Dissertations / Theses on the topic 'Telecommunication in medicine South Australia'

The World Health Organization has recommended Telemedicine to improve health care in developing countries. The objective of this study was to produce Critical Success Factors that will investigate and identify factors that influence the acceptance and continued use of Telemedicine in the Eastern Cape Department of Health, and to suggest ways to sustain this technology from initial adoption (the pilot programme) to full adoption. Sub questions investigated which other facilitating factors, such as management support or previous Information Technology exposure must be present in order for the technology to be adopted successfully. The study made use of a questionnaire to investigate the user acceptance and behaviour of health care workers. A return rate of 76% was achieved. The data was analysed making use of Statistical Package for the Social Sciences (SPSS), specifically the Chi Square test. From these results Critical Success Factors where then formulated to address the problems identified. The Critical Success Factors that were identified include: Implement and disseminate best practice within a legislative framework; Find a champion; Change management strategies; Training; Sustainable finance; Technical issues and Project management principles If these CSFs are addressed before and during the implementation of Telemedicine it will increase the acceptance and use of the technology among health care workers. Critical Success Factors for User Acceptance of Telemedicine in South Africa.

Most rural areas of developing countries are faced with problems like shortage of doctors in hospitals, illiteracy and poor power supply. Because of these issues, Information and Communication Technology (ICT) is often sees as a useful solution for these areas. Unfortunately, the social environment is often ignored. This leads to inappropriate systems being developed for these areas. The aims of this thesis were firstly, to learn how a communication system can be built for a rural telehealth environment in a developing country, secondly to learn how users can be supported to use such a system.

Thesis (DTech (Electrical engineering))--Cape Peninsula University of Technology, Cape Town, 2007
Telemedicine has been identified as a tool to distnllUte medical expertise to medically underserved rural community. However, due to the underdeveloped or non-existent telecommunication infrastructure, which is needed as the platform for telemedicine, the full benefits of telemedicine are yet to be realized in most parts of South Africa and Africa as a whole. This study aims to explore ways on how to provide lP-based lCI system that can be used as a communication platform for telemedicine in rural areas. In order to emulate the onsite face-to-face consultation experience, the rural telemedicine system must be able to provide quality video transmission. Quality video is also important in order for the physician at the distant end to be able to make correct diagnosis. Hence the main focus of this study is on ways ofproviding quality video over lP-based multiservice network. A conceptual model of a rural area network that can be used for rural telemedicine has been deVeloped, and different access technologies that can be used for rural areas are presented. Techniques for compesating IP best effort datagram delivery are provided. Factors that can affect the quality of video transmission on an lP-based packet network are identified, and a holistic approach to mitigate them is proposed. That includes adopting coding techniques that will provide coding efficiency, high quality video that is consistent at high and low bit rates, resilience to transmission errors, scalability, and network friendliness, which will result in perceived quality improvement, highcompression efficiency, and possibility of transportation over different networks. Secondly, it also includes mechanisms to compensate for packet networks idiosyncrasy, especially JP best-effort debilities, in order to meet the latency and jitter requirements of real-time video traffic. For video coding, H.264 is proposed as it meets most of the encoding requirements listed above, and for prioritising and protecting.video traffic from JP network's best-effort debilities a combination of differential services (DiflServ) and multi-protocol label switching (MPLS) have been adopted, where DiflServ is used for traffic classification and MPLS is used for traffic engineering and fast-rerouting in the event of route failure. To verify and validate the proposed solutions, modelling and simulation has been used, where the Network Simulator (NS-2.93) has been used to simulate network functions, and PSNR, VQM score and double stimulus impairment scale (DSIS) have been used for evaluating video quality.

The major socio-economic development challenges facing most African countries include economic diversification, poverty, unemployment, diseases and the unsustainable use of natural resources. The challenge of quality healthcare provisioning is compounded by the HIV/AIDS pandemic in Sub Saharan Africa. However, there is a great potential in using electronic healthcare (e-health) as one of the supportive systems within the healthcare sector to address these pressing challenges facing healthcare systems in developing countries, including solving inequalities in healthcare delivery between rural and urban hospitals/clinics. The purpose of this study was to compile a Provincial E-health Framework (PEHF) based on the feedback from electronic healthcare readiness assessments conducted in selected rural and urban hospitals/clinics in the North West Province in South Africa. The e-healthcare readiness assessment was conducted in the light of effective use of ICT in patient healthcare record system, consultation among healthcare professionals, prescription of medication, referral of patients and training of healthcare professionals in ICT usage. The study was divided into two phases which were phases 1 and 2 and a qualitative design supported by a case study approach was used. Data were collected using different techniques to enhance triangulation of data. The techniques included group interviews, qualitative questionnaires, photographs, document analysis and expert opinions. The outcome of the assessment led to the compilation of the PEHF which was based on Service Oriented Architecture (SOA). SOA was chosen to integrate the hospitals/clinics‟ ICT infrastructure yet allowing each hospital/clinic the autonomy to control its own ICT environment. To assist hospitals/clinics integrate their ICT resources, this research study proposed an Infrastructure Network Architecture which clustered hospitals/clinics to share common ICT infrastructure instead of duplicating these resources. Furthermore, processes of the e-health services (e-patient health IV record system, e-consultation system, e-prescription system, e-referral system and e-training system) were provided to assist in the implementation of the PEHF. Finally, a set of guidelines were provided by the research study to aid the implementation of the PEHF.

