To develop a telemedicine system to improve remote diagnoses and to deliver a cost-effective, better-quality specialist services in developing countries

Health care of 21st Century

Mannan Mridha & Björn Pehrson

KTH-Sweden

Sections of presentation

Telemedicine

Feasibility study

Objectives

Methods

Expected results

TelemedicineWhat is telemedicine?

Telemedicine is the use of electronic communication and information technologies to provide health care when distance separates the medical professional from the patient.

Case Processing

History Taking and Clinical Examination

Digitisation of the case

Case Transmission using high speed net

connectivity

Case Reception bythe specialist

Second Opinion

Telemedical Equipment and Technique

•Tele consultation – Helping the patient to reach a confirm diagnosis.

•Tele monitoring – Example is monitoring a cardiac patient with an ECG.

• Tele health – Mainly consists of health education

• Tele mentoring – Example is telesurgery.

Telemedicine

Types of service

Equipment

Major equipment commonly used are:

General Examination Camera E-Stethoscope ENT Scope Ophthalmoscope X-Ray Digitizer 12 lead ECG machine Spirometer

Types of consultation

SIMPLE E-MAIL CONSULTATION: Consultation of simple cases (case presented without any images).

COMPLEX CASE CONSULTATION: Consultation of more complicated case presented with images like x-Ray, ECG, Ultrasonogram, CT Scan, MRI etc.

X-RAY INTERPRETATION

CT INTERPRETATION

MRI INTERPRETATION

TelemedicineBenefits of Telemedicine in the developing countries?

1. Reduced physician’s fees and cost of medicine

2. Reduced travel expenses

3. Treatment by qualified physician, interpretation of imaging & histopathology, when professionals are distantly placed

4. Early detection of diseases

5. Reduced burden of morbidity

6. Saves work-loss time and increase productivity

7. Home health care by using telemedical home monitoring device for chronic case

For the patient

TelemedicineBenefits of Telemedicine?

• Telemedicine is an excellent opportunity to share the knowledge between physicians all over the world.

• Joint consultation with expert physicians and surgeons for better management of complicated disease.

• Local doctors can be updated at any time with the most recent advancement in medicine.

• Medical education in the form of teleconferencing

For the doctors

TelemedicineBenefits of Telemedicine?

a)    Reduced rush to the medical facilities in the cities

b)      Improve monitoring facilities at the rural based centres

c)      Increased reliance on the government health care system

d)     Increases stuff productivity

e)   Economizes resources (optimal use of instruments and surgical facilities).

For the government

Feasibility study

   Our study addressed::

Policy-related issue,

Organizational and human capacities issues,

Financial issues,

Technical issues

Questions asked were:

  

Policy-related Issues

a. What are the main challenges in the country’s health care system?

b. Which of these could be successfully addressed telemedicine ?

c. What are the current or planned health care programmes or activities in the country that could benefit from the application of health telemedicine? In which way?

d. Have any strategies or policies for implementing health telemedicine been developed in the country previously?

e. Have there been any projects or systems using health telemedicine in the country previously? If so, what is the experience?

Questions asked were:

   Organizational and human capacities Issues

 a. Which are the geographical areas, local institutions and/or focal points that would be

involved in a telemedicine project or service?

b. What kind of human resources are available?

c. What is the computer literacy level among key personnel?

d. What kind of training programmes will be needed?

e. How is the issue of medical responsibility within the country’s health care system in relation to health telemedicine?

f. Is there any existing legislation on confidentiality, security and privacy which could apply for health telemedicine services?

Questions asked were:

   Financial Issues

 a. How will the project be funded with regard to investments and running costs?

b. How will the service be paid for?

c. What is the level of communication costs in the country?

d. Who will provide training and maintenance?

e. What kind of activities, human resources, equipment and other factors can be provided by the local project participants or the government?

Questions asked were:

   Technical Issues

 a. How is the telecommunication infrastructure in the country, in terms of distribution and

costs?

b. What type of communication technology is used?

c. Is the telecommunication infrastructure reliable?

d. Are there any government plans for the current telecommunication infrastructure?

e. Which are the main telecommunication providers in the country?

f. Which are the Internet Service Providers in the country?

g. How is the distribution of technical equipment such as computers, digitized medical equipment, in hospitals, clinics and administrative units?

h. How will maintenance be cared for?

