• Telemedicine
  • WHO digital health guideline: 5. provider-to-provider telemedicine

    Countries need more than warm bodies to staff their health systems, they need those health workers to have appropriate competencies, skills and behaviours. Distance can be a serious barrier to health workers’ interactions. The role of telemedicine in overcoming this is the subject of the fifth recommendation of the WHO guideline on Digital Interventions for Health Systems Strengthening.

    WHO’s review of evidence suggests that provider-to-provider telemedicine “may improve health worker performance, reduce the time for clients to receive appropriate care or follow-up, and decrease length of stay among individuals visiting the emergency department”. It also notes that the opportunity to communicate with one other can help to reduce professional isolation, in particular helping lower-level health workers to access advice to enable better quality of care.

    Nevertheless, evidence also suggests that this form of telemedicine may have little or no effect on health outcomes and some health workers worry about liability and loss of control of their clients’ care.

    WHO recommends provider-to-provider telemedicine in settings where patient safety, privacy, traceability, accountability and security can be monitored.

    Additional comments include a recognition that telemedicine methods are changing with technological advances and that standard operating procedures may help address liability concerns. Implementation considerations include exploring integration with clinical record systems to support provider consultations, reviewing distribution of roles and responsibilities, and considering policy updates to clarify liability issues.

    My next piece in this eHNA series will summarise recommendations on targeted client communication for behavioural change.

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    The WHO Guideline provides evidence-based recommendations of ways to use digital health to improve health services. It has a specific focus on mobile devices and emerges out of guidelines on digital health interventions for RMNCAH developed by this team.

    Topics are:

    Acceptability and feasibility findings Birth and death notification via mobile devicesStock notification and commodity management with mobile devicesClient-to-provider telemedicineProvider-to-providertelemedicineTargeted client communication for behaviour change Health worker decision supportDigital tracking of clients’ health status and services Training and education via mobile devices

    Evidence is presented under headings of:

    EffectivenessAcceptabilityFeasibilityResource useGender, equity and human rights.

    Implementation considerations address key topics from the WHO/ITU National eHealth strategy toolkit, such as:

    Legislation, policy and complianceInteroperability and standardsWorkforce.

    Explore more eHNA coverage of WHO initiatives here.

  • WHO digital health guideline: 4. client-to-provider telemedicine

    Human resource shortages are a significant obstacle to Universal Health Coverage (UHC) in many countries. Telemedicine, by definition, supports “the provision of health care services at a distance”. The WHO 2010 report Telemedicine Opportunities and Developments in Member States provides a recent update on the factors affecting telemedicine and the WHO guideline builds on this.

    WHO recommends client-to-provider telemedicine:

    Under the condition that it complements, rather than replaces, face-to-face delivery of health servicesIn settings where patient safety, privacy, traceability, accountability and security can be monitored.

    Effectiveness evidence suggests that telemedicine may improve some outcomes, such as reducing mortality for some conditions, though little or no difference on other outcomes, such as hospital admissions. Qualitative evidence suggests that health workers appreciate being able to offer prompt advice and care, even if physical contact with the patient is not possible, though have concerns about telemedicine reducing client-health worker relationships, leading to poorer care, making health workers work beyond their capabilities, and leading to clinical liability.

    Despite the mix of available evidence, the guideline development group felt that telemedicine has the potential to expand access to health services, though should not detract for health workforce strengthening and needs standard operating procedures to be established. In African countries, where large distances compound health access barriers, telemedicine may be an important part of a national digital health strengthening plan.  

    This is the fourth piece in an eHNA series on the WHO guideline Recommendations on Digital Interventions for Health Systems Strengthening. The previous chapter was about using mobile devices for birth and death notification. The next one deals with provider-to-provider telemedicine.

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    The Guideline provides evidence-based recommendations of ways to use digital health to improve health services. It has a specific focus on mobile devices and emerges out of guidelines on digital health interventions for RMNCAH developed by this team.

    You can find more eHNA coverage of WHO initiatives here.

  • Competitive telemedicine platform to help achieve UHC

    AfriDOKTA is passionate about transforming the delivery of healthcare in Africa through people, processes and technology. They have developed a telemedicine mHealth platform dedicated to Sustainable Development Goal 3, “Ensuring healthy lives and promoting well-being for all at all ages”. Anyone with a smart phone or internet access can easily download the AfriDOKTA app and would have immediate access to quality outpatient care.

    The Kenyan government is the first African country that has supported the roll-out of AfriDOKTA as part of a nationwide campaign towards universal healthcare. The roll out is supported at the community level by community health workers (CHWs) that train users on how to access health services using the AfriDOKTA app. Users can easily create a personal profile and an electronic medical record to store details of consultations received. The app also gives users referrals to vetted pharmacies and labs with certified medical professionals. 

    A unique design feature of the AfriDOKTA app is that it complies with international data security standards and adheres to the US-based Health Insurance Portability and Accountability Act (HIPAA). The architecture also applies Health Level 7 (HL7), SNOMED, and DICOM standards. These are international principles used for the transfer of clinical data between various software and electronic applications.

