G8 Global Healthcare Applications SubProject 4 "International Concerted Action on Collaboration in T - PowerPoint PPT Presentation


PPT – G8 Global Healthcare Applications SubProject 4 "International Concerted Action on Collaboration in T PowerPoint presentation | free to download - id: 6cfbb-ZDc1Z


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

G8 Global Healthcare Applications SubProject 4 "International Concerted Action on Collaboration in T


USA: Jay H. SANDERS. Australia: S PREROST / I McDONALD ... Hosts: Drs Jay Sanders and Michael Ackerman Friends National Library of Medicine ... – PowerPoint PPT presentation

Number of Views:33
Avg rating:3.0/5.0
Slides: 43
Provided by: drandrl


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: G8 Global Healthcare Applications SubProject 4 "International Concerted Action on Collaboration in T

G-8 Global Healthcare Applications Sub-Project 4
"International Concerted Action on Collaboration
in Telemedicine"
  • André Lacroix, M.D.
  • Canadian representative and Project Chair
  • Telemedicine Unit, Research Centre, Hôtel-Dieu,
    Centre Hospitalier, Université de Montréal (CHUM)

Global Information Society
  • G-8 Governments wish to share more efficiently
    their expertises in selected areas including
  • Healthcare ranks very highly as a priority for
    individual citizens of all countries
  • Global telecommunications networks could
    contribute significantly towards
    achievement of a healthier world

G-8 Global Healthcare Applications Sub-Projects
  • SP-1 Towards a Global Public Health Network
  • SP-2 Improving Prevention, Early Detection,
    Diagnosis and Treatment of Cancer
  • SP-3 Improving Prevention, Early Detection,
    Diagnosis and Treatment of Major
    Cardio- vascular diseases
  • SP-4 International Concerted Action on
    Collaboration in Telemedicine 
  • SP-5 Enabling Mechanisms for a Global
    Healthcare Network

G-8 Global Healthcare Applications SP-4
National Representatives
  • Canada André LACROIX (Chair)
  • France Louis LARENG
  • Germany Dittmar PADEKEN / M. NERLICH
  • Italy Marcello BRACALE
  • Japan Yoshikazu OKADA / Yoich OGUSHI
  • Russia Oleg I. ORLOV
  • U.K. James Mc GEE / Richard WOOTTON
  • Australia S PREROST / I McDONALD

Objectives of G-8 GHAP Sub-Project 4 in
  • Enhance the collaboration between G-8 countries
    to resolve key issues which retard the
    application of the Global Society in Healthcare
    via telemedicine and health telematics
  • Initiate the establishement of an international
    multipoint network between
    Telemedicine Units in academic
    centers in G-8 countries

G-8 SP4 FORUMS in Telemedicine
  • FORUMS bringing together
  • Health care authorities
  • Key decision makers
  • Telemedicine experts and users
  • From G-8, EU-non G-8, and other countries
  • Meetings organized and chaired by
    the national representative of the host
    G-8 country with the help of the
    steering committee

G-8 SP4 FORUMS on Telemedicine
  • Each meeting focuses on one theme
    identified as a key issue
  • Interoperability in Telemedicine and Telehealth
  • Impacts of Telemedicine on health care
  • Evaluation of cost-effectiveness of telemedicine
  • Clinical and technical standards in telemedicine
  • Medico-legal aspects of national and
    international telemedicine

G-8 SP4 FORUM on Interoperability in Telemedicine
and Telehealth Montréal, May 28-30 1998
  • Host A. Lacroix
  • Participants
  • 91 canadians
  • 33 from 10 other countries
  • 39 presentations in plenary sessions
  • Working group sessions
  • technical aspects
  • organisational aspects
  • human factors
  • Report published by CANARIE

Interoperability in Telemedicine Measures that
enable secure, accurate and reliable sharing of
health information and services between
healthcare providers and citizens at any distance
Interoperability in
Telemedicine  On the surface, such issues
appear to be technical in nature, but in reality
the effectiveness of a technical regime is a
product of organisational structures.
Furthermore, both the technical solutions and the
organisational responses are highly influenced by
a multitude of human factors. In fact, many of
the issues in strengthening international
co-ordination and cooperation in telehealth
and telemedicine are tied to resolving legal and
professional matters.
Recommendations on standards, network
reliability, security and applications
  • Strongly recommend that telehealth applications
    and networks should adopt as many standards as
  • The basic standard for telehealth systems should
    follow recommendations of ISO working groups
  • Technical Quality of Service should define
    parameters of performance at a level that remain
    understandable to the clinical user
  • Telehealth systems should receive bandwidth on
    demand, as apprropriate for the application

