Telemedicine technology positioning

© 2006 Cisco Systems, Inc. All rights reserved. Cisco ConfidentialPresentation_ID 1

Tendencias y enfoques en Telemedicina

Healthcare Day - Caracas, February 19, 2009

Stefano SOLIANIHealthcare Solution Architect


Agenda

Telemedicine: definition and scope

Feasibility and technology mapping

Reality & Case studies


Telemedicine definition

Telemedicine is the provision of healthcare services, through use of ICT, in situations where the health professional and the patient (or two health professionals) are not in the same location. It involves secure transmission of medical data and information, through text, sound, images or other forms needed for the prevention, diagnosis, treatment and follow-up of patients.


Telehealth is …

Often used to encompass a broader definition of remote healthcare that does not always involve clinical services. It can involve support groups, health education or prevention activities.

Some of the means to get this done include:

The Internet or e-Health, including patient portals, remote monitoring of vital signs, continuing medical education, patient education, Internet support groups and nursing call centers.


Telemedicine Taxonomy

http://www.citl.org/_pdf/CITL_Telehealth_Report.pdf

Encounter taxonomy (time frame)Encounter taxonomy (time frame)

Specialty based:Tele-radiologyTele-PathologyTele-PsychiatryTele-CardiologyTele-OphthalmologyTele-DermatologyTele-Surgery

Specialty based:Tele-radiologyTele-PathologyTele-PsychiatryTele-CardiologyTele-OphthalmologyTele-DermatologyTele-Surgery

Setting

Intervention type

Emergent setting

Non-Emergent setting

Tele-Consultation

Real-timeCollaborative

Store & forwardReal-timeCollaborative

Tele-Diagnosis



Tele-Treatment



Tele-Monitoring


Store & forwardReal-timeCollaborativeTechnology taxonomyTechnology taxonomy


Hype Cycle for Telemedicine


Priority Matrix for Telemedicine


What Telemedicine solution ?

Sim

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xit

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Low Bandwidth requirements High

VSATDial-up 2.5G

GPRS/EDGE

3G

UMTS/HSPA

LTE

E-UTRA

DSLWiMAXE1 T3 Fiber

14.4K 128K 1M 2M 10M 100M512K

TelesurgeryTelesurgery

Clinical Kiosk

Clinical Kiosk

TelepathologyTelepathology

Mobile/Home Health

monitoring

Mobile/Home Health

monitoring

Teleretinal imaging

Teleretinal imaging

Teledermatology (store&fwd)

Teledermatology (store&fwd)

Teledermatology [video]

Teledermatology [video]

Remote ICURemote ICU

ECG monitoring

ECG monitoring

Video visitVideo visit

E-visitE-visit

Teleradiology [Outsourcing]Teleradiology [Outsourcing]

Call Center

Call Center

Satellite potential span


Pros and cons of VSAT networksAdvantages Availability: VSAT services can be deployed anywhere having a clear view of the Clarke Belt Diversity: VSAT provides a wireless link completely independent of the local terrestrial/wireline infrastructure - especially important for backup or disaster

recovery services Deployability: VSAT services can be deployed in hours or even minutes (with auto-acquisition antennas) Homogeneity: VSAT enables customers to get the same speeds and service level agreements at all locations across their entire network regardless of

location Acceleration: Most modern VSAT systems use onboard acceleration of protocols such as TCP and HTTP; this delivers high-quality Internet performance

regardless of latency (see below) Multicast: Most current VSAT systems use a broadcast download scheme which enables them to deliver the same content to tens or thousands of

locations simultaneously at no additional cost Security: Corporate-grade VSAT networks are private layer-2 networks over the air

