Teleconsultations

Patients’ savings in South & Central Asia in 2015

5630

TELECONSULTATIONS

476737

USD invested in programme

2668949

USD saved by patients

43.7

TRAVEL TIME (YEARS) SAVED BY PATIENTS

USD saved does not include lost wages of beneficiaries.

Communities living in remote and isolated regions of South and Central Asia and East Africa face limited access to specialists and to quality health care services. Patients often have to spend a lot of time and money to reach a specialist. To address such difficulties, the AKDN eHealth Programme provides live (synchronous) and store-and-forward (asynchronous) teleconsultations to patients, thereby mitigating the need for patients to travel to larger cities to access specialty health care services. Through teleconsultations, patients requiring specialist expertise receive a differentiated medical service that is immediate, skilled and low-cost. See an example in our patient impact stories

UPDATES BY COUNTRY

In 2015:
4253

Teleconsultations

288216

USD invested in programme

2519303

USD saved by patients

33.6

TRAVEL TIME (YEARS) SAVED BY PATIENTS

USD saved does not include lost wages of beneficiaries.

Live Teleconsultations

 

 

New sites, service and specialities: Live teleconsultations between the French Medical Institute for Children (FMIC) and the Aga Khan University Hospital, Karachi, Pakistan were introduced in 2015 in three specialities – TeleENT, Teleneurology and Paediatric Teleneurology. Only store-and-forward services were being conducted between these sites since the connection was established in 2007.

 

Three new sites were also added to the eHealth network. Bharak District Hospital and Kisham District Hospital were connected to Faizabad Provincial Hospital for live teleconsultations. FMIC established an eHealth connection with its partner and French NGO, La Chaîne de l’Espoir, for live telecardiology services. FMIC is run through a four-way partnership between the Government of Afghanistan, the Government of France, the Aga Khan Development Network and La Chaîne de l’Espoir.

 

Apart from the new connections, services continued as per usual at other sites. Bamyan and Faizabad Provincial Hospitals received teleconsultations from FMIC. Three Comprehensive Health Centres – Bashore, Ishkashim and Nusai – conducted teleconsultations with Faizabad Provincial Hospital and with Khorog Oblast General Hospital in Tajikistan.

 

Teleconsultations declined in February and again in December. Weather conditions posed a challenge for patients wanting to access teleconsultations, making it difficult for them to reach the hospitals.

 

 

Store-and-Forward Teleconsultations

 

 

New sites and speciality: Store-and-forward teleconsultations enable specialists at the hub sites to examine, review and interpret CT scans, x-rays, mammograms for the purpose of confirming the diagnosis and offering treatment. This is used as a second opinion and also to build capacity of local providers.

 

Teleradiology services initiated between Bharak and Kisham district hospitals and Faizabad Provincial Hospital and also between Bashore, Ishkashim and Nusai Comprehensive Health Centres and Faizabad Provincial Hospital. These Centres were already connected to Faizabad Provincial Hospital for live teleconsultations and eLearning services.

 

A need for teleophthalmology services at the French Medical Institute for Children (FMIC) resulted in the hospital initiating the service with specialists at the Aga Khan University Hospital, Karachi (AKUH, K). Teleradiology services were already being conducted between the two sites.

 

Teleradiology and telepathology services continued between Bamyan and Faizabad Provincial Hospitals and FMIC. Teleradiology cases were referred from FMIC to the AKUH, K. However, with a dedicated radiologist recruited at FMIC to attend to the cases, only complicated cases are now being referred to AKUH, K for second opinion and diagnosis.

In 2015:
4

TELECONSULTATIONS

5010

USD INVESTED IN PROGRAMME

414

USD SAVED BY PATIENTS

0.01

TRAVEL TIME (YEARS) SAVED BY PATIENTS

USD saved does not include lost wages of beneficiaries.

