Telemedicine and E-health - ICT to make people better more quickly

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Telemedicine and E-health -ICT to make people
better more quickly

• Dr Jim BriggsUniversity of Portsmouth
• Talk given at the ICT Study Day7th December 2004

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Contents

• Who am I and where do I work?
• Definitions
• Types of telemedicine
• Case studies
• E-health
• Unanswered questions

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Who am I?

• Dr Jim Briggs
• Principal Lecturer in Information Systems and
  Computer Applications
• Leader of the Healthcare Computing Group
• Director of the UK Telemedicine and E-health
  Information Service (TEIS)

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Where do I work?

• University of Portsmouth
• Medium-sized university
• Mainly city-centre location
• Lots of new student accommodation
• Excellent social life
• Excellent study facilities
• By the sea

• 30 courses in the computing/IT field
• Computer Engineering
• Computer Science
• Software Engineering
• Information Systems
• Animation, Games, ET
• Mobile/wireless
• Website
• http//www.port.ac.uk

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Telemedicine and E-health
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Definitions

• Telemedicine
• medicine at a distance
• cf television, telephone, etc.

• E-health
• health services delivered electronically
• cf E-commerce, E-learning, E-government, etc.

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Characteristics of tm systems

• Interaction style
• real-time (e.g. videoconferencing)
• store-and-forward (e.g. email)
• Data types
• text (e.g. patient's notes)
• image (e.g. x-ray)
• Equipment
• general purpose (e.g. PCs)
• specialist (e.g. electronic stethoscope)
• http//jhi.sagepub.com/cgi/content/abstract/7/3-4/
  222

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Case study 1 Cornwall MIUs
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Case study 1 cont.

• Minor Injury Units
• replacing "unviable" accident emergency
  departments
• nurse led
• deal with "straight-forward" problems
• Linked to central AE department by video link to
  provide expert backup
• http//www.bthealth.com/casestdy/cstudy/case11.htm

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Case study 2 ambulance links
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Case study 2 cont.

• ECG, etc. links from ambulance to hospital
• Expert backup for paramedics
• Reducing "call to needle" time for rural heart
  attack patients
• Dundee study reduced average time from 125 to 52
  minutes Pedley et al BMJ 2003
• Also, advance warning to AE staff of details of
  incoming cases
• http//www.rcsed.ac.uk/fellows/bcpaterson/chest_pa
  in.htm

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Case study 3 dermatology
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Case study 3 cont.

• Overload on specialist dermatologists - long
  waiting lists for referrals
• tds Telemedicine Ltd. provides a commercial
  service
• specially trained nurses take digital photos
• specialist software routes to consultant
  dermatologists (anywhere in UK) for diagnosis
• consultant can work from home
• tds replaces local consultant but not totally
• http//www.tds-telemed.com/

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Case study 4 WorldCare
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Case study 4 cont.

• Consortium of 4 big American hospitals
• Provide "second opinion" service worldwide (20
  countries)
• tele-radiology
• tele-pathology
• patient management consultation
• Local physician remains responsible
• http//www.worldcare.com/

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Case study 5 NHS Direct

• Biggest telemedicine project in the world
• Mainly telephone service
• Expanding to
• web
• online diagnosis for common conditions
• health encyclopaedia
• my NHS healthspace (personal info portal) news,
  reminders, knowledge
• digital TV
• http//www.nhsdirect.nhs.uk/

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E-health - the future of health?

• Making health care more easily accessible to the
  patient

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The banking metaphor

• Most transactions carried out by the customer
• Centralisation of specialist services
• Decentralisation of non-specialist services

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Integration of IT into business sectors
Public Services(Health)
Business Services(Banks)
Integration of IT
Manufacturing
1980
1990
2000
Jean-Claude Healy May 2000
IT as a gadget Trojan horse networks, Full
Integration of IT into Business (Organisational,
Legal) Re-engineering of the system
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Are hospitals a thing of the past?
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New sources of "health" 1
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New sources of "health" 2
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New sources of "health" 3
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e-health - Busan, S Korea

• Medical Tourism
• 2 hours by air for 2 billion people
• 1 with disposable income 20 million
• Cardiac - Cancer - Mental Health
• Costs can be competitive
• Popular tourist resort for families

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Some questions left unanswered
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Medico-legal/ethical issues

• Who is (legally) responsible for the patient's
  treatment?
• What country's laws apply?
• Can a correct diagnosis be made by telemedicine?

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Economics of telemedicine

• Communication is getting faster and cheaper
• Equipment is getting smaller (more mobile) and
  cheaper
• People costs are rising
• How do we adapt?
• Who pays?

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What makes tm a success?

• Why has telemedicine caught on in some
  disciplines and some places, but not in others?

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Which is the future of health?
www.teis.nhs.uk