telemedicine proposal

7/31/2019 Telemedicine Proposal

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INTRODUCTION

1.0 Background of the study

Health care, as we know, is primarily about people-to-people interactions. It is about

understanding, diagnosis, physical contact, communication and ultimately, providing care. All of

this is facilitated by the technical processes of imaging, pathological testing, information gathering,

research and so forth. The task for every health care system is how to maximize the personal

contact at the same time as maximizing the technical input, while all the time operating within a

sustainable financial framework.

People working in developing countries have had to think about this task with even more urgency

than those working in richer countries. They have had to think about how to obtain an expert

opinion in remote places, how to support local clinicians who may not have all the skills they need,

how to make sure technical information is interpreted wisely in very difficult circumstances and

how best to use very scarce resources. Telemedicine offers help in meeting these conflicting needs

by improving access to data and to individuals, while driving down the costs of doing so (Richard

Wootton et al).

Telemedicine tool enables the communication and sharing of medical information in electronic

form and thus facilitates access to remote expertise and knowledge. A physician located far from areference centre 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.

Telemedicine is defined as the use of information technologies to exchange health information and

provide health care services across geographical, time, social, and cultural barriers (Reid, 1996). In

general; telemedicine technology includes both store-and-forwards (asynchronous) as well as live

videoconferences (synchronous) transmissions via satellite networks. In the last decade, pilotstudies in SSA countries have shown the potential benefits of telemedicine for patients and

healthcare providers (Kifle et al., 2006). The results demonstrated the socio-economic impacts of

telemedicine, and its potential in the area of improving accessibility, containing costs, and

providing quality care (Brauchli et al., 2004; Craig et al., 2005; Kifle et al., 2006).


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Statement of Research Problem

In most developing countries, many villages still lack basic ICT infrastructure, such as telephone

lines and power supplies that influence telemedicine technology transfer (Avgerou, 2002; Messo et

al., 2005). That is why the transfer of information systems in developing countries is usually

described as a problem (Heeks, 2002a, 2002b; Madon and Sahay, 2000; Montealegre, 1999; Moore

and Benbasat, 1991).

Specifically, when it comes to the health sector, the digital divides between developed and

developing countries are wider than the gap observed in other productive and social sectors

(Ratzan, 2000; Strecher, 2000; Street et al., 1997). Furthermore, productive sectors such as

banking have accepted ICT faster, and allocate 5-10 percent budget for IT, while the healthcare

sector is 10-15 years behind the productive sector, with only 2-3 percent of its budget allocated to

IT (Gravitz, 2000; Lu and Farrell, 1990; Raghupathi and Tan, 2002).

Previous Information and Communication Technology Transfer (ICTT) attempts from

partners in developed countries to developing countries have failed because of neglecting

infrastructural, socioeconomic and cultural factors that impact such transfers (Avgerou &

Walsham, 2000; Bada, 2002; Loch et al., 2003; Mbarika et al., 2001; Meso et al., 2005, Straub et

al., 2001). Accordingly, understanding barriers due to infrastructural and cultural factors fortelemedicine transfers motivates this work.

The following rationale underscores the research significance:

Recent ICTs (and telemedicine) developments in Africa and Ghana as such are

encouraging, including wireless ICT diffusion, Internet use, electronic information

exchanges, and remote consultations.

Healthcare is essential for Ghanaians with multiple medical problems. Many have reported

growing medical problems in Sub-Saharan Africa (SSA). These problems stimulated new

approaches like telemedicine for better access and reduced costs as iterated by Dr. Osei

Darkwa, President Ghana Telecom University College on Monday May 7, 2007.

There is dire shortage of medical personnel and facilities in SSA including Ghana.


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The brain drain phenomenon is apparent throughout SSA. WHO (2006) statistics

revealed that SSA-trained physicians currently practicing in OECD countries represent

23% of existing doctor workforce in countries of origin.

Healthcare providers in developing countries and international organizations are promoting

telemedicine transfer. Additionally, influence of ICTs due to governmental policies,

economic, sociopolitical, cultural and infrastructure factors have attracted international

collaborations (Avgerou, 1998).

