Abstracts

Rationale: Interactive videoconferencing adds a new dimension to telehealth in global health care and inter-disciplinary collaborations. Since July of 2006, the Adult Epilepsy Program at the University of Alberta (UAH) has been holding telemedicine conferences with members of the epilepsy program at the Aga Khan University (AKU) in Karachi, Pakistan. Although AKU has a fully functional epilepsy clinic, their epilepsy surgery program is in its early stages of development. The collaboration objectives are twofold; 1) to share interesting case studies and professional opinions on optimal plans of care and 2) for UAH to guide AKU in the development of their epilepsy surgery program. Since AKU is the major referral center for Karachi - a city with an estimated population of 12,315,843 - the estimated 0.6% global prevalence of epilepsy renders Karachi with an estimated 73,895 patients with epilepsy, 30% (22,168) of whom are probably refractory to medical therapy and hence potential candidates for epilepsy surgery. Methods: Video-conferences between the two sites were arranged 2-3 weeks in advance. The equipment available at AKU consists of a Polycom Picturetel 970 with internet protocol (IP) capabilities. At the UAH, Tandberg 6000 systems with both Integrated Service Digital Network (ISDN) and IP capabilities were used. Extensive testing using both point to point and bridged ISDN and IP connections was successfully carried out between conferences. Ability to display Powerpoint presentations, MRI, CT and video-EEG imaging was made possible from both sites. Connections were consistently tested the day prior to the scheduled conference to ensure available bandwidth and connectivity. Connections using both methods were attempted at speeds between 384-768 kbps. Results: Between July 2006 and June 2008, 16 one and a half-hour videoconference sessions were booked (excluding test sessions). Four of these conferences bridged in specialists from West Virginia University. Most successful connections occurred using IP point to point calls or a bridge connecting end points through IP at 512 kbps. This bandwidth, when connections were successful, allowed for optimal viewing clarity of any images presented with minimal audio and visual disturbances. Table 1 below shows conference connection outcomes. Conclusions: Based on 22 months experience, international tele-epilepsy collaboration between institutions in the developed and lesser developed world has proven feasible and valuable to all participating health professionals involved. Our experience suggests that before initiating an international collaboration such as ours, considerable thought and preparation before carrying out the actual conferences can ensure its success. Some considerations include accounting for time zone differences, equipment type and interoperability at each endpoint, connection capabilities, bandwidth availability, and backup plans in case of unsuccessful connections (e.g. audio conference backup, forwarding of presentations and images to all parties before conference). Testing of connections and all equipment to be utilized at each conference is also strongly suggested.