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eHealth as a tool to support health practitioners November 2013
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eHealth as a tool to support health practitioners November 2013

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“Telemedicine begins with a vision of connecting people to people, connecting resources to needs, and connecting healthcare problems to health care solutions”

“Telemedicine begins with a vision of connecting people to people, connecting resources to needs, and connecting healthcare problems to health care solutions”

Published in Health & Medicine , Business
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  • South African government hospitals are poorly resourced, overcrowded, understaffed and underfunded, contributing to the pressure under which emergency departments operate.
    Quadruple burden of disease
    Communicable diseases,
    Non-communicable chronic diseases,
    Trauma (load is one of the highest in the world). 
    HIV/AIDS
    The result is prolonged waiting times.
    Way forward: An effective system to ensure early recognition of sick patients and prioritisation for treatment is essential.
    Triage
    Telemedicine
  • Complete product range for physicians, clinics, and general practitioners
    Multiple EHR partnerships to ensure data flow in/out of the EHR
    Strong brand—known across the world for reliability and durability

Transcript

  • 1. Good news... KZN DoH eHealth unit has won an award for “Innovative use of ICTs for effective service delivery”
  • 2. eHealth as a tool to support Health Practitioners Department of Health Kwa Zulu Natal
  • 3. Purpose • Is to emphasize on the efficiency of Telemedicine in expanding access to quality healthcare, particularly targeting poor people living in remote areas. – By supporting the implementation of telemedicine, health professionals in rural areas will be empowered in using ICTs to provide quality healthcare • Provide second opinion in real time • Prevent unnecessary and avoidable transfers – at the same time patients will reap the ultimate rewards of these efforts. • Patients treated at appropriate level of care
  • 4. Objectives We do not want to wait for patients to fall sick and come to our health facilities Early detection of Diabetes, Hypertension, TB, and Counseling at an early stage. To reduce the number patients coming to Clinics Patients seen closer to where they live. To reduce number of referrals to the District hospitals Especially the unnecessary & avoidable ones To reduce number of referrals to the Regional hospitals. Especially the unnecessary & avoidable ones
  • 5. We do have our challenges… Distance between health facilities Medico legal issues     Bandwidth HIV & AIDS and TB; High Maternal and Child Mortality; Non-Communicable Diseases; and Violence and Injuries. Setting the Stage for Healthcare Transformation: Key Drivers Paper records
  • 6. Reality… o Long waiting hours at our Health facilities Patients get referred for minor ailments from: - Clinic to a District hospital - District Hospital to a Regional Hospital o Medical officers leave the consultation room to; - View X-Rays in the radiology Department - Look at lab results in the Doctors Common room o Routine X-Rays are not being reported by specialist radiologists -turn around time more than a day -unnecessary avoidable referrals o A Patient gets a New Folder and New folder Number if he/she decides to go to another hospital or clinic .
  • 7. Patient Management eHealth can assist •Second opinion •Prevent unnecessary avoidable referrals •Prevent professional isolation •Patients treated close to where they live
  • 8. Problem statement: 1 Long waiting hours at our Health facilities Patients get referred for minor ailments from: - Clinic to a District hospital - District Hospital to a Regional Hospital ICT Solution TeleConsultation •Connectivity • • • • landline GSM 3G V-Sat • Hardware – Desktop computers – Web camera – Digital Medical devices •Software • MS Lync Benefits • Patients get attention in real time(Golden hour) • Patients treated at the appropriate level of care • Reduced waiting time for the patients • Patients do not have to travel unnecessarily • Patient and provider satisfaction
  • 9. Problem statement: 2 Medical officers leave the consultation room to; - View X-Rays in the radiology Department - Look at lab results in the Doctors Common room ICT Solution • Consulting room/wards should have; • • • • • Network points Desktop computers Internet Intranet Official eMail Benefits • Medical Officers can view the X-Rays on their desk top • View NHLS lab results without leaving the consulting room • Reduced waiting time for the patients • Patient and provider satisfaction
  • 10. 3 Problem statement: Routine X-Rays are not being reported by specialist radiologists -turn around time more than a day -unnecessary avoidable referrals ICT Solution • TeleRadiology Benefits • – Connectivity • ISDN/ADSL line – Hardware • • Digitizer • DR/CR machines • Software • RIS Radiology Information • system • communication system • • PACs Picture archiving and • Medical officers can make an informed decision based on specialist Radiologist opinion Patients get attention in real time (turn around time – few hours) Patients treated at the appropriate level of care Reduced waiting time for the patients Patients do not have to travel unnecessarily Patient and provider satisfaction
