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APT HRD Programme for Exchange of ICT researchers and Engineers 2010 funded by EBC from Japan

Final Project Report

Study on

Practical planning and deployment of the ICT in health for improved health and medical environment

of Lao P.D.R.

April 2012

Collaborative Research Team of

Lao P.D.R. and Japan


FINAL REPORT‐1

Table of Contents

Executive Summary .................................................................................................................................... 2

1. Project Information ................................................................................................................................ 3

1.1 Backgrounds ....................................................................................................................................... 3

1.2 Objectives ........................................................................................................................................... 3

1.3 Project Team ....................................................................................................................................... 4

2. Overview of the study ............................................................................................................................. 6

2.1 Project Schedule ................................................................................................................................. 6

2.2 Basic policies for project implementation .......................................................................................... 8

3. Summary of the project activities .......................................................................................................... 9

3.1 General project activities .................................................................................................................... 9

3.2 Exchange activities ........................................................................................................................... 10

3.2.1 Preliminary investigation ............................................................................................................... 10

3.2.2 Joint Study in Laos-1 ..................................................................................................................... 12

3.2.3 Additional training ......................................................................................................................... 19

3.2.4 Joint Study in Japan ....................................................................................................................... 22

3.2.5 Joint Study in Laos-2 ..................................................................................................................... 24

4. Project outputs ...................................................................................................................................... 26

4.1 Study on Roadmap for development of ICT in Health Sector .......................................................... 26

4.2 Follow-up on the previous pilot project ............................................................................................ 27

4.3 Evaluation on the follow-up results .................................................................................................. 30

4.4 Skilled personnel ............................................................................................................................... 41

5. Project sustainability ............................................................................................................................ 42

6. Future Plan ............................................................................................................................................ 43

7. List of Annexes ...................................................................................................................................... 44


FINAL REPORT‐2

Final Project Report

Project Title

Study on practical planning and deployment of the ICT in health for the improved Health and Medical environment of Lao P.D.R.

Executive Summary

Under the support of APT (EBC-J2)-2008, the Collaborative Research Team of Lao P.D.R. and Japan was conducted the study for the effective promotion of ICT application in health and medical field, and standing on its fruitful result, the 'Pilot project for the improved Health and Medical environment with ICT for rural areas in Lao P.D.R." under the support of APT (EBC-J3)-2009 had been successfully implemented.

This latest collaborative study project was established to continue the positive momentum in Lao team for creating the practical planning and deployment of the ICT in health and medical field in Lao P.D.R. Through the collaborative study on the development of the Roadmap and Action plan, this project is aiming for contribution to the promotion of HRD and capacity building for the ICT in the nation.

The official selection notice by APT Secretariat was issued on 19-Apr-11, and the total approved budget for the project was USD 50,796.

Through this activity, following outputs will be expected as the deliverables of the project:

- Roadmap and Action plan for the practical deployment of ICT in health

- Practical solutions for the issues actually found in the previous pilot project

- Skilled personnel for the sustainable enhancement of ICT in health through the collaborative study and training

The following organizations from Lao government are continuously concerned to this project from the previous project;

- Ministry of Health (MOH)

- Ministry of Posts and Telecommunications (MPT)

- Ministry of Science and Technology (MST)

The former NAST (National Authority of Science and Technology) was separated into MPT and MST after reorganization of Lao government in June 2011.


FINAL REPORT‐3

1. Project Information

1.1 Backgrounds

The previous 2008-J2 study was planned and conducted for the “Promotion of ICT utilization in Health & Medical field through the enhancement of e-health contents”, and through this study “Issues to be solved and solutions with ICT for them” had been summarized.

And, keeping up with such 2008-J2 results, the pilot project under 2009-J3 had been conducted. The previous 2008-J2 was the “Study for finding ICT solution without real ICT environment”. On the other hand, as the result of J3-2009, we already have the condition for “More practical study and consideration with actual ICT environment for more improved e-health”

Therefore, in this project, we will get into the actual work in hospitals. Accordingly, we plan to make business process analysis so as for more effective utilization of e-health, and study on the advancement and functional upgrading of the e-health system for the practical deployment of ICT in health in Lao P.D.R.

1.2 Objectives

In order to achieve the following objectives, collaborative activities have been implemented under the support of APT (EBC-J2-2008) and APT (EBC-J3-2009) programmes:

(1) Narrowing the digital divide in the rural areas (2) Improvement of Health & Medical environment with ICT (3) Encouragement of the nationwide ICT infrastructure enhancement

For utilizing the fruitful result of the above mentioned J3 Pilot Project, and in order for starting full-fledged implementation, following items are the main objectives of this study:

- Development of the Roadmap and Action Plan for the practical deployment of ICT in health.

- Finding the practical solutions for the issues found in the previous pilot project implementation.

- Improvement of the required skills for the sustainable enhancement of ICT in health.


FINAL REPORT‐4

1.3 Project Team

This study project is conducted by researchers and engineers from below listed organizations with each key role for the project. There is a change in the name of organization in Lao P.D.R. due to the government reorganization.

Table 1.3 1 Key role of each organization

Organization Key role Lao P.D.R.

Ministry of Posts and Telecommunications [MPT]

- Administrative coordination as the main applicant - NW related arrangement - Overall grip and future planning for enhancing the

result of this project (Enhancing the target of other sectors than Health

sector) <National e-Government Center> - e-Government related coordination - LAN installation in the hospital - Technological review of case studies for enhancing the result of this project

Ministry of Health [MOH]

- Total coordination on project implementation - Support for follow-up activity - Data collection & analysis of effectiveness

evaluation - Set-up of the structure and personnel assignment

for keeping the sustainability of this project result Japan Fujitsu Limited

[Fujitsu]

- Project management and account coordination - Leading the objective research, study and

evaluation - Development of relevant documents - Arrangement for case study and site visit [main] - Planning of the continuous cooperation for Lao

P.D.R. Japan Telecommunications Engineering and Consulting Service [JTEC]

- Project coordination and liaison with Lao team - Framework of overall project and required reports - Necessary support for development of relevant

documents - Arrangement for case study and site visit [sub] - Planning of the continuous cooperation for Lao

P.D.R. BHN Association [BHN]

- Advice from the professional view point of Telemedicine in ASEAN countries

- Necessary support for development of relevant documents


FINAL REPORT‐5

Table 1.3.2 Members of Project Team

No. Name Organization Title 1 Mr. Xayluxa

INSISIENGMAY MPT Director General

2 Mr. Anousone AKKHAVONG

MPT Deputy Director, Dept. of Information Technology

3 Mr. Visith KHAMLUSA MOH Chief of AV Section, CIEH

4 Mr. Khamphithoun SOMSAMOUTH

MOH Deputy Director, CIEH

5 Mr. Sengaloun SENGSAVANG

MOH IT system officer, Cabinet of MOH

6 Dr. Tavanh MANIVONG MOH Deputy Director Mittaphab Hospital

7 Mr. Keopasexay SAMUNTY MOH Head of Technical Service Mittaphab Hospital

8 Ms. Viengsakhone LUANGPADITH

MOH Medical Doctor Mittaphab Hospital

9 Dr. Phanomsay PHAKAN MOH Deputy Director Luangphabang Hospital

10 Dr. Vone KEOMANY MOH Administrative Department Luangphabang Hospital

11 Mr. Anoulack BOUNYONG MPT [Luangphabang]

Head of Informatics Section e-Government Center

12 Mr. Shigehiko YASUMURA

Fujitsu Director, Business Management Center

13 Mr. Go MAENO Fujitsu Manager, Business Management Center

14 Ms. Mayumi KOBAYASHI Fujitsu Senior Engineer, Business Management Center

15 Mr. Satoru YAMANAKA Fujitsu

Engineer, Service Business Unit

16 Mr. Katsumi MORO BHN Deputy Secretary-General

17 Mr. Masanobu USHIZAKA JTEC Director, Telecommunications System Consulting

18 Mr. Masato TAMURA JTEC Director, Telecommunications Consulting

19 Mr. Makoto HANDA JTEC Director, ICT System Consulting


FINAL REPORT‐6

2. Overview of the study

2.1 Project Schedule

Table 2.1.1 Overall activities

Item Japan Laos Term (1) Preliminary

study - Review of APT (EBC-J3)-2009 results and planning

on the solution for the found issues - Review of APT (EBC-J3)-2009 results and planning