Recommendations on standards, network
reliability, security and applications
  • Existing telehealth infrastructures need to be
    compatible and interoperable with digital dialup
    and/or TCP/IP protocols they should adopt
    evolving new technologies which are performant
    and least expensive
  • Encryption should be used in providing the
    highest possible security to data contained and
    transmitted through telehealth systems
  • There is a need to develop a process model for
    each healthcare/ medical discipline with
    technical needs defined in terms of Quality of
    Service, security and application

Organizational barriers to integrated services
  • Tension in the healthcare system resulting from
  • Credentialing of healthcare workers in
  • Pressure of cost containment in a period of
  • Finding appropriate formulae for reimbursement
  • Political will to make hard decisions and action
  • Lack of concerted efforts to effect changes
    within national and intra-regional contexts
  • Technology-induced pressures on means to ensure
    privacy, confidentiality and security of the
    systems .

Human factors in interoperability
  • Human factors in communication are not well
  • Language barriers
  • Cultural differences
  • Networks of confidence
  • Ethical/legal/social issues
  • Lack of utilisation by healthcare practitioners

Actions to improve human factors
  • Usability-design and useable systems
  • Training and education
  • Incentives to learn and use telemedicine systems
  • Sufficient means to evaluate key systems
  • Champions representing all levels of the
    healthcare system that can benefit from the use
    of telemedicine
  • Adequate access to technical expertise
    among the user community.

FORUM on Impact of Telemedicine on Health Care
Management, Regensburg, Germany, November 21-23
  • Host M. Nerliech
  • Participants
  • 280 participants
  • 69 from 16 countries other than Germany
  • Presentations
  • 83 oral presentations
  • 20 poster presentations
  • Joint participation of G8 GHAP sub-project 5 in
    plenary and working group sessions
  • Proceedings published by IOS Press, Amsterdam

Impact of Telemedicine on Health Care Management
Working group session
  • Many presentations illustrated positive impacts
    of telemedicine on healthcare management
  • Few evaluations of telemedicine have been
    conclusive because of difficulties in measuring
    outcomes should there be standard protocols by
    which outcomes measurements can be done?
  • It has not been possible to compare telemedicine
    against traditional forms of delivering health
    care because often there are no comparative
    processes or outcomes
    against which we can measure
  • Emphasis placed on access to care.

FORUM on Evaluation and cost-effectiveness of
telemedicine, Melbourne, Australia, February
19-20 1999
  • Hosts Ian Heath, Sandra Prerost and Ian
  • Participants
  • 54 participants
  • 22 Australians, 32 from 10 countries
  • Presentations
  • 21 oral presentations
  • Working group sessions
  • Joint meeting with European Comission Telematics
    Applications Program Teleplans

FORUM on Evaluation and cost-effectiveness of
  • The key questions addressed at the conference
  • Where are we now in terms of telemedicine
    evaluation and in particular to assess what are
    the projects that appear to be cost effective,
    focussing on
  • What is transferable and replicable to other
    telemedicine applications and
  • What are the underlying principles for
    telemedicine evaluation
  • What kinds of evaluation should be done
  • Why evaluate ?

FORUM on Evaluation and cost-effectiveness of
  • Evaluation is complex, difficult but not
  • Evaluation takes place in a dynamic and complex
    system. Traditional cost efficiency and
    effectiveness analysis for evaluation is not
    always workable
  • Rapid advances of IT make evaluations vulnerable
    to obsolescence as key hardware and software
  • Telehealth is not a single, homogenous technology
    but diverse
  • Evaluators in a particular site may have
    difficulty using evaluation methodologies from
    other groups

FORUM on Evaluation and cost-effectiveness of
  • The criteria of evaluation should be able to
  • Demonstrate that a telemedicine application was
    superior to other instruments to achieve the same
  • Demonstrate appropriateness of the application to
    the objective and the health service environment
  • Describe systemic interactions with other
    instruments, programs, policies and government
  • Enable measurment of efficacy that is a cost
    effective way to achieve objectives
  • Applicability and flexibility to incorporate
    effects or change

