Telemedicine Annotated Bibliography
By Michael Pancewicz
This annotated bibliography covers 30 of the main journal, online and newspaper articles associated with the subject of telemedicine. I feel that the topic of telemedicine is important in this contemporary era of information and communication technologies. Three of the eight UN Millennium Development Goals are concerned with some aspect of improving issues to do with health.Telemedicine has its pitfalls in that it can be too expensive for the countries and regions which need it most, but if these problems could be overcome then telemedicine could have an important role in helping those in need of medical attention.
There are three sections within this bibliography and they are journal, online and newspaper articles. Being an innovation that has developed most rapidly over the past decade the majority of the information on telemedicine is contained either in Journals or on the worldwide web. This may be a benefit however as these two sources are perhaps the easiest to reach (both can be obtained via an internet connection) for those without access to an extensive library. The articles that have been reviewed cover all aspects of telemedicine and include examples from both the developed and developing countries. I felt this was important as the MDGs are not purely for those in developing countries.
Journals
1. Adewale, O.S. (2004) ‘An internet-based telemedicine system in Nigeria’, International Journal of Information Management, 24(3), p.221
This journal article discusses how Nigeria’s population of 120 million have limited access to basic health care. Geographic isolation, the scarcity of physicians and hospitals, and difficulties of travel to larger cities where such care is available are among the factors limiting this access. In an attempt to offer a solution to this problem the author suggests an internet-bases telemedicine system that could support consultations among remotely placed patients, rural health workers and specialists in the urban cities and provide a secure access to remote patient records.The paper further discusses some of the challenges and implementation issues of telemedicine in Nigeria.
2. Adeyinka, M.B. (1997) ‘Fundamentals of modern telemedicine in Africa’, Methods Inf Med, 36(2), 95-98
Outlined in this article is how FOMTA (Fundamentals of modern telemedicine in Africa) has an initiative which aims to increase the awareness and stimulate the participation of Developing Countries in the telemedicine and health care telematics projects through demonstrations, pilot projects, workshops, and training and exchange activities. Adeyinka believes that it is feasible for telemedicine to be used in the developing countries.
3. Boulanger, B. et al (2001) ‘Telemedicine: a solution to the follow-up of rural trauma patients?’, Journal of the American College of Surgeons, 192(4), 447-452
The hypothesis of this paper is that telemedicine-based follow-up of trauma patients discharged to remote areas is feasible and is associated with high patient and physician satisfaction. Both the study design and results are commented upon and the conclusion states that early results are encouraging with high levels of satisfaction. Thus Boulanger et al believe that telemedicine-based follow-up should be expanded to other regions of Kentucky which have not benefited from this initiative.
4. Brown, N. (1998) ‘The telemedicine information exchange: an online resource’, Computers in Biology and Medicine, 28(5), 509-519
This paper mentions how telemedicine has grown from mostly government-subsidized research initiatives into a fledgling industry. The Telemedicine Research Centre in Portland, USA, is identified as both a product and a vehicle for the rapid growth this industry has seen. Finally this article describes the TIE's development, advantages and disadvantages of a web-based online library, and it's co-development with a rapidly expanding industry.
5. Epstein, D. and Vernaci, R.L. (1998) ‚Telemedicine meets the global village’, Perspectives in Health, 3(2)
An evaluation of the way telemedicine has moved forward since the idea was first pioneered by the space programs of the former Soviet Union and the United States to allow medical teams on the ground to monitor the physical conditions of astronauts in orbit or journeying to the moon. Particular attention is paid to the way information access closes distances and the way the individual tools can be put to work to produce success stories in telemedicine. To conclude Epstein and Vernaci provide a glossary of useful terminologies in the field of telemedicine.
6. Gustke, S.S., Balch, D.C., West, V.L., and Rogers, L.O. (2000) ‘Patient satisfaction with telemedicine’, Telemedicine Journal, 6(1), 5-13
This paper evaluates patient satisfaction with regards to telemedicine and clinical consultations. A satisfaction rate of 98.3% was recorded amongst those questioned. The result was consistent with other findings within this topic. Main areas of dissatisfaction highlighted are appointment scheduling, patient travel times and patient involvement in the physical examination. In conclusion this paper says that additional research needs to be done using different constructs to patient satisfaction.
