Profile: The International Telecommunications Union

The International Telecommunications Union (ITU) is a branch of the United Nations that specializes in ICTs. Founded in 1865 in Paris as the International Telegraph Union, ITU adapted its current name in 1934. In 1947, with the founding of the United Nations, it became an agency within it that specializes in ICTs. The ITU is an agency that works with both countries and the private sector to coordinate with its agenda. According to its website, ITU currently has “a membership of 193 countries and over 700 private-sector entities and academic institutions.”

ITU focuses on development projects, initiatives, and new technologies to fulfill its vision.

ITU focuses on:

• development projects [such as telebanking and telemedicine]
• cyber threats to provide security to the world
• social media
• many more

ITU vision: “committed to connecting the world”

Telemedicine in Ethiopia

This article, a resource Professor Ports gave to my “Health in ICT” presentation group, is a good case study on the topic of telemedicine. Telemedicine is defined as a healthcare delivery technology where physicians examine patients from distant locations using information technologies. It has been growing in popularity for many reasons because:

• there is a clear need/shortage of physicians
• poor infrastructure of clinics in general and access to them
• physician communication can be increased

As I mentioned in my sector presentation, sub-saharan Africa has less than 10 doctors per 100,000 people. In Ethiopia, for example, there are only 38 radiologists nation-wide, and 30 of them are in the nation’s capital. The country’s lack of infrastructure makes it difficult to provide healthcare as well, and often times when clinics are set-up in rural areas they are ill-equipped, according to the WHO. Since its inception, telemedicine has been able to reduce costs and provide optimal utilization of the healthcare system in many countries. This case study illuminates how telemedicine has been beneficial for cardiac patients, since they would not need to factor in as many travel costs. Other possible benefits of telemedicine may include:

•  reduced direct and indirect costs to the healthcare sector, patients and providers
• enhanced equality among citizens, in terms of access to special medical services
• improved cooperation between specialized care and primary healthcare centers
• promote the proficiency of physicians and other healthcare practitioners through ICT trainings and conferences

There are many examples of telemedicine in Ethiopia and have been supported by many international organizations and NGOs. There are many stakeholders involved, including the patients, doctors, universities , IT workers, and government and development workers.

While it is true that telemedicine has made significant contributions to healthcare sector of Ethiopia, many major challenges do exist. There are cultural, economic, organizational and technical issues. One example is that, since there are not many specialists in the country to begin with, they do not have much time to set up these tele-sessions. The technologies might also be difficult for the doctors to use. Other obvious barriers to this method of healthcare include the absence of affordable and reliable telecommunications and the power infrastructure. Internet also costs a good deal of money, and might be delayed. With all of these challenges, there must be a strong commitment in order to make telemedicine more mainstream. In this article’s abstract it was expressed that the universities and higher education have a great role in assisting with these sorts of initiatives. How do you think universities can make lasting contributions to projects such as these? What do envision as the future of telemedicine?

Equal Opportunity Healthcare Emerging from ICTs

Gone are the days of going to a doctor’s office– today we live in a world where it is possible, and feasible, to access professional health care services through the comfort of your own home. The field of telemedicine, which is a specialized branch of the broader telehealth category, seeks to improve patient health by opening a two-way communication channel between patient, and provider, no matter the distance.

What used to be seen as an expensive, futuristic way of delivering services has now grown to a common, more cost-effective manner than traditional face-to-face physical examinations. Supplementary technology services, especially video conferencing, that build upon existing radio/mobile telephony ICTs have been key to the growth of telemedicine. Telemedicine uses a unique combination of the following three sects to provide real- time consultations, testings, monitoring and medical procedures over geographical barriers: 1. Remote Patient Monitoring (RPM) 2. Patient Data Storage and 3. Interactive telemedicine.

In recent years, RPM has grown rapidly, allowing for substantial decreases in health care costs. More sophisticated devices allow patients who suffer from chronic diseases to transmit information, like blood pressure or sugar levels, to a central monitoring station from which a doctor can review it and stay up to date with his patient’s progress from virtually anywhere, any time. This data taken from RPM is kept stored in a network of numerous pieces of equipment, each with a unique storage feature. Data stores combine to form a patient’s complete medical history which is able to be backed up, secured, and forwarded to necessary personnel. Telemedicine then employs the use of interactive features, like video conferencing, to allow for a real time patient to provider or provider to provider communication.

