Opportuni)es

and Challenges in
e-Governance:
mHealth Case Study
Vishnu Pendyala

A Great Quote
Economy grows as more and more people join its
core echelons. People are the most important
economic resources at all )mes.

Agenda
The Healthcare Challenge and the e-
Governance Opportunity.
Mo)va)on, Enabling Factors
mHealth: An Overview
Vision: Machine Augmented Mindfulness
Medical Diagnosis
Realizing the Vision: Challenges
Future Direc)ons and Conclusion

Questions for you

Why is technical research important for
eec)ve e-governance?
How is mHealth related to Machine Learning,
Big Data Analy)cs and Internet of Things?
How can the millions who do not have access to
proper healthcare be provisioned with it?
Can machines replace the doctor eventually?
Can machine assisted gene therapy become a
cure-all?
What are some of the opportuni)es and
challenges in the mHealth space?

Source: World Health Organization

The Healthcare Challenge: World Map

of Access to Physicians

Copyright Sasi Group (University of Sheffield) and Mark Newman (University of Michigan).

Healthcare Spending

Source: World Health Organization, World Health Statistics, 2010: Table 7

Propor)onal Mortality Rate in India

Source: World Health Organization

E-Governance in Healthcare
Governance is all about inclusion, provisioning
and common good control is a small part.
Work mostly has been in automa)ng processes
and dissemina)ng informa)on to masses.
Just one MMP in NeGP: mcts.
Governments have the power to inuence and
provision the research needs.
Need for soWware applica)ons in health that can
reach the masses and revolu)onize care.
What are some such applica)ons?

Mo)va)on and Enabling Factors

Millions of underprivileged who do not have
access to healthcare.
Automated diagnosis has been a formidable
challenge for the past 4 decades.
Prolifera)on of portable compu)ng devices,
wearables.
Informa)on Retrieval has come of age: Self-
Diagnosis on the Internet is common.
Cloud Compu)ng gives ubiquitous access to
enormous processing power.

Gartners Hype Cycle 2014

Source: Gartner

The Reach of Mobile Devices in

Developing Countries

mHealth: An Overview
Use of mobile devices for various aspects of
healthcare is part of eHealth, called mHealth.
From Telemedicine to awareness campaigns.
Connect pa)ents, community health workers
and physicians to serve at the point of care.
Phone as a point-of-care device: devices such
as ultrasound probe plugged into the phone.
Scores of projects already func)oning
successfully, par)cularly in India.

Machine Augmented Mindfulness

Mind monitors health, diagnoses condi)ons
and even cures at a molecular level.
Harvard studies established that mindfulness
creates a feedback loop to govern the health.
Even deadly diseases such as cancer are found
to be caused by the imbalances in the mind.
Can machines take-on mindfulness, like they
took over reasoning, compu)ng and thinking?

Machine Augmented Mindfulness:

Current State
Machines have successfully diagnosed diseases.
Molecular level cure is possible via gene
therapy that is a_rac)ng huge investments.
Wearables make it possible to constantly
monitor the state of health.
Mind cannot be replaced, but some of its
func)onality can be replicated.
We just put all these pieces of the puzzle
together to unfold the vision!

The Vision: E-Governance in Healthcare

Medical diagnosis is
just one example of
what happens in
the cloud

Government
owns the
cloud and the
processes in it

What happens in the cloud is the Research Focus

Approaches to Medical Diagnosis

Conven)onal: First-Order Logic based reasoning;
Rule-bases in olden days; Seman)c Web now.
MYCIN from Stanford had 600 rules and did be_er
than Medical Experts.
Latest Trend: Using Machine Learning and
Informa)on Retrieval.
None of the solu)ons so far are general purpose
and suitable for mass deployment.
Our approach considers it as a problem in Text
Mining: Given a set of discharge sheets, iden)fy
the one thats closest to the given symptoms.

Guidelines
Need a solu)on for medical diagnosis that
Is based on available data: past diagnoses
Is general, inexpensive, and adequate enough
to be used by the masses
Can be implemented using current
technologies for faster availability
Does not need a whole lot of knowledge
engineering or ongoing expert maintenance.

A Sample Discharge Sheet

Diagnosis: Allergic Bronchitis with Asthma
Case Summary: Patient 36 years male was admitted with complaints
of breathlessness & cough for last 7 days. At the time of admission
Pulse 126/min, BP 130/90 mmHg, RR 24/min, SpO2 94 with O2,
Chest spasms wheezing+, ronchi++. Patient was investigated &
treated conservatively with I/V antibiotics, I/V fluids, Nebulization &
other supportive treatment. Now the patient is being discharged in
satisfactory condition.
Treatment Advice:
* Tab. Augmentin 1 gm 1 tab. twice daily
* Syp. Rapitus 2 TSF thrice daily
* Tab. Deriphyllin-R 150 mg 1 tab. twice daily
* Forocort Rotacap 1 cap. Twice daily with Rotahaler

Wordcloud from the Discharge Sheets

Text mining the Corpus

Preprocessing: Remove stopwords, numbers,
punctua)on, tags, sparse terms and convert case.
Each document is represented as a vector (a
point) in a mul)-dimensional space.
Each dimension is a word in the corpus =>
thousands of dimensions.
Each document has a score (TF-IDF) for each word
used in it that determines its posi)on.
Each point is labeled with the diagnosis.

