Taipei Medical University.(PLEASE READ FOOTNOTES PAGE)
Background.What is Telemedicine?Origins and History of TelemedicinePurposes of TelemedicineCategories and Scope of TelemedicineUses of Telemedicine nowadays.Health Information Technology and TelemedicineAreas of collaborationFactors Facilitating TelemedicineBarriers and Positive Impacts TelemedicineCase study Colombia and India.
What is Telemedicine?The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.Four elements are germane to telemedicine:Its purpose 1. to provide clinical support.2. It is intended to overcome geographical barriers, connecting users who are not in thesame physical location.3. It involves the use of various types of ICT.4. Its goal is to improve health outcomes.Tele is a Greek word meaning ``distance'' and Mederi is a Latin word meaning ``to heal''. Time magazine referred to telemedicine as ``healing by wire''. Although often considered ``futuristic'' and ``experimental'', the concept is becoming a reality. In practice, telemedicine simply delivers health care and the exchange of health care information across distances using telecommunications technology. It includes the transfer of basic patient information over computer networks (medical informatics), the transfer of images such as radiographs, computer tomography (CT) scans, magnetic resonance imaging (MRIs) pictures, ultrasound studies, pathology images, video images of endoscopic or other procedures, patient interviews and examinations, consultations with medical specialists and health care educational activities. The essence of telemedicine lies in transferring the expertise and not the patient ± the goal of telemedicine is to eliminate the unnecessary travelling of patients (and their escorts). One immediate benefit of telemedicine is to extend medical services to isolated, geographically dispersed and physically confined persons unable to reach a physician within reasonable time or distance. Indeed, its major promise for the future is to bring health services to people wherever it is not possible or feasible to bring people to health services.Other expressions similar to telemedicine are the terms "telehealth" and "eHealth", which are frequently used to denote broader definitions of remote healthcare not always involving active clinical treatments.Telehealth and eHealth are at times incorrectly interchanged with telemedicine. Like the terms "medicine" and "health care", telemedicine often refers only to the provision of clinical services while the term telehealth can refer to clinical and non-clinical services involving medical education, administration, and research.The term eHealth is often used, particularly in the U.K. and Europe, as an umbrella term that includes telehealth, electronic medical records, and other components of health information technology.
Thus telemedicine is characterized by:a) Geographic separation between client and provider;b) The use of telecommunication technologies to establish communication and interaction between client and provider to enhance clinical functionsc) An underlying system for the delivery of care to be developed, including a division of labor and specialization among the providers and staff; andd) Clinical maintenance and operational functions within the system which are specifically designed for this mode of operation.Image acquisition, storage, display, processing and transport form one particular, common aspect of telemedicine and are becoming an integral part of health care services in several countries including the USA, UK, Canada, Italy, Germany, Japan, Greece and Norway. Thus one of the simplest applications of telemedicine is teleradiology where images are transmitted to remote destinations . At present, there are around 8,000 such units worldwide Telemedicine does not represent a separate medical specialty; rather it is a tool that can be used by health providers to extend the traditional practice of medicine outside the walls of the typical medical practice. In addition, telemedicine offers a means to help transform healthcare itself by encouraging greater consumer involvement in decision making and providing new approaches to maintaining a healthy lifestyle.
Origins of telemedicineDuring the 1920s, radio was used to link physicians and stations situated on-shore to assist ships at sea that had medical emergencies. Desktop telemedicine began as experiments linking television and telephone by AT&T's Bell Laboratory in the 1920s and 1930s.Then, during the 1960s, the National Aeronautics and Space Administration played an important role in introducing telemedicine when humans first went into outer space ± the astronauts had their pulse rates and blood pressure monitored remotely. By the 1970s, telemedicine had evolved to take advantage of satellite technology. For example, paramedics in remote Alaskan and Canadian villages linked with hospitals in distant towns or cities. Subsequently, in December 1988, telemedicine was used to provide consultations from medical centres in the USA to the earthquake-hit Armenia in the erstwhile USSR. Satellite technology had transcended political, cultural, economic and social barriers to provide medical consultation.Interest in telemedicine has increased substantially in the 1990s with the development of medical devices suited to capturing images and other data in digital electronic form, and the development and installation of high speed, high bandwidth telecommunication systems around the world. Clinical applications of telemedicine are at present found in virtually every specialty although the technological basis and practical issues of implementation are highly variable from one clinical application to another. It is clear, though, that during the last two to three years telemedicine has advanced by leaps and bounds.
