1. Telemedicine and Main Issues in Developing Countries: A General Review
Mehrdad Jabbarzadeh Gangeh
Dr. Edmond Zahedi
Dr. Mohd. Alauddin Mohd. ALi
Department of Electrical, Electronics and Systems Engineering Faculty of Engineering
Universiti Kebangsaan Malaysia

2. Is telemedicine and its deployment in developing countries effective?
Improving the quality of health care
Simplifying access to health care
Decreasing costs

3. Issues: Difficulties of Health Care in Developing Countries
Definition of Telemedicine
Different Types of Telemedicine Systems
Hardware, Software, and Bandwidth Requirement for the Different Types of Telemedicine Systems
Potential of Telemedicine to Improve Health Care in Developing Countries
Expected Problems with Telemedicine

4. Access to local health services
Introduction to the Difficulties of Health Care in Developing Countries
Few number of doctors
Access to local health services
Shortage of high level hospital infrastructure
The geographical distribution of existing hospital and health services
In Short:
1) Limited medical expertise and resources
2) Concentration of facilities in metropolitan areas

5. Telemedicine Definition According to ITU
Use of telecommunications and medical technologies
Exchange data, audio and/or visual
Between physician and patient or between physician and health
care professional
Geographically separate locations
On-line or off-line

6. Different types of Telemedicine Systems According to Their Use in Health Care
Teleconsultation
Telediagnosis
Tele-education
Medical emergencies and distant relief
Telesurgery and virtual reality

7. Different types of Telemedicine Systems According to the Medical Applications
Teleradiology :
X- Ray CT
MRI
NM (Nuclear Medicine)
Fluoroscopy
Angiography
Ultrasound
Thermography
Telepathology
Teledermatology
Tele-endoscopy
Telecardiology
Telepsychiatry
Telepharmacy
Telemetry

8. Different Applications of Telemedicine Systems: Definition, Transfer Need and Required Stream

9. Multimedia Stream and Their Bandwidth Requirement

10. Required transfer time of an X-ray image with the size of 64 Mb
Bandwidth Requirement for Telemedicine Systems and Telecommunication Networks
Factors influencing the choice of a special telecommunication service are:
Necessary bandwidth
the volume of data to be transferred (depends on the type of service, application and the quality of service)
required transfer speed
Infrastructure and telecommunication facilities available in rural parts
Price of the service
Required interfaces of the equipment in use to the telecommunication network
Required transfer time of an X-ray image with the size of 64 Mb

11. Hardware and Software Required for Different Types of Telemedicine Systems
Central Processing Unit:
Media Acquisition
Image
Video
Audio
Media Storage
Compression/Decompression Algorithms/Standards
Image and/or Video Processing
User Interface
Communication Media/Interface
Special Medical Equipment

12. Potential Improvements (Non Financial)
Long distance consultation
Quality health care in remote areas
New ways for education and training
Improvement in qualification of national specialists and health technicians
Second opinion and centralisation of resources (specialists, hardware, and software packages)
Reduction of waiting times for consultation

13. Potential Improvements (Financial)
Cost reduction
For patients:
Cutting down on journeys to major health centres or for specialist consultation
Reduction of length of stay, and therefore cost of hospitalisation
For providers of health services:
Reduction in operating costs
Reduction in travel cost and time
for specialist visiting other hospitals
Reduction in costs of training

14. Expected Problems with Telemedicine in Third World Countries (1)
1) Financial:
Increase of costs because of improving the quality of service through providing second opinion
They are not used very often
Who pays for the expenses
Cost effectiveness assessment
2) Liability:
Who is responsible for the patient?
Anyone can establish a web site to offer consulting

15. Expected Problems with Telemedicine in Third World Countries (2)
3) Acceptance:
Physicians resist to use a new technology that they do not understand
Patients and doctors are accustomed to personal visits and are reluctant to alter the traditional method of care
Privacy and confidentiality of information
Insurance
4) Technology:
Scarcity of high-bandwidth telecommunication networks in rural areas
Compatibility of old equipment with telemedicine

16. Conclusion (1)
Telemedicine can potentially improve health care in developing countries through:
Providing the services in rural and difficult to access parts of the country
Providing the possibility of concentration of expertise and resources
Reduction of costs for both patients and providers of health services in some aspects
However, the acceptance and further development of telemedicine
depends on factors among them are:
Some cost/benefit analysis
Types of telemedicine systems and applications that are mostly required in a special country

17. Conclusion (2)
The cost/benefit analysis can be carried out by the ministry of health and finance ministry
Close cooperation between the medical society and engineers
Pilot projects
Education

18. Telemedicine and Main Issues in Developing Countries: A General Review
Mehrdad Jabbarzadeh Gangeh
Dr. Edmond Zahedi
Dr. Mohd. Alauddin Mohd. ALi
Department of Electrical, Electronics and Systems Engineering Faculty of Engineering
Universiti Kebangsaan Malaysia