TELE MEDICINE

Telemedicine - An Overview
Telemedicine is defined as the provision of
“any type of medical service from a
distance”
Telemedicine generally refers to the use of
communications and information technologies
for the delivery of clinical care.
Telemedicine may be as simple as two health
professionals discussing a case over the
telephone, or as complex as using satellite
technology and video-conferencing equipment
to conduct a real-time consultation between
medical specialists in two different countries.
Telemedicine Applications
The major types of telemedicine applications
are:
Electronic Medical Records
Continuing Medical Education
Personalized Health Information
Teleconsultation
 Electronic Medical Records

 Electronic Medical Records (EMR) store all healthcare

information of a person to create an independent set
of medical records
 Healthcare providers can access the EMR from any
location in order to provide diagnosis based on the
most complete level of information
 The EMR should result in the creation of a Personalized
Lifetime Health Plans
 The EMR of all the individuals should provide data and
services to enhance health planning and policy making
at the national level
 Continuing Medical Education

 Continuing Medical Education (CME) application results

in healthcare professionals, regardless of their physical
location, being provided with medical educational
materials through a multimedia environment
 Through telemedicine CME courses healthcare
providers are constantly made aware of the latest
medical innovations
 Through this ongoing interaction with other medical
professionals, healthcare providers in remote locations
feel less isolated and more willing to work in such
locations
 Personalized Health Information

• Personalized Health Information (PHI) delivers high quality health

information to any multimedia user
• A PHI system should provide affordable and reliable health
information in a user-friendly manner to individuals
• This system should empower individuals to take responsibility for
their state of health
• It should assist the individuals in maintaining a healthy lifestyle
Teleconsultation
 Teleconsultation is the provision of medical opinions
through the use of a telecommunication medium
 Teleconsultation is dynamic i.e. it requires interaction
from both the referring medical practitioner and the
consulting physician whether simultaneously (through
video-conferencing) or at different times (through store
& forward systems)
 An effective teleconsultation system incorporates
features of the other three telemedicine applications, in
other words it should:
Provide electronic medical records of individuals who
have used the teleconsultation system
Provide practice linked continuing medical education
Provide access to relevant information to both
healthcare providers and users
Teleconsultation - An Overview
 Teleconsultation is the provision of medical
opinions through the use of a telecommunication
medium
 An effective teleconsultation system should be
capable of transmitting:
 medical images - x-rays, CT, MRI, etc.
 medical data and
voice
 To be effective, teleconsultation systems have to
be:
Extremely Reliable
Efficient and Fast
Cost Effective
 An Effective Teleconsultation
System
 Reliable
A reliable and useful system will require a “Paradigm
Shift” whereby patients, medical officers at the rural
sites, specialists at the centers of medical excellence
and all other healthcare professionals buy into this
new form of healthcare delivery. The Paradigm Shift
can occur through:
Comprehensive “Change Management” procedures
which would carefully and thoroughly explain this
new healthcare delivery system
A pilot project conducted over a few years involving
sites that may be considered to be the most
receptive to new ideas
Medical validation of system is necessary
The system would need to be tested on the prevailing
 An Effective Teleconsultation
System
 Efficient and Fast
Teleconsultation acquisition spokes need to be near
potential customers and be able to transmit cases
quickly through existing telecommunications
infrastructure
Standard Operating Procedures (created through
experience and with the active input of healthcare
professionals) and checklist to ensure efficiency and
reliability
 Cost Effective
Utilize a system which strives to make both the
general and specialist medical practitioner more
efficient in utilizing their time
Store & Forward technology utilizing normal phone
lines
 Benefits of Teleconsultation

• Extends the reach of specialist healthcare from centers

of medical excellence to rural or underserved areas
• Through the teleconsultation system, the general
practitioners at the acquisition spokes have immediate
access to a wide range of medical specialties
• Patients eventually have one “Super Family Doctor”
monitoring their wellness
• Provides immediate benefits in the form of improved
diagnostic and treatment recommendations to rural
areas
• The system retains the patient medical information
which can be viewed by the attending medical
practitioner even if the patient has moved to a different
ELECTRONIC MEDICAL
RECORDS (EMR)
 What is an EMR?
”A patient record, in
which all information is
stored electronically in
such way that it may be
found and reused by
means of computer
tools”
This refers to a
paperless, digital and thi
s
of
computerized system of 10
000
m

maintaining patient data,

designed to increase the
efficiency and reduce
documentation errors by
streamlining the process.
Electronic Medical Records (EMR)

 Access of patient data by clinical staff at any given location

 Accurate and complete claims processing by insurance
companies
 Building automated checks for drug and allergy
interactions
 Clinical notes
 Prescriptions
 Scheduling
 Sending and viewing labs
Medical Records - Access
Laws governing access to medical records:
In the UK:
 Data Protection Acts & Freedom of Information Act 2000
 Patients or their representatives have the right to a copy
of their record. Except:
 where information breaches confidentiality
(e.g. information from another family member or where a patient
has asked for information not to be disclosed to third parties)
 where information would be harmful to patient's well-being
(e.g. some psychiatric assessments).
 Patients have the right to check for any errors in their
record and insist that amendments be made if required.
Medical Records - Access
Laws governing access to medical records:
In the US:
 Only patient and health care providers directly involved in delivering
care have the right to view the record.
 Patient may grant consent for any person to evaluate the record.
 Special Situations.
 Capacity
 When a patient does not have capacity, a legal guardian is
designated
 Medical emergency involving a non-communicative patient
 Consent is assumed unless written documentation has been
drafted previously
 Research, auditing, and evaluation
 Individuals involved in research have access. They are not
allowed access to identifying information.
 Risk of death or harm
 Information can be shared without permission if failure to do so
 Electronic Medical Records

Today’s Reality:

“EMRs are ‘mission critical’ applications that are

required to work 100% of the time every 10 minutes in
primary care.”
The Future of the EMR

As Is
To Be
Vendor Relationships

As Is To Be
 Evolution of Electronic Medical Records

Traditional Present Day Future State

Patient Focused EMR

“As Is”
(Office-based)
ROLE OF IT IN HOSPITAL
MANAGEMENT
IT DEPARTMENTS
Role:
• Essential to leverage the collective clinical
knowledge that healthcare organizations
acquire on a daily basis
• Such clinical knowledge could be applied to
elevate productivity
• Better resource utilization and changing
behaviour of healthcare workers by using
clinical and best practice guidelines
HEALTHCARE IT
Paradox of healthcare technology
• Sophisticated diagnostic tools
• Medical records, lab. Reports. Often forms
continue to be available in print format!
• Information exchange between doctors, labs,
pharmacies and hospitals is often done on
paper!
HOSPITAL IT SYSTEM
• Should help to reduce practice overheads by
improving efficiency, effectiveness and
quality care
• Need high quality electronic medical records
• Need for clinical leadership in development
and procurement of IT in healthcare
organizations
HOSPITAL IT SYSTEM
• Should integrate basic care data across
hospital business systems to create a
complete picture of what was done to the
patient, ascertain who did it, and at what
cost
• Importance of clinical data regarding
outcomes
• Gather longitudinal data - can lead to more
fundamental care delivery re-design