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Information and communications technologies (ICT) in Health. TELEMEDICINE

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University of Vic - Central University of Catalonia. Faculty of Medicine

Veröffentlicht in: Gesundheit & Medizin
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Information and communications technologies (ICT) in Health. TELEMEDICINE

  1. 1. www.uvic.cat Dr Josep Vidal i Alaball josep.vidal@uvic.cat ICT in Health Telemedicine Course 2017-2018 Medicine
  2. 2. Index 214/06/2018 1.History of telemedicine 2.Types of telemedicine 3.Use of telemedicine 4.Evidence for telemedicine 5.Telemedicine in Central Catalonia 6.Other examples of telemedicine 7.Questions ICT in HealthMEDICINE Course 2017 - 2018
  3. 3. Definition of Telemedicine 314/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Telemedicine can be defined as “the use of telecommunications technology to provide medical information and services” (Perednia and Allen, 1995) or as “medicine practiced at a distance” (Wootton, 1996) In 1997, the World Health Organization defined telemedicine as: “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities” (WHO, 1998).
  4. 4. History of Telemedicine 414/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  5. 5. History of Telemedicine 514/06/2018ICT in HealthMEDICINE Course 2017 - 2018 It is very difficult to determine when telemedicine was used for the first time Zundel theorises that telemedicine in the form of bonfires may have been used as early as in the ancient Greece to transmit information relating to war or later on across Europe to transmit information about bubonic plagues (Zundel, 1996) Some authors have suggested telemedicine started in late 18th century with the invention of the telegraph. It is recorded that the telegraph was used in Australia to unite a dying man with his wife and in America during the American Civil War to pass information about wounded soldiers (Eikelboom, 2012).
  6. 6. History of Telemedicine 614/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Other authors consider that the invention of the telephone by Graham Bell in 1875 constitutes the origin of telemedicine, as it is probable that the telephone was used to discuss medical matters between physicians (Garcia Vega, 2003) It is published that in 1879 the telephone was used by an anonymous doctor to listen to a cough and reassure a mother convinced that their child had croup. In that time, some experiments were done to transmit amplified heartbeats though the telephone (Aronson, 1977).
  7. 7. History of Telemedicine 714/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Bashshur and Shannon explain that “from a technological perspective, modern telemedicine emerged from a continuous series of technological advancements in electronic communication and computer processing”. This advances started with the telegraph, continued with television and is now an ongoing process in the internet and digital age (Bashshur and Shannon, 2009).
  8. 8. Types of Telemedicine 814/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  9. 9. Types of Telemedicine 914/06/2018ICT in HealthMEDICINE Course 2017 - 2018 According to the timing of the information transmitted, there are 3 main types of telemedicine: 1. Store-and-forward or asynchronous (not real- time) telemedicine 2. Videoconference or synchronous (real-time time) telemedicine 3. Remote patient monitoring.
  10. 10. Types of Telemedicine 1014/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Asynchronous. Clinical data is collected, stored, and then forwarded to be interpreted later It has the advantage that there is no need for the patient and the clinician to be available at the same time or place (American Telemedicine Association, 2013) Disadvantages: • There is no immediacy of direct patient contact • Some images can have poor quality • It may require repeat consultations if clinical details are not complete enough (Kanthraj and Srinivas, 2007).
  11. 11. Types of Telemedicine 1114/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Real-time time telemedicine It has the advantage of saving time by the opportunity to provide direct interaction between health care professionals that allow clarifying clinical details. Disadvantages: • Higher costs of the technology • Need for significant bandwidth • Video images may have lower resolution than photographs (Coates, Kvedar and Granstein, 2015).
