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The International Telecommunication Union's Report on Telemedicine and Developing Countries
Abstract
This paper reviews some of the main conclusions and recommendations from the Report on Telemedicine and Developing Countries, which was prepared for the International Telecommunication Union (ITU). The report is the result of three years' effort by a group of experts in telecommunications and telemedicine from around the world. It provides an extensive survey of the telemedicine experience of various countries. It discusses the different types and applications of telemedicine, the technologies used, costs and benefits, trends, prospects for global standards, and provides guidelines and recommendations to developing countries for implementation of telemedicine services. The ITU study group which prepared the report is expected to begin some new tasks in 1998, including the identification of a set of pilot telemedicine projects for developing countries.
... H ALF THE POPULATION in the world's poorest countries lacks access to health care. 1 Provider shortages are likely to persist, as many countries do not have the means to train adequate numbers of medical personnel. 2 Cambodia ranks 174th among member states of the World Health Organization on overall health system performance. 3 The average Cambodian has only 0.35 contacts per year with organized health services-the lowest contact rate in the region. ...
... Communications technologies have the potential to help overcome some of the challenges of providing health care in remote regions, by transporting medical knowledge to even the most traditionally inaccessible areas of the globe and increasing provider efficiency. 2 Only a handful of programs have described their clinical experience in the medical literature prompting a call for publication of outcomes from telemedicine projects in the developing world. [5][6][7][8][9][10] We report the results of a pilot study of the case load of the clinic in Th'naut Malou, Cambodia, describing the type and chronicity of patient complaints and patients' satisfaction and willingness to pay for services. ...
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.
... While 85% of the population live in rural areas, only 13% of government health workers work there [3]. Initiatives to improve access to healthcare in less developed countries like Cambodia face major obstacles such as poor basic infrastructure and inadequate resources to train more medical personnel [5]. However, communication technologies have the potential to leapfrog such barriers to bring health care to traditionally poorly served remote regions by providing access to distant medical expertise [5]. ...
... Initiatives to improve access to healthcare in less developed countries like Cambodia face major obstacles such as poor basic infrastructure and inadequate resources to train more medical personnel [5]. However, communication technologies have the potential to leapfrog such barriers to bring health care to traditionally poorly served remote regions by providing access to distant medical expertise [5]. We have initiated two monthly telemedicine clinics that are successfully providing healthcare to residents in a remote region of Cambodia with very limited medical services. ...
... The central focus was the information infrastructure and ongoing use of ICT in the health sector of Bangladesh. In 2009, TRCL (Telemedicine Reference Center Ltd.) has celebrated successful completion of 1st decade in Telemedicine, e-Health and m-Health businesses [1]. ...
The study is based on 3G feasibility in M-Healthcare system. It also addresses the aging problem which becomes severe day by day. At first, a survey was conducted by visiting 8 upazilla hospitals and 6 union community clinics in different districts of Bangladesh to observe the real scenario of m-Health system and actually used technologies. Both remote monitoring and interactive service mode of m-Health system were examined there. In addition, by taking interview of the patients who already got services through 2G m-Health system, we found out the practical lacking and limitations of the present infrastructures. After that we proposed a modified health infrastructure using 3G in remote side and Optical Fiber in backbone side with wide range of services like video conferencing through VoIP and Skype, MMS diagnostic reports, drug prescriptions and mobile purchase and home delivery etc. Analysis shows that 3G needs less transmission time of 4s for medical image upload and transmit. The interactive video visual quality is also better than existing m-Health service based on 2.7G which can be used for monitoring vital signals like ECG signal, heart rate, bone fracture etc in future. The feasibility test shows that huge initial costs and poor ICT culture of healthcare professionals make a barrier to a ubiquitous m-Health system. Moreover the handling of the Hi-tech devices comfortably by villagers also puts a barrier to the smooth running of the system.
... The International Telecommunication Union defines 6 videoconferencing as an audiovisual interactive chat service that provides a bi-directional and real-time exchange of audio and video signals among user groups in two or more locations. ...
The incorporation of telemedicine in emergency medical system is expanding, with successful results in several countries. The objective is to analyze the opinion of experts about using of telemedicine tools in emergency medicine and to evaluate their technical viability in the pre-hospital care in Belo Horizonte, Brazil. Design: Application of a questionnaire to 40 specialists in emergency medicine from different countries. Assessment of average time of sending, processing and receiving 12-lead EKG data transmission via 3G from different regions of the city. Prospective analysis of telemedicine use in 14 pre-hospital care situations.
There was heterogeneity in responses and a large number of unanswered questions by the experts. All regions of the city have shown good technical feasibility in data transmission, with data transmission maximum time of 56 seconds. Similarity between average and mode of analyzed values highlights the homogeneity of the mobile internet coverage. The questionnaire was considered reliable by analyzing the consistency of answers. The experts’ feedback heterogeneity may reflect the innovative character of telemedicine. However, there were not positions contrary to the implementation of tele-urgency and tests showed technical viability of this resource in this city. This pilot project testified the viability of telemedicine in the emergency medical
system in Belo Horizonte and preceded other initiatives in this field.
