Final Project Report - Asia-Pacific Telecommunity · PDF file · 2010-04-30HRD...

HRD Programme for Exchange of ICT Researchers and Engineers 2008

Final Project Report

Study on e-health contents enhancement for the effective utilization of ICT in Health and Medical field of Lao P.D.R.

November 25, 2009

Collaborative Research Team of

Lao People’s Democratic Republic and Japan


CONTENTS

Table of Contents

Executive Summary........................................................................................................................... 1 1. Project Information ....................................................................................................................... 2

1.1 Backgrounds ............................................................................................................................. 2 1.2 Objectives ................................................................................................................................. 2 1.3 Project Team ............................................................................................................................. 3

1.3.1 Key role of each organization .......................................................................................... 3 1.3.2 Members of Project Team................................................................................................ 4

2. Overview of the Project ................................................................................................................. 5 2.1 Project Schedule Overview........................................................................................................ 5 2.2 Study Methodology Overview ................................................................................................... 7

3. Overview of the study .................................................................................................................... 9 3.1 Methodology Overview............................................................................................................. 9

4. Summary of the project activities................................................................................................ 11 4.1 General Project Activities........................................................................................................ 11 4.2 Exchange activities.................................................................................................................. 13

4.2.1 Exchange activities in Lao P.D.R. - 1 (Joint Study in Lao P.D.R. - 1) ............................ 13 4.2.2 Exchange activities in Japan (Joint Study in Japan) ........................................................ 16 4.2.3 Exchange activities in Lao P.D.R. - 2 (Joint Study in Lao P.D.R. - 2) ............................ 20

4.3 Trial in Laos............................................................................................................................ 23 4.3.1 Objectives...................................................................................................................... 23 4.3.2 Period of Trial ............................................................................................................... 23 4.3.3 Overview of Trial .......................................................................................................... 23 4.3.4 Trial results.................................................................................................................... 27

5. Project Outputs............................................................................................................................ 55 5.1 Methodology ........................................................................................................................... 55

6. Project Sustainability................................................................................................................... 56 7. Future Plan .................................................................................................................................. 57

7.1 Current situation...................................................................................................................... 57 7.2 Plan for Future ........................................................................................................................ 58

8. List of Annexes............................................................................................................................. 59


FINAL-1

Final Project Report

Project Title

Study on e-health contents enhancement for the effective utilization of ICT in Health and Medical field of Lao P.D.R.

Executive Summary

This project has been established for the effective promotion of the ICT application in health and medical field. Through the collaborative study on the scheme and methodology of “How to develop, maintain, and utilize the comprehensible e-health contents”, this project is aiming the contribution to the promotion of HRD and capacity building for the ICT application.

The official selection notice by APT Secretariat has been issued on 03-Dec-08, and the total approved budget for the project is USD 38,112.

The main activities of this project are studies and proposals on “How to develop, maintain, and utilize the comprehensible e-health contents”, and through the development and trial with the Example Contents, following outputs are the deliverables of the project.

- Scheme and methodology of How to develop, manage, and operate e-health contents (Key concept and Flow diagram)

- e-health Contents Management Guideline

- Guideline for Remote Consultation between Doctors

- Effectiveness evaluation through the Trial

In summary, the proposed management procedures, which start from establishing the Contents Making Plan, have been brushed up through the trial. The Ministry of Health in Lao P.D.R. will make continuous effort for the nationwide application of the new procedures. The improvement of remote consultation between Doctors has also been tried and it is also targeted to step out for the implementation, such as the application to APT-J3 pilot project.


FINAL-2

1. Project Information

1.1 Backgrounds

In Lao P.D.R., Ministry of Health, headed by minister, has strong intension to utilize ICT in health and medical field, and the “ICT Master Plan (ver.1) for MOH” has been established in October, 2008.

The e-Government project led by National Authority for Science and Technology, which is to be commonly utilized by all the government ministries and agencies, is aimed at commencing the operation in 2009. To this end, the 1st phase of the project is now being implemented.

For Ministry of Health in Lao P.D.R., it is vital to introduce e-health applications in an effective and efficient manner to realize the aforementioned ICT Master Plan by utilizing the ICT infrastructure, which is under deployment in e-Government Project.

Thus, study the ins and outs for the efficient development and effective utilization of the comprehensible e-health related contents is one of the key factors.

1.2 Objectives

The objectives of this project is, in order to effectively promote the ICT application in health and medical field through the enhancement of e-health contents, to study on the scheme and methodology of “How to develop, maintain, and utilize the comprehensible e-health contents” for realizing the contents with following natures;

- Easy to develop for contents maker

- Easy to maintain, manage, and update for contents manager / operator

- Comprehensible and easy to handle for end user


FINAL-3

1.3 Project Team

This study project is conducted by researchers and engineers from below listed organizations with each key role for this project.

1.3.1 Key role of each organization Organization Key role

National Authority of Posts and Telecommunications [NAPT]

- Administrative coordination as the main applicant - NW related arrangement for Trial in Laos - Overall grip and future planning for enhancing the

result of this project (Enhancing the target of other sectors than Health sector)

Ministry of Health [MOH] - Total coordination on project implementation - Material collection for Example Contents - Necessary arrangement and Execution of Trial in

Laos, including the localization into Lao language - Data collection & analysis of effectiveness

evaluation for Trial in Laos - Setup the structure and personnel assignment for

keeping the sustainability of this project result

Lao P.D.R.

National Authority for Science and Technology [NAST]

- Technical matters for localization into Lao language

- e-Government related coordination for Trial in Laos

- Technological review of case studies for enhancing the result of this project (Enhancing the target of other sectors than Health sector)

Fujitsu Limited [Fujitsu] (with an associate professor in Hiroshima International University [HIU])

- Project management and account coordination - Leading the study on “How to develop, maintain,

and utilize the comprehensible e-health contents” - Development of Example Contents and relevant

documents - Arrangement for case study and site visit [main] - Advices from the viewpoint of medical

professional (by the associate professor of HIU)

Japan

Japan Telecommunications Engineering and Consulting Service [JTEC]

- Project coordination and liaison with Lao team - Framing the framework of overall project and

required reports - Necessary support for development of Example

Contents and relevant documents - Arrangement for case study and site visit [sub] - Planning of the continuous cooperation for Lao

P.D.R.


FINAL-4

1.3.2 Members of Project Team

No. Name Organization Title 1 Mr. Xayluxa INSISIENGMAY NAPT Director, Radio Spectrum

Management Division 2 Mr. Visith KHAMLUSA MOH Chief of AV Section, Center for

Information and Education for Health (CIEH)

3 Mr. Somlouay KITTIGNAVONG NAST Acting Director General, Department of Informatic

4 Mr. Shigehiko YASUMURA Fujitsu Director, Business Management Center

5 Mr. Go MAENO Fujitsu Manager, Business Management Center

6 Ms. Mayumi KOBAYASHI Fujitsu Business Management Center 7 Mr. Narutaka NAKAO Fujitsu Director, Healthcare

Information Business Research & Planning

8 Associate Prof. Ippei WATANABE HIU Dept. of Health Services Management, Faculty of Health and Welfare, Hiroshima International University (HIU)

9 Mr. Masanobu USHIZAKA JTEC Director, Telecommunications System Engineering

10 Mr. Tomoaki KANAZAWA JTEC Director, Telecommunications Consulting


FINAL-5

2. Overview of the Project

2.1 Project Schedule Overview

Item Japan Lao Term (1) Preliminary

study - Preliminary study on medical and health

environment in Lao P.D.R - Preliminary study on Contents Theme

DEC 2008 to JAN 2009

(2) Remote discussion via e-mail

- Exchange opinions and preliminary conclusion on the items to be reaffirmed at Joint Study in Lao P.D.R.

FEB 2009

(3) Joint Study in Lao P.D.R. (Japanese team visit Vientiane.)

- Mutual understanding of medical & health and other relevant environment in Lao P.D.R.

- Mutual agreement (face-to-face reaffirmation) on * Project detail schedule * Each role in this project * Contents Theme for Example Contents * Framework and major contents of Interim

Report and Final Report

15-Mar-09 to 21-Mar-09 [1 week]

(4) Preparation of Interim Report

- Draft the Interim Project Report and Finalize the Account Summary

- Finalize the Interim report and submit to APT Secretariat

23-Mar-09 to 31-Mar-09

(5) Continued study especially on Example Contents

- Contact several medical specialists for e-health contents

- Develop the Consultation Report Form

- Study to specify the place and object persons for Trial in Laos

first half of APR 2009

- Preparation for Contents Management Guideline for e-Health contents development *Study how to manage the process of e-Health

Contents Development

- Preparation for Trial in Laos *Study and find the suitable place for Trial in Laos,

and watch the relevant project status

- Preliminary draft of final report *Review of the overall project activities based on the

current reality

(6) Preparation for joint study in Japan and Preparation for “Trial in Laos with Example Contents”

- Site Visit arrangements - Pre-study for Site Visit

APR 2009 to first half of MAY 2009


FINAL-6

Item Japan Lao Term (7) Joint Study

in Japan (members from Lao P.D.R. visit Japan)

- Case studies of e-health technologies in Japan a. Case study on utilization of e-health contents b. Case study on efficient development of e-health

contents c. Site visit for learning telemedicine, medical

education, and latest medical care environment - Mutual agreement on the scheme and methodology

of “How to develop, maintain, and utilize the comprehensible e-health contents”

- Making plan to implement the Trial in Laos

24-May-09 to 6-Jun-09 [2 weeks]

- Preparation for Trial in Laos *Remote support, if any

*Localization of

relevant documents * Detail review with

relevant persons - Trial in Laos

(8) Trial in Laos

Joint Study in Lao P.D.R. - 2

* Summarize the Committee’s review * Conduct the trial in Vientiane Capital,

Luangphabang Province (D-D consultation, Contents Needs Finding)

* Data collection

from middle of Jun-09 to middle of Aug-09 [Joint Study] 02-Aug-09 to 12-Aug-09

- Reflection of the trial result *Analysis of data collected through the Trial in Laos *Necessary modification to the procedures and

relevant documents

(9) Conclusion of the study

- Conclusion of study result as the proposal on the scheme and methodology for e-health contents

latter half of AUG 2009

- Final Draft of Final Report *Overall project activities and account matters *Trial details, Project sustainability, and Future plan

(10) Preparation of Final Report

- Finalize the Final Account Report with evidence

- Finalize the Final Report and submit to APT Secretariat

latter half of AUG 2009 to first week of SEP 2009 Final Report (25-Nov-09)


FINAL-7

2.2 Study Methodology Overview

(1) Selection of target contents theme As a result of the Joint Study in Lao P.D.R., “The Acute Medical Care” has been

selected as the contents theme for the major items, “Contents for Medical and Health education” and “The contents for disease case study” proposed for this project, considering important medicine in Lao P.D.R. is for acute disease rather than for chronic disease. Regarding patients transfer to Central Hospital from Provincial Hospital; several tens of cases per month were reported. Thus, this was well received and agreed by the Collaborative Research Team.

