SlideShare a Scribd company logo
Initial Lessons From Implementing a Telecolposcopy Program on a High Risk Population in California
Rachel Steward1, Jennifer Spohn1, Eliya Tenenboim2, Cathy Sebag2, David Levitz2
(1) FPA Women’s Health, Los Angeles, CA
(2) MobileODT, Tel Aviv, Israel
Telecolposcopy
Demonstration
Click to play video
Abstract
Results
Objective: To assess the feasibility of a live, telecolposcopy system in clinics serving high-risk populations. Of interest is to understand the feasibility of an
integrated telecolposcopy solution from the perspectives of patient and provider acceptance in comparison to in-person oversight of an exam. Methods: A
custom feature was built into MobileODT’s EVA System, a smartphone-based colposcope, utilizing a video-conferencing application. Through screen sharing,
the provider at the point of care showed the expert a live video feed of the colposcopy exam, and the expert then recommended sites to biopsy. Following the
procedure, a satisfaction survey is given to all remote experts, point of care providers, and patients. All twelve subjects who underwent telecolposcopy filled
out a survey. As a control group, N=10 patients undergoing traditional colposcopy were also given surveys. Results: Initial findings showed that experts were
able to assist the junior providers in colposcopy procedures. Patients reacted positively to the live expert supervision. Conclusions: Preliminary results suggest
that live telecolposcopy is feasible on a mobile, connected colposcope.
• The solution overcame challenges in video/image quality and audio
quality. The expert was able to converse in real time, and provide
guidance for the PoC provider to act upon.
• PoC providers found the telecolposcopy feature helpful.
• Overall, patients were more satisfied with telecolposcopy than
traditional colposcopy
• All 4 patients who had both a telecolposcopy or a traditional
colposcopy said they would prefer telecolposcopy to reduce distance
and time traveled
• More patients need to be recruited because the sample size was small.
Introduction
Objective: Assess the feasibility of an integrated telecolposcopy solution from the
perspectives of patient and provider acceptance
Clinical network
Rayburn et. al. "Distribution of American Congress of
Obstetricians and Gynecologists Fellows and Junior Fellows in
Practice in the United States" OBSTETRICS & GYNECOLOGY, VOL.
119, NO. 5, MAY 2012
According to the ASCCP Steering Committee, the current
opportunistic approach to cervical cancer screening in the U.S.
fails to reach sub-populations of women where rates of incidence
and mortality are similar to rates in low and middle income
countries at a rate much higher than the general US population.1
Reasons are complex and the challenge extends to women in
low-resource, medically underserved regions, and therefore
invasive cervical cancer in the US today is strongly linked to
socioeconomic, geographic and racial disparities 1 where health
access has traditionally been a challenge.
The challenge includes a shortage of colposcopy providers in the
US to reach rural women where only 50% of US counties have a
colposcopist (Fig. 1) and those without access to specialists in
urban centers without colposcopy services where loss to follow-
up from initial screening is high.2 For the many patients who live
in counties without a colposcopist, transportation to the clinic is
a real barrier to seeking care.3
Family Planning Associates (FPA
Women’s Health) is a nationally
recognized & accredited family
planning provider that offers patients
safe & convenient access to quality
care in a mix or urban and rural
settings. The network has been
accredited by AAAHC since 1996.
FPA Women’s Health works primarily
with underserved populations
including:
• Low income patients
• Inner-city and rural
populations
• Undocumented
immigrants
However, today, a colposcopist is not
available at many sites due to the
relatively low number of patients with
abnormal screening tests. However,
lack of colposcopists prevent them
from expanding colposcopy services
despite patient need and addressing
loss to follow-up from longer travel
time and distance to another center.
50% of cervical cancers in US are in unscreened women.
Another 10% are in underscreened women4-6 . Reaching this
unscreened population is critical to impact mortality.
Telemedicine can potentially solve this, by extending
colposcopy services to sites lacking expertise and equipment.
The remote expert can assist to better identify sites to biopsy.
Video and audio communication is key. 7-9 To date, no
conclusive study has shown that a telecolposcopy technology
is a means to improve patient care.
It is also unknown how well
patients that live in remote
areas and benefit from
telecolposcopy actually
accept the procedure. Few
studies assessed their
feelings about a remote
expert during the exam.
This study sought to explore
this angle as well, as it
hasn’t been discussed much
in the literature.
Materials and Methods
The EVA System app includes a Decision Support Job Aid for guiding clinical workflow and
documenting results. (A) Screenshots of the key steps. (B) Full decision tree backbone.
(A) (B)
Colposcopy clinic
Tele-colposcopy Traditional
colposcopy
Patient
survey
Patient
survey
Remote
expert
survey
PoC
provider
survey
N=12 N=12 N=12 N=10
The EVA System is functionally
equivalent to a video colposcope.
Telecolposcopy is enabled by the EVA
System – a cloud-connected mobile
colposcope built around a smartphone
platform.
The mobile phone runs 2 mobile
applications, one application to operate
the EVA System, and a second application
to enable videoconferencing.
Experts are contacted by text message,
from which they can connect to the
session from their phone, a tablet, or PC.
All images and
annotations are
stored on a HIPAA-
compliant image
portal.
Offline quality
assurance features
provide decision
support to
providers.
Following the procedure, online surveys containing 10-15
questions were administered to remote experts, PoC providers,
and patients.
Comparisons were made between 2 groups:
• Remote experts vs. PoC providers.
• Traditional colposcopy patients vs. tele-colposcopy patients
Surveys were documented and analyzed using Google Forms.
Surveys were also available in Spanish for non-native English
speakers.
The study protocol was approved by the Institutional Review
Board at Western IRB, protocol no. 20190097.
Results
Survey results suggest this implementation of telecolposcopy overcame technical challenges of poor image and audio
quality that made previous attempts at telecolposcopy unfeasible.
In all cases, the experts were able to determine if and where to biopsy, and whether or not to take an ECC. The were then
able to clearly communicate that to the PoC provider.
Experts were able to converse with the provider in real time, and provide guidance for the PoC provider to act upon.
Expert opinion Point of Care provider
Click to play video
Results and Discussion
References:
1. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology
screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis. 2012;16(3):175–204. doi:10.1097/LGT.0b013e31824ca9d5
2. B Peterson, Neeraja & Han, Jini & M Freund, Karen. (2003). Inadequate Follow-Up for Abnormal Pap Smears in an Urban Population. Journal of the National Medical
Association. 95. 825-32.
3. Coronado GD, Thompson B, Koepsell TD, Schwartz SM, McLerran D. Use of Pap test among Hispanics and non-Hispanic whites in a rural setting. Preventive Medicine.
2004;38(6):713–722. doi: 10.1016/j.ypmed.2004.01.009.
4. Freeman H, Wingrove B. Excess Cervical Cancer Mortality: A Marker for Low Access to Health Care in Poor Communities. National Cancer Institute; Rockville, MD: 2005.
5. [January 19, 2012];Division of Cancer Prevention and Control, National Center for Disease Prevention and Health Promotion. 2011
6. Spence AR, Goggin P, Franco EL. Process of care failures in invasive cervical cancer: systematic review and meta-analysis. Prev Med. 2007;45:93–106.
7. Ferris, Daron & S Litaker, Mark & S Macfee, Michael & A Miller, Jill. (2003). Remote diagnosis of cervical neoplasia: 2 Types of telecolposcopy compared with
cervicography. The Journal of family practice. 52. 298-304.
8. J Etherington, Ian. (2002). Telecolposcopy - a feasibility study in primary care. Journal of telemedicine and telecare. 8 Suppl 2. 22-4. 10.1258/135763302320301876.
9. Ferris, Daron & S Macfee, Michael & A Miller, Jill & S Litaker, Mark & Crawley, Debra & Watson, Diane. (2002). The Efficacy of Telecolposcopy Compared With Traditional
Colposcopy. Obstetrics and gynecology. 99. 248-54. 10.1016/S0029-7844(01)01671-4.
Limitation of study
1. Too small of sample size, study is still ongoing
2. Positive bias in survey results – too many results are 5/5
3. Intra-operator bias – participants gave either high or low scores across
Implications
Patient Provider
Expert
Expert
Expert
Expert
Expert
Expert
Expert
Expert
Integration of telecolposcopy services into the
colposcope makes it scalable, requiring
nothing more than an internet connection.
Multiple experts can be consulted with in
parallel, giving the provider.
Such a telecolposcopy implementation makes
it an ideal solution for LMICs, where there are
not enough providers skilled in colposcopy.
Traditional colposcopy Tele-colposcopy
Conclusion
Our preliminary results suggest that this implementation of tele-colposcopy
addressed the technical challenges in previous attempts of telecolposcopy.
Patient acceptability of telecolposcopy was comparable to traditional colposcopy.
The integration of tele-colposcopy on EVA makes it a scalable solution for LMICs to
address the shortage of providers.

