Telemedicine, Communications and Health Information Maria Zolfo

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

Aim of this session describe the technologies outline the major new health uses of these technologies

Technology 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: 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 equipment Telephone Telephone Fax Fax Video-conferencing Video-conferencing Television Television Radio Radio Computers Computers

Networks LAN ( LAN (Local Area Network): connects personal computers and mainframe computers over a localized area such as a campus of a hospital, university... WAN ( WAN (Wide Area Networks): network which could cover the entire globe, i.e. credit card companies Internet: Internet: includes , file transfer protocol, and access WWW PSTN, PABX,… PSTN, PABX,…

Health applications Tele-consultation (telephone, video- conferencing, internet,…) Tele-consultation (telephone, video- conferencing, internet,…) Diagnostic report (digital scanner with computers and software to transmit and regenerate the image) Diagnostic report (digital scanner with computers and software to transmit and regenerate the image) Electronic patient records Electronic patient records

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

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

Method of working Expert advice from HIV/AIDS specialists is offered to colleagues in the field through a discussion forum on Expert advice from HIV/AIDS specialists is offered to colleagues in the field through a discussion forum on

Discussion forum …

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

3 years evaluation details

Telemedicine, legal issues

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

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

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

Attribution Where appropriate, information contained on this site will be supported by clear references to source data and, where possible, have specific HTML links to that data Where appropriate, information contained on this site will be supported by clear references to source data and, where possible, have specific HTML links to that data The date when a clinical page was last modified will be clearly displayed (e.g. at the bottom of the page) The date when a clinical page was last modified will be clearly displayed (e.g. at the bottom of the page)

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

Transparency of authorship The designers of the website will seek to provide information in the clearest possible manner and provide contact addresses for visitors that seek further information or support The designers of the website will seek to provide information in the clearest possible manner and provide contact addresses for visitors that seek further information or support The Webmaster displays his/her address clearly throughout the website The Webmaster displays his/her address clearly throughout the website

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

Honesty in advertising & editorial policy If advertising is a source of funding it should be clearly stated If advertising is a source of funding it should be clearly stated