  • 11. 4 Problem statement: A Patient gets a New Folder and New folder Number if he/she patient decides to go to another hospital or clinic . ICT Solution • Software – Patient registration • Unique identifier (MPI) • Demographic information • Basic clinical information – Electronic content management • Digitizing Patient folder – Electronic health records • HIS/RIS/PACS Benefits • • • • • • Patient information accessible across all the facilities. Cost saving-prevent duplication of tests Patients treated at the appropriate level of care Reduced waiting time for the patients Patients do not have to travel unnecessarily Patient and provider satisfaction
  • 12. 5 Problem statement: A nurse from clinic/ Medical officer from a District hospital – when they have to refer a patientit takes lot of time and effort if they have to go through the switch board ICT Solution Benefits Software •Microsoft Lync •Microsoft share point As part of Microsoft enterprise license we are already paying for the licenses. We might have to still pay for deployment of the solution. • • • Nurses can discuss with the medical officer in real time. Medical officers can discuss with the medical officers in real time. Patient gets immediate attention thereby preventing unnecessary and avoidable transfers to the next level.
  • 13. TeleConsultation using Microsoft Lync
  • 14. Expected Outcomes • Improved access to quality health services • Strengthen district health system • Strengthen efficiencies of the public health sector and improved systems performance • Improved management of health systems and services at all levels • ICT is an enabler to achieve these outcomes
  • 15. Information Technology/Information System needs 90% bandwidth for Non Clinical use
  • 16. eHealth
  • 17. What is eHealth? The World Health Organization defines eHealth as “the use of information and communication technologies (ICTs) for health to, for example, •treats patients, •pursue research, •educate students, •track diseases and •monitor public health.”
  • 18. Vision eHealth: enabling a long and healthy life for all South Africans. Mission To establish eHealth as an integral part of the transformation and improvement of healthcare services in South Africa, especially enabling delivery on the health sector’s Negotiated Service Delivery Agreement 2010-2014. • • • • Aim The overall aim of this strategy is to provide a single, harmonized and comprehensive e-Health strategy that a) supports the medium-term priorities of the public health sector, b) paves the way for future public sector eHealth requirements, and c) lays the requisite foundations for the future integration and coordination all eHealth initiatives in the country (both public sector and private sector).
  • 19. • • • • • • • The principles are: Get the basics right – infrastructure, connectivity, basic ICT literacy, human resources and affordability planning. Take an incremental approach – build on what exists already in both the public and private sectors and fill the gaps where necessary. Look for early wins in implementations and benefits to build the confidence of health professionals, patients and the public in eHealth. Advocate the benefits of care enabled by eHealth and ensure that these benefits are realized. Constantly evaluate eHealth initiatives and measure improvements in health outcomes in order to build an evidence base that demonstrates the net benefits over time of eHealth and guides planning and decision-making. Establish national co-ordination on all initiatives in order to improve the effectiveness of eHealth at all levels.
  • 20. Three domains need an effective fit Clinical Work Information and Communication Technologies Organization of Medicine and Healthcare (Systems)
  • 21. Knowledge Management Electronic Health Records Health promotion Clinical pathways Clinical information system Patient profiling Clinical Decision sy stem Information Management PAAB Workstations= PC+Laptops + tablets etc Technology Infrastructure DHIS ICD 10 Access control & Information security Hardware=Servers + Devices(SAN) Clinical data analysis NHLS EDI Transversal System= PERSAL +LOGIS+ BAS SANB S Disease management Clinical protocols EMRS Health information systems (HIS) PAC S/ RIS eLearning / distance education Health education Case Manageme nt telemedicin e ECM Referral manageme nt system eHealth Vital registration mHealth Software=network operating software (NOS)+Monitoring software mHealth4C BS telemedici ne TCP/IP(Transmission control protocol/Internet protocol)+ Network Infrastructure=Structured cabling+ Structure(LAN) &unstructured wireless access(WLAN) + Devices(routers+bridges=switches) +telecommunication lines(eHealth) +digital link(structured cabling) +Unstructured wireless(Wimax)
  • 22. Strengthening of our referral and back referral system Community Health worker eHealth, Telemedicine, mHealth, EHR,HIS, Document Management System, Radiology Information system, Laboratory Information System, Pharmacy Information system, NHLS,SANBS, PERSAL, BAS, Logis etc… H
  • 23. eHealth packages simplified… 37 sites have ISDN lines and Video Conferencing equipment •Clinical grand rounds •Training Mid level workers •Interactive tele/Video consultations •Management Meetings
  • 24. Todays session has been possible because we have connected 5 sites with IALCH
  • 25. TeleMedicine teleEducation network Aim: is to have 37 hospitals on the teleTrauma network
