E-Health, an idea and some plans – part 3

By Emmanuel Narokobi

Dr. Ian K Garbett has been busy progressing his Collaborative Telepathology Network Project (CTNP)’ (Click here for paper).

ntn_map

I’ve mentioned this project before, here and here. The CTNP has been designed (and is hoped), will provide a Sustainable Capacity Building of Pathology and Cancer Services in Papua New Guinea and the Pacific.

Having lost a relative myself from cancer it would be nice to see if such a project can provide early detection for cancer and other diseases. In my family’s experience with cancer, it took only 3 weeks between diagnose and death. So hopefully this project will assist to decrease such cancer deaths, especially considering that according to Dr. Ian’s paper, cancer in PNG is expected to rise by 40%.

So about this project. The CTNP will be a:

…robust and sustainable digital pathology program advocated to lay the foundation for an unrivaled communication network throughout its base hospitals to facilitate the training and education of its doctors, nurses and scientists to transform this future.

In the abstract: “A Retrospective Comparative Analysis of Turnaround Time (TAT) for Pathology Samples at Port Moresby General Hospital”, evidence is provided for the possibility of using eHealth technology to create a phased program of telepathology. This uses the technique of digital image capture of a microscope image at a set magnification and its transmission to a virtual platform where experts are able to make diagnoses through internet connectivity.

Successful programs have been established in the Pacific, for example, the Solomon Islands Telepathology Program, the U21/Swinfen Charitable Trust/Queensland Centre for Online Health collaboration at Tabubil and the Fiji School of Medicine Telepathology Program.

All of these have demonstrated both efficacy and workability combined with realistic principles that can be applied to the context in Papua New Guinea.

For example the Solomon Islands program achieved a mean turnaround time of 12 hours after image submission. In Papua New Guinea, with tissue processing at the originating hospital and digital transmission, all the costs and delays in physical transport may be rendered obsolete.

The CTNP is currently in the planning phase and we require a broad base of representation to initiate the program and to guarantee maximal participation of all parties.

In terms of how the project will be operated, the paper states that:

The program is … anticipated to provide an enabling environment to other parallel health prevention, education and curative programs.

This proposal will systematically:

  • review current pathology and cancer services in PNG
  • present new data on turnaround time for histology and bone marrow samples
  • review current global eHealth developments
  • review eHealth and telepathology initiatives in the Pacific region
  • present data from the first ever eHealth survey 2008 for PNG
  • demonstrate telepathology as part of the solution for the challenges in pathology services, cancer services and sample turnaround time in PNG
  • detail a comprehensive telepathology strategy, CTNP, for PNG
  • outline a randomised controlled trial to be undertaken within the CTNP

This overview of the current configuration of pathology and cancer services will be performed to show how a telepathology strategy such as CTNP could re-orientate this service provision to deliver improvement in the:

  • coordination and quality of services
  • time to diagnosis and health intervention
  • patient mortality
  • patient morbidity
  • education and training of health workers

These will form some of the key indicators for the measuring the impact of the project and will focus on patients in rural areas in order to conform to the strategic direction set by the National Department of Health and the scope of the millennium development goals.

and our current state  of affairs with pathology services:

Pathology services have developed, through resource constraint, in a non-comprehensive manner and are often limited to the provincial base hospitals and the tertiary centre at Port Moresby General Hospital (PMGH). This has instead led to a comprehensive referral network. The key block within this network is the relative isolation of PMGH from the rest of the country. This creates financial barriers to accessible health care for PNG citizens outside of National Capital District (NCD).

Most base hospitals and faith based hospitals are able to provide some basic biochemical, microbiological, haematological and blood transfusion services with varying degrees of technological and human resource expertise

PMGH, in collaboration with the University of Papua New Guinea, provides the only post mortem, histopathological and haemato-oncological diagnostic service for Papua New Guinea. The service, in 2007, received 4515 samples and of these processed; 83 post mortems, 4515 histopathology specimens, 1535 fine needle samples, 174 gynaecology cytological samples and 315 non-gynaecology cytological samples. With a backlog of work from 2006, the total workload was 11,997 samples. The system of referral in operation at present is that all specimens from hospitals and clinics outside of Port Moresby are transported by air, road or sea to the pathology department. The following departments provide a service:

  • clinical biochemistry
  • haematology
  • anatomical pathology
  • cytology
  • forensic pathology
  • microbiology
  • immunology
  • blood transfusion services
  • central public health laboratory

Download the full paper here

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