mHealth Applications in the Ministry of Health : Today and Tomorrow.

mHealth Applications in the Ministry of Health : Today and Tomorrow.

128th Anniversary International Medical CongressSymposium on emerging use of mobile technology in health

7th July 2015Dr. Chaminda WeerabaddanaMedical Officer (Heath Informatics)Ministry of Health, Sri Lanka.Thank you chair,

Good afternoon ladies and gentlemen1Contribution of state health servicesAllopathic healthcare delivery in Sri Lanka by state sectorPreventive- 100%Curative - Inpatient - 95%- Outpatient- 50%Annual Health Bulletin 2012 [Internet]. Ministry of Health; 2014. Available from: http://www.health.gov.lk/en/publication/AHB-2012/Annual%20Health%20Bulletin%20-%202012.pdfMost Sri Lankans live within 3 kilometers of a public health care facilityRannan-Eliya, Ravi P., and Lankani Sikurajapathy. "Sri Lanka:Good practice in expanding health care coverage."Good practices in health financing: lessons from reforms in low-and middle-income countries. Washington, DC: World Bank(2008): 311-54.The state health sector plays a major role in providing health services to all Sri Lankan.

Nearly 95%of all inward patients and 50% out patients are catered to by government health institutions.

And most Sri Lankans would have a government health institution with in 3 km from where they live.2Mobile teleCOM Services in Sri LankaSri Lanka is having 5 mobile operatorswith over 98% Percentage of total population covered by a mobile network signal(1)With 107 Mobile Subscription per 100 people(1) Sri Lanka has a good potential for using mHealth solutions to improve the health of its citizens.

1. Bilbao-Osorio B, Dutta S, Lanvin B, Insead, World Economic Forum. The global information technology report 2013 growth and jobs in a hyperconnected world [Internet]. Geneva, Switzerland: World Economic Forum; 2013 [cited 2015 Jun 15]. Available from: http://www3.weforum.org/docs/WEF_GITR_Report_2013.pdf

2. Telecommunications Regulatory Commission of Sri Lanka, Statistics (December 2014) [Internet]. Telecommunications Regulatory Commission of Sri Lanka; 2014. Available from: http://www.trc.gov.lk/images/docs/statis_dec2014final.docxNow lets look at the Mobile Telecommunication Services in Sri Lanka,There are 5 mobile operators and the combined mobile network cover 98% of the total population. There are 107 active mobile subscriptions per 100 people

If you need a medium for enhancing health care delivery, Mobile Telecommunication Services definitely has the reach.3mHEALTHno standardized definition of mHealth has been established.

The Global Observatory for eHealth (GOe) defined mHealth or mobile health as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.

oruse of mobile and wireless technologies to support the achievement of health objectives

http://www.who.int/goe/en/There are many definitions for mHealth.

The simplest use of mobile and wireless technologies to support the achievement of health objectives would be fit most scenarios

4mHealthmHealth has the potential to transform the face of health service delivery

Rapid advances in mobile technologies and applicationsNew opportunities for the integration of mobile health into existing eHealth servicesContinued growth in coverage of mobile cellular networks.Reach extending far beyond the reach of the electrical gridcategories of mHealth services1. Communication between individuals and health servicehealth call centresEmergency toll-free telephone services2. Communication between health services and individualsAppointment reminderscommunity mobilization and health promotiontreatment complianceHealth awareness raising3. Consultation between health care professionalsmobile telemedicine4. Inter-sectoral communication in emergenciesmanaging emergencies and disasters5. Health monitoring and surveillancepatient monitoringsurveillancehealth surveys and data collection6. Access to information for health care professional at point of caremobile patient recordsinformation accessdecision support systems7. Heath Administrative Services

According to the Global Survey on eHealth conducted by the Global Observatory for eHealth, World Health Organization, mHealth services were categorized under 14 categories.

