Title: leukotriene inhibitors
1PUBLIC LECTUREKENYATTA UNIVERSITY
- CHANGING MEDICAL ETHICS IN ICT ERA AND
PATIENT-DOCTOR-COMMUNITY RELATIONSHIP - DR JOSEPH ALUOCH F.R.C.P. E.B.S.
- SEPTEMBER 25th 2014
- NAIROBI
2A Brief History and Overview Of Biomedical
Ethics
3WHAT IS BIOMEDICAL ETHICS?
4MEDICAL ETHICS
- Ethics expresses the ways in which we examine,
explore and attempt to understand the moral life. - What are the moral obligations of health
professionals in a world of advancing technology
and promise. - Allows us to reflect on the relationship between
the professional and the patient.
5MEDICAL ETHICS
- Ethics a generic term for the various ways of
understanding and examining the moral life - Moral Choices
- what values, what reasons and what language
6MEDICAL ETHICS
-
- Applied Ethics a practical discipline
- Investigates ethical issues which arise in
medicine and healthcare by applying the
principles and methods of moral philosophy to
these problems
7MEDICAL ETHICS
-
- The doctor patient relationship
- What makes a good doctor / professional?
- What choices, values and traits
8HOW SHOULD ONE LIVE?(SOCRATES)
- How doctors should treat patients rests on
general moral principles about how a person
should treat another person - Thus
- Biomedical ethics grounded firmly in the study of
moral philosophy
9WHAT IS BIOMEDICAL ETHICS?
- Species of practical normative ethics
- Norms standards of right and wrong action
behaviour - Normative ethics is concerned with how people
ought to act, what sort of person one ought to be
or what sort of policies ought tot be implemented.
10WHAT IS BIOMEDICAL ETHICS?
- Species of practical normative ethics
- What one is obligated or permitted to do, or
prohibited from doing, in different contexts of
biotechnology, medical practice and research. - So we employ principles and theories of normative
ethics to motivate and justify actions and
policies in biomedicine.
11WHAT IS BIOMEDICAL ETHICS?
- Species of practical normative ethics.
- Objectivity
- Impartiality
12WHAT IS BIOMEDICAL ETHICS?
- Descriptive ethics
- Descriptive ethics is concerned with how people
actually behave, not how they ought to behave.
13WHAT IS BIOMEDICAL ETHICS?
- Metaethics
- Metaethics is focussed on the nature of morality
concerned with the point of ethics, i.e. what do
the terms good, bad, wrong, right mean..
14CONTEMPORARY MEDICAL ETHICS
-
- ...the student begins with the patient,
continues with the patient, and ends his studies
with the patient, using books and lectures as
tools... - Sir William Osler, Canadian Physician(1906)
- As quoted in Singer, P, Viens, AM, Cambridge
Textbook of Bioethics (2008)
15ETHICAL REASONING
- Clinical Ethics is learnt in the same way as
clinical medicine is learnt, at the coalface,
through meeting patients and their families,
being involved in their cases. It is a practical
discipline. - The doctor must learn to recognise the ethical
aspects of his/her clinical (and scientific
research work), and to make reasoned decisions
about this work within the framework of the law
and medical council guidelines.
16CONTEMPORARY MEDICAL ETHICS
-
- Society allows doctors a degree of personal
freedom in making decisions and in their
interactions with patients. But in giving doctors
that freedom society expects them to be able to
defend their decisions and actions with
reasons...Doctors must be able to show how their
decisions and actions relate to the law and to
the relevant guidelines.1 - 1Hope, Savulescu, Hendrik, Medical Ethics and Law
(2008)
17ETHICAL REASONING LEARNING TO REASON
- Scientific Reasoning
- The skill of evaluating the scientific evidence
available and applying it, using clinical
judgement to the clinical scenario at hand. This
is a fundamental part of your medical education
and later practice.
- Ethical Reasoning
- In the same way, ethical reasoning is a skill
required to allow you to identify and negotiate
ethical problems, using an organized framework of
ethical methods or tools in the clinical setting. -
Ethical reasoning must stand up to scrutiny, (in
court if necessary) in the same way as the
scientific aspects of decision-making.
18- Traditional Medical Ethics
192500 YEARS OF MEDICAL ETHICSA BRIEF HISTORY
460 BC
2009 AD
Hippocrates
20THE SCHOOL OF HIPPOCRATES5TH CENTURY BC
- Hippocrates The Father of Medicine
- Medical School (Greek Island of Cos)
460 377 BC
21THE HIPPOCRATIC OATH
c.1595
22HIPPOCRATIC OATH I
- I swear by Apollo, the healer, Asclepius,
Hygieia, and Panacea, and I take to witness all
the gods, all the goddesses, to keep according to
my ability and my judgment, the following Oath
and agreement - To consider dear to me, as my parents, him who
taught me this art to live in common with him
and, if necessary, to share my goods with him - To look upon his children as my own brothers, to
teach them this art.
23 HIPPOCRATIC OATH II
- I will prescribe regimens for the good of my
patients according to my ability and my judgment
and never do harm to anyone. - I will not give a lethal drug to anyone if I am
asked, nor will I advise such a plan and
similarly I will not give a woman a pessary to
cause an abortion - But I will preserve the purity of my life and my
arts.
