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Telehealth

Telehealth

arinbasu
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Telehealth

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  1. Telehealth – ideas, evaluation Arindam Basu University of Canterbury Arindam.basu@canterbury.ac.nz

  2. What is Telehealth? • Telecommunications Technology in Healthcare • Delivers Health-related Services • Information to Support Patient Care • AdministrativeActivities • Health Education Image Source: http://www.uq.edu.au/coh/index.html?page=179639&pid=137803

  3. Why Telehealth • Improve Access to Care • Reduce Costs of Transportation • Increase Patient Convenience Significant Potential Impact on Increasing Access to Care for the Underserved

  4. Variability of Services

  5. NZ Rural Workforce Survey 2005

  6. Benefits of Telehealth • Addresses shortage of provider supply in rural areas • Shortage of supply of specialists in urban areas • Reduces health system costs • Patients do not need to drive long distances • Can Reduce Waiting Time • Same Technology can be used for patient care and education

  7. Impediments to Telehealth • Slow Evolution of Evidence about effectiveness • What is the Worth/Value of Telehealth? • What do we know about effectiveness of TH? • Business Cases for TH? • Problems Related to Telehealth Being Trans-boundary

  8. Classification of Telehealth • 1. Provider to Provider Communication in presence of Patient • 2. Provider to Provider Communication in absence of Patient • 3. Telemonitoring • 4. Education

  9. Typology of Telehealth (Discipline Specific) • Tele-Radiology • Tele-Dermatology • Tele-Medicine • Tele-Prevention • …

  10. Typology of Technology in Telehealth • Asynchronous (Store and Forward Technology) • Synchronous Technology (Face to Face, e.g., videoconferencing) • Combination

  11. Provider to Provider (Patient Present) • Pt and PCP intereact with remote specialist over video conferencing/other tech • Pt interact remotely with pcp in presence of allied health practitioners

  12. Provider to Provider (Patient Not Present) • Transmission of health information from one provider to another/specialist for consultation Dialogue • PCP to radiologist for interpretation and discussion Dexis digital X Ray System And Shows Dental Xrays that can be transmitted over network

  13. Telemonitoring • Numerous Applications (?Most Popular) • Pt vital data captured in devices at home and transmitted via Internet • Systems that use algorithms • System Generated Messages • Automated disease Surveillance Systems

  14. Health Education • Computer based health care training program for professionals • CME?? • Videoconferencing Osama Bin Laden’s Execution and Search Operation Videoconference at White House …

  15. Challenges Faced During TH Implementation • 1. Security • 2. Image Resolution • 3. Issues around Technical Support It is important to appreciate the challenges in order to put together the pieces of a puzzle to solve the problem of effectively using Telehealth!

  16. Security Related Challenges • Firewalls can be "too secure" • Customizing IT security devices • Revision of organizational policies • Issues around speed versus security (VPNs are slow) Too Secure Firewalls Can Slow Down the Process of Communication and Prove Difficult to Surmount Barrier!

  17. Image Resolution & Device Issues • Good Quality images require high bandwidth • James Hayes’ research on viewing images on low resolution devices can be used) • Telehealth equipments need to be very flexible James Hayes has done an interesting study and analysis on image resolution for emergency Xrays on Ipad like tablet devices and big screen monitors and have found they can be workable

  18. Technical Support • Need to be reliable, efficient and cost effective • Tech support a challenge for rural centres • How can we solve this?

  19. Telehealth Can Influence Organizations • 1. Evidence Based practice • 2. Foster Team Work • 3. Provider Retention in Rural Areas The Biggest Benefit of Telehealth in Health Sector seems to be its capacity to improve learning and fostering excellent networking for the provision of co-coordinated evidence based care and education, so that’s good!

  20. Evidence Based Practice • TH can be used as a channel to train remote clinicians (Our Nelson Study) • Develop "learning network" (Rakesh's work in India) • Tele-wound care program one specialist treated wounds in 15 counties used via training sessions • Remote pcps connected with opthalmologists - screen diabetic patients Optomed OY is a Finnish-made digital ophthalmoscope that can take digital pictures and can transmit over cell phone networks!

  21. Foster Teamwork • Tele-ICU • Tele-Nursing within ICU "Fundamentally you're talking about making teams that can go from being disconnected cowboys in care to pit crews that actually work together toward solving a problem” AtulGawande, 2012

  22. Provider Retention in Rural Areas • Higher job satisfaction • Reduced driving for doctors for networking engagements

  23. How to Evaluate Impact of Telehealth Programmes • Psychiatry & Dermatology provided strongest evidence of diagnostic reliability • Clinical management related to TH Gen Med & Cardio: good sens and spec for telemedicine • Strongest in radiology, psychiatry, echocardiography, dermatology, home monitoring, mdicalcnsultations • Difficult Exercise

  24. Heinzelmann’s Framework • Based on Donabedian’s Model of Structure Process Outcome • Framework considers following outcomes: • Utilization Oriented (frequency of hospitalization, length of stay) • Disease Oriented (Glycosylated Hb for diabetics) • Patient Oriented (Satisfaction of care)

  25. Donabedian's model of quality assessment for PCS (3). Teshima T Jpn. J. Clin. Oncol. 2005;35:497-506 © 2005 Foundation for Promotion of Cancer Research

  26. Specific Outcomes Heinzelmann’s Framework Considered • 1. Clinical Diagnoses • 2. Clinical Management and Clinical Outcomes • 3. User Satisfaction

  27. Our (Ray/Arin/Pheobe/Tim) Proposed RNCGP Study on the Analysis of Nelson-Marlborough Telehealth Based Training Network for GPs

  28. Findings from Heinzelmann’s Study • Evidence for impact appears to be Strongly with • Home/institution–based applications for congestive heart failure, diabetes, and blood pressure monitoring • Clinic Based: dermatology, cardiology (i.e., echocardiography), and intensive care and emergency care/trauma • In general, patient satisfaction with Telemedicine was demonstrated

  29. Well?

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