UM Healthcare Trust
We aim to devise newer and effective ways for bringing a rapid change in healthcare domain for rural communities. We have launched Jaroka to lower the cost of delivering care dramatically by leveraging ICT to deliver the scarcest resource, medical expertise, remotely. Jaroka Tele-Healthcare model utilizes internet and mobile platform to extend tele-healthcare services in rural Pakistan. This includes voice, Short Text Messaging (SMS),Multimedia Messaging (MMS),GPRS/Edge and VSAT to quickly and efficiently extend medical advice to Rural Health Workers (RHWs) in the field by connecting them to our network of specialists in cities and abroad. This model also includes Pakistan's First Health Map through which the latest and live healthcare information is shared with relevant stakeholder across Pakistan to improve the healthcare in Pakistan.Through this project over 130,000 has been provided treated at hospitals and in fields.
Providing the affordable and accessible healthcare to the rural population of Pakistan is a big challenge. Pakistan is experiencing an acute shortage of qualified healthcare specialists and adequate health facilities in rural areas of Pakistan. It is estimated that 75% of the population of Pakistan reside in rural/remote areas where there is hardly any access to the basic health care services. Moreover because of the geographical isolation and the far distance of Basic Health Units and local hospitals patients only get to reach hospitals when their medical problem becomes acute. It is estimated that 80% of all deaths and 90% of all illnesses in Pakistan result from diseases which are preventable,
World Health Organization (WHO) estimates that 70% of Pakistanis never get to see a doctor in their entire life and instead rely on Rural Health Workers (RHWs) for their medical needs. These RHW are government trained healthcare workers who operate out of their homes in rural areas of Pakistan providing primary and maternal care. There are over 100,000 such healthcare workers in Pakistan, each responsible for a community of about 1,000 in their neighborhood. These RHWs are expected to treat all sorts of diseases and illness which are far beyond their training. At times, they need an opinion of a specialist for better diagnoses. Unfortunately for most of the developing world, including Pakistan, these specialists are simply out of reach. RHWs once trained and sent to their communities to work usually operate in complete isolation with little or no support from any medical community or a doctor. Thus making their task of providing the healthcare cumbersome.
We believe that many of preventable diseases and death can easily be decreased by early diagnosis, awareness, by knowing the disease trend in advance and by providing affordable treatment to the under-served community through properly utilizing ICT technologies and empowering LHWs for the use of these technologies.
Jaroka devises newer and effective ways for bringing a rapid change in healthcare domain for rural communities. Our project is built to lower the cost of delivering care dramatically by leveraging ICT to deliver the scarcest resource, medical expertise, remotely. Jaroka provides an Internet-based and mobile ready (Short Message Services (SMS), tele-medicine network that connects clinicians and RHWs in Mardan with specialists in major cities of Pakistan and around the globe. We have also developed Pakistan's “First Interactive Health Map Surveillance” which provides a visual and interactive mapping of diseases in rural areas. This information is then share with research students, policy makers, medical professionals and other stakeholders for improvement in healthcare.
We strongly believe that modern ICT has unleashed new opportunities for accessible and affordable healthcare to poor and needy living in challenging environments. Today, there are over 140 million mobile users (Source Pakistan Telecom Authority) in Pakistan. That means a 70% penetration of mobile phones which is a remarkable statistic for a developing economy. We are therefore, encouraged and motivated to exploit modern technologies and devise an innovative, reliable and affordable mobile-based Telemedicine solution to overcome the health problems in rural Pakistan.
Our solution, Jaroka, is playing a vital role in capacity building of Health Workers in rural areas of Pakistan by connecting them to health centers and specialists through the use of ICT based Telemedicine solution using the mobile platform. This helps lower the cost of delivering care dramatically by leveraging ICT to deliver the scarcest resources, medical expertise, remotely. Furthermore, Jaroka provides an Internet- based and mobile ready (Short Message Services (SMS), tele-medicine network that connects clinicians and RHWs in Mardan with specialists in major cities of Pakistan and around the globe. We have also developed Pakistan's “First Interactive Health Map Surveillance” which provides a visual and interactive mapping of diseases in rural areas. This information is then share with research students, policy makers, medical professionals and other stakeholders for improvement in healthcare.