24 HIPPOCRATIC OATH III
- I will not cut for stone, even for patients in
whom the disease is manifest I will leave this
operation to be performed by practitioners,
specialists in this art. - In every house where I come I will enter only for
the good of my patients, keeping myself far from
all intentional ill-doing and all seduction and
especially from the pleasures of love with women
or with men, be they free or slaves.
25 HIPPOCRATIC OATH IV
- All that may come to my knowledge in the exercise
of my profession or in daily commerce with men,
which ought not to be spread abroad, I will keep
secret and will never reveal. - If I keep this oath faithfully, may I enjoy my
life and practice my art, respected by all men
and in all times but if I swerve from it or
violate it, may the reverse be my lot.
26BENEFICENCE AND NONMALEFICENCE
- Hippocratic Oath
- Established the principles of Beneficence and
Non-maleficence - Prohibited poisons and potions for abortion or
euthanasia - Maintain confidentiality
- Avoid exploitation
- Pursue best interests of patient
27THE HIPPOCRATIC OATH
- However no acknowledgement of the patients
rights (e.g. truth telling or consent) - Does not deal with welfare of society or of others
28THE HIPPOCRATIC OATH
- The Oath of a closed, self-protecting guild1
- an old boys club?
- Tradition of altruistic doctors practising
paternalistic medicine...?
1Harris, J, Bioethics (2001) OUP
29THOMAS PERCIVAL, ENGLISH PHYSICIAN
- Beginning of modern professional ethics
- First used the term Medical Ethics in his book
on the subject (1803) - Somewhat of a misnomer at this point conflicts
between practitioners were endemic at this time - c.f. Manchester doctors dispute
- Tripartite structure of medicine at the time
- Physicians, Surgeons and Apothecaries
30THOMAS PERCIVAL
- Expanded the Hippocratic focus on the
doctor-patient relationship to a broader social
ethic of medicine emphasizing the professional
responsibility of the physician. - Influenced the early ethical codes of AMA, BMA
and the WMA up until 1940s
31MEDICO-ETHICAL ASSOC. 1800S
- Manchester Medico-ethical Assoc.
- BMA medico-ethical committee 1853
- The attempt to produce codes of professional
ethics to deal with certain recurrent problems
they faced in the practice of their profession. - Colleague control
32AMA CODE OF MEDICAL ETHICS 1849
- Revised to AMA Principles of Medical Ethics 1903
- Leading with revised editions to a code embodying
a set of principles that in the spirit of
Percival, emphasize not only nonmaleficence and
beneficence but also doctors responsibility to
the medical profession and to society at large.
33MEDICAL ETHICSFOUNDATIONS I
-
- Traditional codes of ethics
- Doctors as independent, self-sufficient
philanthropists, whose beneficence is analogous
to generous acts of giving.
34- MODERN /BIOMEDICAL ETHICS
3520TH C NAZI GERMANY AND US
- Experimentation on Humans
- Without their consent
- Perverse extension of the authoritarian nature
of paternalism (Glannon)
36NUREMBERG CODE (1947)
- The judgment by the war crimes tribunal at
Nuremberg laid down 10 standards to which
physicians must conform when carrying out
experiments on human subjects. - 1. The voluntary consent of the human subject is
absolutely essential
37NUREMBURG CODE (1947)
- Informed Consent enshrined in Medical Ethics Code
- Patient oriented approach for the first time
- Medical ethics ceased to be the sole domain of
doctors now tested against the principles of
society (Kennedy, 1981)
38CHANGING SOCIETY 1960S
- Less deference to authority
- Anti-war movements, Vietnam, Cuban Missile
crisis, CND, hippies, public demonstrations for
rights, civil rights movements, feminism - Generally more assertive attitudes to individual
rights and self-determination
39CHANGING MEDICINE
- Technology progressing to offer more expensive
treatments, life-prolonging, scarcity of
resources with increasing costs (Dialysis, Organ
transplant, Artificial ventilation) - Reproductive control with contraception and
abortion concept of reproductive rights
40BIOETHICS (1971)
- a new discipline that combines biological
knowledge with knowledge of human value systems
(Potter, 1971) - The study of the ethical dimensions of medicine
and the biological sciences
Medicine
Science
Ethics
41BIOETHICS
- A growth in Academic comment with a shift in
Moral philosophy increasingly from metaethics to
applied ethics - Increasing ethical issues for society as a whole,
prompted by the new technologies (IVF, Genetics,
Stem cell technologies, etc.) - Non-medical commentary (philosopher, sociologist,
...) on how medicine and science should be
regulated and how doctors and scientists should
behave
42MODERN MEDICAL ETHICSFOUNDATIONS II
- Moral Philosophy
- Contemporary Medical ethics
- 1960s Moral problems of modern society
- CND, Vietnam, ...
- Personal and public responsibility for happens to
the world - Patients have rights and entitlements
43BENEFICENCE AND NONMALEFICENCE
- Early interpretations
- excessively paternalistic
- Now tempered with the recognition of other
principles
44AUTONOMY
- Gradual shift in decisional authority from doctor
to patient - Introduced the patient based principle of
- AUTONOMY
- To sit alongside and complement physician based
principles of beneficence and non-maleficence
45AUTONOMY
- auto self
- nomos law
- Moral Self Rule
- Having the capacity and the right to
self-determination to formulate and follow a
life plan of ones own making
46Sovereign over own mind and body Individual
freedom can be restricted only if risk of harm
to others
Respect for persons as autonomous
ends-in-themselves Capacity to Reason Apply the
moral law unto ourselves
47JUSTICE
- In context of a changing society,
- equality involves the concept of equal access
to society's goods, - i.e. scarce and expensive healthcare resources
- How can these be justly allocated?