Objectives

1.2.1 General Objective

To assess the infrastructure readiness of telemedicine in rural communities in the country

1.2.2 Specific Objective

To increase the rural segment access to quality health care

To investigate the use of the mobile phone to access health care in rural communities

To save time cut cost of delivering health services for person living in remote villages

1.3 Justification

The following rational underscores the research significance;

There are disparities in the provision of health care within developing countries, where the

health facilities in the urban areas are relatively well off in terms of manpower. Other

medical facilities and resource as compared to those in rural areas. Such disparities mean

that rural areas are often at a disadvantage with health workers facing daunting challenges.

In order to provide basic health care for all population, health workers need communication

facilities to obtain advice and information from more affluent urban health centres, as well

as to transmit pertinent data such as epidemiological information hence, the need for

extensive research into telemedicine


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Health care providers in developing countries and international organization are promoting

telemedicine transfer. (Avgerou,1998)

1.4 Significance of the Study

Telemedicine is significant particularly, in countries where specialists are few and where

distance and the quality of the infrastructure hinders the movement of physicians or

patients from rural to the urban centres. It will guide policy makers to consider

telemedicine by stimulating infrastructure development, funding specific telemedicine

programs, or reducing policy barriers.

Ghanaians have experienced many inequalities and these have extended to the health care

setting. One of the major challenges that needs to be addressed is the accessibility and

availability of health care and specialized medical services in rural areas in Ghana hence

the need for an extensive research into telemedicine as a tool in arresting the problem.

The study document could serve as a secondary source data for further study of economic

importance in future

1.5 Anticipated Problems

Financial constraint or cost involved in conducting research over a wide area or scope

Limited time of conduct and present the project

Scarcity of data on telemedicine as it is a developing application of clinical medicine


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LITERATURE REVIEW

2.0 IntroductionTelemedicine is defined in the Websters New world Medical Dictionary as the use of medical

information for the health and education of the patient or health care provider and for the purpose

of improving patient care.

According to the European Commissions Health care Telematics Programme, telemedicine was

define as rapid access to share and remote medical expertise by means of telecommunication and

information technologies, no matter where the patient or relevant information is located. From

these definitions it is clear that Telemedicine is the application of telecommunication technology

within the health industry. In essence, it eliminates distance as a barrier in the delivery of

healthcare.

Telemedicine is the delivery of health care and the exchange of health care information across

distances using telecommunication technology. It can include the transfer of basic patients

informations over computer networks (medical Informatics), the transfer of images such as

radiographs, CT scans, MRIs, Ultrasound Study pathology images, Video images of endoscopic or

other procedures. Patients interviews and examinations, consultation with medical specialist and

healthcare educational services (Ferguson et al.1995).

Telemedicine covers a growing number of medical specialties such as; Cardiology, Home Care,

Radiology, Emergency Care, Surgery, Dermatology, Psychiatry, Oncology, Pathology,

Ophthalmology, Hematology, ENT, Nephrology, Pre-hospital Care etc.

2.1 History

The term telemedicine derives from the Greek word tele meaning and the present word

medicine which itself derives from the Latin word mederi meaning healing. It is a phrase first

coined in the 1970s by Thomas Bird, referring to health care delivery where physicians examine


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distant patients through the use of telecommunication technologies as simple as complex as

telephones and fax machines or as complex as computers and interactive multimedia application.

--- (W.A. Mbarika is Telemedicine the Panacea for sub-Saharan Africas medical Nightmare ).

The idea of performing medical examinations and evaluations through the telecommunication

network is not new. Shortly after the invention of the telephone, attempts were made to transmit

heart and lung sounds to a trained expert who could assess the state of the organs. However, poor

transmission systems made the attempts a failure. The table below gives a retrospective account of

telemedicine

Table 1; Telemedicine in Retrospect

Year Field Details1906 ECG

Transmission

Einthoven, the father of electrocardiography, first investigated on ECG

transmission over telephone lines in 1906! He wrote an article, Le

telecardiogramme at the Archives Internationales Physiologie; 4:132,

1906

1920s Help for ships Telemedicine dates back to the 1920s. During this time, radios were used

to link physicians standing watch at shore stations to assist ships at sea

that had medical emergencies

1924 The first

exposition of

Telecare

Perhaps it was the cover showed below of "Radio News" magazine from

April 1924. The article even includes a spoof electronic circuit diagram

which combined all the gadgets of the day into this latest marvel!(Information and photo by courtesy of Dennis J. Streveler Ph.D.

Healthcare IT Consultant).

