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Telemedicine, Telehealth, Telecare


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Telemedicine, Telehealth, Telecare. Dimitar Hristovski, Ph.D. E-mail: dimitar.hristovski@mf.uni-lj.si Institute of Biomedical Informatics Medical Faculty University of Ljubljana, Slovenia. Definitions. Tele- ( from Greek: far, at a distance, remote )

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Telemedicine telehealth telecare

Telemedicine, Telehealth, Telecare

Dimitar Hristovski, Ph.D.E-mail: dimitar.hristovski@mf.uni-lj.si

Institute of Biomedical InformaticsMedical FacultyUniversity of Ljubljana, Slovenia


Definitions

Definitions

  • Tele- (from Greek: far, at a distance, remote)

  • Telemedicine utilizes information and telecommunications technology to transfer medical information for diagnosis, therapy and education.

  • Telehealthis the use of information and communication technologies to transfer healthcare information for the delivery of clinical, administrative and educational services.

  • Telecareutilizes information and communication technologies to transfer medical information for the diagnosis and therapy of patients in their place of domicile.

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Historical overview of telemedicine development in regard to used technology

Historical Overview of Telemedicine Development in Regard to Used Technology

  • Telegraphy and telephony

  • Radio Communications

  • Televisionand video

  • Information technology (digital data transmission)

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Non technological drivers of telemedicine and telecare

Non-Technological Drivers of Telemedicine and Telecare

  • Extension of Access to Healthcare Services:

    • Remote rural areas (e.g.USA, Australia)

    • Areas cut off from normal transport at certain times of the year by bad weather (e.g.Canada, Norway)

    • Prisoners

    • Psychiatric patients

  • Healthcare Provision for Travelers:

    • At the sea

    • In the air

  • Military Applications

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Non technological drivers of telemedicine and telecare cont

Non-Technological Drivers of Telemedicine and Telecare (cont.)

  • Home Telecare

    • Increase in the proportion of older people in the population

    • Increased incidence of chronic, long-term conditions

    • Majority of elderly people prefer to live in their own homes

    • Tele-visitsby a video link and transmission of up to date information and vital signs

  • Cost Reduction

    • Smaller transport expenses

    • Allow specialist services at remote locations where employment of healthcare workers not economically justified

  • Market Development

  • Health Policy and Strategy

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Technological drivers of telemedicine and telecare

Technological Drivers of Telemedicine and Telecare

  • Computing and Information Technology

    • Falling equipment costs

    • Increased power on the desktop, Ease-of-use

    • Modern developments in videoconferencing

    • Increase in the reliability of equipment

  • Network and Telecommunications Infrastructure

    • Faster and more reliable network connections

    • Low-performance modems based on copper wire transmission supplemented by faster media and technologies using fiber-optic cables

    • Introduction of new communication protocols (e.g. ADSL and ATM)

    • Major developments in wireless and satellite technologies

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Technological drivers cont

Technological Drivers ... (cont.)

  • Technology-Led Society. Ever increasing appetite of society for:

    • Speed

    • Convenience

    • Quality

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


The future for telemedicine

The Future for Telemedicine

  • Moving telemedicine out of the pilot study phase and into the mainstream

  • Health policy and strategy

  • Telecare to play a significant role given the ageing populations throughout the world

  • The role of the Internet

    • Education of both care providers and patients

    • Transmission of health information and images

  • Enhancing healthcare in underdeveloped countries

    • By developed countries, commercial companies and non-profit organizations

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Types of telemedicine

Types of Telemedicine

  • Teleconsultation

  • Tele-education

  • Telemonitoring

  • Telesurgery

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Teleconsultation

Teleconsultation

  • Medical consultation is at the heart of clinical practice

  • Teleconsultation to support clinical decision making is the most frequent example of telemedical procedures (35%)

  • Actors

    • Health providers without a patient

    • Health provides and a patient (changed relationship provider:patient)

  • Mode of communication

    • Telephone

    • Video conferencing link in real time

    • Store-and-forward mode (most frequently in teleradiology for large X-ray files transmission)

