Telemedicine and mobile health with integrative medicine in developing countries

Knowledge of telemedicine and its associated factors among health professional in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Telemedicine is a useful tool for decreasing hospital stress, patient suffering, ambulance needs, hospital anxiety, and costs while improving the standard of care. Nonetheless, the lack of awareness regarding telemedicine poses a barrier to its application, presenting several difficulties in underdeveloped nations like Ethiopia. This review evaluates Ethiopian-specific telemedicine knowledge and associated factors.

METHODS

This systematic review was conducted using a search of several online databases in addition to the main databases, like Medline, PubMed, Scopus, and Science Direct. The writers have looked for, reviewed, and summarized information about telemedicine knowledge in the healthcare system. This study contained seven studies that examined telemedicine knowledge in the Ethiopian healthcare sector. Studies that followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) were found using search engines. The investigation was carried out using STATA version 11. The indicator of heterogeneity (I2) was used to assess the level of heterogeneity among the included studies. The funnel plot was visually inspected, and Egger's regression test was run to check for publication bias. The pooled effect size of every study is estimated using a random-effect model meta-analysis.

RESULTS

Examination of 2160 studies, seven studies involving 2775 health professionals, and seven out of the 2160 publications assessed satisfied the inclusion criteria and were added to the systematic review and meta-analysis. The pooled prevalence of Telemedicine knowledge was 45.20 (95% CI: 34.87-55.53). Whereas the pooled factor was computer training was 2.24 times (AOR = 2.24 (95%; CI: 1.64-3.08)), computer access was 2.07 times (AOR = 2.07 (95% CI: 1.50-2.87)), internet access was 3.09 times (AOR = 3.09 (95% CI: 1.34-7.13)), social media access were 3.09 times (AOR = 3.09(95%; CI: 1.34-7.13)), educational status degree and above were 2.73 times (AOR = 2.73; 95% CI: 0.85-8.82), Awareness were 3.18 times (AOR = 3.18 (95%; CI: 1.02-9.91)), Management support was 1.85 (AOR = 1.85 (95% CI: 01.25-2.75)), computer literacy were 2.90 times (AOR = 2.90 (95% CI: 1.81-4.64)), computer owner were 1.70 times (AOR = 1.70 (95% CI: 1.05-2.76)), male gender were 1.95 times (AOR = 1.95 (95% CI: 1.32-2.87)).

CONCLUSION

The overall pooled prevalence of telemedicine knowledge was low. Gender, education, management support, computer access, social media access, internet access, telemedicine awareness, and telemedicine training associated with telemedicine knowledge.

Telemedical Support Using Smartphones for Spine Surgery in Low- and Middle-Income Countries

Objective: Low- and middle-income countries (LMICs) face many challenges compared to industrialized nations, most notably in regard to the health care system. Patients often have to travel long distances to receive medical care with few reliable transportation mechanisms. In time-critical emergencies, this is a significant disadvantage. One specialty that is particularly affected by this is spine surgery. Within this field, traumatic injuries and acutely compressive pathologies are often time-critical. Increasing global networking capabilities through internet access offers the possibility for telemedical support in remote regions. Recently, high-performance cameras and processors became available in commercially available smartphones. Due to their wide availability and ease of use, this could provide a unique opportunity to offer telemedical support in LMICs. Methods: We conducted a feasibility study with a neurosurgical institution in east Africa. To ensure telemedical support, a commercially available smartphone was selected as the experimental hardware. Preoperatively, resolution, contrast, brightness, and color reproduction were assessed under theoretical conditions using a test chart. Intraoperatively, the image quality was assessed under different conditions. In the first step, the instrumentation table was displayed, and the mentor surgeon marked an instrument that the mentee surgeon should recognize correctly. In the next evaluation step, the surgical field was shown on film and the mentor surgeon marked an anatomical structure, and in the last evaluation step, the screen of the X-ray machine was captured, and the mentor surgeon again marked an anatomical structure. Subjective image quality was rated by two independent reviewers using the similar modified Likert scale as before on a scale of 1-5, with 1 indicating inadequate quality and 5 indicating excellent quality. Results: The image quality during the video calls was rated as sufficient overall. When evaluating the test charts, a quality of 97% ± 5 on average was found for the chart with the white background and a quality of 84% ± 5 on average for the chart with the black background. The color reproduction, the contrast, and the reproduction of brightness were rated excellent. Intraoperatively, the visualization of the instrument table was also rated excellent. Visualization of the operative site was rated 1.5 ± 0.5 on average and it was not possible to recognize relevant anatomical structures with the required confidence for surgical procedures. Image quality of the X-ray screen was rated 1.5 ± 0.9 on average. Conclusion: Current generation smartphones have high imaging performance, high computing power, and excellent connectivity. However, relevant anatomical structures during spine surgery procedures and on the X-ray screen in the operating room could not be identified with reliability to provide adequate surgical support. Nevertheless, our study showed the potential in smartphones supporting surgical procedures in LMICs, which could be helpful in other surgical fields.

