Highlights from Health 2.0: User-Generated Healthcare 2008

“Last week, over 1,000 healthcare and technology industry leaders met in San Francisco for Health 2.0: User-Generated Healthcare 2008 Exit Disclaimer. The conference co-founders, Matthew Holt, author of The Health Care Blog Exit Disclaimer, and Indu Subaiya, MD, packed the two-day event with many presenters and panel discussions on “Web 2.0 technologies, healthcare, and all points between.” This post will share just a few of the many highlights from the event which we found particularly relevant to HIV/AIDS service providers.”
Article
AIDS.GOv.blog, 28 October 2008

Group launches online Zip code atlas of population health

“A public health organization will launch an online database this fall that could help forecast the demand for health care services in specific locations for chronic conditions including diabetes, obesity, and HIV.
The National Minority Quality Forum has created the �Zip Code Analysis Project� to collect data on disease activity among both general and minority populations by postal code.”
Article
Kathryn Foxhall, Government Health IT, 18 September 2008

A review of ICT systems for HIV/AIDS and anti-retroviral treatment management in South Africa

“Abstract:
Telemedicine and e-health systems have been proposed as a support tool, to monitor and evaluate HIV/AIDS management strategies. The aim of the present study was to provide an overview of telemedicine and e-health systems for HIV/AIDS in South Africa as a basis for developing an e-health toolkit for anti-retroviral treatment (ART). An initial literature review and a subsequent interactive networking approach were chosen to identify telemedicine and e-health systems, projects and services for HIV/AIDS and ART facilities in low-resource settings and under-served areas. The literature review produced little useful information. In contrast, the face-to-face interviews and the focus group discussions provided useful information about projects and systems which had not been published. The meetings involved 1 - 5 people per session, about 30 people in total. The review showed that there were some plans for telemedicine and e-health implementation in South Africa. However, there was no all-inclusive ICT-based system in place for AIDS treatment there. With the exception of the major health information systems and electronic patient record systems, none of the telemedicine and e-health systems identified in the review were ready to be deployed across the country as a whole.”
Abstract
S�rensen, Tove; Rivett, Ulrike; Fortuin, Jill, Journal of Telemedicine and Telecare, Volume 14, Number 1, January 2008 , pp. 37-41(5)

University Of Minnesota Researchers Plan Trial Of Web-Based HIV Prevention Program

“Researchers at the University of Minnesota plan to begin a clinical trial to test a Web-based software program that aims to fight the spread of HIV by reducing risky behaviors that can spread the virus, ANI/Malaysia Sun reports.”
Article
Medical News Today, 24 December 2007

Telemedicine projects in resource-limited settings: a tool to increase quality of HIV/AIDS care in remote areas

Maria Zolfo*, Lut Lynen*, Kurt Brauchli**, Martin Oberholzer**
*Institute for Tropical Medicine, Antwerp, Belgium
**University of Basel, Switzerland

Abstract:

Worldwide there are more than 40 million HIV infected people, and 90% of them are living in settings with limited resources. In many countries, and particularly in Africa, HIV/AIDS has become the most important health problem. Besides continuous efforts for prevention, the introduction of antiretroviral therapy (ART) has become a humanitarian and economic necessity and possibility. Recent price reductions for antiretroviral drugs make this intervention possible.

