Worldwide Telemedicine Initiatives Status andIntroduction of Telemedicine in Developing Countries 2010

1. TAIPEI MEDICAL UNIVERSITY
TELEMEDICINE
Worldwide Telemedicine Initiatives Status and
Introduction of Telemedicine in Developing Countries
Vanitha 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 of
application.
– 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 for
Developing 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 a
critical factor, by health professionals, using ICT (1) for the
exchange of information for diagnosis, treatment and
prevention of disease and injuries, all in the interests of
advancing 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 4
Telehealth and Telemedicine?

5. Categories2. 5
• Store-and-forward: 1
• Remote monitoring: 2
• Interactive telemedicine: 3, 4.
2
Medicare 2006©
1 3 4
WHO Telemedicine 2009 Report Karolinska U. 2003©
University of Toronto 2010©

6. Worldwide Situation of Projects developed in 6
Telemedicine
• In 2008 the WHO developed a survey for assessing the current
status 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 the
projects in Telemedicine, according with the record of the national
initiatives of each WHO Office in 2005, being implemented or
completely established, as well, the status of the national policy in
Telemedicine being addressed in each country in this area as a
facilitating factor, and the barriers to the telemedicine identified
during the survey.

7. 7
General status of Projects being implemented or
already implemented in the main application
areas of Telemedicine in the world.

8. 8
Worldwide status of Teleradiology.
WHO Region World bank Income classification

9. Evaluation of a Telemedicine (Telegynaecology) 9
demonstration project in the Magdalene Islands 20044
Jean-Paul Fortin, Marie-Pierre Gagnon, Alain Cloutier and Françoise Labbé
A total of 101 individual patients benefited from a teleconsultation, USG Gynecologic
evaluation was an important feature, given that this Islands are located
more than 1000 km away from supra-regional medical referral centres.

10. 10
Worldwide status of Teledermatology.
WHO Region World bank Income classification

11. Telemetric Devides collaborating with the Telemedicine
11
Working Group of Bangladesh to bring dermatology care to
rural communities in 2012.5
In Bangladesh, approximately 30 percent of the population will suffer from a skin
disease at one point in during their lifetime. However, there are fewer than
300 dermatologists in Bangladesh and all are urban-based

12. 12
Worldwide status of Telepathology.
WHO Region World Bank Income classification

13. Virtual Telepathology in Egypt, applications of WSI in
13
Cairo University 20116
Ayad E
Using the Telemedicine the Universitity of the cairo send lab and image results to
Civico Hospital in Palermo for research purposes.

14. 14
Worldwide status of Telepsychiatry.
WHO Region World bank Income classification

15. Evaluation of a rural telepsychiatry service in Wagga Wagga
(Australia) 2007.7 15
James Greenwood*, Christie Chamberlain, Gordon Parker
Wagga Wagga in rural New South Wales, comprising
a face-to-face interview with a psychiatrist followed by
a telepsychiatry interview with a Sydney-based
psychiatrist.

16. 16
Worldwide status of Telecardiology.
WHO Region World bank Income classification

17. The teleECG initiative in Norway 20103 17
• The teleECG initiative in Norway
is a telemedicine service used to
facilitate early diagnosis and
treatment of suspected
myocardial infarction in patients
not in hospital.
• Ambulances are fitted with
equipment to capture and
transmit ECG images to hospitals
that have an image receiver and
storage system for the images
sent. Once received, the images
are analysed by a cardiologist at
hospital who is able to make a
diagnosis and recommend an
immediate course of action.

18. 18
Other areas of Application.
Tele-retinography

19. 19
Factors facilitating the Telemedicine3
• Governance
• Policy or Strategy
• Scientific development
• Evaluation

20. 20
Current Status of Telemedicine policies
around the world3

21. 21
Barriers in Telemedicine

22. 8
Objectives: To review papers reporting actual experience with telemedicine in
developing countries and to summarize their findings, including the strength
of 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 studies
reviewed suggest publication bias.
even if their lack of focus weakens the
evidence base. Very few of the studies
reviewed have been conducted with high
methodological quality and we,
therefore, make a strong call for more
rigorous methodological assessment in
future, along well-defined guidelines. For
example, cost- effectiveness is a
fundamental aspect of the introduction
of telemedicine and our review found
very few studies which had addressed
this topic

24. Conclusion of the Research Paper.
(1) Avoid proposing very large and expensive projects.
(2) Ensure close collaboration with local doctors, national health
services 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 we
can learn about the experience of others.
• Cost effectiveness analysis can allow us measure the impact of
introducing telemedicine. As well we can give evidence to policy
makers.
• It is important to assess the suitability of the project, because not
always the telemedecine can be the answer for enhance the health
access in isolated communities.

