The overall aim of the research was to produce a validated framework for a Malaysian integrated
and distributed telemedicine system. The framework was constructed so that it was capable of
being useful in retrieving and storing a patient's lifetime health record continuously and
seamlessly during the downtime of the computer system and the unavailability of a landline telecommunication network.
The research methodology suitable for this research was identified including the verification and
validation strategies. A case study approach was selected for facilitating the processes and
development of this research. The empirical data regarding the Malaysian health system and telemedicine context were gathered through a case study carried out at the Ministry of Health
Malaysia (MOHM). The telemedicine approach in other countries was also analysed through a
literature review and was compared and contrasted with that in the Malaysian context. A critical
appraisal of the collated data resulted in the development of the proposed framework (MyTel) a
flexible telemedicine framework for the continuous upkeep o f patients' lifetime health records.
Further data were collected through another case study (by way of a structured interview in the
outpatient clinics/departments of MOHM) for developing and proposing a lifetime health record
(LHR) dataset for supporting the implementation of the MyTel framework. The LHR dataset
was developed after having conducted a critical analysis of the findings of the clinical
consultation workflow and the usage o f patients' demographic and clinical records in the
outpatient clinics. At the end of the analysis, the LHR components, LHR structures and LHR
messages were created and proposed. A common LHR dataset may assist in making the
proposed framework more flexible and interoperable.
The first draft of the framework was validated in the three divisions of MOHM that were
involved directly in the development of the National Health JCT project. The division includes
the Telehealth Division, Public and Family Health Division and Planning and Development
Division. The three divisions are directly involved in managing and developing the telehealth
application, the teleprimary care application and the total hospital information system
respectively. The feedback and responses from the validation process were analysed. The
observations and suggestions made and experiences gained advocated that some modifications
were essential for making the MyTel framework more functional, resulting in a revised/ final
framework.
The proposed framework may assist in achieving continual access to a patient's lifetime health
record and for the provision of seamless and continuous care. The lifetime health record, which
correlates each episode of care of an individual into a continuous health record, is the central key
to delivery of the Malaysian integrated telehealth application. The important consideration,
however, is that the lifetime health record should contain not only longitudinal health summary
information but also the possibility of on-line retrieval of all of the patient's health history
whenever required, even during the computer system's downtime and the unavailability of the
landline telecommunication network
