• Telemedicine
  • Is telemedicine a dying duck or an ugly duckling?

    Two famous Danish authors have links to Africa. Baroness Karen von Blixen-Finecke wrote Out of Africa using her pen name Isak Dinesen. Hans Christian Andersen wrote The Ugly Duckling about a bird born as a misfit into a community of ducks, to find he was a beautiful swan, a bit like telemedicine’s waiting. Both books have become films. Only the Ugly Duckling has become a hip-hop band.

    Unlike ducks and swans, telemedicine hasn’t taken off in Africa in a way that matches its promise. It’s the same for many countries on other continents. Software Advice has asked a few USA citizen what they think about it. Its report, Patient Interest in Adopting Telemedicine, might show how far it still has to go.

    The sample revealed a low use rate. About 73% haven’t used telemedicine. About 18% had in the previous year, with 6% using it more than a year before. Asked how interested they were, people said:

    15% extremely 24% very 37% moderately 18% minimally 6% not at all.

    The report interprets this as 75% of “patients are at least “moderately interested.”” Put alongside the take up rate of about 24%, a more relevant interpretation might be 61% of people aren’t very attracted by telemedicine, 39% are. It’s an improvement on the current rate, but doesn’t seem likely to stimulate a massive telemedicine uptake.

    Does it mean that telemedicine’s a dead duck or an ugly duckling or something more promising we haven’t seen yet?

  • Telementoring works in Africa and on Mars

    A mission to Mars and a remote rural village in Africa may have more in common than initially meets the eye. While they can be separated by as much as 400 million km, they share the characteristic of physical separation between a patient and the medical care they may require. While both may have someone able to deliver basic medical interventions, that person is often not trained to manage complex medical emergencies.

    Telementoring is a technique used by physicians and surgeons, where a specialist can guide a less experienced colleague performing a complex procedure in real-time. This guidance is best provided through a two-way video link with real-time data transfer, although in some cases only voice or one-way video may be sufficient.

    In its first virtual Mars mission simulation called V-ERAS 1, the Italian Mars Society conducted a telementoring experiment, where four of its virtual astronauts were faced with a simulated medical emergency. The exercise consisted of two other virtual astronauts involved in an accident on a simulated spacewalk on the virtual surface of Mars, and arrived at the base seeking medical attention. The injuries encountered were above the virtual astronauts’ level of training, so they established a telemedicine link with the African Centre for eHealth Excellence (Acfee) with Dr. Sean Broomhead, playing the role of a physician at another surface base on the Martian surface. The simulation took place in Madonna di Campiglio, Italy, while Dr. Broomhead was located in Kimberley, South Africa; a separation of over 8,400 km.

    In the simulation, Dr. Broomhead successfully guided the virtual astronauts through the execution of complex medical procedures, including reducing an anterior shoulder dislocation and decompressing a tension pneumothorax, saving the lives of the simulated patients. Of course, such a link could hardly be established between Earth and Mars, due to the communications delay introduced by the great distance between the two. This was rather a simulation of communications between two Mars surface bases.  Where near-real time communications are impossible, video mentoring may play an important role.

    While this type of communication exists in many places world-wide, this was a powerful demonstration of its effectiveness. Not all rural communities in Africa can physically have a slew of experts in all medical disciplines, but they can benefit from their virtual presences. Telementoring can be valuable in many settings and infrastructures.

    Telementoring can make use of:

    Landlines Mobile phones Video links Data links.

    At the most basic level, it can consist of a voice connection facilitating a telementoring consultation between two experts in different medical centres. With increasing infrastructure, video and data streams can be integrated to provide a better telementoring experience.

    The implementation of telementoring in African healthcare centres is an example of an organizational change that can be implemented with or without any additional infrastructure. It is a solution whose simple implementation can have big impacts; and this type of low-hanging fruit should be a starting point in African nations’ eHealth strategies. It is low-budget, high-impact, rapid implementation, and low risk, and would enable medical experts from one centre to assist local healthcare providers with a wide range of their clinical needs.

    Photo courtesy of the Acfee - Dr Sean Broomhead performing a teleconsultation.

  • Telemedicine introduced into Nigeria's Healthcare System

    Airtel Nigeria, leading mobile telecommunications provider, has announced a partnership with Apollo Hospitals, according to a report in BIZ TECH Africa. The aim is use telemedicine to enhance access to world class health care services to the people in Nigeria. The service will be available for Nigerians and Airtel’s Premier customers, and should  reduce trips to India for healthcare consultations and treatments, saving both time and money.

    The telemedicine platform called, Ask Apollo, enables video consultation with Apollo Hospital’s doctors in India by appointment. The estimated cost of a telemedicine consultation is N7, 500, about $50.

