How To Make a Global House–Call

How ORBIS International created an original and

innovative Internet E-Learning & E-Consultation
program to help bring sight back to millions
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D r. E u g e n e H

A Tr ue Visionar y
Over the course of the last two decades, the measurable positive
benefits that are achieved by using online learning and consultation
programs and services have been carefully studied and clearly
documented. Initially, typical applications of using e–resources,
e–learning and e–consultation services and tools were primarily
capitalized upon by the educational and corporate industries.

Fortunately, in recent years the medical industry has recognized the

invaluable advantages that the online community can offer patients
on a global level. One of these remarkable visionaries can be found
in Dr. Eugene M. Helveston, M.D., Ophthalmologist–in–Chief of
ORBIS International (ORBIS). ORBIS is a non–profit humanitarian
organization dedicated to blindness prevention and treatment in
Ta b l e o f C o n t e n t s developing countries.
A True Visionar y 3 In November of 2002, Dr. Helveston found a corporate community
partner with Clarity.ca Inc (Clarity) and together they launched a
Taking A Closer Look 4
new Telemedicine E–Learning and E–Consultation service of the
Seeing the Potential 6 ORBIS Cyber–Sight® program in June of 2003. The Cyber–Sight®
This Page: program is an initiative of ORBIS, targeted at establishing an
Photo by Claude Ho extended presence of the ORBIS Volunteer Faculty with partners
Out of Sight 8 Cover Photos:
Surgeon in OR by Paul Lowe worldwide. This innovative E–Consultation program is a clinical
A New Perspective 9 Cornea box going to plane by Patrick Saine
Mother and daughter by ORBIS International
application designed by Clarity to allow a partner ophthalmologist
Next Page:
located anywhere in the world to be connected with an ORBIS
Conclusion 11 Photo by ORBIS International Telemedicine mentor (Telementor) for professional assistance.

