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© J Pak Med Stud. www.jpmsonline.com Supplement # 2; 2012 Page | 1

JPMS Third International E-Hap Conference-2012

Third International eHap Conference 2012

January 21-22nd 2012

University of Health Sciences, Lahore, Pakistan

Official Partners: Journal of Pakistan Medical Students

J Pak Med Stud 2012; 2(2): suppl (2) 1-24.

NOTE: All the abstracts have been selected and edited by the Scientific Committee of eHap 2012. No abstract was reviewed or

edited by any reviewer or editor of Journal of Pakistan Medical Students, JPMS. All the abstracts have been exactly published as

received from eHap 2012.

About Ehap: The eHealth Association of Pakistan (eHAP) is a non-profit organization which aims

to share and enhance knowledge and advocate policy support for broader implementation of eHealth

programs across Pakistan by bringing together eHealth experts and other stakeholders from different parts

of Pakistan on one platform.

1. History:

A joint meeting of experts in Telehealth (Telemedicine) and technology use for health information

management and learning was held at the Serena Hotel in Islamabad on November 27, 2008. This group

announced the formation of the eHealth Association Pakistan (eHAP). The structure and philosophy of

this group was finalized in its Board Meeting on February 25, 2009 at Aga Khan University, Karachi and

COMSATS Headquarters, Islamabad simultaneously via videoconferencing. The initial structuring of

eHAP was facilitated by Aga Khan University, Karachi with funding from the Rockefeller Foundation.

2. Vision and Mission:

eHAP's Mission:"To promote adoption and use of eHealth as an integral component of health services

and education in Pakistan, through advocacy, evidence, access to recognized experts and resources,

policy-support and capacity-building."

http://www.aku.edu/

http://www.rockefellerfoundation.org/



3. National Affiliations of eHAP:

eHAP serve as a forum for the collection, exchange and dissemination of information related to eHealth

and it works, cooperates and acts as a liaison with other organizations, institutions, governments,

governmental organizations, individuals, societies and corporations involved or concerned with the

development and implementation of eHealth activities and health care health care services in Pakistan.

eHAP has 14 Institutional Members which includes Pakistan Institute of Medical Sciences,

Islamabad, COMSATS Islamabad, Holy Family Hospital Rawapindi, Sehat First, Heart File, GIZ, Shifa

Medical College Islamabad, Internatonal Organization of Migration, College of Family Medicine, Aga

Khan Health Services, Pakistan, Aman Foundation and Aga Khan University Karachi.

4. International Affiliations of eHAP:

eHAP is also the National representative member of the two international societies in

Telehealth/Telemedicien and Health Informatics i.e. International Society for Telemedicine and eHealth

(ISfTeH) and International Medical Informatics Association (IMIA) respectively. These recognitions

allow eHAP to build partnerships with other Associations/Societies who are also respective National

members around the world. eHAP has also recently signed an MoU with American Telemedicine

Association at Tampa Florida.

5. Seminars and eHealth Awareness sessions:

eHAP board members conducted several seminars in educational institutions of the country to create

awareness about eHealth and to attract institutional members. These seminars were conducted in the cities

of Karachi, Islamabad, Rawalpindi, Lahore, Hyderabad, Larkana and other cities. More seminars are

scheduled in the coming months.

5.1 International eHealth Conferences:

5.1.1 First International eHealth Conference:

eHealth Association of Pakistan organized its first International eHealth Conference “Better Health for all

through eHealth” at the Aga khan University, Karachi on January 23-24, 2010. The conference was

telecasted live at the National University of Science and Technology, Islamabad. The conference

attracted stakeholders from the Ministries of Health and Information Technology, National and

International development organizations, Health care institutions, Academic institutions in Health,

engineering and Telecommunication, and students from a variety of disciplines. Several keynote

addresses, scientific sessions, workshops and panel discussions were arranged to provide opportunity to

the experts, researchers, and participants to share their views. For conference recommendations.

5.1.2 Second International eHealth Conference:

eHealth Association of Pakistan organized its Second International eHealth Conference “eHealth and the

Road to the Millennium Development Goals” at International Islamic University, Islamabad, Pakistan on

January 22-23, 2011. The conference was telecasted live at the Aga Khan University, Karachi. This

Conference was a unique feature in Pakistan, allowing healthcare providers, allied health professionals, IT

experts, telecommunication companies, managers, and educational institutions in health, biomedical and

IT fields to reflect on ways to collaborate for improving health of the population. For conference

recommendations.

5.2 eHAP Workshops:

Considering the growing demand of eHealth, a two-day Knowledge Sharing Workshop “eHealth

Knowledge Sharing workshop”, was organized by eHealth Association of Pakistan (eHAP) in

collaboration with LIRNEasia, Sri Lanka on September 29-30, 2010 at Islamabad Club, Islamabad,

PAkistan. The purpose of the workshop was to share and compare the findings of eHealth initiatives in

Pakistan and other South East Asian countries. The workshop was attended by representatives from the

Ministries of Health and IT, public and private healthcare institutions, NGOs and academic institutions.

5.3 Other Achievements:

Built a membership base of over 300 individuals across Pakistan

http://lirneasia.net/



Developed short course in Tele-Health, Health Informatics and eLearning.

Providing access to eHealth literature and resources.

Working with Ministry of Health to develop eHealth strategy for Pakistan.

Keynote Speakers

Dr. Ronald C. Merrell

Dr. Sikder M. Zakir

Dr. Sania Nishtar

Prof. S K Mishra

Dr. Richard E. Scott

Dr. Esther Ogara

Gulzar H. Shah

Dr. Abdus Salam Khan

ABSTRACTS FROM eHAP 2012

THE UTILITY OF MOBILE PHONE IN THE PREVENTION OF CARDIOVASCULAR EVENTS,

THROUGHLIFESTYLE MODIFICATION - A PROSPECTIVE, RANDOMIZED, CONTROLLED, MULTICENTER

CLINICAL TRIAL, IN KARACHI, PAKISTAN.

Javed Ismail, Hosen Kiat, EsbenStrodl, Junaid Ansari, Jun Ma, Andrew Sindone, ShariqKhoja, Dylan Kelly

Introduction: Preventive strategies (primary and secondary) to reduce burden of cardiovascular disease have been met with

limited success due to the cost and difficulty in healthcare delivery. Mobile phone text messaging (SMS/MMS/Voice messages)

demonstrates strong potential as a tool for health care improvement.

Objectives: To assess the effectiveness of lifestyle modification messages delivered by SMS/MMS/Voice mail to patients

following non-fatal cardiac events in reducing future hospitalizations, nonfatal and fatal cardiovascular events, as well as all-

cause mortality.

Methodology: It is a Prospective, Multicenter, Randomized, Controlled clinical trial. The patients hospitalized with their first

cardiac event (nonfatal MI, CABG, PCI, unstable angina) will be recruited from the participating tertiary care cardiac specific

hospitals –the Karachi Institute of Heart Disease Tabba Heart, and the National Institute of Cardiovascular Diseases in Karachi,

Pakistan. We allocate each participant to either the intervention group, i.e. those who will receive behavioral change/life style

modification education through mobile phone, or to the usual standard of care group (non-intervention group). The patient

allocations were carried out through permuted block randomization to ensure a balance in the patients to each group. The

participants were requested to nominate a carer (close relative or friend) who are the persons responsible for taking day-to-day

care of the patients at home. A free and open source software called ‘FrontlineSMS’ will be used for sending SMS messages,

while the medical records of participants will be stored using a community-based electronic medical record system called

‘OpenMRS’. Both these systems will be integrated for the flow of information.

Based on power analysis a total of 1540 patients (770 in the intervention and 770 non-intervention groups) and their respective

carers (n: 1540 as well) will be enrolled over 12 to 16 months. All patients will be followed up for a minimum of 6 to 9 months

(range 21 to 6 months).



A regular mobile phone messages (SMS/MMS/Voice mail) regarding lifestyle modification will be delivered to patients of

intervention group (Secondary prevention) and one of their carer. The mobile phone message based rehabilitation program will

be structured according to the latest guidelines developed by the WHO for the prevention of cardiovascular disease.

Blood samples will be drawn to investigate lipid profile, HbA1c, blood sugar, and urinary urea creatinine etc at regular

designated intervals.

Key Words: Cardiovascular diseases, Mobile phone, SMS, Rehabilitation, Lifestyle modification

Note: Interim analysis till January 2012 will be shared in the conference

HYBRID APPROACH FOR TELE ORTHOPEDIC SERVICES IN PUNJAB, PAKISTAN

Riaz Ahmed Sheikh1, Asif Zafar2 1.Associate professor of Orthopedic Surgery Rawalpindi Medical College,

2. Professor of Surgery, Rawalpindi Medical

Background: Ministry of Information technology, Pakistan’s Telemedicine rural support program has been up and running since

last 3 years. Three hubs in major cities in tertiary care hospitals are connected to 12 remote sites at distinct levels in Sind and

Punjab provinces. Very few district headquarter hospitals in the country have qualified orthopedic surgeons. Initial treatment of

these patients is provided by primary care physicians and General surgeons if available. Patients requiring specialist opinion or

surgery have to travel to major city hospitals.

Methodology: Orthopedic surgeons are now part of team providing specialist consultations to remote regions. Hybrid approach

which combines store and forward and real time face to face consultations is being practiced. Patients referred are scheduled for

consultations 3 days a week. Emergency Teleconsultations do not require prior appointments. Patient’s relevant data, initial

treatment record and images are uploaded on the Medweb server. Face to face consultations take place on scheduled date and

time.

Results: 708 Teleconsultations have taken place since the start of program. Majority have been scheduled appointments. Patient’s

age ranged from 3- 80 years. Conditions treated ranged from congenital orthopedic problems (20) to trauma and fractures (208),

osteoporosis and degenerative disorders like osteoarthritis and backache (465) Patients requiring operative interventions were

transferred to holy family hospital.

Conclusion: Any existing telemedicine set up can be efficiently utilized to incorporate the specialty of orthopedics. The

effectiveness of Tele- consultations was highlighted in the treatment of poly trauma and other orthopedic conditions. This

provided prompt opinion and treatment plan to remote physician and helped in decision making, and decreases in-hospital stay.

INTERNATIONAL TELECOMMUNICATIONS UNION & EMERGENCY TELEMEDICINE RESPONSE IN

PAKISTAN

Asif Zafar 1, 2,

1 Professor of Surgery, Rawalpindi Medical College, Rawalpindi. 2. Telemedicine & e Health Training Center, Rawalpindi,

Pakistan.

Background: Pakistan has been devastated by natural disasters in last decade. ITU is a United Nations agency for information’s

and communications technology. It has played significant role in assisting Government of Pakistan in establishing

communication links for disaster management.

