Assessment of User Needs for Telemedicine Robots in a Developing Nation Hospital Setting

Abstract

Background:

This study aimed to investigate the needs of medical users of telemedicine robots to encourage international cooperation and development.

Introduction:

As the use of telemedicine expands, it is necessary to develop new systems, including robots, which consider the perceived needs of end users to ensure quality of care and positive user experience.

Materials and Methods:

A survey of medical staff was conducted at a hospital in Vietnam to investigate users' needs for a telemedicine robot system.

Results:

A total of 117 medical staff participated in the survey, comprising 74 nurses and 43 doctors. The most preferred type of robot was the humanoid type, female version, and the preferred mobility type was walking. The most requested functions were “heart rate measurement,” “recognition and avoidance of obstacles,” “oxygen saturation measurement,” “Transmitting Medical Information,” and “wireless system.” In addition, the most important considerations in developing a robot system were “cleaning the robot to prevent infection,” followed by “convenience of operation.”

Discussion:

The results of this study largely supported those of similar previous studies. However, some differences may reflect the cultural variation or differences in the level of medical development across contexts.

Conclusion:

To apply robotic systems to help develop telemedicine internationally, it is essential to develop a robot that reflects actual users' needs. If relevant matters such as legal issues are considered and addressed, an appropriate robotic telemedicine system can be successfully developed. Consequently, telemedicine can improve the quality of local medical care, strengthen practitioner capacity, and improve outcomes.

Introduction

The use of various information and communication technologies (ICTs) in the health care sector affords many possibilities for implementing and improving telemedicine. Telemedicine refers to providing medical care to a remote location.¹ It also refers to physically distanced, nonface-to-face care that is typically performed when the patient is in a remote area.² With telemedicine, doctors and patients do not need to be in the same place at the same time, potentially increasing coverage capacity and opportunities for quality care.¹ Millions of patients worldwide have received telemedicine and telehealth services from thousands of medical providers.³ South Korea has allowed telemedicine since 2003, after revision of medical laws in 2002.⁴ Although telemedicine is allowed in South Korea, it takes a limited form compared to other countries such as the United States, Australia, and Europe. Telemedicine can help eliminate health care inequities and disparities by providing timely, high-quality health care services in medically underserved areas.^5,6 Telemedicine has been shown to improve access to health care, save time and money, increase patient satisfaction, and improve treatment outcomes.^6
–8 In particular, telemedicine provides many benefits and opportunities for developing countries, as individuals in remote areas may not have extensive local medical access and instead, rely on far-away medical staff.⁹ According to a 2010 World Health Organization (WHO) report on telemedicine, telemedicine has contributed greatly to the quality and accessibility of health care in developing nations.¹¹ In both developed and developing nations, telemedicine also offers solutions to shortages of health care providers and supports clinical education programs,¹⁰ providing opportunities for academic education and professional development, thereby enhancing academic growth and independence.¹¹

The Korea International Cooperation Agency conducts various Official Development Assistance (ODA) projects in cooperation with programs in developing nations; these include development cooperation, research projects, and humanitarian aid projects. In 2019, 25 of the 109 projects in the Asia-Pacific region (∼23%) were related to health care.¹² Beyond providing material support for infrastructure construction, health care ODA projects tend to focus on education and training to strengthen the capacity of local health care professionals. Therefore, there is an emerging need for medical advice and medical education services to strengthen the capacity of local staff. Some scholars have suggested that using ICTs in ODA projects may help offset the lack of medical staff and facilities in developing countries, as well as overcome geographical distance in areas such as oral health promotion.¹³

As the use of ICTs in health care continues to evolve, there is increasing interest in using robots to enhance the practice of telemedicine. To solve mobility limitations and the lack of timeliness of existing video or computer-based telemedicine systems, researchers have investigated the suitability of using telemedicine service robots for rapid diagnosis and medical treatment.^14,15 The Remote Presence Virtual+Independent Telemedicine Assistant (RP-VITA) in the United States can enable doctors to care for patients remotely using an iPad equipped with medical diagnostic devices, such as ultrasound equipment, a stethoscope, and an endoscope. Able to automatically avoid obstacles, the mobile robot is used for patient care and observation.¹⁶ In Korea, the existing telemedicine system has largely been limited to sharing information through videoconferencing. However, a newly developed Korean telemedicine robot is equipped with wheels to increase mobility, as well as autonomous driving, human-following driving, and collision avoidance functions.¹⁷ These robots also have fixed mobile cameras, which allow medical staff to check a patient's condition and zoom in on the affected areas without changing their posture.

