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A Cure For Iraq's Underprivileged: Technology Brings Modern Medicine Home September 2008
Imagine a woman walking into a healthcare clinic in northern Iraq with her son, who hasn't been feeling well. His fever and rash have been getting progressively worse. The local healthcare worker, who performs a physical examination but is unable to diagnose what's wrong, enters the data into a basic electronic medical record. The record is then transmitted to a medical center in a larger city such as Baghdad. If the physician on the receiving end wants to consult with a specialist, she could reach out to a network of worldwide physicians to present the case and ask for diagnostic help and treatment recommendations. At least, that's what staff at MITRE and other organizations envision happening in the not-too-distant future. Because if it takes a village to raise a child, then it takes a global village to bring medical care to children in remote parts of the world. In Iraq, which in recent times has endured the effects of war, the reign of a dictator, international sanctions, and continuing instability, it's been years since legions of ill children and adults have had access to qualified medical care. "The healthcare infrastructure has been destroyed," explains Chris Spirito, lead information systems engineer at MITRE. "Many physicians have left the country, and those who remain must overcome obstacles such as a lack of basic amenities and little contact with the outside world. Often, they don't have access to information they need, and they're unaware of the latest treatments and techniques." Spirito and colleague Mark Lang, a principal information systems engineer, both support the U.S. Air Force's Electronics Systems Center (ESC). They are part of a group that came together last year to discuss the uses of telemedicine for the disadvantaged, war-ravaged Iraqi citizens in an effort to help stabilize the country. The consortium includes representatives from MITRE, the U.S. Air Force's School of Aerospace Medicine, the USAF Force Protection Squadron, and the USAF ESC International Operations directorate. "This activity started with a desire to rebuild support services in the country," says Spirito. "Our vision is to build a healthcare infrastructure that empowers local clinicians by giving them access to assessment tools and techniques. We want to help them leverage technology so they have a way to consult with doctors around the world on specific cases." The structure of the Iraqi Telemedicine Network (ITN) is designed to supply Iraq with a communication gateway rich in access to experts within and outside the country, medical libraries, and instructional videos. For example:
A Video Solution for an Underserved Population The working group has devised a novel way to apply video communications technology to connect doctors and patients across hundreds, and even thousands of miles. "We're developing a telemedicine infrastructure to alleviate the lack of care, especially in Iraq's underserved, remote populations, where hospital services are limited and connectivity to resources are hampered," Spirito says. "We have been looking at communication options given the war-ravaged state, and believe there are opportunities to use the telecommunication infrastructure to support telemedicine operations," Lang points out. The proposal for the ITN, a plan drawn up by MITRE technology experts and WiRED International, calls for three main components at a telemedicine site:
The plan has been presented to Iraq's Ministry of Health, which has been receptive. In fact, the broad, sweeping reach of the ITN would give the Ministry of Health the ability to track evolving healthcare problems and epidemiological trends nationwide. Opening Lines "The core set of tools behind this exchange are fairly inexpensive—digital cameras, scanners, and the like," Lang says. "Technology is filling a critical gap, because clinicians in distant locations often don't have access to in-country specialists or international experts." The backbone of this technology infrastructure is IT hardware and satellite communication links from hospitals in distant Iraqi provinces to medical providers worldwide, using high-speed Internet connections. Networks, servers, and end-user workstations all play a role in the flow of information. "Presently, there are mostly paper-based records in Iraq, so the telemedicine system concurrently provides a basic healthcare management structure in which clinical interactions and data can be input, including images, test results, and patient notes," Spirito points out. The ITN builds upon Medical Information Centers (MICs) at four major Iraqi medical schools in Baghdad, Basra, Mosul, and Irbil, where there are hard drives containing medical research information. Connectivity with the four MICs is the linchpin to the ITN. "Community hospitals don't have networked access to information," Spirito notes. Therefore, physicians and clinicians throughout the country can connect with the MIC gateways to become better informed about medical practices, connect to online medical libraries, take tutorials, and access other educational programs. The four MICs have already been established in Iraq by WiRED International working independently, and the ITN plan, developed by the consortium of partners, builds upon those operations. The ITN sites would be built by Iraqi technology experts, working in conjunction with MITRE engineers. The goal is to transfer all ITN operations and support tasks to the Iraqis within two years. A Collaboration of Best Practitioners MITRE is uniquely positioned to deliver high impact to the ITN program. Spirito combines a clinical healthcare background with his engineering knowledge. He spent over a decade working as a respiratory therapist, electrocardiogram analyst, and EMT. While Spirito was working at Partners Healthcare in the 1990s, he met the director of the Center for Connected Health, who referred him to Dr. Paul Heinzelmann, who leads the telemedicine program established between Massachusetts General Hospital and a community hospital in Cambodia. The model in Cambodia provided best practices and insights for the Iraqi program. Physicians at major medical centers worldwide are ready to lend their expertise to the ITN. Once the sites have been fully established around Iraq, doctors at institutions such as Massachusetts General Hospital, Georgetown University Hospital, and Duke Medical School have already offered their assistance for some of Iraq's most common maladies, including respiratory issues, malnourishment, hypertension, diabetes, and cardiac abnormalities. "We believe the ITN is a gateway to the future for Iraqi healthcare," Spirito emphasizes. "The infrastructure will empower local providers and connect the entire country's medical community." —by Cheryl Scaparrotta Related Information Articles and News
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