... Developing countries should consider undertaking some telemedicine pilot projects in order to identify the most cost-effective solutions to the provision of health care, especially to those living in remote and rural areas…There is a need for some quantitative analysis based on actual telemedicine experience, for example from pilot projects, which could demonstrate to policy makers and funding bodies the cost-benefits of telemedicine. (28) Perhaps no time is more appropriate than now to effectively address the health needs of the world's poor with the power of Internet technology. This has become the impetus of the Andean e-Health Initiative and is the driving force for the development of a teleconsultation service in rural Ecuador. ...
... In the industrialized part of the world, telemedicine is more and more regarded as a viable tool for delivering health care services in rural and remote areas. Considering the limitations of health care delivery in developing countries, the possibility to deliver medical services at a distance is an attractive idea and the concept of utilizing telemedicine in developing countries has been propagated for a long time [176]. Few pilot studies have shown that telemedicine may be applicable for the support of health care providers in developing countries. ...
... [14] Medical care at a distancethe images are transmitted, because patient and treating physician are not located at the same place. [76] Computer-based monitoring and communication with remote objects. The term comes from the Greek tele = remote, and metron = measure. ...
... Por otra parte, resulta evidente la potencialidad de Internet, comunicaciones móviles, dispositivos portátiles e instrumentación electrónica en el desarrollo de servicios de e-Salud para monitorización, seguimiento y control extrahospitalario de pacientes 8 . No obstante, es obvia la existencia de importantes problemas en su difusión y adopción generalizada por los servicios de salud 9 , más allá de prototipos que han servido para valorar la viabilidad de ciertos servicios e identificar las tecnologías a integrar 10,11 . ...
Se presenta una metodología para la introducción progresiva y ordenada de servicios específicos de e-Salud para el seguimiento extrahospitalario de pacientes crónicos. Identificado como un modelo de pasos con filtro para la gestión del proceso global de introducción, se presenta formalmente estructurado en tres pasos: 1) exploratorio (fase de proyecto piloto); 2) evaluación en profundidad (fase de ensayo clínico), y 3) despliegue (fase de uso tutelado). En la primera fase, controlada por el equipo de I+D, los criterios predominantes son los de funcionalidad y utilidad de las tecnologías involucradas. En la segunda fase, controlada por una Agencia de Evaluación de Tecnologías Sanitarias, prevalece el criterio científico asociado con los resultados obtenidos en el ensayo clínico. La tercera fase es controlada por decisiones de las administraciones sanitarias sobre la introducción de nuevas tecnologías y su financiación. Se describen los requerimientos de la plataforma tecnológica diseñada para soportar los proyectos y ensayos de las fases 1 y 2. Como ejemplo de actuación en la fase 2 se describe un ensayo sobre hipertensión arterial.
... The potential for telemedicine to play a useful role in the developing world has been the focus of attention for several years 15±21 . The dearth of formal evaluations of the costeffectiveness of telemedicine projects and the almost complete lack of evaluations of the outcomes of telemedicine interventions have unfortunately militated against the wider use of telemedicine 21 International Telecommunication Union has reviewed the telemedicine experience of various countries and published its recommendations for the development of telemedicine services in developing countries 17,18 . A major recommendation was that developing countries should undertake pilot projects in order to identify the most cost-effective telemedicine solutions, especially for the provision of health-care to people living in remote and rural areas. ...
In July 1999, the Swinfen Charitable Trust in the UK established a telemedicine link in Bangladesh, between the Centre for the Rehabilitation of the Paralysed (CRP) in Dhaka and medical consultants abroad. This low-cost telemedicine system used a digital camera to capture still images, which were then transmitted by email. During the first 12 months, 27 telemedicine referrals were made. The following specialties were consulted: neurology (44%), orthopaedics (40%), rheumatology (8%), nephrology (4%) and paediatrics (4%). Initial email replies were received at the CRP within a day of referral in 70% of cases and within thee days in 100%, which shows that store-and-forward telemedicine can be both fast and reliable. Telemedicine consultation was complete within three days in 14 cases (52%) and within three weeks in 24 cases (89%). Referral was judged to be beneficial in 24 cases (89%), the benefits including establishment of the diagnosis, the provision of reassurance to the patient and referring doctor, and a change of management. Four patients (15% of the total) and their families were spared the considerable expense and unnecessary stress of travelling abroad for a second opinion, and the savings from this alone outweighed the set-up and running costs in Bangladesh. The latter are limited to an email account with an Internet service provider and the local-rate telephone call charges from the CRP. This successful telemedicine system is a model for further telemedicine projects in the developing world.
... 1 The cost effectiveness of telemedicine in the developing country can be demonstrated by (a) identifying the potential telemedicine projects; (b) establishing one or more pilot projects in order both to establish technical feasibility and to measure the benefits to the health care systems; and thereafter (c) calculating the cost of large scale deployment. 2 The International Telecommunication Union has reviewed the telemedicine experience of various countries and published its recommendations for the development of telemedicine services in developing countries. 3,4 One major recommendation urges developing countries to undertake pilot projects in order to identify the most cost effective telemedicine solutions, especially for the provision of health care to people living in remote and rural areas. ...
