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Telehealth and eHealth The Future of Medicine
Michael Nerlich, MD, PhD Regensburg University
Medical Centre, Germany President of the
ISfTeH (International Society for Telemedicine
and eHealth) October 2007
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(No Transcript)
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A Look Back
pleasure
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A Look Back
even more pleasure
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Telemedicine, eHealth??
What is Telehealth?
What is eHealth?
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Definitions
Telehealth Use of communications and information
technology to deliver health and health care
services and information over large and small
distances Examples Telecare, Teleradiology,
Telepathology, Telesurgery
eHealth Improvement in the quality, safety, and
efficiency of healthcare through information and
information technology Examples e-Education,
e-Prescription, Patient Information File
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Classification

• eHEALTH
• TELEHEALTH
• TELEMEDICINE
• HEALTH INFORMATICS
• HEALTH TELEMATICS
• ? eHealth is the general term!

Telemedicine 2010 Visions for a Personal Medical
Network, Final Report, TM Alliance, 2004
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11-years old boy from Nepal
International Example
... was bitten by a snake ...
... and treated by the local shaman...
The result after 4 weeks of tourniquet...
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Teleconsultation by eMail, Question
International Example
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Teleconsultation by eMail, Answer 1 hour later
International Example
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Teleconsultation by eMail, Result
International Example
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Teleconsultation by eMail, Result
International Example
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Simplest type of Telemedicine!But it works and
helps!
International Example
What is the full potential of telehealth?
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Potential of Telehealth
Medicine Everywhere!
Increased quality of care
Faster medical care
Reduced costs New sources
Crossing Distances Without Borders
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Increased Quality

• Support of evidence-based medicine
• Better Reliability of Medical data
• Reduction of redundancy
• Education and training opportunities
• Support of large scale medical studies (health
  informatics)

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Faster Medical Care

• eHealth enables instant access to patient
  records ? faster diagnosis
• Emergency saves time by bringing remote
  specialists to the patient
• Emergency saves time by parallelizing work
  flows
• Home care via Telemedicine often saves time for
  transportation

In the event of an injury, the hospital will
know that I can pay in 20 seconds. It will take
20 days to get my records. (Larry Ellison,
Oracle Corp., CEO)
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Reduced Costs,New Sources of Income
Use of technology to broaden professional and
economic opportunities Generation of new
sources of income by providing remote services
through eHealth eHealth enables instant
access to patient records ? less working hours
for doctors A more economic utilisation of
expensive medical devices by sharing them via
eHealth
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Crossing Distances without Borders
? Removal of geographic boundaries from medical
practice ? Extending medical benefits to rural
and medically isolated areas ? Tele-Education
enables a more efficient distribution of medical
knowledge ? Easy possibility to help developing
countries ? First class support for armed forces
all over the world
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Handicaps of Telehealth
Medicine Everywhere!
Funding, Reimbursement
Missing acceptance
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Legal Issues, Lack of Regulation
Intra- and Inter-State/Province Differences
in Malpractice laws Medical records
laws Informed consent requirements Statutes
of limitations periods Damage limitations
caps Rules of evidence Responsibility
issues (raised by the new technology)
Confidentiality, Privacy, data protection And
many more
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Funding, Reimbursement
Problems National Healthcare Systems
hesitate to, or do not pay for eHealth systems
Paying party ? beneficiary party lack of
reliable, long-term reimbursement mechanisms,
i.e. incentives for clinicians to change their
behaviours and routines
What kind of services are convenience, which are
medically necessary? (Dr. Gordon Atherley,
Telehealth Assoc. of Ontario past-president)
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Fragmentation, Lack of Structure
? Lack of TRUE implementation of widespread
technical standards ? Incompatibility of
different solutions ? Missing collaboration
between government and NGOs ? Fragmented
National Health Systems complicate introduction
of new services
? Integration and consolidation
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Missing Acceptance
Problems ? Lack of needs assessment ?
Behaviours and routines of medical staff is hard
to change ? Psychological drawback of distance
technologies ? Win-Win Situations are rare ?
Lack of doctors, specialists, staff in some
countries ? Clinically effective?
? Need for Evaluation!
? Collection of convincing arguments!
? Gaining further Acceptance!
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Realisation of Telehealth
Funding Reimbursement of Telemedicine
Gaining acceptance
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Governmental Legislation, Establishment of
Regulations
Harmonisation of eHealth legislation a)
nationally b) internationally Legal certainty
concerning Licensure, accreditation, privacy,
reimbursement Also to keep in mind
seperately Legislation in the field of new
information technologies Legislation in the
field of medicine
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Funding Reimbursement of Telemedicine
Evaluation
Evidence base for choice

• If
• efficiency
• effectiveness
• appropriateness
• support the use of eHealth applications in a
  given surrounding

reimbursement of the application can be
suggested
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Gaining acceptance

