Telemedicine Offers New Dimension in Health Care Delivery

A paediatric patient in Mandeville is being examined by a doctor who is in Montego Bay. Meanwhile, in upper St. Andrew, a 76-year old hypertensive man is receiving his monthly check-up at home. But, his doctor is in an office somewhere downtown Kingston.

These cases, though fictitious, offer examples of telemedicine, which has emerged as the new paradigm in health service delivery in a world where people are demanding quicker, easier and better service from their health care professionals.

Simply put, telemedicine is medicine offered at a distance and entails the use of audio, video or computer technology to investigate, monitor and manage patients who are geographically separated from their caregivers.

It also allows doctors to collaborate on patient care, participate in diagnostic procedures and keep abreast of current practices. It is now used around the world in the treatment of paediatric patients, persons living in remote communities and those requiring home-based care.

“Essentially, what you are talking about is the use of information technology with the management of health information.to create the conditions for access of the patient anytime, anywhere,” explains Dr. Winston Davidson Head of the Telemedicine Research and Development Unit at the University of the West Indies.

Dr. Davidson has created a seven step integrated telemedicine programme known as ‘The Caribbean Model’, which when implemented, will allow a patient to have immediate access to their doctor or their medical records using their telephone as a starting point.

From making the initial phone call, the patient would then be able to link with the doctor through his website.
“It is an integrated system utilising all technology platforms from the telephone to streaming media. We have integrated it into one robust platform and we have built the electronic medical record system on this platform, so that when a person calls via telephone, they can text in their demographic information, they can go voice-over Internet protocol into the website of the doctor to either chat, view media clips or access their records,” he tells JIS News.

Dr. Davidson informs that the programme will be equipped with the capability for patients to send instant pictures to their doctors, which will be helpful in diagnosing a patient’s ailment. It will also have chat room and video- conference capabilities, which will allow the doctor to communicate with medical colleagues in his field.
He points out that the system is by no means restricted for use by doctors as all health and allied personnel stand to benefit, including medical technologists, pharmacists, persons practising alternative medicine among others.

In detailing how the system will work, Dr. Davidson explains that, “the first step is doctor on call, where you will be able to access your doctor (or respective health professional) by just using the telephone. In so doing, you will need to have a ‘doctor on call calling card’ and we will have these available for groups of doctors.”
Dr. Davidson tells JIS News, that negotiations are underway with an overseas company to implement the ‘doctor on call calling card’ capabilities.

He outlines that part of the programme involves patients accessing their medical system electronically through the use of a pin number. “The doctor will manage that because he can manage his website accordingly, (but) the patient has to use a pin number and go through security clearance and then pay whatever the cost the doctor would choose to charge,” he informs.

He stresses that the telemedicine programme has undergone vigorous testing to ensure that it is up to scratch. “Before we implement anything, we have to test. Because medicine is evidence-based, there are medical legal problems associated with the delivery of health care and we have to be responsible and maintain strict protocols. We have already tested most of all we need to do and the Caribbean Model, we know, is robust,” he points out.

The model was available for testing at the recent Caribbean Telemedicine Symposium and Exhibition that was held at the UWI. According to Dr. Davidson, to date, the testing of the model has proven successful.

However, he tells JIS News that the actual implementation of the seven-step integrated Caribbean Model requires funding, as well as the availability of broadband bandwidth for the technology to effectively work. Funding to make the model and all its functions operational will cost an estimated US$1.5 million.

The doctor is enthused by Commerce, Science and Technology Minister, Phillip Paulwell’s recent announcement that the government is seeking an international telecommunications provider to input submarine fibre optic cable, which by extension, will give Jamaica, broadband capability. He says local investors have not expressed an eagerness to fund the programme, and as such, he will seek out other avenues of investments from overseas.

“For the model to be fully operational, the financial investment and broadband is needed. This will finish the network operating centre and the network attached storage,” he says.

He points out that if the funding is secured and all the technological kinks to the system are straightened out, the tentative start up time for the system to work will be between six weeks and two months.

Somewhat disappointed by the indifference of Jamaican investors, Dr. Davidson says ideally, he would have preferred local support. “I would very much like to have local or Caribbean investors in this system because it is Jamaican born and made,” he states.

He reveals that the electronic medical record system, which will be an integral part of the programme, is designed by a three-man team that includes Sanjeev Kumar, a consultant software expert; Robert Gilbert, a medical software expert and himself.

“We think it one of the most comprehensive in the world. We know that because we have evaluated over 487 and done gap analysis on every single software of that 487 and in that gap analysis, we have increased the number of variables from 28 to 45 and our software will have all of those,” Dr. Davidson points out.

Responding to the question as to whether the introduction of a web-based system will negate the face-to-face doctor/patient contact, Dr. Davidson replies that it will not serve as drawback.

“With technological advancement, it enhances the capacity of doctor-patient office contact. The rule of the doctor changes from being paternalistic to more facilitatory. In the final analysis, you cannot deal with (conditions such as) chronic illnesses in a paternalistic way, because the patient does determine the success of that programme.. it gives the patient greater options and it frees the patient and the doctor. It’s a win-win situation,” he says.

As part of the Caribbean Model, some 2,000 health care professionals, including doctors, nurses and pharmacists, will be trained in telemedicine through a certification course to be offered at the UWI later this year. Some 6, 000 persons are anticipated to receive training by 2006.

The 22-module course will involve training in the competencies related to the efficient use of the telemedicine in various technological platforms.

Dr. Davidson says “in designing the certification programme, it fits neatly into the Caribbean Model, so we first dealt with the conceptual framework and looked at the different technological platforms which we integrated.”

Besides having persons trained in telemedicine competencies, he says there are major spin-offs for health tourism.

He says that because the model involves network consultation and health information management through digital health television, “we looked at existing industries to see exactly how these industries could be integrated to create a massive multi-billion dollar niche for health tourism.”

He points to two home-grown markets ripe with potential; the ethno-medicine market, which involves the use of bushes, herbs and spices and the alternative health market, which could be part of the whole therapeutic regime of the wellness and healthy lifestyle tourism industry. These areas, he points out, include spas, different types of health farms, geriatric care and “integrating health into the whole sun, sea health and wellness market.” The forward-thinking Dr. Davidson believes that telemedicine is a surety in the Jamaican health sector, sooner or later.

“I think this heralds a revolutionary change. Every health facility, both private and public, will be able to develop the capacity for not only the export of services but for the great potential in almost all areas”, he notes, mentioning tele-health, which has to do with health education and promotion and tele-care, that has to do with nursing and the use of technologies to improve general conditions.