Global Exchange of Medical Knowledge and Information using Virtual

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 Capital: Honiara Population: 450‘000 Islands: ~1000 Independence: 1978 National Referral Hospital Doctors: 15 (30) Radiologists: 1 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 submitted to server in Basel via email Cases are reviewed and 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 resourceconstrained 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 interdisciplinary exchange of knowledge and information. • Interlink regional and international networks for exchange of knowledge • Preventing an e-fragmentation E-Fragmentation Research Publishing Health Information Access Telemedicine E-learning Teleradiology Teledermatology Tele-HIV-care Education Clinical medicine 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