• Simple handling of systems
• Smart, intelligent appliances
• Fault tolerance
• Follows safety, data protection and privacy
  rules
• High availability of service
• ? Worth the money is not the same as cheap

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The Aim
Medicine Everywhere!
Through Telehealth!
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The Key!!
Medicine Everywhere!
Interoperability International Structures
Through Telehealth!
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The Situation
Medicine Everywhere!
Through Telehealth!
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InternationalOrganizations Institutions

• WHO
• The recipiendary
• Major coordination role
• World wide (193 member states)
• eHealth Unit
• eHealth Resolution
• Global eHealth Observatory
• ITU
• Telecommunication issues
• Standardization role
• Cooperation with WHO
• EU
• European Commission Information Society and Media
  Directorate General Unit H-1 IST for Health
• Major impact through its Framework Programs

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But

• Only WHO is fully dedicated to health issues
• Other organizations deal with health issues
  amongst several other activities
• Therefore WHO has the ultimate coordinating
  responsibility

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InternationalSocieties Associations

• Telemedicine - Around Healthcare Professionals
• Informatics - Around IT Professionals
• Telecom - Around Telecommunication Professionals
• Management - Around Management Professionals
• Patients
• More cooperation and coordination is vital!

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International Body
International Society for Telemedicine and
eHealth (ISfTeH)
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ISfTeH

• developed from the question
• Is there a truly international body that promotes
  eHealth activities ?

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Mission Statement

• The ISfTeH exists to facilitate the
  international dissemination of knowledge and
  experience in Telemedicine and eHealth and to
  provide access to recognized experts in the field
  worldwide!

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International Structurefavoring Interoperability

• ISFTeH is a
• non governmental
• not-for-profit society
• It serves primarily as an
• umbrella association for national Telemedicine
  eHealth organisations
• ISfTeH is thereby
• geopolitically neutral
• democratic

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StructureUmbrella Organisation
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Philosophy

• Further activities of the ISfTeH include
• promotion and support of telemedicine and eHealth
  activities worldwide
• assisting the start-up of new national
  organisations
• supporting developing countries in the fields of
  telemedicine and eHealth.

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ISfTeH

• National members
• Austria, Bangladesh, Bosnia Herzegovina,
  Brazil, Canada, Croatia, Denmark, Finland,
  France, Georgia, Germany, India, Italy, Japan,
  Kosova, Malaysia, Nigeria, Poland, Russia,
  Switzerland, UK, Ukraine, Venezuela
• Associative members
• Brazil, Germany

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2007 ISfTeH Participation in Major
International Events

• ICDS 2007 - TELEMED 2007 Guadeloupe, French
  Caribbean (05.01. - 07.01.2007)
• eHEALTH ASIA 2007 Putrajaya, Malaysia (06.02. -
  08.02.2007)
• NICTe 2007 - Enugu, Nigeria (07.03. - 09.03.2007)
• Telehealth, Hannover, Germany
• 3rd International Conference Telemedicine
  Experience_at_ProspectsDonetsk, Ukraine (27.03. -
  29.03.2007)
• Med-e-Tel 2007 Luxembourg, G.D. of Luxembourg
  (18.04 - 20.04.2007)
• Cross-border eHealth in the Baltic Sea Region -
  Healthcare delivery for the patients
• of today and tomorrow - Stockholm, Sweden
  (21.05. - 22.05.2007)
• Telehealth 2007, The Third IASTED International
  Conference on Telehealth
• Montreal, Quebec, Canada (30.05 - 01.06.2007)
• TTeC 07 Tromsø, Norway (11.06. - 13.06.2007)
• Global Health Care Expansion Congress, Dubai,
  U.A.E., (04.12 - 05.12.2007)
• Telemedicine Society of India, 3rd National
  Conference,
• XII-th ISfTeH International Conference, Chennai,
  India (2-3.11.2007)
• and others to come

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Telehealth CONCLUSIONS
Raised Efficiency
Increased quality of care
Faster medical care
Medicine TRULY Everywhere!
Crossing Distances Without Borders
Reduced costs New sources
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Contact Details

• Registered Office
• ISfT - International Society for Telemedicine
• St. Urbangasse 2
• CH-8001 Zuerich
• Coordinating Office
• c/o Frank Lievens
• Waardbeekdreef, 1
• P.O.Box 12
• 1850 Grimbergen
• Belgium
• phone [phone]
• fax [phone]
• e-mail telemedicine_at_skynet.be
• www http//www.isft.net

Office Prof. Dr. med. Michael NerlichRegensburg
University Medical Center Department of Trauma
Surgery Franz-Josef-Strauss-Allee 1193053
Regensburg GermanyTel 49 (0)941
944-6805Fax [phone] Email michael.
nerlich_at_klinik.uni-r.de www http//www.ict-regen
sburg.de
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For further informationplease visit our
websites
ISfTeH www.isft.netICT www.ict-regensburg.de
Trauma Surgerywww-uch.uni-regensburg.de