Perception about Health Applications (Apps) in Smartphones towards Telemedicine during COVID-19: A Cross-Sectional Study

BACKGROUND

The use of health applications (apps) in smartphones increased exponentially during COVID-19. This study was conducted the with the aim to understand the factors that determine the consumer's perception of health apps in smartphones towards telemedicine during COVID-19 and to test any relation between these factors and consumers towards Telemedicine in India.

METHODS

This questionnaire-based cross-sectional study was conducted from July 2021 to December 2021 in India. Out of 600 selected participants, 594 responded and in that 535 valid questionnaires were measured. The questionnaire consists of close-ended responses, with the first part consisting of demographic information, the second part consisting of questions associated with consumers' perceptions and the third part kept for suggestions and complaints. The questionnaire was distributed using digital platforms via WhatsApp or email. A 5-point Likert scale, ranging from strongly agree' (5) to strongly disagree (1) was used to record responses.

RESULTS

Results revealed a high response rate of 90%. The highest score was obtained for the question assessing the satisfaction of the users towards health apps [1175 = 500 (agree-4) + 675 (Strongly agree-5)]. The interface of the app scored very low, showing disagreement (514) with app functionality, and was the most common disadvantage as perceived by patients. The mean scores of reliabilities and vicinity of health services; efficacy and comprehensive health information; development and improvement of health apps and telemedicine (3.24, 3.18, 3.62, 3.49), respectively, show the difference in attraction existing between groups. There is a strong positive correlation between the variables except for efficacy and comprehensive information about health and Telemedicine (-0.249), development and improvement of health apps, and reliability and vicinity of health services (-0.344) which have a negative correlation.

CONCLUSIONS

The findings of this survey reveal a positive outlook of health apps toward telemedicine. This research also found a strong forecaster of the consumer's perception of health apps in smartphones towards telemedicine. In the broad spectrum, the future of health app affiliates for telemedicine is better affected by the consumer's perception of health app efficacy. This study suggests that health app marketers develop more innovative apps to increase usage and help consumers.

eHealth: A Survey of Architectures, Developments in mHealth, Security Concerns and Solutions

The ramifications of the COVID-19 pandemic have contributed in part to a recent upsurge in the study and development of eHealth systems. Although it is almost impossible to cover all aspects of eHealth in a single discussion, three critical areas have gained traction. These include the need for acceptable eHealth architectures, the development of mobile health (mHealth) technologies, and the need to address eHealth system security concerns. Existing survey articles lack a synthesis of the most recent advancements in the development of architectures, mHealth solutions, and innovative security measures, which are essential components of effective eHealth systems. Consequently, the present article aims at providing an encompassing survey of these three aspects towards the development of successful and efficient eHealth systems. Firstly, we discuss the most recent innovations in eHealth architectures, such as blockchain-, Internet of Things (IoT)-, and cloud-based architectures, focusing on their respective benefits and drawbacks while also providing an overview of how they might be implemented and used. Concerning mHealth and security, we focus on key developments in both areas while discussing other critical topics of importance for eHealth systems. We close with a discussion of the important research challenges and potential future directions as they pertain to architecture, mHealth, and security concerns. This survey gives a comprehensive overview, including the merits and limitations of several possible technologies for the development of eHealth systems. This endeavor offers researchers and developers a quick snapshot of the information necessary during the design and decision-making phases of the eHealth system development lifecycle. Furthermore, we conclude that building a unified architecture for eHealth systems would require combining several existing designs. It also points out that there are still a number of problems to be solved, so more research and investment are needed to develop and deploy functional eHealth systems.

