A strategically important task in the context of health care reform is the organization of a fundamentally new implementation of medical and preventive measures through medical institutions concentrating on specialization. Such a concept can be achieved through the provision of qualified assistance to the population through remote means, using updated information technologies, and the innovative potential of the best specialists. With the progress of information and telecommunication technologies, a fundamentally new direction in the maintenance and delivery of medical care to the population emerged – telemedicine. Nowadays, it has become more than a novel promising technology, but already an essential component of modern healthcare, bringing a positive clinical, economic, moral, and organizational effectiveness. Nevertheless, there are a lot of aspects to the issue of telemedicine that are yet to be addressed in academic research.
The term “telemedicine” encompasses many telecommunication and information methods used in health care, as well as their various clinical applications. According to Annaswamy et al. (2020), the COVID-19 pandemic acted as the main drive for the adoption of telemedicine services into the healthcare industry all around the world. Pramanik et al. (2019) also claim that remote health monitoring is a less costly and efficient solution to the issue of constantly increasing demand in the healthcare sector. Currently, there are several factors that characterize this direction and are varied both in the degree of detailing of its features and in the substance of the technologies and directions included in it.
Undoubtedly, this is an inventive approach that combines medical databases and facilities in conjunction with communication and information devices that allow the examination, observation, and treatment of a patient in a remote way. AlKindi et al. (2020) provide an example in their research – telemedicine clinics proved to be a valuable tool for reducing the flow of renal transplant patients in the UAE hospitals during the COVID-19 pandemic. Elhennawy et al. (2021) report that, in UAE, telemedicine services proved to have a 99.4% accuracy in patient assessments. It can be concluded that UAE has successfully adopted telemedicine as a substantial part of the healthcare sector.
Telemedicine is a practical method of medical science associated with the growth and utilization in the practice of methods for remote delivery of medical care. Valentino et al. (2020) state that throughout the pandemic, telemedicine evolved to provide both regular care and emergency measures. Rockwell and Gilroy (2020) add that the use of telemedicine reduced human exposure to the infection and alleviated some of the stress the healthcare workers are experiencing in the face of the pandemic. Moreover, it can also be used for the exchange of specialized information based on the use of recent information and telecommunication equipment. The COVID-19 pandemic, indeed, has given a vital impetus to the development of telemedicine, which, as a promising area, can radically change the healthcare sector in the world. This research proposal aims to assess the characteristics of the Dubai population that had used telemedicine assistance before and during the COVID-19 pandemic.
The rationale for the Innovation for Dubai Healthcare Industry
The goal of telemedicine is to make quality medical care available to any person without regard to their location and social status. Telemedicine allows raising the efficiency of treatment and diagnostics to a new level in terms of quality. The effectiveness of telemedicine technologies has been proven by a number of studies and implemented operations in a number of nations. Thus, because of the use of information technologies in healthcare, additional opportunities have emerged for the use of new diagnostic and therapeutic approaches. They significantly widen the circle of people who are within outpatient supervision and decrease the number of patient attendances to the clinic. A new effective tool of modern medicine is personal, or home, telemonitoring of the patient’s medical state.
Moreover, telemedicine services are already actively used for COVID-19 detection and treatment in many countries. For example, if symptoms are detected in a patient during a consultation, specialists make a decision about an internal examination or hospitalization. Telemedicine made it possible to solve a key task: to ensure constant monitoring of the patient’s condition, as well as to remove part of the work from the outpatient link and prevent overloading the system. After examining and conducting the necessary research, ambulance doctors or polyclinics can make the decision on the hospitalization of the patient or the possibility of undergoing treatment at home. In the latter case, a patient with COVID-19 goes under the supervision of doctors at a telemedicine center and a healthcare facility. In addition, the doctors of the center can monitor the health of the population who participate in the post-registration study of a vaccine against coronavirus infection.
Primarily, it is vital to investigate the role of telemedicine during the pandemic. The data should be collected from the scientific articles published for the past five years to identify the tendency of telemedicine development. The necessary information to be gathered is the percentage of Dubai clinics that use telemedicine, the frequency of usage, and health outcomes. This part should be formed as a literature review consisting primarily of qualitative data. It is expected to collect the data at the first stages of the research before testing the hypothesis.