Methodology: ITU responded to Pakistan's request for assistance. 100 broadband satellite terminals were dispatched immediately

and ITU’s emergency telecommunications team worked closely with National disaster management organizations. The satellite

terminals were deployed to restore communications and provide a platform from which telemedicine applications/services were

provided in remote areas that were difficult to access and where medical attention was a priority in the aftermath of the disaster.

The satellite terminals supported high-speed data and provided the much needed link between medical aid workers in the field

and referral centers thus providing diagnostic support and real-time consultation with medical specialists in far-off hospitals

anywhere in the world.



Results: Consultations were provided by staff at AKU, Karachi, Ayub teaching hospital Abbottabad and Holy family hospital,

Rawalpindi. Challenges were encountered in release of equipment from customs, deployment at the disaster site, coordination of

all relief and rescue activities.

Conclusion: This is a example of close collaboration of UN agencies like ITU and National disaster management teams in

establishing communications links. There are lessons to be learnt, a comprehensive strategy for collaborative International

response to deal with these challenges is required

MINISTRY OF IT HEALTH NET RURAL SUPPORT PROGRAM-REVIEW OF UTILIZATION OF SERVICES AT

HOLY FAMILY HOSPITAL HUB.

Ali Q1, 2, Murad MF1, 2, Zafar A 2, 3

1 Senior Registrar, Surgical Unit II Holy Family Hospital

2 Telemedicine/E-Health Training Center, Holy Family Hospital, Rawalpindi

3 Professor of Surgery, Rawalpindi Medical College.

Introduction: Government of Pakistan initiated National Telemedicine Rural Support Program. Rural telemedicine centers has

enabled rural population to seek consultation, advice and treatment from specialist doctors in urban center hospitals, without

having to travel hundreds of kilometers and spending their meager financial resources on related transportation and

accommodation.

Materials and Methods: MoIT- Health NET project links telemedicine infrastructure in 2 Hub hospitals in Punjab and one in

Sind. These hubs are linked with four District & Tehsil level hospitals in rural /remote areas of Pakistan. Remote sites have been

finalized based on need, the availability of required medical staff support and physical infrastructure. All sites are equipped with

Video conferencing equipment, and Peripheral devices including digital ECG, Auto scope, Digital Stethoscope and Document

Camera. Connectivity was satellite based utilizing VSAT being provided by PAKSAT. Staff include trained health Care

Professionals at Remote sites with IT Support staff at the HUB and remote sites. Customized web based software was utilized in

all Teleconsultations. The methodology adopted is both Store & Forward and Virtual Clinics (Live Interactive Video

Conferencing) the project provided basic telemedicine services in ENT, Dermatology, and surgical specialties. Weekly Tele

consultation schedule was circulated to streamline Tele –Clinics.

Results: From July 2008 – June 2011, 7652 consultations have been provided in various specialties. Maximum number of

consultations were in otolaryngology (1949) followed by dermatology (1700) and ultrasonology (1547). Attock District had

maximum utilization of the facility followed by Pindi Gheb. Rajan Pur and DG Khan were two districts affected during recent

floods where telemedicine centres where already functional. These two centres were actively utilised in relief efforts. A total of

3593 consultations were provided in these two flood effected districts.

Conclusions: The results were encouraging. It clearly demonstrated that Specialty services can be run from the hub hospitals

provided standard procedures are followed. This experience can be utilized in planning National Telemedicine Program.

EFFECTIVENESS OF MOBILE PHONE SHORT MESSAGE SERVICE (SMS) REMINDERS FOR SURGICAL

OUTPATIENTS ADMISSIONS

S H Waqar,1 M A Zahid,2 Haroon Khan3

1Assistant Professor, Department of General Surgery, PIMS, Islamabad

2Professor, Department of General Surgery, PIMS, Islamabad

3Professor, Department of Pathology, PIMS, Islamabad

Background: Patients’ failing to attend hospital appointments especially for admission in the department of general surgery is a

significant problem for the healthcare providers. It causes suboptimal use of clinical and hospital resources, as well as longer

waiting lists that delay their operations leading to sometimes serious consequences for their health. The objective is to present the

results of a study on the impact of appointment reminders sent as short message service text messages to patients’ cell phones on

nonattendance rates at surgical outpatient clinics.

Methodology: All patients who were scheduled for admission for surgery between January and June 2010 in surgical outpatient

department of Pakistan Institute of Medical Sciences, Islamabad were selected for study. An SMS text message was sent to

patients who were scheduled for admission appointments reminding them of their admission for surgery. This group acted as the



intervention group. Controls were patients scheduled for admission appointments who did not receive any SMS or alternative

reminder.

Findings: During the period of the study, 12.5% (18/144) of patients who received an SMS appointment reminder were non-

attenders, compared to 24.1% (52/216) who did not receive an SMS reminder. Non-attendance rates were 49% lower in patients

who received an SMS reminder than in patients who did not receive a reminder (RR of non-attendance = 0.52; 95% CI = 0.32 –

0.85).

Lessons learnt: The use of SMS reminders appears more effective than traditional appointment reminders and requires less

labour. These findings suggest that SMS text reminders have great potential value in reducing non-attendance rates in outpatient

surgical clinics, but needs more studies to support this conclusion.

Keywords: Text messages, Cell Phones, Nonattendance

PRACTICE OF COLLIMATED RADIOGRAPH IN COMPUTED & DIGITAL RADIOGRAPHY

Shaheen Dhanani, Afsheen Mahmood,Tahir Abbas, Zafar Jamil

Department of Radiology, The Aga Khan university Hospital Karachi.

Objective: To assess the level of practice in radiology technologists to provide collimated radiographs.

Introduction: An x-ray technician is a trained health care worker, with specific skills in the area of manipulating x-ray equipment

to take “insider” pictures of the body so that diseases, conditions, or injury can be visualized and diagnosed. Positioning and

collimation: The routine practice of radiographers includes correct positioning of the organ of interest at the centre and

collimating the x-ray field just to cover the organ; this will deliver a good quality image with an acceptable contrast. Proper

collimation reduces scattered radiation in the region of interest and reduces the noise that degrades the radiographic contrast. This

good practice is still valid with CR & DR, but on the other hand very tight collimation may obscure the radiograph and may

results repeat x-ray which increases the patient dose. Much collimated radiograph may miss pathology or disease.

Methods: A cross-sectional data analysis was done in Radiology Aga Khan University Hospital. Radiographs are evaluated on

the basis of correct (required area) collimation. Survey conducted during month of September in 2011.Total 100 numbers of

radiographs evaluated cross-sectionally.

Results: 100 radiographs were evaluated. Out of them 78% radiographs were collimated. 22% were showing no collimation. 9%

of them radiographs presenting no reason; why did technologist not collimate x-ray??. And 13% radiographs presenting the

reason that collimation is not required by the physicians & pathology requirement.

Conclusion: Radiology people must collimate the x-ray beam which minimize the amount of radiation to patients and reduce

scatter radiation, allows radiograph that show clear structural delineation and increased contrast by preventing secondary

radiation from unnecessary exposing surrounding tissues so that the film fog may be avoided, reducing scatter radiation there by

producing a short-scale radiograph. On the other hand, technologist should not produce too collimated radiographs which obscure

required anatomy. Our audit show that our present positioning techniques in radiography is satisfied but as it’s a mandatory part

of our job description which is “quality care services” , so we have to become more efficient on this issue, and keep unnecessary

radiation exposure to the patients & health care workers zero.

UTILIZATION OF E-HEALTH SYSTEM IN AWARENESS AND REHABILITATION OF SCHIZOPHRENIA

PATIENTS IN SOUTHERN PUNJAB.

Muhammad Riaz Bhatti 1, Mirza Abdul Qadir2

1. Department of clinical psychiatry, Mayo hospital, Lahore, Punjab, Pakistan

2. Department of telemedicine. Mayo hospital, Lahore, Punjab, Pakistan

Abstract: In e-health system psychological and emotional disorder cases rarely get registered and patients also hesitate to

approach a proper psychologist. In the possible reasons religious believes and community pressure can be blamed as key

constraints. While discussing with such patients local and personal coined terminologies create hindrances in under standing the

issues. As test case a family comprising on three Schizophrenia patents belonging to district Rajan Pur, the family comprising



son, mother and uncle were examined through Tele-medicine system at mayo hub for 3-4 months ( from-to , 2011). The disease

in the abnormal balance of the neurotransmitters dopamine and glutamate may have something to do with schizophrenia. The life

quality of the test family was measured on (Cramer, 2008) guidelines based on quality interview. In this regards level of Function

scale were assessed on “Quality of Life Interview” (Hays and Reeve, 2008) interview based on collected using self-report

methods of assessment. The test family patients were interviewed at interval of fifteen days. The patients recovered in six

months. From these studies we concluded that tlee-medicine system can be successfully applied on religious extremism,

psychological and emotional disorders by little improvement in audio video system and human resource development at remote

station.

Key words: emotional disorder, Schizophrenia, southern Punjab, telemedicine

SUCCESSFUL APPLICATION OF TELEMEDICINE IN DIAGNOSIS OF ENT DISEASES UNDER MAYO HUB,

LAHORE, PAKISTAN.

Ijaz Nazir Chaudhary1, Mirza Abdul Qadir2

1. Department of ENT, unit II Mayo Hospital Lahore, Punjab, Pakistan

2. Department of Telemedicine Mayo Hospital Lahore, Punjab, Pakistan

Abstract: The successful diagnosis for ENT disease requires high quality gadgets and generally it is assumed that diagnosis for

outreach patient is impossible. The ENT department Mayo hospital in collaboration with Mayo hospital telemedicine department

provided 2026 (number of patients) during the year 2009-2011. The diseases most commonly observed in baring intensity and

severity levels were 1-weeping ear 2-Sore throat, 3-CSOM (Chronic Suppurative Otitis, Media, 4-DNS (Deviated nasal Septum),

5-Wax and 6-Thyoroid with 331, 273, 291, 283, 209 and 136 patients respectively. It happened because of the availability of the

Electronic auto scope and X-rays the diagnosis became very easy for an ENT specialist to treat. It was noted that these disease

were more common in financially deprived groups. One important thing to mention is that in periphery most of cases are

complicated by improper treatment of Quacks and presented us along with complications. By updated the system quality in

connectivity and visuality it can serve successfully in more areas.

Key words, telemedicine, ENT, quackery, disease distribution.

SCALABLE E-HEALTH APPLICATIONS & TECHNOLOGIES

Introduction: According to statistics 70% of Pakistan’s population resides in rural areas whereas 78% of the quality healthcare

practitioners are practicing in urban areas thus creating a healthcare divide. The patients in rural areas have to travel long distance

and incur high travelling costs and in many cases affordability restricts them to avail basic treatment. The use of telemedicine is

now a very common technology in west to provide quality healthcare services to the remote area population. However this

service is still not commercially viable in the developing countries because of very high capital investment, high running

expenditures, lack of high speed bandwidth & quality of service.

