How telemedicine shortens distances in Mali

IKONtelemedicine in developing contextsA new model of implementing

MALI

BAMAKO

1500KM

1000KM

500KM• X-ray machines and technicians in 7 hospitals• Poor diagnosis, errors in treatment, and a

high number of referrals to Bamako as a result from absence of trained radiologists

• Health personnel poorly spread between the capital and other regions

• More than half of the socio-sanitary staff is situated in Bamako

Only 11 radiologists in Mali, 10 in the capital

Objectives

1. Introduction of telemedicine to improve diagnostics in rural hospitals

2. Improve the quality of primary diagnosis at the level of (rural) general doctors

3. Sustainability of operations

8 hospitals connected with Point G hospital in Bamako2005 pilot in Point G and Mopti, Sikasso, Timbuktu 2007 expansion to Ségou, Gao, Kayes, Kidal2009 PPP with Morila Gold Mine Health ServiceIICD supported project from 2004 till 2011

IKON PROJECT FACTS

Data available 

over period of 10 years

2015: + IKON Android App

2005-2014: Web-based platformReferrer digitizes x‐ray with camera+tripod, adds relevant patient data to case description, sends compressed + secured data to server, radiologist interprets and adds observations + conclusion, sends file back to server, referrer delivers diagnosis to patient.Background: billing module, database 

Analysis 2014Research conducted by Jigsaw Consult / IICD / CERTES

• Data from the platform for 2005-2013 (Date, patient’s unique code, hospital, priority (urgent or non-urgent), sex, age, and the concordance of the doctor’s diagnosis and radiologist’s diagnosis.)

• Calculation of number of images diagnosed using tele-radiology per hospital per year & tracking of agreement doctor / radiologist

• For 2012 / 2013 only: data on scan type, the doctor’s diagnosis, radiologist’s diagnosis, and time taken for the diagnosis. Tracking of agreement doctor / radiologist

• Survey among medical personnel using a questionnaire to identify usage patterns, confidence in tele-radiology and perceptions of its impact.

Number sites / consultations per site

Numbers and types of x-rays

0 200 400 600 800 1000 1200

Limb

Mammogram

Thorax / Chest x‐ray

Cranium (Skull) x‐ray

Sinus x‐ray

ASP (Abdominal x‐ray)

Barium Meal (Upper gastrointestinal series)

HSG (Fallopian tubes)

Kidney, Ureter and Bladder x‐ray

Barium Enema (large intestine)

Spinal

Type of scan   

Benefits of the service

0 2 4 6 8 10 12 14 16 18 20

Access to expert diagnosis

Improved treatment (& confidence in it)

Capacity building / training

Cost benefit to patient

Time benefit to patient

Credibility of diagnosis

Overall improvement in rural healthcare

Introduction of internet / technology

Financial benefit to regional hospital

Archive of files

Scientific interest

Simplicity of service

Benefits of tele‐radiology 

Quality of service (time)

Result objective 2: Improvement of the regional doctors’ diagnostic ability

Scans without prima ry diagnosis decreased from 93% in 2005 to 23% in 2013

20052013

Diagnostic agreement increased from 0% in 2005 to 73% in 2013

100

0 100

20052013

Result objective 1: Improvement of diagnostics through telemedicine

Diagnostic agreement

Result objective 3: Sustainability of operations

Agreement on margin per consult for sustaining technical services

Business model

defined per hospital

70%

Cost benefits for the hospitalWhen electricity, internet, technicians and medical personnel are already available, the additional cost to the regional hospital is minimal

Financial benefit to the regional hospital from IKON:• It is able to charge for a high-quality service

50% of the patient charge for tele-radiology goes to the hospital*

• Patient stays at the hospital rather than moving to Bamako

(*) Decision up to hospital

Charge given to:

In 2013

Radiologist 30%

Hospital 50% (ofwhich 10% goes to the technician)

IKON 20%

Other results• Reduction of time and costs for patients

• eLearning for doctors

• ICT uptake in hospitals

• Improved staff retention in rural hospitals

• Improvement of the prescribed treatment

BUT ALSO• Strong dependency on local change agents• Dependency of local hospitals on strong local 

actor (service provider) 

Conclusions health impact• Tele-radiology improves regional doctors’ diagnostic

ability & prescribed treatment

• Tele-radiology reduces the need for patients to travel

• Tele-radiology reduces doctor’s isolation & enhances professional learning opportunities

Conclusions on approach• The IICD approach of investing in individuals and of

ensuring their ownership resulted in a sustainable solution in an extremely low-resource setting:

- Flexible programme management- Local decision making power- Service based on local demand, and built on local trust and existing relations- Quick iterations, room for experimentation

The article has been published in the April issue (Vol. 21, No. 3) of the Journal of Telemedicine and Telecare

5 year of lessons learned of ICT4health (iicd 2011)

ICT‐ A Genuine Tool to reduce isolation and raise Health Awareness (iicd 2011)

Multimedia Centres for Healthworkers in Ghana (iicd 2011)

Connecting medical specialists in Rural Hospitals through ICT (iicd 2010) 

Health Management Information Systems for Hospitals (iicd 2010)

Digital Hygiene Education and Multi‐media (iicd2010)

ICTs and Continuing Medical Education in East Africa (iicd 2009)

Resources at IICD.ORG

International Institute for Communication and Developmentwww.iicd.org