The delivery of remote health services is used for a variety of purposes: Specialist referral services typically involve a specialist assisting a general practitioner in rendering a diagnosis. This may involve a patient “seeing” a specialist over a live, remote consult or the transmission of diagnostic images and/or video along with patient data to a specialist for viewing later.Direct patient care such as sharing audio, video and medical data between a patient and a health professional for use in rendering a diagnosis, treatment plan, prescription or advice. This might involve patients located at a remote clinic, a physician’s office or home.Remote patient monitoring uses devices to remotely collect and send data to a monitoring station for interpretation. Such “home telehealth” applications might include using telemetry devices to capture a specific vital sign, such as blood pressure, glucose, ECG or weight. Such services can be used to supplement the use of visiting nurses.Medical education and mentoring, which range from the provision of continuing medical education credits for health professionals and special medical education seminars for targeted groups to interactive expert advice provided to another professional performing medical procedure.Consumer medical and health information includes the use of the Internet for consumers to obtain specialized health information and on-line discussion groups to provide peer-to-peer support.
Telemedicine can be broken into three main categories: store-and-forward, remote monitoring and (real-time) interactive services.Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc.) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. It does not require the presence of both parties at the same time. Dermatology (cf: teledermatology), radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured medical record preferably in electronic form should be a component of this transfer. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.Remote monitoring, also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective.Interactive telemedicine services provide real-time interactions between patient and provider, to include phone conversations, online communication and home visits.Many activities such as history review, physical examination, psychiatric evaluations and ophthalmology assessments can be conducted comparably to those done in traditional face-to-face visits. In addition, "clinician-interactive”. interaction can go beyond than just exchange ideas. tele-physical interaction with the patient is one example in a surgery addressed with a robot commanded remotely.
Telenursing:Provide nursing services in care. Where patients have not access to delivery, its applications cover the health care monitoring as well, telenursing can solve the increasing shortages of nurses, keep patients out of hospital.Telepharmacy:Provide pharmacist services, providing pharmaceutical care to patients, it encompasses drug therapy monitoring, patient counseling, prior authorization, monitoring formulary compliance, provide education, and monitoring side effects.Tele rehabilitation:Giving clinicals assessment (the patient’s functional abilities in his or her environment), and giving clinical therapy.Its areas cover the neuropsychology, speech-language pathology, audiology, occupational therapy, physical therapy among others. One important part of telerehabilitation is the continuous monitoring and the continuous follow up that we can develop with the patient, in the other hand is an important educational tool between provider and patient.Teletrauma:Improve efficiency and effectiveness of delivery in trauma environment. Trauma specialist can interact. Telemedicine is also being used in some trauma ICUs to reduce the spread of infections. providers can see the vital signs on the monitor, the respiratory ventilator, and the patient’s wounds. TelecardiologyECGs, or electrocardiographs, can be transmitted using telephone and wireless, actually did tests with transmission of ECG via telephone lines. This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of the department of Medicine.Telepsychiatryuitilizes videoconferencing for patients residing in underserved areas to access psychiatric services. Such as educational clinical programs, diagnosis and assessment, medication therapy management, and routine follow up meetings.TeleradiologyRadiographic images (x-rays, CT, MR, PET/CT, SPECT/CT, MG, US...) can be interchanged from one location to another. For interpretation, and consultation, it can be in real time or non-real time time.TelepathologyAnalyzing pathology at a distance using telecommunications technology to facilitate the transfer of image-rich pathology data giving support of diagnosi )interpretation and consultation), education, and research.TeledermatologyProbably one of the most common applications of telemedicine it is oriented in this area, this scope allows to interact with the general skin conditions, and giving information for consultation and interpretation it can be on real time using health technologies of visual checking.TeleophtalmologyAllow the transference of information of patient using biomedical eye devices which allow the ophthalmologist take decision in long distances.TeledentistryUsing of information technology for evaluate dental care, consultation, education, and public awareness in the same manner as telehealth does.Tele-audiology Providing audiological services it may include the full scope of audiological practice.Tele surgeryRemote surgery (also known as telesurgery) allows to the doctor to perform surgery on a patient even though they are not physically in the same location. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.