A broad term, telemedicine can encompass a range of remote service provisions, including teleconsulting, tele-education, and “tele-assistance” along with telenursing.² The need for robotic systems for teleconsultation and tele-education is increasing. However, there are no clear standards that truly reflect the needs of medical staff to reference when developing robotic telemedicine systems. Effectively using robotic systems in telemedicine requires a thorough understanding of the medical environment and knowing exactly which important functions are required. Therefore, this study focused on generating recommendations for the use of robots in various medical settings in the subareas of teleconsultation and tele-education by examining the needs of local users working in an ODA project. This study may be used as a basis for the development of ODA robot systems for telemedicine. We also hope that the use of various ICTs, including robots, will help invigorate telemedicine in developing countries. In the long run, enhancing telemedicine will improve the quality of local health care and enhance health care professional's capacity.

Materials and Methods

RESEARCH DESIGN

This was a descriptive research study to identify the necessary functions and key elements that should be included when developing a telemedicine robot system, especially for deployment in developing countries.

RESEARCH SUBJECTS

The research subjects were doctors and nurses working at the Children's Hospital in Haiphong, Vietnam, who understood the study purpose and agreed to participate. As this study employed questionnaires in Vietnamese, those who had difficulty understanding or reading Vietnamese were excluded. As an earlier study with similar aims¹⁵ included 91 subjects, this study aimed to include 100 participants and therefore targeted 120 people, anticipating a 20% elimination rate.

RESEARCH TOOLS

A questionnaire was constructed by modifying and supplementing the needs assessment for telemedicine robots' tool developed by Lee et al.¹⁵ The questionnaire contained questions about the application of and preference for robots for telemedicine (6 items), the necessary robot functions for telemedicine (35 items), important factors of telemedicine robots (13 items), and the subjects' general characteristics (6 items). Participants could select multiple applicable units and medical departments that require telemedicine robots as needed. Robot functions were divided into medical, delivery and operation, and transport functions. Responses were on a 4-point Likert-type scale ranging from “not essential” (1 point) to “very necessary (important)” (4 point); higher scores indicated higher demand.

DATA COLLECTION

The research was conducted after obtaining IRB approval from the research institute (SNUH C-1905-1991-1038). The researcher explained the purpose, method, and confidentiality of the research to the study subjects with the help of an interpreter and provided a guidance document in Vietnamese. Participation was voluntary, anonymity was guaranteed, and subjects could withdraw at any time. The survey started after the consent form was received. Data collection involved distributing self-report questionnaires. Participants could ask the researcher questions or ask for assistance while answering the questionnaires. No data that could identify the participants were collected.

DATA ANALYSIS

The general characteristics and needs of the subject were presented as numbers and percentages, and continuous variables as means and standard deviations through descriptive statistics. The differences in demands between doctors and nurses were analyzed through t-tests.

Results

GENERAL CHARACTERISTICS OF PARTICIPANTS

A total of 117 people participated in the study—74 nurses (63.2%) and 43 doctors (36.8%). Women accounted for the majority of subjects—98 (83.8%)—with an average age of 35.58. Most doctors—21 (48.8%)—worked in the Internal Medicine Department, whereas 33 nurses (44.6%) worked in the Pediatric Department. Seventy-three (62.4%) of the respondents said they knew about telemedicine (and educational) robots before this survey, but only 41 (35.0%) said that they had actual experience with telemedicine (and educational) robots; 76 (65%) said they had no experience (Table 1).

Table 1.

