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Telemedicine support for the developing world
Abstract
Telemedicine has been used for some years in the industrialized world, albeit with rather mixed success. There is also a considerable literature on the potential use of telemedicine for the developing world. However, there are few reports of the actual use of telemedicine there. A review identified five telemedicine networks providing second opinions; each network had been in operation for over five years. Although they have different aims and methods of operation, they exhibit some common features. In particular, none of them appear to be dealing with markedly increasing referral rates. Rough calculations suggest that only about 0.1% of the potential telemedicine demand from the developing world is being met. Possible reasons include the referrers being too busy and a perceived loss of control. If this analysis is correct, then the right strategy for future telemedicine in developing countries will be to concentrate on the construction of within-country networks that demonstrably alter health outcomes, can be shown to be cost-effective and sustainable, and will provide a model for other countries to copy.
... While high-income countries often face problems surrounding patient privacy and confidentiality, competing health system priorities, reimbursement, and infrastructure [1,3,7], the implementation of these services in low-and middle-income countries has been limited mainly by financial and technology infrastructure constraints [8]. For instance, the uptake of telemedicine in Pakistan, India, and Sri Lanka has been low, with the estimation that about 99.9% of the need for telemedicine remains unmet across these countries [9]. In particular, the integration of telemedicine services into primary health care settings as a complement to existing modes of care has also been slow [10]. ...
... Similarly, in Australia in 2020, teleconsultation was used by 96% of general practitioners [23]. Literature on the availability of teleconsultation in low-and middle-income countries is limited and has mainly been reported in the form of pilot projects or as interventions for research purposes [9,24]. A majority of this literature highlights financial and technological constraints as the main implementation barriers in low-and middle-income countries in initiating and providing teleconsultation [9,25]. ...
... Literature on the availability of teleconsultation in low-and middle-income countries is limited and has mainly been reported in the form of pilot projects or as interventions for research purposes [9,24]. A majority of this literature highlights financial and technological constraints as the main implementation barriers in low-and middle-income countries in initiating and providing teleconsultation [9,25]. ...
Background:
The integration of teleconsultation into health care systems as a complement to existing approaches to care is growing rapidly. There is, however, limited information on the extent of its implementation across low- and middle-income countries.
Objective:
The aim of this study was to determine the availability and the extent of teleconsultation in Malaysian primary care clinics.
Methods:
A cross-sectional study of public primary care clinics in Malaysia was conducted between November 2020 and December 2020. All clinics in Malaysia that see more than 300 daily patients were recruited. A web-based, self-administered questionnaire including questions on availability of the service, whether it uses video or telephone, and the types of services it provides was distributed to the medical officer in charge of each clinic.
Results:
In total, 97.6% (249/255) of the clinics responded. Out of these clinics, 45.8% (114/249) provided teleconsultation. A majority of the clinics providing consultation (69/114, 60.5%) provided only telephone consultation, while 24.6% (28/114) of the clinics offered video and telephone consultation, and 14.9% (17/114) offered only video consultation. Eighty percent (92/114) of the clinics were located in urban areas. A breakdown by state showed that 17.5% (20/114) and 16.7% (19/114) of the clinics were from two larger states; other states comprised less than 10% each (range 7-9/114). For the clinics providing video consultation, funding for the service came mostly (42/45, 93%) from the Ministry of Health. Conversely, nearly 1 out of 4 (23/97) clinics that provided telephone consultation funded the service either from donations or through self-funding. Most of the clinics provided teleconsultation for diabetes and hypertension. Less than 50% of the clinics with teleconsultation used it for follow up with allied health care providers or pharmacists (video consultation, 20/45; telephone consultation, 36/97).
Conclusions:
Our findings show that telephone consultation is more widely used than video consultation, despite a quarter of its funding being self-subsidized or obtained through donations. Also, teleconsultation was less utilized by allied health care providers and pharmacists. Plans for the expansion of teleconsultation in Malaysian primary health care should take into consideration these findings to ensure a better and more cost-effective implementation of the service.
... Adapted from [12]. ...
... In supporting cancer services in remote areas, teleoncology can facilitate acquiring education, training, and continuing medical education (CME) credits for cancer specialists. Teleoncology also reduces unnecessary referrals, increases the efficiency of diagnosis, positively impacts patient care, and allows for closer scrutiny of overall medical services [12,34]. Moreover, teleoncology initiatives also aid in the identification of areas requiring improvement, allow for the attainment of outstanding professional expertise without the need for travel, and reinforce professional relationships by increasing the opportunities for collaborative publications amongst healthcare professionals working in different institutions [7,41,52,53]. ...
Due to widespread healthcare workforce shortages, many patients living in remote and rural North America currently have reduced access to various medical specialists. These shortages, coupled with the aging North American population, highlight the need to transform contemporary healthcare delivery systems. The exchange of medical information via telecommunication technology, known as telemedicine, offers promising solutions to address the medical needs of an aging population and the increased demand for specialty medical services. This progressive movement has also improved access to quality health care by mitigating the current shortage of trained subspecialists. Minimizing the effects of these shortages is particularly urgent in the care of cancer patients, many of whom require regular follow-up and close monitoring. Cancer patients living in remote areas of North America have reduced access to specialized care and, thus, have unacceptably high mortality and morbidity rates. Teleoncology, or the use of telemedicine to provide oncology services remotely, has the ability to improve access to high-quality care and assist in alleviating the burden of some of the severe adverse events associated with cancer. In this review, the authors describe how recent advances in teleoncology can reduce healthcare disparities and improve future cancer care in North America.
... Actually, teleconsultation can help the societies previously not served -It means to serve those tribal or mountainous region with lesser or no medical facilities because time-distance obstacles exist between health-care providers and end-user get nullified 7 . In addition to these evidences suggest vital socioeconomic advantages to affected person, deprived families, healthpractitioners and the health system, including increased patient accessed communication andeducational goals 22,23 . In-spite of this the reach of telemedicines is restricted and it is yet to be applied in the healthcare system of both the industrialized and developing countries with the initial funding -some pilot projects has been started 22 . ...
... In addition to these evidences suggest vital socioeconomic advantages to affected person, deprived families, healthpractitioners and the health system, including increased patient accessed communication andeducational goals 22,23 . In-spite of this the reach of telemedicines is restricted and it is yet to be applied in the healthcare system of both the industrialized and developing countries with the initial funding -some pilot projects has been started 22 . Many patients and health care providers unable to adopt this teleservice models that is different from traditional system or indigenous methods. ...
The great use of telecommunication technology propels new healthcare system of telemedicine through which diagnosis as well as treatment can be done in the remote areas. The ancient Greek language explain the terminology of telemedicine in the phrase of distance healing. As per WHO, Telemedicine is the delivery of health-care services, where distance is a critical factor, by all health-care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health-care workers, with the aim of advancing the health of individuals and communities. Historically the concept of teleconsultation was evolved in the first half of twentieth century when the data of ECG was communicated through telephone lines, this can be traced as first evidence of this unique healthcare system. Further the introduction of electrical system of telegraph as well as evolution of telephone revolutionized this system of healthcare. when the Technology of telemedicine help both patients as well as service providers in multiple ways involving physicians, surgeons, pharmacists, paramedical staff, IT and electronics engineers, government, hospitals and end user public Location is now a days no problem and therefore there is no limitation of the availability of healthcare facilities to such location or remote location. The biggest role in such development is played by the communication technology which may provide healthcare services to every nook and corner of the location. It can decrease the health staff pressure because in India WHO guidelines ask to maintain the ratio 1:1000 of doctor and Indian public compared to present 0.62:1000 ratio of doctor and public. The great advantage of this system is that in case of epidemic or pandemic like COVID 19 Telemedicine can keep the health staff are well general public free from contagious infection (COVID-19). There are a number of networking communication modes that can be applied, which may improve the patient compliance,dosage regimen can be managed in better fashion thus increase the longevity of person life. Disasters management during pandemics present unique challenges which can be addressed effectively as happened during the lockdown. This technology-based practice can break the infectivity chain of the transmission of communicable diseases This chapter incorporates basic concept of telemedicine, its origin and types, communication technologies, services by telemedicine, types of telemedicine, tools of telemedicine, telemedicine software's and guidelines related to practicingtelemedicine in reference to Indian context.
... Despite the availability of ready to use telehealth devices in industrialised and developing countries (Wootton, 2008), the process of activating telehealth conversations is not straightforward (Weinstein et al., 2014). Reasons for this are reported to be the lack of standards (Nesbitt, 2012), poor progress once initial 'seed' money dries up (Wootton, 2008), lack of financial incentives and poor technology integration (Weinstein et al., 2014). ...
... Despite the availability of ready to use telehealth devices in industrialised and developing countries (Wootton, 2008), the process of activating telehealth conversations is not straightforward (Weinstein et al., 2014). Reasons for this are reported to be the lack of standards (Nesbitt, 2012), poor progress once initial 'seed' money dries up (Wootton, 2008), lack of financial incentives and poor technology integration (Weinstein et al., 2014). There is also the problem of competing workload commitments for the staff in RACFS caring for residents with higher health needs who require extensive support (Gillespie et al., 2019). ...
Background:
Emergency Departments (ED) can be crowded places and not ideal environments for Residential Aged Care Facilities (RACF) residents awaiting assessment. Assessment and care planning may be made available via telehealth thereby avoiding unnecessary transfer to ED, without compromising the quality of care for the older person. Telehealth is attractive addition to improving healthcare decision-making in RACFs.
Objectives:
The aim of this scoping review is to explore the evidence around the use of telehealth and whether it influences the decision to transfer residents of RACF to ED.
Methods:
All peer reviewed literature that focused on RACFs, decision-making and assessment of residents using telehealth in real time, was included. All study designs, pilot studies and some systematic reviews were considered. Databases Medline, Embase and CINAHL were used in this search in June 2022. Search terms were a combination of the population: RACF residents, decision-making and assessments using telehealth, and or transfer to the ED. The search was assisted by a senior university research academic librarian/information specialist and reviewed by senior researchers. The PRISMA-ScR guidelines were used to report this study.
Results:
Of the 124 articles initially identified, 31 were eligible for inclusion for synthesis. The date range of the included studies was 2001 to 2022, with 15 published in the last five years. Critical appraisal was conducted using the Mixed Methods Appraisal Tool.
Conclusion:
This scoping review has mapped evidence that telehealth has been widely used in multiple settings. The association between the use of telehealth with improved clinical outcomes highlights its potential utility in enhancing care delivery for an older population in RACFs. Telehealth has shown that it can improve the decision-making for residents in RACFS, but more robust research designs are needed.
