Yung-Fu Chen

Department of Health Services

Administration, China Medical
University
Outline
 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.
Introduction
 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
Introduction
 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
images.
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
television
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
1990s
Participants in the telehealth interaction

 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 hospital
 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 parenting
 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 sites
 Four types of information transfer common
in telehealth
Audio, text, still images, video
Figure 19.1 X-ray digitizer
Figure 19.2 High-quality
videoconferencing studio
Information box- issues of bandwidth
telecommunications
 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 tele consultations were
performed annually
 The introduction of electronic health
records will create 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
confidentiality
 Reimbursement or the lack of it is also an obstacle for potential
telehealth practioners