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7314MED Health Informatics Question: Summarizes the barriers to the uptake of telemedicine, classifying them into ICT/Infrastructure and management issues.   Evaluates potential ICT/infrastructure support structures available for supporting telemedicine initiatives and Recommends strategies for addressing the challenges identified from Learning Resources and wider research.   Demonstrates an understanding of the current ICT/infrastructure and management challenges for the uptake of telemedicine in Australia. Answer: Introduction: This report will highlight telemedicine network of Africa, an initiative taken by collaboration of the University of Geneva and University hospitals. The network is known as RAFT. It has started providing service to sub-Saharan parts and has extended its service to Bolivia, while service in Nepal is in progress (Annan & Agyepong, 2018). The telemedicine network has specially benefited the low and middle-income countries (LMICs) in Africa. The health related problems that LMICs face are due to the lack of experienced health professional. Moreover, quality care is given to financially stable patients that LMICs lacked. Most experienced and qualified health professionals gathered in urban area hospitals while rural area hospitals were being deployed of the service. RAFT took the opportunity to provide clinical, educational and public health services (Bediang et al., 2014). As educational service, RAFT provided weekly video lectures to post graduates and continuing medical education along with research training activities using e-learning and ICTs. However, RAFT is facing lot of challenges that will be focused on in the following paragraphs. Discussion: ICT/infrastructure and management issues to the uptake of telemedicine: The public health system of Africa has adopted telemedicine however wider use remains a challenge in the low and middle-income countries of Africa. The barriers in the uptake of telemedicine are as follows: Financial sustainability: RAFT has been providing service in Africa for more than ten years and still facing financial issues. Long-term investment is required for its wider implementation. The challenge lies with LMICs, as they are economically less stable countries. Capital is required to ensure that health care professionals as both provider and user provide quality content (Traore, Kamsu-Foguem & Tangara, 2016). To deal with this issue a business model was prepared that would benefit both patient and physician. Despite of all solutions the scaling up of business models is limited within RAFT.  Lack of proper Infrastructure: RAFT is designed for providing service mainly to developing countries. However, the countries lacks proper infrastructure of roads that acts as a barrier to the uptake of telemedicine (Latifi et al., 2014). Lack of infrastructure prevented the movement of telemedicine services to areas that has basic infrastructure. Lack of proper management: Some countries of Africa have embraced RAFT however most countries lacks in proper management that is creating barrier in the uptake of telemedicine services. The main challenge lies with the integration of eHealth with telemedicine. The government of the countries are not taking initiative to develop supportive guidelines and policy that would promote use of telemedicine in state and national level. Support structures that are available for supporting telemedicine in Africa: RAFT project is a completely new concept that has been implemented in some developing countries of the world. Therefore, support structures are required for its wider implementation. mHealth that supports healthcare networks in Africa: RAFT consists of two mHealth projects (1) SMS is being used for fast data collection in district hospitals of Mali and (2) Tuberculosis cure rate can be evaluated by SMS reminders. Information systems in hospitals of Africa: RAFT has included two projects based on open source systems to improve data management and collection of clinical information in the hospitals. RAFT Altiplano: The Altiplano project aims at expanding services of RAFT from sub-Saharan Africa to Bolivia and other countries like Nepal. Recommendations for addressing challenges in the use of telemedicine: Campaigns should be conducted that would focus on raising awareness on telemedicine among rural communities (Kamsu-Foguem & Foguem, 2014). The cost, benefits and use of telemedicine should be well conveyed to them so that they are interested to uptake telemedicine. Use of multiple technologies should be facilitated so that the relationship between patient and physician is strengthened such that rural community is enabled to access the health care services of RAFT. For better results and wider spread of telemedicine use people of rural community should be engaged in the awareness programs. The government should take initiative to lay guidelines and policy for the use of telemedicine (Okoroafor et al., 2017). The policy should be included in state as well as national health care plans.  Coordination with other departments of transport, electricity and water is required for the developing the infrastructure of countries so that services can reach rural community. Long-term investments should be made to eliminate financial issues of RAFT. Both district hospitals in urban areas as well as rural hospitals should be equally benefited from the RAFT project. Current Challenges That Uptake Of Telemedicine Will Face In Australia: Telemedicine has also reached in Australia. Like Africa, there are some challenges in the uptake of telemedicine in Australia. Barriers to the uptake of telemedicine at individual level: At individual level, poor IT literacy is the main barrier to the telemedicine along with concerns for data security and unauthorized access to health records. People in Australia are also facing the issues related to increased cost to practice telemedicine. Barriers at infrastructural level: Financial sustainability is the main infrastructural barrier in Australia. Complexity of technology, lack of proper internet connection in rural areas, incompatibility among software and hardware and lack of technical support adds to barriers for uptake of telemedicine in Australia. Barriers at organizational level: Healthcare system in Australia is currently incompatible with telemedicine service. Lack of policy, guidelines for taxation, lack of copyright and reimbursement structure and bureaucratic difficulties are creating a barrier for the uptake of telemedicine in Australia today. Conclusion: From the above discussions, it can be concluded that the RAFT project has helped to improve health care services in rural areas and LMICs of Africa. Besides the benefits, RAFT is undergoing a number of challenges in the uptake of telemedicine in Africa and Australia. Among the challenges, financial sustainability and poor IT literacy in people are the main barriers. However, holding campaigns and engaging rural people in telemedicine activities might help to solve the issues.  References: Annan, R. K., & Agyepong, J. T. (2018). Pragmatic Teleconsultation Network Model to Address the Bandwidth Deficiency Inhibiting Real-Time Telemedicine Implementation in the Sub-Saharan Africa. International Journal of Innovative Research and Development, 7(7). Bediang, G., Perrin, C., Ruiz de Castañeda, R., Kamga, Y., Sawadogo, A., Bagayoko, C. O., & Geissbuhler, A. (2014). The RAFT telemedicine network: lessons learnt and perspectives from a decade of educational and clinical services in low-and middle-incomes countries. Frontiers in public health, 2, 180. Cadilhac, D. A., Moloczij, N., Denisenko, S., Dewey, H., Disler, P., Winzar, B., … & Bladin, C. (2014). Establishment of an effective acute stroke telemedicine program for Australia: protocol for the Victorian Stroke Telemedicine project. International Journal of Stroke, 9(2), 252-258. Kamsu-Foguem, B., & Foguem, C. (2014). Telemedicine and mobile health with integrative medicine in developing countries. Health Policy and Technology, 3(4), 264-271. Latifi, R., Dasho, E., Merrell, R. C., Lopes, M., Azevedo, V., Bekteshi, F., … & Lecaj, I. (2014). Cabo verde telemedicine program: Initial results of nationwide implementation. Telemedicine and e-Health, 20(11), 1027-1034. O’Gorman, L. D., Hogenbirk, J. C., & Warry, W. (2016). Clinical telemedicine utilization in Ontario over the Ontario telemedicine network. Telemedicine and e-Health, 22(6), 473-479. Okoroafor, I. J., Chukwuneke, F. N., Ifebunandu, N., Onyeka, T. C., Ekwueme, C. O., & Agwuna, K. K. (2017). Telemedicine and biomedical care in Africa: Prospects and challenges. Nigerian journal of clinical practice, 20(1), 1-5. Traore, B. B., Kamsu-Foguem, B., & Tangara, F. (2016). Integrating MDA and SOA for improving telemedicine services. Telematics and Informatics, 33(3), 733-741.

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