Implications for practice:
Using video/telehealth appears to improve RACF staff access to expert clinicians who can then assess and jointly plan care/management that can be provided in the resident's home. Knowledge and skills of RACF staff appear to be improved through joint assessment and decision-making with the use of video/telehealth access to expert clinicians.
... Neurosurg Focus. 2022;52 [6]:E6). 1 We fully agree that the COVID-19 pandemic has catalyzed the utilization of telemedicine services in the field of neurosurgery in countries with limited facilities and thereby confirmed the significance of these services for routine clinical practice. The vast availability of free cutting-edge software for distant video communication (Skype, Messenger, Viber, WhatsApp, etc.), in addition to state-of-theart mobile devices with high-speed internet connection, provide excellent opportunities for real-time, high-quality online neurosurgical consultations, education, and exchange of medical knowledge around the globe. ...
... 5 Despite recent advancements in telemedicine, the majority of physicians and patients in countries with limited facilities still prefer the traditional methods for consultations and medical care, which necessitates the introduction of widespread informational campaigns to clearly explain the pros and cons of telemedicine services. 6 The latter cannot substitute for conventional eye-to-eye contact between physicians and patients; however, it can be of real benefit to differentiate between elective and emergency cases, as well as to provide patient follow-up during the postoperative period. ...
TO THE EDITOR: We read with great interest the editorial by Servadei and Zaed (Servadei F, Zaed I. The role of telemedicine in countries with limited facilities: which peculiarities? Editorial. Neurosurg Focus. 2022;52[6]:E6).1 We fully agree that the COVID-19 pandemic has catalyzed the utilization of telemedicine services in the field of neurosurgery in countries with limited facilities and there-by confirmed the significance of these services for routine clinical practice. The vast availability of free cutting-edge software for distant video communication (Skype, Messenger, Viber, WhatsApp, etc.), in addition to state-of-the-art mobile devices with high-speed internet connection, provide excellent opportunities for real-time, high-quality online neurosurgical consultations, education, and exchange of medical knowledge around the globe.2,3
... Some populations are marginalized, like people with low literacy or elderly adults who may not have similar digital behavior as young adults with higher literacy or behavior in adopting new technologies in a faster way (24). In addition, access to mobile phones is highly skewed with women less likely to own a mobile phone particularly in developing countries (25,26). The gender gap in access to mobile phones has been found to be associated with lower utilization of health care services (27). ...
... In India, the growth of digital interventions for NCDs is mostly observed in the urban areas. Use of mobile phones for delivering NCD services is associated with ownership of mobile phones and geographic levels have an important bearing in the distribution of mobile phone ownership in India (25). As per the census 2011, 68.84% of India's total population live in rural areas, hence, urban-centered growth may not help to improve population health outcomes (33). ...
IntroductionCOVID-19 pandemic has caused major disruptions to delivery of various cancer care services as efforts were put to control the outbreak of the pandemic. Although the pandemic has highlighted the inadequacies of the system but has also led to emergence of a new cancer care delivery model which relies heavily on digital mediums. Digital health is not only restricted to virtual dissemination of information and consultation but has provided additional benefits ranging from support to cancer screening, early and more accurate diagnosis to increasing access to specialized care. This paper evaluates the challenges in the adoption of digital technologies to deliver cancer care services and provides recommendation for large-scale adoption in the Indian healthcare context.Methods
We performed a search of PubMed and Google Scholar for numerous terms related to adoption of digital health technologies for cancer care during pandemic. We also analyze various socio-ecological challenges—from individual to community, provider and systematic level—for digital adoption of cancer care service which have existed prior to pandemic and lead to digital inequalities.ResultsDespite encouraging benefits accruing from the adoption of digital health key challenges remain for large scale adoption. With respect to user the socio-economic characteristics such as age, literacy and socio-cultural norms are the major barriers. The key challenges faced by providers include regulatory issues, data security and the inconvenience associated with transition to a new system.Policy SummaryFor equitable digital healthcare, the need is to have a participatory approach of all stakeholders and urgently addressing the digital divide adequately. Sharing of health data of public and private hospitals, within the framework of the Indian regulations and Data Protection Act, is critical to the development of digital health in India and it can go a long way in better forecasting and managing cancer burden.
... Recent advancements in, and increasing availability and utilization of, ICTs by the general population have been the biggest drivers of telemedicine over the past decade, rapidly creating new possibilities for health care service and delivery. This has been true for developing countries and underserved areas of industrialized nations (Wootton, 2008). ...
... In low-income countries and in regions with limited infrastructure, telemedicine applications are primarily used to link health-care providers with specialists, referral hospitals, and tertiary care centres (Heinzelmann, 2005). Even though low-cost telemedicine applications have proven to be feasible, clinically useful, sustainable, and scalable in such settings and underserved communities, these applications are not being adopted on a significant scale due to a variety of barriers (Wootton, 2008). ...
Information and communication technologies (ICTs) have great potential to address some of the challenges faced by both developed and developing countries in providing accessible, cost-effective, high-quality health care services. Telemedicine uses ICTs to deliver service and exchanging information related to health care issues across distance. The application of telemedicine is rapidly advancing in Bangladesh. Both the public and private sectors have contributed to the development of the telemedicine infrastructure throughout the country. Effective functioning of telemedicine is greatly facilitated when physicians have good knowledge and positive acceptance of it. This study explores the current knowledge and attitude of physicians toward telemedicine at a ‘micro level’. A cross sectional survey was carried out among 200 physicians from Mohammadpur and Mohakhali area of Dhaka city by simple random sampling. A pretested semi-structured questionnaire was used to assess the knowledge and attitude of the respondents. Our findings revealed that majority of the respondents (92%) were aware of telemedicine. Out of 200 respondents, 48.5% had good knowledge of telemedicine. About 37% had average knowledge and 14.5% had poor knowledge of telemedicine. Among the respondents 48% had positive attitude, 32.5% had moderate and 19.5% had negative attitude toward telemedicine. Though it was found that their knowledge level is high but there was lacking of understanding telemedicine concept clearly. Majority of the respondents thought that telemedicine is used for treatment over telephone (75.5%). Associations between the knowledge level and age, rank, specialities and service length of the respondents were found in the study. Statistically significant differences were found in attitude level and the respondents who are user of telemedicine and who are nonuser of telemedicine. Though majority of respondents (82.5%) said that they have never attended any formal training on telemedicine, 82% of the respondents had expressed interest to attend any conference or seminars related to telemedicine and 73.5% of them wanted to use telemedicine at their place of work. The results of this study are expected to help in future successful implementation of telemedicine systems in Bangladesh.
... In low-pay nations and locales with the compelled establishment, telemedicine applications are used to interface human administration providers with specialists, referral clinical centers, and tertiary thought networks [16]. Even however negligible exertion telemedicine applications have shown to be down to earth, clinically significant, acceptable, and versatile in such settings and underserved systems, these applications are not being grasped on a vital scale as a result of a collection of blocks [17]. ...
... Despite its assurance, telemedicine applications have gained moving degrees of ground. In both industrialized and making countries, telemedicine still can't be dependably used in the social protection structure to pass on routine organizations, and scarcely any pilot adventures have had the choice to proceed with themselves once starting seed financing has wrapped up [17]. A couple routinely alluded to difficulties speak to the nonappearance of life expectancy in various telemedicine attempts. ...
Telemedicine is a term commonly used to portray a kind of patient consideration which
includes checking of a patient’s condition by a healthcare worker situated at a healthcare institute which is far from the area of the patient. Interest for electronic patient checking frameworks will considerably develop in one year from now, reinforced by innovative advances.
... Multiple previous studies have demonstrated variability in grading of ROP by retina specialists and trainees from both the United States and internationally, particularly with regard to plus disease. 24,[28][29][30][31][32] Despite the potential limitations, this study and program established insight and guidance in determining screening criteria and program development for children at risk for ROP in Mongolia. In 2018, at the tertiary referral center, preterm births accounted for 13% of all births and 77% of the infants born prematurely weighed less than 2,500 g at birth. ...
... Current successful telemedicine programs have partnered academic institutions and tertiary referral hospitals with those that provide care in remote and rural regions. [31][32][33][34] This is particularly applicable for ROP, where telemedicine can be used to consult internationally recognized experts in ROP diagnosis in challenging cases or in contexts where local providers are not adequately trained in ROP diagnosis. ...
Purpose:
To describe a process for identifying birth weight (BW) and gestational age (GA) screening guidelines in Mongolia.
Methods:
This was a prospective cohort study in a tertiary care hospital in Ulaanbataar, Mongolia, of 193 premature infants with GA of 36 weeks or younger and/or BW of 2,000 g or less) with regression analysis to determine associations between BW and GA and the development of retinopathy of prematurity (ROP).
Results:
As BW and GA decreased, the relative risk of developing ROP increased. The relative risk of developing any stage of ROP in infants born at 29 weeks or younger was 2.91 (95% CI: 1.55 to 5.44; P < .001] compared to older infants. The relative risk of developing any type of ROP in infants with BW of less than 1,200 g was 2.41 (95% CI: 1.35 to 4.29; P = .003] and developing type 2 or worse ROP was 2.05 (95% CI: 0.99 to 4.25; P = .05).
Conclusions:
Infants in Mongolia with heavier BW and older GA who fall outside of current United States screening guidelines of GA of 30 weeks or younger and/or BW of 1,500 g or less developed clinically relevant ROP. [J Pediatr Ophthalmol Strabismus. 2020;57(5):333-339.].
... The use of telemedicine is very advanced and it is a main stay in many Western countries like USA, UK, Australia, Norway, Finland, etc. However, the reverse is the case in the sub-Saharan African countries and other low income countries in the world, due to many barriers, ranging from legal issues to socio-economic issues 23 . ...
... In light of the above, it is highly recommended that the developing countries in the world should quickly embrace the use of teledentistry in providing oral healthcare services for their populace. Moreover, the use of this strategy should be supported by the legal frameworks of these concerned countries, as legal frameworks, amidst other barriers, had been implicated to be a major barrier to its use 23 . ...
... On the other hand, Wootton R. argues that telemedicine applications have achieved different levels of success. In both industrial and developing countries, telemedicine has yet to be used consistently in the healthcare system, and few pilot projects have been able to be maintained after the end of their initial funding [316]. ...
