IJEMD-CSAI, 2 (1) (2023), 1 – 9 https://doi.org/10.54938/ijemdcsai.2023.02.1.
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International Journal of Emerging Multidisciplinaries:
Computer Science and Artificial Intelligence
Research Paper
Journal Homepage: www.ojs.ijemd.com
ISSN (print): 2791-0164 ISSN (online): 2957-5036
Multi-agent Intelligent System Design for Telemedicine
Applications to Develop Health Care Systems of Developing
Countries
Mohammad Hameed Ahmed1*, Subhi Hamadi Hamdoon2
1College of Computing and Information Sciences, University of Technology and Applied Sciences (UTAS), Suhar,
Sultanate of Oman.
2 Radiation Tech. Department, Al Noor University College, Mosul- Iraq.
*Corresponding author
Abstract
Various factors controlling health care in any country, but still there is a weakness in the infrastructure of health care systems
in some developing countries, including many Arab countries, due to the shortage of medical specialists personnel, global
economic crisis, and wars and disasters that struck many countries. A crying need for a tele-medical care becomes a necessity,
and in order to overcoming this weakness we have proposed a multi-agent intelligent Telemedicine system in this research, this
prototype consists of two main units one for the specialized doctor and one for the patient, both of them are communicating
online through some Telemedicine applications and exchange information via different types of cloud databases. The proposed
system can help solve the shortage of specialists urgently and at lower costs. Furthermore, it can save the efforts of the patients'
expensive travel for treatment abroad. Moreover, it can avoid infections from social closeness in times of
disasters and pandemics.
Nowadays Telemedicine systems have gradually become a popular medical model which have always attracted much attention
due to the continuous development of the multi-agents' structure and capabilities of the artificial intelligence systems. So we
will focus in the prototype design of our system on the algorithms, techniques and devices that support the multi-agents' structure
and AI technologies. The Multi-agent approach happens to be a suitable structure for the development of Telemedicine systems.
Worth mentioning it can solve problems that are difficult or impossible for an individual agent or a monolithic system, and the
AI capabilities will minimize human errors and improve health care outcomes.
We will start by a state-of-the-art literature survey as conducted on the E-health system architecture, AI capabilities, and multi-
agent platform, and then we will illustrate prototype design of the suggested Multi-agent intelligent system for Telemedicine
which will contribute in the development of the health care systems in the developing countries.
Keywords: Artificial Intelligence; Healthcare System; Medical System; Multi-Agent; Telehealth; Telemedicine
Email addresses: mohammed.ahmed@utas.edu.om (Mohammad Hameed Ahmed), sebhi.hamadi@alnoor.edu.iq (Subhi Hamadi
Hamdoon)
2 International Journal of Emerging Multidisciplinaries
1. Introduction
One of the most rapidly evolving government sectors in any country is the healthcare industry. Today, the
healthcare system in the developing nations is facing the various challenges presented by economic crisis,
wars and disasters.
Over the past 10 years, debates on global health have paid increasing attention to the importance of health
care systems. It has become especially important to emphasize health care systems in low- and middle-
income countries because of the substantial external funding provided for disease-specific programs,
especially for drugs and medical supplies, and the relative underfunding of the broader health care
infrastructures in these countries. Recent analyses have drawn attention to the weaknesses of health care
systems in low- and middle-income countries especially the developing countries. The strengthening of
health care systems in these countries must be seen as a long-term developmental process [1].
A multi-agent system (MAS or "self-organized system") is a computerized system composed of multiple
interacting intelligent agents [2]. It can solve problems that are difficult or impossible for an individual
agent or a monolithic system to solve. Nowadays, agents have an important and basic role in many practical
programs of E-health among which the disease diagnosis system. The best ideas for creating the practical
programs of E-health and supporting next generation are practical programs and services of E-health multi-
agent systems. Intelligence may include methodic, functional, procedural approaches, algorithmic search
or reinforcement learning [3].
Technology permeates so much of healthcare today that it's impossible to separate Telemedicine from
medical care in general. While not every instance of Telemedicine involves AI, the use of AI within the
field of healthcare has expanded dramatically in recent years. According to a study by MIT, 75% of
healthcare institutions that implemented AI acknowledged an augmented ability to treat illnesses [4].
