GlobalPartnersUnited Presentation April 2010

©GlobalPartnersUnited

GlobalPartnersU n i t e d

E-Health: Telehealth, Telerehab, and Harnessing ICT

for Health Services Development

Evelyn Cherow, Founder and [email protected]

1-301-807-1247

mailto:[email protected]


Report: The Challenge Report: The Challenge of Global Health (2007)of Global Health (2007)

“ “Thanks to a recent extraordinary rise in Thanks to a recent extraordinary rise in public and private giving, today more money is public and private giving, today more money is being directed toward the world's poor and sick being directed toward the world's poor and sick than ever before. But than ever before. But unless these efforts start unless these efforts start tackling public health in generaltackling public health in general instead of instead of narrow, disease-specific problems -- and narrow, disease-specific problems -- and unless unless the brain drain from the developing world can the brain drain from the developing world can be stoppedbe stopped -- poor countries could be pushed -- poor countries could be pushed even further into trouble, in yet another tale of even further into trouble, in yet another tale of well-intended foreign meddling gone awry.”well-intended foreign meddling gone awry.”

Laurie Garrett Laurie Garrett Senior Fellow for Global Health Senior Fellow for Global Health

Council on Foreign RelationsCouncil on Foreign RelationsForeign Affairs,Foreign Affairs,

January/February 2007

http://www.foreignaffairs.org/2007/1.html

http://www.foreignaffairs.org/2007/1.html


GlobalPartnersUnitedA social enterprise organization A social enterprise organization building public-private alliances building public-private alliances devoted to applying devoted to applying ICT technologies ICT technologies for….for….

E-learning for ‘brain gain’E-learning for ‘brain gain’ to meet to meet capacity building,capacity building, healthcare access, and healthcare access, and systems strengthening challenges of low- systems strengthening challenges of low- and middle-resourced countries, andand middle-resourced countries, and

Telehealth, telerehabilitation, & Telehealth, telerehabilitation, & telepractices service deliverytelepractices service delivery

E-Health? What’s in a E-Health? What’s in a name?name?

A variety of terms are used to A variety of terms are used to describe providing describe providing consultation, consultation, resources and service delivery resources and service delivery through ICT tools. through ICT tools.

Professional associations, WHO, and Professional associations, WHO, and the US government have defined the US government have defined terms to foster understanding of the terms to foster understanding of the range of practices associated with range of practices associated with ‘‘telepractices, telehealth, telepractices, telehealth, telerehabilitation, and telemedicinetelerehabilitation, and telemedicine’.’. ©GlobalPartnersUnited

World HealthWorld HealthOrganizationOrganization““Today, eHealth can support the Today, eHealth can support the

different functions of the health different functions of the health system, providing a unique system, providing a unique opportunity for strengthening its opportunity for strengthening its information, intelligence and information, intelligence and knowledge processes…. knowledge processes….

eHealth should be an essential eHealth should be an essential component of any plans and component of any plans and

strategies for health system reform in strategies for health system reform in the 21st century.”the 21st century.”


WHO Strategies for WHO Strategies for eHealtheHealth

The World Health Assembly in May The World Health Assembly in May 2005 adopted resolution WHA58.28….2005 adopted resolution WHA58.28….serves as a basis for WHO's activities on serves as a basis for WHO's activities on eHealth, eHealth, urging Member States to urging Member States to consider drawing up long term strategic consider drawing up long term strategic plans for developing and implementing plans for developing and implementing eHealth services....eHealth services...., and requesting WHO , and requesting WHO to provide technical support to Member to provide technical support to Member States, and facilitate integration of States, and facilitate integration of eHealth in health systems and services, eHealth in health systems and services, including in training.including in training.


Telepractice….Telepractice…. TelepracticeTelepractice — the application of — the application of

telecommunications technology telecommunications technology to delivery of professional to delivery of professional services at a distance by linking services at a distance by linking clinician to client, or clinician to clinician to client, or clinician to clinician, for clinician, for assessment, assessment, intervention, and/or consultationintervention, and/or consultation..

MonitoringMonitoring of patients in homes of patients in homes is a growing application.is a growing application.