3D Visualiza)on of the Corpus

Enter: The Pa)ent

The closer the points in the vector space, the more
similar the documents.
Document with pa)ents symptoms are also
represented as a vector in the same vector space.
The label on the closest point to this symptoms
document in the vector space is the diagnosis.
Find K-Nearest Neighbors (K-NN) of the symptoms
document to suggest possible alterna)ves.
The K nearest neighboring discharge sheets and the
symptoms doc can be used to nd K relevant
ar)cles for further reference and decision support.

Simple Math with Profound Impact

TF.IDF Score is computed as: !.idft,d = !t,d * idft
where

Similarity between two discharge sheets is
where the norm of a vector, | | is

being the m.idf value of a
feature (term / word), i

Challenges
Privacy and Security: Hacking can be fatal.
Cost: Technology is s)ll in commercializa)on zone.
Dataset: Government mandate may be needed.
Human Exper)se: Interven)on needed at )mes.
Quality of available dataset.
Mul)lingual support: 22 ocial languages, 1,652
dierent "mother tongues" in India alone.
High Cost of Type I and II errors.
Acceptance: Skep)cism government can again
help here to inuence posi)ve outlook.

Future Direc)ons
Processing images, video, and audio (including
ultrasound) in conjunc)on with text informa)on.
Real-)me, stateful big data processing.
Aggrega)on of health data to detect or predict
epidemics and health trends.
Add a QA interface using NLP, IVR, Machine
Transla)on.
Extend the ideas to monitor and proac)vely
remedy abnormali)es.

Conclusion
ICT for Healthcare is a formidable challenge and a
huge opportunity for e-governance.
Mobile is the www of 90s the conduit to take
solu)ons to the masses and manifold the RoI.
Good )me to revisit 70s ideas we now have the
compu)ng resources that werent there then.
And more importantly

You can be a Grand Winner too

Source: http://www.npr.org/blogs/goatsandsoda/2014/09/26/351515298/and-the-million-dollar-hult-prize-goes-to-a-doc-in-a-box

Even more importantly

A Great Quote


Math is the heart of ma_er. Once expressed in
math, the ma_er dissolves and yields, just like when
you touch a persons heart, he dissolves and yields.

Questions for you

Why is technical research important for
eec)ve e-governance?
How is mHealth related to Machine Learning,
Big Data Analy)cs and Internet of Things?
How can the millions who do not have access to
proper healthcare be provisioned with it?
Can machines replace the doctor eventually?
Can machine assisted gene therapy become a
cure-all?
What are some of the opportuni)es and
challenges in the mHealth space?

Resources
h_p://www.ecgcheck.com/
h_p://www.alivecor.com/home
h_p://www.mobisante.com
h_p://www.technologyreview.com/news/421827/
ultrasound-gets-more-portable/
h_ps://www.google.com/search?q=%22Mobile
%20Alliance%20for%20Maternal%20Ac)on
h_p://en.wikipedia.org/wiki/Scanadu
h_p://en.wikipedia.org/wiki/Lab-on-a-chip
h_p://nrhm-mcts.nic.in

References

[1] Pendyala, V.S., Fang, Y., Holliday, J., Zalzala, A., (2014, October). A Text
Mining Approach to Automated Healthcare for the Masses. In Global
Humanitarian Technology Conference (GHTC), 2014, IEEE Interna)onal
Conference on. IEEE.

[2] Pendyala, V.S., & Shim, S. S. (2009). The Web as the Ubiquitous Computer.
IEEE Computer, 42(9) 90-92.

[3] Pendyala, V.S., & Holliday, J. (2010, August). Performing intelligent mobile
searches in the cloud using seman)c technologies. In Granular Compu)ng
(GrC), 2010 IEEE Interna)onal Conference on (pp. 381-386). IEEE.

[4] Pendyala, V.S., & Holliday, J. (2011). Cloud As a Computer. Advanced
Design Approaches to Emerging SoWware Systems:: Principles, Methodology
and Tools, 241.

[5] Delizonna, L. L., Williams, R. P., & Langer, E. J. (2009). The eect of
mindfulness on heart rate control. Journal of Adult Development, 16(2), 61-65.

References (Contd.)
[6] Anderson, C. M. (2000). From molecules to mindfulness: How ver)cally
convergent fractal )me uctua)ons unify cogni)on and emo)on*.
Consciousness & Emo)on, 1(2), 193-226.

[7] Amritanshuram, R., Nagendra, H. R., Shastry, A. S. N., Raghuram, N. V., &
Nagarathna, R. (2013). A psycho-oncological model of cancer according to
ancient texts of yoga. Journal of Yoga and Physical Therapies, 3, 129.

[8] Reibel, D. K., Greeson, J. M., Brainard, G. C., & Rosenzweig, S. (2001).
Mindfulness-based stress reduc)on and health-related quality of life in a
heterogeneous pa)ent popula)on. General hospital psychiatry, 23(4), 183-192.

[9] Chandwani, K. D., Chaoul-Reich, A., Biegler, K. A., & Cohen, L. (2008). Mind
Body Research in Cancer. In Integra)ve Oncology (pp. 139-160). Humana Press.

[10] Ludwig, D. S., & Kabat-Zinn, J. (2008). Mindfulness in medicine. Jama,
300(11), 1350-1352.

Q&A

MORE Q&A?
vishnu@pendyalas.org

h3ps://www.linkedin.com/in/pendyala
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