Telemedicine (TM) services a process in which expert medical advice from afar is provided using electronic signals to transfer the medical data from one site to another. As a pilot project to assess the efficacy of TM in developing countries like India, a telemedicine center was set up at the main hospital of Mahakumbh mela--a grand religious fair, at Prayag, a city in north India. The daily reporting of the in-patient and outpatient cases at the fair revealed a surge of diarrhea cases among the pilgrims at the fair. This information was communicated to the referral center at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), which, with the help of its microbiology department, conducted microbiological examinations of stool samples and rectal swabs of patients along with various water samples. Vibrio cholerae was isolated in 22.6% (7/31) of the samples. This information was immediately relayed to the Main Hospital at the fair online, and then to the health authorities, who took strict and prompt measures to improve hygiene. Subsequently, the number of diarrhea cases decreased considerably in a matter of a few days, and thus an epidemic disaster was averted, which could have created havoc in such a large gathering.
... Por otra parte, resulta evidente la potencialidad de Internet, comunicaciones móviles, dispositivos portátiles e instrumentación electrónica en el desarrollo de servicios de e-Salud para monitorización, seguimiento y control extrahospitalario de pacientes 8 . No obstante, es obvia la existencia de importantes problemas en su difusión y adopción generalizada por los servicios de salud 9 , más allá de prototipos que han servido para valorar la viabilidad de ciertos servicios e identificar las tecnologías a integrar 10,11 . ...
A methodology is presented for a smooth, orderly implementation of specific e-Health services for monitoring chronic patients outside of the hospital setting. Identified as a stage-gate model for the management of the overall implementation process, this methodology is presented formally structured into three steps: a) exploratory examination (pilot project stage); 2) in-depth evaluation (clinical trial stage); and 3) deployment (guided use stage). In the first stage, controlled by the R+D team, the predominant criiteria are the functionality and usability of the technologies involved. In the second stage, controlled by an associated Health Technology Evaluation Agency, the predominant criterion is the scientific aspect related to the results obtained in the clinical testing. The third stage is controlled through decisions made by the health administrations as to the implementation of new technologies and the financing thereof. A description is provided as to the requirements of the technological platform designed to serve its the medium for the projects and tests from stage 1 and 2. As an example of what is done in stage 2, a description is given of a trial related to hypertension.
Background
Despite significant progress in health technology and growing interest among countries in incorporating telemedicine into healthcare delivery, its usage remains limited in Iran. The aim of this study is to investigate the challenges related to telemedicine in Iran and pinpoint potential solutions from the viewpoint of health policymakers, marking the first such endeavor.
Methods
This qualitative study was conducted in Iran in 2022. Data were gathered from 19 health policymakers who were selected using purposeful and snowball sampling techniques via in-depth and semi-structured interviews. The research findings were analyzed using the content analysis technique, with coding performed using MAXQDA software. The content analysis approach developed by Erlingsson was utilized to analyze the data.
Results
The study revealed eight main challenges that inhibit the widespread use of telemedicine in Iran. These challenges include policy weaknesses, uncertainty around operating mechanisms, inadequate communication and telecommunication infrastructure, insufficient cultural infrastructure, lack of electronic requirements, redundant bureaucracies, legal gaps, and economic factors. Furthermore, four key solutions to these challenges were identified. These include a national commitment to the development of telemedicine, the establishment of a telemedicine roadmap, the enhancement of e-health requirements and infrastructure, and the preparation of the community to accept telemedicine as a viable option for healthcare delivery.
Conclusion
The implementation of telemedicine in Iran faces significant challenges, some of which are related to the national healthcare system, while others stem from various policy-related institutions and organizations. Addressing these challenges will require extensive inter-organizational cooperation and strong leadership at the governance level. However, it should be noted that fully resolving these issues is a time-consuming process.
This book gives an overview of innovative approaches in telehealth and telemedicine. The Goal of the content is to inform readers about recent computer applications in e-health, including Internet of Things (IoT) and Internet of Medical Things (IoMT) technology. The 9 chapters will guide readers to determine the urgency to intervene in specific medical cases, and to assess risk to healthcare workers. The focus on telehealth along with telemedicine, encompasses a broader spectrum of remote healthcare services for the reader to understand.
Chapters cover the following topics:
- A COVID-19 care system for virus precaution, prevention, and treatment
- The Internet of Things (IoT) in Telemedicine,
- Artificial Intelligence for Remote Patient Monitoring systems
- Machine Learning in Telemedicine
- Convolutional Neural Networks for the detection and prediction of melanoma in skin lesions
- COVID-19 virus contact tracing via mobile apps
- IoT and Cloud convergence in healthcare
- Lung cancer classification and detection using deep learning
- Telemedicine in India
This book will assist students, academics, and medical professionals in learning about cutting-edge telemedicine technologies. It will also inform beginner researchers in medicine about upcoming trends, problems, and future research paths in telehealth and telemedicine for infectious disease control and cancer diagnosis.
