Development of a Community Based Web-Mobile Platform (CBWMP) for diabetes care in Sri Lanka

Abstract
Diabetes is a chronic disease with no permanent cure. Sri Lanka is placed among the countries with the highest diabetes prevalence rates in the world (ie. 2.8 million Sri Lankans have diabetes or pre-diabetes, and most importantly, a significant proportions of the population is yet to be diagnosed). Patients with diabetes need lifelong care to prevent complications which further impose a significant burden on the country‟s expenditure on healthcare. Moreover, patients need to maintain constant contact with the healthcare provider for the optimal management of diabetes. However, such arrangement is often costly and time consuming and therefore it ultimately aggravates the burden to patients, the healthcare system and the economy.
With the development of telecommunication technologies, Telemedicine (i.e. the use of Information Communication Technology to provide healthcare at a distance) has gained attention. Telemedicine can enhance communication between patient and healthcare provider without needing physical presence in one place. Telemedicine can link healthcare professionals from different corners of the globe to share knowledge and expertise. Moreover, evidence is surfacing to suggest that the telemedicine would be a viable alternative to conventional care.
This article showcases a Sri Lankan study which describes the development of a Telemedicine system for Sri Lanka – Community Based Web-Mobile Platform (CBWMP). The concept of the platform is to maintain an electronic

Personal Health Record (e-PHR) in order to provide communication between different parties to optimise patient health information flow and also to coordinate the continuity of care at minimal cost. The CBWMP – integrated mobile phones and e-PHR – is capable of delivering diabetes education, co-ordinating effective management, and screening diabetes status. To avoid any cultural marginalisation, all the services can be accessed in the user‟s preferred native language in Sri Lanka viz. Sinhala, Tamil, and English.
Keywords – e-PHR; telemedicine; mobile health; diabetes

Introduction
Diabetes is not a new disease. It has affected people around the globe for centuries. However, recent studies have shown that, mainly due to socio economic changes, the disease has now re-emerged with a vengeance(1,2). The worldwide pandemic of diabetes accounts for 346 million cases and nearly 80% of those diagnosed live in developing countries(2,3).
Sri Lanka is placed among the countries with the highest diabetes prevalence rates in the world. As rapid industrialisation and modernisation changes the lifestyles of its population, Sri Lanka faces an increased incidence of diabetes. This is a cause for concern in view of the fact that South Asians are more vulnerable to type 2 diabetes(4). According to the Sri Lanka Diabetes and Cardiovascular Study (SLDCS) conducted by the Diabetes Research Unit of the University of Colombo and the Oxford Centre for Diabetes Endocrinology and Metabolism UK, 20% of Sri Lankan adults have either diabetes or pre-diabetes while 33% of patients with diabetes are undiagnosed(2). It further estimated that 2.8 million Sri Lankans have diabetes and a significant proportion of them are yet to be diagnosed(2).
Chowdhury and colleagues predicted that the Sri Lankan population is aging rapidly, and in the future the rate of aging will surpass almost all other developing countries(3). This report also postulated that the above 65 year old population is expected to double by 2035(3). It is obvious that the impact of diabetes on this segment of the population would be a significant burden for Sri Lanka. Owing to the chronic nature of the disease and complications that are associated with diabetes, patients carry an increased risk of morbidity, mortality and a decreased productive existence. At the same time, increased health expenditure together with loss of productive population would certainly hamper the development of the country. This impending crisis calls for innovative strategies.
Looking beyond the conventional wisdom and re-application of age-old preventive tools, evidence suggests that Telemedicine is a viable alternative to conventional care(5,6) which could guide Sri Lanka to meet this challenge. Telemedicine can be defined as the delivery of healthcare using ICT at a distance. Uses of telemedicine can vary; from a videoconference between a patient and a doctor, to a text massage between a junior doctor and a senior, electronic medication reminders, to storage and forwarding of digital photography for diagnosis, to tele-monitoring and sending feedback to patients by the attending physician. Telephone and wireless technology can be used to effectively transfer data from medical devices to a healthcare provider (eg. sending blood glucose value to medical personnel for opinion or remote monitoring of surgically implanted devices such as pacemakers and cardiac defibrillators for clinical or device assessment). Tele-health can empower patients to manage their own health by providing customised information directly from their healthcare provider.

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