Ch10 by suchenfz


									          Chapter 19
Telehealth and Communication
           Yung-Fu Chen
    Department of Health Services
    Administration, China Medical
• The use of telecommunications technologies to
  deliver health services is a new concept. In fact
  the telephone has become so ubiquitous in
  healthcare that it is taken for granted. This
  chapter discusses telehealth and its implications
  for the health system. It provides the history of
  telehealth and introduces the participations
  served by this tool, the methods and
  technologies, and the areas in which technology
  can be applied for enhanced communications.
• Telehealth has been defined as
  – The use of telecommunications to provide health
    information and services, that is, a health-related
    activity carried out at a distance.
  – As all forms of electronic healthcare delivered over
    the Internet, ranging from educational products to
    direct services offered by professionals, non-
    professionals, and even consumers themselves
  – The use of Internet to increase practice efficiencies
    and knowledge bases, to exploit market inefficiencies
    in health and medicine-related commerce, and to
    disseminate information to consumers and providers
• Teleheath encompasses
  – Provision of health information
  – Health administration and education
  – Diagnosis and management
• Telehealth is not just about technology,
  but the use of it to improve healthcare
  delivery, particularly to communities who
  are disadvantaged in terms of their access
  to healthcare
Case Study
        History of Telehealth
• Telehealth covers a very wide range of
  healthcare interaction for many different
  purposes. These interactions can be
  classified by
  – Participant: doctor-to-doctor, doctor-to-patient
  – Type: real-time, non-real-time
  – Information transmitted: audio, video
 Table 19.1: timeline of telehealth
Period   Telegraph                  Telephone application
1835     Telegraph Used in the American Civil War to deliver casualty
                      lists and order supplies. Later used to transmit x-ray
1876     Telephone Initially used for voice communicaion. About 30 years
                      later, used to transmit ECGs and EEGs.
1895       Radio      Used to supply medical advice to seafarer. In 1920
                      the Seaman’s Church Institute of New York provided
                      medical care using radio. The CIRM in Rome has
                      been using radio to provide
 Late      Video/     A two-way closed circuit television link was set up
1960s                 between the Nebraska Psychiatric Institute in Omaha
                      and the state mental hospital in Norfolk for
                      educational purposes.
1990s    Videoconf Videoconferencing for health purposes became more
         erencing common
 Mid-     Internet    Use of the internet for health purpose
    Participants in the telehealth
• The nature of the communication in health
  can be
  – Patient with practitioner
  – Practitioner with practioner
  – Patient with patient (that is, mutual support)
  – Practioner or patient accessing educational
    material (that is, source of health information)
      Patient with practitioner
• Telepsychiatry is a common telehealth
  application usually performed by
  videoconferencing, since this provides
  audiovisual communication
• An evaluation of telepsychiatry services in
  Alberta, Canada, showed that it was
  acceptable to users and there were
  significant cost savings from avoided
  travel by psychiatrists and patients
     Practitioner to practitioner
• Teleradiology is one of the most widespread of
  telehealth applications. It involves the
  transmission of digital radiographs between
  institutions using telecommunications network
• It can be highly cost-effective to transmit
  radiographs using a telecommunication network
  rather than hiring a radiologists for every small
• Teleradiology consultants may also take place
  internationally, which can be particularly
  effectively for out-of-hours reporting
           Patient with patient
• The use of health support groups has become
  popular, because they allow communication
  between people who have similar conditions,
  enabling them to share experiences
• A large number of Internet-based support
  groups facilitating interaction within a wide range
  of problems, from mental health to obesity to
• A study of the use of audio conferencing by
  breast cancer patients in rural Newfoundland
  showed that it provided valuable mutual support,
  despite the distances.
 Types of telehealth interaction
• Real-time
  – Parties communicate simultaneously via a
    telecommunication network, also called synchronous
    or interactive
• Store and forward
  – Involves non-interactive transmission of information
    from on site to another.
  – Sometimes referred to as asynchronous or pre-
    recorded and involves information being captured and
    then transmitted to the other party for advice, opinion
    or specialist consultation
     Technology for telehealth
• The technology required for the telehealth
  system comprises three main components
  – Equipment to capture the information at each site
  – Communication equipment to transmit this information
    between the sites
  – Equipment to display the information at the relevant
• Four types of information transfer common in
  – Audio, text, still images, video
Figure 19.1 X-ray digitizer
Figure 19.2 High-quality
videoconferencing studio
Information box- issues of
• There is a wide choice of
  telecommunications options for telehealth.
  All have their positives and negatives
  – Standard telephony
  – The Internet
  – Mobile phones
  – ISDN
  – Satellite
    Current telehealth practice
• Survey by Association of Telemedicine
  Service Providers (ATSP)
  – In the US, nearly 130 programs of telehealth
    and 40000 teleconsultations were performed
• The introduction of electronic health
  records will vreate information networks
  linking hospitals, physicians, pharmacists
  and other healthcare professionals,
  allowing the sharing of health information
          Health education
• Telehealth offers great gains in health
  education particularly for geographically
  isolated health care workers
• Systematic and regular updating of skills
  and knowledge ae essential elements in
  effective healthcare provision and Internet
  supports this development
       Advantages of telehealth
• Has the potential to make specialist care accessible to
  underserved rural and remote communities
• Several programs in correctional facilities have
  demonstrated the efficiency of telehealth in providing the
  healthcare to prisoners and avoiding transporting them
  for consultations
• Can be advantageous for health professionals and has
  helped dispel professional isolation, particularly for those
  in geographically isolated areas
• Patient empowerment: patients are no longer dependent
  on the limited information provided by the doctors and
  they can take greater control over their health conditions.
  The changing nature of the doctor/patient relationship is
  an important advantage of telehealth
             Barrier to telehealth
• Human and organizational factors represent the major barrier
• A lack of financial support has often been a serious obstacle to
  research and development in healthcare
• Sometimes a lack of trust, commitment and dedication by healthcare
  personnel reflect a lack of readiness for telehealth
• A lack of appropriate training and educational facilities
• The lack of information about cost-effectiveness of telehealth
• Lack of an adequate telecommunication infrastructure in the
  developing world
• The legal and ethical issues including licencing, privacy and
• Reimbursement or the lack of it is also an obstacle for potential
  telehealth practioners

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