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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

iPathtelemedicine platform to support health providers in low resource settings

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

outline
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
what is ipath
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
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
slide9
Sending cases:

email

www

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

slide10
Reviewing cases:

email (alerts)

slide11
Reviewing cases:

email (alerts)

web interface

slide12
Reviewing cases:

email (alerts)

web interface

special remote control (e.g. JAVA applet)

slide13
User Interface

User registration

slide14
User Interface

Personal start page

- List of the groups

- New cases and comments at a glance

user interface
User Interface

Group Display

- case list

user interface16
User Interface

- Comments/Diagnosis

New comments: automatic email alert

Case Display

- Description & Images

ipath worldwide
iPath worldwide

Users

Productive servers

In testing

planned

usage
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

case studies
Case Studies
  • Teledermatology in Eastern Cape, South Africa
  • Telepathology in Solomon Islands
  • Telemedicine in Perinatal Health in Ukraine
teledermatology in south africa
Teledermatology in South Africa

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

UNITRA

Tsilitwa

Port St. Johns

teledermatology in south africa22
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 africa23
Teledermatology in South Africa
  • Teledermatology since 1999
  • No of consultations: 110
  • Median response time: 8 days
teledermatology in south africa25
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.
solomon islands28
Solomon Islands

National Referral Hospital

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

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

limitations
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)
limitations30
Limitations
  • Limited Transportation- no roads or very bad roads
histology lab
Histology Lab

Tissue Processing

Preparing blocks

Cutting

Staining

Histology slides

remote consultations
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
Results (2002-2003)

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

perinatal health in ukraine
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
ipath in teaching and cme
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.)
low resource settings
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 settings39
Low Resource Settings
  • Access to training and health information is very difficult in developing countries
  • Professional isolation (solo practitioner without senior colleague) ==> “Brain Drain”
problems
Problems
  • Access to Computer and Internet
  • Incentives - who benefits from telemedicine?
  • Missing exchange between projects and networks==> “e-fragmentation”
e fragmentation
E-fragmentation

Telemedicine

E-learning

Helath InformationAccess

Teleradiology

Teledermatology

Tele HIV care

DiagnosticsTreatment

Publishing

Education

integrated health information exchange
Integrated Health Information Exchange

Studies, Research

Evidence Base

Dissemination

FeedbackQuality Control

Scientific Publishing

Tele-Teaching

Telemedicine

Case Specific Information

General Information

a way forward
A way forward
  • Connecting different telemedicine projects
  • Increase knowledge sharing and transfer
  • Combine telemedicine with:
    • Teaching
    • Access to health information
local ownership
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
ipath
iPath

More information:http://ipath.ch

ipath for you
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