Currently the telemedicine projects running in Pakistan are funded projects. Despite the fact that the initial capital investment is

provided by the donor agencies, yet the running cost (due to high equipment replacement cost) is un-manageable. As these

projects are running on philanthropic approach, therefore, the quality of service could not be gauged due to free consultation for

the patients. At the same time as there is no common technology platform being used at independent hospitals therefore

scalability itself becomes a big challenge.

Methodology: Scalable technology applications can only be developed & deployed when we make telemedicine a commercial

service. However the paying capacity of the rural area population is the most important factor that needs to be kept in mind.

Therefore the answer to the problem is a robust solution which is developed on common technology platform, cost effective, with

low operational cost and easy to adopt by the users both paramedic and doctors.

Findings: After deploying our solution at Gujar Khan, Bewal, Skardu, Astore, Ghance and PWD Rawalpindi we find out that

there is a huge acceptance by the patients as we are following the classical clinical consultation process and they are willing to

avail paid services as they are saving a huge cost on travelling, boarding & lodging.

Discussion: After getting the system tested and accepted by the end users in a real time environment, now is a time that we

should work on the scalability of this system by integrating it with the existing HMIS systems running independently at various

urban area hospitals.



Lessons Learnt: Effective training of paramedic/nursing staff

Adoptability by the doctors

User acceptable process

E-HEALTH SYSTEM: A TOOL FOR INVESTIGATIONS ON DEMOGRAPHIC DISTRIBUTION PATTERN OF

DERMAL DISEASES IN REMOTE BENEFICIARY NETWORK OF TELEMEDICINE UNDER MAYO HUB.

Syed Atif Hasnain Kazmi1, Usma Iftikhar2, Mirza Abdul Qadir3, Masood Sohail4

1. Department of dermatology Unit-I, Mayo Hospital, Lahore, Punjab Pakistan.


3. Telemedicine Department, Mayo Hospital, Lahore, Punjab Pakistan


Abstract: Dermatology Department King Edward Medical University/ Mayo Hospital, Lahore is actively contributing in

successful running of the medical system with its consultation services. From the year 2009 to 2011, it has provided consultancy

services to more than 12000 patients in the beneficiary network consisting of Gugrat, Jhang, DG Khan and Rajan Pur. On

compiling the data, the picture of disease distribution pattern appeared. Among thirteen diseases, most commonly seen disease

was fungal infection of six types of tinea i.e Tinea capitis, Tinea carporis, Tinea faciei, Tinea cruris, Tinea incognito and Tinea

mannum. Other diseases were, acne vulgaris, scabies & Norwegian scabies, alopecia areata, DLE (discoid lupus erythematosus,

Nodulocystic acne, hirsuitism (polycystic ovary syndrome) and Herpes Zoster. Distribution frequency of the data showed that

these skin diseases were seen in age ranged between 89-69 percent male and females belonging to 25-40 years age group. The

most victimized group was living in unhygienic & poor socio economic standard. While the distribution frequency of skin

disease DLE (discoid lupus erythematosus, Nodulocystic acne with hirsuitism (polycystic ovary syndrome) and Herpes Zoster

belonged to middle class. The key objective of presenting this study is to highlight the importance of telemedicine academically

in health structure showing the epidemics and out breaks. The system also provides opportunities to involve experts from

diversified groups as psychology, educationists, media and policy designers for rehabilitation of poor masses of remote areas.

Key words: Cutaneous diseases, tinea, disease epidemics, telemedicine, e-health system

TELEMEDICINE: A TOOL FOR REGIONAL RESEARCH ON DERMATOLOGY BY UTILIZING BASELINE

DATA ON ACNE VULGARIS (FACE ACNE): A COMMON PROBLEM IN CENTRAL AND SOUTHERN PUNJAB

Masood Sohail1, Usma Iftikhar2, Mirza Abdul Qadir3, Shumaila Waseem4



3. Telemedicine Department, Mayo Hospital, Lahore, Punjab Pakistan


Abstract: The Department of Dermatology, King Edward Medical University/ Mayo Hospital, Lahore is engaged with

Telemedicine Department, since 2009 and it has the highest consultancy rate. The most commonly occurring diseases in the areas

of Gujrat, Jhang, Rajan Pur, Dera Ghazi Khan are fungal infections, scabies and acne vulgaris. The diseases were noted in the age

group 15 to 40 years, male & females. Its frequency of occurrence among other skin diseases was 40%. These diseases are

characterized by papules, plaques, nodules, pastules & comedones. The telemedicine system provides good opportunity to

connect physician and patients belonging to different environments in remote areas, ecological zones and socio-economic groups.

The system can be even more helpful in conducting postgraduate medical research. Its connectivity improves as per given global

standards. The sharp imaging is the key concern in true identification of these diseases and image quality should be more

improved with better audio quality. Moreover, a detailed and to the point case history is essential for better diagnosis &

management. This tool will not only help the patient at remote areas for treatment but also reduce the burden on a tertiary care

hospital.

Key words: Telemedicine, dermatology, acne vulgaris, connectivity

HUMAN ACTIVITY RECOGNITION USING TRANSFORMATION FEATURES OF DEPTH SILHOUETTES: A

SMART EHEALTH SYSTEM TOWARDS LIFECARE SERVICES

AhmadJalal1, Md. Zia Uddin2, and Tae-SeongKim1



1Department of Biomedical Engineering, Kyung Hee University, Republic of Korea

2Department of Electronic Engineering, Inha University, Republic of Korea

Abstract: In this paper, a novel translation and scaling invariant human activity recognition (HAR) system is presented utilizing

depth silhouettes and transformation. To promote healthcare services in indoor settings, such an invariant HAR system is needed

to accommodate different size and position of subjects. In our experimental results, the proposed system achieves the mean

recognition rate of 93.10% for ten typical human activities. Our system should be an essential component of smart home systems

for better eHealth care services

Introduction: To provide better eHealthcare at smart home, HAR is an essential technology to recognize the daily life activities of

residents. Recently, HARhas become an active area of research with its considerable potentialsin e-health and assisted living at

smart homes. In recent years, video-based HAR systems are widely used among researches to recognize daily human activities to

promote proactive care of health and life. However, the conventional approaches mostly utilize features derived from binary and

depth silhouettes which are sensitive to scale and position changes of the users. In this work, we propose an invariant HAR

system which utilizes transformation of depth silhouettes to make HAR insensitive to subject’s size and position.

Methodology: The proposed HAR system consists of depth silhouette extraction, feature representation (via transformation),

feature discrimination (via linear discriminant analysis), code generation, and modeling Hidden Markov Models (HMMs) for

activity recognition asshown in Fig. 1.

Fig. 1Overall flow of our proposed human activity recognition system

3. Findings We have tested our HAR system using ten typical human activities with five different subjects. Table 1 shows the

recognition results, achieving the mean recognition rate of 93.10%.

Table 1. Recognition results of the proposed HAR approach (i.e., a confusion matrix)

Discussion: In this paper, we have presented a depth silhouette and transformation based translation and scaling invariant HAR

system.Our proposed HAR system can be used to recognize human activities, yielding a life log which can be used for better e-

healthcare services.

Lessons Learnt: A subject’s position and scale invariant HAR system can be implemented via transformation of depth

silhouettes, providing good recognition accuracy of human activities. The proposed HAR system could be an essential

component of any intelligent e-health system for assisted living

Acknowledgement: This research was supported by the MKE (The Ministry of Knowledge Economy), Korea, under the ITRC

(Information Technology Research Center) support program supervised by the NIPA (National IT Industry Promotion Agency)

(NIPA-2011-(C1090-1121-0003)).

E-HEALTH: THE ORIGIN OF PROGRESS IN HEALTH CARE SYSTEM IN DEVELOPING COUNTRIES

Introduction: eHealth is a quite new term for healthcare practice sustained by electronic processes and communication, Health

systems diagonally the world is not capable to distribute premium, reasonably priced services to all, and in spite of high-quality

objectives, excellence of care is imperfect. Many patients if they can acquire to a clinic for treatment has even face extended

lingers. In additional patients records has covered in substantial medical files, and services are overwhelmed with rigorous



deficiencies. Therefore discrimination in the condition of health care are one of the most challenges we at present face as global

people and these Strains are only augmented in the rising humankind.

Objectives: To identify the role of eHealth within health care system development in developing countries. To recognize outlook

potentials in health care system enhancement by the use of e Health

Method: Systematic review of the literature from 07 research articles gathered through print and electronic media device

published between the years 2006 to 2009.

Result: e-Health could be used to get better service delivery; look up the excellence and capacity of the health labor strength;

develop health information systems; improve logistics management for and access to medical products and supplies; and boost

the competence with which health sector funds are used.

Conclusion/Recommendations: Several countries do not have the possessions or proficiency to deal with this constantly on their

own, so the activity health analytics will assist tackle the core challenge of collecting data from all the multiple spheres, to offer

an integrated complete view of those data. The walls will need to be taken down; data will require to flow enthusiastically but

securely.

Key words: eHealth, excellence of care, high quality objectives.

SELECTING THE BEST FREE AND OPEN SOURCE SOFTWARE (FOSS) FOR YOUR HEALTHCARE SYSTEM:

A COMPREHENSIVE CHECKLIST FOR IMPLEMENTERS

Suranga N. Kasthurirathne, Burke W. Mamlin, M.D.

Introduction/Background: An increasing number of healthcare providers are adopting software systems. However research

indicates that 73% of these implementations fail [1]. Such a daunting margin of failure and the lure of reducing costs have created

much interest in adopting Free and Open Source (FOSS) alternatives to commercial software [2-3]. However, implementers fail

to realize that FOSS projects are inherently different to commercial solutions, and that different factors may affect their success

[4]. The goal of this research was to study these factors, and prepare a set of guidelines for selecting FOSS healthcare software.

Methodology: A comprehensive literature review and research study was performed to collect the following data. We identified

issues affecting the success of any electronic healthcare system, listed factors controlling the outcome of FOSS projects, and

compared both result sets against actual implementation stories to understand how open source healthcare systems fail.

Our research considered the viewpoints of all stakeholders including healthcare workers, policymakers and developers. We used

our findings to develop a set of guidelines for implementations considering a FOSS solution.

Findings: A series of technical selection criteria were identified based on scalability, performance, interoperability and the need

for proper medical coding standards. Other non-technical findings included the need for proper policy (long term strategy and

supportive administrative policy) from both the implementers and FOSS developers perspective.

Our findings also revealed the need for long term collaboration between the FOSS project and the healthcare implementation.

