Telemedicine in the Caribbean

Telemedicine in the Caribbean The JAMAICA PROJECT by: Dr. Winston George Mendes- Davidson CD; JP ATALACC: Regional Secretary (Caribbean) Head, Jamaica National Telemedicine Project & Honorary Research Fellow Telemedicine (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 institutions. Mission Statement Source: Dr. W. Davidson (copyright) Telemedicine “The Jamaica Project” • 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 territories. • 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 (copyright) 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 Telemedicine “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 changes? • 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 More Developed 90 80 70 60 Less Developed World Source: WHO Jamaica Age in years. 50 40 30 20 10 0 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 Switzerland Luxemburg Denmark Japan France Jamaica $2713 $2644 $2580 $2574 $2373 $2369 $149 73.8M/80.1F 75.6M/83F 74.5M/81.4F 72.9M/78.1F 77.6M/84.3F 74.9M/83.6F 75.2M/77.4F With the Best Primary Care System in the Western Hemisphere Global Competitiveness Is Sustainable Source: W. Davidson. 1999. (copyright) Rising Costs: COMMUNITY COMMUNITY State of Health The Clinic Prevention Primary Health Care The Hospital Treatment Secondary Health Care Rehab Tertiary Health Care Maintain Healthy Lifestyle (Wellness) PRE-PRIMARY PREVENTION PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION 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 Drs. What are Our Opportunities? The National Telemedicine Project • Private / GOJ Part Funded Project • Nat. Sc. & Tech. Fund OPM owns 10 % share capital • 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 5 Home & Health TOURISM, 4 3 2 1 Doctor on Call ISP DOC Silver Gold Network Consulting Partner with Health Cable TV access Full Telemedicine Service Provider Computer/multi -media capture National / Regional Export Services. Health Insurance Tele-health-global Platinum Web Sites Tel-med-serv 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 counseling.  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 cost less than a half the cost of consulting a Dr. in his office.  Costs.Ja $  Home visit, ($167/ min) $2,500.00 / 1/4 hr.  Office visit ($67-$100 / min) $1000.00-$1500 / 1/4 hr.  976-MEDI ($35 /min) (info):$525 / 1/4 hr.  976-DOCD ($40/ min (emerg.):$600 / 1/4hr. ($1.00 US = $62.00Ja) $2,500 $2,000 DOCD $1,500 MEDI $1,000 Home visit $500 Office visit $0 Cost/min Cost/ 15min Ja $. How Do You Pay for “Dr. On Call”? Pay as part of your normal cellular telephone bill Pre-paid Dr. on Call calling card Cellular calls overseas anywhere anytime Co-branding of Dr. On Call Cards Re-imbursement through health insurance coverage. 21st Century Health Care. Patient Needs Early medical intervention Convenient access Decrease length of Minimal costs illness. Prompt response Saves lives Immediate professional help Decrease worker absenteeism 24 hr Dr. coverage Increase to all health production. institutions. Drs. advice and Decrease total opinions available. health costs To the patient, Anytime The provider, Anywhere The insurance To everyone company At affordable cost. The country. Without condition National (Intranet) Network Consultations ( Tel-med-serve) 1. Data, Voice & Video, Integration over a secure national telemedicine broadband IP network backbone 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 Product Amazing Charts Cost for 1 physician 3 office staff $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. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Office Schedule Module Hospital / Institutional module Institutional/Field database integration Interface c 3rd party Scheduling Billing Module Interface c 3rd party Billing Lab / HL7 interface Soap notes Medical/Surgical procedures Online consultations Prescriptions Drug interactions Connect Multiple Locations Wireless access to the service Voice recognition PDA compatible Cell phone compatible Capture and Store images (Using Lead Tool Components) Multimedia patient file storage (Using Lead Tool Components) Digital imaging (Using Lead Tool Components) Reminders Bilingual / Multilingual Unlimited # of Active Users Web Site interface E-mail contact NEW UNIMEDICS EHR: At What Cost ? LOW Unimedics EHR Software Unimedics: Learning Management Software Telemedicine Management software Web content management Silver, Gold, Platinum Learning Management Online Modular Courses Peer to Peer / Multicast Caribbean Health TV Channel OFF-SHORING (Export Niche) • The export of Health Services to Third Countries • 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 Caribbean Full Telemedicine Coverage Healthy-----------At Risk- Early Sickness-- Late