Telemedicine and Main Issues in Developing Countries: A General Review Mehrdad Jabbarzadeh Gangeh Dr. Edmond Zahedi Dr. Mohd. Alauddin Mohd. ALi Department of Electrical, Electronics and Systems Engineering Faculty of Engineering Universiti Kebangsaan Malaysia

Is telemedicine and its deployment in developing countries effective? Improving the quality of health care Simplifying access to health care Decreasing costs

Issues: Difficulties of Health Care in Developing Countries Definition of Telemedicine Different Types of Telemedicine Systems Hardware, Software, and Bandwidth Requirement for the Different Types of Telemedicine Systems Potential of Telemedicine to Improve Health Care in Developing Countries Expected Problems with Telemedicine

Access to local health services Introduction to the Difficulties of Health Care in Developing Countries Few number of doctors Access to local health services Shortage of high level hospital infrastructure The geographical distribution of existing hospital and health services In Short: 1) Limited medical expertise and resources 2) Concentration of facilities in metropolitan areas

Telemedicine Definition According to ITU Use of telecommunications and medical technologies Exchange data, audio and/or visual Between physician and patient or between physician and health care professional Geographically separate locations On-line or off-line

Different types of Telemedicine Systems According to Their Use in Health Care Teleconsultation Telediagnosis Tele-education Medical emergencies and distant relief Telesurgery and virtual reality

Different types of Telemedicine Systems According to the Medical Applications Teleradiology : X- Ray CT MRI NM (Nuclear Medicine) Fluoroscopy Angiography Ultrasound Thermography Telepathology Teledermatology Tele-endoscopy Telecardiology Telepsychiatry Telepharmacy Telemetry

Different Applications of Telemedicine Systems: Definition, Transfer Need and Required Stream

Multimedia Stream and Their Bandwidth Requirement

Required transfer time of an X-ray image with the size of 64 Mb Bandwidth Requirement for Telemedicine Systems and Telecommunication Networks Factors influencing the choice of a special telecommunication service are: Necessary bandwidth the volume of data to be transferred (depends on the type of service, application and the quality of service) required transfer speed Infrastructure and telecommunication facilities available in rural parts Price of the service Required interfaces of the equipment in use to the telecommunication network Required transfer time of an X-ray image with the size of 64 Mb

Hardware and Software Required for Different Types of Telemedicine Systems Central Processing Unit: Media Acquisition Image Video Audio Media Storage Compression/Decompression Algorithms/Standards Image and/or Video Processing User Interface Communication Media/Interface Special Medical Equipment

Potential Improvements (Non Financial) Long distance consultation Quality health care in remote areas New ways for education and training Improvement in qualification of national specialists and health technicians Second opinion and centralisation of resources (specialists, hardware, and software packages) Reduction of waiting times for consultation

Potential Improvements (Financial) Cost reduction For patients: Cutting down on journeys to major health centres or for specialist consultation Reduction of length of stay, and therefore cost of hospitalisation For providers of health services: Reduction in operating costs Reduction in travel cost and time for specialist visiting other hospitals Reduction in costs of training

Expected Problems with Telemedicine in Third World Countries (1) 1) Financial: Increase of costs because of improving the quality of service through providing second opinion They are not used very often Who pays for the expenses Cost effectiveness assessment 2) Liability: Who is responsible for the patient? Anyone can establish a web site to offer consulting

Expected Problems with Telemedicine in Third World Countries (2) 3) Acceptance: Physicians resist to use a new technology that they do not understand Patients and doctors are accustomed to personal visits and are reluctant to alter the traditional method of care Privacy and confidentiality of information Insurance 4) Technology: Scarcity of high-bandwidth telecommunication networks in rural areas Compatibility of old equipment with telemedicine

Conclusion (1) Telemedicine can potentially improve health care in developing countries through: Providing the services in rural and difficult to access parts of the country Providing the possibility of concentration of expertise and resources Reduction of costs for both patients and providers of health services in some aspects However, the acceptance and further development of telemedicine depends on factors among them are: Some cost/benefit analysis Types of telemedicine systems and applications that are mostly required in a special country

Conclusion (2) The cost/benefit analysis can be carried out by the ministry of health and finance ministry Close cooperation between the medical society and engineers Pilot projects Education

Telemedicine and Main Issues in Developing Countries: A General Review Mehrdad Jabbarzadeh Gangeh Dr. Edmond Zahedi Dr. Mohd. Alauddin Mohd. ALi Department of Electrical, Electronics and Systems Engineering Faculty of Engineering Universiti Kebangsaan Malaysia