Transcript Telemedicine and e-health

Telemedicine and e-health
Dr Jim Briggs
University of Portsmouth
[email protected]
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Contents
Definitions
Types of telemedicine
Case studies
E-health
Other issues
Further information
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Definitions
Telemedicine
E-health
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Raw definitions
Telemedicine:

E-health:
medicine at a
distance
cf television

health services
delivered
electronically
cf E-commerce
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No standard definition
"To define telemedicine is to have
something in common with Humpty
Dumpty — that is, by making a word to
mean whatever you want it to mean."
[BJHC&IM]
Google search throws up 13 defns

http://www.google.com/search?q=define:
Telemedicine
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US government
"The use of medical information
exchanged from one site to another
using electronic communications for the
health and education of patients or
providers and to improve patient care."

http://cms.hhs.gov/glossary/default.asp
(Dept of Health and Human Services)
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ATA one(s)
"the use of medical information exchanged from one
site to another via electronic communications for the
health and education of the patient or health care
provider and for the purpose of improving and
extending the availability of patient care"

http://www2.umdnj.edu/omcweb/1998/telemedicine.htm
"access to medical care for consumers and health
professionals via telecommunications technology"

http://www.atmeda.org/about/aboutata.htm
e-health is the "use of the Internet for healthcare"
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JMIR
"e-health is an emerging field in the
intersection of medical informatics,
public health and business, referring to
health services and information
delivered or enhanced through the
Internet and related technologies"
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e-health 2002 conference
e-health is "the leveraging of the information
and communication technology (ICT) to
connect provider and patients and
governments; to educate and inform health
care professionals, managers and consumers;
to stimulate innovation in care delivery and
health system management; and, to improve
our health care system"
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TEIS one
Starting point:

"The use of Information and Communication
Technology (ICT) to deliver healthcare at a
distance"
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TEIS scope
Telemedicine and e-health are terms that are
applied to the use of Information and
Communication Technologies (ICT) in
medicine, health and social care delivery

As such, the subject divides into two main areas:
 improvements to existing services in terms of their
efficiency and effectiveness - for example, pathology,
radiology, education and training, and Electronic Patient
 new service delivery development - for example,
teledermatology, teleophthalmology.
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TEIS scope
For our purposes, we define our area of
interest as those applications that:

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use information and communication
technology …
… to deliver health and/or social care in
new ways …
… on a person to person basis …
… where those people are physically apart
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Types of telemedicine
CJ Fitch, JS Briggs, RA Beresford, "System
issues for telemedicine systems", Health
Informatics Journal, vol. 7, no. 3/4,
September/December 2001, pp222-230
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Characteristics of tm systems
Interaction style
Data types
Equipment
Action
Patient numbers
Duration
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Interaction style
Real-time
(synchronous)

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Store-and-forward
(asynchronous)
Participants all active at
the same time
Use any synchronous
technology (e.g. phone)
Most commonly: video
conferencing
Less often but becoming
more common: vital
signs monitoring
May need high
bandwidth
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Participants do not need
to be active at the same
time
Use any structured form
of message passing
Most commonly: email
Less often but becoming
more common: systems
exchanging messages
May not need high
bandwidth
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Data types
Text
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Image
Patient notes
Diagnosis
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X-rays
Pathology slides
CT/MRI/… scans
Audio/video signals
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Equipment
General purpose
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Specialist
Off the shelf PCs
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Electronic
stethoscopes
Image capture
equipment
Image display
equipment (possibly)
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Action
Intervention
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Advice
Direct influence on
patient treatment
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Indirect influence
Final decision made
by intermediate
party
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Patient numbers
One patient at a
time
Multiple patients
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e.g. where a number
of patient cases are
considered at the
same time
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Duration
Timespan over which communication sessions
take place

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single interaction
single episode of care (multiple interactions over
same problem)
long-term (multiple episodes)
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Categories of telemedicine
HCP Patient
HCP  HCP
CHARACTERISTICS:
TYPE A
TYPE B
TYPE C
TYPE D
TYPE E
TYPE F
Interaction Style
Real-Time
Real-Time
Store/Fwd
Store/Fwd
Real-Time
Store/Fwd
Data Types
Multiple
Multiple
Data
Multiple
Multiple
Data
Equipment
Special
Special
Special
General
Special
General
Action
Direct
Indirect
Direct
Indirect
Direct
Indirect
1
>1
1
>1
>1
1
Number of
Patients
Duration
LABEL
Short Term Long Term Short Term Long Term Short Term Short Term
telemedicine
tele-care
telemonitoring
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tele-health
tele-review tele-referral
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Case study: MIU
Minor Injury Units:
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replacing "unviable" accident & emergency
departments
nurse led
deal with "straight-forward" problems
Linked to central A&E department by video
link to provide expert backup
Examples:
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Cornwall
Portsmouth/Gosport
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Cornwall MIUs
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Gosport MIU
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Case study - ambulance links
ECG, etc. links from ambulance to hospital
Expert backup for paramedics
Reducing "call to needle" time for rural heart
attack patients

