Slides for a lesson to students of the School of Medicina, University of Milano Bicocca, 14 April 2014 (prof.R.Polillo)

1. Roberto Polillo
Derpartment of Informatics, Systems and Communication,
University of Milano Bicocca
Intervento al corso elettivo “Promozione della salute infantile nei Paesi in
via di sviluppo” per studenti della Scuola di Medicina dell’Università di
Milano Bicocca - April 14, 2014
Internet & sustainable telemedicine for
developing Countries: an introduction
1

2. What is telemedicine
"Telemedicine is the delivery of health care services,
where distance is a critical factor, by all health care
professionals using information and communication
technologies for the exchange of valid information for
diagnosis, treatment and prevention of disease and
injuries, research and evaluation, and for the continuing
education of health care providers, all in the interest of
advancing the health of individuals and their
communities.”
WHO, Telemedicine, Opportunities and Developments in Member States, 2010
3

3. Types of telemedicine applications
4
DISTANCE
Synchronous or
asyncronous
communication

4. Types of telemedicine applications
5
DISTANCE
Synchronous or
asyncronous
communication
 Teleradiology
 Telecardiology
 Telepathology
 Teledermatology
 Teleodontoiatry
 Teleaudiology
 Telepsycology
 …

5. ”Affordable" telemedicine
 “Reasonable” technological infrastructure
 Low initial costs
 Sustainability
 Low operating costs
 “Reasonable” technical skills locally
necessary
6

6. The good news
Internet and mobile telephony
ALLOW NOW
to develop affordable and sustainable telemedicine
applications for developing Countries
7

7. Obstacles to telemedicine adoption (according WHO)
In developed Countries:
 Problems connected to protection of personal data
 Different priorities
 Perceived lack of demand
In developing Countries:
 Availability & maintenance of necessary infrastructures:
electric net instability, availability & quality of Internet
connectivity, bandwidth, obsolete computers, computer
viruses, availability of technical personnel
http://www.who.int/goe/publications/goe_telemedicine_2010.pdf
8

8. But we can be optimistic…
 Internet connectivity is constantly improving, even in
developing Countries
 Mobile telephony is available everywhere, and mobile
broadband is growing fast (“mobile miracle”)
 Software development costs are constantly lowering and
open-source software is widely available
 Cloud computing significantly lowers initial investments of
ICT infrastructures (capex → opex)
9

9. Global ICT development (2003-2013*)
10
6.8 B subscribers!6.8 B subscribers!
1 internet access every 2 TV1 internet access every 2 TV
2.7 B people2.7 B people
Source: ITU, Measuring the Information Society, 2013
2 B people
40% annual growth since 2007
2 B people
40% annual growth since 2007

10. R.Polillo - Marzo 201311

11. Mobile broadband growth
“Expectations are high that mobile-broadband services
will become equally as available as mobile-cellulare
telephony in the near future.
Ericsson forecasts that by 2018 there will be 6.5 billion
mobile-broadband subscriptions, almost as many as
there are mobile telephone subscriptions in 2013.”
13
Source: ITU, Measuring the Information Society, 2013

12. Active mobile-broadband subscriptions (2007-2013*)
14
Source: ITU, Measuring the Information Society, 2013
Annual growthPenetration
6 years
divide

13. Active mobile-broadband subscriptions (2013*)
16
Source: ITU, Measuring the Information Society, 2013

14. Types of telemedicine applications
17
DISTANCE
Asyncronous:
•Store-and-forward
•Remote monitoring
Syncronous:
•Interactive telemedicine

15. Store-and-forward (simple)
18
Asyncronouscommunication
Examples:
•Teleradiology
•Teledermatology
•Telepatology
Query with
medical data:
•text
•images
•[video]
Answer
Email
FTP
Dropbox
….
[MMS]
To consider:
•Bandwidth
•Data compression
•Access device

16. 19

17. Store-and-forward (with shared db)
20
Web / VPN
Specific
application
To consider:
•Server location
•Bandwidth
•Data compression
•Common procedures
•Privacy
•Level of service
Data
base
Query with
medical data:
•text
•images
•[video]
Answer

18. EXAMPLE: Pediatric Hospital La Mascota,
Managua (Nicaragua)
21

19. La Mascota and departmental hospitals
Policlinico
Milano
La Mascota
Managua
VPN
22
• 1 central server (Managua)
• 1 PC for every remote
hospital (db and procedures)
• Internet connection
• Data are consolidated on the
central server
• Consultancy from Milano

20. 23

21. 24
Il server dell’amministrazione
Dell’ospedale Dipartimentale
di Chinandega (Nicaragua)

22. Remote monitoring (asynchronous)
25
Comunicazionesincrona/asincronaAsyncronouscommunication
Without Internet access:
•SMS
•MMS
•Twitter
With Internet access:
•Twitter
Whatsapp
•Social media
•Mail

23. Example: Laptop + mobile for communication
via SMS (software: FrontlineSMS)
26
VIDEO: http://www.youtube.com/watch?feature=player_embedded&v=hEK0dTWgqzQ#!
www.kiwanja.net
• Patient monitoring /
follow-up
• Vaccination campaigns
• Medical info
• Emergency management
• …
www.medicmobile.org

24. Interactive telemedicine (synchronous)
27
Comunicazionesincrona/asincronaSyncronouscommunication
No Internet access:
•Cellphone
With Internet access:
•Internet telephony (skype,
whatsapp)
•Video conferencing

25. Example: HealthPoint (India)
28
www.healthpoint.com

26. A more general concept: e-health
 Electronic health records: enabling the communication of patient data between
different healthcare professionals
 Telemedicine: physical and psychological treatments at a distance
 Consumer health information: use of online resources on medical topics by healthy
individuals or patients
 Health knowledge management: best practice guidelines, online resources for the
healthcare professionals, epidemiological tracking
 Virtual healthcare teams: healthcare professionals collaborating and sharing
information on patients through online communication tools
 M-health: using mobile devices in collecting patient health data, providing healthcare
information, real-time monitoring of patient vitals, and direct provision of care
 Healthcare online information systems: for hospital and healthcare professionals:
appointment scheduling, patient data management, work schedule management and other
administrative tasks surrounding health
29

27. Case study: www.cure4kids.org
 A free, global online medical education and collaboration
network
 A web-based education project of St.Jude Children’s Research
Hospital (Memphis, USA) to help health professionals in
countries with limited resources to improve survival rates of
children with catastrophic deseases
 Seminars, papers, oncopoedia,
interest groups, international
live online web conferences
30

28. 31

29. www.cure4kids.org: growth
32
Start: Oct 2002
May 2012: > 31.000
registered users in 183
countries

30. 33
Know-how globalization

31. Conclusions
 The evolution of the Internet, the “mobile miracle”
and the telephony / internet convergence open
possibilities untinkable until a few years ago for
developing Countries
 Abilitating technologies: low cost asyncronous and
synchronous communication, broadband, cloud
computing, software open-source, low cost
smartphone
34
Substainability, delocalization

32. 35
Thanks!
www.rpolillo.it
roberto.polillo@unimib.it