< Concepts to select the contents theme > *Contents are categorized as the following 3 segments, “Contents for the public”,

“Contents for medical staffs” and “Contents for medical doctors”, considered from the view point of contents users in order to widely cover all the medical care.

*One common contents theme should be selected for 3 related contents categories instead of different contents theme for each category so as to target foremost achievement for this project.

*There are 2 classifications in medical care, acute medical care and chronic medical care. The acute medical care (including emergency and accidental case) is suitable theme as it can be improved, expanded and continuously maintained recording and transferring the patient data in each case taking advantage of ICT.

(2) Development of Example Contents

The Collaborative Research Team discussed and agreed to develop simple contents as Example Contents based on the definition above. Japan team prepared for the Consultation Report Form to be used for Remote Consultation between doctors as an Example Contents based on the advice from the medical specialists.

(3) Preparation for relevant documents and manuals

The Collaborative Research Team discussed and agreed to investigate how to develop, manage, operate and update the contents, and to prepare for relevant documents and manuals.

*Note: As the Localization into Lao language is required to a certain extent, the easiness for translation is to be considered in the configuration.

- Key concept and Flow diagram of “How to develop, manage, and operate e-health


FINAL-8

contents”

- e-health Contents Management Guideline

- Guideline for Remote Consultation between Doctors

(4) Implementation of trial with Example Contents

a) To design the implementation guidance of trial (target area, object persons, implementation period, implementation process, evaluation item, method)

b) Localization into Lao language of Example Contents (including questionnaire for needs findings and trial evaluation)

c) Implementation of trial d) Evaluation through the trial (data collection and analysis)

(5) Feedback from result of trial

To brush up and finalize the relevant documents and manuals by reflecting the result of trial


FINAL-9

3. Overview of the study

3.1 Methodology Overview

As the major part of the study in this project, the result of discussion on the scheme and methodology is summarized as follows:

(1) Theme “How to develop, maintain, and utilize the comprehensible e-health contents”

(2) Issues to be solved based on the Joint Study in Lao P.D.R. As the result of the Joint Study in Lao P.D.R., the Issues to be solved are defined

as follows:

Heavy load for especially thespecialists in Vientiane

Release of such doctorsfrom the heavy load

Difficulty to keep the sufficiencyof practical training for upgradethe medical skills

Compensation for theinsufficiency of practicaltrainings

Possibility to reduce the affectionof diseases through the properinformation provision

Provision of the properinformation to the public

Possibility to improve the datamanagement

Application of the suitablemanagement method

Issues Solutions

Figure 3.1.1 Issues to be solved

(3) Approaches The approaches for each solution are concluded as follows:

Release of the specialist doctors from the heavy load

Reduce the number of phone calls from provincial areas by settingcertain rules

- Consultation via e-mail basically (non-real time)

Realize the more smooth communication through ICT (real time)

Compensation for the insufficiency of practical trainingsProvision of the proper information to the public

Application of the suitable management method, which includes- Contents making plan based on the demand / needs- Distribution management so as to grasp the delivery status of

the information Figure 3.1.2 Approaches for each solution


FINAL-10

The followings are the Overview images of each approach:

Realize the more smooth communication through ICT (real time)

Rules to reduce the phone calls from provincial areas

Release of the specialist doctors from the heavy load

Provincial Central

e-mail exchange normally

Real time consultation only if required

Rules

Provincial Central

Oral Talk ONLY

Provincial CentralOral Talk

Common Understandingby data / image sharing

???

Figure 3.1.3 Approach overview image-1

Contents making plan based on the demand / needsDistribution management so as to grasp the delivery status

Application of the suitable management method

<Current> <Improved>

Idea from hospital

Contents making

Distribution

Contents making plan

Contents making

Distribution

Management

Survey to specify the needs

Contents making planshould be started fromgrasping the needs

Several kinds of managers to beassigned as the responsible personfor the proper and securedistribution, updating,etc.

Figure 3.1.4 Approach overview image-2


FINAL-11

4. Summary of the project activities

4.1 General Project Activities

All members in this project actively collaborate in all project activities. Under the limited occasion to have face-to-face discussion and communication, some activities were conducted through e-mail and telephone, and intensive studies have been conducted at the times of exchange activities in Lao P.D.R. and Japan both.

As a whole, all the major activities in this project complied with the project plan, which defined by the Collaborative Research Team after the selection notice from APT secretariat. The summaries of project activities are described as follows:

(1) Project Planning / Preliminary Study Based on the agreed concept and directionality described in the application form,

Lao team and Japanese team made the preliminary studies and prior to the first exchange activity in Lao P.D.R., the Project Plan and the Key Role of each involved organization have mutually agreed for kicking off.

(2) Face-to-face reaffirmation of project details and Field Survey in Lao P.D.R. As one of the exchange activities, Japanese team visited Lao P.D.R. for intensive

discussion and field survey to grasp the current situation in Lao P.D.R. The results of survey have been the base to define the issues to be solved. And the project details agreed in advance have also been reaffirmed.

(3) Continuous study on scheme and methodology to solve the defined issues and pre-study for the trial place

After getting the common understandings on the current situation in Lao P.D.R., Japanese team mainly continued the study on the scheme and methodology as the solution for realizing the improved situation. And Lao team mainly reviewed the relevant project progress such as e-Government project and e-Center for better health project, and found the suitable trial places.

(4) Site visits & case studies in Japan and discussion for finalizing the practical approaches to be tried in the Trial in Laos

As the second exchange activities, Lao team visited Japan for enhancing the knowledge through site visits & case studies and for the intensive discussion on directionality to realize the better scheme & methodology regarding e-health contents and on each approach for conclusion.


FINAL-12

(5) Preparation & implementation of the Trial in Laos Based on the discussion result in Japan, Lao team has discussed in detail for the

Trial, and it has been implemented in Vientiane Capital and Louangphabang Province. And the results of the trial have been reflected to the Project Outputs in final.

(6) Project conclusion Through the active collaboration of all the members, this project has successfully

been concluded with the practical proposal on the scheme and methodology of “How to develop, maintain, and utilize the comprehensible e-health contents” as the project outputs.


FINAL-13

4.2 Exchange activities

4.2.1 Exchange activities in Lao P.D.R. - 1 (Joint Study in Lao P.D.R. - 1) (1) Overview of the Joint Study in Lao P.D.R. - 1

Activities No. Date AM PM Remarks

1 15-Mar. (Sun) - Arrival of Japanese Team

2 16-Mar. (Mon)

Kick-off Meeting Data collection for MOH related matters and detail arrangements

Confirmation / Discussion on Questionnaires 3 17-Mar. (Tue) [Central Hospitals in Vientiane]

- Medical & Health environment, ICT environment - Medical operation, business - Liaison with hospitals in regions

Confirmation / Discussion on Questionnaires 4 18-Mar. (Wed) [Bolikhamxay Province] (*)

Provincial Health Department, Provincial Hospital

- Medical & Health environment, ICT environment - Medical operation, business - Liaison with hospitals in Vientiane

* more than 2 hours distance from Vientiane by car

Confirmation / Discussion on Questionnaires 5 19-Mar. (Thu) [NAPT]

- Overview of network infrastructure

- Status of ongoing projects - Tariff system of

broadband services

[NAST]

- Overview of ICT industry - Status of ongoing projects

6 20-Mar. (Fri)

Preparation Meeting for Wrap Up

Wrap up Meeting

7 21-Mar. (Sat) Japanese Team left for Japan -

MOH : Ministry of Health CIEH : Center for Information and Education for Health, MOH NAPT : National Authority of Posts and Telecommunications NSTA : National Authority for Science and Technology


FINAL-14

(2) Result of the Joint Study in Lao PDR

- Mutual understanding of medical & health and other relevant environment in Lao P.D.R.

