“Telemedicine begins with a vision of connecting people to people, connecting resources to needs, and connecting healthcare problems to health care solutions”

2. Good news...
KZN DoH eHealth unit
has won an award for
“Innovative use of ICTs for
effective service delivery”

7. eHealth as a tool to support
Health Practitioners
Department of Health
Kwa Zulu Natal

8. Purpose
• Is to emphasize on the efficiency of Telemedicine in
expanding access to quality healthcare, particularly
targeting poor people living in remote areas.
– By supporting the implementation of telemedicine,
health professionals in rural areas will be empowered
in using ICTs to provide quality healthcare
• Provide second opinion in real time
• Prevent unnecessary and avoidable transfers
– at the same time patients will reap the ultimate
rewards of these efforts.
• Patients treated at appropriate level of care

9. Objectives
We do not want to wait for patients to fall sick and
come to our health facilities
Early detection of Diabetes, Hypertension, TB,
and Counseling at an early stage.
To reduce the number patients coming to Clinics
Patients seen closer to where they live.
To reduce number of referrals to the District
hospitals
Especially the unnecessary & avoidable ones
To reduce number of referrals to the Regional
hospitals.
Especially the unnecessary & avoidable ones

10. We do have our challenges…
Distance
between health
facilities
Medico legal
issues




Bandwidth
HIV & AIDS and TB;
High Maternal and Child Mortality;
Non-Communicable Diseases; and
Violence and Injuries.
Setting the Stage for Healthcare Transformation: Key Drivers
Paper
records

11. Reality…
o Long waiting hours at our Health facilities
Patients get referred for minor ailments from:
- Clinic to a District hospital
- District Hospital to a Regional Hospital
o Medical officers leave the consultation room to;
- View X-Rays in the radiology Department
- Look at lab results in the Doctors Common room
o Routine X-Rays are not being reported by specialist
radiologists
-turn around time more than a day
-unnecessary avoidable referrals
o A Patient gets a New Folder and New folder Number
if he/she decides to go to another hospital or clinic .

12. Patient Management
eHealth can assist
•Second opinion
•Prevent unnecessary
avoidable referrals
•Prevent professional
isolation
•Patients treated
close to where they
live

13. Problem statement:
1
Long waiting hours at our Health facilities
Patients get referred for minor ailments from:
- Clinic to a District hospital
- District Hospital to a Regional Hospital
ICT Solution
TeleConsultation
•Connectivity
•
•
•
•
landline
GSM
3G
V-Sat
• Hardware
– Desktop computers
– Web camera
– Digital Medical devices
•Software
• MS Lync
Benefits
• Patients get attention in
real time(Golden hour)
• Patients treated at the
appropriate level of care
• Reduced waiting time for
the patients
• Patients do not have to
travel unnecessarily
• Patient and provider
satisfaction

14. Problem statement:
2
Medical officers leave the consultation room to;
- View X-Rays in the radiology Department
- Look at lab results in the Doctors Common room
ICT Solution
• Consulting room/wards
should have;
•
•
•
•
•
Network points
Desktop computers
Internet
Intranet
Official eMail
Benefits
• Medical Officers can view
the X-Rays on their desk
top
• View NHLS lab results
without leaving the
consulting room
• Reduced waiting time for
the patients
• Patient and provider
satisfaction

15. 3
Problem statement:
Routine X-Rays are not being reported by specialist
radiologists
-turn around time more than a day
-unnecessary avoidable referrals
ICT Solution
• TeleRadiology
Benefits
•
– Connectivity
• ISDN/ADSL line
– Hardware
•
• Digitizer
• DR/CR machines
• Software
• RIS Radiology Information
•
system
•
communication system
•
• PACs Picture archiving and
•
Medical officers can make an
informed decision based on
specialist Radiologist opinion
Patients get attention in real
time (turn around time – few
hours)
Patients treated at the
appropriate level of care
Reduced waiting time for the
patients
Patients do not have to travel
unnecessarily
Patient and provider
satisfaction

16. 4
Problem statement:
A Patient gets a New Folder and New folder Number
if he/she patient decides to go to another hospital or clinic .
ICT Solution
• Software
– Patient registration
• Unique identifier (MPI)
• Demographic information
• Basic clinical information
– Electronic content
management
• Digitizing Patient folder
– Electronic health records
• HIS/RIS/PACS
Benefits
•
•
•
•
•
•
Patient information accessible
across all the facilities.
Cost saving-prevent
duplication of tests
Patients treated at the
appropriate level of care
Reduced waiting time for the
patients
Patients do not have to travel
unnecessarily
Patient and provider
satisfaction

17. 5
Problem statement:
A nurse from clinic/ Medical officer from a District hospital –
when they have to refer a patientit takes lot of time and effort if they have to go through the switch
board
ICT Solution
Benefits
Software
•Microsoft Lync
•Microsoft share point
As part of Microsoft enterprise
license we are already paying for
the licenses.
We might have to still pay for
deployment of the solution.
•
•
•
Nurses can discuss with the
medical officer in real time.
Medical officers can discuss
with the medical officers in real
time.
Patient gets immediate
attention thereby preventing
unnecessary and avoidable
transfers to the next level.