Technological innovation has become an integral aspect of our daily life, such as wearable and information technology, virtual reality and the Internet of Things which have contributed to transforming healthcare business and operations. Patients will now have a broader range and more mindful healthcare choices and experience a new era of healthcare with a patient-centric culture. Digital transformation determines personal and institutional health care. This paper aims to analyse the changes taking place in the field of healthcare due to digital transformation. For this purpose, a systematic bibliographic review is performed, utilising Scopus, Science Direct and PubMed databases from 2008 to 2021. Our methodology is based on the approach by Wester and Watson, which classify the related articles based on a concept-centric method and an ad hoc classification system which identify the categories used to describe areas of literature. The search was made during August 2022 and identified 5847 papers, of which 321 fulfilled the inclusion criteria for further process. Finally, by removing and adding additional studies, we ended with 287 articles grouped into five themes: information technology in health, the educational impact of e-health, the acceptance of e-health, telemedicine and security issues.
... Além disso, em seu funcionamento ideal, apresenta elevado grau de resolubilidade, pois cerca de 85% dos problemas de saúde podem ser completamente abordados e finalizados ainda no nível primário em saúde. 2 A partir da grande modernização do sistema de saúde, a telemedicina tem demonstrado sua utilização como ferramenta assistencial e de educação continuada. 3,4 No Brasil, o Telessaúde tem como objetivos principais aumentar a resolubilidade da atenção primária, reduzir desigualdades de atendimento e custos de saúde pública. Atua oferecendo modalidades de teleconsultoria, tele-educação, telediagnóstico e Segunda Opinião Formativa, por meio da Plataforma Telessaúde Brasil Redes. ...
Introdução: O Programa Telessaúde desempenha seu papel na assistência à saúde, especialmente nas regiões que não possuem estrutura ou atendimento médico especializado no Brasil No Pará esse núcleo presta assistência aos 144 municípios do estado. Objetivo: Delinear o perfil dos atendimentos realizados no estado do Pará. Métodos: O desenho do estudo foi observacional, retrospectivo e quantitativo, com análise da base de dados do programa. A fonte consultada foi a plataforma do Telessaúde-Pará com as consultorias realizadas entre 2018 e 2019. Resultados: Verificou-se que, nesse período, 208 teleconsultorias foram realizadas. Médicos foram os profissionais que mais as solicitaram. Os especialistas que responderam às solicitações com maior frequência foram médicos de família e comunidade, neurologistas e dermatologistas. As dúvidas mais frequentes foram as relacionadas a tratamento farmacológico e diagnóstico. A utilização de teleconsultorias evitou potenciais encaminhamentos em 76,9% dos casos. Entre os profissionais que utilizaram a plataforma, mais de 90% afirmaram satisfação com o serviço. Conclusões: Os dados demonstram a importância do programa na resolubilidade da Atenção Primária à Saúde, muito embora ainda haja pouca adesão e subutilização pelos usuários.
... Телемедицинските инструменти и технологии могат да помогнат за епидемиологично наблюдение чрез подпомагане идентифицирането на новите случаи и илюстриране на тенденциите [9]. Възможни са също мониторинг на развитието на болестта и подобрена комуникация за планиране и мобилизиране на екипи за спешна помощ [10]. ...
In times of global pandemic, telemedicine is emerging as an effective and sustainable solution to stop the spread of COVID-19. The aim of this article is to study the public attitudes towards the application of telemedicine in Bulgaria in the conditions of the COVID-19 pandemic. Material and methods. To study the public attitudes for the application of telemedicine in a pandemic, 253 people were interviewed voluntarily and anonymously. We used our own tools – a questionnaire distributed online. Statistical data processing was performed using IBM SPSS v. 23. Results. Respondents with higher education and healthcare workers were more distrustful of health information on the Internet. Over 75% of the respondents stated that they would use remote medical services for consultation with a medical professional in case of a health problem, and nearly 59% of them would pay for remote medical services for consultation and/or monitoring of treatment. The issuance of an electronic referral, an electronic sick leave form and an electronic prescription could limit the spread of COVID-19 according to 77.4% of them. Almost ¾ of our respondents would install a mobile application to contact a doctor in case of emergency. The preferred means of consulting a medical professional in the current pandemic is a telephone conversation. Conclusion. Telemedicine is essential to ensure that patients have access to medical care. In times of global public health emergency, health systems must rely on remote medical examinations and electronic prescriptions to deal with the further spread of the disease.
Key words: telemedicine, telehealth services, pandemic, COVID-19.
... Whereas, less effort has been invested in developing countries due to a limited budget to install technological infrastructure, and telemedicine was just an alternative to healthcare 7 . This scenario suddenly changed when COVID-19 pandemic forced every country to promote preventive measures such as physical isolation and no country was spared from those measures [15][16][17] . ...
Significant progress has been made in using information and communication technologies in medicine, by impacting the quality of health-care delivery system and patient care, and paving the way for ground-breaking tools for e-health and clinical decision-support systems. This study investigates the extent to which the evolution of telemedicine applications has been used to support patient care in Latin America (LATAM) amidst the pandemic. Theoretically, the study applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to identify the impact of telemedicine in the region. Practically, the paper provides a systematic mapping study of the different domain areas and methodological progress in Telemedicine that occurred during the pandemic, and applied a text mining technique to understand the intensities of the terms expressed by the analyzed studies. The results show that while telemedicine has not been extensively used, a greater percentage of the studies report that telemedicine was effective. Approximately 70% positive emotional valence score was found. The paper also provides an empirical discussion and recommendations for the next steps in ample adoption of telemedicine.
... There was also the challenge of how to take care of the patients and provide them with nonstop healthcare and management ( Juan Ricardo Márquez, 2020;Montenegro et al., 2021). Moreover, although technological approaches such as telemedicine proved inevitable, indispensable, and effective during the crises, the issue of digital skills, literacy, and training for the medical xix professionals was also a barrier to its wide use and ample adoption in the healthcare system (Heinzelmann et al., 2005;ATA, 2006;Wootton, 2008;Ryu, 2012;Juan Ricardo Márquez, 2020;Woolliscroft, 2020;UN, 2021b). New innovations and healthcare models will also emerge as telehealth services and standards proliferate (IEEE, 2021). ...
Novel coronavirus commonly known as coronavirus disease 19 (COVID-19) has rapidly spread worldwide and triggered the current global health crisis. It mostly affects humans through the zoonotic transmission of coronavirus 2 (SARS-CoV-2). This chapter focuses on the various epidemics and pandemics (plague, cholera, Spanish flu, etc.) in the history of human civilization, principal component analysis (PCA) for the interpretation of COVID-19 spreading kinetics during the first wave (in the year 2020), the potential use of herbal medicines, dietary remedies, and allopathic therapy to fight COVID-19, and various preventive measures undertaken to combat the pandemic during the first wave. The numbers of confirmed, recovered, active, and deceased cases is considered for the mapping of PCA within different countries. This study can be used as an informative approach for anticipating and strategy-making against COVID-19 or some other pandemics in the ensuing times.
... In spite of this, there is still a reluctance on the part of patients to increase their use of telemedicine (Wootton, 2008). There are several reasons why people may resist the use of new technologies such as telemedicine (Broens et al., 2007). ...
Telemedicine can expand access to health care at relatively low cost. Historically, however, demand for telemedicine has remained low. Using administrative records and a difference‐in‐differences methodology, we estimate the change in demand for telemedicine experienced after the onset of the COVID‐19 epidemic and the imposition of mobility restrictions. We find that the number of telemedicine calls made during the pandemic increased by 230 percent compared to the pre‐pandemic period. The effects were mostly driven by older individuals with preexisting conditions who used the service for internal medicine consultations. The demand for telemedicine remained relatively high even after mobility restrictions were relaxed, which is consistent with telemedicine being an “experience good.” These results are a proof of concept for policy makers to use such relatively low‐cost medical consultations, made possible by new technologies, to provide needed expansion of access to health care.
... 3 Nesse contexto, a telemedicina surge como ferramenta assistencial e de educação continuada aos profissionais de saúde. 4,5 No Brasil, o Telessaúde é uma das ferramentas da telemedicina, é utilizado no meio de saúde coletiva e conta com uma plataforma on-line que não tem fins lucrativos para grandes empresas, visto que se trata de uma iniciativa do Governo Federal para a melhoria da saúde pública no Estado. Portanto, o Telessaúde é uma ferramenta de tecnologia assistiva que dá apoio a atividades em saúde com o uso da telemedicina, e que foi regulamentado por diversas leis até a criação do Programa Nacional Telessaúde Brasil Redes. ...
Introdução: As tecnologias da informação modernizaram diversos ramos de atuação humana, inclusive a medicina. Nesse contexto, surge a telemedicina como um avanço das tecnologias de comunicação aplicadas nessa área. No Brasil, o Telessaúde é uma ferramenta da telemedicina a serviço da saúde pública e funciona com o propósito de elevar a resolubilidade da Atenção Primária à Saúde (APS). No Pará, Norte do Brasil, o núcleo Telessaúde presta assistência aos 144 municípios do estado. Objetivo: Avaliar a resolubilidade dos casos enviados por teleconsultorias e a satisfação dos profissionais solicitantes no Telessaúde Redes Núcleo Pará, de 2015 a 2019. Métodos: Foi realizado um estudo observacional, transversal e quantitativo de série histórica, no qual se consultou a plataforma Telessaúde para verificação dos dados sobre resolubilidade, satisfação profissional e status de utilização do serviço, com base em perguntas geradas automaticamente na plataforma. Resultados: Verificou-se que a resolubilidade variou ao longo dos anos com 45,6 a 70% de referenciamentos evitados, demonstrando-se relativamente pouco variável. Já a satisfação dos profissionais usuários demonstrou-se elevada, variando de 77,9 a 95,45%, estando os solicitantes majoritariamente “satisfeitos” ou “muito satisfeitos” com o serviço. Conclusões: Os dados sugerem a relevância do programa no que tange ao apoio à APS, com efeitos diversos na saúde pública.
... professionals was also a barrier to its wide use and ample adoption in the healthcare system (Heinzelmann et al., 2005;ATA, 2006;Wootton, 2008;Ryu, 2012;Juan Ricardo Márquez, 2020;Tandon, 2020;Woolliscroft, 2020;UN, 2021b). New innovations and healthcare models will also emerge as telehealth services and standards proliferate (IEEE, 2021). ...
Lessons from COVID-19: Impact on Healthcare Systems and Technology uncovers the impact that COVID-19 has made on healthcare and technology industries. State-of-the-art case studies, empirical research, and new trends in technology-mediated solution are discussed to help inform and guide readers in understanding the effects that the COVID-19 outbreak has had across healthcare and technology industries. The book discusses challenges to identify vaccines, changes in legislation on clinical trials and re-purposing of licensed drugs, effects on primary healthcare, best practices adopted by different countries to control the pandemic, and different effects on patients within diverse age groups and comorbidities.