Telehealth (US Telehealth (US Gov’t/HRSA)Gov’t/HRSA) TelehealthTelehealth— the use of — the use of

electronic information electronic information and telecommunications and telecommunications technologies to support technologies to support long-distance clinical long-distance clinical

health care, health care, patient and patient and

professional health-professional health-related education,related education,

public health, and public health, and health administration.health administration.

http://www.hrsa.gov/telehealth/http://www.hrsa.gov/telehealth/

Telehealth Telehealth technologiestechnologies Videoconferencing,Videoconferencing, the Internet,the Internet, store-and-forward store-and-forward

imaging, imaging, streaming media, streaming media,

and and terrestrial and terrestrial and

wireless communi-wireless communi-cations. cations.


E-Health….E-Health….Telemed, telehealth, Telemed, telehealth,

telepracticestelepractices““Telemedicine has become standard Telemedicine has become standard

medical practice and is in daily use medical practice and is in daily use across dozens of countries. Over across dozens of countries. Over 10,00010,000 peer review papers have been peer review papers have been published over the past 20 years published over the past 20 years supporting the clinical effectiveness supporting the clinical effectiveness and cost savings of telemedicine.”and cost savings of telemedicine.”

http://www.amdtelemedicine.com/telemedicine-resources/telemedicine-resources/

telemedicine-defined.htmltelemedicine-defined.html©GlobalPartnersUnited

http://www.amdtelemedicine.com/%23http://www.amdtelemedicine.com/telemedicine-resources/telemedicine-defined.html

Global Forum on Global Forum on Telemedicine:Telemedicine:Int’l Roadmap for ActionInt’l Roadmap for Action (March, 2008) (March, 2008) Sponsored by the Sponsored by the

American American Telemedicine Telemedicine Association and the Association and the Telemedicine and Telemedicine and Advanced Advanced Technology Technology Research Center Research Center (US Army)(US Army)

6 categories of 6 categories of recommendationsrecommendations

Educate Educate grantmakers on grantmakers on the value of the value of telemedicine as telemedicine as An enabler of An enabler of

medical outreach medical outreach programsprograms

To expand training To expand training programs, andprograms, and

Build competency Build competency in the healthcare in the healthcare workforceworkforce©GlobalPartnersUnited

M-health Summit (Oct 2009)M-health Summit (Oct 2009)First Annual First Annual

(Foundation for the NIH)(Foundation for the NIH)

Program FocusProgram Focus

Mobile Mobile Technologies as Technologies as a Platform for a Platform for Health Health Research and Research and Healthcare Healthcare DeliveryDelivery

GoalsGoals Assess policies regarding Assess policies regarding

m-health applications to m-health applications to reduce health disparitiesreduce health disparities

Build bridges between Build bridges between scientific community and scientific community and mobile tech developersmobile tech developers

Highlight public health Highlight public health opportunities and opportunities and challengeschallenges

Craft a vision for future Craft a vision for future applicationsapplications


THE M-HEALTH THE M-HEALTH MOMENTMOMENT

from the mHealth from the mHealth AllianceAlliance

‘‘The use of mobile The use of mobile devices in health devices in health solutions -- is solutions -- is revolutionizing revolutionizing healthcare delivery in healthcare delivery in much of the much of the developing world.’ developing world.’

EVIDENCE:EVIDENCE:THE MHEALTH MOMENTTHE MHEALTH MOMENT

From the mHealth Alliance©From the mHealth Alliance©Today there are Today there are approximately approximately 5 billion mobile devices5 billion mobile devices in use around the world in use around the world

Close to two-thirds of Close to two-thirds of them are in the hands them are in the hands of people living in of people living in emerging market emerging market economies. economies.

•Mobile phones have Mobile phones have the ability to the ability to dramatically change dramatically change the lives of those who the lives of those who use them, including use them, including healthcare providers.healthcare providers.

Photos © Datadyne

mHealth andmHealth andE-learning: E-learning: ImpactImpact

Innovative mHealth Innovative mHealth projects are powering…. projects are powering….

the collection of the collection of health health data, data,

supporting supporting diagnosis and diagnosis and treatmenttreatment, and, and

advancing advancing education and education and researchresearch in even the most in even the most remote and resource-poor remote and resource-poor environments.environments.

