To develop a telemedicine system to improve remote diagnoses and to deliver a costeffective, betterq

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To develop a telemedicine system to improve
remote diagnoses and to deliver a cost-effective,
better-quality specialist services in developing
countries
Health care of 21st Century
Mannan Mridha Björn Pehrson KTH-Sweden
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Sections of presentation

• Telemedicine
• Feasibility study
• Objectives
• Methods
• Expected results

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What is telemedicine?
Telemedicine
Telemedicine is the use of electronic
communication and information technologies to
provide health care when distance separates the
medical professional from the patient.
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Telemedical Equipment and Technique
Case Processing
Case Reception by the specialist
Case Transmission using high speed net
connectivity
Second Opinion
History Taking and Clinical Examination
Digitisation of the case
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Types of service
Telemedicine

• Tele consultation Helping the patient to reach
  a confirm diagnosis.
• Tele monitoring Example is monitoring a
  cardiac patient with an ECG.
• Tele health Mainly consists of health
  education
• Tele mentoring Example is telesurgery.

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Equipment
Major equipment commonly used are

• General Examination Camera
• E-Stethoscope
• ENT Scope
• Ophthalmoscope
• X-Ray Digitizer
• 12 lead ECG machine
• Spirometer

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Types of consultation
SIMPLE E-MAIL CONSULTATION Consultation of
simple cases (case presented without any
images). COMPLEX CASE CONSULTATION Consultation
of more complicated case presented with images
like x-Ray, ECG, Ultrasonogram, CT Scan, MRI etc.
X-RAY interpetation CT interpetation MRI
interpetation
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Benefits of Telemedicine in the developing
countries?
Telemedicine
For the patient

• Reduced physicians fees and cost of medicine
• Reduced travel expenses
• Treatment by qualified physician, interpretation
  of imaging histopathology, when professionals
  are distantly placed
• Early detection of diseases
• Reduced burden of morbidity
• Saves work-loss time and increase productivity
• Home health care by using telemedical home
  monitoring device for chronic case

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Benefits of Telemedicine?
Telemedicine
For the doctors

• Telemedicine is an excellent opportunity to
  share the knowledge between physicians all over
  the world.
• Joint consultation with expert physicians and
  surgeons for better management of complicated
  disease.
• Local doctors can be updated at any time with
  the most recent advancement in medicine.
• Medical education in the form of
  teleconferencing

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Benefits of Telemedicine?
Telemedicine
For the government
a)    Reduced rush to the medical facilities in
the cities b)      Improve monitoring facilities
at the rural based centres c)      Increased
reliance on the government health care
system d)     Increases stuff productivity
e)   Economizes resources (optimal use of
instruments and surgical facilities).
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Feasibility study

•    Our study addressed
• Policy-related issue,
• Organizational and human capacities issues,
• Financial issues,
• Technical issues

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Questions asked were

•   
• Policy-related Issues
• What are the main challenges in the countrys
  health care system?
• Which of these could be successfully addressed
  telemedicine ?
• What are the current or planned health care
  programmes or activities in the country that
  could benefit from the application of health
  telemedicine? In which way?
• Have any strategies or policies for implementing
  health telemedicine been developed in the country
  previously?
• Have there been any projects or systems using
  health telemedicine in the country previously? If
  so, what is the experience?

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Questions asked were

•    Organizational and human capacities Issues
• What kind of human resources are available?
• What is the computer literacy level among key
  personnel?
• What kind of training programmes will be needed?
• Which are the geographical areas, local
  institutions and/or focal points that would be
  involved in a telemedicine project or service?
• How is the issue of medical responsibility within
  the countrys health care system in relation to
  health telemedicine?
• Is there any existing legislation on
  confidentiality, security and privacy which could
  apply for health telemedicine services?

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Questions asked were

•    Financial Issues
• How will the project be funded with regard to
  investments and running costs?
• How will the service be paid for?
• What is the level of communication costs in the
  country?
• Who will provide training and maintenance?
• What kind of activities, human resources,
  equipment and other factors can be provided by
  the local project participants or the government?

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Questions asked were

•    Technical Issues
• How is the telecommunication infrastructure in
  the country, in terms of distribution and costs?
• What type of communication technology is used?
• Is the telecommunication infrastructure reliable?
  
