A new health centre is planned in a remote mountain area to serve a community which is scattered over a large area. The nearest large hospital with complete medical services is difficult to reach.

The services to be offered in the new health centre should include:

• health carers at the health centre for visits made by appointment
• expert doctors from other locations, who are available 24 hours a day via a VPN connection
• a comprehensive care system for chronically sick patients at home
• some visiting health workers
• some provision for emergency operations in the health centre
• diagnostic equipment to identify cases where a person needs to be treated at the large hospital.

The planners are also considering whether to create an internet site with authorized access for the community.

With reference to the technologies involved, discuss ways in which the required services could be met and their effect on the people in the community.

Discussion should focus on:

“health carers at the health centre for visits made by appointment”
People will need a physical presence at the centre for reassurance which means carers need to be employed and in place – enough to cope with the estimated need especially as visits to the hospital are difficult.

“expert doctors from other locations, who are available 24 hours a day via a VPN connection”
Essential for crises which occur outside of the hours the centre is open.
Will need a secure and reliable connection with access from mobile device, and access to any data and phone calls coming into the centre.

“a comprehensive care system for chronically sick patients at home”
Continual measurements can be sent to the health centre; this could be done with wearables. Someone with a heart problem could have the heart rate continually measured on a bracelet with an imbedded RFID to communicate wirelessly via NFC to a receiving device which sends the data automatically to the health centre.
The centre would need to have software to interpret the data (or this could be done at the patient side – therefore less to send) and any fluctuations identified.
Danger signals would mean the doctor needs to know. Health carer would check on minor changes as well as regular check-ups – need for health carers depends on proportion of chronically sick and elderly.
Effect on population – good system to stay at home may be met with some aversion to remote monitoring.

“some provision for emergency operations in the health centre”
Could be dealt with by telesurgery when essential but will need appropriate cameras/connections and software, as well as a doctor who is confident to be involved.

“diagnostic equipment to identify cases where a person needs to be treated at the large hospital”
An ultrasound scanner should probably be purchased. For example, regular scans are needed for pregnant women. However, these need expert technical operators and interpreters. One suggestion would be for the scans to take place via telemedicine and the results sent electronically to be analysed at the hospital.

An internet site for communication and advice would have the advantages of knowledge so that a decision whether or not to make an appointment can be made. Accounts would need to be set up and security ensured via firewalls, encryption etc. as personal medical information is sensitive. It would be helpful to give information as to when an appointment should be made and simple remedies for simple problems. Some people may be suspicious of using this medium for medical uses and be concerned about privacy.