Major Challenging Health Issues and Potential Opportunities of Medical Expert System in Odisha

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ISSN (Print) : 2319 – 2526, Volume-2, Issue-1, 2013

40

Major Challenging Health Issues and Potential Opportunities of Medical Expert System in Odisha

Janmenjoy Nayak¹ & Ashanta Ranjan Routray²

1Department of Computer Science & Engineering, Modern Engineering & Management Studies, Balasore, Odisha

2Department of Computer Application, F.M. University, Balasore, Odisha E-mail: [email protected]¹, [email protected]²

Abstract – Expert systems have been built for a variety of purposes including medical diagnosis, electronic fault finding mineral prospecting etc. Many states across India are facing a lot of problems in the health sector. Like other states, the government of Odisha is taking a number of good attempts to improve the condition of a number of major health problems. But the performance of those steps in the real life applications is not quite encouraging. There are a lot of health issues across all the areas of the state, due to the lack of doctors, lack of well tested medical equipments and some other facilities. Expert system can play a vital role in the area of medical systems. The aim of the study is to apply the expert system as a tool to diagnose various diseases and also solve a number of possible cases properly in accordance with knowledge and inferring procedure.

Keywords – Expert system, knowledge, Health and Family Welfare

I. INTRODUCTION

Traditionally, expert system has been the most important branch of artificial intelligence. Expert systems are built to solve many different types of problems. The expert system is a computer program imitating thinking process and knowledge of expert to solve a specific problem. Expert systems that perform interpretation typically use sensor data to infer situation descriptions[1]. Interpretation systems deal directly with real data rather than with clean symbolic representation of the problem situation. They face difficulties that many other types of systems avoid because they may have to handle data that are noisy, sparse, incomplete, unreliable or erroneous. They need special techniques for extracting features from continuous data streams and methods for representing them symbolically.

Expert system offers an environment where the good capabilities of human and the power of computers can be incorporated to overcome many of the

limitations[2]. The automated design expert system has been designed to assist the engine designer in solving complex multivariable, multi goal problems.

Fig. 1 : Architecture of an expert system

The process of building an expert system is called knowledge engineering and is done by a knowledge engineer[3]. We normally represent knowledge in the form of IF-THEN rules as follows:

IF the load demand is medium, THEN the system is reliable.

If the knowledge base consists the fact that the load demand is medium, it will match the condition of the rule. The rule is thus satisfied and we can conclude that the system is reliable. Expert systems are used extensively in many domains. One of its applications can be found in medical environments. The application is based on the reason that there are increased symptoms and medicines while doctors have limitations to remember all the symptoms and medicines, as well as

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41 dosage of medicines. Accordingly, the expert system is needed to assist doctors in diagnosing particular disease based on its symptoms.

II. WHY WE NEED MEDICAL EXPERT SYSTEMS An expert is a person who has expertise in a certain area i.e. the expert has knowledge or special skills that are not known. An expert can solve problems that most people cannot solve, much more efficiently[4]. The knowledge in expert systems may be either expertise or knowledge that is generally available from books, magazines and knowledgeable persons[5]. Expert systems are being extensively used in medicine to train the medical experts in the various areas of medical systems. Medical expert systems are very helpful when there is lack of certain medical experts in a particular specified domain. As expert system uses knowledge from various extensive sources, so the major problem of using medical expert system is to measure the accurate performance of a particular situation. For every type of situations in the area of medical, a major issue related to safety stands at the front for any problems. Some of the major medical expert systems are DENDRAL, MYCIN, E-MYCIN, TEIRESIAS, and NEOMYCIN etc. The use of medical expert systems claims strongly over the conventional systems because of the following reasons.

 Humans are unable to comprehend large amount of data quickly

 Humans cannot retain large amount of data in memory

 Humans forget the steps of important details of a problem

 Humans get tired from physical of mental work load after doing lots of operations

 Humans are very slow in recalling the important tasks

 Humans cannot take consistent decisions on day after day

 Humans lie, hide and also die

III. SCENARIO OF HEALTH SECTOR IN ODISHA Odisha is one of the major states of India both in terms of land area and population wise. The state is ranked eleventh position in terms of population in India.

According to latest census of India, the population of Odisha state is 4.19 crore. Table – 1 gives the district wise population of Odisha in 2011.