Live Teleconsultations 

 

The AKDN eHealth Programme lays great importance on strengthening the capacity of health facilities, especially government facilities, and improving access to health care for communities. This is why when the Ministry of Health, Kyrgyz Republic signaled a strong interest in and support for initiating eHealth services between government facilities in Bishkek and Naryn, AKDN responded.

 

In March, planning ensued between Aga Khan Foundation, Kyrgyz Republic; AKDN eHRC; officials from Bishkek and Naryn hospitals; Ministry of Health, Kyrgyz Republic (MoH, KR); and Kyrgyztelecom OJSC to connect three health care facilities – one hub site in Bishkek and two spoke sites in Naryn – for teleconsultations and eLearning services.

 

Once an agreement with the MoH, KR was formalized, AKDN eHRC assessed the three sites, procured and installed eHealth equipment and trained eHealth coordinators. Kyrgyztelecom OJSC installed high-speed internet connectivity.

 

Live teleconsultations in Paediatrics commenced between the Republican Children’s Clinical Hospital in Bishkek and the Naryn Oblast Hospital in November. This is the first time that purely government-owned and managed facilities have been connected under the AKDN eHealth Programme. The MoH, KR has taken responsibility for managing and covering the cost of eHealth services in the country beyond the funding lifecycle. AKDN eHRC, under the Aga Khan Foundation, Kyrgyz Republic, is providing technical assistance to these facilities. The eHealth Programme in Kyrgyz Republic is funded by the Aga Khan Foundation, Canada and Global Affairs Canada.

In 2015:
299

TELECONSULTATIONS

110095

USD INVESTED IN PROGRAMME

50594

USD SAVED BY PATIENTS

1.8

TRAVEL TIME (YEARS) SAVED BY PATIENTS

USD saved does not include lost wages of beneficiaries.

Live Teleconsultations

 

 

Responding to the health needs of the community: When the AKDN eHealth team conducted an assessment in Gilgit-Baltistan, they found skin-related issues to be a big concern among communities in the region. The issue was compounded by a lack of dermatologists in the region. The AKDN eHealth Programme responded by initiating teledermatology services for patients at Gilgit Medical Centre (GMC). Physicians from GMC and Aga Khan Booni Medical Centre (AKBMC) received extensive training from the Aga Khan University and AKDN eHRC on how to conduct teleconsultations in Dermatology.

 

Specialists at the Aga Khan University Hospital, Karachi (AKUH, K) continued to offer telepsychiatry services to patients at AKBMC and GMC. Telepsychiatry services initiated in 2014 given the lack of quality Psychiatry services available in the area.

 

In July and August, eHealth activities shifted from GMC to the new Al-Azhar campus, 15 minutes from GMC. The disruption in routine activities temporarily resulted in live teleconsultations declining around that time. Services also declined in Booni around the same time, when patients’ access to AKBMC was severely affected by a flood.

 

New eHealth connection: The Aga Khan Health Service, Pakistan (AKHS, P) identifies health care facilities where eHealth assessments should be conducted to evaluate the viability of initiating eHealth services. In January, AKDN eHRC and AKHS, P conducted an assessment at the Garam Chashma Tehsil Hospital in Chitral and determined the need to initiate eHealth services. Various health care specialities such as Dermatology, Gastroenterology, Obs/Gyn, Paediatrics, Surgery and Urology were identified as eHealth priorities. eHealth connectivity was established between the hospital and AKBMC in October and services between the sites will initiate in 2016.

 

Store-and-Forward Teleconsultations

 

 

Store-and-forward teleconsultations resumed in July 2015 after being temporarily discontinued in early 2015 due to poor connectivity and lack of human resources. During the hiatus, Gilgit Medical Centre worked on a remuneration plan to encourage physicians to conduct eHealth services and increase the uptake of teleconsultations.

 

AKDN eHRC and Aga Khan Health Service, Pakistan implemented a series of activities in Gilgit-Baltistan designed to strengthen teleconsultation services. eHealth coordinators at all sites in Gilgit-Baltistan were trained to use VirtualDoc, an online portal developed by AKDN eHRC to manage physician-patient and physician-physician teleconsultations. eHealth equipment was procured, installed and also upgraded.