(mHealth Alliance©)(mHealth Alliance©)Photos © Datadyne


Easy Seva Easy Seva Last Mile Last Mile InitiativeInitiative

State Department State Department declares SSG Sri Lanka declares SSG Sri Lanka Partnership a 'Game Partnership a 'Game Changer.’Changer.’

In its recently In its recently published brochure, published brochure, ""Partnering with the US Partnering with the US Government," the Global Government," the Global Partnership Initiative of Partnership Initiative of the US Department of the US Department of State highlights SSG's Easy State highlights SSG's Easy Seva project as a model Seva project as a model partnership for USAID.partnership for USAID.

Goal: Goal: BroadbanBroadband Capacity d Capacity

for Sri for Sri LankaLanka


SSG Advisors Easy SevaSSG Advisors Easy SevaLast Mile Initiative Last Mile Initiative

(2007-09)(2007-09) In In Sri Lanka, Sri Lanka, QUALCOMM and QUALCOMM and Dialog Telecom Dialog Telecom partnered with partnered with USAID to develop USAID to develop a franchise a franchise business model business model to bring Internet to bring Internet to rural to rural communities. communities.

By providing local By providing local entrepreneurs entrepreneurs with “telecenters-with “telecenters-in-a box”, in-a box”, partners were partners were able to create a able to create a sustainable sustainable business model business model that has expanded that has expanded to to reach more reach more than 400 villages than 400 villages across Sri Lanka. across Sri Lanka.


Easy Seva CentersEasy Seva Centers …….provide customers with .provide customers with

personal computer usage, and personal computer usage, and broadband telephone services such as broadband telephone services such as

Skype. Skype.

In addition, some centers will provide In addition, some centers will provide online training opportunitiesonline training opportunities and a and a place where residents can receive place where residents can receive microloans and other banking microloans and other banking servicesservices. .


Easy Seva ProjectEasy Seva Project


Easy Seva, a Base of the Pyramid (BoP) Easy Seva, a Base of the Pyramid (BoP) micro-franchise enterprise that micro-franchise enterprise that delivers wireless broadband Internet delivers wireless broadband Internet service to more than 50 rural service to more than 50 rural communities by mobilizing the talent communities by mobilizing the talent and energy of local entrepreneurs. and energy of local entrepreneurs.

In 2007, Easy Seva nominated for GSM In 2007, Easy Seva nominated for GSM Association’s ‘Bridging the Digital Association’s ‘Bridging the Digital Divide’ Award.Divide’ Award.

ATA Evidence-Based Practice for Telemental Health (July 2009) A consensus best practice A consensus best practice

reference based on clinical reference based on clinical empirical experience. empirical experience.

a companion document to a companion document to ATA’s Practice Guidelines ATA’s Practice Guidelines for Videoconferencing-for Videoconferencing-Based Telemental Health, Based Telemental Health,

an educational tool to aid an educational tool to aid practitioners in meeting practitioners in meeting the practice guidelines set the practice guidelines set forth in the guidelines forth in the guidelines document for providing document for providing appropriate mental health appropriate mental health services via telehealth services via telehealth technologiestechnologies. .

An analysis of current published literature.

documents qualitative and quantitative research focused on interactive videoconferencing-based mental health services and telehealth/telemedicine.

provides reference and support for decision-making in developing and providing telemental health services.


http://www.americantelemed.org/i4a/pages/index.cfm?pageid=3718
















American Telemedicine American Telemedicine AssociationAssociation

Telemental Health Standards and Guidelines Telemental Health Standards and Guidelines Working GroupWorking Group

Practice Guidelines for Videoconferencing-Practice Guidelines for Videoconferencing-based Telemental Health based Telemental Health (Oct, 2009) (Oct, 2009)

‘‘Telemental health … is the practice of Telemental health … is the practice of mental health specialties at a distance… mental health specialties at a distance… The purpose of these guidelines is to assist The purpose of these guidelines is to assist practitioners in pursuing a sound course practitioners in pursuing a sound course of action to provide effective and safe of action to provide effective and safe medical care that is founded on current medical care that is founded on current information, available resources, and information, available resources, and patient needs.patient needs.



