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The purpose of this chapter is to present the guideline for improving Quality Healthcare Service using Intelligent Mobile Technology. That is the artifact of the research study. In fact, the artifact is one of the most important parts of any research study. The chapter will begins by describing the synthesis of findings by putting together the results from literature review and the results from primary data collection. The guideline will be created based on the facts from primary data and literature review. After that, the guideline will be tested by interviewing the experts and the feedback from experts will be discussed and considered for the aim to improve the proposed guideline.
5.2 Synthesis of Findings
In this section the findings from the literature review and from user's results were synthesized. Based on the results from data analysis and review of the literatures it has been decided to use new and more flexible and higher bandwidth third generation mobile technology systems (UMTS) in the proposed guideline as opposed to the previous generation of mobile technologies such as 2G, 2.5G. It was found that UMTS able to support integrated digital wireless communications at data rates up 2Mb/s.
UMTS also defines different quality of services (QoS) classes compared to other technologies, these QoS classes are conversation class (i.e. voice, video telephony), streaming class (i.e. MMS, video on demand), internet class (i.e. database access, web browsing) and background class (i.e. SMS, E-mail).
As described in chapter 2 it was also found that, UMTS technology are handle communications in more secure circumstances. UMTS provides five security features, such as network access security, network domain security, user domain security, application domain security and visibility and configurability of security. The security data in the UMTS network will be protected in data storages and while transmitting ciphering keys and authentication data in the system.
The choice of this technology is also due to the fact that, UMTS provides the faster service connectivity such as SMS, MMS. The UMTS also is capable of supporting video calling, the clarity is better and the facility can be enjoyed.
Based on the research data, it was also found that patient can use any mobile device to access the healthcare service. Patient can use his mobile device for sending SMS or MMS which contains his diagnostic information to the hospital. It was also found that majority of people were using SMS to communicate with friends or family, this shows the advantages of the proposed guideline, where the patients could be provided with better healthcare services using any type of mobile device.
It was also decided to use Zantel Company as a mobile service provider for the proposed guideline. Based on the research findings, it was found that Zantel uses 3G technology to provides communication, therefore Short Message Service Center (SMSC) gateway should be used that will play a key role for the translation of message into proper standard (SMSC illustrated details in section 220.127.116.11).
It was also found that Intelligent Server in hospital should be used to receive and send medical data from and to patients through mobile operator. The Intelligent Server would responsible to control all incoming and outgoing data between patient's mobile device and hospital medical database. The server contains active knowledge which uses patient data to generate case specific advice which has Artificial Intelligent features. The server should contain if -then -else rule which helps system to solve patient's problems in real time. The Intelligent Server also should be appreciated that the first incoming data from patient's mobile device will be considered first compared to the second incoming data.
Furthermore, the Intelligent Server should provide prioritizing requests. A triage technique should be used to ensure that the most critically ill patient is served first. The communication techniques must be coordinated in a way that ensures the healthcare professional request to critical alerts and vital requests in order to importance. When multiple communication devices are in use, prioritizing should be a nightmare. Therefore healthcare professional contend with an uncoordinated stream of answering machine messages. The operator domain should also provide a server which provides delivery acknowledgement whether a message is delivered, in waiting mode or not sent.
The server should be constructed in a way to enable data conversion between SMS format and PDU  format. Besides, SMSC should act as a gateway whereby SMS would be capable to received and sent between patients' mobile device and hospital Server.
The aim of conversion data from text/plain to PDU format is that, PDU format contains a lot of meta- information about the sender, also PDU data become in the form of hexadecimal. Hence it is useful for machine reading.
Based on the findings it was also found that users could send acquisition data to the hospital through PDA or smart phone which is measured by Sensor. This Sensor would be connected to the human body and measures the patient's personal data such as body temperature, pressure, heart rate, and etc. As mentioned in the chapter 2, Sensor can be used to monitor the patient's personal data then PDA or smart phone would be utilized to forward the patient's data to the hospital.
However, the majority of Zanzibar people they did not have PDA, nevertheless using PDA and sensor to measure patient's acquisition data will be particular awareness of a patient. It was found that the organization such as World Health Organization (WHO) could be helps the government to enabling Sensors and PDAs to be available in the central clinics in every corner of the country.
