## 3 Results and Discussion
### Topic 3: Innovative Models of Healthcare Delivery
#### 3.4.1 Telehealth and Telemedicine  
In 2015, [PERSON] et al. reported on a remote healthcare strategy designed for the delivery of healthcare for offshore oil and gas operations in the Arctic [43]. The innovation of this model related to an integrated system whereby a 'virtual doctor's office' was established on-site, with links to a hospital. In this setting, the virtual doctor's office included lab testing, X-rays, and ultrasound equipment. The on-site physician then communicated with onshore specialists to support decision-making and patient care. The report highlighted that 22% of medevacs could have been prevented and 72% of medevacs would have led to better and safer patient management if the telehealth system had been used. Similar data reported by [PERSON] et al. [44] found that 39% of patients from offshore facilities could have been treated by telemedicine without being evacuated. Data comparing the frequency of medical evacuations between locations with and without telehealth available reported that the odds of success for medical evacuations were around three times higher (odds ratio = 2.9-3.6) if no telehealth was available [45]. In addition to lower rates of medical evacuations, it has also been reported that oil-rig workers treated via telemedicine were generally satisfied (98%), and employees felt that the provision of telehealth services improved both morale and perceived productivity, as well as making workers feel that the company cared about them being in a remote environment [46]. A number of similar models have successfully utilised other health professionals (non-physicians) to deliver remote healthcare and have also reported favourable outcomes. [PERSON] et al. [47] explored the feasibility of remotely supported ultrasound completed by paramedics. Paramedics completed ultrasounds in simulated trauma situations and were supported by satellite communications (image transmission and expert guidance). Using this approach, they were able to obtain appropriate scans in 94% of cases [47]. Similar findings were reported by [PERSON] et al. [48], whereby paramedics without ultrasound experience were able to capture images in a trauma situation in under five minutes, when they had remote guidance. It has also been demonstrated that such systems can be used to support medication delivery. In one example, 14 oil rigs were given thrombol drugs. Paramedics on the rigs were trained to deliver the drugs, and the rigs also were suppliedwith ECG machines which transmitted data via email. After implementation, 47 cases of chest pain were handled via telemedicine over a 3-year period, but only 13% needed evacuation to shore [49]. [PERSON] et al. [50] report that historically, the use of the telephone for specialist consults meant that patients were often transported to 'be safe'; however, with recent technological innovations and the consultant being able to see the patient and obtain data (e.g., vitals), decision-making and patient care are improved and transfers may be avoided. Most data relating to the virtual doctor's office and similar models have been positive; however, in more extreme remote operations, the possibility for lower-quality telemedicine has been documented [51]. In a systematic review of telemedicine in maritime and extreme weather contexts, it was reported that poor communication networks can impact the quality of telemedicine, and that the distance of medical evacuations, if required, remains a concern [51]. Integrating telemedicine systems into healthcare still presents a number of challenges. These challenges include managing offshore/onshore medical professionals, patient transport, equipment for both collaboration and examinations, rules/regulations, and modifying past ways of working [52]. As such, clear implementation strategies and monitoring processes are essential, and such models should be used to support rather than replace other healthcare strategies [53].