• Telemedicine
  • Does Africa need telemedicine regulations?

    Clarity on the place of telemedicine isn’t always clear. Some doctors are content to use it without specific regulations, others want clarity on how it fits with the traditional patient and doctor relationships and encounters.

    The USA’s District of Columbia has started formal consultation on telemedicine regulations. There are 14. They may help Africa’s telemedicine to move into a regulated environment. A generalised summary’s:

    To use telemedicine, a license to practice medicine’s required, but with some exceptions in existing laws and regulations, and a requirement to comply with regulations in the jurisdictions where the telemedicine provider’s and patients are physically located Doctors’ medical decisions using telemedicine must adhere to the same standards of care as decision in face to face encounters with patients Patient evaluations are needed that meet the requirements in existing standards before providing recommendations or making treatment decisions for patients except when performing interpretive services Doctors must ensure that interpretive services do not result in clinically significant loss of data from image acquisition through transmission to final image display Doctors practicing telemedicine shall: Obtain and document patient consent, except for interpretive services Create and maintain adequate medical records Follow requirements of existing laws and regulations for confidentiality of medical records and disclosure of medical records Adhere to other existing relevant laws, requirements and prohibitions Doctors shall perform patient evaluations to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication Licensed doctors may rely on patient evaluations performed by another licensed doctor if the former is providing cover for the latter If doctor-patient relationships don’t include prior in-person, face-to-face interactions with patients, doctors shall use real-time auditory communications or real-time visual and auditory communications to allow a free exchange of protected health information between patients and the doctors performing the patient evaluation Licensed telemedicine practitioners shall have the current, minimal technological capabilities to meet all standard of care requirements in order to use telemedicine to deliver services or treatment Adequate security measures shall be implemented to ensure that all patient communications, recordings and records remain confidential Written policies and procedures shall be maintained when using email for doctor-patient communications, and these shall be evaluated periodically to make sure they are up to date in addressing: Privacy, to assure confidentiality and integrity of patient-identifiable information Responsibilities of all health care personnel, including doctors, who process messages Hours of operation and availability Types of transactions permitted electronically Required patient information to be included in communications, such as patients’ names, identification numbers and types of transactions Archival and retrieval of patient records Quality oversight mechanisms All relevant patient-doctor emails and other patient-related electronic communications shall be stored and filed in patients’ medical records Patients shall be informed of alternate forms of communications between them and doctors for urgent matters All licensees shall be subject to the requirements of health and healthcare laws and regulations.

    It’s a start for Africa’s telemedicine regulations where health systems haven’t started down this road. Like the District of Columbia recognises, consultation with the medical profession’s the vital first step. Other stakeholders can make contributions too. Having agreed telemedicine regulations, a follow-up’s to ensure effective implantation and compliance.

  • Telemedicine's effective with some children's conditions

    Evidence for telemedicine’s effectiveness has been growing, and steadily assembling over the last 20 years or so. An example’s NHS England and its Telemedicine Evidence. More’s still needed to guide Africa’s health system’s business cases. 

    A study in Paediatrics says that data’s limited about the clinical reliability of telemedicine in evaluating seriously ill children. It’s challenging because telemedicine’s mainly visual, precluding hands-on, physical examinations. 

    Studies have already evaluated observation in assessing febrile children and children in respiratory distress. They’ve validated observations that detect underlying illness as predictive and reliable. The latest study seeks to determine the inter-observer reliability of telemedicine observations, compared with bedside observations. 

    Two types of groups were established. One comprised 132 children aged 2months to 3 years old, presenting with fevers. They were evaluated using the Yale Observation Scale. There were 145 patients aged 2 months to 18 years in the group presenting with respiratory symptoms, and evaluated by using the Respiratory Observation Checklist of signs of respiratory distress derived from validated studies. Telemedicine services for these two groups used commercially available tablet devices providing two-way, live-streamed images with audio. 

    For both groups, the comparison with their control groups showed consistencies. The Yale Scale groups had a good, positive correlation of +0.81 between bedside and telemedicine observers. The study team say this’s a strong agreement. The correlation for the Respiratory Checklist groups was seen as excellent at +0.85 for the impression of respiratory distress, and good, at +0.6, for most of the other Checklist measures.