    AfriDOKTA's use of international standards for storing, accessing, and processing medical images and related information, their plans for strategic collaboration and relevant product benefits make it a strong competitive differentiator in the market. This solid technical foundation should position the platform to support our Universal Health Coverage (UHC) aspirations too.

  • International SOS Foundation releases a teleconsultation guide

    The Medical Dictionary describes two types of teleconsultation. One is between doctors. The other’s between doctors and patients. It refers to networks and video links. Smartphone services such as Figure 1 is an example of a more modern version. It includes nurses too.

    Help in setting up and managing teleconsultation is available from the the International SOS Foundation. It’s launched a white paper on the topic, endorsed by the International Society for Telemedicine & eHealth (ISfTeH).

    Teleconsultation Services for the Mobile Workforce; Considerations & Guidelines for the Provision of Global Services in Compliance with Regulations & Best Practice Clinical Standards of Care provides insights into essential aspects needed to assess teleconsultation services. They include:

    Country level review of legal requirementsGuidelines on clinical best practices, including local healthcare environment, clinical expertise of disease threats at patients’ locations and integration into the local healthcare systemsCase studies for corporate and educational sectorsGlobal best practices for assessing teleconsultation services.

    It can help Africa’s health systems to develop their telemedicine services towards broader teleconsultation services. Modern mHealth technology offers considerable opportunities.

  • ISfTeH’s next annual meeting’s in Portugal

    On 19 to 20 March 2019, the International Society for Telemedicine & eHealth (ISfTeH) conference will be underway in Lisbon, Portugal. Partners include the annual Portugal eHealth Summit which’s co-organised by ISfTeH’s institutional member, Centro Nacional TeleSaúde, part of the Shared Services of the Portuguese Ministry of Health (SPMS). The Portugal eHealth Summit is the largest eHealth event in Europe, bringing together some 10,000 stakeholders from the Portuguese National Health Service.

    It’s ISfTeH’s 24th International Conference. The range of topics is huge. They include:

    Technology to:

    o   Monitor  vital signs for long term conditions

    o   Health management of service users with severe mental illness

    o   Facilitating integrated care in wider communities

    Global Digital Health Index’s state of global digital health Telemedicine’s potential for UHC in Portuguese-speaking CountriesInjecting the human side of telemedicine and eHealthEconomic evaluation of an new guideline of an online clinic in Japan Considerations and guidelines for global teleconsultationPhysicians' experiences, attitudes and challenges in a paediatric telemedicine serviceAlgorithms for predictive medicine AI for healthcare professionals Big Data and tele-ECG eHealth data protection with GDPREffective digital tools for everyday practicePortugal’s experience of telehomecare and telemonitoringPutting IoT to work for caregiversIs technology the solution for chronic disease management?Tele-ECG network in Southern BrazilAI and telemedicine for heart failure diagnostic supportPractice guidelines for primary and urgent careCan telemedicine reflect healthcare system investment Needs?

    Details of the event will be available soon.

  • A telemedicine toolkit from Novartis Foundation supported by CWCDH

    As telemedicine moves further into the mHealth environment, it can become more widespread. To help its expansion, Novartis Foundation, with the Commonwealth Centre for Digital Health (CWCDH) as a messanger, has have compiled a telemedicine toolkit.

    It covers a wide range:

    High-level overviewInteractive implementation guide Business continuity planCommunicationFact sheetFever overview, protocol and role play templates Postpartum haemorrhage overview and protocolReferencesRollout templateWhat to look out for.

    There are two videos:

    Ghana Telmed Toolkit Video 1Ghana Telmed Toolkit Video 2.

    Ghana Health Service and Ministry of Health are core collaborators. Ghana telemedicine has more background information.

    Two objectives for the toolkit are:

    Increased healthcare access for people in low- and middle-income countriesLeverage eHealth best practiced and benefits.

    It sees telemedicine as vital to connect Community Health Workers (CHW) to medical specialists in 24-hour tele-consultation centres. Doctors, nurses and midwives in the centres mentor, coach and advise CHWs in managing emergency cases that are beyond their capabilities. Ghana’s experience shows that telemedicine’s strengthened healthcare capacity can result in:

    Over half of tele-consultations can be solved directly by phone, so mHealth has a core roleHospital referrals can reduce by 31%Empowered CHWsBetter healthcare qualityReduced travel times and costs for patients.

    Developed in Africa, the telemedicine toolkit can help African countries' health systems expand towards a shared, successful model. This can lay a platform for sharing and developing the required eHealth regulation.

  • Rural India uses eHealth with containers

    Shipping containers re-appear in many guises, from roadside cafés to holiday homes. It should come as no surprise that they should have become part of the future of India’s eHealth network.

    A report in The Nation Online says in 2013, Dr. Anurag Agrawal, of the New Delhi-based Institute of Genomics and Integrative Biology (IGIB), saw the possibilities of including shipping containers’ versatility in his work towards a link between genes and lung disease. His plan was to use the movable containers to house and collate health records in rural areas so specialists could analyse the data to identify links between height, weight and predisposition for developing specific lung diseases. The analysis leads on to developing and delivering treatments.

