Discussion
6. DISCUSSION
University
of Cape
Town
Chapter 6
Discussion of Results
The previous chapter discussed how we refined the Uulti-.\Iodal Thlcmedicinc lntcrcommunic~tor
(:I>\u11) prototype in the last (,hree project, c:Tles as well as how the project, was terminate<:!. This chapter describes the final outcomes of the project. First, in Section 6.1, we describe findings regarding the previous telemooicine system implemented in the target area, ill ord~'f to pJa.cc the findings "bom !>.inTI in contl'lLt. )<ext in Section 6.2, we discuss how MoTI performed. In par_
ticular, we describe ~he final results collected from the t.race files and datl\hase lOS" as well as the interview" conducrod with the project participants and ohlcrvatioIlS made by the l'<.'8Carchers. We also discuss the overall finding" "bom telemedicine for the Eastem Cape. In Section 6.3, we discuss Our results with WSpLU to the socially aware computiug framework. Section 6,4 draws out our observntiou" about how telecommunications policies affect the technologiffi one can use in rural and und.erserviced "reas. Finally, we end the ch"pter with concluding remarks in Section 6.5.
6.1 Findings about the previous tclemedicine system implemented
University
of Cape
Town
CHAPTER, 6. DISCUSSION OF H£SU['TS
El;,;cntially, patients "'"c refcrred if they pre5ent a problem that is beyond the knowledge of the nurses at the clinic Or if they are aftiidexi with a serious injnry, rr"um" Or illness that requires hospital care. The nurse told us that she referr!\d p"tients to the hospital On a dtl.ily ba.'is !l.Il.d this was confirmed by (he dodor Doth partkipants indimted that they would like to Ul!C the tclemedicine system throllghom the ,,_k as seen by the doctor's responsc:
Qu<'_"tion: Hom tnfLny Urnes u'ould !IOU li~e to !lS~ 0" ttlem~d;c~n' system?
Doctor'~ Re~poll.'le: At least .1 times dally aCQJrding to ti-«'. lXf'(.nma/ ""01tag~ of docton at NKII [l'hS-fie KnigloJ Ilo.'ipitalj.
Participants clain\<.'li they used the CSIR telemcdicine system two to three times weekly but that the network often flllled for long periods of time. Since nO trflCe data was available on tbe octual system usage, we could not ",rify this claim. Ho,,·ever. from our e.xperience with the MuTI project, ,,-e feel that it is unlikely tha.t the sy~lem was used this frequently in reality.
The nurse and tbe doctor also ~pedfi~'li that the CSIR telemedicine system could he improved.
Problem areas they identified inciud!\d the fflCt that the vidL'O waS nOt dell<, that there was"
~hortage of personnel to opemte the system and that technical "nd po,,-er problems render~'li the system unavailable fairly often. MorL'Over, the doctor found that the web camera WIIS no( ide"l in the CSlR teiem!\dicine system as it rcquir!\d " fair amount of nHl.nual maneuvering by the nurse during a tele'lledicine co""uitation. n,is wM extuOerhated by the fact that the CSIR \'oiO' over IP (VoIP) phone is a sepa<ate device. Thus the doctor hacl to i88ne instructions over the phone,
"ait for the nurse VI adjust the Camera to point at thc patient before going h"ck to the phone for further instructim", and advice,
However, both pru:ticipants did indicat.e that telcmedicine provided a valuable service, Here. it seemed that the participant.s were inRuenood by the promises oftdemcdkine to improw health care delivery in cases where a dire<,1 _vicc is not available. HO'"ever, the full henefits of t.elemedicine were never realiood in practie'e since neither of the particip"'lts used the CSTR system frequcntly enough to discern the effocts On the surronnding mmmunity.
Similarly, as we will discuss in the following 'l"Ctions, .MuTT was praiood as being a good telemedicine wiution for the area. hy OOt.h partidpants but W"l< never used frequently enongh in P'"w.,'tice to dis<:ern the full bencfits of tdellK'liicine. In the case of lIluTI. this was because the participtl.llts had busy sc.hcdules due to the peroonnel shortap;e8 "t both the dinic ""d the 1>oopi-t"l so they had little time VI nse the system. The nurile deocrilx'li her feelings about the CSlR te1emedicine system de311y as S<JeI, below:
University
of Cape
Town
CHAPTER 6. DISCUSSION OF RESULTS 117
Que~tion: What do yo" like about tlit e;risting tdemedicint syslemf
Nurse's Response: It i, cost effcd:!V€ and emllms service delivery as tht patienJ,j don't haIX to go to the hospital to follow long queues.
OveraJl, the CSIR Rystem seen aa useful with room for improvements. In the next section, we rn>lCu"" the re"ults pertaining to the !lIuTl proj<.d . . MuTI was developed t" overcome po_r failures and sdJeduling issue,; which rendered the CSIR telemedicine system unavailable for large periods.
6.2 : rvlulti-modal Tel e m e d ic ille InterCOmlnUllica1.or Evahw1.ion
We oollocted seve",l types of data to evaluate MuTI: stll.tistics of usage recorded in trace file,; and database logs; datil. from >lCIIli-strnc'turcd interviews and data from observations and field not"".
This section prerents OUr results regarding MuTI and discusses a triangulated view of the data.
fi,2.1 Overall Use of MuTI
The graph in Figure 21 shows the overall usage pattern for MnTl from the time it was first installed in April 2004 until the project termination in Oct"be,. 2004. In general, the nul1lC at the clinic used MuTI more often than the doctor at the hospital. This may be due to the raet that the doctor was the oole doctor resporu;ible for N_ie Knight H",pital during the trial period. This left little time for him to parlidpate in the project, whether for asynchrouom; message passing or synehronous cills. A" mentioned ea.-lier in this dissertation, this means that to haw a succe:ssful telemedicine system, one might require multiple doctors and even multiple lllll"SeS to operate the Rystem.
Additionally, the luw u81lge ofMuTI indicates that when telemedicine OCCUrs on a voluntary basis as in our projeet, it has a lower priority relative to paid ",urk duties. This means new telemedidne systems mll.y have a lmver clJ.anee of oUC= if there is insufficient motivation to use these systmns.
Th increase the chance that a new system is properly adopted, suitable remuneration should be provided for health care professionals for using telemedicine services and telemedicine should be integrated into the job description for these profef«ionalo. The fact that one will Ix compen81lwd for tdemedicine >leIvi""" rendered provides motivation for "talI to utilise a new system. This may be more reliable than relying oolely on each individual's personal motivations to use a partieular system, for instance, because they wish to help othem or gain new "kills, as in the case of the MuTI proj<.'Ct.
From the graph in Figure 21, it i" evident that the nm"" at the clink had more time to use MuTI since the clinic used MuTI more ofte,n than the hoopital overall. This may be attributed to the fact