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CityApp Blueprint Challenge Documents

Project Name - Outreach Clinical Diagnosis System (OCDS)
Aashish Acharya(WhiteSpace Pvt Ltd)


Concept

A healthy person is a happy person. Taking risk with our health is taking one step further towards death. Every country requires healthy human resource. Health of the citizens depends upon the availability of health services. The current health situation of our country is such that there are 10,000 people per doctor to be looked after. The situation of health facilities at the rural parts is even fierce. There are not enough manpower and resources for the country to mobilize in the health sector. The sector of health science has not been that fancy to the young students like us to research on and do some project on the same. Yet, every year, millions of dollars are invested in a quest to find better and easier approach to provide health services to the people of the world. The figure below illustrates the migration pattern of health service providers in a country like ours.

 The figure above clearly shows that the quality of health services in the rural parts of the country is below the standards. This has added up one more reason for people to migrate to the cities and urban areas. Every year thousands of people migrate to the cities. Today, more than 50% of the world’s population is dwelling in the cities.

In a country like ours, families pack everything they have got in their home and take a one way ticket to the cities with a hope that they, and their children, will get better access to fundamental needs such as education, electricity, transportation and health services.

            In the cities, except for a few hundred people who are economically well or politically strong, not everyone gets an uninterrupted access to these services. The provision of health services in the cities has become competitive. The competition is in terms of the ‘service bills’. Things have shifted from “who provides service to more people” to “Who gets to earn more for providing whatever services they have got”. The result: deaths of hundreds of people due to the lack of availability of quality health services. And our country being the third world country does not have effective health service anywhere in its priority.

 

With the intention to eradicate all the health related problems in the life of the individual, to support the health workers, I propose to implement a computerized medical diagnosis application “Outreach Clinical Diagnosis System”, which deals with the individual health status and results in synopsis prescription, reports and feedbacks.

To put in simple words, the ‘Outreach Clinical Diagnosis System’ is an app that serves to provide health services to the community. Outreach Clinical Diagnosis System is a patient-centric application that captures interactions between a health care provider and a patient. It will be designed to manage patient data longitudinally, linking multiple interactions over time into a single patient chart. Having this complete patient history available, it will empower clinicians to make more informed decisions about health care, while also enabling a deeper analysis of patient health in order to draw more meaningful conclusions on improving outcomes

It will give an individual the ability to view, store, and update and communicate his/her personal information. The application will contain data about allergies, medications, illness, vaccinations, and social history. Outreach Clinical Diagnosis System can be a better approach to reach out to a greater number of people in regards to the health services. With a basic knowledge of the computer and the internet, any trained health worker can monitor the diagnostic procedures both at the rural as well as the urban parts of the country, thereby benefitting a larger population.

OCDS will have a built in intelligent decision support system that will carry out the general diagnosis process for a patient.

The decision support system of the Outreach Clinical Diagnosis System will be built to be as accurate as possible but will not contain of any treatment procedures (treatment should be under the direct supervision of doctors). Outreach Clinical Diagnosis System will contain the basic health problems and the diagnostic methodologies that can be monitored by a health worker. The overall diagnostic procedures can be monitored by the doctors and the specialists to assure the effective health practices.

The application will be an inference engine based decision support system that supports a health worker while in the process of diagnosis of a patient in a health care station. This application will be designed to be used by a trained health professional only.

Target Audience

This concept will affect the entire city and rural area population in general. This concept can be implemented to reach out to a larger population and facilitate them with better health services. Given that this concept gets implemented, the equation of 1 doctor for every 10,000 people will be largely minimized to reach a more balanced form. All the people who have been waiting their entire life for a better health treatment will get a good health service. The country can have a significant change in its pace of development with a larger number of population that is healthy.

Early Feedback

When I shared this concept to my friends and family, the first question they asked was “Is this even possible?” The next, they tried very hard to convince me how critical the health domain was and how difficult it will be to pass this concept from the executive bodies of the government and get a prototype in the first place. I have taken this concept to one step further and researched for the feasibility of its implementation. The implementation details will follow up in this documentation.

Implementation

There have been a lot of such intelligent systems developed in the past to assist medical diagnosis process, some of which being Microsoft Patient Health Vault Connect and Open-MRS. Intelligent systems such as Mycin and Eliza have been successfully implemented for different medical check-up programs. To make the implementation scenario clearer, let’s look at a hypothetical patient diagnosis scenario:

Say a patient come to a doctor and says:

“...I am having headaches. I think these headaches are coming to me on regular basis and it has got worse in last couple of week. I didn’t have any recent head injuries and the headaches are not causing any fever as well I don’t think I am going to have paralysis because my spinal chord is good and I don’t have problems while I am at the gym or when I am playing....”

The doctor on the other end of the table will have the knowledge of all the symptoms that might arise when a patient has an issue related to the head injury or headache. They are:

The list of symptoms following the chief complaint ‘headache’ is as follows:

·         The patient has injury in head.

·         There is no injury in patient's head.

·         The patient has fever

·         The patient does not have fever

·         Sudden onset of headache

·         Not the first time that this kind of headache has happened

·         The patient is dizzy, unable to walk or talk

·         No dizziness, the patient can walk and talk

·         Frequent and irregular headaches.

·         Regular and less frequent headaches.

·         Pain in the head when moved side to side.

·         No pain, numbness or tingling in the head when moved side to side.

·         Constant headache for last 1 month and is getting worse.

·         No constant headaches

·         Loss of consciousness

·         No loss of consciousness

·         Ongoing loss of consciousness

·         Decreased level of consciousness.

·         Convulsions/Syncope (fainting).

·         Stiffness in the neck

·         Constant Vomiting

·         First encounter after age 40

·         Speech/Movement Impairment

·         Headache with a fever and a petechial rash.

