CHAPTER 3 PROBLEM ANALYSIS. As this research is titled, which is RFID for diabetics, it represents the whole idea of this

Transcription

1 CHAPTER 3 PROBLEM ANALYSIS 3.1 Specification of Research Object As this research is titled, which is RFID for diabetics, it represents the whole idea of this research. Previously, it has been stated that the number of deaths caused by diabetes is increasing every year and also the number of people with diabetes goes higher and higher. Diabetes is not a dangerous disease when it is controlled well and supported by a proper medication. Unfortunately, in many cases, diabetics cannot be helped in emergency situation since doctor in charge does not know the patient s medical history. It is important to have patient s medical history, because not all people can accept any kind of drugs, some of them might have allergy to particular drugs. Therefore, one of the main causes of late medication is lack of information regarding the patient. In information technology field, a new identification system is found. At first, this identification system was to replace the old one which is bar code that we used to see at bookstore and supermarket for identifying item s price and name. While in business field, people found trouble for inventory system. They need to record and track thousands of items at one time and back when they used paper based technique, it was very time consuming and unreliable. Afterward RFID was found to overcome these problems.

2 41 RFID which stands for Radio Frequency Identification, has three major components, they are : tags, readers and middleware. RFID tag is the one used for storing information and this tag comes in various choices of size and price. Usually, RFID tags are attached on the items, but today s technology has developed a very tiny RFID tags that are possible to be planted. While RFID reader is the device that can capture the information stored in the tags by scanning them. The last one is RFID middleware; it is a bridge between RFID and other application which needs the information from RFID system. Finding out about RFID as an interesting technology for storing information, I came up with an idea of implementing RFID for medical history recording. RFID has many benefits over today s practice on handling patient s medical history, some of them are : RFID as pervasive computing Since RFID tags can be attached to any items that needed to be identified and the identification process can be done at any time, thus RFID is called as pervasive computing. The idea of pervasive computing is information processing has been integrated into daily activities. Therefore, system with RFID applied has more flexibility regards to time and place. This is what medical history recording system needs. When there is a situation where a diabetic need an emergency medication, doctor needs to know his history to consider what kind of medication he usually gets, what diet he is working on, does he have inherited illness, and many information. This information commonly is stored in a big file cabinet, if they still use a very primitive method or they store in hospital / clinics database system. Imagine if the patient get

3 42 attack when he is traveling while his medical data is at hometown hospital. It will take much time to send and receive his medical record, while supposedly he gets medication as soon as possible. In this situation, pervasive computing is really needed to have a quick and right action. Therefore, RFID is suitable for medical history recording system. It might seem that people are treated like items, but look at the benefits we can get. If people traveling with medical history in their hands at the same time, the feeling of fear, worry and threatened won t be occur anymore because they realize that any doctor can help them and give the right medication. RFID can handle multiple items at one time As explained on previous chapter about RFID basic knowledge, that RFID reader overcome the problem of barcode reading issue which is the need of line of sight. In RFID system, the readers do not need to be one line with the scanned item however the information inside the tag still can be captured as the tag has been scanned. This capability makes RFID reader can handle multiple items at a time and this is more efficient in terms of time and cost. When there is an accident and many people are injured, they have to be carried to the nearest hospital as soon as possible. Thus, at the same time, medical units have to react fast, careful and accurate. Among those people who injured, there must be some of them with particular disease, especially diabetes. Once again, people with diabetes need special treatment. If the level of glucose is well controlled, then the

4 43 wound will heal like on normal people, but if it shows the opposite, an advance medication is needed to heal the wound. In a terrible accident, victims are not just one or two people, sometimes twenty, fifty or maybe hundreds. If so, then medical units have many medical history records to be collected. By implementing RFID as medical history recording system, collecting patient s medical history is easier to do, even though the number of records to be found is big. Using RFID, not need to call patient s personal doctor and hospital where his usually get medication, because he is carrying all the information needed with him anytime anywhere. As the result, to get patients medical history is as simple as scan his RFID tag that is attached to him. Since RFID readers can handle multiple items thus the same benefits also occur for maintaining numbers of patients at the same time. Knowing that many people die because of diabetes, including my father and grandmother, I am very concern about this issue and expecting a solution so that the same case will not happen again to others. I think RFID is the solution of this problem. To be sure of this idea, I write this thesis and RFID as the main research object. This thesis will cover what is RFID, how RFID save people lives, how RFID tags are attached to people, how RFID system works and what facilities needed to support this system. 3.2 Sampling Method One most important elements of a research is data. Data represents the significance of the research whether the research is valuable enough to be done or not. The data used

