Telemedicine & mHealth

Research highlights

The results of the first phase of the SA National Telemedicine System (NTS) were reviewed at a National Telemedicine Conference in 2000.

The following benefits of the system were tabled:

• Rapid access to a specialist radiologist (now 60 min, previously  5 to 7 days);
• Primary Health Care providers acquiring radiographic interpretation skills;
• Community service doctors increasing their ability to manage many medical conditions (especially for trauma and chest diseases);
• Much less professional isolation for junior medical doctors, in rural based community service;
• Many fewer transfers from rural to Urban Tertiary Centers;
• Doctors, nurses and medical students experiencing better education and training opportunities; and 
• The clear potential to extend telemedicine to additional medical specialties.   

Research highlights included the following:

• In the North West Province Telemedicine allowed community service doctors to differentiate between chronic TB lesions and occupational lung diseases such as asbestosis and lung cancers, so avoiding unnecessary patient transfers; 
• Telemedicine proved useful in increasing bone tumor detection and differentiating them from arthritis; and 
• Greatly improved recognition of those neck trauma patients who could benefit from transfer to a tertiary center, with great reduction of unnecessary transfers.

As a consequence a most successful Tele-radiology triage service has been set up, with the University of Pretoria, for all potential neurosurgery patients. 

Tele-ultrasound has become available in remote and rural ante-natal community health centers as a result of the first phase of the NTS, while formerly this service was located in provincial referral centers.  Resulting benefits are:

• More healthcare providers were trained to offer an ultrasound ante-natal service;
• Ante-natal care and tele-consultation greatly reduced the need for the pregnant to travel; and
• Diagnostic and management services for complicated pregnancies became available.

SA/China Bilateral Agreement (Phase 1)

Methodology
The Telemedicine equipment procured from China was tested and customized to fit the South African health and communication environment. The system uses audio and video applications, therefore requires a bandwidth of about 512kbps. The current communication infrastructure in rural areas could not provide for this bandwidth capacity; furthermore traditional broadbased connectivity is very expensive in areas that lack copper or fiber infrastructure or in geographic areas which are difficult to reach with traditional technology. Wireless Interoperability for Microwave Access (WiMAX) was identified as the cost effective connectivity solution for this kind of an application, given the time and costs to be involved in installing and upgrading the existing terrestrial communication infrastructure. WiMAX,  a standards-based wireless technology that provides high-throughput broadband connections over long distances which can be used for different applications, including” last mile" broadband connections, hotspots and cellular backhaul, and high-speed enterprise connectivity for business. The system was connected using WiMAX at SITA laboratory and two health professionals (a sister on the clinic side and doctor at the hospital side) were asked to use it.

Results
Testing the Telemedicine System using WiMAX gave positive result because picture quality from video cameras and medical peripheries (ENT Scope, Dermatology Camera and Vital Sign monitor) at the clinic side was of high quality. The audio quality from the heart, lungs and intestinal tract using the stethoscope worked fine, although it will need to be improved.

Conclusion
Phase 2 of the project involves testing the systems in a real health environment in Limpopo and Gauteng Provinces. The system has a huge potential for changing healthcare provision and would benefit both patient and health authorities by reducing costs related to transport and unnecessary referrals. 

Primary Health Care Telemedicine Workstation
The Innovation Fund Telemedicine Project has been a very exciting one. It is the first of its kind in Africa. The aim of the project was to develop a Telemedicine Workstation to assist with the delivery of health care to rural and underserved areas in South Africa and Southern African Developing Countries.

The development team has successfully developed a workstation that is simple and user friendly yet efficient enough to deliver specialist medical care. The workstation has been tested in a clinic and the feedback from the user was that the system ensures, “working smarter not harder”.

In addition the project was evaluated by the National Research Foundation (NRF), the delegation felt that the system developed was of a high quality and that it has the potential to be commercialised. The challenge for the project team is to ensure that the product is successfully commercialised and can compete with international systems. Several organisations have already indicated their interest in purchasing the system.