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Introduction to Telemedicine

Introduction to Telemedicine. Arun Raj Kunwar, M.D. Assistant Professor SUNY Upstate Medical University Syracuse, NY kunwara@upstate.edu. Disclosures. No financial affiliations or interest in any thing that will be discussed No commercial interest. What is TM.

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Introduction to Telemedicine

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  1. Introduction to Telemedicine Arun Raj Kunwar, M.D. Assistant Professor SUNY Upstate Medical University Syracuse, NY kunwara@upstate.edu

  2. Disclosures • No financial affiliations or interest in any thing that will be discussed • No commercial interest

  3. What is TM • Use of telecommunications to provide medical information and services • Health delivery/consultations via use of telecommunications -Telephone between two providers -Fax -Video conference -Robotic technology

  4. Types of Technology • Store and forward -Digital images are stored and forwarded -Digital X-rays, digital photos, EKG faxes -Mainly used for non-emergent cases but done for some emergent cases too -Can be forwarded to anywhere in the world

  5. Store and Forward • Teleradiology, the sending of x-rays, CT scans, or MRIs (store-and-forward images) is the most common application of telemedicine in use today -Most radiologists are staying home during on call • Telepathology/ Teledermatology

  6. Two-way Interactive Television (IATV) • Face-to-face consultation • Provides a real time consultations via videoconference • Usually patient with their primary provider gets direct consultations to expert in distant site • Can directly involve patient

  7. IATV • Widely used for urban-rural location where access to care is difficult -the patient does not have to travel to an urban area to see a specialist -availability of specialist services not available before

  8. IATV: Videoconferencing equipment • New ones are more simpler, cheaper and easy to use • New programs now use desktop videoconferencing systems • Attachment of peripherals to make it more interactive such as attachment of stethoscope and otoscope, blood sugar monitoring

  9. Often Combination • Interactive • Store and forward • Audio-video still images • Web to transfer data/other web application • Web based/accessed health records • Electronic prescriptions • Wireless technology in emergency/ ambulances

  10. Application: TM • Health care delivery • Health profession education • Health administration • Public health • Business • Libraries • School education

  11. Benefit of TM • Breaks down barrier to distance/access • Improves quality of care -By direct patient consultations/ consultations to primary care -By providing easy access to education • May lead to decrease health care cost

  12. Application • Urban to rural for specialty/unavailable care • Mental health care to Jail population • Hospice care • Consults to school nurse • Home telehealth and monitoring of chronic disease- Chronic heart disease

  13. Application • Distant health teaching/ monitoring (video recording of exams) • Telesurgery applications for battlefield via use of robot • Teleradiology • Telepathology • Most of the medical specialty are using some form of telemedicine

  14. TM: Experience • SUNY Upstate Child Psychiatric Consultations To Binghamton General hospital -Child Psychiatry is a sever shortage specialty -BGH has been unable to recruit a child psychiatrist for some time

  15. TM: Experience • BMG runs a Child Psychiatry inpatient unit with a help of adult psychiatrists • Child Psychiatrist located at SUNY Upstate at Syracuse consults via videoconferencing • Typically includes, review of the case, talking with patients, families and treatment recommendations

  16. Barrier to Telemedicine • Equipment and infrastructure: -Most telephone do not provide enough bandwidth -Increasing web based application making it simpler -high bandwidth telecommunications access required for more sophisticated uses (Rural connectivity priority)

  17. Barrier to Telemedicine • Licensing issues: Many states will not allow out-of-state physicians to practice • Reimbursement: Many private insurers will not pay for it. In some states new laws that reimburses in same rate as face to face

  18. Barrier to Telemedicine • Fear of malpractice suits physicians • Acceptance of the technology and lack of hands-on interaction with patients (most patient satisfaction studies to date find patients on the whole satisfied with long distance care) • Privacy issues • Worry about depersonalizing health care

  19. Heath Care in Nepal • Percentage of national budget in health:                                     6.2 • Percentage of the current five-year plan allocation in health:        6.0 • GDP about 5% (Nepal Millennium Development Goals: Progress Report 2005)

