iPath telemedicine platform to support health providers in low resource settings

1. iPathtelemedicine platform to support health providers in low resource settings K. Brauchli*, D O‘Mahony, L Banach, M Oberholzer* kurt.brauchli@unibas.ch

2. Outline • What is iPath • iPath - a hybrid web and email solution • iPath Worldwide • Case Studies • Teledermatology in South Africa • Telepathology on Solomon Islands • Telemedicine and Tele-teaching

3. What is iPath • iPath - an open source software to build telemedicine platforms. Developed at University of Basel • ipath.ch - an association to promote telemedicine and to support projects in developing countries

4. iPath - hybrid web and email solution • Telemedicine platform based on web server • Access via web and email • Collaboration in (closed) working groups • Case archive • Automatic and personalised notifications

5. The telemedicine platform

7. Sending cases: email

8. Sending cases: email www

9. Sending cases: email www special equipment:e.g. remote control microscope, ultrasound ...

10. Reviewing cases: email (alerts)

11. Reviewing cases: email (alerts) web interface

12. Reviewing cases: email (alerts) web interface special remote control (e.g. JAVA applet)

13. User Interface User registration

14. User Interface Personal start page - List of the groups - New cases and comments at a glance

15. User Interface Group Display - case list

16. User Interface - Comments/Diagnosis New comments: automatic email alert Case Display - Description & Images

17. iPath worldwide Users Productive servers In testing planned

18. Usage usage statistics of iPath (24.12.2004) * average file size 93KB. Besides images there were another 5864 files ** only 47% of users specified country of origin

19. Usage

20. Case Studies • Teledermatology in Eastern Cape, South Africa • Telepathology in Solomon Islands • Telemedicine in Perinatal Health in Ukraine

21. Teledermatology in South Africa Regional Telemedicine Network Server at University of Transkei, Mthatha, South Africahttp://telemed.utr.ac.za UNITRA Tsilitwa Port St. Johns

22. Teledermatology in South Africa Pilot in Port St. Johns, Eastern Cape • GP in rural South Africa • Small town ± 8 000: District 75 000 • Dermatology: 14% of FP consultations (SA) • Next Dermatologist: 400km

23. Teledermatology in South Africa • Teledermatology since 1999 • No of consultations: 110 • Median response time: 8 days

24. Teledermatology in South Africa

25. Teledermatology in South Africa OUTCOME FOR GP: • I learnt a lot and even though I may have sent some cases late for teleconsultation, one of my main objectives of learning was achieved. • Even though I may have had the correct diagnosis, it was a good learning experience to have my diagnoses confirmed. • The number of cases dropped off over the years. This is definitely due to my improved skill in diagnosis due to learning.

26. Telepathology in Solomon Islands

27. Solomon Islands

28. Solomon Islands National Referral Hospital Solomon IslandsCapital: HoniaraPopulation: 450‘000Islands: ~1000Independence: 1978 Doctors: 15 (30)Radiologists: 1Pathologists: 0Dermatologists: 0

29. Limitations • Shortage of medical specialists- no dermatology, pathology, cytology …. • Shortage of access to health care - many patients come to hospital in advanced stages. • No access to current information- no medical libraries, few current literature, no senior colleagues, no continuing medical education (CME)

30. Limitations • Limited Transportation- no roads or very bad roads

31. Histology Lab Tissue Processing Preparing blocks Cutting Staining Histology slides

32. Remote Consultations Step 1:Selected images captured with digital camera (Nikon CoolPix 990) and submitted to server in Basel via email Step 2:Cases are reviewed by a group of 7 pathologists(Switzerland, Germany and South Africa)

33. Results (2002-2003) Source: Brauchli et al. J Telemed Telecare. 2004;10 Suppl 1:14-7.

34. Perinatal Health in Ukraine • Project of Swiss Centre of International Health • Health System reform • Improve knowledge of Ukrainian practitioners • Foster evidence based medicine • Support regional clinics • Decrease amount of unnecessary referrals

35. Perinatal Health in Ukraine

36. iPath in Teaching and CME • Clinical Meetings / Tumor Boards • Publish content - teaching modules, samples cases, etc. • Remote Presentations • (soon: offline version of content for CD etc.)

37. Tumor Board Meetings

38. Low Resource Settings • Technology must be locally available and manageable • It must be possible to integrate usage of telemedicine into daily routine(>70% submissions by email) • Little “local ownership” of telemedicine projects

39. Low Resource Settings • Access to training and health information is very difficult in developing countries • Professional isolation (solo practitioner without senior colleague) ==> “Brain Drain”

40. Problems • Access to Computer and Internet • Incentives - who benefits from telemedicine? • Missing exchange between projects and networks==> “e-fragmentation”

41. E-fragmentation Telemedicine E-learning Helath InformationAccess Teleradiology Teledermatology Tele HIV care DiagnosticsTreatment Publishing Education

42. Integrated Health Information Exchange Studies, Research Evidence Base Dissemination FeedbackQuality Control Scientific Publishing Tele-Teaching Telemedicine Case Specific Information General Information

43. A way forward • Connecting different telemedicine projects • Increase knowledge sharing and transfer • Combine telemedicine with: • Teaching • Access to health information

44. Local ownership • Open Standards for data • Open Source Software is an opportunity for developing countries to ensure ownership of data. • Examples: UNITRA, HealthNet Nepal, AIMSHOSPITAL (India) • Plans: Ethiopia, Francafrique

45. iPath More information:http://ipath.ch

48. iPath for you ? • Deploying iPath as technical basis fo a telemedicine platform - iPath is open source and freely available. • Participate in the Basel telemedicine network - as expert or non-expert. • Pathology • Dermatology • Perinatal Health