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

• To receive and send diagnostic images in record time

• To streamline diagnosis by specialists

• 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

• Substantial improvement in the quality of medical care

• Savings on diagnostic media

• Savings on travel to the health system and to patients

• 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

• Reduction of costs due to patient transfers

• 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]