Discussion: The misconception that FOSS software is free to adopt has led to many shortcomings in implementation policy.

Implementers place unrealistic expectations on volunteer community support. They fail to make provision for maintenance and

continuous enhancement.

Implementing a FOSS system requires long term mutual collaboration. Implementers must prepare policy groundwork that will

lead to positive community acceptance and involvement. We describe a series of guidelines based on the above observations.

Lessons learnt: We found that interoperability and scalability are decisive technical factors for selecting FOSS healthcare

software; however Implementers should consult with end users before making the final software selection. They must select the

FOSS solution that best suits the users needs, and not necessarily a system that has been adopted successfully elsewhere.

Implementers should be able to maintain a long term and mutually beneficial collaboration effort. Furthermore, adopting FOSS

software does not mean compromising on standards or quality.

References: [1] Renner P., ―Why Most EMR Implementations Fail: How to Protect Your Practice and Enjoy Successful

Implementation‖, 2009.

[2]Shaw N., Pepper D., Cook T., Houwink P., Jain N., Bainbridge M., ―Open source and international health informatics:

placebo or panacea?‖, Informatics in Primary Care vol. 10: pp. 39–43, 2002.

[3]McDonald C.J., Schadow G., Barnes M., Dexter P., Overhage J.M. et al., ―Open Source software in medical informatics—

why, how and what‖, International Journal of Medical Informatics vol. 69, Issues 2-3 pp. 175-184, March 2003.

[4] Fitzgerald B., ―The transformation of Open Source Software‖, MIS Quarterly Vol. 30 No. 3, pp. 587-598, Sep 2006.



USING MOBILE DEVICES FOR HEALTH INFORMATION MANAGEMENT

Shamyl Bin Mansoor and Dr Asif Zafar

Introduction/Background: Management of health information has recently been a very important issue for health practitioners as

the world is moving towards adopting information and communication technologies. In this research we do a study on the use of

information and communication devices, with emphasis on smart phones for managing health information in hospitals while

analyzing it with respect to Pakistan's needs.

In our study we survey how health practitioners have utilized mobile devices for health information management in hospitals,

outside hospitals, within ambulances and other areas where health information flows through. Recently the success of devices

like Apple's IPAD1and Samsung's Galaxy Tab2, have resulted in these devices being used for all kinds of purposes in all kinds of

environments. IPAD has been used in the OR for viewing abdominal CT scan images during surgery3. It has also been used as a

teaching tool in universities teaching medical education and enabled students to view high resolution images, allowing them to

interact using gestures all the while listening to the lecture in the class4. Applications are available that allow viewing CT/MRI

images in smart phones like iPhone or Android based phones. Apart from these smart tablets, devices like Xbox's Kinect have

also been utilized to control surgical robots5. The kinect device recognizes human gestures using a depth camera, therefore

allowing any person to simply move his hands to control anything like a PC to a robot.

Methodology: Based on our survey we propose a system that makes use of these smart devices to improve the working

environment of physicians, surgeons and other personnel that work in a hospital environment. These people can use the proposed

system to improve the way in which they interact with the information of a Hospital Management Information System (HMIS).

Our system is an integration of different technologies and requires an HMIS. The proposed system uses mobile devices that are

connected to the HMIS. A combination of these devices are deployed in the hospital, for example the IPAD in the OT to access

patient specific data during surgery, a smart phone with a doctor keeping him connected 24 hours and an Xbox Kinect in the OT,

allowing the surgeon to view patient data on an HMIS by only using gestures. Another tablet is deployed in the ambulance which

in case of emergencies can be used to add patient data of an incoming emergency and alert the emergency staff.

1www.apple.com 2 www.samsung.com 3http://www.idataresearch.net/idata/blog/?p=532

4http://med.stanford.edu/ism/2010/august/ipad.html

5http://medgadget.com/2011/02/kinect_3d_gaming_camera_used_to_control_da_vinci_surgical_robot.html

Findings Based on our methodology: we can improve the efficiency of workflow management in a hospital by giving mobility to

an HMIS.

Discussion: In today's world it is very important to leverage current technology to ones benefit. Especially in the case of

healthcare management, where a lot of effort is required for health management, these devices can play a key role in smoothening

information management operations in a hospital.

Lessons learnt: From our survey we have learnt that many countries are employing ICTs to improve healthcare management. If a

similar system is implemented in Pakistan, then we can improve healthcare management which in turn improves the overall

healthcare of patients.

About the authors:

Shamyl Bin Mansoor is a lecturer at the School of Electrical Engineering and Computer Science, National University of Sciences

& Technology, Pakistan. He is also currently Director SMART Research lab and faculty advisor for the National ICT R&D

funded project titled "Development of a Tele-Surgical Training Robot and Simulator" which is a collaboration between NUST

and Holy Family Hospital, Rawalpindi.

Dr Asif Zafar, is Professor of Surgery, Rawalpindi Medical College, Head Surgical Unit II, Holy Family Hospital, Project

Director for TeleMedicine and E-Health Training Center and Project Director for the National ICT R&D funded project titled

"Development of a Tele-Surgical Training Robot and Simulator" which is a collaboration between NUST and Holy Family

Hospital, Rawalpindi.

INTRODUCTION OF E- LEARNING INTO THE POST RN BSCN PROGRAM: RESULTS OF A PILOT STUDY

Jacqueline Dias, BasnamaAyaz, Khairulnissa Ajani, Nasreen Sulaiman,

The Aga Khan University School of Nursing

Introduction: Aga Khan Development Network (AKDN) is developing an E-learning strategy. In 2010 as part of the annual

Goals and Objectives exercise, Aga Khan University School of Nursing (AKUSON) decided that Post RN program would be



used as a pilot and offered through blended blending; using both distance learning and face to face interaction in 2014. At present

there is no E-learning program at the national level for a Post-RN Programme. In order to bring this mandate forward a capstone

project was pilot tested using a blended approach and a trio model consisting of student, preceptor and faculty between May and

July 2011.

Methodology: A blended delivery approach was used to test out E-learning strategy by using Moodle. The existing course was

reviewed. Students’ feedback was elicited before, during and at the end of the course. In addition, faculty development for

moodle and use of e-portfolio was organized. Meetings were held with content and technical experts periodically. Final approval

came from the curriculum committee.

Findings/ Discussion: The pilot study concluded that in order to carry this project forward the following are required: (1) Full-

time IT personnel dedicated to this project; (2) Protected time for the faculty to conduct the planning and implementation of this

program (includes a needs assessment and follow-up activities); and (3) close work with partners universities.

Lesson Learnt: The lesson learnt from this pilot study will beutilizing the planning for the E-learning program at the national

level in Pakistan and wherever AKU is located on the map. As a first step in developing the capacity of faculty in E-learning, a

training program is being organized to build the capacity of the faculty at the present time.

PATIENT INFORMATION SYSTEMMANAGEMENT BY USE OF ICT

Rizwan Rasool, Senior Engineer, NORI,

Pakistan Atomic Energy Commission, Islamabad

Abstract: With the advent of web-based modern software applications, non- web Based HMIS software remain confined to local

access and web based potential cannot be utilized. In such situations, use of ICT in the form of IP Based LCD KVMwhich are

commonly used for accessing multiple high end systems in Data Centers, Internet Service Providers (ISPs), Mobile

Communication Networks Help Line etc. from remote locations for various maintenance/operational activities is the best

approach to access these Patient Health Information Systems for routine work. It does not burden IT People to completely

develop the HMIS from scratch using web based application or develop any other linking software for accessing the HMIS over

the web. In this work we suggested to use IP Based LCD KVM for patient health information management. IP Based LCD KVM

systems are mainly used to access, configure and control servers, multiple computer systems both within the office and from

outside as well. Accessing the HMIS servers using IP Based LCD KVM systems is very much useful in resolving HMIS

Development both remotely and locally without converting the non-web based HMIS application to web based application.

Keywords: IP Based LCD KVM, ICT, IT, HMIS

Introduction:Patient data is of vital importance. In Hospitals, Hospital Management Information System (HMIS) is used for

storing and retrieving patient health information both inside and outside the hospital. It requires lot of resources to store patient

information and retrieval from any remote location by both system administrators and users.

Figure 1: Hospital Management Information System Server

The situation become worst when HMIS is developed in a non-web based application and going towards web-based HMIS means

reinventing the wheel. In such situations accessing the HMIS resources itself is a solution both for administrators and users from

remote location.

Background: Data centers, Mobile communication networks , Internet Service Providers (ISPs) are those areas of ICTs where

remote access of servers is a critical issue. Two major issues for above mentioned ICTs were:

· Accessing various essential servers from remote locations.

· Space saving for placement of multiple servers.

The above issues were resolved by use of IP Based LCD KVM.

Hospitals started using ICT for various kinds of activities inside the building that include Telephony systems, CCTV security

systems, Access and Attendance Control systems, LCD Based Patient Information Display System etc. With the advancement in

ICT, Electronic transaction of patient related activities start taking place for the electronic flow of patients' medical information

both inside and outside the hospital. The outdated concept of manual patient data movement involve lot of delays with

which not only patient and their attendants suffer, this delay has a direct impact on patients' medical conditions as well. In a

modern hospital, Patient Health Information is stored in HMIS Servers/computers connected with Hospital Area Networks

(HANs). These systems are of vital importance, as they contain the patients' medical diagnostic conditions and provide the

current status of patient health at any time and any moment. These systems require continuous monitoring for their prompt

operation.



For accessing these systems on 24/7 basis, we need to use ICT for accessing these systems both for administrative and user level

usage.

Unfortunately, Most of the Hospital Information Systems have been developed by using applications that do not support web

based features. It becomes a great challenge for developers to reinvent the whole HMIS on a web based plateform. In such

situations, it is more convenient to access these systems as a whole from remote location for both administrative and user level

usage. This way it is no more required to go for the conversion from non web to web based application. The HMIS resources can

be utilized at any remote location for various types of purposes including maintenance, software development, remote access for

replacement of old software with new one.

Methodology: IP Based Remote access is commonly used in the ICT for remote or local access of various kinds of

communication devices includes mobile communication system devices and servers etc. HMIS servers attached with HANs are

locally accessible and can be accessed over the web by use of IP based KVM. This approach can not only connect the HMIS

servers but all other servers can also be accessed from remote locations. We connected our HMIS servers with IP Based LCD

KVM Device and configured the system for remote access within the building and outside the building as well. Figure 2-5

illustrate the various aspects of installation of the suggested setup.

Findings:

1. Remote access of HMIS Servers.

2. Remotely troubleshoot the HMIS Servers.

3. Web Based access of HMIS Servers independent of plateform used for development.

4. Developing HMIS/Updating HMIS from remote location especially useful in cases when development team is away and the

software is under development.

