4. Telemedicine (โทรเวช)
• The use of medical information exchanged from one
site to another via electronic communication to
improve patients'health status.
5. Telemedicine services
• Specialist referral services
• Remote patient monitoring
• Patient data transfer
• Medical education
• Consumer medical and health information
10. Ambulance Telemetry
• Evaluate, Diagnose, Monitoring, Treat
• Patient in mobile bed
• from remote location or prehospital area
• Data roaming via telecommunication
11. Lifebot project, under US army development
• Telemedicine life support system
• Texas : $14 million advanced EMS ambulance
telemedicine and disaster manage system.
• Important in remote areas where transport times may be
prolonged ; act to protect ambulance personal and
providers during difficult situations.
17. Medical device
• Lifegain : Defibrillator with Bluetooth.
• Camera set
• Notebook + air card for Internet access
• Workstation computer server
20. Encounter management software
• EMS12 MultiviewerDual
• Text/Message chat
• EKG realtime with 2 second delay
• Snap shot picture 2 pics./sec.
• Voice IP
29. Connectivity (wireless computer network)
1.Global System for Mobile communication
• General Packet Radio Service
• Enhance Data rate for Global Evalution
2.Code Division Multiple Access communication
3.Wideband Code Division Multiple Access communication
4.WiMAX
32. Clinical effectiveness
• Monitoring
• Critical decision and management
• From "what's coming in the door"
To "I knew and I'm waiting you"
Now then "OK, you've already treated."
38. Brief history of Ubon ambulance transfer
• Zone 13 = 56 Hospitals (อุบลศรีโสธรเจริญ)
Cover : อุบลราชธานี, ศรีสะเกษ, ยโสธร, อํานาจเจริญ
• อุบลราชธานี = 25 districts
• Before 2549 : BLS ambulance
• October 2549 : Super ALS ambulance
• October 2552 : mini-telemetry ambulance
• Since April 2553 : full option telemetry ambulance
39. UBON model
• 3 fast tract transfers : STEMI, Stroke, Trauma
STEMI was sent as bypass tract
• Advance in specialized patient care have increased the
demand for data communication system.
• We first applied in STEMI patients monitor during
interfacility transfer
41. Upcoming
• Ambulance telemetry protocol
• ICU mobile nurse training program
• Apply social network in advance communication
"Referral data registry"
• Add distributive collaboration to online medical control
43. Not only EP can be online medical control
• Real time evaluation and management of critically ill
patients by multiple specialist.
• Assembly of multiple-victim information
• Assistance in diagnostics
• Transfer of care hand-offs
• Homeland security command and control
45. 1. Establish a vision
• How to increase the volume of service?
• Explore overall vision of the organization
• Model approach
- Access to care model
- Cost savings model
- Access to market model
46. December 2553
• 501 critic patients was transfer by ambulance telemetry
• 91.42% by overall critical interfacility transfer
• 72% applied telemetry during transfer
47. 2. Building a long term financial plan
• Set short and long term financial goal.
• Looking for ongoing revenue (long term sustainability)
• You do not always get what you want but you often get
what you measure.
• Show clear outcome and how to collect it
48. • The death rate in severe traumatic patients who inter
facility needed was reduce from 37% to 31%
• Ongoing research
1. Unit cost
2. Compare clinical outcome
49. 3. Create a convenient and effective work
environment
• The sending room : device position, lighting and white
balance.
• The receiving room (workstation) : directly to consulting
physician's workplace or using forward software to
physician desktop.
• Simple as possible to use first, technology should be
remain in the background.
51. 4. Mainstream telemedicine into the standard care
process
• Standard protocol for telemedicine as same as non-
telemedicine
• Add : equipment protocol, dispatch, documentation,
measurement and billing protocol
• The more change that must be adopted the higher the
likelihood of failure
52. Criteria for activated ambulance telemetry
• Respirator needed • Major trauma
• Impending compromise • >2 episodes seizure in 30
airway mins
• Acute coronary syndrome • AOC protocol
• Shock or impending • Obstetric protocol
• HT emergency • Doctor order
53. 5. Plan and assure effective training
• Communication technology
• Clinical technology
• Diagnostic device user training for both send and receive sites
• Workflow and protocols of care and procedures for use of
devices
• Documentation
• Trouble shooting and access to product and technical support
55. 6. Make sure you have a full time coordinator and
an effective leader and cheerleader
• Clear leader in authority and fly cover the program
participate.
• Key man : necessary skills, passion and commitment to
serve, encourage user, inform management and assure
that the program is properly marketed.
• Full time nurse and technician
• Sending sites person
57. 7. A project plan = manageable milestones =
Reasonable expectation
• Roadmap should be simple, manageable and reasonable
• Do not over plan and paralyze the project
• Set 5y plan, 10y plan, 20y plan and meet them
58. New project release
• 5yr : ICU mobile hub, Referal data registry
• 10yr : อุบลศรีโสธรเจริญ
• 20yr : 3D, Robot
59. 8. Horizontal vs. Vertical implementation
• Limited capable but widely use or limited use but super
capable
• Consider device option and clinical outcome.
• Telemet needs continuous train and support
• Both tract will reach a future large-scale expansion
60. 9. Good market is clinical
• Set public expectations
• Tell the world the good things you've done
• Tell the world what is coming next
61. 10. Publish or perish
• Presenting or publishing the results or status of our
program at least once per year
• Posters, teaching and sharing