Abc of telemedicine

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Abc of telemedicine

  1. 1. The ABCs of Telemedicine Alvin B. Marcelo, MD UP Manila National Telehealth Center
  2. 2. Outline <ul><li>History of telemedicine
  3. 3. Current definition
  4. 4. The Philippine healthcare situation
  5. 5. Telemedicine examples at UP Manila </li><ul><li>Challenges and obstacles
  6. 6. Lessons learned </li></ul><li>The ABCs </li></ul>
  7. 7. History of Telemedicine <ul><li>1924: Radio News Magazine
  8. 8. 1954: Teleradiology
  9. 9. 1959: Telepsychiatry
  10. 10. 1970s: NASA </li></ul>
  11. 11. Telemedicine <ul><li>“the use of medical information exchanged from one site to another via electronic communications to improve patients' health status” </li></ul>American Telemedicine Association, 2010 American Telemedicine Association, 2010
  12. 12. Telehealth <ul><li>often used to encompass a broader definition of remote healthcare that does not always involve clinical services. </li><ul><li>Videoconferencing
  13. 13. Transmission of still images
  14. 14. eHealth including patient portals
  15. 15. Remote monitoring of vital signs
  16. 16. Continuing medical education
  17. 17. Nursing call centers </li></ul></ul>American Telemedicine Association, 2010
  18. 18. Types of Telemedicine Interactions <ul><li>Specialist referral services
  19. 19. Patient consultations
  20. 20. Remote patient monitoring
  21. 21. Medical education
  22. 22. Consumer medical and health information services </li></ul>
  23. 23. Environments for Telemedicine <ul><li>Networked programs
  24. 24. Point-to-point connections
  25. 25. Primary or specialty-care to home connections
  26. 26. Home to monitoring centers
  27. 27. Web-based eHealth patient service sites </li></ul>
  28. 28. The Philippine healthcare situation <ul><li>7,107 islands
  29. 29. Many areas with no access to doctors
  30. 30. Traveling for simple consults not cost-effective
  31. 31. Bottomline: no access to primary care practitioners/specialists until conditions become severe </li></ul>
  32. 32. UP Manila's OneHEALTH Program <ul><li>eRecords
  33. 33. eLearning
  34. 34. eMedicine </li></ul>
  35. 35. eLearning for Health <ul><li>Developed e-Learning Videos (4) funded by the Last Mile Initiative, USAID
  36. 36. Held e-Learning sessions in several provinces (Capiz, Nueva Vizcaya, Quezon, Bicol, Batanes, Cebu)‏ </li></ul>
  37. 37. eLearning for Health
  38. 38. eLearning for Health
  39. 40. Telemedicine at UP Manila
  40. 41. Telemedicine <ul><li>BuddyWorks
  41. 42. SMS, MMS, Email telemedicine
  42. 43. Facilitated Referrals
  43. 44. DOST Telemedicine Project </li></ul>
  44. 45. BuddyWorks <ul><li>E-Gov funded project (2005-2008) ‏
  45. 46. Ten sites in four provinces (portal, computers, workstations, training, fast Internet) ‏
  46. 47. After two years – 8 referrals only </li></ul>
  47. 48. <ul><li>Cagayan (3) ‏
  48. 49. Provincial Health Office
  49. 50. Cagayan State University
  50. 51. Cagayan Valley Medical Center </li></ul><ul><li>Leyte (2) ‏
  51. 52. Eastern Visayas Regional Medical </li></ul>Center <ul><li>School of Health Sciences, UP </li></ul>Manila <ul><li>Capiz (3) ‏
  52. 53. Roxas Memorial Provincial Hospital
  53. 54. Sigma Municipal Health Office
  54. 55. Mambusao General Hospital </li></ul><ul><li>Lanao del Norte (2) ‏
  55. 56. Mindanao State University </li></ul>- Gregorio T. Lluch Memorial Hospital
  56. 57. CHITS
  57. 58. After enhancement Doctors-to-the-barrios 2008: n = 58 2009: n = 124
  58. 59. Enhancements to BuddyWorks <ul><li>Shifted to SMS, MMS, Email </li></ul>
  59. 60. Enhancements to BuddyWorks 849 telehealth referrals from remote doctors over a period of 17 months... <ul><li>(15 October 2007 – 31 March 2009) ‏ </li></ul>