7. Kokdemir, P., and Gorkey, S. (2002) ‘Are telemedicine/telehealth services ethical?’, Sendrom, 14(1), 86-92
A review of the benefits and drawbacks of Telemedicine and Telehealth services and an assessment of the two statements World Medical Association has made on the subject. Benefits listed include how the internet has permitted physicians, other health care professionals, patients, and other consumers to quickly access medical information in unprecedented volume. Information is given on how many consultations were done in the United States by interactive video conference system. On the negative side the privacy of patient information is considered as there are doubts to how well information will be protected.
8. Marsh, A. (1998) ‘The Creation of a global telemedical information society’, International Journal of Medical Informatics, 49(2), 173-194
Although slightly dated this paper highlights the main issues and possibilities with regards to telemedicine. A figure that is given states that the expected revenue by the year 2000 is US$21 billion and this provides a useful comparison to journal articles of more recent times. A significant emphasis is placed on the vital role of the worldwide web in the widespread implementation of telemedicine projects. The Euromed Project is the specified case study and it has identified 20 building blocks resulting in 39 steps requiring multi-disciplinary collaborations in order to prevent the information society being developed in an ad-hoc fashion.
9. Martínez, A. (2004) ‘Rural Telemedicine for Primary Healthcare in Developing Countries’, IEEE Technology and Society Magazine, 23(2), p.13
While admitting that there are indeed benefits of using telemedicine for primary healthcare in developing countries the author states that there are difficulties in achieving these benefits. This is because of the fact that in the rural areas of many developing countries telephone networks and computers are extremely scarce. This is the fundamental difference between developed and developing countries and worryingly this inequality is becoming seen in urban and rural areas within developing countries.
10. Mbarika, V.W.A. (2004) ‘Is Telemedicine the Panacea for Sub-Saharan Africa's Medical Nightmare?’, Communications of the ACM, 47(7), p.21
A review of the efforts made by governmental, non-governmental and international development organisations in a bid to implement telemedicine in the sub-Saharan African countries. Although considered a solution to the growing medical problems seen in the area, telemedicine struggles to be widely used due to the shortage of medical personnel. The region averages fewer than 10 doctors per 100,000 people, and 14 countries within the region do not have a single radiologist. The specialists and services available are concentrated in cities.
11. Miller, T.E., Derse, A.R. (2002) ‘Between Strangers: the practice of medicine online’, Health Affairs, 21(4), 168-179
A review of the use of the internet to allow on-line communication between patients and physicians. The use of on-line communication has been said to improve the quality, timeliness, and efficiency of medical care. With the increased usage of this method, calls have come for a review of regulations with regards to accountability and the establishment of acceptable parameters for online medical practice.
12. Rasid, M.F.A., Woodward, B. (2005) ‘Bluetooth telemedicine processor for multichannel biomedical signal transmission via mobile cellular networks’, IEEE Transactions on Information Technologies in Biomedicine, 9(1), 35-43
Rasid and Woodward discuss the emerging issues in m-Health such as how best to exploit the mobile communications technologies that are now almost globally available. With the design of a processor that samples signals from sensors on a patient, it is hoped that a system can be produced where apatient's biomedical signals can be directly transmitted to a hospital for monitoring or diagnosis. The added objective of being ‘future proofed’ is discussed with the hope that the system can continually be modified simply by updating the software.
13. Stanberry, B. (2000) ‘Telemedicine: barriers and opportunities in the 21st century’, Journal of Internal Medicine, 247(6), 615-628
This paper aims to examine how health telematics will develop in the first 10 years of the new millennium and, in particular, to assess what operational, ethical and legal barriers may lie in the way of this development. Included is a description of the key principles and concepts involved in telemedicine and a short historical overview of telemedicine's evolution over the past century.Four evolving health telematics applications are examined in detail: electronic health records; the transmission of visual media in disciplines such as teleradiology, teledermatology, telepathology and teleophthalmology; telesurgery and robotics and the use of call centres and decision-support software.
