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Health Care: Delivery, Education, Communication

An Internet-Based Telemedicine System in Nigeria

Olumide Sunday Adewale
Department of Computer Science, Federal University of Technology

1. Introduction

Telecommunication technologies are being used to change the healthcare industry in unprecedented and irreversible ways. These technologies are enabling delivery of healthcare to remotely placed patients and facilitating information exchange between generalists and specialists. For many decades now, the use of advanced telecommunications and information technologies has been investigated in an effort to improve healthcare. In particular, the focus has been centered on telemedicine. Telemedicine has been defined as the delivery of healthcare and the exchange of health information across distances, including all medical activities: making diagnosis, treatment, prevention, education and research (Craig, 1999). Telemedicine is also defined as the use of telecommunication technologies to provide medical information and services (Perednia & Allen, 1995). It may be as simple as two health professionals discussing a patient's case over the telephone, or as sophisticated as using satellite technology to broadcast a consultation between healthcare centres in two countries using videoconferencing equipment. The American Telemedicine Association defines telemedicine as the use of medical information exchanged from one site to another via electronic communication for health and education of the patient or healthcare providers and for the purpose of improving patient care (ATA, 2001). Wootton (1996) considered telemedicine as a process, rather than a technology: telemedicine connects patients and healthcare professional in a chain of care.

Telemedicine, the provision of healthcare services, clinical information, and education over a distance using telecommunication technology existed long before the Internet. Some authors noted that telemedicine was broadly conceived even when the term was used almost three decades ago (Willemain & Mark, 1971). Some of the first telemedicine reports were of group therapy (Wittson, Affleck, & Johnson, 1961), nursing interactions (Cunningham, Marshall, & Glazer, 1978), education and training (Menolascino & Osborne, 1970), telemetry (Fuchs, 1979), televisits to community health workers (Straker, Mostyn, & Marshall, 1972), and home care (Mark, 1974), among other applications. In many cases, no physician was involved, and interactivity was not a necessary part of the transaction.

Telemedicine provides a solution to the problems of accessing healthcare, especially among rural populace or in developing countries such as Nigeria, where the lack of availability of information for medical management and physical barriers such as geographic isolation prevent patients from reaching healthcare practitioners to meet their needs. Telemedicine is proving invaluable as the trend of the medical profession grows increasingly towards specialities and subspecialities. Now a patient visiting a general practitioner can consult a specialist via telecommunication facilities, saving both considerable amount of time and money for quality medical care as opposed to the increasingly outdated method of transporting the patient to the specialist for a face-to-face visit.

Telemedicine's applications have also been encouraged due to the widespread use of cheaper, more user-friendly telecommunication equipments such as personal computers, Internet access, satellites, videoconferencing, and telephone among others. The objectives of telemedicine and its applications are to enhance citizen's equality in the availability of various medical services and healthcare despite geographical and economic barriers, to reduce direct and indirect cost (loss of production or income) to patients and the healthcare industry, to save travel time and costs for both practitioners and patients from one geographical location to another, and to improve consultation and co-operation among various units of healthcare in both special cases and primary care by bridging the distance between practitioners and specialists.

Currently, Nigeria has a population of more than 120 million people, a major percentage of which live in the remote rural and poorer areas with most of the best equipped hospitals including teaching hospitals and medical experts located in the urban cities. This situation prevented the majority of people living in remote rural areas from reaching healthcare practitioners to meet their medical service needs. Consequent upon this, governments at federal, state and local levels have been making healthcare in these remote areas their focal point over the years so as to enhance the citizen's equality in the availability of various medical services and clinical healthcare despite geographic isolation; but this has not yielded any serious results. Therefore, establishment of an Internet-based telemedicine system would be most useful in achieving government's aims of enhancing citizen's equality in the availability of various medical services and clinical healthcare despite geographic and economic barriers. This among others would improve quality of healthcare in rural and outlying areas, lower costs of delivering healthcare and give remotely placed physicians the opportunity to consult any patient's case. In this paper, an Internet-based telemedicine environment is developed for Nigeria specifically to support consultations among physicians and provide a secure access to remote patient records. It further discusses some of the challenges and implementation issues of telemedicine in Nigeria.

Thus the rest of this paper consists of: Section 2 focuses on the history of telemedicine since preelectronic era to date while Section 3 presents the Internet-based telemedicine system in Nigeria. Section 4 examines some of the challenges and implementation issues of the system in Nigeria while Section 5 concludes the paper.

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