Traditional Medicine Use among Type 2 Diabetes Patients in KZN

Background. Traditional medicine (TM) is widely used in both developing and developed countries to assist in the attempt to curtail the prevalence and increase in diabetes mellitus. Approximately 53% of South Africans use TM to prevent and treat their diseases. There is no conclusive evidence regarding the safety and effectiveness of TM versus prescribed medicine. The most common therapies used by diabetics in Africa include herbal treatments, nutritional products, spiritual healing, and relaxation techniques. Therefore, this study aimed to evaluate the use of TM in patients with T2DM who are on chronic therapy and living in KwaZulu-Natal. Method. This cross-sectional study was conducted at a district hospital, in which purposive sampling was used to recruit participants and data were collected using a structured questionnaire. Information collected included demographic data, information pertaining to home remedies/TM, and self-care practices employed by participants while using TM. Data were analyzed using Pearson’s chi-squared test, t-test, and multivariate logistic regressions to determine predictors of TM usage. Results. Only 92 (27%) of 340 participants reported using TM, with Indians being the most frequent users (58.24%). Approximately, 83.72% (n = 72) used TM in conjunction with prescribed medication. Most participants (56.32%) acquired TM knowledge from family. The most frequently used TM was lemon and honey, Aloe vera, bitter gourd, green tea, and cinnamon. Traditional medicine use among African participants was 0.56 times (OR = 0.56, 95% CI = 0.34, 0.93) lower than Indian participants. There were no significant predictors for TM usage among the variables tested. Conclusion. A low prevalence rate of TM usage in T2DM patients was found. A significant correlation was noted between ethnicity and TM use. Large-scale studies are required to determine the additive and synergistic effects of TM in health care. Consideration should also be given to integrating TM into mainstream health care.

A financial inclusion app and USSD service for farmers in rural Colombia

This study reports the implementation of a financial inclusion app for farmers in rural Colombia. Stemming from the triple helix initiative, this study aims to make public financing instruments more readily available to farmers. Through a design science research approach, the app was collaboratively conceived, designed, implemented, and evaluated. We provide this reflective design as a case study of how a combination of triple helix collaboration, design science, and agile software development contributes toward the creation of context-oriented artefacts. The app could potentially benefit rural farmers to obtain information regarding the credit access, which is traditionally delivered in face-to-face meetings with bank staff. The findings provided evidence of the benefits and ease of use of the app, including certain affordances and constraints that are perceived by farmers. Moreover, factors such as technology literacy, experience using information and communication technologies (ICT), trust in technology, age of farmers, and mediation suggest that we should consider both material features of technology and social determinants for adoption in case of designing ICTs for rural communities.

Policy Implications of the Concept of Technological Catch-Up for the Management of Healthcare Sector in Developing Countries

The concept of technological catch-up can be used as a theoretical platform to design policies for the management of the healthcare sector in developing countries. In this article, initially, the factors affecting a technological catch-up process were collected through a conceptual literature review and prioritised using a fuzzy Delphi survey. The interdependences among important contributory factors were investigated as well. They were then used to create some policy recommendations for the management of the healthcare sector in developing countries through an interdisciplinary integration of the literature of technological catch-up and healthcare. Some exemplary projects/initiatives using these policies were collected too. The quality of human resources, a comprehensive knowledge management system, interactive learning and innovation-encouraging culture were rated as the most important contributing factors to an effectual technological catch-up in the healthcare sector in developing countries. Also, the creation of distributed health social networks, development of systematic knowledge management systems, forming strategic partnerships and designing path-creating technological catch-up processes by focusing on indigenous innovation were the final policy recommendations. All in all, the healthcare sector in developing countries should stop chasing frontiers, should try taking detours and flying a balloon by adopting a strategy of differentiation.

Testosterone replacement therapy in the era of telemedicine

The events of the 2019 SARS-CoV2 virus pandemic have all but ensured that telemedicine will remain an important aspect of patient care delivery. As health technologies evolve, so must physician practices. Currently, there is limited data on the management of testosterone replacement therapy (TRT) in the era of telemedicine. This review aims to explore the potential benefits and pitfalls of TRT management via telemedicine. We also propose a theoretical framework for TRT management via telemedicine. Telemedicine provides patients and physicians with a new mechanism for American Urological Association guideline-concordant TRT management that can increase patient access to care and provide a safe space for men who may otherwise not have been comfortable with in-person evaluation. However, there are significant limitations to the use of telemedicine for the management of TRT, including the inability to perform a physical exam, inability to administer specific medications, technological barriers, data security, and medical-legal considerations, and both patients and providers should engage in shared decision making before pursuing this approach. Understanding and acknowledging the potential pitfalls of telemedicine for TRT management will enable both patients and providers to achieve optimal outcomes and satisfaction.