14. Stanberry, B. (2001) ‘Legal ethical and risk issues in telemedicine’, Computer Methods and Programs in Biomedicine, 64(3), 225
Stanberry summarizes the main topics of discussion at a workshop hosted by the Centre for Law Ethics and Risk in Telemedicine at the 2nd International Conference on Advances in the Delivery of Care. The paper outlines that there was a broad consensus that many of the legal and ethical issues raised by those who dislike the idea of treating distant patients were not specific to telemedicine but to medicine and healthcare in general.
Online Articles
15. Brown, N. (1996) ‘Telemedicine Coming of Age’, on January 13, 2005(visited 2/02/05)
This paper discusses how telemedicine can vary from a simple phone call between two health professionals to something as sophisticated as using satellite technology to broadcast a consultation between two countries. This article continues by outlining the two different kinds of technology that make up for most of the telemedicine applications in use today: ‘store and forward’ and ‘two-way interactive television’. Advantages to telemedicine are shown yet the barriers to the practice are shown in greater detail. In conclusion the article offers the possibility of a ‘Personal Diagnosis System’ in the future which would monitor our daily health status and notify a physician if we became ill.
16. Einterz, E.M.(2001) ‘Telemedicine in Africa: potential, problems, priorities’,
(visited 28/02/05)
Einterz speaks about how having an up-and-running and paid for telemedicine system would be wonderful yet realistically attention needs to be paid to the more urgent areas of medicine in Africa. His practice struggles to overcome the lowest of low-technology failures such as the lack of portable water, unreliable sources of electricity and underdeveloped systems of transportation and communication. He states that the means to prevent Malaria and childhood malnutrition are known yet money is being spent on telemedicine which won’t be able to cure these diseases. Einterz suggests that the solutions to these problems are known and should not be avoided.
17. Ganapathy, K. (n.d) ‘Telemedicine in India-the Apollo experience’
(visited 19/03/05)
This article briefly reviews some aspects of Telemedicine, particularly its relevance in a developing country like India and the experience of the Apollo Hospitals in setting up telemedicine centres.A simple and easy to understand section called ‘What is telemedicine?’ allows the reader to gain a good awareness of general issues before more detailed aspects are discussed. These aspects include points which need to be addressed in implementing telemedicine projects in India and the aims of a pilot study which is to be carried out.
18. Geneva University Hospitals (n.d) ‘Telemedicine at the World Summit on the Information’
(visited 16/03/05)
In 2003 the Geneva University Hospitals presented several telemedicine projects to the World Summit on the Information Society. This excerpt is general information that will be given on the ability of telemedicine to provide medical expertise without the need to move the patient or physician. Particular attention is given to telemedicine’s potential to open up all points of possible relations on the planet such as increased co-operation between the North and South.
19. Haywood, A., updated July 2002 ‘Telemedicine and the Community Service Programme’,
(visited 14/03/05)
Two definitions for telemedicine are provided and so is a list of the various disciplines involved. South Africa is the case study and a very thorough examination is undertaken exploring the details of telemedicine in this country. South Africa is in Phase II of its nationwide telemedicine program and the mission of the South African Telemedicine System is to facilitate the provision of high quality, cost-effective health care to all the citizens of South Africa, particularly to women and children in the rural areas.
20. Hilman, D. (2004) ‘Health for All Through Telehealth’,
(visited 15/03/05)
This article mentions that telehealth can be the key to achieving Health for All in Africa. Uganda is the case study as there has been criticism of the use of a ‘high-tech’ approach in a country with so many basic needs. In response Hilman states that with the aid of a ‘battery pack’ the project had the capacity to have a 24-hour teleconferencing which helped educate medical and nursing students.