·         Bothered by light

·         Not bothered by light. Nausea with Headaches.

·         Nausea and Vomiting.

 

The lists of diseases that are caused due to headaches are as follows:

·         Intracranial haemorrhage

·         Cervical Spodilytis

·         Brain Tumour

·         Meningitis/Typhoid/Malaria

·         Influenza/Typhoid/Malaria

·         Migraine Headache

·         Depression/Poor Vision

·         Severe Head Injury

·         Moderate Head Injuries

·         Head injury with concussions

·         Mild Head Injuries

                                                   

Now if we look into the conversation between the patient and the doctor again:

“...I am having headaches. I think these headaches are coming to me on regular basis and it has got worse in last couple of week. I didn’t have any recent head injuries and the headaches are not causing any fever as well I don’t think I am going to have paralysis because my spinal chord is good and I don’t have problems while I am at the gym or when I am playing....”

From the description above the facts that we can draw are:

1.      No head injuries

2.      No fever

3.      Headache was not sudden

4.      Headaches come and go often

5.      No pain when moving around, playing and jumping

6.      Headache is constant and has got worse

 

If a digital system be made, the following would be the diagnosis process in which a disease will be confirmed for a patient:





If the above diagnosis process is represented in terms of binary decision tree, the tree segment would look something like this:

 

 

The decision tree thus created can be used to build an XML rule base which can be directly imported to the application to carry out intelligent diagnosis process. The tentative XML schema to serve the above illustrated diagnosis process can be of the following structure:

The prototype of the application is illustrated with the help of Sketchflow in the following diagram:
The prototype of the application is illustrated with the help of Sketchflow in the following diagram:

The prototype of the application is illustrated with the help of Sketchflow in the following diagram:

 

Competition

The implementation of this system will be first of its kind. The scope of the system will be broader than the currently available Medical MIS systems in the Nepali Market. However, the system will have to integrate different aspects of a typical Medical MIS system before it gets to full implementation. Popular MIS systems implemented in medical field are OpenMRS and MIDAS Hospital System

Personas

Nabina Pokhrel:

Nabina Pokhrel is a 25 year old girl from Bhadgaon Sinuwari 5, Sunsari District. She got polio when she was a kid. She has been having issues with movement ever since. She cannot walk properly, without the help of a family member. She has 1 elder brother, 1 elder sister and 1 brother younger to her. Her family is an average middle class family. Her dad teaches at a local school, her mother is a housewife. When she was 15, she showed primary symptoms of Asthma. She has been having issues with her respiratory system ever since. But, no concrete medical problem has been seen in her. A normal inhaler can help her most of the times.

When she was back at home, at times, when there was such kind of health issue (related to asthma and respiration), her brother had to pick her up in his arms and take to the nearest medical facility. For education and job, his brother came to Kathmandu after his SLC. Now with her brothers (both of them) gone, she had no one to help her with her medical issues. Her parents were old and they could not manage to take her to the clinics on their own. The doctors were not always ready to come to her place and give a thorough medical checkup. For these reasons, she had to leave her home town to come and stay with her brothers. 

If only we had an intelligent diagnosis system such as the one discussed above, an HA would take the system (on a tablet or a Laptop) to her place (her hometown) and give a complete and thorough health checkup service. The results of the diagnosis could then be viewed by the respective doctor from any place that suits the doctor. She would not have to live her live going on from place to place, wherever her brother’s job takes him. This is not the life she deserves.

Dr. Bhola Rijal:

Dr Bhola Rijal is a reputed and top Gynecologist in town. Hundreds of women visit him every week from different parts of the country. Everyone wants their checkup to be done by a good doctor like Dr Rijal himself. Unfortunately, on an average day, Dr Rijal is able to provide checkup service to not more than 50 patients. There are long lists of patients on the waiting list for Dr Rijal. To reach out to larger people, he has been using a team of doctors under his guidance. But this has never been enough. Every day the number goes on rising. And, there is limit to the number of doctors he can operate under his supervision.

If only there was a way to increase the output, this would solve everybody’s problems. If only there was a system which could be used by doctors to diagnose a patient and keep track of the diagnosis process, all that Dr Rijal would need to do is find a 2 hours free time in his daily schedule and go through the diagnosis reports sent to him by the team of doctors working under him, instead of guiding every doctor in person. He would just monitor from a remote place and in the meantime, people would not always have to come to Om Hospital (where Dr Rijal works) to get a proper checkup.

Business Model

When this application is complete, its implementation would be in the form of a hospital. We will have doctors of our own and additional supporting medical staffs to provide in house as well as mobile diagnosis facilities.

With this system built, we would be able to provide health service at cheaper rates, the rate that would just make the system self-sustainable. When the service reaches out to large audience, we will have accomplished a good social service as well as raise the revenue generated by the system.

We can have our own drug store to provide prescriptions to the patients. Additionally, our team will serve to deliver the prescriptions to the patient’s home with a bit of delivery charge. The revenue generated by selling the medicines will be more than sufficient for the growth and expansion of the system.

Core Technologies

Work Areas

Technologies

Web Applications

ASP.NET MCV 3 or above

Apps for mobile devices (Tablets and Windows Phone)

XAML and C#.NET

IDE

Visual Studio Sp1 or above

XML Rule Base

XML Notepad 2007

System Prototypes and Conceptualization

SketchFlow

Database

Ms-SQL Server

 

Address

Microsoft Innovation Center Nepal
Unlimited Technology P Ltd
Unlimited Building, PO Box 956, Khichapokhari, Opp Pashupati Plaza, Kathmandu
Tel: +977 1 2011302 / 2011303 / 2010311
Fax: +977 1 4255454
Email: mic@micnepal.org    

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