Medical Teleconsultation System for Healthcare Professionals in Remote and Austere Environments

Resumen

Access to quality healthcare is a privilege that many urban, well-connected communities enjoy, but providing the same level of care to remote and underdeveloped areas can be difficult. This is particularly true in areas with limited access to specialist knowledge and equipment. However, telemedicine has been shown to improve healthcare outcomes by enabling medical professionals to share patient information remotely and receive specialist advice and diagnoses. Studies show this can improve patient outcomes by bridging the gap between urban and rural healthcare access. The Ministry of Public Health in Ecuador recognised the benefits that telemedicine services could offer, particularly in rural areas where access to medical specialists is lacking. In the late 2000s, the Ecuadorean government introduced the National Telemedicine/Telehealth Program which resulted in the launch of a pilot project focused on providing aid to doctors working in remote Amazonian communities as part of their mandatory rural service. A follow-up evaluation of this project by Dr. Leonel Adalberto Vasquez Cevallos resulted in the development of a web platform allowing doctors working in rural communities to submit patient information to receive feedback from specialist doctors. This web platform was later adapted by Dr. Vasquez Cevallos in collaboration with the Amigos de Cayapas Association to support doctors working in health posts in the rural communities of the upper Cayapas river in the Esmeraldas province. Although the telemedicine web application worked well in supporting doctors working in the communities of the Cayapas river, feedback collected from the rural doctors expressed interest in the development of an Android application to facilitate teleconsultations in areas without internet access. This application would allow doctors to record and save teleconsultations in offline mode, and then upload the information once an internet connection becomes available. This would enable doctors to provide better care to patients in remote locations where internet connectivity can be unreliable or completely unavailable. This Master’s thesis presents the functional requirements, design, implementation, and evaluation of a web and Android application created as part of a telemedicine platform to provide telemedicine services to rural doctors working in the health posts of the upper Cayapas river. With support from the Amigos del Cayapas Association and the TEDECO group, testing and user evaluations were carried out on-site in these remote communities to assess the performance of the platform. The testing and evaluation showed the telemedicine platform to be a technical success, however, there was poor adoption amongst the rural doctors who signed up to the platform with just one of the twenty-six registered doctors using the application to ask for clinical advice over the course of a fourmonth period. Further research and testing are needed to understand how a telemedicine platform can best support healthcare in indigenous and impoverished communities in remote locations.