Telemedicine & mHealth

Current telemedicine projects

1. Primary Health Care Telemedicine Workstation
   Telemedicine stations usually require a panel of devices to interface peripherals and video conferencing.  Consequent user 'unfriendliness' and complexity can greatly reduce their utility. In early 2004 the MRC and Stellenbosch University launched a project to correct this, by developing software and a computer interface for medical peripherals and video conferencing in a PHC Workstation. The Workstation is affordable, ruggedised, locally maintainable and has a user friendly human interface and allows automatic and/or remote configuration. This is most suitable for inexperienced computer users in all developing countries.  The test site for the project is Grabouw Community Health Centre. Health Care Workers (HCWs) have been trained and the device is being continually developed, with HCW participation and a helpline is continuously available.  The referral doctor and specialist are based respectively at Hottentots Holland Hospital and Tygerberg Hospital and they provide a turn around time for response to referrals of less than 48 hours.
   
   
2. SA/China Bilateral Agreement
   This project follows an earlier project in the Nkomazi district of Mpumalanga, and overcomes previously encountered difficulties.  It has identified and adapted technologies from the People's Republic of China, focussing on technology suitable for the Primary Health Care (PHC) environment and the necessary connectivity.  It is a first step in establishing a pan African Telemedicine Network, collaborating with NEPAD partners and International funders.
   
   
3. Teledermatology
   This project uses simple, inexpensive store-and-forward technology to transmit patient images electronically asynchronously to a specialist for an opinion.  This pilot project uses Email and current telemedicine networks, to enhance delivery of dermatological care in relatively remote areas of South Africa. Personal computers and simple (3-4 Mpixel) digital cameras are supplied to selected primary health centres. They are located at Umtata (Nelson Mandela Academic Hospital), George (George Hospital), Hermanus (Hermanus Provincial Clinic), Newcastle (Durban) and Polokwane (Limpopo). Patient images, data and referring questions are forwarded, via a secure e-mail system, to specialists, currently based at the University of Cape Town. Preliminary results indicate that the project provides a much needed service.
   
   
4. Rapid Deployment Field Hospital/Mobile Pathlab
   The Rapid Deployment Field Hospital Pathlab is a stand-alone unit specifically designed and based on a modified shipping container, for use in remote locations and harsh conditions.  During transport it has the physical dimensions of a 6m ISO container.  When functioning as laboratory the usable floor space increases from 14m2 to about 25m², with maintenance of structural integrity and security.  It can use a wide variety of communication modalities.
   
   Successful deployment of this laboratory requires remote expert medical advice to be available.  In conjunction with the MRC's Telemedicine Lead Programme, systems are being set up to allow HCWs to consult with designated centres of excellence for patient diagnosis, etc.
   
   
5. KwaZulu-Natal Telemedicine Project
   There are various obstacles which hinder wider implementation of telemedicine in rural areas of South Africa. The obstacles identified include: (i) bandwidth and connectivity in the rural areas; (ii) the lack of diagnostic instruments that are robust, require minimal technical support and can be used by healthcare workers with minimal IT skills; (iii) the absence of existing South African models for the management of telemedicine services; (iv) no dedicated telemedicine centre to act as a hub for telemedicine; (v) the lack of medical specialist staff dedicated to the practice of telemedicine and the provision of specialist services in the form of a “virtual hospital”; (vi) the absence of clinical guidelines for the different aspects of telemedicine and ethical guidelines for ethical and legal practice of telemedicine in South Africa.

The purpose of this project is to address these obstacles. This will be achieved by:

• Innovative use of technology to provide various solutions for the provision of adequate bandwidth to rural areas;
• Provision and evaluation of the use of different telemedicine diagnostic units and instruments in district hospitals and hospital settings;
• Development of booking and administrative procedures for telemedicine;
• Training of medical and technical staff at telemedicine send and receive sites;
• Development of research capacity; and
• Development of a telemedicine hub, with staff to provide telemedicine services.