Background: The use and integration of computers and computer based systems has increased over the past few years in various sectors like health. Because of this, literacy and knowledge of computers and how to use them has led to the introduction of specialized fields like computer science. Given that telemedicine and telehealth programs by definition incorporate information and communication technologies which will require computer usage, it was important to review the role of computer science to the implementation of these programs.
Methods: We reviewed literature with regards to the achievement of telemedicine and telehealth programs.
Results: We found that regions which were highly technologically advanced had a far larger proportion of these health programs than regions that were not as advanced. We also found that illiteracy in computer use proved a hindrance to the programs.
Conclusion: A certain level of computer literacy is required in order to establish telehealth and telemedicine programs.
Keywords: telemedicine, telehealth, computer science
The Computer Science Teachers Association (CSTA) (Tucker et al.
, 2003) defines computer science as “the study of computers and algorithmic processes, including their principles, their hardware and software designs, their applications, and their impact on society.”
Use of computers has increased over the past few years with the number of computers reaching one billion in 2008 (BBC, 2002). With the advancements in technology, the forms of computers have change over the years depending on their usage (analog, digital and hybrid computers) and sizes, for example smartphones, tablets and laptops.
Computers have been integrated into different aspects of life like financial, educational, agriculture, health and personal.
In order to function well in this present day and age, individuals need to have a basic grasp of the principles of computer science and there is a need to improve one’s understanding of the field (Council, 2015).
Computers play a variety of roles in the field of health (Panth and Acharya, 2015a); they are used to gather and store patients’ records, for disease surveillance, run health management and geographic information systems (HMIS and GIS). They are also used in research, bioengineering and health education.
World Health Organisation (WHO, 2010b) defines telemedicine broadly as “the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies (ICTs) for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.”
WHO (WHO, 2016) goes on to describe telehealth as “the use of telecommunications and virtual technology to deliver health care outside of traditional health-care facilities.”
Both the World Health Organisation (WHO) and Medecins Sans Frontieres (MSF) have endorsed the use of telemedicine with MSF having an active telemedicine program in place (Bonnardot et al., 2014).
The Idaho Assistive Technology Project (Idaho Assistive Technology Project, 2007) describes these ICTs as products that can send and receive electronic information in its various forms such as text, graphics, sound, and video. Other functions performed by ICTs on the electronic information include storage, processing, transmission, conversion and duplication. Various examples of these ICTs include:
a) Software (set of instructions for the computer to follow) which includes numerous applications and operating systems
b) Computer hardware (physical parts of the computer) which may vary depending on the type of computer
c) Web-based information and applications which include distance learning, email, online chat, electronic textbooks, instructional software
d) Telephones and other telecommunications products
e) Video equipment along with multimedia products that can be distributed on videotapes, CDs, DVDs, email, or the World Wide Web
f) Office products like scanners, photocopiers, printers and fax machines, calculators
In understanding the telemedicine and the requirements needed to successfully establish and run a telemedicine program, it is important to know what role computer science plays in this.
To assess the role of computer science in the implementation of telehealth and telemedicine
The endorsement of telehealth and telemedicine by WHO falls in line with its goals for Universal Health Coverage (UHC) which means that individuals and communities are able to use promotive, preventive, curative, rehabilitative and palliative health services needed and that these services be effective and affordable(WHO, 2016). This endorsement comes from the manner in which telemedicine and telehealth are seen to promote UHC such as providing services to remote locations, facilitating training of the health workforce and enhancement of diagnosis and treatment, amongst others.
However, even though WHO encourages its member states to implement these programs, studies (van Dyk, 2014) have found that implementation will vary from country to country depending on the following:
a) Core readiness which considers planning and integration.
b) Technological readiness involves the availability, reliability, affordability and ICT and all the related infrastructure.
c) Learning readiness addresses concerns related to the programs and resources available for the provision of training in the use of the technology.
d) Societal readiness along with socio-cultural factors, looks at the interaction between the institution and other institutions in the region and beyond.
e) Policy readiness deals with policies, at the government and institutional level, to address common issues, such as licensing, liability and reimbursement.
It was also found that the level at which a telehealth and telemedicine program is implemented differs depending on the country (WHO, 2016). Some programs can be established on a local level while other can be set up at an international level.
It has been found the telehealth and telemedicine programs are more successfully established in technologically advanced countries, which comprise most of the developed countries while a lack of or insufficient technological advancement has proven to be a barrier in the developing countries (Alajlani and Clarke, 2010; Boxer, 2015a; Bali, 2019).
An online search of peer-reviewed literature was undertaken. The online databases of PubMed and Google Scholar were used. Search terms used to browse the databases were: “computers and telemedicine”, “telemedicine and computer science” and “implementation of telemedicine and telehealth”. We also searched the WHO website for related survey reports.
The online search yielded over 100 articles which included articles from journals and conference papers.
Technology and its components was one of the five main determinants identified in the successful implementation of a telehealth and telemedicine program (Broens et al., 2007). Most economically-developed regions such as Southeast Asia, Europe and the Americas, have sufficiently advanced information technology systems in place with high computer literacy which has supported the establishment of a high proportion of telehealth and telemedicine services and programs; the reverse is seen in the less economically-developed regions like Africa and Eastern Mediterranean which have low proportions (WHO, 2010a; Boxer, 2015b; Combi, Pozzani and Pozzi, 2016).
However, lack of adequate knowledge, lack of acceptance and skill of the technologies employed in these programs influences the implementation (Combi, Pozzani and Pozzi, 2016). In countries with low technological advancement, computer illiteracy proves a major challenge to establishing these health programs (Sood and Bhatia, 2005) because many telemedicine platforms utilities computer software and hardware in order to function on both the patients’ and the doctors’ end (Panth and Acharya, 2015b).
As further advancements are made in technology, telemedicine and telehealth programs work well when utilizing the latest or updated computer innovations, which require the knowledge and skill to run (Roine, Ohinmaa and Hailey, 2001) especially when it comes to combating challenges within the computerized systems like viruses and bugs that could interfere with the functioning of the systems (WHO, 2010a).
Based on the fact that ICT’s are required to run telemedicine and telehealth programs and that these require computerized systems, a certain level of computer knowledge and skill is needed not simply for the specialized personnel in ICT fields but also the health workers who shall interact with these systems. However, the acquisition of these skills depends on an individual’s willingness to learn and the resources of the region or area in which one is based.
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