KB_ICMCC2005.ppt

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  • Cases can be sent in many different ways such as:
    - email
    - web interface
    - virtual slice scanner
    - remote controlled microscope
  • Cases can be sent in many different ways such as:
    - email
    - web interface
    - virtual slice scanner
    - remote controlled microscope
  • Cases can be sent in many different ways such as:
    - email
    - web interface
    - virtual slice scanner
    - remote controlled microscope
  • The same for viewing cases.
    - email (alerts)
    - web interface
    - virtual slice viewer
    - remote controlled microscope
  • The same for viewing cases.
    - email (alerts)
    - web interface
    - virtual slice viewer
    - remote controlled microscope
  • The same for viewing cases.
    - email (alerts)
    - web interface
    - virtual slice viewer
    - remote controlled microscope
  • KB_ICMCC2005.ppt

    1. 1. iPath telemedicine platform to support health providers in low resource settings K. Brauchli*, D O‘Mahony, L Banach, M Oberholzer * kurt.brauchli@unibas.ch
    2. 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. 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. 4. • Telemedicine platform based on web server • Access via web and email • Collaboration in (closed) working groups • Case archive • Automatic and personalised notifications iPath - hybrid web and email solution
    5. 5. The telemedicine platform
    6. 6. Sending cases: email
    7. 7. Sending cases: email www
    8. 8. Sending cases: email www special equipment: e.g. remote control microscope, ultrasound ...
    9. 9. Reviewing cases: email (alerts)
    10. 10. Reviewing cases: email (alerts) web interface
    11. 11. Reviewing cases: email (alerts) web interface special remote control (e.g. JAVA applet)
    12. 12. User registration User Interface
    13. 13. Personal start page - List of the groups - New cases and comments at a glance User Interface
    14. 14. User Interface Group Display - case list
    15. 15. Case Display - Description & Images User Interface - Comments/Diagnosis New comments: → automatic email alert
    16. 16. iPath worldwide Users Productive servers In testing planned
    17. 17. Usage Users Cases Images daily logins (2004) submission by email total 1213 5016 33247* 38 32% developing countries 84** 1798 14006 74% 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
    18. 18. Usage
    19. 19. Case Studies • Teledermatology in Eastern Cape, South Africa • Telepathology in Solomon Islands • Telemedicine in Perinatal Health in Ukraine
    20. 20. Teledermatology in South Africa Regional Telemedicine Network Server at University of Transkei, Mthatha, South Africa http://telemed.utr.ac.za Port St. Johns Tsilitwa UNITRA
    21. 21. 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 Teledermatology in South Africa
    22. 22. • Teledermatology since 1999 • No of consultations: 110 • Median response time: 8 days Teledermatology in South Africa
    23. 23. Teledermatology in South Africa Teledermatology in Port St. Johns (110 consultations) 105 57 104 0 20 40 60 80 100 120 Diagnostic Result possible TM made positive change for treatment Assistance helpful for GP n yes no no difference
    24. 24. 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.
    25. 25. Telepathology in Solomon Islands
    26. 26. Solomon Islands
    27. 27. Solomon Islands Capital: Honiara Population: 450‘000 Islands: ~1000 Independence: 1978 National Referral Hospital Doctors: 15 (30) Radiologists: 1 Pathologists: 0 Dermatologists: 0 Solomon Islands
    28. 28.  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) Limitations
    29. 29.  Limited Transportation - no roads or very bad roads Limitations
    30. 30. Tissue Processing Preparing blocks Cutting Staining Histology Lab Histology slides
    31. 31. 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) Remote Consultations
    32. 32. Results (2002-2003) Source: Brauchli et al. J Telemed Telecare. 2004;10 Suppl 1:14-7.
    33. 33. 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
    34. 34. Perinatal Health in Ukraine
    35. 35. 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.)
    36. 36. Tumor Board Meetings
    37. 37. 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
    38. 38. Low Resource Settings • Access to training and health information is very difficult in developing countries • Professional isolation (solo practitioner without senior colleague) ==> “Brain Drain”
    39. 39. Problems • Access to Computer and Internet • Incentives - who benefits from telemedicine? • Missing exchange between projects and networks ==> “e-fragmentation”
    40. 40. E-fragmentation Diagnostics Treatment Education Publishing Telemedicine E-learning Helath Information Access Teleradiology Teledermatology Tele HIV care
    41. 41. Integrated Health Information Exchange Case Specific Information General Information Telemedicine Tele-Teaching ScientificPublishing Feedback Quality Control Dissemination Studies, Research Evidence Base
    42. 42. A way forward • Connecting different telemedicine projects • Increase knowledge sharing and transfer • Combine telemedicine with: – Teaching – Access to health information
    43. 43. 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
    44. 44. iPath More information: http://ipath.ch
    45. 45. iPath for you ? 1. Deploying iPath as technical basis fo a telemedicine platform - iPath is open source and freely available. 2. Participate in the Basel telemedicine network - as expert or non-expert. • Pathology • Dermatology • Perinatal Health

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