Telehealth and Telemedicine

Table of Contents:

      Definitions

      History

      Uses and technology

      Driving forces, benefits and obstacles

      UW experience

      Conclusions

      References

     Definitions

Telehealth is the use of electronic communications networks for the transmission of information and data focused on health promotion, disease prevention, diagnosis, consultation, education, and/or therapy, and the public's overall health including patient/community education and information, population-based data collection and management, and linkages for health care resources and referrals. Although telehealth is sometimes considered broader in scope than telemedicine, there is no clear-cut distinction between the two.

Telemedicine is the use of audio, video, and other telecommunications and electronic information processing technologies for the transmission of information and data relevant to the diagnosis and treatment of medical conditions, or to provide health services or aid health care personnel at distant sites.

Telediagnosis is the detection of a disease as a result of evaluating data transmitted to a receiving station from instruments monitoring a remote patient and we can define

Teleconsultation as the physical separation between multiple providers during a consultation. To develop this kind of distance medicine we require the used of telecommunications, which is the use of wire, radio, visual, or other electromagnetic channels to transmit or receive signals for voice, data and video communications.

In conclusion, Telemedicine is defined by the Telemedicine Information Exchange (1997) as the "use of electronic signals to transfer medical data (photographs, x-ray images, audio, patient records, videoconferences, etc.) from one site to another via the Internet, Intranets, PCs, satellites, or videoconferencing telephone equipment in order to improve access to health care."  But it can be define also as "the use of advanced telecommunications technologies to exchange health information and provide health care services across geographic, time, social, and cultural barriers. [Slide1]

History

 The practice of medicine through telecommunications, or telemedicine, began in the early 1960’s when the National Aeronautics and Space Administration (NASA) first put men in space. Physiological measurements of the astronauts were telemetered from both the spacecraft and the space suits during NASA space flights.  In 1974, NASA conducted a study with SCI Systems of Houston to determine the minimal television system requirements for accurate telediagnosis [Slide2]

In 1989, NASA conducted the first international telemedicine project, Space Bridge to Armenia/Ufa, after a powerful earthquake struck the Soviet Republic of Armenia in December 1988. An offer of medical consultation was extended to the Soviet Union by several medical centers in the United States. Telemedicine consultations were conducted under the guidance of the US/USSR Joint Working Group on Space Biology using video, audio, and facsimile between a medical center in Yerevan, Armenia and four medical centers in the United States [Slide3]. This project was extended to UFA, , Russia to aid burn victims there after a fiery railway accident (Telemedicine Research Center, 1997).

Uses and technology

Much of telemedicine in different parts of the world uses videoconferencing technology, which involves live two-way video and audio transmission [Slide4]. Basically, it's a picture telephone. It allows health consumers to see and speak with health workers and specialists in distant and sometimes (same) sites, which means quicker diagnosis and a quicker start to the appropriate treatment.

Between 1995 and 2000, the Network 2 successfully transformed the health delivery system, providing services to significantly greater numbers of persons while achieving excellence in health care quality and customer satisfaction [Slide5]. This transformation can be achieved through a systematic process by which well-defined performance targets were established in those areas crucial to organizational success. In other words, you need to define the crucial areas that want to include in this network [Slide6].

It is also critical to establish innovative Care Line structures that allow rapid systems transformation, through the development of network-wide goals and operational strategies. The essence of Network 2's successful transformation was the ongoing monitoring of key performance. These indicators were identified as critical determinants of organizational success.

Significant investments in information and data technology need to be introduced at the outset, providing senior leaders and staff at all levels of the organization with the necessary tools to assess organizational progress and achieve measurable improvements in performance [Slide7]. The intent is to build a world class health delivery system by achieving the highest levels of quality and customer service. Usually an achieving of the 90th percentile nationally for all standardized measures of patient satisfaction and quality are adequate [Slide8].  Use in the real world 

•  Rural telemedicine care: for example, the technician or nurse practitioner in a rural clinic or hospital asks for assessment in specific cases in the rural areas.

