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Public-private cooperation in e-healthcare should grow Staff Correspondent
Public Private Partnerships (PPP) have the tremendous potential to make quality healthcare services reach the vast majority of people and transform healthcare around the world. Using Information and Communications Technology (ICT) in the PPP to deliver healthcare can extend the reach and scope of the healthcare delivery systems and fuel up this transformation. In order to understand the importance, share and explore the ways of collaboration between private and public partnership using ICT to improve healthcare delivery in Bangladesh, The Daily Star Leadership Colloquium on 'ICT in Healthcare' held a session titled “Health transformation through public & private cooperation fueled by ICT” yesterday at The Daily Star Centre. David Aylward, Senior Advisor, Global Health and Technology, Ashoka was the keynote speaker of the session. Kimberly A Rook, Technical Advisor, Knowledge Management & Communication & Project Team Leader, John Hopkins University Bloomberg School of Public Health, USA chaired the session while Dr Abu Jamil Faisel, Project Director, Mayer Hashi and Country Representative of EngenderHealth was the discussant of the session. In the keynote presentation, Mr David projected the innovations in healthcare using ICT and role of public private partnership and integrating these into a common healthcare delivery system. He shaded light on 3 main topics- health transformation, public private cooperation and use of ICT in a resource poor setting like Bangladesh. He stated that health transformation needs disruptive innovations that helps improve service continually and creates a new market and value network replacing existing. He emphasized on the proper linkage among six key elements-People, Village health worker, Rural clinics, Call/information/medical response center, Doctors, Birthing center/hospital to transform healthcare with special focus on wellness, nutrition and primary care. He said that healthcare worker or front line providers are key players in improving healthcare. Train them to use simple technology in delivering healthcare at community level is crucial. He pointed out to the need to establish or utilize existing call centre and information booth properly to disseminate information, empower and educate people to know about their health. He said that wireless network is every corner of Bangladesh and hence it has lots of opportunity to improve healthcare delivery using ICT. He mentioned some of projects to deliver healthcare through using ICT specially empowering pregnant women by proving voice message to their mobile phone to make them aware and help take prompt care to prevent complications. He focused on the importance of building user-friendly simple technologies like mobile software for data collection, awareness etc. Using ICT can ensure that people and providers can access information when they need through mHealth or mobile health, telemedicine or any other means of communication that is accessible for them. He also stated that many organizations including government, NGOs and other private companies are delivering healthcare in Bangladesh distinctly and by their own effort or financial aids they get. But improving healthcare needs a concerted effort and partnership or cooperation is a crucial factor to provide comprehensive and quality healthcare service at a minimum cost. He urged to take leadership role in integrating ICT in healthcare to provide best possible outcome, to create collaboration between public private organizations and create a role model to make it sustainable. At the end of his presentation, Dr Abu Jamil Faisel presented the summary of the session. He added that both public-private and private-private coordination are necessary and creating a platform comprise of experts is imperative to incorporate ICT in healthcare and use it in coordinated healthcare delivery system. After then, the session was opened for discussion and there was an interactive question-answer session on the topic. At the end, Vote of thanks was delivered by Kimberly A Rook. Telemedicine has tremendous potential in Bangladesh Staff Correspondent
Despite its limitations, telemedicine can bring a paradigm shift in how medical services are offered in Bangladesh, a colloquium on ICT in Healthcare was told yesterday. While accurate diagnosis of critical diseases may always not be possible with technology, it can play a vital role in monitoring chronic health conditions, maternal and neo-natal health among other things, it was told. The observations came at a technical session titled “Importance of Live Consultation in Telemedicine” at the first day of The Daily Star Leadership Colloquium 2012 - ICT in Healthcare. The Daily Star, Golden Harvest, Summit Group, Citi Bank and D.Net are organising the two-day annual colloquium at the Daily Star Centre in the city. Telemedicine is the use of telecommunication and information technologies to provide clinical health care at a distance, said Dr Alain B Labrique, an Assistant Professor at the Department of International Health / Epidemiology (joint) of Johns Hopkins Bloomberg School of Public Health in USA, in his presentation. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations, he said. It has tremendous potential especially in Bangladesh, said Dr Labrique, also the Director of Johns Hopkins Bangladesh Ltd. Doctors at the Johns Hopkins, for example, are now using robots to make their daily rounds to monitor patients. The robots, with a TV screen for its head, show the face of the doctor who sitting on his office manoeuvres the robot around the hospital to check on patients, he said. This way, the doctors can check on their patients from their offices or even homes, he added. It is not just in the Johns Hopkins, he added, an initiative in Nepal, for example, is having heartbeats and pulses of patients broadcast to physicians for accurate diagnosis. Bangladesh is also not far behind in telemedicine, said Dr Sikder M Zakir, founder of Telemedicine Reference Center Ltd (TRCL). “We have provided some 11 million telephone consultations in last five years. And only 40 percent of the patients had to be referred to a doctor, seven percent of whom required hospitalisation,” said Zakir. Things used to be difficult as even downloading an email was excruciatingly time-consuming, he said. But things improved over the years as Internet became faster, less expensive and more available. “Now I can even do consultation with a patient in a different neighbourhood,” he said, adding that the country has a promising future in the field of M-health.
