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Introduction to Telemedicine. Arun Raj Kunwar, M.D. Assistant Professor SUNY Upstate Medical University Syracuse, NY kunwara@upstate.edu. Disclosures. No financial affiliations or interest in any thing that will be discussed No commercial interest. What is TM.

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introduction to telemedicine

Introduction to Telemedicine

Arun Raj Kunwar, M.D.

Assistant Professor

SUNY Upstate Medical University

Syracuse, NY

kunwara@upstate.edu

disclosures
Disclosures
  • No financial affiliations or interest in any thing that will be discussed
  • No commercial interest
what is tm
What is TM
  • Use of telecommunications to provide medical information and services
  • Health delivery/consultations via use of telecommunications

-Telephone between two providers

-Fax

-Video conference

-Robotic technology

types of technology
Types of Technology
  • Store and forward

-Digital images are stored and forwarded

-Digital X-rays, digital photos, EKG faxes

-Mainly used for non-emergent cases but done for some emergent cases too

-Can be forwarded to anywhere in the world

store and forward
Store and Forward
  • Teleradiology, the sending of x-rays, CT scans, or MRIs (store-and-forward images) is the most common application of telemedicine in use today

-Most radiologists are staying home during on call

  • Telepathology/ Teledermatology
two way interactive television iatv
Two-way Interactive Television (IATV)
  • Face-to-face consultation
  • Provides a real time consultations via videoconference
  • Usually patient with their primary provider gets direct consultations to expert in distant site
  • Can directly involve patient
slide7
IATV
  • Widely used for urban-rural location where access to care is difficult

-the patient does not have to travel to an urban area to see a specialist

-availability of specialist services not available before

iatv videoconferencing equipment
IATV: Videoconferencing equipment
  • New ones are more simpler, cheaper and easy to use
  • New programs now use desktop videoconferencing systems
  • Attachment of peripherals to make it more interactive such as attachment of stethoscope and otoscope, blood sugar monitoring
often combination
Often Combination
  • Interactive
  • Store and forward
  • Audio-video still images
  • Web to transfer data/other web application
  • Web based/accessed health records
  • Electronic prescriptions
  • Wireless technology in emergency/ ambulances
application tm
Application: TM
  • Health care delivery
  • Health profession education
  • Health administration
  • Public health
  • Business
  • Libraries
  • School education
benefit of tm
Benefit of TM
  • Breaks down barrier to distance/access
  • Improves quality of care

-By direct patient consultations/ consultations to primary care

-By providing easy access to education

  • May lead to decrease health care cost
application
Application
  • Urban to rural for specialty/unavailable care
  • Mental health care to Jail population
  • Hospice care
  • Consults to school nurse
  • Home telehealth and monitoring of chronic disease- Chronic heart disease
application13
Application
  • Distant health teaching/ monitoring (video recording of exams)
  • Telesurgery applications for battlefield via use of robot
  • Teleradiology
  • Telepathology
  • Most of the medical specialty are using some form of telemedicine
tm experience
TM: Experience
  • SUNY Upstate Child Psychiatric Consultations To Binghamton General hospital

-Child Psychiatry is a sever shortage specialty

-BGH has been unable to recruit a child psychiatrist for some time

tm experience15
TM: Experience
  • BMG runs a Child Psychiatry inpatient unit with a help of adult psychiatrists
  • Child Psychiatrist located at SUNY Upstate at Syracuse consults via videoconferencing
  • Typically includes, review of the case, talking with patients, families and treatment recommendations
barrier to telemedicine
Barrier to Telemedicine
  • Equipment and infrastructure:

-Most telephone do not provide enough bandwidth

-Increasing web based application making it simpler

-high bandwidth telecommunications access required for more sophisticated uses (Rural connectivity priority)

barrier to telemedicine17
Barrier to Telemedicine
  • Licensing issues: Many states will not allow out-of-state physicians to practice
  • Reimbursement: Many private insurers will not pay for it. In some states new laws that reimburses in same rate as face to face
barrier to telemedicine18
Barrier to Telemedicine
  • Fear of malpractice suits physicians
  • Acceptance of the technology and lack of hands-on interaction with patients

(most patient satisfaction studies to date find patients on the whole satisfied with long distance care)

  • Privacy issues
  • Worry about depersonalizing health care
heath care in nepal
Heath Care in Nepal
  • Percentage of national budget in health:                                     6.2
  • Percentage of the current five-year plan allocation in health:        6.0
  • GDP about 5%

