Long-running telemedicine networks delivering humanitarian services: experience, performance and scientific output
Richard Wootton, Antoine Geissbuhler, Kamal Jethwani, Carrie Kovarik, Donald A Person, Anton Vladzymyrskyy, Paolo Zanaboni & Maria Zolfo
Volume 90, Number 5, May 2012, 341-347D
Table 4. Other features of the telemedicine networks delivering humanitarian services
| Factor | Africa Teledermatology Project | ITM Telemedicine | Pacific lsland Health Care Project | Partners Online Specialty Consultations | RAFT | Swinfen Charitable Trust | Teletrauma |
|---|---|---|---|---|---|---|---|
| Governance | Site managed by a core group. IT support from the Medical University of Graz; clinical work from Carrie Kovarik | Funding for the project was obtained through a grant from the Directorate General for Development Cooperation | The project was established in 1990 by TAMC and is sponsored by the US Congress. It is codified in Federal Law and governed by a medical director | The network is managed by the Center for Connected Health, a non-profit teaching hospital. There are two dedicated coordinators and one corporate manager | The project is hosted at the division for e-health and telemedicine at Geneva University Hospitals. The focal points in each participating country are responsible for the national governance | The organization is constituted as a registered charity under United Kingdom law. The management board meets every 3 months. Financial accounts and reports are filed every year | General management is by the Regional Trauma Hospital. The methods are according to the Ukrainian Telemedicine and E-Health Development NGO |
| Medical liability | Reliance on the “Good Samaritan” clause; liability not completely eliminated | Experts belong to the ITM or partner institutions | Consultants are located at TAMC, and are licensed, credentialed and vetted. Requesters have liability until patients arrive at TAMC | Physicians sign a terms and conditions statement when referring patients to the network | It is the referring physician’s responsibility to apply the expert’s advice. The identity and credentials of experts are verified by the national coordination team | It is a not-for-profit telemedicine service. United Kingdom medical insurers cover doctor-to-doctor advice according to the so-called “Good Samaritan” clause | Teletrauma works within the health- care system in Ukraine. Consultations are part of the physicians’ duties and are free for patients |
| Patient confidentiality | Data held on a secure server; access to cases only permitted by requesters and experts. Use of full-face photos, names or dates of birth is discouraged. Patient consent is obtained | Referrers sign a “policies agreement” and a disclaimer is made available on the web site. The second-opinion advice is free of charge | Patient Referral Form; informed consent document. Data are stored in a secure, password protected database. HIPAA rules, privacy impact statements and Privacy Act System of Record Notice | Data are uploaded to a secure web site. An encryption service is used for e-mails | The latest version of the tele-expertise tool uses public–private keys to encrypt information and ensure traceability of access | Data are stored on a secure, password-protected server, and can only be accessed via encrypted connections | Patient consent is obtained. Anonymized data are stored in a secure server |
| Sustainability factors | Motivation, personal relationship and trust of requesters and experts | Institutional project | Provision of travel and definitive medical care for indigenous persons at no cost to the patient or to the jurisdiction; funding included in core budget to support graduate medical education | Teleconsultations are also commercially available to patients in other developed countries. This produces the financial margin necessary to sustain this programme in Cambodia | Institutional anchoring; clear exit strategy | Core group of retired/semi-retired board members | Clear technical and organization solutions; clear methodology of clinical usage; quality of recommendations |
| Risk factors and challenges | Work on minimal funding but need of some continued funding for web site maintenance | Linkage to other institutions in the field | Lack of infrastructure, technical and medical expertise, deteriorating equipment. Inadequate financial resources; inadequate administrative, logistical, and ancillary support | Market demand in developed countries; capacity to offer free consultations to patients in Cambodia; lack of training of local experts in Cambodia | Cost of Internet connectivity | How to increase the pool of coordinators | Introduction of telemedicine into clinical protocols in trauma and orthopaedics |
| Future plans | Reach new locations and countries; engage the few dermatologists in the African countries where consults are provided to become experts; expand the educational activities | Collaboration with other networks, under an international umbrella | Continue to improve access to care, expedite referrals/consultations, and continue to mine the PIHCP database for education and training | Train local experts to take over tiers 1 and 2 of severity of incoming requests; expand to other countries (China, India), with local non-profit partners | Expand within countries to reach district hospitals throughout Africa (as well as pilot projects in Latin America) | Become part of a network of networks | Telemedicine has to be introduced into clinical protocols in trauma and orthopaedics |
HIPAA, Health Insurance Portability and Accountability Act; ITM, Institute of Tropical Medicine; NGO, nongovernmental organization; PIHCP, Pacific Island Health Care Project; RAFT, Réseau en Afrique Francophone pour la Télémedecine; TAMC, Tripler Army Medical Center.