The majority of telemedicine services, most of which focus on diagnosis and clinical management, are routinely offered in industrialized regions including, but not limited to the United Kingdom of Great Britain and Northern Ireland, Scandinavia, North America, and Australia In addition, biometric measuring devices such as equipment monitoring heart rate, blood pressure and blood glucose levels are increasingly used to remotely monitor and manage patients with acute and chronic illnesses. Some predict that telemedicine will profoundly transform the delivery of health services in the industrialized world by migrating health care delivery away from hospitals and clinics into homesIn low-income countries and in regions with limited infrastructure, telemedicine applications are primarily used to link health-care providers with specialists, referral hospitals, and tertiary care centres . Even though low-cost telemedicine applications have proven to be feasible, clinically useful, sustainable, and scalable in such settings and underserved communities, these applications are not being adopted on a significant scale due to a variety of barriers.
The goals and activities of telemedicine and health IT are complementary and synergistic. Telemedicine is a method of delivering health care that makes use of health information technologies to accomplish its goals. Conversely, health information technologies (HIT) are an enabling component to the delivery of health services over distances, providing fundamental tools and systems.In short, HIT greatly enhances the utility of telemedicine.It is also important to acknowledge a distinction – telemedicine is not a type of HIT. Certainly telehealth is dependent on the use of telecommunications and related forms of advanced technologies but it fundamentally describes the delivery of patient and consumer care. In this SLIDE we can see how the telehealth and health information applications fit within the larger system of medical care. The base of health information technology supports the deployment and use of EHR, administrative applications consumer information services and core clinical services (of which telemedicine is one component in the delivery of those services).All applications and HIT components are interrelated.As example, the EHR supports the care delivery system in its multiple modes.Telemedicine is facilitated by access to an interoperable EHR that can allow the practitioner to review and evaluate all of the necessary information about the patient prior to and while the patient is being seen. Making use of a fully implemented EHR will improve the quality of care delivered by telehealth mechanisms in the same manner that the EHR will have a general impact on the quality of care in ANY practice modality.
Some potential areas of collaboration can be:Establishing and maintaining networked, organizational relationships.Potential Areas of Collaboration: Networks already established for telemedicine should be used as the initial test beds and role models of mechanisms to exchange health information (e.g., RHIOs). the development of regional approaches to creating uniform patient health records and a unified billing system is critical to fully realizing the benefits of remote clinical services.Overcoming resistance.Potential Areas of Collaboration:: from the technology leaders until health technology, clinical medicine and public health to overcome resistance and develop joint plans for unified health information networksSurmounting the absence of standards and guidelinesSuch levels include allowing different medical record systems to share patient data, assuring that different remote medical devices can intercommunicate with each other or into the same system and allowing health professionals providing distant care with immediate access to the patient’s health history.Financial sustainability
Governance: The planning and implementation of eHealth services requires complex and extended intersecto- ral collaboration, with stakeholders often coming from diverse backgrounds and with a range of priorities and agendas Policy or Strategy: Telemedicine policies and strategies can be used to outline the visions and objectives regarding the application, provision, control, standards, and ethics related to the national and international use of telemedicine solutions Scientific development:The involvement of scientific institutions in the development of telemedicine brings with it a number of potential benefits. Such institutions can dedicate resources to the development and testing of a variety of telemedicine initiatives.Evaluation: Conducting evaluations and disseminating results may be particularly important to the field of telemedicine given the scarcity of empirical evidence on its use. These evaluations can help generate reliable data to develop national telemedicine policy and strategy,