    Segun Ogunsanya, the Managing Director and Chief Executive Officer, Airtel Nigeria, stated that the partnership “is another demonstration of Airtel’s commitment to enhancing the quality of life of Nigerians through innovative products and services. Because we see our customers as more than just a connection, we have taken this further step to provide them access to excellent medical attention, which they ordinarily would have travelled abroad for.” He stressed that the telemedicine partnership offers convenience and a platform for improved healthcare.

  • A satellite initiative for telemedicine in Africa

    Inmarsat, the global mobile satellite communications company, and the Global eHealth Foundation(GeHF) have set up a joint project to develop, trial and deliver innovative telemedicine initiatives across the world. It aims to connect global healthcare specialists with patients in sub-Saharan Africa and other remote locations. Partners include the Children’s Investment Fund Foundation (CIFF), the Royal African Society (RAS), Qualcomm, Mubadala Development Company, and the Gulbenkian Foundation.

    The project goals include GeHF’s ambition to use technology to start a healthcare revolution by working with governments to co-ordinate funding, education, technology and advocacy.  It sees using innovative mobile phone apps and best practices to transform health services in developing countries to promote the development of integrated eHealth systems. It has a telehealth consult telemedicine platform.

    For the telemedicine links, Inmarsat will use the Alphasat satellite to transmit real-time images for global link-ups so specialists can diagnose and treat patients from an immense distance. Alphasat is the world’s most advanced civil telecommunications satellite. It was designed by the UK Space Agencyand the European Space Agency (ESA).

    It offers a considerable opportunity to improve connectivity and integrate collaborative healthcare for Africa. eHNA will report on its take up and impact.

  • Is telemedicine about to take off at last?

    Telemedicine, and its cousins, telemonitoring and telehealth have offered unfulfilled potential to transform healthcare for over a decade. Is the telemedicine plane now full of passengers and revving up at the end of the runway? The Economist thinks it might be, but it still needs a bit more fuel. Itsreport says that modern versions using tablets and smartphones haven’t propelled telemedicine down its runway and up into the skies.

    There are a few salutary observations that extend across all types of eHealth:

    Keen interest doesn’t guarantee success “If you have a chaotic system and add technology, you get a chaotic system with technology”Peteris Zilgavis European Commission Telemedicine may increase costs if it’s added to existing routines rather than replacing them There’s little evidence of cost-effectiveness.

    Perhaps the most important comment is the conclusion that for telemedicine to take off, big rich countries must embrace it, because that’s where the money is. It implies that Africa’s telemedicine future isn’t in its hands. It might also mean that Africa is already on another flight; mHealth, and there’s an accumulating range of options already underway, some proven, some still fledglings about to fly.

    If telemedicine is about to take off, it’s spent an awful long time taxiing to the runway. Has mHealth in Africa left telemedicine refuelling at the airport?

  • Telemedicine does it for chronic diseases

    Remote outpatient consultations that avoided long and costly journeys were often seen as a major role for telemedicine. It’s changed considerably since then, extending into telemonitoring. A USA study shows benefits of telemedicine for chronic disease management (CDM). It’s published in Telemedicine and e-Health.

    It evaluated three telemedicine used for three conditions:

    Congestive Heart Failure (CHF) Stroke Chronic Obstructive Pulmonary Disease (COPD).

    Each of these has its own care model, so not a generic telemedicine model. The main findings are that long-term telemonitoring  is the most efficient and effective model for CHF management. Telestroke has the most impact for prompt interventions leading to optimal treatment. Telepulmonology for COPD using remote measurement of lung function through telespirometry and teleconsultations between care providers and pulmonary specialists offers the best treatment.

    Benefits include fewer hospital admissions and readmissions, shorter lengths of hospital stay and fewer emergency department visits. Patients are more engaged in their care too. There were also some reductions in mortality. Patients, carers, health workers, clinics, hospitals and third party payers all benefit.

    This seems to confirm the progress in telemedicine over the last few years. The study provides evidence for African countries to use in their case for telemedicine investment.

  • TelePharm helps pharmacists be in two places at once

    Iowa-based TelePharm uses cloud-based mobile apps to connect pharmacists to each other and to patients. It’s raised US$2.5 million to help scale its business.

    TelePharm has several different businesses that enable pharmacists to spread their expertise across multiple pharmacies. This allows local chains to reduce their overheads significantly. One branch under the TelePharm umbrella is TeleCheck. The platform allows remote verification of medications, an important and time-consuming job for pharmacist.

    “They have two different responsibilities: verifying it’s the right drug for that patient and basically making sure the patient will be safe with that drug, and making sure what the technician dispensed was the right drug,” TelePharm CEO Roby Miller said to MobiHealthNew. “What TeleCheck does, is it takes that workflow and puts it in the cloud. So a pharmacist has an image of the drug they’re dispensing, the label on the bottle, and the [prescription] as well. So they can compare those images and make sure the drug is the right prescription for that patient.”