- Mutual agreement (face-to-face reaffirmation) on

* Project detail schedule

* Each role in this project

* Contents Theme for Example Contents

The mutually understood results are listed below:

Item What we understood Analysis Number and quality of doctors

- Rather numerically enough in Vientiane, but qualitatively insufficient

- Numerically insufficient in regional areas - All sorts of the skill levels in regions

- Heavy load for especially the specialists in Vientiane

Cooperation between central and regions

- In case exceeding own capability, based on own judgment, doctors get consultation of central hospitals (No specific rules which define the demarcation)

- Normally starting from calling to hospitals where the doctor got training

- Patient to be transferred in case of emergency and intractable disease

(several tens of cases/month to Central) - Trainings are provided in central hospitals

and in region by dispatched trainers

- Great importance of communications especially the case of getting consultation of central hospitals

- Difficulty to keep the sufficiency of practical training for upgrade the medical skills

Medical Equipment

- X-ray machine, ultra sonic, electro cardiograph are equipped in all Provincial Hospitals

- Rather old types and various level (reexamination is required for transferred

patient) - Difficult to maintain due to insufficiency of

Medical Engineer

- Possibility to utilize such medical equipments for remote diagnostic

- Possibility to reduce the necessity of reexamination on the emergency cases


FINAL-15

Item What we understood Analysis ICT environments (Hospitals)

- Internet is one of the major tools for doctors’ skill development

- Hospitals demanding the computerized reporting, information share, data management, etc.

- ICT literacy is not so high

- Rather high expectations for ICT

- Overcome the insufficient ICT literacy is one of the key issues

(Not only providing training, skill free approach is also well considered.)

ICT environments (NW infrastructure)

- CIEH has e-Center central side NW - e-Government equipments mostly installed,

waiting NW to be available - OFC Backbone NW has reached to the

Provincial Capitals. By the cooperation between the telecom operators, redundancy configuration will be realized through the efficient share of the duplicated route. (2010-2011)

- Approximately 30% of the districts have certain difficulties for the OFC installation due to the distance from the major road. Including such districts, it is planned to connect all districts by OFC in 2013.

- Especially in rural areas, fewer households are scattered in wide area. The regulation for rural area wireless connection is planned to be established in 2010.

- NW availability of the relevant projects (e-Center, e-Government) should be watched continuously.

- Effective and efficient expansion for the rural area NW is one of the key issues.

Lao language - Lao language environment is strongly required

- Lack of Lao language environment is one of the major obstacles of low ICT literacy

- Development of the software such as OS in Lao language is out abilities in this study

- Other approach such as less literation, animations are considered.

Others topics in regions

- Regional areas may have communication method, but have difficulties to travel

- Lack of information is still cause the disease

- Periodical reporting procedure in under improvement by using e-mail, but data management seems to be same as printed paper basis.

- Possibility to reduce the affection of diseases through the proper information provision

- Possibility to improve the data management


FINAL-16

4.2.2 Exchange activities in Japan (Joint Study in Japan) (1) Overview of the Joint Study in Japan


0 24-May (Sun) - Departure from Lao P.D.R.

1 25-May (Mon) Arrival of Lao Team Orientation and Schedule

Confirmation

2 26-May (Tue)

Kick-off Meeting [Fujitsu HQs]

- Review of Joint Study in Lao

P.D.R. - Confirmation of study results

in Lao P.D.R. - Overview of Joint Study in

Japan

Case study (1) [Fujitsu netCommunity]

- Utilization of e-health

contents in Japan - Development procedure of e-

health contents

3 27-May (Wed)

Telemedicine activity in Malaysia

[Fujitsu Kawasaki] (by Mr. Moro, BHN Association)

- Introduction of the project for

Telemedicine in Malaysia - Experienced difficulties and

important viewpoints

Site Visit (1) [Fujitsu Hospital]

- Introduction on medical

examination by electronic medical chart

- Patient data management

4 28-May (Thu)

Traveling to Asuke Hospital

Site Visit (2) [Asuke Hospital]

- ICT utilization for remote area - Medical service & welfare

integration - Policy for keeping healthy

lives in remote areas

5 29-May (Fri) Brief review Traveling to Tokyo

6 30-May (Sat) Free

7 31-May (Sun) Free


FINAL-17


Discussion on Management of e-health contents [Fujitsu Kawasaki]

8 01-Jun. (Mon)

- Overview of how to manage, maintain and utilize file and database

- Details of Management process

- Task Assignment for each management step

9 02-Jun. (Tue)

Case Study (2) [Fujitsu Kawasaki]

(by Fujitsu FOM)

- Efficient development of e-health contents

- LMS* and Tool for contents development

- e-health related contents

Discussion on directionality for realizing the better scheme &

methodology regarding e-health contents

[Fujitsu Kawasaki]

- Issues and solution approach - Improvement of the

consultation between doctors

*LMS: Learning Management System

10 03-Jun. (Wed)

Continuous discussion and interim summary

[Fujitsu Kawasaki]

- Directionality of activities - Key approach concepts to

realize well-managed environment

Site Visit (3) [Tokai Univ. Hospital]

- Latest medical care

environment (Emergency Room, Doctor Helicopter)

- Patient Flow Management

Discussion for finalizing each approach [Fujitsu HQs]

11 04-Jun. (Thu)

- Rules and Forms to be applied for the consultation between doctors

- Management Process to be applied

- Plan for the Trial in Laos

12 05-Jun. (Fri)

Discussion for finalizing each approach

[Fujitsu HQs]

- Management flow overview - Items to be included in the

Contents Making Plan - Questionnaires for Contents

Needs Finding

Wrap up Meeting

13 06-Jun. (Sat) Lao Team left for Vientiane Return to Lao P.D.R.


FINAL-18

(2) Result of the Joint Study in Japan

- Introduction of e-health technologies in Japan (Site visit and presentation)

*Case study on utilization of e-health contents

*Case study on efficient development of e-health contents

*Site visit for the purpose of learning telemedicine, medical education, and latest medical care environment in Japan

- Continued discussion on the scheme and methodology of “How to develop, maintain and utilize the comprehensive e-health contents”

The result of discussion on the scheme and methodology of “How to develop, maintain and utilize the comprehensive e-health contents” is described in the article 3.1 Methodology Overview as brief summary and in the article 6.1 Methodology as details.

The summary of study events, such as case studies and site visit, are listed below:

Item Presented What we learned / understood Fujitsu netCommunity

Future system image for personal health care

Latest HD image transmission

Information board

- e-health, as tools, can be applied to support the whole life of human in many aspects. (up to now just as future vision)

- Display-type information board might be applicable for information provision to public.

BHN's telemedicine activity in Malaysia

Introduction of the project for Telemedicine in Malaysia

Experienced difficulties and important viewpoints

- HRD on ICT for medical staff and doctor is keeping the sustainability. (essential)

- Assigning ICT staff in each hospital is also one of the keys to success.

- Real time communication maybe best in theory, however, without the full-availability, it seems meaningless.

- Realistic consideration is required, such as effective combination of real time and non-real time communication.

- Continuous data collection, such as the 48-hour response rate, is also important.


FINAL-19

Item Presented What we learned / understood Visit to Fujitsu Hospital

Electrical Medical Record system

Patient data management

- From the viewpoint of data management, it is well operated and effective. (Work volume and required resources are kept unchanged)

- Operational difficulty still exists after the introduction of the system. (Importance of training)

Visit to Asuke Hospital

ICT utilization for remote area

Medical service & welfare integration

Policy for keeping healthy lives in remote areas

- Human NW (good relation) should be the base of the ICT utilized medical and nursing care.

- All staffs’ well understanding of the EMR effectiveness will reduce the objection for the introduction.

- Clear policy and initiative of the director will lead the good introduction and operation of ICT utilized medical care system.

- Inequality especially for the remote area is one of the major problems. (Unified law application rather caused such situation)

e-learning demonstration

Learning Management System, contents developing tool

e-health related contents

- As the total solution for managing e-learning, the demonstrated LMS is quite attractive.

- The function as contents making tool has possibility to realize the easiness to make contents in Lao language. (synchronized recording with presentation documents)

Visit to Tokai University Hospital

Emergency Room Doctor Helicopter Patient Flow Management

- Enough facility and personnel assignment is required to cope with all the emergency cases.

- From the viewpoint of business operation in hospital, the cooperation with the neighboring hospitals is well ongoing.

- Efficient operation of hospital may require the reduction of scale (No. of beds).


FINAL-20

4.2.3 Exchange activities in Lao P.D.R. - 2 (Joint Study in Lao P.D.R. - 2) (1) Overview of the Joint Study in Lao P.D.R. - 2

Activities No. Date AM PM remarks

1 02-Aug. (Sun)

Flight to Vientiane

2 03-Aug. (Mon)

Visit MOH Cabinet - Explanation and discussion on Joint Study in Laos - 2 overview

Visit NAPT - Explanation and discussion on Joint Study in Laos - 2 overview

Discussion and Preparation for the Trial - Setting up for Web video conference (“Join Meeting “)

- Brushing up the Questionnaire etc.

MOH NAPT

CIEH

3 04-Aug. (Tue)

Visit NAST - Explanation and discussion on Joint Study in Laos - 2 overview

Visit EOJ and JICA office - Explanation and discussion on Joint Study in Laos - 2 overview

NAST EOJ / JICA

(CIEH)

On site Trial [Luangphabang Province]

4 05-Aug. (Wed)

Visit Provincial Health Department - Trial overview explanation

Visit Provincial Hospital - Trial orientation - Setting up & Demonstration of Remote Consultation

Luangphabang Province

On site Trial [Luangphabang Province]

5 06-Aug. (Thu)

Visit Provincial Hospital - Trial for Remote Consultation - Hearing form staffs by Questionnaire

Visit Public Health School - Trial orientation - Hearing by Questionnaire

Luangphabang Province

On site Trial [Mitaphab Central Hospital]

6 07-Aug. (Fri)

Visit Mittaphab Hospital - Trial orientation - Setting up & Demonstration of Remote Consultation

Visit Mittaphab Hospital - Trial for Remote Consultation - Hearing form staffs by Questionnaire [in parallel]

Mittaphab Hospital

(responsible for

Luangphabang Province)

7 08-Aug. (Sat)

8 09-Aug. (Sun)

(Document Preparation such as the summary of the activities in the previous week)


FINAL-21

Activities No. Date AM PM remarks

9 10-Aug. (Mon)

Technical discussion with NAST regarding e-Government NW Summarizing the Collected data

Summarizing the Collected data Documentation for Wrap Up

NAST

CIEH 10 11-Aug.

