Mobile Healthcare: Mallu Case Study by Eksote in Finland

The Mallu vehicle is a new type of mobile healthcare service that is used in remote regions where these services don’t exist. The objective is to introduce more advanced services to locations that don’t have a dedicated healthcare center.

The targets for the Mallu system are:

• To answer the healthcare needs of people living far away from stationary service locations 
• To secure and develop the basic services of people in remote locations 
• To enhance wellbeing and health as well as to prevent illness 
• To support the health and wellbeing of the elderly and to support independent living 
• To produce new and reliable mobile services 

The customers include all community members, but the largest customer group is elderly people that have problems of travelling to the locations of stationary services. The first pilot tests in 2011 showed that as many as 65% of the customers were aged 65 or older.

The services

The Mallu vehicle provides primary nurse and pharmacy services. Special health related theme days are also organized using the vehicle. 

The vehicle has a fixed route and the target is to visit each dedicated site every fortnight. The time the vehicle is in one location varies from one hour upwards, depending on the need. The nurses provide services like ear rinsing, stitch removal, prescription renewals, vaccinations and other injections. Blood pressure monitoring, blood sugar level sampling and related advice are also included, while some quick sampling like INR is also performed in the van.

The broadband connection in the vehicle enables the usage of Eksote's regional health district patient register, so that all patient specific health issues can be monitored and reported online. Some dental services can be included depending on the equipment installed in the vehicle. 

The route of the vehicle in Southern Carelia, Finland 

The connectivity solution

One of the main requirements for the services is an always online data connection that is guaranteed to function in more remote locations. The Goodmill managed router system meets the challenge. The Mallu vehicle is equipped with a router that includes up to four different commercial mobile broadband connections. In current operations along the predefined routes, Eksote uses two SIM-cards from the two main operators in Finland.

The system overview of the Mallu healthcare vehicle 

The solution brings all the health district’s databases to the vehicle over secured VPN tunneling. The van then operates like any other connection inside the hospital or healthcare center with similar rights and capabilities. This also enables more modern services like live video streaming from the van, enabling doctors consultation on demand.

The costs

The total cost for the vehicle including salaries, vehicle rental and IT infrastructure are €115,000 per year. With a single customer’s cost between €52 - €104 per visit, the all costs of the service can be covered. This is obviously a very interesting value proposition for Eksote.

The summary

As the costs of health care are rising in general, a mobile service unit is a way to deliver services to more remote locations. A modern IT infrastructure is needed to support the service, which requires secure access to databases for medical records, electronic prescription databases and so on. The Goodmill managed router solution is a perfect building block and enabler for this. With always online broadband, imagination is only the limit to expand and upgrade the services in the future.

Ambulance Broadband Data Connectivity

The modern ambulance services are introducing a variety of life saving applications that require always online broadband. Pirkanmaa Hospital District is one of the forerunners of high-end applications in this field.

 

The Used Services

 

The hospital district needs to chart patients and share data in real-time, and easily manage Ambulance Trauma workflow and analyze patient data. Ultimately, the used applications help hospitals realize significant clinical and operational benefits to improve performance and quality. It is even possible to capture data using a finger touch-screen interface, and make charting quick, accurate, and comprehensive.

 

The modern applications enable hospitals and staff to see the status of all patients, including real-time information from charting in the field. It is possible even to use workflow management system allows agencies to manage EMS through review and approvals, ultimately replacing the paper trail. The hospital district can then use pre-built server reports and powerful data analytics package to observe trends, and effect change.

 

Ambulances are outfitted with docking stations and tablet PCs. Data is entered by tapping the screen, including voice recognition. Paramedic can send patient data in real-time the hospital and this system allows one to capture quickly and accurately far more information than manual on paper charts. The patient data is then instantly available to the emergency department and clinical audit staff.

 

The system naturally requires data connectivity that is reliable, resilient and meets the challenging coverage problematic of a big country like Finland.

 

The Router System

 

Pirkanmaa Hospital District has chosen top of the field routing solution that is capable to switch from network to another seamlessly in a matter of seconds. For guaranteed availability, the routers system is remotely managed, and the solution includes state of the art mobile IP capabilities.

 

The systems consist of routers, including mobile terminals, router software, management software and tunneling software. A picture of a concept set-up is presented below.

 

 

 

The figure shows that the hospital or command center can be connected to any vehicle through secured IPSec based VPN’s through a VPN gateway. This VPN gateway can be any of the currently commercially available standard gateways. In case of high-end video surveillance, a special mobile IP server is needed in the land site. This enables the extremely smooth switch over between networks with very little influence to picture quality or delay in picture.

 

The WAN networks can be selected freely based on the availability of mobile terminals that are integrated in the router. In this case the most used Finnish Operators were selected to provide for the best possible combined coverage. The selection of used alternative WAN links is based on need for connectivity and cost. It is important to note that the solution provides a smooth transition to future dedicated broadband networks: when LTE is one of the selected modems, it will be used there where available. As the LTE network coverage grows, the usability increases flexibly. The services can be implemented immediately and upgraded as more broadband capacity will be available.

 

Specific Solution Benefits

 

It is clear that the solution for these lifesaving applications cannot be provided with standard routing systems. There are requirements that need special attention and the router system is in key position to provide for these. This includes for instance:

• Extremely quick switch over times through multiple active radio modems
• Data Session Persistency while using different network, for enabling real time applications such as Video and VoiP, as well as keeping critical data sessions open all the time
•  Secure data communication through built-in VPN capabilities
• Auto roll back
• Double memories
• Fall back to previous working configuration is new one is corrupted
• Hardware based modem control
• In case of modem dysfunction the router has hardware power-up reset functionality
• Power back-up
• In case of power loss, like in starting the vehicle, the router keeps power on for app. 20-30 seconds.

The advanced management system is essential in minimizing the implementation and operating costs as well as maximizing the availability at all times during operation. The Goodmill Systems’ management features and benefits include:

• Device management remotely
• Remote management via the active route/link, can be any
• All configurations administrated by the management system
• Monitoring
• Wan link status
• VPN status
• Configuration revision
• Router Log management
• Router firmware download and initialization
• Controlled remotely by the management system
• Recovery to earlier version if needed
• Mobile terminals managed and controlled by the system
• Secure and scalable installation
• Secure procedure to add devices under management
• Automated self-setup and configuration with remote management  and predefined parameters

Summary

 

Using multichannel routing is the killer enabler that meets the current and future needs of data connectivity in field use for Public Safety Sector. The solution enables the development of services and functionality in vehicles that is only limited by the coverage and data capacity limitations of the best availability that any single commercial network provides. Our experience is that the session’s persistency and the high availability needed can be provided only with our approach. The mobility of the vehicle influences the network functionality in such a way that it excludes currently available bundling solutions for this type of usage.

 

The high end implementation of Pirkanmaa Hospital District system is a proof of the concept and the results can be seen with improved service and ultimately saved lives.