ABSTRACT
This thesis has to do with the transfer of medical records
taken remotely to a doctor via GSM wireless communication link. Specifically it
makes use of the Short Messaging System (SMS) of the Global System for Mobile
communication (GSM). The records will be taken by a nurse and stored in the
hospital database via a visual basic developed user-interface. Whenever the
threshold for a certain parameter set by the doctor is exceeded an SMS alert is
sent to the doctor indicating an emergency to which the doctor sends back a
reply giving directives to the caregiver on procedures to undertake pending his
arrival. On the doctor’s visit, the history of records taken during his time of
absence can be accessed by him for proper prescriptions for the patient which
is equally stored in the database. Also if there is a new patient, the record
is sent automatically to the doctor.
CHAPTER ONE
INTRODUCTION
1.1 Background
of the Study
Worldwide, people living in
rural and remote areas struggle to access timely, quality specialty medical
care. Residents of these areas often have access to substandard specialty
healthcare, primarily because specialist physicians are more likely to be
located in areas of concentrated population. There is also the challenge of
having very few experts especially those managing chronic diseases even in the
urban areas. Effective management of diseases especially chronic diseases can
result in improved health outcomes and increased quality of life since more
than 80% of primary care visits and two thirds of medical admissions into
hospital emergency departments are related to chronic diseases. For example,
controlling a parameter such as blood pressure in people with diabetes and
hypertension has been shown to reduce mortality and incidence of severe and
costly complications such as renal and cardiovascular disease.
Health care
systems are now changing due to the dynamic nature of technological and
scientific medical practices. The health care providers are now swiftly
adopting these technologies into their health care procedures. Because of
innovations in computing and communication technologies, many elements of
medical practice can be accomplished when the patient and health care provider
are geographically separated. The separation can be as small as across a town,
across a state or even across the world.
Remote patient monitoring is
relatively a new area of interest which enables medical professionals to
monitor a patient remotely using various technological devices. It is primarily
used for monitoring chronic diseases or specific diseases like heart diseases,
diabetes mellitus, and hypertension e.t.c. These services can provide
comparable health outcomes to traditional in-patient encounters, supply greater
satisfaction to patients and is cost effective. Monitoring a patient at home or
in a clinic without a resident expert using known device like blood pressure
monitors, glucose meters e.t.c. and transferring the information to a caregiver
is a fast growing emerging service. In developing countries like South Africa,
Primary Remote Diagnostic Consultation
[1] not only monitors an already diagnosed chronic disease but has the promise
to diagnosing and managing the disease a patient will typically visit a general
practitioner for. Remote patient monitoring can also be applied in
electrocardiography, radiology, to mention but a few.
The transfer of these medical
data can be done through a variety of telecommunication technologies including
ordinary telephone lines, ISDN, internet, intranets, satellites and mobile
phones to mention but a few. This project has to do with the transfer of
medical records taken remotely to a doctor via GSM wireless communication link.
Specifically it makes use of the Short Messaging System (SMS) of the Global
System for Mobile communication (GSM). The records are taken by a nurse and
stored in the hospital database via a visual basic developed user-interface.
Whenever the threshold for certain parameters set by the doctor is exceeded an
SMS alert is sent to the doctor indicating an emergency to which the doctor
sends back a reply giving directives to the caregiver on procedures to
undertake pending his arrival. On the doctor’s visit, the history of records
taken during his time of absence can be accessed by him for proper diagnosis
and prescriptions for the patient
which is equally stored in the database. Also if there is a new patient, the
record is sent automatically to the doctor.
1.2 AIMS
OF THE PROJECT
The major aim of this project
is to make health care services available to isolated communities and remote
regions like military bases, ships and the like. It is also aimed at reducing
mortality rate especially in developing countries like Nigeria where the needed
expertise is limited. The system should be able to significantly reduce the
time taken in making health care accessible to them. The burden of inferior
healthcare will be taken care of through this system. This system can be
extended in its application to areas like fine-tuning the management and
allocation of rural health care emergency services by transmitting images to
key medical centres for long distance evaluation by appropriate medical
specialists, permitting physicians doing clinical research to be linked
together despite geographical separation, sharing patients’ records and
diagnostic images. Generally speaking, this project is aimed at transmission of
medical data for diagnosis or disease management and also health advice by
telephone in emergency cases.
