Implementation Of Telemedicine System Research Articles

A Framework for Implementation of Telemedicine

While there is wide implementation of telemedicine in developed economies, other countries lag behind. However, for more than a decade, some of these countries have recognized the potential benefits of information and communication technology (ICT) in the delivery of health care. There is an urgent need for an understanding of telemedicine implementation issues affecting various nations, as Telemedicine systems innovations and implementation initiatives are still in their early stages, albeit with a lot of struggles in these countries. The purpose of this study is to develop a framework for implementation of Telemedicine systems. The study considered both qualitative and quantitative data that was collected from hospitals in three counties within Kenya, and then finally, a framework for the implementation of telemedicine was proposed. The study provides some key insights into the implementation of Telemedicine systems in public hospitals and, to some extent, in private hospitals in Developing Countries. Having contextualized the implementation of telemedicine, the study concluded from the findings that Telemedicine implementation is an all-encompassing process that is predicated on policy and legislation issues, organizational issues, social and technological factors, and as such, for successful implementation, careful consideration of all these is fundamental

Reinforcing Regional Emergency and Critical Care Networks: The Implementation of Telemedicine Systems in Remote Areas

<p>隨著全國每萬人醫師數逐年上升，醫療資源仍集中於都會區域，偏遠地區緊急醫療資源仍相對不足。衛生福利部於2018年「通訊診療治療辦法」放寬遠距醫療之照護對象與模式，並在2021年正式將急診納入「全民健康保險遠距醫療給付計畫」給付範圍。遠距醫療在急重症病人照護已有實證應用，基於遠距醫療專科門診系統建置經驗，結合醫療與資訊科技發展，建置急診遠距醫療會診系統。在面臨緊急醫療搶救，急診遠距醫療須具備好的工具進行資訊傳遞，包含友善操作介面、即時且重要的醫療資訊交換、紀錄留存及綠色通道團隊預先啟動，並可提供大量傷患迅速應變支援，縮短急重症病人醫療處置等待時間。急診遠距醫療會診系統之建置已開啟創新之急重症就醫模式，惟系統功能仍須透過滾動式修正及持續教育訓練，使醫護人員熟悉操作並列入常規系統使用，以作為偏遠地區醫院急診病人第二意見諮詢及轉診評估，降低病人不必要之轉診，提升病人醫療品質。</p> <p> </p><p>Although the number of medical doctors per 10,000 residents in Taiwan has been increasing, most medical resources remain concentrated in metropolitan areas, and emergency medical resources in remote areas remain insufficient. In 2018, the Ministry of Health and Welfare passed the Rules of Medical Diagnosis and Treatment by Telecommunications to expand the coverage of people and models eligible for telemedicine services. In 2021, emergency services were included in the coverage of the National Health Insurance Telemedicine Benefits Plan. Telemedicine has been applied in emergency and critical care with empirical evidence. Based on the experience in establishing a telemedicine specialist outpatient system and the incorporation of medical and information technologies, a remote emergency consultation system was established. To ensure effective emergency care, an emergency telemedicine model must incorporate favorable tools for information transmission, including a user-friendly interface that facilitates real-time and critical medical information exchange and record keeping. The model should also allow for early preparation of the green channel team, ensure that support is at hand for rapid response to a large number of patients, and shorten the waiting time of emergency and critically ill patients for medical treatment. The establishment of the remote emergency consultation system has opened the door to an innovative emergency and critical care model. However, the system functions should be improved on a rolling basis, and continuous staff training is required to familiarize staff with the operation of the system as a routine system. Thus, the system can be used for second opinion consultation and referral assessment for emergency patients in remote hospitals, thereby reducing unnecessary referrals and improving the quality of medical care.</p> <p> </p>

Application of Telemedicine in the Provision of Healthcare in Nigeria: An Insight from COVID-19

