Undergraduate Paper Winner: A Decision Support Framework for Telemedicine Implementation in the Developing World

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Session
Student Competition Winning Paper Presentations - Undergraduate Paper

Authors
Miekie Treurnicht
Stellenbosch University

Description
Telemedicine refers to the delivery of healthcare services by means of information and communication technology (ICT). Telemedicine, being an ICT, has appealed to engineers as an opportunity for innovative development, making technology the primary driver of telemedicine development. This technology-push model where engineers pursue challenging technological goals primarily, does not guarantee appropriate and quality healthcare. It is therefore also necessary to assess the true need of the population and develop a comprehensive framework to implement and develop technology only as a means and not a goal in itself.

Abstract
Telemedicine refers to the delivery of healthcare services by means of information and communication technology (ICT). Telemedicine, being an ICT, has appealed to engineers as an opportunity for innovative development, making technology the primary driver of telemedicine development. This technology-push model where engineers pursue challenging technological goals primarily, does not guarantee appropriate and quality healthcare. It is therefore also necessary to assess the true need of the population and develop a comprehensive framework to implement and develop technology only as a means and not a goal in itself.

The South African Medical Research Council (MRC) and Stellenbosch University (SU) jointly developed a telemedicine workstation, as an attempt to alleviate a wide-spread shortage of healthcare professionals in South African primary healthcare. This workstation employs ICT for effective communication between healthcare facilities to capture and send diagnostic data of patients between the facilities. The technology-push approach followed was successful, from a technical perspective. However, considering the fact that the pilot unit, implemented at Grabouw Community Health Centre fell into disuse, a shadow of doubt was cast on the relevance of the technology to the clinical needs. This uncertainty was addressed in this project with a clinical-pull approach using fundamental patient data, namely diagnoses in patient files. The purpose of this project is therefore to support decision making with respect to the future development and implementation of telemedicine workstations. A decision support framework is developed and validated using the MRC/SU telemedicine workstation as a reference.

The decision support framework developed in this project can be used as a tool for developing a regional telemedicine strategy. Future use of this tool requires the population of a data warehouse developed in this project by extracting, transforming and loading data from clinical data sources. The data warehouse serves as a platform for specification analysis and mathematical models to evaluate possibilities for telemedicine in the region.

The data sources for this project are health information systems and patient files. Data are extracted from the patient files, transformed and loaded into a database, developed for this purpose. Data from three facilities (Grabouw Community Health Centre, Robertson - and Ceres Hospitals) in the Western Cape of South Africa are used, representing a region relevant for telemedicine implementation. The data warehouse is populated from the data loaded into the database to package the data in a usable format for analysis. Diagnosis data together with telemedicine device profiles are used in the analysis.

The merit of telemedicine implementation at a facility is evaluated using mathematical models. Engineering economics are used to determine the economic feasibility of a basic telemedicine workstation at a chosen facility. Potential telemedicine device utilization at this facility is evaluated using mixed integer programming.

This study serves as a pilot project to develop and validate the decision support framework. The scope of this project is limited to a specific region suitable for telemedicine workstation implementation. This project is therefore not limited to provide only general solutions for telemedicine. It is a generic tool to enable decision makers to implement telemedicine as a needs driven technology in specific regions in the developing world.




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