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.
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.
Worldwide telemedicine initiatives status and
TAIPEI MEDICAL UNIVERSITY TELEMEDICINE Worldwide Telemedicine Initiatives Status and Introduction of Telemedicine in Developing CountriesVanitha Paramasivam.Alexander B. Rubashkyn.MBA Students
2 Outline• Recall: What is Telemedicine?, Categories of Telemedicine.• Worldwide Situation of Projects developed in Telemedicine. – Comparison WHO regions. – Comparison Income (High, Upper-middle, lower-middle, and low).• Worldwide Situation of Projects in the main areas of application. – Comparison WHO regions. – Comparison Income (High, Upper-middle, lower-middle, and low)• Other Initiatives.• Factors Facilitating Telemedicine.• Barriers in Telemedicine.• In what circumstances the Telemedicine is suitable for Developing Countries?. – Meta-analysis (evaluation of projects implemented in developing countries). – Case of study (Puerto Caicedo, Hospital – Putumayo).• Interoperability in Telemedicine.• Conclusions.• References.
Worldwide Situation of Projects developed in 6 Telemedicine• In 2008 the WHO developed a survey for assessing the current status of Telemedicine in their member states3.• Around 114 countries complete at least on section of the survey (59% of the total members, 81% world population).• The purpose of the survey was to understand the status of the projects in Telemedicine, according with the record of the national initiatives of each WHO Office in 2005, being implemented or completely established, as well, the status of the national policy in Telemedicine being addressed in each country in this area as a facilitating factor, and the barriers to the telemedicine identified during the survey.
7General status of Projects being implemented or already implemented in the main application areas of Telemedicine in the world.
8 Worldwide status of Teleradiology.WHO Region World bank Income classification
Evaluation of a Telemedicine (Telegynaecology) 9 demonstration project in the Magdalene Islands 20044 Jean-Paul Fortin, Marie-Pierre Gagnon, Alain Cloutier and Françoise LabbéA total of 101 individual patients benefited from a teleconsultation, USG Gynecologicevaluation was an important feature, given that this Islands are locatedmore than 1000 km away from supra-regional medical referral centres.
10Worldwide status of Teledermatology.WHO Region World bank Income classification
Telemetric Devides collaborating with the Telemedicine 11Working Group of Bangladesh to bring dermatology care to rural communities in 2012.5In Bangladesh, approximately 30 percent of the population will suffer from a skin disease at one point in during their lifetime. However, there are fewer than300 dermatologists in Bangladesh and all are urban-based
12 Worldwide status of Telepathology.WHO Region World Bank Income classification
Virtual Telepathology in Egypt, applications of WSI in 13 Cairo University 20116 Ayad EUsing the Telemedicine the Universitity of the cairo send lab and image results toCivico Hospital in Palermo for research purposes.
14 Worldwide status of Telepsychiatry.WHO Region World bank Income classification
Evaluation of a rural telepsychiatry service in Wagga Wagga (Australia) 2007.7 15 James Greenwood*, Christie Chamberlain, Gordon Parker Wagga Wagga in rural New South Wales, comprising a face-to-face interview with a psychiatrist followed by a telepsychiatry interview with a Sydney-based psychiatrist.
16 Worldwide status of Telecardiology.WHO Region World bank Income classification
The teleECG initiative in Norway 20103 17 • The teleECG initiative in Norway is a telemedicine service used to facilitate early diagnosis and treatment of suspected myocardial infarction in patients not in hospital. • Ambulances are fitted with equipment to capture and transmit ECG images to hospitals that have an image receiver and storage system for the images sent. Once received, the images are analysed by a cardiologist at hospital who is able to make a diagnosis and recommend an immediate course of action.
