Transcript 06 Oct 2016 The Role Of Ict In Health Care Delivery By Edson

THE ROLE OF ICT IN HEALTH
CARE DELIVERY
Bugando Medical Centre
Presented by Edson Joseph &
Alfred Dandu
What is ICT?
ICT (information and communications
technology - or technologies) is an umbrella
term that includes any communication device or
application, encompassing: radio, television,
cellular phones, computer and network
hardware and software, satellite systems and so
on, as well as the various services and
applications associated with them, such as
videoconferencing and distance learning. ICTs
are often spoken of in a particular context, such
as ICTs in education, health care, or libraries.
Presented by Edson Joseph &
Alfred Dandu
Health information
technology (HIT)
• Health information technology (HIT) is
the application of information processing
involving both computer hardware and
software that deals with the storage,
retrieval, sharing, and use of health care
information, data, and knowledge for
communication and decision making.
Presented by Edson Joseph &
Alfred Dandu
Three sections
Telemedicine
PAC (Picture Achieving Communication)
Ward Lookup
Presented by Edson Joseph &
Alfred Dandu
What is telemedicine
• Telemedicine is the use of telecommunication and
information technologies in order to provide clinical health
care at a distance. It helps eliminate distance barriers and
can improve access to medical services that would often
not be consistently available in distant rural communities. It
is also used to save lives in critical care and emergency
situations.
• Telemedicine (also referred to as "telehealth" or "ehealth") allows health care professionals to evaluate,
diagnose and treat patients in remote locations using
telecommunications technology. Telemedicine allows
patients in remote locations to access medical expertise
quickly, efficiently and without travel.
Presented by Edson Joseph &
Alfred Dandu
medical professionals
Presented by Edson Joseph &
Alfred Dandu
Telemedicine means.
•
•
•
•
•
VTC(Video Teleconfering)
E-mails
Mobile Devices(Cell-phones, Tablets)
Radio calls.
Online management systems
Presented by Edson Joseph &
Alfred Dandu
video conference (video
conferencing)
• A video conference is a live, visual connection
between two or more people residing in
separate locations for the purpose of
communication. At its simplest, video
conferencing provides transmission of static
images and text between two locations. At its
most sophisticated, it provides transmission of
full-motion video images and high-quality audio
between multiple locations.
Presented by Edson Joseph &
Alfred Dandu
VTC uses
Presented by Edson Joseph &
Alfred Dandu
BMC - VTC
Presented by Edson Joseph &
Alfred Dandu
BMC - VTC
Presented by Edson Joseph &
Alfred Dandu
BMC - VTC
Presented by Edson Joseph &
Alfred Dandu
E-mails
• Messages can be categorized as either clinical or
administrative. Structured clinical consultations, or evisits, are carried out by channeling encrypted email
through a secure online portal linked to the patient’s
electronic health record. The provider responds as he or
she would in an office—for instance, by writing a
prescription, ordering a lab test or imaging study,
referring the patient to a specialist, or recommending a
follow-up appointment. Such interaction can replace
office visits for nuisance illnesses, saving patients the
time, cash, and hassle of missing work and schlepping to
the doctor’s office.
Presented by Edson Joseph &
Alfred Dandu
E-mails
Presented by Edson Joseph &
Alfred Dandu
Online management systems
• Telemedicine software is used specifically
to provide clinical care. Usually,
telemedicine software connects patients
with their doctors, or medical professionals
to other healthcare providers.
• These software are normally designed and
developed by ICT engineers/Programmers
following medical practitioners
requirements.Presented by Edson Joseph &
Alfred Dandu
Online management systems
Presented by Edson Joseph &
Alfred Dandu
Advantages of
telemedicine
Presented by Edson Joseph &
Alfred Dandu
More Convenient and
Accessible Patient Care
• In today’s healthcare world, convenience is key.
• Patients who live in remote locations, or who are
homebound or just can’t take off time from work,
can access care virtually. Video conferencing,
smartphone apps, and online management
systems connect more patients with providers than
ever before.
Presented by Edson Joseph &
Alfred Dandu
Cost-efficiency.
• An increasing number of doctors are
charging less for a telemedicine
consultation than they would for an inperson visit.
• Telemedicine also reduces unnecessary
non-urgent ER visits and eliminates
transportation expenses for regular
checkups.