Telemedicine has shown promise, especially in places like Kenya, where often times patients die not from their ailments, but rather from misdiagnoses and subsequent mistreatment. Providers can connect with their colleagues in order to ensure a proper diagnosis and correct course of treatment. This is especially helpful when looking at the skill and training gaps between doctors in developing nations and doctors in more developed ones. In this sense, good health care becomes available to those who previously suffered unnecessarily at the hands of poorly trained physicians.

Of course, there are still issues of accessibility in accordance with a nation’s networked readiness, but the future of telemedicine looks bright as we continue to shift our everyday lives more and more towards technological reliance.

Use of e-Health: Teleradiology in Mali

As was made evident during class discussion last week, there is a lot of controversy over whether e-Health and telemedicine are the best ways for countries to currently spend money developing.  One of the major issues many people had with it was that there was a lack of basic infrastructure.. i.e. poor or no electricity/internet.

Through my research on Mali this semester I have found that they are fairly far behind and represent a very low spot in the digital divide.  For example, I could not even find a national ICT plan.  However, they have surprisingly been able to accomplish the teleradiology.  This project aimed to connect rural health centers with the larger hospitals in the Timbuktu, Mopti, and Sikasso.  They established internet connections that successfully enabled specialists in the hospitals to make more accurate determinations of x-ray images. The idea for this project is based on the statistic that ”in general half of the generalist doctors make mistakes in interpreting an x-ray, compared to only 5% of the radiologists.”

Although there were some struggles along the way, such as unexpected additional costs and lack of training programs, these have been fixed in the current model for the program.  Now it is possible for people living in some rural areas to get much quicker and reliable information/results. Furthermore, there is now established internet connectivity between the rural areas and the major health/business centers in the surrounding areas.  This should help to decrease the digital divide and encourage others to utilize the internet and increase the amount of internet users in the rural villages.

Source: Teleradiology in Mali

Telemedicine adoption “disappointing’ so far

February 17th, 2012

This article is a general overview of the disappointments of the slow adoption of telemedicine, a provision of healthcare or medical information/services through communication lines or broadband connection. This technology has been around for decades, and while it has great potential for solving problems of global healthcare (especially in developing countries) the adoption of this technology has been less rapid than hoped. Jamie Yap, the author of the article, discusses a few reasons for the slow adoption of telemedicine.

1. One of the most prevalent reasons for low adoption rates was the lack of official government support as well as insurance companies in reimbursing patients for the cost of telemedicine services and devices. Clinical reimbursement is one initiative that would provide motivation for people to use telemedicine services.

2. A lack of broadband penetration in emerging markets such as Vietnam, Indonesia, and the Philippines. Limited availability of broadband networks is also serving as a large infrastructure related obstacles in large, rural populations such as India and China. Low broadband availability also means that there is less awareness among practitioners and patients towards the benefits of telemedicine. This awareness also creates obstacles in a legal sense as some practitioners are reluctant to use telemedicine because of legal issues surrounding possible medical indemnity issues.

3. Patients above the age of 65 experience hesitation or difficulty in adopting this new technology. However, the elderly is a group that could likely experience great benefits from the adoption of this technology.

4. Most telemedicine projects tend to be government-funded initiatives that lack private sector support. This leads to a lack of sustainability in the initiatives once government funds run out. There needs to be a unified effort between government and private sectors in order to promote sustainable telemedicine initiatives.

Hopefully the future of telemedicine will be bright. A new wave of medical school students are being educated in the areas of telemedicine. This new focus in education will help to promote awareness of the benefits and opportunities that telemedicine adoption presents.

Telemedicine adoption “disappointing” so far

The article focuses mainly on the barriers preventing telemedicine to succeed in both rural and urban areas.  Since telemedicine has existed in the healthcare landscape for over a decade now, its adoption efforts in most areas are considered “modest, if not disappointing,” but some believe that as broadband initiatives have become more pervasive on a global level in the past few year, telemedicine has potential to be revived and revolutionized.