on the required skill improvement - Discussion for idea illumination to make appropriate

Roadmap and Action Plan for the practical deployment of ICT in health

May 2011 to Aug. 2011

(2) Remote discussion between Laos and Japan

- Having common understandings on the result of Preliminary study

- Clarification on the points to be discussed in the Joint Study in Laos

- Detailed scheduling for the Joint Study in Laos-1

Jul. 2011 to Aug. 2011

(3)Preliminary investigation

(Follow-up)

- Follow-up for the better utilization of the system, which have been installed under the support of APT (EBC-J3)-2009

- Solve the issues found in the previous project

Aug. 2011

(4) Joint Study in Laos-1

(Kick-off)

- Discussion on the Roadmap and its Action Plan for the practical deployment of ICT in health

- Clarification on the action points for follow-up work of the previous project

- Survey on the network expansion and enhancement of Database system in the hospitals

Sep. 2011

(5) Preparation of Interim Report

- Draft the Interim Project Report and Finalize the Account Summary

- Finalize the Interim report and submit to APT Secretariat

Sep. 2001 to Oct. 2011

(6) Continued study and preparation

- Study for the next APT pilot project and Roadmap

- Preparation for joint study in Japan

- Study and draft for the next step of ICT utilization for APT pilot project and Roadmap

Oct. 2001 to Nov. 2011

(7) Additional training in Laos

(Follow-up)

Activity on Action item for follow-up - Additional training for each hospitals - LAN expansion in Mittaphab hospital

Dec. 2011


FINAL REPORT‐7

Item Japan Laos Term (8) Joint Study in

Japan (Training)

- Case studies of e-health technologies in Japan a. Case study on utilization of advanced e-health b. Site visit for learning leading-edge e-health in

Japan - Discussion on the directionality of e-health in Laos - Discussion on Roadmap

Jan. 2012

(9) Joint study in Laos-2

- Final Evaluation - Conclusion of the study result - Finalize the Roadmap - Confirmation of Action item status for Follow-up

work - Discussion for the next step

Apr 2012

(10) Preparation of Final Report

- Writing out a Final Report Mar. to May 2012

*Overall project activities and account matters *Project sustainability and Future plan

- Finalize the Final Report including Account Report with evidence

- Finalize the Final Report and submit to APT Secretariat

APT Notification on Selection 19

Deadline for Project Activities 18

3. e-health Roadmap Creation 6

1st review

Preparation of Interim report

Submission to APT 31

Preparation of Final report

Submission 18

9. Next Pilot Project Proposal (APT-J3) ↓Invitation ↓　Apply

Preparation for Application 19 19

*1 Joint Study in Laos/Kicking off had to be delayed because of reorganization of Lao Government.

2011 Apr May Jun Jul

1. Preliminary Study & Remote Discussion

8. Final ReportingPhase

4. Interim Reporting Phase

6. Joint Study in Japan

7. Joint Study in Laos-2

Apr

5. Following up activities for previous J3

2. Joint Study in Laos- 1 *1

Nov May

0. Events

Aug Sep Oct Feb MarActivity items Dec 2012 Jan

Figure 2.1.1 Overall activities and schedule


FINAL REPORT‐8

The general project schedule is prolonged under the influence that included large ministries reorganization of the Lao government for approximately one month from the original plan.

2.2 Basic policies for project implementation

(1) Development of the Roadmap and Action Plan for the practical development of ICT in health sector in Laos

- To realize practical blueprint for the development of ICT in health sector in Laos, creating work should be implemented under initiative of Lao team mainly by Ministry of Posts and Telecommunication through close cooperation with Ministry of Health.

- Japanese team will give necessary advices to Lao team from the ICT professional point of view.

(2) Finding the practical solutions for the issues found in the previous pilot project

implementation.

- Even good evaluation result has been worked out in the previous pilot project, the system is not yet used practically in the hospital work. We need to find the reasons by checking the current status and discuss the possible solutions with system users.

- To define action items for improving the current status and follow-up the activities. (3) Improvement of the required skills for the sustainable enhancement of ICT in health.

- Supplementary trainings for the medical staffs will be done through follow-up work for the previous pilot project as much as possible.

- Set useful lectures of various areas for Lao team during Joint Study in Japan.

- Strengthening capacity of the long/mid-term policy making for the core member of Lao team through creation of the Roadmap/action plan for development of ICT in health sector.


FINAL REPORT‐9

3. Summary of the project activities

3.1 General project activities

The intensive studies have been conducted at the exchange activities both in Laos and Japan. Since the occasion to have face-to-face discussion was limited, some discussions were conducted through email and web video teleconference.

As a whole, all the major activities complied with the project plan, which defined by the Collaborative Research Team after the selection notice from APT secretariat. The summaries of project activities are described as follows:

(1) Project Planning / Preliminary Study/ Preliminary investigation

Based on the agreed concept and directionality described in the application form, Lao team and Japanese team made the preliminary studies prior to the first exchange activity in Laos. The Project Plan and the Key Role of each involved organization have mutually agreed for kicking off.

(2) Face-to-face reaffirmation of project details in Laos (Joint Study in Laos-1)

As one of the exchange activities, Japanese team visited Laos for discussion and follow-up work for the previous pilot project. As a result of discussion, the detailed planning of Roadmap creation and action items for follow-up work were agreed. It was also agreed to apply for the next APT-J3 pilot project due to high demand raised by hospitals and MOH. Site surveys at the district level hospital and Savanhakhet provincial hospital were conducted for the further system expansion based on MOH request. The project details were agreed at the kick-off meeting.

(3) Continuous study on Roadmap creation

After getting the common understandings on our rough ideas of ICT utilization in health sectors, Lao team mainly drafted the Roadmap and Japanese team supported remotely.

(4) Additional training and other activities for follow-up work (in Laos)

As requested by MOH and hospitals during the kick-off meeting, additional training of the system was conducted in each hospital for medical staffs to be familiar with PC and the system. Other action items for follow-up work were also tracked such as LAN expansion in Mittaphab hospital for more practical usage of the system. The trial of the system has been done at Nambak District Hospital and Savanhakhet Provincial Hospital.

The meeting for Roadmap with MPT, MOH and hospitals was also organized to start the discussion with related organizations.