The specific objective is to evaluate the population groups of Dubai who had used the telemedicine services before and during the COVID-19 pandemic to find out the link between population and tendency to use telemedicine. The data obtained from all telemedicine consultations in Doctor for Every Patient system in the time period from January to February 2020 and from May to June 2020 will be assessed. The system will provide the age, nationality, gender, and major complaints of the patients who used the telemedicine services in the aforementioned time period for the assessment. The database also allows monitoring the ways in which certain demographics, such as age or gender, display specific user patterns of telemedicine. The ability to analyze which age, gender, or socio-economic groups use telemedicine services more frequently or in certain ways will allow for better insight into the implementation and utilization of the system. It is expected to obtain the necessary information by the beginning of April 2022, analyze it until the end of the same month, and submit the ready research by the end of May 2022.
The final objective refers to the data systematization and publishing of the results. At this step, all parts of the research are checked and proofread, the measurements are confirmed, and the formatting mistakes are fixed. This step should be conducted at the beginning of 2022 in order to correct minor imperfections and ensure the research is done properly. Ultimately, the paper is approved by the scientific advisor, defended, and published.
Central Research Question
The main question this research project aims to study refers to the characteristics of the patients who used the telemedicine services in Dubai before and during the COVID-19 pandemics. What are the main age, gender, and nationality of the patients who utilized telemedicine services in Dubai before and during the pandemic? The following hypothesis is proposed: the female population and younger generation groups utilize telemedicine services more frequently, according to prior findings, which are not fully evident in the Middle East literature (Abdool et al., 2021). However, the evidence that suggests as such is currently limited and requires further investigation in order to fully support the hypothesis. An additional research objective is to study the most common complaints the population of Dubai addresses the telemedicine services with.
Overview of Literature and Potential Theoretical Framework
There is quite a lot of research regarding the rise of telemedicine and especially its use during the COVID-19 pandemic. For example, Webster (2020) states that many countries today use the experience of China, which adopted the remote counseling services during the coronavirus outbreak in Wuhan. The United States was the second to implement the changes, and in March 2020, the Centers for Medicare and Medicaid Services released new regulations for the use of telemedicine. Bokolo (2020) reports that the U.S. government has issued specific legislation such as the Coronavirus Preparedness and Response Supplemental Appropriations Act to regulate the utilization of telemedicine during the pandemic. Audio and video solutions were implemented into the American healthcare system.
However, Asia remains one of the major players in the digital market. Thus, it is imperative to understand the needs of the existing and potential patients. Naik et al. (2021) offer an interesting insight into the issue, stating that targeted health education, positive communication, and modification of patient behavior are key factors for understanding the population’s perception of telemedicine. Kadir (2020) also reports that, with the use of telemedicine, the working time of healthcare professionals can be distributed more effectively, alleviating stress and mental health issues. People should be informed more about the opportunities, and advantages telemedicine offers in order to improve their perception of it.
Moreover, healthcare professionals should also be encouraged to improve their knowledge of telemedicine and digital health technologies. Modern information technologies, as well as factors of telemedicine, are encountered quite often in everyday medical procedures. However, the widespread implementation of telemedicine into health care should be intricate and systemic. In their study, Wernhart et al. (2019) surveyed healthcare workers on the use of telemedicine in their work, and the results proved that an intervention is needed. According to the authors (2019), participants, while demonstrating moderate knowledge of digital health technologies, expressed doubts about the usability and efficiency of these technologies. There is a significant gap in understanding telemedicine both on the side of healthcare professionals and patients, and countries all around the world should address it. Leite et al. (2020) also add that the lack of legal regulations in the field of telemedicine is another challenge the countries should resolve, especially regarding data protection, privacy, and inclusiveness issues. Thus, it can be concluded that the legal framework regarding telemedicine is a federal-level issue that should be resolved in the near future.
The problem of disparities patients experience when attempting to receive quality health care is another point of perspective. For example, according to Chunara et al. (2021), young female Black patients are most often at risk of discrimination when using telemedicine services in New York. Moreover, lower income and reduced household zip code size also present significant barriers to reaching healthcare. These issues are often culturally or nationality-specific and should be studied separately. Fluminghan et al. (2019) also concluded after researching all Cochrane systematic reviews related to telemedicine that more controlled and randomized trials are necessary for providing more factual evidence for this field. The studies in this field are the most current nowadays, as the need for telemedicine services rises exponentially all around the world.
