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PD41 Role Of Artificial Intelligence In Improving Access To COVID-19 Diagnosis During Pandemic
- Pedro Galvan, Jose Fusill, Felipe Gonzalez, Ronald Rivas, Benicio Grossling, Jose Ortellado, Juan Portillo, Julio Borba, Enrique Hilario
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 38 / Issue S1 / December 2022
- Published online by Cambridge University Press:
- 23 December 2022, p. S105
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Introduction
The evolution of advances in informatics, technology in medicine, and artificial intelligence (AI) offers opportunities to enhance health care during the coronavirus disease 2019 (COVID-19) pandemic. The challenge for biomedical engineers is to implement these developments in clinical practice to improve global health. Populations living in low-income countries do not have access to specialist care and quality diagnostic services for COVID-19. Therefore, an AI system based on a telemedicine platform for diagnosing COVID-19 could help mitigate the lack of highly trained radiologists at regional hospitals and serve as a triage system for rationalizing the use of reverse transcription polymerase chain reaction (RT-PCR) testing and other health resources in low-income countries. Thus, the utility of an AI system for diagnosing COVID-19 in Paraguay was investigated.
MethodsThis is a descriptive multicenter observational feasibility study of an AI tool for the rapid detection of COVID-19 in chest computed tomography (CT) images of patients with respiratory difficulties who attended public hospitals across the country.
ResultsBetween March 2020 and August 2021, 3,514 rapid diagnostic tests were carried out on patients with respiratory disorders to rule out COVID-19 in 14 hospitals nationwide. The average age of the patients was 48.6 years (52.8% were men); the most common age ranges were 27 to 59 years, followed by older than 60 years and 19 to 26 years. The most frequent findings on the CT images were severe pneumonia, bilateral pneumonia with pleural effusion, bilateral pulmonary emphysema, diffuse ground glass opacity, hemidiaphragmatic paresis, calcified granuloma in the lower right lobe, bilateral pleural effusion, sequelae of tuberculosis, bilateral emphysema, and fibrotic changes. Overall, there was 93 percent agreement and 7 percent discordance between the AI system and the RT-PCR test results. Compared with RT-PCR testing, the AI system had a sensitivity of 93 percent and a specificity of 80 percent.
ConclusionsParaguay has an AI-based telemedicine screening system for the rapid detection of COVID-19 that uses chest CT images of patients with respiratory conditions.
PD42 Diagnosis Of Chronic Diseases During The COVID-19 Pandemic Through Telemedicine
- Pedro Galvan, Ronald Rivas, Benicio Grossling, José Ortellado, Carlos Arbo, Juan Portillo, Julio Borba, Enrique Hilario
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 38 / Issue S1 / December 2022
- Published online by Cambridge University Press:
- 23 December 2022, pp. S105-S106
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Introduction
The diagnosis and management of chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic was one of the biggest challenges facing healthcare systems globally, especially in low-income countries. Since basic health care for chronic diseases can overwhelm the capacity of conventional face-to-face healthcare services, there is growing interest in using information and communication technology and telemedicine to improve access to medical services that are often not consistently available in rural communities. In this context, telemedicine tools should be directed toward maintaining basic health services for patients with chronic conditions in rural and underserved hospitals. This study evaluated a telemedicine system in remote public hospitals in Paraguay to demonstrate how telemedicine improved access to tertiary level diagnostic services for patients with chronic conditions.
MethodsThis descriptive study evaluated the use of telemedicine for diagnosing patients in remote public hospitals to improve provision of basic health services to patients with chronic disease during the COVID-19 pandemic. The type and frequency of diagnostic studies performed were determined.
ResultsDuring the study 677,023 telediagnoses were performed in 67 hospitals. The 435,568 electrocardiograms performed in 61 hospitals indicated normal physiology (60.1%), unspecified arrhythmias (10.5%), and sinus bradycardia (8.4%). The 227,360 teletomography tests performed in 12 hospitals were undertaken on the head (52.4%) because of trauma (motorcycle accidents) and cerebrovascular diseases, chest (15.8 %), and other anatomical regions. The 14,076 electroencephalograms performed in 19 hospitals were undertaken for antecedents of seizure (53.3%), disease progression controls (14.0%), and headache (12.5%). Nineteen prenatal ultrasound scans were conducted.
