Healthcare development

Virtual HospitalAin Shams

Tamer Emara MD PhDDirector of Ain Shams Virtual Hospital

The Treat and Teach initiative

No disclosures or conflicts of interest

Healthcare Dilemma

Quality

(Training)

Availability (Numbers and/or

Distribution)

Centralization

Cost

THE PROBLEM ?

Can we reach the balance ?

THE PROBLEM ?

Africa has

• 15% of the world population

• 24% of disease burden

• 3% of healthcare workforce

And we suffer from Brain Drain

THE PROBLEM ?(cont.)

• 23 countries in Africa having 1-4 Neurologist / country

• 11 countries with a population of 26 million with no neurologists at all.

• 1 out of 6 countries have no neurology training programs at all.

• 250,000 students have to leave their countries for higher education

• WHO suggests that a 140% increase in healthcare workforce is needed to fill the gap

How we tackle it

How we tackle it

The Healthcare Delivery BottleneckQuality-Availability-Cost

ELECTRONIC HEALTH RECORDS $HEALTHCARE INFORMATION EXCHANGE $

PERSONALIZED MEDICINE $REMOTE MONITORING $

MODERN APPROACHES

On Call vs Telestroke

• Study 2004-2009 --> TS vs On Call rtPAinjection rates

• 2/3 cases remained in ASRH/PSC (Drip and Keep)

• $ 120 M saved !

On call : 414/3239 (12.8%)

TS : 230/617 (37.3%)

Telestroke NetworkMODERN APPROACHES

• Investing in people rather than funding or infrastructure is urgently needed.

• Start Training programs NOW!!

• 2014 → Ain Shams University launched the Treat & Teach initiative which uses a mix of telemedicine and onsite training to achieve:

Treat & Teach

Treat Teach• Help proper decision

making in the treatment of patients across Africa in needed specialties.

• Improve healthcare services.

• Train and empower African physicians in rare specialties.

• Provide scientific expertise in establishing and running training programs across Africa.

TeachTreat &

The Treat and Teach InitiativeFilling The Gap

TeachTreat &

The Treat and Teach InitiativeFilling The Gap

Blending Online and

Onsite

Save Time

Save Money

Create Local Champs

No Compromise

The Treat and Teach InitiativeFilling The Gap

Submitted a proposal for an STDF grant to start a

neurology online clinic 2014, which was accepted 2015

The Treat and Teach InitiativeFilling The Gap

AVH Current UnitEst. March 2016

JAN 2017 Eliminating the barrier to entryWe provide the hardware, software and the personnel

Online In EgyptOnsite: EAU1 2 37 months (200 hours) One Week 3 Months

Needs assessment

visit

Timed plan with tangible

outcomes

Online + Onsite Training

A 2-3 months visit for each

trainee to ASUH

Start the new service in

spoke

Win Win

AVH Pilot

The change

• 8 years old boy presents with frequent fall and generalized weakness more prominent in lower limbs and trunk than upper. No history of consanguinity, otherwise healthy. O/E. CN are intact, hypotonia and hyporeflexia in the lower limbs 3/5 power, weak trunk muscles pt can not flex up his truck while lying supine. Can not stand up without support of his arms, normal sensation. Intact gait, walks with toes. Calf muscles are hypertrophic. Shoulder muscle wasting.

Treat & Teach

2017

Ain Shams Virtual HospitalAdopted by college

All Major Specialties

2017

AVH Future HQ

MDS-AVH collaboration

Virtual course outreach. An onsite course will follow

TELEMEDICINE Equitable healthcare

Advanced Education Innovation Hub

HealthcareIncubator Resource

Mobilization Admin

What’s next in tele-education

Telemedicine services

• Online clinic300 cases in 8 months100 live 23 specialties12 governorates and 6 countries (Arabs)

What’s nextScalability problemCompliance problemBackfires

Dedicated platform

• Hospital-Hospital

Morning Telestroke/NeuroICU rounds

What’s next24/7 telestroke services

TREATS

The REgional Ain Shams TeleStroke network

Thank You !

www.asuvh.com

Bibliography

• www.asuvh.com

• World population prospects-population division- united nations" 2017 revision, esa.un.org.

• EuroRSCG, http://bigthink.com/strange-maps/185-the-patients-per-doctor-map-of-the-world

• A systematic review of telestroke.Rubin MN1, Wellik KE, Channer DD, Demaerschalk BM

• JCI 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the AHA/ASA. Powers et al. Stroke 2018