Rural communities have limited access to health information which is made available on the internet. This is due to poor infrastructure (i.e., lack of clinics or Internet access) and that gives them problems in accessing information within the domain of health. The availability of Information and Communication Technologies (ICTs) in a rural community can provide the community with a number of beneficial solutions to their problems as they maximize the potential of knowledge sharing and delivery. This research seeks to make use of ICTs deployed in the community of Dwesa, in order to contribute to improving the health standards of the community. It seeks to accomplish this by carrying out an investigation and literature review with the aim of understanding health knowledge sharing dynamics in the context of marginalized communities. The knowledge acquired will then be used in the development and implementation of a semantic web-based e-Health portal as part of the Siyakhula Living Lab (SLL) project. This portal will share and deliver western medical knowledge, traditional knowledge and indigenous knowledge. This research seeks to make use of a combination of Free and/or Open Sources Software in developing the portal to make it affordable to the community.

Australia and many other developed communities are ageing rapidly, placing a strain on the delivery of health services. This thesis examines the use of innovative health services management coupled with information and communication technology (ICT) to more efficiently deliver services to disabled older people in the hospital, community and residential care. The hypothesis explored is that ICT can provide clinical services to older people in poorly serviced communities and groups, thus extending the influence and capabilities of specialist health care professionals. The relevance of these studies is predominantly for those people who live outside the metropolitan regions, particularly in remote and rural communities, and also for those frail older people, who because of disability, are unable to travel to specialist health services. There are a series of studies presented in this thesis which have all been published. They have demonstrated that in a community and rural setting, ICT use in the assessment and management of geriatric syndromes such as dementia is valid and practical. This included the validation of commonly used assessment tools via Telehealth. A Telehealth protocol for assessment of Alzheimer's Dementia (AD) was developed and published. The use of ICT to link health services clinical and administrative data for determining stroke outcomes and disability has been evaluated and a resource utilization prediction model developed. Finally, in residential care a survey and a qualitative study of poor uptake of ICT services in hostels and nursing homes revealed insights into ICT perception by the older people in care facilities and their professional staff. The implications and future development of these studies have been discussed, especially barriers to increased uptake of ICT, cost comparisons and the potential of future technologies such as video conferencing mobile phones.