48ETHICAL CHALLENGES OF THE ICT IN HEALTHCARE IN
A CHANGING SOCIETY
49INTRODUCTION
- The primary objective of the medical profession
is to render service to humanity reward or
financial gain is a subordinate consideration. - AMA Principles of Medical Ethics
- Codes of Medical Ethics Current Opinions with
Annotations, 1997.
50ETHICS MEDICINE - PART 1
- Ethics can be viewed as a prerequisite for the
success of medical practice, much the same way
that safety is a prerequisite for the success of
airline travel. - Dyer, KA. JMIR 20013(2)e23
51Modern Biomedical Ethics
- Modern bioethics reformulates the fundamental
moral problems as a problems for society, rather
than merely ones of professional self-regulation. - Takes the patients perspective as its starting
point.1
52ETHICS MEDICINE - PART 2
- In both cases, if the prerequisites are not in
place to ensure trust in the product or services
provided, consumers will not utilize the product
or service. - Dyer, KA. JMIR 20013(2)e23
53MEDICAL ETHICS
- Most physicians are governed by their own
internal code of ethics. - The commitment to help and serve others has
traditionally taken precedence over economic
interests. - Medicines code of ethics is considered to be far
more stringent than the law. - Professional organizations have more formalized
codes to ensure that their members behave
ethically.
54MEDICAL ETHICS ON THE INTERNET
- Online entrepreneurs, business medical,
rushed to cash in on the Internet bonanza, with
its promise of great potential wealth. - Investor shareholder interests are often
placed above the welfare of patients. - These actions are in direct conflict with many
of the existing medical codes of conduct.
55MAJOR AREAS NEEDING GUIDELINES IN MEDICAL
INTERNET ETHICS
- Doctor-patient, provider-patient,
therapist-client relationships - Online medicine, online therapy
- Online research
- Quality of information on medical and healthcare
Web sites - Ethical conduct of medical and healthcare Web
sites - Privacy and security
56QUESTIONS RAISED BY PROVIDING HEALTHCARE SERVICES
ON THE INTERNET
- Does a physician, provider or therapist
consultant to a website have an ethical
obligation to site visitors? - At what point does the a patient-provider
relationship begin? - Does an online relationship require that an
off-line one exists?
57MORE QUESTIONS RAISED
- Do any of the ethical guidelines that guide and
protect the patient-provider relationship apply
in cyberspace? - Is the relationship reduced to a medical or
healthcare provider-consumer one? - What are the limits of online medicine or online
therapy? - What is the ethical obligation of dealing with
unsolicited e-mail?
58WHOS TRAVELING OVER THE INTERNET?
Patient
Clinician
59MEDICINE HEALTHCARE ON THE INTERNET
- Medical websites, more than any other type of
site on the Internet, should ensure visitors
personal privacy and prevent personal medical
information, including patterns of use and
interests, from being sold, purchased, or
inadvertently entering the hands of marketers,
employers, and insurers. - Principles Governing AMA Web Sites
- Winker MA JAMA 20002831600-1606
60GUIDELINES FOR QUALITY MEDICAL AND HEALTH WEBSITES
- 1996 - Health on the Net Foundation Code of
Conduct - 1999 - Medscape The Ethics of the Medical
Internet - 2000 - AMAs Guidelines for Medical and Health
Information Sites on the Internet - - Internet Healthcare Coalitions
International Code of Ethics - - MedCERTAIN development of an trustmark
- 2001 - URAC Hiethics Fee-based Health Website
Accreditation program
61ETHICAL CONDUCT OF MEDICAL AND HEALTHCARE WEB
SITES
- Medical website designers, writers, backers,
consultants, e-health marketers, healthcare
providers and physicians must understand the
unique position they are in with online
healthcare consumers. - Online entrepreneurs and non-medical
professionals should be educated not to exploit
online patients or clients and follow a Medical
Internet professional code of conduct.
62PRIVACY SECURITY
- Without enforceable guidelines for creating
healthcare sites and ensuring privacy, and
standards for conducting online research,
Internet users risk their private life
unexpectedly becoming public and face potential
repercussions if insurance companies, employers,
friends or family discover confidential
information about their health.
63CONCLUSIONS - PART 1
- The major areas identified for further
examination study in this paper include - How privacy, security, confidentiality should
be ensured when visiting a website or conducting
transactions over the Internet. - How website visitors can determine the quality of
information at a website. - How the doctor-patient, patient-provider, and
therapist-client relationships should be
translated into practicing online medicine and
online therapy.
64Conclusions - Part 2
- How website designers, developers, sponsors
managers should develop maintain ethical
medical and healthcare websites. - How online medical and healthcare businesses
should be ethically conducted. - How online research should be ethically
conducted. - How all the professions involved in the medical
or healthcare Internet should ethically comport
themselves.