(Tue) Wrap Up for Trial Summary & Project Finalization

Schedule confirmation for Final Report and further

CIEH

11 12-Aug. (Wed)

Flight to Tokyo

MOH : Ministry of Health CIEH : Center for Information and Education for Health, MOH NAPT : National Authority of Posts and Telecommunications NSTA : National Authority for Science and Technology EOJ : Embassy of Japan JICA : Japan International Cooperation Agency


FINAL-22

(2) Result of the Joint Study in Lao P.D.R. - 2

- Conduct the on site Trial in Luangphabang Province and Mittaphap Central Hospital in Vientiane Capital *Details are described in 4.3 hereinafter

- Discussion and mutual agreement for the future enhancement (Especially for the application to the APT-J3 supported pilot project) * The overview of the APT-J3 application is shown below:

Overview of the Pilot Project to be applied to APT-J3

1. Objectives(1) Narrowing the digital divide in the rural areas(2) Improvement of Health & Medical environment through ICT(3) Encouragement of the nationwide ICT infrastructure enhancement

2. Current status

(1) ICT Master Plan (Ver.1) of MOH- It has been established in October, 2008 as the first individual ministry basis one in

cooperation with relevant authorities such as NAPT and NAST.- In the ICT Master Plan, the priority has given to the Provincial Hospitals for the

network expansion in order to step out for the nationwide enhancement of the ICT based improvement of Health & Medical environment.

(2) As the outcomes of the 2008 APT-J2 supported Collaborative Research:- Three major issues in health & medical field were picked up, and the solutions

through ICT have been proposed and tried.- The trial has been successfully completed and sustainable implementation after the

trial is strongly required.(3) e-Government project lead by National Authority for Science and Technology (NAST) is

ongoing. And utilization of it is one of the key issues for the ICT enhancement in Laos.

e-Government Project by NAST

Overview of the Pilot Project to be applied to APT-J3 (cont.)

3. Purpose of the pilot project under APT-J3(1) Establishment of the ICT access points for the proper information provision to the

public (especially health & medical information) by expanding the existing e-Government NW.

(2) Deployment of the ICT facilities available for (but not limited to):- Remote consultation between Central Hospitals and Provincial Hospitals- e-Education for doctors, nurses, and other medical staffs

Pilot project overview in Province

e-Government National Center

10 departments in province

Governor Office

e-Government Provincial Center

e-Government Provincial Center

Pilot Project area (Province)Expansion of

access network Provincial Hospital

ICT access point(open to public)

ICT facilities(for remote consultation)

ICT facilities(for medical e-Education)

Governor Office

10 departments in province

Figure 4.2.3 Overview of the Pilot Project to be applied to APT-J3


FINAL-23

4.3 Trial in Laos

4.3.1 Objectives The Collaborative Research Team has come to a conclusion on the scheme and

methodology of “How to develop, maintain, and utilize the comprehensible e-health contents”. Thus, in order to make the conclusion into the more practical ones, the Trial in Laos has been conducted to evaluate the effectiveness of them and to brush them up.

4.3.2 Period of Trial Approximately three (3) months (including preparation and evaluation)

- Preparation (localization etc.) : 08-June-09 to 30-June-09 - Detail review with relevant persons : 07-July-09 to 17-July-09 - Pre-setting up of System for Trial : 26-June-09 to 31-July-09 - On site Trial and Data analysis : 05-August to 31-August-09

4.3.3 Overview of Trial The places of the Trial have been fixed based on the study by Lao team and confirmed

in the Joint Study in Japan.

- Central side : Responsible Central Hospital in Vientiane Capital - Provincial side : Luangphabang (Place for on site Trial)

Champasak (Reserved place)

Two provinces of Luangphabang, and Champasak have been selected as the place of Trial in Laos.

< Criteria for selection>

Suitable conditions to conduct the Trial- Major hospitals in region are located.- Public Health Schools are located.- e-Government Network coverage as an

advantage for sustainability (prioritized)

<General Flow>Detailed review of the process in Lao Team with relevant persons

Explanation to Trial participants

Execution of the Trial

Data collection & analysis

Feedback of the trial result

The review itself is a part ofTrial. Any opinion should becollected.

Trial areas

e-Center areas(reference)

e-Gov. Priority areas(5 provinces)

Phongsaly

Loungnamtha

BorkeoOudomxai Houanphan

XiengkhouangXaiyabuly

Vientiane

Khammouane

Salavan Xekong

Attapeu

Champasak

Vientiane Capital

Savannakhet

Borlikhamxai

Luangphabang

Figure 4.3.1 Place and General Flow of the Trial in Laos


FINAL-24

The relations among “Result of Study” – “Trial” – “Output” are shown below.

Result of Study

Questionnaires(for Needs Finding)

Which kind of contents are required for:

- Medical advices betweenDoctors- Education forMedical Staffs- Information Provision to Public

* Reflected to Contents Making Plan

Consultation Forms(Between Doctors)

Consultation Rules(Between Doctors)

e-Health Contents Management Guideline for practical use

- How to develop- How to maintain- How to utilize

Consultation Guideline for practical use(between Doctors in Central and Provincial Hospitals)

- Consultation Rules- Consultation Forms

Output (as a part of Final Report)

Review result itself is a part of Trial

Trial

Trial between Central & Provincial areas

Hearing based on the Questionnaires

Committee’s Opinion(Modified points & reason)

Doctors’ Opinion

Detailed Review

Opinions of Doctors, Nurses,

Lecturers, etc.

ManagementProcedures

Items for Contents Making

Plan

Preparation-NW availability-PC availability-Explanation-Questionnaire

Figure 4.3.2 Overview of “To Do items” and “Output” image of the Trial in Laos

In addition, organizational structure and medical service structure in MOH are shown in the following figures as reference to know the background and the environment for conducting the Trial.


FINAL-25

Structure of Ministry of Health (MOH)

Ministry of HealthMedical CouncilInstitute of Public Health

Minister 3 Vice Ministers

Department of

Hygiene & Prevention

Department of

Curative

Cabinet of

MOH

Department of

Planning&

Budget

Departmentof

Inspection

Department of

Food &

Drug

Department of

Organization&

Personnel

ProvincialHealth

Department(PHD)

University ofHealth Science

College of Health Technology

Nursing SchoolPublic Health SchoolsPHC Schools

Drug & FoodAnalysis Center

Traditional Medicine Center

Medical EquipmentService Center

Center for Information Education f or Health

Mahosot Hospital

Mittaphab Hospital

Sethathirath Hospital

Mother&Child Hospital

Ophthamology Hospital

Rehabilitation Center

TuberculosisCenter

Mother&Child Center

Environment & Water Supply

Center

Dermatology Center

Malaria Center

AIDS Center

National Laboratory &

Epidemiology Center

(PHC: Primary Health Care)

NEXT slide

Figure 4.3.3 Structure of Ministry of Health

Administrative Organization in Health Sector at Province and District

Provincial Health Department(PHD)

Technical Division

DistrictHealth Office

(DHO)

AdministrationDivision

Prevention &

Health Promotion

Division

Provincial Hospital *1

Health Centers(HC)*1 within the 16 Regional Hospitals, 5 Hospitals have the function as

Regional Center:Oudomxay, Luangphabang, Vientiane, Savanakhet, Champasack

Figure 4.3.4 Administrative Organization in Health Sector at Province and District


FINAL-26

Structure of Medical Services

CentralHospital(4)

Regional Hospital(5)

Provincial Hospital(11)

District Hospital(127)

Health Center(750)

-Mahosot Hospital-Mittaphab Hospital-Setthathirath Hospital-Mother&Child Hospital

Tertiary Service Level: whole country

Secondary Service Level, partially tertiary service level: Regional area covering several provinces

Secondary Service Level: Province

PHC Service, partially secondary service level: District

PHC Service: Sub-district

Oudomxay Provincial HospitalLuanphabang Provincial HospitalVientiane Provincial HospitalSavanakhet Provincial HospitalChampasak Provincial Hospital

Figure 4.3.5 Structure of Medical Services

Responsibilities of Central Hospitals

Phongsaly

Loungnamtha

BorkeoOudomxai Houanphan

XiengkhouangXaiyabuly

Khammouane

Salavan Xekong

Attapeu

Champasak

Vientiane Capital

Savannakhet

Borlikhamxai

Louangphabang

Vientiane

Responsible Provinces ofeach Central HospitalSetthathirath

Hospital

3 Provinces (Vientiane, Khammouane, Savannakhet) are basically doing unaided

Mittaphab Hospital

Mother&Child Hospital

Mahosot Hospital

Responsible Central Hospital for Luangphabang Province:

Mittaphab Hospital

Figure 4.3.6 Responsibilities of Central Hospitals


FINAL-27

4.3.4 Trial results (1) Relevant organizations / persons involved in the Trial in Laos

- Detail review meeting

*Advisor : Deputy Director, Cabinet of MOH

*Secretariat : Center for Information & Education for Health, MOH

*Members : 3 Directors of CIEH, MOH

3 research members of Lao Team (MOH, NAPT, and NAST)

5 technical staffs of CIEH, MOH

*Missions : Review the Contents Management Procedures proposed by the Collaborative Research Team (Questionnaire brushing up inclusive)

Give opinions from the management viewpoints on which kinds of contents are required (for education, for information to public)

- Trial Participants and roles

*Doctors in Central Hospitals, Doctors in Regional / Provincial Hospitals

- Answer to the Questionnaires for Contents Needs Finding “Which kinds of contents are required for medical staffs’ skill improvement, for proper provision of public health information”

- Conduct the remote consultation between doctors and give opinion on that

*Lecturers & Students in Public Health Schools, Nurses & Medical Staffs in Regional / Provincial Hospitals

- Answer to the Questionnaires for Contents Needs Finding “Which kinds of contents are required for medical staffs’ skill improvement, for proper provision of public health information?”