Thesis (MScEng)-- Stellenbosch University, 2013.
ENGLISH ABSTRACT: South Africa has a great number of patients and not enough medical expertise to attend to their patient needs. The South African Department of Health (DoH) has recognised the potential benefit of the Picture Archiving and Communication System (PACS) to address the health needs of rural patients who do not have access to specialised medical care. PACS allows specialist remote access to patient information to assist the diagnosis and treatment process remotely. South African healthcare institutions have been implementing PACS for over a decade, in an attempt to address the health needs of rural patients that do not have access to specialised medical care. Despite numerous deployment attempts, and the DoH’s support for PACS, the system is not operating successfully in South Africa. PACS was chosen due to its proven success as an appropriate technical system in most international hospitals of first and third- world countries (van Wetering, 2008) (Horri, 2010). However, specifications, guidelines and best practice operational methods for the appropriate PACS technical structure are lacking in South African literature and in governmental strategies. Additionally, there are no guidelines for implementation or support for hospital decision makers to manage the system and enterprise change. The purpose of this thesis is to (a) define a PACS technical and operational structure suited for the South African public healthcare environment and, (b) to develop guidelines for implementation and optimisation of PACS for managing the system and the enterprise change and progressively reach the defined structure. A combination of literature research, field observations and focus group discussions led to the understanding of the current (“As-Is”) PACS healthcare delivery system in South Africa and its barriers. Three types of PACS structures were found to be currently available: a DICOM-only image management system; a vendor supplied PACS; and a super-PACS. It was found that currently very few PACS systems in South Africa are operational and integrated with other healthcare institutions. This was due to a combination of factors: a) the complex, long chain of interdependent process steps and domains; b) vendor imposed limitations and propriety data formats; in combination with c) a lack of governing standards to ensure integration of digital PACS systems within the healthcare delivery environment; and lastly d) key decision makers lack the expert knowledge necessary to make informed decisions to deploy and manage PACS optimally. Further research led to establishing the (“To-Be”) PACS technical and operational structure suited for the South African public healthcare environment. Research has shown that the suited PACS technical and operational structure is a hospital-owned PACS system, free from vendor-imposed limits. The system consists of two databases, one with patient information and the other with patient images. The two databases are integrated by a hospital-owned server, which accesses the separate data files by means of patient identity keys. The requirements for the PACS implementation and optimisation guidelines for managing the system and the enterprise change to progressively reach the defined structure were developed. Different Enterprise Architectural Frameworks, as improvement and optimisation guidelines, were considered and compared in accordance with the requirements established. A maturity model (MM) was deemed as the appropriate framework to offer guidelines for managing PACS implementation and optimisation in the public medical sector of South Africa. After establishing that the available MMs were not sufficient in process or technical system detail, a new MM was developed for the deployment and maturation of PACS. The study was validated by means of usability study, user acceptance and goal checking, through focus group discussion and expert review. Users found the model to be a suitable deployment and optimisation guide, as well as a strategic planning tool. Verification was achieved by means of requirement analysis and consistency checking through the focus group discussions. It was found that it is needed to define a PACS technical and operational structure is suited for the South African public healthcare environment and that the guidelines for implementation and optimisation of PACS for managing the system and the enterprise needs to change to reach the defined structure functional. Implementing the use of PACS MM to reach the defined structure in South Africa will assist in improving healthcare delivery in South Africa and improving PACS system operation.
AFRIKAANSE OPSOMMING: Suid-Afrika het 'n groot aantal pasiënte en nie genoeg mediese kundiges om aan hul pasiënt behoeftes te voorsien nie. Die Suid-Afrikaanse Departement van Gesondheid (DvG) erken die potensiële voordeel van ‘n Foto Argief en Kommunikasie Stelsel (PACS) om die gesondheidsbehoeftes van alle Suid-Afrikaners aan te spreek – tot die landelike pasiënte wat nie toegang tot gespesialiseerde mediese sorg het nie. PACS laat spesialiste toe om toegang te kry tot afgeleë pasiënt inligting, en daardeur fasiliteer dit die diagnose- en behandelingsproses. Suid-Afrikaanse gesondheidsorginstellings poog al vir meer as ‘n dekade om PACS te implementeer, om daardeur die gesondheidsbehoeftes van landelike pasiënte wat nie toegang tot gespesialiseerde mediese sorg het nie, aan te spreek. Ten spyte van talle ontplooiings pogings, en die DvG se steun vir PACS, is die stelsel steeds nie suksesvol in Suid-Afrika nie. PACS is gekies as ‘n oplossing, as gevolg van die sisteem se bewese sukses as 'n geskikte tegniese stelsel in meeste internasionale hospitale in eerste en derde wêreld lande (van Wetering, 2008) (Horri, 2010). Suid-Afrikaanse regering strategie en literatuur het egter ‘n gebrek aan spesifikasies, riglyne en beste- praktyk operasionele metodes vir die toepaslike PACS tegniese struktuur. Benewens is daar geen riglyne vir die implementering en ondersteuning van die stelsel en die onderneming se verandering vir hospitaal besluitnemers nie. Die doel van hierdie tesis is om (a) 'n PACS tegniese en operasionele struktuur, geskik vir die Suid-Afrikaanse openbare gesondheidsorg omgewing te definieer, en (b) riglyne vir die implementering en afronding van PACS vir die bestuur van die stelsel en die onderneming se verandering teen doel om progressief die gedefinieerde struktuur te bereik. 'n Kombinasie van literatuur navorsing, veldwaarnemings en fokusgroepbesprekings het gelei tot die begrip van die huidige ("as- is") PACS gesondheidsorg proses in Suid-Afrika en die hindernisse daarvan. Drie tipes PACS strukture is tans beskikbaar in SA: 'n DICOM (net-mediese- beelde) beheer stelsel, 'n verkoper verskafde PACS, en 'n super-PACS. Deur uitgebreide navorsing is daar gevind dat baie min PACS stelsels in Suid-Afrika tans operasioneel en geïntegreer is met ander gesondheidsorg instellings. Dit was te danke aan 'n kombinasie van faktore: a) die kompleks, lang ketting van interafhanklike proses stappe en gebiede; b) ondernemer opgelê beperkings en ordentlikheid data formate; in kombinasie met c) 'n gebrek aan beheer standaarde integrasie van digitale PACS stelsels om te verseker binne die lewering van gesondheidsorg-omgewing, en laastens d) sleutel besluitnemers nie die deskundige kennis wat nodig is om ingeligte besluite te sit en te bestuur PACS optimaal te benut. Verdere navorsing het gelei tot die vestigting van die geskikde("to-be") PACS tegniese en operasionele struktuur, vir die Suid-Afrikaanse openbare gesondheidsorg omgewing. Die geskik PACS tegniese en operasionele struktuur bestaan uit ‘n hospitaal-besitde PACS stelsel, vry van ondernemer-opgelegde grense. Die stelsel bestaan uit twee databasisse, een met 'n pasiënt inligting en die ander met dei pasiënte se mediese beelde. Die twee databasisse geïntegreer deur 'n hospitaal-besitde-rekenaarbediener, wat toegang tot die afsonderlike data lêers het deur middel van die unieke pasiënt nommers. Die vereistes vir die PACS implementering en afrondings riglyne, vir die bestuur van die stelsel en die ondernemings veranderinge, is ontwikkel. Verskillende ondernimings argitektuur raamwerke is oorweeg en vergelyking in terme van hulle vermoe om aan die gesigde vereistes et voldoen. As ‘n resultaat is die volwassenheid model (MM) beskou as die toepaslike raamwerk om riglyne vir die bestuur van PACS implementering en afronding in die openbare mediese sektor van Suid-Afrika te bied. Na die beskikbare MMs geasseseer was en nie voldoende bewys is, was 'n nuwe MM ontwikkel vir die implementeering en afronding van PACS. Die studie was gevalideer deur middel van die bruikbaarheid studie, gebruikers aanvaarding en doelwit asseseering, deur middel van fokusgroep besprekings en kundige oorsig. Gebruikers het gevind dat die model geskikte as implementeerings en afrondings gids, sowel as 'n geskikte strategiese beplanning hulpmiddel is. Verifikasie is bereik deur middel van vereiste-ontleding en konsekwentheid analiseering deur die fokusgroep besprekings en spesifikasie analise. Die PACS tegniese en operasionele struktuur wat definieer was, is geskik vir die Suid-Afrikaanse openbare gesondheidsorg omgewing en dat die riglyne vir die implementering en afronding van PACS funksioneel is . Die implementering en gebruik van die gedefinieerde struktuur deur mideel van die PACS MM in Suid-Afrika, sal help in die verbetering van gesondheidsorg dienslewering en die verbetering van PACS stelsel operasie.

