Telehealth In the New Millennium

1
Telehealth In the New Millennium
Presented at
ISN Informatics Symposium

• Michele L. Hales
• University of Alberta
• Edmonton, AB CANADA

Dubai, UAE
February 5, 2001
2
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."

3
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
4
Transmission

• 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 gt1Mb
• Satellite expensive

5
Categories 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
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Valuable Product Services
Source VHA Annual Information Systems Survey 1998
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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/research
body.jsp?Reportehlt_20000131
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A transition
e-health is now the term to use when describing
the rise of digital technologies, electronic
transmission and the convergence of
technologies. Mitchell, JohnFrom Telehealth to
E-Health The Unstoppable Rise of E-Health.
1999. Department of Communications,
Information Technology and the Arts, Australia.
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Telehealth

• 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.

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Telehealth/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)
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Telemedicine, telehealth, e-health

• Consumer-driven
• Provider-driven

• e-health
• Telemedicine and Telehealth

• The public will tell us what they want
• in e-health.
• Providers no longer dictate but become partners
  with patient or client.

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Driving 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

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Trends 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.

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Strengths 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

15
Some 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

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Opportunities

• Collaboration
• - various government agencies
• - health organizations
• - industry
• Strengthen incentive program
• Develop and exchange knowledge

17
Successful Telehealth Endeavours

• School-based health centers
• Hibernia off-shore oil drilling platform
• Correctional Facilities
• Tele-
• - dermatology
• - radiology
• - cardiology
• - oncology
• - surgery
• - psychiatry
• - pediatrics

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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.

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Teledialysis (OSMH) contd

• 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

20
Teledialysis (OSMH) contd

• 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

21
Telehealth Initiatives Globally

• Armenia
• Australia
• Canada
• Europe
• South Africa
• United States of America

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E-mail Discussion Lists

• TELEHEALTH
• To listserv_at_maelstrom.stjohns.edu
• Body Subscribe TELEHEALTH YourName
• E-HEALTH
• To listserv_at_maelstrom.stjohns.edu
• Body Subscribe EHEALTH YourName
• NETPSY
• To listserv_at_maelstrom.stjohns.edu
• Body Subscribe NETSPY YourName
• ITNA
• To listserv_at_bcm.tmc.edu
• Body Subscribe itna FirstName LastName

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Publications

• 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

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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

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Organizations Associations contd

• 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

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Telehealth Future

• Precedents are now being set
• New generation of technology arrives every 18 -
  30 months
• The future is being shaped by us now

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Conclusion

• 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

28

• The computer is very fast, accurate and stupid.
  Man is very slow, inaccurate and brilliant.
  Together they make an unbeatable team. --
  Albert Einstein

FOR MORE INFO...
Michele.Hales_at_UAlberta.CA