Tele-endoscopic otorhinolaryngological examination: preliminary study of patient satisfaction.

OBJECTIVE: Modern telecommunications and computer technologies enable the delivery of expert consultations and remote diagnoses that previously required transportation of patients or medical specialists. The purpose of this study was to determine whether patients are satisfied with one form of telemedicine consultation. METHODS: A general practitioner was trained to perform endoscopic otorhinolaryngological examinations. After the training period, he examined patients at a local health center in Alta, 250 km from Troms?. Images from the endoscopic examination were transmitted to the otorhinolaryngologist at the University Hospital of Troms? for real-time consultation. Twenty-six patients, on a randomly selected day, were asked to complete a questionnaire after the tele-endoscopic examination. The questionnaire was returned anonymously by 24 of the patients. RESULTS: Although patients interacted with the specialist only via videoconferencing, the results show that most (23/24) were satisfied with this type of consultation, and they reported more advantages than disadvantages. Twenty-one patients indicated that they would accept another tele-endoscopic consultation if they required examination by an otorhinolaryngologist in the future. CONCLUSION: Although the sample is limited, the results justify continued investigation of this and other types of telemedicine consultations.     

Patient satisfaction with telemedicine consultation in primary care: comparison of ratings of medical and mental health applications.

OBJECTIVE: To assess the viability of telemedicine as a vehicle for offering mental health consultations to primary-care patients. METHODS: Satisfaction ratings from 34 mental health encounters were compared with ratings from a convenience sample of 59 non-mental health encounters on four aspects of satisfaction: self-reported ability to speak freely; probability of further use of telemedicine; perceived experience of telemedicine personnel; and relative preference for a telemedicine visit compared with a face-to-face visit. The study was conducted in the context of the Telemedicine Program at the University of California, Davis. RESULTS: No significant differences in satisfaction were found between mental health and non-mental health encounter groups for any of the four aspects of satisfaction. CONCLUSIONS: Ratings from patients receiving mental health consultation using telemedicine yielded levels of satisfaction similar to those found in telemedicine consultations in non-mental health medical areas. The results support telemedicine as a means to extend mental health consultation to rural primary-care patients.     

Role of a Dentist in Comprehensive Management of a Comatose Patient with Post Traumatic Head Injury and Neuropathological Chewing

Injury of the head and neck region can result in substantial morbidity. Comprehensive management of such patients requires team work of several specialties, including dentists. A young female patient with extensive loss of cranium and associated pathological chewing was referred to the dental department. The lost cranium was replaced by a custom-made, hand-fabricated cranioplast. Trauma due to pathological mastication was reduced by usage of a custom-made mouthguard. Favorable results were seen in the appearance of the patient and after insertion of the mouthguard as evidenced in good healing response. The intricate role of a dental specialist in the team to manage a patient with post traumatic head injury has been highlighted. The take away message is to make the surgical fraternity aware of the scope of dentistry in the comprehensive management of patients requiring special care.     

A randomised controlled trial of joint consultations with general practitioners and cardiologists in primary care.

BACKGROUND: Joint consultation sessions of a small group of general practitioners (GPs) and a specialist in orthopaedics proved to be an effective way of decreasing the referral rate of orthopaedic patients. Cardiac complaints comprise an important category of health problems with high referral rates. AIMS: To study the effects of joint consultation on the quality of care and referrals for patients with cardiac complaints. DESIGN OF STUDY: Randomised controlled trial. SETTING: Forty-nine GPs participated in 16 consultation groups, each with one of 13 cardiologists, in monthly joint consultations over a period of about 18 months. METHOD: The GPs selected patients about whom they were uncertain, and those needing urgent referral were excluded. Patients were randomly assigned to joint consultation or to usual care. After a follow-up period all patients had a joint consultation for outcome assessment. Referral data were provided by two regional health insurance companies and questionnaires were given to the patients, GPs, and cardiologists to gauge their opinion of the trial. RESULTS: One hundred and forty-eight patients in the intervention group and 158 patients in the control group fulfilled the whole protocol. The quality of care was similar in both groups. In the intervention group, 34% of the patients were referred, compared with 55% in the control group (P = 0.001), and fewer patients underwent further diagnostic procedures (7% compared with 16%, P = 0.013). Referrals to cardiology as a proportion of all referrals decreased in the practices of the participating GPs, compared with their reference districts (P = 0.024). CONCLUSION: Joint consultation is an effective method that provides a quality of care that at least equals usual care and that contributes to a better selection of patients who need specialist care.     