ConclusionsAlthough the results are promising for using telemedicine to bridge gaps and improve equity in the provision of basic health services for patients with chronic diseases in remote locations during the COVID-19 pandemic, a widespread use assessment should be undertaken before this tool is adopted.
PP165 Bridging The Gap Of Health Services During The COVID-19 Pandemic Through Telemedicine
- Pedro Galvan, Ronald Rivas, Luciano Recalde, José Ortellado, Carlos Arbo, Juan Portillo, Juan Mazzoleni, Enrique Hilario
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 37 / Issue S1 / December 2021
- Published online by Cambridge University Press:
- 03 December 2021, pp. 23-24
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Introduction
Health care for patients with chronic pathologies was scarce and limited worldwide during the COVID-19 pandemic. The challenge for clinical and biomedical engineers is to develop a bridging system to maintain the basic health services for chronic pathologies. Populations living in low-income countries did not have access to basic health services during the pandemic and depended on the scarce resources of their emergency health system. There were also equity issues between urban and rural populations. In this context, telemedicine tools should be directed toward maintaining the basic health services for patients with chronic pathologies. This study evaluated the results of a telemedicine system in remote public hospitals in Paraguay to show how health care for patients with chronic pathologies has been maintained by providing access to tertiary level diagnostic services by specialists.
MethodsThis descriptive study evaluated the results of using telemedicine between 2014 and 2020 for diagnosis in remote public hospitals to bridge the gap in providing basic health services for patients with chronic pathologies during the COVID-19 pandemic.
ResultsA total of 620,289 telediagnoses were performed in 67 hospitals. The 399,806 electrocardiogram diagnoses performed in 61 hospitals were normal (62%) or showed unspecified arrhythmias (13%) and sinus bradycardia (10%). The 207,597 teletomography tests performed in 12 hospitals were performed on the head because of motorcycle accidents and cerebrovascular diseases (54%), on the chest (14%), and other anatomical regions. The 12,867 electroencephalograms performed in 19 hospitals were for the antecedents of seizure (54%), evolutionary controls (14%), and headache (12%). The 19 ultrasound studies corresponded to prenatal controls.
ConclusionsAlthough the telemedicine tool implemented in public health to bridge the gap in basic health services for patients with chronic pathologies during the COVID-19 pandemic offered better equity in the provision of services in remote locations, a widespread use assessment should be undertaken before this tool is adopted.
PP119 Innovative Screening System For COVID-19 Using Application Of Artificial Intelligence For Telemedicine
- Pedro Galvan, Jose Fusillo, Felipe Gonzalez, Oraldo Vukujevic, Ronald Rivas, Luciano Recalde, Jose Ortellado, Juan Portillo, Julio Mazzoleni, Enrique Hilario
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 37 / Issue S1 / December 2021
- Published online by Cambridge University Press:
- 03 December 2021, p. 20
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Introduction
Artificial intelligence (AI) and innovative technology offer opportunities for enhanced health care during the COVID-19 pandemic. Populations living in low-income countries do not have access to reverse transcription polymerase chain reaction (RT-PCR) testing for COVID-19 and, thus, depend on the scarce resources of their health system. In this context, an automated screening system for COVID-19 based on AI for a telemedicine platform could be directed towards alleviating the current lack of trained radiologists who can interpret computed tomography images at countryside hospitals.
MethodsThis descriptive study was carried out in Paraguay by the Telemedicine Unit of the Ministry of Public Health and Social Welfare in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute and the University of the Basque Country. The utility of the screening system for COVID-19 was analyzed by dividing the results from two tailored AI systems implemented in 14 public hospitals into four likelihood levels for COVID-19.
ResultsBetween March and October 2020, 911 COVID-19 diagnoses were performed in 14 regional hospitals (62.6% were men and 37.4% were women). The average age of the patients diagnosed with COVID-19 was 50.7 years; 59.1% were aged 19 to 59 years. The two AI systems used have different background information for detecting COVID-19. The most common findings were severe pneumonia and bilateral pneumonia with pleural effusions. The role of computed tomography was to find lesions and evaluate the effects of treatment. The sensitivity of AI for detecting COVID-19 was 93%.
ConclusionsAI technology could help in developing a screening system for COVID-19 and other respiratory pathologies. It could speed up medical imaging diagnosis at regional hospitals for patients with suspected infection during the COVID-19 pandemic and rationalize scarce RT-PCR and specialized human resources in low-income countries. These results must be contextualized with the local or regional epidemiological profile before widespread implementation.