(Nepal Millennium Development Goals: Progress Report 2005)

nepal
Nepal
  • 24.1 percent of the population earn less than an dollar per day
  • 31 percent of the population is living below poverty line (Nepal Millennium Development Goals: Progress Report 2005)
nepal basic health indicators
Nepal: Basic Health Indicators
  • Hospital beds per 10,000 population 4.26 2001/02
  • Number  Physicians per 10,000: 2
  • Nurses per 10,000 population: 2 
  • Urban population (%)14. 2001

(Nepal Millennium Development Goals: Progress Report 2005)

population distribution
Population Distribution
  • Due to the thinly scattered population profile in the hilly and mountainous regions, the accessibility to health facilities is still a problem Nepal
telemedicine nepal
Telemedicine: Nepal
  • Nepal has large rural population with limited access to medical care
  • Most of the health care experts and physicians are located in urban areas-mainly Kathmandu
telemedicine in nepal
Telemedicine in Nepal
  • Regional hospitals are presently connected via internet for health information access
  • Limited use of technology for education
ministry of health
Ministry of Health
  • Telemedicine Project in Developmental phase.
  • ?Connect all health post center
e network research and development
E-Network Research and Development
  • Mahabir Pun
  • have started the telemedicine program in three villages as a pilot project. Nangi, Ramche and Tikot, all of Myagdi District Myagdi District.
note ngi nangi rmc ramche tkt tikot are the villages where telemedicine program has been set up
(Note: ngi – Nangi, rmc – Ramche, tkt – Tikot are the villages where telemedicine program has been set up)
tm nepal
TM: Nepal
  • Om Hospital & Research Centre (P.) Ltd and Apollo hospital in New Delhi

-Consultation

  • Dr. Mohan Raj Pradhan HealthNet Nepal-Store and forward method: feasibility study
center for nyaya health achham
Center for Nyaya Health Achham
  • Nyaya Health is a 501(c)(3) nonprofit organization working to improve the health of poor communities in Nepal through the provision of medical and public health services
  • http://www.nyayahealth.org/about.html
center for nyaya health achham30
Center for Nyaya Health Achham
  • Nyaya Health activities in Achham is a four-bed, five-room clinic focusing on primary care, maternal and child health, HIV, and tuberculosis
  • Plans to develop Telemedicine to provide medical services at two sites in Achham
center for nyaya health achham tm plan
Center for Nyaya Health Achham: TM Plan
  • Email-based communication with specialists regarding complex patients as issues arise
  • Voice-based communication with specialists on complex patients, potentially even in emergency scenarios
  • Communication from clinicians at the center clinic with Community Health Workers in the villages, for assistance with triage and treatment
center for nyaya health achham tm plan32
Center for Nyaya Health Achham:TM Plan
  • Cytopathological assessment of Pap smears for cervical cancer, via transmission of images through digital microscopy;
  • Interpretation of complex ultrasound or X-ray images for direct patient care, training, and quality assurance;
  • Reading of complex microscopy slides for patient care, training, and quality assurance;
center for nyaya health achham along with tm
Center for Nyaya Health Achham: Along with TM
  • Microfinancing
  • Selling of goods/promotion of business thought internet
shahid gangala national heart center
Shahid Gangala National Heart Center
  • Dr. Jyoti Bhattarai Kunwar recently got funded by International Diabetes Foundation
  • To compare the effectiveness of diabetes care via TM in rural health post Vs treatment as usual
nepal tm goals
Nepal TM: Goals
  • Connecting all rural health posts to Internet
  • Providing direct consultations for patient care
  • Some specialty are easily adopted

-Psychiatry

-Dermatology

-Diabetes management

-Preventive health education

nepal tm goals36
Nepal TM: Goals
  • Partnering with leading international groups for expert and second opinion -Johns Hopkins Medicine International runs global "Medical Second Opinion" service
  • Also for education
nepal health profession education
Nepal: Health Profession Education
  • Most of the lectures are videotaped and can be accessed from distant site
  • Live lecture feeds
  • Case discussions
  • Can lead to saving in cost of travel for health workers
nepal tm barrier
Nepal TM: Barrier
  • Lack of any law/regulation
  • Rural and even urban connectivity/ bandwidth limitations
  • Funding
other uses of tm to enhance health care in nepal
Other uses of TM to enhance health care in Nepal
  • Electronic medical records
  • Google health service
tm nepal application
TM Nepal: Application
  • Electronic prescription
  • Known to reduce medication error/ saving significant cost/suffering
nepal tm business application
Nepal TM: Business Application
  • Out sourcing
  • Medical transcription
  • Software development/Medical records
  • Medical consultations- MDweblive.com
  • Patient education