 

Priority health issues which can be addressed by connecting health care centres were identified by the team along with equipment, network, technology support and trainings required to implement and manage a well-functioning eHealth system in the health centres.

 

Discontinuation of services at various sites in Gilgit-Baltistan: eHealth services at three sites, Immit Health Centre, Thoi Health Centre and Gulmit Health Centre, were discontinued in 2015. Due to connectivity challenges at the centres in Immit and Thoi, services from these facilities were shifted to Yasin Health Centre and Chatorkhand Health Centre.

 

eHealth services were discontinued between Gulmit Health Centre and Aliabad Extended Family Health Centre given a lack of eHealth activity between the sites. In late 2015, tunnels were constructed parallel to Attabad Lake resulting in reduced travel time between Gulmit and Aliabad. This resulted in a diminished need for teleconsultation services between the two health centres.

 

Store-and-forward teleconsultations were conducted between Soust Health Centre and Aliabad Extended Family Health Centre; Chatorkhand Health Centre and Singal Medical Centre; and Yasin Health Centre and Civil Hospital, Gupis in 2015.

In 2015:
1074

TELECONSULTATIONS

73416

USD INVESTED IN PROGRAMME

98638

USD SAVED BY PATIENTS

8.4

TRAVEL TIME (YEARS) SAVED BY PATIENTS

USD saved does not include lost wages of beneficiaries.

Live Teleconsultations

 

 

Live teleconsultations in Tajikistan are conducted between sites within the country as well as between Tajikistan and Afghanistan. Three district hospitals – Darwaz, Ishkashim and Roshan – receive teleconsultations from Khorog Oblast General Hospital which in turn receives teleconsultations from National Medical Centre and the French Medical Institute for Children in Afghanistan.

 

In March 2015, teleconsultations in dermatology and neurology initiated at Khorog Oblast General Hospital from the French Medical Institute for Children.

 

Various events caused a decline in the number of teleconsultations conducted over the year. An extended public holiday in March slowed down eHealth activities. Furthermore, a focal eHealth coordinator at the three district hospitals was absent during the year and assigned later in the year.

 

Store-and-Forward Teleconsultations

 

Store-and-forward cases are referred only in teleradiology. In 2015, Khorog Oblast General Hospital referred 674 cases to National Medical Centre and to the Aga Khan Health Board, USA for second opinion and diagnosis.

 

The need to refer cases to Aga Khan Health Board, USA came about in November 2014 when the radiologist at National Medical Centre was away for two months. However, in January 2015, when the radiologist returned, Khorog Oblast General Hospital started sharing cases with National Medical Centre again. Now, only complicated cases are shared with the Aga Khan Health Board, USA for second opinion.

2015 marked the conclusion of the Joining Hands Initiative (JHI). Under JHI, teleconsultations were offered from the Aga Khan Hospital, Dar es Salaam to Primary Medical Centres in Dodoma and Mwanza. The programme connected district and regional hospitals and health centres. Services were provided in the areas of Family Medicine, Internal Medicine, Obs/Gyn and Paediatrics. AKDN eHRC, in collaboration with Aga Khan Foundation; Aga Khan Health Service, Tanzania; and the Ministry of Health and Social Welfare, facilitated the implementation of eHealth services at the sites. The initiative helped establish systems to refer patients for required services and improve community awareness and health practices.

 

No live or store-and-forward teleconsultations took place at any of the sites in 2015. Remuneration models for health care providers and uptake of eHealth services were a challenge. As specialists at Aga Khan Hospital, Dar es Salaam were working on a voluntary basis, their availability was often limited. As JHI approached its concluding stages in early 2015, the implementation of eHealth technologies decreased significantly further resulting in no teleconsultations being conducted.

 

From 2013 until the programme concluded in March 2015, 134 teleconsultations were conducted. Of these, 49 were live teleconsultations and 85 cases were referred using store-and-forward technology.