Appl Clin Inform 2016; 07(04): 1025-1050
DOI: 10.4338/ACI-2016-06-R-0089
Review
Schattauer GmbH

Telemedicine for Developing Countries

A Survey and Some Design Issues
Carlo Combi
1   Dipartimento di Informatica, Università degli Studi di Verona, Verona, Italy
,
Gabriele Pozzani
1   Dipartimento di Informatica, Università degli Studi di Verona, Verona, Italy
,
Giuseppe Pozzi
2   Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
› Institutsangaben
Funding This work has been partially funded by Regione Veneto through the “Cooperazione decentrata allo sviluppo” program (CUP B48I13000590003, B42C14000270002), by the Department of Computer Science of the University of Verona, and by the Department of Electronics, Information, and Bioengineering of the Politecnico di Milano.
Weitere Informationen

Correspondence to:

Giuseppe Pozzi
Dipartimento di Elettronica
Informazione e Bioingegneria
Politecnico di Milano
p.za L. da Vinci 32
I-20133 Milano
Italy

Publikationsverlauf

received: 11. Juni 2016

accepted: 19. September 2016

Publikationsdatum:
18. Dezember 2017 (online)

 

Summary

Background Developing countries need telemedicine applications that help in many situations, when physicians are a small number with respect to the population, when specialized physicians are not available, when patients and physicians in rural villages need assistance in the delivery of health care. Moreover, the requirements of telemedicine applications for developing countries are somewhat more demanding than for developed countries. Indeed, further social, organizational, and technical aspects need to be considered for successful telemedicine applications in developing countries.

Objective We consider all the major projects in telemedicine, devoted to developing countries, as described by the proper scientific literature. On the basis of such literature, we want to define a specific taxonomy that allows a proper classification and a fast overview of telemedicine projects in developing countries. Moreover, by considering both the literature and some recent direct experiences, we want to complete such overview by discussing some design issues to be taken into consideration when developing telemedicine software systems.

Methods We considered and reviewed the major conferences and journals in depth, and looked for reports on the telemedicine projects.

Results We provide the reader with a survey of the main projects and systems, from which we derived a taxonomy of features of telemedicine systems for developing countries. We also propose and discuss some classification criteria for design issues, based on the lessons learned in this research area.

Conclusions We highlight some challenges and recommendations to be considered when designing a telemedicine system for developing countries.

Citation: Combi C, Pozzani G, Pozzi G. Telemedicine for developing countries: a survey and some design issues.