    TeleCounsel is another TelePharm service. This actually allows pharmacists to interact virtually with patients directly.  It’s being used in hospitals which have pharmacists on their staff and supports pharmacists in providing discharge counselling for patients leaving the hospital. The counselling is informal, and talking with patients before they leave hospital leads to better medication adherence. Counselling is often difficult to facilitate because it needs pharmacists to be in many different places simultaneously. TeleCounsel allows pharmacists in one location to talk to many patients and even counsel them when they’re at home.

    TelePharm is relatively new. It was founded in August 2012. Its software is in eight small, regional pharmacy chains in three USA states: Iowa, Illinois, and Texas.

    Similar technology could be used in other parts of the world. It could be especially valuable in countries where there’s a shortage of healthcare professionals. Many African countries could benefit from this or similar technology.

  • Allegheny paves a way for telemedicine

    When an emergency medical practitioner needs to get a doctor’s opinion, the patient usually needs to be moved. Now Allegheny Health Network in Pittsburgh, Pennsylvania has begun a one-year pilot of a telemedicine tool that helps to avoid unnecessary patient transport. The iPad video chats connect the emergency practitioner to a doctor to review the patient’s condition. Director for the Bureau of Emergency Medical Services, Richard Gibbons said “The benefits of telemedicine to the patient are innumerable, offering direct in-home access to a physician who can see them and talk to them.”

    Emergency services crews have already used the technology on one patient, a 59-year-old woman with diabetes who called 911 after experiencing anxiety, sweating and shakiness. After the emergency crew provided her with orange juice and a glucose solution, the woman felt better and told the emergency crew that she didn’t want to go to the hospital. They offered her a telemedicine visit, via iPad, and after a short interview the doctor cleared her to stay home.

    Evidence is building for telemedicine’s value across many disciplines. An example is that specialists are able to diagnose some stroke patients using video, nearly as well as in person. This opens the possibility of making decisions early and starting treatment.

    This Pittsburgh study should help to quantify the range of the gains possible when using telemedicine in increasingly complex healthcare situations.

  • Telemonitoring helps to lower blood pressure

    Living in remote mountain areas might have splendid views, but it can limit the reach of healthcare. A study from Italy in BMC Medical Informatics and Decision Making shows that a combination of a physician-nurse approach supported by remote telemonitoring of blood pressure (BP) is likely to improve outcomes in patients with uncontrolled hypertension.

    There were two groups, Home-Based Telemedicine (HBT) and Usual Care. At the start of the study, there was no significant difference in BP values between the groups, but there were at the end of the study. The out-of-range BP differences were:

    Systolic BP: 26% (HBT), 81% (Usual Care) Diastolic BP: 8% (HBT), 62% (Usual Care)

    The mean changes in blood pressure were about:

    Systolic BP: 15% (HBT), 5% (Usual Care) Diastolic BP: 15% (HBT), 4% (Usual Care)

    The results were a combination of the impact of healthcare professionals and telemonitoring. The study says that “Many epidemiological studies have shown that the treatment and control of blood pressure (BP) is inadequate in more than 50% of hypertensive patients in spite of availability of several classes of well tolerated and effective antihypertensive drugs.” In this context, the healthcare professional and telemonitoring seems to offer a way forward in some circumstances.

    The report says that the cost analysis used in the study considered only the services provided to the patient in the HBT group. It didn’t evaluate the cost effectiveness of the service. More importantly, the study makes no exaggerated claims for benefits. It’d be valuable to know the medium and long term benefits for patients, carers and health services.

  • Telemedicine's small diagnostic differences

    Are telemedicine’s diagnoses better, worse or the same as face-to-face diagnoses? A study reported in the Journal of American Medical Association (JAMA) says they are about the same for the dermatology services.

    The findings are “If the in-person dermatologist recommended the patient be seen the same day, the teledermatologist agreed in 90% of the consultations. If the in-person dermatologist recommended a biopsy, the teledermatologist agreed in 95% of cases on average. When the teledermatologist did not choose the same course of action, there was substantial diagnostic agreement between the teledermatologist and the in-person dermatologist. The teledermatologists were able to triage 60% of consultations to be seen the next day or later. The teledermatologists were able to triage, on average, 10% of patients to be seen as outpatients after discharge.”

    Another important finding is that differences in diagnosis and treatment recommendations is linked to remote physicians proposing more conservative treatment or requesting more biopsies.

    Researchers at the University of Pennsylvania produced these results from their analysis of 50 hospital patients who had skin conditions that needed evaluation.

    The study is valuable knowledge for African countries proposing telemedicine initiatives for dermatology services.