1. To develop a telemedicine system to improve remote diagnoses and to deliver a cost-effective, better-quality specialist services in developing countries Health care of 21 st Century Mannan Mridha & Björn Pehrson KTH-Sweden

2. Sections of presentation Telemedicine Feasibility study Objectives Methods Expected results

3. Telemedicine What is telemedicine? Telemedicine is the use of electronic communication and information technologies to provide health care when distance separates the medical professional from the patient.

4. Case Processing History Taking and Clinical Examination Digitisation of the case Case Transmission using high speed net connectivity Case Reception by the specialist Second Opinion Telemedical Equipment and Technique

5. Tele consultation – Helping the patient to reach a confirm diagnosis. Tele monitoring – Example is monitoring a cardiac patient with an ECG. Tele health – Mainly consists of health education Tele mentoring – Example is telesurgery. Telemedicine T ypes of service

6. Equipmen t Major equipment commonly used are: General Examination Camera E-Stethoscope ENT Scope Ophthalmoscope X-Ray Digitizer 12 lead ECG machine Spirometer

7. Types of consultation SIMPLE E-MAIL CONSULTATION: Consultation of simple cases (case presented without any images). COMPLEX CASE CONSULTATION: Consultation of more complicated case presented with images like x-Ray, ECG, Ultrasonogram, CT Scan, MRI etc. X-RAY INTERPRETATION CT INTERPRETATION MRI INTERPRETATION

8. Telemedicine Benefits of Telemedicine in the developing countries? 1.Reduced physicians fees and cost of medicine 2.Reduced travel expenses 3.Treatment by qualified physician, interpretation of imaging & histopathology, when professionals are distantly placed 4.Early detection of diseases 5.Reduced burden of morbidity 6.Saves work-loss time and increase productivity 7.Home health care by using telemedical home monitoring device for chronic case For the patient

9. Telemedicine Benefits of Telemedicine? Telemedicine is an excellent opportunity to share the knowledge between physicians all over the world. Joint consultation with expert physicians and surgeons for better management of complicated disease. Local doctors can be updated at any time with the most recent advancement in medicine. Medical education in the form of teleconferencing For the doctors

10. Telemedicine Benefits of Telemedicine? a) Reduced rush to the medical facilities in the cities b) Improve monitoring facilities at the rural based centres c) Increased reliance on the government health care system d) Increases stuff productivity e) Economizes resources (optimal use of instruments and surgical facilities). For the government

11. Feasibility study Our study addressed: : Policy-related issue, Organizational and human capacities issues, Financial issues, Technical issues

12. Questions asked were: Policy-related Issues a.What are the main challenges in the countrys health care system? b.Which of these could be successfully addressed telemedicine ? c.What are the current or planned health care programmes or activities in the country that could benefit from the application of health telemedicine? In which way? d.Have any strategies or policies for implementing health telemedicine been developed in the country previously? e.Have there been any projects or systems using health telemedicine in the country previously? If so, what is the experience?

13. Questions asked were: Organizational and human capacities Issues a.Which are the geographical areas, local institutions and/or focal points that would be involved in a telemedicine project or service? b.What kind of human resources are available? c.What is the computer literacy level among key personnel? d.What kind of training programmes will be needed? e.How is the issue of medical responsibility within the countrys health care system in relation to health telemedicine? f.Is there any existing legislation on confidentiality, security and privacy which could apply for health telemedicine services?

14. Questions asked were: Financial Issues a.How will the project be funded with regard to investments and running costs? b.How will the service be paid for? c.What is the level of communication costs in the country? d.Who will provide training and maintenance? e.What kind of activities, human resources, equipment and other factors can be provided by the local project participants or the government?

15. Questions asked were: Technical Issues a.How is the telecommunication infrastructure in the country, in terms of distribution and costs? b.What type of communication technology is used? c.Is the telecommunication infrastructure reliable? d.Are there any government plans for the current telecommunication infrastructure? e.Which are the main telecommunication providers in the country? f.Which are the Internet Service Providers in the country? g.How is the distribution of technical equipment such as computers, digitized medical equipment, in hospitals, clinics and administrative units? h.How will maintenance be cared for?