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2016.
The delivery of healthcare services should be of a high standard for everyone. For people in the location of Mantunzeleni this is not the case as there are still challenges that they go through in order to gain access to sufficient healthcare services. The location consists of four villages and the other nine which surround the four, in total this makes thirteen villages that are served by one clinic. These villages are divided by forest, rivers and mountains, people have to cross these and walk long distances to get to the clinic. Gaining access to basic healthcare services in rural areas has never been easy, hence this study seeks to understand the role telehealth could play to help improve the situation. It has been reported in the literature that telehealth has potential to address some of the problems experienced by healthcare service providers located in the rural areas. Research questions were posed to address the problem of limited access to healthcare services of under-served communities in rural areas. The study adopted an interpretive approach to understand how the people using healthcare services in the setting attach meaning to their experiences of the healthcare service. The study therefore seeks to understand how telehealth could improve healthcare service delivery through the participants’ views, perceptions and experiences. The research strategy for this study is a single case study without attempting to generalise the findings. Qualitative data was gathered using unstructured interviews, observations and co-design methods. The current state of telehealth and challenges of healthcare services in rural under-served communities was established through a review of relevant literature. It was important to actively involve the respondents in the research process for them to feel a sense of ownership. Data was analysed using a thematic analysis. The findings revealed the challenges currently hampering the delivery of healthcare in the research setting include poor infrastructure, high cost, the shortage of medical professionals, travelling distance, time management and lack of communication about the services. It was also revealed the role telehealth could play a role to improve access to healthcare and the findings indicate that the nurses feel that extending the healthcare service to include alternative access methods to health information, education and expertise could lead to a sense of appreciation, knowledge gain, dealing with distance problems and improved referrals, cost saving to improve healthcare service delivery.