Telemedicine tools enable the communication and sharing of medical information in electronic form and thus facilitate access to remote expertise and knowledge. A physician located far from a reference center can consult his colleagues remotely in order to solve a difficult case, follow a continuing education course over the Internet to improve his knowledge, or access medical information from digital libraries. These same tools can also be used to facilitate the exchange between centers of medical expertise at a national or international level and have been performed many times. The purpose of this chapter is report the use of telemedicine and tele-monitoring in the context of intensive care, lung disease, and non-invasive ventilation.
Ethiopia has one of the lowest ratios of health professionals to population in the world. The few medical specialists who are available work mainly in the capital city and in a few regional cities. The use of telemedicine in public health facilities can mitigate the shortage of medical personnel. We conducted a survey of selected public health facilities located in Addis Ababa, Ethiopia. The study could be modified and extended to other countries in Sub-Saharan Africa. In this study, we adapted Bakry's e-government assessment model, STOPE (Strategy, Technology, Organizational, People, and Environment) to assess telemedicine readiness. Validity and reliability tests were conducted using the Smart PLS software package. The survey data was analyzed using SPSS version 16, and descriptive and analytical statistical reports were generated. The color-coded feature of the McConnell International analysis tool was used to display the results. All factors in STOPE indicated amber color, which implies the need for substantial improvements at the health facilities in order to adopt Telemedicine. The STOPE model results from this study show that the degree of readiness for telemedicine implementation varies from a weak rating for Technology readiness to strong rating for Organization readiness.
While there are significant potential advantages and benefits from telemedicine, the evidence of its cost-effectiveness and sustainability is meagre. This is because much of the telemedicine activity so far has been in the form of pilot projects or demonstrations in universities and hospitals with subsidized funding from government or other sources. The number of self-sustaining, commercial applications of telemedicine is still very small. Telemedicine undoubtedly yields cost savings in certain circumstances, but often the savings and benefits accrue to those who do not have to pay for the service. Thus, few service providers have found a way to recover their costs (and make a profit) from those to whom they provide their service. Even fewer countries have actually budgeted for the provision of telemedicine as a service widely available to their citizens. Nevertheless, with the rapidly declining cost in hardware and telecommunications, the level of interest and the corresponding activity in telemedicine is rising rapidly. Most of the telemedicine experience to date has been in the industrialized world. It is apparent that the first requirement of developing countries is for more information about telemedicine, what it is, and how it might be able to help solve some of the shortages in medical and health care. Given the potential of telemedicine to facilitate the provision of medical information and health care in rural areas, it seems useful for developing countries to undertake pilot projects in order to evaluate its potential and cost-benefits. The results of such pilot projects could be part of the development of a national health for all policy which takes telemedicine into account. In view of the other priorities of developing countries, especially those of the least developed countries, financing telemedicine activity is likely to remain a challenge for some time to come. Funding from external donor agencies may well be necessary, but local commitment and participation in pilot projects is essential if the project is to have a chance of success. As telemedicine requires a multidisciplinary approach, the active participation of telecommunication operators must be assured. Despite some false starts in the deployment of telemedicine as a continuing service to the general population - as opposed to a few well-to-do clients - telemedicine has great potential to improve access to health care and to contain costs in developing countries.
Telemedicine is often proposed as a solution to certain health-care problems in the developing world. There seems to be little published experience on which to make judgements. A literature search revealed 39 articles, of which only two related to any kind of direct clinical work; most of them were review articles or editorials. The majority of the work reported was educational in nature, and there has been little clinical experience. It seems probable that telemedicine can help with the education of health-care workers and patients; it seems likely that it could bring major benefits to the organization of health-care. Without proper trials, it will be impossible to determine the place of health-care in the developing world. Trials are the only way in which rational decisions can ultimately be reached regarding whether scarce resources should be devoted to telemedicine in developing countries, or whether they should be employed in more conventional health-care measures whose outcomes are known to be cost-effective.
Chromosomal rearrangements involving partial deletion of the short arm of chromosome 4 and partial duplication of the short arm of chromosome 8 have been described both in Pitt-Rogers-Danks syndrome (PRDS) and Wolf-Hirschhorn syndrome (WHS), the former being considered a milder phenotype of the latter. We describe a patient with partial deletion of chromosome 4 and partial duplication of chromosome 8 documented by array-comparative genomic hybridization (Array-CGH). In addition to the typical features of PRDS, the patient exhibited some clinical signs (genital hypoplasia, radioulnar synostosis and mesomelic limb shortness) infrequently, or never previously, reported in PRDS. These findings broaden the spectrum of anomalies generally associated with these syndromes.
Briefly discusses the impact of information technology on medicine and health care. Introduces the concept of an integrated health information system, and details its functions and its benefits, especially for developing countries. Defines telemedicine and describes its origin, scope and functioning. Details its advantages, namely the expansion and export of skills, and explains its use in fetal telemedicine, teleendoscopy, telemedical education and telepathology.