Pulmonary telemedicine--a model to access the subspecialist services in underserved rural areas

Background

To describe the use of videoconference telemedicine for providing outpatient pulmonary consultation to a remote, underserved clinic site.

Methods

Analysis of data from the Milwaukee Veteran Affairs Medical Center (VAMC) pulmonary telemedicine clinic. Pulmonary physicians at the Milwaukee VAMC provide outpatient consultations with the use of videoconference technology to patients located at the Iron Mountain VAMC in Iron Mountain, MI (346 km or 215 miles from Milwaukee). Data on demographics, referral patterns, access to care, consultation process, and outcomes are presented.

Results

A total of 314 patients (684 visits) received telemedicine consultations between January 1, 1998 and December 31, 2004. Common reasons for referral were abnormal radiology (38%), chronic obstructive pulmonary disease (COPD) (26%), and dyspnea (13%). Physical exam was performed by the telemedicine registered nurse or respiratory therapists in 90% of visits. Common diagnoses were COPD (29%), benign pulmonary nodule (11%), bronchial asthma (6%), and lung cancer (6%). Telemedicine consultation resulted in a change in management for 41% of patients. Only 8% of patients required an in-person clinic visit at Milwaukee VAMC following a telemedicine visit. Telemedicine saved patients 473,340 km or 294,120 miles of travel over the study period.

Conclusions

The provision of subspecialty services using telemedicine to a remote underserved rural population provides improved patient access to subspecialty care. Physicians are able to rely on medical history and radiology to manage patients across a broad spectrum of complex pulmonary conditions with the assistance of a non-physician health care provider at the remote site.     

An integral care telemedicine system for HIV/AIDS patients

OBJECTIVE: In this article we will describe a new approach to improve the quality of care of chronic HIV/AIDS patients, combining the integral care approach with a telemedicine system. METHODS: Following the integral care approach, we included the patient in a multidisciplinary care team, covering the whole process of care with a telemedicine system that allows the patient to improve his/her self-care and to be remotely followed-up by the healthcare professionals. RESULTS: This challenge has been met by the creation of the "VIHrtual Hospital" project. Its main goal is the definition, development, clinical routine installation and evaluation of a telemedicine service that complements standard care with a telecare follow-up for treating stable HIV infected patients, in a chronic stage of their disease, and study if that improves the quality of assistance and the expense per patient compared to the conventional control (without telemedicine service) that patients usually have. Although the study is not yet finished, in the discussion the main benefits and drawbacks of this telemedicine system are described. CONCLUSIONS: The main conclusion of the article is that a new home telecare model for chronic HIV/AIDS patients has been created and has been implemented through the "VIHrtual Hospital" in the Clinic Hospital in Barcelona (Spain). The architecture of this web-based system fulfills the demanding security and integration requirements of the IT department of the hospital. An easy-to-use graphical interface for both patients and professionals has also been developed. The low costs of the system allow us to cover a wide range of patients and promising results are being obtained regarding the use of telemedicine systems for improving the follow-up care of chronic HIV/AIDS patients and for creating a new care model for this disease.     

Ambulatory oral surgery: 1-year experience with 11?680 patients from Zagreb district,Croatia

Aim

To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia.

Methods

Sociodemographic and clinical data on 11 680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age.

Results

The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (P < 0.001) and intraoral incisions (P < 0.001) were performed among male patients, whereas significantly more alveolectomies and apicoectomies were performed among female patients (P < 0.001). A greater prevalence of periodontal disease was found in patients residing in Zagreb than in patients residing in rural areas.

