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Telehealth in the developing world: current status and future prospects

机译：发展中国家的远程医疗：现状和未来展望

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Abstract: In a setting of constant change and confusing terminology, telehealth continues to gain ground in both developed and developing countries within the overarching milieu of e-health. Evidence shows telehealth has been used in essentially all countries of the world, but is embedded in few. Uses and needs of telehealth vary between the developed and developing world; the latter struggles with both communicable diseases and noncommunicable diseases, and with very few resources. Common clinical applications include teleconsultation, telecardiology (transmission of ECGs), teleradiology, and teledermatology. Many telehealth projects exist throughout Latin America and the Caribbean, Asia, and Africa, but there is little published evidence and only isolated examples of sustained programs, although several sustained humanitarian networks exist. Application of mobile solutions (m-health) is on the rise in many developing countries. Telehealth is still not integrated into existing health care systems globally. Reasons vary: lack of proven large-scale operations, poor evidence base, inadequate implementation, lack of attention to the “soft side” of implementation (readiness, change management), and many others. For the developing world, reasons can be more pragmatic, including limited resources, unreliable power, poor connectivity, and high cost for the poverty stricken – those most in need. Telehealth is poised to improve health and health care in the developing world, driven by both altruistic and profit motives. But to have the desired effect, telehealth must address very specific and evidence-based health “needs” of each facility, region, or country; the shortage of health workers and specialist services; and the required skills upgrading and training, allowing the developing world to establish its own critical mass of experts. This will only be achieved by raising awareness, understanding, and ability regarding telehealth capability and limitations, and by the coordinated political and professional will of all those involved to guide public and private innovation and telehealth integration.
机译：摘要：在不断变化和令人困惑的术语的背景下，远程医疗在电子卫生的总体环境中继续在发达国家和发展中国家中占有一席之地。有证据表明，远程医疗基本上已在世界上所有国家/地区使用，但很少被使用。远程医疗的用途和需求在发达国家和发展中国家之间有所不同;后者与传染病和非传染病作斗争，而且资源很少。常见的临床应用包括远程咨询，远程心脏病学（心电图的传输），远程放射学和远程皮肤病学。拉丁美洲，加勒比海地区，亚洲和非洲各地都存在许多远程医疗项目，但是尽管存在多个可持续的人道主义网络，但很少有公开的证据，而且只有单独的可持续项目示例。在许多发展中国家，移动解决方案（移动医疗）的应用正在增加。远程医疗仍然没有集成到全球现有的医疗系统中。原因各不相同：缺乏经过验证的大规模运营，缺乏证据基础，实施不充分，缺乏对实施的“软性”方面（准备，变更管理）的关注，还有许多其他原因。对于发展中国家而言，原因可能更加务实，包括资源有限，电力不可靠，连通性差以及遭受贫困的人（最需要的人）付出高昂的代价。远程医疗已准备好在利他和利润动机的推动下改善发展中国家的卫生和保健。但是，要想达到预期的效果，远程医疗必须满足每个机构，地区或国家非常具体且基于证据的医疗“需求”;卫生工作者和专家服务的短缺;以及所需的技能升级和培训，使发展中国家能够建立自己的重要专家队伍。只有提高对远程医疗能力和局限性的认识，理解和能力，并通过所有相关人员的协调政治和专业意愿来指导公共和私人创新以及远程医疗集成，才能实现这一目标。

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