This paper examines e-health in detail. E-health is the use of distant communication technologies in the healthcare context and the use of advanced information and communication technologies (i.e., the Internet) that meet the needs of citizens, patients, healthcare practitioners and professionals. The goal of the authors is to show that e-health services have improved telemedicine to the point of substantially transforming its very meaning. As such, e-health expands and redefines the operational usage of telemedicine services. E-health, for instance, is much more oriented to the wide-range possibilities of service delivery (i.e., e-health offers Web services such as WebMD.com, which receives a very high number of visitors). Besides, legal and licensing matters are no longer issues in e-health, in the same way that health insurance is not an obstacle with e-health, which may also be the cure to the paucity of knowledge that telemedicine services used to provide. Nevertheless, e-health also presents major limitations, among which are the lack of real-time interaction between the patient and provider and the inaccessibility to e-health by a certain number of disadvantaged and isolated groups. Finally, this paper ends with a discussion section, in which an extensive summary and suggestions for future research are given.
The development of e-Health services in rural environments, where broadband networks are usually not accessible, requires
a specific analysis of available resources to improve Quality of Service (QoS) management. This work quantifies the maximum
number of simultaneous users that fulfill the specific QoS levels in common e-Health services, including both store-and-forward
and real-time telemedicine applications. The analysis also proposes variations in the modelling of traffic distributions regarding
the number of multiplexed users. The results obtained in this study permit an accurate users dimensioning, which is necessary
to optimize the performance and to guarantee the QoS requirements in this kind of services where network resources are limited.
The healthcare system in the US has been in the midst of a rapid transition in response to changing trends and patterns of care. The growing emphasis on evidence-based medical practice, continuous quality improvement, clinical and cost-effectiveness, and risk management have led to a sea change in medical practice that has been stressful for clinicians, patients, and administrators. As care becomes more tightly managed, it becomes a challenge for clinicians, administrators, and patients to balance time, money, resources, and clinical outcomes. Can emerging technologies help solve these complex problems? How has the demise of the dot.com industry effected these trends and slowed the proliferation of potential solutions? This innovative, trans-faculty course will teach the student how information technologies are shaping and redefining the health care marketplace through examining aspects related to 1) improved economies of scale, 2) greater technical and business efficiencies in the delivery of care to patients, 3) advanced tools for patient education and self-care, 4) network integrated decision support tools for clinicians, and 5) e-health applications and e-commerce. Students are required to take this course in conjunction with HST 923, the tutorial/practicum portion of the course, where they will work in interdisciplinary teams (including students in medicine, business, law, engineering, computer science, media, public health, and government) to analyze, develop, and present an innovative solution to a current or future clinical management program or health care problem which will incorporate (but is not limited to) management techniques, services, and technologies as presented during lectures and laboratories. Students' proposed solutions will draw upon their understanding of tools and principles acquired during the course and will be presented as an application design on the final day of the course. Opportunities to interact with corporate sponsors will enhance the emphasis on practical solutions to real world problems.Sponsored driven projects in past years have included those from Pfizer Health Solutions, Merck, Johnson and Johnson, Mass General, and Warner Lambert. (Note: A special project will be organized and supported by the faculty this year to help students identify ways to support efforts to combat bio-terrorism through improved uses of clinical and bioinformatic systems.)
While there are significant potential advantages and benefits from telemedicine, the evidence of its cost-effectiveness and sustainability is meagre. This is because much of the telemedicine activity so far has been in the form of pilot projects of demonstrations in universities and hospitals with subsidized funding from government or other sources. The number of self-sustaining, commercial applications of telemedicine is still very small. Telemedicine undoubtedly yields cost savings in certain circumstances, but often the savings and benefits accrue to those who do not have to pay for the service. Thus, few service providers have found a way to recover their costs (and make a profit) from those to whom they provide their service. Even fewer countries have actually budgeted for the provision of telemedicine as a service widely available to their citizens. Nevertheless, with the rapidly declining cost in hardware and telecommunications, the level of interest and the corresponding activity in telemedicine is rising rapidly. Most of the telemedicine experience to date has been in the industrialized world. It is apparent that the first requirement of developing countries is for more information about telemedicine, what it is, and how it might be able to help solve some of the shortages in medical and health care. Given the potential of telemedicine to facilitate the provision of medical information and health care in rural areas, it seems useful for developing countries to undertake pilot projects in order to evaluate its potential and cost-benefits. The results of such pilot projects could be part of the development of a national health for all policy which takes telemedicine into account. In view of the other priorities of developing countries, especially those of the least developed countries, financing telemedicine activity is likely to remain a challenge for some time to come. Funding from external donor agencies may well be necessary, but local commitment and participation in pilot projects is essential if the project is to have a chance of success. As telemedicine requires a multidisciplinary approach, the active participation of telecommunication operators must be assured. Despite some false starts in the deployment of telemedicine as a continuing service to the general population--as opposed to a few well-to-do clients--telemedicine has great potential to improve access to health care and to contain costs in developing countries.
