A Participatory Action Research approach to telemedicine supported health care delivery in rural Nepal

Rural and geographically isolated, the majority of Nepalese communities have very low incomes, poor transportation, and scarce health care resources; these people provide the context for this study. The consequences of these deprivations include high maternal and infant mortality rates, high prevalence of infectious disease and poverty. There are therefore exceptional challenges and disparities in meeting health care needs. However the recent advent of modern information communication technology (ICT) or Telemedicine has unleashed a new wave of opportunities for supporting the delivery of health care services. Despite suggestions that telemedicine will offer hope in developing countries there is only limited published evidence to support this claim. Telemedicine is and must remain a process of the delivery of care rather than a technology. The system must connect patients and healthcare professionals in a chain of care, rather than follow the wide array of existing or new and advanced technology. The successful introduction of telemedicine with tangible outputs requires an in-depth understanding of the existing health care system of the country and its challenges; strongly expressed ‘genuine need’ for the service by all the stakeholders as interested partners (patients, practitioners, health care service providers and the public); the actual status of ICT infrastructure in the country and costs. This study used a Participatory Action Research (PAR) approach to explore the feasibility, acceptability and impact of a telemedicine system in partnership with Dhulikhel Hospital: Kathmandu University Hospital and with three of its 12 rural, remote outreach centres, and the populations they serve. Participatory, repeated data collection methods included surveys, interviewing, listening and being with staff and communities over a two year period. The researcher and researched engaged in a complex inter-locking journey from which the Unlocking, Unblocking and Validation concepts emerged. The findings of this study emphasise the pivotal role that the rural health care workers play. Telemedicine not only has a place in improving access to healthcare through enhanced communication but it also empowers health care workers. These people need continued support to develop their competencies and boost their confidence within the changing health care environment. In conclusion telemedicine is primarily about people rather than technology. Effective and holistic telemedicine development is built upon a combined, interactive model involving access, communication and empowerment

Telehealth in the developing world

Co-published with the Royal Society of Medicine Pres

Technology Resources for Earthquake Monitoring and Response (TREMOR)

Earthquakes represent a major hazard for populations around the world, causing frequent loss of life, human suffering, and enormous damage to homes, other buildings, and infrastructure. The Technology Resources for Earthquake Monitoring and Response (TREMOR) proposal is designed to address this problem. This proposal recommends two prototype systems integrating space-based and ground technology. The suggested pilot implementation is over a 10-year period in three focus countries – China, Japan, and Peru – that are among the areas in the world most afflicted by earthquakes. The first proposed system is an Earthquake Early Warning Prototype System that addresses the potential of earthquake precursors, the science of which is incomplete and considered controversial within the scientific community. We recommend the development and launch of two small satellites to study ionospheric and electromagnetic precursors. In combination with ground-based precursor research, the data gathered will improve existing knowledge of earthquake-related phenomena. The second proposed system is an Earthquake Simulation and Response Prototype. An earthquake simulator will combine any available precursor data with detailed knowledge of the affected areas using a Geographic Information System (GIS) to identify those areas that are most likely to experience the greatest level of damage. Mobile satellite communication hubs will provide telephone and data links between response teams, while satellite navigation systems will locate and track emergency vehicles. We recommend a virtual response satellite constellation composed of existing and future high resolution satellites. We also recommend education and training for response teams on the use of these technologies. The two prototypes will be developed and implemented by a proposed non-profit nongovernmental organization (NGO) called the TREMOR Foundation, which will obtain funding from government disaster management agencies and NGOs. A for-profit subsidiary will market any spin-off technologies and provide an additional source of funding. Assuming positive results from the prototype systems, Team TREMOR recommends their eventual and permanent implementation in all countries affected by earthquakes.Postprint (published version

Evaluation of IDRC-supported eHealth projects : final report

This report provides an in-depth account of the evaluation findings and recommendations for the next five years of IDRC’s eHealth programming. The quantitative and qualitative assessment covered 25 projects representing activities in 25 countries in Africa, Asia, and Latin America and the Caribbean (LAC) of which approximately 50% have been completed and 50% remain on-going ranging in scope from $30,000 -$2,422,652. The total dollar value of the projects included in this evaluation is approximately $17 million CAD. To complement the evaluation a targeted literature review of eHealth, a series of Lessons Learned Workshops with grantees and IDRC staff, and key informant interviews with internal and external stakeholders were conducted..

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe