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Telemedicine panel follow -on

By Hamish Fraser, MBChB, MRCP, MSc Moderator Emeritus | 26 Feb, 2012

Follow on from the panel "Creating, working in, and evaluating Telemedicine projects"



Hamish Fraser, MBChB, MRCP, MSc Moderator Emeritus Replied at 6:20 PM, 26 Feb 2012

Thanks to Terry, Antoine, Richard and Shariq and other responders for a great discussion.

I would like to re-iterate a point that came up in some of the comments, that telemedicine needs to be seen as part of the larger process of improving clinical diagnosis and management especially in remote areas. Take the example of a clinician (Dr, nurse or other health professional) managing patients in a remote clinic. Their ability to correctly diagnose a patient presenting with say pneumonia depends on their training, the availability of investigations especially CXR, a white cell count etc. and access to additional expertise. Telemedicine can help with expert analysis of the clinical and radiographic findings and in training junior staff. The clinician may also be helped by clinical decision support tools like the IMCI algorithm for pediatric care. There is also the question of clinical records and documentation. These are important as a way of ensuring that key data such as lab results and previous diagnoses get back to the clinician and also in tracking case mix, quality of care and gaps in the care process.

One project we are working on at PIH is the collection of a minimum data set on every patient visit in an EMR to allow tracking of diagnoses and case mix. If this is extended to medications, lab data and then key outcome data, it will allow a much better assessment of the true impact of interventions like telehealth. It should help to determine the key gaps in information and whether better training, access to data, decision support, expert opinion or other interventions (like better supply chain) is most likely to improve care for particular problems. It also offers the potential to generate a telemedicine referral from within the EMR, with a place to integrate the reply that is accessible on future consultations. Some examples of integrating telemedicine and medical records exist but have not yet seen wide use in resource poor environments. Doing this in a very clean and efficient way is key, but building separate applications for EMR, telemedicine, decisions support and training is unlikely to scale or support effective evaluation.

Andrew Kanter, MD MPH Replied at 12:31 AM, 27 Feb 2012

I would like to second Hamish's contribution and also add that some of the decision-support may be relatively simple interventions which can be deployed off-line in connection-poor environments, help ensure a minimum data set of information collected on the patients, and provide guidance and recommendations short of a full teleconsultation. The Millennium Villages Project is piloting both a application-based decision support (Immunization recommendations using OpenMRS and Community Health Worker guidelines using CommCare/ChildCount+ and a more traditional teleconsultation approach. Hopefully we'll have some good data to show in the next few months.

Andrew S. Kanter, MD MPH FACMI
Director of Health Information Systems/Medical Informatics
Millennium Villages Project
Earth Institute, Columbia University

Asst. Prof. Clinical Biomedical Informatics
and Clinical Epidemiology

622 W. 168th Street, VC5 (VC-562)
New York, NY 10032
Office: +1 212 305 4842
Cell: +1 646 469 2421
Skype: akanter-ippnw

A/Prof. Terry HANNAN Moderator Replied at 4:35 PM, 14 Mar 2012

Hamish, I think the entry "clinician (Dr, nurse or other health professional)" is an important part of the language for e-health discussions as this makes the care delivery concept more global than just 'doctor' focussed. Many of the resource poor regions have no 'docs' to deliver care. We can now add the 'patient' as an essentail component of care as their roles will continue to be enhanced by the new technologies supporting social media. Your second paragraph touches on the complex CPOE area as a critical source of data capture. A whole new discussion topic.

Blerim Berisha Replied at 11:22 AM, 26 Mar 2012

Hi, I’m Blerim Berisha, I work at the educational unit of the Telemedicine Centre of Kosova.
I would like to thank all those that are part of previous discussion ("Creating, working in, and evaluating Telemedicine projects") and this follow on for great informations and comments. I’m learning a great deal from these discussions.
Our project started with many doubts in our country about it’s benefits and cost effectiveness and I agree with many here when they say that it is difficult to measure that. Although I work in the Electronic Library and I’m not much involved in the clinic part of our Centre, because of my almost 9 year experience of working in Telemedicine I can say that it is very challenging to build and also sustain the Telemedicine project. Because of many issues we had a much more success in tele-education than in telemedicine (clinical consultations). Exchanging experiences of different projects will be very helpful in our aim to make Telemedicine more and more successful.

Blerim Berisha
Electronic Library manager
Telemedicine Centre of Kosova

Trevor Lewis Replied at 5:41 PM, 30 Mar 2012

Hello Everyone,

At the Center for Health Market Innovations, we have identified a number of different interesting telemedicine models. More information on these models can be found at www.HealthMarketInnovations.org.

You may also be particularly interested to learn about Sehat First, an interesting social franchise for health in Pakistan that utilizes telemedicine. They have had some very interesting experiences in working to scale up their model. More information on the model, as well as a talk by the program's founder can be found here: http://healthmarketinnovations.org/blog/2011/jun/13/telemedicine-action.


Trevor Lewis
Results for Development Institute (R4D)
Center for Health Market Innovations (CHMI)

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