As a result of the analysis of existing Dubai’s systems and platforms for providing assistance to the population and telemedicine consultations, the electronic medical system SALAMA was selected. SALAMA is a professional medical digital tool designed by the Dubai Healthcare Authority. The peculiarity of the platform lies in its relative simplicity and availability, as well as the possibility of widespread use in medical institutions of any level, which are its main advantages. As such, SALAMA may be used to collect all the data concerning telemedicine use and build an outline of features that influence the practical operations of telemedicine. This can be achieved through a stratified assessment of data that is categorized by demographics, time frames, locations, and other vital factors.
For the research, data of all patients (the total sample is 5,000 people) who used telemedicine consultations in the time period from January to February 2020 and from May to June 2020 will be extracted. The research too for data extraction will include age, gender, nationality, and major complaints of the patients – acute, chronic, or COVID-19-related. The patients who scheduled the appointment during the aforementioned time period but did not attend it will be excluded from the sample. The Excel sheet with the patient data – without any information that could be used for identification – will be transferred into the SPSS statistical analysis software package 24 for assessment.
Means and standard deviation will be used to summarize numerical variables, while counts and percentages will be used to summarize categorical variables. 95% confidence intervals for means and proportions will be calculated. A chi-squared test will be used to compare the percentage of the patients who attended the consultation before and after the medical institutions were open. For the sub-analysis, t-test or ANOVA will be used to compare the numerical variables between the subgroups, while the chi-squared test will be used to compare the categorical variables between the sub-groups. A p-value < 0.05 will indicate the statistical significance, and the tests will be characterized by a two-tailed feature.
Development from Existing Research
Research Project Innovation
In the face of the surge in coronavirus disease cases, doctors and global health care infrastructures are striving to adhere to treatment methods that remove the need for in-person meetings between patients and healthcare specialists. A special role in the fight against the pandemic was given to digital medical services, which provided remote consultations of doctors. These services made it possible not only to maintain social distance in hospitals and free specialists to fight the pandemic but also to provide psychological assistance remotely. A key area of telemedicine was identified, the development of which must be supported in the fight against the pandemic. For example, Al-Ahbabi and Ahmad (2021) report about the challenges the Al-Ain City Hospital, a government-owned facility, in UAE met when it decided to implement telemedicine services throughout the COVID-19 pandemic. The expansion of services for remote communication with a doctor in self-isolation for routine appointments and complaints must occur in the nearest future.
Some countries such as China, Russia, Spain, and the USA already offer to undergo primary visual testing for COVID-19 online. However, Waqas et al. (2021) report that Arab countries experience a lack of innovations regarding their healthcare industry, and many gaps in research are present here. AlGhufli et al. (2021) also state that the pandemic has severely impacted the mental health of frontline healthcare workers, and interventions should be made. The healthcare system is under enormous pressure nowadays, and telemedicine can help relieve some of the stress. Moazzami et al. (2020) claim that direct-to-consumer telemedicine can help physicians effectively assess patients with early symptoms of COVID-19 before hospitalization. Other diseases also have not gone anywhere, and doctors’ consultations are sometimes necessary for the patients. Meena et al. (2021), for example, state that non-communicable chronic diseases may become dangerous for the elderly population in the absence of communication with clinicians during the pandemic. Telemedicine could prove to be invaluable for such cases, as the threat of COVID-19 is not yet fully alleviated.
Moreover, with the use of telemetric features of implants, mobile transmitting devices, and the growth of database networks, monitoring of the patient’s condition has ceased to be limited to outpatient examination procedures in the clinic. Now it also covers the time between the patient’s visits to the clinic. For example, receiving data on dangerous episodes of arrhythmia and changes in therapy or on the state of the electro cardio therapy system, the doctor can make adjustments to the course of the patient’s treatment. If necessary, the patient could be called for an extraordinary outpatient examination. Therefore, for those who would like to receive a doctor’s consultation, telemedicine will be a good solution.
