As part of a "Mobile Telemedicine" initiative undertaken by the Millennium Villages Project in Ghana, I have been researching and documenting existing software platforms that enable and support remote consultation activities.
How is mobile telemedicine defined? According to the the Rockefeller Foundation,
Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status or for educational purposes. It includes consultative, diagnostic, and treatment services.
Mobile health information technology (mHealth) typically refers to portable devices with the capability to create, store, retrieve, and transmit data in real time between end users for the purpose of improving patient safety and quality of care.
The flow of mobile health information is characterized by portable hardware coupled with software applications and patient data that flows across wireless networks. Mobile health enables clinical access to a variety of major software applications central to patient care and subsequently increases clinicians’ reach, mobility, and ease of information access, regardless of location. For example, a clinician might use a mobile device to access a patient’s electronic health record (EHR), write and transmit prescriptions to a pharmacy, interact with patient treatment plans, communicate public health data, order diagnostic tests, review labs, or access medical references.
Data transmission is realized by technologies common in everyday life including blue tooth, cell phone, infra-red, wifi, and wired technologies, all of which operate as part of a network. Mobile devices can be helpful across the health care spectrum—transmitting vital information quickly during an acute public health crisis or being used for on-going needs such as education and training. When utilized for patient care, mobile devices are credited with improving patient safety by eliminating errors commonly associated with paper-based medical records and enhancing the continuity of care. In addition to improved patient outcomes, workflow and administrative efficiencies from the use of mobile devices can produce cost savings for the user or user organization.
There are multiple telemedicine platforms, both open-source and commercial, that aim to reduce unnecessary referrals and improve quality of care at the point–of-care. Below are some open-source telemedicine platforms that I found.
I have focused on open-source applications for a couple of reasons. First, open-source applications are affordable than commercial products - at least in terms of licensing costs (albeit not maintenance costs, something organizations tend to foregt.) Because the source code is accessible, users also have greater customization capabilities and technical support will always be possible, even if not from the original software developers. Here are some open-source telemedicine platforms for consideration.
The iPATH Telemedicine Platform is an open-source software. Users can access the system via web and email and can collaborate in private working groups. Cases can also be relayed to the central server through special equipment, such as diagnostic tools or applications linked to mobile phones. The software also includes a case archive and automated and personalized notifications. iPATH was developed with health workers practicing in resource poor settings in mind.
Port St. Johns in the Eastern Cape of South Africa piloted the telemedicine system in the context of dermatology—teledermatology. Out of the 110 consultations, 105 consultations[1] reported diagnostic results were possible by using the system; out of the 110 consultations, 57 noted that telemedicine made a positive change for treatment (and slightly over 40 reported there was no difference). In the Ukraine, iPATH use was able to support regional clinics and decrease the number of unnecessary referrals.
iPATH software can be utilized for teleconsultation, collaboration, case management and the reduction of unnecessary referrals.
Developed by Johns Hopkins Center for Clinical Global Health Education, the electronic Mobile Open-source Comprehensive Health Application (eMOCHA) is an open-source application that is designed to assist health programs in developing countries through the coordination of wireless devices linked to a local clinic-based server. The program runs on Android-supported devices. It utilizes Open Data Kit (ODK) for data collection, and also supports the exchange of audio, visual and text media. The server component, which employs PHP and MySQL, aggregates and analyzes the data and also has the capability of displaying the information collected. Users also have the ability to customize components of the overall application.
Overall, this product was designed to assist health programs in resource poor settings by improving provider communication and education and patient care.
NB: Scheduled for release in early 2010.
MocaMobile, now called Sana, strives to support the provision of healthcare delivery in remote areas through mobile information systems. Currently, Sana supports remote diagnosis by medical specialists via the Android platform for mobile devices. Additionally, the customizable platform links to other mHealth and eHealth software.
Sana connects health workers to medical professionals, facilitates the collection and analysis of data, in addition to providing a number of customizable add-ons and integration with other systems. The system supports audio, image, location-based data, and text. Video will be supported in the near future. Applications for Sana include: physical diagnosis applications (cervical cancer screening, childhood sickness diagnostics, skin condition diagnosis); follow-ups post-surgery; emergency response (evaluation of motor vehicular crash scenes); Moca benefits (on-the-spot screening, specialty clinic follow-up).
To ensure reliable and low-cost data transfers, especially given the unreliable networks and infrastructure in most resource poor countries, Sana uses the following strategies: synchronization with the server (provided network is available—if network is unavailable, the information is stored on the phone), packetization (uploads large files in chunks so as not to completely lose data if a network failure occurs mid-upload), and multimodal transfers (transfer data on a variety of interfaces including GPRS, WiFi, SMS and USB). Sana also seamlessly interfaces with OpenMRS, among other open-source applications and will also integrate XForms into the platform.
Given the great interoperability of this system, users can customize not only the Sana system, but also the other open-source applications that integrate with Sana.
BigBlueButton offers high-quality, open-source teleconference software that can be used for remote telemedicine consultations.
This open-source software for mobile devices is focused on primary health homecare. The goal is to use mobile tools to promote the improvement of health services for people with low incomes.
The Borboleta Project seeks to develop mobile electronic health records capable of integrating text, audio and visual data; provide privacy and security for users and patients; synchronize mobile databases to reduce replication; transmit multimedia data over wireless networks to and from smartphones; data mining healthcare information; and human computer interaction and automatic speech recognition. It is unclear if the Borboleta Project will develop teleconsultation applications to be integrated into its platform.
Xebra is an open-source platform whereby facility-based reviews of medical imaging results are supported.
ZephyrOpen is an open-source Software Development Kit for Health Monitoring Devices that use blue tooth physiological sensors. The software is currently being reformatted for Android-enabled phones, but current codes can be supported by Java-enabled phones.
OpenVista(R) is the open-source version of OpenVistA. The healthcare information system was developed by the US Veterans Affairs. It is an in-patient and outpatient system. The system has a high degree of integration. However, it is not clear if teleconsultation can be supported by the system.
[1] The actual number of health workers conducting the consultations is unclear. This figure of 110 only reflects the number of consultations.
Photo courtsey Biko Biko
Mobile Telemedicine platforms Nadi.Kaonga
Thanks for a great review of the number and variety of different mobile applications for telemedicine -a broad spectrum of solutions, some better than others, to be sure. Those that are able to store and forward data seem especially well positioned given the still spotting network coverage in so many remote areas. I've circulated the link to this article among colleagues for their information. It's important that health programs leverage the years and millions invested in mobile technology and communications to extend much needed health services to those too distant to otherwise receive quality health care.
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