Telemedicine and ehealth in Modern Health Care: An Introduction

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Telemedicine and e-health in Modern Health Care
An Introduction

• Rifat Latifi, MD, FACS
• Professor of Surgery
• University of Arizona, Tucson, AZPresident,
  International Virtual e-Hospital Foundation,
  Anchorage, Alaska
• Director, Telemedicine Program of Kosova

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2nd BALKAN TELEMEDICINE SEMINAR

• Part of the scheduled activities of IVeH
  (www.iveh.org/projects), which is implementing a
  two-year project "Improving Health Care in the
  Balkans Using Telemedicine, Advanced Technologies
  and Cultural Exchange Program as a Platform",
  funded by the Bureau of Education and Cultural
  Exchange Agency of the Department of State of the
  USA.

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2nd BALKAN TELEMEDICINE SEMINAR

• This three-day intensive workshop on is being
  organized by the International Virtual e-Hospital
  Foundation (www.iveh.org), by the State
  Department of U.S. USAID/Albania and Telemedicine
  and Advanced Technology Research Center
  (TATRC/MRMC), Fort Detrick, Maryland.

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2nd BALKAN TELEMEDICINE SEMINAR

• Current Practices and Principles of
  Telemedicine and e-Health

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Objective

• The objective of this intensive program is for
  doctors, nurses, engineers, administrators, and
  other participants from Albania, Kosova,
  Macedonia, Montenegro and other countries to be
  introduced to the most current principles and
  practices of telemedicine and e-Health and
  discuss the future of telemedicine and its
  potential in this region and globally.

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MAIN OBJECTIVE

• TO INTRODUCE TELEMEDICINE IN ALBANIA IN A ROBUST
  WAY AND SEED THE PLANS FOR NATION WIDE
  IMPLEMENTATION OF TELEMEDICINE PROGRAM THAT
  IMPROVE ALBANIAS HEALTHCARE AND WILL BECOME PART
  OF THE GLOBAL TELEMEDICINE

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MAIN OBJECTIVE

• To develop champions to carry this process in
  Albania and the Balkans and to make you an
  integral part of our program, dreams and goals

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Main Topics 2nd Balkan Seminar

• INTRODUCTION TO BASICS OF TELEMEDICINE, E-HEALTH,
  AND MODERN ELECTRONIC LIBRARYFrom Basics to
  Global Approaches of Telemedicine and
  e-HealthExamples of Clinical Telemedicine
  Applications

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Main Topics 2nd Balkan Seminar

• Telemedicine 2007 Where do we stand and where we
  are going?
• Telemedicine from Primary Care to Medical School-
  Ensuring Sustainability
• Military Telemedicine and e-Health from
  Laboratory to Battlefield Lessons for Civilians

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Main Topics 2nd Balkan Seminar

• Advances in Telemedicine
• New Frontiers of Advanced Technologies

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Telemedicine Historical notes

• 1900 -telephone was introduced
• WWI-radio communications
• 1920 Haukeland Hospital in Norway- radio links
  to ships
• 1924- Radio News prediction
• 1929- Television introduced

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Telemedicine Notes

• 1955- Nebraska Psychiatric Institute
• 1964- Institute connected with another hospital
  and Telemedicine was born
• In 1967 the Massachusetts General Hospital
  established a microwave connection with Logan
  Airport and began medical consultation for
  travelers
• Monitoring the status of cosmonauts and
  astronauts required telemetry

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Telemedicine Notes

• The first traveler was Yuri Gagarin in 1961 and
  his vital signs reported by the new technology of
  telemetry
• From 1972 to 1975 NASA supported a demonstration
  project in Arizona called Space Technology
  Applied to Rural Papago Advanced Health Care
  (STARPAHC) using microwave transmission
  connecting a mobile health unit to a public
  health hospital for consultations
• The ALASKA ATS-6 program in 1971 linked 26 sites
  in Alaska by satellite for the purpose of medical
  support.

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Telemedicine Notes

• In 1974 NASA established the basic requirements
  for video quality declaring acceptable 200 lines
  or a rate of 10 frames per second the minimal
  configuration
• Lonely ships in the oceans in Northern Europe
• Earthquakes

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Friendship Airport Disaster Exercise 1978

• Purpose
• Implement Regional Disaster Plan
• Test Actual EMS Response
• Enact Coordinated Triage to Multiple Facilities
• Determine Feasibility of On-Scene Image
  Transmission and its Role in Triage and Transport

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Friendship Airport Disaster Exercise

• Exercise Conditions
• Simulated Airplane Crash
• 72 Casualties
• Activation of Regional Disaster Plan
• On-Scene Command Station
• Triage/Transport

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Transoceanic cholecystectomy operation Lindbergh

• A laparoscopic cholecystectomy performed from
  New York in Strasbourg, FranceSep 9, 2001
• Conclusion Distance is meaningless

Prof. Marescau at work
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Robotic Surgery

• Accomplishment- there were not possible before
• Dexterity enhanced
• Computer assisted
• Image guided

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A NEW GENERATION OFAMERICAN INNOVATION

• The White HouseApril 26, 2004
• Washington DC

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Transforming Health Care through Health
Information Technology

• The innovations in electronic medical records and
  the secure exchange of medical information will
  help transform health care in America -
  improving health care quality- reducing health
  care costs
• - preventing medical errors
• - improving administrative efficiencies
• - reducing paperwork and
• - increasing access to affordable health
  care.
• Electronic Medical records for all Americans
  within next 10 years

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Step One Adopting Health Information Standards

• The President called for the completion and
  adoption of standards, collaboratively developed
  with the private sector, that will allow medical
  information to be stored and shared
  electronically while assuring privacy and
  security.

