Chapter 19 Telehealth and Communication

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Chapter 19Telehealth and Communication

• Yung-Fu Chen
• Department of Health Services Administration,
  China Medical University

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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.

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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

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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

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Case Study
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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

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Table 19.1 timeline of telehealth
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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)

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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

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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

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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.

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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

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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

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Figure 19.1 X-ray digitizer
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Figure 19.2 High-quality videoconferencing studio
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Information box- issues of bandwidth
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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

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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

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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

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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

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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