simmons telehealth haiti-earthquake-relief-recovery

Telehealth for Haiti earthquake relief & recovery

Scott C. Simmons, MS Director of TeleHealth

Timeline < 24 hrs. 1st UM/Medishare team @ UN compund @ PAP ~ 3 days initial TH capacity via BGAN, Skype ~ 10 days tent-based field hospital @ PAP c/ expanded VTC ~ 21 days added teleradiology ~ mid-June moved to existing Bernard Mevs facility

Operational situation •  Completely ad hoc ­  Nothing in place: systems, procedures, command

center ­  Donated materiel, personnel, flights/fuel, meds

•  Many non-medical functions ­  Logistics ­  Flight control, manifesting ­  FtL exec, Mia exec, FLL & MIA int'l, Homestead AFB)

­  Volunteers ­  Supplies & warehousing

Operational situation •  What was in place was relationships ­  LOA with USSOUTHCOM for collaboration in telehealth ­  TATRC/MRMC telehealth & Ryder combat surgical

training center ­  Haiti: President Previl, Medishare, other health facilities

& NGO's ­  Private sector & industry ­  Medicine ­  American Telemedicine Association

University of Miami/Project MediShare

Field Hospital

Port Au Prince, Haiti 2010

Sleeping Tent

Peds Tent Adult

Tent

Supply Tent

IsolationTents

Command Center Reception

Showers Port-a-Johns Urinals

Airport Perimeter Wall

Chain Link Fences

Supplies (exposed)

UMH-Haiti Site Layout

Sleeping Tents

ORs ICU

N

On-site communications

Access Haiti Satellite Internet

Amateur Radio Hughes BGAN

UMH-Haiti connectivity

VSAT-A

VSAT-B

Access Haiti

IP Phone

Ricoh Printer

Laptop

IP Phone

Juniper Router

Cisco POE

Switch

HP Printers (2)

Command Center

Laptops Linksys Router

Linksys Router/AP

Internet Cafe Laptops

In Reception

Tent

In Reception

Tent

In Command

Tent

Telehealth applications •  Teleradiology

•  Deferred consultation –  Swinfen Charitable Trust –  U. Miami & U. Virginia

•  Real-time consultation ­  Scheduled •  bedside (trauma/crit. care)

­  Ad hoc •  peds cardiology •  hematology/oncology

Technology considerations in HADR operations

Basic requirements •  Deployable assets •  Reach-back comms •  Gateway services •  Completely self-reliant •  Multimode –  Real-time & store-and-

forward

•  IP-based

On-scene: workflow IT •  Registration/Intake –  Identity –  Triage

•  EHR •  Inventory –  Supplies –  Pharmacy –  Resupply ordering

On-scene: TH hardware, software •  Imaging –  Visible light –  Radiographic

•  Biomed devices •  VTC/multimedia

collaboration •  Local wireless •  Satcomms •  Power

Gateway services •  Consult distribution •  VTC bridging •  Database hosting •  Identity management •  Credentialing •  Resource allocation

Other considerations •  Training •  Psychosocial support –  Social N/W-ing –  Voice/video calls –  Entertainment

Humanitarian telehealth

•  Reducing barriers to charity care –  Travel –  Security/safety

•  Training of in-country health professionals

•  Pre-travel screening & post-travel f/u

Characteristics of an idealized HADR telehealth system

Idealized HADR TH system characteristics

•  Implements both store-and-forward & real-time systems and methods

•  Integrates with workflow informatics

•  Staff is familiar with TH systems, concepts & trained in their use

Idealized HADR TH system characteristics

•  Core TH infrastructure ties into on-grid & off-grid power. Primary power system automatically fails over to backup system(s).

•  Databases available for various operational needs, e.g. generalized contact information (based on an organizational/functional position); volunteer, equipment, & supply needs; inventory

Idealized HADR TH system characteristics

•  Field medical facilities include an internet café for calling, VTC, e-mail, web access so that volunteers can keep in touch with families, friends, and employers, access to information.

•  Systems in place for management of monetary, equipment, or supply donations. Donated equipment accompanied by technicians able to install & train on its use.

•  Systems in place for knowing the most contemporary information about other medical capacity, facility, transport mechanisms & availability, as would a pre-defined process for certification, scheduling, and processing of volunteers, both in the field and remotely (telehealth providers).

Idealized HADR TH system characteristics

•  A network of specialists that are willing to provide telehealth services would be available along with a means of contacting & scheduling them

•  Shelter provided for mission-critical equipment. On-site technical expertise for setting up, maintaining training and troubleshooting telehealth systems.

•  Smart routing would move IP traffic via any available communication path & distribute the traffic simultaneously among multiple paths (load balancing)

Final observations •  Issues not technical, but operational, organizational,

political •  Need pre-existing mechanisms for GOV/CIV collaboration •  Need to leverage academic/NGO core competencies --

clinical care -- virtual surge capacity •  Much good will in private sector •  People & organizations willing to donate after the event, but

need to get the stuff before event •  Most difficult donation was bandwidth/connectivity, esp.

data plans  •  Too bad iPad didn't come out earlier... •  Disaster tourism an issue... •  2 thumbs up for shelter box tent, from Rotary Club

International

Convenient, connected care.

Questions?

ssimmons@med.miami.edu (305) 243-8252