5 44 has to be reliable. Generally, reliable data is provided from trusted organization for example world organization, national department and census organization. It is also possible to collect data directly from the source by interviewing and questioning. Interviewing is asking some questions directly to the source and it is a face to face communication, while questioning is a paper based collecting data by providing some questions that respondents have to answer. Survey to particular population is one of the methods of collecting data. In some research, data has to represent a big range of population and sometimes it is not possible to collect data from each individual. One solution for this problem is using sample. In statistic, sample is a part of population where its elements are represented each variety of whole population. As example, a research for calculating percentage of students with tattoo in Indonesia, it is hard to count one by one, thus sample can be used in this case. In research of RFID for diabetics, I need to know the number of people with diabetes, particularly in Indonesia. Fortunately, there are organizations that responsible for managing Indonesian health, so that I get the data from these organizations. The data that support this research is obtained from World Health Organization and Indonesia Ministry of Health. To support this research, the following data is provided : Mortality level caused by diabetes Occurrence of diabetes

6 45 Indonesia population Indonesia major health problem 3.3 Data Analysis This section shows data that support the idea of implementing RFID for diabetics. All data are collected from reliable organizations; they are World Health Organization (WHO) and Indonesia Minister of Health (Depkes RI). World Health Organization has estimated the mortality from diabetes in the world as 987,000 deaths for year 2002 and it was 1.7% of total world mortality. Moreover, it was also estimated to be at least 170 million people with diabetes in the world in year As a result, mortality attributable to diabetes could be higher, since diabetes is a serious and can be chronic condition. The following table shows statistic data representing the number of deaths attributable to diabetes in year 2000 based on WHO article, titled The Burden of Mortality Attributable to Diabetes Realistic estimates for the year The objective of having this statistic is to estimate the global number of deaths due to diabetes in year A computerized generic formal disease model (DisMod II) was used to calculate these numbers. DisMod II is a software program, developed for the Global Burden Disease 2000 study and routinely used by WHO for disease estimates.

7 46 Table 3.1 (Partial) Estimated number of deaths attributable to diabetes (thousands) [17] Number of deaths attributable to diabetes 0-34 years years 65 years All (M/F) (M/F) (M/F) (M/F) All AFR 20.0/ / / /152.1 All AMR 2.3/ / / /239.1 All EMR 1.9/ / / /70.9 All EUR 4.8/ / / /250.6 All SEAR 29.1/ / / /538.8 All WPR 3.0/ / / /246.4 **) AFR, African Region ; AMR, Regions of America ; EMR, Eastern Mediterranean Region ; EUR, European Region ; SEAR, South East Asia Region ; WPR, Western Pacific Region Based on the above table, global excess mortality attributable to diabetes is estimated at 2.9 million deaths (1.4 million men and 1.5 million women) and it is equivalent to 5.2% of all-cause mortality in year 2000 ; 1 million deaths in developed countries and 1.9 million deaths in developing countries. As conclusion of above table, South East Asia region place the highest number of deaths attributable to diabetes and the peak was in people aged years. Moreover, people with diabetes younger than 35 years, 75% of all deaths were attributable to diabetes, while people with diabetes aged years, 59% of deaths were attributable to diabetes and people with diabetes older than 64 years,

8 29% of all deaths were attributable to diabetes. The conclusion of above table is illustrated by the following diagram. 47 Figure 3.1 Variation in number of deaths attributable to diabetes according to lowest and highest RR of death [17] **) RR the ratio of the mortality rate among individuals with diabetes to that among individuals without diabetes. The following table is Indonesia demography summary in order to show the situation of our main focus in this research. Based on WHO statistic, Indonesia is in the fourth place of top ten countries in numbers of people with diabetes after India, China and USA. This is not good news and as Indonesian, we have to concern to our health issues. Moreover, in the table 3.3, it shows the top ten causes of deaths in Indonesia, and one of them is diabetes mellitus.

