Amrita Mobile Health Solution - A

mobile healthcare solution for rural India

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ABSTRACT

People in rural areas face some different health issues than people who live in towns and

cities. Getting health care can be a problem when you live in a remote area. You might

not be able to get to a hospital quickly in an emergency. You also might not want to

travel long distances to get routine checkups and screenings. Rural areas often have

fewer doctors and dentists, and certain specialists might not be available at all. Nearly

70% of all deaths, and 92% of deaths from communicable diseases, occurred among the

poorest 20% of the population. Because it can be hard to get care, health problems in

rural residents may be more serious by the time they are diagnosed. This research work

aims to improve the health care facilities in the rural areas. It also aims at providing

improved information and communication facilities between the health care officials and

the rural population via various android applications. A mobile application has been

developed which will help us monitor our blood pressure, sugar level, medicine intake

pattern, provide us with proper notification at the time of medicine intake and assist in

location based tracking of epidemics. A dedicated server program has been developed

which will help medical officers to identify the possible candidate for a particular

disease, send notifications and inform users at the time of vaccination schedule.

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CONTENTS

List of figures…………………………………………………………….…………... i

List of tables.. …..…………………………………………………….………..... …... ii

Chapter 1 Introduction

1.1 Overview……………………………………………………...…. 01

1.2 Scope of the project …………………………………………… 03

Chapter 2 Related Works 05

Chapter 3 Amrita Mobile Health Solution

3.1 Overview………………..………………………………………… 07

3.2 System Architecture………………………………………………. 10

3.3 Operating environment…………………………………………… 11

Chapter 4 System Design

4.1 Logical Design…………………………………………………. . . 14

4.2 Physical Design………………………………………………….... 17

4.3 Database Design. ………………………………………………… 20

4.3.1 Server side tables…………………….……………………. 21

4.3.2 Client side tables …….…………………………………… 22

Chapter 5 Advantages of the System 24

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Chapter 6 Applicability of the System 25

Chapter 7 Future enhancements 26

Chapter 8 Conclusion 27

References 28

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LIST OF FIGURES

1.1 Health infrastructure versus population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .…2

1. 2 Access to physicians. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...2

3.1 System architecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

4.1 Context diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

4.2 Level 0 DFD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

4.3 Level 0 DFD - Server . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

4.4 Level 0DFD - Server. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

4.5 Level 1 DFD - User. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

4.6 Consultational advice . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . .17

4.7 Monitoring medication pattern. . . . . . . . . . . . . . … . . . . . . . . . . . . . . . . . . . . . . . .17

4.8 Location based tracking of epidemics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

4.9 Personal details. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

4.10 Medical details. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ….. . . . . . . . . . . . . . . . 19

4.11 Childcare and notification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

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LIST OF TABLES

1.1 Percentage of villages with access to various healthcares. . . . . . . . . . . . . . . . . . . . 2

1. 2 National Immunization Schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...2

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CHAPTER 1

INTRODUCTION

1.1 Overview

India is the second most populous country of the world and has changing socio-political

demographic and morbidity patterns that have been drawing global attention in recent

years. Despite several growths orientated policies adopted by the government, the

widening economic, regional and gender disparities are posing challenges for the health

sector. About 75% of health infrastructure, medical man power and other health

resources are concentrated in urban areas where 27% of the population lives.

Contagious, infectious and waterborne diseases such as diarrhea, amoebiasis, typhoid,

infectious hepatitis, worm infestations, measles, malaria, tuberculosis, whooping cough,

respiratory infections, pneumonia and reproductive tract infections dominate the

morbidity pattern, especially in rural areas. However, non-communicable diseases such

as cancer, blindness, mental illness, hypertension, diabetes, HIV/AIDS, accidents and

injuries are also on the rise. The health status of Indians, is still a cause for grave

concern, especially that of the rural population. This is reflected in the life expectancy

(63 years), infant mortality rate (80/1000 live births), maternal mortality rate (438/100

000 live births); however, over a period of time some progress has been made. To

improve the prevailing situation, the problem of rural health is to be addressed both at

macro (national and state) and micro (district and regional) levels. This is to be done in a

holistic way, with a genuine effort to bring the poorest of the population to the centre of

the fiscal policies. A paradigm shift from the current ‘biomedical model’ to a

‘sociocultural model’, which should bridge the gaps and improve quality of rural life, is

the current need. It is unfortunate that while the incidence of all diseases are twice

higher in rural than in urban areas, the rural people are denied access to proper health

care, as the systems and structures were built up mainly to serve the better off. While the

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urban middle class in India have ready access to health services that compare with the

best in the world, even minimum health facilities are not available to at least 135 million

of rural and tribal people, and wherever services are provided, they are inferior.