    A container appeared in a village in Uttar Pradesh. Villagers soon had video access to a doctor and could see a paramedic in person. They could also leave blood samples and submit cardiograms.

    This initial success was hindered by IGIB’s link to government. It is one of India’s 39 state-funded Council for Scientific and Industrial Research laboratories, and is limited its scope to expand.

    Then IGIB partnered with the Indian hospital chain Narayana Health (NH) and Hewlett-Packard (HP) to install over 40 eHealth container centres across India. The service includes EMRs, bio-metric patient identification and integrated diagnostic devices. It’s a business model that could be appropriate for Africa’s drive towards UHC.

    India has one doctor for every 11,000 people, well below WHO’s recommended rate of one per 1,000lth. The eHealth container with HP cloud technology offered a dynamic solution. Clinical and administrative data is monitored and medical advice provided remotely.

    Dr Agrawal believes more benefits are available. Telemedicine has improved access to second opinions and international consultation in urban areas. It’s benefits in rural India may be more limited.

  • Texting between healthcare professionals and patients increases

    For Africa’s health systems, investment in mHealth could be laying the foundation for an increasing trend in relationships between healthcare professionals and patients. A survey by West Corporation, sponsored by Tele Vox Solutions, and available from mHealth Intelligence, says more patients are texting  with their healthcare providers.

    It’s gone beyond appointment reminders. Provider-Patient Texting Is Poised for Growth has identified five other activities that have a large texting component. Demand by patients is:

    Preventive care                                                    95%Chronic condition management                          87%Post-treatment instructions                                 85%Check-ins based on remote monitoring data      84%Co-payment information and reminders              83%Delays that impact appointments                        80%Appointment reminders                                       71%.

    In addition, 60% of patients say it is very or extremely important for their healthcare provider to text them about five other topics:

    Remote health monitoringPreventive careDisease managementBillingScheduling delays.

    There’s a mismatch between supply and demand. For example, for preventive care patients demand 95% and providers text 25%, and chronic condition management patients demand 87% and providers text 31%. A similar trend is found across services such as post-treatment instructions (85% vs 7%), check-ins based on remote monitoring data (84% vs 6%), co-payment information and reminders (83% vs 6%), and delays that impact appointments (80% vs 49%).

    It seems that USA patients are more mobile-savvy than their healthcare providers. The findings indicate that Africa’s health systems may have an opportunity to build on their mHealth investment and expand their direct connections and engagements with their patients.  

  • Telemedicine can help patients with opioid dependencies

    Addiction isn’t pleasant. Trying to reverse its impact is always challenging. An issue brief from Polycom, a global communications firm, and available from mHealth Intelligence, says opiod addiction’s an epidemic, so inevitably, can stretch across all sectors of society. 

    Enabling Providers to Address the Opioid Epidemic with Telemedicine describes how Circle Park Behavioral Health Services, a US provider in rural South Carolina, uses telemedicine to support people dealing with opioid addiction. Prescribing Medication-assisted Treatment (MAT) has to comply with strict legal controls, including numbers of patients who can access MAT. Polycom’s platform helps healthcare professionals to match patients need MAT with providers who have the waiver space to treat them.

    Providers can connect with patients at times and places of their choosing too. Fitting consultations in daily time commitment and giving patients comfortable place to communicate rather than doctors’  offices all help with the journey that can leave addiction behind. These frequent contacts give healthcare professionals opportunities to assess patients’ daily routines, issues and progress.

    While MAT’s the main telemedicine role, it’s not the only one. Addicts often have to deal with chronic health issues such as high blood pressure, diabetes and heart failure. The telemedicine initiative’s seen as an opportunity to connect with patients outside the office on these and other care management and co-ordination activities.

    Africa’s priorities for telemedicine should be showing equivalent benefits. Establishing the impact of these provides valuable knowledge to justify more investment.

  • Saudi Arabia’s RAH@H aims to improve healthcare quality
      

    Connecting and integrating healthcare resources to improve quality’s a core eHealth goal. In Riyadh, the Remotely Accessible Healthcare at Home (RAH@H) initiative offers a daily, patient centric, connected health model to achieve it. Five themes are integrated: 

    EducatingEmpoweringInfluencingMonitoringTreating. 

    Achieving these depends on RAH@H operating at the centre of a technological hub.

    Available both on Android and IOS, RAH@H uses modern technologies for telemedicine, webinars, and observations from medical devices to serve patients. Healthcare needs of vulnerable communities that don’t have ready access to services. They include pregnant women, especially with complications such as hypertension, gestational diabetes and cardiac conditions.

    Interventions include:

    Improved nutritionPrevention and protection against diseases and illness.

    These aim for outcomes of:

    Better life qualityCreating satisfied and empowered patientsIncreased treatment compliance.

    Based in Riyadh, RAH@H’s project custodian’s the Director General of Prince Naif Bin AbdulAziz Health Research Center at King Saud University in Riyadh. It's concept and technology can have a role in African countries and their vulnerable, underserved communities.