Through these sustainable capacity building efforts over the long term, the basic healthcare and well-being of rural Pakistanis will be improved. Our services are now being replicated to 3 districts namely Mardan, Narowal and Badin in Pakistan through Software As A Service Model (SAAS) without having to incur any infrastructure cost.
We continue to innovate our efforts to improve healthcare in Pakistan. Our successful implementation of mobile ready tele-healthcare projects for rural and disaster-hit communities in past continuously inspire us and motivate us to further take healthcare to next level.
We believe that following attributes makes Jaroka unique over any other ICT related project :
1) This is a first ever project being successfully implemented in rural Mardan, province of Pakistan, which leverages both ICT and Mobile technologies to make healthcare accessible for remote areas with internet challenging environment.
2) The project is completely built on existing infrastructure (both physical and software) and does not require any new technology for replication. Furthermore, the system is accessible from anywhere in Pakistan through internet or mobile technology.
3) The project can be replicated to any new site within hours using Software As A Service (SAAS) subscription model. Our subscription model does not require the new facilities to have any servers or IT infrastructure. Hence making is most cost effective and sustainable healthcare model.
4) Our SMS services does not require smart phone or expensive gadgets and is neither service provider dependent. All of our services can run on any mobile and with any internet provider in Pakistan. No special device is required. Anyone with a SMS-enabled device with an account with Jaroka can use this service.
5) Jaroka is a complete scale-able model. Depending on the requirements, services and number of users can be extended without halting the system.
The project was directly implemented by UM Healthcare Trust and it is incharged of the project. The major organizations/groups participated during the implementation of the project are:
1) National University of Sciences and Technologies (NUST)- School of Electrical Engineering and Computer Science (SEECS): NUST-SEECS is one of the leading Universities in Pakistan, which has established a dedicated team of professors and students to conduct R&D for tele-medicine based ICT solutions. One of the projects pursued under this initiative is the establishment of Pakistan’s first medical Grid to monitor and record disease outbreaks and manage centralized electronic medical records and provide geo-mapping of this information thus creating a virtual map of Pakistan diseases. It is assisting the government and donor agencies make better and educated decisions to launch the right health related projects in Pakistan. NUST-SEECS served as our research and software development partner. Initially our solution was hosted on the CHPSC centre of SEECS.
2) Association of Pakistani descent Physicians in North America - APPNA: Association of Pakistani descent Physicians in North America. It is a 10,000 member doctor's association based out of the USA and Canada. APPNA was formed in 1976 and has been active in providing healthcare related services in Pakistan. They are experienced medical professionals who understand the need for healthcare for the poor, especially during a disaster. Our project utilized this talent pool to not only seek experts and specialists but also utilized their network to form more alliances within the expatriate Pakistani-Americans community. Their feedback and input in developing our solution had been vital to our success.
3) NRDP National Rural Development Program (NRDP): We are currently working with National Rural Development Program (NRDP), a not for profit non government rights based development and humanitarian organization committed to working with marginalized and vulnerable rural communities of Pakistan to unlocking their potentials for a sustainable change through integrated community development for replication of our services at Narowal (Punjab) and Badin (Sindh). These services are provided to NRDP through Software As A Service (SAAS) model
4) Digital Vision Program at Stanford University (http://www.rdvp.org): Digital Vision projects focus on the rapidly evolving mix of software applications that leverage ICT technologies including advanced mobile and land-based data networks in developing economies. Mr. Atif Mumtaz,, Digital Vision Fellow who is also the project lead this Project. For our project used “Jaroka” , a telemedicine based solution hosted at Standford University designed by Mr.Atif Mumtaz.
The main objectives of our project are:
1) To provide immediate, sustainable, and affordable medical care to the needy in best possible way even during humanitarian crisis.
2) To make use of innovative technologies including web and mobile technologies in extending healthcare services to hard to reach areas.
3) Adding value to Mobile Network infrastructure in Pakistan.
4) Capacity building of Rural Health Workers by connecting them to Health Centers and specialist through the use of ICT Telemedicine.
5) Enhance the collaboration and run Tele-Heatlhcare moment among medical institutes, academic sectors, non-profits and UM-Trust on health care domain.
