Seven years of telemedicine in Médecins Sans Frontières demonstrate that offering direct specialist expertise in the frontline brings clinical and educational value

Abstract

BackgroundMédecins Sans Frontières (MSF), a medical humanitarian organization, began using store-and-forward telemedicine in 2010. The aim of the present study was to describe the experience of developing a telemedicine service in low-resource settings.MethodsWe studied the MSF telemedicine service during the period from 1st July 2010 until 30th June 2017. There were three consecutive phases in the development of the service, which we compared. We also examined the results of a quality assurance program which began in 2013.ResultsDuring the study period, a total of 5646 telemedicine cases were submitted. The workload increased steadily, and the median referral rate rose from 2 to 18 cases per week. The number of hospitals submitting cases and the number of cases per hospital also increased, as did the case complexity. Despite the increased workload, the allocation time reduced from 0.9 to 0.2 hours, and the median time to answer a case decreased from 20 to 5 hours. The quality assurance scores were stable. User feedback was generally positive and more than 90% of referrers who provided a progress report about their case stated that it had been sent to an appropriate specialist, that the response was sufficiently quick and that the teleconsultation provided an educational benefit. Referrers noted a positive impact of the system on patient outcome in 39% of cases.ConclusionsThe quality of the telemedicine service was maintained despite rising caseloads. The study showed that offering direct specialist expertise in low-resource settings improved the management of patients and provided additional educational value to the field physicians, thus bringing further benefits to other patients.

Telemedicine strategy of the European Reference Network ITHACA for the diagnosis and management of patients with rare developmental disorders

“…It also suggests that for many of the cases, co-operation with other rare disease ERNs would be beneficial for patients, as this would allow experts from several different disciplines to comment on the same cases. Also, a similar tendency to increasing complexity of queries over time has been observed previously in other telemedicine approaches [17].…”

Electronic consultations (E-consults) and their outcomes: a systematic review

“…At the time of our 2015 review, most studies reported high PCP satisfaction with e-consults, including perceived value, improved timeliness of specialty input, and enhanced communication with specialist. Newer studies using PCP surveys support these findings, 11,13,14,[18][19][20][21][22]24,26,[29][30][31][33][34][35][36]41,54,57,60,[62][63][64][65][67][68][69][70][71] and 2 qualitative studies also report generally high PCP satisfaction. 7,39 More recent studies have also described a strong educational benefit to less-experienced PCPs.…”

“…Since 2015, articles have been published that extend e-consult to patients that might not have had access to a specialist face-to-face visit in the first place, such as patients with rare conditions 46 and patients in rural, 42 extremely remote, 27 or otherwise low-resource regions. 68 Faster access to specialist input compared to face-to-face visits. Sleep medicine e-consultation followed by the specialists' order of a sleep study and positive airway pressure therapy, if indicated, resulted in a decrease over 4 years in the interval between sleep consult and positive airway pressure prescription from 60 days to 7 days.…”

The relationship between counselling methods after health check-ups and lipid profile improvement: a retrospective cohort study in Korea

“…Although a few reports [13,14] have indicated that telemedicine is more cost-effective than face-toface medical care, due to recent advances in information and communication technology (ICT), the results of the current study support the most basic principle [15]-direct patient education is the most effective method of managing chronic diseases.…”