TES América has successfully
implemented the first integrated telemedicine system
in the department of Meta, Colombia. The system,
which began operating in April 2009, interconnects
29 municipalities in rural areas using fixed
satellite service.
MAIN OBJECTIVES
To design and implement an
integrated solution to facilitate delivery of
specialized medical diagnosis services to 28 rural
municipalities by the main hospital located in the
departmental capital (Villavicencio).
To generate the greatest possible
social impact by maximizing the existing resources
in each hospital and taking into account the most
frequent diseases in the department.
To promote use of the system and
train medical and support staff from the
Villavicencio hospital and the 28 municipalities.
SPECIFIC OBJECTIVES
-
To provide interactive
diagnostic services and videoconferencing
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To receive and send diagnostic
images in record time
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To streamline diagnosis by
specialists
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To make diagnosis more accurate
with high medical quality
-
To improve the medical quality
of treatment decisions
-
To provide second opinions on
diagnosis and treatment
MAIN CHARACTERISTICS OF THE
SOLUTION
Total municipalities installed:
29 (see map)
Departmental capital:
Villavicencio
Referring hospitals: 28
Reference hospital: 1
(Villavicencio Departmental Hospital)
Space segment: SATMEX 5 satellite
in Band C, 1 MHz bandwidth used.
Earth segment: 28 1.8-m VSAT
stations, orthogonal polarization, one 2.4-m VSAT
station, orthogonal polarization, in the city of
Villavicencio
Location of the department in
Colombia
Location of the hospitals
SERVICES IMPLEMENTED:
TES-TMI (Traffic Medical
Information) (Triage) software
Web Collaboration clinical and
emergency interconsultation
Tele-radiology
Tele-dermatology
Tele-obstetrics–tele-gynecology
Tele-cardiology
Tele-Clinical laboratory
Digital clinical history (DCH)
Tele-radiology
In general, most hospitals in the
municipalities of the departments have X-ray
equipment; some handle fixed plates only.
What is important about this
service is that most hospitals have a radiology
technician but no radiologist, making the
plate-reading service through the system offered by
the reference hospital in Villavicencio fundamental.
Tele-dermatology
The high prevalence of
dermatological diseases in children and adults makes
implementing this service in the municipalities a
priority, especially since Colombia’s dermatologists
are concentrated in the major cities. In addition,
dermatological symptoms are often directly related
to systemic diseases, such as leishmaniasis.
Tele-cardiology
This means the support of
primary-care physicians by specialists in cardiology
and maternal care. The system uses digital
phonendoscopes, fetal monitors and ECG so that the
specialists in the reference hospital have
sufficient data to resolve patients’ heart problems
and those of mothers in labor. Note that maternity
patients in the department of Meta present a high
level of pathology.
Tele-gynecology
This fundamental service for
addressing pathologies in patients in the various
areas should contribute to the timely diagnosis of
gynecological and obstetrical diseases (e.g. uterine
cancer). A specialized videocolposcopy system for
telemedicine was installed so that the different
pathologies—whether infectious or contagious or
suspected cancer—could be remotely diagnosed.
Digital clinical history (DCH)
In the project for Meta, Digital
Clinical History (DCH) software was implemented in
the twenty-nine (29) municipalities so that their
inhabitants’ disease history could be tracked on a
single form in a single database.
The DCH software complies with
Colombia’s Law 23, Law 3380 of 1981 and Decree 1995
of 1996 on the confidentiality of information.
ECONOMIC ASPECTS OF THE SOLUTION
This is the first telemedicine
system installed in Colombia. Its applications are
distinguished by providing a series of treatment and
financial benefits that help maximize resources, as
can be seen below:
-
Access to a specialist’s
opinion by primary-care physicians or physicians
in remote villages
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Substantial improvement in the
quality of medical care
-
Savings on diagnostic media
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Savings on travel to the health
system and to patients
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More efficient use of resources
-
Expensive equipment covers its
cost in less time
-
Substantially quicker response
time for medical decisions
-
The results from a single test
are useful for different treatment levels, and may
be consulted with no time limit, thanks to
computer storage.
Cost reduction
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Reduction of costs due to
patient transfers
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Reduction in treatment and
decision-making times
-
Elimination of duplicate
examinations as a result of the system
-
More information when patients
are referred
-
Fewer diagnostic examinations
-
Decrease in diagnostic and
therapeutic errors
-
Greater monitoring and control
-
Optimization of human resources
-
Better control of spending
It is customary for patients to
be transferred between different cities in Colombia
when the diseases they present with require
specialized care which small hospitals cannot
provide, due to their installed capacity. This
circumstance increases costs for those hospitals,
given that critical patients are usually transferred
by air. Note that critical patients are transferred
with at least two persons—a doctor and/or nurse and
a companion.
The decision to refer patients is
taken by the primary-care physician in the small
hospitals within two or three hours, once the
patient has been evaluated and stabilized. With the
telemedicine system installed by TES AMERICA, this
valuable time may be used by the primary-care
physician to carry out the necessary consultations
using TES-TMI and Web Collaboration (real-time
video-conferencing) software with the staff of
specialists at a higher-level hospital, in this case
the one in Villavicencio, the departmental capital,
which logically provides that physician with
first-hand access to valuable opinions for patient
care. Therefore, if referral must take place, there
are two advantages currently not available in our
country:
1- The decision to refer can be
taken jointly with the specialist(s) involved with
the pathology being addressed by the primary-care
physician.
2- If the decision is to refer
the patient, the specialist in the reference
hospital knows in advance in what condition the
patient will arrive there.
One factor that is directly
linked to this conduct is that the telemedicine
system implemented by TES AMERICA will frequently
prevent the unnecessary referral of patients and its
related costs, as primary-care physicians can manage
different pathologies in their workplace with good
guidance from specialists.