More Related Content

What's hot

Tct presentation final
Tct presentation finalTct presentation final
Tct presentation final
BGuez
 
mHealth Israel_Startup Contest Finalist_Biop Medical_one pager
mHealth Israel_Startup Contest Finalist_Biop Medical_one pagermHealth Israel_Startup Contest Finalist_Biop Medical_one pager
mHealth Israel_Startup Contest Finalist_Biop Medical_one pager
Levi Shapiro
 
Clinical Trial Accrual Challenges: Is Social Media Here to Help? (A. Denicoff)
Clinical Trial Accrual Challenges: Is Social Media Here to Help? (A. Denicoff)Clinical Trial Accrual Challenges: Is Social Media Here to Help? (A. Denicoff)
Clinical Trial Accrual Challenges: Is Social Media Here to Help? (A. Denicoff)
Esmeralda Casas-Silva, Ph.D.
 
Could this change how radiology residents record their clinical output?
Could this change how radiology residents record their clinical output?Could this change how radiology residents record their clinical output?
Could this change how radiology residents record their clinical output?
Apparao Mukkamala
 
Considerations for a Successful Teledermatology Application
Considerations for a Successful Teledermatology Application Considerations for a Successful Teledermatology Application
Considerations for a Successful Teledermatology Application
Health Informatics New Zealand
 
Cyber knife robotic radiosurgery system
Cyber knife robotic radiosurgery systemCyber knife robotic radiosurgery system
Cyber knife robotic radiosurgery system
Belinda Toney
 
[Typ]Poster[Sbj]1593Synoptics[Dte]20150906
[Typ]Poster[Sbj]1593Synoptics[Dte]20150906[Typ]Poster[Sbj]1593Synoptics[Dte]20150906
[Typ]Poster[Sbj]1593Synoptics[Dte]20150906
Mark Gusack
 
LuCIFEx: Lung Cancer Identification through Feature Extraction
LuCIFEx: Lung Cancer Identification through Feature ExtractionLuCIFEx: Lung Cancer Identification through Feature Extraction
LuCIFEx: Lung Cancer Identification through Feature Extraction
NECST Lab @ Politecnico di Milano
 
How the Cloud Save Lives by MobileODT
How the Cloud Save Lives by MobileODTHow the Cloud Save Lives by MobileODT
How the Cloud Save Lives by MobileODT
Ariel Beery
 