Participants' Characteristics (n = 117)

GENERAL INFORMATION	n (%) OR MEAN (SD)
Gender
Female	98 (83.8)
Male	19 (16.2)
Age mean	35.58 (7.60)
20s	27 (23.1)
30s	59 (50.4)
40s	22 (18.8)
50s	9 (7.7)
Position
Nurses	74 (63.2)
Doctors	43 (36.8)
Internal medicine	21 (48.8)
Specialty (Physicians)
Pediatrics	16 (37.2)
Surgery	4 (9.3)
Supporting part (Radiology, Nuclear Medicine, etc.)	2 (4.7)
Pediatrics	33 (44.6)
Internal medicine department	12 (16.2)
Special units (Intensive care unit, Operating room, etc.)	9 (12.2)
Department (Nurses)
Surgery department	8 (10.8)
Others	12 (16.2)
Know about robots for teleconsultation and education before this survey
Yes	73 (62.4)
No	44 (37.6)
Experience with teleconsultation and education
Yes	41 (35.0)
No	76 (65.0)

Regarding respondents' preferred form of telemedicine (cooperative and educational) robots, the humanoid form with monitors (93, 79.5%) was the most preferred form, and the most preferred “gender” type for the robot was female (52, 44.4%), followed by neuter robots (42, 36.8%). The most preferred type of robot movement was upright walking (73, 62.4%). Intensive care units (ICUs) were most frequently mentioned as those in need of telemedicine robots (63, 53.8%) (Table 2).

Table 2.

Types of Teleconsultation and Tele-Education

CLASSIFICATION	n (%) OR MEAN (SD)
Preferred types of robots
Humanoid type with a monitor	93 (79.5)
Simple movable type with a Monitor	21 (17.9)
Humanoid type without a monitor	3 (2.6)
Preferred gender of robots
Female	52 (44.4)
Screen without gender	42 (36.8)
Male	13 (11.1)
Neuter gender	9 (7.7)
Preferred mode of movement
Upright walking type	73 (62.4)
Tread type	24 (20.5)
Wheels type	20 (17.1)
Teleconsultation and educational robots needed in which medical department? (Multiple answers allowed)
Intensive care unit	63 (53.8)
Cardiology	57 (48.7)
Surgery	51 (43.6)
Orthopedics	44 (37.6)
Radiology	44 (37.6)
Division of infectious diseases	42 (35.9)
Chest surgery	42 (35.9)
Radiation oncology	41 (35.0)
Plastic surgery	40 (34.2)
Emergency medicine	40 (34.2)
Intensive care unit	79 (67.5)
Teleconsultation and educational robots needed in which unit?
Recovery room	64 (54.7)
Operating room	63 (53.8)
Aseptic care room	57 (48.7)
Emergency room	53 (45.3)
Medical ward	45 (38.5)
Surgical ward	45 (38.5)
Isolated room	44 (37.6)
Hemodialysis unit	37 (31.6)
Newborn unit	33 (28.2)
Delivery room	13 (11.1)
Outpatient	9 (7.7)

PREFERRED FUNCTIONS FOR COOPERATIVE OR EDUCATIONAL TELEMEDICINE ROBOTS

Table 3 shows the rankings of the required functions of telemedicine robots. Most doctors preferred functions related to the recognition and avoidance of surrounding obstacles, image playback, cardiac measurement, and delivery of patient examination reports. Nurses indicated a high demand for cardiac measurement, oxygen saturation measurement, recognition and avoidance of surrounding obstacles, delivery of patient examination reports, and robot arm/leg movement functions.

Table 3.

Ranking of Functional Needs of Robots

RANK	TOTAL	DOCTORS	NURSES
1	Heart rate monitor	Obstacle avoidance: onboard sensors detect impending collisions and prevent the robot from coming into contact with objects in close proximity	Heart rate monitor Oximeter
2	Obstacle avoidance: onboard sensors detect impending collisions and prevent the robot from coming into contact with objects in close proximity	Video and image play heart rate monitor Transmission of patient examination report	Heart rate monitor Oximeter
3	Oximeter		Obstacle avoidance: onboard sensors detect impending collisions and prevent the robot from coming into contact with objects in close proximity Transmission of patient examination report Robot arm leg movement
4	Transmission of patient examination report
5	Wireless system	Blood pressure measuring function Sharing Image file Wireless system
6	Blood pressure measuring function		Blood sugar test measuring function
7	Video and image play Transmitting medical information Automatic navigation		Wireless system Transmitting Transmitting Medical Information Docking station: manually or automatically drive to a battery charging station
8		Oximeter Temperature measuring function
9		Oximeter Temperature measuring function
10	Docking station: manually or automatically drive to a battery charging station Voice recognition with contextual perception (voice interaction)	Voice recognition with contextual perception (voice interaction) Automatic navigation	Blood pressure measuring function Sharing Image file Wireless system Changing direction function Camera movement Automatic navigation

Doctors and nurses showed statistically significant differences in the required functions of teleconsultation and educational robots. Nurses indicated a greater need for stress measurement (p = 0.004), zoom in/out (p = 0.038), and turnover functions (p = 0.020) (Table 4).