Population of Odisha in 2011 District

Code State/District Population in 2011

Sex Ratio

Literacy Rate Odisha 41,947,358 978 73.45 01 Bargarh 1,478,833 976 75.16 02 Jharsuguda 579,499 951 78.36 03 Sambalpur 1,044,410 973 76.91 04 Debagarh 312,164 976 73.07 05 Sundargarh 2,080,664 971 74.13 06 Kendujhar 1,802,777 987 69.00 07 Mayurbhanj 2,513,895 1005 63.98 08 Baleshwar 2,317,419 957 80.66 09 Bhadrak 1,506,522 981 83.25 10 Kendrapara 1,439,891 1006 85.93 11 Jagatsinghapur 1,136,604 967 87.13 12 Cuttack 2,618,708 955 84.20 13 Jajapur 1,826,275 972 80.44 14 Dhenkanal 1,192,948 947 79.41 15 Anugul 1,271,703 942 78.96 16 Nayagarh 962,215 916 79.17 17 Khordha 2,246,341 925 87.51

18 Puri 1,697,983 963 85.37

19 Ganjam 3,520,151 981 71.88 20 Gajapati 575,880 1042 54.29 21 Kandhamal 731,952 1037 65.12

22 Baudh 439,917 991 72.51

23 Subarnapur 652,107 959 74.42 24 Balangir 1,648,574 983 65.50 25 Nuapada 606,490 1020 58.20 26 Kalahandi 1,573,054 1003 60.22 27 Rayagada 961,959 1048 50.88

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42 28 Nabarangapur 1,218,762 1018 48.20 29 Koraput 1,376,934 1031 49.87 30 Malkangiri 612,727 1016 49.49 Table 1 : District wise Population of Odisha (SRC:

Annual Census Report of Odisha)

Painting a grim picture on the health care sector, the planning commission has blamed the shortage of medical professionals for the dismal scenario. The

public health care has been a serious decline during the last to or three decades because of non availability of medical and paramedical staff, diagnostic services and medicines. The peoples of Odisha have been affected by a number of dangerous diseases like Typhoid, Diarrhoea, Tuberculosis, Dengu, Malaria, Diabetes, Malaria, Jaundice, Pneumonia, Chicken pox etc. Fig-2 depicts the occurrence of percentage of different diseases in Odisha.

.

Fig. 2 : Percentage of different diseases in Odisha .

The situation in availability of specialist man power in community health centers is particularly bad as against the sanctioned posts. According to the annual report about 59.4% surgeons, 45% obstetricians and gynecologists, 61% physicians and 53% paediatricians were not in position. The distribution of doctors in different districts of Odisha is highly skewed. If the target doctor population norm is taken as 1:100, then there is a requirement of at least 6000 doctors. Table -2 and table -3 depicts the Health Infrastructure of Odisha and Health institutions in Odisha respectively .

Particulars Required In

Position Shortfall

Sub-center 7283 6688 595

Primary Health

Center 1171 1279 -

Community Health

Center 292 231 61

Multipurpose Worker

(Female)/ANM at Sub Centers & PHCs

7967 6768 1199

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43 Health Worker

(Male ) MPW (M) at Sub Centers

6688 3392 3296

Health Assistant (Female)/LHV at PHCs

1279 726 553

Health Assistant

(Male) at PHCs 1279 168 1111

Doctor at PHCs 1279 1353 -

Obstetricians

&Gynaecologists at CHCS

231 - -

Physicians at CHCs 231 - -

Paediatricians at

CHCs 231 - -

Total Specialists at

CHCs 924 - -

Radiographers 231 8 223

Pharmacist 1510 1984 -

Laboratory

Technicians 1510 311 1199

Nurse/Midwife 2896 637 2259

(Source: RHS Bulletin, March 2008, M/O Health &

F.W., GOI)

Table 2 : Health Infrastructure of Odisha Health Institution Number

Medical College 4

District Hospitals 32

Referral Hospitals

City Family Welfare Center Rural Dispensaries

Ayurvedic Hospitals 8

Ayurvedic Dispensaries 624

Unani Hospitals -

Unani Dispensaries 9

Homeopathic Hospitals 6

Homeopathic Dispensary 603

Table 3: Health institutions in Odisha

The health and family welfare department of Odisha Government have been making constant and sincere efforts to implement schemes to ensure adequate health care services to the people. Steps are being taken to bring about improvement in the health care system of the state. Attention is also paid to take special care of the needs of tribal areas and backward regions.

The main objectives of the health of the health sector programmes are as follows:

 Provision of adequate qualitative, preventive and curative health care to the people of the state.

 To provide affordable quality health care to the people of the state not only through the allopathic system of medicine but also through the homoeopathic and ayurvedic system.

 To improve health care in the KBK districts of the state

 To eliminate diseases like Polio and Leprosy from the state and prevent and control other communicable diseases.

 To reduce maternal and infant mortality and to improve maternal and child health.

 To improve hospital services at the primary, secondary and tertiary levels in terms of infrastructure, drugs and personnel.

 To import training to doctors, nurses and other paramedical staff to upgrade their skills and knowledge to improve equality health care in the state.