6) To participate in initiatives of the Government and other relevant organizations regarding health care, population welfare, vaccination, emergency medical services, extension of health care education and the like.
7) To develop an efficient healthcare model that can easily be replicated to various parts of Pakistan and all over the world.
The project is designed using open source technology with most of the coding done using PHP. Jaroka offers two interfaces, mobile-based and internet browser based. The system can be used using both methods to register patients, report symptoms and attain diagnosis. The system is hosted on Linux based server
Hardware: 2 Servers
Hosting the mobile gateway and the Electronic Medical Record Database namely OpenEMR (open-source). One server is live while the other is used as a backup with all data and resources mirrored over the two systems. For replication, the services will be provided to the client via Software As A Service (SAAS) model.
The system runs over a Linux server while OpenEMR uses a MySQL database at the backend. An Apache server hosts the website and the PHP scripts are used to handle the SMS and deliver response acquired from OpenEMR and the medical doctors.
The platform used is a Linux machine running over a server with following specifications.
Processors: One Intel Quad Core Xeon X3220 at 2.40 GHz each
Installed Memory: 4 GB
Disk Storage: 160 GB
Networking: M3F-PCIXF-2 Myrinet-Fiber/PCI-X NIC
The project has major accomplishments in the domains of E-Health, M-Health and Electronic Surveillance. Following are the activities/development conducted under Jaroka.
1)Implementation of Electronic Management of Record (EMR) System :
Our simple yet customized EMR (Electronic Management of Record) stores, views, retrieves and analyzes the medical records of patients. This software is developed by using open source technologies and is successfully tested, installed and implemented at the facility. The highlighted features are:
- Patient’s registration
- Storing and retrieving of Patient’s Complete History/Record
- Patient appointment
- Storing/retrieving and sharing of Subjective- Objective- Assessment-Plan (SOAP) ( SOAP is a standard format of sharing medical records of patient with doctors anywhere in the world )
- Records attachments (ECG, Digital X-Rays)
- Search facility
- Medical Prescription
On average the 120 to 150 patients record is daily stored in our database and regular data analysis are carried out in order to make necessary decisions.
2)Implementation of Mobile Services using Short Messages Service (SMS)/Multi-Media Services (MMS)
Under Jaroka, we are successfully running Short Messaging Service (SMS) and Multimedia Messaging Service (MMS) to extend healthcare at the doorsteps of the patients even at remote place where there is no internet available. Through these services Health Workers are successfully treating a large number of population especially females who due to cultural barrier cannot visit hospital.
Following SMS/MMS services are successfully running :
- Add new patient to the system
- Add disease for a patient
- Search of Patient through unique ID
- Storing/Retrieving history of the patient
- Storing/Retrieving SOAP record of the patient
- Disease Definition
- Retrieve Symptoms of the disease ( text + Pictures )
- Retrieve basis System SMS commands
- Retrieve detailed Help/SMS commands
- Broadcast SMS message to Group
3) Launch of Interactive Health Grid
Under this project, we have developed Pakistan's first interactive Health Grid. This Visual health information representation is one of the key ingredients for effective health management system. Jaroka have customized Google Maps to plot the patients onto map according to their address location. Furthermore, Jaroka Health Map refines the patients according to the disease categories in which they fall. We can select a particular disease and view all the registered patients suffering from this disease.Moreover, Jaroka allows for mapping of diseases on Google maps that could be used to track pandemics and epidemics. Any vulnerable areas or a spread of disease can quickly be tracked through Jaroka as the database maintains the record of disease incidence and the geographical location where it occurred.
4) Built capacity of Rural Health Care in using technology for Healthcare:
Jaroka in close collaboration with health agencies, National University of Sciences and Technology (NUST) and other stakeholders successfully formulated LHWs training material and curriculum. Over 50 Rural Health Workers have been trained and we aim to train 100-150 by 2014.
5) Collaboration Among Stakeholders:
Since the inception of project, Jaroka has strengthen collaboration with wide range of stakeholders including USAID, Google, Association of Physicians of Pakistani Descent of North America (APPNA), ISIF Asia, Interactive Research and Development, National University of Sciences and Technology, World Health Organization, National Rural Support Program (NRSP), Comprehensive Disaster Response Services (CDRS).