  12. 12. Types of Telemedicine 1214/06/2018ICT in HealthMEDICINE Course 2017 - 2018 (Coates, Kvedar and Granstein, 2015)
  13. 13. Types of Telemedicine 1314/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Remote patient monitoring can be considered a type of telemedicine as patient’s health information is gathered with technological devices and send and stored in the patient’s electronic medical records for future evaluation and use (Daniel and Sulmasy, 2015) Useful in patients with chronic conditions. Can allow patients to maintain independence, prevent complications and minimize personal costs Uses sensors on a device enabled by wireless communication to measure physiological parameters
  14. 14. Types of Telemedicine 1414/06/2018ICT in HealthMEDICINE Course 2017 - 2018 https://www.mdtmag.com/article/2013/05/wireless-enabled-remote-patient-monitoring-solutions
  15. 15. Types of Telemedicine 1514/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Wearables: Electronic devices with micro-controllers that can be worn on the body as implants or accessories
  16. 16. Examples of Telemedicine 1614/06/2018ICT in HealthMEDICINE Course 2017 - 2018 (Daniel and Sulmasy, 2015)
  17. 17. Use of Telemedicine 1714/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  18. 18. Global Survey on eHealth 2009 (WHO) 1814/06/2018ICT in HealthMEDICINE Course 2017 - 2018 The majority of telemedicine services, most of which focus on diagnosis and clinical management, are routinely offered in industrialized regions Some predict that telemedicine will profoundly transform the delivery of health services in the industrialized world by migrating health care delivery away from hospitals and clinics into homes In low-income countries and in regions with limited infrastructure, telemedicine applications are primarily used to link health-care providers with specialists, referral hospitals, and tertiary care centres.
  19. 19. Global Survey on eHealth 2009 (WHO) 1914/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Potential barriers to telemedicine diffusion: • Costs +++ • Some patients and health care workers resist adopting service models that differ from traditional approaches • Shortage of studies documenting economic benefits and cost-effectiveness of telemedicine • Legal considerations: absence of an international legal framework • Technological challenges: the systems being used are complex.
  20. 20. Global Survey on eHealth 2009 (WHO) 2014/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  21. 21. Global Survey on eHealth 2009 (WHO) 2114/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Approximately 30% of responding countries have a national agency for the promotion and development of telemedicine, and developing countries are as likely as developed countries to have such an agency (World Health Organization, 2010) Findings from the survey show that teleradiology currently has the highest rate of established service provision globally (33%)
  22. 22. Global Survey on eHealth 2009 (WHO) 2214/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Results of survey:
  23. 23. Global Survey on eHealth 2009 (WHO) 2314/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  24. 24. Global Survey on eHealth 2009 (WHO) 2414/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  25. 25. Global Survey on eHealth 2009 (WHO) 2514/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  26. 26. Global Survey on eHealth 2009 (WHO) 2614/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  27. 27. Evidence for Telemedicine 2714/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  28. 28. Efficacy and effectiveness of telemedicine 2814/06/2018ICT in HealthMEDICINE Course 2017 - 2018 In 2002, Hailey et al. published a large systematic review of 66 studies looking at the evidence for benefits of telemedicine and found little good quality studies However, they found convincing evidence of the efficacy and effectiveness of teleradiology, telepsychiatry, teleechocardiography, teledermatology and home telecare Savings and clinical benefits identified mainly derived from the avoidance of travel (Hailey, Roine and Ohinmaa, 2002).
  29. 29. Efficacy and effectiveness of telemedicine 2914/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Ekeland et al. in 2010 published a comprehensive systematic review of reviews including 80 studies They found 31 reviews concluding that telemedicine was effective and 18 reviews with promising but incomplete evidence They concluded that the evidence base of the effectiveness of telemedicine was accumulating (Ekeland, Bowes and Flottorp, 2010).
  30. 30. Efficacy and effectiveness of telemedicine 3014/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Of all studies looking at the efficacy and effectiveness of the different telemedicine services, the largest number of studies came from teledermatology. The most assessed aspect of teledermatology is its accuracy, reliability and particularly interobserver concordance Nami et al. in a study including 391 patients obtained a concordance rate between face-to-face and store-and-forward teledermatology of 91.05% (Nami et al., 2015).
  31. 31. Access 3114/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Access is one of the best studied aspects relating to telemedicine. Telemedicine provides better access to users in addition to reducing the waiting time between diagnosis in primary care and hospital In 2014 Vidal-Alaball et al. demonstrated that waiting times for the usual dermatology services could be reduced with teledermatology from a mean of 30 days before the implementation of teledermatology to a mean of 16 days after its implementation (Vidal-Alaball et al., 2014).
  32. 32. User and professional acceptance 3214/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Telemedicine services enjoy a high acceptance among users A cross-sectional satisfaction survey that included 1.734 patients reported 95% of patients were very satisfied with the quality of the health care they received (Polinski et al., 2016) Good professional acceptance has also been reported with teleulcer programmes. For example by Kolltveit et al. using focus groups to assess health professionals’ experience with a telemedicine programme (Kolltveit et al., 2016).
  33. 33. User and professional acceptance 3314/06/2018ICT in HealthMEDICINE Course 2017 - 2018 A comprehensive systematic review recently published by Mounessa et al. reported that patients and providers where highly satisfied with the 2 types of telemedicine: store-and-forward and real time telemedicine (Mounessa et al., 2017).