In the mobile healthcare service patient could use his mobile device to communicate with doctor through video call. The video call service is the most important technology which provides chance to the patient to tell doctor his problem face to face. But, the service is not popular and not mostly used in Zanzibar, this may caused by a very few of mobile phones that support video call service and high cost of that service.
During the analysis of users' data, it was found that a cost is the one of the problem which hinders Zanzibar people in getting better healthcare. The others reason such as far distance between people residence and hospital, and wasting a lot of time for waiting medical service which caused by lack of healthcare professionals. Although the majority of people are live near to the pharmacy. Therefore, in order to solve these problems the proposed guideline is presenting the best mobile communication technology for the means to improve quality healthcare service to the people.
It was also found that the majority of people were agreed with the proposed guideline. For that reason, it was identified that there is necessity of the mobile healthcare system in order to improve quality healthcare service, where patient could provide better healthcare service using his/her mobile phone at anytime and everywhere.
5.3 Overview of the Proposed Guideline
The architecture of Intelligent Mobile Technology for improving Quality Healthcare Service is proposed here. This proposed guideline was created based on the analysis of the primary data and secondary data.
Figure 5.1: Overview of the proposed service Architecture
There are three domains in this architecture such as User, Mobile Phone Operator and Hospital.
User (Patient) domain should initiate the service by sending either SMS or MMS which contains his diagnostic data to the hospital, through mobile phone operator. The SMS and MMS servers should be used to support the sending and reception of data between patient and hospital. When patient decided to send SMS, would be required to fill in his personal information such as name, gender, age and etc. The patient will also be required to identify his illness by providing either symptom or disease. These patient's data would be used to produce suitable medical decision by comparison between the patient diagnostic data and knowledge stored in an expert system.
On the side of MMS, patient could capture his infected area such as face, eye, ear, mouth, and etc using his mobile device's camera, after that patient should send an image to the hospital in the format of multimedia message. MMS enables doctor to see the original patient's infected area and it could be to produce reasonable medical recommendations.
Not only SMS or MMS, patient also could send his acquisition data which measured by sensor via PDA or smart phone, as it is shown in the figure 5.2 below.
Figure 5.2: Measurement of patient's acquisition data via sensor to the PDA
In that case, sensor would be used to measures patient data such as temperature, body pressure, heart rate and etc. As shown in the figure 5.2 above, the most patient's acquisition data which measured by physiological sensor are Electroencephalography (EEG) to measure the electrical activity produced by the brain, Electrocardiogram (ECG) to record the electrical activity of the heart over time, Electromyography (EMG) to evaluate physiologic properties of muscles, blood pressure and heart rate (Safeer, et al., 2008). The data measured by the sensor unit are transmitted to the PDA via the Bluetooth interface between the sensors and the PDA. The choice of Bluetooth is motivated by the fact that it is the most widely used low power and short range wireless. The PDA will acts as a gateway between patient and hospital, after PDA collected the patient's data via sensor, and then the data will be forwarded to the hospital through mobile phone operator.
However the sensor technology would be used to measure exactly patient data, but at the present the sensor not widely used in Zanzibar. Therefore as described in the findings section, the sensors would be in the clinic centers and it will be a particular interest when used in the patient behavior to monitoring and acquiring health intensive data.
Patient also could communicate with doctor via video call. This technology would allow patient to show his medical problem to the doctor using his mobile phone's video camera, and also will enable doctor to see the patient's medical problem. The video call service will facilitate doctor to produce the best medical decision based on the patient's problem.
In this study, the benefits for the recovering patient will clear and researcher's aim was to develop a more complete, user friendly and easy to deploy healthcare solution.
Mobile Phone Operator domain
Another domain of the proposed guideline is mobile phone operator. According to Schiller (2003) mobile phone operator also known as mobile network operator is a telephone company that provides services for mobile phone subscribers. Mobile network operators are deployed different types of service includes Voicemail, SMS, MMS, Video call etc.