16. Our objectives are to: a)select telemedicine equipment to meet the medical need of the local communities, b)determine the factors involved in transmission of medical data to adapt to the existing connectivity and other facilities, c)prepare appropriate education and training programme d)implement a pilot telemedicine system at some model centres, e)develop the methods towards a sustainable telemedicine-technology for safe and reliable & cost effective operation, f)evaluate the centres to find if IT & Telemedicine services can improve the quality of care and access to health-care, g)prepare recommendations & guidelines on how the rural and remote areas in the developing countries can benefit from self-sustaining telemedicine communication systems.

17. Our partners IT University/KTH, Sweden (coordinate, develop and implement) Grameen Health, Bangladesh (provide rural health centres) Grameen communication, Bangladesh (provide network support) BIRDEM Hospital, Bangladesh (provide medical specialists) PG Hospital, Bangladesh (provide medical specialists)

18. Method: Phase I: Development of equipment system for monitoring, diagnosis & consultation, Phase 2: Development of reliable information management systems and networks, Phase 3: Implementation and evaluation of the systems.

19. Power Zoom Push-button 1-50x zoom allows both close focus and wide angle images. Auto Focus The camera automatically stays in focus for ease of use. Freeze Frame Freeze frame produces the clearest possible image, making it ideal for both low- and high-bandwidth solutions. Accurate Colors One button white balance sets highly accurate colors quickly and easily. Polarization Elimination of surface skin reflection allows camera to see into epidermal layers. Touch and View The AMD-2500 includes manual or automatic iris control to maximize image brightness. AMD 2500 General Examination Camera Telemedical Equipment And Technique

20. Pictures taken by AMD 2500 General Examination Camera

21. Telemedical Equipment And Technique Dermoscope ViewGeneral Exam View Pictures taken by AMD 2500 General Examination Camera

22. Direct Ophthalmoscope Telemedical Equipment And Technique V ideo version of the traditional diagnostic scope used by the vast majority of primary physicians worldwide. V iew and illuminate retina, head of optic nerve, retinal arteries, vitreous humor even through an undilated pupil, but better viewable with pupil dilated. F ocus in eyepiece is equal to image on video monitor.

23. Telemedical Equipment And Technique Superior Imaging The AMD-300s teams Welch Allyn's patented Solarc lamp with Sony's HyperHAD CCD to deliver a crisp, clear, uniform image from edge to edge. Superior Illumination Welch Allyn's arc lamp produces white light for true color and the advanced design projects light into the fiber optic bundle at a wider angle, producing consistent illumination across the monitor. Easy To Use Automatic white balance and iris control match the level of illumination to the needs of the camera. Flexibility & Economy The AMD-300s adapts to a wide range of rigid and flexible diagnostic scopes. Rugged Construction The solid camera housing, reinforced cable and rugged system chassis guarantee long life under continuous use. The lamp has an average life of 500 hours.

24. Telemedical Equipment And Technique

25. CARDIOPHONOGRAM BY AMD-3400R&S PhoneSteth

26. 2D ANALYSIS OF HEART SOUND BY AMD-3400R&S PHONE STETH

27. Telemedical Equipment And Technique Large Format 12 Bit X-ray Digitiser Cobra Scan CX-312T DICOM (Digital Imaging & Communication in Medicine) compatibility Can scan image plates with 700 dpi (max) whereas only 150 dpi is required to fulfill DICOM compatibility Supplied with X-scan 32 Software which enhances image quality up to minute detail.

28. Telemedicine Expected results Telemedicine can enhance Bangladesh Government Health Programme that envisage a client oriented services, known as Essential Service Package (ESP) to: Increase health coverage, Improve quality of services, Cost effectiveness, Accountability

29. Other Benefits of Telemedicine? The facilities can be used for other purposes to reduce the digital divide such as: Education and research Business and trade Administration and management