5. Time Saving.

6. Saving the Traveling cost.

7. Effective way of accessing systems providing telecare/ eHealth services for data entry, for retrieving information and most

importantly for trouble shooting of system.

8. Virtual availability of all resources.

Discussion:In Pakistan, due to lack of expertise in web based modern applications, HMIS software remain confined to local

access and web based potential cannot be utilized. In such situations, use of ICT in the form of IP Based LCD KVM is the best

approach to access these systems and work. It does not burden IT People to completely develop the HMIS from scratch using

web based application or develop any other linking software for accessing the HMIS over the web.

Lessons Learnt: The use of ICT in the form of IP Based LCD KVM systems for patient health information management for local

and remote management can provide best results in hospitals.

A GENERIC APPROACH FOR HL7 V3.0 MESSAGING

Yasar Khan, Maqbool Hussain, Shagufta Umer, Muhammad Afzal, Farooq Ahmad

Department of Computing, NUST School of Electrical Engineering and Computer Science

Introduction: To provide better health care services, medical bodies should be brought closer to each other by enabling them to

exchange health related data with each other. The problem is that these systems are heterogeneous systems in terms of the data.

To overcome this problem, these healthcare systems need to adapt a common healthcare standard for exchange of data. Health

Level Seven (HL7) is such a standard in the healthcare arena, which provides interoperability among healthcare organizations.

Based on HL7, we have developed a generic middleware solution for health organizations, having heterogeneous data, to enable

them to share information with each other. To evaluate our approach, we have tested it on healthcare laboratory domain

messaging. The major advantage of our system is that with minimal inputs and efforts, it can be customized and then deployed in

different health environments.

Methodology: We have designed a generic and extendable architecture for our solution, considering organization independence

and technology independence. Our system is composed of three main modules. Data Access module is responsible for data

retrieval operations over any type of data store, such as RDBMS, XML etc. With the data mapping feature, the Mapper module

can map data with a non-standard structure to HL7 standard for the purpose of HL7 standard xml based message generation and

parsing. This standard message is then communicated with the intended destination using Communication module. For the

purpose of transportation and reliable delivery of messages, this module is capable of queuing and logging messages.



Findings: Our generic system has been deployed in a test environment and has been evaluated against healthcare laboratory

domain messages, such as test order, test results etc. These tests have been carried out in multiple scenarios involving different

healthcare organizations.

Discussion: Our system brings interoperability between medical bodies having heterogeneous data which in turn make medical

bodies interoperable. At the same time provides reliable communication infrastructure by providing queuing and logging systems

in the communication infrastructure. This system will bring healthcare information exchange to a standard and ultimately will

improve the health care services which will result in a great benefit to human beings.

Lessons Learnt: The real challenge that we have confronted is resolving mappingheterogeneities, with their complete context,

between non-standard structures of data with the standard structure provided by HL7. Vocabulary incorporation in messages to

fulfill the global understandability objective leads towards complexity in automatic code generation.

CONTINUING MEDICAL EDUCATION FOR PRACTICING FAMILY PHYSICIANS BY DISTANCE LEARNING:

A PIONEERING EXPERIENCE OF FMH COLLEGE OF MEDICINE AND DENTISTRY

Dr. Fahad Anwer

Senior Registrar in the Department of Family Medicine FMH College of Medicine and Dentistry, Lahore

Introduction: Primary Health Care (PHC) is the most important tier of heath care system in every country. General practitioners

have been providing most of medical care to masses of Pakistan. Most of them are solo practitioners without any academic link to

teaching institute. Therefore during the last 25 to 30 years of rapid advancement of medical knowledge, they remained out of

touch and gradually become outdated. Since general practitioners are busy practitioners, they seldom find time for continuing

medical education (CME) or continuous professional development (CPD).

According to current statistics of P.M.D.C., around 1,25,034 general practitioners have been registered as GPs in Pakistan till

31st August 2011, and almost all of them are practicing without any training of family medicine because of scarcity of training

programs. To update their knowledge and familiarize them with the concept of continued medical education, there was a dire

need to provide distance learning CME to practitioners working in different parts of Pakistan, which suited their working

environment and life style.

Methodology: In 2006, a CME was designed on the syllabus of an international postgraduate examination which serves the dual

purpose of education as well as qualification. The course covered all areas of Family Medicine in just seven months with an

average of 24 sessions per month. To reinforce the learning of participants the recordings of the sessions, handouts of sessions

and latest articles from scientific journals were provided to all the participants. Recorded lectures and other educational material

were distributed among 500 registered family physicians via courier service across the country. The registered doctors were sent

reading material in the form of books, articles, hand outs and CDs containing lecture videos, standard video clips of clinical

methods and procedural skills.

To ensure that the learning is taking place, each educational activity was backed by a Multiple Choice Question (MCQ) paper.

These MCQ tests served the dual purpose of ensuring learning as well as practicing for MRCGP International examination. The

answer sheet was mailed back to the CME department and based on the test scores of the participants, they were awarded a

certificate of participation in CME and a specific number of credit hours.

Conclusion: A teaching medical Institute, Fatima Memorial Hospital has taken the challenge of reaching out to doctors working

in distant areas of Pakistan in a scientific way. Family physicians benefitted

from the distance learning course by enhancement of knowledge and also preparing for postgraduate examination. This distance

learning program has the potential of reaching out to a vast majority of doctors of developing countries of the world, and will

hopefully open a new chapter in the education of family physicians in Pakistan.

TRANSFORMATION OF EHR TO SEMANTIC MODEL FOR CLINICAL DECISION SUPPORT

Muhammad Abbas, Khalid Latif, Farooq Ahmad, Muhammad Afzal

Department of Computing, NUST School of Electrical Engineering and Computer

Introduction: One of the main reasons for the adoption of Electronic Health Record (EHR) was to provide Clinical Decision

Support (CDS) capability to health information systems. The adoption of CDS was slowed by the use of non-standard and

application specific clinical information models. Later multiple standard information models were suggested, but instead of



solving the problem, another issue of interoperability among those standards arose. The current health information models

suggested by standards are not semantically interoperable with each other. This work proposes a common semantic model that

aligns various standards to provide a standard base access to clinical information for CDS system.

Methodology: The proposed architecture includes a model transformation component that maps the XML schema of EHR Extract

with our designed ontology of EHR Extract. After fetching an EHR Extract from the clinical database, it is transformed into an

OWL representation using the already created mappings. The transformed EHR Extract is then given to the inference engine,

which deduces new information from the medical data using the clinical rules stored in the knowledge base of CDS. This new

information then generates alerts, reminders, and suggestion to the patients or clinicians.

Findings: The conversion of clinical data into semantic model provides a base for CDS systems. Any OWL based inference

engine can be applied to the semantic data for providing evidence based care. The CDS system integrates three different kinds of

models for reasoning: (1) Information model, (2) Concept model, and (3) Inference model. A workable CDS also needs the

development of interfaces between these three models. The availability of EHR data in OWL format using our approach and the

OWL version of SNOMED-CT reduces the work of developing an interface between these two similar models, thus easing the

development of CDS system.

Discussion: The benefit of converting EHR data into semantic models simplify the mapping of such data to the already existing

biomedical and clinical ontologies and terminologies represented in the same semantic formalism. The integration of knowledge

from different areas would reduce the challenge of interoperability in healthcare communication, thus improving the quality of

healthcare.

Lessons Learnt: There is a need of an upper level semantic ontology for EHR, to which all standard information models should

be mapped to provide semantic interoperability among health information systems. This idea gives way for the development of a

generic CDS as a service deployed on a cloud server.

PROVIDING HARMLESS OWNERSHIP PROTECTION OF SHARED PATIENT DATA

Komal Waseem1 and Muddassar Farooq2

Introduction: In developing countries where mobile penetration is high but areas remain devoid of basic health facilities, the

implementation of e-health technology can help exploit the available resources. A large number of patients suffering from various

heart diseases do not have immediate access to health care facilities or a physician. In cardiology, the electrocardiogram (ECG) is

the basic diagnostic tool used by health care professionals to detect Arrhythmia, a clinically used word for conditions in which

there is deviation from the heart's normal electrical activity. A typical ECG signal consists of characteristic peaks know as P, Q,

R, S, T. The accurate and reliable detection of these waves measures the performance of any ECG analyzing system. Arrhythmia

detection via ECG relies heavily on the expertise of the physician. Therefore, it is necessary to improve ECG diagnosis by

implementing an automatic system that analyzes the ECG for any arrhythmia with minimum user intervention. The proposed

system utilizes the computational power of smart/mobile phones by displaying a patient’s ECG, extracting relevant features and

detecting arrhythmia. This e-health solution can be implemented on laptops, tablets and other portable devices that will not only

complement the physician’s diagnosis but also provide heart patients with a mobile-ECG monitoring facility.

Methodology: The prime focus of our methodology is to achieve a high arrhythmia detection rate. We aim to develop a scheme

that reduces the possibility of diagnosing an arrhythmic patient as being normal or to have low false negative rate. In this regard,

an ECG analysis tool is developed that has the competence to extract features from an ECG waveform. Rule-based classifiers are

applied on these features’ set to develop a classification model that subsequently differentiates between normal and arrhythmia

ECG waveforms.

Findings: Our initial experiments reveal that by using a hierarchical approach instead of a combined classification scheme, a low

false negative rate is achieved. Eight evolutionary classifiers are tested on 6 types of arrhythmia, giving an accuracy of 98%. The

two-phase system architecture is able to differentiate between normal and abnormal ECG instances despite the overlapping

feature’s boundaries. A detailed overview of these findings is provided in our research paper [1]. To establish the accuracy of this

system, we have further obtained real-world, digitized 12-Lead ECG samples from two major hospitals in Pakistan. This ECG

data has been labeled by a competent physician as normal or belonging to one of the arrhythmia types.

Discussion: Our ECG arrhythmia detection scheme is a scalable solution that can be implemented on Smart phones, PDAs,

laptops and similar electronic devices. It supplements the skill set of a physician by accurately detecting six kinds of arrhythmia.

The diagnosis rules extracted from the classification scheme can be updated and modified in consultation with physicians, thus

providing a flexible solution. The effectiveness of this scheme in an m-health enviornment is described in [1].

Lessons Learnt: The effective implementation of arrhythmia detection scheme as part of an e-health solution can improve the

overall health care facility for cardiac patients in developing countries. It can minimize the delay in diagnosis in overcrowded



medical facilities and also minimize the risk of error in ECG interpretation. As an enhancement, patient ECG information can be

communicated to advanced medical facilities using Smartphones and mobile networks technology.