Conclusion

The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients’ awareness of the importance of oral health.Oral health is essential to general health and well-being, and tooth loss is an important indicator of oral health status. Reduction of tooth loss is one of the targets for achieving global goals for oral health (1).Croatian dental health system, along with general health care, is regulated by the Health Care Law and divided into three levels of care: primary, secondary, and tertiary. Primary dental health care is performed by doctors of dental medicine with the help of dental assistants; it includes prevention, detection, and treatment of oral diseases, as well as rehabilitation of the masticatory system. Secondary or specialist outpatient dental health care treats patients in need of expert opinion, advice, or treatment. Tertiary care provides care only for patients requiring hospitalization.In order for the system to work properly and without overload, levels of health care must cooperate. Most patients with oral needs visit a primary health care system dentist, so further education of these professionals is essential for a better system of specialist referrals and a more efficient health care system. In Croatia, there are no data about the types and frequencies of oral surgery treatment so the aim of this study was to gain insight into the types and frequencies of diagnoses and ambulatory surgical treatments at the Department of Oral Surgery at University Hospital Dubrava in Zagreb, Croatia. We also investigated whether there was a significant difference in clinical diagnoses and procedures according to sex, age, and place of residence.     

Telemedicine to Iowa's correctional facilities: initial clinical experience and assessment of program costs.

OBJECTIVE: To evaluate the costs and benefits of a prison telemedicine program for the institutions involved and to assess early provider satisfaction. MATERIALS AND METHODS: A survey of primary care and consulting providers from four prisons and an academic tertiary care facility in Iowa was conducted during the first year of telemedicine service linked with the state's correctional facilities, from March, 1997 to February, 1998. Data were evaluated from 247 completed telemedicine encounters. Cost estimates were made for (1) 1997 cost data for the 4,396 Iowa prisoners who were transported to The University of Iowa Hospitals and Clinics (UIHC) for their health care, and (2) the equipment, circuitry, and personnel costs necessary on both ends of the network to provide comparable telemedicine service to remote patients and providers. A formula for estimating the cost of implementing a telemedicine service is presented. It includes a projection for determining at what point the cost of the telemedicine visit approaches the average cost of an on-site visit (breakeven point). There was also a brief survey administered to presenting and consulting physicians to determine their overall satisfaction with the telemedicine system for diagnosis, treatment planning, and follow-up. RESULTS: The average cost to the prisons for an on-site inmate visit to the University of Iowa Hospitals and Clinics (UIHC) was $115 during our study period, from March 1997 to February 1998. Using a formula that specifies a number of fixed and variable costs for implementing telemedicine, we were able to determine that the breakeven point for Iowa's correctional facilities would require 275 teleconsultations per year, per site (total of 1,575 consultations a year). Given the higher equipment investment at the UIHC hub, the breakeven point would be around 2,000 teleconsultations annually. Cost studies did not include medical care, which is assumed to be relatively comparable for both on-site and telemedicine interactions. Overall, referring physicians expressed a higher rate of satisfaction with telemedicine than specialists (4.19 to 3.45, respectively, on a scale of 1 to 5 - 5 representing the highest ranking). Both consulting and referring physicians ranked the quality of transmission the highest among all questions regarding satisfaction with the telemedicine system. CONCLUSIONS: No one should anticipate instantaneous cost-effectiveness with telemedicine. However, with careful planning, implementing a telemedicine program can be "cost-acceptable" initially. Telemedicine ultimately becomes cost-effective as the volume of teleconsults increases.     

Dismantling discrimination in dental education.

In existence for more than 100 years, the schools of medicine and dentistry of Howard University and Meharry Medical College have been responsible for training the majority of African-American physicians and dentists. The dissolution of the doctrine of "separate but equal" has resulted in the acceptance of larger numbers of African-American health professionals to America''s medical and dental educational institutions. The University of Tennessee School of Dentistry is a primary example of a formerly segregated institution that has changed its policies and presently possesses a respectable number of African-American dental alumni. In a recent acknowledgment of this fact on Alumni Day, black graduates of this University celebrated and sponsored a program to increase the number of African-American matriculants at the school.     

Elements of morphology: Standard terminology for the teeth and classifying genetic dental disorders

Dental anomalies occur frequently in a number of genetic disorders and act as major signs in diagnosing these disorders. We present definitions of the most common dental signs and propose a classification usable as a diagnostic tool by dentists, clinical geneticists, and other health care providers. The definitions are part of the series Elements of Morphology and have been established after careful discussions within an international group of experienced dentists and geneticists. The classification system was elaborated in the French collaborative network “TÊTECOU” and the affiliated O‐Rares reference/competence centers. The classification includes isolated and syndromic disorders with oral and dental anomalies, to which causative genes and main extraoral signs and symptoms are added. A systematic literature analysis yielded 408 entities of which a causal gene has been identified in 79%. We classified dental disorders in eight groups: dental agenesis, supernumerary teeth, dental size and/or shape, enamel, dentin, dental eruption, periodontal and gingival, and tumor‐like anomalies. We aim the classification to act as a shared reference for clinical and epidemiological studies. We welcome critical evaluations of the definitions and classification and will regularly update the classification for newly recognized conditions.     