How to Make a Global House–Call 3


Taking A Closer Look
Anne Frank once said “How wonderful it
is that nobody need wait a single moment
before starting to improve the world.”
Nothing could be truer in today’s digitally
and electronically connected world. This
fact was made evident once again with Dr.
Helveston’s vision to further enhance the
capacity of ORBIS’s Volunteer Faculty to
provide ongoing assistance to the global
ophthalmologist community by creating
an easily accessible Telemedicine website,
providing top–notch patient diagnosis
and treatment to anyone in the world
who needs it. Having the vision is the first
step, but turning a vision into a practical
application calls for good old–fashioned
analysis and technical ‘know–how’. Luckily,
that’s Clarity’s specialty.
The true purpose of the project analysis
process is to turn a concept into a working
reality. Excellence in front–end analysis of
any project is not only found in the ability
to accurately identify and create a program
that meets the user needs of today, but
to design a program that incorporates
a flexible infrastructure that anticipates
the way the program may need to evolve.
Working closely with the Volunteer Faculty
of ORBIS, Clarity ensured that the multi–
faceted needs of the partner doctors and
patient recipients, now and in the future,
were taken into full consideration.
As our world continues to grow, so do the
demands upon the medical community to
find new ways to provide medical services
4 How to Make a Global House–Call
Photo by Kiran Ridley
to patients situated in ever–expanding
geographical areas. Some initial analytical
considerations that are beneficial to take
into account include:
Who Are the Target Users?
In order to design an effective and efficient
telemedicine program/website, it is vital to
accurately identify the target users.This can
include partnering doctors, hospitals and
clinics or the provision of general diagnosis
and information services directly to patients.
The needs of these different user groups
significantly affect the internal information
flow structure, delivery of information and
services as well as the privacy requirements
the program incorporates.
Information Processing
Clearly establishing the consultation agenda
is critical to determining the best forms
of information gathering, processing and
sharing with the target users.This qualitative
system typically includes using one or two
methods of data acquisition and processing
known as ‘open’ and ‘closed’ processes. A
‘closed’ process is defined by asking people
very specific questions and giving them
boxes to tick. The ‘open’ process is defined
by asking people questions and giving
them space to formulate their own replies.
Traditionally, using a combination of both
‘open’ and ‘closed’ processes produces the
richest and most useful responses.
Photo by Polly Braden
User Capabilities the E–Consultation system incorporated a
patient consent form that they must sign to
Developing a program or website that give their personal physician permission to
is dependent upon accurate and timely send their information and relevant images
information exchange becomes completely to the Telementors that can only be used
ineffective if the end–user’s technical for specific diagnostic and/or educational
capabilities can not match the program’s purposes. Further patient safeguards
technical requirements. For example, when also clearly outlines to them that their
dealing with diagnostic images (pictures healthcare and well being always rests with
or X–rays), it is important to assume their personal physician and not with the
that the user will be working with a low Telementor(s) who have been asked for
bandwidth environment. Consequently, professional input.
the program should be designed to accept
images collected with a basic digital camera Clarity’s extensive experience within the
(typically 10k or less) to ensure the success medical community has taught them that
of all submitted images into the system. the key challenges in electronic learning
and consultation program design are not
Program Accessibility just technical – but also conceptual. ORBIS
needed the E–Learning and E–Consultation
When working within the medical community, programs designed with the capacity
it is essential that any and all appropriate for precise data capturing of extremely
parameters of doctor and patient privacy are specific information to facilitate the most
identified and met. Ensuring that partnering accurate diagnosis possible. In order to
medical professionals are correctly verified accomplish this, it was imperative that
and properly registered prior to granting every aspect of the program analysis and
them access to any critical information or design requirements were based upon both
resources is an important part of the design relevant and verifiable data.
process. Additionally, the highest program
security measures must be incorporated
to ensure patient privacy is maintained
and that the patient has approved of their
information being shared in this way.
On the ORBIS website, partner doctors can
only access their own cases and Telementor
doctors can only access cases they have
been assigned. Clarity also ensured that
How to Make a Global House–Call 5
 Photo by ORBIS International
Seeing the Potential
The most important data that really matters to ORBIS is the fact
that 37 million of the world’s people are blind and another 124
million have low vision and are at risk of becoming blind – and
75% of those don’t have to be. Millions can be cured with low–cost
techniques routinely practiced in many countries and ORBIS has
long since risen to the challenge to find new ways to deliver these
techniques to the people that need them on an international level.
Twenty-five years ago, ORBIS’s first eye care treatment and
ophthalmic training programs were launched on board the world’s
only Flying Eye Hospital, a former passenger aircraft converted into
a state-of-the art surgical training facility. Accompanying the ORBIS
plane is an international team of dedicated health professionals from
around the world, working together to share ophthalmic technology
and skills with their counterparts in developing countries. It has
been the success of the Flying Eye Hospital program that paved the
way for ORBIS to expand its mission to the Internet. It has been the
success of the Flying Eye Hospital programs that paved the way for
ORBIS to extend its mission to the Internet.
As the Flying Eye Hospital programs were put in place, Dr. Helveston
noticed what could be phrased as a kind of ‘disconnect’ once the
plane had left a location. This prompted him to conduct an informal
study using an email consultation process with patients in Cuba. His
original instructions to the partner doctors were to note but not
6 How to Make a Global House–Call
Photo by ORBIS International
act upon the resulting recommendations
and diagnosis offered through email.
Over the course of three separate visits to
Cuba, purely by coincidence, Dr. Helveston
ended up working directly with some of those
same patients and produced an independent
diagnosis and treatment plan.The partnering
doctors then showed him the diagnosis and
treatment plans that had been previously
