ABSTRACT

In most under-developed or third world countries like Nigeria, there are very large
numbers of patients in the remote rural areas that need specific healthcare support
services at home. Due to shortages of medical experts, hospitals coupled with geographic
isolation and lack of opportunities for these experts, the few available medical experts are
often reluctant to serve in such poorer areas with lesser opportunities and advantages. As
a result of this, people living in these rural and poorer areas have limited access to basic
healthcare services and consequently receive lower quality healthcare services, compare
to those living in urban areas where best equipped hospitals and with medical experts are
distributed. Those patients living in the rural areas requiring the attention of healthcare
practitioners to meet their needs must travel to distant healthcare centres, which is quite
unaffordable due to the present state of medical emergencies.
Thus it has become very crucial and important to develop a robust system that will
drastically improve and change the present state of healthcare delivery services. In this
research work, an interactive-mode telemedicine environment is designed to provide
tools for overcoming the unequal distribution of medical experts, establishing meaningful
consultations between the rural health workers and specialists located in larger medical
centers.
The proposed system also provides opportunities for the healthcare workers to gain
access to vital information that can aid in the diagnosis of patient’s health state or the
development of suitable treatment plans and for the patients to fully enjoy an enhanced
healthcare service in the rural areas and urban cities.
The technological approach for the implementation of the proposed system is based on
open source solutions. The system is implemented on Windows 2003 network operating
system platform. Web server is apache extend with support for PHP. In recognition of the
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confidentiality of data contained in the system, communication network are protected
with open-(ssh) library for data encryption and role-based authentication is built into the
system as security pass mark for accessing information in the data base.

TABLE OF CONTENTS

Title Page i
Declaration ii
Certification iii
Acknowledgement iv
Dedication v
Abstract vi
Table of Contents vii
List of Tables x
List of Figures xi
CHAPTER ONE: INTRODUCTION
Background of the study 1
Motivation of the study 3
Objective of the study 4
Research methodology 4
Contribution to knowledge 5
Organisation of the rest of the thesis 5
CHAPTER TWO: LITERATURE REVIEW ON TELEMEDICINE
SYSTEM AND RELATED WORKS
Introduction to Telemedicine 6
History of Telemedicine 7
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Review of E-Health 13
E-Health History 13
Overview of some existing telemedicine System 15
Telecardiology 18
Dermatology 21
Electronic medical records for rural health systems 22
Wristclinic 24
CHAPTER THREE: SYSTEM ANALYSIS AND DESIGN
Telemedicine system 25
Telemedicine system architecture 25
Implemented System description 29
Administrative module 32
Consultation module 33
3.3.2.1 Consultation/diagnosis 33
3.3.2.2 Remote Consultation 37
3.3.2.3 Test module 50
Referral module 50
Training module 52
Designing telemedicine system database 53
3.4.1 Entity Relationship Diagram (ERD) 55
3.5 Designing the healthcare enterprise memory 59
3.6 Strategic healthcare decision support services 65
3.7 Implementing the system database 66
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CHAPTER FOUR: SYSTEM IMPLEMENTATION AND
PERFORMANCE ANALYSIS
System Implementation 73
4.1.1 System security and privacy 73
4.1.2 System Interface 75
4.1.3 Teleconsultation database result 78
Performance analysis 78
4.2.1 Software Analysis 78
4.2.2 Hardware analysis 80
4.2.3 Technical analysis 81
4.2.4 Interoperability 81
Challenges and implementation bottleneck 82
4.3.1 Organisational and cultural intertia 82
4.3.2 Technology and information change 82
4.3.3 Lack of IT funding and human resources 83
Training 84
4.4.1 Pro and cons training methods 85
CHAPTER FIVE: CONCLUSION AND RECOMMENDATIONS
Conclusion 87
Recommendations 88
Area of further research 89
References 90
Appendix A (Source code listing) 94
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LIST OF TABLES
PAGES
Table 3.1 Clinical table (CT) Associated with two patients 36
Table 3.2 Entity Relationship Table 55
Table 3.3 A Synopsis of the System SHDS 66
Table 3.2a A Relation table 68
Table 3.3a A Relation table 68
Table 3.4 A Relation table 68
Table 3.5 A Relation table 69
Table 3.6 A Relation table 69
Table 3.7 Relation obtained from table 3.5 and 3.6 69