Public knowledge, perception, and expressed choice of telemedicine in rural West Virginia.

OBJECTIVE: It is doubtful that any new health care delivery system that requires as much adjustment as telemedicine does will be sustained if its users do not fully support it. We sought to determine the familiarity with, perceptions of, and attitudes toward telemedicine among rural adults in West Virginia. METHODS: Data were collected in a statewide telephone survey of 461 non-institutionalized rural adults. The survey contained questions about familiarity with telemedicine, perceptions about its attributes and benefits, and willingness to use it for routine, specialty, and emergency care. Responses were examined in relation to the subjects' age, sex, socioeconomic status, access to care, and insurance coverage. RESULTS: Despite mass media coverage of the subject, only one third of the respondents had heard of telemedicine. Nearly two thirds thought patients would find it less satisfactory than seeing a physician in person. Male subjects, younger subjects, and those with higher incomes were more likely to think telemedicine would be as satisfactory as a face-to-face meeting. There was a general consensus on the benefits of telemedicine, such as greater convenience and easier contact with specialists. For chronic conditions, 47% of the respondents would use telemedicine if no physician was available locally, whereas 27% would go out of town to see another physician in person, and 25% would wait for their own physician. For emergency care, these figures were 41%, 58%, and 0. Three fourths of the respondents were somewhat or very willing to use telemedicine for routine or specialist care. CONCLUSION: More work needs to be done to demonstrate the efficacy of telemedicine and disseminate this knowledge to the public.     

The Spacebridge to Russia Project: internet-based telemedicine.

The National Aeronautics and Space Administration (NASA) has been a pioneer in telemedicine since the beginning of the human spaceflight program in the early 1960s. With the rapid evolution in computer technology and equally rapid development of computer networks, NASA and the Department of Surgery in Yale University's School of Medicine created a telemedicine testbed with the Russia Space Agency, the Spacebridge to Russia Project, using multimedia computers connected via the Internet. Clinical consultations were evaluated in a store-and-forward mode using a variety of electronic media, packaged as digital files, and transmitted using Internet and World Wide Web tools. These systems allow real-time Internet video teleconferencing between remotely located users over computer systems. This report describes the project and the evaluation methods utilized for monitoring effectiveness of the communications. The Spacebridge to Russia Project is a testbed for Internet-based telemedicine. The Internet and current computer technologies (hardware and software) make telemedicine readily accessible and affordable for most health care providers. Internet-based telemedicine is a communication tool that should become integral to global health care.     

Evaluation of a telemedicine link between Darwin and Adelaide to facilitate cancer management.

The videoconferencing link between the Royal Adelaide Hospital Cancer Centre in South Australia and the Royal Darwin Hospital in the Northern Territory was established to allow Darwin clinicians to discuss cases in multidisciplinary oncology meetings at the tertiary referral center. This was evaluated by questionnaires distributed to the 20 health professionals involved and a group of 8 patients with breast cancer whose case histories had been discussed via videoconferencing. All clinicians found the telemedicine link to be either useful or very useful in at least one aspect of their practice. The major benefit was cited as enabling remote area clinicians to participate in multidisciplinary cancer meetings. Three of the 5 remote clinicians who practiced solely in the Northern Territory found that the telemedicine consultation increased their workload, while only 2 of 13 clinicians who practiced solely in South Australia reported an increase over their normal activities, the others reporting no difference. Benefits identified included better support of isolated clinicians, decreased travel, and enhanced education and peer review. Perceived difficulties were technical problems, the impersonal nature of the interaction, inability to examine the remote patient and lack of reimbursement for the consultation. Seven of the eight patients surveyed were satisfied or very satisfied with the telemedicine consultation. Four patients wished to have access to videotape of the multidisciplinary meeting. Of those requiring travel for treatment, all believed that the telemedicine consultation influenced their care and shortened their time away from home.     