Table 4.

Functional Need

FUNCTION	MEAN ± SD			t	p
FUNCTION	TOTAL (n = 117)	DOCTORS (n = 43)	NURSES (n = 74)	t	p
Medical function	3.37 ± 0.45	3.32 ± 0.46	3.41 ± 0.45	−1.094	0.276
Heart rate monitor function	3.52 ± 0.52	3.49 ± 0.55	3.54 ± 0.5	−0.523	0.602
Oximeter function	3.50 ± 0.54	3.44 ± 0.59	3.54 ± 0.5	−0.961	0.339
Blood pressure measuring function	3.45 ± 0.55	3.47 ± 0.55	3.45 ± 0.55	0.181	0.856
Blood glucose meter function	3.42 ± 0.58	3.33 ± 0.61	3.47 ± 0.55	−1.339	0.183
Recognition of nonverbal signals (e.g., users' facial expressions)	3.42 ± 0.58	3.4 ± 0.58	3.43 ± 0.58	−0.334	0.739
Temperature measuring function	3.38 ± 0.58	3.44 ± 0.55	3.35 ± 0.61	0.806	0.422
Electronic stethoscope function	3.34 ± 0.54	3.23 ± 0.57	3.41 ± 0.52	−1.670	0.098
Pen light function	3.28 ± 0.57	3.21 ± 0.6	3.32 ± 0.55	−1.053	0.295
Stress evaluation function	3.24 ± 0.62	3.02 ± 0.67	3.36 ± 0.56	−2.943	0.004
Ruler (length measurement) function	3.22 ± 0.67	3.16 ± 0.65	3.26 ± 0.68	−0.729	0.468
Operational function	3.37 ± 0.43	3.34 ± 0.40	3.39 ± 0.44	−0.571	0.569
Examination record delivery (e.g., laboratory test result) function	3.49 ± 0.54	3.49 ± 0.55	3.49 ± 0.53	0.018	0.985
Medical information delivery (e.g., admission note) function	3.44 ± 0.53	3.4 ± 0.54	3.46 ± 0.53	−0.627	0.532
Video and image play function	3.44 ± 0.50	3.49 ± 0.51	3.42 ± 0.50	0.724	0.470
Voice recognition with contextual perception (voice interaction) function	3.43 ± 0.56	3.42 ± 0.59	3.43 ± 0.55	−0.128	0.899
Touch screen function	3.40 ± 0.54	3.37 ± 0.54	3.42 ± 0.55	−0.449	0.654
Videotaping or sound recording function	3.38 ± 0.55	3.28 ± 0.59	3.43 ± 0.53	−1.454	0.149
Voice command function: If it is not possible to control by hand function	3.38 ± 0.54	3.35 ± 0.53	3.41 ± 0.55	−0.546	0.586
Bidirectional videoconferencing system function	3.38 ± 0.54	3.37 ± 0.58	3.39 ± 0.52	−0.191	0.849
Video screen capture function	3.38 ± 0.51	3.40 ± 0.49	3.38 ± 0.52	0.174	0.862
Image file sharing function	3.38 ± 0.49	3.47 ± 0.50	3.34 ± 0.48	1.364	0.175
Statistical value display function	3.37 ± 0.58	3.30 ± 0.6	3.41 ± 0.57	−0.924	0.357
Screen sharing function	3.36 ± 0.55	3.33 ± 0.52	3.38 ± 0.57	−0.500	0.618
Onscreen messages to notify the user of such conditions as loss of far end video, incomplete or dropped connections, mute, etc., function	3.33 ± 0.53	3.28 ± 0.50	3.36 ± 0.54	−0.851	0.397
Laser pointer (for indicating) function	3.26 ± 0.56	3.21 ± 0.51	3.28 ± 0.59	−0.693	0.490
Sending message function	3.30 ± 0.56	3.28 ± 0.63	3.31 ± 0.52	−0.294	0.769
Video screen capture	3.30 ± 0.55	3.16 ± 0.53	3.38 ± 0.54	−2.101	0.038
Function	3.30 ± 0.55	3.16 ± 0.53	3.38 ± 0.54	−2.101	0.038
Video transmission and reception simultaneous confirmation function	3.29 ± 0.53	3.23 ± 0.53	3.32 ± 0.53	−0.909	0.365
Movement function	3.42 ± 0.44	3.36 ± 0.42	3.45 ± 0.44	−1.043	0.299
Obstacle avoidance: onboard sensors detect impending collisions and prevent the robot from coming into contact with objects in close proximity	3.51 ± 0.52	3.56 ± 0.50	3.49 ± 0.53	0.719	0.474
Function	3.51 ± 0.52	3.56 ± 0.50	3.49 ± 0.53	0.719	0.474
Wireless system function	3.46 ± 0.55	3.47 ± 0.63	3.46 ± 0.50	0.053	0.957
Automatic navigation	3.44 ± 0.52	3.42 ± 0.54	3.45 ± 0.50	−0.276	0.783
Function	3.44 ± 0.52	3.42 ± 0.54	3.45 ± 0.50	−0.276	0.783
Docking station: manual or automatic drive to a battery charging station connected to an electrical outlet function	3.43 ± 0.53	3.37 ± 0.54	3.46 ± 0.53	−0.858	0.393
Automatic camera movement	3.42 ± 0.55	3.37 ± 0.54	3.45 ± 0.55	−0.705	0.482
Function	3.42 ± 0.55	3.37 ± 0.54	3.45 ± 0.55	−0.705	0.482
Movement of robot's arms and legs function	3.42 ± 0.53	3.30 ± 0.51	3.49 ± 0.53	−1.833	0.069
Turn over function	3.36 ± 0.53	3.21 ± 0.51	3.45 ± 0.53	−2.377	0.020
Height adjustment function	3.29 ± 0.53	3.19 ± 0.50	3.35 ± 0.53	−1.680	0.096

