Wootton Richard, Bonnardot Laurent
Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
Fondation Médecins Sans Frontières, Paris, France.
Front Public Health. 2019 Aug 21;7:226. doi: 10.3389/fpubh.2019.00226. eCollection 2019.
The Collegium system was first made available in 2012 to support organizations conducting humanitarian or non-commercial telemedicine work in low resource settings. It provides the technical infrastructure necessary to establish a store-and-forward telemedicine service. During the subsequent 6 years a total of 46 networks were established, based on the Collegium infrastructure. The majority of the networks were set up to provide a clinical service (33), with six designed for education and training, and the remainder for test or administrative purposes. Of the potentially operational networks which were set up (i.e., those established for clinical or educational purposes), 15 networks (38%) were stillborn and did not handle a single case after being established. In contrast, the two most active networks had handled almost 12,000 cases. The average case rate of the five most active clinical networks operating in low-resource settings (i.e., the total number of cases divided by the length of time for which the network had been established) ranged from 0.5 to 29.4 cases/week. Across the networks there was little evidence of sigmoidal growth in activity, which is consistent with reports of other telemedicine activity in North America. A brief survey was sent to 49 network coordinators, from 31 networks. Responses were received from 9 coordinators (18% of those invited to participate). The median satisfaction with the system was 8 (on a scale from 1 = not at all satisfied to 10 = very satisfied). The free text comments were mainly technical suggestions regarding image transfer, the mobile application, or other modes of communication. The results of operating the Collegium system demonstrate that supporting telemedicine work in low resource settings can be successful, since the networks handled a very wide range of clinical cases, and at activity levels up to several cases per day. However, approximately one-third of the networks that were established did not handle a single clinical case. Nonetheless, this might represent a form of success in the sense that it prevented the waste of resource involved in an organization purchasing a telemedicine infrastructure only to find that it was not used.
合议制系统于2012年首次推出，旨在支持在资源匮乏地区开展人道主义或非商业远程医疗工作的组织。它提供了建立存储转发远程医疗服务所需的技术基础设施。在随后的6年里，基于合议制基础设施共建立了46个网络。大多数网络的设立是为了提供临床服务（33个），6个用于教育和培训，其余的用于测试或行政目的。在已建立的潜在运营网络（即那些为临床或教育目的而建立的网络）中，15个网络（38%）胎死腹中，建立后未处理过一例病例。相比之下，两个最活跃的网络处理了近12000例病例。在资源匮乏地区运行的五个最活跃的临床网络的平均病例率（即病例总数除以网络建立的时长）为每周0.5至29.4例。在各个网络中，几乎没有证据表明活动呈S形增长，这与北美其他远程医疗活动的报告一致。向来自31个网络的49名网络协调员发送了一份简短的调查问卷。收到了9名协调员的回复（占受邀参与人数的18%）。对该系统的满意度中位数为8（评分范围为1 = 一点也不满意至10 = 非常满意）。自由文本评论主要是关于图像传输、移动应用程序或其他通信方式的技术建议。合议制系统的运行结果表明，在资源匮乏地区支持远程医疗工作可以取得成功，因为这些网络处理了非常广泛的临床病例，且活动水平高达每天数例。然而，大约三分之一已建立的网络未处理过一例临床病例。尽管如此，从某种意义上说，这可能代表了一种成功，即它避免了组织购买远程医疗基础设施却未使用而造成的资源浪费。
