Telemedicine has been connecting patients to healthcare for almost 30 years, but continuous barriers, such as resistance from clinicians, prohibitive costs and more recently, an inability to meet bandwidth requirements have hindered the uptake of telemedicine. Director at Mark Banfield & Associates Consulting (Pty) Ltd, Mark Banfield, discusses how these challenges are being addressed with eHealth innovation and how telemedicine is effectively transforming healthcare access in Africa.

The popularity and ease of access to mobile technology has resulted in more and more clinicians and nurses incorporating them into their workflows. While WhatsApp, Skype and similar IM applications are useful communication tools, they lack the security and clinical functionality to share confidential patient files, images and narrative – and that is where robust mobile telemedicine technology comes in.

Telemedicine for low-resource environments

Last year I founded AfriHealth, an organisation which supplies medical devices and health technology to the South African market. One of the eHealth suppliers we represent is Canadian-based Tech4Life Enterprises, which are the developers of a mobile telehealth solution called MDConsults that was specifically designed for low-resource environments.

MDConsults was designed to address a lot of the challenges we face Africa; the system is cost-effective, easy to use and can run on a slow internet connection like 2G. MDConsults has a range of features such as live video-conferencing and the ability to incorporate special telemedicine devices to capture patient vitals, etc. and support diagnosis, as well as reporting of radiology and pathology images.

Use in real-world settings

To date we have been involved in 16 implementations of MDConsults in low-resource settings, from Pakistan to numerous countries across Africa.

With funding from the Zimbabwean government, we’re currently running a pilot with a hospital group in Zimbabwe where a single doctor and a few of his colleagues are responsible for 40 remote clinics. Previously, the staff had to use Skype and satellite telephones to communicate. But now, in the five clinics piloting MDConsults, the proper securities are in place which allow them to conduct teleconsultations with the added advantage of incorporating electronic medical records (EMRs), notes from clinicians at the clinics, as well as various images. As a result, clinicians are now able to engage with their patients in a more holistic manner.

From the feedback we’ve received it’s apparent that the system has truly changed their work practices for the better. Patients and doctors no longer have to travel long distances, and patients can now more easily access professional care from a specialist when they need it, as opposed to having to rely on a nurse or a GP at a clinic.

MDConsults has also been deployed in various projects in Kenya, from an on-going psychiatric programme to monitor and evaluate patients remotely, to providing paediatric support to outreach clinics to improve the triage process.

Preparing South Africa for telemedicine

South Africa faces a unique set of challenges when it comes to implementing telemedicine but I think it’s important to see what is possible within the confines of regulatory frameworks rather than take no action. Firstly, by law you have to obtain informed written consent from patients before telehealth can be used. This is problematic in most instances.

Another issue is data security, specifically in relation to the requirements stipulated by the POPI Act and National Health Act with regards to how personal data is stored and transmitted. Currently, data generated by MDConsults is hosted outside of SA, so we have to look at how we can partner with local service providers like Vodacom to secure local hosting to overcome that obstacle.

The third issue, which is less serious, is the requirement for clinicians to have a relationship with their patients to make a diagnosis. With MDConsults, we avoid this issue because a local healthcare provider, who is known to both the clinician and the patient, would be providing the service of connecting the two parties.

Ensuring quality and patient safety

Telemedicine works really well in certain clinical disciplines and less so in others. Psychiatry and dermatology are the two fields that benefit the most directly from telemedicine services at this stage. Psychiatric patients don’t need point-of-care devices, but they do need on-going monitoring and interpretation of lab results. In that case, blood can be taken at a clinic and the results can be uploaded onto the system and attached to that particular patient profile. The doctor can then consult with the patient while looking at their lab results at the same time.

Dermatology on the other hand is a field which is very difficult to make a diagnosis in. Typically, a patient will present with some sort of skin condition which is treated with a very broad spectrum cream, and it’s only when the problem persists that they would then be referred to a specialist who needs to see them face-to-face. But if you’re using a dermoscope or a microscope that can capture an enormous magnification of the affected area, you can make a diagnosis remotely.

Beyond traditional telemedicine

Point-of-care devices are making a marked difference in offering clinical decision support to rural doctors – much like an electronic stethoscope that Tech4Life has developed. During a teleconsultation the onsite healthcare worker positions the device onto the patient’s diaphragm under the guidance of a remote doctor. The doctor is then able to hear those sounds directly which can help him make a diagnosis.

Other devices we supply include a maternal risk band, which provides non-invasive haemoglobin readings as well as blood sugar, blood pressure and pulse. We also have various optical devices, such as a microscope which would be used in dermatology, and a range of otoscopes.

All of these instruments are USB plug-and-play devices which transmit captured images or sounds via MDConsults’ platform, and can be recorded during the teleconsultation. There are also devices that are connected via embedded SIM cards that send results from the point-of-care device to the treating clinician.

Extending to education

Telemedicine systems are also a great tool to continue medical training. Community doctors working in rural settings often have no backup, resources or experience available to them when carrying out their jobs. Telemedicine can change that, offering doctors support while giving them the opportunity to continue their education at the touch of a button.

This benefit of telemedicine presents numerous opportunities to address the lack of skilled healthcare professionals and improve the skills of those we do have. Imagine linking all public health facilities, from academic hospitals to rural clinics, with telemedicine systems to enable consultations regardless of location? I think as technology progresses and connectivity expands, this sort of connected healthcare ecosystem could become a reality.

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