Thesis (MEng)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Telemedicine is de ned as an electronic exchange of medical information and/or the delivery of clinical health care over a distance, by means of Information and Communication Technology (ICT). South Africa is faced with the problem of providing health care to a population in urban, as well as across vast rural areas. In addition to this, the South African health care system must deal with economical imbalances and a shortage of human resources to provide quality health care. Telemedicine services could provide a solution. Since the introduction of the rst national telemedicine services initiative in the late 1990s, a number of South African telemedicine services have been implemented in the public health care system. The majority of these telemedicine services have been prone to failure and many were prematurely terminated. The circumstances which in uence the failure or success of these services are not unknown. The lack of insight, and the high failure rate of telemedicine services implemented in the South Africa were the reasons for conducting this study. The purpose of the study is to assess telemedicine services implemented in the Western Cape public health care sector. The purpose is also to provide recommendations for improving the current and future telemedicine services in the Western Cape and other provinces. A telemedicine services assessment was conducted on a total of 26 telemedicine services identi ed at 6 health care facilities located in the Western Cape. The assessments were based on the TeleMedicine Services Maturity Model (TMSMM), which was developed speci cally for the purpose of assessing telemedicine services. The TMSMM capability statements were used as a yardstick to assess the maturity of each of the elements of telemedicine services in terms of the three service level groups (micro-,meso- and macro-level) and ve telemedicine domains (man, machine, material, method and money). The assessment process included: (i) the identi cation of telemedicine services at the selected health care facilities; (ii) the gathering of the relevant telemedicine service data by means of structured interviews; (iii) the transformation of the complex ow of information into Data Flow Diagrams (DFDs); (iv) the loading of telemedicine services data into a data warehouse; and (v) the analysis of data by means of On-Line Analytical Processing (OLAP), as well as box-and-whisker plots and statistical correlations. Based on the results of the TMSMM assessment, an electronic questionnaire was developed and administered amongst health care workers throughout the entire Western Cape. The questionnaire con rmed that the ndings from the TMSMM assessment are indeed representative of the entire Western Cape. The assessment of the telemedicine services provides information about the elements which a ect the success or failure of these services. This therefore addresses the initial research problem and ful ls the purpose of the study. These results were used as an input to the analysis of strengths, weaknesses, opportunities and threats (SWOT) of the delivery of telemedicine services in the Western Cape public health sector. For future references and studies, the SWOT analysis provides a point of departure for a strategic telemedicine services framework for a province like the Western Cape.
AFRIKAANSE OPSOMMING: Telegeneeskunde, per de nisie, behels die deel van mediese inligting en/of die lewering van kliniese gesondheidsdienste oor 'n afstand, deur middel van inligting en kommunikasie tegnologie (ICT). Telegeneeskunde dienste is moontlik een van die oplossings vir die lewering van gesondheidsdienste vir 'n bevolking wat versprei is oor 'n groot landelike gebied binne 'n publieke gesondheidsektor wat mense hulpbronne kort om kwaliteit gesondheidsorg te lewer. Die publieke gesondeheidstelsel van Suid Afrika het 'n drie-dubbele las van siektes, ekonomiese wanbalans and 'n tekort aan mediese praktisyns. Sedert die eerste nasionale inisiatief vir telegeneeskunde dienste in die laat 1990s bekend gestel is, is 'n paar telegeneeskunde dienste in die publieke gesondheidsektor van Suid Afrika geïmplementeer. Die meerderheid van hierdie dienste blyk onsuksesvol te wees. The faktore wat die implementeringsukses beïnvloed is nog nie goed nagevors nie. Die doel van hierdie studie is om telegeneeskunde dienste wat in die Wes- Kaap publieke gesondheidsektor geïmplementeer is te ondersoek. Die doel is verdermeer om aanbevelings te maak met die oog op die verbetering van bestaande en toekomstige dienste in die Wes-Kaap asook ander provinsies. Eerstens is 'n telegeneeskunde diens assessering uitgevoer op 'n totaal van 26 dienste 6 fasiliteite. Hierdie assesserings is gebasseer of the Telegeneeskunde Diens Volwassenheidsmodel (TMSMM), wat ontwikkel is spesi ek met die doel om telegeneeskunde dienste te assesseer. Dit word gedoen deur die dienste te meet in terme van drie vlakke (mikro-, meso- en macrovlak) en vyf domeine (man, masjien, materiaal, metode en geld). Die TMSMM vermoeë-stellings word as maatstaaf gebruik. Die assesseringsproses sluit in (i) die identi sering van telegeneeskunde dienste by die aangewese gesondheidsfasiliteite; (ii) die versameling van relevante telegeneeskunde data deur middel van gestruktureerde onderhoude; (iii) die transformasie van komplekse inligtings vloei na data vloeidiagramme (DFDs); (iv) die laai van telegeneeskundige dinste data in 'n databasis; and (v) die analyse van data deur middel van aanlyn analitiese verwerking (OLAP) sowel as boxen- snorbaard gra k en statistiese korrelasies. Gebasseer op die resultate van die TMSMM assesseringsproses, is 'n elektroniese vraelys ontwikkel en geadministreer onder gesondheidswerkers regoor die Wes-Kaap ten einde te bevestig of die gevolgtrekkings van die TMSMM assessering die hele provinsie verteenwoordig. Die assessering van die telegeneeskundige dienste verskaf inligting in terme van die faktore wat die sukses van telegeneeskundie dienste beïnvloed. Sodoende word die aanvanklike navorsingsprobleem aangespreek. Hierdie resultate is toe gebruik as inset vir die analise van die sterk punte, swak punte, geleenthede en bedreigings (SWOT) in die publieke gesondheidsektor van die Wes-Kaap in terme van telegeneeskundige dienste. Hierdie SWOT-analise kan in die toekoms gebruik word as vertrekpunt vir die ontwikkeling van strategiese raamwerk vir die implementering van telegeneeskundige dienste in 'n provinsie soos die Wes-Kaap.

Includes bibliographical references (leaves 280-305). Argues that despite the liberal use of social control theory in the literature on the social history of venereal diseases, rationale discourses do not necessarily lead to government intervention. Comparative analysis reveals that culturally similar locations can experience similar impulses and constraints to the development of social policy under differing constitutional arrangements.

