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Telemedicine

Telemedicine. Definition : The practice of medicine at a distance. A successful telemedicine program often starts with a face to face meeting. Then…ORBIS Telemedicine, Cyber-Sight. Provides low cost extended presence connecting doctors on a continuous basis. Cyber-Sight. How does it work?.

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Telemedicine

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  1. Telemedicine Definition: The practice of medicine at a distance

  2. A successful telemedicine program often starts with a face to face meeting

  3. Then…ORBIS Telemedicine, Cyber-Sight Provides low cost extended presence connecting doctors on a continuous basis

  4. Cyber-Sight How does it work?

  5. information original links  The Server sends consult receives consult P M Located at Flight Safety, Flushing, NY receives answer sends answer

  6. E-Consultation • As described in the previous slide offers partners the opportunity to obtain consultation on difficult patients from an expert with the added opportunity to interact during the evaluation process and to share results of treatment in these patients

  7. The consultation process goes like this: • The partner is identified, trained, assigned a passwordand user name, andwhen needed given a camera and computer • The partner is assigned to a mentor team • A challenging patient is photographed by the partner and the history and pictures of the case are uploaded and sent • The mentor is alerted, answers the consult, and a dialogue is established • The partner closes the case when it is completed

  8. Mentor Teams are made up of experts in the following sub-specialties • Cornea • Retina • Glaucoma • Oculo-plastics • Pediatric ophthalmology/strabismus • Uveitis • ROP • Genetics • Retinoblastoma • Cataract • Neuro-ophthalmology • Etc.

  9. The patient’s clinical condition is documented with a digital camera* *The camera should be set at 640x480, PC or TV to obtain smallest picture

  10. Partner logs on to web site • Go to: www.orbis.org • Click on Cyber-Sight (left side of screen scroll down ¼ screen) • Click on Cyber-Sight again on right side of screen • Click on E-consultation • Add user name and password– these are assigned by ORBIS • This brings up the formatted page for patient information upload

  11. Partner sees this screen and is greeted by name

  12. Partner Selects sub-specialty from “drop down” menu

  13. Sub-specialty selected

  14. Strabismus format

  15. Pictures have been uploaded

  16. Partner submits this information I know the child needs glasses, patching, and surgery. How would this be done best? Should I cut the plus? If so should I cut the same percentage in each eye? Is it possible that wearing glasses will result in alignment? What should I do first?

  17. The mentor sees the patient information, pictures, diagnosis, plan, and questions

  18. The mentor Answers

  19. A dialogue continues until The partner closes the case

  20. Cyber-Sight Some examples of consultations

  21. Mentor diagnosis:Brown OS Partner diagnosis: Double elevator palsy

  22. Partner diagnosis: Duane Type III Mentor diagnosis:Duane Type II

  23. Mentor suggestion:Simultaneous abduction: Duane IV Partner diagnosis: Left eye fibrous tissue

  24. Partner diagnosis:Blowout fracture postop, recess RSR Mentor advises:Forced ductions, likely need to free RIR

  25. Subconjunctival hemorrhage: Partner and mentor agree

  26. Partner and mentor agree: Conjunctival laceration

  27. Note double ring sign of optic nerve hypoplasia Mentor: Unilateral hypoplasia of the optic nerve Partner: Amblyopia?

  28. Partner: Corneal dermoid Mentor: Agree – corneal dermoid

  29. Partner: What is it? Mentor: Epithelial implantation cyst

  30. Partner: What is it? Mentor: Granular dystrophy

  31. Partner and Mentor agree: Traumatic cataract

  32. Partner: Corneal foreign body Mentor: Agree – treat rust ring

  33. Partner: Intraocular tumor – what is it? Mentor: Retinal angioma

  34. Partner: Retinal angioma Mentor: Agree – retinal angioma

  35. Partner: Foveal cyst Mentor:Idiopathic retinal epithelial detachment

  36. Partner: Retinoschisis Mentor:Traction detachment

  37. Three unusual and instructive cases…

  38. Mentor: I agree – LSO palsy; could the left SO tendon be missing? Partner diagnosis:LSO palsy

  39. Absent muscle Absent trochlea Partner: What about the tendon? Mentor: The left superior oblique tendon complex is absent or severely atrophic

  40. Partner diagnosis: Congenital RSO palsy, 3 surgeries, what next? Mentor suggestion:CT for presence of RSO Trochlea present Muscle absent

  41. I see two trochleas

  42. Partner points out absence of RSO muscle belly

  43. Partner diagnosis: Brown OD vs. LSO palsy Mentor comment:Most likely Brown OD; LSO palsy a long shot; depends on traction test

  44. Partner demonstrates traction test – normal OD, lax OS Partner finds Absent LSO tendon at exploration

  45. Two other parts of the Cyber-Sight Program:

  46. E-Resource • Ophthalmology Minute • Featured Cases • Question of the week • Decision Making in Strabismus • Eye Pathologist (link)

  47. E- Learning • BCSC questions • Student course activity log in • CME opportunities

  48. BCSC and CME

  49. Cyber-Sight is ORBIS Telemedicine • Full program initiated spring 2003 • 140 mentors • 296 partners • 68 sites • 32 countries • 135 mentors 40 answering consults • W2,075 consults – 6,000 communications • 1,372 strabismus / ped. ophth. • 200 E-Learning students

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