OP139 Attaining Universal Electrocardiographic Diagnosis Coverage Through Telemedicine
- Pedro Galvan, José Ortellado, Ronald Rivas, Juan Portillo, Julio Mazzoleni, Enrique Hilario
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 36 / Issue S1 / December 2020
- Published online by Cambridge University Press:
- 28 December 2020, p. 1
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Introduction
Innovative health technologies, like telemedicine, offer advantageous telediagnostic apps that can improve the health care of populations in remote regions. However, evidence on how these developments can enhance universal coverage for electrocardiographic (ECG) diagnosis to support a cardiovascular disease prevention program is limited. The utility of telemedicine for attaining universal coverage for ECG diagnosis according to the national cardiovascular disease prevention program in Paraguay was investigated.
MethodsThis cross-sectional survey included adults (aged 19 to 80 years) and children (aged 1 to 18 years) with a medical prescription. The study was carried out by the Telemedicine Unit to evaluate the utility of a telemedicine net for a countrywide detection and prevention program for cardiovascular disease. The results obtained by the tele-ECG net, which was implemented in sixty public hospitals countrywide, were analyzed and used to verify adherence to the cardiovascular prevention program.
ResultsBetween 2014 and 2019, 331,418 remote ECG diagnoses were performed. Of these, eighty-two percent (n = 270,539) were in adults and eighteen percent (n = 60,879) were in children. Among the adult diagnoses, the majority (52%) were pathological and included sinus bradycardia (13%), right bundle branch block (6%), left ventricular hypertrophy (5%), and ventricle repolarization disorder (5%). Among the children, only twenty percent of diagnoses pathological and included sinus bradycardia (11%) and sinus tachycardia (4%). The mean rate of adherence to the prevention program was 38.2 per 1,000 diagnoses performed.
ConclusionsThe results showed that telemedicine can significantly enhance coverage for universal ECG diagnosis to support cardiovascular disease prevention and health programs. However, before carrying out the systematic implementation of such a program contextualization using the regional epidemiological profile must be performed.
VP27 Countrywide Screening Of Cardiovascular Diseases Through Telemedicine
- Pedro Galvan, Jose Ortellado, Ronald Rivas, Juan Portillo, Julio Mazzoleni, Enrique Hilario
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 35 / Issue S1 / 2019
- Published online by Cambridge University Press:
- 31 December 2019, p. 82
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Introduction
Through telemedicine, advantageous telediagnostic systems can be developed to improve the health care of populations that do not have access to specialists. However, evidence on how such innovation technology can enhance the countrywide electrocardiographic (EKG) screening to support a prevention program for cardiovascular diseases is limited. The usability of telemedicine to improve the countrywide detection of heart diseases according to the national cardiovascular disease prevention program in Paraguay was investigated.
MethodsThis cross-sectional survey included adults (≥19 and ≤ 80 years) and children (≥1 and ≤ 18 years) with medical prescription. The study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare (MSPBS) in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute (IICS-UNA) to evaluate the utility of a telediagnostic net for detection and prevention program of cardiovascular disease in public health. For this purpose, the results obtained by the EKG telediagnosis net implemented in sixty countrywide public hospitals were analyzed and verified the adherence to the cardiovascular prevention program.
ResultsA total of 246,217 remote EKG diagnoses were performed between January 2014 and August 2018. Of the total, 80.6 percent (198,494) corresponded to adults and 19.4 percent (47,723) to children. The adult diagnoses were mainly normal (66.3 percent), sinus bradycardia (11.2 percent), right bundle branch block (4.8 percent), left ventricular hypertrophy (4.7 percent), ventricles repolarization disorder (4.4 percent), sinus tachycardia (4,4 percent), ischemia (1.7 percent), atrial fibrillation (1.1 percent), left bundle branch block (0.7 percent), and unspecified arrhythmias (0.6 percent). The children's diagnoses were mainly normal (79.4 percent), sinus bradycardia (10.6 percent), sinus tachycardia (3,2 percent), unspecified arrhythmias (2.8 percent), right bundle branch block (1.9 percent), left ventricular hypertrophy (1.0 percent), left bundle branch block (0.4 percent), ventricles repolarization disorder (0.3 percent), and atrial fibrillation (0.2 percent). The mean adherence rate to the prevention program was 2.3 between 2014 and 2018 for each thousand diagnosis performed.
