International Conference on Telemedicine & Digital Health September 20-21, 2021 Singapore, Singapore

Biography:

LCDR Stefan Rozycki, MD, graduated from the Uniformed Services University of the Health Sciences in 2013, afterwhich he completed his categorical Otolaryngology internship at Naval Medical Center Portsmouth.  He then voluntered to be an Undersea Medical Officer where he completed Dive School at the Naval Undersea Medical Institute.  He then was the Department Head at the Naval Submarine Support Command at Pearl Harbor, HI, where he qualified as a Sumbarine Medical Officer and oversaw the wartime readiness of 20 actively deploying fast-attack submarines.  In 2018 he returned to Naval Medical Center San Diego to complete his residency in Otolaryngology. 

Abstract:

Objectives: With military service members stationed around the world aboard ships and remote fixed facilities, subspecialty care frequently occurs outside of the TRICARE network, the health care program of the United States Department of Defense Military Health System, including foreign hospitals. Furthermore, usage aboard U.S. Navy ships has been limited in scope. This has direct costs associated with the medical care rendered and indirect costs such as difficulty navigating systems, access to records, and appropriate followup. Telemedicine has expanded access to otolaryngologic care where coverage has been deficient, with overall costs that are not well defined. This study aims to demonstrate the ability of consult management aboard a deployed U.S. Navy ship and to determine the direct costs associated with the use of an HIPAA-compliant, store-and-forward telemedicine system available to overseas medical providers to obtain specialty consultation at a tertiary care military treatment facility.

Study Design: Retrospective case series.

Methods: We reviewed consults submitted through the system from February 2018 to May 2018. Consult management was performed remotely by a deployed otolaryngologist in various locations underway and in port in the Pacific Rim. The direct cost associated with each consult was compared with the cost had the patient been treated in the host nation.

Results: During the deployment, there were eight consults submitted and directed to a neurotologist/skull base surgeon for an opinion. The estimated cost for treating these patients overseas was $124,037, while the estimated cost of retaining the patients in the Military Health System was $27,330. Extrapolated to a 12-month period, the cost savings of this program could be over $400,000.

Conclusions: Telemedicine consultation has the ability to be initiated and managed remotely—expanding access to subspecialty physicians by service members stationed around the world. Furthermore, it has the potential for substantial cost savings within the military health care system along with intangible benefits that sustain the military health care system downstream.

Biography:

Pramod Gaur is an Adjunct Professor at Pace University and Co-Chair of the Technology Collaborative of Westchester County Livable Communities Program. Dr. Gaur was inducted into the 2013 ATA Class of Fellows and is considered Telehealth Subject Matter Expert. Dr. Gaur’s activities in the past 20 years include demonstrations to the US Presidential Advisor, the US Congress, The White House Conference on Aging and International Delegates at the United Nations. Dr. Gaur received his doctoral degree from the University of Kansas and received his postdoctoral training at the University of Wisconsin in Madison and the University of Maryland in Baltimore.

Abstract:

Over the last three decades the telehealth industry has been evolving from technology driven industry to payer (reimbursement) driven to current provider driven industry. In the initial phase, emerging information and communication technologies were the driver to demonstrate telehealth capabilities. Once it was demonstrated that the telehealth services can be sustained and scaled, the next phase was focussed on reimbursement (“who pays for it”) for telehealth services. This phase led to both penalties (30 day readmission) and incentives (value based payments) for providers. As telehealth industry was moving towards the next phase of provider based models, COVID-19 pandemic related lockdowns accelerated the use of telehealth by patients and providers to access the care for all patients. Governments and payers provided a series of waivers to relax the requirements and parity of reimbursemnet with the in-person care.Now a new hybrid care delivery model is emerging where providers are incorporationg in-person and virtual appointments for care. Latest update from all key stakeholders (patients/caregivers, providers, payers and regulators) will be provided during this presentation

Biography:

Fritz P is from IPath Telemedicine Network gemeinnützige GmbH  D-26603 Aurich, Germany 

Abstract:

Introduction: Doing disease classification and treatment decisions in countries with restricted resources is hampered by (l1) lack of sophisticated diagnostic tools such as high quality radiological methods, laboratory investigations and morphological methods and (2) lack of highly specialized experts. We report about the use of two diagnosis assistance systems and a ICD-10 related laboratory data set. All date are anonymized and each patient was asked for participance in a telemedical approach.

