1. Telehealth In the New Millennium Michele L. Hales University of Alberta Edmonton, AB CANADA ISN: Informatics Symposium February 5, 2001 Dubai, UAE Presented at

2. What is Telehealth? "Telehealth is defined as the use of communications and information technology to deliver health and health care services and information over large and small distances."

3. Director General of W.H.O. Dr. Hiroshi Nakajima, the Director-General of the World Health Organization (WHO) pointed out that information and telecommunication technology, as “one of the main driving forces in the current globalization of trade, economics and politics”, and it had “equally important implications for health.” TELECOM 97 Forum

4. Transmission  Telephone lines are slow but inexpensive at 64 kilobytes per second (baud)  ISDN telephone lines – integrated service digital network is faster at 256 kb  ATM – asynchronous transfer mode >1Mb  Satellite – expensive

5. Categories of Information Flow  Data interactive, data entry, batch, file update, file transfer, file sharing  Image fax, graphics, conferencing, interactive, store/forward  Voice voice only, voice/data, inquiry/retrieval, conferencing, store/forward, recording  Video conferencing, screen capture, interactive, recording Information Monitoring: network management, security, integrity, licensing, malpractice

6. Valuable Product & Services Source: VHA Annual Information Systems Survey 1998

7. Richard D. Lee, Dierdre A Conley, Andy Preikschat: WitCapital. eHealth 2000: Healthcare and the Internet in the New Millennium. January 31, 2000 Available at: www.witcapital.com/research/researchbody.jsp?Report=ehlt_20000131

8. A transition: Telehealth Telemedicinee-health e-health is now the term to use when describing the rise of digital technologies, electronic transmission and the convergence of technologies. Mitchell, John:From Telehealth to E-Health: The Unstoppable Rise of E-Health. 1999. Department of Communications, Information Technology and the Arts, Australia.

9. Telehealth  Clinical diagnosis  Direct care delivery  Tele-education/telelearning (including patients & professionals)  Telemedicine  Telematics (for health research and health services management) Integration of information technology in healthcare has tremendous potential, which is only now being realized.

10. Telehealth/E-health  Telehealth is moving closer to e-commerce  Health information is being disseminated via the web  A more well-informed consumer  Increased patient knowledge increases challenges to the healthcare providers decisions The primary care physician of the future is the patient (or guardian)

11. Telemedicine, telehealth, e-health Consumer-driven Provider-driven e-health Telemedicine and Telehealth  The public will tell us what they want in e-health. in e-health.  Providers no longer dictate but become partners with patient or client.

12. Driving Forces of Telehealth  Health and socioeconomic needs  Shortage of specialists in remote regions  Sense of professional isolation  Demand for equitable and accessible healthcare services  Decrease in cost for equipment & telecommunication  Aging population

13. Trends in Telehealth  Increased use in correctional facilities and home health care settings.  Fine-tunes the management and allocation of rural health care emergency services by transmitting images to key medical centres for long distance evaluation/triage by appropriate medical specialists.  Permits physicians doing clinical research to be linked together despite geographical separation, sharing patient records an diagnostic images.  Improves medical education for rural health care professionals.

14. Strengths & Benefits  Empowers the public  Strengthens and integrates healthcare services  Creates information resources, continuing education & training to healthcare providers  Increases accessibility of specialty care to underserved populations  Telehealth applications provide foresight to new possibilities  Provides support to providers  Provides instant communication with colleagues

15. Some Telehealth Challenges  Policy issues: Liability, licensure and reimbursement  Need for technical and professional standards  Privacy, confidentiality and security must be addressed  Need to stay abreast of changes in funding for projects  Acceptance of the technology  Infrastructure barriers to some rural areas – possibly the greatest challenge

16. Opportunities  Collaboration: - various government agencies - health organizations - industry  Strengthen incentive program  Develop and exchange knowledge

17. Successful Telehealth Endeavours  School-based health centers  Hibernia off-shore oil drilling platform  Correctional Facilities  Tele- - dermatology - radiology - cardiology - oncology - surgery - psychiatry - pediatrics

18. Teledialysis (OSMH)  Orillia Solider's Memorial Hospital (OSMH) - established Canada's first region-wide, teledialysis network.  Using computerized systems, the OSMH monitors patients at least 100 kilometres from the regional centre, bringing healthcare services closer to home.  The network officially opened in October 1997.

19. Teledialysis (OSMH) cont’d:  Linked via ISDN lines, a high-speed phone connection allowing videoconferencing to take place between doctor and patient in real-time.  To achieve a complete transfer of data, three ISDN lines are going at the same time.  Excellent picture quality

20. Teledialysis (OSMH) cont’d:  Dialysis machines are connected via modem, through a standard phone line to the server at the regional centre. From there, the information is transmitted to the screen.  Enables patients to videoconference with remote doctors.  It provides medical follow-up care for stable hemodialysis patients.  Provides patient privacy

21. Telehealth Initiatives Globally:  Armenia  Australia  Canada  Europe  South Africa  United States of America

22. E-mail Discussion Lists  TELEHEALTH To: listserv@maelstrom.stjohns.edu Body: Subscribe TELEHEALTH YourName  E-HEALTH To: listserv@maelstrom.stjohns.edu Body: Subscribe EHEALTH YourName  NETPSY To: listserv@maelstrom.stjohns.edu Body: Subscribe NETSPY YourName  ITNA To: listserv@bcm.tmc.edu Body: Subscribe itna FirstName LastName

23. Publications  Journal of the American Medical Association - jama.ama-assn.org/  MD Computing - www.mdcomputing.com/  Telehealth Magazine - www.telehealthmag.com/  Telehealth Net - telehealth.net/  Telemedicine Journal - www.liebertpub.com/TMJ/  Telemedicine Today - www.telemedtoday.com/  Telemedlaw

24. Organizations & Associations:  Association of Telehealth Service Providers - www.atsp.org  Canadian Society of Telehealth - www.ucalgary.ca/md/CST/  California Telehealth and Telemedicine Center - telemed.calhealth.org/  Finnish Society of Telemedicine - www.fimnet.fi/telemedicine/engindex.htm

25. Organizations & Associations cont’d:  Healthcare Information and Management Systems Society (HIMSS) - www.himss.org  International Society for Telemedicine (ISFT) - isft.org  National Centre of Telemedicine, Tromso, Norway - www.telemed.rito.no/Eng/index.html  Office for the Advancement of Telehealth - telehealth.hrsa.gov

26. Telehealth Future  Precedents are now being set  New generation of technology arrives every 18 - 30 months  The future is being shaped by us now

27. Conclusion Telehealth is just another way to practice what one already knows how to do, but through a new means It will be the way of the future

28. “The computer is very fast, accurate and stupid. Man is very slow, inaccurate and brilliant. Together they make an unbeatable team.” -- Albert Einstein FOR MORE INFO... Michele.Hales@UAlberta.CA