(5) Site visits & training in Japan (Joint Study in Japan)

As the second exchange activity, Lao team visited Japan for enhancing the knowledge through site visits and examination of case studies.

(6) Face-to-face discussion in Laos (Joint Study in Laos-2)


FINAL REPORT‐10

Japanese team visited Laos to evaluate the follow-up work for the previous pilot project, to finalize the project and discuss on the Roadmap and final project outputs.

(7) Project conclusion

Through the active collaboration of all the members, this project has successfully been concluded with the practical results which were expected as project outputs of this study.

3.2 Exchange activities

3.2.1 Preliminary investigation

(1) Schedule overview

Table 3.2.1 Summary of Activity during Preliminary investigation

Date

Activities Remarks

AM PM 4-Aug Fri Flight from Japan Pick-up repaired PC/Scanner from

FSBT (Fujitsu Systems Business Thailand)

5-Aug Sat Move to Luangphabang with repaired PC/Scanner

Visit Luangphabang Provincial Hospital

- Checking the current status of IP Microwave system for analyzing the cause of the failure

6-Aug Sun Visit Luangphabang Provincial Hospital - Checking the current status for other systems

7-Aug Mon Visit Luangphabang Provincial Hospital - Installation and Testing of new POE with support from Fujitsu FTA

(Fujitsu Telecommunications Asia) engineer in Malaysia

8-Aug Tue Visit Luangphabang Provincial Hospital - PC/Scanner installation and testing

9-Aug Wed Visit Luangphabang Provincial Hospital - Change wireless adaptor for

PC - Discussion on equipment

failure and solution

Visit Luangphabang e-Government Center - Discussion on equipment failure

Move to Vientiane

10-Aug

Thu Visit to MPT (Mr. Snith) - Explanation on equipment

failure and solution

Meeting with MPT (e-Government) - Discussion on equipment failure

and solution

MOH was not available

11-Aug

Fri Visit Embassy of Japan (EOJ) Leave for Japan


FINAL REPORT‐11

(2) Result of Preliminary investigation After the previous pilot project, since there were several problems of the system and

the network, we tried to solve the problem remotely from Japan by using the Web Video Conference system (JoinMeeting) installed in the project (The related port of the network was decided to open considering the remote support). Most of the problems have been just a setting issue or temporary power problem and Hospital staffs could solve them by themselves with the remote support from Japan, however, we faced the physical hardware problem of the equipment shown below and in Luangphabang hospital in July 2011, and decided to repair or replace the equipment after contacting the manufacturer.

- POE (Power on Ethernet) of IP Microwave System - PC for Open ICT Access Point - Scanner

The detailed investigation of the POE failure is described in 3.2.2. (2) b) 5) “Wireless access network (IP Microwave system)”.

The current status of system was investigated, and the improvement of system utilization has been discussed with hospitals, as well as MPT who has ultimate responsibility for the maintenance of equipment about the solutions for the issues faced during operation of the system.


FINAL REPORT‐12

3.2.2 Joint Study in Laos-1


Table 3.2.2 Schedule of Joint Study in Laos-1

Date

Activities Remarks

AM PM 4-Sep Sun Arrival of Japanese Team

5-Sep Mon Visit MOH Cabinet

- Explanation and discussion

Visit MPT - Explanation and discussion

Visit MST - Explanation and discussion

Discussion and Preparation for Kicking off (by core members)

6-Sep Tue Kick-Off Meeting in Vientiane (MOH building)

Internal meeting (review on result of Kick-off meeting)

7-Sep Wed Visit Mittaphab Hospital with MST＆MPT

Move to Luangphabang

8-Sep Thu Visit Luangphabang e-Government Center

- Explanation Visit Luangphabang Provincial Health Department

Visit Luangphabang Provincial Hospital

- Discussion & follow-up J3 - Checking the request

9-Sep Fri Visit Nambak* District Governor's office, Health Office and Hospital

- Explanation and survey

Return to Luangphabang City Visit Luangphabang Provincial Hospital - Report on survey result

*3 hours from Luangphabang by car

10-Sep Sat Move to Vientiane

11-Sep Sun Preparation for Wrap-up meetingt

12-Sep Mon Visit MPT

-Courtesy call on Minister to explain survey result

- Discussion on next step

Visit e-Government center - Discussion on trial

Preparation for Wrap up

13-Sep Tue Preparation for Wrap up Wrap Up Meeting

14-Sep Wed Move to Savanhakhet Province* Savanhakhet Provincial Hospital - Survey

*7 hours from Vientiane by car

15-Sep Thu Move to Vientiane Leave Vientiane (Moro, Tamura)

16-Sep Fri Meeting at e-Government center Leave Vientiane (Kobayashi)


FINAL REPORT‐13

(2) Results of the Joint Study in Laos-1

a) Study on Roadmap

Discussion on the roadmap was made among project members as follows:

- Common recognition on the necessity of the clear vision and practical Roadmap for further enhancement of ICT in health was shared.

- Roadmap will be a solid foundation for establishing the mid-term action plan and guideline for large scale implementation.

- Roadmap is indispensible to get financial support from donors.

- Lao team will take an initiative to make Roadmap and action plan after re-organization of the Lao government as soon as possible.

- It is essential to apply for APT-EBC-J3-2011 programme to go forward for the next step.

- Further study on roadmap and action plan is required.

b) Follow up on the previous pilot project (J3-2009)

The issues found after the implementation of the previous pilot project have been discussed and checked during the Pre-investigation with users of the system based on the evaluation results from the previous project, some of which are different from the current status, we tried to identify the possible causes and the solutions.

The details of the current status of the system implemented in the previous project, causes and solutions are described as below;

1) Remote Consultation (Web video conference system : JoinMeeting)

The system was evaluated as good and effective to solve the problem for doctors facing during the diagnosis/treatment of patient, however it’s not yet used on a daily basis or regularly.

Possible reasons 1. Location of the system is too far from the doctor’s room 2. Difficulty to use the system due to lack of IT skill

Proposed solution 1. LAN expansion in hospital and increase of client PCs for remote consultation 2. More training for doctors to be given 3. Set-up of the rules to use the system regularly such as every Monday morning

from 10am


FINAL REPORT‐14

2) Document sharing (by accessing the file server)

Document sharing was evaluated as convenient and effective to solve the problem for doctors and medical staffs who want to learn or get more information about diagnosis/treatment, however it’s not yet used periodically.

Possible reasons 1. Location of the PC for document sharing is too far from the doctor’s room 2. Difficulty to use the system due to lack of IT skill 3. Not so many contents stored

Proposed solution 1. LAN expansion in hospital and increase of client PCs which can access the file

server 2. More training for doctors and medical staffs to be given 3. Attractive contents* to be created in order to encourage the daily use

Note*) Educational materials under consideration of collaboration with a Japanese medical university

3) Server management

The function of server was evaluated as satisfied, however there are some cases that the server is down due to the power down or other reasons and the system administrators in hospital feel difficulty to do the settings or other operations.

Possible reasons 1. System administrators in hospital are not IT specialists.

Proposed solution 1. More training for system administrators to be given 2. Location of server to be moved to e-Government center so as to operate and

maintain by e-Government staffs who are IT specialist

4) Open ICT Access Point (PC for the public)

This was evaluated as good for the public to get the medical and health information, however there were some issues with PC or network and the priority was not so high compared to other systems so that the PC is not yet open to the public.

