Bulletin of the World Health Organization

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.