Telemedicine now includes doctor to patient phone calls, teleconsultations, videoconferencing, and real-time remote patient monitoring using mobile devices.  These ICT labors have the potential to maximize efficiency in the health care industry, but there are few blockades that come along with its adaptation efforts.

Reasons for low adoption of telemedicine:

1. Lack of support by governments and insurance companies to reimburse patients for the cost of telemedicine services and devices
2. Lack in access, awareness and legal understanding
3. Lack of examples of telemedicine succeeding on a wider scale beyond pilot programs
4. Standards, regulations to create ubiquity
5. Needs public-private joint support

Overall, the telemedicine system seems to be supported but not enough for it to be adopted on full scale.  ICT systems like this will not be affective unless they are fully implemented, utilized and sustained with great collaboration between the public and private sectors.

Telemedicine links between Canada, Kenya, and Uganda

In the article “Global Diffusion of the Internet X” he references another article which is titled “Into Africa: The Telemedicine Links Between Canada, Kenya, and Uganda” written in the Canadian Medical Association Journal. In it the author describes how the medical practices of physicians in rural Canada was really not that different from how it is in East Africa.This article, written in 1987, is certainly outdated and I’m sure many things have changed, but it is interesting to note that even then they were eagerly talking about their use of teleconferencing in order to advance development through the use of technology.

It appeared in the article that the key to making all of this possible, even in 1987 they struggled with the same things that make these projects difficult today, is whether or not it would make sense economically. Whenever you have a project where a developed country is working with an underdeveloped country, money will always be a deterrent to the progress which they wish to make. However, in this case, an organization called the International Satellite Organization (Intelsat) and the International Institute of Communications worked together to start a project called Project SHARE. This project has “made teleconference and telemedicine links between Canada and East Africa economically feasible.” This and other projects like it are probably more common now as technology advances as this was 25 years ago but it is interesting to note that these slight advancements in technology’s use in development have been ongoing and consistent.

The remainder of the article described how scholars at universities, medical schools mostly, are using the telemedicine technology to send information like EEG’s back and forth and how they send out images to get examined twice a week. The medical facilities at the University of Nairobi and Makerere University in Kampala, Uganda are the only medical schools in East Africa and are in desperate need for other scholars to be able to communicate with. This teleconferencing project has made them much more capable of treating patients and functioning as a medical organization with lives in their hands.

Expectations in Telemedicine for Developing Countries

With the recent developments in machines that can perform surgeries remotely, Telemedicine seems to be an unstoppable force in the future of health care. However, this unstoppable force still has to overcome issues in infrastructure, funding, culture, literacy, and countless other obstacles before it can reach its full potential. While reading out case study on the use of Telemedicine in Ethiopia I found myself exactly which branches stood the best chance of being implemented in a developing nations, and which among those were the most valuable. Considering those two questions, I found that the following were likely to be the most important for rural areas of developing countries:

• Telepathology - the transfer of image-rich pathology data between distant locations for the purposes of diagnosis, education, and research
• Telepharmacy - drug therapy monitoring, patient counseling, prior authorization, refill authorization, monitoring formulary compliance with the aid of teleconferencing

Obviously, these two branches do not cover all of the healthcare needs for rural patients, but both go a long way in providing convenience to rural citizens with minimal infrastructure needs. Telepathology in particular can prevent rural citizens from making long trips to the city to solve minor problems, and telepharmacy can help deliver and renew prescriptions for basic ailments. With the use of telepathology, local clinics can send images to doctors across the world along with a description of the symptoms in order to receive a diagnosis. These technologies also only require cameras, cell phones, and an internet connection, while teleradiodiolgy, telecardiology, and other branches require significantly more investment in equipment. In fact, the entire infrastructural requirements for Telepathology and Telepharmacy could be overcome by a single smartphone connected to a 3g network, which many of us take for granted as something we always have with us.

Bebemama

Bebemama is a mobile app providing maternal health information to web-enabled phones. It was created as part of the World Bank’s Apps for Development competition, garnering an honorable mention. The purpose of the app is to deliver information on maternal health to women who may not have access to a health care provider but do have a mobile phone. The app displays World Bank data on fertility, maternal and child health for specific countries or groups of countries. It also includes health care advice for before, during and after pregnancy from the U.S. Department of Health and Human Services.

