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TitleThe need for a telemedicine strategy for Botswana? A scoping review and situational assessment.
AuthorsNcube, B; Mars, M; Scott, RE
JournalBMC health services research
Publication Date26 Aug 2020
Date Added to PubMed28 Aug 2020
AbstractHealth, healthcare, and healthcare system problems within the developing world are well recognised. eHealth, the use of Information and Communications Technologies (ICT) for health, is frequently suggested as one means by which to ameliorate such problems. However, to identify and implement the most appropriate ehealth solutions requires development of a thoughtful and broadly evidence-informed strategy. Most published strategies focus on health informatics solutions, neglecting the potential for other aspects of ehealth (telehealth, telemedicine, elearning, and ecommerce). This study examined the setting in Botswana to determine the need for a telemedicine-specific strategy. A situational assessment of ehealth activities in Botswana was performed through a scoping review of the scientific and grey literature using specified search terms to July 2018; an interview with an official from the major mhealth stakeholder; and benchtop review of policies and other relevant Government documents including the country's current draft eHealth Strategy. Thirty-nine papers were reviewed. Various ehealth technologies have been applied within Botswana. These include Skype for educational activities, instant messaging (WhatsApp for telepathology; SMS for transmission of laboratory test results, patient appointment reminders, and invoicing and bill payment), and robotics for dermatopathology. In addition health informatics technologies have been used for surveillance, monitoring, and access to information by healthcare workers. The number of distinct health information systems has been reduced from 37 to 12, and 9 discrete EMRs remain active within the public health institutions. Many infrastructural issues were identified. A critical assessment of the current draft ehealth strategy document for Botswana showed limitations. Many telemedicine services have been introduced over the years (addressing cervical cancer screening, teledermatology, teleradiology, oral medicine and eye screening), but only one project was confirmed to be active and being scaled up with the intervention of the Government. Botswana's draft 'ehealth' strategy will not, in and of itself, nurture innovative growth in the application of telemedicine initiatives, which currently are fragmented and stalled. This lack of focus is preventing telemedicine's recognised potential from being leveraged. A specific Telemedicine Strategy, aligned with and supportive of the pre-existing ehealth strategy, would provide the necessary focus, stimulus, and guidance.
TitleThe EU-project United4Health: User-centred design of an information system for a Norwegian telemedicine service.
AuthorsSmaradottir, B; Gerdes, M; Martinez, S; Fensli, R
JournalJournal of telemedicine and telecare
Publication Date1 Oct 2016
Date Added to PubMed7 Nov 2015
AbstractOrganizational changes of health care services in Norway brought to light a need for new clinical pathways. This study presents the design and evaluation of an information system for a new telemedicine service for chronic obstructive pulmonary disease patients after hospital discharge. A user-centred design approach was employed composed of a workshop with end-users, two user tests and a field trial. For data collection, qualitative methods such as observations, semi-structured interviews and a questionnaire were used. User workshop's outcome informed the implementation of the system initial prototype, evaluated by end-users in a usability laboratory. Several usability and functionality issues were identified and solved, such as the interface between the initial colour scheme and the triage colours. Iterative refinements were made and a second user evaluation showed that the main issues were solved. The responses to a questionnaire presented a high score of user satisfaction. In the final phase, a field trial showed satisfactory use of the system. This study showed how the target end-users groups were actively involved in identifying the needs, suggestions and preferences. These aspects were addressed in the development of an information system through a user-centred design process. The process efficiently enabled users to give feedback about design and functionality. Continuous refinement of the system was the key to full development and suitability for the telemedicine service. This research was a result of the international cooperation between partners within the project United4Health, a part of the Seventh Framework Programme for Research of the European Union.
TitleMaximum Time Between Tests: A Digital Biomarker to Detect Therapy Compliance and Assess Schedule Quality in Measurement-Based eHealth Systems for Alcohol Use Disorder.