Thesis (PhD)-- Stellenbosch University, 2013.
ENGLISH ABSTRACT: A telemedicine service is a healthcare service (-medicine) that is delivered over a distance (tele-). The interest in the potential of telemedicine to increase the quality, accessibility, utilization, e ciency and e ectiveness of healthcare services is fuelled by the rapid development of information and communication technology (ICT) and connectivity. Despite this potential, the success rate of telemedicine services disappoints. Many mistakes in the implementation of telemedicine services are repeated over and over again and best practices are not captured and replicated. This study responds to the need for reference models for the assessment and optimization of telemedicine services in a consistent, systematic and systemic way. Maturity models are reference models that describe typical patterns in the development of organizational capabilities and depict a sequence of stages towards the desired state. Many reference models exist that are applicable to telemedicine services, but none of these provide guidance for the optimization of services, like a maturity model does. Many maturity models exist within a health systems context, but none of these can be applied "as is" to telemedicine services. In this study an iterative top-down design approach is followed to develop a Telemedicine Service Maturity Model (TMSMM). This model facilitates the assessment of a telemedicine service on micro, meso, and macrolevel along all the domains that comprise the telemedicine health system. Sets of capability statements are de ned, which follow each other in a cumulative manner, hence providing a maturation path towards the desired maturity state. These sets of capability statements provide yardsticks according to which quantitative values are allocated to an intangible concept, such as maturity. Once an individual service is assessed, further actions towards the optimization of the service can be derived from these yardsticks. The multidimensional design of the TMSMM, as well as the fact that capability statements facilitate the consistent quanti cation of maturity, makes it possible to analyze the aggregated results of cohort of services. To accomplish this, principles of business intelligence and data warehouse design are applied together with online analytic processing (OLAP) procedures. The TMSMM addresses the previously unful lled need for a reference model to assess and optimize telemedicine services in a consistent, systematic and systemic way. This study spans several academic and professional domains and thereby contributes to the scienti c world of telemedicine and ehealth.
AFRIKAANSE OPSOMMING: 'n Telegeneeskunde diens is 'n gesondheidsdiens (-geneeskunde) wat oor 'n afstand gelewer word (tele-). Met die snelle ontwikkeling van inligtings-en kommunikasietegnologie hou telegeneeskunde die potensiaal in om die kwaliteit, toeganklikheid, benutting, doelmatigheid en doeltre endheid van gesondheidsdienste te verhoog. Ten spyte van hierdie potensiaal, stel die aantal onsuksesvolle telegeneeskunde dienste teleur. Heelwat foute in die implementering van telegeneeskundedienste word oor en oor gemaak, terwyl die beste praktyke nie vasgevang en herhaal word nie. Hierdie studie is onderneem in reaksie op die behoefte aan 'n verwysingsmodel vir die assessering en optimering van telegeneeskunde dienste op 'n konsekwente, sistematiese en sistemiese manier. Volwassenheidsmodelle is verwysingsmodelle wat tipiese patrone in die ontwikkeling van organisatoriese vermoeëns beskryf. Dit stip 'n aantal fases neer wat uiteindelik behoort te lei na die ideale organisatoriese toestand. Daar bestaan verskeie verwysingsmodelle wat van toepassing is op telegeneeskunde dienste, maar geeneen daarvan gee leiding met die oog op die optimering van die diens, soos in die geval van 'n volwassenheidsmodel nie. In hierdie studie word 'n iteratiewe van-bo-na-onder ontwerpsbenadering gevolg om 'n telegeneeskunde volwassenheidsmodel (TMSMM) te ontwikkel. Hierdie model fasiliteer die assessering van 'n telegeneeskunde diens op 'n mikro-, mesoen makrovlak en met betrekking to al die fasette waaruit 'n telegeneeskunde stelsel bestaan. 'n Aantal vermoeëstellings is gede nieer. Hierdie stellings volg op mekaar en akkumuleer om sodoende 'n volwassenheidspad na die verlangde toestand aan te dui. Hierdie vermoeëstellings verskaf maatstawwe waarvolgens kwantitiewe waardes toegeken kan word aan 'n ontasbare konsep, soos volwassenheid. Sodra 'n individuele diens geassesseer is, kan verdere aksies met die oog op die optimering van die diens afgelei word. Die multidimensionele ontwerp van die TMSMM, tesame met die feit dat die vermoeëstellings volwassenheid op 'n konsekwente manier kwanti seer, maak dit moontlik dat die data van 'n kohort dienste saamgevoeg kan word met die oog op analise. Beginsels van besigheidsintelligensie, datastoorontwerp asook aanlyn analitiese prosessering (OLAP) word hiervoor ingespan. Die TMSMM spreek tot die voorheen onvervulde behoefte aan 'n verwysingsmodel waarmee telegeneeskunde dienste geassesseer in geoptimeer word in 'n konsekwente, sistematiese en sistemiese manier. Hierdie studie strek oor verskeie akademiese en professionele domeine en lewer sodoende 'n bydrae tot die multidissiplinêre wetenskapswêreld van telegeeskunde en e-gesondheid.