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  • References

  • 1 World Health Organization. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth. Global Observatory for eHealth Series. 02 World Health Organization; 2009
  • 2 Ingenerf J. Telemedicine and terminology: different needs of context information. IEEE Trans Inf Technol Biomed 1999; 03 (02) 92-100.
  • 3 Wootton R, Geissbuhler A, Jethwani K, Kovarik C, Person DA, Vladzymyrskyy A. et al. Comparative performance of seven long-running telemedicine networks delivering humanitarian services. J Telemed Telecare 2012; 18 (06) 305-311.
  • 4 Istepanian RSH. Telemedicine in the United Kingdom: current status and future prospects. IEEE Trans Inf Technol Biomed 1999; 03 (02) 158-159.
  • 5 Joseph V, West RM, Shickle D, Keen J, Clamp S. Key challenges in the development and implementation of telehealth projects. J Telemed Telecare 2011; 17 (02) 71-77 doi:10.1258/jtt.2010.100315.
  • 6 Lamminen H, Sernberg V, Ruohonen K, Roine R. A three-year follow-up of Finnish telemedicine programs. IEEE Trans Inf Technol Biomed 2001; 05 (02) 174-177.
  • 7 Lakovidis I, Pattichis CS, Schizas C. Guest editorial special issue on emerging health telematics applications in Europe. IEEE Trans Inf Technol Biomed 1998; 02 (03) 110-116.
  • 8 Hsieh J, Hsu M. A cloud computing based 12-lead ECG telemedicine service. BMC Med Inf and Decision Making 2012; 12: 77 doi:10.1186/1472–6947–12–77.
  • 9 Istepanian RSH. Guest editorial special issue on mobile telemedicine and telehealth systems. IEEE Trans Inf Technol Biomed 2000; 04 (03) 194.
  • 10 Bahaadinbeigy K, Yogesan K, Wootton R. A survey of the state of telemedicine in Western Australia. J Telemed Telecare 2010; 16 (04) 176-180.
  • 11 Comyn G. Telemedicine for the benefit of patients, healthcare systems and society. – COM. 2008 689. Nov 4th, 2008. 2008. Available from: http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex:52008DC0689
  • 12 BCC Research. Global markets for telemedicine technologies, report code: Hlc014f. 2014 Available from: http://www.bccresearch.com/market-research/healthcare/telemedicine-technologies-hlc014f.html#gsc.tab=0
  • 13 Mordor Intelligence. Global Telemedicine Market – Growth, Trends and Forecasts. 2015-2020 2015 Available from: http://www.mordorintelligence.com/industry-reports/global-telemedicine-market-indus try#tab-1
  • 14 Wootton R. Telemedicine and developing countries-successful implementation will require a shared approach. J Telemed Telecare. 2001: 7.
  • 15 Wang TT, Li JM, Zhu CR, Hong Z, Hong-Yu DMAYang, Ren JC. et al. Assessment of utilization and costeffectiveness of telemedicine program in western regions of China: A 12-year study of 249 hospitals across 112 cities. Telemed J E Health 2016; 22 (11) 1-12 doi:10.1089/tmj.2015.0213.
  • 16 Combi C, Pozzani G, Pozzi G. Design, development, deployment of a telemedicine system in a developing country: Dealing with organizational and social issues. In 2015 International Conference on Healthcare Informatics, ICHI 2015, Dallas, TX, USA, October 21–23, IEEE Computer Society 2015; 545-554 doi:10.1109/ICHI.2015.103.
  • 17 US National Library of Medicine, National Institutes of Health. PubMed. 2016 Available from: https://www.ncbi.nlm.nih.gov/pubmed
  • 18 Ley M. DBLP – Computer Science Bibliography [Internet]. 2016 Available from: http://dblp.uni-trier.de/
  • 19 Tulu B, Chatterjee S, Laxminarayan S. A taxonomy of telemedicine efforts with respect to applications, infrastructure, delivery tools, type of setting and purpose. In 38th Hawaii International Conference on System Sciences (HICSS-38 2005), CD-ROM / Abstracts Proceedings. 3-6 January 2005 Big Island, HI, USA. IEEE Computer Society. doi:10.1109/HICSS.2005.56.
  • 20 Tulu B, Chatterjee S, Maheshwari M. Telemedicine taxonomy: A classification tool. Telemed J E Health 2007; 13 (03) 349-353 doi:10.1089/tmj.2006.0055.