65- INFORMATION COMMUNICATION TECHNOLOGY IN HEALTH
CARE
66PILLARS OF HEALTH INDUSTRY
Chemistry
19th Century
Physics
20th Century
ICT
21st Century
67ICT IN MEDICINE
68ICT IN HEALTH CARE DELIVERY
Growing
- Globalisation
- Health care economics
- Patient process
- Medical profession
- New technologies (mobile videophone, mobile
networks)
2000 2010
68
69- Impacts ICT include-
- Medical informatics
- Telemedicine
- Medical Information
- E-Learning
Functions of Internet
70(No Transcript)
71MEDICAL INFORMATICS
- This is a term used to describe how medical
information is handled, accessed, manipulated and
retrieved.
72WHAT IS HEALTH INFORMATICS?
- Healthcare informatics is a combination of
computer science, healthcare science, information
science and cognitive science
73 TELEMEDICINE
- This is the delivery of healthcare where
distance is a critical factor by all health care
professionals using information and communication
for the exchange of valid information for
diagnosis treatment and prevention of disease and
injuries, research and evaluation and for the
continuing education of healthcare providers, all
in the interest of advancing the healthcare of
individuals and their communities. 2
74 HEALTH INFORMATION
- Medical professionals are better informed
implying that information can get to them faster
and from anywhere using internet.
75THE IMPORTANCE OF INFORMATION
- The healthcare of our clients is largely
dependant on information. - Every action taken depends on previous
information and knowledge. - The delivery of health care requires information
about - Science of type of care (nursing)
- Patient or client
- Provider
- Outcomes
- Process and systems for delivery of care
76THE IMPORTANCE OF INFORMATION
- Patient or client
- Information on the client is required for his/her
individual care. - The assessment process consists of gathering
information. - The use of technology can assist in collecting
this information. - Information on the client can be found in the
patient record, the patients history, lab
results. - Information on the client changes and grows over
time.
77E LEARNING
- ICT has also presented innovative educational
delivery methods which have overcome the
traditional barriers to continuous medical
education. - The virtual campus
- Podcasts
- Video conferencing
78GENERAL BENEFITS
- Elimination of chart-pulling, chart-filing, chart
loss. - Easy electronic review of patient information
before visits. - Notification of completed diagnostics and labs to
review. - Notification of required follow-ups, tests, etc.
- Potential reduction in medical errors with
decision support and easier access to relevant
information. - Reduction in prescription errors and subsequent
time lost communicating with pharmacies.
79GENERAL BENEFITS
- Easy communication with patients other providers
specialists, hospital visits, etc. - More complete and detailed information available
for claims, malpractice suits, etc. - Potential reduced costs for labor and supplies
related to charts and chart maintenance. - Improved flow of information between staff
members. - Accountability
80E-HEALTH
Quality of care
Access to care
- Image assistant by computers
- Continuos education
- E-prescription
- Telemedicine
- Teleconsultation
- Electronic health record
- Digitalized health system
- Hospital information systems
- Regional networks
- e-reimbursement/procurement
- Smart cards
Economy of care
80
81E-HEALTH INCLUDES
- Health/hospital information systems
- Health surveillance
- e-learning for health care professionals (medical
continuing education) - Remote patient monitoring
- Telehealth/Telecare
- Telemedicine
82GET YOUR ICT STRAIGHT
83DIGITAL TECHNOLOGY
- DIGITS( NUMBERS)
- DIGITS( LATIN- FINGERS)
- HISTORICALLY BEACONS
- SMOKES (analogue)
- DRUM SOUNDS
- INFORMATION HANDLED IN NUMBERS
- DIGITAL SIGNALS NOT VISIBLE
- RECOGNIZE( images sounds and words)
- DIGITAL Vs ANALOGUE
84A BIT ABOUT BYTES
bit bit 0 or 1
byte B 8 bits
Kilobyte KB 1,000 bytes
Megabyte MB 1,000 Kilobytes
Gigabyte GB 1,000Megabytes
85WHAT IS FIBER OPTICS?
- Transmitting communications signals over
hair thin strands of glass or plastics -
86FIBER OPTIC APPLICATIONS
- Fiber is the least expensive, most reliable
methods for high speed and/or long distance
communications - Fiber optic systems transmit using infrared
light, invisible to the human eye, because it
goes further in the optical fiber at those
wavelengths -
87(No Transcript)
88PATIENT RECORDS
- One obvious use of ICT in medicine is the
introduction of databases to store patient
records
89 . . the future of the library is that there is
no library -- at least not as we know it today
90THE INFINITE LIBRARY
If youre over 50, todays libraries are
probably nothing like the ones you remember ...
Enter any major library today and youll find an
armory of computers and ,,,,,,,,,,,,,,,,
91ICT NURSING
- Improves ability to efficiently and accurately
assess treat their patient - Nurses largest group of health care worker,
leading edge of transformation or health care - Diminishing professional nurses
- Use of lower cadre nurses in e-nursing
92(No Transcript)
93WHAT IS TELEMEDICINE?
- . . . the use of electronic information and
communication technologies to provide and support
health care when distance separates the
participants . . .