Telemedicine for healthcare: Capabilities, features, barriers, and applications

Regular hospital visits can be expensive, particularly in rural areas, due to travel costs. In the era of the Covid-19 Pandemic, where physical interaction becomes risky, people prefer telemedicine. Fortunately, medical visits can be reduced when telemedicine services are used through video conferencing or other virtual technologies. Thus, telemedicine saves both the patient's and the health care provider time and the cost of the treatment. Furthermore, due to its fast and advantageous characteristics, it can streamline the workflow of hospitals and clinics. This disruptive technology would make it easier to monitor discharged patients and manage their recovery. As a result, it is sufficient to state that telemedicine can create a win-win situation. This paper aims to explore the significant capabilities, features with treatment workflow, and barriers to the adoption of telemedicine in Healthcare. The paper identifies seventeen significant applications of telemedicine in Healthcare. Telemedicine is described as a medical practitioner to diagnose and treat patients in a remote area. Using health apps for scheduled follow-up visits makes doctors and patients more effective and improves the probability of follow-up, reducing missing appointments and optimising patient outcomes. Patients should have an accurate medical history and show the doctor any prominent rashes, bruises, or other signs that need attention through the excellent quality audio-video system. Further, practitioners need file management and a payment gateway system. Telemedicine technologies allow patients and doctors both to review the treatment process. However, this technology supplements physical consultation and is in no way a substitute for a physical consultation. Today this technology is a safe choice for patients who cannot go to the doctor or sit at home, especially during a pandemic.

The development of the postpartum mobile support application and the effect of the application on mothers' anxiety and depression symptoms

OBJECTIVE

The study aimed to develop the postpartum mobile support application to support postpartum mothers and to examine the effects of the use of mobile app on mothers' anxiety level and depression symptoms.

RESEARCH DESIGN/SETTING

It is a parallel group pretest-posttest randomized controlled study carried out between July 2017 and February 2020. The mothers (62 in the experiment and 62 in the control group) who gave birth in full-term at a university hospital in Konya province in Turkey and who had healthy newborns constituted the study group. Data were collected using the Information Form, the STAI State and Continuity Anxiety Scale, and the Edinburgh Postpartum Depression Scale. Mixed pattern variance analysis (mixed anova), t test in dependent groups, t test and chi square analysis in independent groups were used to analyze the data.

FINDINGS

Most of the mothers who used the application fed their baby only with breast milk and felt more sufficient about breastfeeding. The depression symptoms of mothers using the postpartum mobile support application was lower than that of the mothers in the control group; however, it was found that the application was not adequate alone to decrease anxiety levels and depression symptoms (p > 0.05).

CONCLUSIONS

The postpartum mobile support application is an important and useful source in accessing reliable information; however, it was found to be insufficient to lower anxiety levels and prevent depression symptoms at the end of the six-week postpartum period.

Design and comparison of scheduling strategy for teleconsultation

BACKGROUND

Telemedicine is playing an increasingly more important role in disease diagnosis and treatment. The market of telemedicine application is continuously promoted, thus bringing some issues on telemedicine operations management.

OBJECTIVE

We aimed to compare the teleconsultation scheduling performance of newly designed proactive strategy and existing static strategy and explore the decision-making under different conditions.

METHODS

We developed a discrete-event simulation model based on practical investigation to describe the existing static scheduling strategy of teleconsultation. The static strategy model was verified by comparing it with the historical data. Then a new proactive strategy was proposed, whose average waiting time, variance of waiting time and completed numbers were compared with the static strategy.

RESULTS

The analysis indicated that the proactive strategy performed better than static under the current resource allocation. Furthermore, we explored the impact on the system of both strategies varying arrival rate and experts' shift time.

CONCLUSIONS

Under different shift times and arrival rates, the managers of telemedicine center should select different strategy. The experts' shift time had a significant impact on all system performance indicators. Therefore, if managers wanted to improve the system performance to a greater extent, they needed to reduce the shift time as much as possible.