offered via the email consultations and
they found that there was no difference
between the in–person consultation and
diagnosis and what was produced via the
email exchange. These surprising results
prompted Dr. Helveston to then seek
independent diagnosis confirmation with
10 different consulting ophthalmologists,
who all independently confirmed the same
diagnosis in each case. It was these results
that propelled Dr. Helveston to take the
next step and begin the development of a
Telemedicine service website with Clarity.
In 2002, when ORBIS decided to create a
Telemedicine website, they recognized the
necessity to partner with an organization
that truly understood the specialized
requirements of the health care industry. For
the last 8 years, Clarity has been successfully
designing unique website applications
tailored to meet the exacting needs of a
broad range of healthcare organizations
working within a wide variety of technical
environments. Clarity’s industry specific
expertise combined with their unwavering
commitment to finding new ways to serve
their community, locally and globally, resulted
in the perfect partnership both professionally
and personally between Clarity and ORBIS.
The ORBIS Telemedicine site also clearly
showcases the potential of exchanging
and managing knowledge with remote
locations globally via the Internet for any
type of organization that works within
the international arena. Clarity has always
understood that while technology is the
basis of their business, their business
is actually about meeting the very real
needs of the very real people that are
using the technology. Consequently, all
of programs Clarity designs utilize the
most current technological business
tools available to produce highly intuitive,
user–friendly applications.
How to Make a Global House–Call 7
 Out of Sight
There’s an old quote “Out of sight, out of
mind” and when it comes to creating any
program, no matter how complex, that’s
something Clarity’s program designers
always remember. Clarity uses a variety
of proprietary technological tools that act
as the nervous system linking everything
together to create one cohesive, seamless
multi–functional program.
The ORBIS Telemedicine website is no
exception. Driving the primary program
is Clarity’s Content Manager (CCM 5), a
straightforward Web–based application
enabling content owners to work
together on the creation, management
and publication of any type of content. The
CCM 5 flawlessly determines, integrates
and applies the new automated business
processes of each organization into their
existing business processing system.
Supporting the complex information
exchange that both the E–Learning and
E–Consultation facets of the ORBIS
Telemedicine website requires, is Clarity’s
E–Learning infrastructure known as
LiMe (Learning Information Management
Environment). This highly specialized core
system tool is designed to enable non–
technical users to create, manage, track
and deliver web based information to the
client’s target users. Additional system
features of LiMe includes the ability to
not only track, but assess the results and
status of the ongoing information that is
exchanged between the organization and
its’ user groups.
The union of Clarity’s CCM 5 content
management system and LiMe information
infrastructure, provides the perfect platform
to optimize the multiple forms of case
sensitive data that must be gathered and
8 How to Make a Global House–Call
–Call
Photo by Patrick Saine
analyzed to ensure the most accurate
diagnosis in the shortest time period. This
program foundation enables what is a
technically complicated information sharing
process to appear and work in a highly
intuitive format for the users.
One of the most critical components that
most users never see is the administrative
feature of the program. Clarity believes it’s
absolutely essential that the program be
designed for their clients to easily manage
and update. Through the administration
features of the E–Consultation application,
authorized ORBIS staff can set up new
partner locations, add partner Ophthal-
mologists and link partner Ophthal-
mologists with Telementor teams. The
global reporting also allows ORBIS staff
to view all cases managed through the
system and accurately report the number
of people benefiting from this program.
Every facet of Clarity’s approach to program
development and design is based upon the
clear understanding of how important it is
that the users experience be as effortless
and as rewarding as possible. The ORBIS
Telemedicine website is a great example
of using a truly innovative approach to
sharing knowledge to facilitate the healing
process on a global level, to areas that might
not otherwise have access to this level of
excellence in resources and information.
Photo by Paul Lowe
A New Per spective
As more organizations realize the almost E–Consultation application is designed to
unlimited potential that E–Learning and E– automatically notify Telementors possessing
Consultation applications present, they are the appropriate specialties, when new cases
also recognizing the very distinct difference arrive and allows the Telementors to login
between the success that a well designed and send recommendations back to the
program offers versus the significant drain partner Ophthalmologists. Partner doctors
on their personnel, financial and operational can also review relevant active and/or
systems that an inefficient, awkward completed cases they have been authorized
program can cause. Clarity designed the to examine.
ORBIS Telemedicine website to ensure that
both form (ease of use) and function (results Once logged in, the ORBIS Telementor
obtained) work together flawlessly. doctors see all active cases they have been
assigned. Telementors then have the choice
From the partnering doctor’s perspective,the to examine new cases or view active cases
ORBIS Telemedicine process involves initially they have already begun work on. Working
registering and receiving authentication with the specially tailored screen templates
from ORBIS to access the E–Consultation Clarity designed to meet the exacting case
site. Once a doctor has been verified,The E– information needs to facilitate an accurate
Consultation program enables the partner diagnosis and information sharing process
ophthalmologist to login to the system, between themselves and the partner
create new cases and view their own doctors, the Telementors can analyze and
existing cases. When a new case is created, begin to work with the partner doctors
the partner Ophthalmologist specifies the to help find the best treatment for their
response priority of the case, the medical patients. Telementors can also search and
specialty the case requires, downloads review all completed cases for reference and
diagnostic information and uploads research purposes to assist in their ongoing
pictures with the case file to be reviewed diagnostic efforts.
by the Telementor (ORBIS doctor). The
How to
t Make a Global House–Call 9
 “Clarity is extremely
proud of our work with
Orbis to make the web a
key tool in the elimination
of avoidable blindness and
restoration of sight in the
developing world.”
Photo by Kiran Ridley
~ Rob Sykes, Clarity
Conclusion

