Telemedicine in the Pacific:

1
Telemedicine in the Pacific Past, Present and
Future Victoria Garshnek, Ph.D. Telemedicine
Project Office University of Hawaii School of
Medicine Honolulu, Hawaii
2
Telemedicine in the Pacific

• Historical Overview
• Reasons for telemedicine in Pacific
• -Experiments/Issues
• -Today ? Future

3
What is Telehealth?

• Telehealth the use of electronic information
• and telecommunications technologies to
• support long-distance.
• Clinical health care (telemedicine)
• Health-related education and information
• - Public health
• - Health administration

4
Ways to Do Telehealth

• Telephone
• E-mail
• Dedicated Web Page
• Video Conference

5
Choice Depends On

• Available resources, services, and technical
  support
• Interest, knowledge and skill of the user
• Level of development of the health system
• Type of medical information exchanged

6
Pacific Basin

• Why a special area?
• Why develop Telemedicine there?

7
Reasons for Pacific Telemedicine

• 5 of the 7 largest armies there
• Large military hospitals
• Isolated communities

8
Reasons for Pacific Telemedicine
DoD provides secondary/tertiary care to medically
underserved people of US Associated Pacific
Islands - Federated States of Micronesia -
Republic of Palau - Republic of Marshall
Islands - Commonwealth of N. Marianas - Guam
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
Reasons for Pacific Telemedicine

• Obstacles/Difficulties
• Pacific very large
• 16 time zones/date line
• 60 Earths natural disasters
• Communication links
• Air transportation minimal
• Some locations do not have physician

13
Pacific Situation Medical Support

• Where medical support may be lacking
• The number of physicians and/or specialists
  necessary to serve the population
• Professional isolation and lack of continuing
  education for existing health care providers
• Inappropriate facilities and technologies to
  serve their populations.

14
Pacific Evacuation

• US affiliated islands
• Family members might accompany
• Very expensive!
• To Tertiary hospital (very far away!)
• Represents large proportion of health/medical
  expenditures in Pacific

15
Early Pacific Telemedicine

• Tripler AMC
• University of Hawaii
• Island Hospitals

16
Early Days of Telemedicine 1993

• Experiments to help
• Assess the needs within communities
• Identify cultural issues with the introduction of
  such services
• Identify other barriers and problems that might
  affect the usefulness in the region

17
1993 Kwajalein Experiment

• Atoll in Marshall Islands (DoD missile testing)
• Needed to reduce costs of evacuations
• ITV infrastructure already there
• Defense satellite communication
• 2x/month fax/e-mail video conference
• Averted many medical evacuations

18
1994 Pacific Basin Medical Officers Training
Program

• Pohnpei (FSM)
• Used PEACESAT (University of Hawaii)
• Picasso image phone

19
Picasso Still-Image Video Phone

• Picasso Still Image Telephone System
• Color Monitor
• Video Camera
• Accessories for Digital Imaging
• Laptop Computer
• Fax Machine

This system can deployed and is connected by
analog phone lines or via satellite link-up.
20
Training Program Experiements

• Weekly Directors rounds/lectures
• Teleradiology (consults, pediatric x-rays)
• Demonstrated that low-cost system can be a
  powerful telemedicine tool.

21
Issues

• Language
• Standards/licensing
• Operational protocols
• Financial reimbursements
• Culture
• Ethics/privacy
• Sustainability

22
Mid-1990s The Internet

• Cost effective
• Rapid development of applications
• A basic foundation for telemedicine services

23
1997 Pacific Island Health Care Project

• US associated Pacific islands
• Past
• Send specialists
• Phone consult
• Fax
• Medical evacuation
• Now Website Telemedicine

24
PIHCP

• Patients seen no-cost or reimbursable
• Standardized format
• Personal computer
• Clinicians view complete request
• Web-based, Store-and-forward format
• Database/archive/fiscal management
• Can be used over regular phone lines
• Multi-media, multi-point e-mail text images

25
PIHCP
26
PIHCP Today

• Accepted component of patient care at Tripler
• Has increased access to/quality of care in remote
  Pacific islands
• Has already logged over 2,000 cases

27
Telemedicine Research Today

• Department of Defense
• Asthma in-home monitoring
• Cardiac follow-up
• Cardiac Rhythm Post-discharge Monitoring
• Community Pediatric Research, Teaching, Service
  Project
• Digital Echocardiography
• Electronic Childrens Hospital of the Pacific
• Pacific Asynchronous Telehealth
• Remote Access to Medical Specialists Critial Care
  and Home Care Monitoring
• Teleradiology
• Telepathology
• Video otoscopy

28
Telemedicine Research Today

• Veterans Administration
• Teledermatology
• Tele-cardiology
• Tele-homecare
• Tele-nutrition
• Tele-ophthalmology
• Tele-pharmacy
• Telemedicine Surgery Clinic

29
Telemedicine Today

• Island Clinics/hospitals
• Bay Clinic (Big Island, Hawaii)
• Tele-radiology
• Tele-dermatology
• Tele-dentistry
• Castle Medical Center (Oahu, Hawaii)
• Videoconference, clinical telehealth carts
• Community Clinic (Maui, Hawaii)
• Videoconference, clinical telehealth carts

30
Active Telehealth Operations in the Pacific
Alaska
Korea
Japan
Okinawa
Kosrae
Hawaii
USAKA
Guam
Pohnpei
Marshall Islands
Yap
Chuuk
Palau
American Samoa
Diego Garcia
31
Telemedicine Today

• University of Hawaii
• Continuing efforts in distance learning projects
• Collaborations with other institutions and
  Nations (grants)
• Focus National-international concerns in
  bioterrorism preparedness training, infectious
  disease outbreak surveillance

32
Pacific Experience Lessons Learned

• Do a needs-assessment first
• Always look first at the simplest, least
  expensive solutions
• Develop clinical champions
• Make system convenient for clinicians at both
  ends
• Understand that you may not be able to address
  all medical problems
• Developments in telehealth must be coordinated
  and integrated

33
Future????

• Broadband capability
• Inexpensive
• Simple/user friendly
• Minimal training
• Familiar items/dual use
• Artificial intelligence
• Expert systems
• Small and mobile (pocket telemedicine)

34
Mahalo Nui Loa
Grazie!