  20. Nepal • 24.1 percent of the population earn less than an dollar per day • 31 percent of the population is living below poverty line (Nepal Millennium Development Goals: Progress Report 2005)

  21. Nepal: Basic Health Indicators • Hospital beds per 10,000 population 4.26 2001/02 • Number  Physicians per 10,000: 2 • Nurses per 10,000 population: 2  • Urban population (%)14. 2001 (Nepal Millennium Development Goals: Progress Report 2005)

  22. Population Distribution • Due to the thinly scattered population profile in the hilly and mountainous regions, the accessibility to health facilities is still a problem Nepal

  23. Telemedicine: Nepal • Nepal has large rural population with limited access to medical care • Most of the health care experts and physicians are located in urban areas-mainly Kathmandu

  24. Telemedicine in Nepal • Regional hospitals are presently connected via internet for health information access • Limited use of technology for education

  25. Ministry of Health • Telemedicine Project in Developmental phase. • ?Connect all health post center

  26. E-Network Research and Development • Mahabir Pun • have started the telemedicine program in three villages as a pilot project. Nangi, Ramche and Tikot, all of Myagdi District Myagdi District.

  27. (Note: ngi – Nangi, rmc – Ramche, tkt – Tikot are the villages where telemedicine program has been set up)

  28. TM: Nepal • Om Hospital & Research Centre (P.) Ltd and Apollo hospital in New Delhi -Consultation • Dr. Mohan Raj Pradhan HealthNet Nepal-Store and forward method: feasibility study

  29. Center for Nyaya Health Achham • Nyaya Health is a 501(c)(3) nonprofit organization working to improve the health of poor communities in Nepal through the provision of medical and public health services • http://www.nyayahealth.org/about.html

  30. Center for Nyaya Health Achham • Nyaya Health activities in Achham is a four-bed, five-room clinic focusing on primary care, maternal and child health, HIV, and tuberculosis • Plans to develop Telemedicine to provide medical services at two sites in Achham

  31. Center for Nyaya Health Achham: TM Plan • Email-based communication with specialists regarding complex patients as issues arise • Voice-based communication with specialists on complex patients, potentially even in emergency scenarios • Communication from clinicians at the center clinic with Community Health Workers in the villages, for assistance with triage and treatment

  32. Center for Nyaya Health Achham:TM Plan • Cytopathological assessment of Pap smears for cervical cancer, via transmission of images through digital microscopy; • Interpretation of complex ultrasound or X-ray images for direct patient care, training, and quality assurance; • Reading of complex microscopy slides for patient care, training, and quality assurance;

  33. Center for Nyaya Health Achham: Along with TM • Microfinancing • Selling of goods/promotion of business thought internet

  34. Shahid Gangala National Heart Center • Dr. Jyoti Bhattarai Kunwar recently got funded by International Diabetes Foundation • To compare the effectiveness of diabetes care via TM in rural health post Vs treatment as usual

  35. Nepal TM: Goals • Connecting all rural health posts to Internet • Providing direct consultations for patient care • Some specialty are easily adopted -Psychiatry -Dermatology -Diabetes management -Preventive health education

  36. Nepal TM: Goals • Partnering with leading international groups for expert and second opinion -Johns Hopkins Medicine International runs global "Medical Second Opinion" service • Also for education

  37. Nepal: Health Profession Education • Most of the lectures are videotaped and can be accessed from distant site • Live lecture feeds • Case discussions • Can lead to saving in cost of travel for health workers

  38. Nepal TM: Barrier • Lack of any law/regulation • Rural and even urban connectivity/ bandwidth limitations • Funding

  39. Other uses of TM to enhance health care in Nepal • Electronic medical records • Google health service

  40. TM Nepal: Application • Electronic prescription • Known to reduce medication error/ saving significant cost/suffering

  41. Nepal TM: Business Application • Out sourcing • Medical transcription • Software development/Medical records • Medical consultations- MDweblive.com • Patient education

  42. Q&A

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