The beta version of the app was developed in Hindi, and now both English and Hindi are available languages. French and Spanish versions are under development. The application is free and open-source.

The Bebemama app is an innovative way to deliver important information to women who may not have knowledge they need about pregnancy. According to Bebemama.org, “Today, 57% of people in developing countries have a mobile phone subscription, more than the people with access to proper health care, either because no doctor is available or because they cannot afford the fees. ” Because of the relative availability of mobile phones, providing this information via cellular technology is great in theory. Unfortunately, in practice, there are a lot of issues with Bebemama. Even the most basic web-enabled phones are expensive, and the previously mentioned 57% are not typically using an iPhone or Android. Also, even if users can access the data, the information provided is not entirely what they need; fertility stats and information on fetal and maternal mortality isn’t the most constructive data to provide a mother who is simply looking for tips on how to stay healthy. The language barrier is a problem as well, though translating information into a workable language may not be a great help if the information is difficult to reach or if literacy is an issue.

Glucose Buddy Smartphone App

When I was diagnosed with Juvenile Diabetes nearly five years ago, countless advances had already been made in the realm of diabetes management. Only a decade ago, blood glucose meters were large (about the size of a graphing calculator), slow, and somewhat unreliable. Now, however, meters are incredibly compact, fast, and astonishingly accurate. Insulin delivery systems have followed a similar trajectory of evolution and advancement beginning with syringes and vials which have recently fallen by the wayside in favor of more convenient pens and pumps. The progress is amazing and has made measurable differences in the lives of diabetics. Now, methods of keeping blood glucose logs are following suit. When I was first diagnosed, I would have to write all of my numbers and the time of day in a notebook to bring to my doctor so that she could adjust my insulin dosages accordingly. Now, however, there is a smartphone application, Glucose Buddy, which allows me to input this data into my iPhone (which I always carry around anyway) and transfer that information to my doctor electronically. This process cuts down on waiting time between doctor visits and is particularly valuable since I am a student in New Orleans, but my doctor works in Jackson, MS.

The application is very user-friendly and provides both patients and doctors with useful tools that a pen and notebook simply cannot offer. As soon as I use my meter to check my blood glucose level, I go to my Glucose Buddy app, make a note (before breakfast, after lunch, after exercise, for example), and punch in whatever number my meter displays. Glucose Buddy automatically detects the time of day, but it is possible to change that in order to retroactively add a meter reading. With this information, the app then adds the number and note to an electronic logbook, which is essentially a digitized copy of a paper notebook. The really interesting feature of this app, however, is that the program then converts the conventional logbook display into a graphical representation. The graph displays, with three different colored lines, the high, low, and average blood glucose readings for every day on which data was entered. This graph allows a patient and a doctor to quickly analyze readings in a visual manner, saving time and energy. Furthermore, the app has a “quick sync” feature which allows patients to send data to their doctors as the patient collects it, allowing for immediate insulin dosage corrections. This app can have great implications for people who either have trouble keeping up with a logbook or who do not live near their specialists. Especially in rural Mississippi, it is not uncommon for patients to have to drive upwards of two hours to visit a specialist. This means that time in between visits can be so lengthy that it prohibits the best possible medical care. Glucose Buddy essentially eliminates the physical distance between doctors and patients, allowing for timely and responsive healthcare.

While Glucose Buddy has proved very helpful in my personal attempts to manage my diabetes, I represent minority group of diabetic patients. By no means do all diabetics have access to either the internet or a smartphone on which do download the application, nevermind both assets at once. This tool could potentially revolutionize the way in which rural diabetic populations communicate with their doctors and receive medical care. Glucose Buddy makes it possible for patients who live great distances from their specialists to have a higher level of care, but people in these rural populations are less likely to have access to both smartphones and the internet. Furthermore, the application is only good if a patient actually uses it regularly. If a patient forgets to input data or fails to sync the information to his or her physician, the application cannot function at its full potential. Given the number of mobile phone subscriptions across the globe, however, it could be possible to create a Glucose Buddy type system for text messages. This would serve a greater number of patients by circumventing both the issue of internet access and the lack of availability of smartphones.