The mobile phone operator will be Zanzibar Telecommunication Company Limited (Zantel) which provides the SMS and MMS services and video call as well. The mobile operator will be responsible to send and receive data between patient's mobile phones and Hospital Server. Zantel is the one largest telecommunication limited in east Africa which using new communication technology (3G). As described in the chapter 2, 3G also it is known as UMTS, an improvement over 2G providing wireless access to the data and information to the users from anywhere and anytime. Therefore patient could provide the healthcare service within a few seconds.
A patient could use any of the three mobile services (SMS, MMS or Video call) to provide better healthcare. The mobile service subscriber should realize the three different servers as illustrated details to the following sub sections.
18.104.22.168 Short Message Service Center (SMSC)
According to bodic (2005) a SMSC is a network element in the mobile telephone network which delivers SMS messages. SMSC should be responsible to handle the SMS operations of a wireless network. When an SMS message is sent from a patient's mobile phone, it will reach an SMS center first. The SMS center then should forward the SMS message towards the destination (as shown in the figure 5.3). The main duty of an SMSC is to route SMS messages and regulate the process, if the recipient is unavailable (for example, when the Hospital Server is emergence shut down or when a patient's mobile phone is turned off), the SMSC should store the SMS message. It will forward the SMS message when the recipient is available.
Figure 5.3: Short message service system Architecture
The figure 5.3 above shows the structure of sending and receiving SMS from one device to another. For instance, the device X is a patient's cell phone and the device Y is a Hospital Server, and the device X want to send SMS to device Y as shown in the figure 5.3 above. Therefore, the centralize SMSC should be the responsible to handle communications between these two devices.
On the other hand, as shown in the figure 5.3 above, the MSC stand for Mobile Switching Center is the central communications hub or switch of a cellular telephone system that is responsible for routing all the calls/SMSs from the various base stations to the others base stations  .
Multimedia Messaging Service Center (MMSC)
MMS messages are delivered in a completely different way than SMS. According to Eylert (2005), suddenly when multimedia message is received from patient's device, the first step is for the sending device to encode the multimedia. The message then will forwarded to the carrier's MMS store and forward server, known as the MMSC. Once the MMSC has received a message, it first determines if the receiver's device is "MMS capable", that is it supports the standards for receiving MMS. If so, the MMS will be forwarded to the recipient. In this proposed guideline, patient would be allowed to send MMS i.e. image, audio or clips which shows his/her medical problems.
22.214.171.124 Video Call Service Center
Video call center should be also in the mobile phone operator would the responsible to controls all video calling communication between patient and doctor. Video call center support live communication an addition to their audio services. As illustrated by Eylert (2005) Video communication can dramatically improve the time it takes to solve problems and increase user's satisfaction. The use of video call centers can often replace the need for on-site support.
5.3.3 Hospital domain
The third domain of the proposed guideline is hospital domain. This domain contains the three main components such as Intelligent Server, Healthcare Professional and Medical Database, as shown in the figure 5.4 below.
Figure 5.4: The Components of Hospital domain
126.96.36.199 Intelligent Server
As described in the finding section, Intelligent Server should be responsible to control all incoming and outgoing data inside and outside the hospital, a server should have intelligent feature which provides priority conditions. Hac (2000) stated that the Intelligent Server provides a safe and not intrusive way of using Artificial Intelligent technology to add value to conventional processes and applications. Hence, after patient's data received in this component, the data will be converted into PDU format as described details in the findings section. The Server will forward the patient's data to the Medical Database (see figure 5.4) in order to produce medical recommendations. The server also should have features which makes possible to handle large number of patients who will access services even at the same time.
188.8.131.52 Healthcare Professional
The second component of Hospital domain is HealthCare Professional (HCP). HCP is the healthcare qualified person, who is responsible to ensure that medical expert system is working properly all the time, HCP should defined the symptoms, disease and their treatment and stored in the medical database.
On the other hand, doctor would have mobile phone or PDA that support MMS and video call services. Where when the patient sends his diagnostic data through MMS service, the doctor would view the patient's diagnostic image or diagnostic Audio/Video clips via his mobile device. The video call service provides opportunity to the patient to tell doctor his illness face to face. The doctor also through his mobile device would receive an alert from medical database for further medical advice. After that doctor will suggestion medical recommendations based on the patient's complaint.
