Simmons telehealth haiti-earthquake-relief-recovery

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An overview and lessons learned from our University of Miami/

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Simmons telehealth haiti-earthquake-relief-recovery

  1. 1. Telehealth for Haiti earthquake relief & recovery Scott C. Simmons, MS Director of TeleHealth
  2. 2. Timeline< 24 hrs. 1st UM/Medishare team @ UN compund @ PAP~ 3 days initial TH capacity via BGAN, Skype~ 10 days tent-based field hospital @ PAP c/ expanded VTC~ 21 days added teleradiology~ mid-June moved to existing Bernard Mevs facility
  3. 3. Operational situation•  Completely ad hoc ­  Nothing in place: systems, procedures, command center ­  Donated materiel, personnel, flights/fuel, meds•  Many non-medical functions ­  Logistics ­  Flight control, manifesting ­  FtL exec, Mia exec, FLL & MIA intl, Homestead AFB) ­  Volunteers ­  Supplies & warehousing
  4. 4. Operational situation•  What was in place was relationships ­  LOA with USSOUTHCOM for collaboration in telehealth ­  TATRC/MRMC telehealth & Ryder combat surgical training center ­  Haiti: President Previl, Medishare, other health facilities & NGOs ­  Private sector & industry ­  Medicine ­  American Telemedicine Association
  5. 5. University of Miami/Project MediShare Field Hospital Port Au Prince, Haiti 2010
  6. 6. UMH-Haiti Site Layout Airport Perimeter Wall Urinals Showers Port-a-Johns Supplies (exposed) ORs ICU Sleeping Supply Tent Tent Sleeping Tents Adult Peds Tent Tent Command Reception Center IsolationTents Chain Link Fences N
  7. 7. On-site communicationsAmateur Radio Hughes BGANAccess Haiti Satellite Internet
  8. 8. UMH-Haiti connectivity Cisco POE Switch IP Phone In IP Phone Reception Ricoh Printer Tent Juniper Router Laptop VSAT-A HP Printers (2) In VSAT-B Command Command Center Tent Linksys Laptops Router In Access Internet Cafe Haiti Laptops Reception Linksys Tent Router/AP
  9. 9. Telehealth applications •  Teleradiology •  Deferred consultation –  Swinfen Charitable Trust –  U. Miami & U. Virginia •  Real-time consultation ­  Scheduled •  bedside (trauma/crit. care) ­  Ad hoc •  peds cardiology •  hematology/oncology
  10. 10. Technologyconsiderations inHADR operations
  11. 11. Basic requirements •  Deployable assets •  Reach-back comms •  Gateway services •  Completely self-reliant •  Multimode –  Real-time & store-and- forward •  IP-based
  12. 12. On-scene: workflow IT •  Registration/Intake –  Identity –  Triage •  EHR •  Inventory –  Supplies –  Pharmacy –  Resupply ordering
  13. 13. On-scene: TH hardware, software •  Imaging –  Visible light –  Radiographic •  Biomed devices •  VTC/multimedia collaboration •  Local wireless •  Satcomms •  Power
  14. 14. Gateway services •  Consult distribution •  VTC bridging •  Database hosting •  Identity management •  Credentialing •  Resource allocation
  15. 15. Other considerations •  Training •  Psychosocial support –  Social N/W-ing –  Voice/video calls –  Entertainment
  16. 16. Humanitarian telehealth •  Reducing barriers to charity care –  Travel –  Security/safety •  Training of in-country health professionals •  Pre-travel screening & post-travel f/u
  17. 17. Characteristics of an idealized HADR telehealth system
  18. 18. Idealized HADR TH system characteristics•  Implements both store-and-forward & real-time systems and methods•  Integrates with workflow informatics•  Staff is familiar with TH systems, concepts & trained in their use
  19. 19. Idealized HADR TH system characteristics•  Core TH infrastructure ties into on-grid & off-grid power. Primary power system automatically fails over to backup system(s).•  Databases available for various operational needs, e.g. generalized contact information (based on an organizational/functional position); volunteer, equipment, & supply needs; inventory
  20. 20. Idealized HADR TH system characteristics•  Field medical facilities include an internet café for calling, VTC, e-mail, web access so that volunteers can keep in touch with families, friends, and employers, access to information.•  Systems in place for management of monetary, equipment, or supply donations. Donated equipment accompanied by technicians able to install & train on its use.•  Systems in place for knowing the most contemporary information about other medical capacity, facility, transport mechanisms & availability, as would a pre- defined process for certification, scheduling, and processing of volunteers, both in the field and remotely (telehealth providers).
  21. 21. Idealized HADR TH system characteristics•  A network of specialists that are willing to provide telehealth services would be available along with a means of contacting & scheduling them•  Shelter provided for mission-critical equipment. On-site technical expertise for setting up, maintaining training and troubleshooting telehealth systems. •  Smart routing would move IP traffic via any available communication path & distribute the traffic simultaneously among multiple paths (load balancing)
  22. 22. Final observations•  Issues not technical, but operational, organizational, political•  Need pre-existing mechanisms for GOV/CIV collaboration•  Need to leverage academic/NGO core competencies -- clinical care -- virtual surge capacity•  Much good will in private sector•  People & organizations willing to donate after the event, but need to get the stuff before event•  Most difficult donation was bandwidth/connectivity, esp. data plans •  Too bad iPad didnt come out earlier...•  Disaster tourism an issue...•  2 thumbs up for shelter box tent, from Rotary Club International
  23. 23. Convenient, connected care.
  24. 24. Questions?ssimmons@med.miami.edu (305) 243-8252

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