94TELEMEDICINE AND THE FUTURE
- Education (Virtual University)
- Clinically in everyday practice, education,
remote - Patient oriented, in practise, education and
monitoring at home - Network, between doctor ,pt., pharmacy and all
health personnel - Disasters, catastrophes,e.g.earth quake
- Telesurgery
95TELEMEDICINE APPLICATIONS
- The main application areas of telemedicine
systems are - telehomecare and telecardiology,
- teleradiology,
- telepathology
- ...
- (There are other specialties that use
telemedicine services, as teledermatology,
teleophthalmology, telesurgery, telepsychiatry
etc., but these are poor of applications at the
moment).
96TELERADIOLOGY
- Radiology is one of the fields where telemedicine
has been more developed - Teleradiology is the most widely used
telemedicine service at present - Teleconsoluting
- TeleDiagnosis
- E-Learning
97KEEP YOUR ICT COOL
98EMERGING APPLICATIONS
- Telepharmacy
- Teledentistry
- Broader Home Health
- Remote Surgery
99TYPES OF TELEMEDICINE
- Synchronous-Describes interactive video
connections because the transmission of
information in both directions is occurring at
exactly the same period. (Live Telemedicine) - Asynchronous-Describes store and forward
transmission of medical images or information
because the transmission typically occurs in one
direction in time. (Store and forward
telemedicine)
100LIVE TELEMEDICINE
ADVANTAGES DISADVANTAGES
- Multiple specialty use.
- Interactive.
- High quality video and audio.
- Patient provider relationship.
- Scheduling constraints.
- High equipment costs.
- Expensive line charges.
101DONT LET ICT PULL YOU DOWN
102STORE AND FORWARD
ADVANTAGES DISADVANTAGES
- No scheduling constraints.
- Less burdensome technical requirements.
- Low connection and equipment costs. (POTS)
- Information stored centrally, more secure.
-
- Limited Specialties.
- Delay in getting feedback.
- No patient provider interaction.
- Incomplete view of the case.
103CORE PRINCIPLES OF TELEMEDICINE
- Is only a tool (like a stethoscope)
- Must be physician directed
- Must be integrated into established clinical
operations and routines - Physician-patient relationships must be preserved
104TELECARE
- Tele-Home Care allows to offer medical assistance
to the patients directly to their home - Tele-Home Care may improve the quality of life of
patients - Home-care and community based health service are
becoming an increasingly important part of the
healthcare services, allowing the so called
Continuity of care
104
105(No Transcript)
106TELE - PATHOLOGY
107TELE - MONITORING
108TELEMONITORING DEVICES
109DEVICE FOR GLUCOSE MONITORING
110MEDICAL PERIPHERALS
111CHALLENGES OF HEALTHCARE PROVIDERS (PUBLIC AND/OR
PRIVATE)
- To improve quality and treatment and care of
patient and of life of the citizens. - To reduce costs (expenditure control).
- To use advanced diagnostic and therapeutical
technologies (CT,MRI, etc.) for a large number of
patients/citizens.
112(No Transcript)
113Rabbit, where are you going?I am going to
kill the Elephant Can you do that?Well, Ill
try, and try again. Tanzanian, ProverbThank
you
114WHAT IS E-HEALTH??
- ICT in healthcare
- Mostly Iinternet
- Healthcare telematics
- Medical records
- Telemedicine
- Digital imaging
- In fact re-organising healthcare
115EXAMPLES
- Electronic medical records
- eHealth platform portal site
- Register for physiotherapy and nursing
- Electronic medical prescriptions
116EXAMPLES EMP
- Electronic Medical Prescription
- Avoid erroneous interpretation
- Possibly concurrently with paper
- Avoiding fraud, theft, forging
- Over-medication can be discovered
- Diverse added values possible, requiring law
changes
117THANK YOU IF YOU HAVE BEEN LISTENING
118WHAT IS TELEMEDICINE?
- . . . the use of electronic information and
communication technologies to provide and support
health care when distance separates the
participants . . .
119TELEMEDICINE AND THE FUTURE
- Education (Virtual University)
- Clinically in everyday practice, education,
remote - Patient oriented, in practise, education and
monitoring at home - Network, between doctor ,pt., pharmacy and all
health personnel - Disasters, catastrophes,e.g.earth quake
- Telesurgery
120EMERGING APPLICATIONS
- Telepharmacy
- Teledentistry
- Broader Home Health
- Remote Surgery
121TYPES OF TELEMEDICINE
- Synchronous-Describes interactive video
connections because the transmission of
information in both directions is occurring at
exactly the same period. (Live Telemedicine) - Asynchronous-Describes store and forward
transmission of medical images or information
because the transmission typically occurs in one
direction in time. (Store and forward
telemedicine)
122LIVE TELEMEDICINE
ADVANTAGES DISADVANTAGES
- Scheduling constraints.
- High equipment costs.
- Expensive line charges.
- Multiple specialty use.
- Interactive.
- High quality video and audio.
- Patient provider relationship.
123STORE AND FORWARD
ADVANTAGES DISADVANTAGES
- Limited Specialties.
- Delay in getting feedback.
- No patient provider interaction.
- Incomplete view of the case.
- No scheduling constraints.
- Less burdensome technical requirements.
- Low connection and equipment costs. (POTS)
- Information stored centrally, more secure.
