Journal of the International Society for Telemedicine and eHealth <p>The Journal of the International&nbsp; Society for Telemedicine and eHealth (<strong>JISfTeH</strong>) is an official journal of the International Society for Telemedicine and eHealth whose stated mission is to "Facilitate the international dissemination of knowledge and experience in <strong>Telemedicine</strong> and <strong>eHealth</strong> and provide access to recognised experts in the field worldwide." <strong>JISfTeH</strong> is a peer reviewed, open access, online journal that seeks to publish information on all aspects of eHealth activity and research from around the World. Its primary focus is on original research, critical reviews, preliminary communications and case reports. Scientific letters and letters to the editor are also welcomed. <strong>JISfTeH</strong> encourages&nbsp; submission of&nbsp; preliminary communications and short reports from developing countries. Papers are published online immediately on acceptance of the final galley proofs to ensure rapid access to new work.</p> <p><strong>Editors-in-Chief:</strong> Prof. Maurice Mars, and Prof. Richard E. Scott</p> <p><strong>Online ISSN:</strong>&nbsp;2308-0310</p> The University of KwaZulu-Natal for the International Society for Telemedicine and eHealth en-US Journal of the International Society for Telemedicine and eHealth 2308-0310 <p>Authors who publish with this journal agree to the following terms:</p><p><br />Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p> Here We Go Again - 'Digital Health' Richard Scott Maurice Mars ##submission.copyrightStatement## 2019-01-22 2019-01-22 7 e1 (1 2) 10.29086/JISfTeH.7.e1 e-(Oral) Health: A World-Wide Overview [Guest Editorial] <p>Editorial</p> Rodrigo Mariño ##submission.copyrightStatement## 2019-05-03 2019-05-03 7 e7 (1 2) 10.29086/JISfTeH.7.e7 2019: The Year of Teledentistry in France? <p>In France, access to a dentist for elderly people, disabled people or inmates is limited. A person’s access to a dentist decreases by 25% when joining a nursing home. A national report&nbsp;mentioned that 85% of residents in nursing homes didn’t have access to a dentist in the past year and 42% in the last 5 years. There are fewer data on disabled people, but 48% of people with disabilities have, at least, one important issue related to oral health. Two examples of teledentistry, the e-DENT project from University Hospital of Montpellier and the TEL-E-DENT project from the public Hospital of Guéret, are presented to describe how teledentistry works in France, the current legal framework, remuneration of teledentistry and the pros and cons of teledentistry in France.&nbsp;2019 will be crucial for the development of teledentistry as a number official decisions will be made that will influence the implementation of this kind of activity.</p> Nicolas Giraudeau Olivier Roy Eve Malthiery Joao Pasdeloup Jean Valcarcel Steve Toupenay Serge Fournier ##submission.copyrightStatement## 2019-05-03 2019-05-03 7 e8 (1 5) 10.29086/JISfTeH.7.e8 Teledentistry Overview: United States of America <p>This paper describes current teledentistry practices in the United States of America.&nbsp; The health landscape of the country is reviewed and the emerging need for remote health services discussed. The origins, current guidelines, legal issues, and financial arrangements for teledentistry are described.&nbsp; Specific attention is paid to emerging teledentistry programmes throughout the country, including a case study of a successful and expanding teledentistry programme in the state of Oregon. Although the literature has long touted the health and economic benefits associated with teledentistry, it has become clear that this technology has generally outpaced policymaking and regulatory agencies. This paper attempts to contextualise and review leading developments in teledentistry to aid in the dissemination of otherwise fragmented efforts and experiences.</p> Katelyn Nichols ##submission.copyrightStatement## 2019-05-03 2019-05-03 7 e9 (1 6) 10.29086/JISfTeH.7.e9 Current Scenario of Teledentistry in Public Healthcare in India <p>India is the largest democracy and the second most populated nation in the world. Although with 190,000&nbsp;&nbsp; dentists, India ranks top in the absolute number of dental graduates, rural Indians and urban slums remain deprived of quality dental healthcare due to unequal distribution and access. About 1,000 telemedicine nodes have been established by Government/Private/Trust agencies to reinforce the national healthcare delivery system in India however an organised and dedicated teledentistry network is non-existent but for the Collaborative Digital Diagnosis System (CollabDDS). CollabDDS was developed in India for tele-consultation, diagnosis, remote education and as a data repository. It is a