Telemedicine |
The classical format of Telemedicine as remote consultation between patient and health professional or between two health professional applied in the western health system mainly target at the improvement of clinical services and cost reduction. The expected effects of telemedicine in resource poor settings are manifold and comprise of social, educational and clinical aspects. Telemedicine as a means to transfer expert knowledge to remote health facilities supports the local health professionals providing basic health services to the rural population. The use of Information & Communication Technologies enables health professionals to access expertise which is usually centralised in the main urban centres and allows them to sustain their continuous medical education and gain higher proficiency and keep their professional advancement intact. Beside the professional isolation which may be overcome through the electronic media also the social isolation preventing many health professionals to work in remote areas may be reduced. This might also help to counter balance the increasing shortage of health work forces in the rural areas of many countries with limited resources.
Maria Zolfo
Maria Zolfo, M.D., specialist in Infectious Diseases (Catholic University, Rome). She trained in Tropical Diseases at Institute of Tropical Medicine, Antwerp, in 1998 and worked from 1999 till 2003 in Zimbabwe. Since 2003, she is working at the Institute of Tropical Medicine, Antwerp, in the HIV/AIDS overseas unit as responsible of a Telemedicine project, giving distance advice on HIV/AIDS care to colleagues working in low resource settings.
Clinical management of HIV/AIDS through Telemedicine;comparison of open source vs. commercial systems
Since 2003, the Institute of Tropical Medicine, Antwerp (ITMA) organises each summer the Short Course on Antiretroviral Therapy (SCART), for physicians willing to specialise in HIV/AIDS care in low resource settings. After the completion of the course the SCART participants can seek advice for the management of difficult clinical cases through a hybrid web/e-mail discussion forum which can be accessed via http://telemedicine.itg.be/
Registered users have the possibility to submit cases and questions, to play an active role in discussions and to have access to various educational material as well as news and journals. Evaluations show that users first of all see an educational benefit for themselves though the platform is used also for the establishment of diagnosis, the reassurance of physicians and the collection of literature.
Among the main desired impacts of ICT in low resource settings the creation of knowledge, the support of capacity building and the empowerment of people are considered to be essential. What has to be avoided is the duplication of efforts, the reinvention of the wheel with pilot projects and the focus only on success stories.
The combination of a course taking part at an institute with a platform offering the possibility of exchange after the course is a successful initiative to create community of people facing similar problems. Mentorship and support is possible through telemedicine.
Antoine Geissbuhler
Antoine Geissbuhler is a Professor of Medical Informatics, Chairman of the Department of Radiology and Medical Informatics at Geneva University, Director of the Division of Medical Informatics at Geneva University Hospitals, and President of the Health-On-the-Net Foundation Council.
Supporting healthcare professionals where they are most needed: the telemedicine network in French-speaking Africa
Facing the situation that many countries worldwide suffer from a critical shortage of health service providers while factors like maternal or child survival directly depend on the density of health workers shows clearly that there is an urgent need to bring health services into remote places with no sufficient health supply.
The RAFT network focuses on the development of a South-South distance education and support network for care professionals in French-speaking Africa, including first-line healthcare in the network. Another focus is on capacity building for the production of quality, locally adapted, online health/healthcare contents. At present 18 African countries a part of the network.
Basis of the successful initiative is the focus on people and local experts.
Virtual communities for teleconsultations allow asynchronous communication and consist of identified professionals.
In terms of quality management the network collaborates with the Health-On-The-Net Foundation and has common projects with WHO and the Global Health Library.
The majority of the courses are produced in Africa. E-courses are always followed by discussions between participants.
RAFT brings together health education and health services. Beside that the exchange between south-south and south-north as well as the focus on the human network make RAFT a remarkable example for the useful application of ICT in health systems.
RAFT is accessible via http://raft.hcuge.ch
Marc Blunier
Marc Blunier has an Engineering degree in Electrotechnics and and a post graduate degree in Health Technology Management from the University of Applied Sciences in Bern. He works as a project leader and Health Technology & ICT Specialist at the Swiss Tropical Institute since 2003.
Ukraine MCH Program: Information & Communication Technologies in Health
Within the Ukraine Swiss Mother and Child Health Program a telemedicine component is implemented to overcome country specific problems like the big geographical dimensions or the strongly hierarchical organized centralized health system. Part of the existing problem was low internal and external exchange of knowledge and information.
Telemedicine should contribute to sharing experiences and expertise among health professionals as well as increasing professional skills and improving health service delivery. A communication network was established which allows the exchange through all levels of the health system vertically and horizontally as well as between national and international colleagues and experts.
Technically the telemedicine network is based on iPath, a platform developed at the University of Basel.
More than 300 registered participants with more than 300 cases over 5 years demonstrate the acceptance of this platform. For the future the evaluation of the impact of telemedicine is programmed and questions like for instances the impact on patient referrals will be studied.
The platform is accessible via http://ipath.ukma.kiev.ua/