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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)
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Roberto PolilloDerpartment 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
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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
Types of telemedicine applications4
DIS
TAN
CE
Synchronous or asyncronouscommunication
Types of telemedicine applications5
DIS
TAN
CE
Synchronous or asyncronouscommunication
Teleradiology Telecardiology Telepathology Teledermatology Teleodontoiatry Teleaudiology Telepsycology …
”Affordable" telemedicine
“Reasonable” technological infrastructure Low initial costs Sustainability
Low operating costs “Reasonable” technical skills locally
necessary
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The good news
Internet and mobile telephony
ALLOW NOW to develop affordable and sustainable telemedicine
applications for developing Countries
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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 personnelhttp://www.who.int/goe/publications/goe_telemedicine_2010.pdf
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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
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 people40% annual growth since 2007 2 B people40% annual growth since 2007
R.Polillo - Marzo 201311
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.”
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Source: ITU, Measuring the Information Society, 2013
Active mobile-broadband subscriptions (2007-2013*)
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Source: ITU, Measuring the Information Society, 2013
Annual growthPenetration
6 yearsdi
vide
Active mobile-broadband subscriptions (2013*)16
Source: ITU, Measuring the Information Society, 2013
Types of telemedicine applications17
DIS
TAN
CE
Asyncronous: •Store-and-forward•Remote monitoringSyncronous:•Interactive telemedicine
Store-and-forward (simple)18
Asyn
cron
ous
com
mun
icati
on
Examples:•Teleradiology•Teledermatology•Telepatology
Query with medical data:•text•images•[video]
Answer
EmailFTPDropbox….[MMS]
To consider:•Bandwidth•Data compression•Access device
19
Store-and-forward (with shared db) 20
Web / VPNSpecific application
To consider:•Server location•Bandwidth•Data compression•Common procedures•Privacy•Level of service
Data base
Query with medical data:•text•images•[video]
Answer
EXAMPLE: Pediatric Hospital La Mascota, Managua (Nicaragua)
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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
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Il server dell’amministrazioneDell’ospedale Dipartimentale di Chinandega (Nicaragua)
Remote monitoring (asynchronous) 25
Com
unic
azio
ne s
incr
ona
/ as
incr
ona
Asyn
cron
ous
com
mun
icati
onWithout Internet access:•SMS•MMS•TwitterWith Internet access:•TwitterWhatsapp•Social media•Mail
Example: Laptop + mobile for communication via SMS (software: FrontlineSMS)
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VIDEO: http://www.youtube.com/watch?feature=player_embedded&v=hEK0dTWgqzQ#!
www.kiwanja.net
• Patient monitoring / follow-up
• Vaccination campaigns• Medical info • Emergency management• …
www.medicmobile.org
Interactive telemedicine (synchronous) 27
Com
unic
azio
ne s
incr
ona
/ as
incr
ona
Sync
rono
us c
omm
unic
ation
No Internet access:•CellphoneWith Internet access:•Internet telephony (skype, whatsapp)•Video conferencing
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
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Case study: www.cure4kids.org
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
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www.cure4kids.org: growth
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Start: Oct 2002
May 2012: > 31.000 registered users in 183 countries
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Know-how globalization
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