remote expert dental programme served between three dental schools with the Centre for Dental Education and Research at the All India Institute of Medical Sciences in New Delhi. There are some major challenges which exist and need to be addressed including lack of government initiatives, reimbursement schemes, data protection laws, technical infrastructure, advanced biological sensors, bandwidth support, orientation among doctors, and linguistic diversity, along with patients’ fear and unfamiliarity. With an area of 3,287 million km<sup>2</sup>, an urban-rural divide, inaccessible areas, the country is an ideal setting for the provision of eHealth. This paper highlights the present status, challenges and future of teledentistry in India.</p> OP Kharbanda Harsh Priya Rajiv Balachandran Charu Khurana ##submission.copyrightStatement## 2019-05-01 2019-05-01 7 e10 (1 8) 10.29086/JISfTeH.7.e10 e-Oral Health and Teledentistry in Finland - an Overview <p>Despite universal health coverage and a strong public health system, the oral health profile of Finland falls behind in an international age-matched prevalence of oral diseases. The oral healthcare system is organised and funded mainly by municipalities. Other stakeholders include the Finnish Student Health Service foundation (FSHS), government and private practices, where the Social Insurance Institution of Finland plays a major role in funding. Rise in the treatment need in recent years due to the increasing dentulous ageing population has challenged the healthcare system. Governmental response to the demand is an ongoing social and healthcare reform and increase of oral health professional education since 2004. However, the current and future treatment need is not met only by conventional prevention strategies and physical service provision. Finland has over the years supported a determined policy of building a digital healthcare architecture. This applies also to all fields of oral healthcare: virtual education, digital diagnostics, digital clinical workflow, national electronic patient records, patient-generated data registers, electronic prescriptions, remote consultation, digital service&nbsp; management, as well as research and big data mining. These tools could play an important role in improving national oral health and increasing equity. This is an overview of the above-mentioned fields of e-Oral health and teledentistry in Finland&nbsp;based on current scientific literature, national reports, strategies and legislation.</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> Anni Marjukka Palander Arto Holopainen Tiina Rantamo Rantamo ##submission.copyrightStatement## 2019-05-03 2019-05-03 7 e11 (1 9) 10.29086/JISfTeH.7.e11 Current State of Teledentistry in Chile <p>Chile is a country where the geography and territorial distribution of the population make healthcare a constant challenge. Despite a reported improvement on oral health indicators, some levels of inequality are still noted in terms of access to healthcare services. In this context, teledentistry has been considered an effective tool to respond to the population’s healthcare needs. The aim of this paper is to present the current state of teledentistry in Chile. This paper describes the initiatives and programmes of teledentistry developed in Chile, the ethical and legal aspects, financing sources and pending challenges for its consolidation. It is expected that teledentistry will contribute toward an increase in coverage and access to specialists, improve the appropriateness of referrals and reduce costs of specialist care.</p> Carlos Zaror Carolina Vergara-Gonzalez Natalia Ibalaca Juan Pablo Olmos Silvana Perez ##submission.copyrightStatement## 2019-05-03 2019-05-03 7 e12 (1 6) 10.29086/JISfTeH.7.e12 Improving Access to Specialist Dental Services Using a Telehealth Platform in Victoria, Australia <p>Australians in rural and remote locations have worse health outcomes compared to that of their metropolitan counterparts and this is due in part to poor access to health services. Public specialist dental services in Victoria, Australia are predominantly offered in the capital city Melbourne. For rural patients this can mean considerable travel, out of pocket costs and delays due to long wait-times. In 2015 Dental Health Service Victoria (DHSV) embarked on a pilot project to enable access to rural clients by linking community dental clinics with the Royal Dental Hospital Melbourne using a Telehealth platform. <strong>Aim:</strong> The objectives of the pilot were to develop specialist care pathways and enable patient access, support community clinicians to work to full scope through a peer education approach and to identify the appropriate equipment and telehealth platform to support this model of care. <strong>Method: </strong>DHSV launched its pilot project