AuthorsZetterström, A; Hämäläinen, MD; Karlberg, E; Winkvist, M; Söderquist, M; Öhagen, P; Andersson, K; Nyberg, F
JournalAlcohol and alcoholism (Oxford, Oxfordshire)
Publication Date1 Jan 2019
Date Added to PubMed13 Dec 2018
AbstractTo evaluate, in a breathalyzer-based eHealth system, whether the time-based digital biomarker 'maximum time between tests' (MTBT) brings valuable information on alcohol consumption patterns as confirmed by correlation with blood phosphatidyl ethanol (PEth), serum carbohydrate deficient transferrin (CDT) and timeline follow-back data. Data on 54 patients in follow-up for treatment of alcohol use disorder were analysed. The model of weekly averages of 24-log transformed MTBT adequately described timeline follow-back data (P  <  0.0001, R =  0.27-0.38, n  =  650). Significant correlations were noted between MTBT and PEth (P  <  0.0001, R  =  0.41, n  =  148) and between MTBT and CDT (P  <  0.0079, R  =  0.22, n  =  120). The time-based digital biomarker 'maximum time between tests' described here has the potential to become a generally useful metric for all scheduled measurement-based eHealth systems to monitor test behaviour and compliance, factors important for 'dosing' of eHealth systems and for early prediction and interventions of lapse/relapse.
TitleGoing digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice.
AuthorsKeasberry, J; Scott, IA; Sullivan, C; Staib, A; Ashby, R
JournalAustralian health review : a publication of the Australian Hospital Association
Publication Date1 Dec 2017
Date Added to PubMed9 Jan 2017
AbstractObjective The aim of the present study was to determine the effects of hospital-based eHealth technologies on quality, safety and efficiency of care and clinical outcomes. Methods Systematic reviews and reviews of systematic reviews of eHealth technologies published in PubMed/Medline/Cochrane Library between January 2010 and October 2015 were evaluated. Reviews of implementation issues, non-hospital settings or remote care or patient-focused technologies were excluded from analysis. Methodological quality was assessed using a validated appraisal tool. Outcome measures were benefits and harms relating to electronic medical records (EMRs), computerised physician order entry (CPOE), electronic prescribing (ePrescribing) and computerised decision support systems (CDSS). Results are presented as a narrative overview given marked study heterogeneity. Results Nineteen systematic reviews and two reviews of systematic reviews were included from 1197 abstracts, nine rated as high quality. For EMR functions, there was moderate-quality evidence of reduced hospitalisations and length of stay and low-quality evidence of improved organisational efficiency, greater accuracy of information and reduced documentation and process turnaround times. For CPOE functions, there was moderate-quality evidence of reductions in turnaround times and resource utilisation. For ePrescribing, there was moderate-quality evidence of substantially fewer medications errors and adverse drug events, greater guideline adherence, improved disease control and decreased dispensing turnaround times. For CDSS, there was moderate-quality evidence of increased use of preventive care and drug interaction reminders and alerts, increased use of diagnostic aids, more appropriate test ordering with fewer tests per patient, greater guideline adherence, improved processes of care and less disease morbidity. There was conflicting evidence regarding effects on in-patient mortality and overall costs. Reported harms were alert fatigue, increased technology interaction time, creation of disruptive workarounds and new prescribing errors. Conclusion eHealth technologies in hospital settings appear to improve efficiency and appropriateness of care, prescribing safety and disease control. Effects on mortality, readmissions, total costs and patient and provider experience remain uncertain. What is known about the topic? Healthcare systems internationally are undertaking large-scale digitisation programs with hospitals being a major focus. Although predictive analyses suggest that eHealth technologies have the potential to markedly transform health care delivery, contemporary peer-reviewed research evidence detailing their benefits and harms is limited. What does this paper add? This narrative overview of 19 systematic reviews and two reviews of systematic reviews published over the past 5 years provides a summary of cumulative evidence of clinical and organisational effects of contemporary eHealth technologies in hospital practice. EMRs have the potential to increase accuracy and completeness of clinical information, reduce documentation time and enhance information transfer and organisational efficiency. CPOE appears to improve laboratory turnaround times and decrease resource utilisation. ePrescribing significantly reduces medication errors and adverse drug events. CDSS, especially those used at the point of care and integrated into workflows, attract the strongest evidence for substantially increasing clinician adherence to guidelines, appropriateness of disease and treatment monitoring and optimal medication use. Evidence of effects of eHealth technologies on discrete clinical outcomes, such as morbid events, mortality and readmissions, is currently limited and conflicting. What are the implications for practitioners? eHealth technologies confer benefits in improving quality and safety of care with little evidence of major hazards. Whether EMRs and CPOE can affect clinical outcomes or overall costs in the absence of auxiliary support systems, such as ePrescribing and CDSS, remains unclear. eHealth technologies are evolving rapidly and the evidence base used to inform clinician and managerial decisions to invest in these technologies must be updated continually. More rigorous field research using appropriate evaluation methods is needed to better define real-world benefits and harms. Customisation of eHealth applications to the context of patient-centred care and management of highly complex patients with multimorbidity will be an ongoing challenge.
