|Author(s):||Kurt Brauchli1, M. Oberholzer1|
|Affiliation(s):||1Pathology, University of Basel, Basel, Switzerland|
Developing countries are facing various problems in delivering medical services to their population lack of resources as well as a dramatic shortage of trained and experienced doctors and nurses. Good quality services and medical specialists are often concentrated in urban areas only. Poor roads and limited transport and communication infrastructure are severe obstacles for providing health care services to rural communities. In addition, the few medical specialists are often working in severe professional isolation without access to senior colleagues, diagnostic support or continuous medical education. Objectives: The iPath project at the University of Basel, launched in 2001, aims at improving access to specialist diagnosis, second opinion consultations and medical information for health providers and medical specialists in developing countries by means of Information and Communication Technologies and to analyse and evaluate the feasibility, accuracy and sustainability of remote support and collaboration through telemedicine.
Since 2001, an open-source Internet-based collaboration platform for medical knowledge and information exchange between medical specialists in developing countries and their partners in Europe has been developed and operated by the iPath project. The platform is designed with an explicit focus on allowing access to users with limited connectivity. Collaboration is possible via email or a web browser and is organised in the form of virtual communities closed and moderated user groups in which participants can present and discuss cases. Asynchronous store-and-forward and synchronous or real-time collaboration is possible on the same data. Today, hundreds of participants from all continents are frequently using the platform. Over 9,000 cases with a total of over 60,000 images have been discussed. Participants are organised in several dozen virtual communities with activities ranging from diagnostic support for hospitals with limited resources, to specialist groups for enabling access to second opinion consultations, to providing continuous medical education. A particularly interesting application comprises specialist forums moderated by (retired) specialists from Europe who discuss difficult cases with colleagues in developing countries and provide diagnostic support, often with references to current literature. They also use the possibility to selectively refer very complex consultations to appropriate sub-specialist groups on the same platform and thus enable high quality second opinion consultations. Another application is the provision of diagnostic support for hospitals with limited resources by a group of volunteer specialists. Diagnostic accuracy of such remote consultations was assessed for the field of histopathology in two independent studies. Concordance levels were over 90%. Collaboration in virtual communities is also a viable source for quality assurance as well as for continuous medical education. An analysis of the user activities reveals that many do not submit consultations or diagnostic comments but are regularly reading the discussions. In addition, the platform is used for publishing live and distributed presentations and case discussions that can be followed from anywhere using a standard web browser and an ordinary internet connection (>25KB/s). Conclusions: Telemedical collaboration in the form of on-line virtual communities is a viable solution for supporting health care professionals in areas with limited resources by providing access to remote diagnosis, second opinions and continuous education, provided that the communities are appropriately moderated. A major advantage of the virtual community model over traditional point-to-point telemedicine consultations is that they allow and promote South-South collaboration. If properly organised, virtual communities can play an important role in capacity building and in establishing and maintaining fruitful partnerships between geographically separated partner institutions and individuals.