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The basic nature of rural health problems is attributed also to lack of health literature and

health consciousness, poor maternal and child health services and occupational hazards.

The majority of rural deaths, which are preventable, are due to infections and

communicable, parasitic and respiratory diseases. Infectious diseases dominate the

morbidity pattern in rural areas (40% rural: 23.5% urban). Waterborne infections, which

account for about 80% of sickness in India, make every fourth person dying of such

diseases in the world, an Indian. Annually, 1.5 million deaths and loss of 73 million

workdays are attributed to waterborne diseases. To improve the prevailing situation, the

problem of rural health needs to be addressed in a very efficient manner. This research

work focuses on this aspect [1][2][3].

1.2 Scope of the project

This research work aims to improve the health care facilities in the rural areas. It also

aims at providing improved information and communication facilities between the

health care officials and the rural population. This research work focuses on various

aspects of health care facilities and it can be broadly classified into two areas:

a) Personal health care

b) Primary health care

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TABLE 1.1 Percentage Villages with Access to various Health Care

FACILITIES ROUND THE YEAR (ACCESS BY TYPE OF FACILITY)Infrastructure/Services % Villages

PHC 68.3

Sub-centre 43.2

Govt. Dispensary 67.9

Govt. Hospital 79.0

The personal healthcare aspect focuses on the following areas:

Consultational advice

Reminders for medicine patterns

Monitoring medication of elders

Monitoring daily lifestyle

The primary healthcare aspect focuses on the following areas:

Child and maternal care

Early learning of outburst of epidemics

Location based tracking of epidemics

Identifying possible candidate for a particular disease

Statistics and surveys

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CHAPTER 2

RELATED WORKS

Some firms have started using mobile technologies and smart networks to improve the

quality of care, reduce costs, and contribute to a healthier world. American Telephone

and Telegraph Company [AT&T]'s mHealth Solutions are a new set of IT solutions for

healthcare that combine mobility technologies, devices, connectivity and applications to

help drive down medical costs and deliver improved patient outcomes. AT&T Managed

Tablets is a highly-secure, end-to-end management solution bundling software and

services with certain tablets that is easy to purchase and deploy. AT&T mHealth

Solutions presents DiabetesManager is an initiative between AT&T and WellDoc, which

combines the DiabetesManager application and feedback engine with AT&T's highly-

secure hosting environment, support and customer care [12].

Another venture is ashametrics which provides mobile health solutions and tools for a

healthier life. Ashametrics enables patients and clinicians the ability to collect

physiological data on a mobile phone and upload it to a medical record database.

Ashametrics LifeBands are soft wearable textile bands that measure physiology and

transmit data wirelessly to a mobile phone or nearby PC. Lifebands can also be used to

record/log data internally and downloaded later via Bluetooth or USB. The AshaView

software enables real-time monitoring and recording of physiological data. The mobile

application supports simple plotting, real-time annotation, and the ability to configure all

the settings on the Ashametrics LifeBands (such as sampling rate, date/time,and patient

ID). Up to seven sensor bands can be connected simultaneously. Data can be

downloaded to a PC via USB for post-processing. The basic version of the AshaView

mobile application is available for FREE in the Andoid Market [15].

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CellTrust Corporation has created a secure mobile healthcare solution that turns the

standard SMS into a powerful HIPAA-compliant tool. This enables healthcare

organizations and vendors to communicate patient data via secure text messaging to

clinicians’ and patients’ mobile device [11].

Grand Challenges Canada is a unique and independent non-profit organization dedicated

to improve the health of people in developing countries. In rural Bangladesh most

women do not seek care for breast cancer until it is too late and Grand Challenges will

develop and test novel mobile phone tools for female Community Health Workers

(CHWs) to case-find, refer, and encourage women to attend the breast centre; CHWs

will learn new marketable skills which will make the system sustainable [13].