June 2015 collaborating with four Community Dental sites. The specialties trialled during the pilot project were Oral Medicine, Oral Surgery, Endodontics and Orthodontics. An action based research framework was adopted so that improvements to the operational framework and clinical pathways could be made throughout the life of the pilot. <strong>Results: </strong>By the end of the pilot programme, DHSV was satisfied the program objectives had been met and the modality was accepted by specialists, community dentists, and patients as a satisfactory substitution for a traditional face-to-face referral and consult mode. <strong>Conclusion:</strong> Based on this outcome, the programme was endorsed and implemented across the state of Victoria in January 2018.</p> Jennifer Baker ##submission.copyrightStatement## 2019-05-03 2019-05-03 7 e13 (1 6) 10.29086/JISfTeH.7.e13 Tele-odontology in Brazil: Strategies and Challenges for the Training of the Healthcare Network <p>Different initiatives have been undertaken to guide the telehealth process in the Brazil. The Ministry of Health structured and implemented the Telehealth Brazil Programme initially to cover nine state centres. Later, it expanded the programme to take in the whole country, at which time it became known as the Telehealth Brazil Network. Among the goals of the Telehealth Brazil Network is the development of strategies for clinical training, health education, and training for management, planning and assessment skills, designed for the Family Health Strategy teams. In this context, this paper aims to presents the potential of and difficulties in implementing tele-odontology in Brazil, focusing on teleconsulting, tele-education and telediagnostic experiences developed to date. It will also present the legal and financial support aspects established in the country, as well as the results found so far in relation to the impacts of strategies and user satisfaction. Finally, suggestions for future perspectives are presented. Related to the strategies implemented in Brazil, it is necessary to analyse the data obtained regarding the successes and failures observed over the years. The positive results obtained with tele-education showed that the Telehealth Programme presents as an efficient tool for the training of the health care network. However, points like the limited use by professionals, some technical limitations and the impact on health indicators should still be better studied.</p> Caren Serra Bavaresco Ana Estela Haddad ##submission.copyrightStatement## 2019-06-18 2019-06-18 7 e14 (1 5) 10.29086/JISfTeH.7.e14 Post-Discharge eLearning Platform for Cardiac Patients: Developing the Format of the Educational Units and Recording the Contents <p>Myocardial infarction patients face an increased risk of cardiovascular problems. This risk can be reduced by adjusting one’s lifestyle. However, once discharged from the hospital and faced with self-care at home the patient faces a loss of adequate information and diminishing motivation with time after infarction the event. There is a gap of two weeks between being released from the hospital and the patient having any chance of joining organised cardiac rehabilitation programmes, if these are organised by the health system at all. Unfortunately, by that time the highest motivation for lifestyle change has already been lost.</p> <p>An eLearning platform has been put forward to bridge this period, however, the content needs to be carefully prepared to educate and motivate the patient and their family. By analysing how health information is acquired over the Internet today, and by applying social-cognitive learning and storytelling into educational videos we developed a format of an effective educational unit. In order to develop an essential set of educational units seven interviews were recorded with members of medical teams and five with patients who had coronary disease, of which two were with their partners who were their informal caregivers.</p> <p>The format of the educational unit was designed as such that it can be viewed in 4-8 minutes and was composed of three videos featuring peer-patients and medical team members. The videos were accompanied by a short text of up to 50 words, illustrations or quiz questions. From the recorded video material 60 educational videos were edited and used to compose 20 educational units for patients with coronary disease. Legal issues regarding Rights of Publishing and General Data Protection Regulation issues were solved and backend data analytics was developed. Thus, the platform was prepared for next step which will be a large random clinical study.