Dundee study reduced average time from 125 to
52 minutes [Pedley et al; BMJ 2003]
Also, advance warning to A&E staff of details
of incoming cases
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Dundee trial
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Case study - MDTs
Multi-disciplinary teams (e.g. in cancer
care) need to discuss patient cases
Travel costs (i.e. time) prohibitive
Video-conference links allow staff to
meet at more frequent intervals
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East Midlands cancer network
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Case study - teledermatology
Overload on specialist dermatologists - long
waiting lists for referrals
tds provides commercial service
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specially trained nurses take digital photos
specialist software routes to consultant
dermatologists (anywhere in UK) for diagnosis
consultant can work from home
tds replaces local consultant but not totally
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tds sites
North Manchester
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reduced waiting list from 18 months to 17 days in
6 weeks
Medway
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dealt with backlog of 3000 patients in 15 weeks
Expanding into Essex, Hertfordshire and
Texas
http://www.tds-telemed.com/
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Case study - WorldCare
Consortium of 4 big American hospitals
Provide "second opinion" service
worldwide (20 countries)
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tele-radiology
tele-pathology
patient management consultation
Local physician remains responsible
http://www.worldcare.com/
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Case study - NHS Direct
Biggest telemedicine project in the world
Mainly telephone service
Expanding to:
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web
 online diagnosis for common conditions
 health encyclopaedia
 my NHS healthspace (personal info portal): news,
reminders, knowledge
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digital TV
http://www.nhsdirect.nhs.uk/
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e-health
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The banking metaphor
Most transactions
carried out by the
customer
Centralisation of
specialist services
Decentralisation of nonspecialist services
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including at home
Services become
"commodities"
Is there a need for
specialist equipment?
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Integration of IT
Integration of IT
into Business Sectors
Manufacturing Business Services Public Services
(Banks)
(Health…)
1980
1990
2000
Jean-Claude Healy
May 2000
IT as a gadget
Trojan horse: networks, …
Full Integration of IT into Business
(Organisational,
Legal) Re-engineering
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the system
Are hospitals a thing of the past?
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e-health blueprint - Malaysia
Four Flagship Applications
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Tele-Consultation
Tele-Continuing Medical Education for
Health Professionals
Mass Customised Personalised Information
and Education
Lifetime Health Plan
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Telemedicine
links
USA
EUROPE
AUSTRALIA
(For 24hr medical coverage)
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e-health - Pusan, S Korea
Medical Tourism
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2 hours by air for 2 billion people
 1% with disposable income = 20 million
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Cardiac - Cancer - Mental Health
Costs can be competitive
Popular tourist resort for families
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Other issues
Ethics
Economics
Success factors
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Medico-legal/ethical issues
Who is (legally) responsible for the patient's
treatment?
What country's laws apply?
Where is the clinician licensed to practice?
Can a correct diagnosis be made by
telemedicine?
Stanberry B. The Legal and Ethical Aspects of
Telemedicine. Royal Society of Medicine
Books, 1998.
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Economics of telemedicine
Infrastructure (network) costs
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getting cheaper
Equipment costs
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getting smaller and cheaper
People costs
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access to expertise
travel by healthcare professionals
building costs
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Economics 2
What else to include?
Patient costs
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is this the reason
business cases fail?
Social costs
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cost to society of
being ill
environmental cost
of travel
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What makes tm a success?
Why has telemedicine caught on in some
disciplines and some places, but not in
others?
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high-level support
fortune: right-time, right-place
mature technology
evangelists
Do implementers of tele-X learn from:
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the X literature?
the telemedicine literature?
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Further information
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TEIS
UK Telemedicine and E-health Information
Service
http://www.teis.port.ac.uk
http://www.teis.nhs.uk
Over 2000 records covering:
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telemedicine/e-health activities (>220)
organisations
people
publications
equipment
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TIE
Telemedicine Information Exchange (US)
http://tie.telemed.org/
Covers:
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Extensive bibliography (>14,000 entries)
Projects
Events calendar
Funding sources
News
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CEW
Confederation of e-health websites (Q)
http://www.teis.port.ac.uk/orgs/cew/
Other organisations include:
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UK E-health Association
Royal Society of Medicine
IHM/ASSIST
Norwegian Centre for Telemedicine
EHTEL
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Journals
Telemedicine:
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Journal of Telemedicine and Telecare
IEEE Transactions on Information Technology in
Biomedicine
Telemedicine Journal and e-Health
Telehealth Practice Report
Health informatics more generally
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Medical Informatics and the Internet in Medicine
Health Informatics Journal
Journal of Medical Internet Research
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The end
[email protected]
Healthcare Computing Group,
University of Portsmouth
http://www.disco.port.ac.uk/hcc/
http://www.teis.port.ac.uk/
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