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THE ROLE OF ICT IN HEALTH CARE DELIVERY Bugando Medical Centre Presented by Edson Joseph & Alfred Dandu What is ICT? ICT (information and communications technology - or technologies) is an umbrella term that includes any communication device or application, encompassing: radio, television, cellular phones, computer and network hardware and software, satellite systems and so on, as well as the various services and applications associated with them, such as videoconferencing and distance learning. ICTs are often spoken of in a particular context, such as ICTs in education, health care, or libraries. Presented by Edson Joseph & Alfred Dandu Health information technology (HIT) • Health information technology (HIT) is the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making. Presented by Edson Joseph & Alfred Dandu Three sections Telemedicine PAC (Picture Achieving Communication) Ward Lookup Presented by Edson Joseph & Alfred Dandu What is telemedicine • Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations. • Telemedicine (also referred to as "telehealth" or "ehealth") allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications technology. Telemedicine allows patients in remote locations to access medical expertise quickly, efficiently and without travel. Presented by Edson Joseph & Alfred Dandu medical professionals Presented by Edson Joseph & Alfred Dandu Telemedicine means. • • • • • VTC(Video Teleconfering) E-mails Mobile Devices(Cell-phones, Tablets) Radio calls. Online management systems Presented by Edson Joseph & Alfred Dandu video conference (video conferencing) • A video conference is a live, visual connection between two or more people residing in separate locations for the purpose of communication. At its simplest, video conferencing provides transmission of static images and text between two locations. At its most sophisticated, it provides transmission of full-motion video images and high-quality audio between multiple locations. Presented by Edson Joseph & Alfred Dandu VTC uses Presented by Edson Joseph & Alfred Dandu BMC - VTC Presented by Edson Joseph & Alfred Dandu BMC - VTC Presented by Edson Joseph & Alfred Dandu BMC - VTC Presented by Edson Joseph & Alfred Dandu E-mails • Messages can be categorized as either clinical or administrative. Structured clinical consultations, or evisits, are carried out by channeling encrypted email through a secure online portal linked to the patient’s electronic health record. The provider responds as he or she would in an office—for instance, by writing a prescription, ordering a lab test or imaging study, referring the patient to a specialist, or recommending a follow-up appointment. Such interaction can replace office visits for nuisance illnesses, saving patients the time, cash, and hassle of missing work and schlepping to the doctor’s office. Presented by Edson Joseph & Alfred Dandu E-mails Presented by Edson Joseph & Alfred Dandu Online management systems • Telemedicine software is used specifically to provide clinical care. Usually, telemedicine software connects patients with their doctors, or medical professionals to other healthcare providers. • These software are normally designed and developed by ICT engineers/Programmers following medical practitioners requirements.Presented by Edson Joseph & Alfred Dandu Online management systems Presented by Edson Joseph & Alfred Dandu Advantages of telemedicine Presented by Edson Joseph & Alfred Dandu More Convenient and Accessible Patient Care • In today’s healthcare world, convenience is key. • Patients who live in remote locations, or who are homebound or just can’t take off time from work, can access care virtually. Video conferencing, smartphone apps, and online management systems connect more patients with providers than ever before. Presented by Edson Joseph & Alfred Dandu Cost-efficiency. • An increasing number of doctors are charging less for a telemedicine consultation than they would for an inperson visit. • Telemedicine also reduces unnecessary non-urgent ER visits and eliminates transportation expenses for regular checkups. Presented by Edson Joseph & Alfred Dandu Extended Specialist and Referring Physician Access –With telehealth, patients in rural or remote areas benefit from quicker and more convenient specialist access. Presented by Edson Joseph & Alfred Dandu Increased Patient Engagement – When patients are committed to their own healthcare goals, it leads to lower costs and improved health. – Engaging your patients through telemedicine can help them maintain appointments and care schedules. Presented by Edson Joseph & Alfred