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Tele education

Tele-education

Types of tele-education depending on who is the recipient and what is the purpose of the transmission:

  • Clinical education from teleconsultation

  • Clinical education via the Internet

  • Academic study via the Internet

  • Public education via the Internet

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Telemonitoring

Telemonitoring

Telemonitoring is the use of a telecommunications link to gather routine or repeated data on a patient’s condition (e.g.blood pressure, ECG, ultrasound …)

  • Data acquisition process:

    • Manual, then electronic transmission

    • Automatic, then electronic transmission

  • The purpose of monitoring is to decide if and when an adjustment is needed to the patient’s treatment

  • The adjustment can be communicated verbally by telephone or automatically using a touch-tone telephone and a computer telephone integrated (CTI) system

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Telesurgery

Telesurgery

  • Compared to other ‘tele’ applications, telesurgery in its infancy

  • Types:

    • Telementoring: assistance given by specialists to surgeons carrying out a surgical procedure at a remote location

    • Telepresence surgery: guides robotic arms to carry out remote surgical procedures

      • Distance can be small (same room) using movement scaling technique (large movement of surgeon’s hands scaled down to very precise, tremor-free movements

      • Data Glove for hand’s movement transmission

      • Virtual reality operation simulation before the real surgery

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Benefits of telemedicine

Benefits of Telemedicine

  • Better access to healthcare

  • Access to better healthcare

  • Improved communication between carers

  • Easier and better continuing education

  • Better access to information

  • Better resource utilization

  • Reduced costs

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Limitations of telemedicine

Limitations of Telemedicine

  • Poor patient-healthcare provider relationships

  • Poor relationships between healthcare professionals

  • Impersonal technology

  • Organizational disruption

  • Additional training needs

  • Difficult protocol development

  • Uncertain quality of health information

  • Low rates of utilization

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Barriers to progress of telemedicine

Barriers to Progress of Telemedicine

  • Telecommunications infrastructure and standards

  • Cost effectiveness

  • National policy and strategy

  • Ethical and legal aspects

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Technology of telemedicine systems

Technology of Telemedicine Systems

  • Types of telemedicine information

    • Text and data

    • Audio

    • Still (singe) images

    • Video (sequential images)

  • Important transmission parameters

    • Still image and video compression

    • Frame rate and bandwidth

    • Telecommunication standards

  • Teleconsultation system components

    • Videoconferencing system

    • Multipoint videoconferencing system

    • Image display system

    • Telemonitoring devices

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Technology cont

Technology...(cont.)

  • Telecommunication media suitable for telemedicine system implementation

    • Public Switched Telephone Network

    • Leased lines

    • ISDN

    • Satellite

    • Wireless Technologies

    • ATM

    • ADSL

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Technology cont1

Technology ... (cont.)

  • Integration and operational issues

    • Integration with other healthcare information systems (e.g.Electronic medical record)

    • Store-and-forward operation

    • Real-time telemedicine

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Telemedicine service providers and applications

Telemedicine Service Providers and Applications

  • Mainstream health sector services

    • General practitioners and Primary Care Services

      • Monitoring of conditions

      • Minor injuries and emergencies

      • Better coordination with secondary care

    • Acute hospital and Secondary care services

      • Tele-radiology

      • Tele-dermatology

      • Tele-neurophysiology

      • Tele-cardiology

      • Tele-psychiatry

      • Tele-ophthalmology

      • Tele-pathology

      • Tele-obstetrics

      • Tele-oncology

Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


Providers and applications cont

Providers and Applications... (cont.)

  • Pharmacy services

    • Electronic prescriptions

    • Buying drugs over the Internet

  • Commercial services and other agencies

    • Managed care organizations

    • Transport services

    • Military agencies

    • Space exploration agencies

  • Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare


    Recommended literature

    Recommended Literature

    • Essentials of Telemedicine and Telecare. A.C. Norris. John Wiley & Sons 2002. ISBN 0-471-53151-0

    Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Telemedicine, Telehealth, Telecare