Presented by Edson Joseph &
Alfred Dandu
Extended Specialist and
Referring Physician Access
–With telehealth, patients in rural or
remote areas benefit from quicker
and more convenient specialist
access.
Presented by Edson Joseph &
Alfred Dandu
Increased Patient
Engagement
– When patients are committed to their own
healthcare goals, it leads to lower costs and
improved health.
– Engaging your patients through telemedicine
can help them maintain appointments and
care schedules.
Presented by Edson Joseph &
Alfred Dandu
Better Patient Care Quality
• Telemedicine offers patient-centered
approaches, such as improved timeliness
of care. This is critical to quality patient
care. Patients can address healthcare
issues quickly with real-time urgent care
consultations and learn about treatment
options within minutes.
Presented by Edson Joseph &
Alfred Dandu
Privacy assurance.
• Telemedicine complies with medical laws,
which aim to prevent private or secure
medical documents from being leaked.
"You wouldn't want to Skype with your
medical professional and talk about all
your personal medical history," But
telemedicine "is safe. It's private."
Presented by Edson Joseph &
Alfred Dandu
Disadvantages
• 1. Electronic glitches. Technology is only
as reliable as the electrical current that
keeps it running. Inclement weather and
other annoyances can cause a power
outage or disrupt an internet connection,
complicating online consultation with a
doctor. Workers should keep that in mind
prior to scheduling online visits.
Presented by Edson Joseph &
Alfred Dandu
Disadvantages
• 2. Medical professionals resistance. The bulk
of resistance comes from some doctors
struggling to comfortably use the new
technology.
Presented by Edson Joseph &
Alfred Dandu
Disadvantages
• 3. Inadequate assessment. While having
the ability to interface with your primary
care medical professionals or dentist is a
major plus, certain non-verbal cues might
still slip through the cracks."To me, there
are no limits on how you can use
telemedicine, but of course one of the
cons is you cannot personally touch or feel
the patient,"
Presented by Edson Joseph &
Alfred Dandu
Telemedicine status at bugando
• Basically we do not have fully telemedicine
service at our centre.
• Currently we have VTC and
• We do use Electronic mails(part of Telemedicine
service) as a means of communication to
receive visit requests from peripheral
hospitals(Shirati, Kagondo,
Rubya,Ndala,Sumve, Kabanga, Bukumbi,
Mwadui, Manyovu,Kolandoto) for specific
specialty eg. ENT, orthopedics, and general
surgeon etc. Presented by Edson Joseph &
Alfred Dandu
Telemedicine previous status at
bugando
Before we had radio calls as a means of communication
where by most of the hospitals including;
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
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
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

Kibondo Hospital
Kasulu Hospital
Kagondo Hospital
Kabanga Hospital
Kigoma Hospital
Sengerema DDH
Sumve Hospital
Murgwanza Hospital
Nyakahanga Hospital
Used to consult the Medical doctors and specialists from
BMC to get the consultation advice.
But in the long run the radio calls got technical problem
and they no longer functioning.
Presented by Edson Joseph &
Alfred Dandu
Challenges on using e-mails
Lack of Official Telemedicine unit office
 Communication tools such as Computer set
 Most of the hospitals we are support do not have
internet access.
 Its not proper tools for telemedicine and its more
secure on PHI(Protected Health Information) to
comply with HIPAA(Health Insurance Portability and
Accountability Act)
 Most of the Hospitals do not have official e-mail.

Presented by Edson Joseph &
Alfred Dandu
Picture Archival and
Communication System (PACS)
Presented by Edson Joseph &
Alfred Dandu
What is PAC?
• As imaging departments move from film-based
acquisition and archiving (hard-copy film and
document storage) to digital acquisition and
archiving (soft-copy storage), a complex
computer network has been created to manage
images. This network is called Picture Archiving
and Communication Systems (PACS) and can
be likened to a “virtual film library.” Images
stored on digital media are housed in PACS
archives.
Presented by Edson Joseph &
Alfred Dandu
What is PACS?
• PACS is a sophisticated array of hardware
and software that can connect all
modalities with digital output (nuclear
medicine, ultrasound, computed
tomography, magnetic resonance imaging,
angiography, mammography, and
radiography).
Presented by Edson Joseph &
Alfred Dandu
The acronym PACS can best be
explained as follows:
• P—Picture: the digital medical image(s)
• A—Archiving: the “electronic” storage of the images
• C—Communication: the routing (retrieval/sending) and
displaying of the images
• S—System: the specialized computer network that
manages the complete system
Presented by Edson Joseph &
Alfred Dandu
PACS image format
• A PACS can accept any image that is in
digital imaging and communications in
medicine (DICOM) format, for which it is
set up to receive, whether it is from
cardiology, radiology, or pathology.
