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TELEMEDICINE AND HEALTH
INFORMATION TECNOLOGIES: Its impact in health delivery services in developing
countries.
TAIPEI MEDICAL UNIVERSITY1
Vanitha Paramasivam, Alexander Bermudez Rubashkyn.
MBA Students, Health Care Administration.
Outline
Background. What is Telemedicine? Origins and History of Telemedicine
Purposes of Telemedicine Categories and Scope of Telemedicine Uses of Telemedicine nowadays. Health Information Technology and Telemedicine
Areas of collaboration Factors Facilitating Telemedicine Barriers and Positive Impacts Telemedicine Case study Colombia and India. References
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What is Telemedicine? The delivery of health care services, where distance is a critical
factor, by all health care professionals using information and communication 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 interests of advancing the health of individuals and their communities 1
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Telemedicine is characterized by:
What is Telemedicine? (cont.)
Distance
Telecommunication Technologies
Delivery of Health Care
Operational health systems
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Origins and History2,3.
1920s Use of radio to link physicians and stations situated in remote areas.
1930s AT&T experiments linking television and telephone
1960s NASA, Human monitory to Austronauts
1970s Developments of Satellite technology. 1988 USA physician providing consultations
remotely in the Armenian earthquake (USSR).
1990s interest have increased with the development of medical devices and the Internet.
After 1990 advance in Telemedicine by leaps and bounds.
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Purposes of Telemedicine
The delivery of remote health services is used for a variety of purposes4:
Specialist referral services.Direct patient care.Remote patient monitoring.Medical education and mentoring.Consumer medical and health information.
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Telemedicine Categories5.
Store-and-forward: 1 Remote monitoring: 2 Interactive telemedicine: 3, 4.
1
2
3 4
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Scope of Telemedicine
Telenursing Telepharmacy Telerehabilitation Teletrauma Telecardiology Telepsychiatry Teleradiology Telepathology Teledermathology Teleophtalmology Teledentistry Tele-audiology Telesurgery
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Uses of Telemedicine6,7
Developed Countries Developing Countries
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Health Information Technology and Telemedicine4
HIT enhances the utility of Telemedicine. HIT and Telemedicine goals are complementary and
synergistic.
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Health Information Technology and Telemedicine (Cont)Areas for Collaboration between Telemedicine and Health IT4
Establishing and maintaining networked, organizational relationships.
Overcoming resistance.Surmounting the absence of standards and guidelinesFinancial sustainability
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Factors Facilitating Telemedicine Development8
Governance Policy or Strategy Scientific development Evaluation
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Barriers9 and Positive Impacts10 Telemedicine
Positive Impacts Barriers
• Reducing the variability of diagnoses
• Enhancing access, quality, efficiency, and cost-effectiveness . In particular in isolated communities.
• Socieconomic benefits: Patients, Families, Health .practitioners
• Resilience to adopt new models of health delivery
• Lack of ICT literacy• Linguistic and cultural
differences• Lack of studies in
economical benefits• Legal considerations• lack of policies.• Health professional
authentication.• Regulations in technology
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Case Study: Colombia Systematic Review of Telemedicine Projects in Colombia11
28% Rural Areas
Hemorrhagic Dengue: 18.9/100.000
Malaria 150.000 per year
Challenges: Infrastructure.ICT Literacy, Access to technology. (armed conflict)
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Case Study: India
• 72% Rural Area ¾ Live in remote areas• Lack of ICT Literacy• Reluctance of physicians to use Telemedicine• Lack of economic investment.• The Policies are not addressing clearly the target population
Challenges and opportunities for the adoption of Telemedicine in india12,13.
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Group 1: Shawon and Hector ask, one of the five purposes of telemedicine is for remote patient monitoring, which utilizes telemetry devices. What are some examples of these telemetry devices?
Holter – Heart monitoring
Glucometer Iphone Monitoring
Iphone BP monitor
Polysomnography
Elderly Home BP monitor
Wrist oxymeter – Iphone based
oxymeter
Group 3: Baraa ask, how the telemedicine can be cost-effective?
It depends, and it is not easy to know whether determinate telemedicine delivery is cost-effective or not.
