Implementation of Telemedicine in Afghanistan-Challenges and
Issues
Muhibullah Aman Dr. Jawid Ahmad Baktash
Faculty of Computer Science Faculty of Computer Science
Kabul University, Afg Kabul University, Afg
aman.617@outlook.com jawid.baktash@yahoo.com
ABSTRACT
Telemedicine is the use of modern technology ,
telecommunication system and information
technologies for providing healthcare and remote
treatment and transformation of clinical information to
provide that care. And it will be very useful and
effective for developing countries like Afghanistan,
which still suffering Traffic issue in their cities,
insecurity and lack of hospitals and health specialists.
It can be divided into two modes of operations: real
time mode, in which patient data are available at the
remote terminal immediately after acquisition, and
store-and-forward mode, which involves accessing the
data at a later time.
Recent technological advances have enabled the
introduction of a broad range of telemedicine
applications, such as tele-radiology, tele-consultation,
tele-surgery, remote patient-monitoring, and health-care
records management that are supported by computer
networks and wireless communication technology. The
mobile phone has been recognized as a possible tool for
telemedicine since it became almost available for every
Afghan at all cities of Afghanistan.
Keywords ----- Telemedicine, Telehealth, Healthcare,
Remote Treatment, Clinical Information, tele-
radiology, tele-consultation, tele-surgery, remote
patient-monitoring,
1. INTRODUCTION
The group later did similar tests with a wireless
personal digital assistant (PDA). Tele-radiology
The above examples reflect the merging of
cellular communication and the Internet in
telemedicine and in telecommunication. Many
market projections indicate that mobile
computer is both an emerging and enabling
technology in healthcare. The merging of the
Internet and mobile computing is promoting the
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Dr. Muhammad Hadi Hedayati
Faculty of Computer Science
Kabul University, Afg
hdhedayati@gmail.com
applications utilizing cellular modems and
wireless pocket computers have also been
demonstrated by various groups. Some parties
have shown that with a bio signal acquisition
unit connected to a notebook, which interfaces
to a cellular phone equipped with built-in traffic-
channel modem, vital signs can be transmitted
from an ambulance to a hospital not only in
store-and-forward mode, but also in real-time
mode. Modeling and simulation of bio signal
transmission over cellular channels have been
carried out.
Medical and
Healthcare Telecommunication
Services
Telemedicine
Informatics
Figure 1- Telemedicine and Related Areas.
developments of handheld devices, wireless
infrastructures, application programming
languages, and protocols, all aiming to provide
mobile Internet access.
This comes as a direct result of the efforts
allocated by organizations and individuals in
pioneering research in this exciting field and has
resulted in an even greater influx of resources
made available for more R&D projects, pilots
and studies.
As is the case with most specialized fields,
research in telemedicine is faced with particular
challenges, a fact exacerbated by the variety of
the diverse disciplines involved. Admittedly, a
large part of the addressed issues stem from the
sensitivity of the general field of medicine and
its life-altering potential. Such general issues
include ethical and legal matters, design and
authoring of research protocols, receiving
approval from Institutional Review Boards,
confidentiality, informed consent of a study’s
subject, etc. Further to coping with the usual
aspects of these issues, telemedicine research
also needs to cope with their technological
perspective, as defined by the Information and
Communication Technologies (ICT) that will be
used in each specific study.
2. System Design
Beyond these general issues, research in the
field of telemedicine is also faced by unique
challenges, the most important of which are
presented below: ·
Working methodology. The diversity of
technologies and scientific fields involved in
Telemedicine complicates the definition and
design of research processes. Each specific part
of an application needs to be individually
addressed using appropriate methodologies from
the respective fields.
Patient participation. Enrolling patients in
telemedicine studies has been notoriously
difficult, with rates of rejection reaching as high
as 75%, with recent reviews showing that over
one third of research studies are based on
samples of roughly 20 patients.
Diversity of partners. A typical telemedicine
research will need input from extremely diverse
fields, such as: psychology, health sciences, law,
business marketing, computer science,
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telecommunications and engineering. A major
effort is required in order to coordinate the
necessary processes and information flows that
will transcend such disparate cultures.