Dandu Better Patient Care Quality • Telemedicine offers patient-centered approaches, such as improved timeliness of care. This is critical to quality patient care. Patients can address healthcare issues quickly with real-time urgent care consultations and learn about treatment options within minutes. Presented by Edson Joseph & Alfred Dandu Privacy assurance. • Telemedicine complies with medical laws, which aim to prevent private or secure medical documents from being leaked. "You wouldn't want to Skype with your medical professional and talk about all your personal medical history," But telemedicine "is safe. It's private." Presented by Edson Joseph & Alfred Dandu Disadvantages • 1. Electronic glitches. Technology is only as reliable as the electrical current that keeps it running. Inclement weather and other annoyances can cause a power outage or disrupt an internet connection, complicating online consultation with a doctor. Workers should keep that in mind prior to scheduling online visits. Presented by Edson Joseph & Alfred Dandu Disadvantages • 2. Medical professionals resistance. The bulk of resistance comes from some doctors struggling to comfortably use the new technology. Presented by Edson Joseph & Alfred Dandu Disadvantages • 3. Inadequate assessment. While having the ability to interface with your primary care medical professionals or dentist is a major plus, certain non-verbal cues might still slip through the cracks."To me, there are no limits on how you can use telemedicine, but of course one of the cons is you cannot personally touch or feel the patient," Presented by Edson Joseph & Alfred Dandu Telemedicine status at bugando • Basically we do not have fully telemedicine service at our centre. • Currently we have VTC and • We do use Electronic mails(part of Telemedicine service) as a means of communication to receive visit requests from peripheral hospitals(Shirati, Kagondo, Rubya,Ndala,Sumve, Kabanga, Bukumbi, Mwadui, Manyovu,Kolandoto) for specific specialty eg. ENT, orthopedics, and general surgeon etc. Presented by Edson Joseph & Alfred Dandu Telemedicine previous status at bugando Before we had radio calls as a means of communication where by most of the hospitals including; Kibondo Hospital Kasulu Hospital Kagondo Hospital Kabanga Hospital Kigoma Hospital Sengerema DDH Sumve Hospital Murgwanza Hospital Nyakahanga Hospital Used to consult the Medical doctors and specialists from BMC to get the consultation advice. But in the long run the radio calls got technical problem and they no longer functioning. Presented by Edson Joseph & Alfred Dandu Challenges on using e-mails Lack of Official Telemedicine unit office Communication tools such as Computer set Most of the hospitals we are support do not have internet access. Its not proper tools for telemedicine and its more secure on PHI(Protected Health Information) to comply with HIPAA(Health Insurance Portability and Accountability Act) Most of the Hospitals do not have official e-mail. Presented by Edson Joseph & Alfred Dandu Picture Archival and Communication System (PACS) Presented by Edson Joseph & Alfred Dandu What is PAC? • As imaging departments move from film-based acquisition and archiving (hard-copy film and document storage) to digital acquisition and archiving (soft-copy storage), a complex computer network has been created to manage images. This network is called Picture Archiving and Communication Systems (PACS) and can be likened to a “virtual film library.” Images stored on digital media are housed in PACS archives. Presented by Edson Joseph & Alfred Dandu What is PACS? • PACS is a sophisticated array of hardware and software that can connect all modalities with digital output (nuclear medicine, ultrasound, computed tomography, magnetic resonance imaging, angiography, mammography, and radiography). Presented by Edson Joseph & Alfred Dandu The acronym PACS can best be explained as follows: • P—Picture: the digital medical image(s) • A—Archiving: the “electronic” storage of the images • C—Communication: the routing (retrieval/sending) and displaying of the images • S—System: the specialized computer network that manages the complete system Presented by Edson Joseph & Alfred Dandu PACS image format • A PACS can accept any image that is in digital imaging and communications in medicine (DICOM) format, for which it is set up to receive, whether it is from cardiology, radiology, or pathology. • DICOM is universally accepted industry standard for transferring radiologic images and their medical information between computers. Presented by Edson Joseph & Alfred Dandu DICOM • An international standard (ISO) describing how radiology