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CHAPTER 3

AMRITA MOBILE HEALTH SOLUTION

3.1 Overview

Amrita Mobile Health Solution [AMHS] focuses on two main aspects of healthcare,

personal healthcare and primary healthcare. The personal healthcare aspect focuses on

the following areas:

a) Consultational advice – the user will be provided with an interface in his

mobile in which he can enter the readings of pressure and sugar level and it will

be stored in the user’s database. If a similar pattern of information is entered for

3 or more days, then the mobile can show a message indicating whether to

consult the doctor or whether his values are normal or not. Here the mobile will

be acting as a knowledge base.

b) Reminders for medicine patterns – Alarms can be set on the time when the

medicine has to be taken. It will display which medicine has to be taken and also

its dosage.

c) Monitoring medication of elders – An UI can be created in which the user has

to tap the button after he had taken a particular medicine. It can be set as on

tapping the button the information that he had taken a particular medicine will be

sent to the intended person and also the information will be stored in the user’s

database.

d) Monitoring daily lifestyle – It focus on recording the person’s pressure and

sugar level, intake of medicines etc on a daily basis and by analyzing these data

the medical officer can monitor the lifestyle of the person and can advice on

improvements if needed.

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The primary healthcare aspect focuses on the following areas:

a) Child and maternal care – It focuses on maternal and childcare. Our main

focus is to help prevent various diseases like tuberculosis, diphtheria, pertusis,

tetanus, polio and measles in children by timely alerting the parents about the

date and time of vaccination via mobile. The information whether the vaccine

has been given or not will be recorded in the user’s as well as healthcare office’s

database so that it can prove useful in future. It also focuses on maternal care.

The details regarding the pregnant women will be stored in the healthcare

office’s database and they will be alerted regarding the various injections and

vaccines to be taken during the maternity period.

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TABLE 1.2NATIONAL IMMUNIZATION SCHEDULE

Age Vaccines

Birth BCG, OPV0

6 weeks DTwP1, OPV1, Hep B1$, Hib1$ (BCG if not given at

birth)

10 weeks DTwP2, OPV2, Hep B2, Hib2

14 weeks DTwP3, OPV3, HepB3, Hib3

9-12 months Measles

16-24 months DTwP B1, OPV4, MMR$

5-6 years DT

10 years TT

16 years TT

Pregnant women TT1 (early in pregnancy)

TT2 (1 month later)

TT booster (if vaccinated in

b) Early learning of outburst of epidemics – By monitoring the data received

from the people, the medical officer can detect the outburst of any epidemics at a

very early stage.

c) Location based tracking of epidemics – By monitoring the data received from

the people, the medical officer can find out in which area a particular disease is

getting spread.

d) Identifying possible candidate for a particular disease – By monitoring the

lifestyle of a person the medical officer can detect the chances of any disease in

future.

e) Awareness messages – This module provides with the message sending facility

to all the registered users informing them about medical camps, health tips and

other health care related information.

The server side focuses on patients’ personal details as well as medical history. It

focuses on the following aspects:

a) Patient registration

b) Record updating

c) Record deletion

d) Information retrieval

e) Report generation

The server also receives all the medical information sent from various users via android

mobiles and stores them in the database for future references. It is the server that

calculates the dates based on immunization schedule and sends SMS to the intended

person’s mobile informing them about the date of vaccination.

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3.2 System Architecture

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3.3 Operating Environment

The Amrita Mobile Health Solution is developed using the latest mobile technology

android. Android is a free, open source mobile platform. It includes operating system,

middleware and key applications. It is developed by Google and Open Handset Alliance

in 2007. Android is built on the open Linux Kernel. Furthermore, it utilizes a custom

virtual machine that has been designed to optimize memory and hardware resources in a

mobile environment. Android is an open source; it can be liberally extended to

incorporate new cutting edge technologies as they emerge. The platform will continue to

evolve as the developer community works together to build innovative mobile

applications. The various characteristics of android are:

Data transmission using Wi-Fi, GSM, EDGE, CDMA, EV-DO and UMTS.

It has a rich set of libraries for audio, video and image files.

Dalvik Virtual Machine

SQ-Lite for data storage.

IPC message passing facilities.

Integrated browser

Comprehensive libraries for 2D and 3D graphics.

Have features for video camera, touch screens, GPS etc.

The advantages of android include:

• Its an open platform. This means that its code is available for people to look at.

• We can switch from one application to another with minimal changes.

• Android allows third parties to make applications for the phone that can be installed by

anyone.

• An Android phone is guaranteed to work with Google products.

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• Android platform will work on notebook and computers. This means that you could

have device that share the same platform giving you the ability to purchase applications

that will work on all devices.

• Multitasking

• Android gives better notification.

• Application freedom is guaranteed.

• Android allows customization of home page and use of widgets.

