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Telemedicine

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Telemedicine Definition: The practice of medicine at a distance A successful telemedicine program often starts with a face to face meeting Cyber-Sight E-Consultation ... – PowerPoint PPT presentation

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Title: Telemedicine


1
Telemedicine
  • Definition
  • The practice of medicine at a distance

2
A successful telemedicine program often starts
with a face to face meeting
3
ThenORBIS Telemedicine, Cyber-Sight
Provides low cost extended presence connecting
doctors on a continuous basis
4
Cyber-Sight
How does it work?
5
The Server
sends consult
receives consult
P
M
Located at Flight Safety, Flushing, NY
receives answer
sends answer
6
E-Consultation
  • As described in the previous slide offers
    partners the opportunity to obtain consultation
    on difficult patients from an expert with the
    added opportunity to interact during the
    evaluation process and to share results of
    treatment in these patients

7
The consultation process goes like this
  • The partner is identified, trained, assigned a
    password and user name, and when needed given a
    camera and computer
  • The partner is assigned to a mentor team
  • A challenging patient is photographed by the
    partner and the history and pictures of the case
    are uploaded and sent
  • The mentor is alerted, answers the consult, and a
    dialogue is established
  • The partner closes the case when it is completed

8
Mentor Teams are made up of experts in the
following sub-specialties
  • Cornea
  • Retina
  • Glaucoma
  • Oculo-plastics
  • Pediatric ophthalmology/strabismus
  • Uveitis
  • ROP
  • Genetics
  • Retinoblastoma
  • Cataract
  • Neuro-ophthalmology
  • Etc.

9
The patients clinical condition is documented
with a digital camera
The camera should be set at 640x480, PC or TV to
obtain smallest picture
10
Partner logs on to web site
  • Go to www.orbis.org
  • Click on Cyber-Sight (left side of screen scroll
    down ¼ screen)
  • Click on Cyber-Sight again on right side of
    screen
  • Click on E-consultation
  • Add user name and password these are assigned
    by ORBIS
  • This brings up the formatted page for patient
    information upload

11
Partner sees this screen and is greeted by name
12
Partner Selects sub-specialty from drop down
menu
13
Sub-specialty selected
14
Strabismus format
15
Pictures have been uploaded
16
Partner submits this information
I know the child needs glasses, patching, and
surgery. How would this be done best?
Should I cut the plus? If so should I cut the
same percentage in each eye? Is it possible that
wearing glasses will result in alignment? What
should I do first?
17

The mentor sees the patient information,
pictures, diagnosis, plan, and questions
18
The mentor Answers
19
A dialogue continues until The partner closes the
case
20
Cyber-Sight
  • Some examples of consultations

21
Mentor diagnosisBrown OS
Partner diagnosis Double elevator palsy
22
Partner diagnosis Duane Type III
Mentor diagnosisDuane Type II
23
Mentor suggestionSimultaneous abduction Duane
IV
Partner diagnosis Left eye fibrous tissue
24
Partner diagnosisBlowout fracture postop, recess
RSR
Mentor advisesForced ductions, likely need to
free RIR
25
Subconjunctival hemorrhage Partner and mentor
agree
26
Partner and mentor agree Conjunctival laceration
27
Mentor Unilateral hypoplasia of the optic nerve
Partner Amblyopia?
28
Partner Corneal dermoid
Mentor Agree corneal dermoid
29
Partner What is it?
Mentor Epithelial implantation cyst
30
Partner What is it?
Mentor Granular dystrophy
31
Partner and Mentor agree Traumatic cataract
32
Partner Corneal foreign body
Mentor Agree treat rust ring
33
Partner Intraocular tumor what is it?
Mentor Retinal angioma
34
Partner Retinal angioma
Mentor Agree retinal angioma
35
Partner Foveal cyst
MentorIdiopathic retinal epithelial detachment
36
Partner Retinoschisis
MentorTraction detachment
37
Three unusual and instructive cases
38
Mentor I agree LSO palsy could the left SO
tendon be missing?
Partner diagnosisLSO palsy
39
Absent muscle
Absent trochlea
Partner What about the tendon?
Mentor The left superior oblique tendon complex
is absent or severely atrophic
40
Partner diagnosis Congenital RSO palsy, 3
surgeries, what next?
Mentor suggestionCT for presence of RSO
Trochlea present
Muscle absent
41
I see two trochleas
42
Partner points out absence of RSO muscle belly
43
(No Transcript)
44
Partner demonstrates traction test normal OD,
lax OS
Partner finds Absent LSO tendon at exploration
45
Two other parts of the
  • Cyber-Sight Program

46
E-Resource
  • Ophthalmology Minute
  • Featured Cases
  • Question of the week
  • Decision Making in Strabismus
  • Eye Pathologist (link)

47
(No Transcript)
48
E- Learning
  • BCSC questions
  • Student course activity log in
  • CME opportunities

49
BCSC and CME
50
Cyber-Sight is ORBIS Telemedicine
  • Full program initiated spring 2003
  • 140 mentors
  • 296 partners
  • 68 sites
  • 32 countries
  • 135 mentors 40 answering consults
  • W2,075 consults 6,000 communications
  • 1,372 strabismus / ped. ophth.
  • 200 E-Learning students

51
The flow of consults is as follows
  • The partner is congratulated for having the right
    diagnosis and correct treatment plan.
  • Or an alternate diagnosis and treatment plan is
    suggested.
  • Additional workup is recommended.
  • Teaching points and suggested additional reading
    are made.

52
Thank you.
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