the doctors. The training of lady health workers (LHWs) for using modern technologically advanced equipment will increase their technical competence and prove an effective mean of improving their educational capabilities. They will be linked to specialist doctors in teaching hospitals, which will further improve their patient management skills.
People
Ajay Kumar Tanwani (Research Engineer)
Mudaser Ahmed (Research Engineer)
Sajjad Athar (Research Engineer)
Humayun Irshad (Research Engineer)
Ali Hasnain (Research Engineer)
Muhammad Kamran (Research Associate)
Jawad Masood (Research Student)
Asad Mehmud (Research Student)
Jamal Afridi (Research Student)
Irfan Khan (Research Student)
Publications
Publications can be downloaded from publications section.
1. Ajay Kumar Tanwani, Jamal Afridi, M. Zubair Shafiq, Muddassar Farooq, "Guidelines to Select Machine Learning Scheme for Classification of Biomedical Datasets", 7th European Conference on Evolutionary Computation, Machine Learning and Data Mining in Bioinformatics (EvoBIO), Lecture Notes in Computer Science, Springer, Tubingen, Germany, 2009.
2. Muhammad Zulkifl Khalid, Ali Akbar, Ajay Kumar Tanwani, Amna Tariq and Muddassar Farooq, "Using Telemedicine as an Enabler for Antenatal Care in Pakistan", 2nd International Conference on E-Medical System (E-Medisys), Tunisia, October, 2008.