To develop android applications the following software needs to be installed on our

system:

• Java Development Kit [ JDK]

• A compatible Java IDE [ Eclipse]

• Android SDK tools and documentation

• Android Development Tools[ ADT] plug-in for Eclipse

The healthcare office system i.e., the server is coded using the popular programming

language java. Java is a general-purpose, concurrent, class-based, object-oriented

language that is specifically designed to have as few implementation dependencies as

possible. It is intended to let application developers "write once, run anywhere"

(WORA), meaning that code that runs on one platform does not need to be recompiled

to run on another. Java is currently one of the most popular programming languages in

use, particularly for client-server web applications.

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To send and receive SMS text messages to cell phones from a JAVA application the

Ozeki JAVA SMS SDK is used. It was designed to be used in JAVA applications that

have a GUI or that operate as a background service. The SMS technology was created to

provide an infrastructure for the transportation of short messages containing a maximum

of 140 bytes (8 bit objects) of useful data in mobile telecommunication networks. The

transportation is done in the GSM signaling path in traditional GSM networks, and as

GPRS packets in GPRS networks. Messages are composed using the PDU specification.

An SMS is a binary string containing all the necessary information to form the message

header needed for transportation and the message body containing the payload. The

basic addressing scheme of SMS messages are mobile telephone numbers called

MSISDN. Ozeki has released the Java SMS SDK to add SMS functionality to JAVA

applications in a very efficient way. This SDK communicates with the Ozeki NG SMS

Gateway, through a TCP/IP socket. The socket is always connected, which makes it

possible, to receive SMS delivery reports and incoming SMS messages instantly. The

Ozeki Java SMS SDK implements the TCP/IP communication and provides methods

calls and events you can implement to achieve the desired functionality. Using this SDK

very fast and efficient SMS solutions can be developed. To be able to use this SDK, you

need to install Ozeki NG SMS Gateway into your corporate network. Ozeki NG SMS

Gateway will be responsible for attaching your system to the mobile network. It will

receive the TCP/IP connections from the JAVA SMS SDK and it well send and receive

SMS messages through the configured communication method [14]. 

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CHAPTER 4

SYSTEM DESIGN

The system design is to deliver the requirements as specified in the feasibility report.

The main objectives of the design are practicality, efficiency, cost, flexibility and

security. The system design contains logical design and physical design.

4.1 Logical design

The logical design of a system pertains to an abstract representation of the data flows,

input and output of the system. This is often conducted via modeling which involves a

simplistic representation of an actual system. Here modeling is done using Data Flow

Diagram [DFD]. DFD is a hierarchical graphical model of the system that shows the

different processing activities or the functions that the system performs and the data

interchange between these functions. The DFD which is the top level view of the

Information System is called context diagram [16].

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4.2 Physical design

The physical design relates to the actual input and output processes of the system. This

is laid down in terms of how data is inputted into the system, how it is

verified/authenticated, how it is processed, how it is displayed as output [16].

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4.3 Database design

A database is a set of logically related files organized to facilitate access by one or more

application programs and to minimize data redundancy. The most important aspect of

building an application is the design of tables or the database schema. The overall

objective in the process of table design has been to treat data as an organizational

resource and as an integrated whole [16].

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4.3.1 Server side tables

TABLE 1: VACCINEDETAILS

FIELD DESCRIPTION DATA TYPE

ID Automatically generated INTEGERUSERID Unique id of the user TEXTOPV1 1st vaccination date TEXTOPV2 2nd vaccination date TEXTOPV3 3rd vaccination date TEXTMEASLES 4th vaccination date TEXTOPV4 5th vaccination date TEXTDT 6th vaccination date TEXTTT1 7th vaccination date TEXTTT2 8th vaccination date TEXT

TABLE 2: MEDICALDETAILS

FIELD DESCRIPTION DATA TYPE

PID Unique id of the user INTEGERPNAME Name of the user TEXTMEDIDATA Medical data TEXT

TABLE 3: PERSONALDETAILS

FIELD DESCRIPTION DATA TYPE

PID Unique id of the user INTEGERPNAME Name of the user TEXTAGE Age of the user TEXTSEX Sex of the user TEXTADDRESS Address of the user TEXTPHONE Mobile number of the user INTEGER

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TABLE 4: MEDINTAKEDETLS

FIELD DESCRIPTION DATA TYPE

ID Automatically generated INTEGERUSERID Unique id of the user TEXTDAY Current date TEXTMEDICINE Name of the medicine TEXTINTAKESTATUS Medicine intake status TEXT

TABLE 5: SYMPTOMS

FIELD DESCRIPTION DATA TYPE

ID Automatically generated INTEGERUSERID Unique id of the user TEXTSYMPTOM Symptoms shown by the ser TEXTLOCATION GPS data TEXTDATE Current date TEXT