  • 26. teleConsultation Room Physical Assessment • Integrated diagnostic system efficiency Vital Signs Monitoring • Automated spot-check and continuous vital signs collection • Simple, fast, easy-to-use range of devices Thermometry • Fast, predictive oral thermometry • Technology and innovation leader in category Cardiopulmonary • Aggressive development of ECGs • Full range of PC-based connected devices Computers in every ward and consulting room so that we can access Lab results and view X-Rays
  • 27. Way forward
  • 28. Way forward • Telemedicine steering committee – Facility level • Telemedicine coordinator – Facility level (Medical manager) • Site coordinator – Nurse practitioners at least 3 per site • Technical support – Full time Telemedicine/IT support
  • 29. Applications of telemedicine in everyday life
  • 30. Telemedicine Background: • Referral of patients using (Voice) a landline/cellular phone Tele-consultation. Proposal – Needs analysis to be undertaken at facility level – Voice/data/video-tele video consultation • Digital Medical Devices • Telemedicine Management software
  • 31. Hardware Background: •Computers have been installed in the facilitiesbut not in consulting rooms and wards Proposal – Gap analysis to be undertaken – Hardware • • • • • Desktop Workstation Laptop/Tablets Multi function Printer Copier Fax Projectors Servers/Cloud servers
  • 32. Networking Background: •The Hospitals – Cabling done – No network points in wards and consulting rooms – File servers provided •The clinics have land lines – Cabling has been completed network points installed Proposal – – – – Network Cabling Network hardware File server room VSAT for clinics
  • 33. teleRadiology Background: •CTs and X-Rays are being reported by fulltime Radiologists at urban centers •QOS is being compromised in facilities that do not have a radiologists Proposal – Phase one • Digitizer films scanned and emailed to a Radiologist – Phase two • Replacement of analogue to digital X-Rays (DR/CR) • Radiology Information system
  • 34. teleDermatology Background: •QOS is being compromised in facilities that do not have a Dermatologists • Patients referred to an urban center Proposal – The use of communications technology to facilitate the provision of health care for persons with skin disease is an area of increasing interest and activity – What is required • Digital camera and internet connection • Willing Dermatologists
  • 35. telePsychiatry Background: •QOS is being compromised in facilities that do not have a Psychiatrists • Patients referred to a psychiatric hospital Proposal – The use of videoconferencing technology to facilitate the provision of health care for persons with mental health issues – What is required is VC equipment for a • Video consultation • Counseling sessions
  • 36. Revitalization of Primary Health care by using ICTs at every level of care… Connectivity Hardware Software Connect teleConsultation Primary care Cardiology Dermatology Emergency care Trauma Ophthalmology ENT Paediatric Obs & Gyn Surgery Dentistry Radiology Community Care Givers Nurse Practitioners Nurse Practitioners Nurses & AHP Practitioners Medical officers Nurses & AHP Practitioners Medical officers Specialists Nurses Practitioners Allied Health Practitioners Medical officers Specialists Super Specialists Send site Send site Receive site Send site Receive site Outreach to Clinics and CHCs by Medical Officers Send site Receive site Receive site Outreach to District Hospitals by Specialists
  • 37. Thank You! Dr Rajeev Rao Eashwari Manager teleHealth and Information technology Department of Health Province of Kwa-Zulu Natal
  • 38. ICT in health • • • • Information and Communications Technology (ICT) is vital for social change and economic development. It is increasingly seen as an essential tool for developing our communities. The South African National Telemedicine Strategy seeks to integrate the healthcare system by connecting and giving support to remote and rural medical centres of South Africa and most importantly, strengthening the referral systems. From April 1999 to March 2000, Phase I of Telemedicine was implemented in six provinces in South Africa, focusing mainly on four clinical applications, which include the Tele-radiology, Tele-pathology, Tele-ophthalmology and Tele-ultrasound. The purpose of this presentation is to emphasize on efficiency of Telemedicine in expanding access to quality healthcare, particularly targeting poor people living in remote areas. By supporting the implementation of telemedicine, health professionals in rural areas will be empowered in using ICTs to provide quality healthcare and at the same time patients will reap the ultimate rewards of these efforts.
  • 39. 6 Problem statement: Today, healthcare organizations are facing a tsunami of data — coming at them from all directions — while their storage approaches are still designed for yesterday’s silo’d world.  ICT Solution Benefits • • • The combination of medical images, EMR data and other business-related content easily consume today’s disk drives. But those same drives will be overcome by the pending wave of new formats on the horizon – including genomes and digital pathology data – coming as a second surge. • • • • The data explosion adds hidden costs to our healthcare system. Patient information accessible across all the facilities. Reduced waiting time for the patients Patients do not have to travel unnecessarily Patient and provider satisfaction