iPathtelemedicine platform to support health providers

in low resource settings

K. Brauchli*, D O‘Mahony, L Banach, M Oberholzer

* kurt.brauchli@unibas.ch

Outline

• What is iPath

• iPath - a hybrid web and email solution

• iPath Worldwide

• Case Studies– Teledermatology in South Africa– Telepathology on Solomon Islands

• Telemedicine and Tele-teaching

What is iPath

• iPath - an open source software to build telemedicine platforms. Developed at University of Basel

• ipath.ch - an association to promote telemedicine and to support projects in developing countries

• Telemedicine platform based on web server

• Access via web and email

• Collaboration in (closed) working groups

• Case archive

• Automatic and personalised notifications

iPath - hybrid web and email solution

The telemedicine platform

Sending cases:

email

Sending cases:

email

www

Sending cases:

email

www

special equipment:e.g. remote control microscope, ultrasound ...

Reviewing cases:

email (alerts)

Reviewing cases:

email (alerts)

web interface

Reviewing cases:

email (alerts)

web interface

special remote control (e.g. JAVA applet)

User registration

User Interface

Personal start page

- List of the groups

- New cases and comments at a glance

User Interface

User Interface

Group Display

- case list

Case Display

- Description & Images

User Interface

- Comments/Diagnosis

New comments: automatic email alert

iPath worldwide

Users Productive servers In testing planned

Usage

Users Cases Images daily logins(2004)

submission by email

total 1213 5016 33247* 38 32%

developingcountries

84** 1798 14006 74%

usage statistics of iPath (24.12.2004)

* average file size 93KB. Besides images there were another 5864 files

** only 47% of users specified country of origin

Usage

Case Studies

• Teledermatology in Eastern Cape, South Africa

• Telepathology in Solomon Islands

• Telemedicine in Perinatal Health in Ukraine

Teledermatology in South Africa

Regional Telemedicine Network Server at University of Transkei, Mthatha, South Africahttp://telemed.utr.ac.za

Port St. Johns

TsilitwaUNITRA

Pilot in Port St. Johns, Eastern Cape

• GP in rural South Africa

• Small town ± 8 000: District 75 000

• Dermatology: 14% of FP consultations (SA)

• Next Dermatologist: 400km

Teledermatology in South Africa

• Teledermatology since 1999

• No of consultations: 110

• Median response time: 8 days

Teledermatology in South Africa

Teledermatology in South Africa

Teledermatology in Port St. Johns

(110 consultations)

105

57

104

0

20

40

60

80

100

120

Diagnostic Result

possible

TM made positive

change for treatment

Assistance helpful for

GP

yes

no

no difference

Teledermatology in South Africa

OUTCOME FOR GP:

• I learnt a lot and even though I may have sent some cases late for teleconsultation, one of my main objectives of learning was achieved.

• Even though I may have had the correct diagnosis, it was a good learning experience to have my diagnoses confirmed.

• The number of cases dropped off over the years. This is definitely due to my improved skill in diagnosis due to learning.

Telepathology in Solomon Islands

Solomon Islands

Solomon IslandsCapital: HoniaraPopulation: 450‘000Islands: ~1000Independence: 1978

Solomon IslandsCapital: HoniaraPopulation: 450‘000Islands: ~1000Independence: 1978

National Referral Hospital

Doctors: 15 (30)Radiologists: 1Pathologists: 0Dermatologists: 0

Doctors: 15 (30)Radiologists: 1Pathologists: 0Dermatologists: 0

Solomon Islands

Shortage of medical specialists- no dermatology, pathology, cytology ….

Shortage of access to health care - many patients come to hospital in advanced stages.

No access to current information- no medical libraries, few current literature, no senior colleagues, no continuing medical education (CME)

Limitations

Limited Transportation- no roads or very bad roads

Limitations

Tissue Processing

Preparing blocks

Cutting

Staining

Histology Lab

Histology slides

Step 1:Selected images captured with digital camera (Nikon CoolPix 990) and submitted to server in Basel via email

Step 2:Cases are reviewed by a group of 7 pathologists(Switzerland, Germany and South Africa)

Remote Consultations

Results (2002-2003)

Source: Brauchli et al. J Telemed Telecare. 2004;10 Suppl 1:14-7.

Perinatal Health in Ukraine

• Project of Swiss Centre of International Health

• Health System reform

• Improve knowledge of Ukrainian practitioners

• Foster evidence based medicine

• Support regional clinics

• Decrease amount of unnecessary referrals

Perinatal Health in Ukraine

iPath in Teaching and CME

• Clinical Meetings / Tumor Boards

• Publish content - teaching modules, samples cases, etc.

• Remote Presentations

• (soon: offline version of content for CD etc.)

Tumor Board Meetings

Low Resource Settings

• Technology must be locally available and manageable

• It must be possible to integrate usage of telemedicine into daily routine(>70% submissions by email)

• Little “local ownership” of telemedicine projects

Low Resource Settings

• Access to training and health information is very difficult in developing countries

• Professional isolation (solo practitioner without senior colleague) ==> “Brain Drain”

Problems

• Access to Computer and Internet

• Incentives - who benefits from telemedicine?

• Missing exchange between projects and networks

==> “e-fragmentation”

E-fragmentation

Dia

gn

ost

ics

Tre

atm

ent

Ed

uca

tio

n

Pu

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g

Telemedicine E-learning Helath InformationAccess

Teleradiology

Teledermatology

Tele HIV care

Integrated Health Information Exchange

Case Specific Information

General Information

Tel

emed

icin

e

Tel

e-T

each

ing

Sci

enti

fic

Pu

bli

shin

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FeedbackQuality Control

Dissemination

Studies, Research

Evidence Base

A way forward

• Connecting different telemedicine projects

• Increase knowledge sharing and transfer

• Combine telemedicine with:– Teaching– Access to health information

Local ownership

• Open Standards for data

• Open Source Software is an opportunity for developing countries to ensure ownership of data.

• Examples: UNITRA, HealthNet Nepal, AIMSHOSPITAL (India)

• Plans: Ethiopia, Francafrique

iPath

More information:

http://ipath.ch

iPath for you ?

1. Deploying iPath as technical basis fo a telemedicine platform - iPath is open source and freely available.

2. Participate in the Basel telemedicine network - as expert or non-expert.• Pathology• Dermatology• Perinatal Health