1. Extending Kansas Telemedicine Applications in Africa Ryan Spaulding Director, Center for Telemedicine & Telehealth Research Associate Professor, Health Policy & Management

2. Telemedicine in U.S.  Current telemedicine movement began in late 1980’s  At least one telemedicine program per state  Many are based in university medical centers  Combination of grant and state funding; few are self-sustaining  Research and development focused  American Telemedicine Association www.americantelemed.org www.americantelemed.org

4. Kansas Telemedicine Experience  First implemented in 1991 with one hospital  Primarily facilitated by interactive videoconference  Program has expanded into more hospitals, schools, nursing homes, and clinics  Cardiology, mental health, oncology, pediatrics, many others

5. Telehealth Practice Ryan Spaulding, PhD Director Center for Telemedicine & Telehealth Assistant Professor, Health Policy and Management Kansas University Medical Center

6. Telemedicine in Early 1990’s

7. Telemedicine in 2010

8. Group Sessions and Educational Events

9. Mobile Video Units

10. Electronic Otoscope for Pediatrics

15. Echocardiograms

16. Intended Benefits of Telemedicine  Improve health care access in rural areas  Retain patients locally in their home communities  Reduce patient travel time and costs  Improve patient quality of life  Reduce provider travel time to outreach sites and associated costs

17. Challenges  Limited adoption by providers  Requires significant coordination  Not integrated in clinic flow  Reimbursement not standardized  Rural areas have inconsistent broadband internet service  Financial sustainability is difficult

18. Technical Infrastructure  Videoconference unit  High Definition (HD) is now the standard  Robust IP connectivity is needed (H.323 protocol)  True HD requires 1-2 Mbps  HD units can still achieve better quality than SD at lower bandwidths (384 or 768)  Firewalls need proper settings  Quality of Service (QoS) priority is preferred

19. Also Home Telehealth  Particularly useful for post-acute management…  …and older population  May reduce ED visits, hospitalizations  May delay nursing facility placement  May reduce Medicare and Medicaid costs

23. International Projects  Yerevan, Armenia – Tumor boards, 2 nd Opinion service  Kathmandu, Nepal – Cancer related education, physician-patient consultation  Uganda, Africa – continuing nursing education

25. Future Directions  Decentralized telemedicine stations  Mobile, wireless solutions  Integration in clinical spaces  More seamless  Integration with other health information technologies  3G, 4G, smartphones

26. International Challenges  Specialist availability  Robust, reliable bandwidth  Communication (language, time difference)  Cultural issues  Resources  Sustainability

27. Questions or Comments