Exploring factors associated with the uneven utilization of telemedicine in Norway: a mixed methods study

Background

Norway has a long history of using telemedicine, especially for geographical reasons. Despite the availability of promising telemedicine applications and the implementation of national initiatives and policies, the sustainability and scaling-up of telemedicine in the health system is still far from accomplished. The main objective of this study was to explore and identify the multi-level (micro, meso and macro) factors affecting telemedicine utilization in Norway.

Methods

We used a mixed methods approach. Data from a national registry were collected to analyze the use of outpatient visits and telemedicine contacts in Norway from 2009 to 2015. Interviews with key stakeholders at national, regional and local level helped complete and contextualize the data analysis and explore the main issues affecting the use of telemedicine by health authorities and hospitals. Relevant national documents were also used to support, contradict, contextualize or clarify information and data.

Results

Telemedicine use in Norway from 2009 to 2015 remained very low, not exceeding 0.5% of total outpatient activity at regional level and 0.1% at national level. All four regions used telemedicine. Of the 29 hospitals, 24 used it at least once over the 7-year period. Telemedicine was not used regularly everywhere, with some hospitals using it sporadically. Telemedicine was mostly used in selected specialties, including rehabilitation, neurosurgery, skin and venereal diseases. Three major themes affecting implementation and utilization of telemedicine in Norway emerged: (i) governance and strategy; (ii) organizational and professional dimensions; (iii) economic and financial dimensions. For each theme, a number of factors and challenges faced at different health care levels were identified.

Conclusions

This study allowed shedding light on multi-level and interdependent factors affecting utilization of telemedicine in Norway. The identification of the main implementation and utilization challenges might support decision makers and practitioners in the successful scaling-up of telemedicine. This work provides a knowledge base useful to other countries which intend to implement telemedicine or other digital health services into their healthcare systems.

     

Patient satisfaction with telemedicine in home health services for the elderly

In a pilot study of telemedicine in home health services (HHS) for elderly patients, we implemented and evaluated a telemedicine system with a 33-kbs narrow-band approach to determine its effectiveness in providing quality services. Fifty patients were selected for the study. We found that telemedicine was effective in terms of reducing the number of clinic visits and achieving patient satisfaction. The average number of clinic visits per month was significantly decreased from 0.64 to 0.42 (p < 0.05) after the use of telemedicine. 72% of patients were satisfied with telemedicine, but only patient location showed a significant difference for patient satisfaction (p < 0.05). Patients in their homes (82%) were more satisfied than patients in nursing homes (50%). Of four types of services provided, medical consultation (100%) was the most highly satisfactory service with telemedicine, followed by physical therapy (83.3%). Although the satisfaction scores did not indicate a significant difference in the system characteristics, the quality of verbal communication appeared to be a more important factor in influencing patient satisfaction than set-up time or quality of image. A computer-based patient record was also developed to view a patient summary and to document encounters at the patient's home. Since the system is a low-cost approach that is easy to interface with a notebook computer, it can support various other HHSs.     

The relative cost of outpatient telemedicine services.

OBJECTIVE: This study compares the costs of offering outpatient care to primarily orthopedic and dermatology patients via live, interactive telemedicine to the estimated costs of direct face-to-face care for the same patients. MATERIALS AND METHODS: A simple, yet detailed methodology was used to evaluate the cost of adding telemedicine to a health care delivery system, using a "hub-and-spoke" model located in Minnesota. The costs and cost savings of telemedicine were evaluated from the perspectives of patients, providers, insurers, employers, and society as a whole. Sensitivity analysis was used to investigate the impact of various factors on the model. RESULTS: The variable cost of a telemedicine referral was $144, versus an estimated face-to-face referral cost of $183. Reductions in patient travel costs and in lost employee productivity were the principal benefits of the system. The break-even point, where total costs equal total cost savings, equalled 1,449 consultations annually. Sensitivity analyses indicated that the breakeven point varies from a low of 152 telemedicine consultations for a "best case" scenario to no possible breakeven point for a "worst case" scenario. CONCLUSIONS: At the system's current level of 300 consultations per year, the telemedicine system is estimated to add $45,000 to society's costs of providing medical care for these patients. The additional cost is primarily due to personnel expenses and an increase in the volume of specialty care. Patients see specialists more often due to improved access to care and lower transportation costs. Providers bear the cost while patients and employers enjoy substantial savings.     

