The Brief Review on Telemedicine: New Dream in Developing Countries

The true merit of telemedicine has yet to be determined by systematic empirical studies (1, 2). Telemedicine is referred to as improper distribution of human and fundamental resources (3). Telemedicine needs more investigation to reveal its advantages and disadvantages (4).

Telemedicine has different applications in medicine. We will define some of them here. In 1974, Gravenstein used laser-mediated telemedicine in anesthesia; consultants evaluated patients and operation room by a color-television monitor and collaborated with anesthesiologists. The Oregon teledermatology project was a 24-hour pediatric echocardiography service by telephone, which was conducted between two general and children hospitals with 500 kilometers distance. The non-psychiatric physicians can give consultation and education from psychiatrists by closed-circuit television (eg, between Hanover, New Hampshire, and Claremont). It is surprising that primary scientific foundation of telemedicine was in 1950 about X-ray transmission by radio or telephone.

Radiology is one of the developing areas in telemedicine. However, the absence of critical care specialists is a problem, which can be eliminated by telemedicine via two-way audiovisual link between a small private hospital and a large university medical center (eg, San Antonio and South Texas Hospital in Harlingen with 250 miles distance) (5). Telecommunication was used by the National Aeronautics and Space Administration (NASA) for helping disaster victims in 1985 earthquake in Mexico City by Advanced Technology Stellate (6). The European Space Agency (ESA) has started its activations since 1996 and emphasized that satellite communication is a strong technology in providing telemedicine services, especially in remote areas such as Sub-Saharan Africa. After 1996, the evaluation of telemedicine by stellate communication issues is mandatory for Telemedicine Task Force (TTF) in collaboration with World Health Organization (WHO), the European Commission, and African representatives (7). Telemedicine has some benefits due to providing medical care over distances by phone line, satellite, or internet for people; otherwise, they will have no access to them (8). However, there are minor practical experiences about it (9) because of ambiguous evidence regarding the impact of telemedicine on economic and medical aspects in developing countries (10). Mobile health acts as a useful device for access, coverage of medical problems, and meta-analysis has shown its positive impacts on outcomes of chronic diseases (11). The absence of knowledge about application of technology is one of the obstacles to the extension of telemedicine. Readiness for acceptance of technology, infrastructures, and people is definitely required. In Saudi Arabia, Jordan, Syria, Kuwaiti, Iraq few knowledge is about telemedicine (12). The main disadvantages of telemedicine, especially in coronavirus pandemic, include difficulty to make a diagnosis due to the lack of physical examination and inability to use physician hands-on expertise, the suddenly changed practice due to the COVID-19 pandemic, the remarkable shift to virtual clinics because of the national lockdown and social isolation during the pandemic, the elderly people with restricting technological skills, unawareness of telemedicine as a choice technology and access to services (13). Telemedicine has a considerable role in pain management and care in patients with multiple sclerosis, phantom limb pain, and chronic pain by primary care physicians and psychologists (14). The cost-effectiveness of this approach, particularly in remote and rural regions, is advantageous (15). Latifi et al. concluded that telemedicine is an optimal, continuous, and low cost for rebuilding medical systems in developing countries (16). It is assumed as a problem-solving approach in developing countries. Approximately, 80% of the world’s people live in these regions. Telemedicine can be used for clinical, educational, administrative purposes by which educational aspect is more applicable in developing countries. Low-cost clinical telemedicine is possible via email and digital cameras. It is important to note the establishment of telemedicine does not require high financial infrastructures (17). The assessment of 27 referrals showed usefulness and cost-effectiveness in Bangladesh project by digital cameras and tripods (18). One systematic review showed an improved correlation between centers, assistance in ordering, management of drugs, helpful monitoring, and identifying of patients (19). In Peru and Nicaragua rural regions study, the findings demonstrated insufficiency of healthcare. In this regard, telemedicine can improve this condition (20). It is obvious that rapid development of interesting telemedicine challenges results in healthcare decision-makers rethinking telemedicine infrastructures (21). One pilot study established low-cost telemedicine link is technically easy and has significant benefits in diagnosis, management, and education in developing countries (22). One of the important benefits is to share data and research with other collaborations and consultations about patients’ information (23). Advances in communications and IT induce a new vision to secondary and tertiary healthcare to people with low socioeconomic levels in India (24). The present investigations result in case innovation approaches for resolving conventional problems (25). Telemedicine provides problem-solving methods in ultra-short duration. Telemedicine mail is written in Java software for telemedicine (26). Approximately only 0.1% of telemedicine demand has been responded to. The correct way will focus on making active networks, which alter health outcomes and provide models for some countries (27). Telemedicine via mobile telephone with camera and digital cameras can be helpful in rural areas (28). TV with space is a low-cost medium. Also, faster internet connections are a way for access to healthcare facilities (29). The health technology by internet (eHealth), such as mobile health, is quickly improving in developing countries and can facilitate communication between patients and healthcare (30). Overall, it was accepted that telemedicine could be provided better healthcare in rural areas, which their hospitals are located in remote places (31). The people who live in rural areas suffer from lower life expectancy and poor health care status (32). A new kit designed with sensor for evaluation of vital signs such as blood pressure, heart rate, and saturation of blood oxygen; then, sends information to mobile application, records and delivers them to a physician. Data are available on USB (33). Beyond successful implementation of telemedicine in health informatics, there are some challenges, especially in developing countries, such as fundamental needs, trained staff, and integrated regional strategies (34). E-readiness is defined as resource and ability to create changes by internet (35). One study showed acceptance of technology and entrance of telemedicine to Iranian hospitals, and the authors have believed that proper educational programs can help extend telemedicine and economic aspects (36). In Iranian survey, awareness of score was 13 ± 5.5 of 35, which means low awareness, 43.7% heard before about teleconsultation, friends, and public media (30.3%) despite this, the clinician staff had positive attention to telemedicine or electronic pathways (37). It seems infrastructures such as internet technology are poor in Iran and with improving it, telemedicine will be a good choice (38). The surveys in Iran showed that appealing telemedicine does not need funding, trained medicine, and optimal devices (39). Iran is a country with many remote rural areas and naturally, the people cannot receive appropriate medical services due to this reason, especially in winter. Iranian telemedicine association has started its activity since 2016, and the first Iranian telemedicine congress was held in 2017. Authors believe these good steps to a new insight of medicine and support of them can improve our national health status and fair division of medical facility. About 90% of Iran's territory is located in the Iranian plateau and is considered a mountainous country. More than half of the country's land is mountains and highlands, 14 are deserts, and less than 14 are also cultivated lands. Earthquakes are the major vulnerability factor in Iran where approximately 74,000 deaths have occurred as a result of seismic events (40).

Here, we brought one example of many remote rural regions in Iran with difficult accessibility to other areas with primary medical resources (Figure 1). Therefore, according to Iran geography and disasters ranking, we will need telemedicine infrastructures for overcoming problems, which may exist on the way of healthcare providing.