But the technology has its limitations, admitted Dr Labrique, it lacks the human touch and confidentiality, and many people are unwilling to trust technology with something as vital as their health. Many rural people first go to the local Kabiraj, he said, the reason being the matter of cost, the matter of availability and local knowledge. These are some of the problems that telemedicine should address, he said. To make it effective, telemedicine should be problem-driven instead of being technology-driven, he added. “You need to identify what are the health problem sets. For Dhaka, the problem set is different than, say, in rural areas,” said Dr Alain B Labrique. The problem set would steer the design of telemedicine services, he added. Another benefit of telemedicine is that it has a major potential in mental health, said Mahrukh Mohiuddin from the James P Grant School of Public Health, BRAC University. Agreeing with Mohiuddin, Dr Labrique said many patients feel more comfortable to talk about their personal matters over the phone than in person. The country needs a vision and some regulations for telemedicine practices, said Dr Labrique. For example, 90 percent of deliveries in Gaibandha take place in homes, he said. The vision could be to ensure that majority of the deliveries take place in hospitals while monitoring maternal and neonatal health could be done through telemedicine, he added. While the private sector is showing growing interest in the health sector telemedicine has immense potential, said Dr Labrique. There is always a conflict of interest as public health works in a different way than the private sector, he said adding that the partnership should be formed delicately and transparently. Kimberly A Rook, Knowledge Management & Communication & Project Team Leader, Johns Hopkins University Bloomberg School of Public Health, chaired the session. Doctors, medical practitioners, pharmacists, informational technology experts and representatives of telecommunication companies were present at the session. Barriers in use of technology must be overcome Staff Correspondent
Availability of technologies is just not enough but using those with appropriate language and process is crucial to take healthcare services to the doorsteps of citizens, observed speakers while speaking on “Communications Barriers in Accessing Healthcare”. They said people will not accept any service, even if it is available, if the service is not reliable to them. They identified barriers in socio-economic, political, cultural and behavioral aspects which arise while using communications technologies in various services. They said information sent about services must be accessible to both men and women, and understandable and reliable to all. In his speech, Murali Shanmugavelan, a communication policy analyst and researcher with 16 years of experience in the international development sector focused on the available communication technologies, users' behavior to that and the barriers in accessing the technologies. He himself challenged a number of things, including whether infrastructure can do everything. He said people behave differently when they get a technology to interact and adjust with their own ecology. People may not accept a service even if it is available if they don't believe that the service is reliable or if it is far away from them, said Murali. He, however, did not say how the barriers can be removed In this regard, he said, what communications can do in social processes and how it actually plays out in a particular system, and therefore how and in what circumstances communications can provide more desirous impact on the society, need to be discussed. He said the colloquium organised by The Daily Star will demystify the complex system and complex ideas regarding communications. “The discussion would not have been possible 10,000 days ago but technology has made it possible,” said Murali, adding that the procession of communications and what process is perfect for what aspect is a mammoth task. “There are a lot of socio-economic and political factors you have to bear in mind because technologies have different impacts in different socio-economic and political system,” he said. In this regard, he emphasised on political will and commitment. About using mobile phone, he asked, “How do rural women use the mobile phone? Do they actually own the phone? Do they actually access phone? Do they control overtalking?” Giving an example of a radio programme in South India, Murali said people there started calling 'radio rice' as the programme was very interactive. “People were so associated with it they forgot the actual name of the rice,” he said and added, “Technologies shape our understanding as well.” The same way, he said, communications can play huge role in providing health services to the people in Bangladesh. Murali also said, “We need to think how we engage technologies in the communication process to make healthcare system more accountable and transparent". Speaking in the session, managing director of Telemedicine Dr Sikder M Zakir said proper policy and procedure are needed if health services are to be taken to people through telemedicine, mobile-health and e-health. He divided mobile as tools in three categories consumer, clinical and administrative. “By consumer application, we are giving health service through Grameen Phone since 2006,” he said. Zakir said administrative tool is also being used the same way, but using clinical tool in giving health services is difficult as any wrong information can cause death to the patient. About using communications technology, he said the people will have to understand sending of information through the health services tools. Mahrukh Mohiuddin of Brac University chaired the session which was also attended by a group of doctors, students and NGO representatives. Preparing a comprehensive healthcare information system Staff Correspondent
