Principles of the Telemedicine by jennyyingdi


                in the Caribbean
             JAMAICA PROJECT
        by: Dr. Winston George Mendes- Davidson CD; JP
            ATALACC: Regional Secretary (Caribbean)
           Head, Jamaica National Telemedicine Project
                    Honorary Research Fellow
(University of the West Indies School for Grad. Studies & Research)
             What is Telemedicine?

• Telemedicine is an Information Technology
     network of medical and allied expertise
  linked together for the purpose of delivering
         medical services at a distance

Functional Definition: by
W. Mendes-Davidson 2004
                  Why telemedicine?
 Advance in the use of communication and information technology in medicine
  have become ubiquitous as technology becomes cheaper, more user friendly
  and creating greater diagnostic accuracy and efficiency in health management

 The problems of multimedia real time transmission are rapidly diminishing

 Better solutions at cheaper costs now becoming available than conventional
  solutions to health care

 World Trade Organization (GATT) begins in force in January 2005 and
  competition in all services will be online in the global domain

 All patients in the world will now belong to any Dr in any part of the world who
  has the capacity to communicate real time on the multimedia cellular
  telephones to the average citizen and to manage health info more efficiently.

 Medical practice in the Caribbean will be marginalized in the medium term as
  competition now involves e-health solutions overseas i.e. international health
  conglomerates, including online pharmacies, therapies, systems and health
                            Mission Statement
Source: Dr. W. Davidson
                          Telemedicine “The Jamaica
     To establish a national health service information technology network,
dedicated to deliver health service made available and affordable to Jamaicans
at home and abroad; later expanding to the wider Caribbean and West African
   To provide an affordable national telemedicine and tele-health information
  technology platform including digital health TV content, for the delivery and
   export of health services from Jamaica reaching clients including tourists
                      where ever they are, at home or abroad.
 To facilitate the development of a Caribbean Health Tourism market as part of
      the process of diversification and expansion of Caribbean Tourism.
    To enable the full participation of health professionals from Jamaica, the
   Caribbean and Africa, in accessing the global IT marketplace, so that these
    professionals may export their services in the global domain to facilitate
                     national and regional health development
Source: Dr. W. Davidson
                               How Telemedicine?
                          “The Mendes-Davidson Model”

• Medicine at a distance, facilitated by provision of a seven
  step integrated voice/video/data health services over a
  secure broadband network
   – Share communications infrastructure between offices
     and any other health facility at home or abroad
   – Access to health services / information management ,
     anytime, anywhere
   – Hi-ethical health standardized business practice,
     process and allied services including health tourism
     within Jamaica and the Caribbean
   – Export health services via health free-zone
       throughout global domain
    “made simple”

 • Is there a place for
Telemedicine in Jamaica
  and the Caribbean?
            How can we tell?
     Let us all do a SWOT analysis
• S=Strengths:
  What advantages do we have? What do you do well? What resources do we
  have? What are our strengths perceived to be? What resources do we have
  access to?

• W=Weakness: What do we do badly? What should we avoid? What
   could we improve?

• O=Opportunity: Where do good opportunities face us? What
   interesting trends are we aware of? Are there opportunities from changes in
   technology trends? or Government policy? Or Social patterns? Or lifestyle

• T=Threats: What obstacles do we face? What is our competition doing?
   Are required specifications for our jobs changing? Is technology threatening
   your position? Is it a matter of financing, or debt? Are we prepared to make
   changes, even fundamental ones?
What are our strengths ?
                            Rising Life Expectancy
                                      Trends in life expectancy, 1950-2000                    Source: WHO
                                      More Developed          Less Developed      World     Jamaica




Age in years.






                     1950   1955   1960    1965        1970       1975     1980      1985     1990    1995   2000
  Country Health Expenditure Per Capita Per Year
 & Male / Female Longevity; W.H.O Estimates-2000
United States   $4187            73.7M/79.7F
Germany         $2713            73.8M/80.1F
Switzerland     $2644            75.6M/83F
Luxemburg       $2580            74.5M/81.4F
Denmark         $2574            72.9M/78.1F
Japan           $2373            77.6M/84.3F
France          $2369            74.9M/83.6F
Jamaica         $149             75.2M/77.4F
With the Best Primary Care System in the Western
      Global Competitiveness Is Sustainable
  Source: W. Davidson. 1999. (copyright)

                              Rising Costs:

State of Health
                            The Clinic        The Hospital
 Maintain                 Prevention            Treatment     Rehab

 Healthy                  Primary                Secondary
 Lifestyle                Health                   Health
                          Care                      Care
 (Wellness)                                                    Care

