Telemedicine in the Caribbean The JAMAICA PROJECT by: Dr. Winston George Mendes- Davidson CD; JP ATALACC: Regional Secretary (Caribbean) Head, Jamaica National Telemedicine Project & Honorary Research Fellow Telemedicine (University of the West Indies School for Grad. Studies & Research)
What is Telemedicine? • Telemedicine is an Information Technology network of medical and allied expertise linked together for the purpose of delivering medical services at a distance Functional Definition: by W. Mendes-Davidson 2004
Why telemedicine? • Advance in the use of communication and information technology in medicine have become ubiquitous as technology becomes cheaper, more user friendly and creating greater diagnostic accuracy and efficiency in health management • The problems of multimedia real time transmission are rapidly diminishing • Better solutions at cheaper costs now becoming available than conventional solutions to health care • World Trade Organization (GATT) begins in force in January 2005 and competition in all services will be online in the global domain • All patients in the world will now belong to any Dr in any part of the world who has the capacity to communicate real time on the multimedia cellular telephones to the average citizen and to manage health info more efficiently. • Medical practice in the Caribbean will be marginalized in the medium term as competition now involves e-health solutions overseas i.e. international health conglomerates, including online pharmacies, therapies, systems and health institutions.
Mission Statement • Source: Dr. W. Davidson • (copyright) • Telemedicine “The Jamaica • Project” • To establish a national health service information technology network, dedicated to deliver health service made available and affordable to Jamaicans at home and abroad; later expanding to the wider Caribbean and West African territories. • To provide an affordable national telemedicine and tele-health information technology platform including digital health TV content, for the delivery and export of health services from Jamaica reaching clients including tourists where ever they are, at home or abroad. • To facilitate the development of a Caribbean Health Tourism market as part of the process of diversification and expansion of Caribbean Tourism. • To enable the full participation of health professionals from Jamaica, the Caribbean and Africa, in accessing the global IT marketplace, so that these professionals may export their services in the global domain to facilitate national and regional health development
How Telemedicine? • “The Mendes-Davidson Model” • Medicine at a distance, facilitated by provision of a seven step integrated voice/video/data health services over a secure broadband network • Share communications infrastructure between offices and any other health facility at home or abroad • Access to health services / information management , anytime, anywhere • Hi-ethical health standardized business practice, process and allied services including health tourism within Jamaica and the Caribbean • Export health services via health free-zone throughout global domain Source: Dr. W. Davidson (copyright)
Telemedicine “made simple” • Is there a place for Telemedicine in Jamaica and the Caribbean?
How can we tell?Let us all do aSWOTanalysis • S=Strengths: What advantages do we have? What do you do well? What resources do we have? What are our strengths perceived to be? What resources do we have access to? • W=Weakness: What do we do badly? What should we avoid? What could we improve? • O=Opportunity:Where do good opportunities face us? What interesting trends are we aware of? Are there opportunities from changes in technology trends? or Government policy? Or Social patterns? Or lifestyle changes? • T=Threats: What obstacles do we face? What is our competition doing? Are required specifications for our jobs changing? Is technology threatening your position? Is it a matter of financing, or debt? Are we prepared to make changes, even fundamental ones?
