The ABCs of Telemedicine
Alvin B. Marcelo, MDUP Manila National Telehealth Center
Outline
History of telemedicine
Current definition
The Philippine healthcare situation
Telemedicine examples at UP ManilaChallenges and obstacles
Lessons learned
The ABCs
History of Telemedicine
1924: Radio News Magazine
1954: Teleradiology
1959: Telepsychiatry
1970s: NASA
Telemedicine
the use of medical information exchanged from one site to
another via electronic communications to improve patients' health
status
American Telemedicine Association, 2010
American Telemedicine Association, 2010
Telehealth
often used to encompass a broader definition of remote
healthcare that does not always involve clinical services.
Videoconferencing
Transmission of still images
eHealth including patient portals
Remote monitoring of vital signs
Continuing medical education
Nursing call centers
American Telemedicine Association, 2010
Types of Telemedicine Interactions
Specialist referral services
Patient consultations
Remote patient monitoring
Medical education
Consumer medical and health information services
Environments for Telemedicine
Networked programs
Point-to-point connections
Primary or specialty-care to home connections
Home to monitoring centers
Web-based eHealth patient service sites
The Philippine healthcare situation
7,107 islands
Many areas with no access to doctors
Traveling for simple consults not cost-effective
Bottomline: no access to primary care practitioners/specialists
until conditions become severe
UP Manila's OneHEALTH Program
eRecords
eLearning
eMedicine
eLearning for HealthDeveloped e-Learning Videos (4) funded by
the Last Mile Initiative, USAID
Held e-Learning sessions in several provinces (Capiz, Nueva
Vizcaya, Quezon, Bicol, Batanes, Cebu)
eLearning for Health
eLearning for Health
Telemedicine at UP Manila
TelemedicineBuddyWorks
SMS, MMS, Email telemedicine
Facilitated Referrals
DOST Telemedicine Project
BuddyWorksE-Gov funded project (2005-2008)
Ten sites in four provinces (portal, computers, workstations,
training, fast Internet)
After two years 8 referrals only
Cagayan (3)
Provincial Health Office
Cagayan State University
Cagayan Valley Medical Center
Leyte (2)
Eastern Visayas Regional Medical
Center School of Health Sciences, UP
Manila Capiz (3)
Roxas Memorial Provincial Hospital
Sigma Municipal Health Office
Mambusao General Hospital
Lanao del Norte (2)
Mindanao State University
- Gregorio T. Lluch Memorial Hospital
CHITS
After enhancement
Doctors-to-the-barrios
2008: n = 582009: n = 124
Enhancements to BuddyWorksShifted to SMS, MMS, Email
Enhancements to BuddyWorks849 telehealth referrals from remote
doctors over a period of 17 months...
(15 October 2007 31 March 2009)
SMS Telemedicine
3 day old male, home delivered by untrained hilot with CC of
fever for one day duration. PE patient is febrile (38.5C),
irritable and with poor suck (as observed). im referring this to
the hospital for neonatal sepsis. the weather here is so bad ...
they could not yet travel by the sea. i do not have IV meds so i
just prescrived co-amoxiclav and paracetamol per orem as temporary
management.
SMS Telemedicine
please avoid co-amoxiclav coz it might cause hepatotoxicity;
short of bringing the patient to the hospital, you may give
ampicillin 100 mg/k/day IM q12. if ampicillin is unavailable, you
may give cefalexin 100 mg/k/day q8 oral
TeleDermatology
TeleOphthalmology
REFER LOR 55 Female suddenly lost sight after 'hitting a spider'
she felt on her eye.
TeleOphthalmologyAssessment:
Acute Angle Closure Glaucoma left eyePlan:
Timolol eye drops 1 drop on the affected eye 2 x daily
Latanoprost eye drops 1 drop on the affected eye once at
nightBrimonidine eye drops 1 drop on affected eye 2 x
dailyPilocarpine eye drops 1 drop 4 x daily on the affected
eyeDorzolamide eye drops 1 drop on affected eye 3 x daily
TeleRadiology
TelePsychiatry
Facilitated Referral
BuddyWorks Lessons
Go as far as possibleTelemedicine in cities difficult to
justify
The more remote, the better
Identify existing trust networksEnhance that with telemedicine
techniques
Establish trust first then do telemedicine (not other way
around)
GPs are most fertile for telemedicine
Use appropriate technology
Web-based Telemedicine
DOST Telemedicine ProjectEmergency Care and Coordination
Services
RxBox telemedicine device
TRIAGE central coordinating system
EXPERT transaction system for poisoning
RxBox
Expert Interface
StakeholdersLocal Government Units (LGU)
Provincial Health Office (PHO)
Center for Health Development Department of Health (CHD-DOH)
Philippine Health Insurance Corporation (PHIC)
UP Manila National Telehealth Center (UPM-NThC)
Congressional Commission on Science and Technology and
Engineering (COMSTE)
The ABCs of Telemedicine
A
AgreementThere should be mutual understanding between the two
parties of their expectations and responsibilities
There should be pre-existing relationship between the two
parties (or at least the facilitation of an accepted 'broker')
B
BridgeThe methodology of connecting the two parties
Must be acceptable to both parties
Must be appropriate (don't expect fast Internet in remote areas
of the country)
C
ControlGuidelines and protocols for the encounter
Preparing connection
Maintaining connection
Exchanging information between two parties
Post-conference documentation
ABC
A agreement establish trust
B bridge use most appropriate connection
C control follow guidelines and document
Thank you very much!
National Telehealth Center
University of the Philippines Manila
www.telehealth.ph
NATIONAL TELEHEALTH CENTERUniversity of the Philippines
Manila
Quality health care through ICT...