References: [1] Waseem, K., Javed, A., Ramzan, R. and Farooq, M. Using Evolutionary Algorithms for ECG arrhythmia

detection and classification. 7th International Conference on Natural Computation, Jul 26-28 2011, Shanghai, China. v 4, p 2386-

2390.

ACCESSING LITERATURE IN HEALTH SCIENCES

Nageen Ainuddin

Director, Pakistan Scientific and Technological Information Center (PASTIC)

Islamabad

Introduction / Background: There are several factors responsible for poor health conditions in the developing countries such as

lack of clean water, shortage of medical equipment, supplies, and essential medicines, drought in certain countries, floods in

others, poor sanitation, malnutrition, political problems, etc. Furthermore, lack of access to scientific, technological and medical

information by the medical practitioners, academicians and researchers adds up to this situation. One reason being lack of

infrastructure & resources for acquiring the literature as the cost of subscribing to journals from the developed countries is too

expensive, lack of policies as well as lack of awareness about the availability of the medical literature. Due to these reasons the

researchers in the medical field are not able to increase their research capability, generate knowledge and contribute to the world

of science. Awareness about access to timely, relevant, high-quality information and knowledge by researchers, students,

teachers, and policymakers in developing countries is bound to improve the overall health scenario in these countries. In many

countries medical libraries and information centres exist which are making effort to provide health information services to the

medical community.

New technologies such as information and communication technology has now provided opportunities to access a variety of

scientific information for the professional development of in all fields. Use of IT has increasingly improved the capacity of

researchers to use medical, scientific, and technical knowledge to solve health, environmental, and social problems and the

knowledge gap was decreased. The Open-Access initiative has proved very beneficial through which scientific and medical

literature is made freely available globally through the INTERNET. The paper or the poster would present the audience with

information about the the major names that fall under Open Access the Public Library of Science, Hinari of WHO for least

developed countries, Free Journals online, Scientific Electronic Library Online,. Pubmed, Hubmed, & Pubget (both free and

priced depending on the publisher) Free Medical e-books, Medicalstudent.com, etc. Other search engines and databases discussed

are Medline, Mesdscape, Healthweb, Medical Matrix, Cancerlit, Cochrane Library, Healthfinder, etc.

Pakistan Scientific & Technological Information Centre (PASTIC) is the premier organization in Pakistan in the field of

scientific and technological information handling and dissemination, serving thousands of researchers in the country. PASTIC

National Centre is located in Islamabad having Sub-Centres at Karachi, Lahore, Peshawar, Quetta, Faisalabad and Muzaffarabad.

PASTIC users are found in research and development organizations, higher education institutions, business, industry, government

departments, health sector, libraries, etc. Major activities of PASTIC include responsive and anticipatory information and support

services such as: S&T Documents Delivery Service,

Literature Surveys/ Off-line searches, Technology Information Service, Patent Services, Reference Library Services, etc. These

services are provide on modern lines using new technologies.

E-HEALTH IN DEVELOPING COUNTRIES! CAN IT BE A DREAM COME TRUE?

Sania Moti, Amyn Deedar Ali Hajani

(Nursing Interns Aga Khan University Hospital) Fresh Graduates

Introduction and Objectives: Developing countries are facing serious health crisis with thousands of people dying just because of

the scarcity of basic health care facilities. These threats result from insufficient health education, lack of man power in health

sector and outdated clinical treatment. There have been loop holes in information sharing, learning and management in the health

sector. This has currently become a public health concern because of its growing and long lasting physical health impacts on the

population at large. Access to appropriate and precise health information (e-health) is a key factor for development worldwide.

Majority of the previous researchers have studied the benefits of developing e-health in developed countries since such an

advancement was a mere dream for the developing countries but researchers nowadays have shown great interest in looking into

the effects of setting up e-health in developing world. Our primary objective in this paper is to create awareness about the

importance of the introducing e-health setups in developing world which has been overlooked.



Methods: A thorough literature review was done.

Results: These studies mention that information and communication technologies (ICTs) can improve the delivery of information

and services to the healthcare community. Along with it distance learning; tele-diagnosis etc can further help to overcome the

shortcomings in the health sector. However, most of these studies were carried out in developed countries where effects of

introducing e-health are studied in depth. The scenario of developing countries is different where people compromise with

limited health care resources so to talk about ‘e-health’ is just close to impossible.

Recommendations: We recommend that in order to setup e-health in developing world there are several other factors that come

into play such as literacy level, economic stability, computer literacy and so on. So it is necessary to make sure that how new

technologies can be appropriately employed to improve health in the world's poorest nations.

E-HEALTH FOR STRENGTHENING HEALTH SYSTEM IN CENTRAL ASIA

Purpose/ Objective: Central Asia is the core region of the Asian continent with a large populationresiding in rural areas. The

Central Asian regions of Afghanistan and Northern part of Gilgit Baltistan, share a common limitation in terms of accessibility to

quality health care. Afghanistan presents a society that is struggling post war development, while Gilgit Baltistan region

confronts the health inequity due to harsh climate and uneven roads. Communities residing in rural areas of both the regions have

basic health facilities but requiretraveling long distances to consult a physician. Moreover, health care providers serving in

remote areas feel isolated from other areas. The Aga Khan Development Network (AKDN) eHealth resource centre (eHRC)

tackled these constraints by initiating eHealth in both the areas.

Methodology: The AKDN eHRC strived to address health inequity by establishing Telehealth link between different levels of

health care facilities for improved patient management, avoiding unnecessary referrals, that ultimately saves patients’ time and

cost incurred in going to next level facility. The eHealth initiative also aimed to work towards the capacity building of health care

providers serving at different levels for their continuous professional development (CPD).

Both synchronous (live) and asynchronous (store-and-forward) modes of Telehealth are being used. Synchronous Telehealth

involved the utilization of video conferencing equipment and software (‘OOvOO’ and ‘Elluminate’) in high bandwidth situation

whereas for store-and-forward consultation, a free and open source software ‘iPath” was used in case of low bandwidth.

In Afghanistan, Bamyan provincial hospital (BPH)wasconnected with French Medical Institute for Children (FMIC), Kabul

which is a tertiary health care facility. Live consultations were provided through video conferencing from FMIC to Bamyan in

the required specialties mutually identified. Store-and-forward consultations were carried out using iPath for pathology and

shared folder for radiology cases. In GB, iPath was used for case consultation for most peripheral health facilities, while with

higher bandwidth between secondaryand tertiary centers, live consultations were conducted via OOVOO software.

Results: In Afghanistan, from Sep-Oct 2011, there have been 656 live and 780 store-and-forward consultations conducted. Live

consultations have been requested in seven specialties. Each teleconsultation saved over USD200 for the patients and the current

cost for health system is USD25 per consultation. The average time saved was 5 days or even more.

In GB, during eighteen month duration 309 cases were reported on iPath on 45 different types of ailments and 25 live

consultations conducted between secondary care centres. The cost saving of per patient was approximately USD 12- 55and

average teleconsultation cost saved was 1.7 USD. The average time saved by patient was 4 days.

A total of 20 eLearning sessions were delivered from FMIC to Bamyan and 15 were conducted in GB.

Conclusion: The eHealth initiatives in Afghanistan and GB not only provided cost effective and time efficient health solution but

also have built the capacity of healthcare providers at the remote sites. The initiative has shown great success with high rates of

satisfaction among healthcare providers and patients.

Future Direction: The success of eHealth initiatives in Afghanistan and GB has led AKDN eHRC to expand its services.

Currently work has been started to leverage health services in cross border regions of Gorno-Badakhshan Autonomous Oblast

(GBAO) in Tajikistan and Badakhshan province of Afghanistan sharing similar natural resources, economic potentials and

common ethnic and cultural roots. To evaluate eHealth potential, eHRCteam conducted an eHealth feasibility assessment there.

A proposal has been designed to improve access and quality of health services in the cross-border region using eHealth solutions

with the aim to strengthen health systems and address inequities in health.

CONCEPTUAL FRAMEWORK FOR A COMPREHENSIVE EHEALTH EVALUATION TOOL

Shariq Khoja, Hammad Durrani, Richard Scott, Afroz Sajwani



Introduction/background: As eHealth spreads globally, and various technical problems are effectively addressed and mitigated;

the question of evaluating impact of eHealth solutions and whether to invest in eHealth or not becomes more important. The

study presents the eHealth Evaluation Framework and tools that were developed after studying several evaluation theories.

Objective: The objective of the study is to develop an eHealth evaluation tool based on a conceptual framework that includes the

relevant theories for evaluation of eHealth programs.

Methodology: A literature review of peer-reviewed papers from Medline search was conducted, which revealed over 500

abstracts. Full text articles for the 60 papers retrieved and reviewed by two researchers. In addition twenty white papers and

documents on eHealth evaluation, evaluation theories extracted through Google search were also reviewed. Several frameworks

and theories of evaluation health technologies were studied to develop a comprehensive framework for eHealth evaluation, called

KDS framework. The framework was validated by researchers from PAN Asian Collaborative for Evidence-based eHealth

Adoption and Application (PANACeA). Comprehensive eHealth evaluation tool is now developed based on the KDS tool.

Results

Developing the Framework

The study provides a two dimensional conceptual framework. The framework on the horizontal axis divides eHealth program in

different stages such as development, implementation, integration, sustained operation. While on the vertical access it identifies

different thematic outcomes of eHealth evaluation such as Health Services, Technology, Economic, Readiness and Change,

Socio-Cultural, Ethical and Policy. The interconnections of different stages of eHealth services with the themes requires proper

understanding which can be done by evaluating these stages and indentify the factors which affecting its performance.

Developing the Tool

The eHealth Evaluation Framework lead to development of eHealth Evaluation Tools. The face validity of the tool was carried

out by sharing the tools with different eHealth Researchers around the world. The content validity is in process via use of the tool

for the evaluation of PAN Asian Collaboration for Evidence-based eHealth Adoption and Application (PANACeA) projects;

after this validity, the tool would be accordingly modified, tested and made available for other eHealth program/project

evaluation.

Conclusions: The study presents steps for development of eHealth evaluation tools, from identification of themes, development

of a framework, and formation of specific tools. eHealth evaluation should be done from the perspective of healthcare providers,

clients and management to achieve a broader sense on the benefits of any eHealth service, program or activity.

MOBILE HEALTH (MHEALTH) SOLUTION FOR BEHAVIOUR CHANGE IN THE COMMUNITY

Purpose/ Objective: Recognizing the limited resources available for supporting health in developing countries, researchers have

to take advantage of the advancements in telecommunication and mobile devices, to improve healthcare delivery. According to

International Telecommunication Union ITU, there were an estimated 5.3 billion mobile subscriptions worldwide in 2010, with

moresubscriptions than people in developed countries and rates of68% in developing countries. Mobile technologies offer a great

potential in overcoming health challenges in developing countries. Mobile health (mHealth) supportsacquisition, transfer,

storage, processing, and securing the raw and processed data to deliver meaningful results.