    The study concludes that telemedicine, using commercially available telecommunications equipment, is reliable for assessing febrile children and children with respiratory distress. These findings offer a sound baseline for Africa’s health systems to pursue increased and sustainable investment in this role for telemedicine.

  • Ten telehealth questions you should ask

    Digital health is on the rise as eHealth, mHealth and telehealth services are being implemented across the globe. Telehealth is being adopted by major health systems, health plans and employers to deliver more immediate access to care and reduce costs to organisations and the people and patients they serve. This widespread adoption is being driven largely by consumers who want telehealth services and more personalised care. A survey by American Well, a telemedicine provider, found that 65% of consumers want to use telehealth and 7% would consider leaving their primary care physician for one that offered telehealth, says an article in Healthcare IT News.

    The lure of telehealth for hospitals and providers isn’t solely about the risk of losing patients. It’s also about gaining market share. For hospitals and providers, telehealth enables more frequent connections with existing patients and the capacity to reach new patients in new markets. It also offers a tool to improve healthcare and coordination. 

    When new technology changes the healthcare model, there are questions and fears. Dr Peter Antall, American Well’s Chief Medical Officer Medical Director of the national medical network Online Care Group, compiled the top ten questions providers ask when they’re considering telehealth. These are:

    How does it work? Is it legal? How can I get paid for using telehealth? Which use cases or conditions should I treat with telehealth? How do I examine a patient? How do I go about building a programme? What is the liability? What kind of results can I expect to see? What’s the best medium for practicing telehealth? Why should I do telehealth?

    These are important questions for anyone considering telehealth services. African countries are no exception. Answers to these critical questions will ensure they have the insights needed to make informed decisions about telehealth services and make sure they’re right for them. Other important financing questions will help with budgeting and planning for affordability and sustainability.

  • Telemedicine benefits prisoners and prisons

    Africa’s eHealth initiatives have to deal specifically with its wide range of geographic, demographic and health communities. Prisoners are one of these, and often aren’t mentioned in eHealth strategies. Both prisoners and prisons can benefit from eHealth, especially telemedicine that can avoid costly, high-security visits to hospitals that can delay treatments and disrupt prison staffing levels. World Prison Brief and the Institute for Criminal Policy Research say there’s about a million people in Africa’s jails, so it’s a large community.

    The Pew Charitable Trusts’ been examining telemedicine’s potential. Its report includes a review of prisoners’ healthcare in Texas and the University of Texas Medical Branch (UTMB) that provides most of the prisoners healthcare. UTMB provides about 127,000 telemedicine consultations a year with inmates, many for primary care or mental health needs. All five state prisons in Wyoming also provide telemedicine services, with some 440 total telemedicine visits a year. Healthcare providers also use telemedicine to consult specialists at another hospital.

    The business case for telemedicine for prisoners is straightforward. It has direct cost and health benefits that can contribute to affordability. Despite this, Pew found the similar obstacles to adoption that prevail in general healthcare, such as a lack of high-speed broadband connections.

    Users have also highlighted the need for doctors to be on site for some hands-on diagnoses and treatments. This can help them to understand the unique world of prison life and culture that their patients occupy.

    While Africa has many other eHealth priorities, it’s important to include prisoners in their chosen initiatives. The lessons and benefits can help to use eHealth for other communities.

  • Tele-ICU delivers massive benefits in the US

    Not all eHealth’s good eHealth, it seems. In the USA, EHRs, telemedicine and mHealth initiatives are being scrutinised for not delivering their promised benefits. Instead of increasing efficiency, cutting costs and decreasing delays, many eHealth initiatives are doing the opposite, costing hospitals millions and frustrating doctors and nurses.

    But, a recent report in the American Journal of Critical Care says it isn’t all bad. It shows that telemedicine is improving the way care is provided in the Intensive Care Units (ICU). It’s also reported in an article in Healthcare IT News.