26. Case of Study (Puerto Caicedo - Hospital) in 26
Amazonas Rainforest Colombia
Ministry of Telecommunications of Colombia 2011
Comments and final edition: Alexander B. Rubashkyn

27. 27
Interoperability 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.
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29. Group 4: Do you think India or Colombia has a Greater potential 29
to develop their telemedicine Technology over the next decade?
Colombia Systematic Review of Telemedicine Projects in Colombia10
28% Rural Areas
Challenges: 45 000 000
Malaria 150.000 per year Infrastructure.
Hemorrhagic ICT Literacy, Access No policy
Dengue: to technology.
18.9/100.000 (armed conflict) EHR in 2013
India Challenges and opportunities for the adoption of Telemedicine in india11,12.
Challenges: Infrastructure,
72% Rural Area 1 200 000 000
Reluctance of physicians to
use Telemedicine, Access to
Diarrhea Is one of the most Policy
technology, the Policies are
important cases of death.
not addressing
clearly the target No EHR only EMR
population (some places)

30. 30
Conclusions
• Telemedicine as tool have an important role to play in the improvement of
the quality and efficiency of health systems in the world.
• Telemedicine deserves special consideration for the local; Access should as
well be focus on elements that help introduce the telemedicine,
(Infrastructure, Standards, Policies, ICT technologies), even more when
worldwide satellite communication is available at reasonable cost,
telemedicine can be used in many different ways such as improving
healthcare access, supporting health workers in isolated settings or
addressing the shortage of specialist doctors.
• Harmonized globally interoperable standards fundamental to ensure
global exchange of information in Telemedicine.
• Telemedicine thus works toward the concept of medicine, which
transcends boundaries.

31. If you have health, you probably will be happy,
and if you have health and happiness, you have
all the wealth you need, even if it is not all you
want.
Alexander R.

32. Complementary References
(Second part)
1. WHO definition: WHO. A health telematics policy in support of WHO’s Health-For-All strategy for global health
development: report of the WHO group consultation on health telematics, 11–16 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 Labbé 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. DOI 10.1258/shorts.2010.010045
9 The American Telemedicine Association, Core Standards for Telemedicine Operations November 2007

33. References
(First Part- previous presentation)
1 WHO definition: WHO. A health telematics policy in support of WHO’s Health-For-All strategy for global health
development: report of the WHO group consultation on health telematics, 11–16 December, Geneva, 1997. Geneva,
World Health Organization, 1998.
2 Rosen, E. (1997), “The history of desktop telemedicine'', Telemedicine Today, Vol. 5 No. 2, pp. 16-17, 28.
3 Currell, Telemedicine versus face to face patient care: effects on professional practice and health care Outcomes.
Cochrane Database of Systematic Reviews, 2000.
4 Dena Puskin, Barbara and Stuart, *2006+ “Telemedicine, Telehealth, and Health Information Technology”, An ATA
Issue Paper, The American Telemedicine Association, May 2006
5 Strode SW, Gustke S, Allen A. Technical and clinical progress in telemedicine. 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):384–390.
7 Wootton R. Telemedicine support for the developing world. Journal of Telemedicine and Telecare, 2008, 14(3):109–
114.
8 Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth
2009. WHO (Global Observatory for eHealth Series, 2)
9 Resolution WHA58.28. eHealth. In: Fifty-eighth World Health Assembly, Geneva, May 16–25, 2005 (http://
apps.who.int/gb/ebwha/pdf_files/WHA58/WHA58_28-en.pdf, accessed 9 november 2012
10 Craig J, Patterson v. Introduction to the practice of telemedicine. Journal of Telemedicine and Telecare, 2005
11 Carlos Rey-Moreno, Javier Simó Reigadas, Estrella Everss Villalba, Juan Jose Vinagre† and Andrés Martínez
Fernández, systematic review of telemedicine projects in Colombia, doi: 10.1258/jtt.2009.090709, J Telemed Telecare,
April 2010 vol. 16 no. 3 114-119.
12 Shabbir, Syed-Abdul, Scholl J., Jian W and Li Y. Challenges and opportunities for the adoption of telemedicine in
India, DOI: 10.1258/jtt Journal of Telemedicine and Telecare Vol 17 No 6 2011 pg 336-337 October 2011.
13 Siriginidi, Subba Rao, Achieving millennium development goals: Role of ICTS innovations in India, Telematics and
Informatics VL26 IS2 Sp127 Ep143 February 2008