Oral health care in the 21st century: implications for dental and medical education.

The past decade has been turbulent for dental education, marked by debate about the future directions of the curriculum and the profession itself. The bulk of the dental school curriculum is still devoted to tooth restoration or replacement techniques, although the need for these procedures has declined. Some dental educators now advocate an oral physician model as the desired direction for the profession, with expanded training in systemic disease pathophysiology and a practice scope that extends beyond exclusive focus on the teeth and supporting structures. Proponents of this model contend for curriculum time with faculty who desire to maintain a technical focus. The outcome of this curricular tug-of-war has implications for medical education, because many oral health problems now fall into the overlapping educational and patient care environments of physicians, dentists, and other health care providers. Will physicians perceive the new dentist as an encroachment on territory or as a resource to enhance patient care? Within dentistry, the traditions of tooth restoration and prosthodontics shape the profession's culture. Are dental educators ready to reconfigure a curriculum that is deeply intertwined with the professional identity of 150,000 U.S. dentists practicing today? To stimulate thinking about these issues, the authors analyze the responses of dental education to changes in the public's oral health and to calls for curricular reform, propose strategies for modifying the way dentists are prepared for their professional responsibilities, and explore the sociology of change in academic institutions, because elements of dental education targeted for reform are revered components of school culture.     

How well do general practitioners manage dyspepsia?

This paper reports the incidence of dyspepsia in general practice, the characteristics of patients, the types of complaints presented and the management of the dyspeptic patient by general practitioners. Fourteen general practitioners in the Maastricht region of the Netherlands studied 318 consecutive patients presenting with dyspepsia. Two questionnaires were used: one filled in by the patient (82% response), the other by the physician (100% response). The diagnostic conclusions which were established after three months of follow-up were compared with the diagnostic hypotheses at the initial consultation. The annual consultation rate for dyspepsia was calculated as 27 per 1000 registered subjects. One third of the patients had an earlier history of dyspepsia. Almost all patients (95%) complained of pain, and 37% had been suffering from pain for more than three months before consulting the general practitioner. The general practitioner prescribed medication in 70% of cases; less commonly the patient was referred for x-ray (14%), endoscopy (13%) or to a specialist (11%). A higher age was associated with a higher probability of referral, and with the finding of organic disease. A history of ulcer disease was strongly correlated with the diagnosis of an ulcer during the current episode. The overall concordance between the general practitioner's diagnostic hypothesis at the initial consultation and the diagnostic conclusion after three months of follow-up was 78%; it was highest when minor pathology was suspected. We conclude that dyspepsia is managed well in general practice and is only rarely associated with major lesions. Dyspeptic patients referred to a specialist therefore constitute a highly selected population.     

Building the capacity to build capacity in e-health in sub-Saharan Africa: the KwaZulu-Natal experience

BACKGROUND: Sub-Saharan Africa has a disproportionate burden of disease and an extreme shortage of health workers. There are already too few doctors to train doctors in specialities and sub-specialties. E-health is seen as a possible solution through distance education, telemedicine, and computerized health information systems but there are few people trained in e-health. We describe 12 years of experience at the University of KwaZulu-Natal (UKZ-N) in education and training in postgraduate medical disciplines, medical informatics, and telemedicine. MEDICAL EDUCATION: Videoconferencing of seminars and grand rounds to regional training hospitals commenced in 2001 and has grown to 40 h of interactive conferencing taking place weekly during academic terms involving over 33,000 participants in 2010. Videoconferenced sessions are directly recorded to DVD and DVDs are sent to other medical schools in Africa that do not have the infrastructure to directly connect. E-HEALTH EDUCATION: Students and academic staff were initially sent to the United States for training in medical informatics and workshops were held in South Africa for people from sub-Saharan Africa. This led to the development of postgraduate academic programs in medical informatics and telemedicine at UKZ-N. African students were then brought to UKZ-N for training. The model was changed from UKZ-N to students and staff based at their home universities with the aim of building capacity in the staff at partner institutions so that they can in time offer their own e-health academic programs. CONCLUSIONS: The need for capacity development in all aspects of e-health in sub-Saharan Africa is great and innovative solutions are required.