In addition, the book covers technology-mediated solutions and infrastructures applied, digital transformations, modeling techniques, statistical projections, and the benefits and use of cloud computing and artificial intelligence. This is a valuable resource for healthcare professionals, medical doctors, researchers and graduate students from both biomedical and technological fields who are interested in learning more about the use of new technologies to fight a pandemic.
Key Features
- Discusses the effects of COVID-19 on healthcare and technology
- Presents case studies and state-of-the-art research and technologies to help readers effectively understand the effects of COVID-19
- Empowers researchers to work on effective hypothesis to test the disruptions and changes that have occurred as a result of COVID-19
- Bridges practical and theoretical gaps in terms of lessons learned during COVID-19 in the healthcare and technology sectors.
With the help of this book, readers will be able to:
(1)
understand the effects of COVID-19 on the healthcare and technology sectors
(2)
obtain a comprehensive view of the case studies and methodologies, state-of-the-art research, technologies, and effective practices that have impacted the different sectors during COVID-19
(3)
work on effective hypotheses to test the disruptions and changes that have spanned across the duration of COVID-19 in preparedness for what is next
(4)
bridge the practical and theoretical gaps or lessons learned during the COVID-19 pandemic, particularly within the healthcare system and technology sector.
... Au début des années 1970, des expériences avec des méthodes de communication modernes ont été conç ues pour apporter les services de médecins spécialistes à un nombre accru de patients [1]. Avec la démocratisation de l'accès à l'internet haut débit et la multiplication des utilisateurs, la télémédecine s'est développée ces dernières années rapidement dans le monde [2]. Par rapport à son utilité et son efficience, des études récentes ont montré un degré de satisfaction de 79 % [3] à 87 % [4] parmi les patients qui l'ont utilisée et son efficacité par des sociétés savantes dans les pays où elle a été déployée [5]. ...
Résumé
Objectifs
Dans le contexte de l’épidémie de SARS-CoV-2, les patients présentant des pathologies relevant de l’otoneurologie médicale ont pu être dissuadés de consulter, s’exposant ainsi à un risque de perte de chance. Ce guide de conseils de bonne pratique vise à définir l’apport de la téléconsultation à l’évaluation de l’adulte ou de l’enfant vertigineux, et à préciser les éléments recueillis à distance devant conduire à une prise en charge médicale rapide.
Méthodes
Ces conseils de bonne pratique reposent sur l’expérience des auteurs ainsi qu’une revue de la littérature. Le recensement des solutions de télémédecine adaptées à l’otoneurologie a été effectué sur la base d’une requête par moteur de recherche datant de mars 2020.
Résultats
La première évaluation clinique du patient vertigineux ne peut être réussie en téléconsultation que si les conditions suivantes sont réunies : prise de contact préalable pour vérifier la faisabilité de l’évaluation à distance, présence indispensable d’un aidant auprès du patient, possibilité de réaliser des enregistrements vidéos. Que ce soit chez l’adulte ou chez l’enfant, et de façon identique à l’évaluation présentielle, l’anamnèse permet d’apprécier le type, la durée, la fréquence et les circonstances de survenue du vertige. Lors de la téléconsultation peuvent être réalisés des tests d’oculomotricité, une recherche de nystagmus, une évaluation de la posture, des tests neurologiques simplifiés, la mise en évidence d’un vertige positionnel voire son traitement. Chez l’enfant doivent être recherchés en priorité des antécédents de surdité ou ophtalmologiques, un contexte fébrile ou traumatique, une otorrhée, des signes d’irritation méningée.
Conclusion
La télémédecine en otoneurologie trouve sa légitimité dans la fiabilité d’un bilan clinique, basé sur l’interrogatoire et quelques tests élémentaires, incitant à proposer des algorithmes décisionnels adaptés à la téléconsultation. Cette dernière comporte néanmoins des limites lors d’un premier épisode vertigineux en urgence, si bien qu’elle ne peut se substituer, dans un certain nombre de cas, à une consultation en présentiel. Elle est souvent adaptée pour le suivi de patients vertigineux sélectionnés par une évaluation présentielle initiale.
... While this modality has been developing slowly in the more developed regions of the world, it has taken time to find its use in the developing areas [35]. It has various benefits to offer such as (1) Improving the oral healthcare delivery to remote areas (2) Making dental care accessible to everyone (3) Bringing down the costs by enabling every person to get regular checkups (4) Helping gather data for research that can be applied to the betterment of oral health (5) Reducing the risk of virus transmission by bringing down physical visits to clinics until the vaccination process is complete International Journal of Dentistry ...
In the Southeast Asian region, various policies have been advocated by health regulatory bodies that entail protective measures such as face masks, gloves, maintaining distance in public areas, and more. These protective measures are aimed at helping reverse the growth rate of the coronavirus. Dentists in this region have incorporated several changes to their practices to help minimize risks of person-to-person transmission inside dental offices. This narrative review aimed to provide an in-depth overview of the current situation in the Southeast Asian region regarding the use of teledentistry during the pandemic. Teledentistry involves the transfer of patient information across remote distances for online consultation and treatment planning. A few years back, it used to be a lesser-known entity but has seen an exponential rise in its incorporation into dental practices all around the Association of Southeast Nations (ASEAN) region. Many clinics in the Southeast Asian region have started using online consultations to ensure that patients can be diagnosed or followed up during their treatment. Teledentistry is the clear answer in the coming months as it will help reduce the risk of virus transmission and help patients get access to oral healthcare and dentists to see their patients. This article reviews the current pandemic situation in the ASEAN region, the recent evidence, and the scope of teledentistry. It also provides recommendations for the future and sheds light on the different types of teledentistry and how it can be incorporated into practices by regulatory authorities in this region.
... 4 In spite of the successes, many patients and doctors prefer the use of traditional methods of consultation and treatment, which requires large-scale information programs to inform the public about the benefits of telemedicine. 9 It should be clear that telemedicine cannot replace the direct contact between a doctor and a patient, but it can be very useful both in distinguishing emergencies from and nonemergencies and in tracking operated patients. ...
... The lack of technological infrastructures was previously considered a primary barrier to telemedicine in developing countries. Recent surveys demonstrated that digital methods of communication, such as mobile phones and the Internet, have become widely available among the general population over the past decade [23]. In Egypt, statistical figures demonstrated that more than 90 million mobile users and nearly 37% of the population were Internet users by 2012 [21]. ...
Objectives:
The study is aimed at evaluating knowledge, attitude, and barriers to telemedicine among the general population in Egypt.
Methods:
A questionnaire-based cross-sectional design was carried out among the general Egyptian population. A convenience sampling method was used to approach the eligible participants from University Teaching Hospitals of eight governorates from May to July 2020.
Results:
A total of 686 participants filled the questionnaire (49.4% were males, mean age 36.7 ± 11.2 years old). Half of the participants stated that they previously used a telemedicine tool, mainly to follow up laboratory results (67.3%). Video or phone calls (39.3%) and mobile applications (23.7%) were the most commonly recognized telemedicine tools by the participants. The included participants exhibited a high level of knowledge and attitude towards telemedicine. On the other hand, 21.9% stated that telemedicine services could jeopardize patient privacy. 32.8% reported that telemedicine service could lead to disclosing medical information to people who are not authorized to do so. Almost half of the participants agreed to strongly agreed that telemedicine service could increase medical errors. 60.80% of the participants said that they are more likely to prefer telemedicine than traditional ways. However, 13.70% stated that telemedicine is more likely to be challenging to use.
Conclusion:
The Egyptian population has high knowledge about the applications of telemedicine. In addition, the vast majority of Egyptians appear to perceive the benefits of telemedicine positively and are willing to use it. However, some barriers that have been found must be taken into consideration to adopt telemedicine successfully, especially for people who are old, are low educated, and live in remote areas. Future studies should address the utility of telemedicine in improving the quality of healthcare and patient's health outcome and quality of life.
... Moreover, Pappot, Taarnhoj and Pappot (2020) and Wootton (2008) added that the opportunity embedded in telemedicine translates to extension of medical services to remote people in the region with limited access to medical services, in particular in the area where the centres that are saddled with providing vital information and sensitizing the general public on health related issues are not available. Scott and Mars (2015) as well as Lewis, Synowiec, Lagomarsino and Schweitzer (2012) noted that the benefits inherent in online healthcare delivery for patients and the general populace in various forms have lent credence to an increase in the popularity of telemedicine as a part of medical practice in a number of developing countries including the sub-Saharan African region. ...
Sub-Saharan Africa has experienced unprecedented technological advancement, just like several other regions of the world. This improvement in technology lends credence to the proliferation of android mobile phones, laptops computers and the Internet facilities that enhance interaction on the social media which in turn generates momentous alterations in the ways the residents of the region construct their daily lives. From epidemiological perspective as well as the viewpoint of change and development, via these information technologies, rendering health-related care and services to the residents in the remote places of the region and gaining access to vital information that prompts prevention and control of diseases are now feasible unlike before the advancement. Therefore, telemedicine symbolizes a health innovation in the region. In the light of this, this paper systematically reviewed the extent to which telemedicine has gained acceptance among the residents of the region; and the socio-cultural factors and practices that promote and decelerate the general acceptance of telemedicine in the region. To accomplish the objective, the review was done meta-analytically and meta-synthetically to explore recent relevant studies. The paper discovered that reduction in the cost of gaining access to health information, harnessing online health and medical services, are among the benefits derived from telemedicine while fake online information, impoverished network service delivery, financial incapacity, theft, technical faults, underutilization of the technology devices and cyber-crime are among the factors that militate against wide acceptance of telemedicine in the region.
... Even though there has not been comprehensive studies on telemedicine, only a few studies have focused on the evaluation of telemedicine to bring to light the challenges, as against prospects. Our study contributes to this gap by providing a framework to assess both health providers' and clients' needs for telemedicine especially in rural communities [44]. Furthermore, this study found that funding for training of health workers, inappropriate application of technology, maintenance of equipment and poor network infrastructure were some of the challenges likely to affect telemedicine implementation. ...
