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Abc of telemedicine
 

Abc of telemedicine

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    Abc of telemedicine Abc of telemedicine Presentation Transcript

    • The ABCs of Telemedicine Alvin B. Marcelo, MD UP Manila National Telehealth Center
    • Outline
      • History of telemedicine
      • Current definition
      • The Philippine healthcare situation
      • Telemedicine examples at UP Manila
        • Challenges and obstacles
        • Lessons learned
      • The ABCs
    • History of Telemedicine
      • 1924: Radio News Magazine
      • 1954: Teleradiology
      • 1959: Telepsychiatry
      • 1970s: NASA
    • Telemedicine
      • “the use of medical information exchanged from one site to another via electronic communications to improve patients' health status”
      American Telemedicine Association, 2010 American Telemedicine Association, 2010
    • Telehealth
      • often used to encompass a broader definition of remote healthcare that does not always involve clinical services.
        • Videoconferencing
        • Transmission of still images
        • eHealth including patient portals
        • Remote monitoring of vital signs
        • Continuing medical education
        • Nursing call centers
      American Telemedicine Association, 2010
    • Types of Telemedicine Interactions
      • Specialist referral services
      • Patient consultations
      • Remote patient monitoring
      • Medical education
      • Consumer medical and health information services
    • Environments for Telemedicine
      • Networked programs
      • Point-to-point connections
      • Primary or specialty-care to home connections
      • Home to monitoring centers
      • Web-based eHealth patient service sites
    • The Philippine healthcare situation
      • 7,107 islands
      • Many areas with no access to doctors
      • Traveling for simple consults not cost-effective
      • Bottomline: no access to primary care practitioners/specialists until conditions become severe
    • UP Manila's OneHEALTH Program
      • eRecords
      • eLearning
      • eMedicine
    • eLearning for Health
      • Developed e-Learning Videos (4) funded by the Last Mile Initiative, USAID
      • Held e-Learning sessions in several provinces (Capiz, Nueva Vizcaya, Quezon, Bicol, Batanes, Cebu)‏
    • eLearning for Health
    • eLearning for Health
    •  
    • Telemedicine at UP Manila
    • Telemedicine
      • BuddyWorks
      • SMS, MMS, Email telemedicine
      • Facilitated Referrals
      • DOST Telemedicine Project
    • BuddyWorks
      • E-Gov funded project (2005-2008) ‏
      • Ten sites in four provinces (portal, computers, workstations, training, fast Internet) ‏
      • After two years – 8 referrals only
      • Cagayan (3) ‏
      • Provincial Health Office
      • Cagayan State University
      • Cagayan Valley Medical Center
      • Leyte (2) ‏
      • Eastern Visayas Regional Medical
      Center
      • School of Health Sciences, UP
      Manila
      • Capiz (3) ‏
      • Roxas Memorial Provincial Hospital
      • Sigma Municipal Health Office
      • Mambusao General Hospital
      • Lanao del Norte (2) ‏
      • Mindanao State University
      - Gregorio T. Lluch Memorial Hospital
    • CHITS
    • After enhancement Doctors-to-the-barrios 2008: n = 58 2009: n = 124
    • Enhancements to BuddyWorks
      • Shifted to SMS, MMS, Email
    • Enhancements to BuddyWorks 849 telehealth referrals from remote doctors over a period of 17 months...
      • (15 October 2007 – 31 March 2009) ‏
    •  
    • 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.
    • 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
    • TeleDermatology
    • TeleOphthalmology REFER LOR 55 Female suddenly lost sight after 'hitting a spider' she felt on her eye.
    • TeleOphthalmology
      • Assessment:
      Acute Angle Closure Glaucoma – left eye
      • Plan:
      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
    • TeleRadiology
    • TelePsychiatry
    • Facilitated Referral
      • Go as far as possible
        • Telemedicine in cities difficult to justify
        • The more remote, the better
      • Identify existing trust networks
        • Enhance that with telemedicine techniques
        • Establish trust first then do telemedicine (not other way around)
      • GPs are most fertile for telemedicine
      • Use appropriate technology
      BuddyWorks Lessons
    • Web-based Telemedicine
    •  
    • DOST Telemedicine Project
      • Emergency Care and Coordination Services
      • RxBox – telemedicine device
      • TRIAGE – central coordinating system
      • EXPERT – transaction system for poisoning
    • RxBox
    • Expert Interface
    • Stakeholders
      • Local Government Units (LGU) ‏
      • Provincial Health Office (PHO) ‏
      • Center for Health Development – Department of Health (CHD-DOH) ‏
      • Philippine Health Insurance Corporation (PHIC) ‏
      • UP Manila – National Telehealth Center (UPM-NThC) ‏
      • Congressional Commission on Science and Technology and Engineering (COMSTE) ‏
    • The ABCs of Telemedicine
    • A
      • Agreement
        • There should be mutual understanding between the two parties of their expectations and responsibilities
        • There should be pre-existing relationship between the two parties (or at least the facilitation of an accepted 'broker')
    • B
      • Bridge
        • The methodology of connecting the two parties
        • Must be acceptable to both parties
        • Must be appropriate (don't expect fast Internet in remote areas of the country)
    • C
      • Control
        • Guidelines and protocols for the encounter
        • Preparing connection
        • Maintaining connection
        • Exchanging information between two parties
        • Post-conference documentation
    • ABC
      • A agreement – establish trust
      • B bridge – use most appropriate connection
      • C control – follow guidelines and document
    • Thank you very much!
      • National Telehealth Center
      • University of the Philippines Manila
      • www.telehealth.ph