  • 21 Beltrame F, Boddy K, Maryni P. Adopting telemedicine services in the airline framework. IEEE Trans Inf Technol Biomed 2001; 05 (02) 171-174.
  • 22 Anogianakis G, Maglavera S, Pomportsis AS. Relief for maritime medical emergencies through telematics. IEEE Trans Inf Technol Biomed 1998; 02 (04) 254-260.
  • 23 Chimiak WJ, Rainer RO, Chimiak JM, Martinez R. An architecture for naval telemedicine. IEEE Trans Inf Technol Biomed 1997; 01 (01) 73-79.
  • 24 The World Bank. The World Bank – Working for a World Free of Poverty [Internet]. 2016 Available from: http://www.worldbank.org/
  • 25 European Commission, Digital Agenda for Europe. eHealth Action Plan 2012-2020: Innovative healthcare for the 21st century. 2012 Available from: https://ec.europa.eu/digital-agenda/en/news/ehealth-actionplan-2012–2020-innovative-healthcare-21st-century
  • 26 The World Bank. Health expenditure, public (% of GDP). 2016 Available from: http://data.world-bank.org/indicator/SH.XPD.PUBL.ZS
  • 27 Martìnez A, Villarroel V, Seoane J, del Pozo F. Analysis of information and communication needs in rural primary health care in developing countries. IEEE Trans Inf Technol Biomed 2005; 09 (01) 66-72.
  • 28 Martìnez A, Villarroel V, Seoane J, del Pozo F. Rural telemedicine for primary healthcare in developing countries. IEEE Technol Soc Mag 2004; 23 (02) 13-22.
  • 29 The World Bank. Fact sheet: Infrastructure in sub-Saharan Africa. 2014 Available from: http://go.world-bank.org/SWDECPM5S0
  • 30 Wootton R. The possible use of telemedicine in developing countries. J Telemed Telecare 1997; 03 (01) 23-26.
  • 31 Martìnez A, Villarroel V, Seoane J, del Pozo F. A study of a rural telemedicine system in the Amazon region of Peru. J Telemed Telecare 2004; 10: 219-225.
  • 32 Odutola AB. Developing countries must invest in access to information for health improvements. J Med Internet Res 2003; 05 (01) e5 doi:10.2196/jmir.5.1.e5.
  • 33 Rodrigues RJ, Risk A. eHealth in Latin America and the Caribbean: development and policy issues. J Med Internet Res 2003; 05 (01) e4 doi:10.2196/jmir.5.1.e4.
  • 34 Parent F, Coppieters Y, Parent M. Information technologies, health, and „globalization”: anyone excluded?. J Med Internet Res 2001; 03 (01) E11 doi: 10.2196/jmir.3.1.e11.
  • 35 Meso P, Mbarika VWA, Sood SP. An overview of potential factors for effective telemedicine transfer to Sub-Saharan Africa. IEEE Trans Inf Technol Biomed 2009; 13 (05) 734-739.
  • 36 Moodley D, Pillay AW, Seebregts CJ. Position paper: Researching and developing open architectures for national health information systems in developing African countries. In Liu Z, Wassyng A. editors, FHIES, volume 7151 of Lecture Notes in Computer Science; Springer: 129-139.
  • 37 Bai J, Hu B, Zhang Y, Ye D. A communication server for telemedicine applications. IEEE Trans Inf Technol Biomed 1997; 01 (03) 205-209.
  • 38 Xue Y, Liang H. Analysis of telemedicine diffusion: The case of China. IEEE Trans Inf Technol Biomed 2007; 11 (02) 231-233.
  • 39 Pal A, Mbarika VWA, Payton FC, Datta P, McCoy S. Telemedicine diffusion in a developing country: The case of India (March 2004). IEEE Trans Inf Technol Biomed 2005; 09 (01) 59-65.
  • 40 Hussein R, Khalifa A. Telemedicine in Egypt: SWOT analysis and future trends. GMS Medizinische Informatik, Biometrie und Epidemiologie 2012; 08 (01) 1-16.
  • 41 Bice SD, Dever G, Mukaida L, Norton SA, Samisone J. Telemedicine and telehealth in the Pacific islands region: A survey of applications, experiments, and issues. In Peacesat. Pacific Telecommunications Council; 574-581.
  • 42 Norton SA, Floro C, Bice SD, Dever G, Mukaida L, Scott JC. Telemedicine in Micronesia. Telemed J 1996; 02 (03) 225-231.