FINAL-28

Part 1 General information

Place Questionnaire for Needs Finding Remote Consultation Trial- Luang prabangProvincial Hospital

- Luang prabangPublic Health School

- Mittaphab Hospital

-Doctors: 11-Nurses: 14-Teachers:15-Administrative Staffs: 12 -Others: 8

Total: 60

-Doctors/Nurses/Medical Staffs: 25

Total: 25

Place Questionnaire for Needs Finding Remote Consultation Trial- Luang prabangProvincial Hospital

- Luang prabangPublic Health School

- Mittaphab Hospital

-Doctors: 11-Nurses: 14-Teachers:15-Administrative Staffs: 12 -Others: 8

Total: 60

-Doctors/Nurses/Medical Staffs: 25

Total: 25

Number of participants in each Trial


FINAL-29

Part 2 Evaluation of the Example Contents Questionnaire for “Needs Finding” General Information Total 60 respondents answered this questionnaire and they are divided between 42% male and 58% female. The breakdown of the occupation is shown below; Total Male Female (n=60) (n=25) (n=35)

Doctor

Nurse

Admi

IT

Teacher

Others

23%

18%

20%

25%

12%

2%

32%

20%24%

24%

26%

9%

17%

3%

26%

20%

*Note) “Others” includes Assistant, Hygienist or Laboratory worker, etc. Q1. Have you ever used computer? Q2. Can you access computer and use internet?

Yes

No

88%

12%

Yes

No42%58%

88% of the respondents have an experience to use computer, but only 42% use the internet.


FINAL-30

Q3. How do you handle and solve the problem or difficult issues? (Multiple answers)

Total (n=60)

0% 10% 20% 30% 40% 50% 60%

Others

Consult w/Central hospital

Consult w/Director

Consult w/Chief

Consult w/Senior staff

Search information via Internet

Read the books

Try to solve by myself

Doctor (n=11)

0% 20% 40% 60% 80% 100%

Others

Consult w/Central hospital

Consult w/Director

Consult w/Chief

Consult w/Senior staff

Search information via Internet

Read the books

Try to solve by myself

53% of the respondents stated that they “Consult with senior staff” to solve the problem, but 38% said that they “Read the books” which is leading to “Try to solve by myself”, that is selected by 23%. When looking at the answers from doctors, the percentage of “Consult with senior staff”, “Read the books” and “Try to solve by myself” are increased to 90%, 72% and 63% respectively.


FINAL-31

Q4. What steps do you follow to solve your problem? (Multiple answers)

Total (n=60)

0% 10% 20% 30% 40% 50%

Re-diagnosis and re-treatment

Re-check in case of uncured

Provide the treatment

Consult with others if it is not clear

Diagnosis the disease

Examine the disease

Doctor (n=11)

0% 20% 40% 60% 80% 100%

Re-diagnosis and re-treatment

Re-check in case of uncured

Provide the treatment

Consult with others if it is not clear

Diagnosis the disease

Examine the disease

38% of the respondents marked that “Consult with others if it’s not clear” and this answer were selected by 91% of the doctors. The other steps are chosen equally as seen in the above graph. <Analysis for “How to solve the problem” Q3 and Q4> It can be demonstrated from the result that the consultation with others is the most-used way to solve the problem, but there are also many doctors who try to solve by themselves by means of reading the books or searching the information via internet. If the environment is improved to use the internet easily and the necessary medical contents are available in the database, we can expect that more doctors will use the database via internet.


FINAL-32

Q5. What kind of disease you have faced most?

Total (n=60)

0% 10% 20% 30% 40% 50% 60%

Other

Accidence

Flu

Heart disease

Diabett

Trachoma

Pneumonia

Tuberculosis

Cholera

Dengue fever

Diarrhea

Malaria

Doctor (n=11)

0% 20% 40% 60% 80% 100%

Other

Accidence

Flu

Heart disease

Diabett

Trachoma

Pneumonia

Tuberculosis

Cholera

Dengue fever

Diarrhea

Malaria

*Note) “Other” includes Appendicitis, Nephritis, Bone infection, Kidney, etc. Mostly-faced disease is “Accidence” selected by 57% of the respondents and 2nd is Heart Disease which includes high pressure (48%), then “Diarrhea” (38%). When looking at the replies from the doctors, “Accidence” was chosen by 82% and “Heart Disease” was 46%.


FINAL-33

Q6. What kind of diseases do you need the remote consultation? (Multiple answers)

Total (n=60)

0% 10% 20% 30% 40% 50%

Other

Pediatric diseases

Gynecology and obstetric

Accidence

Influenza

Heart disease

Diabett

Trachoma

Pneumonia

Tuberculosis

Cholera

Dengue fever

Diarrhea

Malaria

Doctor (n=11)

0% 10% 20% 30% 40% 50% 60% 70%

Other

Pediatric diseases

Gynecology and obstetric

Accidence

Influenza

Heart disease

Diabett

Trachoma

Pneumonia

Tuberculosis

Cholera

Dengue fever

Diarrhea

Malaria

*Note) “Other” includes Cancer, Nephritis, Bone infection, Bone Tumor, Pediatric, etc.


FINAL-34

Nearly half of the respondents mentioned that the remote consultation is needed for “Heart Disease” and the second is “Accidence” followed by “Pediatric disease” which was marked by 25% of the respondents, while “Accidence” was the highest-need for remote consultation selected by 64% of the doctors, the second-highest is “Other” and then, “Heart disease” chosen by 45%. Q7. How do you often consult with remote doctors? Total Doctor (n=60) (n=11)

More than 2times per day

Once a day

Once a week

Once a month

Less than oncea month

58%

13% 6%

13%

10%

56%22%

22%

58% of the respondents replied that the frequency of the remote consultation is “Less than once a month”, however, if we see the replies from doctors, the ratio of those who selected “More than 2 times per day” and “Once a week”, which is 13% each of the total respondents, is increased to 22% each of the doctors. <Analysis for “Diseases and Remote consultation” from Q5 to Q7> It can be described that the heart disease and the accidence are the most common topic for remote consultation, however further survey is necessary to know what kind of medical contents for those topics are required, such as the heart disease in acute case or chronic case, which will be included in the “Contents Making Plan” to develop the effective medical contents. Currently the consultation is carried out not so often with remote doctor, we might say that the doctors who need the remote consultation are limited to the small number of the doctors and they are doing it very frequently such as more than 2 times per day. We found the relationship between the frequency and the disease, which is “Heart disease” selected by such doctors. It is very probable that the doctors who face the heart disease require the remote consultation more frequently, but we need to interview with such doctors to understand the real situation.


FINAL-35

Q8. Which area, topics do you want to improve your skill? (Multiple answers)

Total (n=60)

0% 10% 20% 30% 40% 50% 60% 70% 80%

OtherEnglish

IT literacyCommunication skillManagement skill

Treatment of diseaseAnesthesia

Rehabilitation/massaNew type of medicineKnowledge of disease

Doctor (n=11)

0% 20% 40% 60% 80% 100%

OtherEnglish

IT literacyCommunication skillManagement skill

Treatment of diseaseAnesthesia

Rehabilitation/massaNew type of medicineKnowledge of disease

The result shows that about 70% of the respondents want to improve “English” and “IT literacy”, followed by “Management skill” and “Communication skill” and this tendency is similar for the doctors, but the ratio is increased to 91%. Regarding the medical related skills, “New type of medicine” is at the top. Q9. Which area, topic your staffs need to improve their skill? (Multiple answers) Almost all the doctors answered that their staffs need the skill of “IT and English”, and one doctor described that “Need to learn how to solve the problem of diseases through ICT”.


FINAL-36

Q10. How do you improve your skill? (Multiple answers)

Total (n=60)

0% 10% 20% 30% 40% 50% 60% 70% 80%

Other

Study with books

Study visit in country or abroad

Participate in training course

On the job training (OJT)

Access to the manual via network

Doctor (n=11)

0% 10% 20% 30% 40% 50% 60% 70% 80%

Other

Study with books

Study visit in country or abroad

Participate in training course

On the job training (OJT)

Access to the manual via network

73% of the respondents selected “Participate in training course” for the improvement of their skill and “Study visit in country or abroad” marked by 68%. When checking the answers from the doctors, “Access to the manual via network”, “On the job training” and the above top 2 answers are chosen equally (73% each, see the above graph for the doctors).


FINAL-37

<Analysis for “Skill” from Q8 to Q10> We see that the most required skills in Laos now are English and IT, which are not in the medical fields even for the doctors, this must be because they are not in the environment to use PC or English frequently. It can be expected that IT skill will be improved by using PC daily, and they will be familiar with English by taking English lessons via internet. In the next APT J3 project, we plan to prepare for the dedicated PC for the remote consultation and the database also for educational contents, which not only for medical contents, their IT environment will be improved. The “Contents Making Plan” should also cover the educational contents for IT and English. At the same time, it’s seen from the result of Q10 that there are many doctors who want to improve their skill by accessing to the manual or information via network, not only by participating in the training course, OJT or study visit. We can see the high demand of database with medical contents accessed via network, which will be implemented in APT J3 project.


