Download - KB_ICMCC2005.ppt
iPathtelemedicine platform to support health providers
in low resource settings
K. Brauchli*, D O‘Mahony, L Banach, M Oberholzer
Outline
• What is iPath
• iPath - a hybrid web and email solution
• iPath Worldwide
• Case Studies– Teledermatology in South Africa– Telepathology on Solomon Islands
• Telemedicine and Tele-teaching
What is iPath
• iPath - an open source software to build telemedicine platforms. Developed at University of Basel
• ipath.ch - an association to promote telemedicine and to support projects in developing countries
• Telemedicine platform based on web server
• Access via web and email
• Collaboration in (closed) working groups
• Case archive
• Automatic and personalised notifications
iPath - hybrid web and email solution
The telemedicine platform
Sending cases:
Sending cases:
www
Sending cases:
www
special equipment:e.g. remote control microscope, ultrasound ...
Reviewing cases:
email (alerts)
Reviewing cases:
email (alerts)
web interface
Reviewing cases:
email (alerts)
web interface
special remote control (e.g. JAVA applet)
User registration
User Interface
Personal start page
- List of the groups
- New cases and comments at a glance
User Interface
User Interface
Group Display
- case list
Case Display
- Description & Images
User Interface
- Comments/Diagnosis
New comments: automatic email alert
iPath worldwide
Users Productive servers In testing planned
Usage
Users Cases Images daily logins(2004)
submission by email
total 1213 5016 33247* 38 32%
developingcountries
84** 1798 14006 74%
usage statistics of iPath (24.12.2004)
* average file size 93KB. Besides images there were another 5864 files
** only 47% of users specified country of origin
Usage
Case Studies
• Teledermatology in Eastern Cape, South Africa
• Telepathology in Solomon Islands
• Telemedicine in Perinatal Health in Ukraine
Teledermatology in South Africa
Regional Telemedicine Network Server at University of Transkei, Mthatha, South Africahttp://telemed.utr.ac.za
Port St. Johns
TsilitwaUNITRA
Pilot in Port St. Johns, Eastern Cape
• GP in rural South Africa
• Small town ± 8 000: District 75 000
• Dermatology: 14% of FP consultations (SA)
• Next Dermatologist: 400km
Teledermatology in South Africa
• Teledermatology since 1999
• No of consultations: 110
• Median response time: 8 days
Teledermatology in South Africa
Teledermatology in South Africa
Teledermatology in Port St. Johns
(110 consultations)
105
57
104
0
20
40
60
80
100
120
Diagnostic Result
possible
TM made positive
change for treatment
Assistance helpful for
GP
yes
no
no difference
Teledermatology in South Africa
OUTCOME FOR GP:
• I learnt a lot and even though I may have sent some cases late for teleconsultation, one of my main objectives of learning was achieved.
• Even though I may have had the correct diagnosis, it was a good learning experience to have my diagnoses confirmed.
• The number of cases dropped off over the years. This is definitely due to my improved skill in diagnosis due to learning.
Telepathology in Solomon Islands
Solomon Islands
Solomon IslandsCapital: HoniaraPopulation: 450‘000Islands: ~1000Independence: 1978
Solomon IslandsCapital: HoniaraPopulation: 450‘000Islands: ~1000Independence: 1978
National Referral Hospital
Doctors: 15 (30)Radiologists: 1Pathologists: 0Dermatologists: 0
Doctors: 15 (30)Radiologists: 1Pathologists: 0Dermatologists: 0
Solomon Islands
Shortage of medical specialists- no dermatology, pathology, cytology ….
Shortage of access to health care - many patients come to hospital in advanced stages.
No access to current information- no medical libraries, few current literature, no senior colleagues, no continuing medical education (CME)
Limitations
Limited Transportation- no roads or very bad roads
Limitations
Tissue Processing
Preparing blocks
Cutting
Staining
Histology Lab
Histology slides
Step 1:Selected images captured with digital camera (Nikon CoolPix 990) and submitted to server in Basel via email
Step 2:Cases are reviewed by a group of 7 pathologists(Switzerland, Germany and South Africa)
Remote Consultations
Results (2002-2003)
Source: Brauchli et al. J Telemed Telecare. 2004;10 Suppl 1:14-7.
Perinatal Health in Ukraine
• Project of Swiss Centre of International Health
• Health System reform
• Improve knowledge of Ukrainian practitioners
• Foster evidence based medicine
• Support regional clinics
• Decrease amount of unnecessary referrals
Perinatal Health in Ukraine
iPath in Teaching and CME
• Clinical Meetings / Tumor Boards
• Publish content - teaching modules, samples cases, etc.
• Remote Presentations
• (soon: offline version of content for CD etc.)
Tumor Board Meetings
Low Resource Settings
• Technology must be locally available and manageable
• It must be possible to integrate usage of telemedicine into daily routine(>70% submissions by email)
• Little “local ownership” of telemedicine projects
Low Resource Settings
• Access to training and health information is very difficult in developing countries
• Professional isolation (solo practitioner without senior colleague) ==> “Brain Drain”
Problems
• Access to Computer and Internet
• Incentives - who benefits from telemedicine?
• Missing exchange between projects and networks
==> “e-fragmentation”
E-fragmentation
Dia
gn
ost
ics
Tre
atm
ent
Ed
uca
tio
n
Pu
bli
shin
g
Telemedicine E-learning Helath InformationAccess
Teleradiology
Teledermatology
Tele HIV care
Integrated Health Information Exchange
Case Specific Information
General Information
Tel
emed
icin
e
Tel
e-T
each
ing
Sci
enti
fic
Pu
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shin
g
FeedbackQuality Control
Dissemination
Studies, Research
Evidence Base
A way forward
• Connecting different telemedicine projects
• Increase knowledge sharing and transfer
• Combine telemedicine with:– Teaching– Access to health information
Local ownership
• Open Standards for data
• Open Source Software is an opportunity for developing countries to ensure ownership of data.
• Examples: UNITRA, HealthNet Nepal, AIMSHOSPITAL (India)
• Plans: Ethiopia, Francafrique
iPath
More information:
http://ipath.ch
iPath for you ?
1. Deploying iPath as technical basis fo a telemedicine platform - iPath is open source and freely available.
2. Participate in the Basel telemedicine network - as expert or non-expert.• Pathology• Dermatology• Perinatal Health