Material and Methods: We investigated the medical data of tow Afghanistan hospitals in Mazar I Sharif in Afghanistan since 2010 uploaded on ipath-network (a non governmental organization for telemedicine) including a register for breast disease (N=1609 cases). For a subset of cases (N=105cases) we used two diagnosis assistance systems (Memem7 and Isabel-Health) and a laboratory data set in order to investigate whether their application is feasible In these data sets. For all calculation the golden standard was the consensus diagnosis of 2-4 experienced pathologists. All data were completely anonymized

Results: A list of helpful differential diagnoses were provided in 28/105 or 75/105 cases (26.7% respectively 71.4%). The target diagnosis proposed by the human experts was recognized in 22/74 or 40/74 cases (29.7 to 54.1%)- In 31/105 cases the human experts provided no target diagnosis. The breast disease register allowed to built up a disease profile for the most important breast diseases as mastitis, fibroadenoma, fibrocystic disease and invasive breast cancer from the reported context variables. In addition a IBC-score (score for an invasive breast cancer) was calculated to calculate an additional probability for a malignant or benign breast disease. The sensitivity of this IBC score for recognizing a malignant disease was 79.6 %. The AUC (area under curve) for the IBC score was 0.85

Discussion: We provide a feasibility study that anonymized medical data after standardized mathematical transformation may be a helpful and promising tool for testing either diagnosis assistance systems as well as methods of artificial infelligence ( IBC-Score based on logistic regression). Therefore daily diagnostic use and research use using telemedical approaches go hand in hand, supporting each other.

Biography:

Olena (Elena) Klyuchko- has 3 specialties: PhD (biophysics), Magisterial (computer sciences), Bachelor (linguistics). Obtained her education in the best Universities of Ukraine, Italy, Great Britain. She worked as researcher for a long time at Kyiv Institute of Physiology and Elbrus Medico-Biological Station of National Academy of Sciences,Ukraine (EMBS NANU), etc. She specialized in biophysics of the brain, influence of chemicals on organisms, development of information technologies for medicine and biology (including information system for monitoring of chemicals in environment “EcoIS” with telecommunication elements). Currently she is Associate Professor of National Aviation University (Kyiv,Ukraine); has more than 250 scientific publications

Abstract:

Presented investigations started at research centre of Caucasus Mountains – Elbrus Medical and Biological Station (EMBS) of the National Academy of Sciences of Ukraine [1] at m.Elbrus slopes (2100 m a.s.l.), v.Terskol (now – territory of Russia). Research works here were organized by Academician Sirotinin MM many years ago [1], his outstanding scientific "hypoxic" school reached the heights of pathophysiological science, being the source of many theories, ideas and practically used inventions.

Investigations of this scientific school are known, at EMBS were united efforts of many research groups from different countries, as well as Ukrainian researchers. Due to their achievements Kyiv was called “the capital of hypoxia studies” (Academician Chernigovsky VM, 1980-th) [1]. Studies of organisms reliability problems in extreme conditions stimulated the need to involve telemetric methods, as well as nowel technical and mathematical ones [1]. In the late 1970-th Ukrainian researchers there used the method to monitor electrocardiograms (ECG) and oxygen saturation  in organisms of climbers to Elbrus Mountain (5642 m a.s.l.), from the distance up to 10 km with portable radio. Along with traditional experimental research methods in fields of extreme, ecological, aerospace, sports physiology there were developed mathematical models of main functional systems of organism: models of functional respiratory system, adaptation to hypoxia, estimation of hypoxia development at coronary heart disease, cerebral ischemia, etc. (OnopchukYuM, Beloshitsky PV, Klyuchko OM, 2008). This made it possible to predict the state of organism in extreme situations; use the received information for forecasting, effective treatment, training, improvement of sports results, increase of organism resistance [1]. The conducted fundamental researches have allowed: for the first time in the world practice to open new highly effective direction - hypoxytherapy for treatment, prevention, rehabilitation, increase of resistance and working capacity; substantiate the concepts of stepwise adaptation to hypoxibaria, of organism oxygen regimes, changes in reactivity and resistance in phylogeny and ontogenesis; introduce such concepts as reliability of organism functioning (Beloshitsky PV, 1989), bioinformation (Beloshitsky PV, Beloshitsky SP, 2002), offer to define information diseases and information methods of treatment (Beloshitsky PV, Beloshitsky SP, Klyuchko OM, 2002, 2003). These works permitted to transform the science about hypoxia from experimental-descriptive into numerical one with possibility of future digitalization [1, 2]; this was a new breakthrough in the system of knowledge about human in those years.

Today the technical part of these works is continued in National Aviation University (NAU), Kyiv (Ukraine), where the information system for large-scale monitoring of environment “EcoIS” with telecommunication possibilities was developed [2-5] together with included automated work places [6], expert system [7], and etc. (Klyuchko OM, 2014-2021) This new specialized computer-based information system permits to monitor the changes in organisms as result of chemical environmental pollution in wide time ranges (from 0 to few years after the influence) using modern information and telecommunication technologies, on the base of novel databases and detector groups [3-5]. Together with this, the development in NAU means for distant education, means of telecommunications permits to use and demonstrate digitalized educative materials for all courses distantly that is especially important during Covid-19 pandemia. Distant means of education and telecommunication possibilities developed in NAU permit to demonstrate students the results obtained previously at EMBS as files of different formats, including educative movies, chronicles, obtained experimental data, and etc; as well as results of “EcoIS” system development together with its constituent elements and used methods