CHAPTER ONE

INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Telemedicine can be broadly defined as the use of information and
telecommunication technologies to provide medical information and services at a
distance. Telemedicine has existed long before the internet, some authors
observed that telemedicine was broadly conceived even when the term was used
almost three decades ago. Some of the first telemedicine reports were of group
therapy (Withson, et. al., 1961), nursing interactions (Cunningham, et. al., 1978),
education and training (Menolascino et. al., 1970), telemetry (Fuchs, 1979),
televisits to community health workers (Straker, et. al., 1972), and home care
(Mark, 1974), among other applications. In many cases, no physician was
involved, and interactivity was not a necessary aspect of the processing.
The term Telemedicine is the delivery of medicine at a distance. The term
is composed of the Greek word τελε (tele) meaning ‘far’, and medicine.
Telemedicine may be as simple as two health professionals discussing a case over
the telephone, or as complex as using satellite technology and video-conferencing
equipment to conduct a real-time consultation between medical specialists in two
different countries. It can also involve the use of an unmanned robot.
Telemedicine generally refers to the use of communications and
information technologies for the delivery of clinical care.
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Telemedicine is most beneficial for populations living in isolated
communities and remote regions and is currently being applied in virtually all
medical domains.
Specialties that use telemedicine often use a “tele-” prefix; for example,
telemedicine as applied by radiologists is called Teleradiology. Similarly
telemedicine as applied by cardiologists is termed as telecardiology, etc.
The ability of telemedicine to facilitate medical care irrespective of
distance and availability of personnel on site makes it attractive to both the public
and private health sectors. Telemedicine allows better utilization of scarce
medical personnel and resources. It enhances citizen’s equality in the availability
of various medical services and healthcare despite geographical and economic
barriers, at a lower cost. In particular, telemedicine may be seen as a valuable
tool for providing much needed medical services to remote rural areas. It
promises to enhance continued medical education of our young doctors, nurses
and other healthcare practitioners in rural areas, both in training and in established
practice(O. S. Adewale, 2004).
Healthcare system ranges from highly specialized urban areas, to small
rural clinics in most part of underdeveloped and developing countries. The legacy
of recent decades is an inappropriate distribution of health practitioners and
expertise that are concentrated in major urban centers, while people living in rural
areas have limited access to basic healthcare because of geographical isolation
and poor public transportation.
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Telemedicine is one form of advanced technology that may be part of the
solution to a number of healthcare and education problems in most
underdeveloped and developing countries.
Therefore, in this thesis, a web-based medicine system is designed and
implemented for Nigeria.
1.2 MOTIVATION OF THE STUDY
The third world countries are usually characterized by high population
density. Nigeria for instance has an estimated population of about 120 million
people. More than seventy percent (70%) of her populist reside in the rural areas
with shortages of medical experts, and hospitals. Due to geographical isolation
and lack of opportunities for medical experts, few available medical experts are
often reluctant to serve in remote rural and poorer areas. As a result of this,
people living in this remote rural and poorer areas have limited access to basic
healthcare services and consequently receive lower quality of healthcare service
compare to those living in urban areas where best equipped hospitals and medical
experts are available. Patients living in these areas requiring the attention of
healthcare practitioner to meet their needs must travel to distance healthcare
centres, which is quite impossible due to the present state in medical emergences.
Therefore, there is the need to develop a web-based telemedicine system
that will improve upon the quality of medical services, lower cost of delivering
such service to the people in remote areas, and providing more up-to-date medical
information to rural healthcare workers demarcated from the main stream of
information awareness.
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1.3 OBJECTIVE OF THE STUDY
The main objective of this work is to provide, develop and implement a
telemedicine system, which will:
i) enhance citizen’s equality in the availability of various medical services and
healthcare delivery despite geographical and economic barriers through the
use of web-based telemedicine application.
ii) reduce direct and indirect cost (loss income), usually incurred as a result of
moving patients from one geographical location to another in search of better
and quality medical services.
iii) improve consultation and co-operation among various units of healthcare
services in both special cases and primary care by bridging the distance
between practitioners and specialists.
iv) provide opportunities for the healthcare practitioners to gain access to
information that can aid in the diagnosis of patient’s healthcare conditions.
1.4 RESEARCH METHODOLOGY
A review of related literature was carried out. A web-based telemedicine
system that would provide efficient and convenient methods for the remote rural
healthcare workers and physicians located at the cities to collaborate with one
another over patient’s cases was developed and implemented. Technological
approach to the development of the system is based on apache as a web-server
with extended capability for PHP scripting language and MySQL as a relational
database.
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1.5 CONTRIBUTION TO KNOWLEDGE
The need to develop a web-based telemedicine system that will improve
upon the quality of medical services, lower cost of delivering service to the people
in remote areas, and providing more up-to-date medical information to rural
healthcare workers demarcated from the main stream of information awareness.
1.6 ORGANISATION OF THE REST OF THE THESIS
The rest of the thesis is structured as follows: in chapter two, we review
telemedicine system generally and discussed its features and prospect as regards
to the medical profession generally. Some related literature was also reviewed.
In the third chapter, we describe and design an automated system for the
proposed telemedicine system.
In the fourth chapter, an implementation of the system designed is
presented using PHP and MySQL.
In the chapter five, conclusion and recommendations were made.
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