9 48 Table Summary of Indonesia Demography [34] Year Males Females Both Sexes Population (millions) Life expectancy (years) Under-5 mortality (per 1,000 live births) Adult mortality (per 1,000) Maternal mortality (per 100,000 live births) According to Intercensal Population Survey, BPS Statistics Indonesia in 2005, population in Indonesia was 218,868,791 people, excluded Nanggroe Aceh Darussalam and Nias which was 5,493,504 people. Categorized by ages, the population detail were : 0 4 years : 19,095, years : 42,870, years : 141,484, years : 9,925,983

10 49 Table Top ten causes of death, all ages Indonesia, 2002 [35] Causes Deaths (000) (%) Years of Life Lost (%) All Causes Ischaemic heart disease Tuberculosis Cerebrovascular disease Lower respiratory infections Perinatal conditions Chronic obstructive pulmonary disease Road traffic accidents Diabetes mellitus Hypertensive heart disease Diarrhoeal diseases As seen on above table that diabetes mellitus is cause number 8 of top ten causes of death in Indonesia. Moreover, diabetes killed about 46,000 people in 2002 which was 3% of population. In addition, Indonesia was also recorded as the top fourth country with most diabetics in the world. Therefore, we should concern about this issue to shrink the 3% instead of having number of deaths due to diabetes grows higher and higher.

11 Procedure Any systems certainly have particular standard of procedure. These procedures explain what steps need to be taken for effective and efficient usage of systems. Procedures also ensure the success of working systems, meaning systems will work well, efficiently and effectively as the procedure is followed properly. A good procedure is one that leads users easily to get what they expect from the system. For example, when a customer wants to apply a credit card, they need to provide ID card, pass book and salary report. Next step is filling application form and wait the approval from the bank. This is an example of procedure that commonly seen. There is a procedure of taking patient s medical history. This can be done either informal or formal. The informal procedure is when in charge doctor asks to family and relatives of the patient about his daily medication, family health history, his present disease and so on. Meanwhile, formal procedure of taking patient s medical history is done doctor to doctor as the one who has right to know patient s medical history detail. This communication between doctors can be done by phone call or direct meeting. Generally, phone call is the first choice since distance is no more problem and it is very simple way to communicate. Nurse, receptionist or other medical units do not have right to issue patient s medical history. They might accept the demand to issue medical history, but they need to have related doctor s approval. These procedures sound familiar and simple. They might be simple yet with some conditions. Making phone call is easy to do, but it does not guarantee that the person we need to speak to is available at the same time when we are. As a result, we cannot reach

12 51 the person we need to talk to and usually we make another phone call in some minutes later. This kind of case can be classified as wasting time, whereas the information from this person is very important and we need it as soon as possible. Though distance is not a matter, it also does not guarantee the success of direct communication. Once again, the problem is whether the person we need to talk to is available or not. As conclusion, to have direct communication, both parties have to be available at the same time. Since we are used to this standard of procedure, in some way we are lack of concern about the negative possibility of this procedure. Other than availability problem, this procedure also has weakness in reliability and accuracy. Refer to the explanation about procedure in taking patient s medical history, we found that human participation dominate the whole procedure. Therefore, human error occurrence might be another problem of this procedure. Under some circumstances such as panic, in rush and emergency, people tend to make mistakes. The most common mistake happened in this procedure is hand the wrong information, for example giving other s medical history with the similar name. Moreover, people cannot memorize all information and state them exactly one by one when they are asked. Thus, doctor cannot rely on people s testimonial since there are completeness and accuracy problem. Having above description regarding procedure of taking patient s medical history, we found that today s procedure is simple, yet unreliable and ineffective. This can be a serious problem, particularly dealing in medical field where people need immediate action. Therefore, advance procedure should be developed to gain better services in taking patient s medical history.

