Experience of Supporting Telemedicine Networks With the Collegium System: First 6 Years.

Richard Wootton,Laurent Bonnardot

doi:10.3389/fpubh.2019.00226

Abstract

The Collegium system was first made available in 2012 to support organizations conducting humanitarian or non-commercial telemedicine work in low resource settings. It provides the technical infrastructure necessary to establish a store-and-forward telemedicine service. During the subsequent 6 years a total of 46 networks were established, based on the Collegium infrastructure. The majority of the networks were set up to provide a clinical service (33), with six designed for education and training, and the remainder for test or administrative purposes. Of the potentially operational networks which were set up (i.e., those established for clinical or educational purposes), 15 networks (38%) were stillborn and did not handle a single case after being established. In contrast, the two most active networks had handled almost 12,000 cases. The average case rate of the five most active clinical networks operating in low-resource settings (i.e., the total number of cases divided by the length of time for which the network had been established) ranged from 0.5 to 29.4 cases/week. Across the networks there was little evidence of sigmoidal growth in activity, which is consistent with reports of other telemedicine activity in North America. A brief survey was sent to 49 network coordinators, from 31 networks. Responses were received from 9 coordinators (18% of those invited to participate). The median satisfaction with the system was 8 (on a scale from 1 = not at all satisfied to 10 = very satisfied). The free text comments were mainly technical suggestions regarding image transfer, the mobile application, or other modes of communication. The results of operating the Collegium system demonstrate that supporting telemedicine work in low resource settings can be successful, since the networks handled a very wide range of clinical cases, and at activity levels up to several cases per day. However, approximately one-third of the networks that were established did not handle a single clinical case. Nonetheless, this might represent a form of success in the sense that it prevented the waste of resource involved in an organization purchasing a telemedicine infrastructure only to find that it was not used.

Highlights

Collegium Telemedicus is a not-for-profit organization which provides the technical infrastructure necessary to establish a store-and-forward telemedicine service
Our aim in making the Collegium system available was to facilitate the introduction of telemedicine by organizations delivering health care in low-resource settings
A substantial proportion of the networks that were set up using the Collegium infrastructure— approximately one-third—did not handle a single clinical case, this might represent a form of success in the sense that it prevented the waste of resource involved in an organization purchasing a telemedicine infrastructure only to find that it was not used

Summary

Introduction

Collegium Telemedicus is a not-for-profit organization which provides the technical infrastructure necessary to establish a store-and-forward telemedicine service. The Collegium system is provided under a Software As A Service model, and is designed to be easy to use (“usability”), with few technical (hardware and software) requirements for users, and to be able to serve requests from increasing numbers of users (“scalability”). Our hypothesis was that organizations delivering health care in low-resource settings would make use of it to establish trial telemedicine services. We expected that those which succeeded would either convert to a bespoke service based on the Collegium model, or would transfer their operation to another telemedicine provider

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