Telemedicine Support


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Recent telemedicine and physician's perspective of it, patient-doctor relationship and reimbursement problem.

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Telemedicine Support

  1. 1. Medical Informatics & Applications Telemedicine Supports Dani Iswara Health Management Information System Field Epidemiology Training Program Public Health Science Faculty of Medicine Gadjah Mada University Yogyakarta, Indonesia RIGHT Seminar, Jan 10, 2009, Med Fac-UAJ, Jakarta
  2. 2. Access Quality Cost-benefit Sustainability → Health outcomes
  3. 3. Telemedicine... Mobile Non/web-based Cable, wireless Data Hospital, Clinic, Application Network Private, Pharmacy Ax, physical, lab exam, Tx Push/pull Telemedicine A/synchronous station → Not-so-new technology 3
  4. 4. What is Telemedicine? Telemedicine (telemedisin = kedokteran jarak jauh) Medical/clinical services ● Long distance (geographics; regional, ● national, international) Information & communication technology ● (ICT) Telehealth (health care), telecare 4
  5. 5. What is Telemedicine offered? Efficient ● Effective ● Interactive ● Collaborative ● Ubiquitous ● 5
  6. 6. What is Telemedicine for? Types of telemedicine Teleconsultation ● Telephone, SMS, web, email, forum, blog ● Teleconference (videoconference) ● Tele-education ● Telemonitoring (chronical ds, drugs/labs ● monitoring) Teleradiology, telesurgery, telecardiology, ● telepathology, telepsychiatry, teledermatology 6
  7. 7. Telemedicine in Indonesia SMS Gateway (ITB; 2006): Reporting & monitoring → disaster, TB, lepra Dasar-dasar Implementasi Telemedicine (Johan Harlan; PSIK Univ. Gunadarma; 2007) Standard formats → txt, XML, MPEG, JPEG, pixel, ICD 10, HL7? 7
  8. 8. Telemedicine in Indonesia (2) Since 2005: Videoconference equipments VoIP equipments Internet KepMenKes No. 857 Tahun 2007 Pengembangan Jaringan Komputer Online Sistem Informasi Kesehatan Nasional (Siknas Online) 8
  9. 9. Barriers of Telemedicine developing countries Cultural problems Inapropriate 'experts' Regulations Reimbursements Human resources Technologies 9
  10. 10. Cost Impacts of Telemedicine Chronic ds ● Outpatient ● consultation Length of stay ● 10
  11. 11. Sample Position Statements of Telemedicine Internet Prescribing “Store and forward providers should take care regarding direct prescribing for patients via electronic communications. Most states have regulations that discourage or prohibit practitioners from prescribing for patients that they have not seen face to face. In many cases, the wording of these regulations is such that a live and interactive consultation would meet the requirements for a “face to face exam”. Since most store and forward providers are working in collaboration with a provider at the point of care, this should not inhibit patient care. The dermatologist should take care to recommend as opposed to prescribe.” American Academy of Dermatology (2004) 11
  12. 12. Sample Statement on Telecomunication in Medicine Physician-Patient Relationship quot;If a patient receives professional advice or treatment, even gratuitously, there is prima facie evidence that a physician-patient relationship exists.quot; The American College of Obstetricians & Gynecologists (ACOG) 12
  13. 13. Sample Guidelines for the Surgical Practice of Telemedicine Telesurgery (Remote Surgery) quot;Appropriate Use: Demonstration and/or teaching technique or procedures... -- using inanimate trainers as the objects of the procedure. -- using animate model for purposes of testing technology. -- on patients under strict guidance of an IRB and only when a qualified surgeon is present to intervene in a timely fashion if technical difficulties arise.quot; Society of American Gastrointestinal and Endoscopic Surgeons (SAGES); 2004 13
  14. 14. Summary Telemedicine is only a tool Potentiality of telemedicine Patient safety first Guidelines & standards Researches & evidences 14
  15. 15. Thank You...Q & A You are free to share (copy, distribute, transmit) & adapt this work  under the similar license Creative Commons Attribution­ Noncommercial­Share Alike 3.0 Unported (CCA­NC­SA 3.0 Unported) Dani Iswara Last updated: January, 2009 15