13 Existing Problem People change; we often hear about this saying, but in what aspect do we change and what is the proof. People change in every aspect of life and one of the aspects is lifestyle. Unfortunately, today s lifestyle ruins people s health. The lifestyle we are living now is closed to fast food and less work out. As we know, time is getting expensive since people now focus on their jobs to gain wealth and reach richness in life. Therefore, they spend most of the time in the office, sitting on chair and working with their computers. It is common to have meal on the desk and what they are eating; it is fast food, for examples: french fries, burgers and a glass of soda. Why do they choose fast food instead of fresh cooked meal? Just like it is called, fast food, it is fast served, simple to carry and affordable. Compare to its simplicity, fast food has more disadvantages. The combination of nutrition in fast food is not properly combined. Fast food contains more fat and carbohydrate, while protein, vitamins and mineral are not enough supplied. The following table shows the nutrition fact of fast food as meal. Table Nutrition fact of fast food Fat Carbohydrate Protein French fries (medium) 20g 47g 4g Big Mac 30g 47g 25g Coca cola (12oz can) 0g 39g 0g Today s lifestyle is not just about fast food, more fact that also support ruining people s health is less work out. It is stated on previous paragraph that people now are spending most of the time sitting on their chair and working with the computers. If they have time

14 53 off, watching television or playing video games becomes number one choice instead of having exercise. This condition is not able to balance the consumption of meal, especially fast food. The habit of having fast food and less work out leads to health problems. The major problem is obesity. It is certainly will happen since there is no fat burning inside the body while meals add more and more fat every time we eat. Obesity and diabetes type 2 is close related. Weight gain might lead to insulin resistance and the result is pancreas has to work harder producing insulin. Moreover, physical inactivity also might cause insulin resistance. Thus people with obese should concern about their weight and do proper diet to be saved from threat of diabetes. World Health Organization (WHO) records that 60% of the global population do not have enough physical activities and according to International Obesity Task Force (IOTF), in 2002, it was recorded about 58% of diabetes globally can be caused by body mass index (BMI) above 21 kg/m 2, classified as overweight. Moreover, WHO statistic data shows that in year 2000, the occurrence of people with diabetes was approximately 171,000,000 people and it is predicted the number will grow up to 366,000,000 people with diabetes in year Other than that, WHO also records that three million people die every year due to diabetes. While in Indonesia, WHO records that the number of people with diabetes in 2000 was 8,426,000 and this number is predicted increasing to 21,257,000 in year Indonesia is the fourth country in the world with the most people with diabetes. We also have to

15 54 concern about the 3% of population die every year due to diabetes. If we cannot shrink this 3%, thus in 2030 the number of deaths attributable to diabetes will become 212,570 people. Diabetes is known as severe disease since it can cause complication to other disease, for example heart disease and stroke. In fact, people with diabetes can live freely and happily with some conditions. Proper control, right medication, healthy diet, physical activity and avoidance of obesity are conditions that diabetics need to perform in daily life. However, people with diabetes have unstable condition; the level of glucose is easily changed when they miss a diet. This kind of situation is happened often and it needs a right and fast medication. Another problem is found regards to emergency situation. As I clearly explained earlier in chapter 1 and this problem is the main concern of mine when proposing this idea to be a research thesis, it is medical history. In emergency situation like my father and grandmother had in the hospital, medical history is one thing that very important before further medication is done. Nevertheless, an effective way to get medical history from patient has not been invented. Based on my experience, hospitals here are still using conventional way, which is making a phone call to the related doctor who usually takes care of the patient. The fact is making phone call is very time consuming and it is not reliable, because it might have sound disturbance during the conversation so that the information received is not the right one. Late information holds back medical unit to give the right first aid and this makes patient s condition worse or might lead to death.

16 The same impact will result when wrong information is received. Therefore, medical history is something that its occurrence is very significant and cannot be abandoned. 55 This research has focus on problem of providing medical history especially for diabetics. Since diabetes is a serious disease and has to be handled as soon as possible with proper medication, thus the occurrence of medical history is very important. Indirectly, by providing reliable medical history, it will reduce the number of deaths attributable to diabetes because of right medication can be done as patient get in to hospital.