KwaZulu Natal Department of health

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
There are few or no specialist neurosurgeons or radiologists employed at public hospitals, especially in rural areas of the province, despite numerous forms of advertisements to attract suitable, qualified personnel. Emergency patients, such as head trauma cases, who urgently require specialist treatment have to be transpoted by ambulance to Inkosi Albert Luthuli Central Hospital in Durban. The travelling distance may be as much as +350km, which compromises healthcare quality for emergency patients.

B. Strategic Approach

 2. What was the solution?
The teleradiology programme provides specialised radiological services in hospitals, particularly in rural areas, and provides montorships to regional and district hospitals.

 3. How did the initiative solve the problem and improve people’s lives?
Emergency radiological images are sent electronically from a rural to a central hospital. Radiology reports are sent through ISDN or ADSL networks (no longer by road transport) and are received by specialists in Durban on the same time and same day.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
See Attached

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
This an internal idea of the KZN Departement of Health. Specialist in the receiving site are full time employed by the Department. The following are involved Team from Telehealth and Information Technology Directorate of KZN Department of Health. Inkosi Albert Luthuli Central Hospital - Team from Radiology Unit. ISDN/ADSL is provided by Telkom
 6. How was the strategy implemented and what resources were mobilized?
TECHNICAL - The project is funded within normal budget of the Department under ICT directorate. Equipment is funded within Health Technology budget (CT scanners) HUMAN RESOURCES - Specialists in receiving site-Inkosi Albert Luthuli. The initiative has past the project phase into programme since year 2004 and each year is budgeted with ICT budget of the Department Therefore it is sustanable.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Teleradiology project/programme is an intergral part of radiological health services of the Department. And part of the strategic objectives. The project contributed to improved quality of care, customer satisfation and improved clinical mentorship for junior doctor, who no longer have to work single handedly.

 8. What were the most successful outputs and why was the initiative effective?
vLooking for early wins. Department will set goals and then work methodically to achieve them, monitoring telemedicine successes, and looking for ways to expand upon programs and initiatives that work. Department established the "Radiology Managers Forum" and Telemedicine Steering Committee" where progress of implementation of the strategy is discussed.

 9. What were the main obstacles encountered and how were they overcome?
The use of ISDN network makes CT scan images to transmit very slow. The pressure has continued to climb and we have sight of further complaints for the Radiologists in that they are claiming that due to the link not performing suitably their work load has increased plus they are raising concerns around patient care. (over radiation due to additional scans being required) ADLS network was a suitable option to ISDN but it was not available in some rural area. Another challenge is copper cable theft which causes interruptions to the project. We are now installalling wireless network. DICOM tags were a problem as it was not clear at the receiving site who was a patient since there was no unique identifier from sending hospital. This was resolved by making changes on the DICOM tags i.e. "first three letters of the hospital and patient name"

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The innovation has made a specialised healthcare services available to rural and underserved areas Electronic radiological reports from specialist are made available same-time/ same-day to referral regional hospital. Patients from rural and underserved areas get specialized and emergency-life saving healthcare without unnecessary being transferred to IALCH. The total transmission is the cost of the telephone cost per minute. Radiogical, head trauma patient are treated where they live without being tranfered to big city hospital, hence saving patient's life, saving patients family money to visit their love one who may have been treated at big city hospital. This has indeed improve patient satisfaction.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The initiative is sustainable as it is an intergral part of healthcare service delivery, inline with strategic objectives of the department. The project started with 3 hospitals and today there are 12 hospitals on the Teleradiology network. We looked at how heath services are being delivered and then creatively assertain which one that can be delivered and/or enhanced through the use of ICT. The project is being replicated throught the province.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Use of ICTs can be an enabler to health service delivery and make those service that otherwise would have not been available, then available to rural and underserved areas Lessons: Identify health disparities and promote telemedicine technologies that reduces them. Suggestions: Innovation should follow the following steps: 1.Clarify the problem 2.Idea generation 3.Incubation (testing/piloting) 4.Implementation (upscaling, diffusion or rollout) 5. Evaluation Innovation and Improvement happens when you start to measure.

Contact Information

Institution Name:   KwaZulu Natal Department of health
Institution Type:   Government Department  
Contact Person:   Rajeen Eashwari
Title:   Doctor  
Telephone/ Fax:   +27 33 846 7107
Institution's / Project's Website:  
Address:   private Bag x9057
Postal Code:   0032
City:   Pietermaritzburg
State/Province:   KwaZulu Natal

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