Telehealth and Communication

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

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 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 1960s Video/ television A two-way closed circuit television link was set up between the Nebraska Psychiatric Institute in Omaha and the state mental hospital in Norfolk for educational purposes. 1990s Videoconferencing Videoconferencing for health purposes became more common Mid-1990s Internet Use of the internet for health purpose

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

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 teleconsultations were performed annually 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 confidentiality Reimbursement or the lack of it is also an obstacle for potential telehealth practioners