Possible reasons 1. Rules and process of using the PC for public not fully understood by system

administrators


FINAL REPORT‐15

2. Internet connection in Luangphabang via e-Government NW, which is attractive for the public sometimes slow and disconnected due to lower bandwidth to the internet gateway or other reasons

Proposed solution 1. Rules and the process to be discussed and PC is to be opened to the public 2. More training for the system administrators to be given 3. Contents for the public to be kept locally and updated effectively

5) Wireless access network (IP Microwave system)

The network between Luangphabang hospital and Mittaphab hospital was temporarily disconnected It’s found out to be hardware failure that the equipment (named POE: “Power on Ethernet” connecting with the power system) located in the doctor’s room in Luangphabang hospital was broken (one of the circuit was burnt as below).

Figure 3.2.2 Burnt circuit of POE (IP Microwave system)

Possible reasons 1. Something metallic fallen down from the ceiling or somewhere (as the cover

was open), or ants come in through the cable hole. 2. Hospital staffs are not familiar with NW equipment (no technical knowledge)

Proposed solution 1. To instruct the hospital people to close the cover and not to disconnect the

power cable for NW equipment 2. Periodical check by e-Government center staffs for NW equipment (and IT

systems)

During Joint study in Laos-1, action items for the current issues have been decided to be executed under this project as shown in the following list:


FINAL REPORT‐16

Figure 3.2.2 List of Action Items for Follow-up work

Action item Action taken by Deadline Details

(1) LAN expansion in hospital

MPT) National e-Government center

end of November, 2011

- 5 (+3) divisions in Mittaphab hospital to be extended to use the system Quotation provided by e-Gov. center

(2) Training for users/administrators

Fujitsu end of this project - 1 week training for Mittaphab hospital and Luangphabang (LPQ) hospital Remote consultation system Document sharing Open ICT Access Point (for LPQ) Wireless access network (for LPQ)

- Planned in December, 2011

(3) Server location in hospital

MPT) National e-Government center

end of December, 2011

- To be moved from Mittaphab hospital to e-Gov. center so as to be maintained and operated by e-Gov. center

- New IP address to be assigned (TBD)

(4) Periodical check for NW equipment and IT system

e-Government center in Luangphabang

Permanent activity

- e-Gov. staff to visit LPQ hospital once a week or month in order to check NW equipment and IT systems

- To support in case of the problem- Periodical training for computers to be

planned (already provided 3 times)

Action items Action taken by Deadline Details

(5) Set-up the rule to use the system

Mittaphab hospital and Luangphabang hospital

end of September, 2011

- Need to fix the date and time weekly basis (once or twice a week) to use the system in order to get familiar with the system

(6) Specialist list to be prepared for Remote Consultation

Mittaphab hospital

end of September, 2011

- Specialist list including the name of specialist doctor, telephone number, e-mail address, section name in Mittaphab hospital to be sent to Luangphabang hospital

(7) New contents to be put in file server

Mittaphab hospital, MOH(Luangphabang hospital)

end of September, 2011 (first target)

Permanent activity(to be done regularly, such as weekly or monthly)

- New contents to be put in “doctor”, “edu” or “open” directory of file server. Web contents Educational materials Information for public Other materials

(8) Projector for educational purpose

Fujitsu end of December, 2011

- Luangphabang hospital will use the LCD projector in the meeting room for educational purpose to show the lecture (or remote consultation) done in Mittaphab hospital recorded or real-time by JoinMeeting (Web video conference system).


FINAL REPORT‐17

c) Site survey under the project

Based on the result on the follow up of the previous pilot project and other requirements from Lao members, the outline of the survey to be conducted under this project was discussed as indicated below;

Central Hospital

System overview

(3) Central Database

Consultation report

Educational material

Information to public

Patient data

Facility data

Patient data

Facility data

Information to public

e-Government NW by MST (existing)

(4) Open ICT Access Point

(2) Web Video Conference

Provincial Hospital

- Remote Consultation- Contents Making (recording)

- e-Education

- Access to Public information

District and/or Provincial Hospital

- Electronic facility data

- Electronic patient data

Local Database?

Blue part: Implemented in previousAPT J3, to be used regularly and effectivelyPink part: Feasibility to be checked in APT J2

LAN Expansion to 5 more divisions

Figure 3.2.2 Planned outline of next expansion

Considering the feasibility and priority of each item shown in the above figure, LAN expansion in Mittaphab hospital was agreed to be the highest priority since the users (doctors) in hospital can access the system more easily.

In addition, based on the request from by MOH for the remote consultation system with a high priority, Nambak district hospital in Luangphabang province was selected as a candidate site for the trial. Site survey was carried out during Joint study in Laos-1 in order to check the network availability and IT skills. The survey report is attached as below.


FINAL REPORT‐18

Table 3.2.2.1 Survey report for Nambak District Hospital

Table 3.2.2.2 Survey report for Savanhakhet Provincial Hospital


FINAL REPORT‐19

3.2.3 Additional training


Table 3.2.3 Summary of Activities during Additional Training

Date

Activities Remarks

AM PM 4-Dec Sun Flight from Japan

5-Dec Mon Visit MOH Cabinet

- Explanation on follow-up work and additional training

Visit Mittaphab Hospital - Explanation and discussion - Meeting on Injury Surveillance System with Japanese doctors

Visit MPT - Discussion on Roadmap

6-Dec Tue Roadmap Meeting with MPT/MOH/Hospitals

Visit Mittaphab Hospital - Checking LAN network

7-Dec Wed Meeting with MPT - Discussion on network

Meeting with MPT Move to Luangphabang

8-Dec Thu Visit Luangphabang Provincial Hospital - Explanation on follow-up work and additional training

Visit Luangphabang Provincial Hospital - Projector installation and test (Action item (8))

Since the doctors in Luangphabang hospital became suddenly busy in this period due to preparation for National Event, the schedule was changed to 19 and 21 Dec. and the visit to Savanhakhet was added.

9-Dec Fri Move to Nambak District with e-Government staff in Luangphabang

Visit Nambak District Hospital - Trial of the system - Discussion on network

Move to Luangphabang 10-Dec Sat Move to Vientiane

11-Dec Sun Move to Savanhakhet

12-Dec Mon Visit Savanhakhet Provincial Hospital - Discussion on next step - Trial of the system

Visit e-Government center in Savanhakhet - Discussion on network

Move to Vientiane

13-Dec to 16-Dec

Tue to Fri

Visit Mittaphab Hospital - Additional Training (Action item (2)) - Checking of LAN expansion (Action item (1))

Visit to JICA

17-Dec Sat Visit Mittaphab Hospital - Checking the server

18-Dec Sun Move to Luangphabang

19-Dec Mon Visit Luangphabang Provincial Hospital - Additional Training

Move to Vientiane

20-Dec Tue

21-Dec Wed Visit to EOJ Leave Vientiane (Kobayashi)


FINAL REPORT‐20

(2) Result of Additional Training

As shown in the above table, some action items for follow-up work such as LAN expansion in Mittaphab hospital and Projector installation in Luangphabang hospital, and the additional training for Mittaphab and Luangphabang hospital have been done and the trial of the system in both Nambak District Hospital and Savanhakhet Provincial Hospital. The final status of action item is shown in Table 4.2.1 “List of Action Items for Follow-up work (Final Status)”.