• Specialty Telemedicine care: For training or diagnosis of different illness or pathologies such as AIDS, obstetrics, joint illness, uncommon diseases in one particular specialty.

   Driving forces, benefits and obstacles

For some applications of telemedicine, more rigorous evaluations will support claims about their value and will encourage their more widespread use [Slide9]. For other applications, better evaluation may discourage adoption, at least until technologies and infrastructures improve or other circumstances change. That is to be expected [Slide10]. The purpose of evaluation—and the purpose of this report—is not to endorse telemedicine but to endorse the development and use of good information for decision-making.

It is recognized that telemedicine applications—like other health services and technologies—will diffuse in some measure despite limited systematic assessment of their benefits and costs. This diffusion may also be marked by too much attention to the more glamorous but not necessarily more cost-effective technologies, although strong incentives to control costs may be weakening tendencies in this direction. Conversely, telemedicine applications may also languish for lack of good evidence documenting their relative value compared to alternative services or for lack of evaluation research identifying the obstacles standing in the way of useful and sustainable programs [Slide11], [Slide12].

   UW experience

The University of Washington (UW) Academic Medical Center has received a three-year, $2.028 million grant from the National Library of Medicine to develop and evaluate new applications of the National Information Infrastructure in the care of patients. Commonly called the "Information Superhighway," the National Information Infrastructure is a partnership between the U.S. government, private industry and public institutions. Its goal is to create a seamless interweaving of computer and communications technology for education, commerce, health care, libraries, natural resource management and other uses.

The WAMI region is an ideal testing ground for health-care applications of new communications technology [Slide13], because of the strong relationships we have already built over the past 25 years with communities and health professionals across the Pacific Northwest [Slide14] and Alaska through our regionalized medical education program [Slide15], [Slide16]

The project, entitled From Bench to Bedside and Beyond, will measure the effects of a regional information infrastructure on health-care delivery [Slide17], research and public health [Slide18]. It will expand on previous and current UW projects in the testing of electronic communications and data transfer technologies in medicine [Slide19]. These endeavors include a demonstration project on rural telemedicine consultations and the Integrated Advanced Information Management System, which has improved access to computerized resources for UW health sciences departments and local affiliates [Slide20], [Slide21]. Several UW departments with experience in information technology will be involved [Slide22].

Among the many project goals are:

·     Provide clinicians and public health agencies with convenient, timely access to vital information when and where they need it.

·        Evaluate ways to ensure security during electronic transfer by checking the identity of the clinician and patient and by encoding the information.

·         Make retrieval of information more logical from the caregivers' perspective by linking databases, information resources and services.

·         Improve the electronic delivery and archiving of medical images.

·    Offer access to library resources, software tools for clinical decision making, bibliographic databases, practice guidelines, expert systems and other automated systems, literature searches such as Medline, and electronic copies of articles from professional and research journals.

·         Create better integration for the exchange of data among public health and clinical practice sites.

·         Develop multi-function workstations for all types of communication, data access and transfer, and information management.

·         Measure costs and savings that result from increased access to information.

  Conclusions

Computing and communications technologies will drive significant and dramatic change for “the players, dynamics, rules and requirements” of medicine and healthcare. No community, provider, or practice will be immune, and the primary care in the year 2020 will undoubtedly be in some ways unrecognizable [Slide23]. As we utilize the computers sitting on our desk and the digital wireless phone hanging from our belts, we may be able to envision medical practice in the next five years as information devices all interconnected through wireless communications, all exchanging a variety of information types, all informing a variety of healthcare constitutes, but the vision of the future is far less clear. In many ways it will be better, in some ways it may be worse, depending on your point of view. Without doubt it will be different [Slide24].  It is temping to consider this rapid change as frightening and disorienting at best and detrimental to medicine and healthcare at worst. Regardless of one’s perspective, it is safe to say that it is inevitable. With luck, the concepts in this module will aid primary care practitioners in developing a sense of the coming change and embracing the change so that the year 2020 will provide even more rewards than are present today.

This project is a joint effort of the University of Washington School of Public Health and Community Medicine
and the United States Centers for Disease Control. It is an approved APEC project.