  34. 34. Costs of Telemedicine 3414/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Several studies have studied the costs of telemedicine using different methods of health economics Bashshur et al. published a literature review reporting the results of 7 studies comparing costs of teledermatology in primary care with face-to- face consultations. The methods used included cost-effectiveness analysis & cost-benefit analysis. They concluded that teledermatology in primary care is increasingly demonstrating to be cost- effective (Bashshur et al., 2016).
  35. 35. Limitations of Telemedicine 3514/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Armfield and colleagues have argued that despite the fact that we have a large literature base on telemedicine, the evidence base for it is limited as very few of the thousands of articles relating to medicine, telehealth or telecare on MEDLINE are incorporated into critically appraise summaries. Reasons: • It is difficult to use randomised controlled trials for determining the effectiveness of telemedicine • Clinicians are adopting telemedicine slowly and patchy They recommend that studies looking at telemedicine should look at efficacy, effectiveness, economic aspects and health worker’s preferences and these aspects should be introduced when designing telemedicine programs (Armfield et al., 2014).
  36. 36. Telemedicine in Central Catalonia 3614/06/2018ICT in HealthMEDICINE Course 2017 - 2018 https://www.youtube.com/watch?v=7sgwPpU1O3I
  37. 37. Telemedicine in Central Catalonia 3714/06/2018ICT in HealthMEDICINE Course 2017 - 2018 In the Catalonian central region, three counties, Anoia, Bages and Berguedà, have developed several telemedicine programs, which have had considerable success in reducing waiting lists while having wide acceptance among users Among the programs of telemedicine, the most successful is teledermatology and the most innovative are teleulcers and teleaudiometries Teledermatology was first introduced in the in the county of Anoia in 2007. Since them, this programme has evolved and has consolidated.
  38. 38. Telemedicine in Central Catalonia 3814/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  39. 39. Telemedicine in Central Catalonia 3914/06/2018ICT in HealthMEDICINE Course 2017 - 2018 All telemedicine programs work in the same way; the primary care physician or nurse take a photograph of the lesion or the injury and attaches it to the electronic medical records of the patient along with an explanation of the injury The use of electronic medical records guaranties confidentiality of images, since it avoids potentially insecure electronic storage and e-mail The specialists of the hospital access the electronic medical records, review the images and propose a treatment or action plan.
  40. 40. Telemedicine in Central Catalonia 4014/06/2018ICT in HealthMEDICINE Course 2017 - 2018 The primary care physician or nurse review these instructions and makes a telephone call to the patient to explain the results of the consultation All of this can usually be done in less than 5-7 working days If the specialist of the hospital has any doubts, ask the primary care professional to refer the patient for a face-to-face visit.
  41. 41. Teledermatology 4114/06/2018ICT in HealthMEDICINE Course 2017 - 2018 This program has had considerable success in reducing dermatology waiting lists, from a mean of 30 days (95% CI: 29-32) to a mean of 16 days (95% CI: 15-17) after its implementation (Vidal- Alaball et al., 2014).
  42. 42. TeleUlcers 4214/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Inspired by the good results of teledermatology, in November 2012 Teleulcers was introduced in the counties of Bages and Berguedà Teleulcers is a project aiming to improve the care of patient with chronic wounds or ulcers. Expert vascular advice is available for primary care nurses. Three main features define this service: 1. Transversality 2. Virtual teleconsultation system 3. Nursing leadership in the care of patients with chronic wounds (Navarro et al., 2014). http://www.ticsalut.cat/observatori/innova-tic-salut/70/teleulceres
  43. 43. TeleAudiometries 4314/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Latest telemedicine service being introduced in Bages and Berguedà (2013). Has some similarities with teledermatology &Teleulcers but no photographs are taken Patients are referred to a Primary Care Centre when an audiometry is performed Audiometry, together with some clinical information is scanned and inserted in the electronic medical records Otorhinolaryngologist access electronic medical records, review the audiometry and propose an action plan Primary care physician reviews these instructions and makes a telephone call to the patient to explain results This service also used to follow up patients with hearing loss.
