Telehealth and the Human Factor

“Telemedicine is about human interaction and the content. It is not about the technology. Telemedicine only succeeds when barriers are addressed and overcome.” – Dr. Michael Sullivan

 

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The World Health Organization (WHO)  defines telemedicine as “the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interest of advancing the health of individuals and their communities.” (WHO, Telemedicine, Opportunities and Developments in Member States, 2010)

The driving question asks:
“How can telehealth support healthcare delivery in the Philippines?”

A study by Trevor et al revealed that in many low- and middle-income countries, information communication technology (ICT) is being increasingly employed for different purposes in various health-related areas. Of ICT-enabled health programs, 42 percent use it to extend geographic access to healthcare, 38 percent to improve data management and 31 percent to facilitate communication between patients and physicians outside the physician’s office.  With our 7,000 plus islands geographically described as an archipelago and centers of specialized medicine concentrated in metropolitan areas, there exists an inequality in the provision of healthcare from those living in urban areas to those in the remote and rural regions of the country. In this regard, telehealth can definitely play a supportive role to the traditional practice of medicine.

The Arizona Telemedicine Program’s telehealth experts outlined a strategy for creating sustainable telemedicine programs in developing countries.  It can easily summed be up as initiate-build-operate-transfer:  Phase 1 starts off by conducting meetings with high level public officials including that of the health sector, Phase 2 is the identification of a national telemedicine champion, Phase 3 is to build out and launch the network of rural telemedicine clinics and Phase 4 is the critical disengagement process as well as assessment of the program. Country partners that they have started this on are Panama, Balkan countries, Mexico and China. The areas of medicine covered were telepediatrics, teleobstetrics, telepulmonology, teledermatology, and tele-emergency medicine.

According to WHO,  obstacles to telemedicine adoption are: problems connected to protection of personal data, different priorities, perceived lack of demand in developing countries, availability and maintenance of necessary infrastructures such as electric net instability, availability and quality of internet connectivity, bandwidth, obsolete computers, computer viruses and availability of technical personnel.

We were tasked to revise two portions of Telehealth Act of 2012. I did go through the bill but what concerns me more would be its implementation.  With proper planning and resources, the barriers stated above can be overcome even in our setting.

My concerns arise from the experiences that Dr. Marcelo himself noted. One apprehension is that of sustainability. The Telehealth Bill allocates a budget for the telehealth program. However, I am not sure if it would be sufficient. Local government must be involved from inception when the centers for telemedicine are identified. Another area for concern for me is that any top down decision makes implementation difficult. I am skeptical that the  initiate-build-operate-transfer strategy the Arizona Telemedicine Program proposes or the Telehealth Act itself would take root without any sense of ownership from the people who it wishes to serve as well as health workers tasked to carry out the program. There may be deficiences in the technology aspect, it is the human factor which fills in the gaps and ensures success. In a previous topic and slide presentation, I discussed that innovative programs were better built from the ground up. There must be involvement of the community and local government with the program design and the technology solution must align with an indigenous need not an imposed one.

 

References:
1. Telehealth Act of 2012. Accessed thru: http://www.congress.gov.ph/download/basic_15/HB06336.pdf
2. Marcelo. Telehealth in the Philippines. Accessed thru: http://bit.ly/telehealthinthephilippines
3. Arizona Telemedicine Program’s International Telehealth Experts Outline Strategy for Creating Sustainable Telemedicine programs in Developing Countries. Accessed thru: http://www.uahealth.com/news/arizona-telemedicine-program-s-international-telehealth-experts-outline-strategy-creating
4. Byers. WHO: Telehealth Use Developing in Low and Middle income Countries. Accessed thru: http://www.clinical-innovation.com/topics/health-information-exchange/who-telehealth-use-developing-low-and-middle-income-countries
5. Polillo. Internet and Sustainable Telemedicine for Developing Countries: An Introduction. Accessed thru: http://www.slideshare.net/rpolillo/internet-and
6. Sullivan. Developing a National Telemedicine Network. Accessed thru: http://www.slideshare.net/HINZ/developing-a-national-telemedicine-network

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