In an enclosed room at Rwanda Military Hospital in Kanombe, students listen attentively to instructions from a video interaction. This is part of their medical training, a session that allows them to interface with senior health professionals from top countries around the world. However, this practice is not entirely limited to teaching future doctors. On the opposite side of this hospital building, medics gather in a conference room to discuss sophisticated cases with other doctors from different hospitals who have more knowledge on the issues.
This is telemedicine; a trend of offering medical services that started as early as 2011 at Rwanda Military Hospital. The aim of this new approach was to improve student training and consequently medical service delivery through regular consultation of experts on advanced medical cases.
“Everyone is involved nowadays; it is part of the medical practice. Medical students follow the training in real time but the technology applies even in medical procedures. You could be having a patient here in Rwanda but get guidance from other countries,” says Dr Pacifique Mugenzi, the head of research and education at Rwanda Military Hospital.
Dr Mugenzi, who is also a trained oncologist, adds that at least once a week, doctors at the hospital meet to discuss complicated cases with other doctors, eventually deriving useful solutions.
“We have discussed surgical cases, gynaecological cases and I recall a liver case where we deliberated about its management. Many issues are involved in these discussions but most of them revolve around surgery,” adds Dr Mugenzi.
How telemedicine works
Telemedicine is a form of electronic health that involves the use of telecommunication and information technologies to provide clinical healthcare from a distance.
Unlike the ordinary practice that requires patients to interface with doctors face-to-face, barriers of access to medical services such as long distance are not involved in telemedicine, meaning that medical services that would be unavailable in some distant communities can be provided.
Dr Mugenzi adds that currently the Rwanda Military Hospital is using telemedicine to train undergraduate and post-graduate doctors from the country to solve the problem of distance and travel costs required for physical presence.
“From Kigali to Butare, for instance, you would actually need a number of hours to travel but we are using telemedicine to shorten the process. Even senior lecturers elsewhere need not move to Rwanda to conduct lessons,” he adds.
Telemedicine provides a base to collaborate with hospitals all over the world and Rwanda Military Hospital has been working with institutions such as the Mercy Hospital in Oklahoma, USA.
The recently signed memorandum of understanding between Rwanda and South Korea will improve the quality of telemedicine offered at Rwanda Military Hospital and other referral hospitals within the country.
Also, this arrangement is expected to improve hospital information system (HIS) and provision of ICT-based medical services.
“Much as the pact is still in early stages, Korea is far more advanced in the field of telemedicine. For example, they may have health centres without all the facilities but use the technology to treat people from another centre with the necessary facilities. During the visit of their delegation, they made assessments on the infrastructure at the hospital. We performed exchanges using telemedicine between RMH and Bushenge to exhibit whether the systems would support the project,” Dr Mugenzi explains.
Like any other medical procedure, use of telemedicine requires some specialised equipment mostly in the field of information technology.
According to Fredrick Nzabahimana, the IT officer in charge of telemedicine at the hospital, the sessions are conducted in form of videoconferencing that requires services like a stable internet connection, among others.
“You need a broadband connectivity and a public IP to allow the user to connect to other people in other countries. The screen and the camera are sometimes combined especially for the new equipment but could be co-joined if separate,” explains Nzabahimana.
At the military hospital, the duration of a session is normally between 30 minutes to one hour.
Although telemedicine goes as far as administering pharmaceuticals to people, Nzabahimana points out that without an upgraded system some services in telemedicine are difficult to provide.
He, however, maintains that required expertise is necessary and forging partnerships with other people come in handy.
“It is possible to use remote communication information facilitates in clinical care but you need well-trained doctors and IT staff. This is the future of treatment that provides many options for doctors to communicate with the patient and also with other people in the same field,” he adds.
Removing barriers to global health
A global survey by the World health Organisation on e-health found that information and communication technologies have great potential to address some of the challenges faced by both developed and developing countries in providing cost-effective, high-quality health care services.
Telemedicine uses ICT to overcome geographical barriers and increase access to healthcare services. This is particularly beneficial for rural and underserved communities in developing countries – groups that traditionally suffer from lack of access to health care.
In developed countries like the US, acute care through e-health account for more than $370 billion or 29 per cent of annual healthcare costs.
Similarly, results from the Banner Health trial showed that compared with standard telehealth-based care delivery model in the medical/surgical unit reduced the length of stay by 17 per cent, the cost of care per case by 16 per cent, death or discharge to hospice care by 26 per cent, and accidents from falls by 36 per cent.
Much as telemedicine developments are already profound in Rwanda’s referral hospitals, findings suggest that there is close linkage between such technology and the use of robotics. The deployment of drones to distribute medical services to rural health areas of the country will be an added advantage.
How to use telemedicine
Personal health apps
A multitude of apps have been created to help consumers better organise their medical information, in one secure place. These digital tools allow you to store health records, upload information from devices, such as a blood glucose monitor or blood pressure cuff, and share information with your health care providers. Some even offer personalized reminders and recommendations.
Some companies provide their employees with access to a collection, or portal, of health care apps as a workplace benefit. These websites allow employees to complete health assessments, get medical advice, find a plan-approved health care provider, and get advice and information on staying healthy. Some companies are even experimenting with e-visits, so employees can “see” the doctor without having to take time away from work.
Home health monitoring
Do you check your blood pressure at home? How do you get your results to your doctor? Home health monitoring makes that easy.
Devices such as blood pressure monitors can be connected to the Internet or to video equipment that allows real-time, face-to-face interaction with health care providers. Home health monitoring can be particularly useful for people with chronic diseases, such as heart disease, as well as those who live in rural or remote areas. The benefits are greater convenience, fewer office visits, and easier access to medical care and advice.
Even more exciting is the advent of wearable monitoring systems. These devices are connected through networks to a clinic or monitoring center. These devices can assess sounds, images, body motion, and vital signs such as blood pressure, body temperature, heart rate and pulse, body weight, and blood oxygenation. Devices can also monitor sleep patterns and physical activity.
“Smart homes” take home monitoring one step further. A smart home is equipped with sensors and automated devices designed for remote monitoring, early detection of problems or emergencies, and promotion of safety and quality of life. Such a home might include a sensor system that assesses your vital signs and activity, and provides security monitoring and response.
Smart homes and wearable monitoring devices offer the potential of enabling older adults to live independently, if they prefer, rather than in assisted living facilities.
Doctors talking to doctors
Doctors can also take advantage of technology to provide better care to their patients. One example is virtual consultations that allow primary care doctors to get input from specialists when they have questions about a particular diagnosis or treatment. The primary care doctor sends test results, X-rays or other images to the specialist to review. The specialist can respond electronically or request a face-to-face meeting if needed. In some cases, the specialist may even “see” the patient via video.
The potential of telehealth
While technology undoubtedly has a cool factor, it isn’t just fun and games. Technology has the potential to improve the quality of health care and to make it accessible to more people. Indeed, the Department of Health and Human Services has included greater use of technology as one of its Healthy People 2020 objectives for improving the health of all Americans. Isn’t it time to make telehealth work for you?