Telemedicine and e-Health research solutions in literature for combatting COVID-19: a systematic review

COVID-19 had led to severe clinical manifestations. In the current scenario, 98 794 942 people are infected, and it has responsible for 2 124 193 deaths around the world as reported by World Health Organization on 25 January 2021. Telemedicine has become a critical technology for providing medical care to patients by trying to reduce transmission of the virus among patients, families, and doctors. The economic consequences of coronavirus have affected the entire world and disrupted daily life in many countries. The development of telemedicine applications and eHealth services can significantly help to manage pandemic worldwide better. Consequently, the main objective of this paper is to present a systematic review of the implementation of telemedicine and e-health systems in the combat to COVID-19. The main contribution is to present a comprehensive description of the state of the art considering the domain areas, organizations, funding agencies, researcher units and authors involved. The results show that the United States and China have the most significant number of studies representing 42.11% and 31.58%, respectively. Furthermore, 35 different research units and 9 funding agencies are involved in the application of telemedicine systems to combat COVID-19.

Telemedicine Practice: Review of the Current Ethical and Legal Challenges

Background: Telemedicine involves medical practice and information and communications technology. It has been proven to be very effective for remote health care, especially in areas with poor provision of health facilities. However, implementation of these technologies is often hampered by various issues. Among these, ethical and legal concerns are some of the more complex and diverse ones. In this study, an analysis of scientific literature was carried out to identify the ethical and legal challenges of telemedicine. Materials and Methods: English literature, published between 2010 and 2019, was searched on PubMed, Scopus, and Web of Science by using keywords, including "Telemedicine," "Ethics," "Malpractice," "Telemedicine and Ethics," "Telemedicine and Informed consent," and "telemedicine and malpractice." Different types of articles were analyzed, including research articles, review articles, and qualitative studies. The abstracts were evaluated according to the selection criteria, using the Newcastle-Ottawa Scale criteria, and the final analysis led to the inclusion of 22 articles. Discussion: From the aforementioned sample, we analyzed elements that may be indicative of the efficacy of telemedicine in an adequate time frame. Ethical aspects such as informed consent, protection data, confidentiality, physician's malpractice, and liability and telemedicine regulations were considered. Conclusions: Our objective was to highlight the current status and identify what still needs to be implemented in telemedicine with respect to ethical and legal standards. Gaps emerged between current legislation, legislators, service providers, different medical services, and most importantly patient interaction with his/her data and the use of that data.

Nano-MOFs as targeted drug delivery agents to combat antibiotic-resistant bacterial infections

The drug resistance of bacteria is a significant threat to human civilization while the action of antibiotics against drug-resistant bacteria is severely limited owing to the hydrophobic nature of drug molecules, which unquestionably inhibit its permanency for clinical applications. The antibacterial action of nanomaterials offers major modalities to combat drug resistance of bacteria. The current work reports the use of nano-metal-organic frameworks encapsulating drug molecules to enhance its antibacterial activity against model drug-resistant bacteria and biofilm of the bacteria. We have attached rifampicin (RF), a well-documented antituberculosis drug with tremendous pharmacological significance, into the pore surface of zeolitic imidazolate framework 8 (ZIF8) by a simple synthetic procedure. The synthesized ZIF8 has been characterized using the X-ray diffraction (XRD) method before and after drug encapsulation. The electron microscopic strategies such as scanning electron microscope and transmission electron microscope methods were performed to characterize the binding between ZIF8 and RF. We have also performed picosecond-resolved fluorescence spectroscopy to validate the formation of the ZIF8-RF nanohybrids (NHs). The drug release profile experiment demonstrates that ZIF8-RF depicts pH-responsive drug delivery and is ideal for targeting bacterial disease corresponding to its inherent acidic nature. Most remarkably, ZIF8-RF gives enhanced antibacterial activity against methicillin-resistant Staphylococcus aureus bacteria and also prompts entire damage of structurally robust bacterial biofilms. Overall, the present study depicts a detailed physical insight for manufactured antibiotic-encapsulated NHs presenting tremendous antimicrobial activity that can be beneficial for manifold practical applications.

How Resource Scarcity and Accessibility Affect Patients' Usage of Mobile Health in China: Resource Competition Perspective

BACKGROUND

The last decade has witnessed many achievements in China's health care industry, but the industry still faces major challenges among which the uneven distribution of medical resources and the imbalance between supply and demand are the most pressing problems. Although mobile health (mHealth) services play a significant role in mitigating problems associated with health care delivery, their adoption rates have been low.

