iPath by fjhuangjun

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									 Global Exchange of Medical
 Knowledge and Information
 using Virtual Communities

 some experiences from the iPath project



Kurt Brauchli* and Martin Oberholzer
       Department of Pathology Basel

          * kurt.brauchli@unibas.ch
Problems in developing countries

• Limited resources
• Shortage of trained and informed staff
• Access to knowledge and information
   no career opportunities
   “brain drain”
• Limited communication and transportation


Question: can ICTs help?
Solomon Islands
                 Solomon Islands




Solomon Islands             National Referral Hospital
Capital: Honiara
Population: 450‘000             Doctors: 15 (30)
Islands: ~1000                  Radiologists: 1
Independence: 1978              Pathologists: 0
                                Dermatologists: 0
Transportation on Solomons




Telepathology service since 2001
         Step 2: Remote consultation




Selected images captured with digital
camera (Nikon CoolPix 990) and sub-     Cases are reviewed and
mitted to server in Basel via email     discussed by a group of
                                        pathologists




Report sent
automatically by
email.
          Worldwide applications




Users:   1500+
Cases:   9000+
Images: 60000+

      Users      Productive servers   In testing   planned
                          Conclusion 1

• Diagnostic support for health providers in low
  resource areas over internet- or email-based
  telemedicine is a reality.
• Telepathology Diagnosis are timely and
  accurate. 90-97% concordance with respect
  to clinical relevancy1.
• But .....
  .... (How) can telemedicine contribute to
  strengthening health systems ?

1data   from two review studies. In process of publication
              Proposition



• Distance collaboration in “virtual
  communities” is a viable way of utilising
  ICTs for strengthening health systems
   Strengthening Health Systems

• The major capital of a health system are the
  people working in health care services.
• Health providers capable and motivated to
  make informed decisions
  – Access to training
  – Access to relevant and up-to-date information

• Access alone is not enough!
  – Guidance how to put information and knowledge
    into practice
                         Example Tsilitwa1




1community   development project of SA Council for Scientific and Industrial Research: www.csir.co.za
                 Example Tsilitwa


Dermatologist:
“Systemic Lupus Erythematosus”

Nurse:
“... I have these books, but I don’t know where
to start reading and I don’t have time to read a
whole book. Now I know where to start ...“
        Role of Telemedicine


• Sustainable transfer of knowledge
• Improving referral systems
  – Transport knowledge to the primary care
    and not only the patients to the centres of
    knowledge.
• Quality control and immediate feedback
• Foster communication within the health
  system
  Strengthening Health Systems


• Overcoming professional isolation
• Improve working conditions in resource-
  constrained areas
• Decrease loss of career opportunities
  due to rural posting
• Motivation through mutual exchange
• Reduce brain drain
       The telemedicine platform




      Group or
“virtual community”
      The “virtual community”


• Closed user group

• Presentation and
  sharing of material

 Any object: images,
 documents, forms
      The “virtual community”


• Comments by all
  members

• Optional:
  – Automatic alerts
  – Publish objects
  – Live meetings /
    presentations
       The “virtual community”

Important aspects:

• Role of users defined within group
• Transparent and accountable (social control)
• The community turns the consultation of one
  into a learning experience for many
• Networking people
• Archive of material for later review and
  reference
  Towards transfer of knowledge

• Improving educational value of consultations

• Inclusion of literature references and articles
  in consultations

• Creating common taxonomies to label
  consultations as well as educational material

• Including the regional specialists can help to
  improve local relevancy of information
       The key is not technology

• The key to successful implementation is not
  technology, but ...

• Organisation of work-flow and communication
   – Critical mass of activity
   – Many communities on a common platform allow for
     added value and cross benefits
   – Flow of information in all directions. Not only
     North-South!

• Inclusion of all stakeholders
• Decentralised regional networks
       Where to go from here?

• Integration of telemedicine, knowledge
  management and e-learning into a broader
  framework of multi-lateral and inter-
  disciplinary exchange of knowledge and
  information.

• Interlink regional and international networks
  for exchange of knowledge

• Preventing an e-fragmentation
                              E-Fragmentation




                                                          Publishing
                                         Education
                   medicine




                                                          Research
                   Clinical




                Telemedicine          E-learning     Health Information
                                                          Access


Teleradiology

    Teledermatology

                      Tele-HIV-care
               knowledge and information
                     management




telemedicine                               e-learing
            But remember ...

Applications ...
     Select applications pragmatically and
     evaluate in clinical context

Organisation ...
     Bottom-up, driven from the clinical needs

Technology ...
     As user-friendly as possible

 users must own “their” system!
                     The end



                   Thank you!


Links:
   – Platform: http://telemed.ipath.ch
   – Project page: http://www.ipath.ch
        About the iPath Project

The iPath project is a “Swiss Verein” associated
with the University of Basel. The main aims are:

• Software development and research:
  – iPath telemedicine platform, “Open-source
    telemedicine toolbox”

• Support for developing countries:
  – Organisation of pathology consultations
  – Provision of an internet-based collaboration platform
  – Consultation for technical infrastructure

								
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