Title: Telemedicine
1Telemedicine
- Definition
- The practice of medicine at a distance
2A 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
4Cyber-Sight
How does it work?
5The Server
sends consult
receives consult
P
M
Located at Flight Safety, Flushing, NY
receives answer
sends answer
6E-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
7The 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
8Mentor 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.
9The patients clinical condition is documented
with a digital camera
The camera should be set at 640x480, PC or TV to
obtain smallest picture
10Partner 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
11Partner sees this screen and is greeted by name
12Partner Selects sub-specialty from drop down
menu
13Sub-specialty selected
14Strabismus format
15Pictures have been uploaded
16Partner 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
18The mentor Answers
19A dialogue continues until The partner closes the
case
20Cyber-Sight
- Some examples of consultations
21Mentor diagnosisBrown OS
Partner diagnosis Double elevator palsy
22Partner diagnosis Duane Type III
Mentor diagnosisDuane Type II
23Mentor suggestionSimultaneous abduction Duane
IV
Partner diagnosis Left eye fibrous tissue
24Partner diagnosisBlowout fracture postop, recess
RSR
Mentor advisesForced ductions, likely need to
free RIR
25Subconjunctival hemorrhage Partner and mentor
agree
26Partner and mentor agree Conjunctival laceration
27Mentor Unilateral hypoplasia of the optic nerve
Partner Amblyopia?
28Partner Corneal dermoid
Mentor Agree corneal dermoid
29Partner What is it?
Mentor Epithelial implantation cyst
30Partner What is it?
Mentor Granular dystrophy
31Partner and Mentor agree Traumatic cataract
32Partner Corneal foreign body
Mentor Agree treat rust ring
33Partner Intraocular tumor what is it?
Mentor Retinal angioma
34Partner Retinal angioma
Mentor Agree retinal angioma
35Partner Foveal cyst
MentorIdiopathic retinal epithelial detachment
36Partner Retinoschisis
MentorTraction detachment
37Three unusual and instructive cases
38Mentor I agree LSO palsy could the left SO
tendon be missing?
Partner diagnosisLSO palsy
39Absent muscle
Absent trochlea
Partner What about the tendon?
Mentor The left superior oblique tendon complex
is absent or severely atrophic
40Partner diagnosis Congenital RSO palsy, 3
surgeries, what next?
Mentor suggestionCT for presence of RSO
Trochlea present
Muscle absent
41I see two trochleas
42Partner points out absence of RSO muscle belly
43(No Transcript)
44Partner demonstrates traction test normal OD,
lax OS
Partner finds Absent LSO tendon at exploration
45Two other parts of the
46E-Resource
- Ophthalmology Minute
- Featured Cases
- Question of the week
- Decision Making in Strabismus
- Eye Pathologist (link)
47(No Transcript)
48E- Learning
- BCSC questions
- Student course activity log in
- CME opportunities
49BCSC and CME
50Cyber-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
51The 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.
52Thank you.