Disadvantages Latency: Since they relay signals off a satellite in geosynchronous orbit 22,300 miles above the Earth, VSAT links are subject to a minimum latency of

approximately 500 milliseconds round-trip. This makes them a poor choice for "chatty" protocols or latency-sensitive applications (ex: VoIP) Encryption: The acceleration schemes used by most VSAT systems rely upon the ability to see a packet's source/destination and contents; packets

encrypted via VPN defeat this acceleration and perform slower than other network traffic Environmental concerns: VSATs are subject to signal attenuation due to weather; the effect is typically far less than that experienced by one-way TV

systems that use smaller dishes, but is still a function of antenna size and transmitter power and frequency band Installation: VSAT services require an outdoor antenna installation with a clear view of the sky (southern sky if the location is in the northern hemisphere

or northern sky if the location is in the southern hemisphere); this makes installation in skyscraper urban environments or locations where a customer does not have "roof rights" problematic


TeleHealth Applications and devices

Applications Medical, surgical, diagnostic Emergency care Disaster management Homecare Rehabilitation Tele-Education EMR E-prescribing Health 2.0 social media function

Devices Digital ECG Electronic Stethoscope [High Resolution] Camera Retina Scanner Tele-pathology Microscope X-Ray Digitizer Fetal Heart Rate Monitor Pulmonary Function Test Machine Glucose meter Blood pressure cuff Pulse oximeter Cholesterol meter

Weight scales


Infrastructure value in Telemedicine

• Endpoints and medical devices play an important role in Telemedicine solution, as they are the ones sending the requested information (data, voice, video).

• But most of the value is provided by intelligent call control to video collaboration. Voice and video endpoints, presence, contact center must be integrated and supported by call control (using SIP). The integration of video endpoints, directory services and presence, plus required QoS and Security provides telemedicine solutions that effect business process and could not have been offered just few years ago, without the progress made towards this integration.

Directory svcs

Presence svcs

Call control svcs

Cable DSL FTTx

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U N I V E R S I T YU N I V E R S I T Y

Cable DSL FTTxCable DSL FTTx

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U N I V E R S I T YU N I V E R S I T YU N I V E R S I T YU N I V E R S I T Y

QoS - Security


Case studies


Seattle Children Hospital TM program

Video


Alaska ATS-6 Telemedicine (1974)

Issue The geographic setting and climate of Alaska are significant barriers to

health care

Solution Use satellite communication to implement a telemedicine solution to

test and demonstrate the ability of indigenous community health aides

Results The capabilities provided by broadband satellite communications can

be effectively used in treatment and care of medical patients in remote and isolated regions such as Alaska.

Paraprofessional personnel such as Community Health Aides, having limited medical and technical training, are capable of successfully presenting patients for medical consultation.

Realistically, telemedicine increases cost and, if done well, improves health impact. Therefore, evaluation becomes the problem of weighing cost (measurable, computable) against improvement in health impact (not easily quantifiable).


Alaska Federal Health - Care Access Network

Began 1998

Statewide satellite-based IP network reaching to nearly 200 sites

42 connected servers throughout Alaska

Store and forward technology

Tech support and training

“AFHCAN Carts” at remote sites

http://www.afhcan.org/


New Usage Model for Telemedicine- Mexico

Remote Health Consultation

Bridge the Healthcare Divide

Access for all @ Healthcare (Telemedicine)

Tele-Pharmacy

Doctor & Nurse Training

Continuous education

Enhance quality of Healthcare Professional

Community Healthcare Survey

Proactive & preventive Healthcare Services

Rural reach


Denmark - MedCom

MedCom is a non-profit co-operation between authorities, healthcare professionals and IT vendors, working to create a market for electronic communication in the Danish Health Care sector.

In a three year project, an number of telemedicine development and implementations projects have been carried out within:

– Cardiology (included in a Intentional project Health Optimum)

– Diabetes: both home-monitoring and treatment over video conference

– Alcohol treatment over video conference

– Physiotherapy

– Tele radiology

– Preparation of surgery over video conference

– Home-hospital for children

– Home-hospital for COPD patients


Current Status of Telehealth in India

The Ministry of Health & Family Welfare and the Ministry of Communication and Information Technology are jointly creating a national health information infrastructure, for easy capture and dissemination of health information

Steps are also being taken to educate various stakeholders of the healthcare industry about the need for complying with health information standards