In fact, we found that the PCs used for the training were not the PCs from trainees’ department, but their family’s or friend’s PC, since there are not enough PCs provided by the hospital. In order to improve the system utilization, at least 1 PC for each department should be provided. It’s decided to purchase the additional PCs under this project if the budget is allocated. Finally 7 PCs have been purchased in April 2012, which will be distributed to each department after the final evaluation.

a) Additional Training for Mittpahab Hospital

Date : 13th to 16th December 2011 Place : Mittaphab Hospital No. of trainees (14 in total) :

13 doctors from Mittaphab hospital 1 technical staff for IT/Network from Mittaphab hospital

Agenda: 1. Explanation on the policy for overall system 2. Explanation on the policy for e-Government network and LAN expansion in

Mittaphab hospital by MPT 3. Detail lecture for the system implemented in previous APT J3 project 4. Practical Training for Remote consultation (Non-emergency case by using

Report form and Emergency case by using JoinMeeting*) and Document sharing with File sever (3 days)

b) Additional Training for Luangphabang Hospital

Date : 19th and 20th December 2011 Place : Luangphabang Provincial Hospital No. of trainees (7 in total) :

6 doctors from Luangphabang Provincial Hospital 2 Deputy directers Luangphabang Provincial Hospital 1 doctor from Mittaphab hospital

Agenda: 1. Explanation on the policy for overall system 2. Explanation on Projector utilization for the Remote Consultation and education 3. Lecture for how to manage the equipment of IT system and IP Microwave

System in case of the problem


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4. Practical Training for Remote consultation (Non-emergency case by using Report form and Emergency case by using JoinMeeting*) and Document sharing with File sever (1.5 days)

Note*: The following functions of JoinMeeting were to be learned during this

training; 1) Basic Operation

- Create users - Start meeting - Join meeting - Share the document on White board after uploading the data (Print with JoinNet Printer or just copy and paste in case of JPEG data) - White board (write text, draw circle/square, point, change colour/size, etc) - Finish meeting

2) Advanced Operation - Shared Desktop to show your PC screen to the others - Change Chairman by giving out the token - Web browsing (internet connection) - Recording/stop recording during the meeting - Watch or download the recorded meeting - Adjust the volume of sound/show video - Change password/role/name of the user

c) Trial at Nambak District Hospital / Savanhakhet Provincial Hospital

Date : Nambak District Hospital on 9th December 2011 &Place : Savanhakhet Provincial Hospital on 12th December 2011 What was done in trial

1. While the network for both hospitals is not yet connected to e-Government network, the internet connection was used for the trial.

2. After installing the client software for JoinMeeting (Web video conference system), Remote Consultation was conducted with Mittaphab hospital and we confirmed that remote consultation could be done successfully.

Issues found in trial

1. The communication during the remote consultation was stopped due to the slow speed internet.

2. Document sharing by accessing File server couldn’t be done, e-Government network is not available.

Proposed Solutions for found issues

1. The network from hospital to e-Government center to be connected. 2. Document sharing by VPN over internet to be considered in next pilot project


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3.2.4 Joint Study in Japan


Table 3.2.4 Overview of the Joint Study in Japan

Date

Activities Remarks

AM PM 9-Jan Mon Departure from Laos

10-Jan Tue Arrival of Lao team

Orientation and schedule confirmation

11-Jan Wed (a) Presentation of Latest Healthcare Solutions [Fujitsu HQ]

(b) Site visit to National Center for Global Health and Medicine

12-Jan Thu (c) Presentation of Perinatal telemedicine Discussion on IP network [Fujitsu Kawasaki]

(d) Site visit to Fujitsu Kawasaki Hospital Presentation of Medical project (METI)

13-Jan Fri (e) Site visit to Fujitsu netCommunity

(f) Site visit to NTT “NOTE”

14-Jan Sat Discussion on action items Wrap-up

15-Jan Sun Lao team left for Vientiane

(2) Result of the Joint Study in Japan

(a) Fujitsu’s Healthcare solutions

Fujitsu’s healthcare solutions were presented together with the general history of ICT introduction in medical field in Japan. The trainees understood that the step by step introduction of ICT system in medical field in Laos is important as same as in Japan considering the familiarization of the system for the users such as medical staffs.

We discussed on the location of the server for hospital system. It’s explained to be located at the hospital in many cases in Japan due to the difficulty of treating the personal information. However, few IT staffs for management of server are available in Laos and we need to consider the case of Laos as the situation is different from Japan.

(b) Visit to National Center for Global Health and Medicine (NCGHM)

The detailed operation for Injury Surveillance System was demonstrated for which the data input is already introduced for Mittaphab and Mahosot hospital under another pilot project by using the server in Japan. We need to carefully consider to have the linkage with our system which will be implemented in the next APT Pilot Project in


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order to avoid the duplicated operation for the data input.

(c) Presentation on Prenatal telemedicine, discussion on IP network

Prenatal medical care is one of the prioritized topics for MOH. We understand that the introduction of presented prenatal system in village or rural area in Laos will solve the current issues and save a lot of pregnant women and baby. However human resources and NW connection in rural area are indispensable in addition to the education for the women to go to hospital as many pregnant women make the delivery by themselves, which makes the increase of the number of lost mother and baby especially in rural area. We need to prepare for that before the introduction of prenatal telemedicine.

The potential issues on IP Network in e-Government in Laos were presented by Fujitsu engineer. There was a question on the security from Lao team and it’s explained that several methods for the security are available at various level. The details will be discussed when the concrete requirement is raised.

(d) Visit to Fujitsu Kawasaki Hospital

The flow of hospital ICT system from the patient registration to the payment was demonstrated and the trainees could experience the hospital work process. It gave an idea for the design of hospital system in the next Pilot Project.

(e) Visit to Fujitsu netCommunity

Fujitsu netCommunity presents Fujitsu's ICT solutions and prosperous future built on social innovations. The trainees got the idea on how the presented ICT utilization can be done in Laos, such as Palm Secure system which could be used as a security system at the entrance of Data Center. The trainees also had widened their view of ICT utilization in not only health and medical field but also in the other fields.

(f) Visit to NTT NOTE

NTT NOTE is the place, where visitors can have a hands-on experience of a cutting-edge ICT services provided by NTT. During this visit, the trainees could experience the broadband environment with advanced technology.


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3.2.5 Joint Study in Laos-2


Table 3.2.5 Schedule overview of Joint Study in Laos-2

Date 2012 Activities

remarksAM PM

28-Mar Wed Flight to Vientiane (Ms. Kobayashi)

29-Mar Thu Meeting with MOH Mittaphab Hospital - Meeting with Director - Checking status,

evaluation

30-Mar Fri Move to Luangphabang Luangphabang Provincial Hospital -Meeting with Director

Luangphabang Provincial Hospital - Checking current status of the

system, explanation of final evaluation and arrangement for trial in Nambak district.

