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eHealth and Telemedicine in Nigeria

Introduction

According to WHO report, in Nigeria life expectancy dropped from 53.8 years for females and 52.6 years for males in 1991 to 46 years for females and 45years for males in 2004. The infant mortality rate(IMR) rose from 87.2 per 1,000 live births in 1990 to 104 in 2004. The maternal mortality ratio of 800 per 100,000 live births is one of the highest in the world.

The disability adjusted life expectancy (DALE) of 38.3 years ranks 187 in the WHO report. There is thus an urgent need to support the health system with adequately trained personnel and medical facilities in order to improve the quality of healthcare.

Important causes of morbidity and mortality in Nigeria include malaria, TB, malnutrition, HIV/AIDS , parasitic infestations, typhoid fever, pneumonia, complications of pregnancies and deliveries, hypertension and diabetes mellitus. Others include strokes, cancers, sickle cell disease and accidents, coronary artery disease and pulmonary arterial embolism, amongst others. eHealth has a crucial role to play in the diagnosis and management of these conditions and related complications.

The Nigerian health care system is presently characterized by inadequate infrastructures and lack of basic amenities. The federal government has commenced refurbishment of some of the teaching hospitals. Most of the existing health services are inaccessible to the vulnerable group especially the poor and people living in rural and underdeveloped areas.

What is e-Health?

eHealth is a relatively new term in health care practice and one of the most rapidly growing areas in health and ICT today. The term encompasses a range of services that involve health care and information technology supported by electronic processes and communication. It involves the use of information and communication technology(ICT) to improve patient care.

The World Health Organization defines eHealth as ‘the cost-effective and secure use of information and communications technologies(ICT) in support of health and health- related fields, including health-care services, health surveillance, health literature , and health education, knowledge and research'.(WHO 2005).

Eysenbach G, a world-renowned eHealth expert defines eHealth as ‘an emerging field in the intersection of medical informatics, public health and business , referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state -of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology'.(Eysenbach, 2001).

What is Telemedicine?

Telemedicine involves the use of medical information transferred from one site to another through electronic communications to improve patient's health care including diagnosis and treatment.
Telemedicine may be as simple as two medical professionals discussing a case over the telephone, or as advanced as using video teleconferencing systems.


Two forms of e-Health/Telemedicine

eHealth occurs in two forms which include synchronous or ‘real time' communications and asynchronous or ‘store and forward' communications.
Synchronous eHealth requires a communication link between two or more parties that allows a real-time interaction to occur. Synchronous telemedicine may use video-conferencing equipment with attachment of peripheral devices which aid in interactive examinations. For instance, a tele-stethoscope(eStethoscope) allows the consulting physician in remote location to listen to the patient's heartbeat and lungs, a tele-ophthalmoscope(eOphthalmoscope) and tele-otoscope(eOtoscope) allow a remote physician to examine a patient's eyes and ears respectively.

Asynchronous eHealth involves the acquisition and transmission of patient's medical data such as radiological studies, laboratory results and biomonitoring information to a physician at a convenient time for assessment offline. A digital image is taken using a digital camera(‘stored') and then sent (‘forwarded') to another location. Asynchronous eHealth doesn't require the parties to be present at the same time.


Applications of e-Health Technologies.


There are clinical and non-clinical uses of eHealth technologies.


Clinical Applications of eHealth technologies(Telemedicine) include:


Clinical eHealth Clinical services consisting of remote patient evaluation, treatment and monitoring by digital equipment. These include specialist referral services, primary remote diagnostic visits and remote patient monitoring.

Specialist referral services: involve a general medical practitioner in a remote location consulting a specialist or a specialist consulting another specialist for second opinion. This may involve a patient being evaluated by a specialist over a live, remote consult or the transmission of diagnostic images and/or video along with patient data to a specialist for viewing later.
Almost 50 different medical subspecialties have successfully used telemedicine. Radiology through the use of teleradiology continues to make the greatest use of telemedicine with patients' radiological images from remote sites interpreted by Radiologists. Other applications of telemedicine include telecardiology, telepathology, teledermatology and telepsychiatry amongst others.

Teleradiology is the electronic transmission of patient radiological images from one location to another for the interpretation and / or consultation. Teleradiology allow prompt interpretation of radiologic examinations and give greater access to consultations and improved continuing medical education.

Primary Remote Diagnostic Visits: whereby devices examine a patient and a connected physician residing in another location virtually examines and treats a patient. This can play a crucial role in a developing country like Nigeria with shortage of health care professionals.

Remote patient monitoring : devices remotely collect and send data from homebound patients to a monitoring station for interpretation. The data may include patient's vital signs, ECG and blood glucose. Such services can supplement the use of home visiting nurses .

e-Prescriptions : It replaces handwritten paper orders by doctors. It allows physicians to use a computer or a personal digital assistant(PDA) to electronically transmit a prescription to a pharmacy selected by the patient. After placing the electronic order, the system checks for the patient's drug history including allergies, interactions with other prescriptions and whether the drug is covered by the patient's insurance by searching the pharmacy and health plan databases. The e-prescription is convenient to pharmacies due to automatic creation and storage of electronic records of the prescription. The e-prescription improves drug safety by decreasing the amount of prescription errors and subsequently reduces avoidable health care costs.

e- Medical Records(EMR): The collection, storage, indexing, communication and access to patient data. It enables easy communication of patient data between health care providers and a greater access to a wide variety of the patient's comprehensive health information. The health care provider can access this data to get more complete information of the patient's health in elective and emergency cases.

Evidence Based Medicine: This system provides medical information on appropriate treatment under certain patient conditions. It enables the healthcare professional to determine whether a patient's diagnosis and management are in line with current medical research.

Virtual healthcare teams: They consist of teams of health care providers who collaborate and share medical information on patients for intramural care, through electronic equipment like videoconferencing equipment.

Other clinical applications of eHealth include health advice by telephone in emergent cases (teletriage) and advice on prevention of diseases, and promotion of good health by patient monitoring and follow-up.

By

Dr Osbert Egiebor, MD, FAAP, FACR.

Dr Egiebor is a Nigerian Physician practicing in the United States of America. He performs regular voluntary medical missions in Nigeria.

He is actively involved in the establishment of Lincoln Advanced Radiology & Diagnostic Medical Centre in Benin City, Nigeria. The project is being undertaken by Nigerian Physicians in the United States in order to improve the standard of healthcare and medical education in Nigeria. The centre will serve as a teaching facility for Nigerian Physicians and medical students.
Careers & Jobs at Lincoln Advanced Radiology & Diagnostic World class Centre
 

 

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Comments

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April 16, 2008

 

Olutunji in Lagos says:

 

 

Welcome to what has been missing in black Africa.. the power of Information shared. There are bodies of knowledge that need to go from personal property to shared resource for the improvement of our lives.
Thank you Doctor. 

 

 

April 3, 2008

 

Zainab Al from Kaduna says:

 

 

Thank you Doctor for sharing this exciting and useful information on applying technology to improve healthcare. And please spread your tentacles all over Nigeria and Africa. We need more of such from our people in the diaspora. 

 

 


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