184.108.40.206 Medical Database
Another component of Hospital domain is medical database. In this study Medical Database is the one of the main target. It will contain medical expert system which used to assist in decision making. The expert system is a computer application that performs a task that would otherwise be performed by a human expert. Expert systems are extensively used in the medical fields. It provides expert advice and guidance in a wide variety of activities, from computer diagnosis to delicate medical surgery. The medical expert system will be used to produce medical recommendations by contrast between patient's diagnostic data and medicinal data which are stored in the system.
The basic structure of the expert system will look as shown in the figure below.
Figure 5.5: The Basic Organizational Structure of Expert System
The expert system contains three distinct components these are Knowledge Base, Working Memory and Inference Engine.
220.127.116.11.1 The knowledge Base
The nuclear of an expert system is the Knowledge Base. The Knowledge Base is a special kind of database for knowledge management, providing the means for the computerized collection, organization, and retrieval of knowledge. The collection of patient data representing related experiences, the medical treatment is related to the patient problems and stored solutions. The knowledge base is usually stored in the form of if -then-type rules, such as if the patient diagnostic is malaria then its treatment is chloroquine. If a fact exists that the patient diagnostic is malaria, this matches the pattern "malaria" then rule is satisfied and performs its action of "chloroquine".
According to Castillo et al., (1997) Knowledge Base includes two basic elements. First element is concrete knowledge base, the database of facts such as the problem situation for example, facts on actual cases to be solved and the theory of the problem area. Second element is abstract knowledge, the special heuristics or rules that direct the use of knowledge to solve patient's problems in a particular domain. For example, in medical diagnosis, the symptoms, diseases and the relationship among them from the abstract knowledge, whereas particular symptoms of given patients from the concrete knowledge.
18.104.22.168.2 The Working Memory
The Working Memory represents relevant data for the current problem being solved. It contains the data that is received from the patient during the expert system session. Values in working memory are used to evaluate antecedents in the Knowledge Base. Consequents from rules in the Knowledge Base may create new values in Working Memory, or update old values. That mean that when the patient wants to access the healthcare service at the first time, should create his session (account) to send his personal information with diagnostic data then medical database would stored the patient's information. Patient also could update his session by updating his diagnostic data when he wants to access service at the second time. For instance, assuming that, a last week patient was sick by malaria and today the same patient is trouble by another sickness. Therefore, patient does not allowed to create new session, instead the patient could open his old session by provides his username and password, after that patient would allowed to update his symptom and disease area by putting new diagnostic data. Because of Medical Database will keep all the patients' information, therefore every time when a patient accessed to the healthcare services his records will be stored.
22.214.171.124.3 The Inference Engine
This is the control mechanism that organizes the problem data and searches through the Knowledge Base for applicable rules. As illustrated Giarratano (1998) an Inference Engine is the heart of the expert system. This component is essentially a computer program that provides a methodology for reasoning based on information already gathered in the Knowledge Base and acquires information from the user. The conclusions drawn by the inference engine may be based either on uncertain knowledge or deterministic knowledge. Uncertain knowledge can occur in a concrete knowledge base (for example, when the patient is not sure about his symptoms) or in an abstract knowledge base (for example, a given combination of symptoms occurs in a given disease very frequently but not always). Deterministic knowledge can occur when the patient entered mismatched or invalid information (for example patient typed a word "malorie" instead of "malaria"), the medical expert system will fail to produce medical recommendations and the result, the system will forward the guidance which wants patient to make sure that all information entered are correct or to see doctor personally for further medicinal.
The Inference Engine contains three sub elements these are Explanation Facilities, User Interface and Knowledge Acquisition.
An Explanation Facilities Subsystem provides an explanation of the conclusions drawn or of the actions taken by the expert system. This makes it possible to trace responsibility for medical solutions to their diagnostic problems, both in the transfer of expertise and in problem solving. According to Zielinski et al., (2006) in expert system, the Explanation Facilities just reference the surface knowledge encoded in the rules, rather than the deep knowledge about the domain which originally motivated the rules. The expert system will only conclude medical treatment X because of diagnostic Y. The Explanation Facilities it depends the kinds of Knowledge Base which are stored into the system. It might not produce the suitable solution, if it would not find the similar knowledge, for example if the patient fails to understand or accept explanation, the system can't re-explain in another way (as human can).
