Digital Pulse - Ch 3 - Sec 4 - The Telemedicine TeleInViVo Initiative

Development Issues: Health, Portable Technology, Teleconferencing and Diagnosis

Programme Summary

The TeleInViVo project involves the establishment of transportable telemedicine workstations (PC computers with telecommunication capabilities) that are connected to light, portable ultrasound stations. These devices, to be used initially as a telemedical device at Nakaseke Hospital and Mulago Hospital, are intended to foster communication between physicians who specialize in certain diseases and physicians who work in the isolated rural areas of Uganda. The purpose of this programme is to improve general health services in Nakaseke Hospital as well as to garner access for health workers to medical support from colleagues across the country. Another goal is to reduce referral from Nakaseke to Mulago Hospital.

Telemedicine involves provision of health care services through Information and Communication Technology (ICT). It supports health care service provision in areas in which the ratio of doctor or health-worker-to-patient is too high to manage or where a particular specialty is lacking. Nakaseke Hospital lies 60 km outside Kampala, the capital of Uganda. The hospital was lacking even basic telephone connections at the outset of the project. A multipurpose community telecentre, established there in 1999, provided the infrastructure for the training of local doctors in the use of basic computers and Internet connection.

The project makes telediagnosis and teleconsultation a reality in even the most extreme conditions, while promoting international medical collaboration and mutual sharing of specialist information and expertise.

Summary of ICT Initiatives

The computer system that this programme uses is supportive of a wide range of medical applications (from gynaecology to abdominal scans). The integrated workstation uses techniques -- the Internet, ISDN, a phone line, and GSM -- that allow one physician to collect three-dimensional ultrasound data of a patient and to send this data to another physician who specializes in the particular disease that the patient has. This data transmission can occur online, that is, while both doctors are connected, or offline, for instance, overnight, through narrowband channels. In the latter case waiting times are minimised, whereas in the former case additional scans may be requested by the remote expert during the teleconsultation to hone in on the diagnosis. Only the actions introduced by one user are transferred to the remote location, so that the second workstation has to calculate only the corresponding image. That is, no bulky image data are transferred over the network, enabling the two doctors to see exactly the same image on their screens in real time. Any delay between two locations reflects the latency of the intermediate network. Some of the tangible benefits identified by the project include:

• Savings from reduced travel costs of either specialists or patients;
• Savings on hospital costs for patients that can be diagnosed remotely;
• Savings resulting from the provision of services in remote clinics as opposed to expansion of urban/regional hospitals.

Intangible benefits include:

• Increased opportunity for consultation and second opinions and reduction of mistakes
• Reduced waiting times and transfer delays
• Reduction in lost incomes for patients and travel expenses for family members
• An improved efficiency and effectiveness of specialists with a broader reach
• Improved overall health-care management
• Improved collegial support and opportunities for peer-to-peer teaching and learning

Click here for more information on the above.

Two doctors from the Mulago Medical School were trained in June 1999 in the use of TeleInViVo equipment in Coimbra, Portugal. They have in turn trained a number of doctors from Nakaseke and Mulago Hospital. Two technicians were also trained in servicing and back-up in Germany in September, 1999, when they worked to install TeleInViVo equipment at Mulago Medical School. Two young students are studying project developments: one from the Faculty of Technology (engineering department) and another from the Medical School (radiology department).

The device will be tested in different socio-economic conditions and adjusted to meet the needs of developing countries and countries in transition. It currently comes in two versions: a fully portable, self-contained device, and a workstation version (a PC attached to an ultrasound scanner for internal hospital use). UNESCO has been evaluating EU-TeleInViVo in Uganda at two different sites. The Ugandan Ministry of Health has also established a task force to investigate possible adoption and expansion of the program, and excellent example of local capacity building and appropriation. Click here for more information.

By the time of the project's completion, it is hoped that a medical teleconference emergency workstation will be available in Europe as well as in other regions of the world that provide health care services to underserved areas like ecological disaster areas, remote rural areas, and isolated islands.

Partners: Mulago Hospital (Kampala Uganda), HPD Hospital de Ponta Delgada (Acores), Nakaseke Telecenter, Nakaseke Hospital (Uganda), HUC Hospitais da Universidade de Coimbra (Portugal), Central Area Hospital (Aralsk, Kazakhstan), Almaty Laboratory (Almaty, Kazakhstan), The European Union, Fraunhofer Institut für Graphische Datenverarbeitung (IGD), Dr. Stärk Computer GmbH (DSC) (Langen, Germany), PIE Medical (Maastricht, Netherlands), Centro de Computação Gráfica (CCG) (Coimbra, Portugal), Computer Graphics Center (ZGDV) (Darmstadt, Germany), Center of Advanced Technology on Image Analysis (CATAI) (Tenerife, Spain), UNESCO (Paris, France), Hospitais da Universidade de Coimbra (HUC) (Portugal), Hospital de Ponta Delgada (HPD) (Azores, Portugal).

Source: The Nakaseke site and theTeleInViVo website.

For More Information Contact:

Fraunhofer IGD

Prof. Dr.-Ing. Georgios Sakas

Fraunhoferstr. 5

D-64283 Darmstadt

Germany

Tel.: 49-6151-155-153

Fax: 49-6151-155-559

gsakas@igd.fhg.de