Telemedicine Experience in Latin America “MANIAPURE program in Venezuela”

1. Telemedicine Experience in Latin America“MANIAPURE program in Venezuela” ATA/ATALACC Panama,Aug.17 2008 Eng.Morel Orta/Tomás Sanabria M.D.

2. Pintor Walter Arp ,< 1965 buscando el gallito de las Rocas llegó a Maniapure

3. Maniapure Naturaleza y ciencia

5. Where do we come from? We work in very isolated communities

6. Where do we come from? Centro la Milagrosa Maniapure region Cedeño district Bolívar State, Venezuela

7. Centro La Milagrosa - Maniapure

8. A Physician and comunication made the difference ! Primary care at Centro La Milagrosa ADS Medicine : one MD on his Rural year & clerckships with 6th year medical students UCV Last year Dental Medicine students from UCV y USM universities and others Clinical Lab & Bioanálisis > 400 patients monthly at CLM Dental primary care since 1998 Centro La Milagrosa ADS students UCV since January 2001

9. after Our Experience before

10. Our Experience Top Specialty doctors available for the most remote regions • Rural MD makes primary evaluation • second opinion request vía Internet. • Confirmatorio sub-specialty consultation • we have been able to solve complex cardiovascular and neurosurgical cases without delays.

11. Our 13 yearExperience Reproduced in 3 months Wonken - Municipio Gran Sabana

12. Our Experience WONKEN - Gran Sabána - WiFi

13. Who are we ? Telesalud de Venezuela is a private company created by health and IT professionals whose experience originated in the Maniapure project. The company is dedicated to provide telemedicine services to rural (and more recently urban) areas of Venezuela . Our program continues to be free of charge to the Maniapure project, but for other clients, services are being financed by private and public institutions, as part of their social responsibility.

14. Our Experience Ability to solve problems fast Our team follows the community wills Multidisciplinary team Dedication and love for our work Independance in transportation

15. Our Experience Some results from La Milagrosa clinic • 13 years of telemedicine (radio, phone, fax, Internet) • 14 MDs on their rural year (one year each) • > 450 clerckship students on health related sciences • > 100 volunteer clerkships (France, Spain,USA,GB , Japan,Egipt,New Zealand etc) • 1.500 patients/month seen ( regional centers). • Aproximately 5% requiere teleconsultation. • Aproximately 20% of teleconsults require referal.

16. Our Experience Active centers

17. Technical Platform Digital video camera ECG PC Microscope Digital Camera Portable Lab Laptop Laptop or portable device • BroadBand Internet • ADSL • VSAT • WI-FI • BroadBand Internet • ADSL • EVDO • WI-FI Specialty MD Printer VoIP phone Firewall Scaner Rural clients Application Server Web Server Virtual Triage Center Our Operating Model

18. Operating Model Internal Medicine Dermatology Parasitology Cardiology E.N.T. Trauma- Orthopedics Specialty MD’s Broad Band Internet Second opinion Web based application Virtual Triage Center (VTC) Internal Medicine specialist Second opinion Web based application Broad Band Internet Rural health prof. Rural Clinic Rural Hospital Other clients Remote clients

19. Operating Model Processes Virtual Triage Center (VTC) Remote client Specialty MD’s • Generates teleconsultation and sends it to VTC. • Receives answer from VTC and makes decision by his own criteria. • Consults medical literature online. • Demands second opinion at medical sub-specialty centers. (fourth level institutions). • Physician at VTC receives second opinion request and answers general specialty questions. • Forwards sub-specialty questions to sub-specialty related health care professionals. • forwards to clients answers received from sub-specialty physicians. . • Generates service statistical data and billing information for administrative purposes. • Afiliated sub-specialty physician receives and answers requests received from VTC.

20. Operating Model Telesalud Web page

21. What can we offer ? • We can offer a wide range of services among which : • Second medical opinion services. • • Consultation and site assesment for the installation of rural telemedicine services. • • Telemedicine project management. • Telemedicine web based application design. • • Telemedicine equipment providers. • Telehealth personel education and training.

22. What can we offer? technology telesalud People with needs (patients & communities) $$ Financial resources Human resources (universities & local)

23. What can we offer? Telemedicine components Knowledge & Experience Training Human Resources • Students and clerckships • General Practitioners • Subspecialties (Health & Technology) Technology • Software and applications • Telecomunication • Hardware & software (TI) • Medical equipment

24. Dr.J.R.Arosemena’s visit to Maniapure-LaUrbana-Tumeremo-La Esperanza-Uriman and Kamarata 12 Flying hours

25. Where are we going ? La Esperanza -Guyana border 50 kms in 3 hours.First Internet conexion on Sat.Jan 19 2008 at 11 pm…

27. Where are we going ? January 2008 - Urimán ATALACC President , Dr J.R. Arosemena ,visits Uriman at gives advice to “microscopist”

28. PC-ECG con USB y sala Telemedicina Urimán

29. Learning from Others… Tuba City Flagstaff ( 3ra ciudad de Arizona)

30. Ecocardiografía = vía Internet

32. Colorado valley / near Maniapure May 2008

33. telecardiology

34. Tele-ophtalmology ?

35. Colorado 2008 evaluation results: -470 patients screening for tropical diseases. ->200 patient ophtalmol. Evaluat. -25 echocardiograms (2 surgical congenital cases detected / ASD and VSD).

36. PortableLight™ project portableLight can be charged in 3 hours of sunlight and provide 8 hours of working light (100 lumens) and connected provide energy for small medical equipment.

38. Curiapo – Orinoco Delta

40. First “Excelence Price” for 2008 From: "Proyectos" <proyectos@venezuelacompetitiva.com> Subject: DATOS REUNIÓN CASOS GANADORES PREMIO A LA EXCELENCIA 2008 Date: August 11, 2008 5:21:38 PM GMT-04:30 To: <tomasana@cantv.net>, <tomasana@mac.com> 2 Attachments, 6.6 KB Save Slideshow Estimado Dr. Sanabria, Tal como conversáramos hace un momento, el día viernes 15 de agosto estaremos realizando la presentación de los casos ganadores 2008. La reunión se realizará en la sede de nuestras oficinas: Dirección: Campo de la Universidad Metropolitana, Centro de Artes Integrales (Colina Creativa), Módulo 3, Planta Alta, Terrazas del Ávila. La hora de la reunión: 9:00 am Punto de referencia para llegar: Como quien viene a Supermercados Éxito, en el portal de la Universidad Metropolitana encuentras dos puertas: Entra por la izquierda que dice Universidad Metropolitana, y en la primera sigues a mano izquierda (como quien va al Colegio Ávila). Allí está el estacionamiento y la Colina Creativa. El modulo 3 está justo encima del Gimnasio. Para nosotros será un honor contar con su presencia. FELICITACIONES! Cualquier otra información adicional, puede comunicarse con nosotros. Cordiales saludos, Andreina

41. thank you !! www.tele-salud.com www.maniapure.org