FORUM on Clinical and Technical Quality and
Standards of Telemedicine  Washington, USA,
April 29-30 1999
  • Hosts Drs Jay Sanders and Michael Ackerman
    Friends National Library of Medicine
  • Participants
  • 340 HII99 120 participants G8 FORUM
  • 9 countries
  • Presentations
  • National and international standards
  • Working group session
  • Jointly with HII99 Improving Health in a Digital
    World, April 26-28 1999

FORUM on Clinical and Technical Quality and
Standards of Telemedicine  Washington, USA,
April 29-30 1999
  • World Health Organization
  • U.S.National Library of Medicine
  • U.S.Department of Defense
  • American College of Radiology
  • Canadian Institute of Health Information
  • NASA
  • Food and Drug Administration (FDA), USA
  • Institute of Medicine, US National Academy
  • International Medical Informatics Association
  • US Department of Health and Human Services
  • Medical Records Institute
  • G8 countries academic centers

FORUM on Clinical and Technical Quality and
Standards of Telemedicine 
  • Technical Standards for Telemedicine and
  • It was apparent from this session that standards
    are not yet established for telehealth.
  • Different specialties and fields have different
    needs and that many defacto standards will
    arise as telemedicine systems are implemented.
  • Technical standards to unite technologies are
    necessary. Standardized image formats and
    compression, interoperable software and hardware
    as well as capture device technology and
    transmission technology will allow globality in
    telemedical care.

FORUM on Clinical and Technical Quality and
Standards of Telemedicine 
  • Technical Standards for Telemedicine and
  • Health practitioners need to determine what is
    needed to perform clinical services and provide
    an accurate diagnosis for patients, and/or
    provide adequate home and remote monitoring for
  • Standards are nonetheless only applicable if
    they are used in practice.
  • Joint work between industry and medical
    specialties is the way of the future in insuring
    interoperability and interconnectivity

FORUM on Clinical and Technical Quality and
Standards of Telemedicine 
  • Clinical Standards forTelemedicine/Telematics
  • Clinical standards for telemedicine do not
    currently exist, and there is no obvious path to
    develop them.
  • Professional bodies (Colleges of medicine,
    nursing, etc.) have a lead role to play in
    establishing the clinical requirements but it is
    not clear how to merge the technology standards
    discussions with the clinical standards
  • All standards or guidelines that evolve must be
    evidence based and must be supported through
    rigorous evaluation programs for existing
    telemedicine services.

FORUM on Clinical and Technical Quality and
Standards of Telemedicine 
  • Integration of Telemedicine and Health Care
  • There are a number of organizations, government
    and other, who are making progress on the broader
    issues related to standard for the application of
    information technology in health.
  • This effort, and those of others developing more
    specific telemedicine standards, must be
    considered and coordinated to create
    a global approach to standards

FORUM on Medico-legal aspects of national and
international applications   London, UK, November
28-29 1999
  • Hosts Prof James McGee and Richard Wootton
  • Participants
  • 102 participants G8 FORUM 180 Telemed 99
  • 11 countries
  • Presentations
  • 25 plenary speakers
  • Working group sessions
  • Jointly with Telemed 99 and The Royal Society of
    Medicine, November 30 and December 1 1999

G8 FORUM on Medico-legal aspects   Consensus
Session on Security, Privacy and
  • Develop country wide public key infrastructures
  • Creation and maintenace of certification
    authorities ?
  • Implementation of any system will be superior to
    current relative lack of protection
  • Primary issue of consent
  • Differences between public and private health
  • Technical solutions to privacy exist but will
    require policy directions and funding to implement

G8 FORUM on Medico-legal aspects   Medicolegal
  • A common theme was the current legal uncertainty
    surrounding telemedicine and the need for
    policy/guidelines/law to reduce this uncertainty
  • Key issues have been identified, but there was
    little agreement on the best policy solutions
  • Different jurisdictions have been deciding the
    policy issues differently
  • The lack of harmonization across jurisdictions
    (e.g., re licensure) could be a significant
    impediment to global telemedicine.