</p> Borut Kirn ##submission.copyrightStatement## 2019-06-17 2019-06-17 7 e18 (1 7) 10.29086/JISfTeH.7.e18 Telefitting Between Kajetany and Odessa, Ukraine for Cochlear Implants <p>Hearing implant fitting is a key component of postoperative patients’ healthcare, by providing the optimum auditory nerve electrical stimulation parameters. It often entails time consuming and long travel to a medical centre, with associated costs. In 2009, the Word Hearing Centre introduced the National Network of Teleaudiology to reduce the burden to patients, and it now consists of 21 co-operating centres in Poland and four abroad in the Ukraine (Odessa and Lutsk), Kyrgyzstan (Bishkek), and Belarus (Brest). The centre in Odessa is sufficiently equipped but programming of cochlear implants cannot be conducted by their team there due to a lack of trained specialists and limited experience. This study reports the use of the telefitting service between Kajetany in Poland and Odessa in the Ukraine. <strong>Methods: </strong>Specialists in Poland connect by videoconference with patients and support specialists via the Internet, and use remote desktop software to access a remote computer and perform fitting. On completion of telefitting, patients completed a questionnaire in which they compared the telefitting experience with face to face conventional fitting. <strong>Results:</strong> Supported by a local specialist, 316 patients in Odessa underwent remote telefitting by specialists in Kajetany. &nbsp;Over 95% of respondents were; satisfied with telefitting, found it a suitable alternative to standard fitting, felt that they had good contact by videoconference with the audiologist in Poland, and that it saved them time and money.&nbsp; <strong>Conclusion:</strong> The development of the telefitting model has increased accessibility to hearing care services in Odessa and opens new possibilities for patients.</p> Piotr Henryk Skarżyński Weronika Świerniak Maciej Ludwikowski Łukasz Bruski ##submission.copyrightStatement## 2019-03-20 2019-03-20 7 e17 (1 6) 10.29086/JISfTeH.7.e17 A Train-the-Trainers (TtT) Program for Engineers for Hosting Multiparty International Clinical Teleconferences <p><strong>Background:</strong> International clinical teleconferencing connecting hospitals contributes to the standardisation of medical care. <strong>Introduction: </strong>The perception that participating in international teleconferences is easy while hosting and coordinating them is difficult has limited the expansion of these kinds of programmes. We evaluated the effectiveness of a Train-the-Trainer (TtT) programme on hosting international multiparty teleconferences targeted at hospital engineers. <strong>Methods: </strong>From 2015 to 2017, 20 engineers and physicians from 17 institutions in 10 countries participated in Kyushu University Hospital’s TtT programme. Hands-on training and hosting a Training Report Conference (TRC) were conducted. The impact of the programme was assessed using questionnaires about the participants’ confidence, perception of barriers, and teleconference activity before and one year after the training period. <strong>Results: </strong>The mean training period was 16.7 days (median, 19 days). Twelve TRCs were hosted by trainees connecting 56 institutions in 11 countries. All participants gave positive evaluations of the overall programme, 19 (95%) "very good" and 1 (5%) "good", and the trainers 9 (90%) "very good" and 1 (10%) "good"). Following the TtT programme, the mean number of trainee-hosted events increased significantly (0.8 to 1.3, p&lt;0.001), and more respondents (12/17, 71%) reported barriers to hosting a programme than participating in one (5/17, 29%, p&lt;0.001). Trainee confidence in both hosting and participating in international teleconferences was significantly higher after TtT. <strong>Conclusion: </strong>There are more barriers to hosting than participating in international clinical teleconferences. This TtT programmes for engineers could contribute to more active hosting engagement.</p> Kuriko Kudo Tomohiko Moriyama Shunta Tomimatsu Shintaro Ueda Shuji Shimizu ##submission.copyrightStatement## 2019-03-21 2019-03-21 7 e16 (1 8) 10.29086/JISfTeH.7.e16 Development and Presentation of an Ethical Framework for Health and Medical Apps <p>The ubiquity of mobile applications makes it difficult to weigh up opportunities and potential risks. One significant aspect of an ethical assessment regarding the development and use of health and medical apps is the lack of clear and consistent guidelines and measures of value. <strong>Aim</strong>: The aim of this paper was to identify the main ethical determinants associated in the context of health and medical apps and develop a framework for ethical reflection. <strong>Methods: </strong>A systematic literature search in the database PubMed was undertaken and the journal Biomed Central Medical Ethics was hand searched and 32 met the review criteria. On this basis of the review an interview guide was developed and five purposively