Background: Telemedicine has proven to be one of the modern medical discoveries in recent times, serving as a technological tool to deliver healthcare at a distance and providing medical solutions to remote communities with limited access to quality healthcare. However, the challenges associated with the use of telemedicine in Ghana make it difficult to scale up its application at the Primary Healthcare (PHC) level. Aim: The aim of the study was to assess the current trends and applications of telemedicine in health care delivery at the primary health care level in Ghana. The study also sought to identify the prospects and challenges of telemedicine implementation in Ghana. Study Design: The study employed both qualitative and quantitative design involving 200 respondents made up of 80 healthcare professionals and 120 patients from four primary healthcare facilities in the Ahafo-Ano North District of the Ashanti region of Ghana Methods: Survey questionnaire, semi-structured interview guide, and field observations were used to find out the knowledge of providers, capacity, availability of network infrastructure, and challenges of implementing telemedicine at the PHC level from the viewpoint of healthcare 'professionals' and to verify factors that can persuade patients to participate in the implementation of telemedicine. Logistic regression analysis was conducted to estimate the factors influencing 'patients' decision to participate in telemedicine, while the qualitative data were analyzed using thematic content analysis. Results: The results show that knowledge and education about telemedicine, easy access to specialist care at home, widespread use of mobile telephony, and reduction in travel cost due to telemedicine significantly influence both providers' and patients' participation in telemedicine at the primary healthcare level. The minimum educational level for patients to participate in telemedicine implementation is a primary education (OR = 0.233, p<0.025). On the other hand, inadequate infrastructure, legal issues such as non-certification of providers, reimbursement and confidentiality challenges are some of the factors that impede telemedicine implementation. Conclusion: The authors suggest that developing countries need to take advantage of the massive use of mobile telephony and embrace telemedicine application to increase access to healthcare in rural areas. Again, certification of care providers is critical for effective application and integration of telemedicine and this should be adaptive to local needs, high internet connectivity and the demands of both healthcare professionals and patients especially in rural communities.
... Following a review by Richard Wootton (2008) To succeed in developing countries, low-cost telehealth systems should be used because they are feasible, clinically useful, and sustainable. The sensible approach is to build intracountry telehealth networks as soon as possible and for the networks to be under the control of the ministry of health. ...
This book describes how telehealth care can be applied to
the care of patients with respiratory disorders at home.
Although it is most relevant to respiratory care practitioners,
many chapters will be useful to other practitioners in other
disciplines in telehealth. This includes telehealth care
managers, care planners, and information technology staff. In
fact, the book will cover fields other than just telehealth and
home care, which makes this book useful to anyone involved
or related to health care.
... Later on, it was observed that given the benefits it could be considered for urban landscape as well, The benefits it could bring in terms of timesaving (by not needing to go to a clinic and. get tested for receiving a diagnostic and having a receipt issued, etc.), travel avoidance (by being remotely monitored and eliminating the need for patients to be at the same location as the health care provider), by-passing language barriers (being able to travel and still receive medical assistance in local dialect)and making available the best professional (specialized surgeons can perform surgery on a patient even though they are not physically in the same location) [14][15][16]. One of the frameworks for the implementation of telemedicine in chronic care provided by Salisbury et al. is illustrated in Figure 1 [17]. ...
The surge in diabetes prevalence has seized the increasing attention of Physicians, Patients, Healthcare Support Systems, as well as policymakers. Telemedicine is a frugal intervention in diabetes care and has often argued to be effective in enhancing Availability, Affordability, and Accessibility (3As) of the diabetes care system. This study maps diabetes care components on 3As of diabetes care systems through focus group discussions of all the stakeholders including diabetes patient, physician, dietitian, patient attendant, and health administrator. Further Monte-Carlo based simulation is adopted to estimate cost-savings (indirect cost) on family income. The results of the study show that telemedicine can be an effective intervention and can generate significant cost savings (indirect cost), which is equivalent to three to four percent of the average annual income of a family.
... Medical professionals need to be trained on the new healthcare method. Patients, on the other hand, should be informed about the purpose of telecare and should be instructed how to safely and securely use the devices [6]. The lack of sufficient computer-literate professionals with experience in managing computer services, combined with the lengthy process required to master computerbased medical devices, could hinder the implementation of telehealth services [7]. ...
Global pandemics pose unprecedented challenges to healthcare. In the current situation, telemedicine appears to be a sustainable and effective solution in the implementation of precautions, prevention and treatment in order to discontinue the spreading of the coronavirus infection (COVID-19).
The aim of this paper was to research and analyze the role of telemedicine in assistance to healthcare in the COVID-19 pandemic.
Methods: The PubMed Database, Google Scholar, SpringerLink, ScienceDirect (Elsevier) and sites of public authorities have been accessed and reviewed.
Results: Advantages, restrictions, policy and application of telemedicine in the conditions of COVID-19 pandemic have been studied and analyzed.
Conclusion: Healthcare systems are put under an extreme test during global pandemics. Telemedicine is crucial during the COVID-19 pandemic because it guarantees that patients have access to medical care.
... In the beginning of the 1970s, experiments with modern communication methods were designed to provide medical care to a greater number of patients [1]. With now widespread high-speed internet access and a growing number of users, telemedicine has rapidly developed all over the world in recent years [2]. With regard to its utility and effectiveness, recent studies have shown: ...
Objectives: In the context of the SARS-CoV-2 pandemic, patients may have been discouraged from seeking consultations, thus exposing themselves to the risk of losing their chances. This guide aims to define how teleconsultation can help assess dizzy adults or children and gather the information needed to provide prompt healthcare.
Methods: These recommendations are based on the experience of the authors, as well as on the literature. A survey on the otoneurological approach through telemedicine was conducted based on a literature search until March 2020.
Results: The first clinical evaluation of the dizzy patient can be successful only by teleconsultation if the following conditions are met: initial contact to verify the feasibility of remote evaluation, the presence of a caregiver, who assists the patient, the possibility of making videos. Whether in the case of adults or children and as in the case of a face-to-face assessment, medical history through telemedicine allows the assessment of the characteristics, duration, frequency and potential triggers of vertigo. During the teleconsultation, the following tests can be performed: oculomotor assessment, balance assessment, simple neurological tests, verification of positional vertigo / nystagmus and even its treatment. In children, the following should be sought: a history of hearing or eye failure, a context of fever or trauma, otorrhea, signs of meningeal irritation.
Conclusion: Otoneurological telemedicine is based on the accuracy of the clinical evaluation, which is based on the sampling of the history and a few simple tests, encouraging the creation of a decision-making algorithm adapted to teleconsultation. However, the latter has its limitations during the first physical examination of a dizzy patient in emergencies and, at least in some cases, cannot replace a face-to-face consultation. Teleconsultation is often tailored to conduct follow-up consultations for previously selected dizzy patients during a face-to-face assessment.
... Internet is used in providing tele-medicine, special care must be taken to ensure the safety of patients and medical data as Internet has a number of security issues (Wang 1999). Although tele-medicine is used in developed countries for some years now with mixed rate of success, only 0.1% of the potential telemedicine demand from the developing world is being satisfied (Wootton 2008). ...
... For digital health to develop its full potential in Africa, solutions and applications have to be developed and deployed based on real needs, fostering innovative ideas and combinations of existing and new technologies. Capacity should be developed at different scales and across all sectors of digital health, moving from vertical silos to widely-connected systems, by facilitating the evolution and development of infrastructure for existing centers of excellence, and establishing North-South (between developed and developing countries) as well as South-South collaborative networks of excellence, based on models of successful implementations [25,55]. ...
Digital health, which is the use of digital, mobile and wireless technologies for health, is increasingly recognized for its potential to strengthen overall health system performance as digital health can increase access to health services, and improve quality and efficiency of care through de-isolation of healthcare professionals in remote locations. One of the most pressing issues in challenged health systems is a global shortage and uneven distribution of health workers, which will likely increase due to rising incidence of non-communicable diseases (NCDs) and a globally aging population, which will generate additional healthcare demand. Digital health can be a catalyst to address this shortage and other urgent issues in challenged health systems. When designing, developing, implementing, and maintaining digital health solutions, the insufficient availability of skilled human resources is consistently described as a major limiting factor. However, several programs, aimed at building digital health capacity at different levels in Africa address this gap. Independent of geography, digital health is a field of science at the intersection of other domains, which is interdisciplinary by definition and which will require more inter-professionalism. There is no single digital solution that fits all. For digital health to develop its full potential in Africa, solutions and applications have to be developed and deployed in cooperation with local human capacity, based on real needs, fostering innovative ideas and combinations of existing and new technologies.
... Even though low-cost telemedicine applications have proven to be feasible, clinically useful, sustainable, in underserved communities, its utilization has not been on a signifi cant scale due to a variety of barriers [14]. ...
... Despite its promise, telemedicine applications have achieved varying levels of success, as some patients and physicians resist adopting service models that differ from traditional approaches. 5 However, legal considerations are the major obstacle to telemedicine uptake. Among them the absence of an international legal framework; the lack of policies that govern patient privacy and confidentiality in data transfer, storage and sharing; and last but not least, the risk of medical liability for the health professionals offering telemedicine services. ...
... Today, telehealth is one aspect of the use of ICT. It is widely believed that ICT generally has the potential to improve clinical care and public health (Wotton, 2008). According to Wotton et al. (2009), in addition to facilitating medical education, administration and research, appropriate use of ICT may: ...
Purpose
The purpose of this paper is to analyse the integration of industry 4.0 related technologies of telehealth within innovative housing models addressed to senior population, in order to facing the growing issue of a sustainable management of the population ageing.
Design/methodology/approach
A qualitative exploratory analysis of four case studies of senior cohousing facilities located in different countries was performed. The cases analysed were selected as pioneering cases in the adoption of innovative and economically sustainable organizational solutions.
Findings
The study made it possible to identify which are the common characters that successful experiences have highlighted. Although each facility needs to adapt to the social, cultural, demographic and economic context in which it is located, there are some recurring aspects, which have proved to be key success factors.
Research limitations/implications
This research analyses only four cases. This suggests that the sample does not provide an exhaustive representation of the models adopted in this field. However, the study is an exploratory research and it can provide a basis for further analyses.
Practical implications
This study provides valuable indications for the design and management of senior cohousing facilities, as regards the services to be offered, the network of services and facilities that can be complementary to the residences, the activities to be conducted and organized, the degree of involvement of the elderly in the planning of activities and services. With regard to the adoption of telehealth-related technologies, the study provides indications on which new technologies resulting from the industry 4.0 revolution are going to be adopted, that is, remote surveillance, remote diagnostics and the use of sensors and video. These technologies, thanks to the artificial intelligence, can detect anomalies and provide predictive analyses on the behaviour and health of the elderly.