• DICOM is universally accepted industry
standard for transferring radiologic images
and their medical information between
computers.
Presented by Edson Joseph &
Alfred Dandu
DICOM
• An international standard (ISO) describing
how radiology images are identified and
formatted and how imaging devices
communicate with each other
• Jointly developed by the American College
of Radiology and the National Electronic
Manufacturers Association
• Based on the ISO Open Standards
Intercommunications (OSI) model
• http://dicom.nema.org/
Presented by Edson Joseph &
Alfred Dandu
Other standard..
The HL-7 standard oversees most clinical and administrative
data such as demographics, reports, claims, and orders. As
with DICOM, HL-7 is composed of many parts and is used
at many levels within various hospital systems. It is the
standard generally used in communication between the
hospital information system (HIS) and the radiology
information system (RIS). The HIS holds the patient’s full
medical information, from hospital billing to the inpatient
ordering system. The RIS holds all radiology-specific patient
data, from the patient scheduling information to the
radiologist’s dictated and transcribed report.
Presented by Edson Joseph &
Alfred Dandu
ADVANTAGES OF PACS:
• Elimination of less efficient traditional film libraries and their
inherent problem of physical space requirements for hard-copy
images
• Convenient search for and retrieval of images
• Rapid (electronic) transfer of images within the hospital (e.g.,
clinics, operating rooms, treatment units)
• Ease in consulting outside specialists—teleradiology.
Teleradiography is the electronic transmission of diagnostic
images from one location to another for purposes of interpretation
and/or consultation.
Presented by Edson Joseph &
Alfred Dandu
Cont..ADVANTAGES OF
PACS:
• Simultaneous viewing of images at multiple locations
• Elimination of misplaced, damaged, or missing films
• Increase in efficiency of reporting exams with softcopy images (compared with hard-copy images)
• Reduction of the health and environmental impact
associated with chemical processing, as a result of
decreased use
Presented by Edson Joseph &
Alfred Dandu
Four Major PACS Components
1. Acquisition
-CR
-DX
-CT
-MR
-US
-DF
-OT
2. Network
RIS
4. Display
-CRT
-LCD
-Laser Film
Image Database
3. Archive
39
Radiation Protection in Digital Radiology
L09 Picture Archival and Communication System (PACS)
Image Acquisition
• In modern radiology departments, most images
are acquired in a digital format, meaning that the
images are inherently digital and can be
transferred via a computer network. Ultrasound,
computed tomography (CT), magnetic
resonance imaging (MRI), and nuclear medicine
have been digital for many years and have been
taking advantage of PACS far longer than
general radiography has
Presented by Edson Joseph &
Alfred Dandu
Display Workstations
• A display workstation is any computer that a health
care worker uses to view a digital image. It is the most
interactive part of a PACS, and these workstations are
used inside and outside of radiology. The display station
receives images from the archive or from the various
radiology modalities and presents them for viewing. The
display workstation has PACS application software that
allows the user to perform minor image-manipulation
techniques to optimize the image being viewed. Some
display stations have advanced software to perform
more complex image-manipulation techniques
Presented by Edson Joseph &
Alfred Dandu
Display Workstations
Presented by Edson Joseph &
Alfred Dandu
Common screen (display)
resolution:
•
•
•
•
1280 × 1024 (1K)
1600 × 1200 (2K)
2048 × 1536 (3K)
2048 × 2560 (5K)
Mammography requires a 5K or 5-megapixel resolution
to provide the viewing capacity needed.
2K monitor is used for CR readings.
1K monitor is sufficient to view the images by a referring
Presented by Edson Joseph &
physician.
Alfred Dandu
Radiologist Reading Stations
• The radiologist reading station is used by
a radiologist when making a primary
diagnosis. The reading station has the
highest quality hardware, including the
best monitor. The computer hardware
meets the needs of the PACS vendor, but
it will usually be very robust, requiring little
downtime. The keyboard and mouse can
be customized.