ConclusionsThe results show that the telemedicine can enhance significantly the EKG screening to support a prevention program for cardiovascular diseases and health programs. However, before carrying out its systematic implementation, a contextualization with the regional epidemiological profile must be performed.
PP05 Developing Equity In Remote Locations Through Telediagnosis
- Pedro Galvan, Miguel Velazquez, Ronald Rivas, Gualberto Benitez, Jose Ortellado, Antonio Barrios, Enrique Hilario
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 34 / Issue S1 / 2018
- Published online by Cambridge University Press:
- 03 January 2019, pp. 67-68
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Introduction:
Clinical background: Until recently, populations living in remote areas did not have access to specialist care and quality diagnostic services and thus depended on the low response capacity of their local health system. Subsequently, there were equity issues between urban and rural populations. Therefore it was considered telediagnosis applications should be directed towards developing better equity in the provision of services in remote locations without access to specialists. This study has evaluated the results of a new telemedicine system in remote public hospitals in Paraguay, in order to show how the response capacity of the local integrated health service delivery networks has been improved by providing access to tertiary level diagnostic services by specialists. Objective: This study aims to evaluate the utility of telemedicine as a tool for developing better equity in the provision of services in remote locations.
Methods:This was a descriptive study, where the results of using telemedicine for diagnosis in remote public hospitals were evaluated as a tool to improve access to diagnostic services countrywide between 2014–2017. For these purposes, type and frequency of pathology diagnosed was determined.
Results:A total of 311,562 telediagnoses were performed in fifty-seven hospitals. The 191,435 electrocardiogram diagnosis performed in the fifty-five hospitals were mainly normal (62.1%), unspecified arrhythmias (12.5%), and sinus bradycardia (10.4%). Also 115,924 teletomography tests were performed in twelve hospitals, where 54.4 percent corresponded to head as a consequence of accidents (motorcycles) and cerebrovascular diseases, 13.8 percent to chest, and the rest the other anatomical regions. Regarding the 4,184 electroencephalogram tests performed, antecedents of seizure (54.3%), evolutionary controls (14.0%), and headache (11.5%), were mainly diagnosed. The nineteen ultrasound studies corresponded to prenatal controls.
Conclusions:Despite the results of the telediagnosis implemented in the public health to develop better equity in the provision of services in remote locations, a widespread use-assessment should be analyzed before this tool is adopted.
PP155 Telemedicine Enhance Universal Coverage Of Diagnostic Services
- Pedro Galvan, Miguel Velazquez, Ronald Rivas, Gualberto Benitez, Jose Ortellado, Antonio Barrios, Enrique Hilario
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 34 / Issue S1 / 2018
- Published online by Cambridge University Press:
- 03 January 2019, p. 127
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Introduction:
Through the telemedicine, advantageous telediagnostic systems can be developed to improve the health care of remote populations that don't have access to specialists. However, evidence on how such innovation technology can enhance universal coverage of diagnostic services in rural communities is limited. The usability of telemedicine to improve the coverage of diagnostic services in public health in Paraguay was investigated.
Methods:This descriptive study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare (MSPBS) in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute (IICS-UNA) and the University of the Basque Country (UPV / EHU) to evaluate the utility of a telediagnostic system for universal coverage in public health. For this purpose, the results obtained by the telediagnosis system implemented in fifty-six public countryside hospitals were analyzed and compared to a “face to face” diagnosis.
Results:The results obtained by the telediagnosis system implemented in fifty-six public countryside hospitals were analyzed. In that sense, 293,142 remote diagnoses were performed between January 2014 and September 2017. Of the total, 37.29 percent (109,311) corresponded to tomography studies, 61.44 percent (180,108) to electrocardiography (ECG), 1.26 percent (3,704) to electroencephalography (EEG) and 0.01 percent (19) to ultrasound. There were no significant differences between the remote and the “face to face” diagnosis. With the remote diagnosis a reduction of the cost was obtained, that supposes an important benefit for each citizen of the interior of the country.
Conclusions:The results show that the use of telemedicine can significantly enhance the universal coverage of diagnostic services and health programs, maximizing professional time and productivity, increasing access and equity, and reducing costs. However, before carrying out its systematic implementation, a contextualization with the regional epidemiological profile must be performed.