Ipath telemedicine platform to support health providers in low resource settings
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iPath telemedicine platform to support health providers in low resource settings. K. Brauchli*, D O‘Mahony, L Banach, M Oberholzer * [email protected] Outline. What is iPath iPath - a hybrid web and email solution iPath Worldwide Case Studies Teledermatology in South Africa

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Ipath telemedicine platform to support health providers in low resource settings l.jpg

iPathtelemedicine platform to support health providers in low resource settings

K. Brauchli*, D O‘Mahony, L Banach, M Oberholzer* [email protected]


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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


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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


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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




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Sending cases:

email

www


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Sending cases:

email

www

special equipment:e.g. remote control microscope, ultrasound ...


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Reviewing cases:

email (alerts)


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Reviewing cases:

email (alerts)

web interface


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Reviewing cases:

email (alerts)

web interface

special remote control (e.g. JAVA applet)


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User Interface

User registration


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User Interface

Personal start page

- List of the groups

- New cases and comments at a glance


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User Interface

Group Display

- case list


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User Interface

- Comments/Diagnosis

New comments: automatic email alert

Case Display

- Description & Images


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iPath worldwide

Users

Productive servers

In testing

planned


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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



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Case Studies

  • Teledermatology in Eastern Cape, South Africa

  • Telepathology in Solomon Islands

  • Telemedicine in Perinatal Health in Ukraine


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Teledermatology in South Africa

Regional Telemedicine Network Server at University of Transkei, Mthatha, South Africahttp://telemed.utr.ac.za

UNITRA

Tsilitwa

Port St. Johns


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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


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Teledermatology in South Africa

  • Teledermatology since 1999

  • No of consultations: 110

  • Median response time: 8 days



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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.




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Solomon Islands

National Referral Hospital

Solomon IslandsCapital: HoniaraPopulation: 450‘000Islands: ~1000Independence: 1978

Doctors: 15 (30)Radiologists: 1Pathologists: 0Dermatologists: 0


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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)


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Limitations

  • Limited Transportation- no roads or very bad roads


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Histology Lab

Tissue Processing

Preparing blocks

Cutting

Staining

Histology slides


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Remote Consultations

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)


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Results (2002-2003)

Source: Brauchli et al. J Telemed Telecare. 2004;10 Suppl 1:14-7.


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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



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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.)



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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


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Low Resource Settings

  • Access to training and health information is very difficult in developing countries

  • Professional isolation (solo practitioner without senior colleague) ==> “Brain Drain”


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Problems

  • Access to Computer and Internet

  • Incentives - who benefits from telemedicine?

  • Missing exchange between projects and networks==> “e-fragmentation”


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E-fragmentation

Telemedicine

E-learning

Helath InformationAccess

Teleradiology

Teledermatology

Tele HIV care

DiagnosticsTreatment

Publishing

Education


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Integrated Health Information Exchange

Studies, Research

Evidence Base

Dissemination

FeedbackQuality Control

Scientific Publishing

Tele-Teaching

Telemedicine

Case Specific Information

General Information


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A way forward

  • Connecting different telemedicine projects

  • Increase knowledge sharing and transfer

  • Combine telemedicine with:

    • Teaching

    • Access to health information


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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


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iPath

More information:http://ipath.ch


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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