simmons telehealth haiti-earthquake-relief-recovery
DESCRIPTION
An overview and lessons learned from our University of Miami/TRANSCRIPT
Telehealth for Haiti earthquake relief & recovery
Scott C. Simmons, MS Director of TeleHealth
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
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
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
University of Miami/Project MediShare
Field Hospital
Port Au Prince, Haiti 2010
Sleeping Tent
Peds Tent Adult
Tent
Supply Tent
IsolationTents
Command Center Reception
Showers Port-a-Johns Urinals
Airport Perimeter Wall
Chain Link Fences
Supplies (exposed)
UMH-Haiti Site Layout
Sleeping Tents
ORs ICU
N
On-site communications
Access Haiti Satellite Internet
Amateur Radio Hughes BGAN
UMH-Haiti connectivity
VSAT-A
VSAT-B
Access Haiti
IP Phone
Ricoh Printer
Laptop
IP Phone
Juniper Router
Cisco POE
Switch
HP Printers (2)
Command Center
Laptops Linksys Router
Linksys Router/AP
Internet Cafe Laptops
In Reception
Tent
In Reception
Tent
In Command
Tent
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
Technology considerations in HADR operations
Basic requirements • Deployable assets • Reach-back comms • Gateway services • Completely self-reliant • Multimode – Real-time & store-and-
forward
• IP-based
On-scene: workflow IT • Registration/Intake – Identity – Triage
• EHR • Inventory – Supplies – Pharmacy – Resupply ordering
On-scene: TH hardware, software • Imaging – Visible light – Radiographic
• Biomed devices • VTC/multimedia
collaboration • Local wireless • Satcomms • Power
Gateway services • Consult distribution • VTC bridging • Database hosting • Identity management • Credentialing • Resource allocation
Other considerations • Training • Psychosocial support – Social N/W-ing – Voice/video calls – Entertainment
Humanitarian telehealth
• Reducing barriers to charity care – Travel – Security/safety
• Training of in-country health professionals
• Pre-travel screening & post-travel f/u
Characteristics of an idealized HADR telehealth system
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
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
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).
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)
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
Convenient, connected care.
