title: Long-running telemedicine networks delivering humanitarian services: experience, performance and scientific output.
abstract: OBJECTIVE
  To summarize the experience, performance and scientific output of long-running telemedicine networks delivering humanitarian services.
  
  
  METHODS
  Nine long-running networks--those operating for five years or more--were identified and seven provided detailed information about their activities, including performance and scientific output. Information was extracted from peer-reviewed papers describing the networks' study design, effectiveness, quality, economics, provision of access to care and sustainability. The strength of the evidence was scored as none, poor, average or good.
  
  
  RESULTS
  The seven networks had been operating for a median of 11 years (range: 5-15). All networks provided clinical tele-consultations for humanitarian purposes using store-and-forward methods and five were also involved in some form of education. The smallest network had 15 experts and the largest had more than 500. The clinical caseload was 50 to 500 cases a year. A total of 59 papers had been published by the networks, and 44 were listed in Medline. Based on study design, the strength of the evidence was generally poor by conventional standards (e.g. 29 papers described non-controlled clinical series). Over half of the papers provided evidence of sustainability and improved access to care. Uncertain funding was a common risk factor.
  
  
  CONCLUSIONS
  Improved collaboration between networks could help attenuate the lack of resources reported by some networks and improve sustainability. Although the evidence base is weak, the networks appear to offer sustainable and clinically useful services. These findings may interest decision-makers in developing countries considering starting, supporting or joining similar telemedicine networks.
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway. r_wootton@pobox.com
authors.forename: Richard
authors.initials: R
authors.lastname: Wootton
authors.forename: Antoine
authors.initials: A
authors.lastname: Geissbuhler
authors.forename: Kamal
authors.initials: K
authors.lastname: Jethwani
authors.forename: Carrie
authors.initials: C
authors.lastname: Kovarik
authors.forename: Donald A
authors.initials: DA
authors.lastname: Person
authors.forename: Anton
authors.initials: A
authors.lastname: Vladzymyrskyy
authors.forename: Paolo
authors.initials: P
authors.lastname: Zanaboni
authors.forename: Maria
authors.initials: M
authors.lastname: Zolfo
mesh_terms: D000533:Altruism; D003299:Cooperative Behavior; D004526:Efficiency; D017598:Efficiency, Organizational; D014943:Global Health; D019538:Health Care Surveys; D006302:Health Services Research / Q000706:statistics & numerical data*; D006801:Humans; D017146:Models, Organizational; D015279:Organizational Culture; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data