Project Proposal

1. Project Background and Justification

Personal digital assistants (handhelds) have been used to collect community health information, to access current medical information, to allow communication among healthcare professionals, and to improve administration of health systems. Handhelds are widely used by the medical profession in developed countries and have been used in pilot projects in developing countries as well. Most prominent of these is the Satellife PDA Project in Africa from 2001 to 2002, which has demonstrated the viability and effectivity of handhelds in improving health in rural populations. The Jiva Teledoc project in India extends this concept by developing a health information system for the monitoring of patients through the use of mobile phones via WAP and GPRS technology.

This project aims to build upon the previous implementations of mobile technology for rural health and customize it to the Philippine setting. Neither the Satellife PDA project nor Jiva Teledoc may be applicable in the local environment. Deployment of handhelds similar to Satellife will be too expensive and will not scale in other developing countries. These handhelds also do not have the capability to transmit data. The Jiva Teledoc project is capable of transmitting health information, but this utilizes GPRS. GPRS is not widely available in rural areas in the Philippines and in most of the developing world.

2. Project Description

This project is the first of its kind and aims to develop a graphical user interface for a mobile telehealth system using Symbian and Java over SMS. SMS is chosen as the bearer technology to transmit information since SMS coverage is almost universal (greater than 99%) in the Philippines. The technology developed here is therefore applicable to other developing countries where SMS is the more ubiquitous mobile data transfer technology, as compared to GPRS or WAP.

The system will include an electronic patient record and health survey form with information upload/retrieval using SMS, and a localized searchable onboard health information reference. The user device will be a mobile phone equipped with a multimedia storage card. A mobile phone was chosen over a handheld for its communication functionality and ability for information interchange. It also represents a significant cost advantage over comparable handhelds with phone capabilities.

Symbian C/C++ and Java will be used to develop the customized phone software. Content in text and multimedia format will also be developed and loaded onto the onboard memory. Relevant reference information such as drug lists, diagnostic aids, and treatment guidelines will also be stored on the multimedia card. All these information will be fully searchable and indexed.

Among the information to be loaded onboard the multimedia card will be : 

• WHO Model Essential Drug List 
• Country-specific drug list for Philippines 
• Tuberculosis treatment guidelines 
• Malaria treatment guidelines 
• Other treatment guidelines

This project aims to test the viability of using mobile phones with customized applications as tools in the dissemination of health information and delivery of healthcare for community health workers. The project will test mobile phones for :

• applicability in the rural setting 
• battery life 
• durability in harsh environments 
• usability of software and system 
• effectivity in disseminating information 
• effectivity in the improvement of specific healthcare parameters 
• financial sustainability

3. Project Outputs 

The project seeks to deliver the following outputs :

• A mobile electronic patient record system using Symbian/Java over SMS Relevant health information references on multimedia card storage, such as diagnosis and treatment guidelines, and drug lists

4. Project Objectives

General Objective

• To improve delivery of primary healthcare and to provide access to relevant health information through mobile phone technology

Specific Objectives

• To deliver low-cost healthcare diagnostic and management information to rural patients through a mobile telehealth system
• To provide relevant healthcare information to the point of care to community healthcare workers using information modules on multimedia card
• To develop a mobile electronic patient record system using SMS
• To facilitate development of an online network of health care providers and researchers through mobile

The main beneficiaries of this project will be a rural community in Lanao del Norte. This locale was chosen because the project partner (the Philippine Council for Health Research and Development) has an established initiative for an Internet multipurpose community telecenter. This project further complements the fixed wireline assets of the Internet telecenter with the mobile assets of the proposed project. Other project beneficiaries will include :

• technology partners, through the development of a pioneering mobile telehealth system through SMS (PCHRD, ASTI)
• local government units, through increased health of their constituents

The only recurring cost for the system will be : (1) Internet connectivity and hosting, and (2) transaction costs for SMS messages. Connectivity and hosting will be provided by the Advanced Science and Technology Institute, with mirror sites in the Philippine Council for Health Research and Development. These already have Internet connectivity allocated in their operational budget. Maintenance of the content will be provided by the existing staff in the above partner organizations. The cost of SMS messages (US 4 cents or approximately 20 cents per day) is projected to be minimal and can be shouldered by the local community, local government unit or by the rural community users themselves. To further defray the cost of SMS, transmission of information can be achieved through other wireless means (infrared, Bluetooth or WiFi) and transferred to and from Internet access points in Internet cafes or the multipurpose community telecenters. Transfer of information can be performed on a batch basis and sent through the Internet. Information retrieval can also be performed through this process. This eliminates the cost of SMS transactions altogether.

The project will be implemented according to the timeline in the Methodology section. Periodic monitoring of milestones will be conducted through the submission of interim technical reports on a quarterly basis. The technical reports will contain information on milestones and deliverables achieved, problems encountered, and financial status. These documents shall be made available online at the project website and at www.synapsehealth.com/projects.

A FORMATIVE EVALUATION APPROACH will be used for development. Prospective users will be involved in each stage off development, and feedback from these users/testers will guide the creation and refinement of the interface.

The standard software development life cycle model will be implemented in the development of the customized application and information modules.