Presented by Edson Joseph &
Alfred Dandu
Archive Servers
• An archive server is the file room of the PACS. It
is composed of a database server or image
manager, short-term and long-term storage, and
a computer that controls the PACS workflow,
known as a workflow manager. The archive is
the central part of the PACS and houses all of
the historic data along with the current data
being generated. In many institutions the archive
serves as the central hub that receives all
images before being released to the radiologists
for interpretation. Presented by Edson Joseph &
Alfred Dandu
Archive Servers
Presented by Edson Joseph &
Alfred Dandu
Network
• A computer network or data network is a
telecommunications network which allows
computers to exchange data. In computer
networks, networked computing devices
exchange data with each other using a
data link. The connections between nodes
are established using either cable media
or wireless media.
Presented by Edson Joseph &
Alfred Dandu
Network
Presented by Edson Joseph &
Alfred Dandu
PAC structure - BMC
Presented by Edson Joseph &
Alfred Dandu
Lets go through some errors
and consequences that may
occur on each component
Presented by Edson Joseph &
Alfred Dandu
Examples of errors within and
between PACS components
• Acquisition errors
• Improper technique
selection
• Wrong exam performed
• Image deleted
• Network errors
• Archive errors
• Storage media
corrupted
• Storage failure
• Sequestered exams
• Display errors
• Image lost
• Image corrupted
• Unable to transmit
• Mis-calibration
• Associated data not
displayed
• Artificial shutters
Presented by Edson Joseph &
Alfred Dandu
Acquisition: Improper Technique
Selection
• On selecting the path of PAC system from
the radiation machine.
• Consequence: is unnecessary radiation
exposure to patient
Presented by Edson Joseph &
Alfred Dandu
Acquisition: Wrong exam
performed
• Radiographer may image thorax using
digital examination intended for abdomen
• Digital signal is rendered inappropriately
for review
• Consequence: may be repeated
examination and unnecessary radiation
exposure to patient
Presented by Edson Joseph &
Alfred Dandu
Acquisition: Image deleted
• Radiographer may delete image at
acquisition station without transmitting to
PACS
• It may not be possible to restore deleted
image
• Consequence: may be repeated
examination and unnecessary radiation
exposure to patient
Presented by Edson Joseph &
Alfred Dandu
Network: Image lost
• Interruption in network service may result
in losing the image
• It may not be possible to retransmit image
from acquisition station
• Consequence: may be repeated
examination and unnecessary radiation
exposure to patient
Presented by Edson Joseph &
Alfred Dandu
Network: Image corrupted
• Interruption in network service may
degrade image
• It may not be possible to retransmit image
from acquisition station
• Consequence: may be repeated
examination and unnecessary radiation
exposure to patient
Presented by Edson Joseph &
Alfred Dandu
Network: Image corrupted
Presented by Edson Joseph &
Alfred Dandu
Network: unable to transmit
• Interruption in network services prevents
transmission of images from acquisition
station
• Local storage capacity of acquisition
station is limited
• If acquisition continues, images can be
lost, causing repeated examinations and
unnecessary radiation exposure to
patients
Presented by Edson Joseph &
Alfred Dandu
Archive: storage media
corrupted
• Storage media failure can prevent
images from being retrieved
• May require repeated
examinations and unnecessary
radiation exposure to patients
Presented by Edson Joseph &
Alfred Dandu
Archive: storage failure
• Storage failure can prevent images from
being archived
• If images have already been deleted from
acquisition station, may require repeated
examinations and unnecessary radiation
exposure to patients
Presented by Edson Joseph &
Alfred Dandu
Archive: images sequestered
• When demographic and examination
information on images does not match
information from RIS, images may be
hidden from view
• Unless reconciliation is performed,
radiographer may repeat examination with
unnecessary radiation exposure to
patients
Presented by Edson Joseph &
Alfred Dandu
Display: mis-calibration
• Improperly calibrated display can make
digital images appear under-exposed
• Radiologist may instruct radiographer to
repeat examinations or increase radiologic
technique causing unnecessary radiation
exposure to patients.