In this research we will focus on the ability of AI in developing the healthcare systems in the developing
countries through the multi-agent E-health systems that uses different applications of Telemedicine. In the
following sections we will introduce the structure of multi-agent system, the AI E-health systems, and then
we will propose a multi-agent intelligent system for Telemedicine applications which help in the
development of health care systems in the developing countries. The suggested prototype system can serve
all patients in any country remotely through Telemedicine applications that connecting a community
national hospitals and medical main centers in the country with a specialized hospitals in the regional area
and international, and to focus on applying AI algorithms, techniques, and devices in this system in order
to establish a new intelligent Telehealth system for developing countries, this system will fill the shortage
and weakness of the medical care system in these countries.
The aim of this research is to develop a multi-agent system for telehealth care, which has the following
main objectives:
First: It guarantees Tele-diagnosis and other important Telemedicine applications as medical treatments in
qualified and high-quality medical centers with lower costs and without travelling difficulties and costs.
Second: It guarantees that provides the requirements of prevention and protection from infection and
ensures social distancing in times of disasters and pandemics.
Multi-agent Intelligent System Design for Telemedicine Applications 3
Third: It provides various artificial intelligence capabilities of algorithms, techniques and devices; at the
end all these procedures and developments will be increasing the quality of health care system in the
country.
E-health and Developing Countries
Telemedicine refers to the use of advanced technology to deliver healthcare services remotely (E-health).
The terms E-health (Telehealth) and Telemedicine are often used interchangeably, but Telehealth has
evolved to encapsulate a broader array of digital healthcare activities and services. Telemedicine refers
specifically to the practice of medicine via remote means; Telehealth is a blanket term that covers all
components and activities of healthcare and the healthcare system that are conducted through
telecommunications technology.
Telehealth can also be combined with medical insurance system in order to develop health care system in
some countries, Telehealth Medical Insurance System (TMIS) that facilitates communication between the
patients and medical providers remotely through insurance companies guarantee protection rules of dealing
with pandemics, preserve patients from infection by some viruses or other infectious diseases, and it
guarantees medical treatments in a qualified high-quality medical provider with lower prices and without
travelling difficulties and costs. [5]
Several technologies are being deployed for Telehealth including mHealth (or mobile health), video and
audio technologies, digital photography, remote patient monitoring (RPM), and store and forward
technologies, in addition the communications technologies will provide health care from a distance, these
technologies may include computers, cameras, Internet, videoconferencing, and satellite and wireless
communications. Table 1 illustrates the E-health main advantages and Telemedicine popular examples [6]:
Table 1. E-health main advantages and Telemedicine popular examples
E-health Advantages and Benefits E-health / Telemedicine Examples
Enhancing quality and extending domain of health Virtual visit with a health care provider for Tele-
care. diagnosis.
Empowerment of consumers and patients Remote patient monitoring.
More support for people who are managing their Surgeon using robotic technology or do surgery
health conditions from a different location.
Online education of physicians. Sending your provider a message through your
electronic health record (EHR).
Getting care after office hours, and getting care at Watching an online video sent by your provider
home from a specialist who is not close by. about how to use an inhaler.
Lower cost, since virtual visits may be cheaper Getting an email, phone, or text reminder that it's
than in-person visits time for a cancer screening.
4 International Journal of Emerging Multidisciplinaries
Recently, in the developing countries, including Arab countries, Telemedicine has been gaining popularity
in recent years which includes: Remote Consultations, Remote Monitoring, Telepharmacy, Mental Health
and Medical Education. But some analyses found a lack of innovation in the field of digital health in the
Arab countries and many gaps in research were found in Arab countries, Digital health research was
clustered around themes of big data and artificial intelligence; a lack of progress was seen in telemedicine
and digital health.
Role of AI and Multi-agent in E-health
Artificial Intelligence and Telemedicine go hand in hand today. The application of this technology to the
healthcare system has various benefits like cost reduction, fast processing of patient records, and much
more. There are three main types of telemedicine where artificial intelligence is widely used. Patient
monitoring, healthcare information technology, and Tele-diagnosis are among them. So, let’s look at each
of them in detail [7].
The main AI use cases in Telehealth include information analysis and collaboration, remote patient
monitoring, and intelligent diagnostics and assistance. The power of AI can be leveraged to augment
physicians in their abilities to diagnose and treat patients, mitigate their own burnout and enhance the entire
spectrum of the patient journey. The distributed artificial intelligence is used in creating software based on
intelligent agents in E-health special parts. The controversial issues here are: Communicative protocols
among electronic groups including, negotiation template, virtual chat rooms, role definition, agents’
responsibilities, and reorganizing the system in a dynamic way when new members sign in as agents or
creating a new multi-tasking system with a new objectives [8].