Originality/value
The study made it possible to identify the key success factors for senior cohousing facilities regardless of the characteristics of the context in which they are located. In addition, it provides a first analysis of the potential of telehealth-related technological solutions, paving the way for further studies aimed at assessing how, thanks to new technologies, the level of economic sustainability of senior cohousing solutions can be improved.
... 18 However, the human factors previously reported with earlier adoption of teleoncology may still be limiting its use. 7,19 For example, some LMICs have a proliferation of underused videoconferencing centers, whereas others have been very successful. 20,21 Failure to use telemedicine has been ascribed to fear of change, loss of political control or professional control over patients, and a reluctance to seek second opinions. ...
Cancer is the second leading cause of death worldwide, with approximately 70% of the 9.6 million deaths per year occurring in low- and middle-income countries (LMICs), where there is critical shortage of human and material resources or infrastructure to deal with cancer. If the current trend continues, the burden of cancer is expected to increase to 22 million new cases annually by 2030, with 81% of new cases and almost 88% of mortality occurring in LMICs. Global health places a priority on improving health and reducing these disparities to achieve equity in health for all people worldwide. In today’s hyper-connected world, information and communication technologies (ICTs) will increasingly play an integral role in global health. Here, we focus on how the use of health-related technology, specifically ICTs and artificial intelligence (AI), can help in closing the gap between high-income countries (HICs) and LMICs in cancer care, research, and education. Key examples are highlighted on the use of telemedicine and tumor boards, as well as other online resources that can be leveraged to advance global health.
... In contrast to these examples, our objective was to develop a similarly sensitive pneumotachograph that could be easily manufactured by hand for less than $1 in the developing country, with few resources, but could still be interfaced to any cellphone. The reason for this approach is to encourage ownership and facilitate maintenance of the device, and even possibly its further development by local stakeholders [1,20]. ...
There are numerous examples in which the introduction of expensive medical equipment into the developing world fail for lack of a basic understanding of the device operation, lack of spare parts and poor maintenance. This paper describes the development of a Fleisch pneumotachograph and cellphone based telespirometer that can easily be built from “junk box” medical and electronic components available in the developing world. This approach should introduce a sense of local ownership to the project as well as encouraging participation by the local electronics repair industry. Experimental results confirm that the forced expiratory flow data are reliably modulated onto an audio signal and transmitted by cellphone to a base station for examination by a district nurse or doctor. Flow measurement and data transmission accuracies are sufficiently good for remote diagnoses of chronic obstructive pulmonary disease.
The article presents a retrospective analysis of bibliographical sources devoted to the development and use of telemedicine technologies in Russia and abroad. Each historical period had ultimate and advanced technologies for telemedicine purposes. Telemedicine history can be viewed as a gradual progression of communication tools and remote information exchange. On the other hand, stages of telemedicine history are based on the progressive development of clinical capabilities. Telemedicine development can be classified into periods by technological types of telecommunications (telephone, radio, satellite communications, etc.) and by clinical forms of application (remote transmission of diagnostic examination data; teleconsultations for planned and emergency care; telemedicine for remote work; biotelemetry; telemonitoring; mobile telemedicine for remote and hard-to-reach areas, etc.) In both cases, periods have blurred and tentative boundaries, with many stages “intersecting” or ongoing simultaneously. It can be remarked that “remote provision of medical aid and medical services through telecommunications” had globally started at least 50 years before the very idea and concept of telemedicine was formulated, and the term came into use. Telemedicine has been successfully applied in many countries, including the Russian Federation, and has proven to be an effective method for improving access to medical services in lowly populated and remote areas and for reducing the costs of medical services.
This chapter focuses on the enhancement of medical services through the integration of unmanned aerial vehicle (UAV) technology and machine learning algorithms. It explores the broad spectrum of applications and benefits that arise from combining these two technologies. By employing UAVs for automated delivery, medical supplies can be efficiently transported to remote or inaccessible regions, thereby improving access to vital items. Remote patient monitoring, facilitated through UAVs and machine learning, enables real-time data collection and analysis, enabling the early identification of health issues. UAVs equipped with medical equipment and machine learning capabilities enhance emergency medical response by providing immediate assistance during critical situations. Disease surveillance and outbreak management can benefit from the use of UAVs and machine-learning algorithms to identify disease hotspots and predict the spread of illnesses.
Teletıp internet çağının başlamasıyla birlikte her türden yapılabilecek olan sağlık müdahalelerine mesafe ve uzaklık tanımaksızın tedavi olabilmenin önünü açmıştır. Özellikle kronik hastalığı olanlar, engelliler, yaşlı nüfus gibi hasta gruplarının sağlık hizmetlerine etkili şekilde erişmesinin yollarından biri olmuştur (Badur, 2022). Covid-19 pandemisi sağlık çalışanlarında da yüksek bir farkındalık oluşturmuştur. Pandemi sırasında birçok sağlık çalışanı, vakaların artması ile birlikte çok yoğun şekilde çalışmış ve insanların hayatını kurtarmak için çaba sarf etmiştir. Ayrıca bu süreçte sağlık çalışanları ve ağır çalışma mesaileri sebebiyle yorgun düşmüş ve risk altında çalışmaya maruz kalmıştır. Bu makale tez çalışması üzerinden örnekle üretilmiş olup araştırmamızın amacı, Covid-19 pandemi sürecinde sağlık personelinin teletıp hakkındaki farkındalık düzeyini incelemektir. Çalışmada 414 sağlık personeli katılımcısı sağlanmıştır. Veri toplamak için anket uygulama çalışması yapılmıştır. Araştırmamıza katılan katılımcıların demografik verilerini SPSS programı ile analizi yapılmıştır. Çalışmada t-f testi, korelasyon, regresyon, faktör analizi, varyans analizi gibi birçok yöntem kullanılmıştır ve kullanılan yöntemlerin açıklamaları yapılmıştır. Sağlık personeli olmayan katılımcılar anket dışı bırakılıp değerlendirilmemiştir. Anket çalışması sonucuna göre çalışmanın analizleri yapılıp mevcut literatür incelenip araştırma yorumlanmıştır. Çalışma sonuçlarına göre Covid-19 pandemisinin sağlık çalışanlarının teletıp farkındalık düzeylerini arttırdığı gözlemlenmiştir.
The pandemic of COVID-19 forced the world to reduce the social interactions and push the world toward keeping destinations. During the pandemic, the need for online health services was profoundly felt also in Pakistan. Online health services saw a boost all around the country; however, there are still many challenges in the acceptance of the online services in Pakistan yet. Objective: To assess the acceptance and adaption of telemedicine services in three public sector hospitals of district Quetta during the pandemic of COVID-19. Methods: Questionnaire was designed and distributed among 385 physicians from Civil Hospital, Bolan Medical College and Fatima Jinnah Hospital and the results were interpreted with the help of the SPSS. Results: A total of 385 respondents were selected for the given purpose. 231 were male and 154 were female. 250 of the respondents said that only the urban areas were taking advantage of the telemedicine services while due to lack of internet facilities, the people from rural areas were devoid of the online services. The results also showed that 111 doctors had started telemedicine services since the pandemic. 235 of the respondents said that the youth were more inclined toward accepting telemedicine as compared to elderly. Conclusions: Telemedicine has not seen a large-scale acceptance and yet the people are relying on conventional methods of treatment and not switching to telemedicine as largely as they should have so had the doctors.
Objective: This manuscript aims to verify the perception of otorhinolaryngologists regarding teleconsultation, which was only approved by BFCOM in the face of the public calamity situation experienced in Brazil due to the Coronavirus disease outbreak. Methods: For this purpose, 100 otorhinolaryngologists were invited to fill out a questionnaire on previous knowledge regarding the use of telemedicine and their perception of medical practice in relation to teleconsultation, ethics, service quality and compensation. After filling in, the data was plotted in tables for descriptive analysis of the answers on the topic. Results: Sample is composed by 51% female and 47% male, 40.9 median age. Regarding telemedicine use, since teleconsultation is not fully regulated by BFCOM, which impairs on physician usage. Physicians usually point out ethical matters, reduced service quality and tele-diagnosis unreliability as limiting factors, explaining willingness to face-fo-face consultation. Conclusion: Thus, this study indicates physicians’ perceptions on telemedicine applications in Brazil, focusing on limiting factor.
We sought to compare the costs of a nighttime pediatric telemedicine and medication delivery service per disability-adjusted life year (DALY) averted to the costs of current hospital emergency care per DALY averted from a societal perspective. We studied a nighttime pediatric telemedicine and medication delivery service and hospital emergency care in a semi-urban and rural region of Haiti. Costs of the two services were enumerated to represent the financial investments of both providers and patients. DALYs averted were calculated to represent the “years lives lost” and “years lost to disability” from diarrheal, respiratory, and skin (bacterial and scabies etiologies) disease among children from 0 to 9 years old. The incremental cost-effectiveness ratio was estimated and compared with the per capita gross domestic product (GDP) of Haiti ($1,177). Cost-effectiveness was defined as an incremental cost-effectiveness less than three times the per capita GDP of Haiti ($3,531). The total costs of the nighttime telemedicine and medication delivery service and hospital emergency care to society were $317,898 per year and $89,392 per year, respectively. The DALYs averted by the service and hospital emergency care were 199.76 and 22.37, respectively. Correspondingly, the incremental cost-effectiveness ratio is estimated at $1,288 signifying the service costs an additional $1,288 to avert one additional DALY. A scaled nighttime pediatric telemedicine and medication delivery service is likely a cost-effective alternative to hospital emergency care for preemergency pediatric conditions in Haiti, and possibly in similar lower-middle-income countries.
Objective: We sought to compare the costs of a nighttime pre-emergency pediatric telemedicine and medication delivery service (TMDS) per disability-adjusted life year (DALY) averted to the costs of hospital emergency medicine (HEM) per DALY averted from a societal perspective.
Methods: We studied a nighttime pediatric TMDS and HEM in a semi-urban and rural region of Haiti. Costs of the 2 services were enumerated to represent the financial investments of both providers and patients. DALYs averted were calculated to represent the years lives lost (YLL) and years lost to disability (YLD) from diarrheal, respiratory, and skin (bacterial and scabies etiologies) disease among children from zero to 9 years old. The incremental cost-effectiveness ratio (ICER) was estimated and compared to the per-capita gross domestic product (GDP) of Haiti ($1,177). Cost-effectiveness was defined as an ICER less than 3 times the per-capita GDP of Haiti ($3,531). Univariate sensitivity analysis was performed to evaluate how uncertainty of individual parameter estimates (utilization rates, costs, lost wages, discounting factor) affected the ICER.