    The study shows most ICU nurses are noticing improved productivity and collaboration. More than 1,200 nurses responded to the online survey. About 79% agreed tele-ICU systems help nurses to improve patient care. Some 75% agreed it improves job performance.

    There are about 45 tele-ICUs that connect more 200 hospitals and 6,000 beds in the USA. It's estimated between 800 to 1,000 nurses practice in tele-ICUs and another 16,000 interface with these units. 

    Tele-ICU uses audio or visual technology, or a combination of both, to monitor critical care remotely in ICUs. It provides data on patients’ vital signs, physiological status and laboratory and diagnostic test results and helps healthcare professionals to make faster and better decisions

    Most ICU nurses found telemedicine beneficial: 

    63% said tele-ICU enables faster work performance 66% saw improvement in collaboration 64% found it improved job performance 60% said it improves communication 60% said it helps with nursing assessments.

    Respondents said the biggest benefits to tele-ICU is the ability to monitor vital sign trends, provide medical management, enhance patient safety and detect unstable physiological status in patients.

    Despite the massive benefits the report found, the impact of tele-ICUs is still limited. The biggest barriers are staff attitudes, audio and video problems and the belief that telemedicine interferes with care. The report says "These findings can be used to further inform the development of competencies for tele-intensive care nursing." Healthcare organisations can "match the tele-intensive care nursing practice guidelines of the American Association of Critical-Care Nurses and highlight concepts related to the association's standards for establishing and sustaining healthy work environments." 

    For Africa’s health systems, tele-ICU offers a new area of eHealth investment. The returns look promising.

  • Telemedicine reduces elderly's ER visits

    It’s well known that older people need more healthcare than younger people. This doesn’t mean that their demand can’t be managed. A study by a team from Rochester University in New York and the University of Wisconsin, and published in Telemedicine and e-Health, a Liebert publication, found that people living in Senior Living Communities (SLC) effectively engaged with telemedicine need fewer Emergency Room (ER) visits than people who live in less engaged SLCs or without access to high-intensity telemedicine for acute illnesses.

    It shows that telemedicine alone isn’t enough. Its benefits are maximised by a high degree of health worker engagement. The precise, specific engagement needed isn’t a straightforward matter. The study team identified potential factors, but recommended more research to understand resident and staff engagement, and how to increase it.

    Data came from a secondary analysis of data from a prospective cohort study evaluating the effectiveness of high-intensity telemedicine for SLC residents. Comparisons of engaged SLCs with less engaged SLCs and no telemedicine found that:

    There were 503 telemedicine visits 362, 72%, were for more engaged SLCs 141, 28% were for less engaged SLCs More engaged SLC residents had an annualised ER visit rate of 28% Less engaged SLC residents had an unchanged annualised ER visit rate People without access attended ER’s at the same rate too, which isn’t surprising.

    Stakeholder engagement is easy to identify as a prerequisite for maximising benefits. It can take time to achieve and sustain, but the study shows that without it, benefits may be missed completely. African countries have to ensure that resources needed are provided as part of each eHealth project. Resources aren’t enough. The study shows that achieving effective engagement has some mysteries that are not yet revealed.

  • Zimbabwe's moving mHealth and telemedicine on

    mHealth’s on the rise in Zimbabwe. A report in TechZim highlighted several initiatives:

    Eco net‘s launched its dial-a-doctor service NetOne’s followed on and launched one too WhatsApp ’s used for telemedicine and has several components: WhatsApp groups, where doctors in a firm are using it to stay connected through groups which enable better communication and coordination in teams Within WhatsApp groups, where doctors exchange ideas about specific cases case At points of care for quick peer consultation to check diagnoses or drug dosages Improve access to healthcare Helping doctors to keep in touch with colleagues as part of a social network.

    Alongside these developments, the Zimbabwe Telemedicine Network‘s (ZTN) making progress too. A report on progress’s in the International Society for Telemedicine and eHealth (ISfTeH) Newsletter. In January, a telemedicine link was set up between Nyatate Rural Health Centre the district hospital.