RELEVANT SOCIAL ASPECTS
Around the world, telemedicine is
increasingly playing a leading role as an empowering
factor in the delivery of health services for
primary-care physicians, specialists and patients.
In the specific case of the
department of Meta, Colombia, telemedicine is
clearly assuming an important role with respect to
the delivery of health services for many reasons,
including the number of persons lacking specialized
care, the distance at which inhabitants are located
within the department’s territory and the topography
of the department.
The medical assistance currently
provided to inhabitants of Meta is personalized,
which means that health care is physically provided
in actual hospital facilities.
Establishment of the telemedicine
system for the department of Meta has significant
advantages, such as the following:
Immediate access by the
population to specialized care from physicians at
the Departmental Hospital in the city of
Villavicencio, regardless of where they are located,
as this type of technology allows permanent
connectivity to the small hospitals located in all
of the department’s municipalities.
Better quality of medical care
for the population, since primary-care physicians
can effectively and rapidly communicate with
specialists located at the Departmental Hospital in
Villavicencio.
Substantial savings on diagnostic
media since, in private and public Colombian health
institutions, it is not unusual to see duplicate
examinations when patients are referred to a
high-complexity hospital.
Greater effectiveness when
referring patients from primary-care establishments
(small hospitals, total of 28) to the reference
hospital for critical pathologies. This means that
the decision to refer a patient can be made jointly
with specialists in the Villavicencio Departmental
Hospital, once the patient has been properly
stabilized using the telemedicine system, thus
significantly reducing complications and mortality.
Reduction of economic and social
costs related to patient transfers, as people with
different pathologies are all too often referred to
medium- and high-complexity institutions when they
could be treated at the primary-care site with
proper guidance from specialists through a
telemedicine system.
Less time to make treatment
decisions for specific patients being treated in a
primary health-care institution.
Clear reduction of diagnostic and
therapeutic errors in primary-care centres, as the
primary-care physician literally has a staff of
specialists on hand through the telemedicine system,
which means significant savings on health
administration in the department.
Greater coverage with the
advantages already described for the department’s
population, given that, with the telemedicine system
installed, adults and children from all social
strata in the department benefit from good health
care.
EPIDEMIOLOGICAL ASPECTS
DEPARTMENT OF META, COLOMBIA
There are many scientific and
technological aspects and factors behind the need to
implement a telemedicine system in the Department of
Meta.
Telemedicine in South America is
just beginning. There is no country in which it has
been fully established to date, other than in the
department of Meta, Colombia. Specific experiments
are taking place in some regions, but from the
social and government policy point of view, it has
still not been implemented.
It is worth mentioning that in
Latin America, Colombia is third, behind Mexico and
Chile, for the best-established health care
structures, with a medical care system that provides
effective coverage for all socio-economic strata.
The pyramid structure of health care that was in
place ten years ago changed substantially with the
legislative reforms to the sector.
Today the country has a
horizontal structure for patient care that is
reflected in the stratification of public health
entities at levels I, II, III and IV (high
complexity). Keep in mind that a truly innovative
system, SISBEN, was established in Colombia to offer
health coverage to disadvantaged population groups.
This system provides medical coverage to the most
vulnerable and poorest people in the country. This
is consistent with the existing national regulations
for emergency care, which in general require that
care be provided to patients with critical problems
by any private or public entity, regardless of the
patients’ socio-economic status.
It is important to point out that
the health efforts being made by the Colombian
government in the department of Meta are major but
still have low coverage. This situation is primarily
due to the topography of the department, which,
although mostly flat, is quite extensive.
Establishing a telemedicine
service in Meta is a priority and necessary due to
its geographic location, the major problems with
public health and treatment coverage and the widely
dispersed population of this territory.
The scientific and technological
telemedicine project seeks to provide a
comprehensive health service focusing on the
following parameters:
Patient treatment
Access to specialized medicine
for disadvantaged communities.
FACTORS FOR SUCCESS OF
SOLUTION
Founded in 1999, TES América is a
dynamic young company that offers specialized
engineering services and puts together personalized
innovative solutions for the wireless
telecommunication industry. It is supported by its
research and development department in achieving the
best possible efficiency and optimization in the
solutions it offers. Its main characteristic that
should be emphasized is its neutrality, as it is not
connected to any equipment or technology supplier,
which gives it the freedom to design the most
efficient and competitive solutions on the market.
The solution focused on needs and
not technology; the technical solution was
configured by responding as efficiently as possible
to each need.
The services to be provided by
telemedicine reflect the epidemiological reality of
Meta, as the department’s morbidity-mortality
statistics were taken into account in designing the
solution.
Participation by medical and
scientific staff from the regions concerned, who
were involved from the initial stage of the project
and who have been trained in the concepts and use of
technological tools by the Faculty of Medicine of
the University of Rosario, with which TES America
established a partnership for such projects.
The system allows the delivery of
health services by transfer and referral through the
public health network in Meta.
With the technology installed,
medical personnel can establish high-quality data,
video and voice communications, connecting the
different hospitals and providing on-line technical
support to facilitate maximum use of the system.
Technologies successfully tested
in other countries in the world and approved by the
FDA are used.
Telemedicine serves as a support
tool for care in the event of disasters and cases of
force majeure.
TES América’s specialization
helped maximize use of the space segment with the
corresponding impact on costs and overcome the
interference problems that occurred in the city of
Villavicencio as a result of Wi Max systems, which
were resolved with RF filters.
Karim Nader y Daniel Rosas Tapia
Carrera 15ª 118-12, Bogotá Colombia
TEL 57 (1) 7433535
[email protected] |