Drawing on extensive experience with international healthcare and telemedicine, Ronald S. Weinstein, MD, professor with the University of Arizona College of Medicine – Tucson, College of Pharmacy and Mel and Enid Zuckerman College of Public Health, and founding director of the Arizona Telemedicine Program, describes a “top down” strategy for assisting developing nations in creating sustainable national telemedicine programs in the current issue of Telemedicine and e-Health.
In the article, “Testing a Top-Down Strategy for Establishing a Sustainable Telemedicine Program in a Developing Country: The Arizona Telemedicine Program—U.S. Army—Republic of Panama Initiative,” Dr. Weinstein and his co-authors describe four critical tasks for U.S. academic telemedicine contractors to accomplish in order to help developing nations create sustainable national telemedicine programs of their own.
First, conduct meetings with high level health officials in the developing country. Essential participants include the Minister of Health and the Presidents (Rectors) of the national universities. The immediate objectives are to get high-level governmental buy-in for the project and to lay the groundwork for creating a local functional demonstration telemedicine network (i.e., three to five rural telemedicine clinics) preferably within a relatively small rural area (100 to 200 square miles) near a highway.
The second step calls for the identification of a national telemedicine champion, ideally a mid-career, highly respected practicing physician in a high-need medical specialty, such as infectious disease, pediatrics, or women’s health. The champion comes to the U.S. academic contractor’s training facility for a mini-sabbatical-type learning experience, generally lasting a minimum of three to four weeks.
The third step calls for the build-out and operationalization of the network of rural telemedicine clinics. For distance education purposes, and for staff sharing, the rural clinics are interoperable. The diagnostic hub is typically at a regional Ministry of Health, or Social Security, Hospital.
Fourth, Dr. Weinstein and his team describe the critical disengagement process including the assessment of the program.
Moving through these four steps is a multi-year process. Success can be measured in terms of: sustainability of the program once the academic contractor departs; increases in numbers of new telemedicine clinic sites in the network over time; and telemedicine patient accrual rates and outcomes.
UA College of Medicine faculty members have developed international telemedicine programs in Panama, the Balkan countries, Mexico and China.
For more information about the UA colleges mentioned above, please visit their websites:
• UA College of Medicine – Tucson, www.medicine.arizona.edu
• UA College of Pharmacy, www.pharmacy.arizona.edu
• UA Mel and Enid Zuckerman College of Public Health, www.publichealth.arizona.edu
The article may be viewed at http://online.liebertpub.com/doi/abs/10.1089/tmj.2013.0025