Global Telemedicine Project Survey
Please answer the following questions each month regarding how you used telemedicine in the past three months. This survey should take between 10-15 minutes. We are trying to collect information about how telemedicine is used at your project site and gather evidence of project impacts.
Please enter the MONTH and YEAR for which you are filling this survey out for. For which MONTH and YEAR are you filling out this survey?
Month
*
Please Select
January
February
March
April
May
June
July
August
September
October
November
December
Year
*
Please Select
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
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2009
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1926
1925
Project Site Name Please choose the project site from the list below for which you are filling this survey out for.
*
Please Select
Rock Sound Clinic, Rock Sound, Bahamas
Fudan Children's Hospital, Shanghai, China
Centre de Telemedicine Haiti, Port Au Prince, Haiti
Nirmal Health Services, Nahan, India
Paras Hospitals, Panchkula, India
Bhaktapur Cancer Hospital, Bhaktapur, Nepal
Jumla Hospital, Jumla, Nepal
Gangalal Heart Center, Kathmandu, Nepal
Institute of Medicine/TUTH, Kathmandu, Nepal
Model, Kathmandu, Nepal
Nepal National Hospital, Kathmandu, Nepal
Kavre, Nepal
Yeti, Kathmandu, Nepal
Mugling Highway, Mugling, Nepal
Jos University Teaching Hospital, Jos, Nigeria
FMC Yenagoa, Yenagoa, Nigeria
Zamboanga City Medical Center, Zamboanga City, Philippines
Shyira District Hospital, Nyabihu, Rwanda
Bugando, Tanzania
Shirati, Tanzania
Kabale District Hospital, Kabale, Uganda
Chidamoyo, Karoi, Zimbabwe
Project Site Name
Location
ZC Jail
San Ramon Corrections Facility
Mahayag Municipal Hospital
Name
*
First Name
Last Name
Position/Title (role in this project)
Are you filling this out for yourself or for others? If choosing "other", please fill out who you are completing this survey for and give the number of people or size of unit (for example: Dr. Prakash, 1).
*
Self
Other
Have you conferred with another doctor about a patient using telemedicine contact in this past month?
*
Yes
No
Have you used telemedicine technology in this past month?
*
Yes
No
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Did not use telemedicine
Telemedicine technology was not used in this past month for patient encounters.
Please let us know the reason(s) why you are have not used telemedicine technology in this past month (i.e. barriers you face that prevent the use of telemedicine).
*
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Use of Telemedicine (Over the Past Month)
Telemedicine technology was used this past month for patient encounters.
How often this past month have you used telemedicine technology (i.e. Kubi, Butterfly IQ, etc.)?
*
0 times
1-4 times (about once a week)
5-15 (multiple times a week)
16-30 (daily)
N/A
Kubi
Butterfly IQ
Digital Stethoscope
Other
Kubi How often this past month have you used telemedicine technology
Butterfly How often this past month have you used telemedicine technology
Digital stethoscope How often this past month have you used telemedicine technology
Other How often this past month have you used telemedicine technology
Did you use the Butterfly IQ+ for any of the following? Please check all that apply.
*
Obstetrics
Pelvis
Abdomin
Cardiology
Tumors
Arteries
Musculoskeletal
Kidneys
Women's Health
Scrotum
Bladder
COVID-19
Anesthesiology
Other
Please provide a list of doctors, specialties, and their affiliate hospitals you have consulted with regarding to the ultrasound images. If no one was consulted, please respond None.
*
Provide a list
None
Please provide a list of doctors, specialties, and their affiliate hospitals you have consulted with regarding to the ultrasound images.
In the last month, how many patients have been referred to other hospitals? Please list the names of those hospitals. If no one was referred, please respond None
*
Provide a list
None
In the last month, how many patients have been referred to other hospitals? Please list the names of those hospitals.
Did you utilize the training offered by Butterfly Network? https://www.butterflynetwork.com/education
*
Yes
No
How many Doctors have been trained in total? Have there been any new trainings in this last month?
How many Nurses have been trained in total? Have there been any new trainings in this last month?
Are there any comments available regarding the training?
How many times did you request technical support from the Butterfly Network?
*
Are there any pictures of healthcare workers using the Butterfly IQ+.
*
Yes
No
Please email (ghoncheh.angha@globaloffsitecare.org) and upload any pictures of healthcare workers using the Butterfly IQ+. These pictures will be submitted to the Butterfly Network as part of their Global Health Program.
