Several developed countries have approached the
“availability” problem by proposing large-scale “integrated
health-care networks” and database systems.
These have often been government initiatives, extremely
expensive, and often not viable except in small regions
(e.g. Netherlands, Hong Kong).
Another, much cheaper approach to the “availability”
problem has been the recent development of “personal
health records” (PHRs) or “personally controlled
health records.” These were or are most clearly represented
by Google Health (http://health.google.com/
until 1/1/2012) and Microsoft Health Vault [3] in the
USA; but there are several others, as a Web search easily
reveals. These PHRs are Web-based systems (so
“WWW-PHR”, Fig. 1), and subscribers can input information
themselves and can control who (else) has
access to their records. Such PHRs are available wherever
there is access to the Web. However, large areas
of the developing world still do not have access to the
Web.
In contrast, since long before the development of
WWW-PHRs Vietnam and some places in Malaysia
(e.g. Sarawak) have used paper-based, “patient-owned”
medical records. These are paper booklets, as for school
exercises, and healthcare providers (who provide the
booklets) enter all clinical notes, lab results, etc. into
them. The booklet is entrusted to the care of the patient,
who brings it whenever he or she presents again. Such
booklets are portable and thus always available medical
records. Their disadvantages are the similar to those
of paper-based hospital or clinic records, except for the
ownership – the handwriting in them is not always legible;
they may be forgotten (as they are not an item which
each person usually carries) or lost, etc.. The structure
we propose here can be seen as a digital version of the
Vietnamese health care records, to be used in similar
contexts.
While the Internet is not ubiquitously available
throughout SE Asia or other developing regions, mobile
phone networks have a much greater geographical coverage,
and cellphone usage is much higher than Internet
usage. So it seems logical to utilize cellphones rather
than the Internet for digital health records in these regions.
The field of serious mobile applications is evolving
rapidly. Kenya has a hugely successful cellphone
banking system for individuals [4], which has already
been copied in about 60 other (developing) countries.
Mobile health systems are also evolving, but most are
for healthcare providers rather than for “normal” cellphone
users. Examples of these include openMRS /
openROSA [5] and SANA [6]. Healthcare personnel
use cellphones to collect and transmit patient data