31-Mar Sat System check of Open ICT

1-Apr Sun Documentation

2-Apr Mon Move to Nambak District Hospital

Nambak District Hospital - Remote Consultation trial

with Luangphabang Hospital - Evaluation

Move to Luangphabang

3-Apr Tue Luangphabang Provincial Hospital - Final evaluation after improvement and additional training

Move to Vientiane

4-Apr Wed Meeting with MOH Mittaphab Hospital - Final evaluation after improvement and additional training)

Flight to Vientiane (Mr. Tamura)

5-Apr Thu Courtesy call on MPT Vice Minister and Director Generals Courtesy call on MOH cabinet

Core member meeting (MPT/MOH)

- Briefing on the project results

- Discussion on finalizing work

6-Apr Fri Core member meeting (MOH)

Evaluation survey in Mittaphab Hospital

7-Apr Sat Documentation

8-Apr Sun Documentation

9-Apr Mon Core member meeting (MPT/MOH)

Meeting on Roadmap (MPT/MOH)


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(2) Result of the Joint Study in Laos-2

a) Finalization of the projects

Major project activities to be finalized were discussed and summarized as follows:

- It is decided that the Roadmap for development of the ICT in health sector is completed under the initiative of Ministry of Posts and Telecommunications (MPT) in cooperation with Ministry of Health (MOH) and that the Roadmap should be attached to the final report as Annex.

- Detailed discussions on the Roadmap were made several times during Joint Study in Laos-2 and we finally agreed on the pre-final draft of the document.

- As it is described in the Roadmap, it seems to be difficult to combine our activity of ICT in health sector in Laos with nationwide deployment immediately. But it is necessary to continue it as a further action such as pilot projects for next several years, and to give the feedback to the Sector Working Group of Health (SWG) in Laos because there is a demand that they need to keep e-health related momentum to realize medium-and-long term vision.

b) Evaluation for Follow-up activities

The evaluation for follow-up work has been conducted for the doctors and medical staffs in Mittaphab and Luangphabang hospitals and the result is attached in 4.3 “Evaluation on the follow-up activities”

10-Apr Tue Visit EOJ and JICA Leave Vientiane (Mr. Tamura) Mittaphab Hospital - Final evaluation

11-Apr Wed Mittaphab Hospital - Discussion on next step

Leave Vientiane (Ms. Kobayashi)


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4. Project outputs

4.1 Study on Roadmap for development of ICT in Health Sector

“Roadmap for development of ICT in health sector” is attached as Annex-1. As mentioned in Chapter 1.2 of this report, development of the Roadmap for

practical deployment of ICT in health sector in Laos is one of the main objectives of the study project. To create practical blueprint which fits for the situation of Laos, the Roadmap was elaborated under the initiative of MPT in cooperation with MOH.

Because the road map should show directionality and the milestone of the action of this field on the middle/long term basis, it was studied based on the needs of health sector and the national level policies and objectives. It is also important to synchronize the progress of e-health with a pace of improvement of the ICT literacy of the person concerned and the expansion of the broadband network to rural areas so that e-health utilized widely and effectively in Laos.

In addition, from the experience of the past collaborative research and the pilot project in Laos, the high-priority needs of the real healthcare cases is the remote consultation which is realized in the previous APT-J3 project, but it is also found that it is necessary to facilitate those foundations such as general information processing infrastructure of the hospital including patient data base and broadband network with in-hospital LAN at each institution in parallel to realize sustainable enhancement of future e-health.

Based upon the elements above, the roadmap assumes 2020 as a goal and suggests the enhancement by sequential three phases toward the goal shown as below:

- Preliminary phase - Development and deployment phase - Operational and follow-up phase

The roadmap in Annex-1 is one of the model/guideline that pictured approximate possible introduction time and the order of the medical related ICT solutions that can be assumed at present, and this road map is not the only route. In addition, other than the medical ICT application, which becomes the leading role for the realization of the road map, so-called associated project including construction of WAN/LAN and the training for users must be planned and carried out steadily.

In this 1-year-project, the needs analysis of the healthcare field and the drafting of the individual project budgets in each phase was not sufficient. However, it has a significant meaning that MPT and MOH created the road map which assumed 2020 goal jointly while being conscious of 2015 that is a goal of MDGs. It is important to obtain the consensus from the stakeholder including a donor from now on.


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4.2 Follow up on the previous pilot project

(1) Final status of Action Item List for Follow-up work

Several action items have been executed under this project, however there are some action items which are continued activity for update or the conclusion has not been reached and we need to follow-up such action items in the next project (shown in red).

Table 4.2.1 List of Action Items for Follow-up work (Final Status)


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(2) LAN expansion in hospital

a) Mittaphab Hospital

The network diagram of LAN expansion in Mittaphab hospital which has been executed in December 2011 (Action item (1)) is shown below;

Figure 4.2.1 Network diagram of LAN expansion in Mittaphab hospital


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b) Luangphabang Hospital

LAN expansion was planned only for Mittaphab hospital due to the limitation of budget under this project, however, there is a strong request from Luangphabang provincial hospital for the LAN connection between each department and the server which will be used also for accessing the database of patient record in near future. As for the Patient Database, it’s decided to implement in the next Pilot Project in Mittaphab Hospital, Luangphabang Hospital can be a target hospital for expansion of the system after the detailed site survey. The requirement on patient database from Luangphabang hospital is to be input when we design the database in the next project so that the database can be applied to not only Central level Hospital, but also Provincial level Hospital. The image of LAN network in hospital is shown below;

Figure 4.2.2 Image of LAN expansion in Luanghabang hospital (for accessing Patient Database in next step)


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4.3 Evaluation on the follow-up activities

The questionnaire and interview have been conducted for the evaluation on “already done” action items of follow-up work as below ;

Action Item (1) LAN Expansion in Mittaphab Hospital Action Item (2) Additional Training Action Item (8) Projector installation

As mentioned in 4.2, the other action items which are “on-going” and “permanent activity” will be tracked in the next Pilot Project.

The evaluation result is summarized as follows;

Table 4.3.1 Summary of Evaluation Result

Action item Summary Remarks (1) LAN

expansion in Mittaphabn Hospital

<Convenience and more utilization> 100% of doctors are satisfied with LAN expansion due to the easiness of accessing the system and they will use the system more often than before.

For keeping satisfaction: - The distribution of PCs is late in this

project even LAN was expanded to each department. We need to track the doctor’s satisfactory level in the next project.

(2) Additional Training

Non-emergency case (by Report form) Most of the doctors think that the process is understandable, however there are a few doctors who still feel a little difficulty due to the forgotten process.

For the next step: - PC distribution will lead the doctors

to use the system more often than before so that they can be familiar with PC and more practical usage of this system will be expected.

For the stable operation: - IT specialist who is taking care of

the system operation and maintenance is necessary to be allocated in the hospital and regular training is to be provided for the doctors and staffs.

For the improved operation: - The contents should be updated and

newly added regularly so that the doctors will access them frequently.

Emergency case (by using JoinMeeting) All the doctors said that this system can be used practically and the manual is understandable. As for the operation, they improved their skill after the training, however, the continuous usage of the system is very important to keep their level.

Document Sharing for File Server Most of the doctors replied that they can do the document sharing more often than before, if the contents will be new and updated.

(8) Projector in Luangphabang Hospital

<Efficiency and more Practical usage> All of doctors are satisfied with Projector introduction due to the easiness of accessing the system and they will use the system more often than before.

For next step: - For the educational purpose, the

lecture given by Central hospital via JoinMeeting will be shared with the medical staffs and students who are studying in the hospital.


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General information 21 doctors responded to the questionnaire and 14 (67%) are Central doctors

(Mittaphab Hospital) and 7 (33%) are Provincial doctors (Luangphabang Provincial Hospital).