  • 43 da Silva SMattos, Hazin SMV, Regis CT, de Araújo JSS, de Lira FCAlbuquerque, Moser LRDN. et al. A telemedicine network for remote pediatric cardiology services in North-East Brazil. Bulletin of the World Health Organization 2015; 93 (12) 881-887.
  • 44 Nexus Mundi Foundation. Chikuni Mission Hospital. 2014 Available from: http://s328691085.online-home.us/
  • 45 Gori A, Taddei A, Mota D, Rocca E, Carducci T, Piccini G. et al. Open source teleconsulting system for international cooperative medical decision making in congenital heart diseases. Comput Cardiol 2010; 37: 481-484.
  • 46 Patologi Oltre Frontiera. Available from: http://www.apof.eu/
  • 47 Geissbuhler A, Ly O, Lovis C, L’Haire JF. Telemedicine in Western Africa: lessons learned from a pilot project in Mali, perspectives and recommendations. In AMIA Annual Symposium Proceedings. volume 2003. American Medical Informatics Association; 249.
  • 48 Bagayoko CO, Muller H, Geissbuhler A. Telemedicine network in French-speaking Africa (RAFT). In Medical Imaging and Telemedicine. 108-113.
  • 49 Bagayoko CO, Muller H, Geissbuhler A. Assessment of Internet-based tele-medicine in Africa (the RAFT project). Comput Med Imaging Graph 2006; 30 (06) 407-416.
  • 50 Geissbuhler A, Bagayoko CO, Ly O. The raft network: 5 years of distance continuing medical education and tele-consultations over the internet in French-speaking Africa. I J Medical Informatics 2007; 76 5-6 351-356.
  • 51 Fondazione Don Carlo Gnocchi ONLUS. SIERRA LEONE – Sostegno all’Holy Spirit Hospital di Makeni: formazione del personale, rafforzamento attivit_a di diagnostica e telemedicina, coordinamento presenze equipe chirurgiche internazionali. 2014 Available from: http://www.dongnocchi.it/solidariet%C3%A0-in ternazionale/siamo-stati-anche-in/sierra-leone/sierra-leone-1/sostegno-all-holy-spirit-hospital-di-makeni-1.3373
  • 52 Fondazione CUMSE. Progetto telemedicina. 2013 Available from: http://www.cumse.it/progetti-in-africa/progetti-realizzati/progetto-telemedicina/
  • 53 Shiferaw F, Zolfo M. The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia. Global Health Act. 2012: 5.
  • 54 Nchise A, Boateng R, Mbarika V, Saiba E, Johnson O. The challenge of taking baby steps | preliminary insights into telemedicine adoption in Rwanda. Health Policy Technol 2012; 01 (04) 207-213 doi:10.1016/j.hlpt.2012.10.004.
  • 55 Deglise C, Suggs SL, Odermatt P. Short message service (SMS) applications for disease prevention in developing countries. J Med Internet Res 2012; 14 (01) e3 doi:10.2196/jmir.1823.
  • 56 Patterson V, Swinfen P, Swinfen R, Azzo E, Taha H, Wootton R. Supporting hospital doctors in the Middle East by email telemedicine: something the industrialized world can do to help. J Med Internet Res 2007; 09 (04) e30 doi:10.2196/jmir.9.4.e30.
  • 57 Bhatta R, Aryal K, Ellingsen G. Opportunities and Challenges of a Rural-telemedicine Program in Nepal. J Nepal Health Res Counc 2015; 13 (30) 149-153.
  • 58 Chan CV, Kaufman DR. A technology selection framework for supporting delivery of patient-oriented health interventions in developing countries. J Biomed Inform 2010; 43 (02) 300-306.
  • 59 Holle R, Zahlmann G. Evaluation of telemedical services. IEEE Trans Inf Technol Biomed 1999; 03 (02) 84-91.
  • 60 Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: A systematic review of reviews. I J Medical Informatics 2010; 79 (11) 736-771.
  • 61 Ekeland AG, Bowes A, Flottorp S. Methodologies for assessing telemedicine: A systematic review of reviews. I J Medical Informatics 2012; 81 (01) 1-11.
  • 62 Chen W, Akay M. Developing EMRs in developing countries. IEEE Trans Inf Technol Biomed 2011; 15 (01) 62-65.
  • 63 Czekierda L, Masternak T, Zielinski K. Evolutionary approach to development of teleconsultation system for imaging medicine. IEEE Trans Inf Technol Biomed 2012; 16 (04) 550-560.
  • 64 Shiferaw F, Zolfo M. The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia. Global Health Act. 2012: 5.