Thesis (MEng)-- Stellenbosch University, 2013.
ENGLISH ABSTRACT: South Africa’s health sector has not yet shown enough improvement to reach the Millennium Development Goals related to health. One of the problem areas is the low infant and child vaccination coverage in certain areas of South Africa. The use of mobile phones in health care (mHealth) has the potential to strengthen the primary health care system through improved information management. A mobile health solution for vaccination (MHSV) can be used to improve information management of vaccinations, which in turn can improve vaccination coverage. However, the feasibility of implementing such an MHSV in the South African context is unknown. This study therefore investigates the feasibility of using mobile phones to improve information management for child vaccinations in South Africa. Feasibility is determined by using a feasibility framework together with business model development. The feasibility framework, which is informed by a literature study, surveys and a case study, determines the feasibility of an MHSV in terms of human factors, technical feasibility, information management, policies and ethics, and economics. It is found that an MHSV is feasible in South Africa, although certain areas pose challenges that will have to be considered. Complementing the feasibility framework, business models are developed to suggest possible ways in which an MHSV can be deployed in South Africa. These models build on the results from the feasibility framework and are developed using Osterwalder’s business model canvas. The effect of the National Health Insurance (NHI) on these business models is also examined. In order to validate the feasibility framework and business models, interviews were held with experts in health care and mobile phone solutions. These interviews show that the research is valid and that the feasibility framework and business models can be generalised to the wider field of mHealth solutions.
AFRIKAANSE OPSOMMING: Suid-Afrika se gesondheidsektor het nog nie genoeg verbetering getoon om die gesondheidsverwante Millenium Ontwikkelingsdoelwitte te bereik nie. Een van die probleemareas is die besondere lae inentingsdekking van babas en kinders in sekere gebiede van Suid-Afrika. Die gebruik van selfone vir gesondheidsorg hou die potensiaal in om die primêre gesondheidsorgstelsel te versterk deur inligtingsbestuur te verbeter. ’n Inentingsoplossing wat gebruik maak van selfone, bekend as ‘n “mobile health solution for vaccination” (MHSV), kan inligtingsbestuur van inentings verbeter, wat hoër inentingsdekking tot gevolg kan hê. Die haalbaarheid van die implementering van so ’n MHSV in die konteks van Suid-Afrika is egter onbekend. Hierdie studie ondersoek dus die haalbaarheid daarvan om selfone te gebruik vir beter inligtingsbestuur van kinder-inenting in Suid-Afrika. Haalbaarheid word vasgestel deur ’n haalbaarheidsraamwerk en die ontwikkeling van besigheidsmodelle te gebruik. Die haalbaarheidsraamwerk, wat toegelig word deur ’n literatuurstudie, vraelyste en ’n gevallestudie, bepaal die haalbaarheid van ’n MHSV in terme van menslike faktore, tegniese haalbaarheid, inligtingbestuur, beleid en etiek, en ekonomie. Daar word gevind dat ’n MHSV haalbaar is in Suid-Afrika, alhoewel sekere areas uitdagings inhou. Die haalbaarheidsraamwerk word aangevul deur die ontwikkeling van besigheidsmodelle wat moontlike maniere voorstel waarop ’n MHSV in Suid-Afrika ontplooi kan word. Hierdie modelle word geskoei op die resultate van die haalbaarheidsraamwerk en word ontwikkel met behulp van Osterwalder se besigheidsmodelskema (“business model canvas”). Die effek van die nasionale gesondheidversekering op hierdie modelle word ook ondersoek. Onderhoude met kundiges in die veld van selfoonoplossings vir gesondheidsorg word gebruik om die haalbaarheidsraamwerk en die besigheidsmodelle te valideer. Die onderhoude toon dat die navorsing geldig is en dat die haalbaarheidsraamwerk en besigheidsmodelle veralgemeen kan word na die wyer veld van selfoonoplossings vir gesondheidsorg.

"June 2002"
Bibliography: p. 347-360.
xiii, 360, [200] p. : ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (M.Med.Sc.)--University of Adelaide, Dept. of Public Health, 2002

"October 2004"
Includes bibliographical references (leaves 313-337)
x, 337 leaves : ill. (col.), maps (col.) ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2004

The research study assessed the user-friendliness of a hospital information system within a telemedicine context at Tertiary Inkosi Albert Luthuli Central Hospital (IALCH) in order to achieve the broad objective of developing a model for managing the implementation of these systems in the province. The current situation with the Hospital Information System implemented in IALCH is that doctors and nurses have difficulties in accessing the X-Ray images; ordering drugs, making patient notes, and accessing patient records at follow up sessions at a later date in the format they want. There are also problems with patient and staff confidentiality for some types of records. These problems raise the following questions: Have doctors adapted to change from traditional to computerised Hospital Information Systems implemented in IALCH? Have nurses adapted to this change and how user-friendly is the Hospital Information System at IALCH? The effectiveness and efficiency of the MEDICOM hospital information system and telemedicine system at IALCH for these groups in relation to their participation in the hospital information system and telemedicine system related activities was investigated using Geyser’s (1992) framework for a user-friendly information system and frameworks from Coiera, Westbrook and Wyatt (2006), Rigby (2006), and IMIA (2006). The population of the study were seven hundred and eighty six (786) doctors and one thousand eight hundred and sixteen (1816) nurses working at Inkosi Albert Luthuli Central Hospital. Pertinent questions regarding the user-friendliness of the MEDICOM hospital information system and telemedicine system were addressed and answered. Based on surveys by questionnaire survey, focus group interviews and observation the factors that affect the user-friendliness of MEDICOM hospital information system and telemedicine system were identified. The survey data was evaluated and analysed manually. The study revealed that the nursing, pharmacy and billing modules of MEDICOM hospital information system were not user-friendly, but the system was reliable and always in operation when needed. The users could manipulate the logical operators of the system effectively, generally could control the system and handle errors. They were happy with the output of the hospital information system in terms of layout. However, the system provided technical support only and users wanted more training on the system. In summary, the study concludes that the Department of Health in KwaZulu-Natal should not roll-out the MEDICOM hospital information system to all hospitals in the province as yet. Since there is no single hospital information system or health information system in South Africa, it is therefore time to develop an eHealth Strategy for South Africa to enable a patient-centric focus to health care delivery across a networked model of care. Therefore, a single integrated and comprehensive hospital information system could be implemented in South Africa provided the issues raised for attention in the study are addressed.
Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