The major outcomes achieved by Jaroka are:
1) Implementation of successful, well-tested and innovative ICT and mobile based Tele-Healthcare System for rural/remote communities. The model has been recognized as most innovative healthcare delivery model for rural and disaster-hit communities in Pakistan and abroad. Through this system over 130,000 patients including 17,000 Internally Displaced people and 19,450 flood victims during floods/humanitarian crisis are treated.
2) Launch of SMS/MMS healthcare services which can run on any existing infrastructure, on any mobile and through any service provider in Pakistan. These services are helping us to reach beyond our regular (120/day) patients.
3) Launch of Pakistan’s first Interactive Health Gird (Google Maps) for rural communities. The data and information is shared on subscription basis through Software As A Service (SAAS) model with relevant stakeholders.
4) Jaroka has started the tele-healthcare moment by replicating the services in partnership with National Rural Support Programme at Narowal Healthcare facility , Pakistan through our SAAS subscription model.
5) Build capacity of over 60 Lady Health Worker (LHWs) using internet-based mobile technologies.
6) Value added Mobile Networks.
7) Scientific publications in top level international conference and journals.
8) Strong collaboration and partnerships with direct/indirect stakeholders.
Jaroka has credit of following publications:
1) Shamila Keyani, Ahmad Mumtaz, Hina Mustaq and Aftab Hussain,“Affordable and accessible tele-healthcare to rural areas of Pakistan through web and mobile based technologies”, 6th International Symposium on High Capacity Optical Networks and Enabling Technologies, Alexandria, Egypt 28-30 December 2009,
2) Qurrut-ul-Ain Babar, Hammad Qureshi, Shamila Keyani, Atif Mumtaz, "Monitoring Disease Outbreak through Geographical Representation in Rural Areas," Proceedings Development in E-systems Engineering 2011, Dubai, 6-8 December 2011.
3. “ Mobiles for Development: Enabling Low-Cost e-Applications for Rural and Remote Areas (e-Health)" Essay written in 2009 ITU Cybersecurity and ICT Applications Essay Competition by Hina Mushtaq.
Jaroka has been Featured in :
- NPR (National Public Radio)
- SAMMA TV
- Google Blog
- Asahi!Shimbun (Japan Newspaper)
- Scotland Radio
Furthermore, the Jaroka has been presented on many renowned platforms including :
- Science And Technology Meeting at WHITE HOUSE, USA
- Partnered with Association of Physicians of Pakistani Descent of North
America (APPNA) for Jaroka. Our team was invited to present Jaroka at
APPNA conference held in San Francisco, USA, 2009 and in Dallas, USA,
- Women Deliver 2010- presented at young women deliver panel session (only project from Pakistan in Panel)
- Jaroka was Selected as 3 most innovative project by Interactive Research and Development (IRD) to presented at Dubai, 2014
- Jaroka was invited to be presented at High Capacity Optical Network and Enabling Technologies at Alexandria, Egypt.
- Presented Jaroka at ICT4D 2014 Workshop at ITU, Lahore, Pakistan
Awards and distinctions won by Jaroka Tele-Healthcare are as follow: - Won grant by USAID/HEC (2008-2009) - Twice won grant by Information Society Innovation Fund (ISIF) Asia - 2009 and 2013 - Twice Won Grant by Google Tides Foundation - 2010 and 2011 - mBillionth Award (2010) - DHL YES Award (2009) - TEDMED 2012 Full Front line scholarship - Grant to attend mHealth Summit 2012,Washington DC - Partnered with Association of Physicians of Pakistani Descent of North America (APPNA) for Jaroka. Our team was invited to present Jaroka at APPNA conference held in San Francisco, USA, 2009 and in Dallas, USA, 2010. - Jaroka Android Application got runner up position for Ericsson-PTA Mobile Excellence Award contest from all over Pakistan. - Atlas Service Corps Fellowship, Washington DC(2010-2011) - Women Deliver 2010 Scholarship (only project from Pakistan in Panel) - Foundation of Youth Social Entrepreneurship Fellowship- FYSE- ( 2009-2010) - ITU Cyber-Security Competition (2009)
Shamila Saleem Keyani