IV. ROLE OF NRHM IN ODISHA

Odisha has implemented the activities of National Rural Health Mission efficiently and effectively for attaining the goals and objectives of National population policy and millennium development goals. NRHM has transformed public health service delivery in the state.

The decentralization, responsiveness to local needs, paradigm shift in health system management and availability of united funds has improved the facilities and their credibility among members of the public.

Under NRHM scheme overall 37,078 VHSCS has been constituted and 23,302 joint accounts at sub center level are operational. Rogi Kalyan Samiti is operational at 32 DH, 231 CHCS and 117 PHCS[6]. In total 39 PHC have been strengthened with 33 staff nurse for 24 X 7 services and 131 CHC are functioning on 24 X 7 and facility survey has been completed in 231 health institutions at below district level. A total of 34,252 ASHAS have been selected and 25654 are trained up to 4^th module. To augment the man power contractual appointments of 9 MBBS doctors, 366 staff nurse, 703 ANMs and 29 paramedics have been done under NRHM and need to strengthen positioning of specialists in the state. Table – 4 depicts the component wise expenditure under NRHM against approved PIP for the year 2010-11.

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44 Activities SPIP Expenditu

re

%Utilizati on against

PIP

ASHA 1312.27 957.75 72.98

United Funds 842.80 582.00 69.05 Hospital

Strengthening 970.00 1082.66 111.82 Annual Maintenance

Grants 62.00 120.47 194.30

New

Constructions/Renov ation and Setting Up

5720.00 86.34 1.51 Corpus Grants to

HMS/RKS 613.00 639.84 104.38

Action Plans (District, Block, Village)

0.00 16.25

Panchayati Raj

Initiative 3802.20 49.10 1.29

Mainstreaming of

Ayush 649.51 531.78 81.87

IEC-BCC NRHM 168.00 144.04 85.74 School

HelathProgramme

Additional Contractual Staff (Selection, Training, Remuneration)

427.67 382.18 89.36

PPP/NGOs

Training 137.19 0.00 0.00

Planning,

Implementation &

Monitoring

1576.98 84.24 5.34 Procurements 166.09 1232.29 741.94 New

Initiatives/Strategic Intervention (As per State Health policy)

60.73 0.00

Research, Studies,

Analysis 30.00 0.00

Support Service 137.03 10.24 7.47 NRHM Management

costs/contingencies 971.08 757.39 77.99

Other expenditures (power backup, Convergence etc)

634.37 0.00

Total 18280.92 6678.56 36.53

Table 4 : The component wise expenditure under NRHM against approved PIP for the year 2010-11 V. OVERALL HEALTH DEVELOPMENT PROFILE OF

ODISHA

For the financial year 2008-2009, the state government has made a budgetary provision of Rs.

804100 under the state plan for externally aided projects such as DFID, OHSP and Sardar Ballabh Bhai Patel P.G. Institute of Pediatrics (SVPPIP) Cuttack. Under the centrally sponsored plan, the schemes included during 2008-2009 are the National Fileria control programme, the National Anti-Malaria programme and training programmes for medical and paramedical staff in the state among other staff oriented schemes. Under the central plan schemes such as the family welfare programme, procurement of anti-T.B drug for the National T.B control programme, National Malaria control programme, National programme for control of Blindness, the Leprosy elimination programme and a number of training programmes for field personnel, etc.

are included.

VI. CONSTRUCTION OF MEDICAL EXPERT SYSTEM The road to selecting an expert system tool is paved with confusion since there is such a rich variety to choose from today. The choice of the development tool often drives much of the development process, since many products by design prescribe an inherent building process[7]. Expert system tools are programming systems that simplify the job of constructing an expert system[8]. They range from very high level programming language to low level support facilities.

ESTA, ACQUIRE, FLEX, EYSYS are some of the popular software packages used in the construction of medical expert systems[9]. Except these two famous AI languages like LISP and PROLOG are used to develop medical expert systems.

VII. ROLE OF MEDICAL EXPERT SYSTEM IN ODISHA Several factors such as poverty, low educational level, inadequate sanitation to the population contribute with poor health status in Odisha. The overall population statistics of Odisha can be depicted from fig-3.

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45 .

Fig. 3 : Population statistics of Odisha .

According to the statistics the increasing population rate of Odisha creates a lot health problem. There is also a shortage of hospitals, dispensaries, maternity and child health centers. The rural areas have still very low health professionals to population ratio. Medical expert system can play a vital role by providing support in some major clinical problems like prediction of diseases, prevention of diseases, diagnosis of diseases etc. These can be used frequently in most of the dangerous diseases both in rural and coastal areas. Some of the health indicators are given in Table – 5, Table – 6 gives the total idea about the records of approval of human resources.

