Systematic Review: Telemedicine Solutions in Saudi (2000–2023)

Abstract

A systematic review of telemedicine in Saudi Arabia between 2000 and 2023 was used to identify its effectiveness, focusing on four research objectives. In the first objective, the study identified telemedicine’s high adoption and utilization in Saudi Arabia. In the second objective, the study reports challenges such as lack of training, legal requirements, cultural aspects, and limited information. The paper points to a high patient satisfaction rate and improved patient outcomes in the third objective. In the fourth objective, the prospects of telemedicine include artificial intelligence and machine learning. Further, there is continued government support through Vision 30, which seeks to improve healthcare. The practical implications include bridging the gap between the rural and the urban. Further studies need to consider the different cultures in different countries and how they influence telemedicine use, adoption and implementation.

Key Words: telemedicine, e-health, technology, Saudi Arabia

Systematic Review: Telemedicine Solutions in Saudi (2000-2023)

Introduction and Background

The review investigates the country’s adoption, challenges, patient outcomes and prospects associated with telemedicine solutions. Previous studies have suggested that telemedicine is an efficient tool for reducing unnecessary hospital visits, which ensures faster specialist care for the patients who need it the most (Langabeer et al., 2017). This uses social sites, with WhatsApp being popular in Saudi Arabia (Kaliyadan et al., 2020). However, there are concerns regarding the lack of integration with standard forms such as digital imaging and communications in medicine, misuse and data confidentiality (Kaliyadan et al., 2016).

The research question is: Is telemedicine an effective intervention in Saudi Arabia?

Methodology

The paper took a systematic review approach to identify credible and relevant articles to answer the research question. The systematic review relied on the Systematic Review checklist and Reporting Items for Systematic Elements of Meta-Analysis Protocols (PRISMA-P) to provide guidelines for the study preparation (Liberati et al., 2009). The search strategy involved electronic databases such as Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar and MEDLINE (PubMed). The inclusion and exclusion criteria are shown in Table 1. The keywords used include Saudi Arabia, e-health, and technology, telemedicine, e-health, technology, Saudi Arabia.

Table 1: inclusion-Exclusion Criteria

Systematic Review

Telemedicine Adoption and Utilization

The study by Kaliyadan et al. (2020) found that there were positive attitudes towards the adoption and utilization of telemedicine in Saudi. However, physicians in the country questioned the need for more clarity regarding telemedicine. Currently, Saudi has developed and implemented guidelines on the use of telemedicine (Ministry of Health-Saudi Arabia, 2022). El-Mahalli et al. (2012) state that the Saudi government has allocated a considerable budget for e-health, which indicates the promising future of telemedicine in the country. In contrast, the authors also point out that health professionals have low adoption compared to the high interest among non-adopters. On utilization, Kaliyadan et al. (2020) reported low resistance to change among health professionals. Usually, resistance can be due to diagnostic reliability, patient acceptance, lack of clarity on legal frameworks and technological issues. Albarrak et al. (2021) state that most health professionals have a smartphone or smart device to communicate with patients via social media or email. Further, the participants involved in the study showed positive perceptions of telemedicine and were willing to adopt it for medical practice.

Barriers and Challenges

El-Mahalli et al. (2012) reported using limited telemedicine modalities in Saudi Arabia. Also, health providers identify a need for knowledge about telemedicine as the most significant barrier to its adoption in Saudi Arabia. This corroborates Albarrak et al.’s (2021) study, which found that most medical practitioners in Saudi Arabia need more knowledge of telemedicine technology. El-Mahalli et al. (2012) recommend focused and proper training of stakeholders and dissemination of information about telemedicine. On the other hand, Kaliyadan et al. (2020) point out that gender plays a critical role in Saudi Arabia. For instance, female patients might be uncomfortable sharing images for teleconsultations or video consultations. Therefore, Kaliyadan et al. (2020) recommend the consideration of the local cultural context. Kaliyadan et al. (2013) report that during a study on tele-dermatology, some of the patients refused photography, with the highest percentage being females (2 males and 21 females). Some of the reasons identified by the patients were religious or social. Albarrak et al. (2021) include other barriers, such as cost, lack of training, and privacy issues, as significant hindrances to telemedicine adoption in Saudi Arabia. According to Albarrak et al. (2021), this can be solved by enhancing awareness through training, seminars, and workshops.

