Residents of two remote Cambodian villages now have access to HMS-affiliated hospitals and physicians—and the expertise and experience that go with them—without the use of airline tickets or visas. Clinicians in both countries are using readily available technology to connect rural Cambodians, many of whom have never seen a doctor before, with local physicians volunteering in the Partners HealthCare Center for Connected Health.
Advances in medicine have always gone hand in hand with advances in technology, but the patient is usually on the receiving end of the final product. Through the center, patients and practitioners are changing the patient–doctor relationship using mass market technology to deliver and receive health care.
The Center for Connected Health (formerly Partners Telemedicine) enables hospitals to connect with patients outside the clinic with widely available technology like digital cameras, cell phones, and the internet. A high-risk cardiac patient, for example, is able to transmit vital signs to a nurse via an at-home monitoring device, enabling the nurse to help manage the patient’s care from a distance and provide treatment when it is needed.
In 2001, the center began an initiative called Operation Village Health in partnership with American Assistance for Cambodia, a relief agency founded by former Newsweek bureau chief Bernie Krishner, to assist Cambodian health care workers in providing more sophisticated care. Clinics are held once a month in the villages of Rovieng and Banlung. To reach the Rovieng site, a nurse makes the trip from the capital, Phnom Penh, which can take up to seven hours. There, the nurse interviews, examines, and digitally photographs patients and e-mails the information to Boston, where physicians respond with medical opinions and treatment suggestions. Care is coordinated with a hospital in the capital city.
“What has turned out to be really interesting is that it isn’t infectious diseases we’re seeing, but mostly non-communicable chronic conditions like hypertension and diabetes,” said Paul Heinzelmann, an HMS clinical instructor in medicine at Massachusetts General Hospital and the project leader for Operation Village Health. “Cambodia is one of those countries often described as having a ‘double burden.’” While infectious disease continues to be a problem, Heinzelmann said, Cambodians are increasingly diagnosed with chronic diseases that need long-term management. By now, nearly two thirds of patients at the Rovieng clinic are repeat customers. Each clinic brings up to 20 patients per month, and more than 800 consultations have been performed since the program began by volunteer physicians at MGH, Brigham and Women’s Hospital, and Partners/Dana–Farber Cancer Care.
Operation Village Health has attracted international attention and acclaim. In May 2006, the initiative was chosen as the winner of the Stockholm Challenge in the health category. The Stockholm Challenge is presented every two years and recognizes projects that use information and communication technology to counteract social and economic disadvantage.
In the future, said Heinzelmann, the program aims to bring clinics to additional villages. The center is also working with Cambodian clinicians to explore the use of digital pen technology to streamline the process and standardize reports, and other nonprofit organizations are helping to restructure local hospitals’ operations, including increased integration of telemedicine, which in turn will increase support for the clinics and their expansion.