The Waikato Virtual Lesion Clinic - better, sooner and more convenient
The Waikato Virtual Lesion Clinic - better, sooner and more convenientThe Waikato Virtual Lesion Clinic - better, sooner and more convenient
The Waikato Virtual Lesion Clinic - better, sooner and more convenient
Health Informatics New Zealand
 
Cost effective healthcare in medical imaging
Cost effective healthcare in medical imagingCost effective healthcare in medical imaging
Cost effective healthcare in medical imaging
All India Institute of Medical Sciences
 
Transitioning into 24/7 Teleradiology Coverage - Dr Anjali Agrawal
Transitioning into 24/7 Teleradiology Coverage - Dr Anjali AgrawalTransitioning into 24/7 Teleradiology Coverage - Dr Anjali Agrawal
Transitioning into 24/7 Teleradiology Coverage - Dr Anjali Agrawal
Mathew B R
 
Medical Deep Learning: Clinical, Technical, & Regulatory Challenges and How t...
Medical Deep Learning: Clinical, Technical, & Regulatory Challenges and How t...Medical Deep Learning: Clinical, Technical, & Regulatory Challenges and How t...
Medical Deep Learning: Clinical, Technical, & Regulatory Challenges and How t...
Devon Bernard
 
eHealth Reality in North America
eHealth Reality in North AmericaeHealth Reality in North America
eHealth Reality in North America
Plan de Calidad para el SNS
 
Morphological and Spectral Markers of Cervical Cancer Cells
Morphological and Spectral Markers of Cervical Cancer CellsMorphological and Spectral Markers of Cervical Cancer Cells
Morphological and Spectral Markers of Cervical Cancer Cells
Global Risk Forum GRFDavos
 
doc
docdoc
Radiology Safety at the Forefront of Patient Care
Radiology Safety at the Forefront of Patient CareRadiology Safety at the Forefront of Patient Care
Radiology Safety at the Forefront of Patient Care
Foundation Radiology Group
 
Personalized Medicine through Tumor Sequencing
Personalized Medicine through Tumor SequencingPersonalized Medicine through Tumor Sequencing
Personalized Medicine through Tumor Sequencing
Golden Helix Inc
 
CellDetect Bladder
CellDetect BladderCellDetect Bladder
CellDetect Bladder
Ouriel Faktor
 
Utilization of virtual microscopy in a cooperative group setting
Utilization of virtual microscopy in a cooperative group settingUtilization of virtual microscopy in a cooperative group setting
Utilization of virtual microscopy in a cooperative group setting
BIT002
 

What's hot (20)

Tct presentation final
Tct presentation finalTct presentation final
Tct presentation final
 
mHealth Israel_Startup Contest Finalist_Biop Medical_one pager
mHealth Israel_Startup Contest Finalist_Biop Medical_one pagermHealth Israel_Startup Contest Finalist_Biop Medical_one pager
mHealth Israel_Startup Contest Finalist_Biop Medical_one pager
 
Clinical Trial Accrual Challenges: Is Social Media Here to Help? (A. Denicoff)
Clinical Trial Accrual Challenges: Is Social Media Here to Help? (A. Denicoff)Clinical Trial Accrual Challenges: Is Social Media Here to Help? (A. Denicoff)
Clinical Trial Accrual Challenges: Is Social Media Here to Help? (A. Denicoff)
 
Could this change how radiology residents record their clinical output?
Could this change how radiology residents record their clinical output?Could this change how radiology residents record their clinical output?
Could this change how radiology residents record their clinical output?
 
Considerations for a Successful Teledermatology Application
Considerations for a Successful Teledermatology Application Considerations for a Successful Teledermatology Application
Considerations for a Successful Teledermatology Application
 
Cyber knife robotic radiosurgery system
Cyber knife robotic radiosurgery systemCyber knife robotic radiosurgery system
Cyber knife robotic radiosurgery system
 
[Typ]Poster[Sbj]1593Synoptics[Dte]20150906
[Typ]Poster[Sbj]1593Synoptics[Dte]20150906[Typ]Poster[Sbj]1593Synoptics[Dte]20150906
[Typ]Poster[Sbj]1593Synoptics[Dte]20150906
 
LuCIFEx: Lung Cancer Identification through Feature Extraction
LuCIFEx: Lung Cancer Identification through Feature ExtractionLuCIFEx: Lung Cancer Identification through Feature Extraction
LuCIFEx: Lung Cancer Identification through Feature Extraction
 
How the Cloud Save Lives by MobileODT
How the Cloud Save Lives by MobileODTHow the Cloud Save Lives by MobileODT
How the Cloud Save Lives by MobileODT
 
The Waikato Virtual Lesion Clinic - better, sooner and more convenient
The Waikato Virtual Lesion Clinic - better, sooner and more convenientThe Waikato Virtual Lesion Clinic - better, sooner and more convenient
The Waikato Virtual Lesion Clinic - better, sooner and more convenient
 
Cost effective healthcare in medical imaging
Cost effective healthcare in medical imagingCost effective healthcare in medical imaging
Cost effective healthcare in medical imaging
 
Transitioning into 24/7 Teleradiology Coverage - Dr Anjali Agrawal
Transitioning into 24/7 Teleradiology Coverage - Dr Anjali AgrawalTransitioning into 24/7 Teleradiology Coverage - Dr Anjali Agrawal
Transitioning into 24/7 Teleradiology Coverage - Dr Anjali Agrawal
 