1955: Telepsychiatry The Nebraska Psychiatric Institute was one of the first facilities in the

country to have closed-circuit television in 1955. In 1971 the Nebraska

Medical Center was linked with the Omaha Veterans Administration

Hospital and VA facilities in two other towns.

1967 Massachusetts

General

Hospital

This station was established in 1967 to provide occupational health

services to airport employees and to deliver emergency care and medical

attention to travelers

1970s Satellitetelemedicine

Via ATS-6 satellites. In these projects, paramedics in remote Alaskan andCanadian villages were linked with hospitals in distant towns or cities.

Source: Telemedicine; Technology for medical diagnosis and patient care;

http://users.forthnet.gr/ath/giovas/telemed/ (Accessed 1st September 2011 at 11am)


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2.2 Types of Telemedicine - (Wikipedia, the free encyclopaedia)

Basically telemedicine is divided into three main types namely:

Store-and-forward

Interactive services

Remote monitoring

2.2.1 Store and forward

With the help of store and forward Telemedicine type all details related to medical data, images,

video, audios reports and everything is collected and transmitted to the medical expert, doctor, for

diagnosis or assessment offline. It requires the clinician to rely on a history report and audio

information in place of physical examination.

2.2.2 Interactive Service

This is a real time communication in between patient and doctor. This includes telephonic

conversation, home visit as well as online interactions. Lots of activities like review of history,

physical examination, assessment and check-ups are carried out in such type of telemedicine. This

clinician interaction telemedicine procedure is affordable as compared to the treatment and

diagnosis carried out at face to face interview.

2.2.3 Remote monitoring

Also known as self-monitoring or testing enables medical professionals to monitor a patient

remotely using various technological devices. Lots of chronic disease, specific conditions like

heart disease, asthma, or even diabetes can be managed and monitored by this means. These are

definitely comparable and cost effective as compared to those traditional; face to face interactions

between the doctor and patient.

2.3 Growing Demand for Telemedicine - (Sandy Taylor; 2010)

Telemedicine can be depended on in times of emergency when there is no medical doctor.

Learning and using telemedicine techniques during emergency is simple today with the help of


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online source. Care at a distance, telemedicine is a handy tool for people trying to reach some

medicines, treatment consultancy during illness.

Today telemedicine has developed rapidly as a means of receiving and interacting all about

medical information, examination, and consultation. All thanks to the latest technology,

telemedicine is supporting diagnosis and treatment with no personal face to face communication.

Surly telemedicine is fast, effective, simple, cost saving as well as the best way to receive some

medical guidance when no doctor is around.

Due to the high demand of medical care needs especially for those who do not have access to

medical centres and are most often concentrated within the rural areas. The aim is to find answers

to the following;

Will telemedicine improve the quality of health care?

Will it improve the delivery of health care in remote areas?

2.4 Concept of Telemedicine

From the various definitions, a telemedicine system creates a visual medical consultation where

the local medical attendant becomes the eyes, ears and hands of the remote medical expert. He/she

collects the necessary information for decision making and serves to implement the necessary

actions and treatment.

Telemedicine provides tertiary healthcare to people at remote areas through a visual reduction in

distance. Text, sound, pictures and videos are being merged and interconnected in completely new

way for diagnoses and treatment thereafter.

2.4.1 Potentials of telemedicine (Richard Wootton, 2001) Building bridges between clinicians and patients to overcome the barriers of distance and

time.

Developing visual communities that interacts and shares knowledge

Enhancing continuity of care


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Improving access to healthcare in remote or isolated areas.

2.4.2 Generic application of Telemedicine (S.R Joshi, 2000)

Clinical applications - include handling urgent consultations, scheduled consultations,

remote visits of patients and the video reviews of certain studies done in advance.

Administrative applications- covers telemedicine system for promoting and accelerating

the replication, update and transfer of clinical information including medical records,

examination data and financial information

Educational application: this includes applications that facilitate the process of sharing the

material available for teaching and examination purposes in the medical field.

2.4.3 Benefits of Telemedicine (Samuel K Moore, 2002)

Telemedicine has a number of benefits namely:

Reducing the cost of service delivery

Easy and quick access to the specialist

Cost effective post treatment consultation

Travel time reduction

Enhanced quality and efficiency of medical care

2.5 Technology

Telemedicine technology is based on a speciality centre and a consultation centre linked to each

other. A speciality centre is a well-equipped room where a specialist can communicate with a

patient in a remote area the equipment required are a high- resolution video camera (polycam) web

camera, document camera, microscope, computer, microphone, speaker, telephone and a modem.