Patient Satisfaction and Outcomes

A study by Al-Sofiani (2021) identified high satisfaction among Saudi patients who were using telemedicine. Further, the study reported that telemedicine was critical in controlling glucose among patients. These findings are supported by Kaliyadan et al. (2013), where the participants reported high satisfaction with using a 4G smartphone for mobile tele-dermatology. According to El-Mahalli et al. (2012), some benefits include providing patient care and management, enhancing access to healthcare, and improving the quality of care.

Telemedicine Prospects

According to Alaboudi et al. (2016), telehealth initiatives in Arabia date back to the early 2000s. The government’s main aim was to bridge the healthcare gap between the rural and the urban areas. One of the initiatives was the ‘Telemedicine Project’ in 2011, which focused on monitoring, treating and diagnosing patients from a distance (Albarrak et al., 2021). Further, Saudi Vision 2030 has pointed out the importance of telehealth in achieving quality healthcare services (Vision 2030, 2016). The expansive embrace of telehealth in Saudi shows the country’s commitment towards integrating technology solutions (Al Ballharith et al., 2022). According to Almutairi et al. (2023), the forward-looking considerations of telehealth in Saudi Arabia are shaped by a combination of strategic policy directions, evolving societal needs and technological advancements.

First, there are expectations of significant advancements in the technology underpinning telehealth. Machine learning and artificial learning (AI) offer exciting prospects for enhanced diagnostic accuracy, personalized treatment plans and predictive analytics (Waqas et al., 2021). According to Qaffas et al. (2021), in the future, it is expected that telemedicine platforms in Saudi Arabia will employ algorithms to analyse patient data and predict potential health issues before they turn critical. In addition, Almutairi et al. (2023) predict there will be the use of AI-driven chatbots for patient screening. Second, the Saudi population has grown to accept the Internet of Things (IoT) and wearable technology devices (Qaffas et al., 2021). These devices administer medications, track physical activities and monitor vital signs. On a societal lens, a growing population of tech-savvy and younger generation has become the primary demographic seeking medical services (Almutairi et al., 2023). Hence, it is expected that there will be an amplification of telehealth services. Third, policy-wise, Saudi Arabia’s Vision 2030 has provided the guidelines and infrastructure development for digital transformation in healthcare (Vison 2030, 2016). As telemedicine continues to grow in Saudi Arabia, the country will introduce more comprehensive regulations focusing on virtual care quality, data security, and patient safety.

Conclusion

The paper reviewed telemedicine in Saudi Arabia using a systematic review as the research methodology—the systematic review aimed to identify the effectiveness of telemedicine in Saudi Arabia. The identified scholarly articles point to the high adoption and utilization of telemedicine. This is seen in the positive perception among medical professionals. In addition, the professionals who have reported owning smart devices are using them to communicate with patients. Second, the paper found challenges and barriers such as limited knowledge, cultural aspects, privacy issues, cost and lack of training. Some mitigation measures identified include training (through seminars and workshops), dissemination of information, and consideration of cultural issues during implementation. Third, the paper identified high satisfaction among the patients who used telemedicine. The benefits included improved healthcare and enhanced patient management. Finally, the paper identified the prospects of telemedicine, including the use of algorithms in telemedicine, wearable devices and government support through Saudi Vision 2030. The systematic review recommends further study that compares the cultural context of different countries in the adoption and utilization of telemedicine.

References

Al Baalharith, I., Al Sherim, M., Almutairi, S. H. G., & Albaqami, A. S. A. (2022). Telehealth and transformation of nursing care in Saudi Arabia: a systematic review. International Journal of Telemedicine and Applications, 2022. https://www.hindawi.com/journals/ijta/2022/8426095/

Alaboudi, A., Atkins, A., Sharp, B., Balkhair, A., Alzahrani, M., & Sunbul, T. (2016). Barriers and challenges in adopting Saudi telemedicine network: The perceptions of decision makers of healthcare facilities in Saudi Arabia. Journal of infection and public health, 9(6), 725-733. https://www.sciencedirect.com/science/article/pii/S1876034116301393