Every expert system contains User Interface subsystem. The User Interface is the interface between the expert system and the user. In order for an expert system to be an effective tool, it must incorporate efficient mechanisms to display and retrieve information in an easy way. According to Castillo et al., (1997) a language processor for friendly, problem oriented communications between the user and the expert system should be included. Another important aspect of the User Interface subsystem is that users commonly evaluate expert systems based on the quality of the User Interface rather than on that of the expert system itself. Therefore the user interface will be responsible for posing the questions to the patient, reading the patient's replay and explaining the rules used to reach a medical conclusion.
A Knowledge Acquisition subsystem accumulates transfers and transforms problem solving expertise from knowledge sources (patient's medical problems) to a medical expert system in order to construct or expand the Knowledge Base. The Knowledge Acquisition involves determining the factual knowledge and the heuristics used by an expert to manipulate that knowledge, these heuristics can only be obtained from an expert.
Due to the fact that, healthcare is the very mission critical area. Therefore the proposed guideline would meet all three requirements for maintaining security. These requirements are confidentially, integrity and availability. The requirements will be achieved by specified the number of security functions which covering areas such as access control, auditing, error recovery, and etc. Appropriate confidence in this service will be also considered. The security also will maintain in order to allow patients to determine that the information which it is providing is correct, secure, and received.
In addition the guideline also will maintain the other security levels such as authentication, authorization and non repudiation, where every patient should be required to enter his username and password before using the service, if it is a first time, patient must register by creating his account. After that system will require patient personal details such as address, gender, age, weight, and etc. The patient should also enter his symptoms or disease before sending his diagnostic data to the hospital. The importance of this patient's data, not only to provide medical recommendation, but also to enable the Medical Database to keep the patients records in every time when they are accessed the services. Medical Database is the responsible to analysis the patient's diagnostic data, but if it happens, the system couldn't find the right medical solution, an alert will be forwarded to the doctor via mobile device for further clarification.
5.4 Utilization of the Scenario
A figure 5.6 below shows the sequence activities of patient to the proposed guideline, when he/she wants to provide healthcare service using any mobile service such as SMS, MMS or Video call.
Figure 5.6: Sequence activity of proposed guideline
As shown in the figure 5.6 a patient via his mobile device can send either SMS (which contains his demographic information and symptoms or disease), or patient can send MMS (diagnostic image i.e. eye, ear, mouth and etc, or video clips/audio clips which described patient's sickness/complaint).
Patient also can communicate with doctor using video call for further medical investigation then medical expert system which assisted by doctor will produce the best medical recommendations or treatments. Furthermore, patient via PDA can send his acquisition data to hospital which measured by sensor such as body temperature, heart rate and etc, as described details in the User domain section (5.3.1). The medical recommendations would be replayed to the patient's mobile device through mobile phone operator.
Let's assume that Haji is a patient, and he want to access healthcare service using his cell phone. When Haji wants to send SMS which contains his medical data to the hospital, first he interacts with mobile phone operator. In order to deliver the message to the operator, the SMSC will receive SMS from mobile switching center (MSC) via base station subsystem (BSS), then SMSC will check the recipient if available, if do, then SMSC will forward the message to Hospital Server via MSC (as it is shown in figure 5.3). The MSC will find the nearest BSS where recipient found.
After that, Intelligent Server (recipient) will receive message from mobile service subscriber then it check the status of a message, here message will be received in the form of text, and then the Intelligent Server will convert the message into PDU format in order to be more readable to the Medical Database. The Server will forward the patient's information to the medical database for further medical investigation (as shown in the figure 5.4). The medical expert system will use the input patient's data and the problem specific knowledge base to produce a medical recommendation.
In that case, the doctor should check the medical recommendations in order to confirm first before the results forwarded to the patient. The authorized doctors can access this medical information from their computer or PDA (inside the hospital or even outside) both at real time as well as afterwards, and can even interact with the mobile device of the patient, obtaining anytime information about health status to the specific subject and the specific context. Afterward feedback will be revised to the Hospital Server and ready for sending to the patient via mobile operator. The Haji will receive medical recommendation in the format of text message for further progression.