  44. 44. Teleaudiometries 4414/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  45. 45. TeleOphthalmology 4514/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Used to screen for diabetic retinopathy (DR) Photographs of the retina are taken by a nurse and included in the e-clinical history Primary Care doctors specialized in screening for DR access electronic medical records, review the photographs, write a diagnosis and suggest a follow up Primary care physician reviews these instructions
  46. 46. Other examples of Telemedicine 4614/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  47. 47. TeleStroke (“TeleIctus”) 4714/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Treatment of Cerebrovascular disease (CVD) Communicate a local hospital with a third level hospital with and on-call Neurologist (videoconferencing) The objective of offering better, more equitable and efficient care, to people who suffer from an episode of stroke or who is suspected of being suffering from it The system allows you to work from portable stations from which you can establish triple band multiconferencing systems through which the patient and the radiological image can be visualized simultaneusly. http://www.ticsalut.cat/observatori/innova-tic-salut/27/xarxa-teleictus
  48. 48. TeleStroke (“TeleIctus”) 4814/06/2018ICT in HealthMEDICINE Course 2017 - 2018
  49. 49. Teleburns 4914/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Treatment of patients with severe burns Characteristics: • Perform a direct diagnosis by an expert doctor from the Burns Unit (videoconferencing) • Indicate the correct treatment and the type of subsequent control • Indicate, where appropriate, the transfer to the burning unit and the appropriate type of transport • Direct control of the evolution of the wounds • Register the patients or indicate their subsequent transfer if the evolution is not adequate • Medical / nursing training.
  50. 50. Teleburns 5014/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Advantages: • Avoid unnecessary journeys for patients • Receive treatment in a center closest to their home • Give added value to the quality of the treatment of burned patients. http://www.ticsalut.cat/observatori/innova-tic-salut/108/telecremats
  51. 51. Teleradiology 5114/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Communicate local hospitals with bigger hospitals with and on-call Radiologist (asynchronous – synchronous) Objectives: • Offer greater clinical coverage and better access to the diagnosis of radiological images • Improve diagnosis • Improve health care coverage. Possibility of providing 24- hour radiologists coverage in small hospitals • Saving costs through more efficient use of available resources. http://www.ticsalut.cat/observatori/innova-tic-salut/132/teleradiologia
  52. 52. Home monitorization: Arrhythmias - Pacemakers 5214/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Monitoring of chronic patients with arrhythmias to control them remotely Their wear a home monitor, connected to a defibrillator device, which periodically sends data to a web platform and from here on the hospital's website, where the Arrhythmias team carries out the follow-up Similar project to control remotely pacemakers. http://www.ticsalut.cat/observatori/innova-tic-salut/82/telemonitoritzacio-domiciliaria http://www.ticsalut.cat/observatori/innova-tic-salut/145/monitoritzacio-a-distancia-de-sistemes-destimulacio- cardiaca
  53. 53. Private Services 5314/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Telepsicology platform that provides access to psychologists throughout Spain from anywhere at any time Insurance companies (“mutuas”) are increasingly offering Telemedicine services http://www.ticsalut.cat/observatori/innova-tic-salut/135/estabilitas
  54. 54. Telepediatrics 5414/06/2018ICT in HealthMEDICINE Course 2017 - 2018 On line consultations www.tupediatraonline.com http://www.ticsalut.cat/observatori/innova-tic-salut/133/tu-pediatra-online
  55. 55. Other experiences 5514/06/2018ICT in HealthMEDICINE Course 2017 - 2018 • Tele orthopaedics • Tele rehabilitation • Tele neurophysiology • Tele endocrinology • Tele geriatrics • Etc, etc ! http://www.ticsalut.cat/observatori/innova-tic-salut/68/rehabitic http://www.ticsalut.cat/observatori/innova-tic-salut/34/plataforma-col%c2%b7laborativa-teleneurofisiologia
  56. 56. Other experiences 5614/06/2018ICT in HealthMEDICINE Course 2017 - 2018 https://www.youtube.com/watch?v=bGfwKjbZNeA https://www.youtube.com/watch?v=tCajVa263Ks
  57. 57. 5714/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Questions?
