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Telemedicine – how do we define “impact”?
- Michael Rigby (10 September 2001)
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Hard Data Required
- Peter Corr (11 September 2001)
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Telemedicine in India
- Syed Sameer Ahmed, Shaista Parveen (6 October 2005)
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Michael Rigby, Senior Lecturer Centre for Health Planning and Management, Keele University
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The editorial by Edworthy (1) demonstrates the dangers of external commentary on what is most useful for developing countries. How can we measure the comparative impact of teleconsultation in Uzbekistan or Cambodia with teleconsultation in snowbound northern Canada, telemetry in Norway supporting the elderly at home, or teleradiology avoiding long painful journeys in remote parts of the British Isles? What values do we use – economic, social, Quality Adjusted Life Years, consumer feedback, political position, or provider satisfaction? More importantly, how do we measure the impact of telemedicine on the health systems of developing countries? Will strengthening secondary care for a few disadvantage basic primary care, or environmental health, for the many? Will investment in the required rural telecommunications be at the expense of providing potable water? Will developing countries too be seduced by the expensive impact of technology-led tertiary care for the few, while ignoring the endemic impact of modified health-related behaviour? And will opportunistic global traders exploit the vulnerable? Most electronically available health knowledge is from the “developed” world – it may not be appropriate for developing countries. Remote experts may not know what treatments are available, affordable, or acceptable locally. Teleconsultation through a local clinician initially may strengthen local skills, but when used on a larger scale it may stifle the development of local resources and lead to a dependence on economically draining Western commercial exports of expertise-on-line. The risks of globalisation reducing local autonomy have been reported (2). These are real issues, but should be debated on the grounds of local values of appropriateness and priorities. Needs-pull, not supply-push, should be the determinants. The voices of local experts, rather than external commentators, should be heard as the lead voices (3,4). Initiatives to identify culturally and locally relevant yet sound sites should be encouraged, and open debate initiated on the core issues (5). If telemedicine is to have any significant and safe impact in developing or other countries, global agencies such as the WHO need to encourage and accumulate studies on its local impact, whilst also seeking a global framework to ensure its safety and ethics (5,6). Opportunities for benefit from telemedicine are great; so are the opportunities for harm. The future debate should be couched in terms of local health priorities and impact, and on global ethics to ensure sustainable assured solutions. 1. Edworthy SM. Telemedicine in developing countries; BMJ 2001, 323, 524-525. 2. Rigby M. The Management and Policy Challenges of the Globalisation Effect of Informatics and Telemedicine; Health Policy, 46, 97-103, 1999. 3. Costello A, Zumla A. Moving to research partnerships in developing countries BMJ 2000;321:827-829 4. Lam CLK. Knowledge can flow from developing to developed countries; BMJ 2000, 321, 830 5. Rigby M. And into the 21st. Century: Telecommunications and the Global Clinic; in Rigby M, Roberts R, Thick M (eds.): Taking Health Telematics into the 21st. Century; Radcliffe Medical Press, Abingdon, 2000,187-206. 6. Rigby M, Forsström J, Roberts R, Wyatt J. Verifying quality and safety in health informatics services; BMJ 2001, 323, 552-556 |
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Peter Corr, Professor of Radiology Durban, S Africa
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Dear Editor, the only way that the usefulness of telemedicine can be confirmed in developing countries is by performing well controlled studies within these countries. Each telemedicine application is unique in its expected outcomes. What is possible in Canda may not be possible in Kenya. sincerely, Peter Corr |
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Syed Sameer Ahmed, Intern Osmania General Hospital, Hyderabad. 500001, A.P. , INDIA, Shaista Parveen
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I wholly agree with the author’s view that Telemedicine may have a more profound effect on developing countries than on developed ones. Telemedicine is promising to revolutionise the delivery of healthcare in India. Telemedicine can bridge the existing divide in terms of healthcare between the Urban and Rural areas. If we look at the statistics, about 75% of the qualified doctors practice in urban areas and 23% in semi-urban areas, so this leaves only 2% of the doctors to cater the health needs of a whopping 70% of the population living in villages. The most unfortunate outcome of this distribution is that 80% of medical facilities are being provided to the urban areas and a meager 20% to rural areas. The solution to provide health care to the poor rural, inaccessible population with paltry medical facilities is Telemedicine. Telemedicine is a confluence of Information and Communications technology, Medical engineering and Medical professionals. India is one of the largest producers of doctors and nurses in the world and not far behind in terms of providing science and technology required for successfully setting up the stage for Telemedicine in India. Telemedicine is the hope for a common villager for a better access to healthcare. Now it is up to us medical professionals to spread the awareness among the general population and make this promising venture a success. With the backing of the Government and some nonprofit organizations leading the way, Telemedicine is bound to revolutionise the healthcare delivery to the poor across India. Competing interests: None declared |
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