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Prof. Ali Akbar Safavi&
F MarjaniSchool of Electrical and Computer Engineering
Shiraz University1
- Topics
• Introduction• Some Economic aspects• The case study of Fars Province• Conclusions
2
- eHealth Introduction
3
• The importance of Health and Technology Opportunities
• The Governments, Private Sector, and People should all be aware of opportunities, financial market, savings, and the possible services.
• Some analysts are predicting another big year for venture capital investment in digital health.
• There are also indicators that this market is not a bubble. All of which begs the questions: – is your money in digital health yet?
– how much areyou getting the services?
-
4
• According to research by Mercom Capital Group, consumer-focused technologies took in 65% of all VC investments in Q3 of 2014, including $345 millions in mobile health deals and $101 millions in telehealth funding.
• VC firms also invested $85 million in personal health firms, $70 million in social health companies, and $23 million for tech supporting medical scheduling, rating and shopping. These investments are up sharply from 2013
5
• Top 10 mHealth Apps for in 2015 (Surveying more than 65,000 physicians in
a network and an additional 500,000 in some referral network)
10. Pocket First Aid & CPR (Jive Media)
9. Glucose Buddy – Diabetes Log (Azumio)
8. Fooducate – Healthy Food Diet (Fooducate)
7. Instant Heart Rate (Azumio)
6. Emergency First Aid/Treatment (Phoneflips)
5. RunKeeper – GPS Track Run Walk (FitnessKeeper)
4. First Aid (American Red Cross)
3. Lose It! (FitNow)
2. White Noise Lite (TMSoft)
1. Weight Watchers Mobile (Weight Watchers International)
6
• On the other hand:
• The use of mobile and wireless technologies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service delivery across the globe.
• Fourteen categories of mHealth services were surveyed: health call centres, emergency, toll-free telephone services, managing emergencies and disasters, mobile telemedicine, appointment,reminders, community mobilization and health promotion, treatment compliance, mobile patient,records, information access, patient monitoring, health surveys and data collection, surveillance, health,awareness raising, and decision support systems.
• WHO supports7
8
- The Case Study in Fars Province(Studied in 2013-2014)
• Focus on attending of two major medical centers in Shiraz (Imam Reza and Motahari Clinics)
• Statistical information from IT center of Imam Reza and Motahari Clinics
• Approximately 300 questionnaires
9
- Result of questionnaires
10
On average, about 3,500 people visited the two clinics
• Daily attending percentage for different medical experts
24%
15%8% 6% 5% 3% 1%
38%
0%5%
10%15%20%25%30%35%40%
- Result of questionnaires
• Distribution of patients from different provinces
11
86%
6%4%
3% 1%Fars
Kohkiloye va boirahmad
Bushehr
Khozestan
Hormozgan
- Result of questionnaires
• distribution of patients according to the patient's location distance (in percent )
12
34%
14% 13%
34%
4%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Shiraz city Less than 50km
50 to 100 km Between 100and 500 km
More than 500km
- Result of questionnaires
• Frequency of number of accompanied persons for patients (in percent )
13
11%
42%
33%
14%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Unaccompanied One Two Three or more
- Result of questionnaires
• Frequency of travels on road to Shiraz (in percent )
14
36%39%
22%
3%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Less than 2 hours Between 2 to 4hours
4 to 8 hours More than 8hours
- Result of questionnaires
• Frequency of a vehicle 's trip to Shiraz (in percent )
15
1%
41% 40%
18%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Plane Public transport Private car Taxi charter
- Result of questionnaires
• Types of transport vehicles are used (in percent )
16
11%
43%40%
6%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Bus General Taxi Private car Taxi charter
- Result of questionnaires
• Frequency of Public transportation costs to Shiraz (in percent )
17
34% 33%
28%
5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Less than 15tomans
Between 15 to 30tomans
Between 30 to 80tomans
More than 80thousand tomans