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If you filled out "other" in the previous question, please provide what telemedicine technology you use.
How many different physicians/staff members use the technology out of the total physicians/staff members you have? (e.g., 10/130)
*
How satisfied are you (or the people) with using telemedicine technology to care for patients in this last month?
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Not satisfied at all
1
2
3
4
Very satisfied
5
1 is Not satisfied at all, 5 is Very satisfied
How satisfied are you (or the people) with using telemedicine technology to care for patients in this last month?
Please use this space to provide any comments about your satisfaction response.
Did you provide a telemedicine appointment this past month for any patients who are considered socioeconomically disadvantaged or part of an underserved community?
*
Yes
No
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Served Disadvantaged/Underserved
Patients who are considered part of a disadvantaged or underserved population were served using telemedicine technology during this past month.
What percentage of patients who were not able to pay were served using telemedicine in this past month?
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For what percentage of patients were you able to use telemedicine to save them from traveling a long distance (e.g., more than an hour) to a hospital to see a specialist in this last month?
*
Back
Next
Training
Training for use of telemedicine technology during a patient encounter was conducted during this past month.
Were any training sessions held this past month?
*
Yes
No
Back
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Conducted Training in the Past Month
How many people were trained this last month?
*
What is the total number of people trained at your project site?
*
What percentage of people are trained at your project site?
*
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Teleconsults
A teleconsult is when an attending physician contacts a doctor who is not physically present using a phone or internet connected device to get advice.
Did you conduct any teleconsults (i.e. when an attending physician contacts a doctor who is not physically present using a phone or internet connected device to get advice) this month?
*
Yes
No
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Teleconsults Conducted
How many teleconsults were conducted in this past month?
*
How much did the teleconsult(s) reduce the morbidity of the patient(s) overall in this past month?
*
None
Some
A lot
Did using the telemedicine technology reduce the amount of time it took to get a teleconsult in this past month?
*
Yes, it reduced the amount of time
No, it increased the amount of time
It was about the same amount of time
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Communication
Was communication with your healthcare team made better, worse, or the same using telemedicine technology in this past month?
*
Better
Worse
Same
Back
Next
Communication was Better
How much better did using the telemedicine technology improve the communication with your healthcare team?
*
Not at all better
Somewhat better
A lot better
Please use this space to provide any comments you have about communication with your healthcare team due to telemedicine technology.
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Communication was Worse
How much worse did using the telemedicine technology affect the communication with your healthcare team?
*
Not at all worse
Somewhat worse
A lot worse
Please use this space to provide any comments you have about communication with your healthcare team due to telemedicine technology.
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PPE
PPE stands for personal protective equipment such as gloves, mask, goggles, etc. We are asking this question to see if the amount of PPE was reduced due to using telemedicine technology during a patient appointment/encounter. One scenario where this may occur is if a Kubi is being used in an infectious ward for example.
How much PPE (personal protective equipment) did you or your unit use when conducting a telemedicine appointment compared to traditional visits in this past month?
*
More
Less
Same
Please provide any additional comments regarding use of PPE here.
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Time Seen Quality
How did the telemedicine technology used in the past month affect the time it took to see patients?
How much does telemedicine technology affect patient seen time in this past month?
*
Increases the amount of time
Decreases the amount of time
The amount of time is about the same
How is the quality of the appointment affected?
*
Improved
Worsened
No change
Back
Next
Internal Consults
A consult with a doctor or nurse who works at the same facility.
Have internal consults using telemedicine been conducted in this last month?
Yes
No
Back
Next
Internal Consults Conducted
How many telemedicine internal consults have been conducted?
*
Have telemedicine internal consults been helpful to improving patient care?
*
Yes
No
Back
Next
External Consults
A consult with a doctor (doctor-to-doctor) who is not part of the same facility as the person requesting the teleconsult.
Have external consults using telemedicine been conducted in this last month?
Yes
No
Back
Next
External Consults Conducted
How many telemedicine external consults have been conducted?
*
Have telemedicine external consults been helpful to improving patient care?
*
Yes
No
Back
Next
End of Survey
Thank you for completing our monthly survey. Please let us know how satisfied you feel about taking this survey (consider length of time, effort, and ability to give feedback).
Not satisfied at all
1
2
3
4
Very satisfied
5
1 is Not satisfied at all, 5 is Very satisfied
Please let us know how satisfied you feel about taking this survey
If you have any comments/feedback you would like to provide us, please do so here.
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