Tele-radiology system design for rural and semi urban healthcare centres in Uganda

Abstract

The study was conducted to investigate and design a system that facilitates efficient exchange of medical data (images and reports) between health professionals with the aim of obtaining a diagnosis at a distance while ensuring that the format of the medical images (i.e. DICOM) is not altered. Taking into consideration the fact that the presence of radiologists is unevenly distributed within Uganda and due to their scarcity, tele-radiology seems to bear the potential to play a key role in quality healthcare administration within the county as it bridges the gap of equal access to diagnostic imaging specialists. Methods: The Design Science Research approach was employed and a cross sectional study design was conducted to document and identify the mechanisms used by radiologists in extending specialized healthcare to rural health centers in Uganda and the challenges faced. This led to the specification of tele-radiology requirements and the design of models (process flow diagrams). In total, 23 key informant interviews with purposively selected representatives at the radiology department from 9 varying health facilities across the country were conducted. The specified requirements and design models were validated by 9 study participants who were part of the initial 23 participants. The data was descriptively analyzed using excel spreadsheet software and a systematic review of literature between 2002-2021 on qualitative evaluation of previous studies on tele-radiology and PACS was also done. The key challenges investigated facing current mechanisms were categorised into workflow, technological as well as organizational. These translated into four (4) key functional requirements (FR) and 24 Non Functional Requirements (NFR). As-is and to-be activity diagrams mapping the four essential functional requirements were designed using bizagi modeling software. A validated web-based application prototype for radiology image and data transfer was also implemented as proof of concept. The study proves that there is a need to address the documented challenges before diagnostic imaging can be improved and harmonized across Uganda’s health facilities. The tele-radiology system design is expected to aid health information exchange between specialists in the context of shared health data.