- Result of questionnaires
• Types of resting places in Shiraz (in percent )
18
2%
11%3%
84%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Hotel Inn Motel We don’t need a place to rest
- Result of questionnaires
• Costs of resting place in Shiraz (in percent )
19
86%
6% 3% 5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Less than 15tomans
Between 15 to 30tomans
Between 30 to 50thousand tomans
More than 50thousand tomans
- Result of questionnaires
• Frequency of food in Shiraz (in percent )
20
8%
24%
56%
12%
0%
10%
20%
30%
40%
50%
60%
Bring own food Family home General Dining Is not required
- Result of questionnaires
• Frequency of food costs in Shiraz (in percent )
21
51%
27%
13%9%
0%
10%
20%
30%
40%
50%
60%
Less than fivethousand tomans
5 to 15 thousandtomans
Between 15 to 30tomans
More than 30thousand tomans
- Result of questionnaires
• Visiting a doctor for treatment per patient per year
• (in percent )
22
31%
24% 24%21%
0%
5%
10%
15%
20%
25%
30%
35%
First time One to threetimes
Four to six times More than sixtimes
- Result of questionnaires
• The waiting time for patients to get appointment(in percent )
23
34%
43%
17%
6%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Less than 30minutes
Between 30minutes to 1 hour
Between 1 to 2hours
More than 2hours
- Result of questionnaires
• The waiting time for patients to see a doctor (in percent )
24
25%
39%
28%
8%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Less than 2 hours Between 2 to 3hours
Between 3 to 5hours
More than 5hours
1. Evaluation of Social costs2. Evaluation of the initial investments required to provide
telemedicine applications
Some Economic aspects
25
26
- Total costs
Total initial costsTotal Mode Each Station
Data transmission equipment costs - 2,147,500
Cost of software and systems for telemedicine 50,000,000 -
The cost of training staff and doctors - 200,000
Total 50,000,000 2,347,500
Running initial costsTotal Mode Each Station
Salary of new employee 4,000,000 2,900,000
Internet fee - 170,000
Total 4,000,000 3,160,000
2.1. Fuel consumption
2.2. Levels of air pollution.
2.3. The amount of dead and injured in transport accident
2.4. Travel time
2.5. Travel and transportation expenses
2.6. Local Economy
2.7. Quality of life
27
2. Evaluation of the economic advantages of telemedicine in different dimension
2.1. Fuel consumption
• Typical Energy Consumption of various transportation systems in Iran
28
Average fuel consumption of automobile in road: 7.72 liters per100 Km
Average distance traveled to receive Shiraz: 308.15 km
Average petrol cost : 550 tomans
Average clinic visitor : 3500 patient
Percentage of patient use car : 58 %
Average distance travel in Shiraz city : 25.1 km
Average fuel consumption of automobile in city : 11.65 Liter
Average fuel consumption of automobile in road: 7.72 liters per100 Km
Average fuel consumption of Public Vehicle in road: 24.58 liters per100 Km
Average Gasoline cost for Public transport : 250 tomans
Percentage of patient use Public transport : 41%29
2.1. Fuel consumption
30
2.1. Fuel consumption
In Day In Year
Average fuel consumption
(liter)
Average fuel consumption cost
(toman)
Average fuel consumption
(liter)
Average fuel consumption cost
(toman)
Road trip by automobile
4,829,370 2,656,255,0001,762,720,050
969,533,075,000
Road trips by public transport
10,868,690 2,717,172,5003,967,071,850
991,767,962,500
Travel in city 909,580 500,269,000 331,996,700 182,598,185,000
Total 16,607,640 5,873,696,5006,061,788,600
2,143,899,222,500
The total fuel cost of the patients transportation
31
2.2. Standards of air pollution.
Date CP THC NMHC Nox HC + NOx PM P***
Euro1 July 92 2.72(3.16) - - - 0.97(1.13) - -
Euro 2 January 96 2.2 - - - 0.5 - -
Euro 3 January 2000 2.3 0.2 - 0.15 - - -
Euro 4 January 2005 1 0.1 - 0.08 - - -
Euro 5 January 2009 1 0.1 0.068 0.06 - 0.005** -
Euro 6 January 2014 1 0.1 0.068 0.06 - 0.005** -
• Average of HC and NOx releases : 0.295 gr/km
• Average of Co releases : 0.98 gr/km
• Formula 1: Average Co , HC and NOx releases per day =
Average distance (km) * (Co +HC+ NOx (g/km)) * Average number of visitors per day
• Formula 2: Average Co , HC and NOx releases per year =
Average distance (km) * Average number of visit * (Co +HC+ NOx(g/km)) * Average number of visitor * 365 day