• Are there any government plans for the current
  telecommunication infrastructure?
• Which are the main telecommunication providers in
  the country?
• Which are the Internet Service Providers in the
  country?
• How is the distribution of technical equipment
  such as computers, digitized medical equipment,
  in hospitals, clinics and administrative units?
• How will maintenance be cared for?

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Our objectives are to

• select telemedicine equipment to meet the
  medical need of the local communities,
• determine the factors involved in transmission of
  medical data to adapt to the existing
  connectivity and other facilities,
• prepare appropriate education and training
  programme
• implement a pilot telemedicine system at some
  model centres,
• develop the methods towards a sustainable
  telemedicine-technology for safe and reliable
  cost effective operation,
• evaluate the centres to find if IT Telemedicine
  services can improve the quality of care and
  access to health-care,
• prepare recommendations guidelines on how the
  rural and remote areas in the developing
  countries can benefit from self-sustaining
  telemedicine communication systems.

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Our partners
IT University/KTH, Sweden (coordinate, develop
and implement)  Grameen Health, Bangladesh
(provide rural health centres)  Grameen
communication, Bangladesh (provide network
support)  BIRDEM Hospital, Bangladesh (provide
medical specialists)  PG Hospital, Bangladesh
(provide medical specialists)
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Method

• Phase 1 Development of equipment system for
  monitoring, diagnosis consultation,
• Phase 2 Development of reliable information
  management systems and networks,
• Phase 3 Implementation and evaluation of the
  systems.

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Telemedical Equipment And Technique
Power Zoom Push-button 1-50x zoom allows both
close focus and wide angle images. Auto Focus
The camera automatically stays in focus for ease
of use. Freeze Frame Freeze frame produces the
clearest possible image, making it ideal for both
low- and high-bandwidth solutions. Accurate
Colors One button white balance sets highly
accurate colors quickly and easily. Polarization
Elimination of surface skin reflection allows
camera to see into epidermal layers. Touch and
View The AMD-2500 includes manual or automatic
iris control to maximize image brightness.
AMD 2500 General Examination Camera
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Telemedical Equipment And Technique
Pictures taken by AMD 2500 General Examination
Camera
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Telemedical Equipment And Technique
Dermoscope View
General Exam View
Pictures taken by AMD 2500 General Examination
Camera
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Telemedical Equipment And Technique
Video version of the traditional diagnostic scope
used by the vast majority of primary physicians
worldwide. View and illuminate retina, head of
optic nerve, retinal arteries, vitreous humor
even through an undilated pupil, but better
viewable with pupil dilated. Focus in eyepiece
is equal to image on video monitor.
Direct Ophthalmoscope
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Telemedical Equipment And Technique
Superior Imaging The AMD-300s teams Welch
Allyn's patented Solarc lamp with Sony's
HyperHAD CCD to deliver a crisp, clear, uniform
image from edge to edge. Superior Illumination
Welch Allyn's arc lamp produces white light for
true color and the advanced design projects light
into the fiber optic bundle at a wider angle,
producing consistent illumination across the
monitor. Easy To Use Automatic white balance
and iris control match the level of illumination
to the needs of the camera. Flexibility
Economy The AMD-300s adapts to a wide range of
rigid and flexible diagnostic scopes. Rugged
Construction The solid camera housing, reinforced
cable and rugged system chassis guarantee long
life under continuous use. The lamp has an
average life of 500 hours.
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Telemedical Equipment And Technique
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CARDIOPHONOGRAM BY AMD-3400RS PhoneSteth
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2D ANALYSIS OF HEART SOUND BY AMD-3400RS PHONE
STETH
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Telemedical Equipment And Technique

• DICOM (Digital Imaging Communication in
  Medicine) compatibility
• Can scan image plates with 700 dpi (max)
  whereas only 150 dpi is required to fulfill DICOM
  compatibility
• Supplied with X-scan 32 Software which enhances
  image quality up to minute detail.

Large Format 12 Bit X-ray Digitiser Cobra Scan
CX-312T
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Expected results
Telemedicine

• Telemedicine can enhance Bangladesh Government
  Health Programme that envisage a client
  oriented services, known as Essential Service
  Package (ESP) to
• Increase health coverage,
• Improve quality of services,
• Cost effectiveness,
• Accountability

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Other Benefits of Telemedicine?

• The facilities can be used for other purposes to
  reduce the digital divide such as
•        Education and research
•        Business and trade
•        Administration and management