Telemedicine is trying to bridge the urban rural divide by taking healthcare to interiors of India. There are more than 150 telemedicine initiatives today, most of them supported by Indian Space Research Organization [ISRO] and IT Ministry

Efforts are being directed towards setting up of standards and IT enabled healthcare infrastructure in the country


University of Miami - Center on Aging

Business Challenge: Help family members serve as an

extension of the medical system

Network Solution: Provided video-based counseling and

skills training, support groups, and educational seminars on Cisco Unified IP Phone 7985G

Created text-based tips and resource lists displayed on IP phone screen

Business Results: Enabled caregivers to access formal and

informal support and resources without leaving family member

Provided cost-effective training and information

Helped reduce self-reports of isolation, loneliness, burden, and distress


Ontario Telemedicine Network Government-funded Healthcare Delivery 110 employees, 1500 Participating Health Care

Professionals

BUSINESS CHALLENGE Support delivery of complex medical care that is

exacerbated by sparsely populated large area lacking access to modern facilities/specialists

Facilitate cost-effective, time-sensitive delivery of expert healthcare to citizens in remote locations

SOLUTION Employ Cisco’s MPLS Network, Unified

Communications, Collaborative Care, and Unified Contact Center Express to bring remote specialist care without travel

Reliable high-bandwidth videoconferencing stations transfer audio, video, and data to allow for remote evaluations and diagnoses

Backbone is Cisco Medical-Grade Network

BUSINESS RESULTS Provincial medical-related travel costs reduced

Canadian $8 million annually Network hosts more than 32,000 clinical

consultations each year safety and patient flow


Ontario Telemedicine Network

.


Telemedicine in Afghanistan

BUSINESS CHALLENGES

Lack of access to healthcare throughout the country

SOLUTIONS

Roshan, a telecom operator in Afghanistan, has launched a Telemedicine solution to expand healthcare access and delivery across the country. Using broadband technology, wireless video consultation and digital image transfer, the Telemedicine project will provide hospitals in Afghanistan with real-time access to specialist diagnosis, treatment and training expertise from abroad.

Roshan has teamed with Cisco, Aga Khan University Hospital (AKUH, Pakistan), French Medical Institute for Children (FMIC) and other technology suppliers.

Teleradiology, the electronic transmission of radiological patient images (60-80 transmissions and 10 to 15 teleconferences between hospitals per month).

Telemedicine capabilities will gradually be expanded to address different services and procedures including evaluation of tissue samples and the on-line performance of medical and surgical procedures.

BUSINESS RESULTS

Telemedicine not only immediately enhances access to medical diagnosis and treatment, but it also helps to build and sustain the nation's healthcare capacity through sharing of expertise.

Patients will now benefit from the international knowledge without the need to transport specialists to the country.


Scottish Centre for Telehealth

BUSINESS CHALLENGES Shortages of healthcare practitioners and increasing costs, combined with aging populations, have put

significant strains on health systems throughout the world.

SOLUTIONS Cisco HealthPresence combines state-of-the-art video, audio and call centre technology with medical

information over a highly secure network to create a virtual face-to-face experience for patients and caregivers who may be miles apart. Cisco HealthPresence is a technical platform that interfaces with medical diagnostic equipment, such as stethoscopes and otoscopes, as well as a vital signs monitor that can measure blood pressure, temperature, pulse rate and pulse oximetry to capture the physiological condition of the patient. An attendant is available to operate the medical devices on behalf of the remotely located caregiver as well as to maintain the technology in good operating condition.

BUSINESS RESULTS Delivery of safe, affordable and accessible

healthcare


Recommendations


TeleMedicine is missing Govt/MoH support

What’s missing? State level strategies and leadership Reimbursement regulations Adoption incentives Mechanisms for collaboration and coordination Inability to make telemedicine consults seamless w/ current workflows Accessible resources for networking, support, training Integration with HIT initiatives An inventory of telemedicine services and providers Consistent coverage policies



Links

ATA www.americantelemed.org

CTIL http://www.citl.org

Health & Medicine

Telemedicine technology positioning