Medical Deep Learning: Clinical, Technical, & Regulatory Challenges and How t...
Medical Deep Learning: Clinical, Technical, & Regulatory Challenges and How t...Medical Deep Learning: Clinical, Technical, & Regulatory Challenges and How t...
Medical Deep Learning: Clinical, Technical, & Regulatory Challenges and How t...
 
eHealth Reality in North America
eHealth Reality in North AmericaeHealth Reality in North America
eHealth Reality in North America
 
Morphological and Spectral Markers of Cervical Cancer Cells
Morphological and Spectral Markers of Cervical Cancer CellsMorphological and Spectral Markers of Cervical Cancer Cells
Morphological and Spectral Markers of Cervical Cancer Cells
 
doc
docdoc
doc
 
Radiology Safety at the Forefront of Patient Care
Radiology Safety at the Forefront of Patient CareRadiology Safety at the Forefront of Patient Care
Radiology Safety at the Forefront of Patient Care
 
Personalized Medicine through Tumor Sequencing
Personalized Medicine through Tumor SequencingPersonalized Medicine through Tumor Sequencing
Personalized Medicine through Tumor Sequencing
 
CellDetect Bladder
CellDetect BladderCellDetect Bladder
CellDetect Bladder
 
Utilization of virtual microscopy in a cooperative group setting
Utilization of virtual microscopy in a cooperative group settingUtilization of virtual microscopy in a cooperative group setting
Utilization of virtual microscopy in a cooperative group setting
 

Similar to Initial Lessons From Implementing a Telecolposcopy Program on a High Risk Population in California

Cancer and the General Internist
Cancer and the General InternistCancer and the General Internist
Cancer and the General Internist
LanceCatedral
 
Benefit vs[1][1][2][1]. risk in children's exposure to radiation for medical ...
Benefit vs[1][1][2][1]. risk in children's exposure to radiation for medical ...Benefit vs[1][1][2][1]. risk in children's exposure to radiation for medical ...
Benefit vs[1][1][2][1]. risk in children's exposure to radiation for medical ...
Prunariu Ludmila
 
Oral cancer screening_aids
Oral cancer screening_aidsOral cancer screening_aids
Oral cancer screening_aids
Joydeep Das
 
EXPLORATION OF WILLINGNESS TO PAY FOR CANCER GENETIC TESTING AMONG COLORECTAL...
EXPLORATION OF WILLINGNESS TO PAY FOR CANCER GENETIC TESTING AMONG COLORECTAL...EXPLORATION OF WILLINGNESS TO PAY FOR CANCER GENETIC TESTING AMONG COLORECTAL...
EXPLORATION OF WILLINGNESS TO PAY FOR CANCER GENETIC TESTING AMONG COLORECTAL...
Universiti Malaysia Sabah
 
Reliability, accuracy and cost effectiveness of prenatal screening
Reliability, accuracy and cost effectiveness of prenatal screeningReliability, accuracy and cost effectiveness of prenatal screening
Reliability, accuracy and cost effectiveness of prenatal screening
Rustem Celami
 
Neep_et_al-2014-Journal_of_Medical_Imaging_and_Radiation_Oncology
Neep_et_al-2014-Journal_of_Medical_Imaging_and_Radiation_OncologyNeep_et_al-2014-Journal_of_Medical_Imaging_and_Radiation_Oncology
Neep_et_al-2014-Journal_of_Medical_Imaging_and_Radiation_Oncology
Michael Neep
 
Cancer and Internist - Koronadal Internist Society.pdf
Cancer and Internist - Koronadal Internist Society.pdfCancer and Internist - Koronadal Internist Society.pdf
Cancer and Internist - Koronadal Internist Society.pdf
LanceCatedral
 
Detecting Distress in Gynecologic Cancer Patients Worksheet.docx
Detecting Distress in Gynecologic Cancer Patients Worksheet.docxDetecting Distress in Gynecologic Cancer Patients Worksheet.docx
Detecting Distress in Gynecologic Cancer Patients Worksheet.docx
studywriters
 
AlisonSlemaker_PHS Conference Poster
AlisonSlemaker_PHS Conference PosterAlisonSlemaker_PHS Conference Poster
AlisonSlemaker_PHS Conference Poster
Alison Slemaker
 
Primary care-based, teleretinal-screening protocol (Los Angeles Safety Net)
Primary care-based, teleretinal-screening protocol (Los Angeles Safety Net) Primary care-based, teleretinal-screening protocol (Los Angeles Safety Net)
Primary care-based, teleretinal-screening protocol (Los Angeles Safety Net)
UCLA CTSI
 
Addressing rural and remote access disparities for patients with inflammatory...
Addressing rural and remote access disparities for patients with inflammatory...Addressing rural and remote access disparities for patients with inflammatory...
Addressing rural and remote access disparities for patients with inflammatory...
Vicki Cristol
 
VOLUME 22, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 69CJO.docx
VOLUME 22, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 69CJO.docxVOLUME 22, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 69CJO.docx
VOLUME 22, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 69CJO.docx
jessiehampson
 
Use of new image capturing and sharing systems in colposcopy training Ameli T...
Use of new image capturing and sharing systems in colposcopy training Ameli T...Use of new image capturing and sharing systems in colposcopy training Ameli T...
Use of new image capturing and sharing systems in colposcopy training Ameli T...
triumphbenelux
 
International Journal of Reproductive Medicine & Gynecology
International Journal of Reproductive Medicine & GynecologyInternational Journal of Reproductive Medicine & Gynecology
International Journal of Reproductive Medicine & Gynecology
SciRes Literature LLC. | Open Access Journals
 
How evidence affects clinical practice in egypt
How evidence affects clinical practice in egyptHow evidence affects clinical practice in egypt
How evidence affects clinical practice in egypt
Wafaa Benjamin
 