Why ICT for Capacity Why ICT for Capacity Building…Building… To To interlink and connectinterlink and connect the the

multiple, often disconnected multiple, often disconnected entities and individuals for entities and individuals for knowledge sharing in a knowledge sharing in a sustainable and scalablesustainable and scalable milieu milieu

To inculcate learning and new To inculcate learning and new skills for individuals, skills for individuals, organizations, agencies, or organizations, agencies, or governments to governments to meet shared goals meet shared goals and attain desired outcomesand attain desired outcomes

Secondary outcome:Secondary outcome: To grow To grow computer literacy and literacycomputer literacy and literacy


STRATEGY:STRATEGY:21st Century 21st Century Online Online and Mobile and Mobile Learning and Learning and TelepracticesTelepractices To apply To apply virtual, telepractice, and distance virtual, telepractice, and distance educationeducation applications coupled with capacity applications coupled with capacity building mechanisms to deliver building mechanisms to deliver educational educational curricula, health-related information, clinical curricula, health-related information, clinical service consultation and services, and public service consultation and services, and public health consultationhealth consultation to enhance: to enhance: Individual’s and country’s technological capacity Individual’s and country’s technological capacity

for for expediting learning and mentoringexpediting learning and mentoring Rehabilitation generalist workforce developmentRehabilitation generalist workforce development

via design and dissemination of via design and dissemination of certificate certificate programsprograms for personnel preparation in education, for personnel preparation in education, health, public service, and a wide range of health, public service, and a wide range of knowledge and skill domainsknowledge and skill domains


Virtual Virtual Education and Education and Telepractices: Telepractices: BenefitsBenefits

Reduction of barriers Reduction of barriers to access to access

for specialized expertisefor specialized expertise Program deliveryProgram delivery quality verified quality verified Online course contentOnline course content replication and replication and

updating updating in in a cost-effective manner/data analyticsa cost-effective manner/data analytics

Ongoing training and mentoring Ongoing training and mentoring anytime, anytime, anywhereanywhere with mobile/Internet with mobile/Internet accessibilityaccessibility


Capacity Building Capacity Building via Technology:via Technology:

BenefitsBenefitsCisco©Cisco©Disseminating Disseminating timely, timely,

replicable replicable evidence-based evidence-based practices for addressing practices for addressing health disparitieshealth disparities Systems strengthening Systems strengthening

and changeand change Quality public health, Quality public health,

education, civic, and education, civic, and related related human and human and social capital social capital resource resource growthgrowth


Capacity Building via Capacity Building via Technology:Technology:BenefitsBenefits Creating effective Creating effective

partnerships and partnerships and virtual communities of virtual communities of practice to improve:practice to improve: Knowledge exchangeKnowledge exchange Capacity building Capacity building

across geographic across geographic ‘north-south’ and ‘north-south’ and ‘south-south’ ‘south-south’ boundariesboundaries

Improve global/regional Improve global/regional understanding by understanding by twinning ‘centers of twinning ‘centers of excellence’excellence’


IMPACT: Capacity Building IMPACT: Capacity Building through through e- and Mobile Applications for e- and Mobile Applications for Program & Policy Development Program & Policy Development To build To build VirtualVirtual Communities Communities

of Practice, Leadership, & of Practice, Leadership, & AdvocacyAdvocacy: : qualified health, qualified health, education, rehabilitation, and education, rehabilitation, and PWDs leadership, & civic PWDs leadership, & civic personnelpersonnel

Communities of Practice Communities of Practice (CoPs),(CoPs),Mentoring & AdvocacyMentoring & Advocacy ““CoPs CoPs form as groups of people with common form as groups of people with common

spheres of interests join in, across, or within spheres of interests join in, across, or within sector(s), peer-to-peer, creating sector(s), peer-to-peer, creating learning learning

networks networks designed for collaborative knowledge designed for collaborative knowledge sharing, problem solving, and a myriad of sharing, problem solving, and a myriad of

evolving purposes over time. “evolving purposes over time. “ From From Etienne WegnerEtienne Wegner