Facing the necessity to assist physicians in low resource settings to treat patients with newly introduced ART and to offer good standard of care for Opportunistic Infections (OIs), the Institute of Tropical Medicine, Antwerp (ITMA) set up a computer aided training program for healthcare providers working is these settings. Expert advice from HIV/AIDS specialists about ART and management of OIs has been offered to colleagues working in different resource limited settings. The telemedicine advice has been organized initially through an e-mail network but later, in response to the need of continuous medical education on HIV and ART, through a discussion forum on a telemedicine web site (http://telemedicine.itg.be). More than 300 cases and questions have been assessed from April 2003 (date of first telemedicine referral) till today, with evaluation of direct impact on patients care, individual patient management, and resolution of more general problems as organization of health services for AIDS care. Only a quarter of cases/questions is available on the telemedicine discussion forum web site, which resulted in 345 interactions between colleagues with more than 12 000 accesses on the web. Several similar activities have showed with their experience and longer existence a good functionality in supporting transfer of medical information between colleagues for remote diagnostic, teaching, and consultations:
One telemedicine project that has a long experience with low resource settings is the iPath telemedicine project at the University of Basel (http://telepath.patho.unibas.ch). This platform was initiated in 2001 and is now used by more than 1000 doctors on all continents for consultations, case discussions and educational applications. By the end of 2004, over 1900 consultations from developing countries had been submitted and diagnosed by experts from around the world (on average 70 cases per month). These consultations came from approximately 80 users in 20 developing countries. While iPath is not exclusively targeted at low resource settings - most users are from Western Europe - the software for the iPath project has been continuously adapted to needs of users from developing countries. As a result, the basic functions for discussing cases on iPath are available not only with an Internet browser, but also over an email interface, which allows users with a slow connection to utilise telemedicine as well. Besides, the iPath software is open source and freely available ( http://ipath.sourceforge.net ). Several telemedicine projects are using iPath (e.g. South Africa, Nepal).

Workshop description and methodology: what is the workshop about and how the workshop will be conducted?.
The workshop will focus on practical information about how to use telecommunications to improve health care for HIV/AIDS patients in remote areas.
The workshop will be divided in 3 parts:

1. Presentation of successful experiences with telemedicine systems in developing countries: ITMA telemedicine and discussion forum functionality; iPath, open source telemedicine server with integrated web- and email-interface: experiences from long term telemedicine application in developing countries � problems and solutions.
2. Basic technical requirements with a focus on off-the-shelf equipment such as ordinary PC computers, email or internet connections and low cost digital cameras.
3. Analysis of appropriate resources and expertise needed in different countries and for different types of telemedicine.
4. Comparison of different low cost technologies available at the moment on the market for telemedicine projects � looking at technical requirements and communication strategies.
5. Use of telemedicine as method of education and training for medical and paramedical staff (distance teaching and medical literature delivery).

Objective: what will be achieved in the workshop?
After the workshop completion, participants will have a clear knowledge of:

• different telecommunication systems that can be used in telemedicine
• necessary equipment to set up a telemedicine network
• how to access education and training through the Internet
• cost effectiveness of telemedicine
• future perspectives: collaboration among network operator; exchange of data between systems; real-time exchange of knowledge, information and expertise

Target audiences
This workshop is mainly targeted at people who want make use of telemedicine in low resource settings. In addition, it should be interesting for organisations who want to create and utilise their own telemedicine networks and/or link up with existing telemedicine networks.

Towards a Mobile Intelligent Information System with Application to HIV/AIDS

D. Kopec, R. Eckhardt, S. Tamang, D. Reinharth
Brooklyn College; Albert Einstein Coll. of Medicine, USA

Abstract:

The United Nations Security Council reports HIV/AIDS as the fastest growing threat to human development. In addition, the World Health Organization (WHO) reports that nearly 5 million persons (4.3 million adults and 700,000 children) are newly infected with HIV each year; more than 95% of them found in developing countries. Since STDs as a group are a personal problem which few people feel comfortable discussing, we believe that hand-held PDAs can provide an opportunity the learning about this disease while insuring anonymity. This device will employ the newest technologies including Bluetooth wireless technology, which can transmit and receive data via a short-range radio link using a globally available frequency band (2.4 GHz ISM band), enabling rapid and accurate synchronous and asynchronous data communication. The first generation of Bluetooth permits exchange of data up to a rate of 1 Mbps per second, even in areas with much electromagnetic disturbance. This emerging technology will facilitate HIV/AIDS outreach around the globe.