 PRE-PRIMARY              PRIMARY             SECONDARY      TERTIARY
What are our weaknesses?
Overarching health priorities determined
     by epidemiological evidence
  Human resources
     Adequate numbers, skills mix, quality
     Leadership for Public health

  Health Systems development-reform
     Reform, policies & plans

  Quality of Care
     Standards clinical effectiveness, audit
     Health technology and infrastructure

  Information systems
     MIS, research

  Sustainable financing
                                                Source: Dr. B. Wint: CMO
                                                Nov. 2004
Program priorities in Public health
system to address the weaknesses
 Accidents & violence
 Control of Com. disease
     HIV/AIDS/STI, Tb, Foodborne
 Control of Chronic disease
     CVD, Hypertension, Diabetes, Cancer
   Reproductive health
   Child and adolescent health
   Mental health & substance abuse
   Emergency care
   Environmental health
                                    Source: Dr. B. Wint: CMO
                                    Nov. 2004
Paradigm shift: Bottom line for all
What are Our Opportunities?
The National Telemedicine Project
         • Private / GOJ Part Funded Project
  • Nat. Sc. & Tech. Fund OPM owns 10 % share
         • Investment to Date: > US $10.0 mil
       • Eight Years Research & Development
• Phase 1: R&D phase implemented, with systems
               and protocol verification.
   • Phase 2: Pre-implementation & pilot testing
     presently as precursor to full implementation
                 phase in a few months
    • Technical agreement with ZTE for National
                 Infrastructure upgrade
    Project achievements / benchmarks:
       National Telemedicine Project
   Comprehensive Telemedicine: “The Mendes-Davidson Model”

                     Provider: Bundled user friendly equipment

           Universal Electronic Health (Medical) Record System

                      Human Capacity Development (Training)

                       Research for Sustainable Development

                    Affordable Fault-Tolerant Bandwidth Supply

   Secure Multi-Service IP National Network for Health Providers

                   Equity / Venture Capital / Strategic Partnerships
  Telemedicine “The Mendes-Davidson Model”
Seven Step Integrated Telemedicine Infrastructure

Copyright: Author: Dr. Winston Davidson. Use of
  part or all of this diagram must be with the
           permission of the author.                                                                      7
                                                                                           6          Full
                                                                          5          Home &
                                                                                     Health           Provider
                                                  4                  Consulting      TOURISM,
                                                                                     National /
                                                                     Partner with    Regional
                                          Computer/multi             Health
                                3         -media capture                             Export
                                                                     Cable TV
                 2         Web                                       access

                           Sites                                                     Health
       1         ISP                              Tel-med-serv                       Insurance
    Doctor      DOC                                                                        Tele-health-global
    on Call            Silver

                                    EHR (Electronic Health Record)   Data Infrastructure
       “Doctor On Call” (DOC)
        Telephone Medicine
Immediate 24 hour telephone access of
       patients to Drs. On call.
        Services include:
      Emergency medical advice.
  Emergency medical telephone screening.
     Emergency medical dispatch.
   Non-emergency medical information.
   Non-emergency medical counseling.
  Non-emergency general medical advice.
      Why Does Every-one Need
          “Doctor on Call”?
They need easy access to Medical Service -
 from home, school, workplace, recreational
   area or any other location, at any time.
    Access to a telephone is the only requirement.
 Service satisfies immediate needs of the patient from
                   where ever they are.
    Doctor gives prompt expert medical advice or
   Doctor gives quick dispatch of emergency cases.
  Early intervention leads to prevention of illness and
         death at minimal costs to all concerned.
      Prevention is always better than cure.
                   Cost Analysis
Dr on call will           $2,500
 cost less than a
 half the cost of          $2,000
 consulting a Dr. in                                           DOCD

 his office.               $1,500
       Costs.Ja $                                             MEDI
 Home visit, ($167/
  min) $2,500.00 / 1/4                                         Home visit
 Office visit ($67-$100    $500
  / min) $1000.00-$1500                                        Office visit
  / 1/4 hr.                                            Ja $.
 976-MEDI ($35 /min)
  (info):$525 / 1/4 hr.             Cost/min   Cost/
 976-DOCD ($40/ min                           15min
  (emerg.):$600 / 1/4hr.
($1.00 US = $62.00Ja)
 How Do You Pay for “Dr. On
Pay as part of your normal cellular
           telephone bill
 Pre-paid Dr. on Call calling card
Cellular calls overseas anywhere
Co-branding of Dr. On Call Cards
 Re-imbursement through health
       insurance coverage.
21st Century Health Care.
     Patient Needs          Early medical
  Convenient access        intervention
     Minimal costs    Decrease length of
   Prompt response              illness.
       Immediate           Saves lives
     professional help Decrease worker
  24 hr Dr. coverage        absenteeism
        to all health          Increase
         institutions.         production.
    Drs. advice and        Decrease total
  opinions available.        health costs
          Anytime        To the patient,
        Anywhere          The provider,
      To everyone        The insurance
  At affordable cost.         company
   Without condition      The country.
     National (Intranet) Network
    Consultations ( Tel-med-serve)

