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Paul Heinzelmann, MD, Jenny Hapgood, MS candidate Joseph Kvedar, MD

Internet-based specialist consultation: overview of needs assessment and planning strategy for remote Ecuador. Paul Heinzelmann, MD, Jenny Hapgood, MS candidate Joseph Kvedar, MD. A Project of the…. Andean e-Health Initiative. MISSION:

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Paul Heinzelmann, MD, Jenny Hapgood, MS candidate Joseph Kvedar, MD

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  1. Internet-based specialist consultation: overview of needs assessment and planning strategy for remote Ecuador Paul Heinzelmann, MD, Jenny Hapgood, MS candidate Joseph Kvedar, MD A Project of the…. Andean e-Health Initiative MISSION: To improve community health through innovative applications of information and communication technologies (ICTs), and to promote patient and physician education. Contact us for more information at: www.andeanehealth.homestead.com 1

  2. Planning Goals… People Clearly define the healthcare needs of the community. Telecom Infrastructure Affirm reliable Internet services and bandwidth. Applications Design usable and effective ICT applications that address specific healthcare needs with minimal disruption of existing hospital workflow. SustainabilityPlan Consider: Financial, Technical, Cultural Understand local stakeholders, and Define what outcomes to measure Evaluation Plan 2

  3. National Health Statistics: People Health expenditures (% of GDP): Ecuador 2.4 US 13.0 2001*** Physicians per 1000: Ecuador 1.7 US 2.8 1998**** 2000**** Mortality(per 1000 live births) Infant Mortality Ecuador 32.0 US 6.8 2003*** 2003*** Under-5 Mortality Ecuador 45.4 US 8.7 2001* 2001**** *= Population, Health and Nutrition Information Project: Ecuador, 9/02 **= Profile of the Health Services System of Ecuador. PAHO, 11/01 ***= CIA Factbook web site ****=World Bank web site 3

  4. People Existing Medical Services: Hospital Pedro Vicente Maldonado Full-time physicians • 3 Family Practice • 1 overnight, on-call resident Part-time physicians • 2 General Surgeons (on-call) • 2 Anesthesiologists (on-call) • 1 Emergency Medicine (hospital director) • 1 Radiologist (1 day per week) Ancillary Services • Basic labs, x-ray, ultrasound Secondary and tertiary care • 3 hours away in Quito • No integrated specialist referral system • 1 Ambulance 4

  5. People Existing Education Programs: Hospital Pedro Vicente Maldonado • No Continuing Medical Education for physicians • Periodic rotating medical students/residents People Regional Employers: • Macadamia nut, pepper & pineapple growers • Dairy farmers • Cattle ranchers • Hearts of Palm farmers • Schools • Ministry of Health 5

  6. Telecom Infrastructure ISPs: Fixed lines & Mobile phones Per 1000 Ecuador 31 U. S. 7000 (est.) Ecuador 170 U. S. 1118 2001 2002 2001 2001 Internet users: Computers per 1000: Ecuador <3 % of pop. U.S. 57% of pop. Ecuador 23 U.S. 625 2002 2001 2001 2001 The Digital Divide CIA World Factbook: www.cia.gov/cia/publications/factbook/geos/ec.html World Bank: Country profile tables 6

  7. Applications Potential Targets of Internet-based consultation: as identified by focus group (2/03) Patients • Costs associated with referral or transfer to Quito facilities Physicians • Uncertainty in diagnosis and treatment • Professional Isolation • Lack of continuing education opportunities Hospital • Lost hospital revenue from transfer and referral of patients to Quito facilities 7

  8. Applications Physician Survey:Estimated Consultations per Week Estimated need for specialist consultation per week at HPVM. (2001, n=4) 8

  9. Sustainability Plan Technical sustainability • Software: • easy to use • requires little training or maintenance • simplifies image processing • provides a standardized format • Hardware: • durable, low maintenance • Telecomm Infrastructure: • ubiquitous, reliable Internet service 9

  10. Sustainability Plan Financial sustainability Potential Revenue Sources 1. Employer fees (AHD Health Package Plan) 2. Patient fees (fee-for-service) 3. Retainer fees from nearby resorts 4. “membership fees” for in-country specialists Potential Initial Capital Sources 5. Financial and Gifts-In-Kind from corporate sector 6. Grants (ie USAID) 7. Private Foundations 10

  11. Harvard University Sustainability Plan Cultural sustainability Understand Stakeholders & Build Capacity University of Notre Dame University of Wisconsin Tulane University Partners Telemedicine Quito Hospitals Local Employers Specialists telemedicine Chasquinet Foundation AHD Patients Physicians Remote Clinical Sites Hospital PVM Univ. San Francisco Quito Ministry of Health 11

  12. Evaluation Plan Key focus: physiciansand patients Methodology: Social and behavioral research approach with a mix of quantitative and qualitative data • Understand factors affecting user acceptance and adoption • 1. Knowledge, Attitudes, Practices, Beliefs (KAPB) re: use of the • Internet for health care services by patients and physicians. • Baseline • After 6 & 12 months of operations • Assess impact on local services • 2. Physician decision-making capacity & patient care • Number of referrals & transfers vs. Internet consultations • Turnaround time for specialist opinions 12 (Disease outcomes are not realistic at this preliminary stage)

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