-
124TELEMEDICINE EQUIPMENT
Power Zoom Push-button 1-50x zoom allows both
close focus and wide angle images. Auto Focus
The camera automatically stays in focus for ease
of use. Freeze Frame Freeze frame produces the
clearest possible image, making it ideal for both
low- and high-bandwidth solutions. Accurate
Colors One button white balance sets highly
accurate colors quickly and easily. Polarization
Elimination of surface skin reflection allows
camera to see into epidermal layers. Touch and
View The AMD-2500 includes manual or automatic
iris control to maximize image brightness.
AMD 2500 General Examination Camera
125QUALITY IMAGES
Pictures taken by AMD 2500 General Examination
Camera
126HOW IT WORKS
- Video conference system
- Cameras each end
- TV screens/computers each end
- Various medical peripherals
- Video connection
- T-1 line
- Satellite
- Phone line (POTS)
- Internet
127 ) ) ) ) ) ) ) ) ) ) )
) ) ) ) ) ) ) ) ) ) ) ) )
Hub Site
Remote Site
T-1
128(No Transcript)
129CORE PRINCIPLES OF TELEMEDICINE
- Is only a tool (like a stethoscope)
- Must be physician directed
- Must be integrated into established clinical
operations and routines - Physician-patient relationships must be preserved
130TELEMEDICINE APPLICATIONS
- The main application areas of telemedicine
systems are - telehomecare and telecardiology,
- teleradiology,
- telepathology
131TELECARE
- Tele-Home Care allows to offer medical assistance
to the patients directly to their home - Tele-Home Care may improve the quality of life of
patients - Home-care and community based health service are
becoming an increasingly important part of the
healthcare services, allowing the so called
Continuity of care
132PATHOLOGY
- Histology slides can be transmitted to
pathologists using a digital camera attached to a
microscope
133LIVE TELEMEDICINE EQUIPMENT
- General Examination Camera
- E-Stethoscope
- ENT Scope
- Ophthalmoscope
- X-Ray Digitizer
- 12 lead ECG machine
- Spirometer
134ECG WITH PERSISTENT MEMORY
135DEVICE FOR EMERGENCY
136OTHER DEVICES
Magnetic stirrer
Heat ramp pressure probe
Organ bath
Algae fluorometer
Negative pressure tank
Solar Powered Datalogger
137ADVANTAGES
- Specialist advice without the patient having to
travel to the central hospital - Cost saving in transport and patient
accommodation - Better utilisation of specialist resources
- Educational opportunities
138DISADVANTAGES
- Incorrect diagnoses
- Cost of hardware
- Need good telecommunication network
- Training of staff
- Medicolegal concerns- patient confidentiality
139PITFALLS
- Cost- digitizers are expensive
- Telecommunications limited in many parts of
Africa and Asia- satellite shows promise - Medicolegal issues- patient confidentiality
- Training of physicians
140FUTURE DIRECTIONS
- Digital cameras may replace digitizers and are
much cheaper - Wireless communications are rapidly expanding in
developing countries - Internet II may provide sufficient bandwidth for
telemedicine - Offers many educational opportunities
141MOZAMBIQUE PROJECT
- January 1998 First ITU Telemedicine project was
implemented in Mozambique, connected two
hospitals (one in Maputo, the capital of the
country, and the second in Beira) for
teleradiology.
142MOBILE EHEALTH IN RURAL AREAS
- There are two solutions
- Mobile phone can be used for management and
consultations related to medical services. - Mobile eHealth care clinics/units traveling in
rural areas from one village to another and
connected to nearby hospital by wireless
communication for consultations.
143MOBILE TELECOMMUNICATION IN DEVELOPING COUNTRIES
- The number of mobile phones in many developing
countries is drastically increased during the
last five years offering technical platform for
many mobile eHealth services to be organized.
144MOBILE NETWORK COVERAGE IN SELECTED COUNTRIES
(ITU, 2007)
- Combodia 87, Gambia 85, Guinea 80, Kenya 77,
Pakistan 90, Rwanda 90, Senegal 85, Togo 85,
Uganda 80, Zimbabwe 75.
145GOALS OF TELEMEDICINE
- To provide consultation and interpretation in
regions of demonstrated need - To provide specialist services in hospitals
without on site support - To promote educational opportunities for
physicians
146Conclusion 1
- Experience demonstrates that there is no single
solution that will work in all settings. The
complexity of technologies and the complexity of
needs and demands of healthcare suggests the
gradual introduction, testing and refining of new
technologies.
147Telemedicine in Developing Countries
- Telemedicine has the potential for offering to
developing countries both qualitative and
quantitative improvements. - Many developing countries have inadequate
health-care and medical services. Developing
countries suffer from a shortage of doctors and
other health-care professionals. - Developing countries are inevitably short of high
level hospital infrastructures. The geographical
distribution of existing hospitals and health
services is far from ideal usually they are
limited to urban centres at county or district
level. - For countries with limited medical expertise and
resources, telecommunications services and
network have the potential to provide a solution
to some of many problems. Increasingly, there is
a recognition that health services must be
provided close to the people who need them and an
integrated, cost-effective approach is necessary.
148- The state of health of population is a direct
determinant of development. Access to better
health services reduces poverty and increases
productivity. Investment in health is a
prerequisite to economic and social progress. - Population growth and the emergence of new health
problems are increasing the demand for health
services and for more expensive treatments.