Results: The total costs of the nighttime TMDS and HEM to society were $285,931.72 per year and $89,335.41 per year, respectively. The DALYs averted by the TMDS and HEM were 199.76 and 22.37, respectively. Through sensitivity analyses, the ICER of the TMDS ranged from $791.43 to $1,593.35.
Conclusion: A nighttime pediatric TMDS is a cost-effective alternative to HEM for pre-emergency pediatric care in semi-urban and rural regions in Haiti, and possibly in similar lower-middle income countries.
The global community is facing the “digital transformation of healthcare” with the integration of telehealth and telemedicine, incorporation of electronic health records, and interoperable health information exchange. This remarkable transformation is having an impact on countries around the world. The emergence of more affordable advanced communication technologies and development of enhanced communication networks is providing realistic opportunities for low- and middle-income developing countries to integrate telemedicine into their health systems. The increasing use of cell phones, the Web, cloud-based videoconferencing, high-resolution imaging, and digital information platforms provides a means to access healthcare services in areas of the world where that access was previously a challenge or nearly impossible. The basic concept is to enhance access to healthcare services, education, training, and sharing knowledge in a manner that is culturally appropriate for the countries being served and in a manner that meets their defined needs, improves health outcomes, and can be realistically implemented and ultimately sustained. This chapter is designed to address those steps in planning and implementing international telehealth programs, within a country and between countries. These international programs require a comprehensive, thoughtful, collaborative approach that addresses the health requirements of individual countries and their unique cultural, social, and political perspectives.
Health is a fundamental human right although more than one billion people are unreached in terms of quality healthcare services. Insufficient healthcare facilities and unavailability of medical experts in rural areas are the two major reasons that kept the rural people unreached to healthcare services in developing countries, like Bangladesh. According to the World Health Organization (WHO) statistics, the doctor to population ratio is 1: 1500 in urban areas and 1:15000 in rural areas of Bangladesh. This scenario can be dramatically changed if we can simply convey medical tips using ICT infrastructure to the targeted unreached community. Recent development of Information and Communication Technologies (ICT) of the digital divide has been reduced and these technologies have the great potential to address contemporary global health problems. Telemedicine refers to the use of information and communication technologies to distribute information and or expertise necessary for healthcare services provision, collaboration and or delivery among geographically separated participants including physicians and patients. Telemedicine can be the key for providing good health care facilities to the target unreached community especially low resource countries, like ours (Bangladesh).
In this research work, we have developed an intelligent telemedicine system based on Smart phone. The price of smart phone has reduced drastically in recent time and the number of users is increasing in a rapid rate. Recent study shows that even the relatively poor populations at rural areas are using smart phones. Our Smartphone based telemedicine system, therefore has a great potential to deliver the health care services for rural population of Bangladesh at very reduced cost and less hassle, as it requires a very little movement or out of home town.
DICOT (Digital Imaging and Communication for Telemedicine) is the name of the machine which has been built by telemedicine working group of Bangladesh, and in use at some telemedicine centers. One of the major problems of the DICOT users is long cumbersome registration process. In this thesis work we have developed android apps which will provide opportunity of health care at home. After logging in apps, user can update their basic medical records and can choose and get a confirmation of appointment of specialist doctors.
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Different medical records can be updated like body temperature, glucometer, ECG, personal information and others. After updating with database then a confirmation message of assigned appointed day and time will be sent to the patient through android app. So, patients need not experience a long cumbersome process of registration. A website of database has been developed using HTML, CSS and PHP.
We have also developed a Telecardiology system which has been designed and implemented in this work. The Raw analog type ECG signal is amplified and filtered by band pass filter. Analog signal is digitized using Arduino board and then, interface between Arduino and smart phone sends this signal to Smartphone. Digitized value of the filtered ECG signal is stored in SD storage card of Smart phone. Using Bluetooth or existing telecommunication network digitized ECG signal can be sent to other Smart phone or to Server.
During transmission of signal it generally gets corrupted by random noise or white Gaussian noise of the existing telecommunication network(s) and even some data points may be lost. Adaptive filter with three different algorithms have been used in MATLAB platform for denosing i.e. removing noise from the ECG signal. In this research work we have used three algorithms named as LMS (Least Mean Square), NLMS (Normalized Mean Square), and RLS (Recursive Least Square) and tested their performances to reduce the noise from ECG signal.
We have taken 250 mV amplitude ECG signal from MIT-BIH database and 5mV (2 % of original ECG signal), 10 mV (4% of original ECG) 15mV (6% of original ECG), 20 mV (8% of original ECG signal) and 25mV (10% of original ECG signal) of random noise and white Gaussian noise is added with ECG signal and Adaptive filter with three different algorithms have been tested to reduce the noise that is added during transmission through the telemedicine system. Normalized mean square error was calculated. For highest amplitude random noise, 25 mV (10% of original ECG signal) added ECG signal, we have got normalized mean square error for LMS, NLMS and RLS adaptive filters are respectively 3.5566×10-4, 2.8322×10-4, 1.5938×10-5.For the case of 25 mV amplitude Gaussian Noise we have found simulation result of normalized mean square error for LMS, NLMS and RLS adaptive filters respectively 4.2407×10-4, 2.459×10-4 and 7.0148×10-5. The errors are very less in all of the cases and we found RLS Filter performed
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the best amongst the three FILTERS mentioned above in our MATLAB simulation for denosing the ECG signal.
We have used Cubic Spline Interpolation for regaining missing data point of ECG signal. We have taken 5000 data points of ECG signal from MIT-BIH database. In our simulation 11 data points (From 689 to 699 of original data points of ECG), 201 data points (from 800 to 1000 of original data points of ECG), 300 data points (From 1600 to 1900 of original data points of ECG), 500 data points (From 2000 to 5000) and 6 data points (From 4095 to 5000) are made zero and cubic spline interpolation function was called and it could regain the original data points of ECG signal. The Normalized Mean Square Error was calculated and it was found respectively .0909,
.0050, .0033, .0020 and .1667. In all of the cases normalized mean square error is very less and so Cubic Spline Interpolation could be a good solution for regaining missing data points of original ECG signal.
DICOT (Digital Imaging and Communication for Telemedicine) machine is in use to send different medical report like X-ray, mammography, skin image and others, and Gray Scale image is sent without compression.
To increase the efficiency and reduce the BANDWITH requirements, we have developed a DCT based image compression technique. We have used five medical gray scale images of File size 110 KB, 51.1 KB, 118 KB, 62.5KB and 62 KB and after using compression technique we have got 92.5 KB, 38.1 KB, 113 KB, 44kB and 39 kB size of compressed image file. The compression ratio of file sizes becomes 15.9%, 25.4%, 4.23%, 29.6% and 37.097% respectively. File sizes are reduced to maximum 37.097 % without significant loss in image quality or medical information contained in it. Our result suggests that file size can be reduced in an efficient way using DCT and image reconstruction is possible without any loss of medical information, though some not very important fine details are lost.
Access to quality healthcare is a major problem in Sub-Saharan Africa with a doctor-to-patient ratio as high as 1:50,000, which is far above the recommended ratio by the World Health Organization (WHO) which is 1:600. This has been aggravated by the lack of access to critical infrastructures such as the health care facilities, roads, electricity, and many other factors. Even if these infrastructures are provided, the number of medical practitioners to cater for the growing population of these countries is not sufficient. In this article, how information and communication technology (ICT) can be used to drive a sustainable health care delivery system through the introduction and promotion of Virtual Clinics and various health information systems such as mobile health and electronic health record systems into the healthcare industry in Sub-Saharan Africa is presented. Furthermore, the article suggests ways of attaining successful implementation of telemedicine applications /services and remote health care facilities in Africa.
This is the first population-based study of earthquake injuries and deaths that uses a cohort approach to identify factors of high risk. As part of a special project that collected data about the population in the aftermath of the earthquake that hit Northern Armenia on 7 December 1988, employees of the Ministry of Health working in the earthquake zone on 7 December 1988, and their families, were studied as a cohort to assess the short and long term impact of the disaster. The current analysis assesses short term outcomes of injuries and deaths as a direct result of the earthquake.
From an unduplicated list of 9017 employees, it was possible to contact and interview 7016 employees or their families over a period extending from April 1990 to December 1992. The current analysis presents the determinants of 831 deaths and 1454 injuries that resulted directly from the earthquake in our study population of 32,743 people (employees and their families).
Geographical location, being inside a building during the earthquake, height of the building, and location within the upper floors of the building were risk factors for injury and death in the univariate analyses. However, multivariate analyses, using different models, revealed that being in the Spitak region (odds ratio [OR] = 80.9, 95% confidence interval [CI]: 55.5-118.1) and in the city of Gumri (OR = 30.7, 95% CI: 21.4-44.2) and inside a building at the moment of the earthquake (OR = 10.1, 95% CI: 6.5-15.9) were the strongest predictors for death. Although of smaller magnitude, the same factors had significant OR for injuries. Building height was more important as a factor in predicting death than the location of the individual on various floors of the building except for being on the ground floor of the building which was protective.
Considering that most of the high rise buildings destroyed in this earthquake were built using standard techniques, the most effective preventive effort for this disaster would have been appropriate structural approaches prior to the earthquake.
Voice and data communication facilities (email via VHF radio) were installed in 39 previously isolated health facilities in the province of Alto Amazonas in Peru. A baseline study was carried out in January 2001 and a follow-up evaluation in May 2002, after nine months of operation. We measured the reliability of the technology and the effect the system had on staff access to medical training and information. We also measured the indirect effects on the general population of access to better health-care. The experimental data were collected from 35 of the 39 sites in face-to-face questionnaire interviews. Before installation of the system, the mean consultation rate was 3 per month per facility (95% CI 1.5 to 4.5). At the end of the study, the mean consultation rate was 23 per month per facility (95% CI 14.7 to 31.5). There were 205 emergency transfers from the 39 health facilities. The system was employed in all these cases to alert the referral centre. The mean time required for evacuation was reduced from 8.6 h to 5.2 h. Health-care personnel reported that in 58 of the emergency cases (28%) the use of the system saved the life of the patient. The study shows that the use of communication technologies appropriate to local needs solves many problems in rural primary care, and that voice and email communication via VHF radio are feasible and useful for rural telemedicine.
