Transcript Slide 1

Telemedicine: potential for use in
developing country environments
S. Yunkap Kwankam
Department of Health Service Provision
Cluster on Evidence and Information for Policy
World Health Organization
Geneva, Switzerland
Overview
• What is telemedicine?
• The health system
• Examples and potential of telemedicine
• Use of ICT world wide
• Contribution to strengthening health
• Partnerships - role for Civil Society
• Conclusion
What is telemedicine?
Telemedicine:
• The delivery of health care services, where distance is a
critical factor, by health care professionals using
information and communications technologies for the
exchange of valid information for diagnosis, treatment
and prevention of disease and injuries, research and
evaluation, and for the continuing education of health
care providers, all in the interest of advancing the
health of individuals and their communities
- WHO (1997)
What is Telehealth?
Telehealth:
• The use of electronic information and
communication technologies to support
long-distance clinical health care, patient
and professional health-related education,
public health and health administration
- US Office for the Advancement of Telehealth
What is eHealth?
Source: The eHealth Landscape (2001)
Capacity of ICT

Entire contents of the Library of Congress
transmitted in 30 minutes

450,000 people communicating by telephone
simultaneously via the Internet

all through a fiber smaller than diameter of
human hair.
Comparisons

US postal system delivered 101billion pieces of
mails

618 billion email messages delivered in same
year in US

2005 - estimated 35 billion emails sent around
the world daily
Goal - both level and distribution
Level
Distribution
Health


Responsiveness


Fairness in financing

Health system functions
Financing
Stewardship
Fund pooling
Purchasing
Provision
Personal health
services
Non-personal health
services
Resource generation
Revenue collection
Intermediate goal - Effective Coverage
Availability
Coverage
Accessibility
Coverage
Affordability
Effective
Coverage
Acceptability
Coverage
Coverage
Resourceconstrained
Quality
Coverage
Intermediate goal
• Provider performance
– Health gain - quality: effectiveness,
safety
– Efficiency
THE CHANGING PRACTICE ENVIRONMENT
Current Approach
 Care based on visits
 Professional autonomy
 Professionals control care
 Provider records
 Decision based on experience
 Safety is individual issue
 Secrecy is necessary
 The system reacts to needs
 Cost not controlled
 Independent providers
New Model
 Continuous relationships
 Customized patient care
 Patient is source of control
 Information flows freely
 Evidence-based decisions
 Safety is a system property
 Transparency is necessary
 Needs are anticipated
 Control costs
 Cooperation is a priority
Source: Janet M. Corrigan, Institute of Medicine Committee on the Quality of Health Care in America
PERSPECTIVES OF PATIENT-BASED INFORMATION
POPULATION
- REFERENCE
- HEALTH STATUS
- SERVICE UTILIZATION
AND PRODUCTION
- RESEARCH
GROUPS
- BY CLINICAL ATTRIBUTES
CLINICAL FINDINGS REFERENCE
GROUP COMPARISONS
IDENTIFY ASSOCIATED ATTRIBUTES
- BY INTERVENTION CHARACTERISTICS
MANAGEMENT AND REPORTING
PROCESS CONTROL
INDIVIDUAL
-
SEQUENCIAL
CHRONOLOGICAL
PROBLEM-ORIENTED
PERMANENCY
HISTORICAL RECOVERY
COMMUNICATION
RECENT EVENT RECOVERY
DETAIL
DIFFERENT “VISIONS” OF DATA
DIFFERENT OUTPUTS
INTENSIVE DATA MANIPULATION
Telemedicine - examples
• Telemedicine in at least 60 WHO
Member States
• Consultation, radiology, cardiology,
etc.
• Different types of infrastructure POTS, ISDN, radio, satellites
• different locations - clinic, home,
mountain top, at sea
Potential of telemedicine
• Improved access
• Cost reduction
• Informed policy and decision-making
• Improved quality of care and delivery
systems
Potential for practice improvement

Dramatic reduction in medical errors

Greater recruitment and retention of health care workers due to
availability of ICT tools that improve the quality of work life

