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What is telemedicine?

There is no generally accepted definition of telemedicine. The literal meaning is ‘health[care] at a distance’. Thus, telemedicine may represent health care practised in real time, using a video link for example, or asynchronously, perhaps by email. The type of health care interaction is perfectly general, and may encompass diagnosis and management, education – of staff, patients and the general population – and administrative meetings.

The history of telemedicine has been bedevilled by loose terminology, which, some observers feel, has not assisted its cause.¹ What began originally as ‘telemedicine’ has become successively ‘telehealth’, ‘online health’, ‘e-health’, ‘connected health’, etc. In this book, different contributors use slightly different terms to describe their telemedicine experience, depending on their local environment. While the editors have tried to reduce the number of terms used, we have deliberately not enforced a uniform terminology throughout, in recognition of these local differences.

Scope of the problem

Telemedicine is one aspect of the use of information and communication technology (ICT) in health care. It is widely believed that ICT generally has the potential to improve clinical care and public health. In addition to facilitating medical education, administration and research, appropriate use of ICT may:

• improve access to health care;
  
  
• enhance the quality of service delivery;
  
  
• improve the effectiveness of public health and primary care interventions;
  
  
• improve the global shortage of health professionals through collaboration and training.

However, many questions remain about the potential value to people in resource-constrained settings such as the developing world.

There are major problems of inequity of access to health care in developing countries, to which telemedicine offers a potential solution. It may be valuable in other ways as well.

Crisp report

In 2007, Lord Crisp reported about how UK experience and expertise in health could best be used to help improve health in developing countries^.2 He concluded that sufficient progress towards the United Nations’ Millennium Development Goals (e.g. in reducing child and maternal deaths, and tackling HIV/AIDS, tuberculosis and malaria) would not occur unless:

• developing countries are able to take the lead and own the solutions – and are supported by international, national and local partnerships based on mutual respect;
  
  
• the UK and other industrialized countries grasp the opportunity – and see themselves as having a responsibility as global employers – to support a massive scaling-up of training, education and employment of health workers in developing countries;
  
  
• there is much more rigorous research and evaluation of what works, systematic spreading of good practice, greater use of new information, communication and biomedical technologies, closer links with economic development, and an accompanying reduction in wasted effort.

Clearly, telemedicine could play a major part in facilitating all of these activities. Furthermore, one can imagine the consequences if every hospital in the richer countries were to be linked up on a formal basis with a small group of hospitals or health centres in developing countries. Through mutual learning and collaboration in health service provision, such health partnerships could ultimately change health-care delivery at the national level; they might also change how the industrialized nations perceive the world. Telemedicine and ICT would be essential to maximizing the potential of these health partnerships.

Aim of the book

Any discussion of telemedicine in the developing world raises difficult questions about resource use, sustainability and global equity in access to health care. Despite the large number of published articles on the concept of telemedicine in the developing world, there are remarkably few examples of successful implementation.³ In this book, we have attempted to assemble a representative cross-section of the very wide range of work that has been carried out to date. Thus, the book offers a state-of-the-art review of telemedicine in the developing world, and should also provide the basis for a high-level operations manual. It could be considered unethical, after all, not to learn from the experience of others and to squander scarce resources on an idea that may have already been proved to be unfeasible.

The major sections of the book cover policy, clinical and educational matters. We hope that you enjoy reading it.

References

¹ Wootton R. Telemedicine and isolated communities: a UK perspective. J Telemed Telecare 1999; 5(Suppl 2): 27–34.

² Crisp N. Global Health Partnerships. The UK Contribution to Health in Developing Countries. London: COI, 2007. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicy-AndGuidance/DH_065374.

³ Wootton R. Telemedicine support for the developing world. J Telemed Telecare 2008; 14: 109–14.

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