Ministry of Health Pakistan, with support from Aga Khan University (AKU) and International Development Research Centre

(IDRC) Canada, piloted a mobile mHealth project for behavioral change among pregnant women in Takthbai, Khyber

Pakhtoonkhwa (from February 2009- March2011).

The objective was to evaluate the impact of the Safe motherhood Program Behavioral Change Communication using mobile

technologies (SMP e-BCC) on health seeking behavior of clientele towards the use of Emergency Obstetric Care (EmOC)

services, in one of the remote districts of Pakistan.

Methodology: The project started with situational analysis, discussions with community, formatting and customization of the

software, trainings of the selected health staff i.e. lady health workers (LHWs) and field surveys. This was followed by creating

short messages for health promotion and translating into the local language (Pushto). These messages covers major aspects of

maternal health such as antenatal visits, vaccination, pregnancy care, nutrition,do’s and don’ts during pregnancy, preparation for

delivery,andfamily planning and post natal care. The messages were sent regularly to expectant mothers and the frontline health

workers using an interactive SMS solution called ‘Frontline sms’

A community-based, open-source software calledOpenMRS was used for maintaining medical records of the patients. Open

MRS is an enterprise electronic medical record system platform to support the delivery of healthcare in developing countries. It is

also accessible via mobile phonesmaking it appropriatefordata retrieval even with limited internet connectivity.Save motherhood

project (SMP) is integrated with patient medical record for data management. Registration forms wereinstalled in mobile phones

given to each LHWs with proper training to register and enter the data of a pregnant community woman and submitting these

registrations forms to the OpenMRS server.

Results: In one year nearly 347 mothers were registered in this project, out of which 97.7% received awareness messages on

regular basis. The messages content was focused on baby development, pregnancy problem and associated risk with delivery.

After project implementation, our evaluation revealed that 38.3% of mothers delivered their babies in health facility and 18.1%



mothers gave breastfeed within an hour of birth. The study showed that this project decreased ratio of delivery and pregnancy

related misconceptions in the community.

Conclusion: The mHealth initiative discussed above demonstrates a scalable and replicable low cost solution, which can be used

for applications other than safe motherhood. The integration of SMS-solution with the community-based medical record system

shows an innovation with huge impact on improving health behaviour of individuals and the community.

MANUSCRIPT TITLE: EXPERIENCE OF NURSES WITH USING EHEALTH IN GILGIT BALTISTAN, PAKISTAN

Running Title: Nurses’ experience with eHealth

Objective: To explore the experience of nurses in using eHealth for patient care and learning in the high mountains of Gilgit

Baltistan, Pakistan.

Design: Qualitative study design, employing the case study methodology was used.

Setting: All health centers of Gilgit Baltistan, Pakistan using eHealth were taken as a single case. These include four primary

healthcare centres, three secondary care centres and one medical centre.

Participants: Nurses using eHealth on a regular basis at the primary and secondary care facilities.

Intervention: In-depth interviews were conducted using semi- structured interview guide to study nurses’ perspective about

eHealth, and its impact on their professional life.

Main outcome measure: The responses categorized under six major headings include: problems at health centres prior to eHealth;

role of eHealth in addressing these problems; benefits of eHealth; challenges in eHealth; community’s perception about eHealth;

and future recommendations.

Results: According to the respondents, eHealth enhanced access to care for remote populations, and improved quality of health

services by providing opportunities for continuing learning. Nurses also appreciated eHealth for reducing their professional

isolation, and providing exposure to new knowledge through teleconsultations and eLearning.

Conclusion: Low-cost and simple eHealth solutions have shown to benefit nurses, and the communities in the remote

mountainous regions of Pakistan.

CHALLENGES TO SETTING UP HMIS (HOSPITAL MANAGEMENT INFORMATION SYSTEM) IN PUBLIC &

PRIVATE HOSPITALS; A COMPARATIVE STUDY

Mr. Muhammad Asim Ansari, Dr. Haroon Khan

This Study was carried out in 2 Islamabad based hospitals; 1 from Public side and the other was Private. This comparative study

helped a lot in identifying and understanding the issues and challenges being faced during working on HMIS in both public and

private sector.

Challenges were observed, studied and compared during the main phases of the process such as Planning, Development,

Implementation and Training of a HMIS.

Appropriate flow of information and documentation & logging of this information input is one of the essentials for

accountability. It becomes the basis for all budget and business development plans in any private business. This is the pre-

requisite for establishing a HMIS in private hospital. Whereas in public hospital it was a departmental rather individual initiative

and effort. There was no push and support from administration since public hospital departments have a fixed budget. Need

assessment survey and report was prepared in private hospital since it is the crucial element for planning of any HMIS. A task-

force comprises of IT experts along with healthcare professionals were gathered on one table to formulize workflows and grids.

Gap analysis was also carried out to propose a strategy to meet the deadline. Private hospital easily arranged these personnel as

there was a firm dedication behind it but it was very difficult task for public hospital. Limited resource-persons with outdated

domain knowledge were there in public hospital to start working on developing a software application. Hardware was another

issue to work on as it matters in term of cost. Appropriate version of servers and adequate number of computer terminals were

also among the hurdles during implementation. Deployment strategy was found very crucial since it needs a bit extra number of

professionals to cope with. Module by module deployment was the way of choice in implementation. Training of the staff and



troubleshooting was very easy after adopting the aforementioned way of implementation. Staff aptitude and approach towards

training of application was also another challenge to deal. It was observed that staff from both private and public hospital was

reluctant to accept the change.

Findings showed that the challenges and experiences to setting up HMIS in both public & private hospitals are somehow similar

despite the fact that there was a high degree of commitment and dedication from the higher management and administration of

the private hospital than that of public one.

E-HEALTH FOR IMPROVEMENT AND BETTER QUALITY OF HEALTH CARE SYSTEM IN DEVELOPING

WORLD

Karamali, N (MPH, BScN) and Asif, N (M.Ed, BScN)

Introduction/background: Globalization has lead to a significant challenge for health care institutions to provide affordable and

quality care to the clients. Developing world is at more challenging situations than developed nations due to untrained health care

workers, shortage of trained professionals, bifurcated health opportunities in urban verses rural health settings, deprived

infrastructures, increase morbidity, issues related to inaccessibility towards health care information and research and inequity in

providing budgets from government. Such challenges are in a high need to be addressed at country level and one of the strategies

to respond to it is e-health. This solution is often considered as cost effective and user friendly by health care professionals.

However, the subject of e-health needs more exploration by evidence based research practices. In order to evaluate the

improvement and impact of e-health solutions for better quality of health care system in developing world, and to provide a road

map for policy makers; this systemic review has been done so that the effectiveness and consequences of different e-health

modalities on the quality of health care system can be assessed.

Methodology: We reviewed several scholarly data base like Pub med, Cinhal, Ebscot, Springer link etc. in order to systematically

review the concepts related to e-health. Majority of the data bases were published between 2000-2010. Conceptual maps related

to quality if health care improvement and e-health interventions were also systematically analyzed from the related literature. All

the other relevant theoretical and methodological materials were also reviewed. More than 15 systemic reviews were done in

order to assess the impact of e-health interventions on the quality and improvement of health care system.

Findings: Out major findings were in several areas of health care improvement and safety. Initially findings talk about the storage

and management of electronic data, including the issue pertinent to safety and security. Secondly, it also deals with improved

decision making due to electronic and easily accessible technology to improve medication usage and patient satisfaction. Another

major finding is related to the improvement of care even from a distance.

Conclusion: The important area to ponder is the sustainability of such electronic solutions for better health care systems in

developing world. The major gap exist in this technology is between planned verses implemented benefits. In addition, the

confidentiality and reliability of the available data is questionable. Therefore, it is significant to conduct more researches for the

futuristic global needs for e-health keeping in mind the practicality regarding the use of such technology at larger community

level.

AUTOMATED SMS TEXT MESSAGES TO MONITOR THE COVERAGE DURING POLIO SUPPLEMENTARY

IMMUNIZATION ACTIVITIES IN KARACHI, PAKISTAN

Momin Kazi, Murtaza Ali, YasirShafiq, Ayub Khan, Asad Ali

Background: Karachi is the only major city in the world that has not been able to interrupt wild type polio transmission.

Supplementary Immunization Activities (SIAs) are an important tool by which countries have sought to increase polio

immunization coverage. However, more than 50 SIAs have so far failed to interrupt the transmission of poliovirus in Karachi,

mainly due to poor third party monitoring. Cell phone use has risen remarkably over the last decade in Pakistan. Since 2004, the

number of cell phones use has increased from 5 million to 99 million with almost every household having at least one cell phone.

In this study, we plan to use the wide network of cell phone to monitor the coverage rates during every SIA in Karachi, Pakistan.

Methods: This third party assessment will be conducted after every SIA in a representative sample of Karachi. A baseline survey

including basic demographics,short message service (SMS)language preferences and household’s GPS coordinates will be

collected on smart phones. A computer program will be developed which will send SMS messages to parents next day after every

SIA, inquiring if the vaccinator came to their house and whether their child received vaccine dose or not. Parents will be able to



respond via SMS and the computer program will record their responses, as well as highlight parents who have not responded so

they can be reminded via repeat SMS or telephone call. The study timeline is from July 2011 to December 2012.

Analysis plan: This data will be linked to GIS and a visual report of areas according to SIA coverage’s will be presented.

Conclusion: This automated, low cost independent monitoring system of evaluating coverage of SIAs will not be subjected to

bias like political or administrative pressures and this system can be upgraded to country level.

ASSESSMENT OF HUMAN RESOURCE DATA MANAGEMENT AND ITS USE AT OPERATIONAL AND

STRATEGIC LEVELS IN PAKISTAN

Ramesh Kumar1, S Mursleen2, Zulifiqar Khan2

1 Health Services Academy, Cabinet Division, Government of Pakistan

2 World Health Organization

During the last decade, enormous investment has gone into health information systems but in a fragmented manner. Due to lack

of a clear vision, policy and strategy, the results of these efforts have been disappointing. WHO has provided technical support

for assessment of existing systems and development of comprehensive HRIS strategy. Pakistan conducted an HRIS assessment

by involving all the stakeholders across the country.

In HRIS process, the 82 questions in the WHO, HRIS Assessment tool were distributed into five thematic groups and then the

HRIS stakeholders were identified for each group based on the programmatic interest of particular stakeholders. Representatives

from government, private sector and donors participated in the assessment. Participants from broader stakeholders were

interviewed. The adjacent graph provides the overall results of the assessment. The assessment results have clearly indicated that

all components of the HRIS system need interventions for improvements in data collection, management and use.

