TELEMEDICINE – Telemedicine for developing countries: a survey and some design issues

by Carlo Combi, Gabriel Pozzani, Giuseppe Pozzi

Applied Clinical Informatics 2016;7(4):1025-50 (Open access)

Background – Developing countries need telemedicine applications that help in many situations, when physicians are a small number with respect to the population, when specialized physicians are not available, and when patients and physicians in rural villages need assistance in the delivery of health care. Moreover, the requirements of telemedicine applications for developing countries are somewhat more demanding than for developed countries. Indeed, further social, organizational, and technical aspects need to be considered for successful telemedicine applications in developing countries.

Objective – We consider all the major projects in telemedicine, devoted to developing countries, as described by the proper scientific literature. On the basis of such literature, we want to define a specific taxonomy that allows a proper classification and a fast overview of telemedicine projects in developing countries. Moreover, by considering both the literature and some recent direct experiences, we want to complete such overview by discussing some design issues to be taken into consideration when developing telemedicine software systems.

Methods – We considered and reviewed the major conferences and journals in depth, and looked for reports on the telemedicine projects.

Results – We provide the reader with a survey of the main projects and systems, from which we derived a taxonomy of features of telemedicine systems for developing countries. We also propose and discuss some classification criteria for design issues, based on the lessons learned in this research area.

Conclusions/Challenges – We highlight some challenges and recommendations to be considered when designing a telemedicine system for developing countries:

  • high cost of telemedicine systems and solutions, especially for rural areas;
  • resistance to change and slow clinical acceptance of telemedicine;
  • unavailability of the required ICT infrastructure for telemedicine (e.g. Internet connection, bandwidth for high speed telecommunications, etc);
  • regulatory bodies;
  • accreditation and licensing of telemedicine service providers, to prevent malpractice;
  • business models and reimbursement;
  • user-friendly interfaces;
  • training for personnel, including those who are uncertain of their skills;
  • implementing standards and guidelines;
  • fostering continuing use, and much more.

[Note: A valuable source of information on the technical, practical and health systems issues.]