Annex H - Telemedicine in the Pacific, Past Present and Futu

8/8/2019 Annex H - Telemedicine in the Pacific, Past Present and Futu

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Telemedicine in the Pacific:

Past, Present and Future

Victoria Garshnek, Ph.D.

Telemedicine Project OfficeUniversity of Hawaii School of Medicine

Honolulu, Hawaii


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Telemedicine in the Pacific-Historical Overview

-Reasons for telemedicine in Pacific

-Experiments/Issues-Today Future


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What is Telehealth?Telehealth: the use of electronic information

and telecommunications technologies to

support long-distance.

- Clinical health care (telemedicine)

- Health-related education and information

- Public health

- Health administration


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Ways to Do Telehealth

-

Telephone- E-mail

- Dedicated Web Page

- Video Conference


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Choice Depends On

Available resources, services, and

technical support

Interest, knowledge and skill of the user

Level of development of the health

system

Type of medical information exchanged


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Pacific Basin

-Why a special area?

-Why develop Telemedicine there?


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Reasons for Pacific Telemedicine

- 5 of the 7 largest armies there

- Large military hospitals

- Isolated communities


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Reasons for Pacific TelemedicineDoD provides secondary/tertiary

care to medically underserved

people of USA

ssociated PacificIslands

- Federated States of Micronesia

- Republic of Palau- Republic of Marshall Islands

- Commonwealth of N. Marianas

- Guam


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Reasons for Pacific Telemedicine

Obstacles/Difficulties

- Pacific very large

- 16 time zones/date line

- 60% Earths natural disasters

- Communication links- Air transportation minimal

- Some locations do not have physician


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Pacific Situation: Medical SupportWhere medical support may be lacking:

The number of physicians and/or specialistsnecessary to serve the population

Professional isolation and lack of continuingeducation for existing health care providers

Inappropriate facilities and technologies toserve their populations.


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Pacific Evacuation

US affiliated islands

Family members might accompany

Very expensive!

To Tertiary hospital (very far away!)

Represents large proportion ofhealth/medical expenditures in Pacific


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Early Pacific Telemedicine Tripler AMC

University of Hawaii

Island Hospitals


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Early Days of Telemedicine: 1993 Experiments to help:

Assess the needs within communities Identify cultural issues with the

introduction of such services

Identify other barriers and problemsthat might affect the usefulness inthe region


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1993: Kwajalein Experiment Atoll in Marshall Islands (DoD

missile testing)

Needed to reduce costs ofevacuations

ITV infrastructure already there

Defense satellite communication

2x/month; fax/e-mail; videoconference

Averted many medical evacuations


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1994: Pacific Basin Medical Officers

Training Program

Pohnpei (FSM)

Used PEACESAT (University of Hawaii)

Picasso image phone


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Picasso Still-Image Video PhonePicasso Still-Image Video Phone

Picasso Still ImageTelephone System

Color Monitor Video Camera

Accessories forDigital Imaging

LaptopComputer

Fax Machine

*This system can deployed and is connected by analogphone lines or via satellite link-up.


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Training Program: Experiements

Weekly Directors rounds/lectures

Teleradiology (consults, pediatric x-rays) Demonstrated that low-cost system can

be a powerful telemedicine tool.


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Issues

Language

Standards/licensing Operational protocols

Financial reimbursements

Culture Ethics/privacy

Sustainability


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Mid-1990s: The Internet

Cost effective

Rapid developmentof applications

A basic foundationfor telemedicineservices


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1997: Pacific Island Health Care Project US associated Pacific islands

Past:

Send specialists Phone consult

Fax

Medical evacuation

Now: WebsiteTelemedicine


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PIHCP Patients seen no-cost or reimbursable

Standardized format

Personal computer

Clinicians view complete request

Web-based, Store-and-forward format

Database/archive/fiscal management Can be used over regular phone lines

Multi-media, multi-point e-mail text & images


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PIHCP


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PIHCP Today

Accepted component of patient

care at Tripler

Has increased access to/quality of

care in remote Pacific islands

Has already logged over 2,000cases


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Telemedicine Research Today Department of Defense

Asthma in-home monitoring

Cardiac follow-up

Cardiac Rhythm Post-discharge Monitoring Community Pediatric Research, Teaching, Service Project

Digital Echocardiography

Electronic Childrens Hospital of the Pacific

Pacific Asynchronous Telehealth

Remote Access to Medical Specialists Critial Care and

Home Care Monitoring Teleradiology

Telepathology

Video otoscopy


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Telemedicine Research TodayVeterans Administration

Teledermatology

Tele-cardiology Tele-homecare

Tele-nutrition

Tele-ophthalmology Tele-pharmacy

Telemedicine Surgery Clinic


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Telemedicine Today Island Clinics/hospitals

Bay Clinic (Big Island, Hawaii) Tele-radiology

Tele-dermatology Tele-dentistry

Castle Medical Center (Oahu,Hawaii)

Videoconference, clinical telehealth

carts Community Clinic (Maui, Hawaii)

Videoconference, clinical telehealthcarts


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Active Telehealth Operations

in the Pacific

American

Samoa

Diego

Garcia

Guam

Yap

Korea

Japan

Marshall

Islands

Hawaii

Chuuk

Pohnpei

Okinawa

Palau

USAKA

Kosrae

Alaska


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Telemedicine TodayUniversity of Hawaii:

-Continuing efforts in distance learningprojects

-Collaborations with other institutions and

Nations (grants)-Focus: National-international concerns in

bioterrorism preparedness training,

infectious disease outbreak surveillance


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Pacific Experience: Lessons Learned Do a needs-assessment first Always look first at the simplest, least

expensive solutions Develop clinical champions Make system convenient for clinicians at both

ends Understand that you may not be able to

address all medical problems Developments in telehealth must be

coordinated and integrated


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Future???? Broadband capability

Inexpensive

Simple/user friendly

Minimal training

Familiar items/dual use

Artificial intelligence

Expert systems

Small and mobile(pocket telemedicine)


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Grazie!Grazie!

Documents

Annex H - Telemedicine in the Pacific, Past Present and Futu