Telematic is the application of computer technology in modern telecommunication. Telemedicine will be of growing importance in the international collaboration in surgery.
Review of the different telematic applications for surgery and presentation of technology and tools. Practical user's guide.
Analysis of our international network of telesurgical staff meetings between 6 University Hospitals. Review of the situation of telemedicine in Switzerland and around the world.
After performing some comparative tests we chose to work with 6 ISDN channels at the world wide standard H.320 (rate of 384 Kb/s) which is widely available in Switzerland and around the world. Technical options, market opportunities and relationship between needs and goals of telemedicine are presented on a user point of view.
More than 70 telesurgical staff meetings allowed us to get an overview of this technology, in order to benefit of telemedicine applications for teaching and clinical use. Important factors are the analysis of needs and goals prior to the teleconference.
Consultation, second opinion, teaching and training should be new clinical applications of telemedicine, leading to an increase of surgical quality control in Europe and in the world.
Telepathology is probably the latest addition to the world of pathology. The costs of pathologic tests have increased, the requirements for shortened turnaround time are omnipresent and we are all aware of the current litigious environment. Telepathology is one of the answers to at least some of these requests. Here we review the current status of telepathology in the world of telemedicine; compare differences, similarities and applications of static and dynamic telepathology; and give a short introduction to the basic setup of a telepathology laboratory.
We describe an 11-year-old boy of Saudi origin with an interstitial deletion in the short arm of chromosome 4 (p15.32p16.3) as determined by G-banding and fluorescent in situ hybridization. His clinical manifestations were similar but not identical to previously reported cases of interstitial deletion in the same chromosomal region, and were not those associated with Wolf-Hirschhorn syndrome. The boy had normal facial characteristics, short stature, minor anomalies of hands and feet, amblyopia of the right eye, bilateral hearing loss, and hypotonia. On developmental testing, he had borderline intelligence, with a severe sensory integration and motor planning disorder, and severe deficits in the communication domain. In addition, he had severe oligodontia affecting his secondary dentition. This finding supports the presence of one or more genes involved in dentition in this chromosomal region.
Telemedicine is use of the new computer-based communication technologies for medical purposes. It augments the exchange of scientific information, while its applications in the fields of patient care and medical education cover remote diagnosis and therapy as well as remote education and training.
This article reviews the development of telemedicine and its application to specialties such as anaesthesiology, dermatology, medicine, surgery and pathology at the University Hospital of Basle, Switzerland.
Since 1980 the Department of Medicine has held multidisciplinary teleconferences for expert consultation and medical education. Since 1992 the Institute of Pathology has been linked to remote hospitals for real-time biopsy, and, since 1997, remote dermato-histopathological diagnosis has been performed in conjunction with a number of centres and practitioners. International academic teleconferences have been held in the field of surgery since 1986 and there is an interactive education programme via telemedicine in the field of anaesthesiology. The technology in use must be adapted to needs: since few practitioners are currently connected to the Internet, teleconferencing will still be the rule in the Department of Medicine. Remote diagnosis in dermatology and pathology requires high-resolution images transmitted by self-developed software via 64 Kb/s ISDN connection, while surgery works with ISDN teleconferencing at 384 Kb/s to ensure live transmission of surgical procedures with high-quality images.
Our practice, based on several hundred cases, suggests that telemedicine is useful in simplifying and expanding access to remote interdisciplinary expertise, as well as improving medical education in a number of specialties. Telemedicine's multidisciplinary approach is to be recommended.
One objective of the growing telehealth and telemedicine literature base is to inform potential adopters and raise their awareness through pilot projects. However, pilot studies often fail to create sustainable solutions because certain conditions are needed for long term success: (1) matching needs to appropriate solutions: while needs assessment can identify needs, adopters must view, test, and experience potential solutions under a number of circumstances; (2) change and new technology: technological implementation brings both foreseen and unforeseen changes, difficult to forecast, and pilot projects can create artificial expectations; (3) awareness of context: there has been a pervasive tendency to treat telemedicine or telehealth as separate from the context of health care delivery, but telemedicine is only a communication and information tool, and should not be considered as separate from other health care delivery activities; (4) availability of long term funding; while loans, government grants and private sector partnering can bridge gaps temporarily, sustainable solutions require that savings from existing systems can be applied to pay for telehealth and telemedicine installations. This paper makes a case for adopting best practices by proposing that a data base of case studies documenting best practices and success factors be developed and made widely available.