5.5 Outcome of the Guideline
Guideline will deliver the two essential categories, these are improving quality healthcare service to the people and saving healthcare cost compare to the cost where people were spends currently to the medical.
How proposed guideline will improve quality healthcare service
The proposed guideline will achieve the improvement of quality healthcare service to the people as well as government based on the followings factors; better communication with patients, improved medical care and treatment and broader benefits to the society.
126.96.36.199 Better communication with Patients
The proposed guideline (mobile healthcare) could greatly increase public awareness of health issues. A patient could send his complaint data via mobile device at anytime, anyplace and everywhere. By comparing to the current healthcare system, the mobile healthcare will provide better communication to the patients, therefore the patients would residing and recuperating at their house rather than to go to the hospital as well they can avoid visiting clinic frequently. At any time patient might communicate to the hospital to provide medical recommendations.
188.8.131.52 Improved care and Treatment
The proposed guideline could provide for better overall healthcare outcomes. The mobile healthcare service will not only improve compliance with treatment regimens, it will also ameliorate disease management through automated monitoring and data transmission.
In terms of overall disease management, Intelligent Server will be used to receive patient data and then it forwarding to the Medical Database. After that medical expert system will be used to analyze a time series of patient data and identify abnormalities with suitable treatment.
184.108.40.206 Broader benefits to Society
Not only will patients benefits from improved access to service, better healthcare and treatment and improved communication, but also mobile healthcare will translate into broader benefits to the society. These broader benefits could include improved life expectancy, quicker diagnostics of potential epidemics and management of associated risk. Moreover, the proposed guideline will provide better insight into the causes of certain diseases and reduce absences from work. In summary this guideline will create a smarter, healthcare society.
How proposed guideline will reduce medical cost
Cost savings are widely seen as the main opportunity arising from this guideline. Government healthcare systems and healthcare professionals will be the main beneficiaries of the reduction in costs of patient services and process efficiencies.
On the first hand, patients will benefits for saving healthcare cost. The patient would stay at home rather than visiting to the hospitals. As it was found in the findings of primary data, the majority of Zanzibar people are reside far distance from hospitals. In the current situation people they spend a lot of money as well as wasting time for transportation to follows the healthcare service. While in hospital patients also are required to buy medical certificate, then to stay in a queue for waiting service, after that patient should be necessitated to pay in order to meet the doctor for treatment. Therefore in the mobile healthcare system patient will provide opportunity to save all the mentioned above issues and others.
The table below shows an example of comparison between cost where patient spent on the current healthcare system and after the proposed guideline (mobile healthcare). Let's assume patient is live around 5 Km to the hospital and he is sick by Malaria.
Current Healthcare System
400 (to pharmacy for buying medicine)
Medical Certificate cost
Doctor cost/Treatment cost
800 (treatment charges plus SMS cost)
Table 5.1: Sample of costs for healthcare service (per Tanzania Shillings, TSH/=)
Note: USD $1 = 1,307.00 TSH/=
* The entire Event may vary, it depends the distance and type of Hospital or Dispensary.
** This cost is approximated may be higher.
*** This cost is approximated and mostly it is expected to be less than as shown in that table.
On the other hand, the government as well as will benefits from this research by reduce its budgets. As described in the chapter 2, currently, government spends more that 8.1% percent for healthcare system out of all government budgets per year. Therefore the proposed guideline will assist government to save on healthcare budget and the cost on building additional hospitals. The needs to increase medical professionals could also be reduced. The System will run on the central public hospital. The target of the proposed service is Mnazi Mmoja Hospital. This is the main referral hospital in Zanzibar.
