TeH,15/09/08 Telemedicine in low resource settings: templates and examples of proven practices Maria Zolfo

TeH, 15/09/08 Potential uses of telemedicine in developing world Educational purposes Asynchronous nature (self-study via the web) Interactive (videoconferencing) Clinical purposes For disasters relief Telemedicine for second opinions

TeH, 15/09/08 Potential uses of telemedicine in developing world Educational purposes Asynchronous nature (self-study via the web) Interactive (videoconferencing) Clinical purposes For disasters relief Telemedicine for second opinions

TeH, 15/09/08 Educational purposes Asynchronous education Self-study via the web:

TeH, 15/09/08 Educational purposes Interactive: videoconferencing RAFT

TeH, 15/09/08 Educational purposes Interactive: videoconferencing RAFT

TeH, 15/09/08 Potential uses of telemedicine in developing world Educational purposes Asynchronous nature (self-study via the web) Interactive (videoconferencing) Clinical purposes For disasters relief Telemedicine for second opinions

TeH, 15/09/08 Clinical purposes Disaster relief, e.g., Armenian earthquake in 1988 (satellite link called ‘space bridge’ between physicians in Armenia, States and Russia) Transmission of fax data and audio- and videoconferencing for teleconsultations

TeH, 15/09/08 Clinical purposes: second opinion-advice Partners Healthcare, Boston, USA Tripler Army Medical Center, Honolulu, USA iPath Association, Basel, Switzerland Swinfen Charitable Trust, Canterbury, UK Réseau Afrique Francophone de Télémédecine (RAFT), Geneva, Switzerland

TeH, 15/09/08 Partners Healthcare Referring sites Rovieng Health Centre, Cambodia Rattanikiri Hospital, Cambodia Expert sitesSihanouk Hospital, Phnom Penh; Harvard Medical School, Boston Description consultations for health workers in North Cambodia (2001, 2 nd site in 2003; )

TeH, 15/09/08 Tripler Army Medical Center Referring sitesUS-associated Pacific islands Expert sitesTripler Army Medical Center, Hawaii DescriptionA web-based teleconsulting system is used by the main US Army hospital in Hawaii to support referrers in hospitals around the Pacific (1997, web)

TeH, 15/09/08 iPath Association Referring sites Several, e.g. Cambodia, Solomon Islands, Bangladesh; Ukrainian Swiss Perinatal Health Project Expert sitesMainly Swiss, European DescriptionThe iPath software was originally developed for telepathology case conferences; more recently the software is as well for general teleconsulting (2001, and web)

TeH, 15/09/08 Swinfen Charitable Trust Referring sites Global (34 countries) Expert sitesGlobal 13 countries Description teleconsultation with specialist opinions from a small panel of volunteer consultants; the operation has now grown to service over 100 hospitals around the world, with a panel of more than 300 consultants (1999, and web)

TeH, 15/09/08 Réseau Afrique Francophone de Télémédecine (RAFT) Referring sitesAfrica Expert sitesGeneva DescriptionCore activity is distance education via webcasting of interactive courses; some teleconsultation with specialists in Geneva (2001, web via satellite)

TeH, 15/09/08 Other telemedicine approaches, on HIV/AIDS care TeleconsultationsWarm line ATIC Case conferencesPharmAccess TwinningAmerican International Health Alliance Moi University Web-based collaborationsAIDSPortal Partners in Health Cell-Life

TeH, 15/09/08 Telemedicine ITM, Antwerp, Belgium SCART: Short Course on AntiRetroviral Therapy (since 2003) ( - and web-based consultions)

TeH, 15/09/08 Telemedicine interactive sites, 2007

TeH, 15/09/08 4 years evaluation (April 2003-March 2007, n: 642 referrals)

TeH, 15/09/08 End users' benefit

TeH, 15/09/08 Telemedicine website visits/year

TeH, 15/09/08 Forum members, 2007

TeH, 15/09/08 Utilization rate (second opinions) OperatorCases (n)Duration (years) Partners Healthcare9006 Tripler Army iPath Associationc500*5 Swinfen Charitable Trust15009 RAFT20**5 *Telepathology conferences; **distance education

TeH, 15/09/08 Why isn’t demand escalating?

TeH, 15/09/08 Why isn’t demand escalating? Free telemedicine service not valued? Cultural problem? Inappropriate experts? Referrers too busy? Perceived loss of control?

TeH, 15/09/08 Swinfen referrals: loss of control?

TeH, 15/09/08 Why isn’t demand escalating? Free telemedicine service not valued? Cultural problem? Inappropriate experts? Referrers too busy? Perceived loss of control? Digital divide Computer literacy Intuitive/user friendly interphase

TeH, 15/09/08 Low-cost telemedicine in the developing world Feasible Clinically useful Sustainable Scaleable

TeH, 15/09/08 Way forward Development of intra-country networks: (1) demonstrably alter health outcomes; (2) can be shown to be cost-effective and sustainable; (3) will act as a model for other countries to copy. Successful implementation would result in one or more successful telemedicine that could be replicated widely. Wootton R. Telemedicine support for the developing world. J Telemed Telecare. 2008;14(3):109-14