Research report submitted to the School of Economic and Business Sciences, University of the Witwatersrand in partial fulfilment of the requirements for the degree of Master of Commerce (Information Systems) by coursework and research, 2 November 2017
Mobile health applications are fast becoming an influential source of information for pregnant women. Studies have shown that pregnant women download 3 such apps on average on their cellphones. These mobile technologies have been shown to help women monitor their progress during their pregnancy and personalise healthcare to suit their needs. To date, llimited research has been directed towards understanding usage behaviours with these apps. Various authors have argued that there is a need to expand the scope of research from simple usage behaviour to deeper levels as technology becomes more sophisticated and easily available. M-health technologies are increasingly becoming more varied and sophisticated and as such this study aims to explore post-adoption usage specifically of mobile health pregnancy applications in the South African context. This study specifically looked at post adoption usage behaviours and used Hsieh and Zmud’s (2006) framework as a basis of understanding these behaviours. The potential influences on these behaviours were sourced from various studies done on pregnant women usage of ICT in general. These influences were then investigated to see whether they were relevant in the context of m-health pregnancy support applications. The primary method of data collection was open ended semi structured interviews with twelve pregnant women. Data analysis was done using the iterative model for qualitative data analysis proposed by Miles and Huberman (1994). The findings revealed that pregnant women displayed post adoption usage behaviours of routine use and IS continuance. With regards to the infusion stage, the study found that pregnant women engaged in the first set of post adoption usage behaviours i.e. extended usage and deep usage. They did not engage in second stage behaviours namely emergent use, feature extension or intention to explore behaviours. The influences identified in the literature were found to be relevant in the context of m-health applications and additional influences such as cost of seeing gynaecologist, number of features on the app and social structures were found to have an influence on usage of the apps. This study provides unique insights into the views of pregnant women’s experiences with m-health apps. Specifically, by using interpretive research it uncovers the subjective meanings around post adoption usage behaviours, understanding how pregnant women engage in these behaviours and subsequently how these behaviours are sustained during their pregnancy. The study recognises m-health pregnancy support apps as important tools in the pregnancy journey. It highlights how pregnant women value these apps and view them as huge information sources, reassurance and comfort during their pregnancy. It is argued that medical professionals cannot distance themselves away from these apps and need to work in conjunction with them to provide robust maternity care to their patients. 5 Theoretically, this study adds to our understanding of post adoption usage behaviours specifically in the context of m-health pregnancy apps. Limited studies have been done in this field specifically in the South African context and the study provides a foundation for further research. Further research can be done to understand how these apps are changing the relationship between pregnant women and medical professionals and furthermore, whether the information received from these apps is reliable and credible.
GR2018

Erratum pasted onto front end paper.
Bibliography: leaves 248-260.
xii, 260, 9 leaves :
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Examines the establishment and early history of the Adelaide medical school, which was influenced by reforms of medical education in Great Britain. Finds that the content of the Adelaide medical course conformed with British standards, and gave adequate teaching by the standards of the day. Undergraduate teaching and postgraduate opportunities can be seen as Anglo-Australian synergies made possible by formal and informal linkages with the British empire in its last century.
Thesis (M.D.)--University of Adelaide, Depts. of Surgery and History, 2000

Erratum pasted onto front end paper.
Bibliography: leaves 248-260.
xii, 260, 9 leaves :
Examines the establishment and early history of the Adelaide medical school, which was influenced by reforms of medical education in Great Britain. Finds that the content of the Adelaide medical course conformed with British standards, and gave adequate teaching by the standards of the day. Undergraduate teaching and postgraduate opportunities can be seen as Anglo-Australian synergies made possible by formal and informal linkages with the British empire in its last century.
Thesis (M.D.)--University of Adelaide, Depts. of Surgery and History, 2000

The importance of records management to the provision of healthcare services cannot be overemphasised. If medical records are not managed properly, this might result in the provision of poor healthcare services. This is because usually if medical records are not properly managed, the healthcare institutions attain inaccurate, untimely, incomplete and unauthentic records or the records fade completely. Records that are not managed properly are easily lost, modified, altered, misfiled and/or damaged, which results in a struggle to locate them and, eventually, much time is lost. Records of this kind may not support healthcare service providers properly in decision-making, problem-solving, monitoring and evaluation of service for continuous service improvement. This study utilised the five elements of trusted records management (records management governance practice, staff capacity and competencies, recordkeeping system and technology, and records archival processes) to investigate the development of a framework to embed medical records management into the healthcare service delivery practice for effective records management practice. The study predominantly utilised a quantitative approach with some support from a limited scope of qualitative data to augment numeric data. The data was collected using the four different techniques, namely questionnaire, interview, observation and system/documents analysis. The study revealed that the mode of medical record management was not effectively enabling the institution to manage medical records properly due to lack of integrated medical records management framework into the healthcare business process. The medical records management technology also lacked file tracking system, records backup, and audit trail which compromise records safety and security. The study recommended supply of the necessary resources, with a framework that the healthcare institutions may adopt to embed medical records management into the healthcare service delivery. ECM may also be implemented to incorporate electronic records management systems, information management, web content and other add-ons to support the records management framework in ensuring effective discharge of all records management functional requirements on the healthcare business process. A further study was recommended about the development of an online outpatient consultation system and medical records access to avoid patient long turnaround time for service.
Information Science
D. Litt. et. Phil. (Information Science)