Design and Implementation of a Telemedicine System in Nigeria
Chapter One
OBJECTIVE OF THE STUDY
The main objective of this work is to provide, develop and implement a telemedicine system, which will:
- enhance citizen’s equality in the availability of various medical services and healthcare delivery despite geographical and economic barriers through the use of web-based telemedicine
- reduce direct and indirect cost (loss income), usually incurred as a result of moving patients from one geographical location to another in search of better and quality medical
- improve consultation and co-operation among various units of healthcare services in both special cases and primary care by bridging the distance between practitioners and
- provide opportunities for the healthcare practitioners to gain access to information that can aid in the diagnosis of patient’s healthcare
CHAPTER TWO
LITERATURE REVIEW ON TELEMEDICINE SYSTEM AND RELATED WORKS
INTRODUCTION TOTELEMEDICINE
Telemedicine is defined as the use of telecommunication technologies to provide medical information and services. It may be as simple as two health professionals discussing a patient’s case over a telephone line, or as sophisticated as using satellite technology to broadcast a country using video conferencing equipment.
The America telemedicine Association defines telemedicine as the use of medical information exchanged from one site to another via electronic communication for health and education of the patient or healthcare providers and for the purpose of improving patient care.
Wootten (1996) considered telemedicine as a process, rather than a technology: Telemedicine connects patients and healthcare professional in a chain of care.
Telemedicine is useful as a communication tool between a general practitioner and a specialist available at a remote location.
Care at a distance (also called in absentia care), is an old practice which was often conducted via post; there has been a long and successful history of in absentia health care, which – thanks to modern communication technology – has metamorphosed into what we know as modern telemedicine (O. S. Adewale 2003).
HISTORY OF TELEMEDICINE
Telemedicine technologies can be traced to the pre-electronic era. For example, wealthy families commonly sent urine samples to their doctors, who would use a urine chart to arrive at a diagnosis (Sosa-Iudicissa et al., 2000). This would be an early example of pathology. Teleprescribing was practiced before postal services were established and there are well-documented examples (Jurin, 1726). The development of postal services in the mid-nineteenth century facilitated prescription by pos: a sick person would write to an eminent physician enclosing his medical history. The physician’s reply would include a diagnosis, directions for a regimen and a prescription (Porter and Porter, 1989).
Telephony that became widespread in the late nineteenth century was used for medical work from the beginning. It is still widely used for this purpose. However, the telephone can be used for other purposes than simple voice communication. The first trans-telephonic “electrical stethoscope” was demonstrated in England in 1910 (Brown, 1910), which was used to amplify the sounds from a stethoscope and transmitted them through the telephone network. Similar devices are still in use today to permit a physician to carry out remote auscultation using low-cost equipment. Other medical uses for ordinary telephone network include transmission of images and ultrasound images via a computer modem (Shaint, et. al., 1996) and also the use of fax machines (Rollger, et. al.,1997). Internationally, there has also been mounting interest in call centers and their use of modern telecommunications for the purpose of medial triage (Lancet, 2001). These initiatives originated mostly in the US in response to the need to reduce escalating healthcare costs (Fries et al., 1993) However, they became widespread in the early 1990s as part of a broader strategy by many US healthcare organizations to implement demand-management strategies focused on improving consumer health knowledge and preventing unnecessary use of expensive health resources.
CHAPTER THREE
SYSTEM ANALYSIS AND DESIGN
TELEMEDICINE SYSTEM
The telemedicine system will provide a solution to the problem of accessing healthcare, especially for the rural healthcare workers, it enable the sending of the patient’s demographic and clinical data, X-rays and ultrasound images through the telemedicine network system for diagnosis of any patient’s illness. This allows for circumstance for patient’s loss of quality of healthcare, increase the access to expert-supported healthcare services based in hospitals located in larger cities and mitigates the isolation of rural health workers by bringing them in regular contact with the physicians in the urban city hospitals.
TELEMEDICINE SYSTEM ARCHITECTURE
The main factor being put into consideration while designing the telemedicine system are Interoperability and multiple accessibility with minimum requirements on the user’s side. Thus due to large flow of information delivery over the Internet, the system is implemented as a standard Internet application. The client side requires no more than standard Internet browser installed on the local computer, while the main application functionality is assured by the server side. Figure 3.1 depicts network application architecture of the telemedicine system. This includes, user interface made up of access services points (shown as client system below) at the remote site, a high – speed, highly reliable and scalable regional network and content management gateway with database server.
CHAPTER FOUR
SYSTEM IMPLEMENTATION AND PERFORMANCE ANALYSIS
SYSTEM IMPLEMENTATION
The system was implemented in four units: the initial unit, which covers security and privacy as regards to administrative authentication rights and the confidentiality of the patient’s electronic health record, the second and third units implement the end-user working sheets or interface for healthcare professionals and rural health workers alike and the fourth unit that construct the database.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
CONCLUSION
This project involved the development of a pilot internet and communication technology-based telemedicine system for primary community health care in urban and rural areas of Nigeria.
The research work describes a telemedicine environment that could be used to provide tools for overcoming the unequal distribution of medical experts, establishing meaningful consultation between remote rural healthcare practitioners and specialist typically located in the urban medical centers. It also provides opportunities for the healthcare practitioners to obtain access to information that can aid in the diagnosis of patient’s health conditions or the development of suitable treatment plans and for the patients to enjoy an enhanced level of healthcare service in the remote rural areas. The system could as well be used in the urban medical centers as an underground support for medical practitioners, thereby allowing more accurate diagnosis, more effective treatment and enhanced level of healthcare services.
The proposed system is at its maturity stage and more contributions are still required from either private or government healthcare institutions in other to make the system feet and robust towards meeting the demand for quality healthcare from all ramification of healthcare services. Apart from the stored and forward approach as stated above an interactive two-way remote consultation and diagnosis between the patients in the remote rural areas, remote rural health workers and specialist in the urban cities could be supported using H.323 standard over a network in the future. Using video conferencing technology and specially adapted medical tools and devices interfaced to the computer, the remote specialist can see his patient, talk with the remote rural health worker, hear heartbeat through remote stethoscope, see images from ear through stethoscope, nose, and throat or skin conditions or make some other remote measurements of vital signs through a device such as Tandberg’s Healthcare system III. Other area to be expected is the possible addition of data mining technique to the system. This would allow the formulation of diagnostic behaviours and the building of a knowledge based system to assist in medical diagnosis and treatment.
RECOMMENDATION
The target of this research work is to make this information available via a web portal for all physicians and remote rural health workers. Based on this the following recommendations are made:
- Government should try and adopt changes and define a communication channel.
- With the aspect of privacy, government has to make strong policy decisions to support
- Majority of areas in Nigeria especially the rural areas have no electricity supply, for the system to be established in Nigeria electricity must be provided.
- Internet facilities have to be extended to the rural
- An Internet-based distance learning system should be developed to extend educational capabilities to healthcare professionals throughout therural communities of Nigeria without having to provide facilities and teachers in every rural location.
AREA OF FURTHER RESEARCH
Some components of the proposed system are still under development; in particular the focus of the on-going work is the acquisition of tacit knowledge and the creation of a variety of medical knowledge bases. Put simply, the implementation of this system is non-trivial and perpetual activity that involves the active participation of a variety of player, more importantly a team of knowledge memory and healthcare practitioners. Other areas to exploit may be possible addition of data mining technique to the system. This would allow the formulation of diagnostic behaviours and build an expert system that will assist in medical diagnosis.
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