32
2.2. Levels of air pollution.
The total Average pollution releases Due to
patients transportation (In grams)
33
2.2. Levels of air pollution.
Daily average pollution releases
Average pollution releases in year
Travel in road 1,375,119 1,897,252,202
Travel in city 134,768 185,938,720
Total 1,509,887 2,083,190,921
The number of injuries per 100 thousand population = 31.11
The number of deceased per 100 thousand population = 418.48
Average number of accompanied patient = 1.64
Percentage of non-resident attending Shiraz = 65.6%
Average daily clinic passengers = 0.656 * 3500 * (1 +1.64) = 6061.44
Average number of deaths caused by accidents in days:
(31.11 * 6061.44) / 100000 ≈ 1.9
Average number of dead caused by accidents in year:
1.9 * 365 = 693.5
Average number of injuries caused by accidents in days:
(418.48 * 6061.44) / 100000 ≈ 25.4
Average number of injuries caused by accidents in year :
25.4 * 365 = 9271 34
2.3. The dead and injured people in transport accidents
Total average time spent per visit to each patient,
1. Travel time
2. Waiting time to get an appointment
3. Waiting time for appointment
35
2.4. Travel time
Average time
Average travel time 3 h , 9 min
Average waiting time to get an appointment 2 h , 40 min
Average waiting time for appointment 2 h , 50 min
Total 8 h , 39 min
- Direct costs:
1. Average Cost of transportation
2. Average Cost of Food
3. Average Cost of Accommodation
- Indirect costs:
1. Average number of off days
2. Average number of accompanied Patient
36
2.5. Travel and transportation expenses
Total Average Cost for Per person:
37
2.5. Travel and transportation expenses
Average Cost
Average Cost of transportation 30,515
Average Cost of Food 13,500
Average Cost of Accommodation 11,400
Total 55,415
Average number of accompanied Patient = 1.64
Total Average Cost for Per person:(1.64*55,415) + 55,415 = 146,296 toman
38
2.6. Local Economy
Enhance social harmony and economic
•Availability and easy access for all citizen
•Reduce transportation
•Reduce air pollution
•Savings in energy costs
•Reduce traffic in city center
•Increase driving comfort
•Reduce the amount of dead and injured in transport accident
•Reduce diseases related air pollution
39
2.7. Quality of life
Government Costs
1.For Fuel
2. For Road Accidents (Medical Services)
3. For Insurance Companies
4. For Pollution
40
• For Fuel
Daily :
toman11,831,956,500=58,285.5*58*3500
Annual :
toman4,318,664,122,500 =11,831,956,500*365
41
Medical Services Costs (due to accidents)
• Injured Annually 6500
• Annually DEADs 520
• The average of 1,600,000 Rials per person (Daily) for medical services
• Insurance Companies costs annually
• 790,059 ,000,000 (rials)
42
رار آنها در بخش حمل و نقل کشوشسهم آالینده ها در هزینه های اجتماعی ناشی از انت
43
Social Costs due to Pollution
F = The social costs of transport
E = The total amount of fuel consumed by the vehicle used to transport
B =The total amount of fuel consumed to transport patients in day.
G =The total amount of fuel consumed to transport patients in year.
C =The total social cost of transportation of patients to consume in day.
A =The total social cost of transportation of patients to consume in year.