Correspondence to:

Giuseppe Pozzi
Dipartimento di Elettronica
Informazione e Bioingegneria
Politecnico di Milano
p.za L. da Vinci 32
I-20133 Milano
Italy

  • References

  • 1 World Health Organization. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth. Global Observatory for eHealth Series. 02 World Health Organization; 2009
  • 2 Ingenerf J. Telemedicine and terminology: different needs of context information. IEEE Trans Inf Technol Biomed 1999; 03 (02) 92-100.
  • 3 Wootton R, Geissbuhler A, Jethwani K, Kovarik C, Person DA, Vladzymyrskyy A. et al. Comparative performance of seven long-running telemedicine networks delivering humanitarian services. J Telemed Telecare 2012; 18 (06) 305-311.
  • 4 Istepanian RSH. Telemedicine in the United Kingdom: current status and future prospects. IEEE Trans Inf Technol Biomed 1999; 03 (02) 158-159.
  • 5 Joseph V, West RM, Shickle D, Keen J, Clamp S. Key challenges in the development and implementation of telehealth projects. J Telemed Telecare 2011; 17 (02) 71-77 doi:10.1258/jtt.2010.100315.
  • 6 Lamminen H, Sernberg V, Ruohonen K, Roine R. A three-year follow-up of Finnish telemedicine programs. IEEE Trans Inf Technol Biomed 2001; 05 (02) 174-177.
  • 7 Lakovidis I, Pattichis CS, Schizas C. Guest editorial special issue on emerging health telematics applications in Europe. IEEE Trans Inf Technol Biomed 1998; 02 (03) 110-116.
  • 8 Hsieh J, Hsu M. A cloud computing based 12-lead ECG telemedicine service. BMC Med Inf and Decision Making 2012; 12: 77 doi:10.1186/1472–6947–12–77.
  • 9 Istepanian RSH. Guest editorial special issue on mobile telemedicine and telehealth systems. IEEE Trans Inf Technol Biomed 2000; 04 (03) 194.
  • 10 Bahaadinbeigy K, Yogesan K, Wootton R. A survey of the state of telemedicine in Western Australia. J Telemed Telecare 2010; 16 (04) 176-180.
  • 11 Comyn G. Telemedicine for the benefit of patients, healthcare systems and society. – COM. 2008 689. Nov 4th, 2008. 2008. Available from: http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex:52008DC0689
  • 12 BCC Research. Global markets for telemedicine technologies, report code: Hlc014f. 2014 Available from: http://www.bccresearch.com/market-research/healthcare/telemedicine-technologies-hlc014f.html#gsc.tab=0
  • 13 Mordor Intelligence. Global Telemedicine Market – Growth, Trends and Forecasts. 2015-2020 2015 Available from: http://www.mordorintelligence.com/industry-reports/global-telemedicine-market-indus try#tab-1
  • 14 Wootton R. Telemedicine and developing countries-successful implementation will require a shared approach. J Telemed Telecare. 2001: 7.
  • 15 Wang TT, Li JM, Zhu CR, Hong Z, Hong-Yu DMAYang, Ren JC. et al. Assessment of utilization and costeffectiveness of telemedicine program in western regions of China: A 12-year study of 249 hospitals across 112 cities. Telemed J E Health 2016; 22 (11) 1-12 doi:10.1089/tmj.2015.0213.
  • 16 Combi C, Pozzani G, Pozzi G. Design, development, deployment of a telemedicine system in a developing country: Dealing with organizational and social issues. In 2015 International Conference on Healthcare Informatics, ICHI 2015, Dallas, TX, USA, October 21–23, IEEE Computer Society 2015; 545-554 doi:10.1109/ICHI.2015.103.
  • 17 US National Library of Medicine, National Institutes of Health. PubMed. 2016 Available from: https://www.ncbi.nlm.nih.gov/pubmed
  • 18 Ley M. DBLP – Computer Science Bibliography [Internet]. 2016 Available from: http://dblp.uni-trier.de/
  • 19 Tulu B, Chatterjee S, Laxminarayan S. A taxonomy of telemedicine efforts with respect to applications, infrastructure, delivery tools, type of setting and purpose. In 38th Hawaii International Conference on System Sciences (HICSS-38 2005), CD-ROM / Abstracts Proceedings. 3-6 January 2005 Big Island, HI, USA. IEEE Computer Society. doi:10.1109/HICSS.2005.56.