    Each site had a Very Small Aperture Terminal (VSAT) satellite system link. To date, there have been 580 new consultations and 223 reviews of 240 scheduled. About 75% of patients are female, 30% are older than 65 and 10% younger than 15. Like many other African countries, ICT’s quality is adversely affected by rain, power outages and overcast conditions, but despite this, the initiative has already resulted in increased access to doctors consultation, fewer hospital referrals and savings for the patients.

    The plan is for ZTN to research the impact and extend the service to ten to 15 sites over the next 18 to 24 months. As usual for all eHealth, the availability of finance will determine the scale and pace. This phase will also define and select appropriate standards for bandwidth, room size and setup, web cameras, software, hardware and EMRs. Dealing with EMR standards is a considerable undertaking and links to Zimbabwe’s other EHR initiatives described by eHNA.

    ZTN’s goals are:

    More access to doctors Capacity building of rural health centre nurses More access to information for healthcare professionals Cost savings Better clinical outcomes Fewer referrals.

    These are consistent with Zimbabwe’s results for WhatsApp and dial-a-doctor. The direction for eHealth looks promising.

  • Telemedicine market set to expand further

    The global market for telemedicine is expected to be worth more than $34 billion by the end of 2020. An article in Healthcare IT News looks at a new market research report, Global Telemedicine Market - Growth, Trends & Forecasts (2015-2020), published by Mordor Intelligence.

    As could be expected, North America is leading the charge as the largest market globally, accounting for more than 40%. Driving growth is an increasing aging population, increasing incidences of chronic diseases and a rapid rise in the software market.

    Many healthcare systems are also trying to reduce the number of hospital visits and the length of stay in hospital. In response, there’s a growing trend for patients to be monitored in their homes paving, the way for more telemedicine.

    While tremendous growth is forecast, the market still has some obstacles to overcome. A lack of physician support, poor cases of implementation, high technology costs, and legal and reimbursement concerns are all hindering the growth of the market, and will have to be addressed to reach its expected growth by 2020. These are challenge that Africa’s healthcare has to address too. 

  • Smartphones can do telemedicine

    As photos on smartphones become better, they can replace images provided by telemedicine. Figure 1’s already using images in the same way, as eHNA posted earlier. A study by a team from South Africa’s Stellenbosch and Pretoria Universities and Sweden’s Karolinska Institut has shown that smartphone photos are as good as telemedicine photos.

    In Liebert’s Telemedicine and e-Health, the report says the team hired a professional photographer to photograph a series of three types of objects, none of which were clinical, with three smartphones; an Apple iPhone, a Samsung Galaxy S2, and a BlackBerry. Photos were also taken with Canon Mark II digital camera as a comparator.

    Sixty lay people were shown them in a blind review to assess the quality from the four devices. There were wide variations between and within categories.  The iPhone had the highest proportion of images evaluated as good. It was also best for more objects. Results for the Samsung, Blackberry and Canon were similar.

    The team says its results provide good indications that smartphones from the three mobile platforms can provide doctors with a working tool that can help with photographic documentation and image-based communication. Tele-experts weren’t included in the study, so their views are needed before a switchover. Before this happens, the team are confident that there’ll be an increasing volume of tele-advice provided using smartphones or tablets. Figure 1’s experience confirms it. Doctors’ practices may make the switch in real time, so Africa’s healthcare has an opportunity.

  • Telemedicine will grow by 18% a year

    An assessment of the global telemedicine market by Research and Markets says spending will grow at a compound rate of more than 18% a year up to 2020. It says the shortage of physicians in rural and remote areas provides the opportunity for telemedicine to reach millions of patients, leading to a rapid and widespread deployment. The study, Global Telemedicine Market Outlook 2020, reviewed telemedicine technologies, including hardware, software and services. Total spending in 2014 was an estimated US$ 17.8 billion.

    The estimated growth is attributed to the high prevalence of chronic diseases, the increasing number of smartphone users, the need for better quality services and increasing elderly populations.

    But, reimbursement challenges, uneven telecom network distributions in remote areas, and high operating cost hinder implementation. This may tip Africa away below the average growth. It may also be constrained by affordability.

    The dominant suppliers included in the report include McKesson, Philips Healthcare, GE Healthcare, and Cerner. Will they see an average growth in African countries?