TELEMEDICINE - TELECARDIOLOGY!

PROFESSOR DR HAMED OEMAR, PHD

Senior Consultant Cardiology, Echocardiologist,

e-Health Supervisor, Faculty of Medicine UiTM Malaysia

TELEMEDICINE:

Medical equipment is one of the basic requirements to set up a telemedicine station and support an examination. With the right

telemedicine equipment and telemedicine software, new and cutting edge healthcare can be provided.

INTRODUCTION

•  Closed the Gap: shutting the breach between a modern and a rural hospital

•  A Golden Bridge: bridging an inadequate of latest technology on one-to-another

•  Inter-connection: linking a hospital to another hospital

•  Education Hub: media for upgrading knowledge, skill and competence of MD/NR

E-HEALTH AND M-HEALTH

Pelayanan kesehatan berbasis elektronik (e-Health) telah dianjurkan oleh World Health Organization (WHO) sejak 2005

TO SOLVE MANY PROBLEMS OF

INADEQUATE CONDITIONS

Menyelesaikan masalah komunikasi yang paling banyak dihadapi oleh Rumah Sakit, Pasien dan Keluarga pasien

TO SOLVE MANY PROBLEMS OF

INADEQUATE CONDITIONS

Menyelesaikan masalah kekurangan tenaga dokter yang dihadapi oleh Rumah Sakit dan Pasien/ Keluarga pasien

TO SOLVE MANY PROBLEMS OF

INADEQUATE CONDITIONS

Menyelesaikan masalah kekurangan & kelambatan pelayanan spesialis/sub-spesialis terhadap berbagai penyakit sulit dan berat

RATIO POPULATION AND DOCTOR

•  2012 data shows 30 doctors 100,000 population, ratio is 1:3300

Organisasi Kesehatan Dunia (WHO) tahun 2012, jumlah dokter dengan penduduk Indonesia tidak

sebanding, sehingga bisa dikatakan hal ini paling buruk se-ASEAN (Association of South East Asia Nations)

KONDISI GEOGRAFI

•  Indonesia adalah negara kepulauan (17.000 pulau). •  Penempatkan dokter spesialis di seluruh pulau jelas

memiliki kendala tersendiri. •  Masyarakat yang berada di kabupaten, kecamatan,

atau desa apalagi di daerah perbatasan mau tak mau harus cukup puas dilayani oleh dokter yang bukan spesialis atau bahkan mantri dan perawat.

FLOW PASIEN BEROBAT KE LUAR NEGERI •  Animo masyarakat Indonesia untuk berobat

keluar negeri juga cukup tinggi. •  Ketua IDI “Dalam setahun hampir 1 juta

orang berobat ke luar negeri dengan uang yang dibelanjakan ke luar negeri untuk kepentingan berobat mencapai angka Rp 20 triliun”

PEMBANGUNAN KESEHATAN •  Peningkatkan pembangunan kesehatan di

Indonesia akan sulit kalau tidak ada “terobosan baru”

•  Tujuan Pembangunan Nasional: •  Meningkatkan kesadaran, kemauan, dan

kemampuan hidup sehat •  Investasi bagi pembangunan sumber daya

manusia yang produktif secara sosial dan ekonomis.

RUMAH SAKIT YANG MEMILIKI DOKTER SPESIALIS DI INDONESIA

NO DOKTER

SPESIALIS JUMLAH JUMLAH RS YANG TIDAK

MEMILIKI

JUMLAH RS YANG

MEMILIKI

% RS YANG MEMILIKI DOKTER

SPESIALIS

1 Anak 5,241 511 1,854 78.42 Obgyn 6,242 502 1,863 78.83 Penyakit Dalam 4,862 596 1,769 74.84 Bedah 4,230 654 1,711 72.35 Radiologi 2,106 1,096 1,269 53.76 Anestesi 3,361 787 1,578 66.7

7Jantung & Pembuluh Darah 1,179 1,767 598 25.3

8 Saraf 1,820 1,399 966 40.89 Paru 1,093 1,698 667 28.210 Mata 2,431 1,215 1,150 48.611 THT 2,290 1,214 1,151 48.712 Patologi Klinik 1,009 1,615 750 31.713 Kes. Jiwa 1,083 1,744 621 26.314 Patologi Anatomi 467 2,047 318 13.415 Urologi 412 2,094 271 11.516 Orthopedi 765 1,905 460 19.517 Kulit&Kelamin 902 1,854 511 21.618 Forensik 99 2,303 62 2.6

19Dokter Spesialis Lainnya 2,233 1,940 425 18

✓

✓

✓

✓

✓

✓ ✓

Sumber: KemKes RI, Data 2008 ✓ = Tersedia Spesialis <30%

WHEN DO WE NEED TELEMEDICINE?