That is why we have to conduct economical assessment of the technology used for telemedicine.
For example in the case of study in India and Colombia, the policy makers doesn't have enough evidences about how cost-effective is the telemedicine, and they doesn't have tools to address a policy related to the Telemedicine, and this is becoming a big barrier for several countries.
Group 3: Zwakele ask, What makes telemedicine appropriate for use in developing countries?
Several developing countries and regions, have limited infrastructure, furthermore in those countries there is not enough quantity of health providers per capita, so that is why using telemedicine applications we can link the health delivery services to those remote areas which doesn't have health infrastructure and health providers.
Group 4: Dana and Cheryl ask, Why do you say Indian physicians are reluctant to use telemedicine, and what can be done to encourage them to use these new technologies? In India the doctors have enough technology link for use the
telemedicine in order to provide health services in remote areas.
However, the doctors are payed according with the number of patients seen in the Hospital, because the Health System in India just allow the reimbursement and the copayment in real time, the patients in remote areas using the Telemedicine are not to able to pay the copayment; On the other hand the reimbursement is not corresponding with the physician's effort. So that it is why the Doctor does not accept the Telemedicine.
The real solution that can be used to solve this situation is to improve the mechanism of payment, and give special recognizement to the doctors which provide telemedicine services. In the other hand the ICT literacy among doctor is relatively low, and this is an issue that we can solve providing continuous education.
Group 4: Dana and Cheryl ask, What do you think the most promising application of telemedicine is in each of your countries? If you're not sure what it is for your country, then what do you think the most promising application is in general/globally?
In Colombia and India, and several of other countries, the Ischemic Hearth Disease is the main cause of mortality. Using the telemedicine as a tool to be used in tele-cardiology we can use is for monitoring this disease in several stages, as one interactive medicine for emergency based department.
BeforeDuring After
References1 WHO definition: WHO. A health telematics policy in support of WHO’s Health-For-All strategy for global health development: report of the WHO group consultation on health telematics, 11–16 December, Geneva, 1997. Geneva, World Health Organization, 1998.2 Rosen, E. (1997), “The history of desktop telemedicine'', Telemedicine Today, Vol. 5 No. 2, pp. 16-17, 28.3 Currell, Telemedicine versus face to face patient care: effects on professional practice and health care Outcomes. Cochrane Database of Systematic Reviews, 2000.4 Dena Puskin, Barbara and Stuart, [2006] “Telemedicine, Telehealth, and Health Information Technology”, An ATA Issue Paper, The American Telemedicine Association, May 20065 Strode SW, Gustke S, Allen A. Technical and clinical progress in telemedicine. JAMA. 1999 Mar 24-31;281(12):1066-8.6 Heinzelmann PJ, Lugn NE, Kvedar JC. Telemedicine in the future. Journal of Telemedicine and Telecare, 2005, 11(8):384–390. 7 Wootton R. Telemedicine support for the developing world. Journal of Telemedicine and Telecare, 2008, 14(3):109–114.8 Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth 2009. WHO (Global Observatory for eHealth Series, 2) 9 Resolution WHA58.28. eHealth. In: Fifty-eighth World Health Assembly, Geneva, May 16–25, 2005 (http:// apps.who.int/gb/ebwha/pdf_files/WHA58/WHA58_28-en.pdf, accessed 9 november 201210 Craig J, Patterson v. Introduction to the practice of telemedicine. Journal of Telemedicine and Telecare, 200511 Carlos Rey-Moreno, Javier Simó Reigadas, Estrella Everss Villalba, Juan Jose Vinagre† and Andrés Martínez Fernández, systematic review of telemedicine projects in Colombia, doi: 10.1258/jtt.2009.090709, J Telemed Telecare, April 2010 vol. 16 no. 3 114-119.12 Shabbir, Syed-Abdul, Scholl J., Jian W and Li Y. Challenges and opportunities for the adoption of telemedicine in India, DOI: 10.1258/jtt Journal of Telemedicine and Telecare Vol 17 No 6 2011 pg 336-337 October 2011.13 Siriginidi, Subba Rao, Achieving millennium development goals: Role of ICTS innovations in India, Telematics and Informatics VL26 IS2 Sp127 Ep143 February 2008
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