1. TAIPEI MEDICAL UNIVERSITY TELEMEDICINEWorldwide Telemedicine Initiatives Status andIntroduction of Telemedicine in Developing CountriesVanitha Paramasivam.Alexander B. Rubashkyn.MBA Students

2. 2 Outline Recall: What is Telemedicine?, Categories of Telemedicine. Worldwide Situation of Projects developed in Telemedicine. Comparison WHO regions. Comparison Income (High, Upper-middle, lower-middle, and low). Worldwide Situation of Projects in the main areas ofapplication. Comparison WHO regions. Comparison Income (High, Upper-middle, lower-middle, and low) Other Initiatives. Factors Facilitating Telemedicine. Barriers in Telemedicine. In what circumstances the Telemedicine is suitable forDeveloping Countries?. Meta-analysis (evaluation of projects implemented in developing countries). Case of study (Puerto Caicedo, Hospital Putumayo). Interoperability in Telemedicine. Conclusions. References. 3. 3 What is Telemedicine? The delivery of health care services, where distance is acritical factor, by health professionals, using ICT (1) for theexchange of information for diagnosis, treatment andprevention of disease and injuries, all in the interests ofadvancing the health of individuals and their communities(WHO). 1 UNPD Cast.E 2006 (1) Information and Communication Technologies 4. Group 3: What is the difference between 4Telehealth and Telemedicine? 5. Categories2.5 Store-and-forward: 1 Remote monitoring: 2 Interactive telemedicine: 3, 4. 2Medicare 2006 1 34WHO Telemedicine 2009 ReportKarolinska U. 2003 University of Toronto 2010 6. Worldwide Situation of Projects developed in 6Telemedicine In 2008 the WHO developed a survey for assessing the currentstatus of Telemedicine in their member states3. Around 114 countries complete at least on section of the survey(59% of the total members, 81% world population). The purpose of the survey was to understand the status of theprojects in Telemedicine, according with the record of the nationalinitiatives of each WHO Office in 2005, being implemented orcompletely established, as well, the status of the national policy inTelemedicine being addressed in each country in this area as afacilitating factor, and the barriers to the telemedicine identifiedduring the survey. 7. 7General status of Projects being implemented or already implemented in the main applicationareas of Telemedicine in the world. 8. 8Worldwide status of Teleradiology.WHO RegionWorld bank Income classification 9. Evaluation of a Telemedicine (Telegynaecology) 9demonstration project in the Magdalene Islands 20044Jean-Paul Fortin, Marie-Pierre Gagnon, Alain Cloutier and Franoise LabbA total of 101 individual patients benefited from a teleconsultation, USG Gynecologicevaluation was an important feature, given that this Islands are locatedmore than 1000 km away from supra-regional medical referral centres. 10. 10Worldwide status of Teledermatology.WHO Region World bank Income classification 11. Telemetric Devides collaborating with the Telemedicine 11Working Group of Bangladesh to bring dermatology care torural communities in 2012.5In Bangladesh, approximately 30 percent of the population will suffer from a skin disease at one point in during their lifetime. However, there are fewer than300 dermatologists in Bangladesh and all are urban-based 12. 12Worldwide status of Telepathology.WHO RegionWorld Bank Income classification 13. Virtual Telepathology in Egypt, applications of WSI in 13Cairo University 20116 Ayad EUsing the Telemedicine the Universitity of the cairo send lab and image results toCivico Hospital in Palermo for research purposes. 14. 14Worldwide status of Telepsychiatry.WHO Region World bank Income classification 15. Evaluation of a rural telepsychiatry service in Wagga Wagga(Australia) 2007.7 15James Greenwood*, Christie Chamberlain, Gordon Parker Wagga Wagga in rural New South Wales, comprisinga face-to-face interview with a psychiatrist followed bya telepsychiatry interview with a Sydney-basedpsychiatrist. 16. 16Worldwide status of Telecardiology.WHO Region World bank Income classification 17. The teleECG initiative in Norway 2010317 The teleECG initiative in Norwayis a telemedicine service used tofacilitate early diagnosis andtreatment of suspectedmyocardial infarction in patientsnot in hospital. Ambulances are fitted withequipment to capture andtransmit ECG images to hospitalsthat have an image receiver andstorage system for the imagessent. Once received, the imagesare analysed by a cardiologist athospital who is able to make adiagnosis and recommend animmediate course of action. 18. 18Other areas of Application. Tele-retinography 19. 19Factors facilitating the Telemedicine3 Governance Policy or Strategy Scientific development Evaluation 20. 20Current Status of Telemedicine policiesaround the world3 21. 21Barriers in Telemedicine 22. 8Objectives: To review papers reporting actual experience with telemedicine indeveloping countries and to summarize their findings, including the strengthof the evidence.Design: A retrospective review was conducted. Study quality was assessed.Setting Four commonly-used electronic databases.Main outcome measures: Study quality scores. 23. The positive findings in the studiesreviewed suggest publication bias.even if their lack of focus weakens theevidence base. Very few of the studiesreviewed have been conducted with highmethodologicalquality andwe,therefore, make a strong call for morerigorous methodological assessment infuture, along well-defined guidelines. Forexample, cost- effectiveness is afundamental aspect of the introductionof telemedicine and our review foundvery few studies which had addressedthis topic 24. Conclusion of the Research Paper.