Title[Telemedicine in Germany].
AuthorsMarx, G; Beckers, R
JournalBundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
Publication Date1 Oct 2015
Date Added to PubMed22 Aug 2015
TitleThe use of telemedicine in Italian Blood Banks: a nationwide survey.
AuthorsBerti, P; Verlicchi, F; Fiorin, F; Guaschino, R; Cangemi, A
JournalBlood transfusion = Trasfusione del sangue
Publication Date1 Jan 2014
Date Added to PubMed15 Nov 2012
AbstractTelemedicine is defined as the use of electronic information and communication technologies to provide health care between distant people. Many activities in transfusion medicine could benefit from the application of telemedicine. To map the spread of the use of telemedicine in transfusion medicine in Italy, the Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) performed a nationwide survey: the results are presented in this paper. A survey, dealing with different aspects of the use of telemedicine, was performed by sending a questionnaire to 280 Italian Blood Centres. The survey was designed to evaluate the diffusion of telemedicine and the features of the systems, with special attention to the systems' safety and legal adequacy. One section of the questionnaire was designed to identify the features of the systems considered essential by the respondents. Out of 280 Blood Services contacted, 196 (70%) filled in at least one of the questions of the online questionnaire. Globally the use of some form of telemedicine was reported by 70% of the respondents. Telemedicine is used for remote validation of laboratory tests by 32% of the Centres that responded, for remote biological validation of blood units by 34% and for assignment of blood components by 29%. Less frequently, telemedicine is used to control electronic refrigerators, for electronic blood requests and for bed-side identification of patients. The use of telemedicine is widespread in Italian Blood Services. There appears to be some heterogeneity between structures with regards to the evaluation of the systems' safety and their legal adequacy. No telemedicine system should be introduced into practice until it has proven to have the same standards of safety as the corresponding "on site" activity.
TitleAn e-health driven laboratory information system to support HIV treatment in Peru: E-quity for laboratory personnel, health providers and people living with HIV.
