Regional Consultation on Telemedicine Sharing Experience and a way forward by Dr Mohamed Ali Dr Nusaiba Farouk Hassan Overview Demography Evolution of EHealth and Telemedicine Current Scenario ID: 691445
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Telemedicine in Maldives
Regional Consultation on Telemedicine: Sharing Experience and a way forward
by:
Dr. Mohamed Ali
Dr. Nusaiba Farouk HassanSlide2
Overview
Demography
Evolution of E-Health and Telemedicine
Current Scenario
Strategic Direction
Innovations and applications of eHealth and telemedicine
Strength
Weakness
Opportunity
Threats
The way forwardSlide3Slide4
Demography
An archipelago: 1192 Islands
Inhabited: 200 islands
Population: 360,000
Distribution:
Largest: Over 100,000 in Male’ City
Area: 90,000 sq km ( sea)
Ethinicity
- AsianSlide5Slide6Slide7Slide8Slide9Slide10
Background
In constitution: The right of every citizen to access good quality health services is protected.
The Government: Constitutionally mandated to realize this right for all.
Guiding Principles;
Recognizing Health as a human right and its universality
Ensuring equitable access to affordable, quality health services based on primary health care approach
Harnessing solidarity for health in all national policies
Ensuring policy development based on facts and scientific evidenceSlide11
Vision
for Health
:
Improving the quality and affordability of health care with a focus on access for all.
Goal for E- Health:
Providing standardized high quality medical services, by using interoperable, compatible, reliable, and scalable E-Health solutions such as telemedicine, HIMS, whereby all residents of Maldives have equal access medical expertise available in the Maldives as well as internal medical care institutes. Slide12
Strengths:
ICT is one of the fastest growing areas in Health
Existing institution based
programmes
/ databases
National ID
Nos
are being entered to independent systems, which can be used as a unique patient identifier
Large potential for M-Health;
extensive use of mobile phones and related devicesSlide13
Major Healthcare initiatives in place:
Online Nutrition and Child Health Surveillance System (ONCHSS)
SEARO Integrated Data Analysis System (SIDAS)
Hospital Information System (HIS)
E-Government Portal for online birth and death registration
Neonatal/Perinatal Database Slide14
E – Health Objectives
Establish an integrated health information System
Improve access and quality of health care given to general public using E-Health
Strengthen the capacity to monitor health indicators and conduct system reviews in a timely manner
Facilitate efficient emergency or disaster management and timely decision making in health emergency situationsSlide15
Specific Strategies
Establishment of a governance structure to deliver the E-Health Strategy
Unique citizen identifiers for a common health services and health insurance
Implementing Telemedicine
Availability of needed health information at a national level in a timely manner
Implement consumables management information system
Begin introduction of more clinical information systems and EPRs
Expand use of M-Health
Invest in computing infrastructure
Access to broad-band services
Adequate communication of E-Health strategies Slide16
Current
Investments, goals and plans:
Patient centered information systems
Electronic Health Record Systems
Telemedicine
Information Databases
Preventive Health Services using Mobiles Slide17
Telemedicine in Maldives
Vision: P
rovide
a telemedicine solution to Maldives which is compatible, scalable, reliable and inter-operable. The objective is to upgrade the quality of health care and minimize the cost of medical care through effective acquisition of relevant clinical information at remote sites. And also to ensure that all residents of Maldives have equal access to high quality health services regardless of their location. Slide18
Telemedicine in Maldives
Objective:
Enable people in islands to use
tele
-consultation and avoid travel and support continuing medical education:
Implemented in II Phases
Aiding agencies
Integrated Human Development Project; World Bank
Khalifa
Bin Al
Nahyan
Foundation; Abu DhabiSlide19
Implementation:
Phase I: Integrated
Human Development Project; World Bank
Telemedicine: 4 Main hubs connected on 5
th
May 2010
Indhira
Gandhi Memorial Hospital – Central
Kulhudhufushi
Regional Hospital - North
Thinadhoo
Regional Hospital – South
B.