Virtual CommunitiesVirtual Communities come together willingly come together willingly

across sectoral, geographic, and departmental across sectoral, geographic, and departmental divides in shared passions and field(s) of interest divides in shared passions and field(s) of interest to—to—

Share repertoire of techniques, tools, stories, Share repertoire of techniques, tools, stories,

experiencesexperiences Build knowledge & capacity with regular Build knowledge & capacity with regular

interactioninteraction Develop expertise as a joint enterpriseDevelop expertise as a joint enterprise Solve problems via community, domain and Solve problems via community, domain and

practice’practice’

Derived from Etienne Wenger Derived from Etienne Wenger Building Communities of PracticeBuilding Communities of Practice::

Pioneers of Change (July, 2005)Pioneers of Change (July, 2005)©GlobalPartnersUnited


Virtual Program Evaluation Virtual Program Evaluation andand

Outcomes Outcomes AccountabilityAccountability GPU builds in online GPU builds in online Evaluation Evaluation

ComponentComponent constructed to: constructed to: TrackTrack individual and group processes individual and group processes

and outcomesand outcomes MeasureMeasure program efficiency and program efficiency and

effectiveness effectiveness


Virtual Program Virtual Program Evaluation andEvaluation and

Outcomes Outcomes AccountabilityAccountability

GPU constructs essential GPU constructs essential evaluations for:evaluations for:

Self-correctionSelf-correction Accountability Accountability TransparencyTransparency

Mobile Technologies Mobile Technologies AccessAccess““A networked world A networked world

is redefining health care…but is redefining health care…but effective partnerships are effective partnerships are needed to help individual needed to help individual

users and worldwide users and worldwide organizations deal with new organizations deal with new

technologies”technologies”

Joan Dzenowagis, PhDJoan Dzenowagis, PhDWHO e-Health GovernanceWHO e-Health Governance



The United Nations The United Nations Millennium Development Millennium Development

Goals (2003) and DisabilityGoals (2003) and DisabilityUnder Discussion at the UN & Under Discussion at the UN &

WBWB Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality and empower

women Reduce child mortality


The United Nations The United Nations Millennium Development Millennium Development

Goals (2003)Goals (2003) Improve maternal health Combat HIV/AIDS, malaria and

other diseases Ensure environmental sustainability Develop a global partnership for

development


GlobalPartnersUnited GlobalPartnersUnited Consortium Alliance Consortium Alliance

Cross-Sectoral Expertise DomainsCross-Sectoral Expertise Domains

Telemedicine, Telemedicine, Telerehabilitation, Telerehabilitation, and Telepracticesand Telepractices

Disability Program, Disability Program, Policy, and Policy, and (Re)Habilitation(Re)Habilitation

Community-based Community-based Health Care Health Care Systems Systems StrengtheningStrengthening

Universal DesignUniversal Design

Early Childhood, Early Childhood, Primary, Special Primary, Special EducationEducation

Maternal and Child Maternal and Child Health/Public Health/Public HealthHealth

Mental HealthMental Health Youth DevelopmentYouth Development Leadership, Leadership,

Advocacy &Public Advocacy &Public PolicyPolicy

GlobalPartnersUnited GlobalPartnersUnited Consortium AllianceConsortium Alliance

Cross-Sectoral Expertise DomainsCross-Sectoral Expertise Domains

Rights-based Rights-based Governance and Governance and Societal InclusionSocietal Inclusion

Transition & Transition & Vocational Training Vocational Training and Employment for and Employment for Persons with Persons with Disabilities (PWDs)Disabilities (PWDs)

Persons with Persons with Disabilities/ActivistsDisabilities/Activists

Instructional Instructional Design, E-and Adult Design, E-and Adult Learning, and Web Learning, and Web Portal DevelopmentPortal Development

The Arts and Social The Arts and Social ChangeChange


GPU GPU AllianceAlliance


Partnerships Growing RapidlyPartnerships Growing Rapidly

New MOU: Global VSAT Forum New MOU: Global VSAT Forum (GVF)(GVF)Satellite Communications Industry Satellite Communications Industry AssociationAssociation

Swinfen Charitable TrustSwinfen Charitable TrustUK Telemedicine Focused CharityUK Telemedicine Focused Charity