1. Data, Voice & Video, Integration over a secure
   national telemedicine broadband IP network
2. Consultations / referrals between and among health
   and allied institutions and personnel in the public &
   private health sectors.
3. Capture & storage of data voice and video
   conferencing clips
4. Online video conferencing, peer to peer & multicast
5. MOH Telephone and IP-Telephony Service
6. Ethical Web based health records / information
   management system
   Massachusetts Tech. Collaborative;
       (October 16th 2003 Report)
• Report Highlights Application of 7 EMR
  health care technologies:
• Improved quality
• Decrease overall claims costs
• Reduce errors
• improve patient satisfaction and overall care
• Expanding coverage
• Potentially saved $2.48 billion us
Electronic Medical Records From
 Client Based Systems Rejected
                                Cost for 1 physician 3
                                       office staff
     Amazing Charts                     $250-500

       MDinteractive                      $600

        SOAP ware                      $300-$1,200

  Kairosmd (Caribbean)                   $2000

Clinical Practice Facilitator             $695
             Web Based EHR for All Drs, Health
           Institutions / Health & Allied Personnel
                  Developed For Global use
                                                     Version 1
1.    Office Schedule Module
2.    Hospital / Institutional module
3.    Institutional/Field database integration
4.    Interface c 3rd party Scheduling
5.    Billing Module
      Interface c 3rd party Billing
      Lab / HL7 interface
                                                                     NEW UNIMEDICS
8.    Soap notes                                                     EHR: At What Cost ? LOW
9.    Medical/Surgical procedures
10.   Online consultations
11.   Prescriptions
12.   Drug interactions
13.   Connect Multiple Locations
14.   Wireless access to the service
15.   Voice recognition
16.   PDA compatible
17.   Cell phone compatible
18.   Capture and Store images (Using Lead Tool Components)
19.   Multimedia patient file storage (Using Lead Tool Components)
20.   Digital imaging (Using Lead Tool Components)
21.   Reminders
22.   Bilingual / Multilingual
23.   Unlimited # of Active Users
24.   Web Site interface
25.   E-mail contact
Unimedics EHR Software
   Unimedics: Learning Management

                           Telemedicine Management software

Web content management                            Learning Management

  Silver, Gold, Platinum           Online Modular Courses       Peer to Peer / Multicast
Caribbean Health TV Channel
  OFF-SHORING (Export Niche)
• The export of Health Services to Third
• Off-shoring market already developed
  between USA India & Thailand
• Pilot Projects presently testing protocols
• Pilot Projects to develop health export
  business models being tested
• Pilot Projects to establish Centers Of
  Excellence (COE) in Jamaica & the
                                     Full Telemedicine Coverage

 Healthy-----------At Risk- Early Sickness-- Late Sickness---------Recovery

Wellness                     At Risk– Early Sickness            Late Illness          Recovery
                                                                                   / Convalescence

                                                                                       Recovery /
    Wellness                           Medical (Off-shoring)                            Geriatric
  Health Tourism                         Health Tourism                              Convalescence
                                                                                     Health Tourism
Spas / Wellness Centres                       Diagnostic/ Ambulatory /Off-      Recovery / Convalescence Centres
  Ecotourism Centres /                        shoring/ Medical & Hospital       Lifestyle change Alternative Health/
Alternative Health / Ethno                             Services                Ethno medicines / Specialized Elderly
  medicines/ Integrated
                                                 Medical Health Tourism           Institutions Off-shoring & Hotel
      Hotel Services
 Wellness Health Tourism
                                      Copyright: Dr. Winston Mendes Davidson       Convalescent Health Tourism
Caribbean Health Tourism / Telemedicine Infrastructure
             For Sustainable Services

          • Cost competitive advantage (much lower costs) with
very little structural change for Health & Tourism integration to achieve

            • Internationally recognized Health Institutions

• Excellent Professional training (repute) of Drs. & Nurses in Caribbean

           • Low cost geriatric health tourism opportunities

• “The Mendes-Davidson Model” Integrates diverse tech. platforms to
       derive Health info-management and economic synergies

                  • Available broadband IT platform
                        Caribbean Health Tourism
“The Hotel is a Hospital (therapeutic centre) for well people, while the Hospital (therapeutic centre) is a
Hotel for ill people” (W. Mendes-Davidson, 1997).