(1) LAN Expansion in Mittaphab Hospital

Q1-1. Do you think it will be more convenient to use the system after LAN expansion from IT room to each department?

Central doctor (n=14)

Yes, I think so.

Maybe yes.

Not quite.

No, I don't htink so.

100%

100% of the Central doctors responded as “Yes, I think so”.

Q1-2. Please write down the reason for Q1-1.

Many doctors replied that “it’s easy to access” and “regular usage is possible”.

Q2-1. Do you think you can access the system more frequently after LAN expansion?

Central doctor (n=14)

Yes, I think so.

Maybe yes.

Not quite.


86%

14%

86% of the doctors chose “Yes, I think so” and 14% said “Maybe, yes”.


FINAL REPORT‐32


Some doctor stated that “If I have a PC, I can use the system regularly”.

<Analysis for “ LAN Expansion in Mittaphab Hospital” >

All the doctors are satisfied with LAN expansion due to the easiness of accessing the system and they are going to use more frequently than before (they can use the system only in IT room), so that the regular usage of the system can be possible. However as noted in 3.2.3, at the time of evaluation, they didn’t have a PC so that PC availability was a big concern for them. After provision of PC at each department, the system utilization will be improved.

(2) Additional Training

a) Non-emergency case (by using Report form)

Q1-1. Did you fill in the Consultation Report easily?

Total Central doctor Provincial doctor (n=21) (n=14) (n=7)

Easy

Not so difficult

A bit difficult

Difficult

Others33%

40%27%

50%

25%

25%

67%

33%

40% of the doctors selected “Easy” and 33% is “Not so difficult”, the doctors who mentioned as “A bit difficult” are 27%. As seen from the above pie charts, no doctors from Provincial doctors choose “Easy”, however 67% feel “Not so difficult”. There are 33% of Provincial doctors and 25% of Central doctors who felt somewhat difficult.


One of the doctor replied that “My English is not so good”, another doctor mentioned that “PC is not available in our department. It will be easy if we use it everyday”.


FINAL REPORT‐33

Q2-1. Do you think the flow of the process is understandable?


Yes, I think so

Yes, maybe

No, not really

No, I don't think so

71%

29%

79%

14%

57%43%

71% of the doctors chose “Yes, I think so” and 29% said “Yes, maybe”. The Central doctors have a higher proportion (79%) of “Yes, I think so” than the Provincial doctors (57%).

Q2-2. If you choose "2 to 4" in Q2-1, please write down the reason.

There was no comment.

Q3. Anything else would you like to comment on this system

There are many positive comments like “Please continue this system”, “The system is convenient” or “It should be used widely in the health system”.

<Analysis for “ Non-emergency case (by using Report form)”>

There are still 27% of the doctors who feel a little difficulty to fill in the consultation report, it may come from non-familiarity with PC operation. Therefore, they need to use the system more often after they receive the PC so that they could become familiar with the PC and system operation.

100% of the doctors reported that the flow of the process in the manual is understandable. As for the comments about English, we prepared 2 versions of the report format, one is in English and the other in Lao, but the manual is available only in English. We need to translate the manual into Lao, as we’ve got the positive opinion on the continuation of system utilization and expansion of the system.

b) Emergency case (by using JoinMeeting)

Q1-1. Do you think whether it's easy to do the following JoinMeeting operation? (1: Easy, 2: Quite easy, 3: A little bit difficult, 4: Difficult)


FINAL REPORT‐34

1) Basic Operation

- Create users - Start meeting - Join meeting - Share the document on White board after uploading the data (Print with JoinNet Printer or just copy and paste in case of JPEG data) - White board (write text, draw circle/square, point, change colour/size, etc) - Finish meeting

1

2

3

4

Create Users

Start Meeting

Join Meeting

Share the document

White board

Finish Meeting

Central doctor

Provincial doctor

Central and Provincial doctors answered that almost all the basic operation is “Quite

easy” which is same or improved from the result of the following previous J3 project especially for “Share the document” for Provincial doctors;

<Previous APT-J3>

1

2

3

4

Create Users

Start Meeting

Join Meeting

Share the document

White board

Finish Meeting

Central doctor

Provincial doctor


FINAL REPORT‐35

2) Advanced Operation

- Shared Desktop to show your PC screen to the others - Change Chairman by giving out the token - Web browsing (internet connection) - Recording/stop recording during the meeting - Watch or download the recorded meeting - Adjust the volume of sound/show video - Change password/role/name of the user

1

2

3

4

Shared Desktop

Change Chairman

Web browsing

Recording function

Watch/download meeting

Adjust sound/video

Change password, etc

Central doctor

Provincial doctor

Both of Central and Provincial doctors feel that “Shared Desktop” and “Change

password” are not so easy operation. In addition to that, Provincial doctor think the the function of “Watch/download meeting” and “Adjust sound/video” are not so easy. On the contrary, Central doctors feel more difficulty on “Web browsing”. For the Central doctors, they feel more difficulty than the previous J3 project as shown below;

<Previous APT-J3>

1

2

3

4

Shared Desktop

Change Chairman

Web browsing

Recording function

Watch/download meeting

Adjust sound/video

Change password, etc

Central doctor

Provincial doctor


FINAL REPORT‐36

Q1-2. Please write down the reason for Q1-1. (Which point do you feel difficulty?)

The answers were “Sometimes forget how to do” and “No PC in our department”.

<Analysis for “Basic operation and Advanced operation of JoinMeeting” >

As for the basic operation, it seems that Provincial doctors improved their skill to use the system especially “Share the document” which is very important basic function for the Remote Consultation as sharing the patient data or picture to make the communication better and smoother. The reason why the Central doctors feels more difficulty on advanced operation than before is non-availability of PC in their department even LAN is connected to each department. This issue will be solved after the PC is distributed.

Q2-1. Did you do the web conference without any problem?


Yes, I did

A little problem, but no stress

Felt a stress

No smooth at all

48%

10%

43%

64%

36%

29%

71%

Total 91% of the doctors stated that they didn’t have big problem and 10% selected

“felt a stress”. When looking at the Central and Provincial doctors separately, 71% of the Provincial doctors felt a little problem while 48% of Central doctors felt like that, 29% of Provincial doctors stated that they felt a stress.

Q2-2. If you choose “2 to 4” in Q2-1, please write down the reason.

The Provincial doctor explained the reasons for “felt a stress” as “Not so good Network connection”.


FINAL REPORT‐37

Q3-1. Do you think the manual for JoinMeeting is understandable?


Yes, I think so.

Maybe yes.

Not quite.


86%

14%

86%

14%

86%

14%

86% of the Central and Provincial doctors responded as “Yes, I think so” and the rest of the doctors selected “Yes, maybe”.


There was an answer that “If there is PC”.

Q4-1. Do you think this system can be used practically for Remote Consultation?


Yes, I think so.

Maybe yes.

Not quite.


90%

10%

93%

7%

86%

14%

90% of the doctors reported as “Yes, I think so”. 7% of Central doctors said “Maybe

yes”, while it’s 14% of Provincial doctor.


There were the comments that “It should be started and we can follow it.” and “If I have a PC, it can be used practically”.


