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Internet and sustainable telemedicine for developing countries: an introduction
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Internet and sustainable telemedicine for developing countries: an introduction


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Slides for a lesson to students of the School of Medicina, University of Milano Bicocca, 14 April 2014 (prof.R.Polillo)

Slides for a lesson to students of the School of Medicina, University of Milano Bicocca, 14 April 2014 (prof.R.Polillo)

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  • 1. Roberto Polillo Derpartment of Informatics, Systems and Communication, University of Milano Bicocca Intervento al corso elettivo “Promozione della salute infantile nei Paesi in via di sviluppo” per studenti della Scuola di Medicina dell’Università di Milano Bicocca - April 14, 2014 Internet & sustainable telemedicine for developing Countries: an introduction 1
  • 2. What is telemedicine "Telemedicine is the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interest of advancing the health of individuals and their communities.” WHO, Telemedicine, Opportunities and Developments in Member States, 2010 3
  • 3. Types of telemedicine applications 4 DISTANCE Synchronous or asyncronous communication
  • 4. Types of telemedicine applications 5 DISTANCE Synchronous or asyncronous communication  Teleradiology  Telecardiology  Telepathology  Teledermatology  Teleodontoiatry  Teleaudiology  Telepsycology  …
  • 5. ”Affordable" telemedicine  “Reasonable” technological infrastructure  Low initial costs  Sustainability  Low operating costs  “Reasonable” technical skills locally necessary 6
  • 6. The good news Internet and mobile telephony ALLOW NOW to develop affordable and sustainable telemedicine applications for developing Countries 7
  • 7. Obstacles to telemedicine adoption (according WHO) In developed Countries:  Problems connected to protection of personal data  Different priorities  Perceived lack of demand In developing Countries:  Availability & maintenance of necessary infrastructures: electric net instability, availability & quality of Internet connectivity, bandwidth, obsolete computers, computer viruses, availability of technical personnel 8
  • 8. But we can be optimistic…  Internet connectivity is constantly improving, even in developing Countries  Mobile telephony is available everywhere, and mobile broadband is growing fast (“mobile miracle”)  Software development costs are constantly lowering and open-source software is widely available  Cloud computing significantly lowers initial investments of ICT infrastructures (capex → opex) 9
  • 9. Global ICT development (2003-2013*) 10 6.8 B subscribers!6.8 B subscribers! 1 internet access every 2 TV1 internet access every 2 TV 2.7 B people2.7 B people Source: ITU, Measuring the Information Society, 2013 2 B people 40% annual growth since 2007 2 B people 40% annual growth since 2007
  • 10. R.Polillo - Marzo 201311
  • 11. Mobile broadband growth “Expectations are high that mobile-broadband services will become equally as available as mobile-cellulare telephony in the near future. Ericsson forecasts that by 2018 there will be 6.5 billion mobile-broadband subscriptions, almost as many as there are mobile telephone subscriptions in 2013.” 13 Source: ITU, Measuring the Information Society, 2013
  • 12. Active mobile-broadband subscriptions (2007-2013*) 14 Source: ITU, Measuring the Information Society, 2013 Annual growthPenetration 6 years divide
  • 13. Active mobile-broadband subscriptions (2013*) 16 Source: ITU, Measuring the Information Society, 2013
  • 14. Types of telemedicine applications 17 DISTANCE Asyncronous: •Store-and-forward •Remote monitoring Syncronous: •Interactive telemedicine
  • 15. Store-and-forward (simple) 18 Asyncronouscommunication Examples: •Teleradiology •Teledermatology •Telepatology Query with medical data: •text •images •[video] Answer Email FTP Dropbox …. [MMS] To consider: •Bandwidth •Data compression •Access device
  • 16. 19
  • 17. Store-and-forward (with shared db) 20 Web / VPN Specific application To consider: •Server location •Bandwidth •Data compression •Common procedures •Privacy •Level of service Data base Query with medical data: •text •images •[video] Answer
  • 18. EXAMPLE: Pediatric Hospital La Mascota, Managua (Nicaragua) 21
  • 19. La Mascota and departmental hospitals Policlinico Milano La Mascota Managua VPN 22 • 1 central server (Managua) • 1 PC for every remote hospital (db and procedures) • Internet connection • Data are consolidated on the central server • Consultancy from Milano
  • 20. 23
  • 21. 24 Il server dell’amministrazione Dell’ospedale Dipartimentale di Chinandega (Nicaragua)
  • 22. Remote monitoring (asynchronous) 25 Comunicazionesincrona/asincronaAsyncronouscommunication Without Internet access: •SMS •MMS •Twitter With Internet access: •Twitter Whatsapp •Social media •Mail
  • 23. Example: Laptop + mobile for communication via SMS (software: FrontlineSMS) 26 VIDEO:! • Patient monitoring / follow-up • Vaccination campaigns • Medical info • Emergency management • …
  • 24. Interactive telemedicine (synchronous) 27 Comunicazionesincrona/asincronaSyncronouscommunication No Internet access: •Cellphone With Internet access: •Internet telephony (skype, whatsapp) •Video conferencing
  • 25. Example: HealthPoint (India) 28
  • 26. A more general concept: e-health  Electronic health records: enabling the communication of patient data between different healthcare professionals  Telemedicine: physical and psychological treatments at a distance  Consumer health information: use of online resources on medical topics by healthy individuals or patients  Health knowledge management: best practice guidelines, online resources for the healthcare professionals, epidemiological tracking  Virtual healthcare teams: healthcare professionals collaborating and sharing information on patients through online communication tools  M-health: using mobile devices in collecting patient health data, providing healthcare information, real-time monitoring of patient vitals, and direct provision of care  Healthcare online information systems: for hospital and healthcare professionals: appointment scheduling, patient data management, work schedule management and other administrative tasks surrounding health 29
  • 27. Case study:  A free, global online medical education and collaboration network  A web-based education project of St.Jude Children’s Research Hospital (Memphis, USA) to help health professionals in countries with limited resources to improve survival rates of children with catastrophic deseases  Seminars, papers, oncopoedia, interest groups, international live online web conferences 30
  • 28. 31
  • 29. growth 32 Start: Oct 2002 May 2012: > 31.000 registered users in 183 countries
  • 30. 33 Know-how globalization
  • 31. Conclusions  The evolution of the Internet, the “mobile miracle” and the telephony / internet convergence open possibilities untinkable until a few years ago for developing Countries  Abilitating technologies: low cost asyncronous and synchronous communication, broadband, cloud computing, software open-source, low cost smartphone 34 Substainability, delocalization
  • 32. 35 Thanks!