OBJECTIVE

The objective of this study was to explore the impact of resource scarcity and resource accessibility on the adoption of mHealth from the perspective of resource competition, to examine the concerning factors, and to provide a theoretical basis for promoting mHealth in China.

METHODS

We used 229,516 original registration records of outpatients to conduct an empirical analysis to examine the adoption of mHealth services from the perspective of resource competition.

RESULTS

The adoption rate of mobile services for outpatients was low, accounting for only 31.5% (N=71,707). The empirical results indicated that resource scarcity (beta=.435, P=.01) and accessibility (beta=-.134, P=.02) have a significant impact on the adoption of mHealth. In addition, gender (beta=.073, P=.01) and age (beta=-.009, P<.001) are significantly related to adoption of mHealth. Experience with mHealth has a moderating role in the relationship between resource scarcity (beta=-.129, P=.02), accessibility (beta=.138, P=.04), and adoption of mHealth.

CONCLUSIONS

In this study we demonstrate that the external environment (resource scarcity and resource accessibility) has a significant impact on the adoption of mHealth. This study also demonstrates that experience with mHealth has a moderating role in the relationship between the elements of the external environment. Finally, we confirm that mHealth is a key factor in the delivery and allocation of medical resources and provide a theoretical basis for government agencies to develop policies on mHealth.

Mobile health solutions in developing countries: a stakeholder perspective

Infrastructural deficiencies, limited access to medical care, and shortage of health care workers are just a few of the barriers to health care in developing countries. mHealth has the potential to overcome at least some of these challenges. To address this, a stakeholder perspective is adopted and an analysis of existing research is undertaken to look at mHealth delivery in developing countries. This study focuses on four key stakeholder groups i.e., health care workers, patients, system developers, and facilitators. A systematic review identifies 108 peer-reviewed articles, which are analysed to determine the extent these articles investigate the different types of stakeholder interactions, and to identify high-level themes emerging within these interactions. This analysis illustrates two key gaps. First, while interactions involving health care workers and/or patients have received significant attention, little research has looked at the role of patient-to-patient interactions. Second, the interactions between system developers and the other stakeholder groups are strikingly under-represented.

Telemedicine framework using case-based reasoning with evidences

Telemedicine is the medical practice of information exchanged from one location to another through electronic communications to improve the delivery of health care services. This research article describes a telemedicine framework with knowledge engineering using taxonomic reasoning of ontology modeling and semantic similarity. In addition to being a precious support in the procedure of medical decision-making, this framework can be used to strengthen significant collaborations and traceability that are important for the development of official deployment of telemedicine applications. Adequate mechanisms for information management with traceability of the reasoning process are also essential in the fields of epidemiology and public health. In this paper we enrich the case-based reasoning process by taking into account former evidence-based knowledge. We use the regular four steps approach and implement an additional (iii) step: (i) establish diagnosis, (ii) retrieve treatment, (iii) apply evidence, (iv) adaptation, (v) retain. Each step is performed using tools from knowledge engineering and information processing (natural language processing, ontology, indexation, algorithm, etc.). The case representation is done by the taxonomy component of a medical ontology model. The proposed approach is illustrated with an example from the oncology domain. Medical ontology allows a good and efficient modeling of the patient and his treatment. We are pointing up the role of evidences and specialist's opinions in effectiveness and safety of care.

Combining conceptual graphs and argumentation for aiding in the teleexpertise

Current medical information systems are too complex to be meaningfully exploited. Hence there is a need to develop new strategies for maximising the exploitation of medical data to the benefit of medical professionals. It is against this backdrop that we want to propose a tangible contribution by providing a tool which combines conceptual graphs and Dung׳s argumentation system in order to assist medical professionals in their decision making process. The proposed tool allows medical professionals to easily manipulate and visualise queries and answers for making decisions during the practice of teleexpertise. The knowledge modelling is made using an open application programming interface (API) called CoGui, which offers the means for building structured knowledge bases with the dedicated functionalities of graph-based reasoning via retrieved data from different institutions (hospitals, national security centre, and nursing homes). The tool that we have described in this study supports a formal traceable structure of the reasoning with acceptable arguments to elucidate some ethical problems that occur very often in the telemedicine domain.