Rising Life Expectancy Source: WHO
Country Health Expenditure Per Capita Per Year & Male / Female Longevity; W.H.O Estimates-2000
With the Best Primary Care System in the Western HemisphereGlobal Competitiveness Is Sustainable Source: W. Davidson. 1999. (copyright) Rising Costs: COMMUNITY COMMUNITY State of Health The Hospital The Clinic Prevention Treatment Rehab Maintain Healthy Lifestyle (Wellness) Primary Health Care Secondary Health Care Tertiary Health Care SECONDARY PREVENTION TERTIARY PREVENTION PRE-PRIMARY PREVENTION PRIMARY PREVENTION
Overarching health priorities determined by epidemiological evidence • Human resources • Adequate numbers, skills mix, quality • Leadership for Public health • Health Systems development-reform • Reform, policies & plans • Quality of Care • Standards clinical effectiveness, audit • Health technology and infrastructure • Information systems • MIS, research • Sustainable financing Source: Dr. B. Wint: CMO Nov. 2004
Program priorities in Public health system to address the weaknesses • Accidents & violence • Control of Com. disease • HIV/AIDS/STI, Tb, Foodborne • Control of Chronic disease • CVD, Hypertension, Diabetes, Cancer • Reproductive health • Child and adolescent health • Mental health & substance abuse • Emergency care • Environmental health Source: Dr. B. Wint: CMO Nov. 2004
Paradigm shift: Bottom line for all Drs. Health Information Management
The National Telemedicine Project • Private / GOJ Part Funded Project • Nat. Sc. & Tech. Fund OPM owns 10 % share capital • Investment to Date: > US $10.0 mil • Eight Years Research & Development • Phase 1: R&D phase implemented, with systems and protocol verification. • Phase 2: Pre-implementation & pilot testing presently as precursor to full implementation phase in a few months • Technical agreement with ZTE for National Infrastructure upgrade
Project achievements / benchmarks: National Telemedicine Project • Comprehensive Telemedicine: “The Mendes-Davidson Model” • Provider: Bundled user friendly equipment • Universal Electronic Health (Medical) Record System • Human Capacity Development (Training) • Research for Sustainable Development • Affordable Fault-Tolerant Bandwidth Supply • Secure Multi-Service IP National Network for Health Providers • Equity / Venture Capital / Strategic Partnerships
Telemedicine “The Mendes-Davidson Model”Seven Step Integrated Telemedicine Infrastructure Copyright: Author: Dr. Winston Davidson. Use of part or all of this diagram must be with the permission of the author. 7 6 Full Tele-medicine Service Provider 5 Home & Health TOURISM, National / Regional Export Services. Health Insurance Network Consulting Partner with Health Cable TV access 4 Computer/multi-media capture 3 2 Web Sites 1 ISP Tel-med-serv Doctor on Call DOC Tele-health-global Silver Gold Platinum EHR (Electronic Health Record) Data Infrastructure
“Doctor On Call” (DOC)Telephone Medicine • Immediate 24 hour telephone access of patients to Drs. On call. • Services include: • Emergency medical advice. • Emergency medical telephone screening. • Emergency medical dispatch. • Non-emergency medical information. • Non-emergency medical counseling. • Non-emergency general medical advice.
Why Does Every-one Need “Doctor on Call”? • They need easy access to Medical Service - from home, school, workplace, recreational area or any other location, at any time. • Access to a telephone is the only requirement. • Service satisfies immediate needs of the patient from where ever they are. • Doctor gives prompt expert medical advice or counseling. • Doctor gives quick dispatch of emergency cases. • Early intervention leads to prevention of illness and death at minimal costs to all concerned. • Prevention is always better than cure.
Cost Analysis • Dr on call will cost less than a half the cost of consulting a Dr. in his office. • Costs.Ja $ • Home visit, ($167/ min) $2,500.00 / 1/4 hr. • Office visit ($67-$100 / min) $1000.00-$1500 / 1/4 hr. • 976-MEDI ($35 /min) (info):$525 / 1/4 hr. • 976-DOCD ($40/ min (emerg.):$600 / 1/4hr. ($1.00 US = $62.00Ja) Ja $.
How Do You Pay for “Dr. On Call”? • Pay as part of your normal cellular telephone bill • Pre-paid Dr. on Call calling card • Cellular calls overseas anywhere anytime • Co-branding of Dr. On Call Cards • Re-imbursement through health insurance coverage.