Bangladesh should identify its current and future health needs to prepare a comprehensive healthcare information system for taking medical facilities to the doorsteps of people in a more effective way, a leading health expert said yesterday. “The country should create a matrix of what is available here and in international stage, where are the gaps and how could we narrow those, as health is becoming international faster,” said Dr Ali Rashidee, president and chief executive of InformaticaHealth, a California-based medical informatics company working on telemedicine. “It is not simple. Bangladesh needs to work on many domains. The way things are going, Bangladesh will find itself in troubled waters if it does not start now,” he said. Rashidee's observation came at a technical session on the sidelines of the two-day The Daily Star Leadership Colloquium styled "ICT in Healthcare" at The Daily Star Centre in the capital. In recent years, the health ministry has made a significant progress with respect to developing information systems both at administrative centres and community levels in healthcare sector. But health experts say that Bangladesh still remains at the initial stage of data and process interoperability in the health information sector, with major policy and logistical bottlenecks. During his presentation, Rashidee said it is not easy to standardise data. “Technology is a huge incentive for the country to do something. It is true that technology does not solve all problems, but it solves part of a problem and assists public health sector.” He said in the world's health information system, the first 10 years were full of mistakes. “Then the things started to roll in the right direction. Now the whole system is standard. Bangladesh should take a comprehensive look into what is there. Once we manage to standardise data, we will be able to move to electronic medical record.” Dr Faheem Hussain, assistant professor of quantitative reasoning at Asian University for Women at Chittagong, said there is no standard in Bangladesh in terms of data entry. “Data exchange among the public and private health systems is also costly and is mostly done on ad hoc basis. There is no policy on the issue,” he said, adding that there should be a unique identification number for patients to bolster eHealth movement. S M Ashraful Islam, a joint secretary of the health and family welfare ministry, said nobody can build a public health system without adequate information. “We have taken up a number of steps to establish eHealth in the country. We have introduced data collection system in government offices at grass roots level.” He said the government has installed a software system at all of its hospitals in upazila level and union healthcare centres to monitor the presence of physicians and nurses at their offices. “As a result, our attendance rate has soared to 90 percent,” he said, adding that introduction of unique ID card is not a dream anymore, it is going to be a reality soon. M Nazrul Islam Khan, national project director of Access to Information Programme under the Prime Minister's Office, said there are many organisations in the country that collect information. “But we do not use all the information. It will also not be easy to collect health data and use them,” he observed. Khan said Bangladesh should have a proper population registration at first, since the existing database prepared by the election commission cannot relate a person with his relative, and also does not cover the population below the age of 18. “We are now planning to prepare a population registration. We are now doing its [population registration] design work,” he said, adding that it would be better to prepare the department-wise database. Khan said there should be a change in our mindset while preparing a national database. “There are many people who do not want to support. Also, the cost is an issue.” “We experience a lot of problems in the health sector. I think there should be a unique personal identification number for all patients,” he observed. During the discussion, a participant said it would be a tremendous job to digitise the existing system from the analogue one. “We still do not have data on the country's actual population. We also do not have any supporting data on why a medical college is being set up in a particular district or when a 100-bed hospital is being upgraded to a 200-bed one,” she said. Reaching excellence to the poor Staff Correspondent
With limited resources, Prof K Siddique-e-Rabbani developed an artificial hand for a 10-year-old under privileged girl. Guess how. He bought a hand of a mannequin from a cloth store and worked on it for a fortnight. Finally, he transformed it into something that gave the poor girl a support which she could not even dare to dream of. The girl had lost her hand from the wrist when a bomb abandoned along a road went off. The prosthetic hand fitted so nicely that it blew the girl away. And her mother, a scavenger who looks for used paper in Dhaka University area, paid the professor the best way, with her tears of gratitude. She does not cry for her girl's hand anymore. "I decided to make the hand after I had come to know that a standard artificial hand cost Tk 22,000. So I went for improvisation. The prosthetic hand cost me only Tk 1,500," said Prof Rabbani, chairman of Department of Biomedical Physics and Technology, Dhaka University (DU), in the Leadership Colloquium organised by The Daily Star. He presented a paper in the "Health Technologies for the Future" session of the colloquium featuring some of his inventions that promise the potential to contribute to medical technology for the poor. One of his most significant inventions is the prosthetic hand that can function taking command from the brain. This inspiration came from Rabbani's encounter with the poor girl. He also briefed the audience his idea about how to develop a prosthetic hand with almost the same reflex that humans are born with. The endeavour may sound ambitious, but those who are interested in inventing using local technologies and limited resources, Rabbani can be their inspiration. "As it goes in the present, technology is not free of cost. We need to enhance human capacity to make and repair complicated machines. Once a machine imported goes out of order we need to bring experts from another corner of the