"Healthcare deployment is largely based on workflow and this involves
understanding the culture, religion, taboos and idiosyncrasies"
Store-and-forward (synchronous). In the real-time model, medical data and information are
transmitted as it is being acquired (e.g. video conferencing with attachment of medical equipments). This allows an expert opinion to be sought instantly. In the store-and-forward model, patient’s medical data/information are acquired and stored locally before being forwarded to an expert doctor at other centre at a later time. This is usually implemented for non-emergency use, or in situations where the doctor’s presence is not required at the time of data transfer.
DETERMINE YOUR CLINICAL COMPLEXITY The next step would be to determine the level of clinical requirements. Is the telehealth implementation intended for primary diagnosis or for second/expert opinion? Or is it meant for teaching purpose? Start by examining the clinical discipline, the modality type and complexity of diagnosis required. For example: Patient screening or even follow-up visits for chronic disease with telehealth in the primary care and long-term care segment is extremely easy as the complexity and urgency level is relatively low Remote primary diagnosis of radiology images acquired by a 4-slice CT will probably will not require advance functionalities (e.g. CT MPR for 3D reconstruction) Remote ECG monitoring for high-risk patients would require a real- time and notification tools. It is important to understand that you are providing healthcare
services in rural health, hence the level of complexity in all possible factors should be reduce as there are restrictions in terms of resources (e.g. network bandwidth, advance equipment) and manpower (qualified nurses and/or paramedical staff).
SUSTAINABILITY Uncovering your workflow requirements is just the beginning, it is also important to ensure that the relevant solution is chosen, implemented and supported properly to ensure continuity of care for patients.
AVOID THE BELLS AND WHISTLES When evaluating the solution of choice, do not buy additional functionalities that are not applicable to the scope of work. This is to prevent unnecessary increase of capital purchase (the actual software) as well as related cost that are incurred due to the additional functionalities (e.g. upgrade of equipment like workstation and infrastructure cost like additional network bandwidth).
EASE OF DEPLOYMENT Implementing a telehealth solution in a rural setting can pose some unique challenges, accessibility is one of them. So what do I mean by accessibility? Well, I am referring to the actual environment where the solution is being deployed. The level of remoteness can vary
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considerably, making it extremely costly (if not impossible) to deploy staff to conduct training or technical support. As such, it is important to pay close attention to the end-user’s experience – is application software intuitive/easy to learn and use? For the actual applications, try to select solutions that are ‘mobile’ (zero client installation). This is useful in situations of system failure, one can simply have the end-user switch to another workstation and launch the application to continue provision of care as opposed to unplanned downtime and the urgency to send someone onsite to diagnosis and rectify the problem.
RELEVANT IMPLEMENTATION EXPERIENCE This might sound obvious but what is not apparent is the familiarity with culture of the region where the solution is to be implemented. Healthcare deployment is largely based on workflow and this involves understanding the culture, religion, taboos and idiosyncrasies. For example, in some regions, face-to-face contact is considered an absolute must, hence in such implementations, consider utilising webcams to bridge the gap.
FUTURE PROOFING When implementing the solution, review your operation and business requirements and access if future expansion of the telehealth services will be required. Even if there are no foreseeable expansion plans in the near future, do not rule out the possibility that this might happen. Some areas of focus include: Examine the robustness and flexibility of the architecture, is it scalable or would a major replacement be required for such expansion? Data migration. Are the data stored in a proprietary format? How much would it cost to have them migrated over to a new platform? No information systems operates in silo, there will be situations where exchange of data is required. Does the solution support industry standards for data interoperability, (e.g. HL7) and how much would it cost for integration to other information systems?
SYSTEMS UPTIME The solution is of no purpose if it is not available when needed. Ensure operations continuity by having relevant ‘high availability’, ‘backup’ and ‘recovery’ as well as appropriate business continuity plans in place.
FINAL POINT The points mentioned above are by no means a comprehensive list but hopefully, it has highlighted some commonly overlooked areas in the planning of rural health provision via telehealth adoption. The most important guideline pertaining to telehealth (or healthcare informatics in general), is that it is not the latest or greatest technology that matters but rather, what benefits and value can be brought to the clinicians and more importantly, the patient. Always seek to understand the underlying pinpoints and then develop the solution to address the needs by utilizing the most affordable technology that will deliver the greatest benefits.
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