Photos by ORBIS International Just as our world grows and changes on a daily basis, so do the “The development of this unique
methods we are finding for technology to help better connect
A New Per sp e c t ive ( c o n t i nu e d … ) us with each other to improve our lives in meaningful and E–Learning and E–Consultation
positive ways. Working together, Clarity found a way to maximize process represents what the full
In 2004, Dr. Eugene M. Helveston of ORBIS So far, patients with glaucoma, cataract, technology to bring Dr. Helveston’s original vision of extending
International and Mr. Robert G. Sykes retinal disease, uveitis and brain tumors the presence of their Volunteer Faculty to partners on a global cycle of overseas volunteer work
of Clarity.ca Inc. were honored with the have already received evaluations employing scale, into a working reality that has had significant impact and can really accomplish.This process
prestigious Most Innovative Project Award E–Consultation. Additional benefits this value on the lives of many people.
for 2003, from the Canadian Development program development has garnered include
creates an ‘extended presence’
Economic Agency.This Award recognized the the fact that this platform has since been As the needs of today’s world changes, so too, do the needs of within the global medical
amazing results that the ORBIS Telemedicine adopted by one of the world leading the original E–Learning and E–Consultation program. Clarity
community, enabling the teaching
program had achieved in less than 12 months children’s hospitals, St Jude’s Children’s designed this system with the flexibility and capacity to grow and
of operation, successfully linking 40 leading Hospital in Memphis. change with ORBIS International’s partners as their requirements and mentoring process to extend
Canadian and American Ophthalmologists evolved. New system design refinements include expanding the from what used to be a week long
with 100 Ophthalmologists in 21 developing Clarity’s partnership with ORBIS has once internal consultation parameters so Telementors can request direct
countries to mentor and consult on over again proven not only the compatibility with, feedback from authorized colleagues on specific cases, as well as visit, to an ongoing professional
600 cases. but the very real need that the design and initial exploration into the provision of providing some mentoring relationship that can benefit
implementation of an effective E–Learning services in Spanish and traditional Chinese languages.
By March 28, 2007, Cyber–Sight® received and E–Consultation program fulfills in today’s patients for a lifetime.”
their 3,000 consultation request from medical and care–giving community, whose Whether it’s providing expert consulting, application development, ~ Dr. Eugene Helveston, M.D.,
Krakow, Poland. A total of 541 partners limited internal resources are being asked to application integration, creative design, employee training and/ Ophthalmologist–in–Chief
across the globe have enrolled in the program meet the needs of an increasing population or intranet development services – our impressive team of
of ORBIS International
for consultation on difficult patients with the spread out across ever–growing geographical experienced multi–disciplined professionals enables us to ensure
team of experts at ORBIS Cyber–Sight®. areas.This challenge is, of course, not merely that our clients are presented with only the most effective and cost
limited to the medical community, but one efficient solutions available to support and achieve their unique
To date, the ORBIS Telemedicine program that many corporations and organizations organizational and customer service goals.
has established 17 partner programs in 15 are faced with in a wide variety of industries
countries. While the initial emphasis was and business environments. Thankfully, it’s a To explore what innovative solutions Clarity can provide your
on pediatric ophthalmology and strabismus, challenge that Clarity knows how to meet. organization with or to request more information, please call:
mentor teams are now being established (403) 705–5900 or select Clarity. To learn more about the ORBIS
and partners selected for consultation in Telemedicine program, please select Telemedicine.
all of the subspecialties of ophthalmology.

10 How to Make a Global House–Call

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