1 Department of TeleHealth, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban, South Africa .
2 Office of Global e-Health Strategy, University of Calgary , Calgary, Canada .
Telemed J E Health. 2017 Sep;23(9):766-772. doi: 10.1089/tmj.2016.0155. Epub 2017 Mar 29.
The smartphone simplifies interprofessional communication, and smartphone applications can facilitate telemedicine activity. Much has been written about the steps that need to be followed to implement and establish a successful telemedicine service that is integrated into everyday clinical practice. A traditional and systematic approach has evolved incorporating activities such as strategy development, needs assessment, business cases and plans, readiness assessment, implementation plans, change management interventions, and ongoing monitoring and evaluation. This "best practice" has been promoted in the telehealth literature for many years. In contrast, several recent initiatives have arisen without any such formal undertakings. This article describes the strengths and weaknesses of two "spontaneous" telemedicine services in dermatology and burn management that have evolved in South Africa.
Two spontaneous services were identified and reviewed.
In one unsolicited service, doctors at rural referring hospitals have been taking photographs of skin lesions and sending them with a brief text message history to dermatologists using the instant messaging smartphone app, WhatsApp. In the other, burns service, admissions to the burns unit or the clinic were triaged by telephonic description of the case and completion of a preadmission questionnaire. More recently, management and referral decisions are made only after completion of the questionnaire and subsequent submission of photographs of the burn sent by WhatsApp, with the decision transmitted by text message.
Although efficient and effective, potential legal and ethical shortcomings have been identified.
These "spontaneous" telehealth services challenge traditional best practice, yet appear to lead to truly integrated practice and, therefore, are successful and warrant further study.
智能手机简化了专业间的交流，智能手机应用程序可以促进远程医疗活动。关于实施和建立成功的远程医疗服务并将其整合到日常临床实践中所需要遵循的步骤，已经有很多文献进行了描述。一个传统的、系统的方法已经发展起来，包括战略制定、需求评估、商业案例和计划、准备情况评估、实施计划、变更管理干预以及持续的监测和评估等活动。多年来，这种“最佳实践”在远程医疗文献中一直被推广。相比之下，最近出现了一些没有任何此类正式承诺的倡议。本文描述了南非两个在皮肤病学和烧伤管理中自发产生的远程医疗服务的优缺点。
确定并审查了两个自发服务。
在一个未经请求的服务中，农村转诊医院的医生使用即时通讯智能手机应用程序 WhatsApp，拍摄皮肤病变的照片，并附上简要的短信病史发送给皮肤科医生。在另一个烧伤服务中，通过电话描述病例并填写入院前问卷对烧伤患者进行分诊。最近，仅在完成问卷和随后提交通过 WhatsApp 发送的烧伤照片后，才做出管理和转诊决策，决策通过短信发送。
尽管高效有效，但已经发现了潜在的法律和道德缺陷。
这些“自发”的远程医疗服务挑战了传统的最佳实践，但似乎导致了真正的整合实践，因此是成功的，值得进一步研究。
