e-Health Pilot Project using

TVWS in Bhutan

Arun Ramamurthy

Senior Public Management Specialist (ICT and e-

Governance)

Asian Development Bank

29 May 2014

Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

Developing e-Health capabilities in Bhutan

• Where populations live in scattered settlements, high costs are incurred when patients must

reach healthcare centres from remote locations.

• In 2013, ADB partnered with Bhutan's ministries of Heath and Information and Communications to

demonstrate how internet technology enabled television White Space (TV WS) can address rural

connectivity deficits in a cost-effective way ; and

• In association with Hewlett Packards (HP), how technology enabled health solution provides

access to quality primary health services through e-Health Centres (eHC)

• The following were delivered:

– A dedicated internet lease line of 2 megabits per second (mbps) was provisioned in

Bumthang District Referral Hospital.

– Last-mile connectivity of 2 mbps at the pilot location was deployed using TVWS

technology.

– An e-Health Center was established in the Basic Health Unit in the small remote town of

Tang, 20 kilometers (km) southeast of the Bumthang District Referral Hospital.

What is eHC? • E-Health center (eHC) is a rapidly deployable health facility

– eHC is deployed generally using a standard shipping container with automated

medical equipment such as ECG and Lab tests capabilities with remote

monitoring capabilities (Health cloud)

– In Bhutan, eHC is established with support from Hewlett Packard (HP) in

a basic health unit at remote Tang village of Bumthang District. The eHC is

is connected to district hospital. The patients at eHC access medical

services such as consultation and primary health diagnosis virtually

• Connected to health cloud which provides

– Virtual connections to doctors / super-specialists located in district hospital

through Skype and conventional video conferencing

– Web based EMR (Electronic Medical records) with anywhere access

capabilities

– Automated health data upload from cloud integrated diagnostic

medical equipment

• Last mile internet access of 2 Mbps capacity through television white spaces

(TV WS) technology

eHC in developing world

• Access to health care at rural and remote areas where

– Villages with no primary basic health facilities

– regions with no hospitals of scale

– hospitals but no equipment

– equipment but no doctors and health assistants

• Services provided in the eHC

– Curative, preventive basic health services

– Access to rural medical resources such as doctors

– Collection of automated patient / health data (basic) from medical equipment

– Tracking patient history and building patient databases for future reference and policy formulation

• Advantages of white spaces

• Remote and difficult terrain where conventional internet communications technology is not viable

• To overcome attenuation problems in remote mountainous locations

Health cloud mechanics

Health Cloud

EMR

Local

Database

Server

Connectivity

To Cloud (TV

WS)

Source: Hewlett Packard Living progress presentation

TV WS

Receiver at

Tang project

site

eHC Business Processes

Benefits

• Tangible benefits

– Transport and incidental expenses savings of USD 70 per patients from Tang BHU to District hospital

– The number of patients avoiding trip to district hospital a month and availing EHC service is 40

– Total annual savings is USD 33,600

• Costs incurred

– Onetime cost USD 150,000

– Annual recurring cost USD 20,000

• Intangible benefits

• Availability of near real time quality rural medical service

• Quality of patients data useful for health policy analysis

• Innovation of solution (portability of eHC) and thereby avoid permanent primary health facilities (in Bhutan, it takes USD 500,000 to construct a new BHU)

Installation of TV WS at Tang BHU

Installing the Television White Space antenna and base station Television White Space antenna pointing to Tang point of

presence

Completed Television White Space antenna and base station at Tang Basic Health Unit

Installation at Tang point of presence (PoP)

Trekking up to Tang point of presence with the equipment

Tang point of presence–getting ready for installation

Installation of base station and antenna Antenna 6dBi Base Station

Installation completed at Tang point of presence

Bumthang District referral Hospital

The installation team

Television White Space configuration and throughput tests

Switch and dialup modem at Bumthang Referral Hospital

The times to come?

• The pilot has demonstrated how rural people living in remote locations can be provided with low-cost, convenient access to important health services. Making it easier for them to receive a medical diagnosis facilitates more timely treatment. The pilot also showed how TVWS can quickly address rural connectivity deficits in a cost-effective way (where other solutions may be uneconomical).

• Success of the pilot is due in large part to the close cooperation between the Ministry of Health and the Ministry of Information and Communications, as well as other partners, including HP. The pilot also offered benchmarks, which can be useful for comparing other connectivity mechanisms, such as Worldwide Interoperability for Microwave Access (WIMAX) and Wi-Fi.

• Finally, the pilot provided practical insights into demand generation, infrastructure upgrade, capacity development, and policy requirements. These may be useful in identifying operational issues and approaches to scaling up countrywide, thereby enabling the Health Help Centers to extend their services.

• In the developing world, important TVWS deployments are taking place in Africa. In Asia and the Pacific, deployments in the archipelago of the Philippines (7,107 islands) are the largest to date, spurred also by the need to provide critical communications for relief after the destruction of the Bohol earthquake (October 2013) and Typhoon Haiyan (November 2013).

THANK YOU

Q and A