Unth breast cancer management protocol
Unth breast cancer management protocolUnth breast cancer management protocol
Unth breast cancer management protocol
Nwamaka Lasebikan
 
Practicum Presentation
Practicum PresentationPracticum Presentation
Practicum Presentation
guest231e1f
 
ENRS_Smith_Poster.ppt
ENRS_Smith_Poster.pptENRS_Smith_Poster.ppt
ENRS_Smith_Poster.ppt
FiNi17
 
Nyaya Health Ultrasound Program: Implications for Teleradiology in Resource-D...
Nyaya Health Ultrasound Program: Implications for Teleradiology in Resource-D...Nyaya Health Ultrasound Program: Implications for Teleradiology in Resource-D...
Nyaya Health Ultrasound Program: Implications for Teleradiology in Resource-D...
Duncan Maru
 
China v1
China v1China v1
China v1
Lin Giralt
 

Similar to Initial Lessons From Implementing a Telecolposcopy Program on a High Risk Population in California (20)

Cancer and the General Internist
Cancer and the General InternistCancer and the General Internist
Cancer and the General Internist
 
Benefit vs[1][1][2][1]. risk in children's exposure to radiation for medical ...
Benefit vs[1][1][2][1]. risk in children's exposure to radiation for medical ...Benefit vs[1][1][2][1]. risk in children's exposure to radiation for medical ...
Benefit vs[1][1][2][1]. risk in children's exposure to radiation for medical ...
 
Oral cancer screening_aids
Oral cancer screening_aidsOral cancer screening_aids
Oral cancer screening_aids
 
EXPLORATION OF WILLINGNESS TO PAY FOR CANCER GENETIC TESTING AMONG COLORECTAL...
EXPLORATION OF WILLINGNESS TO PAY FOR CANCER GENETIC TESTING AMONG COLORECTAL...EXPLORATION OF WILLINGNESS TO PAY FOR CANCER GENETIC TESTING AMONG COLORECTAL...
EXPLORATION OF WILLINGNESS TO PAY FOR CANCER GENETIC TESTING AMONG COLORECTAL...
 
Reliability, accuracy and cost effectiveness of prenatal screening
Reliability, accuracy and cost effectiveness of prenatal screeningReliability, accuracy and cost effectiveness of prenatal screening
Reliability, accuracy and cost effectiveness of prenatal screening
 
Neep_et_al-2014-Journal_of_Medical_Imaging_and_Radiation_Oncology
Neep_et_al-2014-Journal_of_Medical_Imaging_and_Radiation_OncologyNeep_et_al-2014-Journal_of_Medical_Imaging_and_Radiation_Oncology
Neep_et_al-2014-Journal_of_Medical_Imaging_and_Radiation_Oncology
 
Cancer and Internist - Koronadal Internist Society.pdf
Cancer and Internist - Koronadal Internist Society.pdfCancer and Internist - Koronadal Internist Society.pdf
Cancer and Internist - Koronadal Internist Society.pdf
 
Detecting Distress in Gynecologic Cancer Patients Worksheet.docx
Detecting Distress in Gynecologic Cancer Patients Worksheet.docxDetecting Distress in Gynecologic Cancer Patients Worksheet.docx
Detecting Distress in Gynecologic Cancer Patients Worksheet.docx
 
AlisonSlemaker_PHS Conference Poster
AlisonSlemaker_PHS Conference PosterAlisonSlemaker_PHS Conference Poster
AlisonSlemaker_PHS Conference Poster
 
Primary care-based, teleretinal-screening protocol (Los Angeles Safety Net)
Primary care-based, teleretinal-screening protocol (Los Angeles Safety Net) Primary care-based, teleretinal-screening protocol (Los Angeles Safety Net)
Primary care-based, teleretinal-screening protocol (Los Angeles Safety Net)
 
Addressing rural and remote access disparities for patients with inflammatory...
Addressing rural and remote access disparities for patients with inflammatory...Addressing rural and remote access disparities for patients with inflammatory...
Addressing rural and remote access disparities for patients with inflammatory...
 
VOLUME 22, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 69CJO.docx
VOLUME 22, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 69CJO.docxVOLUME 22, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 69CJO.docx
VOLUME 22, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 69CJO.docx
 
Use of new image capturing and sharing systems in colposcopy training Ameli T...
Use of new image capturing and sharing systems in colposcopy training Ameli T...Use of new image capturing and sharing systems in colposcopy training Ameli T...
Use of new image capturing and sharing systems in colposcopy training Ameli T...
 
International Journal of Reproductive Medicine & Gynecology
International Journal of Reproductive Medicine & GynecologyInternational Journal of Reproductive Medicine & Gynecology
International Journal of Reproductive Medicine & Gynecology
 
How evidence affects clinical practice in egypt
How evidence affects clinical practice in egyptHow evidence affects clinical practice in egypt
How evidence affects clinical practice in egypt
 
Unth breast cancer management protocol
Unth breast cancer management protocolUnth breast cancer management protocol
Unth breast cancer management protocol
 
Practicum Presentation
Practicum PresentationPracticum Presentation
Practicum Presentation
 
ENRS_Smith_Poster.ppt
ENRS_Smith_Poster.pptENRS_Smith_Poster.ppt
ENRS_Smith_Poster.ppt
 
Nyaya Health Ultrasound Program: Implications for Teleradiology in Resource-D...
Nyaya Health Ultrasound Program: Implications for Teleradiology in Resource-D...Nyaya Health Ultrasound Program: Implications for Teleradiology in Resource-D...
Nyaya Health Ultrasound Program: Implications for Teleradiology in Resource-D...
 