Rehabilitation InternationalRehabilitation International Whirlwind Wheelchair-UCSFWhirlwind Wheelchair-UCSF


GPU GPU Program FocusProgram Focus

650 million people–650 million people–10% of the world’s 10% of the world’s population–have a population–have a disability and are disability and are excluded from excluded from societysociety

80% live in 80% live in developing developing countriescountries

Considered “the Considered “the poorest of the poor”poorest of the poor”

UN Convention on the Rights UN Convention on the Rights of Persons with Disabilities of Persons with Disabilities

(CRPD, 2007)(CRPD, 2007)The first comprehensive The first comprehensive international human rights treaty international human rights treaty of the 21st centuryof the 21st century Currently Currently 144144 state are state are signatories and signatories and 8585 countries have ratified the countries have ratified the treaty.treaty. The Challenge: Implementation The Challenge: Implementation


CRPD SocietalCRPD SocietalInclusion TenetsInclusion Tenets

Article 25: Health Article 25: Health States Parties recognize that persons with disabilities have States Parties recognize that persons with disabilities have

the right to the enjoyment of the highest attainable standard the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. of health without discrimination on the basis of disability.

States Parties shall take all appropriate measures to ensure States Parties shall take all appropriate measures to ensure access for persons with disabilities to health services that access for persons with disabilities to health services that are gender-sensitive, including health-related rehabilitation. are gender-sensitive, including health-related rehabilitation.

Problem Problem Qualified workforce shortage forQualified workforce shortage for….….

Identifying, providing appropriate interdisciplinary Identifying, providing appropriate interdisciplinary habilitation and rehabilitation, and educating children habilitation and rehabilitation, and educating children and employing adults with disabilities looms large, and and employing adults with disabilities looms large, and

Establishing the appropriate legal framework and civil Establishing the appropriate legal framework and civil society organizations needed for appropriate society organizations needed for appropriate implementation of the Convention’s tenetsimplementation of the Convention’s tenets. .


RESOLUTION: RESOLUTION: Mainstreaming disability in the development Mainstreaming disability in the development agenda; Adopted by UN Commission on Social agenda; Adopted by UN Commission on Social

Development (February 12, 2010)Development (February 12, 2010)

““Recognizing Recognizing that the that the achievement of achievement of mainstreaming of disability mainstreaming of disability at all levels remains a major at all levels remains a major challengechallenge, therefore further , therefore further efforts are required to give efforts are required to give practical meaning to the practical meaning to the concept of mainstreaming concept of mainstreaming and its realization in United and its realization in United Nations activities in the Nations activities in the development agenda…. development agenda….


GPUs Global tele-Rehabilitation Institute (GtRI): Services, Consultation & Specialty Education


The eHealth Connection: The eHealth Connection: ICT and the Developing WorldICT and the Developing World

Interview with Rockefeller Foundation Interview with Rockefeller Foundation President,President,

Judith Rodin (Journal of Health AffairsJudith Rodin (Journal of Health Affairs, , Nov-Dec’08)Nov-Dec’08)

““This is not about This is not about a few pilots…but a few pilots…but about galvanizing about galvanizing transformational transformational change….change….

This is going to This is going to take big ideas take big ideas with some risk with some risk taking”taking”


The eHealth Connection: The eHealth Connection: ICT and the Developing WorldICT and the Developing World

Interview with Interview with Rwanda PresidentRwanda President,,Paul Kagame Paul Kagame ((Journal of Health AffairsJournal of Health Affairs, ,

Nov-Dec’08)Nov-Dec’08) Sophisticated ICT in health care …Sophisticated ICT in health care …

is no longer a futuristic fantasy is no longer a futuristic fantasy for the developing world...there’s for the developing world...there’s growing use ..from electronic growing use ..from electronic health records to mobile phone-health records to mobile phone-based systemsbased systems

The challenge is to optimize the The challenge is to optimize the use of the technologies ….use of the technologies ….



GlobalPartnersU n i t e d

Evelyn Cherow, Founder and CEO

[email protected]

mailto:[email protected]

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GlobalPartnersUnited Presentation April 2010

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