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. 2018 Dec;8(2):020414.
doi: 10.7189/jogh.08.020414.

Seven years of telemedicine in Médecins Sans Frontières demonstrate that offering direct specialist expertise in the frontline brings clinical and educational value

Sophie Delaigue  1 , Laurent Bonnardot  2   3 , Olivier Steichen  4   5 , Daniel Martinez Garcia  6 , Raghu Venugopal  1 , Jean-François Saint-Sauveur  7 , Richard Wootton  8
Affiliations

Seven years of telemedicine in Médecins Sans Frontières demonstrate that offering direct specialist expertise in the frontline brings clinical and educational value

Sophie Delaigue et al. J Glob Health. 2018 Dec.

Abstract

Background: Médecins Sans Frontières (MSF), a medical humanitarian organization, began using store-and-forward telemedicine in 2010. The aim of the present study was to describe the experience of developing a telemedicine service in low-resource settings.

Methods: We studied the MSF telemedicine service during the period from 1st July 2010 until 30th June 2017. There were three consecutive phases in the development of the service, which we compared. We also examined the results of a quality assurance program which began in 2013.

Results: During the study period, a total of 5646 telemedicine cases were submitted. The workload increased steadily, and the median referral rate rose from 2 to 18 cases per week. The number of hospitals submitting cases and the number of cases per hospital also increased, as did the case complexity. Despite the increased workload, the allocation time reduced from 0.9 to 0.2 hours, and the median time to answer a case decreased from 20 to 5 hours. The quality assurance scores were stable. User feedback was generally positive and more than 90% of referrers who provided a progress report about their case stated that it had been sent to an appropriate specialist, that the response was sufficiently quick and that the teleconsultation provided an educational benefit. Referrers noted a positive impact of the system on patient outcome in 39% of cases.

Conclusions: The quality of the telemedicine service was maintained despite rising caseloads. The study showed that offering direct specialist expertise in low-resource settings improved the management of patients and provided additional educational value to the field physicians, thus bringing further benefits to other patients.

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Conflict of interest statement

Competing interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Three of the authors are working as coordinators for MSF, one as a specialist and two for the Collegium Telemedicus. The authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no other conflict of interest.

Figures

Figure 1
Figure 1
Numbers of telemedicine cases submitted per quarter, starting in July 2010. The blue line indicates Radiology-only cases; the grey line indicates General cases.
Figure 2
Figure 2
Performance indicators per quarter for general cases. The blue line indicates the answer delay and the grey line indicated the allocation delay.
See this image and copyright information in PMC

References

    1. Médecins Sans Frontières (MSF) International. Available: http://www.msf.org/en/about-msf. Accessed: 16 November 2017.
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