Strategic and Economic Considerations for the. Implementation of Telemedicine/ Telehealth in Remote/

Transcription

1 Strategic and Economic Considerations for the Implementation of Telemedicine/ Telehealth in Remote/ Underdeveloped and Poor Areas of Developing Countries Irwan Rusli, PhD Princeton Institute of Technology Princeton, New Jersey USA

2 Telemedicine The use of information and communication technologies to provide healthcare and services at a distance Telephone Hand phone PC -Laptop Tablet- Smartphone Mobile Unit. From SMS to MMS to Voice Call to Video-to-Video Method of Delivery: Live Direct Save/Record and Forward Monitoring

3 World poverty-stricken areas: World Bank Data: Although it has significantly improved during the last decades, data (2012) showed about 12% of world population (890 million people) lived at or below $1.90 per day. 2.1 billion people lived at or below $3.10 Practically most of them do not have or have little access to healthcare. Telemedicine is the most efficient way of delivering healthcare and services to these poverty stricken areas.

4 Access to Internet/ ICT: Empowerment Long Distance Vocational Training Transfer of knowledge Distribution of knowledge Telemedicine: Transfer of medical information Distribution of healthcare Tele-employment Transfer of jobs/opportunities Distribution of income Other potential Internet/ICT applications: agriculture, trade, home industries, SMEs, logistics, manufacturing, etc. RESULTS: Empowerment Individual and Community Distribution of WEALTH POVERTY REDUCTION

5 Implementation of Telemedicine for Rural / Poor Areas Challenges: Availability of Signal / Broadband Availability of Qualified Manpower Nurses, Nurse Assistants, Midwives, Physician Assistants, etc. Affordability/ Cost (Others: Electricity/ Power, Sanitation, Clean Water, etc.)

6 Availability of Telecommunication Systems Strategy: strongly depends on availability of signals. Most desirable: strong broadband signal, 4G system Intermittent signals may be obtained. Satellite Save/Record and Forward Options are available in case of poor or unavailable signals: Cell phone SMS Save/Record and Transport (Drone or Logistics)

7 Availability of Qualified Manpower Training: Considerable Challenges. Without qualified manpower practically could not run telemedicine Preferably local people. Minimum high school graduate or equivalent Training - long distance learning or on-site and/or on-the-job Qualified instructors Comparable to: Certified Nurse Assistant Certified Physician Assistant Certified EKG Technician Certified Ultrasound Technician etc.

8 Some telemedicine devices

9 Primary Healthcare/ Family Medicine Comprehensive health care for individuals and families for all ages and health conditions. Emphasis on disease prevention and health promotion. Routine check ups and vital sign measurement. Treatment of common illnesses and injuries. Basic family counseling, and assistance in managing overall health.

10 Typical Medical Equipment and Devices for Family Practice Stethoscope Blood Pressure Measurement Temperature Measurement Weighing Scale Height Measurement Otoscope Ophthalmoscope Microscope

11 Typical Equipment and Devices in Family Medicine Office

12 Recommended telemedicine kit: For Family Practice Stethoscope Blood Pressure Measurement Temperature Measurement Weighing Scale Height Measurement Otoscope Ophthalmoscope Microscope Oximeter Blood Sugar Measurement (manual input) Additional Equipment/ Tests (for Specialist): EKG Measurement Abdominal Ultrasound Measurement

13 Some telemedicine devices kk

14 Telemedicine (this presentation) Telemedicine: mostly in urban, city, and suburban areas as internet systems are available at relatively affordable cost. Telemedicine described here: family practice operation may or may not include devices (from video consult only to the measurement of vital signs) It may be added with EKG and/or Ultrasound tests. Typically in the form of cart or briefcase/luggage styles.

15 Typical Current Market Cost of Telemedicine. The costs vary between $20K to $40K, depending on the types of diagnostic application. Family practice units : range from about 20K to 30K Plus EKG and Ultrasound: range from about 30K to 40K They usually include integration software for the system and the video conferencing software system. Additional software fee may be added in the form of monthly or yearly subscription, could be up to $100 per month In addition, some systems may require payment per patient basis up to about $20-$25 per patient. Too expensive for rural and poverty-stricken areas.

16 Affordable Telemedicine System More and more devices are designed for telemedicine with their own software to allow direct communication at a distance. May be aided by video conferencing platform. Each device will be independently utilized. Many device software also have capabilities for file saving or recording that can be forwarded at a later time.

17 Affordable Telemedicine System (cont d) Utilizing individual device software will result in cheaper system -- not necessary to purchase integration software. Some vital sign measurements, optionally, can be done manually and the data are also input manually, such as: oximeter, blood pressure test, weight, height, and temperature. Quality products are available under this affordable program.

18 Individual Devices Cost Estimates Estimation of Price Ranges for Medical Devices, USD$ Device/ function Price Range Estimated Stethoscope Otoscope Microscope Ophthalmoscope Oximeter Thermometer Blood Pressure Blood Sugar EKG Ultrasound

19 Economic Return on Investment (ROI) Estimation of Return on Investment -- Primary/EKG/Ultrasound (USD$) Packet system Primary Only + EKG +EKG +Ultra Estimated Cost/Investment $3,000 $6,000 $12,000 Hours/No. of patient/ day 10 h/20 pt 10 h/20 pt 10 h/20 pt Fee per patient $4 $4 $4 Revenue, per day $80 $80 $80 Revenue@300days/year $24,000 $24,000 $24,000 Assumed Profit 25% $ 6,000 $6,000 $6,000 Return on Investment (ROI) 6 months 1 year 2 years

20 Availability and Delivery of Medicines Most likely significant challenges. Operation Research and Logistics /Optimization Anticipated supplies and needs Utilization of Drones: In conjunction with the delivery of other needed, light items (computer disks, flash drives, documents, etc.) Limited in distance (30 km) and weight (2 kg) Could use intermediate points for battery replacement extend distance.

21 SUMMARY There is an urgent need to provide healthcare to rural/ remote/ underdeveloped and poor-stricken areas in many parts of the world. Intensive efforts can be initiated to increasingly and progressively meeting this need through the implementation of appropriate telemedicine/ telehealth programs. Telemedicine is the most efficient way and (can be) the most cost-effective way of delivering healthcare to the poor. Strategic and economic considerations are keys in the successful implementation of telemedicine.

22 SUMMARY (continued) Typical challenges are the availability of telecommunication/ broadband signals and the availability of skilled workers. Through strategic consideration, effective and affordable telemedicine can be implemented in the rural and poor areas. Access to ICT/internet and in synergy with other key development programs, such as: education, training, and employment, telemedicine will provide empowerment for individual and community toward poverty reduction. Reasonable Return on Investment (ROI) can be achieved in the operation of telemedicine in poor areas that may be suitable for small or medium enterprises (SMEs), social entrepreneurship, as well as government or NGO s funding.

23 Thank You.