Background: In recent times, telemedicine has received wide acceptance in global healthcare as a result of its tremendous potential in solving major healthcare concerns. However, despite the proven benefits of telemedicine and the growing applications in developed countries, Nigeria has failed to fully use this tool in the provision of healthcare in the country. Objectives: To examine the potentials of telemedicine as an alternative option for delivering quality healthcare services in Nigeria, the challenges hindering the utilization, and ways to overcome these challenges. Methods: Review of evidences was carried out on papers sourced from Google Scholar and PubMed databases. The key terms used for the search include "telemedicine", "information technology", "treatment", "Nigeria", "COVID-19", "virtual", and "health care". Papers were critically assessed for intellectual content, and those that did not meet the inclusion criteria or were extraneous to the study's focus were eliminated. A review of related evidence was conducted after data was extracted from selected papers. Results: Telemedicine has the potential to improve healthcare delivery, access, and efficiency. However, the underutilization of telemedicine in Nigeria has been identified to be as a result of some considerable factors which include the absence of a policy on virtual care, insufficient funding, high cost of maintaining virtual health care services, and technological and infrastructural constraints. Conclusions: As a result of the aforementioned, the imbalanced implementation of telemedicine systems in the provision of healthcare in Nigeria necessitates immediate stakeholder attention to establish supporting legislation and assure the availability of suitable infrastructure and services. Other research-based proposals include including virtual care training in school curricula and funding telemedicine research and development in the country.

Telemedicine: Current Obstacles in Telemedicine system Implementation in Rural Areas in Pakistan

Telemedicine is well-positioned in low and middle-income countries (LMICs) to revolutionize wellbeing care due, in portion to expending portable phone get to and web network. This paper assesses the basic components that can potentially facilitate or ruin the advanced wellbeing in Pakistan. The objective of this thing is to recognize the current computerized wellbeing ventures and considers being carried out in Pakistan, as well as the key partners included in these activities. We conclude that whereas telemedicine features a promising future in Pakistan, it is still in its earliest stage at the time of this study. In any case, due to the COVID-19 widespread, there's an increment in requests for digital health and execution of health outcome taking after worldwide social removing conventions, particularly in LMICs. And extend the digital health segment for the improvement of telemedicine frameworks in our country.

System Integration for Medical Data Dissemination and Multimedia Communication in the Implementation of Tele-ECG and Teleconsultation

One of the options to extend medical services coverage is deploying a telemedicine system, where medical personnel make use of ICT (Information and Communication Technology) to overcome distance and time constraints. The implementation of telemedicine systems in Indonesia faces challenges posed by the lack of ICT infrastructure availability, such as communication networks, data centres, and other computing resources. To deal with these challenges, a telemedicine innovation needs to produce a modular and flexible system that is adaptive to medical services needed and the available ICT infrastructure. This paper presents research and development of a telemedicine system prototype for tele-electrocardiography (tele-ECG) and teleconsultation. The contributions offered are integrating system from various open-source modules and the system operational feasibility based on its function and performance. The research is conducted on a testbed which represents various components involved in the telemedicine system operation. Experiments are carried out to assess the system functionality and observe whether tele-ECG and teleconsultation reach their expected performance. Experiment results show that the system works properly and recommend several multimedia communication modes to achieve the target quality based on the available network bandwidth.

Assessment of Kuwait Health System Towards Telemedicine Readiness & Adoption: Organizational and Technical Issues.

This study aims to assess the organisational readiness to predict the success of telemedicine system implementation in Kuwait. Semi-structured interviews were conducted with: (1) IT managers to assess the readiness of the technical infrastructure of Kuwait health system; and (2) policy makers to assess the organisation's ability to receive telemedicine. A set of policies and strategies were developed to demonstrate how the Kuwaiti health system could be ready for telemedicine services.

Teledermatology scale-up frameworks: a structured review and critique

BackgroundThe South African public health sector embarked on a National Telemedicine System implementation program in 1999 and although unsuccessful, the Province of KwaZulu-Natal subsequently implemented teledermatology in 2003, with two currently active services (synchronous and asynchronous). Although sustained these have not been scaled-up to meet the needs of all hospitals in the Province. A recent teledermatology scale-up design requirements elicitation process within KwaZulu-Natal confirmed the need for a framework, and identified requirements through key stakeholders, programme observations, the literature, and experts. This study aimed to identify and characterise existing teledermatology or related eHealth scale-up frameworks, determine whether any met the previously elicited scale-up framework requirements, and were suitable for use in the KwaZulu-Natal public health sector.MethodsA structured literature search was performed of electronic databases (Scopus, Science Direct, IEEE, PubMed, and Google Scholar) seeking proposed or developed teledermatology or related scale-up frameworks. Global public health publications were also hand-searched. The teledermatology or telemedicine, telehealth or eHealth related scale-up frameworks identified were critiqued against the previously elicited teledermatology scale-up framework requirements to determine their suitability for use.ResultsNo specific teledermatology scale-up framework was found. Seven related scale-up frameworks were identified, although none met all the previously identified teledermatology scale-up framework requirements. The identified frameworks were designed for specific scale-up phases and lacked a more holistic and comprehensive approach.ConclusionsThere is an evidenced-based need for the development of a health sector aligned, holistic framework that meets the identified teledermatology scale-up framework requirements. The findings of this paper will inform development of such a framework.

