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iPath telemedicine platform to support health providers in low resource settings. K. Brauchli*, D O‘Mahony, L Banach, M Oberholzer * kurt.brauchli@unibas.ch. 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

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iPathtelemedicine platform to support health providers in low resource settings

K. Brauchli*, D O‘Mahony, L Banach, M Oberholzer* kurt.brauchli@unibas.ch


  • 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

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

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

The telemedicine platform

Sending cases:


Sending cases:



Sending cases:



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

Reviewing cases:

email (alerts)

Reviewing cases:

email (alerts)

web interface

Reviewing cases:

email (alerts)

web interface

special remote control (e.g. JAVA applet)

User Interface

User registration

User Interface

Personal start page

- List of the groups

- New cases and comments at a glance

User Interface

Group Display

- case list

User Interface

- Comments/Diagnosis

New comments: automatic email alert

Case Display

- Description & Images

iPath worldwide


Productive servers

In testing



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


Case Studies

  • Teledermatology in Eastern Cape, South Africa

  • Telepathology in Solomon Islands

  • Telemedicine in Perinatal Health in Ukraine

Teledermatology in South Africa

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



Port St. Johns

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

Teledermatology in South Africa

  • Teledermatology since 1999

  • No of consultations: 110

  • Median response time: 8 days

Teledermatology in South Africa

Teledermatology in South Africa


  • 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.

Telepathology in Solomon Islands

Solomon Islands

Solomon Islands

National Referral Hospital

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

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


  • 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)


  • Limited Transportation- no roads or very bad roads

Histology Lab

Tissue Processing

Preparing blocks



Histology slides

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)

Results (2002-2003)

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

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

Perinatal Health in Ukraine

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.)

Tumor Board Meetings

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

Low Resource Settings

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

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


  • Access to Computer and Internet

  • Incentives - who benefits from telemedicine?

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




Helath InformationAccess



Tele HIV care




Integrated Health Information Exchange

Studies, Research

Evidence Base


FeedbackQuality Control

Scientific Publishing



Case Specific Information

General Information

A way forward

  • Connecting different telemedicine projects

  • Increase knowledge sharing and transfer

  • Combine telemedicine with:

    • Teaching

    • Access to health information

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


More information:http://ipath.ch

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

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