AuthorsGarcía, PJ; Vargas, JH; Caballero N, P; Calle V, J; Bayer, AM
JournalBMC medical informatics and decision making
Publication Date10 Dec 2009
Date Added to PubMed17 Dec 2009
AbstractPeru has a concentrated HIV epidemic with an estimated 76,000 people living with HIV (PLHIV). Access to highly active antiretroviral therapy (HAART) expanded between 2004-2006 and the Peruvian National Institute of Health was named by the Ministry of Health as the institution responsible for carrying out testing to monitor the effectiveness of HAART. However, a national public health laboratory information system did not exist. We describe the design and implementation of an e-health driven, web-based laboratory information system--NETLAB--to communicate laboratory results for monitoring HAART to laboratory personnel, health providers and PLHIV. We carried out a needs assessment of the existing public health laboratory system, which included the generation and subsequent review of flowcharts of laboratory testing processes to generate better, more efficient streamlined processes, improving them and eliminating duplications. Next, we designed NETLAB as a modular system, integrating key security functions. The system was implemented and evaluated. The three main components of the NETLAB system, registration, reporting and education, began operating in early 2007. The number of PLHIV with recorded CD4 counts and viral loads increased by 1.5 times, to reach 18,907. Publication of test results with NETLAB took an average of 1 day, compared to a pre-NETLAB average of 60 days. NETLAB reached 2,037 users, including 944 PLHIV and 1,093 health providers, during its first year and a half. The percentage of overall PLHIV and health providers who were aware of NETLAB and had a NETLAB password has also increased substantially. NETLAB is an effective laboratory management tool since it is directly integrated into the national laboratory system and streamlined existing processes at the local, regional and national levels. The system also represents the best possible source of timely laboratory information for health providers and PLHIV, allowing patients to access their own results and other helpful information about their health, extending the scope of HIV treatment beyond the health facility and providing a model for other countries to follow. The NETLAB system now includes 100 diseases of public health importance for which the Peruvian National Institute of Health and the network of public health laboratories provide testing and results.
TitleApplications and Developments of Telemedicine in Greece.
AuthorsTsioumanis, V; Mangita, A; Diomidous, M
JournalStudies in health technology and informatics
Publication Date1 Dec 2016
Date Added to PubMed29 Jun 2016
AbstractThe need to transmit medical information with images, data and voice from distance via telecommunications has come to our knowledge from ages. The topic has a new interest because of the progress in technology of telecommunications and information systems. The current article makes an effort to inform the reader in a simple way about what Telemedicine is and where it can be used. In this paper is presented the definition and the purpose of telemedicine, followed by the services provide through telemedicine applications. Finally, is analyzed the use of telemedicine in Greece its advantages, benefits and disadvantages, concluding with a final evaluation of it.
TitleReshaping the laboratory results presentation layer: three interfaces for handheld devices.
AuthorsEhrler, F; Brissaud, M; Wipfli, R; Lovis, C
JournalStudies in health technology and informatics
Publication Date1 Dec 2015
Date Added to PubMed21 May 2015
AbstractThe interpretation of laboratory results is a critical part of the clinical decision making process. The proper understanding of many clinical conditions depends on the identification of evidences in the laboratory reports. If the classic tabular presentation of laboratory results has demonstrated its efficiency since many years, the increase number of potential results, the increased complexity of cases and the time shortage to analyses cases raise the question of finding more efficient ways of displaying these results to clinicians. The presentation layer becomes even more crucial when it comes to small-sized interactive displays. In this work, we discuss three alternative graphical representations of laboratory results adapted to handheld devices.
TitleeHealth in the future of medications management: personalisation, monitoring and adherence.
AuthorsCar, J; Tan, WS; Huang, Z; Sloot, P; Franklin, BD
JournalBMC medicine
Publication Date5 Apr 2017
Date Added to PubMed6 Apr 2017
AbstractGlobally, healthcare systems face major challenges with medicines management and medication adherence. Medication adherence determines medication effectiveness and can be the single most effective intervention for improving health outcomes. In anticipation of growth in eHealth interventions worldwide, we explore the role of eHealth in the patients' medicines management journey in primary care, focusing on personalisation and intelligent monitoring for greater adherence. eHealth offers opportunities to transform every step of the patient's medicines management journey. From booking appointments, consultation with a healthcare professional, decision-making, medication dispensing, carer support, information acquisition and monitoring, to learning about medicines and their management in daily life. It has the potential to support personalisation and monitoring and thus lead to better adherence. For some of these dimensions, such as supporting decision-making and providing reminders and prompts, evidence is stronger, but for many others more rigorous research is urgently needed. Given the potential benefits and barriers to eHealth in medicines management, a fine balance needs to be established between evidence-based integration of technologies and constructive experimentation that could lead to a game-changing breakthrough. A concerted, transdisciplinary approach adapted to different contexts, including low- and middle-income contries is required to realise the benefits of eHealth at scale.
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