18Other areas of Application. Tele-retinography
19 Factors facilitating the Telemedicine3• Governance• Policy or Strategy• Scientific development• Evaluation
20Current Status of Telemedicine policies around the world3
8Objectives: To review papers reporting actual experience with telemedicine indeveloping countries and to summarize their findings, including the strengthof the evidence.Design: A retrospective review was conducted. Study quality was assessed.Setting Four commonly-used electronic databases.Main outcome measures: Study quality scores.
The positive findings in the studiesreviewed suggest publication bias.even if their lack of focus weakens theevidence base. Very few of the studiesreviewed have been conducted with highmethodological quality and we,therefore, make a strong call for morerigorous methodological assessment infuture, along well-defined guidelines. Forexample, cost- effectiveness is afundamental aspect of the introductionof telemedicine and our review foundvery few studies which had addressedthis topic
Conclusion of the Research Paper.(1) Avoid proposing very large and expensive projects.(2) Ensure close collaboration with local doctors, national health services or NGOs working in the field.(3) Take into account the published experience of others.(4) Start small, and build evaluation into the pilot stage.(5) Publish the evaluation results, whether positive or negative.(6) Scale up only on the basis of clear success.
Group 1 : having completed your research and presentation what would you say is one of the most important things you have learned about introducing telemedicine in resource poor countries.• The Evaluation of projects already developed is important. So we can learn about the experience of others.• Cost effectiveness analysis can allow us measure the impact of introducing telemedicine. As well we can give evidence to policy makers.• It is important to assess the suitability of the project, because not always the telemedecine can be the answer for enhance the health access in isolated communities.
Case of Study (Puerto Caicedo - Hospital) in 26 Amazonas Rainforest Colombia Ministry of Telecommunications of Colombia 2011 Comments and final edition: Alexander B. Rubashkyn
28 Core Health Information Standards in Telemedicine9• 2007 ATA Report. – Administrative Standards (Identifier Standards). – Clinical Standards (Clinical Representative Standards as ICD and CPT, Vocabulary Systems). – Technical Standards (Electronic Data, LOINC (lab results), ISO/IEEE 11073: ISO/IEEE 11073 (Teledevices), DICOM (Biomedical images, Store-and-forward) ATC (medications), and HIPAA Standards. – Infrastructure (HL7, ASTM).EHR and Its importance in the Telemedicine. 我听 ! 不懂。
Group 4: Do you think India or Colombia has a Greater potential 29to develop their telemedicine Technology over the next decade? Colombia Systematic Review of Telemedicine Projects in Colombia10 28% Rural Areas Challenges: 45 000 000 Malaria 150.000 per year Infrastructure. Hemorrhagic ICT Literacy, Access No policy Dengue: to technology. 18.9/100.000 (armed conflict) EHR in 2013 India Challenges and opportunities for the adoption of Telemedicine in india11,12. Challenges: Infrastructure, 72% Rural Area 1 200 000 000 Reluctance of physicians to use Telemedicine, Access to Diarrhea Is one of the most Policy technology, the Policies are important cases of death. not addressing clearly the target No EHR only EMR population (some places)
30 Conclusions• Telemedicine as tool have an important role to play in the improvement of the quality and efficiency of health systems in the world.• Telemedicine deserves special consideration for the local; Access should as well be focus on elements that help introduce the telemedicine, (Infrastructure, Standards, Policies, ICT technologies), even more when worldwide satellite communication is available at reasonable cost, telemedicine can be used in many different ways such as improving healthcare access, supporting health workers in isolated settings or addressing the shortage of specialist doctors.• Harmonized globally interoperable standards fundamental to ensure global exchange of information in Telemedicine.• Telemedicine thus works toward the concept of medicine, which transcends boundaries.
If you have health, you probably will be happy, and if you have health and happiness, you haveall the wealth you need, even if it is not all youwant.Alexander R.