The required functions can be divided into three different categories: medical functions, delivery and operation functions, and movement functions. The movement functions ranked highest at 3.42 ± 0.44 points, whereas the medical functions and delivery operation functions were ranked at 3.37 ± 0.45 points and 3.37 ± 0.43 points, respectively. For each of these three functions, nurses showed a nonsignificantly higher need than doctors.

IDENTIFIED FUNCTIONAL CONCERNS WITH TELEMEDICINE ROBOTS

Investigating relevant utility factors to consider when developing robots for teleconsultation and tele-education found several areas of concern to the participants (Table 5). The most important factors, in order of priority, were robot disinfection and cleaning for infection prevention (3.60 ± 0.53), followed by ease of operation (3.5 ± 0.55), and data transmission speed (3.50 ± 0.55). Moreover, there were statistically significant differences between doctors and nurses over critical factors in two categories. Specifically, nurses regarded the size (p = 0.048) and the shape of the robot (p = 0.026) as of greater importance.

Table 5.

Important Factors to Consider when Developing a Robot

IMPORTANT FACTORS	MEAN ± SD			t	p
IMPORTANT FACTORS	TOTAL	DOCTORS	NURSES	t	p
Robot disinfection for infection prevention and washing available	3.60 ± 0.53	3.60 ± 0.54	3.59 ± 0.52	0.099	0.921
Convenience of manipulation	3.55 ± 0.50	3.47 ± 0.5	3.59 ± 0.49	−1.356	0.178
Data transmission speed	3.50 ± 0.55	3.51 ± 0.55	3.50 ± 0.56	0.110	0.913
Image quality	3.50 ± 0.52	3.49 ± 0.51	3.51 ± 0.53	−0.252	0.802
Multilingual support services	3.48 ± 0.52	3.49 ± 0.51	3.47 ± 0.53	0.154	0.878
Strength of robot	3.48 ± 0.50	3.40 ± 0.49	3.53 ± 0.50	−1.374	0.172
Remote control function	3.47 ± 0.53	3.44 ± 0.55	3.49 ± 0.53	−0.434	0.665
Automatic voice recognition	3.42 ± 0.55	3.37 ± 0.58	3.45 ± 0.53	−0.705	0.482
Minimize loading during program operation	3.40 ± 0.57	3.35 ± 0.57	3.43 ± 0.58	−0.759	0.449
Number of doctors who can participate in remote cooperation and education	3.35 ± 0.55	3.35 ± 0.57	3.35 ± 0.53	−0.024	0.981
Real-time communication function	3.35 ± 0.58	3.26 ± 0.62	3.41 ± 0.55	−1.357	0.178
Size of the robot	3.21 ± 0.60	3.07 ± 0.59	3.30 ± 0.59	−2.003	0.048
Shape of the robot	3.04 ± 0.59	2.88 ± 0.63	3.14 ± 0.56	−2.250	0.026