Eydhafushi
Hospital Slide20
Phase II
34 New Centres joined Telemedicine Network under Khalifa Bin Zayed Al Nahyan Foundation; Abu Dhabi: 20
th
November 2011
Two components
Telemedicine Kiosk and Equipment
Training Component
70 Nurses
10 Specialists; Biomedical Engineers, Obstetrician
Gynaecologists
,
Paediatricians
, Surgeon and PhysiciansSlide21
4 Referral Hospital and 34 Remote points
Hdh
.
Kulhudhufushi
Regional Hospital
Indira
GandI
Memorail
Hospital
Gdh
.
Thinadhoo
Regional Hospital
S.
Hithadhoo
Regional Hospital Slide22
Current Situation
Sporadic Cases
No designated personnel
Trained staff unavailable to provide service
Insufficient attention to Telemedicine due to inadequate number of Clinicians at referral centers
Expensive equipment under lock and Key
No existing referral system
Use of M-Health; applications like what’s
ap
for case discussion by Clinicians
AIM: Strengthening of existing servicesSlide23
Map ISlide24
Innovations and Applications of E- Health / Telemedicine
Tele-Education
Department of Child Health, IGMH and AIIMS, New Delhi
Dengue Season
2011; CMEs in all 4
Centres
Staff at
Thinadhoo
Regional Hospital had participated in the Workshop on Management of Dengue Cases conducted in association with WHO and QSNICH via
tele
-education 2011
Telemedicine
Potentional
for development
Dermatology
Pathology
Radiology
Orthopaedics
General Medicine /
PaediatricsSlide25
Strengths
High Priority Project for Ministry of Health and Family
Health workers at remote points are motivated to learn and maximize use of Telemedicine
Clinicians at the Referral Centers are committed to attend to cases
Human Resource Development Slide26
Weaknesses
Central
Lack of an Alert System
Unaware of the enhanced equipment availability Remote points
Inadequate number of Clinician to attend to inpatient and outpatient facilities, hence telemedicine is not made a priority
No designated personnel / infrastructure
1:38 Ratio of telemedicine carts; central: peripheries
Peripheral
High turn over of trained staff
Nurses trained under Telemedicine project refuse to go back to the island
Inadequate infrastructure and power supply at HC to support equipment
Unavailability of Medications and Basic investigations
Common
Telemedicine Network has not been integrated with the Hospital
Networks
No networking between focal points
Lack of awareness among doctors about Telemedicine
License for teleconferencing has to be purchased; hindrance for
tele
-education
Lack of awareness among clinical staff and management at the hospitals
Lack of telemedicine trained specialists
Referral centers do not have telemedicine links with Regional
Centres
abroad Slide27
Opportunity
SAARC Telemedicine Project
Collarboration with Regional Centres;
AIIMS
Reduce expenditure on Health insurance referrals to male’ and abroad.
Gain the confidence of the public in the health sectorSlide28
Threats
Remote island losing hope due to failure to attend to cases promptly
Lack of maintenance of equipment may lead to loss of equipment performance
Referral
centres
do no have the necessary consultantsSlide29
Way Forward
Encourage
doctors to utilize telemedicine
To integrate M-health in to the
telemedicine system officially
To train the personnel responsible for the telemedicine and assign roles
To assign personnel to manage the telemedicine equipments and to give responsibility of maintaining them
To assign login responsibilities to the individual doctors, rather than the institute
To include
teleconsultation
in the duty roster
To assign CME points in return to the
tele
-consultation hours spent
To give bonus salary for the cases spent on
tele
-consultation
To give preference to
tele
-radiology
To provide basic equipments to the remote kiosks, like USG machines, ECG machines and X-ray machines and maintain the supply to the basic laboratory investigations
Assign budget for telemedicine
WHO and other NGO’s support to implement these services and to train personnel
In
assigning the login responsibilities, the MOH should assign license to
tele
-medicine
Include
tele
-consultation in National Insurances’ (ASANDA) patient evacuation system, to minimize the cost of improper referral and improper referral diagnosis thus reducing cost of referral system.Slide30
Conclusion
Telemedicine is a great promise to Maldivians to achieve better healthcare without having to travel by highs seas to the nearest referral
centre
, and then inevitably to the capital.
Telemedicine is the alternative route to achieving the best possible treatment rather than referring abroad for issues which can be resolved within the country, hence better utilization of resources. Slide31
Thank You!