Foundation architecture of telemedicine system services based on Health 4.0 concept

Telemedicine as an application area of the modern medicine is flourishing supported by the corresponding technologies development. Development of telemedicine technologies is one of the main trends in digitalization of health care service put into practice within the Health 4.0 concept. Implementation of telemedicine systems is particularly topical for countries possessing a great territory, due to which the problem occurs to provide equal access to specialized and hi-tech medical aid for all inhabitants in the country. Creation of the effective telemedicine system for rendering medical aid to patients in remote locations requires a system approach to engineering and implementation of such system. Represented in the article is a structure of the telemedicine system engineering and implementation project with the use of service-oriented approach to simulation of social-economic systems, as well as requirements to upper level services of such system within the first stage of the project.

Study on the efficacy of tele-medicine system implementation at SRMC

Majority of the tele-medicine implementations are not effective in healthcare delivery hence slowly it loses its significance due to various factors, which ultimately defeat the purpose of tele-medicine intervention. Hence, this paper examines the existing tele-medicine implementation and understands its challenges, studies the efficacy of the system and suggests the alternative system with technological and process improvements to improve its efficacy, quality and sustainability. By reviewing the process involved in getting the expert opinion from super specialty hospital, it was found out that there are many bottlenecks in the system, process, technology and access in delivering the quality healthcare services on time. This study carried out between SRMC and NLC Clinic has further helped to suggest a software architecture involving the overall process of electronic medical record flow in association with tele-medicine, tele-radiology and hospital management information system connectivity to improve the efficiency of the tele-medicine.

Study on the efficacy of tele-medicine system implementation at SRMC

Majority of the tele-medicine implementations are not effective in healthcare delivery hence slowly it loses its significance due to various factors, which ultimately defeat the purpose of tele-medicine intervention. Hence, this paper examines the existing tele-medicine implementation and understands its challenges, studies the efficacy of the system and suggests the alternative system with technological and process improvements to improve its efficacy, quality and sustainability. By reviewing the process involved in getting the expert opinion from super specialty hospital, it was found out that there are many bottlenecks in the system, process, technology and access in delivering the quality healthcare services on time. This study carried out between SRMC and NLC Clinic has further helped to suggest a software architecture involving the overall process of electronic medical record flow in association with tele-medicine, tele-radiology and hospital management information system connectivity to improve the efficiency of the tele-medicine.

A Systematic Review of the Implementation Challenges of Telemedicine Systems in Ambulances

Telemedicine systems are gaining attention nationwide as a means for providing care in remote areas and allowing a small number of providers to impact a large geographic region. We systematically reviewed the literature to identify the efficacy and implementation challenges of telemedicine systems in ambulances. A search for published studies on Web of Science and PubMed was completed. Studies were selected if they included at least a pilot study and they focused on feasibility or implementation of telemedicine systems in ambulances. A total of 864 articles were used for title and abstract screening. Full text screening was completed for 102 articles, with 23 being selected for final review. Sixty-one percent of the studies included in the review focused on general emergency care, while 26% focused on stroke care and 13% focused on myocardial infarction care. The reviewed studies found that telemedicine is feasible and effective in decreasing treatment times, report a high diagnosis accuracy rate, show higher rates of positive task completion than in regular ambulances, and demonstrate that stroke evaluation is completed with comparable accuracy to the standard way of delivering care. Although this review identified life-saving benefits of telemedicine, it also showed the paucity of the scientifically sound research in its implementation, prompting further studies. Further research is needed to analyze the capabilities and challenges involved in implementing telemedicine in ambulances, especially studies focusing on human-system integration and human factors' considerations in the implementation of telemedicine systems in ambulances, the development of advanced Internet connectivity paradigms, additional applications for triaging, and the implications of ambulance location.

