Baravilala W. Pacific Health Dialog 2018; 21(1):37-38. DOI: 10.26635/phd.2018.905
37
Perspective OPEN ACCESS
Telehealth in the Pacific: Update 2018.
Wame Baravilala
The Pacific Ocean is the home of twenty five island states and territories with a total population of more than 10 million scattered on more than a hundred small seemingly isolated islands.
Development of the small island states is totally dependent on advances and adoption of modern telecommunications.
Telehealth is a means of enhancing the delivery of healthcare with the support of information and communication technology ( ICT). This refers to a wide range of technology and strategies to deliver virtual medical services. The World Health Organization (WHO) suggested that countries could benefit from the potential of ICT by creating
“national agencies to coordinate telemedicine and e-Health initiatives, ensuring they are appropriate to local contexts, cost-effective, consistently evaluated, and adequately funded as part of integrated health service delivery” 1 Telehealth was initially introduced to the Fiji School of Medicine 18 years ago, as a potential resource through the Pacific Basin Medical Officers Training Program in Pohnpei, Federated States of Micronesia (FedSM). 2 Since the 1990’s, through the Pacific Island Health Care Project (PIHCP), US affiliated Pacific countries (Guam, Commonwealth of the Northern Marianas Islands, Palau, Yap, Chuuk, Pohnpei, Kosrae, Marshall Islands and American Samoa) have had access to telemedicine consultations from Tripler Army Tripler Army Medical Centre (a major US military teaching hospital) in Honolulu. To date more than 8,000 Pacific Islanders have benefitted from the PIHCP, “the longest running telemedicine program in the world delivering humanitarian medical care”.2
In the South Pacific, the Cook Islands have had reports of telemedicine being used to manage cases with referrals from Auitutaki to Rarotonga then onwards to a clinical focal point in New Zealand. In the Solomon Islands, the National Referral Hospital in Honiara had for several years’
access to Telepathology, over 300 specimen slides were prepared in Honiara, digitised then emailed to European pathologist for reports.4
Despite the opportunities that have been provided or are available, there is a dearth of publications and reports on telehealth and/or telemedicine use or innovations in the Pacific apart from what was achieved in the late 1990s and early 2000s. There is significant discrepancy between the availability of telehealth or telemedicine services between the US-affiliated Pacific jurisdictions (USAPJs) and the rest of the Pacific. In the South Pacific, each country has developed its own case referral system, most commonly to hospitals either in New Zealand or Australia, although there is now increasing referrals to hospitals in India and the Philippines.
There is a long-standing relationship between the Pacific Island Ministries of Health and Australia or New Zealand, this has established a consistent relationship for overseas referrals.5 In the developed country for example the USA, Telehealth is growing with an estimated growth of 18-30% per year. In 2012 there were 10 million medical or health consultations in a population of 323 million with 69.3% mobile phone coverage.6 Telehealth is associated with higher patient satisfaction, clinician and patient convenience, clinician flexibility with the potential to increase enrolled patient population. It also saves patient time and money. However, there are legal challenges with regards to doctor-patient- relationship, whether this needs to exist before a telehealth transaction can occur, definition of a patient, how the health professional should be paid, special requirements of persons who live in remote areas, health professional registration and its implications for cross-border consultations.
Former Reproductive Health Adviser, United Nations Population Fund, Asia Pacific Regional Office, Thailand.
wrbaravilala@gmail.com
Received: 5 January 2018; Accepted: 10 January 2018 Citation: Baravilala W. Telehealth in the Pacific: Update 2018.
PacHealthDialog 2018; 21(1):37-38. DOI:
10.26635/phd.2018.903.
Copyright: © 2018 Baravilala W. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Baravilala W. Pacific Health Dialog 2018; 21(1):37-38. DOI: 10.26635/phd.2018.905
38 In the Pacific, mobile phone coverage has
increased significantly in the last two decades.
There has been an increase in mobile subscribers in remote and geographically sparse regions with annual growth rates of 12.6% which is well ahead of developing regions. 7
The mobile coverage rate was 37% but this is expected to increase to 42% by 2020. Mobile broadband connections accounts for only 17%.
Despite increases in mobile phone ownership in the Pacific internet connectivity continues to lag behind.
There is no Pacific data on the use of email or social media for medical consultations, referrals or information gathering but there is no doubt that this does occur. Facebook is the commonest social media and social networking service used in the Pacific with at least 700,000 registered users in 2015. While the exchange of confidential patient information through this media is inappropriate, private groups can potentially be set up to allow the exchange of information for patient management and health surveillance.
Telehealth is not well established in the Pacific and it will need the next generation of health professionals to develop its true potential to improve Pacific health.
REFERENCES:
1. Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth 2009.
WHO 2010.
2. Telehealth in the Pacific Islands: a perspective and update from the Fiji School of Medicine., Pryor J, Baravilala W, Katoanga C.., Pac Health Dialog. 2000 Sep;7(2):6-10.
3. The Pacific Island Health Care Project;
Donald Ames Person*; Tripler Army Medical Center, Honolulu, HI, USA; Frontiers in Public Health | Public Health Education and Promotion., October 2014 Volume 2 Article 175, 1-5
4. Telepathology on the Solomon Islands--two years' experience with a hybrid Web- and email-based telepathology system. Brauchli K1, Jagilly R, Oberli H, Kunze KD, Phillips G, Hurwitz N, Oberholzer M.., J Telemed Telecare. 2004;10 Suppl 1:14-7.
5. Evaluation of the New Zealand Medical Treatment Scheme; Gary Blick, Joanna Smith;
13 March 2015,. Report prepared for the Ministry of Foreign Affairs and Trade;
6. Special Report : Telehealth Reed V. Tuckson, M.D., Margo Edmunds, Ph.D., and Michael L.
Hodgkins, M.D., M.P.H. N Engl J Med 377;16 October 19, 2017 1585-1592
7. Pacific Islands Mobile Economy 2015, GSMA tps://www.gsmaintelligence.com