• Caribbean Therapy Hotels Must Be Professionally
• Develop the highest therapeutic Standards
• Should begin as classy cottage type low
  maintenance facilities
• High level trained health service teams
• Telemedicine Services for prompt intervention
• Home type sun & sea type care facility with
       Is Training Available?
      Human Capacity development (Training)

The telemedicine certificate training
      Training for export of Services
                              Core Concept
The fusion of health, education and tourism and the preparation of human capital
                                 for its implementation
                           Target Population
                          1. Doctors / Dental Surgeons

                                    2. Nurses

                                 3. Pharmacists

                             4. Allied Health Workers

   5. Educators; Human Resource Capacity Development (HRCD) Personnel

                       6. Tourism / Hotel / HRD Personnel

   7. General population (Wellness / Life style / Alternative Health Therapists)
                                      UWI School of Graduate Studies
             Developed by the      In Association with Infoserv Institute   Training program for Drs.
          Telemedicine Research               of Technology                 Nurses, Pharmacists, &
                   Unit                                                     Allied Health Workers
Module       Resource Name                     Presentation                        Material Label
         Telemedicine Caribbean                                             Telemedicine/Telehealth
  1       Model (IP Telephony)                 Powerpt./CD                  Technology (Intro.)
                                                                            Telemedicine Caribbean
  2                                            Powerpt./CD                  Model (Perspectives)
                                                                            Concept, vision and
  3                                            Powerpt./CD                  mission
                                                                            Scope of Telemedicine
  4                                            Powerpt./CD                  Today/ Medico-Legal issues
                                                                            Telemed IP Telephony
  5      Dr. On Call                           Powerpt/CD                   (Fundamentals)
         Medical Emergency
         Telephony Cert.                                                    Medical Emergency
  6      (Optional)                         Didac./ CD/ Demo                Telephony (Optional)
                                                                            Non- Emergency Medical
  7                                          Demo/Interactive               Telephony
                                                                            Practice / Application
  8                                          Hands / On/Self                (Telephony Skills)
                                                                            Basic Info/Com/Tech (ICT)
  9                                            Powerpt / CD                 Skills
          Telemedicine Practice                                             UWI School of Graduate
           Certification (Basic)                                            Studies / Infoserv
                                    Powerpt / CD/ Internet Skills / Fundamentals
10   Tel-Med-Serv                      Self       (CIW International)

                                    Powerpt / CD/ Basic (Network)
11                                     Self       Info/Com/Tech Skills

                                    Powerpt / CD/
12                                     Self       Website Management Skills

                                    Demo/CD/Sel    Electr. Record System/
13                                   f/powerpt     Practice Management

     Multimedia Interactive         Demo/Interac   Multimedia Capture, Store,
14   Telemed Serv. Cert. (MITS)        tive        Forward (Online)

     (MITS) Optional Trainer of     Demo/Interac   Digital/Video/Product/Media
15   Trainers Cert.                    tive        Clips. (Online Consult)

      Telemedicine Practice Cert.                  UWI School of Graduate
            (Intermediate)                         Studies / Infoserv
      Tel-Med-Telehealth-          Powerpt / CD/    Intermediate (Network)
16          Global                    Self          Info/Com/Tech Skills

                                   Powerpt/CD/De    Teleconferencing/
17                                 mos/Self         Streaming/Cable Health TV

                                   Demo/Interacti   Personal Area Networks /
18                                      ve          Personal Digital Assistants

                                   Demo/Interacti   Remote Sites /Home / Health
19                                      ve          Tourism/ Export Services

                                     Didac./ CD/    ICT Budgeting & Cost Control/
20                                     Demo         ROI

                                     Didac./ CD/    Electronic Research and
21                                     Demo         Development methods

                                   Interactive/ CD/ Interpersonal Relations /
22                                      Demo        Marketing

     Telemedicine Practice Cert.                    UWI School of Graduate Studies /
            (Advanced)                              Infoserv
Telemedicine Wide Area Network
Telemedicine Wide Area Network
                                                                   Network Operating Centre                                                                                                                                                                                                                                                                        Network attached Storage
      Local                                                                 (NOC)                                                                                                                                                                                                                                                                                             (NAS)
       Area                                                                                                                                                                                                                                                                                                                                                        Fault tolerant NOC mirror
     Network                                         T1                                                                                                                                                                                                                                                                                                             (FTNOCM); (back-end).
      (LAN)                                     Telephony                                                                                                       ISP/ Web hosting
                                                    VOIP                                                                                                          Site Settings                                   Firewall
              Network Administrator etc.           server