China v1
China v1China v1
China v1
 

Recently uploaded

Solution manual for managerial accounting 18th edition by ray garrison eric n...
Solution manual for managerial accounting 18th edition by ray garrison eric n...Solution manual for managerial accounting 18th edition by ray garrison eric n...
Solution manual for managerial accounting 18th edition by ray garrison eric n...
rightmanforbloodline
 
Call Girls Kolkata 8824825030 Top Class Kolkata Escorts Available
Call Girls Kolkata 8824825030 Top Class Kolkata Escorts AvailableCall Girls Kolkata 8824825030 Top Class Kolkata Escorts Available
Call Girls Kolkata 8824825030 Top Class Kolkata Escorts Available
kmiss 1062#v08
 
Test bank advanced health assessment and differential diagnosis essentials fo...
Test bank advanced health assessment and differential diagnosis essentials fo...Test bank advanced health assessment and differential diagnosis essentials fo...
Test bank advanced health assessment and differential diagnosis essentials fo...
rightmanforbloodline
 
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
Santhosh Raj
 
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa AjmanDiscover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Malayali Kerala Spa Ajman
 
Types of Cancer Treatments | Forms of cancer treatment
Types of Cancer Treatments | Forms of cancer treatmentTypes of Cancer Treatments | Forms of cancer treatment
Types of Cancer Treatments | Forms of cancer treatment
RioGrandeCancerSpeci
 
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 FaridkotFaridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
varun0kumar00
 
Luxury Massage Experience at Affordable Rate - Malayali Kerala Spa Ajman
Luxury Massage Experience at Affordable Rate - Malayali Kerala Spa AjmanLuxury Massage Experience at Affordable Rate - Malayali Kerala Spa Ajman
Luxury Massage Experience at Affordable Rate - Malayali Kerala Spa Ajman
Malayali Kerala Spa Ajman
 
About CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdfAbout CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdf
CentiUP
 
Bathinda ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Bathinda
Bathinda ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 BathindaBathinda ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Bathinda
Bathinda ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Bathinda
varun0kumar00
 
About CentiUP - Introduction and Products.pdf
About CentiUP - Introduction and Products.pdfAbout CentiUP - Introduction and Products.pdf
About CentiUP - Introduction and Products.pdf
CentiUP
 
Mohali Call Girls 7742996321 Call Girls Mohali
Mohali Call Girls  7742996321 Call Girls  MohaliMohali Call Girls  7742996321 Call Girls  Mohali
Mohali Call Girls 7742996321 Call Girls Mohali
Digital Marketing
 
Exosome Therapy’s Regenerative Effects on Skin and Hair Rejuvenation
Exosome Therapy’s Regenerative Effects on Skin and Hair RejuvenationExosome Therapy’s Regenerative Effects on Skin and Hair Rejuvenation
Exosome Therapy’s Regenerative Effects on Skin and Hair Rejuvenation
Advancexo
 
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptxASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
Rommel Luis III Israel
 
PPT DDTK 2 untuk balita dan prasekolah, deteksi dini tumbuh kembang pada anak
PPT DDTK 2 untuk balita dan prasekolah, deteksi dini tumbuh kembang pada anakPPT DDTK 2 untuk balita dan prasekolah, deteksi dini tumbuh kembang pada anak
PPT DDTK 2 untuk balita dan prasekolah, deteksi dini tumbuh kembang pada anak
woelan1
 
PRESSURE INJURY CARE AND MANAGEMENT FOR HCW
PRESSURE INJURY CARE AND MANAGEMENT FOR HCWPRESSURE INJURY CARE AND MANAGEMENT FOR HCW
PRESSURE INJURY CARE AND MANAGEMENT FOR HCW
dnee1
 
Sunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPA
Sunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPASunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPA
Sunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPA
ssuser555edf
 
Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -
Gokul Rangarajan
 
Psychological Safety as a Foundation for Improvement 12-06-24.pdf
Psychological Safety as a Foundation for Improvement 12-06-24.pdfPsychological Safety as a Foundation for Improvement 12-06-24.pdf
Psychological Safety as a Foundation for Improvement 12-06-24.pdf
Healthcare Improvement Support
 
Simple Steps to Make Her Choose You Every Day
Simple Steps to Make Her Choose You Every DaySimple Steps to Make Her Choose You Every Day
Simple Steps to Make Her Choose You Every Day
Lucas Smith
 

Recently uploaded (20)

Solution manual for managerial accounting 18th edition by ray garrison eric n...
Solution manual for managerial accounting 18th edition by ray garrison eric n...Solution manual for managerial accounting 18th edition by ray garrison eric n...
Solution manual for managerial accounting 18th edition by ray garrison eric n...
 
Call Girls Kolkata 8824825030 Top Class Kolkata Escorts Available
Call Girls Kolkata 8824825030 Top Class Kolkata Escorts AvailableCall Girls Kolkata 8824825030 Top Class Kolkata Escorts Available
Call Girls Kolkata 8824825030 Top Class Kolkata Escorts Available
 
Test bank advanced health assessment and differential diagnosis essentials fo...
Test bank advanced health assessment and differential diagnosis essentials fo...Test bank advanced health assessment and differential diagnosis essentials fo...
Test bank advanced health assessment and differential diagnosis essentials fo...
 
