Telemedicine Experience in Latin America

“MANIAPURE program in Venezuela”

ATA/ATALACC

Panama,Aug.17 2008

Eng.Morel Orta/Tomás Sanabria M.D.

Pintor Walter Arp ,< 1965 buscando el gallito de las Rocas llegó a Maniapure

ManiapureManiapure Naturaleza y ciencia

We work in very isolated communities

Where do we come from?

Where do we come from?

Centro la MilagrosaManiapure regionCedeño districtBolívar State, Venezuela

Centro La Milagrosa - Maniapure

Primary care at Centro La Milagrosa ADS

Medicine : one MD on his Rural year & clerckships with 6th year medical students UCV

> 400 patients monthly at CLM

Last year Dental Medicine students from UCV y USM universities and others

Dental primary care since 1998 Centro La Milagrosa ADS

Clinical Lab & Bioanálisis

students UCV since January 2001

A Physician and comunication made the difference !

before after

Our Experience

Nombre: Marta Alicia Flores CardozoEdad: 5 añosLugar de Nacimiento: Túriba, Municipio Cedeño, Estado BolívarLugar de Procedencia: El Mismo.

Motivo de Consulta: Cianosis Peribucal.

Enfermedad Actual:

Pre-escolar femenino de 5 años de edad, natural y procedente de Túriba, cuya madrerefiere que presentó cianosis peribucal en dos oportunidades, de aproximadamente 20minutos de duración y que se relacionaba con la actividad física, por lo cual consulta a estecentro el 29 de Agosto de 2001.

Antecedentes Personales y Familiares: No contributorios

Examen Funcional: Disnea a moderados esfuerzos de 6 meses de evolución.

Examen Físico:Frecuencia Cardíaca; 100 lpm, Frecuencia Respiratoria: 20 rpm. Peso:16kg, Talla: 103cm

Paciente en buenas condiciones generales, afebril, hidratada, consciente.Palidez cutáneo mucosa discreta.Exámen Cardiovascular.Pulso Venoso Seno X dominante a 1 cm del ángulo de Lewis. a 0° de inclinación.Impresiona latido sistólico paraesternal izquierdo. Apex en 5EII con línea medio clavicular,de ascenso normal. Ruidos cardíacos regulares y rítmicos. 1R único, de normal intensidad,se ausculta soplo holosistólico II/IV, de mayor intensidad en la línea paraesternal izquierda,desde el apéndice xifoides hasta el 3er EII, no irradiado, 2R único, con componentepulmonar aumentado de intensidad, diástole silente. Abdomen blando, depresible, nodoloroso, sin visceromegalias, Miembros inferiores sin edema, pulsos periféricos presentesy simétricos, de características normales.

Impresión Diagnóstica: Comunicación Interventricular.

Se realiza hematología completa, donde se reporta Hemoglobina 11.6 g/dl,Hematocrito: 36%, Eosinófilos 21%. Hipocromía y Microcitosis.

Radiografía Posteroanterior de Tórax. Relación cardiotorácica de 0.6 con aumento de latrama vascular pulmonar en ambos campos pulmonares.

Se anexan fotografías del ecocardiograma realizado, así como de la radiografía detórax y el EKG de 12 derivaciones más derivaciones derechas.

•Rural MD makes primary evaluation• second opinion request vía Internet.•Confirmatorio sub-specialty consultation• we have been able to solve complex cardiovascular and neurosurgical cases without delays.

Top Specialty doctors available for the most remote regions

Our Experience

Wonken - Municipio Gran SabanaOur 13 yearExperienceReproduced in 3 months

WONKEN - Gran Sabána - WiFiWONKEN - Gran Sabána - WiFi

Our Experience

Who are we ?

Telesalud de Venezuela is a private company created by health and IT professionals whose experience originated in the Maniapure project.

The company is dedicated to provide telemedicine services to rural (and more recently urban) areas of Venezuela . Our program continues to be free of charge to the Maniapure project, but for other clients, services are being financed by private and public institutions, as part of their social responsibility.

Ability to solve problems fast

Our team follows the community wills

Independance in transportation

Multidisciplinary team

Dedication and love for our work

Our Experience

Some results from La Milagrosa clinic

• 13 years of telemedicine (radio, phone, fax, Internet)• 14 MDs on their rural year (one year each) • > 450 clerckship students on health related sciences • > 100 volunteer clerkships (France, Spain,USA,GB ,

Japan,Egipt,New Zealand etc)• 1.500 patients/month seen ( regional centers).• Aproximately 5% requiere teleconsultation.• Aproximately 20% of teleconsults require referal.

Our Experience

Our Experience

Active centers

BroadBand Internet• ADSL• EVDO• WI-FI

Laptop or portable device

Application Server

Firewall

Web Server

Virtual Triage Center

Specialty MD

BroadBand Internet• ADSL• VSAT• WI-FI

Rural clients

ECG PC

Scaner

Printer

Microscope Digital Camera

Digital video camera

Laptop

VoIP phone

Portable Lab

Technical Platform

Our Operating Model

Operating Model

Virtual Triage Center (VTC)

Rural health prof.