Albarrak, A. I., Mohammed, R., Almarshoud, N., Almujalli, L., Aljaeed, R., Altuwaijiri, S., & Albohairy, T. (2021). Assessment of physician’s knowledge, perception and willingness of telemedicine in Riyadh region, Saudi Arabia. Journal of infection and public health, 14(1), 97-102. https://doi.org/10.1016/j.jiph.2019.04.006

Almutairi, A. G., Almutairi, S. A., Almutairi, A. A., Althobaiti, N. N. H., Alrashedi, K. A. T., & Alotaibi, M. F. (2023). Telehealth in Saudi Arabia: Its Evolution, Present Infrastructure, and Forward-Looking Implications. Global Journal of Health Science, 15(12), 53-57. DOI:10.5539/gjhs.v15n12p53

Al-Sofiani, M. E., Alyusuf, E. Y., Alharthi, S., Alguwaihes, A. M., Al-Khalifah, R., & Alfadda, A. (2021). Rapid implementation of a diabetes telemedicine clinic during the coronavirus disease 2019 outbreak: our protocol, experience, and satisfaction reports in Saudi Arabia. Journal of Diabetes Science and Technology, 15(2), 329-338. https://journals.sagepub.com/doi/abs/10.1177/1932296820947094

El-Mahalli, A. A., El-Khafif, S. H., & Al-Qahtani, M. F. (2012). Successes and challenges in the implementation and application of telemedicine in the eastern province of Saudi Arabia. Perspectives in health information management/AHIMA, American Health Information Management Association, 9(Fall). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510649/

Qaffas, A. A., Hoque, R., & Almazmomi, N. (2021). The internet of things and big data analytics for chronic disease monitoring in Saudi Arabia. Telemedicine and e-Health, 27(1), 74-81. https://doi.org/10.1089/tmj.2019.0289

Kaliyadan, F., Al Ameer, M. A., Al Ameer, A., & Al Alwan, Q. (2020). Telemedicine practice in Saudi Arabia during the COVID-19 pandemic. Cureus, 12(12). doi: 10.7759/cureus.12004

Kaliyadan, F., Ashique, K. T., Jagadeesan, S., & Krishna, B. (2016). What’s up dermatology? A pilot survey of the use of WhatsApp in dermatology practice and case discussion among members of WhatsApp dermatology groups. Indian Journal of Dermatology, Venereology and Leprology, 82, 67. https://ijdvl.com/article?issn=0378-6323;year=2016;volume=82;issue=1;spage=67;epage=69;aulast=Kaliyadan

Kaliyadan, F., Amin, T. T., Kuruvilla, J., & Ali, W. H. A. B. (2013). Mobile tele-dermatology: Patient satisfaction, diagnostic and management concordance, and factors affecting patient refusal to participate in Saudi Arabia. Journal of Telemedicine and Telecare, 19(6), 315-319. https://doi.org/10.1177/1357633X13501778

Langabeer, J. R., Champagne-Langabeer, T., Alqusairi, D., Kim, J., Jackson, A., Persse, D., & Gonzalez, M. (2017). Cost–benefit analysis of telehealth in pre-hospital care. Journal of Telemedicine and Telecare, 23(8), 747-751. https://journals.sagepub.com/doi/abs/10.1177/1357633×16680541

Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., … & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals of Internal Medicine, 151(4), W-65. https://doi.org/10.7326/0003-4819-151-4-200908180-00136

Ministry of Health. (2022). Legal regulations for telehealth services.https://www.moh.gov.sa/en/Ministry/Rules/Documents/Legal-Regulations-for-Telehealth-Services.pdf

Vision 2030. (2016). Vision 2030 Kingdom of Saudi Arabia. https://www.vision2030.gov.sa/

Waqas, A., Mehmood, S., Jawwad, A. M., Pittam, B., Kundu, S., Correia, J. C., & AlMughamis, N. (2021). Telemedicine in Arab countries: innovation, research trends, and way forward. Frontiers In Digital Health, 2, 610837. https://www.frontiersin.org/journals/digital-health/articles/10.3389/fdgth.2020.610837/full