Author: Annie Kelley
(Note: All surveys and graphics mentioned are original data)
The ever-evolving industry of medicine has demonstrated immense progression and development within the past decades. Though this expansion of medical capabilities has contributed to an increased quality of life, one factor remains that appears to be hindering further progression in the industry: the inability of countless individuals to access affordable and practical medical care. In response, the medical industry began to develop telemedical systems in the late 1950s better suited to handle clientele confined to poverty-stricken or rural areas. These telemedical systems utilize various technologies with the intention of helping patients communicate with physicians and other medical personnel that are stationed in distant areas.
Role of Multidisciplinary Teams
In addressing the increasingly prevalent practice, many physicians have expressed the need to develop multidisciplinary teams centered around patient care and communication. As a result, numerous studies have utilized patient satisfaction and physician testimonies to determine the most advantageous approach to designing multidisciplinary teams. Said teams often consist of licensed physicians, oncologists, various nurses, pathologists, radiologists, and other individuals of various specialties. In unison, this combination of personnel allows for patient-centered care to be performed over technological devices, such as telephones and personal computers, which in turn decreases the need for excessive and costly hospital visits.
Telemedicine within Twinning Programs
Additionally, these systems have proven to be especially beneficial in developing nations, where medical and oncological care is far more limited. Specifically, telemedicine facilitates twinning programs, which essentially entail the communicative relationship between hospitals in developed nations and hospitals in developing nations. Moreover, these twinning programs in conjunction with telemedical programs have drastically improved patient survival, as demonstrated by the programs between the King Hussein Cancer Center (KHCC) of Jordan and both the United States-based St. Jude Hospitals as well as the Toronto based Hospital For Sick Children. In these studies, researcher Ibrahim Qaddoumi was able to observe a favorable, positive trend in patient outcomes due to alterations in the course of treatment in response to the telemedical consultations. This in turn contributed to the conclusion that twinning programs are a “feasible and practical twinning tool,” thus further attesting to the shared fondness stemming from the observed benefits of telemedicine. However, expanding upon the purely medical value of these programs, there are also numerous studies attesting to the monetary practicality of telemedicine within twinning programs. Specifically, these programs have facilitated the communication between physicians on a solely virtual basis, as opposed to alternative methods of physically traveling to the partner country, thus eliminating travel-related expenditures.
Challenges in Implementation
One factor responsible for the success of the telemedical programs is the ability to select the means of communication most advantageous in each particular circumstance to all parties involved. Specifically, the two major forms of communication consist of store-and-forward or real-time communication. The former primarily consists of the transmission of images, medical records, and pre-recorded videos to the other collaborating parties. While the latter of which consists of live video conferencing or telephone communication. Although both of these methods of communication are credited with immense success, they are rather demanding in terms of the internet connectivity, technological, and financial requirements. Therefore, given the increasing frequency of telemedical programs, it is rather important to consider the practicality and feasibility of implementing these programs in rural and impoverished areas.
In order to assess the feasibility and practicality of the telemedical programs, a survey was distributed to physicians currently practicing telemedicine. Participants in the survey were chosen using selective criteria that were most conducive to securing an unbiased and pertinent pool of respondents. Said criteria included consistency in terms of country of practice and involvement with telemedicine. Participation was strictly limited to those who practice in the United States, as this would maintain the consistency and reliability of physicians in terms of licensure and scope of practice, as well as legal obligations and standards.
A compilation of twenty-seven physicians, having an accessible email, were found to fit the criteria. Of these twenty-seven physicians, one was unable to respond due to his sole status as a researcher. Within the remaining twenty-six individuals, seven submitted a response within the given time frame.
Composition of Survey
The preliminary portion of the survey consisted of a consent form in which participants were required to agree to the use of responses in the compilation of this research. Within this portion, the consent form addressed and guaranteed the anonymity of the responses. Following the consent form were sixteen questions. Of the sixteen questions, the initial questions primarily dealt with the assessment of the credentials as well as the scope of practice for the physicians. Said questions included the duration of practice, primary patient demographic, and location of practice. Following this inquiry, participants were asked to describe their practice and experiences within telemedicine in terms of the feasibility and practicality of implementation, as well as the effectiveness of the telemedicine programs in which they had participated. Thereafter, the physicians were tasked with expressing the most prevalent concerns and issues in implementing the programs in order to establish an overall numerical consensus. The two quantitative portions of this survey consisted of the questions, “How would you rate the effectiveness of the telemedical program(s)?” and “How would you rate the feasibility of the telemedicine program(s)?” to which respondents replied using a Likert scale of rating one through five.
Results and Findings
Upon analyzing the data there were clear trends indicating favorable outcomes stemming from the implementation of the programs. The majority of the physicians expressed high regard for the programs, despite the conveyed challenges associated with implementation. Furthermore, many of those surveyed found the programs to be reasonably feasible to implement and very effective in nature. Specifically, the average feasibility rating of approximately 3.5 out of 5 (with five being regarded as very feasible), serves as a clear indication of the moderate feasibility of implementing the telemedical programs.
Despite this relatively favorable rating, one possible explanation for the hesitation in higher ratings is the immense challenges presented when implementing the programs. In fact, among the numerous challenges expressed by the physicians, perhaps the most prevalent were time barriers, licensure, information technology (I.T.) issues, and funding/reimbursement. Though these issues are not easily surmountable, the vast majority of the physicians expressed communication and understanding as the most effective solution. Similarly, relative to funding and reimbursement, several participants mentioned the various support systems available to aid in the funding and implementation of these programs. Specifically, there are numerous Non-Governmental Organizations (NGOs), grants, and State Departments that have previously provided funding for these programs, as well as many other programs that provide funding. Such programs include the National Institute for Health, as well as the American Society of Clinical Pathology, who lead a global effort in East Africa. Moreover, despite the vast challenges associated with implementing telemedical programs, there are numerous documented support systems that aid in overcoming these challenges.
Practicality of Implementation
Utilizing the analysis of the practicality and effectiveness of telemedical implementation, there is a blatant trend among those surveyed in favor of the programs. The vast majority of physicians have already witnessed improvements to the quality of care and oncology efforts within the scope of their practice. In fact, when surveyed, the physicians rated the effectiveness of telemedical and twinning programs as being approximately 4.3 out of 5 (with five being very effective).
This rather high rating serves as an indication of the physician acceptance and favorability of the programs. Moreover, it is the high regard for telemedicine in combination with the demonstrated effectiveness of the programs that contributes to the improvement in collaborative based healthcare.
In conclusion, this study, through the examination of the feasibility and practicality of instituting telemedicine programs within the specialty of oncology discovered a favorable consensus among doctors regarding the effectiveness. Moreover, due to the overwhelming physician support expressed, one can assume that the telemedical programs are beneficial in improving oncological and medical efforts, as demonstrated by the institutions represented by those surveyed. Despite this, it is also important to note that when considering implementation, it is necessary to fully assess the challenges as well as the extent to which medical institutions are able to overcome them.