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Published on February 20, 2008

Author: Virginia

Source: authorstream.com

The Challenge of Spreading Telemedicine over the Third World: Open-Web Telemedicine Framework:  The Challenge of Spreading Telemedicine over the Third World: Open-Web Telemedicine Framework M. Fregonara Medici Information Systems Dept. A.O. San Salvatore F. Giani Educational Dept. CEFRIEL Tromsø Telemedicine and eHealth Conference 2006 BEYOND TOMORROW Summary:  Summary Scenario Health and Telemedicine in the World Telemedicine Needs in Third World Telemedicine Project Funds and Costs Reasons Telemedicine Maintenance Costs Telemedicine Projects Strategy Proposal Common Telemedicine Framework Open- and Web- Sources Provider Network: Mission, Approach, Activities Covering of Expenses Conclusions Health in Third World:  Health in Third World New diseases emerge from the Third World (developing and underdeveloped countries) where faltering economies arrested the introduction of the effective healthcare programs The rapidly widening medical gap between the industrialized countries and the impoverished regions produced an “incubator” for medical and healthcare problems of potentially world-wide impact Health in Western World:  Health in Western World The global population have hardly any access to even the most essential forms of medical care, while the richest countries spend a lot of money for new medical techniques to combat mainly “disorders of well-being” The health product sector in the industrialized countries should also invest their budget to support and to aid the dissemination and improvement of healthcare in Third World Telemedicine in Third World:  Telemedicine in Third World Telemedicine represents the solution for the Third World when referring to support long-distance medicine, and to delivery healthcare services and information to people in underserved communities Its benefits can include local accesses to specialty care, enhance the primary-care services, and increase the availability of medical education and health information resources in not very medically areas TLM Needs in Third World:  TLM Needs in Third World The Third World needs Telemedicine services with the following basic characteristics: simple, effective, supported and trained The general situation of Telemedicine in the Third World is difficult and embarrassing: Outdated medical equipment Scarsa presenza di medici e infermieri preparati infrastruttura e tecnologie ICT minimali e poco sofisticate low-bandwidth, unsafe and difficulty connections applicativi telemed proprietari o di ricerca TLM Project Funds:  TLM Project Funds The most international Telemedicine programmes use organisation funds and, for these reasons, the project duration is bound to the financial support: International finances Organisation funds Charitable donations Partner-/Sponsor-ships Voluntary society’s supports Fee-for-service At the end of this period, there is no more maintenance and updating of the ICT systems, and the Telemedicine services are no more assured TLM Project Costs:  TLM Project Costs Project costs are divided into two categories: non-recurring (one-time) and recurring (on-going) costs Both costs may be further subdivided into fixed and variable costs (those costs change depending on the number of users, sites, cases and overall utilization) The typical costs could be even split-up in timeslot: initial, current and future The costs originated, directly or not, in the first five steps of the system activation phase are covered by the telemedicine project funds Problem: who and what keeps alive the telemedicine projects after their end ? TLM Maintenance Costs:  Who and what covers the maintenance expenses of telemedicine projects at their ends ? TLM Maintenance Costs The future and recurring (6th-step) costs are: Personnel salaries & benefits Users’ and Technicians’ support Software assistance Refresher training Hardware maintenance Medical equipment replacement Supplies and miscellaneous Telecommunication costs Project management staff End-user reimbursement General TLM Strategy:  General TLM Strategy telemedicina nel terzo mondo necessita di: apparati medicali -> pagati con fondi internazionali, donazioni, omaggi di produttori scaricati da tasse, servizi telemedicina pagati tra western country, progetti internazion e donazioni; tempo medici -> pagati con fondi internazionali, donazioni e servizi telemedicina tra western country, volontari; costo telecom -> pagati con fondi internazionali, donazioni e servizi telemedicina tra western country, progetti internazion e donazioni, utilizzo di tecnologie semplici, poco prestazionali Low bandwidth e a basso costo; infrastruttura e tecnologie ICT -> sempre più cheap, utilizzo di tecnologie semplici, a basso costo e velocità, riciclaggio -> pagati con telemedicina tra western country, progetti internazion e donazioni; applicativi telemed -> sviluppare applicativi free, reusable e open source pagati con fondi internazionali, donazioni The corner stone:  The corner stone The main ICT services used in Telemedicine are: computer networking, interactive desktop sharing, direct links to health care instruments, data transfer, image transmission, communication by VoIP, etc The connection infrastructure is the corner stone of all the Telemedicine systems The proposal is the realisation, the governance and the maintenance of a common “Transport Layer” for all the Telemedicine systems, especially used for projects over the Third World New Proposed Strategy:  New Proposed Strategy Create an international consortium of Telemedicine providers Diversify the post-project finances Create a common framework for the Telemedicine projects Develop an open-source infrastructure Realise web-based service applications Execute a distance-learning services for the training especially of people over the Third World TPN - Mission and Approach:  TPN - Mission and Approach The proposal goal is to create an international consortium (TPN - Telemedicine Provider Network) for managing a set of ”scope” elements of telemedicine projects through a common ICT framework: Subject (contents and applications) Connectivity (communication, integration and networking) Organisation (managing and funding) Provision (resources and facilities) Equipment (ICT devices and technologies) What is TPN ?:  What is TPN ? International centres, as permanent part of WHO (World Health Organisation), should set up a cooperative network of excellence among telemedicine service providers The proposal consists of creating an international consortium (TPN) to develop and to maintain a common framework to share and to integrate the basic Telemedicine ICT services Therefore the TPN should take care of using recycled devices, cheaper technologies, and low-bandwidth solutions ISfT (vedi articolo) Why open-web sources ?:  Why open-web sources ? Advantages: Freely available source code Right to redistribute modifications and improvements High motivation for developers Excellent support networks, but informal and unaccountable No licences fees Product release distribution is very easy Clients do not need local installation The TPN must maximize these advantages Why not open-web sources?:  Why not open-web sources? Disadvantages: No single entity decides the future of software No guarantee on quality and development goals Code contamination Limited knowledge of the project current status Many third party software packages are not compatible with open source The network performances are very important for usability The TPN must govern the disadvantages and turn them to one's own advantage What does TPN ?:  What does TPN ? First of all, the TPN should analyse the successfully telemedicine systems and services The second step consists in the selection of the best-practice solutions from the points of view of application reusing and integration on a platform The next step consists in sharing and integrating the selected solutions into a common open-source web-based infrastructure (Open-Web source Telemedicine Framework - OWTF) for the main ICT services Afterwards, the TPN should also manage the maintenance of the framework and spreading out its knowledge and usage, especially over the projects for the Third World Who pay TPN ?:  Who pay TPN ? Another source of funding for the TPN should be the fees paid for Telemedicine services by healthcare centres in the industrialised countries. Conclusions:  Conclusions The proposal is to create an international consortium (TPN) to develop and to manage the maintenance of an unique and common ICT framework (OWTF) and for spreading out its knowledge and usage in Telemedicine projects The OWTF maintenance is free for the Third World Centres and is mainly covered by the fees for using the framework between Western Healthcare Centres This solution could represent the first step for an effective challenge of spreading Telemedicine projects over the Third World Thanks for Your attention !:  The Challenge of Spreading Telemedicine over the Third World: Open-Web Telemedicine Framework Mario Fregonara  Information System Dept.  Azienda Sanitaria Locale - Milano 3  p.le Cinelli, 4 - 61100 Pesaro (PU) - ITALY  (+39) 0721 366.365  (+39) 0721 366.365  m.fregonara@ospedalesansalvatore.it Thanks for Your attention !

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