Transcript Telemedicine Systems Proposal.Doc

Regional Consultation on Telemedicine: Sharing Experience and
a way forward
by:
Dr. Mohamed Ali
Dr. Nusaiba Farouk Hassan
Overview
 Demography
 Evolution of E-Health and Telemedicine
 Current Scenario
 Strategic Direction
 Innovations and applications of eHealth and telemedicine
 Strength
 Weakness
 Opportunity
 Threats
 The way forward
Demography
 An archipelago: 1192 Islands
 Inhabited: 200 islands
 Population: 360,000
 Distribution:
 Largest: Over 100,000 in Male’ City
 Area: 90,000 sq km ( sea)
 Ethinicity - Asian
Background
 In constitution: The right of every citizen to access
good quality health services is protected.
 The Government: Constitutionally mandated to realize
this right for all.
 Guiding Principles;
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Recognizing Health as a human right and its universality
Ensuring equitable access to affordable, quality health services
based on primary health care approach
Harnessing solidarity for health in all national policies
Ensuring policy development based on facts and scientific
evidence
 Vision for Health:
 Improving the quality and affordability of health care
with a focus on access for all.
 Goal for E- Health:
 Providing standardized high quality medical services, by
using interoperable, compatible, reliable, and scalable
E-Health solutions such as telemedicine, HIMS,
whereby all residents of Maldives have equal access
medical expertise available in the Maldives as well as
internal medical care institutes.
Strengths:
 ICT is one of the fastest growing areas in Health
 Existing institution based programmes / databases
 National ID Nos are being entered to independent
systems, which can be used as a unique patient
identifier
 Large potential for M-Health; extensive use of mobile
phones and related devices
Major Healthcare initiatives in
place:
 Online Nutrition and Child Health Surveillance
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System (ONCHSS)
SEARO Integrated Data Analysis System (SIDAS)
Hospital Information System (HIS)
E-Government Portal for online birth and death
registration
Neonatal/Perinatal Database
E – Health Objectives
 Establish an integrated health information System
 Improve access and quality of health care given to
general public using E-Health
 Strengthen the capacity to monitor health indicators
and conduct system reviews in a timely manner
 Facilitate efficient emergency or disaster management
and timely decision making in health emergency
situations
Specific Strategies
 Establishment of a governance structure to deliver the E-Health
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Strategy
Unique citizen identifiers for a common health services and health
insurance
Implementing Telemedicine
Availability of needed health information at a national level in a timely
manner
Implement consumables management information system
Begin introduction of more clinical information systems and EPRs
Expand use of M-Health
Invest in computing infrastructure
Access to broad-band services
Adequate communication of E-Health strategies
Current Investments, goals and
plans:
 Patient centered information systems
 Electronic Health Record Systems
 Telemedicine
 Information Databases
 Preventive Health Services using Mobiles
Telemedicine in Maldives
 Vision: Provide a telemedicine solution to Maldives
which is compatible, scalable, reliable and interoperable. The objective is to upgrade the quality of
health care and minimize the cost of medical care
through effective acquisition of relevant clinical
information at remote sites. And also to ensure that all
residents of Maldives have equal access to high quality
health services regardless of their location.