images are identified and formatted and how imaging devices communicate with each other • Jointly developed by the American College of Radiology and the National Electronic Manufacturers Association • Based on the ISO Open Standards Intercommunications (OSI) model • http://dicom.nema.org/ Presented by Edson Joseph & Alfred Dandu Other standard.. The HL-7 standard oversees most clinical and administrative data such as demographics, reports, claims, and orders. As with DICOM, HL-7 is composed of many parts and is used at many levels within various hospital systems. It is the standard generally used in communication between the hospital information system (HIS) and the radiology information system (RIS). The HIS holds the patient’s full medical information, from hospital billing to the inpatient ordering system. The RIS holds all radiology-specific patient data, from the patient scheduling information to the radiologist’s dictated and transcribed report. Presented by Edson Joseph & Alfred Dandu ADVANTAGES OF PACS: • Elimination of less efficient traditional film libraries and their inherent problem of physical space requirements for hard-copy images • Convenient search for and retrieval of images • Rapid (electronic) transfer of images within the hospital (e.g., clinics, operating rooms, treatment units) • Ease in consulting outside specialists—teleradiology. Teleradiography is the electronic transmission of diagnostic images from one location to another for purposes of interpretation and/or consultation. Presented by Edson Joseph & Alfred Dandu Cont..ADVANTAGES OF PACS: • Simultaneous viewing of images at multiple locations • Elimination of misplaced, damaged, or missing films • Increase in efficiency of reporting exams with softcopy images (compared with hard-copy images) • Reduction of the health and environmental impact associated with chemical processing, as a result of decreased use Presented by Edson Joseph & Alfred Dandu Four Major PACS Components 1. Acquisition -CR -DX -CT -MR -US -DF -OT 2. Network RIS 4. Display -CRT -LCD -Laser Film Image Database 3. Archive 39 Radiation Protection in Digital Radiology L09 Picture Archival and Communication System (PACS) Image Acquisition • In modern radiology departments, most images are acquired in a digital format, meaning that the images are inherently digital and can be transferred via a computer network. Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine have been digital for many years and have been taking advantage of PACS far longer than general radiography has Presented by Edson Joseph & Alfred Dandu Display Workstations • A display workstation is any computer that a health care worker uses to view a digital image. It is the most interactive part of a PACS, and these workstations are used inside and outside of radiology. The display station receives images from the archive or from the various radiology modalities and presents them for viewing. The display workstation has PACS application software that allows the user to perform minor image-manipulation techniques to optimize the image being viewed. Some display stations have advanced software to perform more complex image-manipulation techniques Presented by Edson Joseph & Alfred Dandu Display Workstations Presented by Edson Joseph & Alfred Dandu Common screen (display) resolution: • • • • 1280 × 1024 (1K) 1600 × 1200 (2K) 2048 × 1536 (3K) 2048 × 2560 (5K) Mammography requires a 5K or 5-megapixel resolution to provide the viewing capacity needed. 2K monitor is used for CR readings. 1K monitor is sufficient to view the images by a referring Presented by Edson Joseph & physician. Alfred Dandu Radiologist Reading Stations • The radiologist reading station is used by a radiologist when making a primary diagnosis. The reading station has the highest quality hardware, including the best monitor. The computer hardware meets the needs of the PACS vendor, but it will usually be very robust, requiring little downtime. The keyboard and mouse can be customized. Presented by Edson Joseph & Alfred Dandu Archive Servers • An archive server is the file room of the PACS. It is composed of a database server or image manager, short-term and long-term storage, and a computer that controls the PACS workflow, known as a workflow manager. The archive is the central part of the PACS and houses all of the historic data along with the current data being generated. In many institutions the archive serves as the central hub that receives all images before being released to the radiologists for interpretation. Presented by Edson Joseph & Alfred Dandu Archive Servers Presented by Edson Joseph & Alfred Dandu Network • A computer