Majority has independent HR section managed by establishment branch fully equipped with functional computers and internet

facility. Computer staff was available. Though mainly organization had HR regulation rules and coordination mechanism exist

but they are not properly functional. Overall they had no HR data available due to lack of trained professional and non

availability of budget. Data reporting in these organizations were mainly in paper form reporting as their need by administration.

Data reporting and dissemination was very poor, they were not analyzing the data and regular generation of report for policy

input within their organization. Data was transmitted mainly from district facility to provincial head office or within the facility.

Mostly the organization had no proper feedback mechanism on the improvement of HR data.

Lack of good coordination among various departments and programs within health department and private institutions have

severely affected the functioning of health information in Pakistan. Donors supporting various vertical health programs are also

helping the respective programs to establish a parallel information system, which is a challenge for development of a

comprehensive national health information system. Though the surveys and special studies are generating valuable information,

they are not optimally utilized in enhancing efficiency in managing the HRIS.

Pakistan is lacking appropriate HRIS legislation and policies. Thus the current HRIS indeed has a multitude of problems. In

HRIS context, the results of HRIS assessment have the following policy implications:

Enactment and enforcement of HRIS laws and regulations.

Enforcement of data collection activities.

Provision of harmonized data collection, processing and dissemination of tools and supporting guidelines.

Establishment of health and related data respiratory at national, provincial and district level.

Provision of pre-service and continuous in service training in data management and information use.

Enforcement of a comprehensive national HRIS strategy and provision of standard operating procedures for data management.

The next step in the process of establishing a robust national health information system would be the development of national

HRIS strategic plan that fully embraces national health policy guidelines and critical findings of HRIS assessment.

KEY CHALLENGES AND LESSONS LEARNED DURING ESTABLISHMENT OF 24/7 HEALTH HELPLINE IN

PAKISTAN

Dr. Zahid Ali Faheem,Dr. JunaidRazzak, Muhammad Aftab Ibrahim

Dr. Zahid Ali Faheem (MBBS, MCPS, CQP, SEDC Fellow - LUMS)

Dr. Junaid Razzak (MBBS, MD, PHD)

Muhammad Aftab Ibrahim (MCS, CCNP, MCSE, Certified Oracle DBA, Linux Certified)



Background: Increasing availability of mobile telephone communication offers a potential solution to the limited access to

primary preventive and curative health care services. The Aman Health, a project of Aman Foundation has worked on

establishing a Telehealthinitiative in Karachi providing 24/7 Health Helpline services across Pakistan.

Methodology: Aman Telehealth is a 24/7 health helpline service using a specially designed software with a large repository of

medical algorithms and knowledge base in an easy to use Telehealth format The process of setting up the health helpline services

required developing an physical environment, management capacity and service related human resources spanned over several

months. In this process, we examine the challenges and lessons learnt during the setting up of the project.

Results: The following were notable challenges and lesson learns that hampered the effective implementation of the 24 health

helpline in Pakistan:

Lack of understanding about the importance and need of 24/7 Health Helpline.

Complex process of approval for easy to remember Short phone Code and UAN numbers.

Limitations of the adopted licensed software system to implement the IT infrastructure including hardware, bandwidth and

connectivityand back up infrastructure that has to full fill the requirements and support the current system in the disaster and

emergencies.

Recruitment, retention and training of the call agents as Doctors and Nurses due to lack of awareness and readiness to accept the

Health Helpline as their career path.

Data collection of the hospitals and medical facilities to build the Health Directory of Pakistan due to complex network of public

and private health facilities and unavailability of updated information of the medical facilities.

Conclusion: The Aman Telehealth aim is to reduce the death and disease in Pakistan via 24/7 health helpline services, providing

timely triage, medical advice, diagnostic services and counseling on common illnesses by trained doctors and nurses. Important

lessons were learnt during the process of setting up including broader systems issues as well as more local technological issues.

Wider acceptance and utilization of the service would require engagement of civil society, health care providers and the

government.

Key words: eHealth, Telehealth, Health Helpline, Medical Algorithm, Health Directory, Healthcare, Access, Karachi, Pakistan.

GIS MAPPING AS A TOOL FOR SURVEILLANCE ON MATERNAL AND CHILD HEALTH IN RESOURCE

CONSTRAINT SETTING

MominKazi, Murtaza Ali,Ayub Khan, Imran Nisar, Anita Zaidi

Introduction: Department of Paediatrics and Child Health, Aga Khan University, has an active surveillance siteat aperi-urban area

of Karachi. The total surveillance area is 8.1 sq. miles having a population of around 275,000.The area is divided into clusters of

200-250 structures, marked with a unique ID and a Global Positioning System (GPS) coordinate for electronic mapping.

Methods: The surveillance area is divided into clusters/blocks of about 200 structures. Each structure has a unique number

marked on it and each pregnant women and child <5 years has been allotted a unique ID. Block boundary is mapped using the

GPS track log technique. Structures, streets and landmarks are digitized using different GIS mapping techniques. There are four

surveillance rounds annually. Each household is visited by CommunityHealth Workers (CHWs) to register all married women

aged 13- 49 years. All new pregnancies are registered and followed till outcome and the newborns are followed till 59 days of

life. All maternal/child deaths and migrations are recorded.

Results: From Jan to Dec 2010, 10,147 pregnancies and 8,321 births were registered. There were 176 abortions, 227 stillbirths

and 16 maternal deaths.Outcome could not be established for 480 pregnant women. The Maternal Mortality Ratio (MMR) was

192 per 100,000 live births. There were 286 neonatal deaths and 146 post neonatal deaths.The neonatal mortality rate was 34 per

1000 live births and under 5 mortality rate was 52 per 1000 live births.The pregnant women, newborns and other outcome

captured by the field surveillance teams are mapped through GIS system. Detailed maps are prepared to facilitate the study team

and CHWs in surveillance and patient care follow ups. Ongoing epidemiological studies data are mapped for monitoring and

insuring that protocols are being implemented & different relationships are correlated to analyze epidemiological patterns.

Conclusion: Active house to house surveillance in a peri-urban area of Karachi facilitates early diagnosis and provision of health

care to the newborns. GIS mapping facilitates both from epidemiological and monitoring aspects. Geospatial visualization can

assist in tracking ongoing surveillance and look into different relationships at a defined surveillance site.It also provides a strong

base for ongoingand new epidemiological studies.



ESTABLISHING THE CONCEPTUAL BASIS OF KNOWLEDGE MANAGEMENT SOFTWARE

THROUGHUTILIZING HDCIP

Abdus Salam Khan1, Zeeshan Bin Ishtiaque1, Shahzad Asghar2, Yasar Khan2

1Shifa International Hospitals Ltd, Islamabad

2Health Care Information Technology Online Working Group

Introduction: Beginning of 21st century saw tremendous advances in utilizing knowledge from all possible sources of inputs. [1]

With the advent of computer based input capturing it became easy to handle information and its retrieval became a breeze.

[2]Paper based documents were limited in their capability. In the field of medicine research has always required good record

keeping and easy availability of all captured information, so we can imagine that a lot of work was not done in those days which

seem very easy now. Once the computer started making its way into the doctor offices and hospitals, the knowledge started

gathering at the pace that was astonishing.[3]It resulted in creation of a decision support system through knowledge management

of physician patient encounters and other outcome studies.[4][5][6]

Methodology: Heath care data collection initiative of Pakistan is data registry software which is created to capture the patient’s

physician encounter. This collected data is used by our knowledge management softwareto do the data mining of the HDCIP and

look at disease burden, trend, quality of treatment and other parameters and initiate knowledge based input which helps

physicians in their decision making. [7] That decision also becomes the input or part of the knowledge management software.

Finding: Through HDCIP it is easy to improve the quality of physician work.[8][9]The data that is captured through the program

creates the knowledge base required to establish physician decision support system. The knowledge management software is

capable of delivering the incidence of drug-drug interaction, double dosing, polypharmacy and variable based decision support

system.[10] Healthcare portal especially from hospitals, Government and NGO’s utilize knowledge management to access, create

and transfer knowledge from the portal provider to the users.[11]

Discussion: Knowledge management is the new tool in decision support system of a physician. It is built in such a way that each

entry and each decision made becomes a refining point for the software. Physicians take too many decisions and the complexity

of the disease mechanism and the

Probability of an unfavorable action could be greatly minimized by providing them with the effective decision support system.

This decision support system has to be built utilizing local data of the physicians and the patients so the evidence created by that

tool mimics the actual scenarios.

Lesson Learnt: Time has come for us to help the physician community in creating indigenous decision support system and

knowledge management tools.

References:

[1] Healthcare in the 21st Century..Seeking Sustainable, Equitable and Effective Solutions:

http://www.eurunion.org/News/eunewsletters/EUFocus/2008/EUFocus-Healthcare-5-2008.pdf

[2] Doctors and Patients Harness Information Technology. http://abcnews.go.com/Health/Decade/genome-hormones-top-10-

medical-advances-decade/story?id=9356853&page=2

[3] Medical Registries: Continued Attempts for Robust Quality Data. Pass, Harvey I. MD:

http://journals.lww.com/jto/Fulltext/2010/06002/Medical_Registries__Continued_Attempts_for_Robust.19.aspx

[4] Decision Support Systems – DSS (definition): http://www.informationbuilders.com/decision-support-systems-dss

[5] Decision Support System: http://www.microstrategy.com/decision-support-system/

[6] Society of Medical Decision Making: http://www.smdm.org/

[7] Introduction to data mining: http://www.thearling.com/text/dmwhite/dmwhite.htm

[8] Closing the Quality Gap .A Critical Analysis of Quality Improvement Strategies:

http://www.ahrq.gov/clinic/epc/qgapfact.htm

[9] Technical paper on ”Regional strategy for knowledge management to supportpublic health”.

http://www.emro.who.int/lin/media/pdf/em_rc53_6_en.pdf

[10] Using Information Technology to Improve Health Quality and Safety in Community Health Centers. Neil Calman, MD,

Kwame Kitson, MD, and Diane Hauser, MPA: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788767/

[11] Lee, C.S., Goh, D.H., and Chua, A. (2010). An analysis of knowledge management mechanismsin healthcare portals.

Journal of Librarianship and Information Science, 42(1), 20-

44.http://www3.ntu.edu.sg/home/leecs/publications/journal/9%20an%20analysis%20of%20knowledge%20management%20mec

hanisms%20in%20healthcare%20portals.pdf

© J Pak Med Stud. www.jpmsonline.com Supplement .

Page | 24

JPMS Third International E-

Hap Con-2012

Journal of Pakistan Medical Students (J Pak Med Stud. ISSN: 2222-

2332)

Its the first international, open access, peer reviewed, online journal from Pakistan started by

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