Full Project – Design and implementation of telemedicine system – a case study Aminu Kano teaching hospital

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CHAPTER ONE

• Introduction

This Chapter explain the background, brief history, statement of the problem, aims and objectives, Significant, scope and limitation of the proposed study.

1.1       Background to the Study

Telemedicine can be defined as the use of information and telecommunication technologies to provide medical information and services at a distance (Adewale, 2004). Telemedicine has existed long before the Internet, some authors observed that telemedicine was broadly conceived even when the term was used almost three decades ago. In many cases, no physician was involved, and interactivity was not a necessary aspect of the processing. The term Telemedicine is the delivery of medicine at a distance. The term is composed of the Greek word τελε(tele) meaning ‘far’, and medicine. Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries (Craig, 2004). Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care. Telemedicine is most beneficial for populations living in isolated communities and remote regions and is currently being applied in virtually all medical domains (salesman, 2002).

Specialties that use telemedicine often use a “tele-” prefix; for example, telemedicine as applied by radiologists is called Teleradiology. Similarly telemedicine as applied by cardiologists is termed as telecardiology, etc.(Craig, 2004).

The ability of telemedicine to facilitate medical care irrespective of distance and availability of personnel on site makes it attractive to both the public and private health sectors. (Adewale,2004). Telemedicine allows better utilization of scarce medical personnel and resources. It enhances citizen’s equality in the availability of various medical services and healthcare despite geographical and economic barriers, at a lower cost (Adewale,2004). In particular, telemedicine may be seen as a valuable tool for providing much needed medical services to remote areas. It promises to enhance continued medical education of our young doctors, nurses and other healthcare practitioners in remote areas, both in training and in established practice (Adewale, 2004). Healthcare system ranges from highly specialized urban areas, to small remote clinics in most part of underdeveloped and developing countries. The legacy of recent decades is an inappropriate distribution of health practitioners and expertise that are concentrated in major urban centers, while people living in remote areas have limited access to basic healthcare because of geographical isolation and poor public transportation.(Adewale, 2004).Telemedicine is one form of advanced technology that may be part of the solution to a number of healthcare and education problems in most underdeveloped and developing countries.

1.2       Statement of the Problem

The health care of patients in remote areas or isolated areas is challenged by the scarcity of local resources, limited patient access to doctors and hospitals, and the lack of specialized professionals. The existing method of delivery medical care to people in both remote and urban area is impeded by the following problems

1. People living in rural areas have limited access to basic healthcare because of geographical isolation and poor public transportation.
2. people living in this remote areas have limited access to basic healthcare services and consequently receive lower quality of healthcare service compare to those living in urban areas where best equipped hospitals and medical experts are available.
3. Patients living in these areas requiring the attention of healthcare practitioner to meet their needs must travel to distance healthcare centers, which is quite impossible due to the present state in medical emergencies.
4. The majority of the population lives in rural areas, the resources are concentrated in the cities which brought about the challenge of shortages of doctors and other health professionals in a densely populated area.

Drawing these points together, there is a need to focus on the health and well-being in remote areas by developing a telemedicine system that will solved the problem propounded by the people living in both remotes and urban area. Therefore, there is the need to develop a web-based telemedicine system that will improve upon the quality of medical services, lower cost of delivering such service to the people in remote areas, and providing more up-to-date medical information to remote healthcare workers.

1.3       Motivation

The third world countries are usually characterized by high population density. Nigeria for instance has an estimated population of about 150 million people. More than seventy percent (70%) of her populist reside in the remote areas with shortages of medical experts, and hospitals. Due to lack of opportunities for medical experts, few available medical experts are often reluctant to serve in remote area. As a result of this, people living in this remote rural and poorer areas have limited access to basic healthcare services and consequently receive lower quality of healthcare service compare to those living in urban areas where best equipped hospitals and medical experts are available.