•  Many patients find it difficult to travel to clinics, hospitals, or doctors’ offices for any number of reasons.

•  By using video conferencing and other telemedicine technology when applicable, healthcare practitioners and patients can reduce the costs associated with regular office visits.

TELEMEDICINE | WHY USE TELEMEDICINE?

•  Remote healthcare services and technology are quickly becoming common-place for healthcare.

•  Telemedicine enables practitioners to evaluate, diagnose and treat patients remotely using the latest telecommunications technology.

DOCTOR – PATIENT COMMUNICATION IN TELEMEDICINE

E-HEALTH OR TELEMEDICINE STATION

ECHO Room at Center or Hospital

MANFAAT TELEMEDICINE

•  Mendekatkan akses dokter-pasien yang jauh

•  Meningkatkan kwalitas pelayanan kesehatan

•  Komunikasi konsultasi antara RS dan RS

•  Mendapatkan pendidikan spesialis/konsultan dan provider

•  Meningkatkan kepuasan pasien dan RS/provider

•  Mengurangi biaya kesehatan secara umum

•  Meningkatkan efisiensi pelayanan tertiar

INITIATIVE TO BE SUCCESSFUL !1. Establishing an incentive-based program.

“sustainable funding is vital”

2.  Infrastructure. “Having adequate infrastructures [in place] to support these initiatives

3.  Improved telemed reimbursements. 4.  Fostering user acceptance & confidence in telemedIcine. 5.  Resources and time. ”programs must have the proper

allocated resources and time necessary to ensure its widespread adoption”.  

EQUIPMENT FOR TELEMEDICINE

EQUIPMENT IN TELEMEDICINE

•  Fiber optics •  Broadband/wireless coverage •  Video •  Computer •  Voice and imaging.

BASE STATION

•  Echocardiographer Mobile Application •  Web Application •  Network A/V Encoder

SPECIAL CAMERA •  Teleconference

equipment enabling seamless and real-time face-to-face collaboration at the desktop.

SAMPLE: Polycom HDX 7000

•  HD video conferencing for high-quality communication in workplace environments.

•  ideal for education, medical, enterprise & on-demand collaboration solutions, expanding the utility of visual communications quickly and easily

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2

3

4

5

VICON

TRAINING BY EXPERT

•  Class Room versus Teleconference Room and Laboratorium (Tatap-muka)

•  On-line at Far Distance Course •  Self Learning and Assessment Test •  Evaluation

STUDY ON-LINE AT CLASS ROOM

TELECONFERENCE

Seorang MLT melakukan rekaman USG Liver!

Workstation at Telemedicine Center

TELECARDIOLOGY

Contoh, seorang spesialis sedang membuat intererpretasi dan diagnosis echo LA Myxoma

TELE-DERMATOLOGY

Seorang spesialis sedang membuat analisa penyakit kulit penderita dari RS Satelit (Daerah)

Use of information and communication technologies:

i)  To provide specialized health care consultation

to patients in remote locations,

ii) To facilitate video-conferencing among health care experts for better treatment & care,

iii) To provide opportunities for continuing education of health care personnel.

Objectives of Telemedicine

Relevance of Telemedicine

Ø  Inadequate infrastructure in rural/district hospitals

Ø  Large number of indoor/outdoor patients requiring referral for specialized care

Ø  Low-availability of Health Experts in district/remote hospitals

Ø  Shortage of adequate opportunities for training or continuing Medical Education for Doctors in Rural/Remote Health facilities.

IN GENERAL

Benefits of Telemedicine (I)

Benefits to Patients:

Ø  Access to specialized health care services to under-served rural, semi-urban and remote areas,

Ø  Access to expertise of Medical Specialists to a larger population without physical referral,

Ø  Reduced visits to specialty hospitals for long term follow-up care for the aged and terminally ill patients.

Benefits to Physicians:

Ø  Improved diagnosis and better treatment management

Ø  Access to computerized, comprehensive data (text, voice, images etc.) of patients – offline as well as real time

Ø  Quick and timely follow-up of patients discharged after palliative care

Ø  Continuing Education or Training (CME&T) through video conferencing periodically

Benefits of Telemedicine (II)

Hospital and Insurance Benefits:

Ø  Significant reduction in unnecessary visits & hospitalization for specialized care at tertiary hospitals,

Ø  Earlier discharge of patients leading to shorter length of stay in hospitals,

Ø  Increase in the scope of services without creating physical infrastructure in remote hospitals

Benefits of Telemedicine (III)

ADVANTAGE

Ø Real-time transmission. Ø Reduction of both patient and physician

transfers. Ø Scheduling of consultation. Ø Emergency management. Ø Clinical record and remote reporting.