  • 20 Tulu B, Chatterjee S, Maheshwari M. Telemedicine taxonomy: A classification tool. Telemed J E Health 2007; 13 (03) 349-353 doi:10.1089/tmj.2006.0055.
  • 21 Beltrame F, Boddy K, Maryni P. Adopting telemedicine services in the airline framework. IEEE Trans Inf Technol Biomed 2001; 05 (02) 171-174.
  • 22 Anogianakis G, Maglavera S, Pomportsis AS. Relief for maritime medical emergencies through telematics. IEEE Trans Inf Technol Biomed 1998; 02 (04) 254-260.
  • 23 Chimiak WJ, Rainer RO, Chimiak JM, Martinez R. An architecture for naval telemedicine. IEEE Trans Inf Technol Biomed 1997; 01 (01) 73-79.
  • 24 The World Bank. The World Bank – Working for a World Free of Poverty [Internet]. 2016 Available from: http://www.worldbank.org/
  • 25 European Commission, Digital Agenda for Europe. eHealth Action Plan 2012-2020: Innovative healthcare for the 21st century. 2012 Available from: https://ec.europa.eu/digital-agenda/en/news/ehealth-actionplan-2012–2020-innovative-healthcare-21st-century
  • 26 The World Bank. Health expenditure, public (% of GDP). 2016 Available from: http://data.world-bank.org/indicator/SH.XPD.PUBL.ZS
  • 27 Martìnez A, Villarroel V, Seoane J, del Pozo F. Analysis of information and communication needs in rural primary health care in developing countries. IEEE Trans Inf Technol Biomed 2005; 09 (01) 66-72.
  • 28 Martìnez A, Villarroel V, Seoane J, del Pozo F. Rural telemedicine for primary healthcare in developing countries. IEEE Technol Soc Mag 2004; 23 (02) 13-22.
  • 29 The World Bank. Fact sheet: Infrastructure in sub-Saharan Africa. 2014 Available from: http://go.world-bank.org/SWDECPM5S0
  • 30 Wootton R. The possible use of telemedicine in developing countries. J Telemed Telecare 1997; 03 (01) 23-26.
  • 31 Martìnez A, Villarroel V, Seoane J, del Pozo F. A study of a rural telemedicine system in the Amazon region of Peru. J Telemed Telecare 2004; 10: 219-225.
  • 32 Odutola AB. Developing countries must invest in access to information for health improvements. J Med Internet Res 2003; 05 (01) e5 doi:10.2196/jmir.5.1.e5.
  • 33 Rodrigues RJ, Risk A. eHealth in Latin America and the Caribbean: development and policy issues. J Med Internet Res 2003; 05 (01) e4 doi:10.2196/jmir.5.1.e4.
  • 34 Parent F, Coppieters Y, Parent M. Information technologies, health, and „globalization”: anyone excluded?. J Med Internet Res 2001; 03 (01) E11 doi: 10.2196/jmir.3.1.e11.
  • 35 Meso P, Mbarika VWA, Sood SP. An overview of potential factors for effective telemedicine transfer to Sub-Saharan Africa. IEEE Trans Inf Technol Biomed 2009; 13 (05) 734-739.
  • 36 Moodley D, Pillay AW, Seebregts CJ. Position paper: Researching and developing open architectures for national health information systems in developing African countries. In Liu Z, Wassyng A. editors, FHIES, volume 7151 of Lecture Notes in Computer Science; Springer: 129-139.
  • 37 Bai J, Hu B, Zhang Y, Ye D. A communication server for telemedicine applications. IEEE Trans Inf Technol Biomed 1997; 01 (03) 205-209.
  • 38 Xue Y, Liang H. Analysis of telemedicine diffusion: The case of China. IEEE Trans Inf Technol Biomed 2007; 11 (02) 231-233.
  • 39 Pal A, Mbarika VWA, Payton FC, Datta P, McCoy S. Telemedicine diffusion in a developing country: The case of India (March 2004). IEEE Trans Inf Technol Biomed 2005; 09 (01) 59-65.
  • 40 Hussein R, Khalifa A. Telemedicine in Egypt: SWOT analysis and future trends. GMS Medizinische Informatik, Biometrie und Epidemiologie 2012; 08 (01) 1-16.
  • 41 Bice SD, Dever G, Mukaida L, Norton SA, Samisone J. Telemedicine and telehealth in the Pacific islands region: A survey of applications, experiments, and issues. In Peacesat. Pacific Telecommunications Council; 574-581.
  • 42 Norton SA, Floro C, Bice SD, Dever G, Mukaida L, Scott JC. Telemedicine in Micronesia. Telemed J 1996; 02 (03) 225-231.