selected experts on the field of payers, science, consumers, medical ethics and society were interviewed regarding health and medical apps. <strong>Results: </strong>There is a lack of consistent and clear guidelines regarding the use of health and medical apps in literature. Indeed, findings refer to established biomedical principles. The interviews identified that several insecurities related to legal and regulatory issues are common. On the other hand, many advantages of the use of health and medical apps have been pointed out by experts. <strong>Conclusion: </strong>Debates on ethics and the use of health and medical apps should play a significant role in public discussion. Ethical endpoints cannot be considered isolated from each other, and must be regarded as a complex network of aspects connected with each other. Further research should concentrate on the development of consistent guidelines and a framework for reflection of occurring ethical concerns.</p> Pinar Tokgöz Hannah Eger Sarah Sharlyn Funke Alexander Gutjar Thuy Nguyen-Thi Christoph Dockweiler ##submission.copyrightStatement## 2019-03-16 2019-03-16 7 e15 (1 8) 10.29086/JISfTeH.7.e15 Adopting Digital Technology in Midwifery Practice – Experiences and Perspectives From Six Projects in Eight Countries (2014 – 2016) <p>This paper describes the cases of six midwifery projects of the Women Observatory for eHealth at the Millennia2025 Women and Innovation Foundation, to support the adoption of information and communication technologies (ICTs) in midwifery practice in eight countries from 2014 to 2016. The WeObservatory is a digital inclusion incubator aimed at reducing maternal and neonatal mortality in countries with limited resources by strengthening midwifery practice through the access to ICTs and eHealth applications. This paper describes how the collaboration with the WeObservatory supported these projects in the development and adoption of digital solutions for midwifery practice. It examines responses from the project leaders to an online survey conducted by the WeObservatory in January of 2018. Their responses provide insights on opportunities and challenges faced by these projects that can inform future midwifery eHealth projects. Building capacity among midwives for the adoption of digital competencies will help improve the quality of healthcare provided to mothers and their newborn babies in low-income countries.</p> Lilia Judith Perez-Chavolla Véronique Inès Thouvenot Doina Schimpf Amélie Moritz ##submission.copyrightStatement## 2019-01-05 2019-01-05 7 e2 (1 8) 10.29086/JISfTeH.7.e2 Profile and Motivation of Women Enrolled in the Brazilian Telemedicine and Telehealth Postgraduation Distance Education Programme <p><strong>Purpose:&nbsp; </strong>Women’s participation in Telehealth is increasing around the world and they should be prepared to work in this new job market. The aim of this study was to evaluate the profile and motivation of women enrolled in the Brazilian Postgraduate Programme on Telemedicine and Telehealth.<strong> Methods: </strong>A cross-sectional study was conducted from May to July 2018 of all women enrolled in the postgraduate programme using an anonymous online Google form. It consisted of a multiple choice form regarding: age, number of children, profession, date of graduation, current occupation, current number of jobs, workload, postgraduate programmes completed,&nbsp; duration of Telehealth experience&nbsp; and motivation to enrol on the Programme.&nbsp; Data collected were exported to an Excel® sheet, summarised and analysed. <strong>Results: </strong>Of 44 women, 36 completed the survey. Mean age and time passed since graduation were respectively 43.5±13.5 years and 18±17 years for student and 53±13.5 years and 31.5±8.5 for professors; 25 women have at least one child, work more than 30 hours weekly and 10 of them work in two jobs.&nbsp; Health professionals and health occupations were predominant in both groups. Most students had little or no experience in Telehealth.&nbsp; The decreasing order of frequency motivation was professional refinement (63.8%), job opportunity (55.5%), financial gain (52.7%) and innovation (38.8%).<strong> Conclusion: </strong>Regardless of age, children, workload and professional qualification, the major women's motivation for enrolling in the Telehealth Postgraduate Programme is to professional refinement in this field.