A New Era of Telemedicine

Heath care systems in the Global South are often handicapped by a chronic lack of medical equipment, expertise and experience. One of the biggest barriers to providing high quality healthcare access has been limits to the transfer of knowledge and expertise amongst medical practitioners, universities, hospitals and patients.

Expertise however is the often the most difficult to translocate, even more so than equipment or drugs. If a young medical practitioner in a remote area could get a second opinion and advice on management of difficult medical cases from a more experienced doctor, it could be a game changer. Telemedicine does just that. It facilitates a virtual interaction between a patient and a doctor- allowing both remote observance of clinical signals and well as remote monitoring of vital functions through ECGs, Xrays etc. Response to treatment can also be monitored.

Telemedicine as we understand it today has been around for centuries. Starting in the 1950’s, hospitals had begun to share medical information and images via the telephone. [1] However, the absence of effective systems coupled with a general skepticism towards redefining the crucial patient-doctor interaction, meant that even with the internet, telemedicine never took off. However, over the past few years, faster internet connectivity and ubiquitous smartphones have made electronic communication in the health community reliable and a real solution. [2]

The Organisation:

Mèdecins Sans Frontières (MSF) or Doctors without Borders is an international humanitarian organization that aims to provide medical cover to war torn regions, after natural calamities and after epidemics. Created after the Biafra secession in 1971, the organization provides health care and medical training in around 69 countries across the word. [3] In 1999 the organization received the Nobel Peace Prize. [4]

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The mission of MSF has always been to transcend national borders to ensure universal and quality, healthcare access for all, and to bring cutting edge medical care to the poorest and most underserved of nations. In order to achieve its mission, MSF has often been at the forefront of pioneering innovations in resource-limited contexts- from automated TB and malaria diagnostics to inflatable hospitals. [5]

The Tele expertise program:

MSF teams are deployed to zones where natural and man-made catastrophes occur. The scope of sending medical teams and equipment to these regions is limited. High end medical expertise cannot be translocated without depriving the parent organizations and apex institutes. Within this context, MSF has embraced telemedicine to increase their reach by providing high end expertise from apex institutes to areas with dysfunctional health systems.

In 2010, Mèdecins Sans Frontières started three medical tele-expertise networks in English, French and Spanish. In 2013 this was combined into a single multi-lingual network. [6] [7] The aim was to facilitate expertise sharing from specialists working in apex institutes to field clinicians who were working in relative isolation with limited resources and expertise. [8] Today, there are more than 280 volunteer experts from over the world who are a part of this network and more than 350 field clinicians have access to the system. Over the past six years, MSF’s telemedicine platform has been growing rapidly with an average of five to six cases received each day. By February 2016, the platform had received over 3,000 cases. [9]

Challenges:

While majority of the focus within telemedicine has been for nonemergency issues, there are serious concerns around the quality of care being offered through these solutions. Misdiagnosed serious conditions or incorrect prescriptions have not been uncommon. [10] Moreover, this channel is hard to regulate. Issues regarding responsibility in case of an adverse outcome is a legal imbroglio. Local laws and licensing regimes may offer challenges. Many of these issues could be tackled if the expertise provider and the recipient developed mutual trust and a familiarity based on association and respect.

Future Potential:

The provision of providing tele-expertise for ICU Care [11] & geriatric care [12] in remote areas has improved the quality of service and the platform is often used for surgical advice. Tele-surgery could evolve into tele-presence surgery & even robotic tele surgery. Through tele-presence and tele-guidance an experienced operator, from another location, can provide guidance to a less experienced colleague who is performing the actual surgery in real time. With robotic tele-surgery, the remotely located experienced surgeon controls a mechanical arm or machine which is used to perform a surgical procedure. High fidelity real time images of the operative field guide the surgeon who can control the instruments with precision [13].

By adopting technology and digital innovation into its business model in this way, MSF can continue to move closer towards achieving its mission of equal access to high quality healthcare across borders.

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References:

1. Chiron Health. 2016. What is Telemedicine?. [ONLINE] Available at: http://chironhealth.com/telemedicine/what-is-telemedicine/. [Accessed 14 November 2016].
2. MSF USA. 2016. MSF Telemedicine Brings Care to Patients in Remote Areas | MSF USA. [ONLINE] Available at: http://www.doctorswithoutborders.org/article/msf-telemedicine-brings-care-patients-remote-areas. [Accessed 14 November 2016]
3. Médecins Sans Frontières (MSF) International. 2016. MSF history | Médecins Sans Frontières (MSF) International. [ONLINE] Available at: http://www.msf.org/en/msf-history. [Accessed 12 November 2016]
4. MSF USA. 2016. The Nobel Peace Prize | MSF USA. [ONLINE] Available at: http://www.doctorswithoutborders.org/about-us/history-principles/nobel-peace-prize. [Accessed 11 November 2016]
5. 2016. Frontiers | Teledermatology in Low-Resource Settings: The MSF Experience with a Multilingual Tele-Expertise Platform | Public Health Education and Promotion. [ONLINE] Available at: http://journal.frontiersin.org/article/10.3389/fpubh.2014.00233/full. [Accessed 18 November 2016].
6. Laurent Bonnardot,1,2,* Joanne Liu,3,4 Elizabeth Wootton,5 Isabel Amoros,6 David Olson,7 Sidney Wong,8 and Richard Wootton9,10The Development of a Multilingual Tool for Facilitating the Primary-Specialty Care Interface in Low Resource Settings: the MSF Tele-Expertise System. Front Public Health. 2014; 2: 126.
7. Wootton R, Geissbuhler A, Jethwani K, Kovarik C, Person DA, Vladzymyrskyy A, Zanaboni P, Zolfo M.Long-runningtelemedicine networks delivering humanitarian services: experience, performance and scientific output.Bull World Health Organ. 2012 May 1;90(5):341-347D
8. Bonnardot L, Wootton E, Liu J, Steichen O, Bradol JH, Hervé C, Wootton R. User Feedback on the MSF Tele-Expertise Service After a 4-Year Pilot Trial - A Comprehensive Analysis. Front Public Health. 2015 Nov 20;3:257.
9. Melinda Beck. 2016. How Telemedicine Is Transforming Health Care – WSJ. [ONLINE] Available at: http://www.wsj.com/articles/how-telemedicine-is-transforming-health-care-1466993402. [Accessed 18 November 2016].
10. Whitten PS¹,Mair FS, Haycox A, May CR, Williams TL, Hellmich S. Systematic review of cost effectiveness studies of telemedicine interventions.  2002 Jun 15;324(7351):1434-7.
11. Sapirstein A¹,Lone N, Latif A, Fackler J, Pronovost PJ. Tele ICU: paradox or panacea? Best Pract Res Clin Anaesthesiol. 2009 Mar;23(1):115-26.
12. KhunlertkitA, Carayon P. Contributions of tele-intensive care unit (Tele-ICU) technology to quality of care and patient safety.. J Crit Care. 2013 Jun;28(3):315
13. Marescaux J, Leroy J, Gagner M, Rubino F, Mutter D, Vix M, Butner SE, Smith MK. Transatlanticrobot-assisted  Nature. 2001 Sep 27;413(6854):379-80