iPath telemedicine platform to support health providers in low resource settings

1
iPathtelemedicine platform to support health
providers in low resource settings

• K. Brauchli, D OMahony, L Banach, M
  Oberholzer kurt.brauchli_at_unibas.ch

2
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

3
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

4
iPath - hybrid web and email solution

• Telemedicine platform based on web server
• Access via web and email
• Collaboration in (closed) working groups
• Case archive
• Automatic and personalised notifications

5
The telemedicine platform
6
(No Transcript)
7

• Sending cases
• email

8

• Sending cases
• email
• www

9

• Sending cases
• email
• www
• special equipmente.g. remote control
  microscope, ultrasound ...

10

• Reviewing cases
• email (alerts)

11

• Reviewing cases
• email (alerts)
• web interface

12

• Reviewing cases
• email (alerts)
• web interface
• special remote control (e.g. JAVA applet)

13
User Interface
14
User Interface
15
User Interface
Group Display - case list
16
User Interface
Case Display - Description Images
17
iPath worldwide
18
Usage
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
19
Usage
20
Case Studies

• Teledermatology in Eastern Cape, South Africa
• Telepathology in Solomon Islands
• Telemedicine in Perinatal Health in Ukraine

21
Teledermatology in South Africa
Regional Telemedicine Network Server at
University of Transkei, Mthatha, South
Africahttp//telemed.utr.ac.za
UNITRA
Tsilitwa
Port St. Johns
22
Teledermatology in South Africa

• 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

23
Teledermatology in South Africa

• Teledermatology since 1999
• No of consultations 110
• Median response time 8 days

24
Teledermatology in South Africa
25
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.

26
Telepathology in Solomon Islands
27
Solomon Islands
28
Solomon Islands
Solomon IslandsCapital HoniaraPopulation
450000Islands 1000Independence 1978
Doctors 15 (30)Radiologists 1Pathologists
0Dermatologists 0
29
Limitations

• 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)

30
Limitations

• Limited Transportation- no roads or very bad
  roads

31
Histology Lab
32
Remote Consultations
Step 1Selected images captured with digital
camera (Nikon CoolPix 990) and submitted to
server in Basel via email
Step 2Cases are reviewed by a group of 7
pathologists(Switzerland, Germany and South
Africa)
33
Results (2002-2003)
Source Brauchli et al. J Telemed Telecare.
200410 Suppl 114-7.
34
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

35
Perinatal Health in Ukraine
36
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.)

37
Tumor Board Meetings
38
Low Resource Settings

• Technology must be locally available and
  manageable
• It must be possible to integrate usage of
  telemedicine into daily routine(gt70 submissions
  by email)
• Little local ownership of telemedicine projects

39
Low Resource Settings

• Access to training and health information is very
  difficult in developing countries
• Professional isolation (solo practitioner without
  senior colleague) gt Brain Drain

40
Problems

• Access to Computer and Internet
• Incentives - who benefits from telemedicine?
• Missing exchange between projects and
  networksgt e-fragmentation

41
E-fragmentation
DiagnosticsTreatment
Publishing
Education
42
Integrated Health Information Exchange
Scientific Publishing
Tele-Teaching
Telemedicine
Case Specific Information
General Information
43
A way forward

• Connecting different telemedicine projects
• Increase knowledge sharing and transfer
• Combine telemedicine with
• Teaching
• Access to health information

44
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

45
iPath

• More informationhttp//ipath.ch

46
(No Transcript)
47
(No Transcript)
48
iPath for you ?

• Deploying iPath as technical basis fo a
  telemedicine platform - iPath is open source and
  freely available.
• Participate in the Basel telemedicine network -
  as expert or non-expert.
• Pathology
• Dermatology
• Perinatal Health