Sickness---------Recovery Wellness At Risk– Early Sickness Late Illness Recovery / Convalescence Wellness Health Tourism Spas / Wellness Centres Ecotourism Centres / Alternative Health / Ethno medicines/ Integrated Hotel Services Wellness Health Tourism Medical (Off-shoring) Health Tourism Diagnostic/ Ambulatory /Offshoring/ Medical & Hospital Services Medical Health Tourism Copyright: Dr. Winston Mendes Davidson 2004-09-29 Recovery / Geriatric Convalescence Health Tourism Recovery / Convalescence Centres Lifestyle change Alternative Health/ Ethno medicines / Specialized Elderly Institutions Off-shoring & Hotel Services 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 sustainability • 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 Branded • 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 entertainment Is Training Available? Human Capacity development (Training) The telemedicine certificate training project 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) Developed by the Telemedicine Research Unit Module 1 2 3 4 5 Dr. On Call Medical Emergency Telephony Cert. (Optional) Resource Name Telemedicine Caribbean Model (IP Telephony) UWI School of Graduate Studies In Association with Infoserv Institute of Technology Presentation Powerpt./CD Powerpt./CD Powerpt./CD Powerpt./CD Powerpt/CD Training program for Drs. Nurses, Pharmacists, & Allied Health Workers Material Label Telemedicine/Telehealth Technology (Intro.) Telemedicine Caribbean Model (Perspectives) Concept, vision and mission Scope of Telemedicine Today/ Medico-Legal issues Telemed IP Telephony (Fundamentals) Medical Emergency Telephony (Optional) Non- Emergency Medical Telephony Practice / Application (Telephony Skills) Basic Info/Com/Tech (ICT) Skills UWI School of Graduate Studies / Infoserv 6 7 8 9 Didac./ CD/ Demo Demo/Interactive Hands / On/Self Powerpt / CD Telemedicine Practice Certification (Basic) 10 Tel-Med-Serv Powerpt / CD/ Internet Skills / Fundamentals Self (CIW International) Powerpt / CD/ Basic (Network) Self Info/Com/Tech Skills Powerpt / CD/ Self Website Management Skills Demo/CD/Sel f/powerpt Electr. Record System/ Practice Management Multimedia Capture, Store, Forward (Online) Digital/Video/Product/Media Clips. (Online Consult) 11 12 13 Multimedia Interactive Telemed Serv. Cert. (MITS) (MITS) Optional Trainer of Trainers Cert. 14 Demo/Interac tive Demo/Interac tive 15 Telemedicine Practice Cert. (Intermediate) UWI School of Graduate Studies / Infoserv 16 Tel-Med-TelehealthGlobal Powerpt / CD/ Self Powerpt/CD/De mos/Self Demo/Interacti ve Intermediate (Network) Info/Com/Tech Skills Teleconferencing/ Streaming/Cable Health TV Personal Area Networks / Personal Digital Assistants 17 18 19 Demo/Interacti ve Didac./ CD/ Demo Didac./ CD/ Demo Remote Sites /Home / Health Tourism/ Export Services ICT Budgeting & Cost Control/ ROI Electronic Research and Development methods 20 21 22 Telemedicine Practice Cert. (Advanced) Interactive/ CD/ Interpersonal Relations / Demo Marketing UWI School of Graduate Studies / Infoserv Telemedicine Wide Area Network Telemedicine Wide Area Network Local Area Network (LAN) Systems Engineer Network Operating Centre (NOC) T1 Telephony VOIP server (Front-end) 1 4 7 * 2 5 8 8 3 6 9 # Network attached Storage (NAS) Fault tolerant NOC mirror (FTNOCM); (back-end). ISP/ Web hosting Site Settings Network Administrator etc. Firewall Firewall siteLink National Telemedicine / Telehealth Network System domainDNS Cajun P112T 1 2 3 4 9 10 11 12 17 18 19 20 SD Application server Admin computer Ethernet C 7 8 910 12 11 A 12 34 56 1x 2x 3x 4x 5x 6x 1x 2x 3x 4x 5x 6x POWERFAULT DATA ALARM 5 6 7 8 PWR NMA RED NMA 13 14 15 16 LNK COL TX RX RDX 21 22 23 24 Lucent Technologies Router RAS PWR OK WIC0 ACT/CH0 ACT/CH1 WIC0 ACT/CH0 ACT/CH1 ETH ACT COL Storage 7x 8x 9x 10x 11x 12x 7x 8x 9x 10x 11x 12x A B VPN Generic file server Hub Health TV Chan. Op. Centre Telemed computer, Technomedical Admin. Dir. Program/ Edit/ Schedule siteLink3 TALK / DATA TALK RS CS TR RD TD CD subnet PSTN Cable Modem Band width; from V-sat, via wireless; Cable, Via Cable modems PWR OK PWR OK WIC0 ACT/CH0 ACT/CH1 WIC0 ACT/CH0 ACT/CH1 ETH ACT COL WIC0 ACT/CH0 ACT/CH1 WIC0 ACT/CH0 ACT/CH1 ETH ACT COL VPN Wide Area Network (WAN) Switch Towers International collocation VPNs Multi-media /program /edit/ device Rest of Country City &Town Cable Modem / DSL Wireless HS1 HS2 OK1 OK2 PS 1 2 3 4 5 6 7 8 910 12 11 COLACTSTA- CONSOLE Switch Telemedicine / Telehealth units for Drs. Office; Clinic; Hospital; 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 Home Health Cable TV Telehealth Unit Multimedia Streaming and capture diagnostic devices located at patient terminals on LAN and WAN Telemedicine Unit 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