The AI system used is called “deep learning technology,” which is a computer-aided diagnosis. With the
implementation of this technology based on ICTs and AI, benefits can be achieved such as reduction of
diagnostic costs, improvement in the quality of medical care and diagnosis, reduction of the average time
for diagnosis, and extension of remote diagnostic screening services to locations with few specialized
professionals and equipment, as has been shown in other countries [4]. A well-known existing area for
Tele-diagnosis is Tele-dermatology, which lends itself well to automation through AI. Similar promise is
offered in other areas of automated diagnosis such as breast cancer or cervical cancer screening. AI systems
for Tele-monitoring depend on and also expand the scope of other health system ICT components [9].
The agent technology has had a significant growth in all fields, especially in the field of E-health. Multi-
agent systems are following a growing field of distributed artificial intelligence. Coordination subject in
multi-agent systems is the fundamental issue, without which the benefits such as interaction and social
behavior of agents fade. Multi-agent systems in creating and developing vital systems, non-coherent,
dynamic, complex, distributed, and communication between remote users are useful to create E-health
applications [10].
Recently, the agents played essential roles in the practical programs of E-health, which includes the
diagnosing system, facilitating and accelerating the treatment process and avoiding disorganized data
system. The best way to create E-health practical programs and to support the future generation is multi-
tasking systems. Multi-tasking systems are helpful in creating and developing vital, heterogeneous,
dynamic, complicated and distributed systems among agents to make E-health programs practical and
possible [2].
Multi-agent Intelligent System Design for Telemedicine Applications 5
Table 2. Capabilities of AI and reasons for using multi-agent for Telemedicine
Artificial Intelligence Capabilities for Multi-agents Features and Reasons of
Telemedicine using for Telemedicine
AI can provide prompts that make it easier to take a Intelligence and Autonomy
patient’s history during a telemedicine visit,
dynamically adjusting questions based on responses
AI algorithms can also help with diagnostics, Reliability and Reduce human error due to
especially for conditions such as melanoma fatigue, stress, inexperience
AI-based tools can offer personalized reminders for Necessity and Reactive
medication and recommend routine condition
checks based on personal monitoring data.
AI integrates more health data into these systems, Parallelism, Concurrency, and Communication
helping detect patterns pointing to potential issues.
(track daily blood pressure and glucose levels).
Many of the computer technologies and digital tools Extensibility, Adaptability and Cooperation
used by clinicians and patients have built-in AI
AI-driven tools monitor patients, both inside Saving time and costs
medical facilities and outside hospital walls
AI helps clinicians triage patients, diagnose their Easiest Programmable and performing
conditions and plan optimal treatments. automatic functions.
Table 2 stated the capabilities of Artificial Intelligence to Telemedicine and reasons for using multi-agent
systems, all of these combined makes any intelligent Telemedicine system more strong and effectiveness
in developing health care systems in the country [11, 12, and 13].
The prospects for smart healthcare are vast. For individual users, smart healthcare can facilitate better health
self-management. and the content of medical services will be more personalized. For medical institutions,
smart healthcare can reduce costs, relieve personnel pressure, achieve unified management of materials and
information, and improve the patient's medical experience [14].
A Proposed Model for Multi-agent Telemedicine System
Due to the low levels of health care systems in some developing countries, including many Arab countries,
for various reasons, including the global economic crisis, wars and disasters that struck many of these
countries, which led to a weakness in the infrastructure of health care and a shortage of medical personnel.
And in order to overcoming this weakness and shortage urgently and at lower costs and saving effort on
patients instead of their traveling and to avoid infection from social closeness in times of disasters and
pandemics, we have proposed in this paper a prototype design of a Telemedicine system that provides
advanced capabilities, including multi-agents structure and using various artificial intelligence techniques
of algorithms, techniques and devices, so by applying machine learning methods to large datasets of disease
populations, AI is on its way globally to making a significant impact on the way doctors could diagnose a
potential disease. This system can develop the healthcare systems in these countries to a reasonable and
economical extent.