  58. 58. Thank you ! 5814/06/2018ICT in HealthMEDICINE Course 2017 - 2018 Information/contact: josep.vidal@uvic.cat http://www.slideshare.net/jvalaball Twitter/Instagram: @jvalaball
  59. 59. Bibliografia 5914/06/2018 • Perednia, D. and Allen, A. (1995) ‘Telemedicine technology and clinical applications.’, JAMA, 273(6), pp. 483–8. • Wootton, R. (1996) ‘Telemedicine: a cautious welcome’, BMJ. BMJ Publishing Group Ltd, 313(7069), pp. 1375–1377 • World Health Organization (1998) ‘A health telematics policy in support of WHO’s Health-For-All strategy for global health development: report of the WHO group consultation on health telematics’, WHO Group Consultation on Health Telematics. Geneva: World Health Organization, pp. 1–39 • Zundel, K. M. (1996) ‘Telemedicine: history, applications, and impact on librarianship.’, Bulletin of the Medical Library Association, 84(1), pp. 71–9. • Eikelboom, R. H. (2012) ‘The telegraph and the beginnings of telemedicine in Australia’, Studies in Health Technology and Informatics, 182, pp. 67–72. • Garcia Vega, J. (2003) Teledermatología, Store-and-Forward. Santiago de Compostela: Servicio Galego de Saúde, Axencia de Avaliación de Tecnoloxías Sanitarias de Galicia, avalia-t. • Aronson, S. H. (1977) ‘The Lancet on the telephone 1876-1975.’, Medical history, 21(1), pp. 69–87. MEDICINE Course 2017 - 2018 ICT in Health
  60. 60. Bibliografia 6014/06/2018 • American Telemedicine Association (2013) State Medicaid Best Practice Store- and-Forward Telemedicine. • Coates, S. J., Kvedar, J. and Granstein, R. D. (2015) ‘Teledermatology: from historical perspective to emerging techniques of the modern era: part I: History, rationale, and current practice’, Journal of the American Academy of Dermatology. Elsevier Inc, 72(4), pp. 563–574. • Daniel, H. and Sulmasy, L. S. (2015) ‘Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper’, Annals of Internal Medicine, 163(April), pp. 787– 789. • World Health Organization (2010) ‘Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth 2009’, Global Observatory for eHealth series. Geneva • Hailey, D., Roine, R. and Ohinmaa, A. (2002) ‘Systematic review of evidence for the benefits of telemedicine.’, Journal of telemedicine and telecare, 8 Suppl 1, pp. 1–30. MEDICINE Course 2017 - 2018 ICT in Health
  61. 61. Bibliografia 6114/06/2018 • Ekeland, A. G., Bowes, A. and Flottorp, S. (2010) ‘Effectiveness of telemedicine: a systematic review of reviews.’, International journal of medical informatics. Elsevier, 79(11), pp. 736–71 • Nami, N. et al. (2015) ‘Concordance and Time Estimation of Store-and-Forward Mobile Teledermatology Compared to Classical Face-to-Face Consultation’, Acta Dermato-Venereologica, 95(1), pp. 35–39. • Vidal-Alaball, J. et al. (2014) ‘Evaluación del impacto de la teledermatología en la disminución de la lista de espera en la comarca del Bages (2009-2012).’, Aten Primaria, pp. 9–10. • Polinski, J. M. et al. (2016) ‘Patients’ Satisfaction with and Preference for Telehealth Visits’, Journal of General Internal Medicine, 31(3), pp. 269–275 • Kolltveit, B.-C. H. et al. (2016) ‘Telemedicine in diabetes foot care delivery: health care professionals’ experience.’, BMC health services research. BMC Health Services Research, 16(1), p. 13 • Bashshur, R. L. et al. (2016) ‘The Empirical Foundations of Telemedicine Interventions in Primary Care’, Telemedicine and e-Health, 22(5), pp. 342–375 MEDICINE Course 2017 - 2018 ICT in Health
  62. 62. Bibliografia 6214/06/2018 • Armfield, N. R. et al. (2014) ‘Telemedicine - Is the cart being put before the horse?’, Medical Journal of Australia, 200(9), pp. 530–533. • Navarro, A. et al., 2014. Teleúlceres , una alternativa assistencial amb més d’un any d’experiència. ANNALS DE MEDICINA, 97(4), pp.159–162. • Orruño E, Gagnon M-P, Asua J, Abdeljelil A Ben. Evaluation of teledermatology adoption by health-care professionals using a modified Technology Acceptance Model. J Telemed Telecare 2011. 2011;17(June 2016):303–7. • Serrano Aguilar P, Yanes López V. Guía de diseño, evaluación e implantación de servicios de salud basados en telemedicina. Vol. 2006/27, Servicio de Evaluación del Servicio Canario de la Salud. Madrid; 2009. • Mounessa JS, Chapman S, Braunberger T, Qin R, Lipoff JB, Dellavalle RP, et al. A systematic review of satisfaction with teledermatology. J Telemed Telecare. 2017;0(0):1–8. MEDICINE Course 2017 - 2018 ICT in Health

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