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

[摘要] ENGLISH ABSTRACT: Telemedicine is de ned as an electronic exchange of medical information and/orthe delivery of clinical health care over a distance, by means of Informationand Communication Technology (ICT). South Africa is faced with the problemof providing health care to a population in urban, as well as across vastrural areas. In addition to this, the South African health care system mustdeal with economical imbalances and a shortage of human resources to providequality health care. Telemedicine services could provide a solution.Since the introduction of therst national telemedicine services initiative inthe late 1990s, a number of South African telemedicine services have been implementedin the public health care system. The majority of these telemedicineservices have been prone to failure and many were prematurely terminated.The circumstances which in uence the failure or success of these services arenot unknown. The lack of insight, and the high failure rate of telemedicineservices implemented in the South Africa were the reasons for conducting thisstudy.The purpose of the study is to assess telemedicine services implemented inthe Western Cape public health care sector. The purpose is also to providerecommendations for improving the current and future telemedicine servicesin the Western Cape and other provinces.A telemedicine services assessment was conducted on a total of 26 telemedicineservices 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 telemedicineservices. The TMSMM capability statements were used as a yardstickto assess the maturity of each of the elements of telemedicine services interms of the three service level groups (micro-,meso- and macro-level) andvetelemedicine domains (man, machine, material, method and money).The assessment process included: (i) the identi cation of telemedicine servicesat the selected health care facilities; (ii) the gathering of the relevanttelemedicine service data by means of structured interviews; (iii) the transformationof the complexow 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), aswell as box-and-whisker plots and statistical correlations.Based on the results of the TMSMM assessment, an electronic questionnairewas developed and administered amongst health care workers throughout theentire Western Cape. The questionnaire con rmed that thendings from theTMSMM assessment are indeed representative of the entire Western Cape.The assessment of the telemedicine services provides information about theelements which a ect the success or failure of these services. This thereforeaddresses 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 inthe Western Cape public health sector. For future references and studies,the SWOT analysis provides a point of departure for a strategic telemedicineservices framework for a province like the Western Cape.

[发布机构] Stellenbosch University