Sample screen shorts for proposed guideline
Figure 5.7: Service replay Figure 5.8: Patient's Login screen
Figure 5.9: Patient Demographic Information form Figure 5.10: Medical recommendation A
Figure 5.11: Image which show patient infection Figure 5.12: Medical recommendation B
Figure 5.13: Patient's acquisition data Figure 5.14: Medical recommendation C
Descriptions of sample screen shorts
The interface of proposed guideline at the user side will be as shown in the screens shorts above. Once when the patient dial operator's service number (for example *100#), the screen in the figure 5.6 would be appeared which shows the different service provided by mobile phone operator. The patient would be required to select the mobile healthcare system (e.g. 2) as shown in the figure 5.6, after that the screen in the figure 5.7 will be displayed which require patient to enter his username and password. If the patient's username and password are accepted, then the patient can either apply, SMS, MMS, Acquisition data or Video call service.
For example when the user want to send text message, the interface as shown in the figure 5.8 will be displayed which require patient to fill in his demographic information, symptom or/and disease as shown in that screen. Patient should send his diagnostic data to the hospital, then Medical Database will analysis the patient's and the medical recommendations will be produced. The sample screen in the figure 5.9 will be displayed which show the patient's medical recommendation from Medical Database. The medical treatment in the figure 5.9 is the result of patient's diagnostic data from the figure 5.8.
On the side of MMS, as shown in the figure 5.10, user could captured his infection area and sending to the hospital, therefore doctor could view the MMS message from patient using his mobile device. After that doctor will produce medical recommendations based on the patient's diagnostic problem, after that the feedback will be forwarded to the patient's mobile phone as shown in the figure 5.11.
Moreover, patient could measured his acquisition data using PDA or Smart phone that connected to the sensor, as shown the acquisition data results in the figure 5.12. The patient would send the measured data to the hospital, and then Medical Database will analyze the patient's data by comparison to the knowledge stored in the medical system. After that the medical recommendations will be produced and the results would be replayed to the patient's mobile device as shown in the figure 5.13.
Patient also could select video call service, which allowed to talking with doctor personally. The video call service provides opportunity to the patient to tell the doctor his problems directly, and also it enabled the doctor to see the patient's problem face to face. The service would be helped the doctor to produce reasonable medical treatment according to the patient's problem.
5.7 Testing of the Guideline
Validation of the proposed guideline was done by experts. In respect the two experts whom were found to participate in the validation of the guideline. First expert was Mr. Kombo Saleh Kombo, he is Clinician Healthcare Professional and second expert was Mr. Hafidh Saleh Ahmed, he is IT Professional and Data Manager in the ministry of health and welfare Zanzibar.
This section begins by describing methodology used for validation and then provides an analysis of evaluation of the guideline by domain experts. The section also will provide conclusion for identified defect.
The purpose of this section is to pinpoint the methodologies used to test the guideline as well as to provide details criteria's used for testing a guideline. The feedbacks from domain experts which were collected during interview sessions will be explained and will be used to improve the guideline. The interview was conducted through e-mail. The guideline of this study was sent to the domain experts through e-mail. The interview form is attached in the appendix F
The guideline was tested besides four criteria (4c) such as completeness, clarity, correctness and coherence.
The guideline was tested for completeness criteria in order to discovery whether research aim and research objectives were achieved and if they are integrated with the proposed guideline to the mentioned research problems that face the healthcare system in Zanzibar. The guideline also was tested for clarity criteria in order to identify the ability to be easy to understood, easy to use and easy to remember that admittance the clearness of specific entities and established relations from identified research problems to the research proposed guideline. Moreover the guideline was tested for correctness criteria in order to identify the validity and acceptable of research components related to the technologies used such as UMTS, Sensor, and etc, between domains of proposed guideline. The guideline also was tested for coherence of components in order to recognize whether the guideline contains all the concepts from the domains required to the proposed guideline for the aim to improve quality healthcare service in Zanzibar.
5.7.2 Evaluation of the guideline
The guideline was tested by domain experts. The interview form was contained the four important questions (areas) to the proposed guideline. And the result from domain experts noted that, both of them were agreed with the proposed guideline and have confessed that the proposed guideline contained all the concepts of the mobile healthcare system which domains required. The experts also were recognized that the proposed guideline is achieved usability factors and it is evidently the guideline admitted the clarity of specified entities. However both experts mentioned some improvements that should be considered during the implementation time.