Since 2001, a monthly telemedicine clinic has helped provide health care to residents in a remote region in Cambodia. Physicians at Massachusetts General Hospital and Brigham and Women's Hospital in Boston, Massachusetts, and Sihanouk Hospital of HOPE in Phnom Penh, Cambodia, provide consultations via e-mail to a mobile nurse in the district of Rovieng, Cambodia. We describe the operations of the monthly clinic and report the results of a retrospective case review of the first 28 months of consultations. We also report the results of a satisfaction and willingness to pay survey. A total of 264 visits were made during the 28 monthly sessions. Mean duration of chief complaint at initial visit declined from 37 months to 8 months during the first and last 6 months of the study period, respectively. Thirty-six percent (n = 76) of new patients complained of abdominal pain. Nine percent (n = 20) of new patients were given an empiric diagnosis of goiter. The percent of patients requiring referral to a hospital outside of the village decreased over time. All patients surveyed were either "very satisfied" or "satisfied" with their care, and most patients were willing to pay for a visit, with a median amount of USD 0.63. We conclude that store-and-forward e-mail consultative support for mobile nonphysician health care workers is a feasible model for delivering care in the developing world. Further research is needed to demonstrate improvement in health status, cost effectiveness, and sustainability.
Telemedicine systems providing voice communication and email by radio were installed at seven health centres (HCs) and 32 health posts (HPs) in the Alto Amazonas province of Peru during 2001. A cost analysis was performed to estimate the net effect on direct resource consumption from the perspective of society. Prior to the availability of the EHAS telemedicine system, there was a mean of 11.1 urgent patient referrals per year from the HPs and 14.0 referrals per year from the HCs. After the implementation of telemedicine, patient referrals fell to 2.5 per year from the HPs (P = 0.03) and to 8.4 per year from the HCs (P = 0.17). The net economic effect of the telemedicine programme over a four-year period was clearly positive, amounting to annual net savings of US$320,126 (using a 5% discounting rate). A one-way sensitivity analysis using a range of values for the discounting rate, and the number of urgent referrals, confirms that the programme was efficient (i.e. it made net financial savings) in all cases. From the restricted budgetary perspective of the health network, the results also demonstrate that the additional operational costs (telephone and maintenance) introduced by the telemedicine system were lower than the direct cost-savings produced for the health-care network.
Continuing education of healthcare professionals is a key element for the quality and efficiency of a health system. In developing countries, this activity is usually limited to capitals, and delocalized professionals do not have access to such opportunities, or to didactic material adapted to their needs. This limits the interest of such professionals to remain active in the periphery, where they are most needed to implement effective strategies for prevention and first-line healthcare. Telemedicine tools enable the communication and sharing of medical information in electronic form, and thus facilitate access to remote expertise. A physician located far from a reference center can consult its colleagues remotely in order to resolve a difficult case, follow a continuous education course over the Internet, or access medical information from digital libraries or knowledge bases. These same tools can also be used to facilitate exchanges between centers of medical expertise: health institutions of a same country as well as across borders. Since 2000, the Geneva University Hospitals have been involved in coordinating the development of a network for eHealth in Africa (the RAFT, Réseau en Afrique Francophone pour la Télémédecine), first in Mali, and now extending to 10 French-speaking African countries. The core activity of the RAFT is the webcasting of interactive courses. These sessions put the emphasis on knowledge sharing across care professionals, usually in the form of presentations and dialogs between experts in different countries. The technology used for the webcasting works with a slow (25 kbits/s) internet connection. Other activities of the RAFT network include visioconferences, teleconsultations based on the iPath system, collaborative knowledge bases development, support for medical laboratories quality control, and the evaluation of the use of telemedicine in rural areas (via satellite connections) in the context of multisectorial development. Finally, a strong emphasis is put on the development of capacities for the creation, maintenance, and publication of quality medical didactic contents. Specific courses are organized for the national coordinators of the network to develop these competencies, with the help of the Health-On-the-Net Foundation. The richness of the plurality of knowledge and know-how must be steered towards emulation and sharing, respectful of each partner's identity and culture. Collaborations with UNESCO and WHO have been initiated to address these challenges.
Telemedicine implementations often remain in the pilot phase and do not succeed in scaling-up to robust products that are used in daily practice. We conducted a qualitative literature review of 45 conference papers describing telemedicine interventions in order to identify determinants that had influenced their implementation. The identified determinants, which would influence the future implementation of telemedicine interventions, can be classified into five major categories: (1) Technology, (2) Acceptance, (3) Financing, (4) Organization and (5) Policy and Legislation. Each category contains determinants that are relevant to different stakeholders in different domains. We propose a layered implementation model in which the primary focus on individual determinants changes throughout the development life cycle of the telemedicine implementation. For success, a visionary approach is required from the multidisciplinary stakeholders, which goes beyond tackling specific issues in a particular development phase. Thus the right philosophy is: 'start small, think big'.
Unlabelled:
The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa.
Methods:
During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas.
Results:
Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent.
Conclusion:
These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.
Over a two-year period, eight medical students from four U21 universities spent their electives at hospitals in Pakistan, Papua New Guinea and Sri Lanka. They made a total of 49 e-referrals which resulted in 67 queries in a wide range of specialties. The median response time was 20h (interquartile range 5-85). Follow-up data were obtained in 14 of the 30 cases from one hospital (47%). The major categories of the 67 queries were internal medicine, paediatrics and surgery, and in very similar proportions to the 785 queries managed by the Swinfen Charitable Trust over the same period. The presence of a medical student facilitated e-referrals by relieving the pressure on the local doctor to undertake the necessary clerical and technical work. The students reported a rewarding elective experience which appears to have the potential to increase the ease with which heavily burdened medical staff in developing countries can make use of e-referrals.
Individuals do not seek help, even when help is needed and available, because help seeking implies incompetence and dependence, and therefore is related to powerlessness. It was hypothesized that gender, status, and organizational norms affect the importance of maintaining and accruing power, which in turn affect help seeking behaviors. A laboratory and a field study showed that there was more help seeking between equal-status than unequal-status individuals. Further, both studies revealed that males sought more help in collective than individualistic organizational norms, though the trend was not apparent for females. These results shed light on the psychological mechanisms underlying help seeking behaviors and have practical implications for developing steps to foster help seeking in organizations. Copyright 1997 Academic Press.
Before telehealth applications can be judged, there must be some general understanding about what constitutes success. At first sight it seems that defining success in a telehealth application should be relatively easy: a successful application is one that produces high-quality care at low cost. However, the calculation of cost requires some care, since it depends on assuming a particular financial perspective (the patient's, the health-care provider's, or society's) and is meaningless without a statement of the workload being handled. Other factors include the context in which the service is being delivered. Ultimately, the political imperative may override any rational judgement of success.
EDITOR—The editorial by Edworthy shows the dangers of external commentary on what is most useful for developing countries.1 How can we measure the comparative impact of teleconsultation in Uzbekistan or Cambodia with teleconsultation in snowbound northern Canada, telemetry in Norway supporting elderly people at home, or teleradiology avoiding long painful journeys in remote parts of the British Isles? What values do we use—economic, social, quality adjusted life years, consumer feedback, political position, or provider satisfaction?
More importantly, how …
The Swinfen Charitable Trust has managed email consultations for doctors in developing countries since 1999. The process was handled manually for the first three years and then subsequently using an automatic message-handling system. We conducted a prospective review of email consultations between referring doctors and consulting specialists during six months of automatic operation (December 2003 to May 2004). During the study period 125 consultations took place. These concerned a wide range of specialties (e.g. orthopaedics 17%, dermatology 16%, obstetrics and gynaecology 11%, radiology 10%). Of these referrals, 33% (41) were for paediatric cases. Consulting specialists, who were based in five countries, were volunteers. Referring doctors were from 24 hospitals in 12 developing countries. The median time from referral to definitive reply was 1.5 days (interquartile range 0.6-4.9). There was an 85% response rate (n = 106) to a survey concerning the value of the consultation to the referring doctor. All the referring doctors who responded made positive comments about the service and half said that it improved their management of the case. The second-opinion consultation system operated by the Swinfen Charitable Trust represents an example of a global e-health system operated for altruistic, rather than commercial, reasons.
Pediatric subspecialists are often separated from the children who need them by distance, time, or socioeconomic factors. The Electronic Children's Hospital of the Pacific is an Internet-based store-and-forward pediatric consultation system established to overcome these barriers.
To characterize the use of the Electronic Children's Hospital of the Pacific and its impact on access to specialty care, the quality of the care provided, and cost savings.
Prospective trial.
Twenty-two military treatment facilities in the Pacific.
Primary care providers, pediatric consultants, and 5 reviewers.
Consult response time, physician panel review, and evacuation cost avoidance.
There were 267 cases from 16 sites. The mean +/- SD response time by a consultant was 32 +/- 8 hours. The panel review deemed that the initial diagnosis was changed or modified in 15% (39/267) of the cases, the diagnostic plan was changed or modified in 21% (57/267), and the treatment plan was changed or modified in 24% (64/267) (P < .01 for all). Routine air evacuations to a tertiary care medical center were avoided in 32 cases (12%), with an estimated cost savings of $185 408.
The Electronic Children's Hospital of the Pacific improved the quality of patient care by providing expeditious specialty consultation. Significant cost avoidance in this military pediatric population was documented. Store-and-forward Internet-based teleconsultation is an effective means of providing pediatric subspecialty consultation to a population of underserved children.
There is growing interest in the migration of doctors from Africa to developed nations. Little attention has been made in understanding the flow of doctors into African countries.
To describe the nationality, country of primary qualification as a doctor and specialties of doctors registered in Malawi in 2003.
Review of Medical Council of Malawi 2003 register and University of Malawi-College of Medicine graduation records.
There were 252 doctors registered by the Medical Council of Malawi (MCM) of whom 51.2% were Malawian and 48.8% non-Malawian. 35.7% of the doctors had obtained their primary education in Malawi, 17.5% from the UK, 9.9% other African countries and 8.7% from other African countries. There were 72 specialists of whom 23 were Malawian nationals and 49 were non-Malawians.
There is almost an equal distribution of national and non-national doctors in Malawi. However, among specialists, non-national far out-number Malawians by over two and a half times. While the brain drain of doctors from developing nations to developed nations has received interest, there is need also to explore the migration of doctors into resource-poor countries such as Malawi.
UK Summary Self-care is a way of helping the health service to manage the growth in long-term chronic conditions. We developed an Internet-based self-management tool for diabetes following detailed consultations with patients. The Virtual Clinic allows a
- Natalie Armstrong
Natalie Armstrong and John Powell
Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
Summary
Self-care is a way of helping the health service to manage the growth in long-term chronic conditions. We developed an
Internet-based self-management tool for diabetes following detailed consultations with patients. The Virtual Clinic allows a