FINAL REPORT‐38

Q5. Anything else would you like to comment on this system

There are comments that “The system will help the patient diagnosis and treatment and they will be more reliable and stable than ever” and “There should be someone working stable for the system”

<Analysis for “Emergency case (by using JoinMeeting)” >

All the doctors said that this system can be used practically and the manual of JoinMeeting is understandable, however a few Provincial doctor felt a stress due to the Network connection. Actually in Luangphabang sometimes the web browsing is not possible due to non-availability of the internet connection, but the JoinMeeting can be used through intranet connection via e-Government network, not internet connection. Therefore this reason is not applicable, but web browsing is also available as one of the function of JoinMeeting, which cannot be used when internet connection is not available. There is constructive comment on the human resources for system operation and maintenance, the IT specialist is necessary to be allocated in the hospital and the training for the doctors should be provided regularly so that the level of IT literacy in the hospital will be risen-up gradually.

c) Document sharing by accessing the File Server

Q1-1. Do you think it's easy to access the contents in file server (doctor/edu/open)?


Easy

Not so difficult

A bit difficult

Difficult

Others

71%

24%

5%

79%

14%

7%

57%43%

Total 100% of Provincial doctor selected “Easy” or “Not so difficult”, but it’s 93% of the Central doctors and 7% of Central doctors selected “a bit difficult”.


The reasons were “Sometimes forget the process to access the file server” and “Not use everyday".


FINAL REPORT‐39

Q2-1. Do you think you will access the file server more often than before?


Yes, I think so

Yes, maybe

No, not really


67%

33%

71%

28%

57%

43%

71% of Central doctor said “Yes, I think so” and 33% is “Yes, maybe”. The percentage of “Yes, I think so” for Provincial doctors is 57% and less than Central doctor, however total of “Yes, I think so” and “Yes, maybe” is 100% as same as Central doctors.


There were many doctors who didn’t answer, but the comment of “According to network and electric condition" was given by Provincial doctors.

Q3. Anything else would you like to comment on document sharing?.

The comment given was “The contents could be updated”.

<Analysis for “ Document Sharing” >

From the result of questionnaire, 100% of the doctors answered that they will do the document sharing more often than before, however, there are some doctors who forget how to do it so that they feel a bit difficulty. To solve this problem, more frequent usage of document sharing is very important, for which the update of contents or new contents have to be stored in File server so that many doctors feel like accessing such contents. As for the update of the contents, it’s decided as permanent activity in the list of action items for follow-up work (Action item (7)).


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(3) Projector in Luangphabang Hospital

Q1-1. Do you think if it will be efficient to use the projector in the meeting room when using the system for remote consultation and document sharing?

Provincial doctor (n=7)

Yes, I think so

Yes, maybe

No, not really


71%

29%

71% of the Provincial doctors responded as “Yes, I think so” and 29% replied “Maybe yes”. Total 100% doctors gave the positive comments.


The reasons were “can connect the system from our meeting room”, “can have conference with Mittaphab hospital using LCD”, “can share the lecture with students from medical school” and “More people can use”.

Q2-1. Do you think you use the system more frequently than before after projector is introduced?

Provincial doctor (n=7)

Yes, I think so

Yes, maybe

No, not really


71%

29%

71% of the Provincial doctors responded as “Yes, I think so” and 29% replied “Maybe yes”. There is no negative opinion.


FINAL REPORT‐41


The reasons were almost same as Q1-2 like “can connect the system from our meeting room”, “can have conference with Mittaphab hospital using LCD”.

Q3. Anything else would you like to comment on the projector?

There are comments that “Thank you for the projector. Many people can the use the system by using projector.”

<Analysis for “ Projector in Luangphabang Hospital” >

From the result of questionnaire, we can say that all doctors are satisfied with Projector introduction in the meeting room for connecting the system for Remote Consultation and the File server for Document Sharing. In addition to the normal usage of Projector for this project, the Provincial doctors are happy to use also for educational purpose such as sharing the lecture given by the doctor in Mittaphab Hospital through JoinMeeting with medical students for whom Provincial doctors have to give lecture.

4.4 Skilled personnel

Project members in Lao team contributed to accomplishment of the project outputs and were well trained not only technology point of view but also in terms of policy making through exchange activities with Japanese team and creating the roadmap. This means that Lao team will be able to maintain e-health movement by themselves to some extent.


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5. Project sustainability

5.1 Network Infrastructure

As same as the previous Pilot Project, the network connection will continuously be provided by MPT as a part of the e-Government Network. (Neither usage fee nor electricity expense in the room for network equipment is required.)

Since the network connection between Luangphabang and Vientiane is borrowed from LTC due to non-availability of e-Government Network in 2010 and the connection fee is requested by LTC (yet to be paid), MPT will need to change the connection from LTC OFC to e-Government Network as soon as possible.

5.2 Operation and Maintenance

As agreed in the previous Pilot Project, all the equipment installed in the previous Pilot Project will be treated as same as the equipment installed under the e-Government Network. Namely, the equipment located organization should primarily be responsible for operation and maintenance, in case of difficulty to handle, MPT will support to find solutions.

5.3 System Utilization in hospitals

In the hospitals, there are 2 or 3 key persons who have enough knowledge and experiences to use the system and they are able to support the other persons who want to use the system.

However, as always requested by users, additional training is required for practical use, therefore, regular training of the system including IT knowledge for capacity building is to be planned by MOH and MPT in cooperation with Japanese team who will try to get the relevant budget for the sustainability of the system.

In addition, MOH cabinet is aware that IT skilled persons are indispensable at each hospital for the sustainability especially in case of the IT system problem. We are ready to continue the discussion on this requirement with the concerned department.

The most significant thing is that the health officers and staffs need to recognize the importance of ICT system, what or how ICT can be used in health sector, MOH needs to educate them and encourage the ICT utilization.


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6. Future Plan

As mentioned in 4.2 and 4.3, the appreciation of ICT utilization in health sector is expressed by hospital, and MOH has a policy to change the patient record from paper to electronic data for the improvement of administrative work and medical services.

Basic concept of the future plan is mentioned in the “Roadmap for development of ICT in health sector” attached in Annex-1. The next step from now on is Preliminary phase (for period 2012 to 2013), to conduct the research of the prototype ICT system, the pilot deployment in the health sectors and ICT capacity building.

To be more precise, in the next APT Pilot Project, the patient data base and hospital management system will be developed and the current ICT system in Central and Provincial hospitals will be extended to the District level hospital. We are going to dig into the actual hospital work to analyze the hospital work process for designing the system and evaluate how ICT system will work in the health sectors and whether it’s suitable or not, as well as the capacity building on ICT literacy for health officers and staffs. Depending on the result of Pilot Project, the further step will be discussed with related authorities and organizations on top the discussion of Roadmap.

The Roadmap has been prepared by MOH and MPT, but not all the related authorities including health sectors are yet to be aware of and understand this roadmap. There are some ongoing and planned ICT related projects which are not considered in this Roadmap, the discussion will be needed how to integrate such projects. In order to start the detailed discussion with related authorities and organizations in health sectors, in the first place we have to do the publication and presentation of the roadmap, so that we could appeal to the donors to acquire the budget for each project.


FINAL REPORT‐44

7. List of Annexes

Annex 1: Roadmap for development of ICT in Health Sector

Annex 2: Photos

final project report - asia-pacific telecommunity · apt hrd programme for exchange of ict...

Documents