18. TeleConsultation using Microsoft Lync

19. Expected Outcomes
• Improved access to quality health services
• Strengthen district health system
• Strengthen efficiencies of the public health
sector and improved systems performance
• Improved management of health systems
and services at all levels
• ICT is an enabler to achieve these outcomes

20. Information Technology/Information System needs
90% bandwidth
for
Non Clinical use

21. eHealth

22. What is eHealth?
The World Health Organization defines
eHealth as “the use of information and
communication technologies (ICTs) for
health to, for example,
•treats patients,
•pursue research,
•educate students,
•track diseases and
•monitor public health.”

23. Vision
eHealth: enabling a long and healthy life for all South Africans.
Mission
To establish eHealth as an integral part of the transformation and
improvement of healthcare services in South Africa, especially enabling
delivery on the health sector’s Negotiated Service Delivery Agreement
2010-2014.
•
•
•
•
Aim
The overall aim of this strategy is to provide a single, harmonized and
comprehensive e-Health strategy that
a) supports the medium-term priorities of the public health sector,
b) paves the way for future public sector eHealth requirements, and
c) lays the requisite foundations for the future integration and coordination
all eHealth initiatives in the country (both public sector and private sector).

24. •
•
•
•
•
•
•
The principles are:
Get the basics right – infrastructure, connectivity, basic ICT literacy, human
resources and affordability planning.
Take an incremental approach – build on what exists already in both the
public and private sectors and fill the gaps where necessary.
Look for early wins in implementations and benefits to build the confidence
of health professionals, patients and the public in eHealth.
Advocate the benefits of care enabled by eHealth and ensure that these
benefits are realized.
Constantly evaluate eHealth initiatives and measure improvements in
health outcomes in order to build an evidence base that demonstrates the
net benefits over time of eHealth and guides planning and decision-making.
Establish national co-ordination on all initiatives in order to improve the
effectiveness of eHealth at all levels.

25. Three domains need an effective fit
Clinical Work
Information and
Communication
Technologies
Organization of
Medicine and Healthcare
(Systems)

26. Knowledge
Management
Electronic Health Records
Health
promotion
Clinical
pathways
Clinical
information system
Patient profiling
Clinical Decision
sy stem
Information
Management
PAAB
Workstations=
PC+Laptops +
tablets etc
Technology
Infrastructure
DHIS
ICD
10
Access control
& Information
security
Hardware=Servers +
Devices(SAN)
Clinical data
analysis
NHLS
EDI
Transversal
System=
PERSAL
+LOGIS+
BAS
SANB
S
Disease
management
Clinical protocols
EMRS
Health information systems (HIS)
PAC
S/
RIS
eLearning /
distance
education
Health
education
Case
Manageme
nt
telemedicin
e
ECM
Referral
manageme
nt system
eHealth
Vital registration
mHealth
Software=network operating
software (NOS)+Monitoring
software
mHealth4C
BS
telemedici
ne
TCP/IP(Transmission control
protocol/Internet protocol)+
Network Infrastructure=Structured cabling+ Structure(LAN) &unstructured wireless access(WLAN) +
Devices(routers+bridges=switches) +telecommunication lines(eHealth) +digital link(structured cabling)
+Unstructured wireless(Wimax)

27. Strengthening of our referral and back referral system
Community Health
worker
eHealth, Telemedicine, mHealth, EHR,HIS, Document Management System, Radiology
Information system, Laboratory Information System, Pharmacy Information system,
NHLS,SANBS, PERSAL, BAS, Logis etc…
H

28. eHealth packages simplified…
37 sites have ISDN lines and Video Conferencing equipment
•Clinical grand rounds
•Training Mid level workers
•Interactive tele/Video consultations
•Management Meetings

29. Todays session has
been possible because
we have connected 5
sites with IALCH

30. TeleMedicine
teleEducation network
Aim: is to have 37 hospitals on the teleTrauma network

31. teleConsultation Room
Physical Assessment
•
Integrated diagnostic
system efficiency
Vital Signs Monitoring
•
Automated spot-check and continuous
vital signs collection
•
Simple, fast, easy-to-use range of
devices
Thermometry
•
Fast, predictive oral
thermometry
•
Technology and innovation
leader in category
Cardiopulmonary
•
Aggressive development of
ECGs
•
Full range of PC-based
connected devices
Computers in every ward and consulting room so that
we can access Lab results and view X-Rays

