In May 1999, JICA experts provided videophones and TV sets, and
"MEDIFA" started the trial.
From May to the beginning of June 1999, phase 1 of the Telemedicine
trial was implemented, with no charge made for consulting specialists at the central
hospital.
From the middle of June to the middle of October 1999, phase 2 was
implemented, this time with a charge being made for consulting specialists.
In March 2000, MEDIFA expanded the Telemedicine network to 80
clinics, using small-scale grant aid from the Japanese Embassy in Indonesia.
5 Configuration and
equipment of the project
Figure 1 System configuration
6 Services provided
through the project, and charges
(1) Teleconsultation Trial
Phase 1 (May-the middle of June 1999)
This phase was to evaluate the basic practicality
of the system without charging for Telemedicine service. It found that:
- There was a large demand for videophone consultations, despite many
missed appointments and long waits for contact with specialists.
- Of the 26 patients advised to undergo Telemedicine, all agreed to
do so.
- Of those patients, 11 were able to make successful Telemedicine
appointments and all gave a good evaluation of the service, saying they would use it
again.
- All patients said they appreciated their local doctors’
efforts in providing the service.
Phase 2 (the middle of June - the middle of
October 1999)
This phase was to evaluate whether patients would
be willing to pay a fee for the Telemedicine service, so that such fees could be used to
sustain the service.
From the middle of June to September,
consultations were free for the first session, and a charge was made from the second
session. In October, charges were extended to the first session also. The charge to each
patient was as follows:
Local doctor’s fee : Rupiah 13,000
Specialist’s fee : Rupiah 30,000
Telephone fee : (actual charge).
Notes:
(1) In 1999, the Rupiah averaged about 7,500 to
the US $
(2) The normal fee charged by a local doctor is
Rp. 10,000, and by a specialist Rp. 30,000
It was found in phase 2 that:
- The demand for Telemedicine increased, and 66 consultation sessions
were held. The total number of sessions in Phases 1 and 2 was 77 (Fig. 2).
Fig. 2 Number of consultation sessions via
Telemedicine (phase 1 and phase 2)
- Patients were willing to pay for a consultation. From the middle of
June to September, patients paid in all five cases where a second session was needed. In
the first two weeks of October, nine patients paid from their first consultation.
- There was a high level of satisfaction with the service, with 62%
of patients saying they were satisfied. The remaining 38% said they were less satisfied
because:
-- the television images (on 14-inch screens) were
not as
large and sharp as they expected;
-- there were difficulties in making appointments
with specialists;
-- in some cases establishing a connection was
unpredictable, taking 3 to 30 minutes, depending on the quality of the phone line.
- All local doctors participating in the project agreed that
consulting specialists via Telemedicine has advantages over traditional methods. The most
active doctor held 27 sessions.
- Among medical specialties, specialists in internal medicine and
dermatology showed great interest and active support. However, this may depend on the
personal views of the specialists involved.
Fig. 3 Number of sessions in each speciality
Recommendations to improve the system were:
The system should link clinics to the Emergency
Center of a hospital where specialists are available 24 hours. This would help to overcome
difficulties in arranging appointments.
TV screens should be 20 inches or more, even in
clinics, to give better image.
(2) Trial Tele-education of local doctors
The videophone system was also used to allow local
doctors to attend lectures by specialists. This Tele-education is accredited by the
Indonesian Medical Association (IDI), which is expected to give doctors an incentive to
participate. (The presenter and specialists obtain 3 points and participating doctors 1
point. A professional credit is awarded by the IDI for a total of 6 points.)
To allow the sustainable operation of this
Tele-education system, local doctors must pay Rp.10,000 per session.
- 16 Tele-education sessions were held:
| Participants - |
total |
21 doctors |
|
average |
6 doctors/session |
|
|
4 times/doctor |
| 15 family doctors acted as presenters |
- Specialists in internal medicine and dermatology were particularly
active
Fig. 4 Number of Tele-education sessions and
attendants
(3) Service charges
Service |
Charges |
|
Tele-consultation |
Fee
for local doctor |
Rp.10,000
+ Rp.3,000
(for administration) |
Fee
for specialist |
Rp.30,000 |
Telephone
fee |
(actual
charge) |
Tele-education |
(Audience
members) |
Rp.10,000 |
7 Expected socio-economic
impact of the project
The project showed that Telemedicine can be
effective, as well as sustainable without operational subsidies from government.
The introduction of Telemedicine using a low cost
videophone system is expected to not only enable patients to consult specialists that they
might not otherwise have access to; it is also expected to help improve the abilities of
young, local doctors in provincial and rural areas.
8 Main equipment (Videophone)
 |
The picture quality
equalled VHS video quality for still pictures. Even imperfect moving pictures contribute
to better communication between doctors and enable local doctors to get advice from senior
colleagues by showing a patient’s symptoms and condition.
Specifications of videophone (TV400):
Picture: NTSC/PAL
Camera: 1/4" CCD
CIF 352 x 288 pic-cell
QCIF 176 x 144 pic-cell
SQCIF 128 x 96 pic-cell
Max. 15 frames/sec.
Modem speed: Max. 33.6kbps
Interface: ITU-T H.324 (System)
H.263 (Video)
G.723 (Audio)
Power: 90~260V, 50/60Hz, 12W
Size: 60 (H) x 140 (W) x 180 (D) mm |
9 Conclusions
Providing medical consultations via videophone is
effective, sustainable and ready for actual operation, especially in the specialities of
internal medicine and dermatology.
In order to improve its effectiveness, the system
should be centred, if possible, on a 24-hour emergency department of a major hospital.
Tele-education to help train local doctors is also
effective, especially in the fields of internal medicine and dermatology.
Using a small-scale grant aid from Japanese
embassy in Indonesia, MEDIFA expanded the videophone network to 80 clinics, together with
the establishment of an online library of Tele-education seminars and medical information.
10 Contacts
- JICA
Mr. Hirofumi Sugiyama
Department of Economic Research on Telecommunications
Institute for Posts and Telecommunications Policy
Ministry of Posts and Telecommunications of Japan
TEL: +81-3-3224-7390
FAX : +81-3-5573-4338
E-mail : h-sugiyama@mpt.go.jp
- MEDIFA
Dr. Gatot Soetono, MPH
MEDIFA
TEL/FAX: +62-21-850-5427
E-mail: medifa@pacific.net.id