Patients living in these areas requiring the attention of healthcare practitioner to meet their needs must travel to distance healthcare centers, which is quite impossible due to the present state in medical emergencies. Therefore, there is the need to develop a web-based telemedicine system that will improve upon the quality of medical services, lower cost of delivering such service to the people in remote areas, and providing more up-to-date medical information to rural healthcare workers.

1.4       Aim and Objectives of the Study

1.4.1    Aim of the Study

The aim of this work is to develop and implement a telemedicine system that will improve the quality of medical services and quick response to patients living in a remote area or isolated areas (rural).

1.4.2    Objectives of the Study

The followings are the objectives of the study

1. To enhance citizen’s equality in the availability of various medical services and healthcare delivery despite geographical and economic barriers through the use of web-based telemedicine application.
2. To reduce direct and indirect cost (loss of income), usually incurred as a result of moving patients from one place to another in search of better and quality medical services.
3. To improve consultation and co-operation among various units of healthcare services in both special cases and primary care by bridging the distance between practitioners and specialists.

1.5       Significant of the Study

The need to develop a web-based telemedicine system that will improve upon the quality of medical services, lower cost of delivering service to the people in remote areas and providing more up-to-date medical information to rural healthcare workers demarcated from the main stream of information awareness. The healthcare of patients in rural or isolated areas is challenged by the scarcity of local resources, limited patient access to doctors and hospitals, and the lack of specialized professionals. These has led to a new concept in telemedicine which is effective in providing diagnostic services and consultation to these patients and reduce healthcare costs by decreasing the number and duration of hospitalizations and reducing unnecessary surgical procedures.

1.6       Scope and Limitation

1.6.1    Scope of the Study

The scope of this study is the development and implementation of a telemedicine system for remote patients using internet. The developed system would enable the patients to have an interactive with a medical expert in receiving quick medical treatment through sending of sms, email, telephone call and chat. It will also create a platform in which medical expert and specialist can discussed over patient case and come out with a good resolution over the patient problems.

1.6.2    Limitation of the Study

However, delay in reaching the expert might occur due to weak signals of 3G networks in some remote areas. Also, inadequate power supply, network congestion might interrupt the connection of the patients in getting access to a specialist either through sms or call. Though the weak signal of 3G and adequate power supply is still within the golden period of time it should be considered in future research. As telemedicine technology is emerging day by day, the use of latest wireless technology may overcome this issue which ultimately increases the applicability and usefulness of the proposed telemedicine system.

1.7       Operational Definition of Terms

E-Health: Healthcare practice supported by electronic processes and communication.  Electronic Health Record (EHR): A systematic collection of electronic health information about individual patients or populations that is recorded in digital format and capable of being shared across health care settings via network-connected enterprise-wide

Information systems.
Electronic Patient Record (EPR): An electronic form of individual patient information that is designed to provide access to complete and accurate patient data, alerts, reminders, clinical decision support systems, links to medical knowledge, and other aids.

M-Health: Practice of medicine and public health supported by mobile communication devices, such as mobile phones, tablet computers and PDAs for health services and information.

Teleconferencing: Interactive electronic communication between multiple users at two or more sites that facilitates voice, video, and/or data transmission systems: audio, graphics, etc.
Teleconsultation: Consultation between a provider and specialist at distance using either

store and forward telemedicine or real time videoconferencing.

Telemetering: The use of audio, video, and other telecommunications and electronic information processing technologies to provide individual guidance or direction.
Telehealth: Is a broad word that refers to clinical and non-clinical services provided at a distance. It includes provider training, administrative meetings, and continuing medical education as well as clinical services. According to the World Health Organization, telehealth serves, “Surveillance, health promotion and public health functions.”.

Telemedicine: Telemedicine is a subset of telehealth that is related only to the provision of clinical healthcare services and education remotely, through the use of telecommunications technology. Telemedicine technology is frequently used for primary care, the management of chronic conditions, medication management, specialty care, mental health services, and other clinical care that can be provided effectively using secure video and audio connections.

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Full Project – Design and implementation of telemedicine system – a case study Aminu Kano teaching hospital