33. Way forward

34. Way forward
• Telemedicine steering committee
– Facility level
• Telemedicine coordinator
– Facility level (Medical manager)
• Site coordinator
– Nurse practitioners at least 3 per site
• Technical support
– Full time Telemedicine/IT support

35. Applications of telemedicine in
everyday life

36. Telemedicine
Background:
• Referral of patients using (Voice) a
landline/cellular phone Tele-consultation.
Proposal
– Needs analysis to be undertaken at facility level
– Voice/data/video-tele video consultation
• Digital Medical Devices
• Telemedicine Management software

37. Hardware
Background:
•Computers have been installed in the facilitiesbut not in consulting rooms and wards
Proposal
– Gap analysis to be undertaken
– Hardware
•
•
•
•
•
Desktop Workstation
Laptop/Tablets
Multi function Printer Copier Fax
Projectors
Servers/Cloud servers

38. Networking
Background:
•The Hospitals
– Cabling done
– No network points in wards and consulting rooms
– File servers provided
•The clinics have land lines
– Cabling has been completed network points installed
Proposal
–
–
–
–
Network Cabling
Network hardware
File server room
VSAT for clinics

39. teleRadiology
Background:
•CTs and X-Rays are being reported by fulltime
Radiologists at urban centers
•QOS is being compromised in facilities that do
not have a radiologists
Proposal
– Phase one
• Digitizer films scanned and emailed to a Radiologist
– Phase two
• Replacement of analogue to digital X-Rays (DR/CR)
• Radiology Information system

40. teleDermatology
Background:
•QOS is being compromised in facilities that do
not have a Dermatologists
• Patients referred to an urban center
Proposal
– The use of communications technology to facilitate
the provision of health care for persons with skin
disease is an area of increasing interest and activity
– What is required
• Digital camera and internet connection
• Willing Dermatologists

41. telePsychiatry
Background:
•QOS is being compromised in facilities that do
not have a Psychiatrists
• Patients referred to a psychiatric hospital
Proposal
– The use of videoconferencing technology to
facilitate the provision of health care for persons
with mental health issues
– What is required is VC equipment for a
• Video consultation
• Counseling sessions

42. Revitalization of Primary Health care by using ICTs
at every level of care…
Connectivity
Hardware
Software
Connect
teleConsultation
Primary care
Cardiology
Dermatology
Emergency care
Trauma
Ophthalmology
ENT
Paediatric
Obs & Gyn
Surgery
Dentistry
Radiology
Community
Care Givers
Nurse Practitioners
Nurse Practitioners
Nurses & AHP Practitioners
Medical officers
Nurses & AHP Practitioners
Medical officers
Specialists
Nurses Practitioners
Allied Health Practitioners
Medical officers
Specialists
Super Specialists
Send site
Send site
Receive site
Send site
Receive site Outreach to Clinics and CHCs by Medical Officers
Send site
Receive site
Receive site
Outreach to District Hospitals by Specialists

43. Thank You!
Dr Rajeev Rao Eashwari
Manager
teleHealth and Information technology
Department of Health
Province of Kwa-Zulu Natal

44. ICT in health
•
•
•
•
Information and Communications Technology (ICT) is vital for social change
and economic development. It is increasingly seen as an essential tool for
developing our communities.
The South African National Telemedicine Strategy seeks to integrate the
healthcare system by connecting and giving support to remote and rural
medical centres of South Africa and most importantly, strengthening the
referral systems.
From April 1999 to March 2000, Phase I of Telemedicine was implemented in
six provinces in South Africa, focusing mainly on four clinical applications,
which include the Tele-radiology, Tele-pathology, Tele-ophthalmology and
Tele-ultrasound.
The purpose of this presentation is to emphasize on efficiency of
Telemedicine in expanding access to quality healthcare, particularly targeting
poor people living in remote areas. By supporting the implementation of
telemedicine, health professionals in rural areas will be empowered in using
ICTs to provide quality healthcare and at the same time patients will reap the
ultimate rewards of these efforts.

45. 6
Problem statement:
Today, healthcare organizations are facing a tsunami of data
— coming at them from all directions — while their storage
approaches are still designed for yesterday’s silo’d world.
ICT Solution
Benefits
•
•
•
The combination of medical
images, EMR data and other
business-related content easily
consume today’s disk drives.
But those same drives will be
overcome by the pending wave
of new formats on the horizon –
including genomes and digital
pathology data – coming as a
second surge.
•
•
•
•
The data explosion adds hidden
costs to our healthcare system.
Patient information accessible
across all the facilities.
Reduced waiting time for the
patients
Patients do not have to travel
unnecessarily
Patient and provider satisfaction