Complementary References (Second part)1. WHO definition: WHO. A health telematics policy in support of WHO’s Health-For-All strategy for global health development: report of the WHO group consultation on health telematics, 11–16 December, Geneva, 1997. Geneva, World Health Organization, 1998.2. Strode SW, Gustke S, Allen A. Technical and clinical progress in telemedicine. JAMA. 1999 Mar 24-31;281(12):1066-8.3 Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth 2009. WHO (Global Observatory for eHealth Series, 2)4 Fortin JP, Gagnon MP, Cloutier A and Labbé F, Evaluation of a telemedicine demonstration project in the Magdalene Islands, 2004 J Telemed Telecare. 2003;9(2):89-94.5 Grameenphone pilots tele-dermatology project in Bangladesh 2012 http://www.telenor.com/corporate- responsibility/initiatives-worldwide/grameenphone-pilots-tele-dermatology-project-in-bangladesh/ Accessed 21/12/12.6 Ayad E Virtual Telepathology in Egypt, applications of WSI in Cairo University 2011- Diagnostic pathology Diagn Pathol. 2011 Mar 30;6 Suppl 1:S1. doi: 10.1186/1746-1596-6-S1-S1.7 Greenwood J, Chamberlain C, Evaluation of a rural telepsychiatry service 2007 Australas Psychiatry August 2008 vol. 16 no. 4 273-276.8 Wootton R., Bonnardot R, In what circumstances is telemedicine appropriate in the developing world? J R Soc Med Sh Rep 2010;1:37. DOI 10.1258/shorts.2010.0100459 The American Telemedicine Association, Core Standards for Telemedicine Operations November 2007
References (First Part- previous presentation)1 WHO definition: WHO. A health telematics policy in support of WHO’s Health-For-All strategy for global healthdevelopment: report of the WHO group consultation on health telematics, 11–16 December, Geneva, 1997. Geneva,World Health Organization, 1998.2 Rosen, E. (1997), “The history of desktop telemedicine, Telemedicine Today, Vol. 5 No. 2, pp. 16-17, 28.3 Currell, Telemedicine versus face to face patient care: effects on professional practice and health care Outcomes.Cochrane Database of Systematic Reviews, 2000.4 Dena Puskin, Barbara and Stuart, *2006+ “Telemedicine, Telehealth, and Health Information Technology”, An ATAIssue Paper, The American Telemedicine Association, May 20065 Strode SW, Gustke S, Allen A. Technical and clinical progress in telemedicine. JAMA. 1999 Mar 24-31;281(12):1066-8.6 Heinzelmann PJ, Lugn NE, Kvedar JC. Telemedicine in the future. Journal of Telemedicine and Telecare, 2005,11(8):384–390.7 Wootton R. Telemedicine support for the developing world. Journal of Telemedicine and Telecare, 2008, 14(3):109–114.8 Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth2009. WHO (Global Observatory for eHealth Series, 2)9 Resolution WHA58.28. eHealth. In: Fifty-eighth World Health Assembly, Geneva, May 16–25, 2005 (http://apps.who.int/gb/ebwha/pdf_files/WHA58/WHA58_28-en.pdf, accessed 9 november 201210 Craig J, Patterson v. Introduction to the practice of telemedicine. Journal of Telemedicine and Telecare, 200511 Carlos Rey-Moreno, Javier Simó Reigadas, Estrella Everss Villalba, Juan Jose Vinagre† and Andrés MartínezFernández, systematic review of telemedicine projects in Colombia, doi: 10.1258/jtt.2009.090709, J Telemed Telecare,April 2010 vol. 16 no. 3 114-119.12 Shabbir, Syed-Abdul, Scholl J., Jian W and Li Y. Challenges and opportunities for the adoption of telemedicine inIndia, DOI: 10.1258/jtt Journal of Telemedicine and Telecare Vol 17 No 6 2011 pg 336-337 October 2011.13 Siriginidi, Subba Rao, Achieving millennium development goals: Role of ICTS innovations in India, Telematics andInformatics VL26 IS2 Sp127 Ep143 February 2008