  • 43 da Silva SMattos, Hazin SMV, Regis CT, de Araújo JSS, de Lira FCAlbuquerque, Moser LRDN. et al. A telemedicine network for remote pediatric cardiology services in North-East Brazil. Bulletin of the World Health Organization 2015; 93 (12) 881-887.
  • 44 Nexus Mundi Foundation. Chikuni Mission Hospital. 2014 Available from: http://s328691085.online-home.us/
  • 45 Gori A, Taddei A, Mota D, Rocca E, Carducci T, Piccini G. et al. Open source teleconsulting system for international cooperative medical decision making in congenital heart diseases. Comput Cardiol 2010; 37: 481-484.
  • 46 Patologi Oltre Frontiera. Available from: http://www.apof.eu/
  • 47 Geissbuhler A, Ly O, Lovis C, L’Haire JF. Telemedicine in Western Africa: lessons learned from a pilot project in Mali, perspectives and recommendations. In AMIA Annual Symposium Proceedings. volume 2003. American Medical Informatics Association; 249.
  • 48 Bagayoko CO, Muller H, Geissbuhler A. Telemedicine network in French-speaking Africa (RAFT). In Medical Imaging and Telemedicine. 108-113.
  • 49 Bagayoko CO, Muller H, Geissbuhler A. Assessment of Internet-based tele-medicine in Africa (the RAFT project). Comput Med Imaging Graph 2006; 30 (06) 407-416.
  • 50 Geissbuhler A, Bagayoko CO, Ly O. The raft network: 5 years of distance continuing medical education and tele-consultations over the internet in French-speaking Africa. I J Medical Informatics 2007; 76 5-6 351-356.
  • 51 Fondazione Don Carlo Gnocchi ONLUS. SIERRA LEONE – Sostegno all’Holy Spirit Hospital di Makeni: formazione del personale, rafforzamento attivit_a di diagnostica e telemedicina, coordinamento presenze equipe chirurgiche internazionali. 2014 Available from: http://www.dongnocchi.it/solidariet%C3%A0-in ternazionale/siamo-stati-anche-in/sierra-leone/sierra-leone-1/sostegno-all-holy-spirit-hospital-di-makeni-1.3373
  • 52 Fondazione CUMSE. Progetto telemedicina. 2013 Available from: http://www.cumse.it/progetti-in-africa/progetti-realizzati/progetto-telemedicina/
  • 53 Shiferaw F, Zolfo M. The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia. Global Health Act. 2012: 5.
  • 54 Nchise A, Boateng R, Mbarika V, Saiba E, Johnson O. The challenge of taking baby steps | preliminary insights into telemedicine adoption in Rwanda. Health Policy Technol 2012; 01 (04) 207-213 doi:10.1016/j.hlpt.2012.10.004.
  • 55 Deglise C, Suggs SL, Odermatt P. Short message service (SMS) applications for disease prevention in developing countries. J Med Internet Res 2012; 14 (01) e3 doi:10.2196/jmir.1823.
  • 56 Patterson V, Swinfen P, Swinfen R, Azzo E, Taha H, Wootton R. Supporting hospital doctors in the Middle East by email telemedicine: something the industrialized world can do to help. J Med Internet Res 2007; 09 (04) e30 doi:10.2196/jmir.9.4.e30.
  • 57 Bhatta R, Aryal K, Ellingsen G. Opportunities and Challenges of a Rural-telemedicine Program in Nepal. J Nepal Health Res Counc 2015; 13 (30) 149-153.
  • 58 Chan CV, Kaufman DR. A technology selection framework for supporting delivery of patient-oriented health interventions in developing countries. J Biomed Inform 2010; 43 (02) 300-306.
  • 59 Holle R, Zahlmann G. Evaluation of telemedical services. IEEE Trans Inf Technol Biomed 1999; 03 (02) 84-91.
  • 60 Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: A systematic review of reviews. I J Medical Informatics 2010; 79 (11) 736-771.
  • 61 Ekeland AG, Bowes A, Flottorp S. Methodologies for assessing telemedicine: A systematic review of reviews. I J Medical Informatics 2012; 81 (01) 1-11.
  • 62 Chen W, Akay M. Developing EMRs in developing countries. IEEE Trans Inf Technol Biomed 2011; 15 (01) 62-65.
  • 63 Czekierda L, Masternak T, Zielinski K. Evolutionary approach to development of teleconsultation system for imaging medicine. IEEE Trans Inf Technol Biomed 2012; 16 (04) 550-560.
  • 64 Shiferaw F, Zolfo M. The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia. Global Health Act. 2012: 5.