TelehealthTelehealth In the New Millennium In the New Millennium

Michele L. HalesUniversity of Alberta

Edmonton, AB CANADA

ISN: Informatics SymposiumISN: Informatics Symposium

February 5, 2001February 5, 2001 Dubai, UAEDubai, UAE

Presented Presented atat

What is Telehealth?What is Telehealth?

"Telehealth is defined as the use of communications and information technology to deliver health and health care services and information over large and small distances."

Director General of W.H.O.Director General of W.H.O.

Dr. Hiroshi Nakajima, the Director-General of the World Health Organization (WHO) pointed out that information and telecommunication technology, as “one of the main driving forces in the current globalization of trade, economics and politics”, and it had “equally important implications for health.”

TELECOM 97 Forum

TransmissionTransmission

Telephone lines are slow but inexpensive at 64 kilobytes per second (baud)

ISDN telephone lines – integrated service digital network is faster at 256 kb

ATM – asynchronous transfer mode >1Mb

Satellite – expensive

Categories of Information FlowCategories of Information Flow

Data• interactive, data entry,

batch, file update, file transfer, file sharing

Image• fax, graphics, conferencing,

interactive, store/forward

Voice• voice only, voice/data,

inquiry/retrieval, conferencing, store/forward, recording

Video• conferencing, screen

capture, interactive, recording

Information Monitoring: network management, security, integrity, licensing, malpractice

Valuable Product & ServicesValuable Product & Services

Source: VHA Annual Information Systems Survey 1998

Richard D. Lee, Dierdre A Conley, Andy Preikschat: WitCapital. eHealth 2000: Healthcare and the Internet in the New Millennium. January 31, 2000

Available at:www.witcapital.com/research/researchbody.jsp?Report=ehlt_20000131

A transitionA transition::

TelehealthTelemedicine e-health

e-health is now the term to use when describing the rise of digital technologies, electronic transmission and the convergence of technologies.

Mitchell, John:From Telehealth to E-Health: The Unstoppable Rise of E-Health. 1999. Department of Communications, Information Technology and the Arts, Australia.

TelehealthTelehealth Clinical diagnosis Direct care delivery Tele-education/telelearning (including patients

& professionals) Telemedicine Telematics (for health research and health

services management)

Integration of information technology in healthcare has tremendous potential, which is only now being realized.

Telehealth/E-healthTelehealth/E-health Telehealth is moving closer to e-commerce Health information is being disseminated via

the web A more well-informed consumer Increased patient knowledge increases

challenges to the healthcare providers decisions

The primary care physician of the future is the patient (or guardian)

Telemedicine, telehealth,Telemedicine, telehealth, e-healthe-health

Consumer-driven

Provider-driven

e-health

Telemedicine and Telehealth

The public will tell us what they wantThe public will tell us what they want in e-health. in e-health. Providers no longer dictateProviders no longer dictate but become but become

partners with patient or partners with patient or clientclient..

Driving Forces of TelehealthDriving Forces of Telehealth Health and socioeconomic needs Shortage of specialists in remote regions Sense of professional isolation Demand for equitable and accessible

healthcare services Decrease in cost for equipment &

telecommunication Aging population

Trends in TelehealthTrends in Telehealth Increased use in correctional facilities and home health care

settings. Fine-tunes the management and allocation of rural health care

emergency services by transmitting images to key medical centres for long distance evaluation/triage by appropriate medical specialists.

Permits physicians doing clinical research to be linked together despite geographical separation, sharing patient records an diagnostic images.

Improves medical education for rural health care professionals.

