1. Telehealth and Communication

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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)

8. 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

9. 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

10. 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.

11. 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

12. 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

13. Figure 19.1 X-ray digitizer

14. Figure 19.2 High-quality videoconferencing studio

15. 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

16. Current telehealth practice
Survey by Association of Telemedicine Service Providers (ATSP)
In the US, nearly 130 programs of telehealth and 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

17. 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

18. 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

19. 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