Greater access to health care professionals especially in remote and
rural regions through Telehealth

Reduced physician and hospital visits, a reduction in duplication of
services, improved efficiency and grater productivity through more
effective data gathering and information sharing

Evidence-based care through best practices made possible by
integrated decision-support tools
Potential for practice improvement - 2
More knowledgeable workers through convenient
and accessible online continuing education
Improved patient care at the point of delivery
through better access to patient and clinical
information
Greater system accountability with more
information on the performance of health care
organizations and providers
•Improved health system management, planning and
research through better information.
Potential for cost savings
25b-40b by giving US consumers the right
information, which could lead to better medical
results
30b-40b from informed decision-making leading to
more efficient use of medical and clinical resources
30b-40b from use of electronic communications to
replace visits to primary care physician
•15b-20b savings in administrative costs by
eliminating the need to for care givers to recreate
records each time a patient moves or changes
medical plans
Technology intervention
Provision of health services:
• The combination of inputs into a
production process that takes place in a
particular organizational setting and that
leads to the delivery of a series of
interventions
Health
outcomes
Financing
Resource
inputs
Policy
Organization &
management
THE DEVELOPMENT / ANALOG / DIGITAL DIVIDES BY INCOME
Percentage of World Total
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Population
Low
Television
Telephone
Lower Middle
GDP
Upper Middle
Internet
High
Source: Digital Opportunities Taskforce (DOT Force), 2000
SELECTED TECHNOLOGY OUTPUTS BY REGION (1992-1997)
Region
Mobile Phones
per 103 pop
OECD
Eastern Europe & FSR
East Asia
Latin America & Caribbean
Middle East
Sub-Saharan Africa
South Asia
102.21
6.34
24.36
14.43
24.58
1.61
0.69
Pers Computers
per 103 pop
195.37
28.21
46.10
20.33
32.16
5.05
4.72
Fax Machines
per 103
31.43
2.27
6.34
9.05
7.06
1.66
1.60
GPD per
pop capita
20,113.5
4,027.4
6,270.6
5,635.8
8,941.5
1,971.5
1,764.3
Source: Rodríguez F and Wilson E (InfoDev, World Bank 2000). Cited in [7], modified
THE RESEARCH & DEVELOPMENT DIVIDE BY REGION
GLOBAL INTERNET USERS (APRIL 2001)
TOTAL NUMBER OF USERS 427,213,610
0.78%
47.95%
4.56%
4.12%
18.58%
0.38%
23.63%
Source: www.netsizer.com
North America
South America
Central America
Europe
Asia
Oceania
Africa
INTERNET USE - LANGUAGE
NUMBER OF NATIVE SPEAKERS ONLINE (MARCH 2001)
Russian
Portuguese 2.3%
2.5%
Dutch
2.1%
Other
6.2%
Italian
3.1%
English
47.5%
French
3.7%
Korean
4.4%
Spanish
4.5%
German
6.1%
Japanese
8.6%
Chinese
9.0%
Source: Global Reach, Internet Statistics
Global Distributions: - Population, BoD, Health Spending, IP Hosts
Developed:
16 % population
7% burden of disease
89% health spending
94 % of hosts
Australia,
Japan &
Developing:
84 % population
93% burden of disease
11% health spending
6 % of hosts
New Zealand
6.4%
Canada &
3.7 %
Developing
US
Other
65.3%
5.9%
Europe
22.4%
Source: ITU 1999 “Challenges to the Network: Internet for Development”
Asia-Pacific
LAC
1.9%
Africa
0.3 %
GLOBAL INTERNET USERS
Millions of Users
350
28%
300
21%
250
Penetration
200
15%
150
9%
100
50
6%
1%
4%
0.1%
0
1.6%
0.3%
0.5%
0.1%
1995
1996
1997
1998
1999
2000
Developed
30
47
77
124
180
232
Developing
3
7
13
25
51
83
Source: International Telecommunication Union, 2000
Driving force for Telemedicine
• Driven by health needs
• Not led by technology
Mission
 Improve health service delivery, in
particular, and health system
performance in general, through the
use of ICTs in countries
Activity areas