21. Jambusaria, A., updated January 1999, ‘The Advantages of Telemedicine’,
(visited 16/03/05)
This website has five detailed sections which are: the advantages of telemedicine, the disadvantages of telemedicine, types of telemedicine, viewing a telemedicine unit and links to other telemedicine sites. The four types of telemedicine are telepathology, teledermatology, teleradiology and primary care. A definition of the topic is also provided. An example is given to illustrate the advantages of the use of telemedicine but some of the disadvantages include infrastructural and funding problems.
22. Jiva Health (n.d) ‘TeleDoc: Sustainable Healthcare for Rural India’
(visited 18/03/05)
An introduction to the work of Jiva’s ‘Teledoc’ which provides effective healthcare, and brings high-quality medical attention directly to rural India. Information is given on the way Teledoc seeks to bridge this critical gap between rural populations and quality health services by using Java-enabled mobile telephones to provide village-based healthcare workers with real-time ability to record and transmit diagnostic information. To conclude this article outlines six points the program hopes to deliver on.
23. Koomson, G (n.d) ‘Telemedicine in rural Uganda’,
(visited 18/03/05)
On this page George Koomson says that he believes radio can play a big part in improving basic health and reducing the number of maternal deaths. Opinions are also drawn from people who studied a pilot health project in Eastern Uganda’s Iganga district. The overall judgment is that the project was successful as it raised awareness of critical issues and also provided some training. Because of this success the project has been adapted to be carried out in three other districts and there are plans for adaptation to 30 other places.
24. Leitch, R. (n.d) ‘Trout Fishing in Africa’,
(visited 14/03/05)
This column is a response to Einterz’s ‘Telemedicine in Africa: potential, problems, priorities’ article. Leitch takes the view that her model for telemedicine is designed for use in Western countries and that technologies in Africa do allow for telemedicine to take place. Most technologies have minimum power run ability and have the ability to harness sunlight. Leitch is also convinced that investing in telemedicine and enhancing health care resources in the Horn of Africa need be neither a linear progression nor mutually exclusive.
25. Markle Foundation (n.d) ‘Markle Telemedicine Clinic in Cambodia’
(visited 18/03/05)
The Markle Foundation Telemedicine clinic in Ratanakiri Province, Cambodia, provides a model for the way in which information and communication technologies can be harnessed to improve the quality of health and life in the developing world. It brings the specialized skills of doctors at Harvard Medical School-affiliated teaching hospitals to one of the most isolated and medically-underserved areas of Cambodia and the region.
26. Medical Research Council of South Africa (n.d) ‘Telemedicine Research Centres’,
(visited 18/03/05)
This website discusses the challenges to South Africa’s healthcare delivery system. To achieve the goal of providing basic health care to all South African citizens the government has identified Telemedicine as the tool for facilitating this aim. The objectives of the National Telemedicine Research Centre are listed as well as the activities the centre will participate in. Lastly the terms of reference of the Telemedicine Research centre are shown.
27. Onyejekwe, E., updated 9th September 1998, Can telemedicine/telehealth help women?
(visited 17/03/05)
There are two parts to this online article and in the first part the author lays out some of the problems women face in gaining access to telemedicine technology. In the second part the author shows how telemedicine and telehealth can be effectively applied to remove some of these problems. In conclusion, Onyejekwe states that government policies with regards to health, education and total well being are crucial if success is to be achieved.
28. Versweyveld, L. (n.d) ‘"Telehealth in Africa" promotes telemedicine in developing countries’,
(visited 16/03/05)
The content of this webpage is regarding the project “Telehealth in Africa”. The first concern of the project's participants is to provide facilities for diagnosis, prevention, training and education by means of satellite telecommunication systems, radio-bridges, fibre optic cables, computer networks for the transfer of case sheets, X-rays, and diagnostic analysis. A list of renowned institutions and industries in the fields of telecommunications and health, like the International Telecommunication Union (ITU), the Politecnico di Milano, and the French Ministry of Health are also mentioned.
Newspaper Articles
29. Highfield, R. (2001) ‘Surgeons perform operation across the Atlantic’, The Daily Telegraph, filed 27th September