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Step two Doubling Funding to 100 Million for
Demonstration Projects on Health Information
Technology

• To build upon the progress we have already made
  in the area of health care standardization, the
  Presidents proposed FY 2005 budget includes 100
  million for demonstration projects by hospitals
  and health care providers that will help us test
  the effectiveness of health information
  technology and establish best practices for more
  widespread adoption in the health care industry.

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Step three Fostering the Adoption of Health
Information Technology

• As one of the largest buyers of health care,
  the Federal Government can create incentives and
  opportunities for health care providers to use
  electronic
• records.

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Step four Creating a New, Sub-Cabinet Level
Position of National Health Information
Technology Coordinator.

• Health care system that is patient-centered and
  that gives patients information they need to
  make clinical and economic decisions in
  consultation with dedicated health care
  professionals.

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Why adapt the Information Technology in health?

• President George W. Bush, State of the Union
  Address, January 20, 2004By computerizing
  health records, we can avoid dangerous medical
  mistakes, reduce costs, and improve care.
• Health Information Technology Plan will address
  longstanding problems of preventable errors,
  uneven quality, and rising costs in the Nations
  health care system.

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The Problem Challenges to the U.S. Health Care
System

• The U.S. health care system has a long and
  distinguished history of innovation.
• Discoveries move from the laboratory bench to the
  bedside
• Health care spending and health insurance
  premiums continue to rise at rates much higher
  than the rate of inflation.

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The Problem Challenges to the U.S. Health Care
System

• Despite spending over 1.6 trillion on health
  care as a Nation, there are still serious
  concerns about preventable errors, uneven health
  care quality, and poor communication among
  doctors, hospitals, and many other health care
  providers involved in the care of any one person.

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The Problem Challenges to the U.S. Health Care
System

• The Institute of Medicine estimates that between
  44,000 and 98,000 Americans die each year from
  medical errors.
• Many more die or have permanent disability
  because of inappropriate treatments,
  mistreatments, or missed treatments in ambulatory
  settings.

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Unnecessary treatments

• Studies have found that as much as 300 billion
  is spent each year on health care that does not
  improve patient outcomes treatment that is
  unnecessary, inappropriate, inefficient, or
  ineffective.

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The Problem Challenges to the U.S. Health Care
System

• High costs, uncertain value, medical errors,
  variable quality, administrative inefficiencies,
  and poor coordination are closely connected to
  the failure to use health information technology
  as an integral part of medical care.
• The innovation that has made our medical care the
  worlds best has not been applied to our health
  information systems.

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Medicine did not follow other industries

• Other American industries have harnessed advanced
  information technologies, to the benefit of
  American consumers
• Air travel system
• Banking system

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New medicine with old tools

• Medicine still operates primarily with paper
  based records.
• 21st century medical technology and complex
  medical information with 19th century tools.

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• The Solution Health Information Technology

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Health informationtechnologies

• Electronic medical records, computerized ordering
  of prescriptions and other medical tests,
  clinical decision support tools, and secure
  exchange of authorized information improve
  quality, reduce medical errors, and prevent
  deaths.

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One dramatic example

• Virtual Intensive Care Unit (VISICU)
• One intensivist cares for many intensive care
  units
• Reduced mortality
• Increased productivity
• Evidence based medicine practice

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Great examples

• Transmitting X-Rays Over the Internet
  -Teleradiology
• Electronic Laboratory Results
• Electronic Prescriptions- Telepharmacy

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Broadband Internet for Every One

• Promoting Innovation and Economic Security
  through Broadband Technology
• Making broadband access tax-free will lower the
  cost to consumers
• Working to enable the rollout of new broadband
  technologies.
• The Federal Government must do its part to
  remove hurdles that slow the deployment of
  broadband.

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Broadband with high-speed Internet

• Improve the Nations economic productivity and
  offer life-enhancing applications, such as
  distance learning, remote medical diagnostics,
  and the ability to work from home more
  effectively
• Broadband technology will enhance our Nations
  economic competitiveness and will help improve
  education and health care for all Americans

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Important Facts about Broadband

• Broadband in the United States is always-on,
  allowing a computer to remain connected to the
  Internet 24 hours a day.
• Distance learning, remote medical procedures,
  interactive web teleconferencing, and real-time
  video and audio all require Internet speeds
  beyond what traditional dial-up service can offer

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Important Facts about Broadband

• Broadband has grown from just over 7 million
  subscriber lines in December 2000 to almost 24
  million in June 2003, a 230 percent increase.
• Approximately 90 percent of all U.S. zip codes
  have access to at least one form of wireline
  broadband connection (cable modem or DSL), up
  from just over 70 percent at the end of 2000.
• 75 percent of zip codes in the United States have
  access to broadband through both cable modem and
  DSL

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The gap..
Between the imagination and accomplishment
has never been smaller
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Current Challenges
1. Dreams
4.Determination
2.A M B I S I O n
5.Passion
3.Creativity
6.Serendipity
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Conclusions

• Analyze your situation
• Be critical but fair
• Find a solution
• Be visionary
• Strive to be the best in the world
• Adopt Advanced Technologies
• Adopt it, spread it, help develop it

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What is the message?

• Vision for the future
• Dreams
• Dedication
• Collective work

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In other words

• Vision and the dream
• Technology is worth to invest
• Creative and incentives
• Political mandate to realize the goals

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• Never give up on a dream just because the time
  it will take to accomplish it. The time will pas
  anyway.