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
 
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa AjmanDiscover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
 
Types of Cancer Treatments | Forms of cancer treatment
Types of Cancer Treatments | Forms of cancer treatmentTypes of Cancer Treatments | Forms of cancer treatment
Types of Cancer Treatments | Forms of cancer treatment
 
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 FaridkotFaridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
 
Luxury Massage Experience at Affordable Rate - Malayali Kerala Spa Ajman
Luxury Massage Experience at Affordable Rate - Malayali Kerala Spa AjmanLuxury Massage Experience at Affordable Rate - Malayali Kerala Spa Ajman
Luxury Massage Experience at Affordable Rate - Malayali Kerala Spa Ajman
 
About CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdfAbout CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdf
 
Bathinda ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Bathinda
Bathinda ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 BathindaBathinda ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Bathinda
Bathinda ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Bathinda
 
About CentiUP - Introduction and Products.pdf
About CentiUP - Introduction and Products.pdfAbout CentiUP - Introduction and Products.pdf
About CentiUP - Introduction and Products.pdf
 
Mohali Call Girls 7742996321 Call Girls Mohali
Mohali Call Girls  7742996321 Call Girls  MohaliMohali Call Girls  7742996321 Call Girls  Mohali
Mohali Call Girls 7742996321 Call Girls Mohali
 
Exosome Therapy’s Regenerative Effects on Skin and Hair Rejuvenation
Exosome Therapy’s Regenerative Effects on Skin and Hair RejuvenationExosome Therapy’s Regenerative Effects on Skin and Hair Rejuvenation
Exosome Therapy’s Regenerative Effects on Skin and Hair Rejuvenation
 
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptxASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
 
PPT DDTK 2 untuk balita dan prasekolah, deteksi dini tumbuh kembang pada anak
PPT DDTK 2 untuk balita dan prasekolah, deteksi dini tumbuh kembang pada anakPPT DDTK 2 untuk balita dan prasekolah, deteksi dini tumbuh kembang pada anak
PPT DDTK 2 untuk balita dan prasekolah, deteksi dini tumbuh kembang pada anak
 
PRESSURE INJURY CARE AND MANAGEMENT FOR HCW
PRESSURE INJURY CARE AND MANAGEMENT FOR HCWPRESSURE INJURY CARE AND MANAGEMENT FOR HCW
PRESSURE INJURY CARE AND MANAGEMENT FOR HCW
 
Sunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPA
Sunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPASunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPA
Sunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPA
 
Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -
 
Psychological Safety as a Foundation for Improvement 12-06-24.pdf
Psychological Safety as a Foundation for Improvement 12-06-24.pdfPsychological Safety as a Foundation for Improvement 12-06-24.pdf
Psychological Safety as a Foundation for Improvement 12-06-24.pdf
 
Simple Steps to Make Her Choose You Every Day
Simple Steps to Make Her Choose You Every DaySimple Steps to Make Her Choose You Every Day
Simple Steps to Make Her Choose You Every Day
 

Initial Lessons From Implementing a Telecolposcopy Program on a High Risk Population in California