The first expert acknowledged that, the guideline contains all the important components which domains required and it is exposed that the research aim and objectives were reached well. Mr Kombo said that "I hope this guideline if it will be used healthy the problems of disease like malaria in Zanzibar will be decreased significantly". Mr Kombo also suggested that, it is the fact that the healthcare is very important area. However the guideline concerned such as availability, accuracy, confidentiality, and etc, these exposed the important of mobile healthcare system. Therefore the proposed guideline should also contain a special medical sign which included with medical treatment. The reasons to set this special medical sign is that to prove the accurate of treatment where patient should be confirmed that, the medical recommendations received are evidently produced by medical expert system or healthcare professional and not other person such as hacker or un professional person. Mr Kombo also identified that this mobile healthcare system is the new technology in Zanzibar and it is required times to trains the citizen before to implementation of that service began. The training should concern every citizen and everywhere around the country.
The second expert mentioned that at the present Zanzibar citizen suffer to find better healthcare, therefore this guideline would be helps the people to provide better healthcare easily. Mr Hafidh said that, however, over all the concept of this guideline seems viable. The proposed objectives were achieved well and the guideline contained all the concepts from domains required to the mobile healthcare system. But the uses of PDA are not popular in Zanzibar which used to assists people to get better healthcare which connected with sensor. Mr Hafidh also recommended that, the government should be firm to help their citizen in order to provide better healthcare, therefore government should maintain the sensor which will be used to measure acquisition data in every central clinic within the country. Hence, patient could provide medical service from any central clinic by measured his acquisition data via sensor. Mr Hafidh also suggested that Zanzibar still there is a problem of electricity, therefore at the referral hospital where medical system would be implemented, the standby automatically generator should concerned, that is because when the unexpectedly electricity turned off, the standby generator might be recovered.
5.7.3 Conclusion relating to the results from experts
As it is shown in the evaluation of the guideline section, both experts were agreed that the proposed guideline met all the important criteria. The experts were approved that the proposed research aim and specific objectives were achieved well. The feedbacks from domain experts also noted that the guideline contained all the concepts from the domains required to the proposed service and also it was concluded that the experts were agreed with mobile third generation technology (3G) which will be used to allow people to provided better healthcare. The feedbacks also noted that, both experts were agreed the guideline is understandable. Even though, the proposed guideline (mobile healthcare system) is the new technology in Zanzibar. The majority of Zanzibar people they did not know about this technology, therefore before the implementation begins, the training required for all Zanzibar citizen. The domain experts also were suggested that the equipments such as automatic generator and measured sensors are important tools for the mobile healthcare system.
Therefore, the suggestions from domain experts were considered for the aim to improve the guideline and the components such as measured sensors, automatic generator and to trains the Zanzibar citizen will be done during the implementation time under government responsibility. The medical sign will be included during the development of medical expert system that's one of the components of proposed guideline, which will also under government responsibility. Hence based on the results from domain experts, the researcher concluded that the guideline is very important and it will help significantly to improve the quality healthcare service in Zanzibar.
This chapter was described the steps that lead to the creation of guideline for improving quality healthcare service using new and more flexible third generation mobile technology. At the beginning, the syntheses of findings from the literature review and from the primary research were putted together. This was done for the aim to identify appropriate technologies and methods of the guideline. As a result, it was found that the universal mobile technology system (UMTS) is more appropriate technology to be used for connection between patient's mobile device and Hospital Server.
Based on the findings, the architecture of the proposed guideline was provided in order to illustrate an overview of the mobile healthcare system. The three domains which made proposed guideline such as User, Mobile operator and Hospital domain and their components were discussed details. The utilization of the scenario was also described. Here researcher showed the reader the sequence activities which patient should do in order to provide the healthcare service.
Furthermore, the outcome of guideline was described and it was done in order to overview the importance of the proposed guideline. Thus, the researcher provided sample situation which proved the advantage of the mobile healthcare system over current healthcare system. The Sample screen shorts for proposed guideline also were shown in order to provide entire picture on how the mobile healthcare would be.
After that the testing of the guideline was discussed. The details of methodology were afforded in order to produce the image on how testing was carried out and which method used to test the guideline. The feedbacks from experts was also described and considered in order to improve the proposed guideline. The next chapter will describe the conclusions, appraisals and recommendations of the research study.