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Telemedicine and E-health -ICT to make people better more quickly
Dr Jim BriggsUniversity of Portsmouth
Talk given at the ICT Study Day7th December 2004
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Contents
• Who am I and where do I work?
• Definitions
• Types of telemedicine
• Case studies
• E-health
• Unanswered questions
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Who am I?
• Dr Jim Briggs
• Principal Lecturer in Information Systems and Computer Applications
• Leader of the Healthcare Computing Group
• Director of the UK Telemedicine and E‑health Information Service (TEIS)
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Where do I work?
• University of Portsmouth• Medium-sized university• Mainly city-centre
location• Lots of new student
accommodation• Excellent social life• Excellent study facilities• By the sea
• 30 courses in the computing/IT field• Computer Engineering• Computer Science• Software Engineering• Information Systems• Animation, Games, ET• Mobile/wireless
• Website• http://www.port.ac.uk
Telemedicine and E-health
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Definitions
• Telemedicine:• medicine at a
distance
• cf television, telephone, etc.
• E-health:• health services
delivered electronically
• cf E-commerce, E-learning, E-government, etc.
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Characteristics of tm systems
• Interaction style• real-time (e.g. videoconferencing)• store-and-forward (e.g. email)
• Data types• text (e.g. patient's notes)• image (e.g. x-ray)
• Equipment• general purpose (e.g. PCs)• specialist (e.g. electronic stethoscope)
• http://jhi.sagepub.com/cgi/content/abstract/7/3-4/222
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Case study 1: Cornwall MIUs
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Case study 1 cont.
• Minor Injury Units:• 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
• http://www.bthealth.com/casestdy/cstudy/case11.htm
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Case study 2: ambulance links
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Case study 2 cont.
• 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
• http://www.rcsed.ac.uk/fellows/bcpaterson/chest_pain.htm
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Case study 3: dermatology
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Case study 3 cont.
• Overload on specialist dermatologists - long waiting lists for referrals
• tds Telemedicine Ltd. provides a commercial service• 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• http://www.tds-telemed.com/
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Case study 4: WorldCare
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Case study 4 cont.
• Consortium of 4 big American hospitals
• Provide "second opinion" service worldwide (20 countries)• tele-radiology• tele-pathology• patient management consultation
• Local physician remains responsible• http://www.worldcare.com/
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Case study 5: NHS Direct
• Biggest telemedicine project in the world• Mainly telephone service • Expanding to:
• web• online diagnosis for common conditions• health encyclopaedia• my NHS healthspace (personal info portal): news,
reminders, knowledge
• digital TV• http://www.nhsdirect.nhs.uk/
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E-health - the future of health?
Making health care more easily accessible to the patient
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The banking metaphor
• Most transactions carried out by the customer
• Centralisation of specialist services
• Decentralisation of non-specialist services
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Integration of IT into business sectors
Inte
gra
tion
of
ITIn
teg
rati
on
of
IT
IT as a gadgetTrojan horse: networks, …Full Integration of IT into Business (Organisational, Legal) Re-engineering of the system
19801980 19901990 20002000 Jean-Claude HealyJean-Claude HealyMay 2000May 2000
Manufacturing
Business Services(Banks)
Public Services(Health…)
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Are hospitals a thing of the past?
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New sources of "health" 1
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New sources of "health" 2
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New sources of "health" 3
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e-health - Busan, S Korea
• Medical Tourism• 2 hours by air for 2 billion people
• 1% with disposable income = 20 million
• Cardiac - Cancer - Mental Health• Costs can be competitive• Popular tourist resort for families
Some questions left unanswered
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Medico-legal/ethical issues
• Who is (legally) responsible for the patient's treatment?
• What country's laws apply?
• Can a correct diagnosis be made by telemedicine?
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Economics of telemedicine
• Communication is getting faster and cheaper
• Equipment is getting smaller (more mobile) and cheaper
• People costs are rising
• How do we adapt?
• Who pays?
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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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Which is the future of health?
www.teis.nhs.uk