Role of Information Technology in Implementation of Telemedicine System

Introduction: Telemedicine is the wide description of providing medical and healthcare services by means of telecommunications.Methodology: A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,230 abstracts that were reviewed, result of 39 articles and 3 books and author 's experiences were gathered.Findings:Technologies do not only assist medical practitioners and patients receiving treatment, they also benefit perfectly healthy people by providing a wide range of general health assessments.Conclusion: telemedicine is medical services through the use of telecommunications.

Evaluation Framework for Telemedicine Using the Logical Framework Approach and a Fishbone Diagram.

ObjectivesTechnological advances using telemedicine and telehealth are growing in healthcare fields, but the evaluation framework for them is inconsistent and limited. This paper suggests a comprehensive evaluation framework for telemedicine system implementation and will support related stakeholders' decision-making by promoting general understanding, and resolving arguments and controversies.MethodsThis study focused on developing a comprehensive evaluation framework by summarizing themes across the range of evaluation techniques and organized foundational evaluation frameworks generally applicable through studies and cases of diverse telemedicine. Evaluation factors related to aspects of information technology; the evaluation of satisfaction of service providers and consumers, cost, quality, and information security are organized using the fishbone diagram.ResultsIt was not easy to develop a monitoring and evaluation framework for telemedicine since evaluation frameworks for telemedicine are very complex with many potential inputs, activities, outputs, outcomes, and stakeholders. A conceptual framework was developed that incorporates the key dimensions that need to be considered in the evaluation of telehealth implementation for a formal structured approach to the evaluation of a service. The suggested framework consists of six major dimensions and the subsequent branches for each dimension.ConclusionsTo implement telemedicine and telehealth services, stakeholders should make decisions based on sufficient evidence in quality and safety measured by the comprehensive evaluation framework. Further work would be valuable in applying more comprehensive evaluations to verify and improve the comprehensive framework across a variety of contexts with more factors and participant group dimensions.

Design and Implementation of Telemedicine System

Design and Implementation of Telemedicine System

Best Practices for the Effective Implementation of Telerounding

The research base for telemedicine is expanding with nearly the voracity that the implementation of tele-medicine systems has. Telerounding is one specific subset of telemedicine where a team of physicians will gather in a specific location and use a telepresence robot to perform their day to day rounding procedures. This type of telemedicine is fairly new, and thus is lacking a solid research base to guide the implementation and usage of such a system. This paper is an initial attempt at a comprehensive list of best practices for such a system and is based off of current telemedicine literature as well as the experience of the authors.

When protocols fail: technical evaluation, biomedical knowledge, and the social production of ‘facts’ about a telemedicine clinic

Telecommunications systems seem to offer health care providers, professionals and patients a plethora of opportunities to respond to social and geographical inequalities in health care provision, and a new field of health care endeavor has emerged — ‘telemedicine’. This paper presents results from a three year ethnographic study of the development and implementation of telemedicine systems in a British region. We explore how attempts to put into service one ‘telemedicine’ system failed to get beyond the draft of a written protocol. Our analysis focuses on the contests between clinicians, technical experts and external evaluators over what kinds of knowledge and practice count in developing a protocol and evaluating a clinical intervention. We show how the introduction and implementation of ‘hard’ technologies (systems hardware) can be undermined in practice by ‘soft’ technologies (the practices through which evaluative knowledge is produced).

System issues for successful telemedicine implementation

Although there is a great deal of activity in the area of telemedicine in the United Kingdom, it has not yet been widely adopted as a tool for healthcare delivery. This could partly be as a result of the fact that the various parties involved in the development of such projects come from different backgrounds and disciplines and as such do not always fully understand the aspects involved in the successful implementation of such projects. This may lead to projects not working as expected or being abandoned prematurely. This paper examines some common issues relating to telemedicine projects in greater detail. The rapid development of technology may sometimes overshadow the organizational and societal aspects of telemedicine applications but systems are likely to fail or not fully perform as anticipated if issues are not properly considered. The paper aims to provide a comprehensive, although not exhaustive, summary of some of the matters involved. It raises a number of questions in an attempt to increase awareness of all parties, so perhaps aiding the wider, successful implementation of telemedicine systems.

