Telemedicine in KwaZulu-Natal the Past, the Present, the Future
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1 Telemedicine in KwaZulu-Natal the Past, the Present, the Future Maurice Mars Dept of TeleHealth Nelson R Mandela School of Medicine
2 The Eleventh Commandment Thou shalt Thou shalt use change management
3 The Twelfth Commandment Thou shalt Thou shalt have political will
4 Telemedicine the use of medical information exchanged from one site to another via electronic communications to improve patients' health status. American Telemedicine Association
5 Underlying Principles of Telemedicine The interaction can be Live = synchronous or realtime
6 Underlying Principles of Telemedicine Pre-recorded = asynchronous or Store and forward
7 The Problem
8 Telemedicine - A Possible Solution? No prior scans available for comparison. Inmy experience such an appearance warrants urgent surgical intervention.
9 Telemedicine Improved rural healthcare Reduce transportation Increase access to specialists Support isolated doctors Overcome Dr shortages Deliver education Facilitate research
10 Telemedicine History
11 Telemedicine History
12 Telemedicine History Willem Einthoven Telecardiogram Trans phone ECG Arch Internat Physiol 1906
13 TelePsychiatry History Tucker in California used CCTV as a tool for mass therapy because of the increasingly difficult situation of overcrowding and understaffing faced by most mental hospitals
14 Electrotherapy Education
15 Telemedicine The Start ISDN based 256 kbs -1 Store and forward teleradiology Antenatal Tele-ultrasonography Telepathology Tele-ophthalmology
16 Phase 1 Ophthalmology l Ultrasonography GREYS HOSPITAL
17 Telemedicine Problems relate to the technical and organizational challenges... J Telemed Telecare 2001
18 Telemedicine a Solution?
19 Telemedicine in the Developing World
20 The Problem Can one justify spending money on ICT solutions?
21 Reasonable Expectations Realistic or Idealistic Pragmatic or Impractical Beware the enthusiast
22 Reasonable Expectations? Remote telesurgery
23 Reasonable Expectations? based store and forward telemedicine
24 Expectations Reviewed all papers and conference abstracts published in Jan 2005 Dec 2009
25 Consultations Per Site Per Week Cons/Site/Week >5 N= Frequency (%) Avg C/S/W Median Mars and Scott, Telemed ehealth: 2010
26 Are We Ready for ehealth? Investigate ehealth-readiness at district level in KZ-N Test the ehealth-readiness tool in the South African setting
27 Results Mean Range % CI
28 Telemedicine in KwaZulu-Natal Radiology Dermatology Neurosurgery Ophthalmology Psychiatry Oth Orthopaedics Grand Rounds Psychiatry outreach Diabetic retinopathy Education Human resource Pathology IALCH
29 Video Conference Consultation 181 of 223 cases (71.2%) saved referral
30 Services Ophthalmology
31 Services Jan 2004 June cases Not referred 55% Elective transfer 27% Referred 18% Ophthalmology
32 Services Ophthalmology
33 Services Ophthalmology
34
35 Ophthalmology
36 Who Is Going To Do It? Extra work Nice idea but I m not going to do it Not in my job description What are you going g to pay me I don t know anything about ehealth
37 Videoconferenced Some Teledermatology Numbers (3 Sites) Patients referred/site/month 8 Patients t referred/site/week / 2 65 Hospitals 130 /week Patients per day Average consultation time 26 /day <10 min Allow 30 min to set up and see 2 patients In one 8 hour day can see 26 patients t and have 1.5 hours for store and forward ~ 70% saved a transfer ~90 patients /week
38 Build The Capacity To Build Capacity Through h Co-operation
39 ehealth Capacity How many Universities in Africa qualifications Medical Informatics or Telemedicine? Education vs Training vs Awareness
40 Capacity Development Data gatherers Health workers Support staff Analysts Implementers Developers Strategists Policy
41 Tele Education in KwaZulu Natal
42 Education P/G Seminars Routine weekly departmental postgraduate seminar series No Extra Work
43 Videoconferenced Education
44 International Telemedicine Issues Medicolegal Licensure Responsibility Continuum of care Ethical Informed consent Confidentiality Data security
45
46 It is highly unlikely that MPS will assist a member who is registered with the HPCSA with any problems that t arise from their participation p in telemedicine in South Africa
47 Practice Guidelines for Videoconference-Based Telemental Health in South Africa.
48 Political will Issues Change management Policy, strategy, t budget Bandwidth Human capacity Telemedicine equipment Legislative / ethical
49 District Surveillance Central TM MI Rural Home Support Sh School
50
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