Positive Impacts and BarriersReducing the variability of diagnoses Enhancing access, quality, efficiency, and cost-effectiveness . In particular in isolated communities.Socieconomic benefits: Patients, Families, Health practitioners.Resilience to adopt new models of health delivery: Traditional medicine or indigenous practices.Lack of ICT literacy: to use telemedicine and approaches to it effectively. Linguistic and cultural differences between patients (particularly those underserved) and service providers.A shortage of studies documenting economic benefits and cost-effectiveness of telemedicine applications is also a challenge. Demonstrating solid business cases to convince policy-makers to embrace and invest in telemedicine has contributed to shortcomings in infrastructure and underfunding of programmes.Legal considerations as obstacle to telemedicine uptake: Absence of an international legal framework to allow health professionals to deliver services in different jurisdictions and countries.Lack of policies:lack of policies that govern patient privacy and confidentiality vis- à-vis data transfer, storage, and sharing between health professionals and jurisdictions.Health professional authentication,: in particular in e-mail applications Related to legal considerations are technological challenges. The systems being used are complex, and there is the potential for malfunction, which could trigger software or hardware failure. This could increase the morbidity or mortality of patients and the liability of health-care providers as well
It is a fact that several Latin American Countries are poorly developed, so that its why infraestructure can be determinant in health delivery. Colombia is a country with several barriers in health (access, quality, resilience, internal) Around 28% of their total population located in rural areas.The ICT has shown low penetration, and the technologies implemented have not used extensively The Systematic Review of Telemedicine Projects in Colombia is one Systematic review several projects developed in areas of Telemedicine. The systematic Review focuses in assess: Effectiveness, Reliability, Ease of use, Aceptance, Susteinability, Improvemente of the Diagnoses, Improvement of the organization process, Utility variations, Accesibility of the projects.The main areas of application of the projects were: Teledermatology, Teleradiology, Telecardiology, Internal Medicine, Teleambulatory care, Malaria and Dengue Diagnose. 99 Projects.The main findings are: Several projects have failed because the implementation have been centered more in the technology than in the patients or the health provider. Other find show that most of the projects implemented in Colombia have not evaluate the feasibility or the economic impact, evaluation which is important for policy makers to address decisions.Several Challengues are affecting the development of Information Comunication Technologies in Colombia: Infrastructure, ICT Literacy, Conflict problems.
13, Explain the challenges and oportunities of Telemedicine in India. According with the reviewers 0,1 % of the existent tecnologies are used in the total potential utilization.The autors describe several barriers: Lack of inadequate infrastructure, Low computer literacy, Reluctance of physicians to use Telemedicine, Policy Makers are addressing raw problems to address then the access.Its evident that the TM is extremely useful in India, India is a rural country, ¾ of the population live in remote areas.A new barrier is appearing in the horizon, its related to the reluctanceof health provider to give tele health services, because they have evidence their earn, and profit are affected, because there is not clear the mechanism of reimbursement.In the other hand the policy makers have not addressed clearly which is the target population
Telemedicine and health information tecnologies its impact in health delivery services in developing countries
1TAIPEI MEDICAL UNIVERSITY TELEMEDICINE AND HEALTH INFORMATION TECNOLOGIES:Its impact in health delivery services in developing countries. Vanitha Paramasivam, Alexander Bermudez Rubashkyn. MBA Students, Health Care Administration.
2Outline Background. What is Telemedicine? Origins and History of Telemedicine Purposes of Telemedicine Categories and Scope of Telemedicine Uses of Telemedicine nowadays. Health Information Technology and Telemedicine Areas of collaboration Factors Facilitating Telemedicine Barriers and Positive Impacts Telemedicine Case study Colombia and India. References
What is Telemedicine? 3 The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities 1
What is Telemedicine? (cont.) 4 Telemedicine is characterized by:Delivery of Health Care Distance Operational health Telecommunication systems Technologies
Origins and History2,3. 5 1920s Use of radio to link physicians and stations situated in remote areas. 1930s AT&T experiments linking television and telephone 1960s NASA, Human monitory to Austronauts 1970s Developments of Satellite technology. 1988 USA physician providing consultations remotely in the Armenian earthquake (USSR). 1990s interest have increased with the development of medical devices and the Internet. After 1990 advance in Telemedicine by leaps and bounds.