Texas Telemedicine Project: a viability study.

The purpose of this research was to investigate viability factors in the implementation of telemedicine systems. The Texas Telemedicine Project examined the viability of a rural network where multiple facilities shared a switchable long-distance network rather than using fixed point-to-point connections. During Phase I, conducted in 1989, staff at participating institutions analyzed applications for the proposed network and developed methodologies for data collection. The capital costs and potential savings of a telemedicine network linking institutions in Austin and Giddings, Texas, were estimated. In April of 1991, Phase II of the system was implemented, and the first year's actual capital expenditures and savings (e.g., trips avoided, salaries of traveling specialists saved, reduced mileage and patient transport expenses, redundant tests avoided, reduced long distance telephone charges) attributed to the network were calculated. On the basis of the data collected in Phase I, it was projected that each $1.00 applied toward installation and operation of the network should yield $1.50 in benefits, with return on investment (break-even) within 1 year. In practice, there was a net deficit during the first year, although linear extrapolation predicted return on investment in 2.7 years. Linking multiple users over a shared infrastructure has the benefit of distributing cost among the participants and achieving an economy of scale for telecommunications services. The chief barriers to greater savings were the failure of five of the six network sites to design mission-oriented telemedicine policies and the absence of Medicare reimbursement.

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<h3>Aim</h3> Demographic changes, decreasing availability of general practitioners, and at least regional shortage of qualified emergency medical service (EMS) physicians led to increasing arrival times and quality problems. Telemedical solutions could help to solve some of the problems. <h3>Methods</h3> Overall safety and feasibility of prehospital telemedically guided care was already proven in two research projects from 2007 to 2013.^1–3 Their results led to implementation of a multifunctional mobile telemedicine system in the city of Aachen, Germany. From 04/2014 to 03/2015 all ambulances were equipped with a telemedicine system connected to a teleconsultation centre staffed with anesthesiologists experienced in emergency care. Audio, real-time vital data, 12-lead-ECG, picture transmission, and video streaming from ambulances was accomplished with encrypted and parallelized transmission using. Mission numbers prior and after implementation were compared to evaluate systematic influence. <h3>Results</h3> From 04/2014 to 06/2016 overall 4.901 EMS missions were supported and guided telemedically: n=4.151 emergency missions (85%) and n=750 (15%) inter-hospital transfers. Prior to implementation (04/2013–03/2014) 17.305 solely ambulance missions (68.7%) and 7.882 ambulance plus EMS physician unit missions were performed (31.3%). After implementation (04/2015–03/2016) 20.102 ambulance missions (76%) and 6.360 ambulance plus EMS physician missions (24%) were conducted which revealed a significant difference between both phases, p&lt;0.0001. <h3>Conclusion</h3> The implementation of a telemedicine system into routine care led to a significant decrease in conventional on-scene physician missions as well as to an overall decrease in physician guided EMS cases. Therefore, the approach can be judged resource optimising and holds a potential for economic improvements although highly qualified physicians carry out the service. <h3>References</h3> Brokmann JC, Conrad C, Rossaint R, Bergrath S, Beckers SK, Tamm M, Czaplik M, Hirsch F. Treatment of acute coronary syndrome by telemedically supported paramedics compared with physician-based treatment of acute coronary syndrome: a prospective, interventional, multicentre trial. J Med Internet Res2016;18(12):e314doi:10.2196/jmir.6358 Felzen F, Brokmann JC, Beckers SK, Hirsch H, Tamm M, Rossaint R, Bergrath S. Technical performance of a multifunctional prehospital telemedicine system in routine emergency medical care – an observational study. Journal of Telemedicine and Telecare2016; pii: 1357633X16644115. Bergrath S, Reich A, Rossaint R, Rörtgen R, Gerber J, Fischermann H, Beckers SK, Brokmann JC, Schulz JB, Leber C, Fitzner C, Skorning M. Feasibility of Prehospital Teleconsultation in Acute Stroke – a pilot study in clinical routine. PLoS ONE2012;7(5):e36796. <h3>Conflict of interest</h3> None declared. <h3>Funding</h3> None declared.