- solving the nation’s healthcare challenges speedily through ICT
The overriding purpose of the National Telemedicine and E-health Network is to provide access to knowledge, expertise and other healthcare resources in a timely, convenient and cost effective manner using information communication technology tools . The network would provide resources across four domains: Health service delivery, education, administration as well as research.
The network is envisaged in five tracks operating in a mesh like system:
- Tertiary Care track: This involves the tertiary hospitals in the country. There are about 60 hospitals.
- Secondary Care Track: This involves the state specialist hospitals and the private hospitals. over 7000 in number.
- Primary Care Track: This involves the primary healthcare facilities. About 774 centers.
- Mobile Care Track : This involves telemedicine enabled vans, boats and tricycles.
- M-health Care Track: This involves mobile phone based healthcare initiative.for the teeming 150 million Nigerians, providing a means of offering personalized healthcare.
The Nigeria Telemedicine And E-Health Network is an ecosystem of solutions operating in “the cloud” from which service is consumed by various healthcare stakeholders. This is the most cost effective means of getting service to everyone, irrespective of location.
The central cloud computing platform would offer:
- An Electronic Health Information System platform that can support multiple applications (APMIS). APMIS is the All Purpose Medical Information System that is patient-centric,offering secure, lifelong, comprehensive, prospective, computable healthcare records that are scalable to a National Health Information System. It is based on the open source specification: openEHR.org. The openEHR has become the basis for the various ISO and CEN EHR standards.
- A web conferencing and video conferencing environment that operates under low bandwidth consumption. Thus offering point to point (teleconsultation) and point to multipoint (web conferencing) capabilities. we are working with Vsee.com to enable his platform.
- An E-learning and training environment based on the open source MOODLE.
- A Collaborative discussion environment.
- A Voice over internet protocol (VoIP) environment
Some of the current projects being developed to run on this platform initiated by various specialists include:
1) National Tele-consultation system ( second opinion, referral etc )
2) International tele-consultation and tele-education with renowned healthcare center
3) National Tele-pathology/ tele-oncology Network
4) National Health Informatics training and certification (up to MSc) program.
5) Expert Obstetrics and Gynecology Support for National Midwife Scheme
6) Community screening for common treatable causes of blindness.
7) Screening for Chronic Kidney disease.
8 ) Nationwide CME program for Medical Doctors, Nurses and Physiotherapist etc
The concept is to allow the initiating specialty organization or professional to own and control the program that run on this platform. The network is just an enabling environment to make such projects a reality.
The critical point would be CONNECTIVITY, because indeed if you can see the cloud you can participate in network.
Our solution is to create a dedicated healthcare network with the following components:
-A Low cost mobile communication solution in partnership with a national GSM company to offer a dedicated healthcare communication network that allows for unlimited free calls and sms for healthcare purposes.The network would be sustained through a low cost monthly subscription.
- A Nationwide VSAT network working in partnership with Intelsat and I-direct as well as Immersat BGAN. By hosting our own hub and buying bulk bandwidth we would be able to achieve redundancy and offer access at a very low cost per head.
-A National Mobile Internet access. Again working in partnership with a national GSM company we intend to leverage their data service across their network within the country.
- A National Fibreoptic Network: leveraging on the increased fibreoptic network that is currently expanding in the country we are working to deliver broadband connectivity to various institutions. The current Internet 2 project would be a great leverage to our bandwidth requirement.
- A National 4G connectivity: Negotiation is also ongoing to leverage available spectrum for 4G connectivity for healthcare.
Various stakeholders would be able to connect to the central platform using any means of connectivity with peripheral units such as laptops, slate type computing devices(cisco cius, ipad, android galaxy etc), mobile phones etc. The web browser would be the medium for interaction with the central platform thus have a zero software footprint.
The dedicated telemedicine peripheral device would include
1) Telemedicine Portable: This is a laptop based telemedicine system with ability for both real time and store and forward telemedicine procedures.
2) Telemedicine Units: Cart based telemedicine and tele-educational system
3) Telemedicine Centers: Dedicated telemedicine facilities
4) Telemedicine Mobile: Dedicated telemedicine van, boats and tricycles of various functional construct.
The concept is to have all these service manned by the private sector and offering service to the public sector, thus running a public -private partnership model. This model is based on the reoccurring failure of sustainability and efficiency of service delivery within the public sector as well as a dearth of expertise within the system.
The role of the government with this relationship would be largely as a regulator and a creator of an enabling environment. They would assist in providing and setting in place a regulatory framework for telemedicine and e-health to flourish within the country as well as helping coordinate the engagement with various stakeholders .
Governance of the network would be entrenched in stratified advisory councils that are all inclusive of various stakeholders within the healthcare at various levels.
These advisory councils would exist as follows:
- 40+ medical specialty advisory councils
- 774 local government Advisory councils ( target: primary care )
- 37 state advisory councils ( target: secondary care )
- 1 tertiary advisory council ( target: tertiary care). Committee of Chief Executives of Tertiary Hospitals is working currently on this role.
- A central National Steering council
We have already begun engagement with various stakeholders within the healthcare industry with a lot of positive feedback. Most of the activity has been with institution in the tertiary care tracks. Not less than 30 of the 53 Chief Medical directors of the nation’s tertiary hospitals have indicated willingness and have signed up to participate at the institutional level.The Chief Medical Director of the University College Hospital, Ibadan Prof Abiodun Ilesanmi initiated the discussion and has driven the interaction among his colleagues.
Discussions are ongoing with various programs such as the National Cancer Control Program and the National Blood Transfusion Service.
Discussions with the project team of the National Space Development and Research Agency has led to the participation and adoption of the core of my presentation in the Telemedicine Roadmap initiative of the agency of which I was part of the expert committee.
We have also made presentation to the National Postgraduate Medical College with very encouraging response as well.
We have also began to engage various national professional bodies within the country as well as the top level executives of the Federal Ministry of Health. Contact has being made with various state governments so as to engage them as well in the process.
This network concept is also endorsed by the Society for Telemedicine and e-health in Nigeria ( SFTeHIN ) , an affiliate of the International Society for Telemedicine and E-health as a viable means of implementing telemedicine and e-health in Nigeria.