Telemedicine, Telemedicine, Communications and Health Communications and Health

InformationInformation

Maria ZolfoMaria Zolfo

DefinitionDefinition

Telemedicine is the use of information Telemedicine is the use of information technology and telecommunications to technology and telecommunications to provide health services (or support health provide health services (or support health service provision) over a distanceservice provision) over a distance

Aim of this sessionAim of this session

describe the technologiesoutline the major new health uses of

these technologies

TechnologyTechnology

Information can be stored and transmitted as either analogue or digital information

Analogue technologies are broadcast radio and television, traditional telephone, gramophone records, audio cassette players and, in health, X-ray machines and ECGs

Digital technology are computers, audio CDs, digital television, digital mobile telephone and, in health, CT scanning and MRI scanning

It is generally possible to convert information from analogue to digital..

A computer modem, e.g., connects a computer (digital) to the telephone network (analogue)

The modem converts the digital computer signal into an analogue signal for transmission (and then reverses the process at the receiving computer)

Telecommunication is moving towards digital signals:

audio, video, and other data can all be converted to digital signals and then transmitted through the same digital network

digital information can be transmitted more accurately; analogue information always degrades more the further it is sent

digital signals can be transmitted at extraordinarily fast rates

digital signals can be switched and routed more cheaply and flexibly than analogue/signals

Transmission:Transmission: Wires and cabling: telephone networks built

around copper wires and co-axial cables (the bandwidth depends on the type of cable or wire)

Fibreoptic cable: very fine glass fibres carrying digital signals as pulses of light (roll-out is expensive!)

Radio technologies: radio-waves based (low bandwidth and lack of reliability)

Microwave links (similar to radio with higher frequency; high bandwidth)

Satellite technology

End-user equipmentEnd-user equipment

TelephoneTelephoneFaxFaxVideo-conferencingVideo-conferencingTelevisionTelevisionRadioRadioComputersComputers

NetworksNetworks

LAN LAN ((Local Area Network): connects personal computers and mainframe computers over a localized area such as a campus of a hospital, university ...

WANWAN ( (Wide Area Networks): network which could cover the entire globe, i.e. credit card companies

InternetInternet: : includes e-mail, file transfer protocol, and access WWW

PSTN, PABX,…PSTN, PABX,…

Health applications

Tele-consultation (telephone, video-Tele-consultation (telephone, video-conferencing, internet,…)conferencing, internet,…)

Diagnostic report (digital scanner with Diagnostic report (digital scanner with computers and software to transmit and computers and software to transmit and regenerate the image)regenerate the image)

Electronic patient recordsElectronic patient records

Telemedicine ITMATelemedicine ITMA

In 2003 the ITMA In 2003 the ITMA set up a set up a computer aided training project computer aided training project to guide doctors in the to guide doctors in the implementation of antiretrovirals implementation of antiretrovirals (ARVs) and AIDS care in (ARVs) and AIDS care in developing countriesdeveloping countries

BACKGROUNDBACKGROUND

To provide continuous medical To provide continuous medical education in the field of HIV/AIDS for education in the field of HIV/AIDS for doctors following doctors following Short Course on Short Course on Antiretroviral TherapyAntiretroviral Therapy ((SCART), SCART), through a discussion forum on a through a discussion forum on a medical web site, supporting and medical web site, supporting and guiding medical decision making guiding medical decision making and management of difficult clinical and management of difficult clinical casescases

Method of workingMethod of working

Expert advice from HIV/AIDS specialists is Expert advice from HIV/AIDS specialists is offered to colleagues in the field through a offered to colleagues in the field through a discussion forum on discussion forum on http://telemedicine.itg.behttp://telemedicine.itg.be

http://http://telemedicine.itg.betelemedicine.itg.be

Discussion forum …Discussion forum …

3 years evaluation 3 years evaluation (April 2003-March 2006, N: 491 referrals)(April 2003-March 2006, N: 491 referrals)

3 years evaluation details3 years evaluation details

ARVs oriented questions (N=230)

25

48

57

14

19

13

54ARVs general use

ARVs & TB

ARVs side effects

ARVs resistance

ARVs with OIs

ARVs in PMTCT

IRIS

Telemedicine, legal issuesTelemedicine, legal issues

Authority Authority

Any medical or health advice provided and Any medical or health advice provided and hosted on the website will only be given by hosted on the website will only be given by medically trained and qualified medically trained and qualified professionals unless a clear statement is professionals unless a clear statement is made that a piece of advice offered is from made that a piece of advice offered is from a non-medically qualified individual or a non-medically qualified individual or organisationorganisation

Complementarity Complementarity

The information provided on the website is The information provided on the website is designed to support, not replace, the designed to support, not replace, the relationship that exists between a relationship that exists between a patient/site visitor and his/her existing patient/site visitor and his/her existing physician physician

Confidentiality Confidentiality

Confidentiality of data relating to individual Confidentiality of data relating to individual patients and visitors to a medical/health patients and visitors to a medical/health website, including their identity, is website, including their identity, is respectedrespected

Attribution Attribution

Where appropriate, information contained Where appropriate, information contained on this site will be supported by clear on this site will be supported by clear references to source data and, where references to source data and, where possible, have specific HTML links to that possible, have specific HTML links to that data data

The date when a clinical page was last The date when a clinical page was last modified will be clearly displayed (e.g. at modified will be clearly displayed (e.g. at the bottom of the page) the bottom of the page)

Justifiability Justifiability

Any claims relating to the Any claims relating to the benefits/performance of a specific benefits/performance of a specific treatment, commercial product or service treatment, commercial product or service will be supported by appropriate, balanced will be supported by appropriate, balanced evidence in the manner evidence in the manner

Transparency of authorship Transparency of authorship

The designers of the website will seek to The designers of the website will seek to provide information in the clearest possible provide information in the clearest possible manner and provide contact addresses for manner and provide contact addresses for visitors that seek further information or visitors that seek further information or supportsupport

The Webmaster displays his/her E-mail The Webmaster displays his/her E-mail address clearly throughout the website address clearly throughout the website

Transparency of sponsorship Transparency of sponsorship

Support for the website will be clearly Support for the website will be clearly identified, including the identities of identified, including the identities of commercial and non-commercial commercial and non-commercial organisations that have contributed organisations that have contributed funding, services or material for the site funding, services or material for the site

Honesty in advertising & editorial Honesty in advertising & editorial policypolicy

If advertising is a source of funding it If advertising is a source of funding it should be clearly statedshould be clearly stated