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Telehealth In the New Millennium Presented at ISN: Informatics Symposium Michele L. Hales University Telehealth In the New Millennium Presented at ISN: Informatics Symposium Michele L. Hales University of Alberta Edmonton, AB CANADA February 5, 2001 Dubai, UAE

What is Telehealth? 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. "

Director General of W. H. O. Dr. Hiroshi Nakajima, the Director-General of the World 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

Transmission Telephone lines are slow but inexpensive at 64 kilobytes per second (baud) Ø Transmission Telephone lines are slow but inexpensive at 64 kilobytes per second (baud) Ø ISDN telephone lines – integrated service digital network is faster at 256 kb Ø ATM – asynchronous transfer mode >1 Mb Ø Satellite – expensive Ø

Categories of Information Flow Ø Voice Ø • voice only, voice/data, inquiry/retrieval, conferencing, store/forward, Categories of Information Flow Ø Voice Ø • voice only, voice/data, inquiry/retrieval, conferencing, store/forward, recording Ø Video • conferencing, screen capture, interactive, recording Data • interactive, data entry, batch, file update, file transfer, file sharing Ø Image • fax, graphics, conferencing, interactive, store/forward Information Monitoring: network management, security, integrity, licensing, malpractice

Valuable Product & Services Source: VHA Annual Information Systems Survey 1998 Valuable Product & Services Source: VHA Annual Information Systems Survey 1998

Richard D. Lee, Dierdre A Conley, Andy Preikschat: Wit. Capital. e. Health 2000: Healthcare Richard D. Lee, Dierdre A Conley, Andy Preikschat: Wit. Capital. e. Health 2000: Healthcare and the Internet in the New Millennium. January 31, 2000 Available at: www. witcapital. com/researchbody. jsp? Report=ehlt_20000131

A transition: Telemedicine Telehealth e-health is now the term to use when describing the A transition: Telemedicine Telehealth e-health is now the term to use when describing the rise of digital technologies, electronic transmission and the convergence of technologies. Mitchell, John: From Telehealth to E-Health: The Unstoppable Rise of E-Health. 1999. Department of Communications, Information Technology and the Arts, Australia.

Telehealth 1. 2. 3. 4. 5. Clinical diagnosis Direct care delivery Tele-education/telelearning (including patients Telehealth 1. 2. 3. 4. 5. 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.

Telehealth/E-health Telehealth is moving closer to e-commerce Ø Health information is being disseminated via Telehealth/E-health Telehealth is moving closer to e-commerce Ø Health information is being disseminated via the web Ø A more well-informed consumer Ø Increased patient knowledge increases challenges to the healthcare providers decisions Ø The primary care physician of the future is the patient (or guardian)

Telemedicine, telehealth, e-health Consumer-driven Telemedicine and Telehealth Provider-driven Ø The public will tell us Telemedicine, telehealth, e-health Consumer-driven Telemedicine and Telehealth Provider-driven Ø The public will tell us what they want in e-health. Ø Providers no longer dictate but become partners with patient or client.

Driving Forces of Telehealth Health and socioeconomic needs Ø Shortage of specialists in remote Driving Forces of Telehealth Health and socioeconomic needs Ø Shortage of specialists in remote regions Ø Sense of professional isolation Ø Demand for equitable and accessible healthcare services Ø Decrease in cost for equipment & telecommunication Ø Aging population Ø

Trends in Telehealth Increased use in correctional facilities and home health care settings. Ø Trends in Telehealth Increased use in correctional facilities and home health care settings. Ø 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. Ø Permits physicians doing clinical research to be linked together despite geographical separation, sharing patient records an diagnostic images. Ø Improves medical education for rural health care professionals. Ø

Strengths & Benefits Ø Ø Ø Ø Empowers the public Strengthens and integrates healthcare Strengths & Benefits Ø Ø Ø Ø 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

Some Telehealth Challenges Ø Ø Ø Policy issues: Liability, licensure and reimbursement Need for Some Telehealth Challenges Ø Ø Ø 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

Opportunities Collaboration: - various government agencies - health organizations - industry Ø Strengthen incentive Opportunities Collaboration: - various government agencies - health organizations - industry Ø Strengthen incentive program Ø Develop and exchange knowledge Ø

Successful Telehealth Endeavours School-based health centers Ø Hibernia off-shore oil drilling platform Ø Correctional Successful Telehealth Endeavours School-based health centers Ø Hibernia off-shore oil drilling platform Ø Correctional Facilities Ø TeleØ - dermatology - radiology - cardiology - oncology - surgery - psychiatry - pediatrics

Teledialysis (OSMH) Orillia Solider's Memorial Hospital (OSMH) - established Canada's first region-wide, teledialysis network. Teledialysis (OSMH) Orillia Solider's Memorial Hospital (OSMH) - established Canada's first region-wide, teledialysis network. Ø Using computerized systems, the OSMH monitors patients at least 100 kilometres from the regional centre, bringing healthcare services closer to home. Ø The network officially opened in October 1997. Ø

Teledialysis (OSMH) cont’d: Linked via ISDN lines, a high-speed phone connection allowing videoconferencing to Teledialysis (OSMH) cont’d: Linked via ISDN lines, a high-speed phone connection allowing videoconferencing to take place between doctor and patient in real-time. Ø To achieve a complete transfer of data, three ISDN lines are going at the same time. Ø Excellent picture quality Ø

Teledialysis (OSMH) cont’d: Dialysis machines are connected via modem, through a standard phone line Teledialysis (OSMH) cont’d: 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. Ø Enables patients to videoconference with remote doctors. Ø It provides medical follow-up care for stable hemodialysis patients. Ø Provides patient privacy Ø

Telehealth Initiatives Globally: Armenia Ø Australia Ø Canada Ø Europe Ø South Africa Ø Telehealth Initiatives Globally: Armenia Ø Australia Ø Canada Ø Europe Ø South Africa Ø United States of America Ø

E-mail Discussion Lists Ø TELEHEALTH Ø E-HEALTH Ø NETPSY Ø ITNA To: listserv@maelstrom. stjohns. E-mail Discussion Lists Ø TELEHEALTH Ø E-HEALTH Ø NETPSY Ø ITNA To: [email protected] stjohns. edu Body: Subscribe TELEHEALTH Your. Name To: [email protected] stjohns. edu Body: Subscribe NETSPY Your. Name To: [email protected] tmc. edu Body: Subscribe itna First. Name Last. Name

Publications Ø Ø Ø Ø Journal of the American Medical Association jama. ama-assn. org/ Publications Ø Ø Ø Ø 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

Organizations & Associations: Association of Telehealth Service Providers - www. atsp. org Ø Canadian Organizations & Associations: Association of Telehealth Service Providers - www. atsp. org Ø Canadian Society of Telehealth - www. ucalgary. ca/md/CST/ Ø California Telehealth and Telemedicine Center - telemed. calhealth. org/ Ø Finnish Society of Telemedicine - www. fimnet. fi/telemedicine/engindex. htm Ø

Organizations & Associations cont’d: Healthcare Information and Management Systems Society (HIMSS) - www. himss. Organizations & Associations cont’d: Healthcare Information and Management Systems Society (HIMSS) - www. himss. org Ø International Society for Telemedicine (ISFT) Ø - isft. org National Centre of Telemedicine, Tromso, Norway - www. telemed. rito. no/Eng/index. html Ø Office for the Advancement of Telehealth - telehealth. hrsa. gov Ø

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

Conclusion Telehealth is just another way to practice what one already knows how to 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

“The computer is very fast, accurate and stupid. Man is very slow, inaccurate and “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. [email protected] CA