A consultation centre is a centre from whence the local Registered Medical Practitioner (RMP) or

patient can consult the specialist in the speciality centre. The consultation centre and the speciality

centre are linked to each other through on Integrated Services Digital Network (ISDN).


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One of the essential devices used for consultation is a polycam. A polycam is a video conferencing

tool accompanied by a voice transmission enabler. The polycam is connected to the ISDN lines

and to the TV both at the speciality and consultation centre as shown in fig 1.

From the consultation centre x-rays, CT-scan, colour Doppler, Ultrasound etc. are transferred over

the ISDN line with the help of an interface. In the speciality centre the medical records are

received on the system and can be alternatively viewed on the TV through the polycam using an

interface. A web camera can be used in the absence of a polycam. A high resolution/luminosity

subsystem is used for better transmission of x-rays and echocardiograms. High-end scanners are

used in the speciality centre to capture negative and positive images. For the transfer of ECG,

special trans-telephonic equipment is used which is connected to the ECG machine on one side be

seen and heard on the system at the speciality centre.

An electronic or digital stethoscope can be used to hear the heartbeat. The equipment is placed on

the patient and connected to the telephone line and the doctor at the speciality centre can hear the

heart beat on the system or the telephone directly.

Figure 1; Telemedicine Network


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2.6 Telemedicine Consultation Case Study

A live case handle by Dr Alok Ranjan (consultant Neurosurgeon, Apollo Hospitals-Hyderabad): A

patient named shanker Chandra was undergoing treatment in Calcutta under Dr Tamal

Bhaltacharya at the consultation centre in Calcutta. In the cause of the treatment a specialist

opinion was required and Dr Tamal Bhaltacharya referred the case to Dr Alok Ranjan at the

speciality centre in Hyderabad. Calcutta is a full fledge Telemedicine consultation centre and is

connected to the Hyderabad Apollo Hospital.

The patient records were sent in advance and the appointment was fixed according to Dr Alok

Ranjans schedule. Before the consultation begins both the centres have to enter each others

internet protocol (IP) address for a wed camera meeting in the absence of a polycam. The meeting

took place for ten minutes in the course of which Dr Alok advised the patient on his futuretreatment plan (www.appollohospitalgroup.com).

2.7 Process Of Telemedicine - (Aaragonda project- India)

In a telemedicine project, the usage of software can be divided into three stages namely

Data is transferred from consultation centre

Accepting the patient record and fixing up a teleconsultation

Viewing post consultation details.

The three phases of telemedicine process is schematically shown in figure 2 below.


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Figure 2; Three phases of telemedicine process


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METHODOLOGY

3.1 Study Area

Sunyani is located in the mid-western part of Ghana in the Brong Ahafo Region. The Brong Ahafo

Region is one of 10 administrative regions in Ghana. The region itself has 17 administrative

districts and 2 municipalities of which Sunyani is one. Sunyani is the largest settlement in the

Brong Ahafo Region in terms of population and area. It also doubles as the regional capital.

According to the 2000 population census the Region has a population of 179,267. Of this total

Sunyani Town has 61,992 representing 34.5% of the total population with a growth rate of 3.4%

per annum.

Figure 3; Map of Sunyani showing the two hospitals


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EPI-INFO to generate statistics, graphs, and tables. Pearson Chi-Square test will be used to test the

hypothesis.

3.6 Ethical Consideration

Since majority of the data will be gathered using self-administered questionnaires; stakeholders

will be informed of the research intention by means of an introductory letter that briefly states the

study purpose and its significance. They will be made aware that the research is solely for

academic purpose and that their identities will not be disclose in anyway. Also questionnaires will

be designing a way not to tackle sensitive areas head-on.

3.7 Pre-Test or Pilot Study

The questionnaire and all other techniques for data collection will be pre-tested on fellow students

and colleagues to help discern, alter or delete questions that are being misinterpreted or are too

sensitive to be asked without offending respondents.

3.8 Discussions of Findings

This part will discuss the result of the study in relations to the objective, literature review and key

variables of the research.

3.9 Conclusions and RecommendationConclusions drawn from the study will be put across in this part. Also the researcher will give out

his recommendations to the various stakeholders concerned with the study as to how the situation

can be improve upon for the betterment and the good of all people.

telemedicine proposal

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