OutlineThe 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.

IntroductionTelehealth 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

IntroductionTeleheath encompasses

Provision of health informationHealth administration and educationDiagnosis 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 TelehealthTelehealth covers a very wide range of

healthcare interaction for many different purposes. These interactions can be classified byParticipant: doctor-to-doctor, doctor-to-patientType: real-time, non-real-timeInformation transmitted: audio, video

Table 19.1: timeline of telehealthPeriod Telegraph Telephone application

1835 Telegraph 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 interactionThe nature of the communication in health

can bePatient with practitionerPractitioner with practionerPatient with patient (that is, mutual support)Practioner or patient accessing educational

material (that is, source of health information)

Patient with practitionerTelepsychiatry 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 practitionerTeleradiology 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 patientThe 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 interactionReal-time

Parties communicate simultaneously via a telecommunication network, also called synchronous or interactive

Store and forwardInvolves 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 telehealthThe technology required for the telehealth

system comprises three main componentsEquipment to capture the information at each siteCommunication equipment to transmit this

information between the sitesEquipment to display the information at the

relevant sitesFour types of information transfer common

in telehealthAudio, text, still images, video

Figure 19.1 X-ray digitizer

Figure 19.2 High-quality videoconferencing studio

TelecommunicationsThere is a wide choice of telecommunications

options for telehealth. All have their positives and negativesStandard telephonyThe InternetMobile phonesISDNSatellite

Current telehealth practiceSurvey 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 educationTelehealth 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 telehealthHas the potential to make specialist care accessible

to underserved rural and remote communitiesSeveral 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 telehealthHuman and organizational factors represent the major

barrierA lack of financial support has often been a serious

obstacle to research and development in healthcareSometimes a lack of trust, commitment and dedication by

healthcare personnel reflect a lack of readiness for telehealth

A lack of appropriate training and educational facilitiesThe lack of information about cost-effectiveness of

telehealthLack of an adequate telecommunication infrastructure in

the developing worldThe legal and ethical issues including licencing, privacy

and confidentialityReimbursement or the lack of it is also an obstacle for

potential telehealth practioners