Geographical dispersion. Partnering
institutions and organizations in telemedicine
research are not only worlds apart in a
metaphorical sense (as mentioned in the
previous point), but also literally so: partners are
usually dispersed over wide geographical areas –
even continents – with some of the participating
sites being rural locations with limited access
availability. These factors further complicate the
efficient management of the research work.
Confidentiality/data protection. In addition to
the confidentiality constraints that are shared
among all medical studies, the electronic
transmission of medical information (usually
including sensitive personal data) adds a level of
complexity to the issue.
Patient consent. Acquiring informed consent
from patients is exceptionally challenging for
telemedicine research, since patients that usually
have their expenses covered by private or public
insurance will be reluctant to opt for remotely
delivered services. The usual exception to this
refers to chronic conditions, in which frequent
travelling to distant locations is ruled out (thus
the large amount of research in the field of
chronic conditions treatment).
Despite the challenges mentioned above, the
field of research in telemedicine brings much-
needed promises for solving the issues of
shortages in healthcare resources and experts.
Telemedicine presents rich commercial
opportunities accompanied by the potential to
provide healthcare to currently underserved
populations in both rural and urban
environments. Accordingly, it is imperative for
practitioners and researchers in the field to
conquer these challenges and for governing
institutions to facilitate this task
Telemedicine includes transfer of basic patient
information over computer networks (medical
informatics), diagnosis, treatment, monitoring,
and education of patients using systems that
Network Evolution
introduced by various degrees into the medical
environment. Each year, computers are getting
faster, smaller, and cheaper. The extra
processing power and facilities open up the
Medical Environment

 Medical Record
Coding
End Customer Need  Information Retrieval
System
 Integrated
Applications
Telemedical Health
System
Services  Telemedicine
 Multimedia Medical
Network Applications
Architecture/Infrastructure  Health Knowledge
Systems/Experts
products Systems
 Educational and
Training in Health
Platforms Informatics
Security/Confidentiali
Technology
ty/Data Protection
 Quality
Control/Quality
assurance

Figure 2-An abstract mapping of medical applications to network evolution

allow access to expert advice and patient
information. During these processes, location of
patient or relevant information is not important.
The fundamental concepts of telemedicine
technology include Basic principles of
telecommunications and Internet-working of
computer systems; Use of communications
software, including electronic mail and browsers
for the World Wide Web; and Forms of
telecommunications, including
videoconferencing, remote data monitoring and
file transfer, applicable to medical care in
remote or rural environments. In the last few
years,
information and communication technologies
have seen enormous growth, and have been
scope for much more powerful processing and
networking of medical applications.
Communication networks are becoming
increasingly large in size and heterogeneous in
nature. Recent advantages in communication
technologies have contributed to an explosion of
new products and services directed at the
medical environment. An abstract mapping
between medical applications and network
evolution is given in Fig. 2. The general goal of
using communication technologies in medical
environments is to improve the overall quality of
health care at an affordable cost. This requires
close interaction between health care
practitioners and information technologists to
ensure that the proposed technologies satisfy
current user’s needs and anticipate future ones.

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Appropriate application of information
technology in primary health care will extend
traditional
diagnosis
and patient
management beyond the doctor’s clinic into the
everyday living environment. A model of
information management in primary health care
that places special emphasis on the emerging
areas of clinical decision support, computerized
3. Current status
Since 2001, the equipment at the BIRHC has
been used for continuing education courses, as
well as for arthritis and multiple sclerosis
support groups. A second fulltime physician
assistant has joined the clinic. Clinical use of the
system remains very low. The doctors from the
mainland are still resistant to using telemedicine,
even when weather conditions prevent them
from visiting the island. A new nurse on the
island agreed to act as a home health nurse.
Beaver Island residents are receiving home care
for the first time. Telemedicine is being used to
supplement face-to-face visits. In March 2002,
icy road conditions made face-to-face home
health visits
CONCLUSION
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clinical measurements, patient education, and
network connectivity is described. In general
practice, the representative model of information
management can be formulated as shown in
Figure 3.
impossible. Nevertheless, the nurse was able to
check on patients via the home health telecare
units.
