An assessment of telemedicine services within the Western Cape public health care system

Hartmann, Andre (2014-04)

Thesis (MEng)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Telemedicine is de ned as an electronic exchange of medical information and/or the delivery of clinical health care over a distance, by means of Information and Communication Technology (ICT). South Africa is faced with the problem of providing health care to a population in urban, as well as across vast rural areas. In addition to this, the South African health care system must deal with economical imbalances and a shortage of human resources to provide quality health care. Telemedicine services could provide a solution. Since the introduction of the rst national telemedicine services initiative in the late 1990s, a number of South African telemedicine services have been implemented in the public health care system. The majority of these telemedicine services have been prone to failure and many were prematurely terminated. The circumstances which in uence the failure or success of these services are not unknown. The lack of insight, and the high failure rate of telemedicine services implemented in the South Africa were the reasons for conducting this study. The purpose of the study is to assess telemedicine services implemented in the Western Cape public health care sector. The purpose is also to provide recommendations for improving the current and future telemedicine services in the Western Cape and other provinces. A telemedicine services assessment was conducted on a total of 26 telemedicine services identi ed at 6 health care facilities located in the Western Cape. The assessments were based on the TeleMedicine Services Maturity Model (TMSMM), which was developed speci cally for the purpose of assessing telemedicine services. The TMSMM capability statements were used as a yardstick to assess the maturity of each of the elements of telemedicine services in terms of the three service level groups (micro-,meso- and macro-level) and ve telemedicine domains (man, machine, material, method and money). The assessment process included: (i) the identi cation of telemedicine services at the selected health care facilities; (ii) the gathering of the relevant telemedicine service data by means of structured interviews; (iii) the transformation of the complex ow of information into Data Flow Diagrams (DFDs); (iv) the loading of telemedicine services data into a data warehouse; and (v) the analysis of data by means of On-Line Analytical Processing (OLAP), as well as box-and-whisker plots and statistical correlations. Based on the results of the TMSMM assessment, an electronic questionnaire was developed and administered amongst health care workers throughout the entire Western Cape. The questionnaire con rmed that the ndings from the TMSMM assessment are indeed representative of the entire Western Cape. The assessment of the telemedicine services provides information about the elements which a ect the success or failure of these services. This therefore addresses the initial research problem and ful ls the purpose of the study. These results were used as an input to the analysis of strengths, weaknesses, opportunities and threats (SWOT) of the delivery of telemedicine services in the Western Cape public health sector. For future references and studies, the SWOT analysis provides a point of departure for a strategic telemedicine services framework for a province like the Western Cape.

AFRIKAANSE OPSOMMING: Telegeneeskunde, per de nisie, behels die deel van mediese inligting en/of die lewering van kliniese gesondheidsdienste oor 'n afstand, deur middel van inligting en kommunikasie tegnologie (ICT). Telegeneeskunde dienste is moontlik een van die oplossings vir die lewering van gesondheidsdienste vir 'n bevolking wat versprei is oor 'n groot landelike gebied binne 'n publieke gesondheidsektor wat mense hulpbronne kort om kwaliteit gesondheidsorg te lewer. Die publieke gesondeheidstelsel van Suid Afrika het 'n drie-dubbele las van siektes, ekonomiese wanbalans and 'n tekort aan mediese praktisyns. Sedert die eerste nasionale inisiatief vir telegeneeskunde dienste in die laat 1990s bekend gestel is, is 'n paar telegeneeskunde dienste in die publieke gesondheidsektor van Suid Afrika geïmplementeer. Die meerderheid van hierdie dienste blyk onsuksesvol te wees. The faktore wat die implementeringsukses beïnvloed is nog nie goed nagevors nie. Die doel van hierdie studie is om telegeneeskunde dienste wat in die Wes- Kaap publieke gesondheidsektor geïmplementeer is te ondersoek. Die doel is verdermeer om aanbevelings te maak met die oog op die verbetering van bestaande en toekomstige dienste in die Wes-Kaap asook ander provinsies. Eerstens is 'n telegeneeskunde diens assessering uitgevoer op 'n totaal van 26 dienste 6 fasiliteite. Hierdie assesserings is gebasseer of the Telegeneeskunde Diens Volwassenheidsmodel (TMSMM), wat ontwikkel is spesi ek met die doel om telegeneeskunde dienste te assesseer. Dit word gedoen deur die dienste te meet in terme van drie vlakke (mikro-, meso- en macrovlak) en vyf domeine (man, masjien, materiaal, metode en geld). Die TMSMM vermoeë-stellings word as maatstaaf gebruik. Die assesseringsproses sluit in (i) die identi sering van telegeneeskunde dienste by die aangewese gesondheidsfasiliteite; (ii) die versameling van relevante telegeneeskunde data deur middel van gestruktureerde onderhoude; (iii) die transformasie van komplekse inligtings vloei na data vloeidiagramme (DFDs); (iv) die laai van telegeneeskundige dinste data in 'n databasis; and (v) die analyse van data deur middel van aanlyn analitiese verwerking (OLAP) sowel as boxen- snorbaard gra k en statistiese korrelasies. Gebasseer op die resultate van die TMSMM assesseringsproses, is 'n elektroniese vraelys ontwikkel en geadministreer onder gesondheidswerkers regoor die Wes-Kaap ten einde te bevestig of die gevolgtrekkings van die TMSMM assessering die hele provinsie verteenwoordig. Die assessering van die telegeneeskundige dienste verskaf inligting in terme van die faktore wat die sukses van telegeneeskundie dienste beïnvloed. Sodoende word die aanvanklike navorsingsprobleem aangespreek. Hierdie resultate is toe gebruik as inset vir die analise van die sterk punte, swak punte, geleenthede en bedreigings (SWOT) in die publieke gesondheidsektor van die Wes-Kaap in terme van telegeneeskundige dienste. Hierdie SWOT-analise kan in die toekoms gebruik word as vertrekpunt vir die ontwikkeling van strategiese raamwerk vir die implementering van telegeneeskundige dienste in 'n provinsie soos die Wes-Kaap.

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