Barrel is equivalent to 158.99 liters .44
F = 31,571 Rls
E = 120.14 121.80 Liter = 12,256 Million barrels of crude oil
B = 16,607,640 Liter
B = 16,607,640 / 158.99 = 104,457.13 Barrels
B = 104,457.13 / 1,000,000 = 0.10445713 Million barrels of crude oil
G = 6,061,788,600 Liter
G = 6,061,788,600 / 158.99 = 38,126,854.52 Barrels
G = 38,126,854.52 / 1,000,000 = 38.12 Million barrels of crude oil
45
C = (F * G) / E = (31,571 * 0.10445713) / 12,256 ≈ 0.2690 =
26.9 million riyals in DAY
A = (F * G) / E = (31,571 * 38.12) / 12,256 ≈ 98 =
9800 million riyals in YEAR
Thus providing telemedicine services can save a lot
46
• There are vast opportunities for Governments, Private Sector, and People in eHealth and mHealth.
• mHealth is no different from other areas of eHealth in its need to adopt globally accepted standards and interoperable technologies, ideally using open architecture.
• The use of standardized information and communication technologies would enhance efficiency and reduce cost.
• To accomplish this, countries will need to collaborate in developing global best practices so that data can move more effectively between systems and applications.
Conclusions
47
48
Thank You
Telemedicine setup include initial costs and running costs
1.1. Initial costs
1. Data transmission equipment costs
2. Cost of software and systems for telemedicine
3. The cost of training staff and doctors
4. The cost of equipment and telemedicine
1.2. Running costs:
1. Salary of new employee
2. Internet fee
1. Evaluation of the initial investment required to provide a telemedicine applications
49
1. Data transmission equipment costs
1.1. Initial costs
Device Min Cost (Toman) Med Cost (Toman) Max Cost (Toman)
Scanner 222,000 291,000 450,000
Digital Camera 195,000 400,000 2,000,000
Webcam 21,500 100,000 240,000
Headphones 45,000 265,000 750,000
Microphone 11,000 28,000 63,000
Computer 1,000,000 2,000,000 3,500,000
Modem 72,000 84,000 122,000
Phone 76,000 148,000 341,000
Fax 295,000 348,000 860,000
Printer 210,000 535,000 815,000
Total 2,147,500 4,199,000 9,141,000
50
51
2. Cost of software and systems for telemedicine
1.1. Initial costs
Features a telemedicine system :1 . Authentication to Log2 communicate to manage in order the problem3. Schedule plans to meet with a specialist4 . Ability to send and receive messages between doctors , counselors , patient and management system5 . Record patient information6 . Record physicians information7 . Online meetings
52
2. Cost of software and systems for telemedicine
1.1. Initial costs
Features a telemedicine system Continue:8 . Records for patients , including :8.01 . Records of individual patients8.02 . Experiments8.03 . Medical information8.04 . Vital Signs8.05 . Drug consumption8.06 . Registered nurses8.07 . Upload Medical Records8.08 . Action Report8.09 . Reported improvement9 . Add prescriptions per month10 . View all medical records by physicians.11 . X-RAY view images using a web-based PACS system12 . Medical sensor system to connect online and offline
53
3. The cost of training staff and doctors
1.1. Initial costs
Sessions number
Each time sessions (hours)
Cost per hour (Toman)
Total Cost (Toman)
1 4 50000 200000
Train to doctors and specialists in financial and administrative support staff :1. Introduction to telemedicine services2. How to use telemedicine systems and equipment
54
4. The cost of equipment and telemedicine
1.1. Initial costs
Specialist Device Min Cost (Toman)
Med Cost (Toman)
Max Cost (Toman)
ENT Digital Macro View Otoscope 521,500 1,361,500 3,553,725
ENT General Exam Camera 1,746,500 1,749,500 5,229,000
Dermatology Dermascope 138,215 315,000 6,387,500
Interior - Lung Spirometer 53,165 1,207,500 12,250,000
Heart Electronic Stethoscope 416,500 1,329,965 3,009,895
55
1. Cost of new employee
1.2. Running costs
56
1.2. Running costs
Job Title Salary (Toman)
1 Project Manager 2,000,000
2 Finance and Administration Specialist 1,000,000
3 IT Specialist 1,000,000
4 Specialist Physician 1,500,000
5 (medical provider) 700,000
6 Technical Support 700,000
7 Local Doctor 1,500,000
8 Finance and Administration Specialist 700,000
9 Technical Support 700,000
Total 9,800,000
1. Salary of new employee
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