network or data network is a telecommunications network which allows computers to exchange data. In computer networks, networked computing devices exchange data with each other using a data link. The connections between nodes are established using either cable media or wireless media. Presented by Edson Joseph & Alfred Dandu Network Presented by Edson Joseph & Alfred Dandu PAC structure - BMC Presented by Edson Joseph & Alfred Dandu Lets go through some errors and consequences that may occur on each component Presented by Edson Joseph & Alfred Dandu Examples of errors within and between PACS components • Acquisition errors • Improper technique selection • Wrong exam performed • Image deleted • Network errors • Archive errors • Storage media corrupted • Storage failure • Sequestered exams • Display errors • Image lost • Image corrupted • Unable to transmit • Mis-calibration • Associated data not displayed • Artificial shutters Presented by Edson Joseph & Alfred Dandu Acquisition: Improper Technique Selection • On selecting the path of PAC system from the radiation machine. • Consequence: is unnecessary radiation exposure to patient Presented by Edson Joseph & Alfred Dandu Acquisition: Wrong exam performed • Radiographer may image thorax using digital examination intended for abdomen • Digital signal is rendered inappropriately for review • Consequence: may be repeated examination and unnecessary radiation exposure to patient Presented by Edson Joseph & Alfred Dandu Acquisition: Image deleted • Radiographer may delete image at acquisition station without transmitting to PACS • It may not be possible to restore deleted image • Consequence: may be repeated examination and unnecessary radiation exposure to patient Presented by Edson Joseph & Alfred Dandu Network: Image lost • Interruption in network service may result in losing the image • It may not be possible to retransmit image from acquisition station • Consequence: may be repeated examination and unnecessary radiation exposure to patient Presented by Edson Joseph & Alfred Dandu Network: Image corrupted • Interruption in network service may degrade image • It may not be possible to retransmit image from acquisition station • Consequence: may be repeated examination and unnecessary radiation exposure to patient Presented by Edson Joseph & Alfred Dandu Network: Image corrupted Presented by Edson Joseph & Alfred Dandu Network: unable to transmit • Interruption in network services prevents transmission of images from acquisition station • Local storage capacity of acquisition station is limited • If acquisition continues, images can be lost, causing repeated examinations and unnecessary radiation exposure to patients Presented by Edson Joseph & Alfred Dandu Archive: storage media corrupted • Storage media failure can prevent images from being retrieved • May require repeated examinations and unnecessary radiation exposure to patients Presented by Edson Joseph & Alfred Dandu Archive: storage failure • Storage failure can prevent images from being archived • If images have already been deleted from acquisition station, may require repeated examinations and unnecessary radiation exposure to patients Presented by Edson Joseph & Alfred Dandu Archive: images sequestered • When demographic and examination information on images does not match information from RIS, images may be hidden from view • Unless reconciliation is performed, radiographer may repeat examination with unnecessary radiation exposure to patients Presented by Edson Joseph & Alfred Dandu Display: mis-calibration • Improperly calibrated display can make digital images appear under-exposed • Radiologist may instruct radiographer to repeat examinations or increase radiologic technique causing unnecessary radiation exposure to patients. Presented by Edson Joseph & Alfred Dandu Display: associated data not displayed • Data accompanying the image may not be displayed for the radiologist • If missing data includes information on the radiographic technique or patient exposure, the radiologist cannot oversee radiographer practice • Without radiologist oversight, radiographers may perform examinations with unnecessary radiation exposure to patients Presented by Edson Joseph & Alfred Dandu Display: artificial shutters • To improve contrast, radiographer may add artificial collimation • When artificial shutters are non-transparent, radiologist cannot oversee radiographer practice • Without radiologist oversight, radiographers may perform examinations without appropriate collimation, resulting in unnecessary radiation exposure to patients Presented by Edson Joseph & Alfred Dandu Sources of Errors in PACS • Mistakes