However, increasing demand and rising health care
costs have not been matched by the funding of the
health sector in most developing countries. - About one billion people worldwide do not have
regular access to local health services.
149MEDICAL ETHICS IN CHANGING SOCIETY
- Society-complex
- Individual Patients right awareness
- Patients critical consumers
150MEDICAL ETHICS
- Doctors V Patients
- Doctors V Society
- Medicine the art of healing
- Service to humanity
- Doctors as businessmen
151CHANGING FACE OF MEDICINE
- ART To Science
- Service To business
- Patient To consumers
- Lawyers Decision Makers
152WHAT IS ETHICS
- Ethics or moral philosophy is the systematic
endeavour to understand moral concepts and
justify moral principles and theories - Ethics builds and scrutinizes arguments settings
forth large-scale theories on how we ought to
act, and it seeks to discover valid principles
and the relationship between those principle
153MORALITY AND ETHICS
- The terms moral and ethics come from latin and
Greek respectively (mores and ethos). Deriving
their meaning from the idea of custom.. There
is also another Greek word ethos which denotes a
character feature. Aristotle called his ethics a
study of character traits, in sense of virtues
and vices.
154MEDICAL ETHICS
- Is based on philosophical ethics
- It isnt any special ethics but rather ethics of
special cases. - Medical ethics does not concern only doctors but
also patients and society - The central question of medical ethics is the
doctor- patient relationship
155THE NATURE OF MORALITY
- Moral acts are acts done benefit others, they are
altruistic and are not motivated by
self-interest. - Morality makes reference to right/wrong/permissibl
e behavior with regard to basic values -
156THE ORIGINS
- The Beginnings
- The Nuremburg Code, 1948
- Earlier Points of Origin
- Babylonian codes
- Hippocratic Code/Oath
- Islamic Codes
- Jewish Codes
157SOME HISTORICAL POINTS
- Privacy and confidentiality
- Abortion/status of the fetus
- Allocation of scarce resources
- Definition of death
158SOME HISTORICAL POINTS
- Genetics issues
- Reproductive issues
- AIDS
- Animal rights
- Relationship with pharmaceutical industries
159HIPPOCRATIC OATH5-4 CENTURIES B.C
- An obligation of nonmaleficence and an obligation
of beneficence are both expressed in the
Hippocratic oath - I will use treatment to help the sick according
to my ability and judgement, but I will never use
it to injure or wrong them
160THE SOCIAL CONTEXT WHY IS MEDICAL ETHICS SO
PREVALENT?
- Some factors
- Womens Movement
- - Male dominance of medicine
- - Focus on cure rather than care and
prevention - Legalization, legislation, and litigation
- Social interest in freedom and autonomy decline
in the status of medicine
161- The moral duties of the doctor
- The duty to help cure
- The duty to promote and protect the patients
health - The duty to confidentiality
- The duty to protect the patients life
- The duty to respect the patients autonomy
- The duty to protect privacy
- The duty to respect the patients dignity
162- The moral rights of the patient
- The right to high quality medical service
- The right to autonomous choice
- The right to decide
- The right to be informed
- The right to privacy
- The right to health education
- The right to dignity
163- Professionalism is a term which embodies numerous
qualities of physicians as public servants - Professionalism aspires to altruism,
accountability, excellence, duty, honour, and
respect fro other - A commitment to the highest standards of
excellence in the practice of medicine and in the
generation and dissemination of knowledge
164- The concept of professionalism includes the
following values as - Honesty -Commitment to
- Altruism excellence
- Service - accountability
- Commitment -Life-long learning
- Communication
165Principles of Ethics
- Beneficence
- Non-Maleficence
- Autonomy
- Truth telling
- Confidentiality
- Preservation of life
- Justice
166IMPORTANCE OF ETHICAL ISSUES
- Increasing profile/Recent press headlines
- Increase in technology
- Better informed society
- Doctors in Management
- Public scrutiny
167AUTONOMY
- Capacity to think, decide, take action
- Mental incompetence no autonomy
-
168TRUTH TELLING
- In much wisdom is much grief and he that
increaseth knowledge increaseth sorrows - (Ecclesiastics 1,18)
- Patients do not want the truth if the news is bad
- At times there are good reasons for overriding
truth telling principle
169CONFIDENTIALITY
- Act against this principle and you destroy
patients trust - Clash- when keeping confidentiality would harm
others e.g child abuse - Should patients have access to their notes?
170PRESERVATION OF LIFE
- At what stage does human life begin?
- Can we assess another persons quality of life?-
Jehovahs Witness
171EUTHANASIA
- Active an active intervention end life
- Passive deliberately withholding treatment that
might help a patient live longer - Voluntary euthanasia is performed following a
request from a patient - Doctor assisted suicide a doctor prescribes a
lethal drug which is self administered by the
patient - Non-voluntary ending the life of a patient who
is not capable of giving permission - Involuntary ending life against a patients
172GIFTS TO PHYSICIANSFROM INDUSTRY
- Is it ethically permissible to accept gifts from
pharmaceutical representatives? - Any gift accepted by a physician should primarily
entail a benefit to patients and should not be
substantial value. - Individual gifts as long as they relate to the
physicians work.