FINAL-38

Questionnaire for Remote Consultation Trial - Non-emergency case General Information Total 25 doctors responded to this questionnaire and 52% are Central doctors (Mittaphab Hospital) and 48% Local doctors (Luangphabang Provincial Hospital). *Note) There are some questions which are to be asked after a certain time period to use the system, the answers provided to such questions may be given by the responders who suppose the practical use of the system. Q1-1. Did you get the satisfied reply of Consultation Report from Central doctors? (Respondents: Local doctors) Local doctor (n=12)

Yes, I did

Somewhatsatisfied

Not satisfied

No answerswere given

Others

92%

8%

92% of Local doctors responded “Yes, I did” and 8% said “Somewhat satisfied”. Q1-2. If you choose "2,3 or 5" in Q1-1, please write down the reason. There was invalid answer and only one valid reply is available, which described “No practice yet”.


FINAL-39

Q2-1. Do you think whether the heavy load of Central doctors will be reduced by the rules to send the Consultation Report? (Respondents: Central doctors) Central doctor

(n=13)

Will be reducedgreatly

Will be reducedslightly

No, I don't thinkso

No, not at all

Will be increased

Others

77%

23%

77% of Central doctors responded that the heavy load of the Central doctors “will be reduced greatly” and 23% selected “will be reduced slightly”. Q2-2. Please write down the reason for Q2-1. 39% of the Central doctors described the reason that “Time can be saved by this system” and 28% said that “Can get enough information/clear data”. 17% of the doctors stated that “It’s easy” and 11% gave the patient transfer related remarks such as “It’ll reduce the patient transfer without reason”, “Can save money” or “If patient transfer is necessary, the doctor will know the patient data before”. There were also comments like “The data is not clear when extended”, and the ratio is 5%. <Analysis for “Satisfaction of Consultation report” from Q1 to Q2> As menioned in the notice in the General information of this questionnaire, Q1.1 should be asked after practical use of consultation reports. It’s believed that 92% of the Local doctors who answered “Yes, I did” supposed the practical use of this system and they reported that they were satisfied with the reply from Central doctors, we can say that the expectation of the Local doctors for this system is very high and these questions should be asked again a few months after the implementation of the system in APT J3 project. From the result of Q2.1, the Central doctors feels that their heavy load will be reduced by the Consultation report, as the time can be saved (they can reply when they are available) and the enough information and/or clear data can be obtained which is not available when asked by using phone. In addition, the patient transfer will be reduced by this system, which will lead to saving money. Both Local and Central doctors are satisfied with the consultation report.


FINAL-40

Q3-1. Do you have any functions nice to have for this trial system? (Respondents: All doctors) (Multiple answers)

Total (n=60)

0% 10% 20% 30% 40% 50% 60% 70% 80%

Other

Know the time to get the answer

Share the disease cases

Use by mobile phone

Discuss w/other doctors

See other doctor's Consultation report

See other Consultation report via network

Central doctor (n=13)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Other



Use by mobile phone




Local doctor (n=12)

0% 10% 20% 30% 40% 50% 60% 70%

Other



Use by mobile phone





FINAL-41

Around 70% of the doctors reported that they want to “see other consultation report via network” and “see other doctor’s consultation report”, 52% said that they want to “share the disease cases”. When the result is divided between Central doctors and Local doctors, it can be seen that more Central doctors (85%) want to “see other consultation report via network” than Local doctors (58%), but it’s the same ratio between Central doctors and Local doctors (about 50% each) who want to share the disease cases. Q3-2. Please write down the reason for Q3-1. No answers received <Analysis for “Additional function for Consultation report” Q3> As shown in the result, most of the doctors want to see other consultation reports via network and half of them want to share the disease cases. This can be realized by the implementation of database which will contain the remote consultation report for the sharing the disease cases in next project. We need further survey for the detail rules or processes to share the disease cases in the database via network considering the security. Q4-1. Did you fill in the Consultation Report easily? (Respondents: All doctors) Total Central doctor Local doctor (n=25) (n=13) (n=12)

Easy

Not so difficult

A bit difficult

Difficult

Others

48%

28%

12%

12%

62%15%

15%

8%

42%

33%17%

8%

48% of the doctors selected “Easy” and 28% is “Not so difficult”, the doctors who mentioned as “A bit difficult” or “Difficult” are 12% each. As seen from the above pie charts, “Easy” is chosen by 62% of the Central doctors, while there were only 33% of the Local doctors. The doctors who felt somewhat difficult account for approximately 25% of both Central and Local doctors.


FINAL-42

Q4-2. Please write down the reason for Q4-1. The majority of the doctors who selected “Easy” or “Not so difficult” commented that “just following the report form is easy”, but the doctors who chose “A bit difficult” or “Difficult” explained the reason as “It’s first time to use” or “Not familiar with PC”. <Analysis for “Easiness of filling-in the report” Q4> Nearly three fourths of doctors feel that it’s easy to fill-in the consultation report by just following the report form and the difficulty for the rest of the doctors must come from the lack of training for this system, therefore it’s necessary to carry out the enough training before implementing the system in the next project. Q5. How long did it take to make the reply of Consultation Report from Local Doctors? (Respondents: Central doctors) 43% of the Central doctors answered as less than 30 minutes and the rest replied more than 30 minutes, the average time is about 38 minutes. Q6-1. How long did it take to get the reply of Consultation Report from Central doctors? (Respondents: Local doctors) There are very different answers that one is shorter than 2 hour, the other is longer than 10 hours and the ratio is 50% each. Q6-2. Do you think that the time period to get the reply from Central doctors is short? (Respondents: Local doctors) Local doctor (n=12)

Very short

shorter than Iexpected

Longer than Iexpected

Very long

44%56%

All the doctors marked “Very short” or “shorter than expected”.


FINAL-43

Q6-3. How long can you wait for the reply of Consultation Report from Central doctors? (Respondents: Local doctors)

Urgent case Non-urgent caseAverage time period 2 hours 1 day

As shown in the list above the Local doctors can wait for the reply for 2 hours in urgent case, and 1 day in non-urgent case. <Analysis for “Time period for consultation report” from Q5 to Q6.3> In fact, the doctors didn’t make the actual reply of consultation report, but just a sample report, it seems that they imagined the actual case and their answers are not so far from our expected time. However, to confirm their requirement, we need to survey again with the Local doctors if 38 minutes to make consultation report is too long or reasonable for them. Regarding the time period to get the reply (Q6.1), it looks that the doctors supposed 2 cases, urgent case and non-urgent case, they are divided between less than 2 hours and more than 10 hours respectively. From the result of Q6.2, the doctors feel that these time period is very short or shorter than expected, then they probably stated that they could wait for 2 hours for the urgent case, 1 day for the non-urgent case. The above result will be considered and discussed among responsible persons when implementing this system and making a management rule of remote consultation. Current time period for non-urgent case is set to 48hours (2 days) in the “Guideline for Remote Consultation between Doctors”, which may need to be modified. Q6-4. What was the question in the Consultation Report? (Respondents: Local doctors) All the doctors replied to this question commented that the question was about “Diagnosis and/or Treatment”. <Analysis for “Contents of Consultation report” Q6.4> The most common contents of the consultation report will be diagnosis and/or treatment.


FINAL-44

Q7-1. Do you think the flow of the process is understandable? Total Central doctor Local doctor (n=25) (n=13) (n=12)

Yes, I think so

Yes, maybe

No, not really

No, I don't thinkso

50%42%

9%

42%

42%

16%

58%42%

50% of the doctors chose “Yes, I think so” and 42% said “Yes, maybe”. 9% still thinks “No, not really” and those who selected this answer were Central doctors. The Local doctors have a higher proportion (58%) of “Yes, I think so” than the Central doctors (42%). Q7-2. If you choose "2 to 4" in Q7-1, please write down the reason. The Central doctors who marked “No, not really” explained the reason as “It’s in English” and some of the doctors mentioned that “It’s new system” or “Need practice”. There is a reason for “Yes, maybe” from the Central doctor is that “I know the same type of software”. Q8. If you have any ideas to change the process of Consultation Report, please write down your idea. We’ve got some various opinions that “Should have training how to use this system”, “depends on patient case” and “Remote consultation is good way, I believe it will be developed more than remote consultation”. Q9. Anything else would you like to comments about this system There are 67% of positive comments about the system such as “Good system to improve doctor’s skill/to help doctor”, “No loss time to travel” or “Need to operate this system ASAP”, and some constructive comments from Central doctors as “Need to make doctors to understand the system” or “Training on PC is necessary”. There is also a comment from Local doctor that “Another remote consultation to use phone call”.


FINAL-45

<Analysis for “Process of consultation report” from Q7 to Q9> A total 90% of the doctors reported that the flow of the process is understandable and they accepted the system as it is, the rest of the doctors feel a little difficulty due to the lack of training of this system and it’s written in English in some parts of the report. When implementing this system, all part of the consultation report and manual should be translated into Lao and the sufficient training will be conducted in the APT J3 project. <Satisfaction Rating>

-1

1

3

5Satisfied reply

Reduce heavy load

Quick response

Understanbableprocess

The satisfaction rating is shown above, the rate of “Satisfied reply”, “Reduce heavy load”, “Understandable process” is very high, and “Quick response” is comparatively high.


FINAL-46

- Emergency case General Information Total 25 doctors responded to this questionnaire and they are split into 56% of the Central doctors (Mittaphab Hospital) and 44% of the Local doctors (Luangphabuang Provincial Hospital). *Note) There are some questions which are to be asked after a certain time period to use this system, the answers provided to such questions may be given by the responders who suppose the practical use of the system. Q1-1. Are you satisfied with the functions of the trial system? Total Central doctor Local doctor (n=25) (n=14) (n=11)

Satisfied

Somewhatsatisfied

Not reallysatisfied

Not satisfied

Others

92%

8%

86%

14%

100%

100% of the Local doctors and 86% of the Central doctors replied as “Satisfied” and 14% of the Central doctors said that “Somewhat satisfied”. Q1-2. Please write down the reason for Q1-1. More than 50% of the doctors described that “Good system” or “New/Modern and convenient” and 33% mentioned that “Easy/quick to help us to solve the problem”. There are also comments like “Data/Information can be shared” or “Save money for phone call”.