6Purposes of TelemedicineThe delivery of remote health services is used for avariety of purposes4: Specialist referral services. Direct patient care. Remote patient monitoring. Medical education and mentoring. Consumer medical and health information.
10 Uses of Telemedicine6,7Developed Countries Developing Countries
Health Information Technology and 11Telemedicine4 HIT enhances the utility of Telemedicine. HIT and Telemedicine goals are complementary and synergistic.
Health Information Technology and 12Telemedicine (Cont)Areas for Collaboration between Telemedicine andHealth IT4 Establishing and maintaining networked, organizational relationships. Overcoming resistance. Surmounting the absence of standards and guidelines Financial sustainability
Barriers9 and Positive Impacts10 14Telemedicine Positive Impacts Barriers • Reducing the variability of • Resilience to adopt new diagnoses models of health delivery • Enhancing access, quality, • Lack of ICT literacy efficiency, and cost- • Linguistic and cultural effectiveness . In particular differences in isolated communities. • Lack of studies in • Socieconomic benefits: economical benefits Patients, Families, Health • Legal considerations .practitioners • lack of policies. • Health professional authentication. • Regulations in technology
Case Study: Colombia 15 Systematic Review of Telemedicine Projects in Colombia11 28% Rural Areas Challenges: Infrastructure. ICT Literacy, Access to technology. (armed conflict) Malaria 150.000 per year Hemorrhagic Dengue: 18.9/100.000
Case Study: India 16Challenges and opportunities for the adoption of Telemedicine in india12,13.• 72% Rural Area ¾ Live in remote areas• Lack of ICT Literacy• Reluctance of physicians to use Telemedicine• Lack of economic investment.• The Policies are not addressing clearly the target population
Group 1: Shawon and Hector ask, one of the five purposes of telemedicine is for remote patient monitoring, which utilizes telemetry devices. What are some examples of these telemetry devices? Holter – Heart Glucometer Iphone monitoring Monitoring Polysomnography Wrist oxymeter – Iphone based oxymeter Elderly Home BP monitorIphone BP monitor
Group 3: Baraa ask, how the telemedicinecan be cost-effective? It depends, and it is not easy to know whether determinate telemedicine delivery is cost-effective or not. That is why we have to conduct economical assessment of the technology used for telemedicine. For example in the case of study in India and Colombia, the policy makers doesnt have enough evidences about how cost-effective is the telemedicine, and they doesnt have tools to address a policy related to the Telemedicine, and this is becoming a big barrier for several countries.
Group 3: Zwakele ask, What makes telemedicineappropriate for use in developing countries? Several developing countries and regions, have limited infrastructure, furthermore in those countries there is not enough quantity of health providers per capita, so that is why using telemedicine applications we can link the health delivery services to those remote areas which doesnt have health infrastructure and health providers.
In India the doctors have enough technology link for use the telemedicine in order to provide health services in remote areas. However, the doctors are payed according with the number of patients seen in the Hospital, because the Health System in India just allow the reimbursement and the copayment in real time, the patients in remote areas using the Telemedicine are not to able to pay the copayment; On the other hand the reimbursement is not corresponding with the physicians effort. So that it is why the Doctor does not accept the Telemedicine. The real solution that can be used to solve this situation is to improve the mechanism of payment, and give special recognizement to the doctors which provide telemedicine services. In the other hand the ICT literacy among doctor is relatively low, and this is an issue that we can solve providing continuous education.
Group 4: Dana and Cheryl ask, What do you think the most promisingapplication of telemedicine is in each of your countries? If youre notsure what it is for your country, then what do you think the mostpromising application is in general/globally? In Colombia and India, and several of other countries, the Ischemic Hearth Disease is the main cause of mortality. Using the telemedicine as a tool to be used in tele-cardiology we can use is for monitoring this disease in several stages, as one interactive medicine for emergency based department. During After Before
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