An information system to support telemedicine projects in South Africa

Van Zyl, Alwyn (2012-12)

Thesis (MEng)--Stellenbosch University, 2012.

Thesis

ENGLISH ABSTRACT: Telemedicine is a rapidly developing field in the medical sector that utilises modern day technology to provide improved health services to rural and remote areas. Telemedicine can also provide specialist support and remote consultation to facilities where there is a lack of resources. In South Africa, where a large percentage of the population live in rural and remote areas, telemedicine has the potential to alleviate the burden on national health resources, whilst improving the quality of healthcare. Various telemedicine projects have been piloted in South Africa from its inception in 1998, with the primary objective being to address the inequalities of healthcare delivery in South Africa. Most of these projects did not get past their initial pilot phase. It is often difficult to determine the factors that contribute to a telemedicine project’s success or demise, due to the unavailability of documentation for projects. The purpose of this research project is to contribute towards sustained implementation of telemedicine projects, by assisting the Medical Research Council (MRC) in their current efforts. This has been done through the development of an information management system which can record and store relevant information regarding telemedicine projects in South Africa. The system allows users to document telemedicine projects, whilst also giving them access to technical- and descriptive information. A total of 102 projects from the international academic domain were used to perform a meta-study, in order to determine the nature of telemedicine projects. Articles documenting various telemedicine projects were selected from the Journal of Telemedicine and Telecare. The telemedicine process data was then extracted and uploaded from these articles to the first version of the information system developed in this thesis. The meta-study was also used as the first phase of verification for the information system being developed. Changes were made to the information system after the meta-study was completed. These changes included alterations to the database and the interface of the information system. Additional tables were added to the database of the information system, to store the data required by the MRC, in order to document telemedicine projects in South Africa. The verification of the information system consisted of two testing phases. The first testing phase, the alpha test, was performed as part of the meta-study. The second testing phase was conducted after changes were incorporated into the information system, as necessitated by the alpha test and meta-study. In this phase of testing users could access the information system via the Internet. The information system was validated in two phases. Firstly it was shown that the information system met the objectives set out for this project. Secondly it was shown that the information system has the capacity to assist in planning, development, implementation, and research through retrospectively examining two telemedicine projects in which Dr. Sam Surka (senior scientist and clinical manager at the MRC) was involved. Outcomes of the project indicated that the information system is a useful tool for identifying similar telemedicine projects, and for assisting stakeholders in telemedicine projects. Finally the research process was reflected upon to identify future work in terms of collecting telemedicine process data, as well as the assistance of telemedicine research within the South African context

AFRIKAANSE OPSOMMING: Telemedisyne is 'n vinnig ontwikkelende veld in die mediese sektor wat gebruik maak van moderne tegnologie om verbeterde gesondheidsdienste te verskaf aan landelike en afgeleë gebiede. Telemedisyne kan ook spesialis-ondersteuning en afstandsraadgewing bied aan fasiliteite waar daar 'n gebrek aan hulpbronne is. In Suid-Afrika, waar 'n groot persentasie van die bevolking in landelike en afgeleë gebiede woon, het telemedisyne die potensiaal om die las te verlig op nasionale gesondheid hulpbronne, asook die gehalte van gesondheidsorg te verbeter. Verskeie telemedisyne projekte is in Suid-Afrika geloods vanaf 1998, met die primêre doel om die ongelykhede van gesondheidsorg in Suid-Afrika aan te spreek. Meeste van hierdie projekte het egter nie voortbestaan na hul aanvanklike proeffase nie. Dit is dikwels moeilik om die bydraende faktore te bepaal wat 'n telemedisyne projek se sukses of ondergang veroorsaak, as gevolg van die onbeskikbaarheid van dokumentasie vir die projekte. Die doel van hierdie navorsingsprojek is om ‘n bydrae te lewer tot die volhoubare implementering van telemedisyne projekte deur hulp te verleen aan die Mediese Navorsingsraad (MNR) se huidige ondernemings. Dit is gedoen deur 'n inligtingstelsel te ontwikkel wat relevante inligting opneem en stoor ten opsigte van telemedisyne projekte in Suid-Afrika. Die stelsel laat gebruikers toe om telemedisyne projekte te dokumenteer, asook toegang te bekom tot tegniese en beskrywende inligting. 'n Totaal van 102 projekte van die internasionale akademiese omgewing is gebruik om 'n meta-studie uit te voer ten einde die aard van telemedisyne projekte te bepaal. Artikels wat verskeie telemedisyne projekte dokumenteer is gekies uit die “Journal of Telemedicine and Telecare”. Die telemedisyne proses data is vanuit hierdie artikels onttrek en opgelaai na die eerste weergawe van die inligtingstelsel wat in hierdie tesis ontwikkel is. Die meta-studie is ook gebruik as die eerste fase van verifikasie vir die inligting stelsel wat ontwikkel word. Veranderinge was aangebring aan die inligtingstelsel na die meta-studie voltooi was. Hierdie veranderinge sluit in die uitbreiding van die databasis en die koppelvlak van die inligtingstelsel. Addisionele tabelle is bygevoeg tot die databasis van die inligtingstelsel om die addisionele data te stoor soos vereis deur die Mediese Navorsingsraad (MNR), ten einde die telemedisyne projekte in Suid-Afrika te dokumenteer. Die verifikasie van die inligtingstelsel bestaan uit twee toets fases. Die eerste toetsfase, die alfa toets, was uitgevoer as deel van die meta-studie. Die tweede toetsfase was uitgevoer na veranderinge aan die inligtingstelsel gemaak is, soos genoodsaak deur die alfa toets en meta-studie. In hierdie toetsfase kon gebruikers toegang tot die inligtingstelsel kry deur die Internet. Die inligtingstelsel was bekragtig in twee fases. Eerstens, dit is aangetoon dat die inligtingstelsel die doelwitte bereik het, soos uiteengesit vir hierdie projek. Tweedens was aangetoon dat die inligtingstelsel die vermoë het om te help met die beplanning, ontwikkeling, implementering, en navorsing deur twee telemedisyne projekte te ondersoek waarin Dr. Sam Surka (senior wetenskaplike en kliniese bestuurder by die MNR) betrokke was. Uitkomste van die projek het aangedui dat die inligtingstelsel 'n nuttige hulpmiddel is vir die identifisering van soortgelyke telemedisyne projekte, terwyl dit ook belanghebbendes van telemedisyne projekte ondersteun. Ten slotte was daar besin oor die navorsingsproses om toekomstige werk te identifiseer in terme van die versameling van telemedisyne proses data, asook die ondersteuning van telemedisyne navorsing binne die Suid-Afrikaanse konteks.

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