in configuration of PACS • Improper calibration of PACS devices • Discrepancies between PACS and hospital processes • Inadequate training and documentation of PACS and hospital processes • Insufficient planning for PACS service interruptions Presented by Edson Joseph & Alfred Dandu Conclusions • Unfortunately, errors will always occur in PACS. • Some of these errors cause unnecessary radiation dose to patients • QC is the key to detecting errors. • Training is key to averting errors. • Reliability engineering is key to continuity of clinical operations. • Disaster recovery is key to restoring normal clinical operations. Presented by Edson Joseph & Alfred Dandu Laboratory Information System – DisaLab(Wardlook Up) Introduction • Information System - is a system composed of people and computers that processes or interprets information. • Laboratory Information system(LIS) - is a software system that records, manages, and stores data for clinical laboratories.E.g Disalab,Napier etc. Bugando medical centre uses Disalab developed by LST(Laboratory System Technologies) approved by the ministry of healthy, for managing data for clinical laboratories. Introduction.. • Disalab - is an information system which bugando medical centre uses to record, manage and stores data for clinical laboratories. • Wardlook up - is small part of Disalab which links the laboratories and hospital wards/clinics so that they can access lab results from laboratories. Requirement for Wardlook up • For the system to work efficiently it needs: I. II. III. IV. V. People Computers Printers A well structured network The system Requirements… • People On wardlook up the target people are nurses and doctors who will be given the usernames and password for authentication to view results • Computers The computers is for installing the system so that the users can be able to view the results Requirements…. • Printers This is for printing the results. • A well structured network This is for ensuring the communication between the laboratories and the wards/clinics. Requirement… • The system(Wardlook up) After the install of the system, all users must have usernames and passwords so that they can be able to login and access the lab results. Features of the System • Login Panel • Search • View results 1. Login First time users and users whose passwords have been reset must enter their user codes and use their user code as a password. Existing users must use their passwords 2. Search The system gives you the searching criterias like; 1.Select the time period for the result: ● Recent ● Last 7 Day's ● Last 30 Day's ● Last 90 Day's ● This year ● Year's ● All Years (10 years – depend on Data from starting registration date) Search cont… 2. Enter selection criteria. You can select any combinations of the following: ● Hospital Folder Number ● Patient Name, options ○ Name Spelled Exact (default option) ○ Name Begins With ○ Name Sounds Like Patient Initials Approximate Age ● Sex (M/F) ● Date of Birth ● ID Number, Reference or Laboratory Number ● Laboratory 3. Press search button 4.After click search the list of lists will appear. Search cont.. • After having the list of results, pick the one which is the exact match of your criteria's. 3. View Results This feature shows the status of each sample which has been collected from wards/clinics. The following are the view results properties; i. Result not Available (* To Follow) 'Rcvd” This means that the laboratories have received the sample but the results are not available ii. Partly Tested Results Selecting a patient with result that is partly View results cont…. iii. Authorized Test Results This means the sample has been received and the results are available. iv. Confidential Results For a user to see Confidential Results – User code must have Confidential access enabled. v. Rejected Results “Rejc” This means a sample has been rejected Current status of the system(wardlook up) at Bugando Medical centre. • The system has been installed to some of the wards/clinic. Plan: • To install the system to all wards/clinics • To give support,training and guidance to users on how to use the system. • To work closely with the laboratories and Advantages of wardlook up • Lab results can be accessed to the wards/clinics specifically. • Results are available at the time they are required. • Confidential results can not be accessed randomly.(i.e. to a person who is not a medical personnel) • Patient results/records are secured. • Its easy to know the status of the tests you requested for a patient. Challenges • Computer illiteracy • Infrastructures i.e. network,computers,printers etc GOD BLESS YOU AND THANK YOU FOR LISTENING….