This study looks at how an e-Health System can reduce morbidity (poor health) in unreached communities. The e-Health system combines affordable sensors and Body Area Networking technology with mobile health concepts and is called a Portable Health Clinic. The health clinic is portable because all the medical devices fit inside a briefcase and are carried to unreached communities by a healthcare assistants. Patient morbidity is diagnosed using software stratification algorithm and categorized according to triage color-coding scheme within the briefcase. Morbid patients are connected to remote doctor in a telemedicine call center using the mobile network coverage. Electronic Health Records (EHR) are used for the medical consultancy and e-Prescription is generated. The effectiveness of the portable health clinic system to target morbidity was tested on 8690 patients in rural and urban areas of Bangladesh during September 2012 to January 2013. There were two phases to the experiment: the first phase identified the intensity of morbidity and the second phase re-examined the morbid patients, two months later. The experiment results show a decrease in patients to identify as morbid among those who participated in telemedicine process.

The present paper has reported a case study of the “Electronic Doctor's Bag” which is a telemedical tool for home-visit medical services using the mobile communications environment in an isolated island and a disaster area hit by the tsunami. Clinical trials performed for 20 patients around a clinic in Miyako Island indicated that the communication functions of the proposed system were highly evaluated by patients as well as medical staffs. However, the system still has room for further improvement in operability, portability and mobile communication environment. The experience at the shelter in Kesennuma City suggested that mobile healthcare tools such as the proposed system will be strongly required when there are no or only paramedical staffs after leaving of emergency medical staffs.

To support international medical collaboration activities carried out among Japan, Sri Lanka and other countries in Asia, we have been developing a collaboration system, which incorporates synchronous and asynchronous collaboration paradigms through network-effective persistent information sharing. The designed system facilitates synchronous collaborative work on maxillo-facial cases through real-time high-quality image delivery and by bringing the system database objects to a shared-workspace. The asynchronous activities are supported through a web based collaborative environment that enables both activity-centric and object-centric navigation of collaboration contents incorporated with email notifications of the system updates. Multimedia records of synchronous sessions are posted to the system database for later reviewing. Geographically dispersed groups experiencing different scales of network heterogeneities are served by a distributed application level multicast overlay and an adaptive multimedia delivery mechanism. The designed collaboration system also features several useful collaboration tools, user friendly GUI and ubiquitous connectivity.

A remote auscultation support system was developed that compresses and records in real time the patient's breath sound and heart sound, obtained using a stethoscope, and sends this data to an attending doctor at a hospital via network. For real-time recording of the breath sound and heart sound, special-purpose, high-quality sound coding technology was developed and incorporated in the system. This sound coding technology enables the amount of data to be reduced to about 1/18 with virtually no deterioration of the properties of the auscultation sound, high-speed transmission of this data using network, and remote diagnosis of the auscultation sound by a medical specialist. The auscultation locations of each patient, together with the doctor, stethoscoper, and patient database are input into the system in advance at the hospital. At the patient's home or sanatorium, the auscultation sound is recorded according to a human body display that shows auscultation locations, and then sent to the hospital. To ensure patient confidentiality when the auscultation data is transmitted via network, the system scrambles the auscultation data and allows only the attending doctor to play and diagnose the auscultation sound. These features not only support an understanding of the condition of patients being treated at home, but they also enable the construction of an auscultation database for electronic charts that allows auscultation results to be shared within the hospital. When this remote auscultation support system was manufactured and its performance was assessed, virtually the same waveform was obtained for the recorded and played breath sound as for the original breath sound. Results showed that even at a sampling frequency of 11 kHz, remote diagnosis by a medical specialist was in fact possible. Furthermore, if auscultation data of 10 seconds per location for 10 locations is sent, the amount of data sent is only about 120 Kbytes. Since this amount of data converts to only about 25 pages of electronic mail text, even via the existing mobile network the auscultation sounds of many patients can be sent efficiently.