We report on a clinical-genetic study of 16 Wolf-Hirschhorn syndrome (WHS) patients. Hemizygosity of 4p16.3 was detected by conventional prometaphase chromosome analysis (11 patients) or by molecular probes on apparently normal chromosomes (4 patients). One patient had normal chromosomes without a detectable molecular deletion within the WHS "critical region." In each deleted patient, the deletion was demonstrated to be terminal by fluorescence in situ hybridization (FISH). The proximal breakpoint of the rearrangement was established by prometaphase chromosome analysis in cases with a visible deletion. It was within the 4p16.1 band in six patients, apparently coincident with the distal half of this band in five patients. The extent of each of the four submicroscopic deletions was established by FISH analyses with a set of overlapping cosmid clones spanning the 4p16.3 region. We found ample variations in both the size of the deletions and the position of the respective breakpoints. The precise definition of the cytogenetic defect permitted an analysis of the genotype-phenotype correlations in WHS, leading to the proposal of a set of minimal diagnostic criteria, which in turn may facilitate the selection of critical patients in the search for the gene(s) responsible for this disorder. We observed that genotype-phenotype correlations in WHS mostly depend on the size of the deletion, a deletion of <3.5 Mb resulting in a mild phenotype, in which malformations are absent. The absence of a detectable molecular deletion is still consistent with a WHS diagnosis. Based on these observations a "minimal" WHS phenotype was inferred, the clinical manifestations of which are restricted to the typical facial appearance, mild mental and growth retardation, and congenital hypotonia.
Wolf-Hirschhorn syndrome (WHS) is a multiple malformation syndrome caused by partial monosomy of 4p16.3. Pitt-Rogers-Danks syndrome, first thought to be a distinct entity, is a similar condition associated with a microdeletion overlapping the WHS critical region. In this paper we evaluate three WHS patients showing a microdeletion of 4p and remarkable development with respect to the clinical spectrum of WHS.
Telemedicine is often proposed as a solution to certain health-care problems in the developing world. There seems to be little published experience on which to make judgements. A literature search revealed 39 articles, of which only two related to any kind of direct clinical work; most of them were review articles or editorials. The majority of the work reported was educational in nature, and there has been little clinical experience. It seems probable that telemedicine can help with the education of health-care workers and patients; it seems likely that it could bring major benefits to the organization of health-care. Without proper trials, it will be impossible to determine the place of health-care in the developing world. Trials are the only way in which rational decisions can ultimately be reached regarding whether scarce resources should be devoted to telemedicine in developing countries, or whether they should be employed in more conventional health-care measures whose outcomes are known to be cost-effective.
Health care in some developing countries is now at a level that makes programs for care of children with cancer feasible. Examples of successful international programs in this field include twinning programs, nongovernmental assistance organizations, such as the National Children's Cancer Society, and committees of professional organizations, such as the International Society of Pediatric Oncology (SIOP). The international outreach program at St. Jude Children's Research Hospital includes training programs within the hospital, partner sites in 13 countries, a school for Latin American nurses, a distance learning website, and telecommunications programs, which are described in detail. Future programs should be designed to maximize and evaluate impact, report accomplishments and failures, and avoid duplication.
An e-mail link with the facility to send high-resolution digital images is a cheap and uncomplicated telemedicine method. The Swinfen Charitable Trust helped establish such a link in Patan Hospital Kathmandu, Nepal in March 2000. Over 12 months using this link 42 telemedicine referrals were sent to specialists throughout the world. Referrals were: 36% respiratory medicine; 21% neurology, 21% dermatology; 14% cardiology; 5% nephrology; and 3% radiology — 28 had digital pictures attached, of which 96% were of high enough quality on which specialists were able to comment.
Thirty-nine replies were received. The average time for a specialist reply was 2 days, and 45% were answered within 24 hours. All replies were judged by independent assessors to be helpful or very helpful for diagnosis, management and education. The assessors decided that in 50% of cases the advice if acted upon would have shortened hospital stay.
This pilot study has shown that a low-cost telemedicine link is technically feasible and can be of significant benefit for diagnosis, management and education in a developing world setting.
Developing countries are exploring the role of telehealth to overcome the challenges of providing adequate health care services. However, this process faces disparities, and no complementarity in telehealth policy development. Telehealth has the potential to transcend geopolitical boundaries, yet telehealth policy developed in one jurisdiction may hamper applications in another. Understanding such policy complexities is essential for telehealth to realize its full global potential. This study investigated 12 East Asian countries that may represent a microcosm of the world, to determine if the telehealth policy response of countries could be categorized, and whether any implications could be identified for the development of complementary telehealth policy. The countries were Cambodia, China, Hong Kong, Indonesia, Japan, Malaysia, Myanmar, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Three categories of country response were identified in regard to national policy support and development. The first category was "None" (Cambodia, Myanmar, and Vietnam) where international partners, driven by humanitarian concerns, lead telehealth activity. The second category was "Proactive" (China, Indonesia, Malaysia, Singapore, South Korea, Taiwan, and Thailand) where national policies were designed with the view that telehealth initiatives are a component of larger development objectives. The third was "Reactive" (Hong Kong and Japan), where policies were only proffered after telehealth activities were sustainable. It is concluded that although complementarity of telehealth policy development is not occurring, increased interjurisdictional telehealth activity, regional clusters, and concerted and coordinated effort amongst researchers, practitioners, and policy makers may alter this trend.