Our objectives are to:

a) select telemedicine equipment to meet the medical need of the local communities,

b) determine the factors involved in transmission of medical data to adapt to the existing connectivity and other facilities,

c) prepare appropriate education and training programme

d) implement a pilot telemedicine system at some model centres,

e) develop the methods towards a sustainable telemedicine-technology for safe and reliable & cost effective operation,

f) evaluate the centres to find if IT & Telemedicine services can improve the quality of care and access to health-care,

g) prepare recommendations & guidelines on how the rural and remote areas in the developing countries can benefit from self-sustaining telemedicine communication systems.

Our partners

IT University/KTH, Sweden (coordinate, develop and implement) 

Grameen Health, Bangladesh (provide rural health centres) 

Grameen communication, Bangladesh (provide network support) 

BIRDEM Hospital, Bangladesh (provide medical specialists) 

PG Hospital, Bangladesh (provide medical specialists)

Method:

Phase I: Development of equipment system for monitoring, diagnosis & consultation,

Phase 2: Development of reliable information management systems and networks,

Phase 3: Implementation and evaluation of the systems.

Power Zoom Push-button 1-50x zoom allows both close focus and wide angle images.

Auto Focus The camera automatically stays in focus for ease of use.

Freeze Frame Freeze frame produces the clearest possible image, making it ideal for both low- and high-bandwidth solutions.

Accurate Colors One button white balance sets highly accurate colors quickly and easily.

Polarization Elimination of surface skin reflection allows camera to see into epidermal layers.

Touch and View The AMD-2500 includes manual or automatic iris control to maximize image brightness.

AMD 2500 General Examination Camera

Telemedical Equipment And Technique

Telemedical Equipment And Technique

Pictures taken by AMD 2500 General Examination Camera

Telemedical Equipment And Technique

Dermoscope View General Exam View

Pictures taken by AMD 2500 General Examination Camera

Direct Ophthalmoscope

Telemedical Equipment And Technique

Video version of the traditional diagnostic scope used by the vast majority of primary physicians worldwide.

View and illuminate retina, head of optic nerve, retinal arteries, vitreous humor even through an undilated pupil, but better viewable with pupil dilated.

Focus in eyepiece is equal to image on

video monitor.

Telemedical Equipment And Technique

Superior Imaging

The AMD-300s teams Welch Allyn's patented Solarc™ lamp with Sony's HyperHAD CCD to deliver a crisp, clear, uniform image from edge to edge.

Superior Illumination

Welch Allyn's arc lamp produces white light for true color and the advanced design projects light into the fiber optic bundle at a wider angle, producing consistent illumination across the monitor.

Easy To Use

Automatic white balance and iris control match the level of illumination to the needs of the camera.

Flexibility & Economy

The AMD-300s adapts to a wide range of rigid and flexible diagnostic scopes.

Rugged Construction

The solid camera housing, reinforced cable and rugged system chassis guarantee long life under continuous use. The lamp has an average life of 500 hours.

Telemedical Equipment And Technique

CARDIOPHONOGRAM BY AMD-3400R&S PhoneSteth

2D ANALYSIS OF HEART SOUND BY AMD-3400R&S PHONE STETH

Telemedical Equipment And Technique

Large Format 12 Bit X-ray DigitiserCobra Scan CX-312T

DICOM (Digital Imaging & Communication in Medicine) compatibility

Can scan image plates with 700 dpi (max) whereas only 150 dpi is required to fulfill DICOM compatibility

Supplied with X-scan 32 Software which enhances image quality up to minute detail.

TelemedicineExpected results

Telemedicine can enhance Bangladesh Government Health Programme that envisage a client oriented

services, known as Essential Service Package (ESP) to:

Increase health coverage,

Improve quality of services,

Cost effectiveness,

Accountability

Other Benefits of Telemedicine?

The facilities can be used for other purposes to reduce the digital divide such as:

       Education and research

       Business and trade

       Administration and management