Namely;

I have added Health administrative services. Based on our classification of health services as Curative, preventive, supportive and administrative services, it would be difficult to put mHealth solutions geared to towards health administration under any other category, though it would be an integral component in achiving health objectives.6eHealth services will closely follow the Health Service domain categoriesCurative Health Services (CHS)Public Health Services (PHS)Administrative Services (AS)Health Supportive Services (HSS) - labsmHealth services PATTERN WORLDWIDEThe majority of WHO Member States (83%) reported offering at least one type of mHealth service. Many countries offered four to six programmes. mHealth Service CategoryFrequencyHealth call centres59%Emergency toll-free telephone services55%Managing emergencies and disasters54%Mobile telemedicine49%Kay, Misha, Jonathan Santos, and Marina Takane. "mHealth: New horizons for health through mobile technologies."World Health Organization(2011): 66-71.According to the previously mentioned Global Survey on eHealth they have observed most of the World health organization member states offer at least one mHealth service. Health call centers , emergency toll free telephone services and managing emergencies & disasters were the most commonly offered mHealth services.8Types of mHealth servicesThe type of mHealth services that can be delivered varies with the type of handset used.

Basic phones can handle voice and SMS services. Smartphones can also facilitate web browsing, Apps and location based services.

In Sri Lanka most of the handsets currently used are basic or feature phone type , but according to industry sources the smart phone growth in the market is around 400% year on year.

With more smartphone it would be possible to deploy many advanced mHealth solutions to the masses.

91-9-5-9 Short codeNational Hospital of Sri LankaStarted 2014 August

Infrastructure Digital telephone systemIVRStaff telephone operators and nursing officersHealth education, poison related information, clinic information, etc.

Now lets consider some of the services accessible through mobile telecommunication services.10Suwasariya / Health NetHealth Education BureauLaunched November 2011

Free medical advice and health informationThrough website http//www.suwasariya.gov.lk)Call center 0710 107 107

Year201220132014 (first 6 months)Calls received3793481079SexMaleFemaleUtilization58%42%Behavior and psychiatry disorders18%Kidney and genitourinary disorders14%Musculo skeletal disorders8%Kulatunga, Gumindu GAK, et al. "Understanding the Tele-health needs of Suwsariya (Health Net) users."Indian Association for Medical Informatics91 (2014): 96.1-1-0 Emergency LineService established by the Ministry of Local Government and Provincial Councils (CMC)Calls received in a call center (Maradana)Emergencies informed to local services maintained by UC/MC/etc.Service available in ; Colombo , Kalutara , Negombo , Kandy , Jaffna , Badulla , Bandarawela , Anuradhapura , Matara , Tangalle.

5 Ambulances to Colombo1 ambulance each for other stations

Mobitel mChanneling for PUBLIC SECTOR HOSPITALS0711370370

Partners ;Ministry of Health (WP)District Hospital DompeBase Hospital AvissawellaPresidential SecretariatMobitel (Pvt.) Ltd.

https://www.youtube.com/watch?v=F7t2WUTpFKg13Human Resource Management Information System (for Grade Medical Officers)

For health administrationMedical Service II Division of the Ministry of Health

Automated user registration and password recoverySimplify the administrative burden of issuing 16000 usernames and passwords

14Projects in the pipelineHealth API

Implemented by the Health Information Unit of the Ministry of Health and the ICTA.Expose health databases for mobile application developer through the Lanka Gate API Store.

Ex : Hospital information with geo coordinatesClinic details in hospitalsRegistered drugs with CDDA

Health API project is one project that we are very interested in,15Future scopeHealth warnings via SMS based services dengue hotspotsImprove treatment compliance and clinic follow up for TB, STD, etc.Health tips for NCD, Antenatal care, etc.Remote data collection and surveys Eg : NOHS, HDSLab results updates to patients from MRI / Regional cluster labs.Disease and Epidemic Outbreak Tracking Eg: identify and out break clusters for prompt actionSmartphone apps Health Education, Pill reminders, BMI tracking, etc.Patient Monitoring Eg : Arrhythmia monitoring, Sleep monitoring with IoT devices.And many more

16Thank you.Chart2

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Year199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013 DecSubscribers121,388125,834135,504157,774180,724204,350255,049341,622523,529669,113767,411827,195883,108939,013991,2391,243,9941,884,0762,742,0593,446,4113,435,9583,578,4633,608,3923,449,3912,706,787

Year19921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014 Dec

Subscribers2,64414,68729,18251,31671,029114,888174,202256,655430,202667,662931,4031,393,4032,211,1583,361,7755,412,4967,983,48911,082,45414,264,44217,267,40718,319,44720,324,07020,315,15022,123,000

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