Remote clients

Rural Clinic Rural Hospital Other clients

Internal MedicineInternal

Medicine DermatologyDermatology ParasitologyParasitology CardiologyCardiology E.N.T.E.N.T. Trauma-Orthopedics

Trauma-Orthopedics

Specialty MD’s

Second opinion Web based application

Broad Band Internet

Internal Medicine specialist

Second opinion Web based application

Broad Band Internet

Virtual Triage Center (VTC)

Virtual Triage Center (VTC)Remote client

• Generates teleconsultation and sends it to VTC.

• Receives answer from VTC and makes decision by his own criteria.

• Consults medical literature online.

• Demands second opinion at medical sub-specialty centers. (fourth level institutions).

• Generates teleconsultation and sends it to VTC.

• Receives answer from VTC and makes decision by his own criteria.

• Consults medical literature online.

• Demands second opinion at medical sub-specialty centers. (fourth level institutions).

Specialty MD’s

• Physician at VTC receives second opinion request and answers general specialty questions.

• Forwards sub-specialty questions to sub-specialty related health care professionals.

• forwards to clients answers received from sub-specialty physicians. .

• Generates service statistical

data and billing information for administrative purposes.

• Physician at VTC receives second opinion request and answers general specialty questions.

• Forwards sub-specialty questions to sub-specialty related health care professionals.

• forwards to clients answers received from sub-specialty physicians. .

• Generates service statistical

data and billing information for administrative purposes.

• Afiliated sub-specialty physician receives and answers requests received from VTC.

• Afiliated sub-specialty physician receives and answers requests received from VTC.

Processes

Operating Model

Telesalud Web page

Operating Model

We can offer a wide range of services among which :

• Second medical opinion services.

• Consultation and site assesment for the installation

of rural telemedicine services.

• Telemedicine project management.

• Telemedicine web based application design.

• Telemedicine equipment providers.

• Telehealth personel education and training.

What can we offer ?

What can we offer?

People with needs(patients &

communities)

technology

Human resources(universities & local)

$$Financial resources

telesalud

Telemedicine components

Technology

Human Resources

Knowledge & Experience

•Software and applications•Telecomunication•Hardware & software (TI)•Medical equipment

•Students and clerckships•General Practitioners•Subspecialties (Health & Technology)

Training

What can we offer?

Dr.J.R.Arosemena’s visit to Maniapure-LaUrbana-Tumeremo-La Esperanza-Uriman and Kamarata

12 Flying hours

La Esperanza -Guyana border50 kms in 3 hours.First Internet conexion on Sat.Jan 19 2008 at 11 pm…

Where are we going ?

January 2008 - Urimán

ATALACC President , Dr J.R. Arosemena ,visits Uriman at gives advice to “microscopist”

Where are we going ?

PC-ECG con USB y sala Telemedicina

Urimán

Flagstaff

( 3ra ciudad de Arizona)

Tuba CityLearning from Others…

Ecocardiografía = vía Internet

Colorado valley / near Maniapure

May 2008

telecardiology

Tele-ophtalmology ?

Colorado 2008 evaluation results:-470 patients screening for tropical diseases.->200 patient ophtalmol. Evaluat.-25 echocardiograms (2 surgical congenital cases detected / ASD and VSD).

PortableLight™ project

portableLight can be charged in 3 hours of sunlight and provide 8 hours of working light (100 lumens) and connected provide energy for small medical equipment.

Curiapo – Orinoco Delta

First “Excelence Price” for 2008

From: "Proyectos" <proyectos@venezuelacompetitiva.com>Subject: DATOS REUNIÓN CASOS GANADORES PREMIO A LA EXCELENCIA 2008Date: August 11, 2008 5:21:38 PM GMT-04:30To: <tomasana@cantv.net>, <tomasana@mac.com>2 Attachments, 6.6 KB Save SlideshowEstimado Dr. Sanabria,Tal como conversáramos hace un momento, el día viernes 15 de agosto estaremos realizando lapresentación de los casos ganadores 2008. La reunión se realizará en la sede de nuestras oficinas:Dirección:Campo de la Universidad Metropolitana, Centro de Artes Integrales (Colina Creativa), Módulo 3, PlantaAlta, Terrazas del Ávila.La hora de la reunión: 9:00 amPunto de referencia para llegar: Como quien viene a Supermercados Éxito, en el portal de la UniversidadMetropolitana encuentras dos puertas: Entra por la izquierda que dice Universidad Metropolitana, y en laprimera sigues a mano izquierda (como quien va al Colegio Ávila). Allí está el estacionamiento y la ColinaCreativa. El modulo 3 está justo encima del Gimnasio.Para nosotros será un honor contar con su presencia. FELICITACIONES!Cualquier otra información adicional, puede comunicarse con nosotros.Cordiales saludos,Andreina

thank you !!www.tele-salud.com www.maniapure.org