  • 1. Initial Lessons From Implementing a Telecolposcopy Program on a High Risk Population in California Rachel Steward1, Jennifer Spohn1, Eliya Tenenboim2, Cathy Sebag2, David Levitz2 (1) FPA Women’s Health, Los Angeles, CA (2) MobileODT, Tel Aviv, Israel Telecolposcopy Demonstration Click to play video Abstract Results Objective: To assess the feasibility of a live, telecolposcopy system in clinics serving high-risk populations. Of interest is to understand the feasibility of an integrated telecolposcopy solution from the perspectives of patient and provider acceptance in comparison to in-person oversight of an exam. Methods: A custom feature was built into MobileODT’s EVA System, a smartphone-based colposcope, utilizing a video-conferencing application. Through screen sharing, the provider at the point of care showed the expert a live video feed of the colposcopy exam, and the expert then recommended sites to biopsy. Following the procedure, a satisfaction survey is given to all remote experts, point of care providers, and patients. All twelve subjects who underwent telecolposcopy filled out a survey. As a control group, N=10 patients undergoing traditional colposcopy were also given surveys. Results: Initial findings showed that experts were able to assist the junior providers in colposcopy procedures. Patients reacted positively to the live expert supervision. Conclusions: Preliminary results suggest that live telecolposcopy is feasible on a mobile, connected colposcope. • The solution overcame challenges in video/image quality and audio quality. The expert was able to converse in real time, and provide guidance for the PoC provider to act upon. • PoC providers found the telecolposcopy feature helpful. • Overall, patients were more satisfied with telecolposcopy than traditional colposcopy • All 4 patients who had both a telecolposcopy or a traditional colposcopy said they would prefer telecolposcopy to reduce distance and time traveled • More patients need to be recruited because the sample size was small.
  • 2. Introduction Objective: Assess the feasibility of an integrated telecolposcopy solution from the perspectives of patient and provider acceptance Clinical network Rayburn et. al. "Distribution of American Congress of Obstetricians and Gynecologists Fellows and Junior Fellows in Practice in the United States" OBSTETRICS & GYNECOLOGY, VOL. 119, NO. 5, MAY 2012 According to the ASCCP Steering Committee, the current opportunistic approach to cervical cancer screening in the U.S. fails to reach sub-populations of women where rates of incidence and mortality are similar to rates in low and middle income countries at a rate much higher than the general US population.1 Reasons are complex and the challenge extends to women in low-resource, medically underserved regions, and therefore invasive cervical cancer in the US today is strongly linked to socioeconomic, geographic and racial disparities 1 where health access has traditionally been a challenge. The challenge includes a shortage of colposcopy providers in the US to reach rural women where only 50% of US counties have a colposcopist (Fig. 1) and those without access to specialists in urban centers without colposcopy services where loss to follow- up from initial screening is high.2 For the many patients who live in counties without a colposcopist, transportation to the clinic is a real barrier to seeking care.3 Family Planning Associates (FPA Women’s Health) is a nationally recognized & accredited family planning provider that offers patients safe & convenient access to quality care in a mix or urban and rural settings. The network has been accredited by AAAHC since 1996. FPA Women’s Health works primarily with underserved populations including: • Low income patients • Inner-city and rural populations • Undocumented immigrants However, today, a colposcopist is not available at many sites due to the relatively low number of patients with abnormal screening tests. However, lack of colposcopists prevent them from expanding colposcopy services despite patient need and addressing loss to follow-up from longer travel time and distance to another center. 50% of cervical cancers in US are in unscreened women. Another 10% are in underscreened women4-6 . Reaching this unscreened population is critical to impact mortality. Telemedicine can potentially solve this, by extending colposcopy services to sites lacking expertise and equipment. The remote expert can assist to better identify sites to biopsy. Video and audio communication is key. 7-9 To date, no conclusive study has shown that a telecolposcopy technology is a means to improve patient care. It is also unknown how well patients that live in remote areas and benefit from telecolposcopy actually accept the procedure. Few studies assessed their feelings about a remote expert during the exam. This study sought to explore this angle as well, as it hasn’t been discussed much in the literature.
  • 3. Materials and Methods The EVA System app includes a Decision Support Job Aid for guiding clinical workflow and documenting results. (A) Screenshots of the key steps. (B) Full decision tree backbone. (A) (B) Colposcopy clinic Tele-colposcopy Traditional colposcopy Patient survey Patient survey Remote expert survey PoC provider survey N=12 N=12 N=12 N=10 The EVA System is functionally equivalent to a video colposcope. Telecolposcopy is enabled by the EVA System – a cloud-connected mobile colposcope built around a smartphone platform. The mobile phone runs 2 mobile applications, one application to operate the EVA System, and a second application to enable videoconferencing. Experts are contacted by text message, from which they can connect to the session from their phone, a tablet, or PC. All images and annotations are stored on a HIPAA- compliant image portal. Offline quality assurance features provide decision support to providers. Following the procedure, online surveys containing 10-15 questions were administered to remote experts, PoC providers, and patients. Comparisons were made between 2 groups: • Remote experts vs. PoC providers. • Traditional colposcopy patients vs. tele-colposcopy patients Surveys were documented and analyzed using Google Forms. Surveys were also available in Spanish for non-native English speakers. The study protocol was approved by the Institutional Review Board at Western IRB, protocol no. 20190097.
  • 4. Results Survey results suggest this implementation of telecolposcopy overcame technical challenges of poor image and audio quality that made previous attempts at telecolposcopy unfeasible. In all cases, the experts were able to determine if and where to biopsy, and whether or not to take an ECC. The were then able to clearly communicate that to the PoC provider. Experts were able to converse with the provider in real time, and provide guidance for the PoC provider to act upon. Expert opinion Point of Care provider Click to play video
  • 5. Results and Discussion References: 1. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis. 2012;16(3):175–204. doi:10.1097/LGT.0b013e31824ca9d5 2. B Peterson, Neeraja & Han, Jini & M Freund, Karen. (2003). Inadequate Follow-Up for Abnormal Pap Smears in an Urban Population. Journal of the National Medical Association. 95. 825-32. 3. Coronado GD, Thompson B, Koepsell TD, Schwartz SM, McLerran D. Use of Pap test among Hispanics and non-Hispanic whites in a rural setting. Preventive Medicine. 2004;38(6):713–722. doi: 10.1016/j.ypmed.2004.01.009. 4. Freeman H, Wingrove B. Excess Cervical Cancer Mortality: A Marker for Low Access to Health Care in Poor Communities. National Cancer Institute; Rockville, MD: 2005. 5. [January 19, 2012];Division of Cancer Prevention and Control, National Center for Disease Prevention and Health Promotion. 2011 6. Spence AR, Goggin P, Franco EL. Process of care failures in invasive cervical cancer: systematic review and meta-analysis. Prev Med. 2007;45:93–106. 7. Ferris, Daron & S Litaker, Mark & S Macfee, Michael & A Miller, Jill. (2003). Remote diagnosis of cervical neoplasia: 2 Types of telecolposcopy compared with cervicography. The Journal of family practice. 52. 298-304. 8. J Etherington, Ian. (2002). Telecolposcopy - a feasibility study in primary care. Journal of telemedicine and telecare. 8 Suppl 2. 22-4. 10.1258/135763302320301876. 9. Ferris, Daron & S Macfee, Michael & A Miller, Jill & S Litaker, Mark & Crawley, Debra & Watson, Diane. (2002). The Efficacy of Telecolposcopy Compared With Traditional Colposcopy. Obstetrics and gynecology. 99. 248-54. 10.1016/S0029-7844(01)01671-4. Limitation of study 1. Too small of sample size, study is still ongoing 2. Positive bias in survey results – too many results are 5/5 3. Intra-operator bias – participants gave either high or low scores across Implications Patient Provider Expert Expert Expert Expert Expert Expert Expert Expert Integration of telecolposcopy services into the colposcope makes it scalable, requiring nothing more than an internet connection. Multiple experts can be consulted with in parallel, giving the provider. Such a telecolposcopy implementation makes it an ideal solution for LMICs, where there are not enough providers skilled in colposcopy. Traditional colposcopy Tele-colposcopy Conclusion Our preliminary results suggest that this implementation of tele-colposcopy addressed the technical challenges in previous attempts of telecolposcopy. Patient acceptability of telecolposcopy was comparable to traditional colposcopy. The integration of tele-colposcopy on EVA makes it a scalable solution for LMICs to address the shortage of providers.