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Telemedicine in Developing Countries K. Brauchli Telemedicine Unit, University of Transkei Department of Pathology, Un

Telemedicine in Developing Countries K. Brauchli Telemedicine Unit, University of Transkei Department of Pathology, University of Basel. Content. Introduction Case study: Pathology in Solomon Islands How to do Telemedicine iPath – Open Source Telemedicine Server Experiences worldwide.

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Telemedicine in Developing Countries K. Brauchli Telemedicine Unit, University of Transkei Department of Pathology, Un

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  1. TelemedicineinDeveloping CountriesK. Brauchli Telemedicine Unit, University of Transkei Department of Pathology, University of Basel

  2. Content • IntroductionCase study: Pathology in Solomon Islands • How to do Telemedicine • iPath – Open Source Telemedicine Server • Experiences worldwide

  3. Solomon Islands

  4. Solomon Islands

  5. Solomon Islands Solomon IslandsCapital: HoniaraPopulation: 450‘000Islands: ~1000Independence: 1978

  6. Solomon Islands Solomon IslandsCapital: HoniaraPopulation: 450‘000Islands: ~1000Independence: 1978 National Referral Hospital

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

  8. Limitations in Developing Countries • Shortage of general practitioners- many rural clinics are run by nurses only • Shortage of medical specialists - many countries have no dermatologists, pathologists, ophthalmologists, radiologists, etc. • No access to current information- medical libraries have no current material, no continuing medical education (CME)

  9. Limitations in Developing Countries • Limited Transportation- no roads or very bad roads

  10. Limitations in Developing Countries • Limited Communication InfrastructureExample: many islands in Solomons have no telephone – communication only my VHF radio.Existing telephones are often slow and too unreliable for stable internet access. • Limited financial resources

  11. Implications • Patients - cannot afford to visit hospital - visit hospital late • Doctors- no access to specialist knowledge- no advise for patient management- no experience with rare diseases- no communication with patient (unless at hospital)

  12. Solomon Islands Pathology • Problem for Pathology Services:–Specimen sent to Brisbane (AU) by air–Time until diagnosis: 60 days! • Patients do not return:–No communication infrastructure– Limited transport

  13. Suggested solution Telemedicine: • Access to advice and diagnosis from remote specialists with the help of telecommunication technologies.

  14. Solomon Islands Telepathology: Phase 1: Histology Lab- September 2001 Phase 2: Establishing remote diagnostics- 2001-2003 Phase 3: Routine diagnostics - 2003 - ....

  15. Phase 1: Histology Lab Needs for Histology Lab: • Operational under local conditions:- frequent power cuts- high temperature and humidity • Sustainable- locally available spare parts

  16. Phase 1: Histology Lab Tissue Processing

  17. Phase 1: Histology Lab Tissue Processing Preparing blocks

  18. Phase 1: Histology Lab Tissue Processing Preparing blocks Cutting

  19. Phase 1: Histology Lab Tissue Processing Preparing blocks Cutting Staining

  20. Phase 1: Histology Lab Tissue Processing Preparing blocks Cutting Staining Histology slides

  21. Phase 2: 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)

  22. Phase 2: Remote consultations Results: • 360 cases submitted and diagnosed • turn-around time 10 days(1-3 days for diagnosis) • Quality of diagnosis (preliminary results, n=80)*:70% identical diagnosis23% minor discrepancies7% major discrepancies** * Full report in preparation** Includes two cases of sampling errors (false negative needle biopsies)

  23. How to do Telemedicine Two basic ways for telemedicine: • Active telemedicine(or real-time telemedicine) • Passive telemedicine(store-and-forward)

  24. Active Telemedicine Active telemedicine: all partners work at the same time in a fully interactive way. Example: Video-conferencing

  25. Active Telemedicine Active telemedicine: all partners work at the same time in a fully interactive way. Example: Video-conferencingPro: Very interactive. Consultant at remote site can influence what and how things are presented at the other side. Con: - All partners must be available at the same time. - Difficult to archive & reuse

  26. Active Telemedicine Problems in developing countries: • High demand on bandwidthVideo-Conferencing: min. ISDN with 128kb/s • Consultant needs to be available in real time(problematic when in different time zones)

  27. Active Telemedicine - Example Tsilitwa Clinic in rural Transkei • No doctor • No telephone lines • Next hospital with 1 doctor: - 30km over very bad road ... during rainy season Tsilitwa community Roads ...

  28. Tsilitwa Clinic

  29. Tsilitwa Clinic

  30. Tsilitwa Clinic Wireless link Sulenkama(hospital) Tsilitwa(clinic) Mountain Sulenkama Hospital Repeater Site

  31. Tsilitwa Clinic Wireless link Sulenkama(hospital) Tsilitwa(clinic) Mountain Sulenkama Hospital Repeater Site

  32. Tsilitwa Clinic Wireless link Sulenkama(hospital) Tsilitwa(clinic) Mountain Sulenkama Hospital Repeater Site

  33. Tsilitwa Clinic Tsilitwa Clinic: • Scheduled meeting with remote doctor on Tuesday morning • More patients visit the clinic(transport) • Less unnecessary referrals to hospital • Continuing education and empowerment for the nurse

  34. Passive Telemedicine Passive telemedicine: Material submitted in advance. “Experts” comment at a later time. Example: consultation by email

  35. Passive Telemedicine Passive telemedicine: Material submitted in advance. “Experts” comment at a later time. Example: consultation by emailPro: All involved parties can work at time convenient to them – easy to schedule.Written requests and comments allow easy archiving. Con: Experts cannot easily influence selection of presented material and cannot ask questions immediately.

  36. Passive Telemedicine - Example Store-and-forward telemedicine with iPath iPath is .... • ... an open source telemedicine platform • ... Developed at University of Basel • ... Originally designed for telepathology but now used in may specialities • ... Optimized for low bandwidth application (email)

  37. iPath - Telemedicine Server • Concept of Technology mediated communication • A central Server • Access via WWW or Email • Discussions and collaboration in defined user groups

  38. iPath - Telemedicine Server • Why do we need anything special for passive telemedicine?won't email be enough?

  39. How to collaborate

  40. How to collaborate

  41. How to collaborate

  42. How to collaborate

  43. How to collaborate iPath = technology mediated communication

  44. Web Application Server: (iPath-Server Software) Case Database- images- comments/diagnoses WWW interface Email interface

  45. Sending cases: email

  46. Sending cases: email www

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

  48. Reviewing cases: email (alerts)

  49. Reviewing cases: email (alerts) web interface

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

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