Telemedicine in Maldives

Regional Consultation on Telemedicine: Sharing Experience and a way forward

by: Dr. Mohamed Ali

Dr. Nusaiba Farouk Hassan

OverviewDemographyEvolution of E-Health and TelemedicineCurrent Scenario

Strategic DirectionInnovations and applications of eHealth and

telemedicineStrengthWeaknessOpportunityThreatsThe way forward

DemographyAn archipelago: 1192 IslandsInhabited: 200 islandsPopulation: 360,000 Distribution:

Largest: Over 100,000 in Male’ CityArea: 90,000 sq km ( sea)Ethinicity - Asian

Background In constitution: The right of every citizen to

access good quality health services is protected.

The Government: Constitutionally mandated to realize this right for all.Guiding Principles;

Recognizing Health as a human right and its universality

Ensuring equitable access to affordable, quality health services based on primary health care approach

Harnessing solidarity for health in all national policies

Ensuring policy development based on facts and scientific evidence

Vision for Health: Improving the quality and affordability of

health care with a focus on access for all. Goal for E- Health:

Providing standardized high quality medical services, by using interoperable, compatible, reliable, and scalable E-Health solutions such as telemedicine, HIMS, whereby all residents of Maldives have equal access medical expertise available in the Maldives as well as internal medical care institutes.

Strengths:ICT is one of the fastest growing areas in

HealthExisting institution based programmes /

databases National ID Nos are being entered to

independent systems, which can be used as a unique patient identifier

Large potential for M-Health; extensive use of mobile phones and related devices

Major Healthcare initiatives in place:

Online Nutrition and Child Health Surveillance System (ONCHSS)

SEARO Integrated Data Analysis System (SIDAS)

Hospital Information System (HIS)E-Government Portal for online birth and

death registrationNeonatal/Perinatal Database

E – Health ObjectivesEstablish an integrated health information

SystemImprove access and quality of health care

given to general public using E-HealthStrengthen the capacity to monitor health

indicators and conduct system reviews in a timely manner

Facilitate efficient emergency or disaster management and timely decision making in health emergency situations

Specific Strategies Establishment of a governance structure to deliver the E-

Health StrategyUnique citizen identifiers for a common health services and

health insurance Implementing TelemedicineAvailability of needed health information at a national level in a

timely manner Implement consumables management information systemBegin introduction of more clinical information systems and

EPRsExpand use of M-Health Invest in computing infrastructureAccess to broad-band servicesAdequate communication of E-Health strategies

Current Investments, goals and plans:

Patient centered information systemsElectronic Health Record SystemsTelemedicineInformation DatabasesPreventive Health Services using Mobiles

Telemedicine in MaldivesVision: Provide a telemedicine solution to

Maldives which is compatible, scalable, reliable and inter-operable. The objective is to upgrade the quality of health care and minimize the cost of medical care through effective acquisition of relevant clinical information at remote sites. And also to ensure that all residents of Maldives have equal access to high quality health services regardless of their location.

Telemedicine in Maldives• Objective: • Enable people in islands to use tele-consultation and

avoid travel and support continuing medical education:

• Implemented in II Phases

• Aiding agencies• Integrated Human Development Project; World Bank• Khalifa Bin Al Nahyan Foundation; Abu Dhabi

Implementation:• Phase I: Integrated Human Development Project;

World Bank Telemedicine: 4 Main hubs connected on 5th May

2010 Indhira Gandhi Memorial Hospital – Central Kulhudhufushi Regional Hospital - North Thinadhoo Regional Hospital – South B. Eydhafushi Hospital

Phase II34 New Centres joined Telemedicine Network

under Khalifa Bin Zayed Al Nahyan Foundation; Abu Dhabi: 20th November 2011

Two componentsTelemedicine Kiosk and EquipmentTraining Component

70 Nurses 10 Specialists; Biomedical Engineers, Obstetrician

Gynaecologists, Paediatricians, Surgeon and Physicians

4 Referral Hospital and 34 Remote pointsHdh. Kulhudhufushi Regional HospitalIndira GandI Memorail HospitalGdh. Thinadhoo Regional Hospital S. Hithadhoo Regional Hospital

Current SituationSporadic CasesNo designated personnel Trained staff unavailable to provide serviceInsufficient attention to Telemedicine due to

inadequate number of Clinicians at referral centersExpensive equipment under lock and KeyNo existing referral systemUse of M-Health; applications like what’s ap for

case discussion by Clinicians

AIM: Strengthening of existing services

Map I

Innovations and Applications of E- Health / Telemedicine

Tele-Education Department of Child Health, IGMH and AIIMS, New Delhi Dengue Season 2011; CMEs in all 4 Centres Staff at Thinadhoo Regional Hospital had participated in

the Workshop on Management of Dengue Cases conducted in association with WHO and QSNICH via tele-education 2011

Telemedicine Potentional for development

Dermatology Pathology Radiology Orthopaedics General Medicine /Paediatrics

StrengthsHigh Priority Project for Ministry of Health

and FamilyHealth workers at remote points are

motivated to learn and maximize use of Telemedicine

Clinicians at the Referral Centers are committed to attend to cases

Human Resource Development

Weaknesses Central

Lack of an Alert System Unaware of the enhanced equipment availability Remote points Inadequate number of Clinician to attend to inpatient and outpatient facilities, hence

telemedicine is not made a priority No designated personnel / infrastructure 1:38 Ratio of telemedicine carts; central: peripheries

Peripheral High turn over of trained staff Nurses trained under Telemedicine project refuse to go back to the island Inadequate infrastructure and power supply at HC to support equipment Unavailability of Medications and Basic investigations

Common Telemedicine Network has not been integrated with the Hospital Networks No networking between focal points Lack of awareness among doctors about Telemedicine License for teleconferencing has to be purchased; hindrance for tele-education Lack of awareness among clinical staff and management at the hospitals Lack of telemedicine trained specialists Referral centers do not have telemedicine links with Regional Centres abroad

OpportunitySAARC Telemedicine ProjectCollarboration with Regional Centres;

AIIMSReduce expenditure on Health insurance

referrals to male’ and abroad.Gain the confidence of the public in the

health sector

ThreatsRemote island losing hope due to failure to

attend to cases promptlyLack of maintenance of equipment may lead

to loss of equipment performanceReferral centres do no have the necessary

consultants

Way Forward Encourage doctors to utilize telemedicine To integrate M-health in to the telemedicine system officially To train the personnel responsible for the telemedicine and assign roles To assign personnel to manage the telemedicine equipments and to give

responsibility of maintaining them To assign login responsibilities to the individual doctors, rather than the institute To include teleconsultation in the duty roster To assign CME points in return to the tele-consultation hours spent To give bonus salary for the cases spent on tele-consultation To give preference to tele-radiology To provide basic equipments to the remote kiosks, like USG machines, ECG

machines and X-ray machines and maintain the supply to the basic laboratory investigations

Assign budget for telemedicine WHO and other NGO’s support to implement these services and to train personnel In assigning the login responsibilities, the MOH should assign license to tele-

medicine Include tele-consultation in National Insurances’ (ASANDA) patient evacuation

system, to minimize the cost of improper referral and improper referral diagnosis thus reducing cost of referral system.

ConclusionTelemedicine is a great promise to Maldivians

to achieve better healthcare without having to travel by highs seas to the nearest referral centre, and then inevitably to the capital.

Telemedicine is the alternative route to achieving the best possible treatment rather than referring abroad for issues which can be resolved within the country, hence better utilization of resources.

Thank You!