4.3.1 Client side tables

TABLE 1: PRESSUREDATA

FIELD DESCRIPTION DATA TYPE

_ID Automatically generated INTEGERUSERID Unique id of the user TEXTPRESSURE Pressure level of the user TEXTDATE Current date TEXT

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TABLE 2: SUGARDATA

FIELD DESCRIPTION DATA TYPE

ID Automatically generated INTEGERUSERID Unique id of the user TEXTSUGARLEVEL Sugar level of the user TEXTDATE Current date TEXT

TABLE 3: MEDICINEDETAILS

FIELD DESCRIPTION DATA TYPE

_ID Automatically generated INTEGERMEDICINE Name of the medicine TEXTDOSAGE Dosage pattern TEXTTIME Time to take the medicine TEXT

TABLE 4: INTAKEDETAILS

FIELD DESCRIPTION DATA TYPE

_ID Automatically generated INTEGERUSERID Unique id of the user TEXTDATE Current date TEXTMEDICINE Name of the medicine TEXTSTATUS Medicine intake status TEXT

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CHAPTER 5

ADVANTAGES OF THE SYSTEM

The proposed system is user-friendly. The system does not require any extra hardware

and hence the system is cheap. The user does not require any extra knowledge to operate

the application installed in his/her android based smart phone. The application

developed support all smart phones with android version 2.3.3 and above. The proposed

system is portable and low cost and it makes it a system for the common man. The

system is reliable and robust.

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CHAPTER 6

APPLICABILITY OF THE SYSTEM

The system can be implemented in any rural area for healthcare assistance. Though the

system is designed for rural population, it can also be used in urban areas as well. The

server system can be implemented in the National Rural Health Mission [NRHM] health

centre. The system can be implemented not only in NRHM centre but also in other

medical care offices to keep track of the medical records of the people in that locality as

well as give medical assistance in times of need. The application developed is very user

friendly that it can be implemented in any android smart phone and the common man

can use it with ease.

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CHAPTER 7

FUTURE ENHANCEMENTS

As the progress in life is advanced from known to known, the future of any software

package lies in its ability to progress from the specified to the general. The basic

structure of AMHS was designed in such a way that the incorporation of additional

utilities and function could be accomplished very easily without any change in the basic

design. The system can be enhanced by adding mew modules and giving more server

side capabilities. One module that can be added is statistics and surveys i.e., instead of

going to each door and collecting information, can send a SMS with an attached survey

form which the user can use to fill in the details and send back through SMS and the

healthcare officer can store the data in the office’s database. In this work, a dedicated

server is being used, instead a framework can be developed which will allow users to

communicate with any Hospital Information System using their android mobile.

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CHAPTER 8

CONCLUSION

A mobile health application has been developed. This application can be used by any

end user to manage his health as well as communicate with the rural healthcare centre

and avail healthcare notifications. The application is developed for android mobiles. It is

expected to live up to the objectives for which it was designed. There is a hope that this

task management application will be utilized to its maximum and will do a good job in

the long run.

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REFERENCES

[1] Ashok Vikhe Patil, K. V. Somasundaram and R. C. Goyal, “Current health

scenario in rural India”

[2] Banerjee A., Esther C. Duflo, and Angus Deaton (2004). ‘Healthcare Delivery in

rural Rajasthan’, Economic and Political Weekly, 39(9), pp. 944–949, Mumbai.

[3] Laveesh Bhandari and Siddhartha Dutta, “Health infrastructure in rural India”

[4] Marvin Gore and John W Stubbe, “ Elements of system analysis”

[5] Talk with Dr. Priya V C, Medical Officer, NHRM, Kulasekharapuram,

Karunagappally, Kollam

[6] Talk with Mr. Sinoop, PRO, Community Health Centre, Oachira, Alappuzha.

[7] http://www.nlm.nih.gov/medlineplus/ruralhealthconcerns.html

[8] http://www.ruralcenter.org/about

[9] http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-

rural-health-care

[10] arogyakeralam.gov.in

[11] http://developer.android.com

[12] http://www.celltrust.com/solutions/healthcare/celltrust-solutions-healthcare.html

[13] http://www.att.com/gen/press-room?pid=18708

[14] http://www.grandchallenges.ca

[15] http://www.ozeki.com

[16] http://www.ashametrics.com/software

[17] http://www.stackoverflow.com

[18] http://javatechniques.com

[19] http://groups.google.com/group/android-developers

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