  60. 62. SMS Telemedicine 3 day old male, home delivered by untrained hilot with CC of fever for one day duration. PE patient is febrile (38.5C), irritable and with poor suck (as observed). im referring this to the hospital for neonatal sepsis. the weather here is so bad ... they could not yet travel by the sea. i do not have IV meds so i just prescrived co-amoxiclav and paracetamol per orem as temporary management.
  61. 63. SMS Telemedicine please avoid co-amoxiclav coz it might cause hepatotoxicity; short of bringing the patient to the hospital, you may give ampicillin 100 mg/k/day IM q12. if ampicillin is unavailable, you may give cefalexin 100 mg/k/day q8 oral
  62. 64. TeleDermatology
  63. 65. TeleOphthalmology REFER LOR 55 Female suddenly lost sight after 'hitting a spider' she felt on her eye.
  64. 66. TeleOphthalmology <ul><li>Assessment: </li></ul>Acute Angle Closure Glaucoma – left eye <ul><li>Plan: </li></ul>Timolol eye drops – 1 drop on the affected eye 2 x daily Latanoprost eye drops – 1 drop on the affected eye once at night Brimonidine eye drops – 1 drop on affected eye 2 x daily Pilocarpine eye drops – 1 drop 4 x daily on the affected eye Dorzolamide eye drops – 1 drop on affected eye 3 x daily
  65. 67. TeleRadiology
  66. 68. TelePsychiatry
  67. 69. Facilitated Referral
  68. 70. <ul><li>Go as far as possible </li><ul><li>Telemedicine in cities difficult to justify
  69. 71. The more remote, the better </li></ul><li>Identify existing trust networks </li><ul><li>Enhance that with telemedicine techniques
  70. 72. Establish trust first then do telemedicine (not other way around) </li></ul><li>GPs are most fertile for telemedicine
  71. 73. Use appropriate technology </li></ul>BuddyWorks Lessons
  72. 74. Web-based Telemedicine
  73. 76. DOST Telemedicine Project <ul><li>Emergency Care and Coordination Services
  74. 77. RxBox – telemedicine device
  75. 78. TRIAGE – central coordinating system
  76. 79. EXPERT – transaction system for poisoning </li></ul>
  77. 80. RxBox
  78. 81. Expert Interface
  79. 82. Stakeholders <ul><li>Local Government Units (LGU) ‏
  80. 83. Provincial Health Office (PHO) ‏
  81. 84. Center for Health Development – Department of Health (CHD-DOH) ‏
  82. 85. Philippine Health Insurance Corporation (PHIC) ‏
  83. 86. UP Manila – National Telehealth Center (UPM-NThC) ‏
  84. 87. Congressional Commission on Science and Technology and Engineering (COMSTE) ‏ </li></ul>
  85. 88. The ABCs of Telemedicine
  86. 89. A <ul><li>Agreement </li><ul><li>There should be mutual understanding between the two parties of their expectations and responsibilities
  87. 90. There should be pre-existing relationship between the two parties (or at least the facilitation of an accepted 'broker') </li></ul></ul>
  88. 91. B <ul><li>Bridge </li><ul><li>The methodology of connecting the two parties
  89. 92. Must be acceptable to both parties
  90. 93. Must be appropriate (don't expect fast Internet in remote areas of the country) </li></ul></ul>
  91. 94. C <ul><li>Control </li><ul><li>Guidelines and protocols for the encounter
  92. 95. Preparing connection
  93. 96. Maintaining connection
  94. 97. Exchanging information between two parties
  95. 98. Post-conference documentation </li></ul></ul>
  96. 99. ABC <ul><li>A agreement – establish trust
  97. 100. B bridge – use most appropriate connection
  98. 101. C control – follow guidelines and document </li></ul>
  99. 102. Thank you very much! <ul><li>National Telehealth Center
  100. 103. University of the Philippines Manila </li></ul><ul><li>www.telehealth.ph </li></ul>

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