Discussion

This study examined the needs of local medical staff to identify the functions and issues of concern that may be important when developing and implementing robots for use in telemedicine in health care ODA projects.

Identifying the needs of end users is an essential early step in developing an appropriate robot telemedicine system.^15,18 It is critical to determine which functions are required and which elements are important to the medical staff who will use the telemedicine robot; any system developed should take these needs and concerns into account. Participants in this study identified the most necessary functions in robot systems for telemedicine as heart rate monitor, obstacle avoidance capability, oximeter, patient examination report transmission, wireless system, blood pressure measurement, video and still image functions, medical information delivery, automatic navigation function, docking capacity (manual or automatic driving to a battery charging station connected to an electrical outlet), and voice recognition. Six of the 10 most-needed functions (heart rate monitor, oximeter, patient examination report delivery, wireless system, and medical information delivery) were the same as those identified in a study by Lee et al.,¹⁵ which surveyed Korean medical staff about their requirements for a telemedicine robot system. The heart rate monitor function was the most demanded in both studies. Although these are only two small studies, the high perceived need among Korean as well as Vietnamese medical staff suggests that the heart rate monitor function is the most important basic patient observation device to include in a telemedicine robot.

The great requirement for wireless systems appears to be a response to the need to overcome the shortcomings of the existing wired telemedicine system, which may increase the mobility of telemedicine. In a previous study,¹⁹ a wireless telemedicine system was developed to address situations in which the patient could not move. This study showed that with a wireless system, telemedicine can make an immediate response in the event of an accident or emergency situation involving the target person.

Next, participants indicated high demand for the ability to recognize and avoid obstacles. Some telemedicine consultation and educational robots are equipped with self-driving or follow-up features.^9,17 However, before this function can be used in medical environments, safety must be ensured, perhaps by including mechanisms to recognize and avoid nearby obstacles or decelerating to prevent the robot from colliding with the patient.¹⁵ In a medical environment, obstacle avoidance is an important function to ensure patient and provider safety.

Doctors and nurses accord somewhat different priorities to the functions they would demand of a robot telemedicine system. Nurses indicate a higher preference for medical functions, whereas doctors placed more emphasis on mobility and delivery and operation functions. Thus, when developing system functions, it is important to consider who among the medical staff would be the main users of the telemedicine robots.

Apart from the system's functions, the most important factor to consider in developing the robot was “disinfection and cleaning of the robot to prevent infection.” This item was a priority for both doctors and nurses, and this finding reflects the characteristics of the medical environment. In the medical environment, infection prevention and patient safety are top priorities, and their importance has been increasing recently. National policies and institutions also support infection prevention and patient safety through regulation and systemic support.²⁰ If using telemedicine consultation and educational robots causes unnecessary infection and has negative effects on patient safety, such systems would not be approved for use in a medical environment even if they have excellent functionality. Therefore, it is necessary to ensure that all items used in the robot system can be washed and sterilized to prevent crosscontamination.

Participants also identified “convenience of operation” and “data transmission speed” as important factors for a robot telemedicine system. Any robot system must be easy to use and allow the smooth sharing of a wide range of health care data. This result echoes previous studies showing that the capacity for transferring various medical multimedia data is important.²¹ However, as the telecommunication network environment varies across developing countries, contextual considerations should be fully identified in advance when planning to utilize telemedicine consultation and educational robots in ODA projects. Another challenge when deploying telemedicine robots in developing countries may be addressing the telecommunication network infrastructure that is not suitable for the intensive data transmission necessary for telemedicine.²¹ In addition, to enable these robots to be deployed to various developing countries, multilanguage service is also an important consideration. Users have reported that this is an important factor to enhance user convenience and acceptance of the robot.