National (Intranet) Network Consultations ( Tel-med-serve) • Data, Voice & Video, Integration over a secure national telemedicine broadband IP network backbone • Consultations / referrals between and among health and allied institutions and personnel in the public & private health sectors. • Capture & storage of data voice and video conferencing clips • Online video conferencing, peer to peer & multicast • MOH Telephone and IP-Telephony Service • Ethical Web based health records / information management system
Massachusetts Tech. Collaborative; (October 16th 2003 Report) • Report Highlights Application of 7 EMR health care technologies: • Improved quality • Decrease overall claims costs • Reduce errors • improve patient satisfaction and overall care • Expanding coverage • Potentially saved $2.48 billion us
Web Based EHR for All Drs, Health Institutions / Health & Allied Personnel Developed For Global use Version 1 • Office Schedule Module • Hospital / Institutional module • Institutional/Field database integration • Interface c 3rd party Scheduling • Billing Module • Interface c 3rd party Billing • Lab / HL7 interface • Soap notes • Medical/Surgical procedures • Online consultations • Prescriptions • Drug interactions • Connect Multiple Locations • Wireless access to the service • Voice recognition • PDA compatible • Cell phone compatible • Capture and Store images (Using Lead Tool Components) • Multimedia patient file storage (Using Lead Tool Components) • Digital imaging (Using Lead Tool Components) • Reminders • Bilingual / Multilingual • Unlimited # of Active Users • Web Site interface • E-mail contact NEWUNIMEDICS EHR: At What Cost ? LOW
OFF-SHORING (Export Niche) • The export of Health Services to Third Countries • Off-shoring market already developed between USA India & Thailand • Pilot Projects presently testing protocols • Pilot Projects to develop health export business models being tested • Pilot Projects to establish Centers Of Excellence (COE) in Jamaica & the Caribbean
The Scope Of Health Tourism Full Telemedicine Coverage Healthy-----------At Risk- Early Sickness-- Late Sickness---------Recovery Wellness At Risk– Early Sickness Late Illness Recovery / Convalescence Recovery / Geriatric Convalescence Health Tourism Wellness Health Tourism Medical (Off-shoring) Health Tourism Spas / Wellness Centres Ecotourism Centres / Alternative Health / Ethno medicines/ IntegratedHotel Services WellnessHealth Tourism Diagnostic/ Ambulatory /Off-shoring/Medical & Hospital Services Medical Health Tourism Recovery / Convalescence Centres Lifestyle change Alternative Health/ Ethno medicines / Specialized Elderly Institutions Off-shoring & Hotel Services Convalescent Health Tourism Copyright: Dr. Winston Mendes Davidson 2004-09-29
Caribbean Health Tourism / Telemedicine Infrastructure For Sustainable Services • Cost competitive advantage (much lower costs) with very little structural change for Health & Tourism integration to achieve sustainability • Internationally recognized Health Institutions • Excellent Professional training (repute) of Drs. & Nurses in Caribbean • Low cost geriatric health tourism opportunities • “The Mendes-Davidson Model” Integrates diverse tech. platforms to derive Health info-management and economic synergies • Available broadband IT platform
Caribbean Therapy Hotels Must Be Professionally Branded Develop the highest therapeutic Standards Should begin as classy cottage type low maintenance facilities High level trained health service teams Telemedicine Services for prompt intervention Home type sun & sea type care facility with entertainment Caribbean Health Tourism “The Hotel is a Hospital (therapeutic centre) for well people, while the Hospital (therapeutic centre) is a Hotel for ill people” (W. Mendes-Davidson, 1997).
Is Training Available?Human Capacity development (Training) The telemedicine certificate training project
Training for export of Services Core Concept The fusion of health, education and tourism and the preparation of human capital for its implementation Target Population 1. Doctors / Dental Surgeons 2. Nurses 3. Pharmacists 4. Allied Health Workers 5. Educators; Human Resource Capacity Development (HRCD) Personnel 6. Tourism / Hotel / HRD Personnel 7. General population (Wellness / Life style / Alternative Health Therapists)
What Are Our threats? • The Lack Of: • Professional Will • Entrepreneurial Will • Appropriate Business Models • Political Will • Willingness to share techs with Atalacc partners