Presented by Edson Joseph &
Alfred Dandu
Display: associated data not
displayed
• Data accompanying the image may not be
displayed for the radiologist
• If missing data includes information on the
radiographic technique or patient
exposure, the radiologist cannot oversee
radiographer practice
• Without radiologist oversight,
radiographers may perform examinations
with unnecessary radiation exposure to
patients
Presented by Edson Joseph &
Alfred Dandu
Display: artificial shutters
• To improve contrast, radiographer may add artificial
collimation
• When artificial shutters are non-transparent, radiologist
cannot oversee radiographer practice
• Without radiologist oversight, radiographers may perform
examinations without appropriate collimation, resulting in
unnecessary radiation exposure to patients
Presented by Edson Joseph &
Alfred Dandu
Sources of Errors in PACS
• Mistakes in configuration of PACS
• Improper calibration of PACS devices
• Discrepancies between PACS and hospital
processes
• Inadequate training and documentation of PACS
and hospital processes
• Insufficient planning for PACS service
interruptions
Presented by Edson Joseph &
Alfred Dandu
Conclusions
• Unfortunately, errors will always occur in PACS.
• Some of these errors cause unnecessary radiation dose
to patients
• QC is the key to detecting errors.
• Training is key to averting errors.
• Reliability engineering is key to continuity of clinical
operations.
• Disaster recovery is key to restoring normal clinical
operations.
Presented by Edson Joseph &
Alfred Dandu
Laboratory Information System –
DisaLab(Wardlook Up)
Introduction
• Information System - is a system
composed of people and computers that
processes or interprets information.
• Laboratory Information system(LIS) - is a
software system that records, manages, and
stores data for clinical laboratories.E.g
Disalab,Napier etc. Bugando medical centre
uses Disalab developed by LST(Laboratory
System Technologies) approved by the
ministry of healthy, for managing data for
clinical laboratories.
Introduction..
• Disalab - is an information system which
bugando medical centre uses to record,
manage and stores data for clinical
laboratories.
• Wardlook up - is small part of Disalab
which links the laboratories and hospital
wards/clinics so that they can access lab
results from laboratories.
Requirement for Wardlook up
• For the system to work efficiently it needs:
I.
II.
III.
IV.
V.
People
Computers
Printers
A well structured network
The system
Requirements…
• People
On wardlook up the target people are
nurses and doctors who will be given the
usernames
and
password
for
authentication to view results
• Computers
The computers is for installing the system
so that the users can be able to view the
results
Requirements….
• Printers
This is for printing the results.
• A well structured network
This is for ensuring the communication
between the laboratories and the
wards/clinics.
Requirement…
• The system(Wardlook up)
After the install of the system, all users
must have usernames and passwords so
that they can be able to login and access
the lab results.
Features of the System
• Login Panel
• Search
• View results
1. Login
First time users and users whose passwords have
been reset must enter their user codes and use their
user code as a password. Existing users must use
their passwords
2. Search
The system gives you the searching criterias like;
1.Select the time period for the result:
● Recent
● Last 7 Day's
● Last 30 Day's
● Last 90 Day's
● This year
● Year's
● All Years (10 years – depend on Data from starting registration
date)
Search cont…
2. Enter selection criteria. You can select any
combinations of the following:
● Hospital Folder Number
● Patient Name, options
○ Name Spelled Exact (default option)
○ Name Begins With
○ Name Sounds Like
Patient Initials
Approximate Age
● Sex (M/F)
● Date of Birth
● ID Number, Reference or Laboratory Number
● Laboratory
3. Press search button
4.After click search the list of lists will
appear.
Search cont..
• After having the list of results, pick the one
which is the exact match of your criteria's.
3. View Results
This feature shows the status of each
sample which has been collected from
wards/clinics. The following are the view
results properties;
i. Result not Available (* To Follow)
'Rcvd”
This means that the laboratories have
received the sample but the results are
not available
ii. Partly Tested Results
Selecting a patient with result that is partly
View results cont….
iii. Authorized Test Results
This means the sample has been
received and the results are available.
iv. Confidential Results
For a user to see Confidential Results –
User code must have Confidential access
enabled.
v. Rejected Results “Rejc”
This means a sample has been rejected
Current status of the
system(wardlook up) at Bugando
Medical centre.
• The system has been installed to some of
the wards/clinic.
Plan:
• To install the system to all wards/clinics
• To give support,training and guidance to
users on how to use the system.
• To work closely with the laboratories and
Advantages of wardlook up
• Lab results can be accessed to the
wards/clinics specifically.
• Results are available at the time they are
required.
• Confidential results can not be accessed
randomly.(i.e. to a person who is not a
medical personnel)
• Patient results/records are secured.
• Its easy to know the status of the tests you
requested for a patient.
Challenges
• Computer illiteracy
• Infrastructures i.e.
network,computers,printers etc
GOD BLESS YOU AND
THANK YOU FOR LISTENING….