An overview and lessons learned from our University of Miami/

1. Telehealth for Haiti earthquake relief
& recovery
Scott C. Simmons, MS
Director of TeleHealth

2. Timeline
< 24 hrs. 1st UM/Medishare team @ UN compund @ PAP
~ 3 days initial TH capacity via BGAN, Skype
~ 10 days tent-based field hospital @ PAP c/ expanded VTC
~ 21 days added teleradiology
~ mid-June moved to existing Bernard Mevs facility

3. Operational situation
• Completely ad hoc
­ Nothing in place: systems, procedures, command
center
­ Donated materiel, personnel, flights/fuel, meds
• Many non-medical functions
­ Logistics
­ Flight control, manifesting
­ FtL exec, Mia exec, FLL & MIA int'l, Homestead AFB)
­ Volunteers
­ Supplies & warehousing

4. Operational situation
• What was in place was relationships
­ LOA with USSOUTHCOM for collaboration in telehealth
­ TATRC/MRMC telehealth & Ryder combat surgical
training center
­ Haiti: President Previl, Medishare, other health facilities
& NGO's
­ Private sector & industry
­ Medicine
­ American Telemedicine Association

13. University of Miami/
Project MediShare
Field Hospital
Port Au Prince, Haiti
2010

16. UMH-Haiti Site Layout
Airport Perimeter Wall
Urinals
Showers Port-a-Johns
Supplies
(exposed)
ORs
ICU Sleeping
Supply
Tent
Tent
Sleeping
Tents
Adult
Peds
Tent
Tent
Command Reception
Center
IsolationTents
Chain Link Fences
N

17. On-site communications
Amateur Radio
Hughes BGAN
Access Haiti
Satellite Internet

18. UMH-Haiti connectivity
Cisco
POE
Switch
IP Phone
In
IP Phone
Reception
Ricoh Printer
Tent
Juniper
Router
Laptop
VSAT-A
HP Printers (2)
In
VSAT-B
Command Command
Center
Tent
Linksys
Laptops
Router
In
Access
Internet Cafe
Haiti
Laptops
Reception
Linksys
Tent
Router/AP

19. Telehealth applications
• Teleradiology
• Deferred consultation
– Swinfen Charitable Trust
– U. Miami & U. Virginia
• Real-time consultation
­ Scheduled
• bedside (trauma/crit. care)
­ Ad hoc
• peds cardiology
• hematology/oncology

33. Technology
considerations in
HADR operations

34. Basic requirements
• Deployable assets
• Reach-back comms
• Gateway services
• Completely self-reliant
• Multimode
– Real-time & store-and-
forward
• IP-based

35. On-scene: workflow IT
• Registration/Intake
– Identity
– Triage
• EHR
• Inventory
– Supplies
– Pharmacy
– Resupply ordering

36. On-scene: TH hardware, software
• Imaging
– Visible light
– Radiographic
• Biomed devices
• VTC/multimedia
collaboration
• Local wireless
• Satcomms
• Power

37. Gateway services
• Consult distribution
• VTC bridging
• Database hosting
• Identity management
• Credentialing
• Resource allocation

38. Other considerations
• Training
• Psychosocial support
– Social N/W-ing
– Voice/video calls
– Entertainment

39. Humanitarian telehealth
• Reducing barriers to
charity care
– Travel
– Security/safety
• Training of in-country
health professionals
• Pre-travel screening &
post-travel f/u

40. Characteristics of an idealized HADR
telehealth system

41. Idealized HADR TH system
characteristics
• Implements both store-and-forward &
real-time systems and methods
• Integrates with workflow informatics
• Staff is familiar with TH systems,
concepts & trained in their use

42. Idealized HADR TH system
characteristics
• Core TH infrastructure ties into on-grid & off-grid
power. Primary power system automatically fails
over to backup system(s).
• Databases available for various operational
needs, e.g. generalized contact information
(based on an organizational/functional position);
volunteer, equipment, & supply needs; inventory

43. Idealized HADR TH system
characteristics
• Field medical facilities include an internet café for
calling, VTC, e-mail, web access so that volunteers can
keep in touch with families, friends, and employers,
access to information.
• Systems in place for management of monetary,
equipment, or supply donations. Donated equipment
accompanied by technicians able to install & train on
its use.
• Systems in place for knowing the most contemporary
information about other medical capacity, facility,
transport mechanisms & availability, as would a pre-
defined process for certification, scheduling, and
processing of volunteers, both in the field and remotely
(telehealth providers).

44. Idealized HADR TH system
characteristics
• A network of specialists that are willing to
provide telehealth services would be available
along with a means of contacting & scheduling
them
• Shelter provided for mission-critical equipment.
On-site technical expertise for setting up,
maintaining training and troubleshooting
telehealth systems.
• Smart routing would move IP traffic via any
available communication path & distribute the
traffic simultaneously among multiple paths
(load balancing)

45. Final observations
• Issues not technical, but operational, organizational,
political
• Need pre-existing mechanisms for GOV/CIV collaboration
• Need to leverage academic/NGO core competencies --
clinical care -- virtual surge capacity
• Much good will in private sector
• People & organizations willing to donate after the event, but
need to get the stuff before event
• Most difficult donation was bandwidth/connectivity, esp.
data plans
• Too bad iPad didn't come out earlier...
• Disaster tourism an issue...
• 2 thumbs up for shelter box tent, from Rotary Club
International

47. Convenient, connected care.

48. Questions?
ssimmons@med.miami.edu
(305) 243-8252