world to repair it since we don't have the expertise," Rabbani said. "My philosophy is not to patent any invention as this barrier deprives the poor of the benefits," he continued, "We make equipment for the people and intend to spread the benefits." Rabbani is one of those few qualified technologists who are developing medical equipment for the poor. It shocked him when he learned that 80 percent of the world population live in the least developed countries and of them, only one percent have the access to modern healthcare and diagnosis, like ECG and X-Ray. While presenting the keynote paper in the session, Rabbani named a few equipments he has developed and invented so far with the help of his students. His inventions include locally improved computerised ECG machine, muscle and nerve stimulator and bone density measurement machine. He also developed a method of disinfecting water using sunlight. Under a telemedicine project of the government, Rabbani and his team have also developed digital ECG, colonoscope, stethoscope, and microscope, with which patients can be diagnosed from far through internet. The UK, Norway and Korea have already started using some of his inventions on an experiment basis. However, our government turned deaf ears to his urge to market the equipments locally. Rabbani is also working to develop nerve disease scanning process and gadgets for hearing impaired and blind people. "Within a decade our technology of scanning process would become popular across the globe," said an optimistic Rabbani, adding that we need to gradually get rid of the tendency of getting equipments and machineries from the rich countries. Austin Mustafizur Rahman, director of Technology Development and Support of Hunger Orthopaedic & Group, also presented a paper following that of Rabbani's. Rahman lauded Prof Rabbani's spirit and dedication. "The world is changing and we need to get on board too. Prof Rabbani has already started contributing to this changing process," said Rahman. The audience of the colloquium were spell bounded as Rabbani presented his paper. They showered complements and inspiration when he finished his presentation. "We can also fly high and I want to spread this message all over the third world countries," Rabbani responded. Doctors need sufficient data about patients Staff Correspondent Doctors should have enough intuitive data about patients to analyse diseases, a leading health expert said yesterday, urging the physicians to be proactive rather than reactive to their patients. “There should a system so that doctors and patients can communicate with each other easily,” said Kazi I Ahmed, a non resident Bangladeshi living in the United States. Ahmed has developed a software for patients' record management solution that is being used over 400 hospitals and clinics across the USA. He is the founder president, chief executive officer and chairman of NuMedics, Inc at the USA. Ahmed presented the details of the software yesterday at a technical session on the sidelines of the two-day The Daily Star Leadership Colloquium styled "ICT in Healthcare" at The Daily Star Centre in the capital. He delivered his lecture from the USA through a video conferencing and also responded to the audiences' queries. His local representative Sheikh Mohsinuddin, senior strategist at HP Software, moderated the session. Ahmed said in Bangladesh, healthcare related works are still based on paperwork including patient's examination report, prescriptions, and history. But all these data can be incorporated in an automated system using a software, he observed. At the same time, non-disease data of the patients such as age, contact numbers and professions can be included in the software, he said. Sometimes patients lose their papers but the software system can permanently preserve data, Ahmed said.
The software that Ahmed has developed can streamline data collection and demonstrate quality healthcare. A patient need not to fill up forms more than once if the system is introduced in the hospital system. Even there will be no need to fill up forms at laboratory, he said. Ahmed said pharmacies can also be connected through the software so that they can get the electronic prescription and deliver medicine. Mohsinuddin said if the software is installed, the hospital authority would be able to provide service to the patients. It will also be used to establish communication among nurses, doctors and patients. At the same time, the software can establish contact with patient's guardian as well. It is not the hospital management software rather it is a solution for patients' record management system, he said. Mohsinuddin said the software has been developed in such a way that it can connect to different devices that can read blood pressure, diabetes, fever, cholesterol-level of patients and provide these information to doctors directly. In case of video conferencing, the software can help doctors communicate directly with patients, he said. Patients would get information, advice or electronic prescription through short message service or e-mail, if needed through phone or mobile also, said Mohsinuddin. Responding to the audiences, he said that they have facilities at their Gulshan office in Dhaka to train doctors on the uses of the software. At the same time, they have special offer for Bangladeshi hospitals and clinics for procuring the software. Price will depend on the design of the software and the number of people who will get benefit from it, said Mohsinuddin. He said the system has the potential to let the doctor visit more patients in less time. Doctors can communicate with patients within 2 to 5 minutes. Clinics would be able to operate with less manpower. The system's data security is in-built. The software is unified and can be incorporated in different hospitals, he said. During the session, Global Med, a US based company, demonstrated their telemedicine equipment kits which can be connected with the software. E-HEALTHCARE EXHIBITION IN FRAME
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Daily Star : Dhaka Saturday January 07, 2012
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