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      National Telemedicine / Telehealth Network System
                                                                                                                              1        2        3
                                                                                                                              4        5        6
                                                                                                                              7        8        9
                                                                                                                              *        8        #

                                                                                                                                                                         domainDNS                                                                                                                           Cajun P112T   SD

                                                                                                                                                                                                                                 1   2   3     4     9   10   11   12   17   18     19   20

                                                                                                                                                                                                                                 5   6   7  8        13 14   15 16      21   22     23   24
                                                                                                                                                                                                                                PWR NMA RED        LNK COL TX RX RDX

                                                                                                                         Application server

                                                                                                                                                                                                                                                                                  Lucent Technologies

                                                                                                                                                                                                                                                                                                  Router                        PWR    WIC0

                                                                                                                                                                                                                                                                                                                                                                       Storage         Generic
                 Admin computer
                                                                                                                                                                                                                                                                                                                                OK    ACT/CH1   ACT/CH1   COL

                                                                                    7x   8x   9x       10x   11x   12x   7x       8x       9x       10x   11x   12x

                                                                                                                                                                                                                                                                                                                                                                                     file server


                                                                       7 8 910 12

                                                                       12 34 56     1x   2x   3x
                                                                                                       4x    5x    6x    1x       2x       3x
                                                                                                                                                    4x    5x    6x                                                                                                                                                                                        VPN
                                                                                                                                                                             POWERFAULT DATA ALARM

                                           Health TV
                                           Chan. Op.                                                         TALK / DATA
                                                                                                                     TALK                  RS CS TR RD TD CD
                                            Centre                                                                                                                                                                        PSTN
                                                                                                        Cable Modem
                                                                                                                                                                                                                                                                                                                  Band width; from V-sat,
Telemed computer, Techno-
     medical Admin.                                                                                                                                                                                                                                                                                       via wireless; Cable, Via Cable modems
                               Dir. Program/ Edit/ Schedule                                                                                                                                                                                                                                                                                                                                                                                                                  WIC0      WIC0     ETH
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      PWR   ACT/CH0   ACT/CH0   ACT

                                                                                                                                                                                                                                                                                                                                                                                                                                                                      OK    ACT/CH1   ACT/CH1   COL
                                                                                                                                                                                                PWR    WIC0      WIC0     ETH
                                                                                                                                                                                                      ACT/CH0   ACT/CH0   ACT

                                                                                                                                                                                                OK    ACT/CH1   ACT/CH1   COL

                                                                                                                                                                                         Wide                                                                                                                                                                                            Towers                                                                      VPNs
                                  Multi-media /program /edit/
                                           device                                                                                                                                      Network
                                                                                                                                                                                                                                                                                                                                                                                                   Rest of Country

          City &Town                                                                          Switch                                                                                                                                                                                                                                                                                   Wireless       HS1 HS2 OK1 OK2 PS
                                                                                                                                                                                                                                                                                                                                                                                                                               1 2 3 4 5 6 7 8 910 12
                                                                                                                                                                                                                                                                                                                                                                                                                                                  11    CONSOLE

                            Cable Modem                   Telemedicine / Telehealth units for Drs. Office; Clinic; Hospital;
                               / DSL                   Pharmacy; Schools; Factories ; Enterprises; Homes; Hotels; Prisons ;
                                                       Sports Medicine; Homes for Elderly; UWI; UTECH; Training Instits.; All
                                                                               online in real time.

                                                                                                                                                                                                                                                                                                                                                                Hotel / School Health Cable TV
                                                                                                                                                                                                                                                                                                                                                                         Telehealth Unit

           Telemedicine Unit
                                                                                                                                                                          Multimedia Streaming and capture
                                                Home Health Cable TV                                                                                                        diagnostic devices located at
                                                  Telehealth Unit                                                                                                                                                                                                                                                                                                                                     Telemedicine Unit
                                                                                                                                                                            patient terminals on LAN and

                                                Internet / Web, E-Health, Telemedicine Services for export to Overseas
                                                       Jamaicans, Tourists, the Caribbean Community & Ghana.

                                                       System designed by: Dr. Winston Mendes-Davidson.
                                                       This diagram is copyright protected; Use may only be
                                                              made with the permission of the author.
                                                                        20th February 2002.
    What Are Our threats?
• The Lack Of:
       Professional Will
       Entrepreneurial Will
 Appropriate Business Models
          Political Will
Willingness to share techs with
         Atalacc partners

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