(1) Avoid proposing very large and expensive projects.(2) Ensure close collaboration with local doctors, national healthservices or NGOs working in the field.(3) Take into account the published experience of others.(4) Start small, and build evaluation into the pilot stage.(5) Publish the evaluation results, whether positive or negative.(6) Scale up only on the basis of clear success. 25. Group 1 : having completed your research and presentation what would you say is one of the most important things you have learned about introducing telemedicine in resource poor countries. The Evaluation of projects already developed is important. So wecan learn about the experience of others. Cost effectiveness analysis can allow us measure the impact ofintroducing telemedicine. As well we can give evidence to policymakers. It is important to assess the suitability of the project, because notalways the telemedecine can be the answer for enhance the healthaccess in isolated communities. 26. Case of Study (Puerto Caicedo - Hospital) in 26Amazonas Rainforest ColombiaMinistry of Telecommunications of Colombia 2011Comments and final edition: Alexander B. Rubashkyn 27. 27Interoperability in Telemedicine 28. 28 Core Health Information Standards in Telemedicine9 2007 ATA Report. Administrative Standards (Identifier Standards). Clinical Standards (Clinical Representative Standards as ICD and CPT, Vocabulary Systems). Technical Standards (Electronic Data, LOINC (lab results), ISO/IEEE 11073: ISO/IEEE 11073 (Teledevices), DICOM (Biomedical images, Store-and-forward) ATC (medications), and HIPAA Standards. Infrastructure (HL7, ASTM).EHR and Its importance in the Telemedicine. ! 29. Group 4: Do you think India or Colombia has a Greater potential29to develop their telemedicine Technology over the next decade?ColombiaSystematic Review of Telemedicine Projects in Colombia10 28% Rural AreasChallenges: 45 000 000Malaria 150.000 per yearInfrastructure. Hemorrhagic ICT Literacy, Access No policy Dengue:to technology. 18.9/100.000(armed conflict)EHR in 2013India Challenges and opportunities for the adoption of Telemedicine in india11,12.Challenges: Infrastructure, 72% Rural Area1 200 000 000 Reluctance of physicians to use Telemedicine, Access toDiarrhea Is one of the mostPolicy technology, the Policies are important cases of death.not addressing clearly the target No EHR only EMRpopulation(some places) 30. 30Conclusions Telemedicine as tool have an important role to play in the improvement ofthe quality and efficiency of health systems in the world. Telemedicine deserves special consideration for the local; Access should aswell be focus on elements that help introduce the telemedicine,(Infrastructure, Standards, Policies, ICT technologies), even more whenworldwide satellite communication is available at reasonable cost,telemedicine can be used in many different ways such as improvinghealthcare access, supporting health workers in isolated settings oraddressing the shortage of specialist doctors. Harmonized globally interoperable standards fundamental to ensureglobal exchange of information in Telemedicine. Telemedicine thus works toward the concept of medicine, whichtranscends boundaries. 31. If you have health, you probably will be happy, and if you have health and happiness, you haveall the wealth you need, even if it is not all youwant.Alexander R. 32. Complementary References(Second part)1. WHO definition: WHO. A health telematics policy in support of WHOs Health-For-All strategy for global health development: report of the WHO group consultation on health telematics, 1116 December, Geneva, 1997. Geneva, World Health Organization, 1998.2. Strode SW, Gustke S, Allen A. Technical and clinical progress in telemedicine. JAMA. 1999 Mar 24-31;281(12):1066-8.3 Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth 2009. WHO (Global Observatory for eHealth Series, 2)4 Fortin JP, Gagnon MP, Cloutier A and Labb F, Evaluation of a telemedicine demonstration project in the Magdalene Islands, 2004 J Telemed Telecare. 2003;9(2):89-94.5 Grameenphone pilots tele-dermatology project in Bangladesh 2012 http://www.telenor.com/corporate- responsibility/initiatives-worldwide/grameenphone-pilots-tele-dermatology-project-in-bangladesh/ Accessed 21/12/12.6 Ayad E Virtual Telepathology in Egypt, applications of WSI in Cairo University 2011- Diagnostic pathology Diagn Pathol. 2011 Mar 30;6 Suppl 1:S1. doi: 10.1186/1746-1596-6-S1-S1.7 Greenwood J, Chamberlain C, Evaluation of a rural telepsychiatry service 2007 Australas Psychiatry August 2008 vol. 16 no. 4 273-276.8 Wootton R., Bonnardot R, In what circumstances is telemedicine appropriate in the developing world? J R Soc Med Sh Rep 2010;1:37. 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JAMA. 1999 Mar 24-31;281(12):1066-8.6 Heinzelmann PJ, Lugn NE, Kvedar JC. Telemedicine in the future. Journal of Telemedicine and Telecare, 2005,11(8):384390.7 Wootton R. Telemedicine support for the developing world. Journal of Telemedicine and Telecare, 2008, 14(3):109114.8 Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth2009. WHO (Global Observatory for eHealth Series, 2)9 Resolution WHA58.28. eHealth. In: Fifty-eighth World Health Assembly, Geneva, May 1625, 2005 (http://apps.who.int/gb/ebwha/pdf_files/WHA58/WHA58_28-en.pdf, accessed 9 november 201210 Craig J, Patterson v. Introduction to the practice of telemedicine. 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