0
iPath
telemedicine platform to support health providers
in low resource settings
K. Brauchli*, D O‘Mahony,
L Banach, M Obe...
Outline
• What is iPath
• iPath - a hybrid web and email solution
• iPath Worldwide
• Case Studies
– Teledermatology in So...
What is iPath
• iPath - an open source software to build
telemedicine platforms. Developed at
University of Basel
• ipath....
• Telemedicine platform based on web server
• Access via web and email
• Collaboration in (closed) working groups
• Case a...
The telemedicine platform
Sending cases:
email
Sending cases:
email
www
Sending cases:
email
www
special equipment:
e.g. remote control microscope,
ultrasound ...
Reviewing cases:
email (alerts)
Reviewing cases:
email (alerts)
web interface
Reviewing cases:
email (alerts)
web interface
special remote control
(e.g. JAVA applet)
User registration
User Interface
Personal start page
- List of the groups
- New cases and
comments at a
glance
User Interface
User Interface
Group Display
- case list
Case Display
- Description & Images
User Interface
- Comments/Diagnosis
New comments:
→ automatic email alert
iPath worldwide
Users Productive servers In testing planned
Usage
Users Cases Images daily
logins
(2004)
submission
by email
total 1213 5016 33247* 38 32%
developing
countries
84** 1...
Usage
Case Studies
• Teledermatology in Eastern Cape,
South Africa
• Telepathology in Solomon Islands
• Telemedicine in Perinata...
Teledermatology in South Africa
Regional Telemedicine Network
Server at University of Transkei, Mthatha, South Africa
http...
Pilot in Port St. Johns, Eastern Cape
• GP in rural South Africa
• Small town ± 8 000: District 75 000
• Dermatology: 14% ...
• Teledermatology since 1999
• No of consultations: 110
• Median response time: 8 days
Teledermatology in South Africa
Teledermatology in South Africa
Teledermatology in Port St. Johns
(110 consultations)
105
57
104
0
20
40
60
80
100
120
Dia...
Teledermatology in South Africa
OUTCOME FOR GP:
• I learnt a lot and even though I may have sent some
cases late for telec...
Telepathology in Solomon Islands
Solomon Islands
Solomon Islands
Capital: Honiara
Population: 450‘000
Islands: ~1000
Independence: 1978
National Referral Hospital
Doctors:...
 Shortage of medical specialists
- no dermatology, pathology, cytology ….
 Shortage of access to health care
- many pati...
 Limited Transportation
- no roads or very bad roads
Limitations
Tissue Processing
Preparing blocks
Cutting
Staining
Histology Lab
Histology slides
Step 1:
Selected images captured with digital
camera (Nikon CoolPix 990) and submitted
to server in Basel via email
Step 2...
Results (2002-2003)
Source: Brauchli et al. J Telemed Telecare. 2004;10 Suppl 1:14-7.
Perinatal Health in Ukraine
• Project of Swiss Centre of International
Health
• Health System reform
• Improve knowledge o...
Perinatal Health in Ukraine
iPath in Teaching and CME
• Clinical Meetings / Tumor Boards
• Publish content - teaching modules, samples
cases, etc.
• R...
Tumor Board Meetings
Low Resource Settings
• Technology must be locally available
and manageable
• It must be possible to integrate usage of
te...
Low Resource Settings
• Access to training and health
information is very difficult in developing
countries
• Professional...
Problems
• Access to Computer and Internet
• Incentives - who benefits from
telemedicine?
• Missing exchange between proje...
E-fragmentation
Diagnostics
Treatment
Education
Publishing
Telemedicine E-learning Helath Information
Access
Teleradiology...
Integrated Health Information Exchange
Case Specific
Information
General
Information
Telemedicine
Tele-Teaching
Scientific...
A way forward
• Connecting different telemedicine
projects
• Increase knowledge sharing and
transfer
• Combine telemedicin...
Local ownership
• Open Standards for data
• Open Source Software is an opportunity
for developing countries to ensure
owne...
iPath
More information:
http://ipath.ch
iPath for you ?
1. Deploying iPath as technical basis fo a
telemedicine platform - iPath is open source
and freely availab...
KB_ICMCC2005.ppt
KB_ICMCC2005.ppt
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
  • Transcript of "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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