Developing the evidence base - best
practices

approaches, methods, tools and indicators for
projects

capacity building

resource generation
Resource generation - people
• Multiple role of people - consumers,
providers, contributors to financing,
stewards
• “ .. the performance of the health care
system depends, ultimately, on the
knowledge, skills and motivation of the
people responsible for delivering services”
- WHR 2000
Generating - skills and knowledge
• Education, training and continuing
professional development.
• Knowledge generation
• knowledge systems
• Problems
– Numerical imbalances
– Training and skill mix imbalance
– Distribution imbalances
Improved access to health services
• Often Telemedicine trials inspired by lack of
•
•
access to services
Ethiopia - five radiologists cover entire country
Heartbeat Jordan project
–
–
–
–
–
Offered best access to target population
improved economic and clinical efficiency
Raised quality of care delivery
Early detection and non-invasive medical techniques
Cost savings of $167 000 in one district in 3 months per capita health spending $119 (commercial x-rate)
$285 (ppp x-rate)
Informed policy making
• Benefits to service provision
– Using TM infrastructure to close loop on data
and information, horizontally and vertically
– modern communications used to share
information seamlessly. Preserves virtues of
autonomy for providers, without
fragmentation
Indicators of attainment
• helping users to obtain services they need,
when and where (Access)
• making health services work better
(Effectiveness)
• improving knowledge and skills of care
givers (Competence)
• Help to improving relevance of services
(Appropriateness)
Indicators of attainment - 2
• getting best results at lowest cost
(Technical Efficiency)
• help improve dignity of treatment,
autonomy of users, promptness of
attention and confidentiality
(Responsiveness)
• Meeting expectations of population
(Responsiveness)
Barriers to widespread use of Telemedicine
• Multi-dimensional construct
– technical knowledge
– economic viability
– organizational support
– behavior modification
Sustainability of Telemedicine projects?
• Realization of benefits threatened by lack
of sustainability
• Individual spending on health insufficient
to pay for cost of health care (insurance)
• In developing countries few providers can
recover costs in Telemedicine projects - let
alone make a profit
Integrated Services Telehealth Network
(ISTN)
• Multiple services in value chain using
Telehealth infrstructure
• Aggregation of users
• Availability of LINCOS - multipurpose,
multi-media self powered, satellite
communications units
Equipment
Supplier
Hospital
Telecom
Operator
System
Integrator
Health
Services
provider
Community
Equipment
Supplier
Health
Facility
System
Integrator
Commercial
Facility
Telecom
Operator
Service
providers
Community
Other WHO efforts
 The Health Internetwork project
 Trade in health services via
telemedicine
Health InterNetwork: Goals
• Improve global public health by
facilitating the flow of health
information worldwide, using
Internet technologies.
• Enable more effective health service
delivery through
– access to high quality, relevant and
timely information
– better communication within the public
health community.
Objectives
• Support existing public health programs and
priorities through improved access and use
of information and communication
technologies.
• Evaluate the impact of HIN on health service
delivery and, where feasible, on health
indicators.
• Assess the utility, relevance and impact of
HIN in improving information access,
exchange and use in the public health
community.
Concept
• Project cornerstones
– Content: provided through an Internet
portal
– Connectivity: at selected information
access points in countries
– Capacity: skills development for public
health information access,
management and use
Focus
• Focus on public health
– Health service providers
– Researchers and scientists
– Policy makers at all levels
Partnerships
 ITU e-commerce project
 Organizations in official relations with
WHO
Role for Civil Society
 Resolution WHA 40.25
 Objectives
 Privileges
 Responsibilities
Conclusion
 Greatest potential for lasting impact lies
with contributing to improving HSP
 Challenge Civil Society - develop
innovative approaches for sustainable
application of telemedicine to improving
health system objectives
 Sharing not a zero-sum game- two
candles shine better than one