Cabo Verde telemedicine program: initial results of nationwide implementation.

BACKGROUND: Telemedicine and e-health have been suggested as one solution for closing the health disparity gap between the developed world and the developing world. Yet evidence is lacking from current successful programs in the developing world and, in particular, from sub-Saharan Africa. The primary objective of our study was to present the preliminary results of our efforts in building the Integrated Telemedicine and e-Health Program for Cabo Verde (ITeHP-CV), with an emphasis on initial utilization and results. MATERIALS AND METHODS: This is a prospective study of data collected while we worked to establish a fully functional, integrated national telemedicine network and virtual education network in Cabo Verde. We used the International Virtual e-Hospital Foundation strategic approach known as "initiate-build-operate-transfer" over a 26-month period (November 2011-December 2013). We describe herein the five main pillars of this process that have been implemented: (1) capacity building; (2) network development and deployment of equipment; (3) implementation of clinical telemedicine; (4) implementation of activities related to continuing medical education, delivered from within the country and from abroad; and (5) establishment and use of the electronic virtual library. RESULTS: Based on comprehensive technical and medical assessment of the country's needs, 10 fully functional telemedicine centers in all nine inhabited islands of the Republic of Cabo Verde have been established. RESULTS are presented under the five main pillars of capacity building, network deployment, implementation of clinical telemedicine, implementation of continuing medical education activities, and establishment of the electronic virtual library. CONCLUSIONS: The ITeHP-CV has been successfully launched, and the initial results are encouraging. The continuity of the program and sustainability are primary goals once the program is transferred fully to the Ministry of Health of Cabo Verde. A long-term follow-up study is required in order to ensure sustainability and continuity goals are met.

Beyond "Initiate-Build-Operate-Transfer" strategy for creating sustainable telemedicine programs: lesson from the first decade.

BACKGROUND: December 10, 2012 will mark the 10th anniversary of the implementation of telemedicine in the Balkans. This first decade of development and function is due to the passion, creativity, experience, and implementation know-how of the award-winning concept of the International Virtual e-Hospital (IVeH) Foundation. The objective of this article is to analyze the results of the IVeH's core strategy, "Initiate-Build-Operate-Transfer" (IBOT), which has been instrumental in establishing telemedicine in the Balkans and has been adopted by many other countries worldwide, and to describe the lessons learned that go beyond IBOT. MATERIALS AND METHODS: A retrospective review of the results of IVeH engagement in establishing telemedicine in developing countries was conducted. RESULTS: Using IBOT, the IVeH has successfully established two national programs: one in Kosova and one in Albania. Together, they have connected 16 hospitals. Currently IVeH is in the process of creating such programs in many countries around the world. During the analysis of the first decade, we have identified eight factors that should be considered when establishing telemedicine programs. CONCLUSION: IBOT has been successful, but further studies are needed to demonstrate its effectiveness in countries beyond the Balkans.

Cost-benefit analysis on the use of telemedicine program of Kosova for continuous medical education: a sustainable and efficient model to rebuild medical systems in developing countries.

BACKGROUND: The Ministry of Health of Kosova has recently announced the Telemedicine Program of Kosova (TMPK) as the official institution responsible for managing and coordinating the nation's Long-Distance Continuous Medical Education (CME) program. There are a lack of studies on cost-benefit analysis (CBA) and other economic evaluations of telemedicine programs (TMP), in particular the financial value of CME offered through such a service. In addition, there is lack of prospective studies on Monitoring & Evaluation (M&E) of TMP. OBJECTIVE: The goal of this study was to conduct a retrospective CBA of prospective data collected at TMPK over a 5-year period (2005-2010) in order to determine the cost benefit as opposed to the alternative method of delivery of this model for developing countries whose healthcare systems are in disarray. MATERIALS AND METHODS: We reviewed data on the number of participants in virtual lectures both at the Telemedicine Center of Kosova (TCK) as well as the number of participants at six Regional Telemedicine Centers throughout Kosova, the number of lectures broadcasted, the clinical cases reviewed and transmitted for international consultation, and other quantitative data. RESULTS: Only in 2009, approximately 2,000 CME certificates were awarded to physicians and nurses of Kosova, 18 international teleconsultations were conducted, 138 videoconferences, lectures, and seminars were held, and there were over 9,000 visitors at the TCK e-library. Data analysis shows that the TMPK has been an efficient mechanism for CME and sustainable model for rebuilding the medical system. TMPK has been successful in offering physicians, nurses, and other medical professions access to electronic information. CONCLUSIONS: TMP is an efficient mechanism to ensure CME and rebuilding medical systems in developing countries. There is a need for prospective CBA of any TMP and the establishment of M&E programs in any future telemedicine initiatives in developing countries.

"Initiate-build-operate-transfer"--a strategy for establishing sustainable telemedicine programs in developing countries: initial lessons from the balkans.

Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in Kosova has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in the Balkans. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy, "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services in developing countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs, was discussed. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the healthcare infrastructure. The endpoint is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program will be transitioned to the national Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Albania, Macedonia, and other countries around the world. The IBOT model has been effective in creating sustainable telemedicine and e-health integrated programs in the Balkans and may be a good model for establishing such programs in developing countries.

Third intensive Balkan telemedicine and e-health seminar: current principles and practices of telemedicine and e-health--clinical applications and evidence-based outcomes: International Conference on Telemedicine and e-Health February 6-7, 2009 Skopje, Macedonia.

The region, which consists of the countries of Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Kosova, Macedonia, Montenegro, and Serbia, takes its name from the mountain range, the Balkans. The Balkans, a Turkish word for "chain of wooded mountains," covers an area of 700,000 km(2) region in Southeastern Europe and is home to over 55 million inhabitants. A decade of war and ethnic fighting in the 1990s destroyed the medical systems in place, creating a desperate need to rebuild a modern healthcare infrastructure. Telemedicine has been shown to be an effective tool in this regard. The adoption of telemedicine in the Balkans is firmly under way. Since its inception in 2001, the International Virtual e-Hospital (IVeH) has promoted the design, growth, and implementation of telemedicine in a variety of developing countries across the globe. Successful implementation of telemedicine in any region is based on a number of factors, each of great importance. However, one that is key is the education and training of community leadership. Over the past several years, the IVeH has held intensive seminars in the region to promote the application of telemedicine as an effective tool in healthcare modernization. This includes the First Intensive Balkan Telemedicine and e-Health Seminar in Prishtina, Kosova (2002) and the Second Intensive Balkan Telemedicine and e-Health Seminar in Tirana, Albania (2007). Recently, the third installment of these seminars was held in Skopje, Macedonia (February 2009). These three seminars have provided a fertile foundation for telemedicine to emerge as a significant tool in enhancing healthcare in this region. Each has broadened the understanding of the immense capability that telemedicine can offer and has acted as a catalyst for the development of telemedicine in the region. The Republic of Macedonia is the latest country to invest in telemedicine, having a formal commitment from the Ministry of Health to establish a national telemedicine effort. The following is a summary of the Third Intensive Balkan Telemedicine and e-Health Seminar.