Towards designing for equity: active citizen participation in eHealth

Abstract

Purpose-Reducing inequity in accessing healthcare among rural and remote populations remains a problem. Internationally, eHealth is now touted as a potential solution, with a range of diverse approaches and impacts. Yet, the equity gains of implementing eHealth are often not realized due to a lack of effective strategies for citizen participation. The purpose of this paper is to present the background to, and results of, a multidisciplinary eHealth assistance project in a remote region of the Brazilian Amazon, highlighting the importance of citizen participation within planning processes. Design/methodology/approach-The project was conducted in three phasespremission, mission, and post-mission. Discussions were held between health teams and local community leaders, and were coordinated by government health organizations in partnership with the Amazon State University. A multidisciplinary team visited five remote communities in the Brazilian Amazon, where participants underwent clinical assessment using eHealth technologies within pharmacy, cardiology, dermatology, and/or odontology. Analysis and second opinion were provided by relevant specialists and the results were delivered electronically to local healthcare teams. Findings-A total of 111 patients were evaluated with an average age of 54 years. There were several important findings following specialist second opinion, which improved the quality of care they received. These comprise identifying drug interactions and patients requiring further investigation for cardiological and dermatological complaints, including suspected malignancy. Research limitations/implications-Due to a breakdown in communication, data from the post-mission phase are lacking, particularly regarding treatment outcomes. Furthermore, the authors did not perform an analysis of cost-effectiveness. If eHealth technologies are to become part of routine clinical practice it is important that the financial implications are acceptable. Originality/value-This project demonstrates how equity can be designed for with a multidisciplinary approach to eHealth activities in rural and remote environments within Brazil. Such activities typically focus on one particular area, yet primary healthcare facilities see patients with a variety of problems.

Telemedicine in India: current state, challenges and opportunities

“…Specifically, the design of telemedicine systems have often been driven by the provider's and donor's concerns rather than attending to the issues of the beneficiaries (Miscione, 2007). For an effective telemedicine system, the design needs to incorporate the issues of the multiple stakeholders involved in the project, especially ensuring citizen participation (Jones et al, 2012).Optimal utilization of technology in healthcare delivery system requires overcoming barriers at multiple levels-policy, resources and sociocultural levels. Researchers have pointed out the importance of a robust regulatory framework to guide, monitor and implement telemedicine initiatives in India (Lahiri, 2013).…”

Perspectiva Institucional dos Sistemas de Informação em Saúde em Dois Estados Brasileiros

“…As TIC nesse ambiente têm sido utilizadas nas mais diversas esferas no que tange aos ambientes em saúde, como: Prontuário Eletrônico (Bansler & Havn, 2010), Sistema de Informação em Hospitais (Haux, 2006), Telemedicina (Jones et al, 2012), entre outras. Essas tecnologias possuem um enorme potencial para propulsionar melhorias que envolvem ganhos de qualidade e acessibilidade no sentido dos cuidados em saúde e a melhoria considerável do custo-benefício (Souza, Cunha, & Dornelas, 2011).…”

The Importance of Broadband for Socio-Economic Development: A Perspective from Rural Australia

“…The first and foremost issue therefore is uneven access to quality Internet services in rural areas. Rural areas already face socio-economic challenges, such as limited access to healthcare and education facilities as well as reduced opportunities for business expansion (Jones, Cardoso, Hüttner, Oliveira, dos Santos, Lopes & Russomano, 2012;Townsend et al, 2013). Rural infrastructure investments have demonstrated positive socio-economic impacts and increases in productivity and participation (Katz & Suter, 2009).…”

“…Moreover, people living in dispersed areas often face issues of social isolation that can affect their wellbeing, which is exacerbated through poor access to communication networks (Hale et al, 2010;Townsend et al, 2013). Digital infrastructure and initiatives can offer access to services for rural populations marginalised from healthcare systems (Jones et al, 2012). Hale et al (2010) outline four types of healthrelated practices enabled by the Internet: finding health information; accessing healthcare resources (including communication with physicians/providers); purchasing medical/health products; and increased contact with social support networks.…”

“…In the area of healthcare, for example, broadband facilitates: improved quality of rural medical practices and patient care, including continuity of health services and additional medical resources; better access to specialist services; digital consultations with cost savings for patients and public health systems (decreased travel and fewer admissions); greater opportunities for practitioners to participate in professional training and development activities; and recruitment and retention of medical staff in the rural health workforce (Jang-Jaccard, Nepal, Alem & Li, 2014;Jones et al, 2012;Steele & Lo, 2013). In terms of infrastructure, most tele-health applications, such as virtual consultations, require stable high-speed connections to support real-time interactions (Steele & Lo, 2013).…”