173ADVERTISING IN MEDICINE
- Patient information and doctors advertising
medicine - Commercialized health care marketing
- Doctors website
- Media coverage
- Electronic medicine
174ADVERTISING AND PROFESSIONALMISCONDUCT
- Information
- Drawing attention to achievements
- Attracting patients
- Professional advantage
- Financial benefits
175- For sale an antique desk suitable for lady with
thick legs drawers. - Now is your chance to have your ears pierced and
get extra pair to take home, too - Wanted Unmarried girls to pick fresh fruit and
produce at night. - Sheer stocking. Designed fro fancy dress, but so
serviceable that lots of women wear nothing else - We build bodies that last a lifetime
- Man, honest. Will take anything
- Used Cars Why go elsewhere to be cheated? Come
here first!
176- TELEMEDICINE HAS THE POTENTIAL FOR OFFERING
DEVELOPING COUNTRIES BOTH QUALITATIVE AND
QUANTITATIVE IMPROVEMENTS. - These include
- distance consultations, diagnosis and advice for
treatment by medical specialists - education and training. Rural health-care staff
can have regular access to lessons given by
specialists in hospitals (e.g. on the management
of common and special diseases) - access to international medical databases
- increasing effectiveness and efficiency, for
example in reducing waiting times for
consultations, and in introducing medical
information systems. - Health care network and telemedicine facilitate
the provision of medical information distributed
in health district and clinical centres and are
useful for developing countries.
176
177TELEMEDICINE IN DEVELOPING COUNTRIES
- CHALLENGES
- 1.Poor technology infrastructure
- 2. Lack of funding
- 3. Lack of it education
- 4. Insufficient training for health care workers
- Resistance to change HCW patients
-
178TELEMEDICINE CHALLENGES
-
- Ethical Resource allocation cost-effectiveness
- Patient-Doctor relationship
- Effect on healthcare network
- Sustainability at Donor exit
179- Telemedicine in developing countries not a
panacea - Clinical Diagnostic Therapeutic
- Educational Administrative
- Excessive expectations
- Unsustainable funding models
- Lack of trials andevaluation data
180TELEMEDICINE IN RLC.
- Why is telemedicine worth considering in
developing countries - Telemedicine deserves consideration because of
the real needs of developing countries for
healthcare access. - There is also the ethical imperative of trying to
obtain the best possible healthcare in a
resource-constrained environment
181TELEMEDININE IN Dev.Count.
- Now that 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. - Telemedicine thus works toward the concept of
only one class of medicine, which transcends
boundaries
182CHANGING FACE OF MEDICINE
183 PATIENTS DEMANDS
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187 IF YOU HAVE BEEN!
THANK YOU FOR LISTENING
188HEALTHCARE AS A BUSINESS
189ADVERTISE - DEFINITIONOxford English Dictionary
- Make generally known
- promote (goods or services)
- physically to encourage people to buy or use
them. - Ask or offer by public notice.
190- Be demonstrably true in all respects
- not be misleading, vulgar or sensational
- seek to maintain the decorum and dignity of the
profession - not contain any testimonial or endorsement of
clinical skills - not claim that one doctor is superior to others
nor contain endorsements for any particular
doctor an - avoid aggressive forms of competitive persuasion,
such as those that prevail in commerce and
industry.
191CHANGING FACE OF MEDICINE
- ART--------TO SCIENCE
- SERVICE TO BUSINESS
- PATIENT TO CONSUMERS
192HEALTHCARE TODAY
- POLITICAL INFLUENCE
- EXPANDING SERVICES
- QUALITY CARE
- PRIVATE CARE Vs PUBLIC SERVICE MEDICAL TOURISM
193QUALITY OF CARE
- Quality is never an accident it is always the
result of high intention, sincere effort,
intelligent direction and skillful execution it
represents the wise choice of many alternatives -
William. A, Forster
194MEDICINE AS A BUSINESS
- Medical care Economic transaction
- Doctors Purchasing agents
- Medical care Consumer good
- Doctors skilled vendors
- Market price/forces
195ADVERTISEMENT IN MEDICINE
- Be demonstrably true in all aspects
- Not be misleading, vulgar or sensational
- Seek to maintaining the decorum and dignity of
the profession - Not contain any testimonial or endorsement of
clinical skills - Avoid aggressive forms of competitive persuasion
,m such as those that prevail in commerce
196HOSPITAL AS INVESTMENT
- Selection of Area ( prosperous )
- Selection of patient location ( insurance cover)
- Procedure orientated
- Price mark-ups
- Avoiding low profit illness
- Management MBA versus MPH
197HEALTHCARE
- PRODUCTIVITY VERSUS PATIENT CARE
- How many patients seen
- Bed occupancy
198INFORMED CONSUMER
- Ideal market situation range options
- Healthcare and choice service of money health
cover. - Customer Service in Hospitals
- Hospitals are spending huge sums on customer
service for competitive services - Patients simply Customers
199- We all know that health care is big business
these days, but did you know following? - It is six to 10 times more costly to attract a
new customer than it is to retain an existing
one. - A satisfied customer only tells five other
people. - An unhappy customer tells approximately 20 other
people. - It only takes 30 seconds for a customer to form
an opinion.
200HOSPITAL REPORTS
- Customers
- Market shares
- Cash Flow Problems
- Product Vs Results
- Bottom line results
- Consumer Vs patient care needs
- Marketing/ Advertising and consumer service.