</p> Alexandra Monteiro Barbara Monteiro Grisolia Juliana Cardoso Munique Santos ##submission.copyrightStatement## 2019-01-05 2019-01-05 7 e3 (1 4) 10.29086/JISfTeH.7.e3 The Contribution of Online Social Networks for Drug Abuse Treatment Referral: a Pilot Study <p><strong>Background:</strong> The consumption of psychoactive drugs is growing in Brazil, as well as the access of social networks. This study is a preliminary short report about the contribution of online social networks for drug abuse treatment. The study aimed to evaluate the role of an online social network to engage psychoactive drug users in treatment. <strong>Methods: </strong>A descriptive study was undertaken from July to September 2015. The study population were psychoactive drugs users who accessed voluntarily the webpage “Stay Free of Drugs” (SFD) from the social network Facebook. <strong>Results</strong><em>:</em> A total of 25 psychoactive drug users were enrolled in the study, and 16 (64%) accessed a healthcare centre seeking treatment. The average from the users’ online contact to their visit to the healthcare centre was 8.4 days. Half of the participants were exclusive alcohol users and accessed the webpage at night (65%). <strong>Conclusions: </strong>The use of a social network showed a potential importance in referring drug users to treatment, also acting as health education strategy.</p> Diogo Barbosa Luciana Tricai Cavalini Nádia Cristina Pinheiro Rodrigues ##submission.copyrightStatement## 2019-01-25 2019-01-25 7 e4 (1 3) 10.29086/JISfTeH.7.e4 Social Media as an Opportunity for Public Health Interventions: The #Metoo Movement as an Exemplar <p><strong>Background</strong>: Social media have been used exponentially and globally, providing a means for billions of users to connect, interact, share opinions and criticise, becoming one of the main channels of communication for users around the world. One of the most popular free social media networks is Twitter, with more than 100 million active users per day worldwide. <strong>Purpose:</strong> The aim of this study was to analyse a sample of the public conversations generated, using the hashtag #MeToo, around the topic of sexual abuse on Twitter.&nbsp; <strong>Methods:</strong>&nbsp; Using social media marketing software, the use of the #MeToo hashtag was analysed over a period of 60 days (14 September 2017 to 13 November of 2017). <strong>Results: </strong>The #MeToo conversation was mainly in English (79.3%), located in the United States (48.2% of cases), but with global repercussions. The volume of mentions of the #MeToo hashtag was far greater (97.7%), compared with other hashtags related to violence over this period of time, using mostly Twitter (96.2%). <strong>Conclusions: </strong>These results suggest that it is possible to describe different groups using the social media, and analyse their conversations to identify opportunities for successful public health interventions.&nbsp; If the topic is relevant for the general public, it will generate interest and conversations at the global level, supported by a universal and borderless channel such as Twitter.</p> Raquel Gomez Bravo María Gómez Bravo Charilaos Lygidakis Claus Vögele ##submission.copyrightStatement## 2019-04-17 2019-04-17 7 e5 (1 7) 10.29086/JISfTeH.7.e5 Feminisation of Dentistry in Brazil from the Perspective of a MOOC-Type Distance Course - A Short Report <p>The Brazilian public healthcare system (SUS - Brazilian Healthcare System) provides free dental care, covering almost half of the Brazilian population. Providing continuing education to thousands of professionals is a difficult and expensive task given the country’s large size. SUS' Open University in partnership with public universities provides ongoing education to thousands of healthcare professionals using technological resources for distance learning. A distance learning course, in the MOOC (Massive Open Online Course) modality, was developed to provide continuing medical education for dental surgeons to assist patients with chronic diseases. The course is free and has registered 13,089 participants. <strong>Aim:</strong> The purpose of this study is to present the profile of the MOOC course participants. <strong>Methods:</strong> Secondary data were obtained from Federal Council of Dentistry, the National Registry of Health Facilities, the National Institute for Educational Studies and Research Anísio Teixeira and the Registry of Higher Education Institutions and Courses (e-MEC). Data of the MOOC course were collected in the Arouca Platform. <strong>Results</strong>: Dentists in Brazil are predominantly female. However, in some specialties there are more men than women. The majority of participants on the course were female 73.5% and in the age group of 21-40 years. <strong>Conclusion</strong>: This phenomenon is similar to other countries, and needs to be better investigated in Brazil, so that public policies of continuing education of healthcare professionals by means of distance learning, may take the profession's feminisation into consideration. &nbsp;</p> Deise Garrido Camila Maldonado Huanca Ana Emilia Oliveira Maria Celeste Morita Ana Estela Haddad ##submission.copyrightStatement## 2019-03-09 2019-03-09 7 e6 (1 4) 10.29086/JISfTeH.7.e6