Multi-agent systems are considered as the best and most appropriate technology that can be applied to fulfill
the need required in healthcare system. In multi-agent system, the agents are representing and acting on
behalf of users and owners with very difficult goals and motivations. The agents cooperate, coordinate and
negotiate with each other in the same way that we cooperate, coordinate and negotiate with other people in
6 International Journal of Emerging Multidisciplinaries
day-to-day life and consequently can be used as the best technology to solve the problem arrived in medical
healthcare system [15].
Creating multi agent Telemedicine systems can guarantee better online services to patients. This section
provides a proposed multi agent Telemedicine system which can be used in the developing countries to
provide patients with high quality online medical services and to compensate the shortfall in the medical
care system of these countries. In Figure 1, the use case diagram of this system is displayed.
In this system, patients have direct communication with admission section, Telemedicine application, nurse
(or medical assistant) agent and doctor agent. Doctors and nurses can update medical and nursing
knowledge base of hospital. Agents relevant to the database can be updated. Agent can make sensitive
decisions away from the tiredness and mistake, according to their features, and inform the doctor and the
nurse.
• System Prototype Structure
Fig.1 shows the proposed Multi-agent Telemedicine system prototype, in which there are two main units
one for the specialized doctor and one for the patient,
Fig. 1. Proposed Multi-agent Telemedicine System Prototype
Multi-agent Intelligent System Design for Telemedicine Applications 7
Both of the doctor and patient are communicating online through some Telemedicine applications and
exchange information via the following types of cloud databases:
EHR: Electronic Health Record.
ECG: Electro Cardio Gram.
EDU: Clinical Decision Unit.
RTI: Radiograph and Tomography Images.
The specialist communicates with patient from the specialized hospital through different popular
Telemedicine application (Telediagnosis, Telecardiology, Teleradiology, and Teledermatology). The
patient contacts the specialist either from the community hospital (or clinic) for telediagnosis via
Telemedicine workstation with the help of the General practitioner (GP) in that hospital, or from the
patient’s computer at home for urgent medical consultations.
• System Use Case Diagram
Fig.2 shows the use case diagram of the proposed multi-agent Telemedicine system, in which the specialist
Doctor, and Nurse/Medical Provider are exchanged messages about the patient, each actor has a page in the
Telemedicine application with some specified functions. Doctor and Nurse also communicate with other
different agents of GP doctor and medical providers in the doctor agent or medical provider agent. The
patient, doctor, nurse, and other medical provider communicate each to other from his page in the
Telemedicine application.
Fig. 2. Use Case Diagram of the Proposed Multi-agent Telemedicine System
8 International Journal of Emerging Multidisciplinaries
2. Conclusion
In order to overcome the weakness in the infrastructure of health care systems in the developing countries ،
the shortage of medical personnel urgently and at lower costs ،saving effort on patients’ traveling and to
avoid infection from social closeness in times of pandemics, we have proposed in this research a prototype
design of a Telemedicine system that provides advanced capabilities, including multi-agents structure and
using various capabilities of artificial intelligence.
Agent technology and AI has underwent tremendous expansion in recent years in various disciplines,
particularly in the domain of E-health. The multi-agent system approach and the artificial intelligence
possibilities provide a powerful platform for modeling and solving real world problems such as healthcare.
With the continuous development of multi-agent system and AI technology, gradually Telemedicine
implementation and its uses have become more popular and advanced medical model which has always
attracted much attention and can be used in the development of the health care in several countries. Multi-
agent systems in healthcare data are the best combination possible to utilize the advantages that are available
in the capabilities of AI.
The suggested AI-enabled Telehealth offers contributions in the form of quality improvement and
enhancement of health care system in all countries and improve procedures to be specialized to solve
specific problems in the implementation of Telemedicine. The flexibility of both AI and Telemedicine will
give the endless possibilities for development of E-health systems.
The anticipated outcomes if this system completed implemented according to the proposed prototype are:
for individuals, Telehealth care can facilitate better health self-management. Timely and appropriate
medical services can be accessed when needed, and the content of medical services will be more
personalized. For medical institutions, Telehealth care can reduce costs, relieve personnel pressure, achieve
unified management of materials and information, and improve the patient's medical experience. . However,
there are still some problems in the development process. The solution to these problems depends not only
on technological progress and patients' information security, but also on the joint efforts of patients, doctors,
health institutions, and technology companies.
Multi-agent Intelligent System Design for Telemedicine Applications 9
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