Telemedicine in Maldives
• Objective:
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Enable people in islands to use tele-consultation and avoid travel
and support continuing medical education:
• Implemented in II Phases
• Aiding agencies
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Integrated Human Development Project; World Bank
Khalifa Bin Al Nahyan Foundation; Abu Dhabi
Implementation:
• Phase I: Integrated Human Development Project; World
Bank
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Telemedicine: 4 Main hubs connected on 5th May 2010
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Indhira Gandhi Memorial Hospital – Central
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Kulhudhufushi Regional Hospital - North
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Thinadhoo Regional Hospital – South
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B. Eydhafushi Hospital
Phase II
 34 New Centres joined Telemedicine Network under
Khalifa Bin Zayed Al Nahyan Foundation; Abu Dhabi:
20th November 2011
 Two components
 Telemedicine Kiosk and Equipment
 Training Component
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70 Nurses
10 Specialists; Biomedical Engineers, Obstetrician
Gynaecologists, Paediatricians, Surgeon and Physicians
 4 Referral Hospital and 34 Remote points
 Hdh. Kulhudhufushi Regional Hospital
 Indira GandI Memorail Hospital
 Gdh. Thinadhoo Regional Hospital
 S. Hithadhoo Regional Hospital
Current Situation
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Sporadic Cases
No designated personnel
Trained staff unavailable to provide service
Insufficient attention to Telemedicine due to inadequate
number of Clinicians at referral centers
 Expensive equipment under lock and Key
 No existing referral system
 Use of M-Health; applications like what’s ap for case
discussion by Clinicians
 AIM: Strengthening of existing services
 Map I
Innovations and Applications of EHealth / Telemedicine
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Tele-Education
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Department of Child Health, IGMH and AIIMS, New Delhi
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Dengue Season 2011; CMEs in all 4 Centres
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Staff at Thinadhoo Regional Hospital had participated in the
Workshop on Management of Dengue Cases conducted in
association with WHO and QSNICH via tele-education 2011
 Telemedicine
 Potentional for development
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Dermatology
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Pathology
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Radiology
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Orthopaedics
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General Medicine /Paediatrics
Strengths
 High Priority Project for Ministry of Health and
Family
 Health workers at remote points are motivated to learn
and maximize use of Telemedicine
 Clinicians at the Referral Centers are committed to
attend to cases
 Human Resource Development
Weaknesses
 Central
 Lack of an Alert System
 Unaware of the enhanced equipment availability Remote points
 Inadequate number of Clinician to attend to inpatient and outpatient facilities, hence
telemedicine is not made a priority
 No designated personnel / infrastructure
 1:38 Ratio of telemedicine carts; central: peripheries
 Peripheral
 High turn over of trained staff
 Nurses trained under Telemedicine project refuse to go back to the island
 Inadequate infrastructure and power supply at HC to support equipment
 Unavailability of Medications and Basic investigations
 Common
 Telemedicine Network has not been integrated with the Hospital Networks
 No networking between focal points
 Lack of awareness among doctors about Telemedicine
 License for teleconferencing has to be purchased; hindrance for tele-education
 Lack of awareness among clinical staff and management at the hospitals
 Lack of telemedicine trained specialists
 Referral centers do not have telemedicine links with Regional Centres abroad
Opportunity
 SAARC Telemedicine Project
 Collarboration with Regional Centres;
 AIIMS
 Reduce expenditure on Health insurance referrals to
male’ and abroad.
 Gain the confidence of the public in the health sector
Threats
 Remote island losing hope due to failure to attend to
cases promptly
 Lack of maintenance of equipment may lead to loss of
equipment performance
 Referral centres do no have the necessary consultants
Way Forward
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Encourage doctors to utilize telemedicine
To integrate M-health in to the telemedicine system officially
To train the personnel responsible for the telemedicine and assign roles
To assign personnel to manage the telemedicine equipments and to give
responsibility of maintaining them
To assign login responsibilities to the individual doctors, rather than the institute
To include teleconsultation in the duty roster
To assign CME points in return to the tele-consultation hours spent
To give bonus salary for the cases spent on tele-consultation
To give preference to tele-radiology
To provide basic equipments to the remote kiosks, like USG machines, ECG
machines and X-ray machines and maintain the supply to the basic laboratory
investigations
Assign budget for telemedicine
WHO and other NGO’s support to implement these services and to train personnel
In assigning the login responsibilities, the MOH should assign license to telemedicine
Include tele-consultation in National Insurances’ (ASANDA) patient evacuation
system, to minimize the cost of improper referral and improper referral diagnosis
thus reducing cost of referral system.
Conclusion
 Telemedicine is a great promise to Maldivians to
achieve better healthcare without having to travel by
highs seas to the nearest referral centre, and then
inevitably to the capital.
 Telemedicine is the alternative route to achieving the
best possible treatment rather than referring abroad
for issues which can be resolved within the country,
hence better utilization of resources.