Finally
since the cost of complete remote patient monitoring system which incorporates
the sensors used for capturing biometric data is very high, this system goes a
long way in making remote monitoring accessible to the common masses who cannot
afford the cost of services rendered by those complete systems as they can take
their readings manually.
1.3 JUSTIFICATION
OF THE WORK
The system does not require any
prior computer knowledge for the user to be able to implement it. The
requirement is basic understanding of English language, it is user friendly.
Taking of the medical measurements are easy procedures that can be easily
undertaken by anyone after simple explanations.
Moreover in a nation like
Nigeria where there are few experts especially those managing chronic diseases
like diabetes, hypertension etc. this systems comes as a big relief to those in
the regions where the experts are not located as they can still access the
expertise of those experts. Recently there was a case of relocation of many
doctors from a city in Nigeria because of frequent cases of kidnapping. The
result of course was poor health care services to those in that locality. With a system like
this, doctors can still offer healthcare services to their patients from a
secure location. Also this work will help to sensitize the populace on the
usefulness of remote patient monitoring using mobile phones which according to
a study by Boston University School of Public Health [2] is yet to be embraced
by the developing countries. This work can be further justified by the
following advantages of using a mobile phone as a health care intervention.
Low
start-up cost: - living in resource-poor environment
is not a barrier to the use of wireless system for several cultural and
economic reasons. The existence of a so-called “digital divide” along the
socio-economic gradient is less pronounced in mobile phones than in other
communication technologies such as the internet. To make the system affordable
to all especially those in the remote villages of Africa, the system was built
independent of the instruments for measuring the needed parameters.
Functionally
mobile phones are easier to use for people with lower level of skills.
User
friendly-SMS: Pricing polices may enhance certain mobile uses in particular use
of short message system (SMS) text. Text message is less expensive than a phone
call and can reach people whose phones are switched off. It is silent which
means it can be sent and received in places where it may not be practical to
have a conversation
Forms of payment: In developing
countries a prepayment system is used, this involves buying cards which provide
phone time from five minutes to an hour. Customers can use credit as they like
over a period of week and so keep control over their spending and enjoy a very
cheep service. Once the pre-paid outgoing call budget is exceeded, the user can
still receive SMS and calls. Thus the doctor does not need to have credit in
his phone to receive alerts and the system does not cost much to
send an alert.
Finally, the rate of mortality
in remote places due to lack of adequate monitoring by medical experts
especially for chronic disease which is increasing at an alarming rate
justifies the need for the system which is not limited by distance so far there
is a telecommunication network available in that area. With this system doctors
spends less time going to see patients and utilises
more time treating them. It also means real time monitoring without high staff
or capital cost.
1.4 SCOPE
OF THE WORK
This system will be able to
manually capture doctor-specified vital health data like heart rate, blood
pressure, temperature, and plasma glucose level of a patient which is stored in
the hospital database and can be transmitted to a doctor when a set threshold
is exceeded for better management of diseases. +The system will monitor
patients diagnosed with chronic or long-term illness such as diabetes or
cardiovascular diseases and stable victims. It can acquire vital information
about a patient who lives far away from a medical expert. It can alert medical
staff if there is a change in patient’s status that is critical.
The system will have a user
interface to be developed using VB.net through which the nurse or caregiver
feeds in the data to the system which is stored in the database. The database
will include a medical data manager (MDM) that automatically checks patient’s
new data against patient’s record and doctor’s comment. If there is a
disturbing change in the patient’s vital signs, for example high
blood pressure for a hypertensive patient, an alert is sent directly to the
physician. This ensures rapid response by a doctor or medic to any problem that
arises. The database stores all patients’ data. The workflow system controls
overall system processes while the user interface dynamically format and
presents the patient’s data. The SMS alert is sent through a GSM modem
connected to the computer.
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