In order to provide the best quality of telemedicine services and tailor them to the cultural, age, and national background of patients, the characteristics of the patients who use telemedicine services must be studied. For example, Abdool et al. (2021) state that the population’s perception of telemedicine services and their efficiency is heavily related to the individual’s behavioral intentions to use them. Al-Samarraie et al. (2020) also add that there are certain cultural, financial, legal, and regulatory challenges that should be resolved in order for Middle East countries to fully implement telemedicine into their healthcare industries. This research will provide innovative insight into the patients’ characteristics, as well as their major complaints, that can be used for adjusting the existing telemedicine services.
The development and implementation of well-tailored telemedicine technologies in clinical practice is an urgent task aimed at increasing the level of medical care for the population. According to Ekbuli et al. (2021), patients who are at risk of leaving home –especially the elderly ones – may benefit from the use of telemedicine significantly. Moreover, it also allows the rational use of the infrastructure of medical institutions of various departmental subordination, interaction with medical services of other countries, as well as distance learning of medical personnel. Abugabah et al. (2020) say that, nowadays, the healthcare industry should collaborate with all possible stakeholders to make the most use of modern technologies. Timely reception of the necessary information about the state of health of patients, including primary data of examinations, will provide a comprehensive analysis of the situation in relation to both individual and public health. Telemedicine opens up fundamentally new opportunities for qualified medical advice to patients living in remote areas and who do not have the opportunity to travel frequently to a district or city hospital.
Planned or Implementation
This is planned research that will not require any intervention within the existing healthcare system in Dubai. The research is aimed at the assessment of the existing characteristics of the patients and their major complaints without influencing them, directly or not. Thus, no specific or additional means will be implemented before, during, or after the research, and only the previously stated hypotheses will be evaluated.
Need for Ethical Approval
This research has been ethically approved by the Dubai Health Authority, as it uses the personal data of the patients. It must be mentioned that all patient data will be saved in a protected directory, and only the researcher will have access to it. Moreover, no information that might be used for the identification of a patient’s persona will be transferred to the SPSS software for security reasons.
Progress to Date
This is a proposal for the project – it has been reviewed and approved before the start of actual research. Additionally, the project is fully planned, has a clear outline, methodology, theoretical framework, and is supported by factual evidence from peer-reviewed academic sources. The estimated date of the research beginning is the 2nd of February, 2022, and the estimated date of the research submission for review is the 11th of May.
Relationship to Existing Research and Innovations
The world healthcare industry has accumulated significant experience in the practical use of clinical telemedicine – teleconsulting in various disciplines, telemetry, and remote interpretation of diagnostic data. This experience has been reflected in numerous scientific works, articles, monographs, and dissertations. Moreover, in a number of countries, telemedicine procedures are financed by the obligatory health insurance system. However, the health-related illiteracy of patients might pose a significant challenge to the successful implementation of telemedicine services. Nair et al. (2020) state that more than 60 percent of the UAE population demonstrated inadequate health literacy, which often prevents them from addressing medical services. It is of crucial importance to study the population and its preferences related to health and medicine in order to provide the best quality care.
Moreover, clinicians and other healthcare specialists should also develop their knowledge about telemedicine services to promote them among the patients. Alhajri et al. (2021) conclude that audio and video consultations should be adopted for remote medical services provision, as they provide good outcomes for both patients and clinicians, as well as enhance their rapport. The Dubai Health Authority is currently working on the development of new and existing digital medical technologies. Thus, the insights that directly refer to the use of telemedicine services are of utmost importance for it. For example, AlSuwaidi and Moonesar (2021) claim that ease of use, usability, and usefulness are the most important factors influencing patients’ satisfaction with telemedicine services. This research takes on another approach, focusing more on the demographic characteristics of the population using telemedicine, as well as on the major complaints that come through the system.
Contribution to Knowledge
This research project provides valuable insights into the characteristics of the patients who primarily use telemedicine services in Dubai before and during the pandemic. Additionally, it emphasizes the need for continuous development of telemedicine through factual evidence from literature and analysis. It offers a new perspective on the demographics behind the users of telemedicine services in Dubai. Finally, the research also provides information on the most common health issues the population addresses through the SALAMA digital medical system.
Dissemination Plans and Publication
There are no clear plans for the future publication of this research yet, as it will start only in February 2022. However, after the project is completed, it will be submitted for review. In case the research is peer-approved, it will be next submitted for publication in the corresponding academic source. There are no estimated time periods for the research publication, as it has yet to be conducted, completed, and reviewed.
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