FINAL-47

Q2-1. Do you think the remote Consultation by seeing the picture of patient data such as X-ray film is convenient? Total Central doctor Local doctor (n=25) (n=14) (n=11)

Convenient

Somewhatconvenient

Not reallyconvenient

Not convenient

Others100% 100%

100%

100% of the Central and Local Doctors responded as “Convenient”. Q2-2. Please write down the reason for Q2-1. 40% of the doctors described that “It’s convenient and good for common understanding”, 35% stated as “no loss time and fast treatment” or “Can identify quickly”. Another major remarks are “help us for diagnosis” and “Correct information” Q3-1. Do you think the quality of Diagnosis for patients will be improved by this system? (Respondents: Local doctors) Local doctor (n=11)

Yes, I do

Yes, somewhatimproved

No, I don't thinkso

Cannot tell

Others100%

100% of the Local Doctors replied as “Yes, I do”.


FINAL-48

Q3-2. Please write down the reason for Q3-1. Almost all the doctors stated the reason that “it helps the patient diagnosis”, “it’s effective for patient diagnosis” or “correct diagnosis”. There’re also comments such as “Help for staff’s skill improvement” or “Can share the idea with Central doctors”. <Analysis for “Satisfactory” from Q1 to Q3> All doctors are satisfied with this trial system due to the convenience of consultation by seeing the picture or data for patients, which provides the common understanding between Central and Local doctors quickly. All the doctors agreed that the quality of diagnosis for patients will be improved by this system, it’s believed that we can take a next step to implement this system in APT J3 pilot project. Q4-1. Do you have any functions nice to have for this system? (Multiple answers)

Total (n=60)

0% 5% 10% 15% 20% 25% 30%

Conference w/other countries

Conference at anywhere w/PC

Database to share the cases

Conference w/more than 2hospitals

To see movie of conference

Central doctors (n=14)

0% 20% 40% 60% 80% 100%







FINAL-49

Local doctor (n=11)

0% 10% 20% 30% 40% 50% 60%






68% of the doctors replied that they want “to see the movie of the conference” and 56% marked “Conference with more than 2 hospitals” and “Database to share the disease cases”. However the rate of “Conference with more than 2 hospitals” is lower selected by Local doctors than Central doctors. Q4-2. Please write down the reason for Q4-1. 50% of the doctors mentioned that “It’s easy and convenient” and 22% stated that “The idea or information can be shared”, then “Time and/or money can be saved” described by 14.3% of doctors. <Analysis for “Additional functions” Q4> There is a higher demand of “Conference with more than 2 hospitals” in Central doctors. They are likely to need to have a conference between more than 2 hospitals, as there are several hospitals in Central area (Vientiane). For the requirement of seeing the movie of the conference, we plan to implement the database, with which the recorded conference data can be stored and such a data can be seen by Central and Local doctors in the next pilot project.


FINAL-50

Q5-1.Do you think whether it’s easy to operate this system? Total Central doctor Local doctor (n=25) (n=14) (n=11)

Easy

Comparativelyeasy

A bit difficult

Difficult

Others

48%26%

17%

9%

42%

25%

16.5%

16.5%

55%27%

18%

42% of the Central doctor and 55% of Local doctors responded as “Easy”, 25% of Central and 27% of Local selected “Comparatively easy”. 16.5% of the Central doctors said “A bit difficult” and “difficult”, 18% of Local doctors felt “A bit difficult”. Q5-2. Please write down the reason for Q5-1. The doctors who chose “Easy” or “Comparatively easy” described the reason as “I know how to use” or “It’s not confusing”. The reasons for “A bit difficult” or “Difficult” are “Lack of IT/PC skill or English”, “No internet connection” and some doctors commented “The training to get how to use is necessary”. Q6-1. Did you respond smoothly and quickly to solve the emergency case? Total Central doctor Local doctor (n=25) (n=14) (n=11)

Yes, I did

I think I did

I think I didn't

No, I didn't

Others

21%

79% 77%

23% 18%

82%

21% of the doctors answered as “Yes, I did” and 79% selected “I think I did”.


FINAL-51

Q6-2. Please write down the reason for Q6-1. 54% of the doctors mentioned the reason that “it helps us to solve the problem” and 15% described that “Data is clear”. Another 15% who compared with the patient transfer that it’s faster than patient transfer. Q7. How long did it take to do the conference for one Consultation Report? There are some various answers from 20 minutes to 120 minutes and the average is 48 minutes which is given by the doctors who supposed the actual case. <Analysis for “Easy operation and time period for consultation” from Q5 to Q7> Nearly 80% of the doctors commented that the operation is easy or comparatively easy due to the understandable operation. To increase the ratio of the doctors who feel easy for the operation, the training is required. As noted in the notice, they didn’t respond the actual reports to solve the emergency case, however, the doctors supposed such a case when answering the question. No doctors replied that “I didn’t respond smoothly and quickly”, therefore their expectation is likely to be that the system can be used smoothly and quickly since this system helps them to solve the problem faster than the patient transfer and the data shared is also clear. Q8. What was the question in the Consultation Report for the emergent case? The majority of the answers were “Diagnosis of diseases” or “How to treat the patient”. <Analysis for “Contents of Consultation report” Q8> The most common case of the consultation report will be diagnosis of diseases and/or treatment of patient. Q9. How many patients in emergency do you have? (Respondents: Local doctors)

Average 1.4 patients /weekNo. of Patients in emergency

The most of the Local doctors replied as 1 to 2 patients per week, or 5 to 10 patients per month, the average is 1.4 patients in emergency per week.


FINAL-52

<Analysis for “Number of patients in emergency in Local hospital” Q9> The answers from the Local doctors to this question don’t make so much difference, they have 1 emergent patient per 3 to 7 days. We need further survey to see how many patients in emergency with what kind of diseases they have, and this result will be considered for the management process or rules of the consultation reports and contents development. Q10-1. Do you think this system can be used practically for Remote Consultation? Total Central doctor Local doctor (n=25) (n=14) (n=11)

Yes, I think so.

Maybe yes.

Not quite.

No, I don't htinkso.

100% 100% 100%

100% of the Central and Local doctors reported as “Convenient”. Q10-2. Please write don the reason for Q10-1. 25% of doctors described just “I believe that this system can be used.” or “Every doctor is eager to use this system”, which has no reasons. Other 25% explain the reason that “Data is clear and no mistake”. Another major reason is “To improve the medical skill” or “New technology”. We also have some remarks with conditions like “If we have PC and internet connection” or “If not difficult than our ability”. <Analysis for “Practical use” Q10> 100% of the doctors said that this system is convenient, but there are some doctors who expect some improvement with this system and their environment such as “easy operation of the system” and “PC availability in the hospital”. When implementing the system, we need to consider these points which are necessary for the practical use.


FINAL-53

Q11-1. Did you do the web conference without any problem? Total Central doctor Local doctor (n=25) (n=14) (n=11)

Yes, I did

A little problem,but no stress

Felt a stress

No smooth at all

31%

31%

25%

13%

37.5%

37.5%25% 25%

38%

25%12%

Total 56% of the doctors stated that they didn’t feel any stress and 44% in total felt a stress with 13% feeling a stress strongly. When looking at the Central and Local doctors separately, 25% of the Local doctors felt a stress strongly while no Central doctors felt like that. Q11-2. If you choose “2 to 4” in Q11-1, please write down the reason. 33% of the reasons for “Feel stress” or “No smooth at all” were indicated as “Not familiar with this system” or “Internet connection was not good”. There is another reason such as “Not clear for something” and “Staff or equipment is insufficient in hospital”. Q12. Anything else would you like to comments about this system 50% of the doctors described that “Internet connection and PC are required” and 25% reported that “This is good system as it’s convenient and solve the problem quickly”. Other comments received are that “good to improve the skill”, “help doctors to make decision quicker”. <Analysis for “Stress for the system” Q11> As mentioned in the above, main reasons for feeling stress by using the system most probably come from a lack of training and bad internet connection. During the trial, the network condition in Central hospital was not good and the communication was disconnected several times, however, we expect that the network condition will be improved by the e-Government project and the sufficient training is planned to be carried out in APT J3 pilot project to make the doctors feel less stress.


FINAL-54

<Satisfaction Rating>

-1

1

3

5Convenience

Qualityimprovement

Easy operation

Quick response

Practical use

Stress free

As shown in the above satisfaction rating, the rate of “Convenience”, “Quality improvement”, “Practical use” and “Quick response” is very high (full marks), but the “Easy operation” and “Stress Free” are average. We will try to improve these points in order to make their satisfaction rate higher in the next project by conducting sufficient training and checking the network condition to have enough throughput which is likely to cause the stress. Conclusion The result of the questionnaires showed strong support for the trial system, which includes the consultation report, management rules and the web video conference system, and the effectiveness of such system was verified for reducing the heavy load of Central doctors and improving the quality of the diagnosis and/or treatment of patients for Local doctors. Suggestion Before implementing the system, we should consider a sufficient training of the system to be conducted and transfer all the relevant manuals into Lao in order to get the common understanding. As for the needs findings for the contents development, we could get a rough idea of medical contents through the questionnaire, it’s preferable to conduct the same questionnaire in another Provincial area such as Champasak which had been candidate for a trial place. Further survey with more specific questions is also necessary to get more detailed requirement which will be the basis of “Contents Making Plan”.


FINAL-55

5. Project Outputs

5.1 Methodology

As described in 3.1. Methodology Overview, the scheme and methodology of “How to develop, maintain, and utilize the comprehensible e-health contents” is as below;

1) For the development of effective contents, the management process (refer to “Annex-1. e-health Contents Management Guideline”) starting from the planning to the distribution, where all the process is controlled by responsible managers assigned was proposed to be applied. The planning should be based on the requirement from those who use the contents.

