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Chapter 19 Telehealth and Communication

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Title: Chapter 19 Telehealth and Communication


1
Chapter 19Telehealth and Communication
  • Yung-Fu Chen
  • Department of Health Services Administration,
    China Medical University

2
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.

3
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

4
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

5
Case Study
6
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

7
Table 19.1 timeline of telehealth
8
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)

9
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

10
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

11
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.

12
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

13
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14
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

15
Figure 19.1 X-ray digitizer
16
Figure 19.2 High-quality videoconferencing studio
17
Information box- issues of bandwidth
18
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

19
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

20
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21
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

22
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

23
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
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