Wolf-Hirschhorn syndrome (WHS, OMIM 194190) is a chromosomal disorder characterized by retarded mental and physical growth, microcephaly, Greek helmet appearance of the facies, seizures/epilepsy. Closure defects of lip or palate, and cardiac septum defects occur in 30-50% of cases. Its cause is a deletion in the short arm of chromosome 4. We present a male patient, born after 37 weeks gestation, as the fourth pregnancy of non-consanguineous healthy parents, with unilateral cleft lip and palate, hypertelorism, a right-sided ear tag, and mild epispadias. At age 10 weeks he developed acute respiratory distress and acute bowel obstruction requiring emergency laparotomy. This revealed a left-sided posterolateral diaphragmatic defect, type Bochdalek, with incarceration of the small intestines necessitating major bowel resection. Clinical genetic investigation suggested a chromosome anomaly, but regular karyotyping was normal. However, FISH analysis showed a microdeletion in the short arm of chromosome 4 (4p-), consistent with WHS. A combination of this syndrome with congenital diaphragmatic hernia (CDH) has been rarely described. CDH can present either as an isolated defect at birth, or with multiple congenital abnormalities, or as part of a defined syndrome or chromosomal disorder. Therefore CDH, although not common in WHS, can lead to its diagnosis relatively early in life. We strongly recommend a clinical genetic evaluation of each CDH patient with facial anomalies taking into consideration 4p- deletion syndrome.
This article analyzes telemedicine, the use of distant communication technologies within the context of clinical health care, and the effects it has on health communication. The main effect is that telemedicine has the capacity to substantially transform health care in both positive and negative ways and to radically modify personal face-to-face communication (Turner, 2003). This has tremendous implications for health communication scholars in that they can extend the telemedicine debate by integrating fresh insights into more acceptable approaches that will refine and humanize mediated channels of health communication. There are several key areas of telemedicine that need to be discussed (i.e., e-health services, clinical encounters, etc.), all of which are identified in this article. In addition to describing the past and current applications of telemedicine, this article provides a better understanding of unique needs, resources, problems, and opportunities germane to telemedicine services.
The wide development of multimedia clinical applications and the use of inter and intra-hospital communication networks require a specific analysis to increase the efficiency of e-Health services. In this paper we study the optimum combinations of the application parameters needed to fulfil the quality of service (QoS) thresholds according to monitored network measurements in the new healthcare services. A remote diagnosis service has been evaluated establishing good-performance areas, depending on available resources.
Nearly half a century ago, telemedicine was disregarded for being an unwieldy, unreliable, and unaffordable technology. Rapidly evolving telecommunications and information technologies have provided a solid foundation for telemedicine as a feasible, dependable, and useful technology. Practitioners from a variety of medical specialties have claimed success in their telemedicine pursuits. Gradually, this new modality of healthcare delivery is finding its way into the mainstream medicine. As a multidisciplinary, dynamic, and continually evolving tool in medicine, researchers and users have developed various definitions for telemedicine. The meaning of telemedicine encapsulated in these definitions varies with the context in which the term was applied. An analysis of these definitions can play an important role in improving understanding about telemedicine. In this paper we present an extensive literature review that produced 104 peer-reviewed definitions of telemedicine. These definitions have been analyzed to highlight the context in which the term has been defined. The paper also suggests a definition of modern telemedicine. The authors suggest that telemedicine is a branch of e-health that uses communications networks for delivery of healthcare services and medical education from one geographical location to another. It is deployed to overcome issues like uneven distribution and shortage of infrastructural and human resources. We expect that this study will enhance the level of understanding and meaning of telemedicine among stakeholders, new entrants, and researchers, eventually enabling a better quality of life.
The State of Hawaii has been promoting telehealth implementation by developing health policy, soliciting financial endowments, and facilitating the development of a telecommunications infrastructure. Telemedicine or telehealth has been in existence for 40 years, but has yet to make the transition from a feasible tool to an integrated tool in health care delivery. In the emerging and fast changing health care environment, public and private sector organizations find an increasing need to collaborate. Hawaii's Telehealth Planning Project used the multi-sectoral collaborative approach to address telehealth challenges. The paper traces the Project's community development, and identifies Hawaii's legal and regulatory activities along with federal and international activities
Telemedicine may be a useful technique for delivering health care in the developing world. However, there is little practical experience to draw on and real concerns that if additional resources were to become available telemedicine might not be the most appropriate use for them. The logical steps to determine the place of telemedicine in the developing world therefore appear to be: (1) to identify potential telemedicine projects-the Telecommunication Development Bureau of the International Telecommunication Union is trying to do this and has recently sponsored missions to various countries in Africa and Asia; (2) to carry out properly controlled pilot projects in order to demonstrate technical feasibility and to quantify the benefits to the healthcare system; (3) to calculate the costs of large-scale deployment. Assuming that telemedicine is shown to be beneficial, it is only at this final stage that a rational decision can be made about whether telemedicine would be an appropriate use of additional resources in a developing country, as opposed to alternative uses of those resources to solve other important problems of health care.