G8 FORUM on Medico-legal aspects  
  • As infrastructures for the use of PKI evolved,
    governments must ensure that there is an
    appropriate legal framework for its use in the
    healthcare sector and that dialogue takes place
    at an international level to ensure
    interoperability of its use between various
  • Patients must give fully informed consent for the
    use of their personal medical information for
    healthcare, evaluation or research, even if data
    is anonymous its use for commercial purposes
    should be restricted to informed and ethically
    approved uses. Professional and patients
    organizations should work together to promote
    better understanding of privacy and

G8 FORUM on Medico-legal aspects  
  • An international group of national
    representatives must develop ethical and
    medico-legal guidelines for the practice of
    telemedicine formal work conducted by various
    groups such as the Einbeck group should be
    considered as a starting model
  • The major barrier of healthcare professionals
    licensing should be resolved by deciding that the
    telemedicine activity is occurring at the site of
    the consultant the patient should
    agree that he will follow the
    legal rules at the site of the consultant,
    as is done currently when the patient
    travels physically to that

G-8 IMPACT Project (International Multipoint
Project of Advanced Communication in Telemedicine)
  • Develop an International backbone network between
    Telehealth Units in G-8 countries and Australia
  • Develop the technical protocols and agreements
    with academic and industrial partners
  • Test the feasability of multipoint meetings
    using diversified telehealth equipments
  • Initiate the project with selected pilot
    sites in each country
  • Eventual goal link the national networks
    within an international backbone

G-8 IMPACT Project Objectives of meetings
  • Test-bed for G8-SP-4 FORUM recommendations
  • Telelearning programs in diversified fields
  • Joint multidisciplinary and multimodality staff
    meetings of experts in various fields of clinical
    medicine and healthcare
  • Availability of teleconsultation in complex cases
    or during large scale public health emergency
  • Simultaneous interactive retransmission of
    prestigious state of the art lectures
  • Facilitate International collaborative researh
    studies in various biomedical fields

G-8 network
EU network
Progress on IMPACT project
  • February 1999 Japan-Canada network
  • Tokai University, Japan - Memorial University,
    NF-CHUM / Montreal University, Canada
  • Funding of Tokai Univ by Japan Ministry of Health
  • Telelearning in medical schools and joint staff
  • February 1999 USA, France, Germany, Canada
  • Yale Univ/MCV, EITS-CHU Strasbourg, Regensburg
    Univ, CHUM, Univ de Montréal, Oxford
  • Joint staff meetings in
  • endocrine and digestive surgery
  • breast cancer
  • orthopedics and trauma surgery

The future of G8 SP-4 after December 1999
  • The umbrella of G8 GHAP was very useful to
    attract interested participants to this project
  • Despite the absence of committed national
    funding, the G8 GHAP label was very helpful to
    attract funding from public or private sectors to
    realize the FORUMS and the IMPACT projects of
    GHAP SP-4
  • The most industrialized nations bare the
    responsibility to develop and test the
    technologies which have a potential to improve
    global health care including for emerging

The future of G8 SP-4 after December 1999
  • Active participation of experts from all G8
    countries including Russia, Australia and other
  • The fields of telemedicine and health telematics
    are emerging and complex their full integration
    in healthcare delivery will require years of
    concerted efforts
  • Conclusions and interim recommendations have
    emerged from our working group sessions and
    will be presented at the Berlin GHAP
    summary meeting in May 4-5 2000 and
    on our Web site http// www.g7sp4.org

GHAP G-8 SP-4 recommendations
  • The GHAP sub-project 4 participants wish to
    pursue their common efforts in international
  • Additional FORUMS are required to come to
    recommendations on the evaluation and
    implementation of medical, ethical, legal, and
    technical aspects of telemedicine services-
    including aspects of crossborder services.
  • G8 and other participating countries should
    provide sufficient funding to their national
    representatives, experts and expert centers to
    pursue their work and disseminate their
    conclusions and recommendations

GHAP G-8 SP-4 recommendations
  • The G8 SP-4 working group should collaborate with
    other international healthcare organizations such
    as the World Health Organization to facilitate
    the integration of health telematics to
    healthcare strategies worldwide
  • The G8 GHAP SP-4 should report annually
    on its progress and activities to its
    national health authorities and to
    citizens through its Web site.

G-7 Global Healthcare Applications sub-project
4 "International Concerted Action on
Collaboration in Telemedicine"
  • The dedicated participation of a large number of
    national experts is greatly appreciated

Bienvenue à ISfT/CST/Health 2000
  • Montréal, Canada, October 2-5, 2000
  • www.isft2000.com
About PowerShow.com