Software Development for a Secure Telemedicine System for Slow Internet Connectivity

Abstract

Living in a technology-driven era, when everything seems to be just a few clicks away, access to essential health services still remains a distant reality to more than half of the world population. The rural areas of Bangladesh accommodates 70% of its population but qualified medical doctors cannot be retained there because of prevailing socio-economic factors that will be difficult to address within the foreseeable future. This compels the rural people in either not taking any treatment at all, or taking treatments from traditional healers, or taking modern drugs through consultation of unqualified people which often leads to maltreatments and misuse of antibiotics and steroids. If the illness deteriorates, they take all the trouble of going to a distant city hospital through rough terrains and waterways, at a huge cost to the family. To address this problem, ICT-based telemedicine can come with a great promise, particularly in catering to primary and secondary care. A proper medical consultation at this stage can help improve the above mentioned concerns, save a lot of eventual health complications, even death in many cases. It has been observed in the preliminary research that a number of telemedicine initiatives were taken in the past in Bangladesh, yet very few of these sustained down the line. Lack of appropriate system design, technology and implementation modality seemed to be the main causes. Therefore, the Department of Biomedical Physics & Technology of Dhaka University took up research and development in Telemedicine starting in 2011 through development of indigenous technology coupled with its dissemination to achieve a holistic approach to the solution. The initial work involved development of a basic telemedicine software with Electronic Health Record (EHR) and a few integrated online diagnostic devices like a stethoscope and ECG with individual software. Other basic medical tests were done using commer-cially available devices and entering the data into the system through manual typing. A field trial taken up during 2013-2015 indicated initial success of the envisaged basic model. However, the software was basic and would not be able to cater to the requirements envisaged for its further expansion based on the experience. The present work was taken up based on this background and the whole system design approach was redesigned with the following requirements: 1. It should be web based, with cloud storage of all medical records (Electronic Health Records-EHR) including written texts, images and acquired data from integrated medical devices. The latter at this point were stethoscope and ECG, both made locally by BMPT. 2. 3. It has to be user friendly to its users, namely the rural operators, consulting doctors and administrators, with graphical user interface (GUI) and the maximum use of local language. 4. 5. 6. 7. It should have a computer aided prescription generation tool linking data bases of drugs (medicines), and other medical or clinical advices. The latter will need to be created in this software. 8. It should have web-based monitoring facility for the administrators which should have some analytical features with graphical presentation of necessary data, which can be expanded as need arises. 9. It should be optimized for slow internet connectivity, as is encountered in Bangladesh. Each of these areas was individually addressed by developing corresponding tools, and finally put together to make it an integrated, user-friendly telemedicineplatform capable to work efficiently in Bangladesh. An Action Research (AR) approach applied in the socio-technical context dictated the most part of the research and development process. Participations of relevant stakeholders of the system were ensured in all the stages of "design to deployment" cycle of this project. In contrast to many typical workflows followed in HCI area, the present work concentrated on the software development through evolutionary improvements adopting existing technology and tools, rather than focusing on radical innovation by introducing the new form of technologies. Based on the previous experience of BMPT in which the author of this work was also involved, a completely redesigned software, under the purview of this PhD work, was developed. Firstly a working prototype was developed and it was put to use by BMPT under the banner of Dhaka University Telemedicine Programme. Subsequently the software was expanded, modified and refined over the years to add newer features and to incorporate critical feedbacks coming from the users – the rural operators, consulting doctors and administrators. Till date, More than 11,500 patient consultations have been given using the software developed under the present work and the number of rural centres currently being catered is in excess of 30, with 10 doctors giving consultation from any place they choose - home, office or workplace, or even while travelling, using a smartphone. Towards the end of the work a survey was carried out taking samples from the above users regarding ease of use, satisfaction, effectiveness of the software. The results were predominantly positive pointing out to the success of the present endeavour. All low resource countries of the world have similar situations as Bangladesh and this software can easily be adapted to local needs through language translation of the user interface, where needed, and incorporation of appropriate database of available drugs. Any other modifications can also be made working together with people of the target countries. The outcome of the present work, hence has a big horizon in the global scenario and the work will be deemed worthwhile if it can help all these people of the world who has been deprived of the facilities of the modern life over centuries.