The preferred form of robots in this study was humanoid. This was the same preference found by Lee et al.,¹⁵ although the preferred form of motion in this study was upright walking, unlike in previous research. The research by Lee et al.¹⁵ was conducted with Korean medical staff, whereas this study was conducted with Vietnamese medical staff; it is possible that the discrepancy may arise from cultural differences. Moreover, responses may vary depending on participants' experience with and exposure to various robots. Existing remote medical robots such as RP-VITA have been typically equipped with wheels, as these are thought to best suit the mobility, stability, and convenience of operation of the robot. Upright walking would create the most humanoid looking robot, but further research is required to determine whether this preferred feature is compatible with real-world issues of safety and mobility.

This study found that telemedicine robot systems are most needed in ICUs. Ryhan⁹ made suggestions regarding the status and direction of telemedicine in developing countries, showing that the importance of telemedicine in ICUs will continue to increase, and that the quality of care in these units could be enhanced by using telemedicine. This is due to the high demand in developing countries for medical support for severe patient cases. However, research by Lee et al.¹⁵ showed that Korea has different needs; respondents showed a stronger preference for using telemedicine consultation and educational robots in general Internal Medicine wards than in ICUs. This variance in identified units in need of robot services may result from the differences in the current level of development of medical care in each country. The results also reflect the different perspectives between remote areas and local areas in telemedicine.

Relevant laws and bureaucratic systems must be updated to implement telemedicine using robots, as current medical laws limit the uses of telemedicine, often restricting it to conferencing or passive functions rather than active practice. In particular, liability-related regulations and laws should be clearly presented, as it is often unclear who is responsible for medical accidents in telemedicine.^2,22 Such laws should protect medical staff at remote locations and clearly state the chain of responsibility in telemedicine, allowing providers and developers to assess their risk exposure when developing telemedicine in ODA projects. In addition, regulations on personal information protection and information security are also needed, as medical information is shared between countries.^2,22 Finally, local telemedicine laws should also be considered. If local and remote laws conflict with each other, it will be necessary for coordination between agencies or even countries for solutions. Policymakers and practitioners looking to address this issue may benefit from extant examples of such coordination, such as when Korean medical institutions have applied telemedicine in Mongolia²² or when they signed memorandums of understanding with Brazil on cooperating to develop telemedicine technology for smart hospital ships.²³

ICTs will continue to develop in the future, and the use of various ICTs in health care environments will continue to increase. In particular, it should be recognized that telemedicine can provide many benefits and opportunities for improving the standards of care and medical outcomes in developing countries. As we face an era of uncertainty, battling new diseases, remote teleconsultation can have a huge positive impact on medical care. Therefore, it is very important to develop a telemedicine robot system for consultation and education based on the needs of local and remote medical staff. When creating such a system, it is essential to consider how the system will be used, as well as the local and remote laws which will govern its use in practice. Creating a system with these factors in mind would enable improved teleconsultation and enhance the competencies of local medical staff through tele-education. In particular, tele-education could provide continuous educational opportunities to local medical personnel who received short-term training in Korea or elsewhere. This tele-education could be used for postmanagement training programs. Eventually, programs could be developed to provide local medical staff with real-time education, reducing the need for international travel by either the local staff or Korean practitioners. Ultimately, this would provide opportunities to improve the quality of health care and the medical capacity in developing nations, enhancing provider experience and patient outcomes.

Footnotes

Disclosure Statement

No competing financial interests exist.

Funding Information

This work was supported by the Convergence Research Policy Fellowship funded by the Ministry of Science and ICT (MSIT) of Korea and Korea Institute of Science and Technology (KIST) Convergence Research Policy Center. This research was partially supported by the Ministry of Trade, Industry & Energy (MOTIE, Korea) under the Industrial Technology Innovation Program. No. 10063098, “Telepresence robot system development for the support of POC (Point Of Care) service associated with ICT technology.”

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