Strengths & BenefitsStrengths & Benefits Empowers the public Strengthens and integrates healthcare services Creates information resources, continuing

education & training to healthcare providers Increases accessibility of specialty care to

underserved populations Telehealth applications provide foresight to new

possibilities Provides support to providers Provides instant communication with colleagues

Some Telehealth ChallengesSome Telehealth Challenges Policy issues: Liability, licensure and

reimbursement Need for technical and professional standards Privacy, confidentiality and security must be

addressed Need to stay abreast of changes in funding for

projects Acceptance of the technology Infrastructure barriers to some rural areas –

possibly the greatest challenge

OpportunitiesOpportunities

Collaboration:- various government agencies- health organizations- industry

Strengthen incentive program Develop and exchange knowledge

Successful Telehealth EndeavoursSuccessful Telehealth Endeavours School-based health centers Hibernia off-shore oil drilling platform Correctional Facilities Tele-

- dermatology- radiology- cardiology- oncology- surgery- psychiatry- pediatrics

Teledialysis (OSMH)Teledialysis (OSMH) Orillia Solider's Memorial Hospital

(OSMH) - established Canada's first region-wide, teledialysis network.

Using computerized systems, the OSMH monitors patients at least 100 kilometres from the regional centre, bringing healthcare services closer to home.

The network officially opened in October 1997.

Teledialysis (OSMH) cont’d:Teledialysis (OSMH) cont’d:

Linked via ISDN lines, a high-speed phone connection allowing videoconferencing to take place between doctor and patient in real-time.

To achieve a complete transfer of data, three ISDN lines are going at the same time.

Excellent picture quality

Teledialysis (OSMH) cont’d:Teledialysis (OSMH) cont’d: Dialysis machines are connected via modem,

through a standard phone line to the server at the regional centre. From there, the information is transmitted to the screen.

Enables patients to videoconference with remote doctors.

It provides medical follow-up care for stable hemodialysis patients.

Provides patient privacy

Telehealth Initiatives Globally:Telehealth Initiatives Globally:

Armenia Australia Canada Europe South Africa United States of America

E-mail Discussion ListsE-mail Discussion Lists TELEHEALTH

To: listserv@maelstrom.stjohns.eduBody: Subscribe TELEHEALTH YourName

E-HEALTHTo: listserv@maelstrom.stjohns.eduBody: Subscribe EHEALTH YourName

NETPSYTo: listserv@maelstrom.stjohns.eduBody: Subscribe NETSPY YourName

ITNATo: listserv@bcm.tmc.eduBody: Subscribe itna FirstName LastName

PublicationsPublications Journal of the American Medical Association -

jama.ama-assn.org/ MD Computing - www.mdcomputing.com/ Telehealth Magazine - www.telehealthmag.com/ Telehealth Net - telehealth.net/ Telemedicine Journal - www.liebertpub.com/TMJ/ Telemedicine Today - www.telemedtoday.com/ Telemedlaw

Organizations & Associations:Organizations & Associations: Association of Telehealth Service Providers

- www.atsp.org Canadian Society of Telehealth

- www.ucalgary.ca/md/CST/ California Telehealth and Telemedicine Center

- telemed.calhealth.org/ Finnish Society of Telemedicine

- www.fimnet.fi/telemedicine/engindex.htm

Organizations & Associations cont’d:Organizations & Associations cont’d:

Healthcare Information and Management Systems Society (HIMSS)

- www.himss.org International Society for Telemedicine (ISFT)

- isft.org National Centre of Telemedicine, Tromso,

Norway - www.telemed.rito.no/Eng/index.html

Office for the Advancement of Telehealth - telehealth.hrsa.gov

Telehealth FutureTelehealth Future

Precedents are now being set New generation of technology arrives

every 18 - 30 months The future is being shaped by us now

ConclusionConclusion

Telehealth is just another way to practice what one already knows how to do, but through a new means

It will be the way of the future

““The computer is very fast, accurate The computer is very fast, accurate and stupid. Man is very slow, and stupid. Man is very slow, inaccurate and brilliant. Together they inaccurate and brilliant. Together they make an unbeatable team.make an unbeatable team.””

---- Albert EinsteinAlbert Einstein

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Michele.Hales@UAlberta.CA