No. Particulars ^NFHS-I (2008-09)

NFHS-II (2009-10)

NFHS-III (2010-11) 1 Infant Mortality

Rate (IMR) 112.1 81 65

2

Neonatal Mortality Rate (NNMR)

64.7 48.6

3 Under 5

Mortality Rate 131 104.4 4 Chile Mortality

Rate 21.3 25.5

5 Total Fertility

Rate 2.92 2.45 2.4

6

% currently using any method

a. Sterilization 31.6 35.6 8.1

b. Spacing method 10 4.7 6.9

7 % of mothers

receiving ANC 61 79.2 60.9

8 Institutional

Delivery (%) 14.1 22.9 39

9 Safe Delivery

(%) 20.5 33.7

10 Children fully

vaccinated 36.1 43.7 51.8

a. BCG 63.3 84.7 83.6

b. DPT 56.3 61.9 67.9

c. Polio 56.7 68.4 65.1

d. Measles 40.2 54 66.5

Table 5 : Health Indicators

Approval of Human Resources (Rs. In Crore) Sl.

No. Personnel 2005- 06

2006- 07

2007- 08

2008-

09 2009-10 1 Doctors 2.43 0 5.11 21.62

2 Specialists 0 0 0

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46 3 Staff

Nurses 15.4 0 6.78

4 ANM 0 0 7.03

5 Others 8.1 0.92 25.4

Total 0 2.43 23.5 6.03 60.84 Table 6 : Records of approval of Human Resources

A famous expert system namely DENDRAL is capable of determining the structure of chemical compounds given a specification of the compound’s constituent elements and mass spectrometry data obtained from samples of the compound[10]. Another medical expert system MYCIN is used to diagnose infectious blood disease and determines a recommended list of therapies[11]. It interacts with physician to acquire the clinical data and give the output as desired.

Expert system like EMYCIN is an antibiotic that belongs to a group of medicines called macrolides[12].

To take the E-MYCIN tablets, swallow a whole tablet with a glass of water. It is used for treatment of certain bacterial infections, control acne, in addition to other acne treatments, and prevent infections in people with a history of rhelematic disease, which are allergic to penicillin antibiotics.

VIII. CONCLUSION

This paper gives the detailed overview of various medical expert systems in Odisha. The success of medical expert system proved that expert systems technology is strong enough to leave the laboratory, with its academic and well-circumscribed problems, and enter commercial environments with their incomplete and uncertain information, skeptical users who demand justifications, and domains where substantial amounts of knowledge are the prerequisite of good judgment. Still now, there are no adequate and well controlled studies in pregnant women in our state. However, observational studies in humans have reported cardiovascular malformations after exposure to medicinal products containing erythromycin during early pregnancy. The government should ensure greater access to primary health care by bringing medical institutions as close to the people as possible or through mobile health units, particularly in the under-served and backward districts.

The paper demonstrates the role of expert systems in the field of medical and health issues which addresses their future as well as the trends that are foreseen in this area.

IX. REFERENCE

[1] Book Chapter :Buchanan, G.Bruce and H. Edward Shortlife 1985, Rule based Expert systems, Addison- Wesley, Reading MA.

[2] Book: Keller, Robert 1987, Expert system Technology – Development and Application, Yourdon Press, NJ.

[3] Conference Paper: Martin, J. &Oxman, S., Building Expert System A Tutorial, Prentice-Hall International Inc, New Jersey, 1988.

[4] Book: E.Castillo and E. Alvarez 1991, Expert Systems:

Uncertainty and Learning, Computational Mechanics Publications, 1991.

[5] Book: Sidall, James N. 1990, Expert Systems for Engineers, Marcel Dekker, New York.

[6] Government Report: www. health

andfamilywelfareodisha.com.

[7] Conference Paper : Beerel,C.Annabel1987 Expert systems: Strategic Implications and Applications, Ellis Horwood, New York, 1987.

[8] Book: Girratano Joseph C.,RileyD.Gary, 2007 4^th Ed:

“Expert Systems Principles and Programming;

Thomson Learning New Delhi.

[9] Book: Patterson W. Dan 2007, “Introduction to Artificial Intelligence and Expert Systems” Pearson Education.

[10] Journal Article: B.Chandrasekaran 1986, Generic Tasks in knowledge based reasoning: High-level building blocks for Expert system Design-IEEE Expert 1 (3): 23-30.

[11] Journal Article: Prerau, D. S. 1990. Developing and managing Expert system: Proven Techniques for Business and Industry. Reading MA: Addison-Wesley.

[12] Book: Gale, W. A., ed. 1986: Artificial Intelligence and statistics Reading, MA: Addison-Wesley.

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