The health board on the island is still supportive.
Several retired nurses have joined the board. The
physician assistant predicts that their
involvement will catalyze clinical telemedicine
applications. However,
continued funding challenges may prohibit the
clinic from keeping its telemedicine
programmed unless a
long-term solution is developed for the recurring
T-1 line costs.
Telemedicine represents a combination of
expertise and technology that delivers medical
services and information over distance.
Telecommunications technology delivers this
information in the form of voice, data, or video
imagery. The most part of existing literature on
telemedicine has taken as its primary focus the
utility and efficacy of the technology itself, as it
is applied to particular clinical problems and
settings. This is primarily a clinical literature
that is about establishing the safe practice of
medicine using a diverse set of communications
technologies. This literature itself subdivides
according to clinical specialty. Telemedicine is a
form of telecommunication that uses transmitted
images, voice, and other data to allow medical
consultation and education over a distance.
Advances in communication and information
technology have made telemedicine more
feasible as an alternative means of providing
health care and sharing medical technology with
remote areas. Telemedicine achieve its potential
to improve delivery of health care in rural or
remote areas only through cooperation among
health professionals, computer system
developers, telecommunication providers, and
educators. Telemedicine is one way in which
more and better health care can be delivered to
such remote areas throughout the world. The use
of telemedicine systems in hospital clinics, long-
term care facilities, and home care is becoming
REFERENCES
1. Klein, J. A., Introduction to
Telemedicine, April 28, 2001. Available
at http://www.nursingnetwork.com/
telemed1.htm
2. Garshnek, V., Logan, J. S., and
Hassell, L. H., The telemedicine
frontier: Going the extra mile. Space
Pol. 13(1):37–46, 1997.
3. Gantenbein, R. E., Clinical Practices
in the Information Age: An
Introduction to Telemedicine
Technologies,
Department of Computer
Science/School of Human Medicine
University of Wyoming,
Dec. 1999. Available at
http://www.cs.uwyo.edu/»rex/hlsc4970
.html
5
well established and is evolving in effectiveness
and efficiency.
However, there are technological, political, and
professional barriers in delivering health care.
While these barriers are difficult, they can be
overcome with cooperation among health care
professionals, technology specialists, and
governments. The benefits of telemedicine
include improved access to care, greater
efficiency in diagnosis and treatment, improving
access to information and assuring patient
confidentiality, higher productivity, and market
positioning for this century. Telemedicine has
the potential to have a greater impact on the
future of medicine than any other modality and
will profoundly alter the medical landscape of
this century. In the most remote areas, it can
bring high quality health care. In global health
care, it can enhance and standardize the quality
of medical care. Telemedicine is used in a
growing number of medical specialties by health
providers. Also, it has become an integral part of
medical care in space flight. Through its
mobility, it can provide urgently needed health
care. Since the rapid growth in
telecommunications and computer technology
over the last decade, telemedicine has become
an important part of medical development, with
the potential to greatly improve quality of future
health care.
4. Stanberry, B., Legal ethical and risk
issues in telemedicine. Comput.
Methods Programs Biomed. 64:225–
233, 2001. 216 Gu¨ ler and U¨ beyli
5. Hofmann,B.,Amultiparameter PC-
based telemetry unit for biomedical
signals. J. Telemed. Telecare 2:143–
147, 1996.
6. Allen, A., Doolittle, G. C., and
Boysen, C. D., An analysis of the
suitability of home health visits for
telemedicine. J. Telemed. Telecare
5:90–96, 1999.
7. Rizzo,N., Fulvio, S., Camerucci, S.,
Carvalho, M., Biagini, M., and Dauri, A.,
Telemedicine for airline passengers,
seafarers and islanders. J. Telemed. data from an aircraft. J. Telemed.
Telecare 3:7–9, 1997. Telecare 4:62, 1998.
8. MacDonald, A., McNicholl, B. P., and
Wootton, R., Transmission of medical