Recent advances in learning have taken a particularly cognitive perspective and these findings have implications for education in general as well as for the development of intelligent tutoring systems in particular. In the past, effective SmartTutors have been developed for AIDS education to disseminate the critical knowledge relevant to this epidemic (Kopec, Brody, Wood and Shi, 1992). But since 1993, with proliferation of the World Wide Web, the Internet has created a plethora of new opportunities for the delivery of electronic distance learning systems. A new, comprehensive, web-based learning system called SmartTutor has been developed, at Brooklyn College of The City University of New York (CCIT, 2004). This technology provides a user-friendly, self-paced, easy to modify, software environment intended to serve the user’s learning needs and is based on a generic SmartTutor methodology organized around the use of concept mapping. Early assessment of SmartTutor has shown that it is well received by students and helps significantly in their learning processes. It is readily adaptable to the presentation of academic and more general subject matter such as the latest available information on HIV/AIDS. Our new HIV/AIDS SmartTutor will incorporate this SmartTutor paradigm. The paradigm, developed over a number of years since the introduction of SmartBooks in 1992, entails:

1. Consultation between subject matter and domain specialists and experts, educationists, psychologists, computer scientists and the potential end-users.
2. Development of the prototype concept maps with a number or iterative refinements and improvements.
3. 3Design of the specific SmartTutor interface, with concept maps, specific link buttons and system features (glossary, history, help function, self assessment, references, etc.).
4. Coding for a web-enabled platform (e.g. Javascript, XML, Perl, Java, Flash).
5. Testing and evaluation of the systems effectiveness.

Our new SmartTutor would provide worldwide access to medical professionals as well as the general public to learn about HIV/AIDS. This new device could also provide a survey tool to facilitate HIV risk assessment. Demonstrations of the SmartTutor learning system will be presented and the continued development of the applications will be discussed.

World Health Organization [online] WHO HIV/AIDS Programme, [cited 2005-3-1]. Available from Internet: http://www.who.int/hiv/en/

D. Kopec, M. Brody, C. Shi, and C. Wood. “Towards an Intelligent Tutoring System with Application to Sexually Transmitted Diseases” in Artificial Intelligence and Intelligent Tutoring Systems: Knowledge-based systems for learning and teaching, Ellis Horwood Publishers, Chichester, England, May, 1992, pp. 129-51.

A Home Integral Telecare System for HIV/AIDS Patients

Cesar Caceres*, Enrique J. Gomez*, Felipe Garcia**, Paloma Chausa*, Jorge Guzman*, Francisco del Pozo*, Jose Maria Gatell**
*Bioengineering and Telemedicine Unit. Universidad Politecnica de Madrid, Spain
**Infectious Diseases Unit. Clinic Hospital, Barcelona, Spain

Abstract:

VIHrtual Hospital is a telemedicine web system for improving home integral care of chronic HIV patients through the Internet. Using the videoconference, chat or messaging tools included in the system, patients can visit their healthcare providers (physician, psychologist, nurse, psychiatrist, pharmacist, and social worker), having these access to the Electronic Patient Record. The system also provides a telepharmacy service that controls treatment adherence and side effects, sending the medication to the patient�s home by courier. A virtual community has been created, facilitating communication between patients and improving the collaboration between professionals, creating a care plan for each patient. As a complement, there is a virtual library where users can find validated HIV/AIDS information helping to enhance prevention. This system has been developed using low cost technologies in order to extend the number of patients involved in its trial. Thus, VIHrtual Hospital is now on trial in the Hospital Clinic (Barcelona, Spain) involving a hundred patients and twenty healthcare professionals during two years.

Although we are still waiting for the final results of the trial, we can already say that the use of telemedicine systems developed ad hoc for a chronic disease, like HIV/AIDS, improve the quality of care of the patients and their care team. The system described is a good example of the possibilities that technologies are offering to create new chronic patient care models based on telemedicine.