THE SYSTEM IS BASED ON THREE MAIN COMPONENTS

•  The control station (one per tertiary care center)

•  The base station (one per secondary care center)

•  The data hub (one for the whole system)

CONTROL STATION

•  Specialized Desktop Application •  The specialist may control pan, tilt and zoom of

the camera through the keyboard or the on-screen graphical interface

•  Web Application •  view the clinical records and create or edit

consultation reports.

Sequence of Tele-consultation (I) PATIENT IN

Patient visits OPD Local Doctor checks up

Patient receives treatment and is not referred to telemedicine system

Patient referred to the Telemedicine system (some special investigations may be suggested)

Patient visits Telemedicine data-entry console. Operator enters patient record, data and images of test results, appointment date is fixed for online telemedicine session

OUT

OUT

Offline Data transfer

from Nodal Centre

Step

One

Patient 1 Patient 2 Patient 3 Patient 4

.

.

.

Online video conference & tele-consultation for patients between local doctors at the nodal hospital and specialist doctors at the referral hospital

Patient Queue

IN OUT

Step

Tw

o Sequence of Tele-consultation (II)

Connecting the All Health Centers

CONNECTING SATELITES HOSPITALS IN INDONESIA

TELEMEDICINE CENTER

H9

H7

H6

H10

BERBASIS VICON •  Telemedicine berbasis video conference

yaitu pelayanan kesehatan rujukan antara fasilitas pelayanan kesehatan yang dilaksanakan secara jarak jauh

melalui media teknologi informasi dan telekomunikasi, yang memungkinkan terjadi komunikasi tatap muka antara

tenaga kesehatan.

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JENIS PERALATAN TELEMEDICINE �BERBASIS VICON �

•  End-point video confere :2 set (pengampu dan diampu) •  Komputer set/PC : 2 set (pengampu dan diampu)•  Monitor TV 32 inch : 2 set (pengampu dan diampu)•  UPS : 2 set (pengampu dan diampu)

Peralatan tersebut terdiri dari !!

EXPERTS ROLE (Peranan dan Tanggung-Jawab Pakar Supervisor)

•  Kebijakan Program Telemedicine

•  Supervisi Pelakasanaan di Lapangan

•  Koordinasi lalu-lintas informasi pasien-ke-dokter, vs

•  Koordinasi Para Spesialis yang Terdaftar Ikut Program Telemedicine

•  Tanggung-jawab Sistem Pelaporan Kasus, Keakuratan dan Sekuriti Tranfer ke RS Satelit

EXPERT’S STATION & EDUCATIONAL RESPONSIBILITY

•  It is not dependency on one expert or specialist

•  Expert have to do transfer of knowledge and skill to younger specialist in the team group

•  Expert shall have limit period of tenure, for instance, 3-4 years

EDUATIONAL RESPONSIBLE – TRAINING CENTER

•  Young Specialist (Cardiologist, Dermatologist, Neurologist, Radiologist, Pediatricians, Psychiatry, Public Health, etc.)

•  MLT (Medical Laboratory Technicians), Radiographer

•  Nurses (Male and Female)

UU DAN PERATURAN SEBAGAI GUIDELINE •  Undang-Undang No. 36 Tahun 1999 tentang Telekomunikasi •  Undang-Undang No. 36 Tahun 2009 tentang Kesehatan •  Undang-Undang No. 44 Tahun 2009 tentang Rumah Sakit •  Undang-Undang Nomor 11 Tahun 2008 tentang Informasi dan

Transaksi Elektronik •  Keputusan Menteri Kesehatan Nomor 1014 tahun 2008 •  Permenkes RI Nomor 780/Menkes/Per/VIII/2008 tentang

Penyelenggaraan Pelayanan Radiologi •  Petunjuk Teknis Sistem Informasi Kesehatan, 2011, KemKes RI

CONCLUSION •  Telemedicine, if used to its full extent, has the potential to

cause great and far-reaching effects on the field of medicine.

•  The implementation and effective use of Internet, mobile and video technologies offer hospitals, physician groups and health plans ways to improve their performance and provide greater convenience and value to patients.

•  As new health care delivery and payment models evolve, and the systems to support the use of new technologies improve and become less costly, telemedicine offers the potential to improve the efficiency, convenience and cost-effectiveness of our health care system.