2) To understand “What’s the requirement for e-health contents in Laos?”, we have to learn the current situation in the medical field in Laos through the hearing from the medical doctors and staffs in Joint Study in Lao P.D.R. -1.

3) Three issues related to the 3 segments of e-health contents other than data management were identified during Joint Study in Lao P.D.R.-1 (refer to “Figure 3.1.1 Issues to be solved”). The first issue is related to the contents for medical doctors, the second one is for medical staffs for educational purpose, and the third is for public.

4) The hypothesis was made to solve those issues, the example contents which is “Consultation Report Form and List” with contents operation rules (refer to “Annex-2. Guideline for Remote Consultation between Doctors”) for remote consultation between doctors were prepared for the first issue, “Heavy load for Central doctors”. For the second and third issues, we found out the necessity to go back to the start point of contents development rather than making the example contents. The questionnaire for needs findings was prepared to understand the requirement from the medical doctors and staffs.

5) To check the validity of our hypothesis, the trial was conducted during Joint Study in Lao P.D.R.-2. To evaluate the trial, two questionnaires for the remote consultation, which are divided into Non-emergency case (Remote consultation report) and Emergency case (Web video conference system), and the above questionnaire for needs findings were carried out (refer to the “4.3.4. Trial results”). As shown in the trial result, the effectiveness of our solution was verified so as to proceed to the next step, the implementation of the pilot project.


FINAL-56

6. Project Sustainability

Throughout this project, there are many points reaffirmed and newly found to improve the Medical and Health field in Lao P.D.R. Every studied result especially after the Joint Study in Japan, the project member has reported internally MOH so as for the proper understanding and consensus from the relevant persons. And such result and process of the project have also been reported to Minister of Health.

MOH have understood the importance to get back to the basics, namely, the contents management procedure starting from needs finding, which should be the basis of the contents making plan. Through this project period, it has been found the necessity of refining the questionnaires for needs finding, and it will soon be refined for the practical use.

In addition, regarding the remote consultation between doctors in Provincial Hospital and Central Hospital, most of the trial participants are really interested in it, and eager to use it indeed. The management level of relevant hospitals and departments have same opinions on the issues picked out through the survey in this project and strongly require the solutions as proposed in this project.

For the Central Hospital side, the network environment is ready for broadband connection under the e-Government Project led by NAST. And its utilization for better health is one of the major concernments of them. From such viewpoint, the solution for remote consultation really meets their intent and demand.

Besides, for the Provincial Hospital side, there is really high interests and demand for remote consultation to consult with the specialist doctors in Central Hospital. Also, the doctors have responsibility to care for the neighboring provinces and districts area. Therefore, realization of the studied result in Provincial Hospital will be the best practice for both of “expansion to other provinces” and “expansion to the more far areas”.

In order for the realization as best practice, the network expansion for broadband connection and the HRD (some doctors have enough PC literacy, but not all) are indispensable. It is already planned to apply for the APT-J3 supported pilot project as one of the practical solutions.


FINAL-57

7. Future Plan

Although the targeted sector of this project is “health and medical sector”, the result of this project should give positive impact on the other sectors’ utilization so as to maximize the advantageous effect.

Therefore, as the ICT relevant authorities, NAPT and NAST have following intents.

7.1 Current situation

The e-Government Project led by NAST is ongoing and aiming the service-in at the end of August 2009 for Vientiane capital area. As for the Provincial areas, equipment delivery is mostly completed and installation work will be progressed area by area basis depending on the site conditions. (To be completed at the end of 2009)

The NW infrastructure installed for e-Government NW such as the OFC ring inside Vientiane Capital is already in use practically. (Typical example of effective utilization: Tax Department)

Regarding the OFC Backbone NW, OFC links have already reached to the Provincial Capitals except 2 Provinces. All districts somehow have Backbone NW for BTS of mobile services. However, they seem to be not enough for the broadband service provision.

Figure 7.1.1 Current Status and Challenges on Backbone NW

Current Status and Challenges on Backbone NWCurrent Status and Challenges on Backbone NW

Need expansion plan

VientianeCapital

ProvincialCapitals

DistrictCapitals Villages

OpticalFiber

Wireless

All covered for mobile BTSOptical Fiber (excl. 2 Provinces)

lack or weak

• Capable for Broadband Services• To be utilized for e-Government Project by NAST

• NOT enough for Broadband Services

Need expansion plan

VientianeCapital

ProvincialCapitals


OpticalFiber

Wireless


lack or weak



Need expansion plan

VientianeCapital

ProvincialCapitals


OpticalFiber

Wireless


lack or weak




FINAL-58

7.2 Plan for Future

After the installation of e-Government NW, “How to utilize it?” is one of the key issues for the nationwide ICT enhancement. Thus, based on the result of this project, NAST will encourage the relevant authorities. One practical solution is to realize the study result as the pilot project, and its successful result will be the priming water for arousal of relevant authorities’ intents. [It is already planned to apply for the APT-J3 supported pilot project.]

Regarding the nationwide network infrastructure enhancement, by the cooperation between the telecom operators, redundancy configuration will be realized through the efficient share of the duplicated route. (Planned in 2010-2011)

Besides, approximately 30% of the districts have certain difficulties for the OFC installation due to the distance from the major road. Including such districts, it is planned to connect all districts by OFC in 2013.

Especially in rural areas, fewer households are scattered in wide area. The regulation for rural area wireless connection is planned to be established in 2010. In addition, for the effective investment, encouragement of user demand is indispensable. From such point of view, it is quite meaningful to realize the study result of this project so as to let the public especially living in remote area know the effectiveness of ICT access point for the better health.

Also, needless to add, the expanded NW is not only for one purpose, additionally to the medical and health field, it will surely be available for educational field, disaster management field, and so forth. The planned pilot project should be the best practice for the NW expansion into the rural areas.


FINAL-59

8. List of Annexes

Annex 1: e-health Contents Management Guideline (English / Lao) Annex 2: Guideline for Remote Consultation between Doctors (English / Lao) Annex 3: Photos (Exchange Activity in Lao, Exchange Activity in Japan, Trial in Laos)

----- End of Final Project Report -----


ANNEX 1

ANNEXES


ANNEX 1

Annex 1: e-health Contents Management Guideline (English / Lao)


ANNEX 1 - 1

e-health Contents Management Guideline (English / Lao)


ANNEX 2

Annex 2: Guideline for Remote Consultation between Doctors (English / Lao)


ANNEX 2 - 1

Guideline for Remote Consultation between Doctors (English / Lao)


ANNEX 3

Annex 3: Photos (Exchange Activity in Laos) (Exchange Activity in Japan) (Trial in Laos)


ANNEX 3 - 1

Photos (Exchange Activity in Laos) [from 15-Mar-09 to 21-Mar-09]

Date : 16-Mar-09

Place : CIEH* Meeting Room Kick-off Meeting

*CIEH : Center for Information &

Education for Health, Ministry of Health

Date : 18-Mar-09

Place : Bolikhamxay Provincial Health Department

Visit and Hearing at Bolikhamxay Province


ANNEX 3 - 2

Date : 18-Mar-09

Place : Bolikhamxay Provincial Hospital

Visit and Hearing at Bolikhamxay Province

Date : 20-Mar-09

Place : CIEH

Collaborative work at CIEH

Date : 20-Mar-09

Place : CIEH Meeting Room

Wrap Up Meeting


ANNEX 3 - 3

Photos (Exchange Activity in Japan) [from 24-May-09 to 06-June-09]

Date : 26-May-09 Place : Fujitsu HQs

Kick-off Meeting

Date : 26-May-09

Place : Fujitsu netCommunity

Introduction of latest technologies


ANNEX 3 - 4

Date : 27-May-09

Place : Fujitsu Kawasaki

Discussion with BHN Association (Telemedicine in Malaysia)

Date : 27-May-09

Place : Fujitsu Hospital

EMR system demonstration

Date : 28-May-09

Place : Asuke Hospital

Hospital building overview & Telemedicine (Communication with patient in remote area)


ANNEX 3 - 5

Date : 02-June-09

Place : Fujitsu Kawasaki

Case Study on Learning Management System & Contents development tool

Date : 03-June-09

Place : Tokai University Hospital

Hospital building overview & Doctor Helicopter

Date : 05-June-09

Place : Fujitsu HQs

Discussion & commemorative photo after the Wrap Up Meeting


ANNEX 3 - 6

Photos (Trial in Laos) [from 05-August-09 to 11-August-09]

Date : 05-Aug-09 Place : Luangphabang Provincial

Health Department

Trial Explanation in Luangphabang Province

(Provincial Health Department)

Date : 05-Aug-09

Place : Luangphabang Provincial Hospital

Trial Explanation in Luangphabang Province (Hospital)


ANNEX 3 - 7

Date : 06-Aug-09

Place : Luangphabang Provincial Hospital

Trial in Luangphabang Province (Hospital)

Date : 06-Aug-09

Place : Luangphabang Public Health School

Trial Explanation in Luangphabang Province (Public Health School)

Date : 07-Aug-09

Place : Mittaphab Hospital (Central)

Explanation and Discussion in the Central Hospital


ANNEX 3 - 8

Date : 07-Aug-09


Trial Explanation in the Central Hospital

Date : 07-Aug-09


Trial in the Central Hospital

Date : 11-Aug-09

Place : CIEH Meeting Room

Wrap Up Meeting

Date post:	28-Mar-2018
Category:	Documents
Upload:	doannguyet
View:	214 times
Download:	2 times

Final Project Report - Asia-Pacific Telecommunity · PDF file · 2010-04-30HRD...

Documents