eHealth Today 2 The 7th Asia Telemedicine Symposium, 2013 1 - - PDF document

Frank Lievens, ISfTeH The 7th Asia Telemedicine Symposium, 2013 1

Towards eHealth Implementation: What? Where? How Much?

• F. Lievens1,2, M. Jordanova3,4

1Board Member, Secretary and Treasurer of International Society for Telemedicine & eHealth

(ISfTeH), Switzerland

2Director, Med‐e‐Tel, Belgium, lievens@skynet.be 3Space Research & Technology Institute, Bulgarian Academy of Sciences, Bulgaria 4Education Program Coordinator, Med‐e‐Tel, mjordan@bas.bg

eHealth Today

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Frank Lievens, ISfTeH The 7th Asia Telemedicine Symposium, 2013 2

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eHealth Is Already an Integral Part of Public Health

COCIR Telemedicine Toolkit, Supporting Effective Deployment of Telehealth and Mobile Health, May 2011

From eHealth to Personal Well‐ being

Fisk MJ. The Emerging Evidence for …www.medetel.lu/download/2010/parallel_ sessions/presentation/day2/The_Emerging_ Evidence.pdf

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eHealth Promises Prove to be True

• Quick, timely high quality affordable healthcare for all, everywhere,

at any time

• Overcoming shortage of healthcare staff and funding
• Optimization of patient care
• Optimization of the work of medical staff
• Enhancing preventive care
• Protecting human rights
• Educating and thus empowering citizens
• …
• In 2005, the World Health Assembly recognized eHealth as the way to

achieve cost‐effective and secure use

• f

information and communication technologies (ICT) for health and related fields, and urged its Member States to consider drawing up long‐term strategic plans for developing and implementing eHealth services and infrastructure in their health sectors

The fulfillment of these promises requires an approach at global level

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Digital Health Statistics and Trends as per 2012

• How Physicians Utilize Digital Media
• Physicians spend an average of 11 hours
• nline for professional purposes per

week

• Two‐thirds of physicians use online video

to learn and keep up to date with clinical information …

• Nearly half of Consumers say they

would buy mobile health tech to

• Monitor fitness & wellbeing ‐ 20%
• Allow a physician to remotely monitor a

condition ‐ 18%

• Allow a physician to remotely continue to

monitor a previous condition ‐ 11% …

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Source: e‐Health Reporter Latin America, http://www.ehealthreporter.com

Data based on Manhattan Research: Taking the Pulse US 2012 and Rock Health Business Models in Digital Health Consumer & Enterprise, 2012

What?

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Frank Lievens, ISfTeH The 7th Asia Telemedicine Symposium, 2013 4

eHealth ‐ Changing the 3 Main Aspects of Healthcare

• Prevention
• Treatment of diseases
• Facilitating healthy lifestyle &

educating citizens

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Pallavicini et al. BiofeedBack, Virtual Reality and Mobile Phones in the Treatment of Generalized Anxiety Disorder, Med‐e‐Tel 2010 Gudu et al. Challenges in the Implementation …, Med‐e‐Tel 2012

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Nowadays eHealth is everywhere, influencing the Entire Healthcare System! It is able to provide healthcare everywhere and reach those that are in need on land, at sea or in the air

Solutions for remote areas, Russia Reaching under‐served and isolated areas, Brazil Web and SMS‐servers for safe motherhood program and in‐house training of personnel ‐ Philippines, Pakistan, Indonesia Virtual education Supporting wound care VR and treatment of phobias Telerehabilitation of articulation disorders of children

All illustrations are from Med‐e‐Tel, www.medetel.eu

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eHealth Mobile Clinics Reach Those in Need

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Mobile Telemedical Unit (UNICAT GmbH, Germany) intended for emergence

• situations. The Unit is mounted on the

Mercedes‐Benz, high‐speed satellite system, the mobile x‐ray …, 2 beds for hard injured, http://www.unicat.com ISRO's Ophthalmologic Mobile clinic (India) connected with

• phthalmologic

clinic Sankara Nethralaya, www.isro.org Media Lab Asia (India), telemedicine van urgent help, focus: tuberculosis, a diabetes, pre‐natal complications, www.medialabasia.in Mexican Mobile Clinic (Mexico) – stomatology, motherhood, screening …, http://www.mobileclinicsinternational.com/ TANA Telemedicine unit (Russia) ‐ emergency, tuberculosis, malaria, prophylactic examinations … www.tana.ru

Where?

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eHealth Applications Everywhere

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• Algeria
• Telemonitoring of patients with chronic digestive diseases
• Angola
• Training on Telecardiology
• Promoting telehealth
• Egypt
• Intelligent technologies for medical knowledge engineering
• Kenya
• Anti Retroviral Treatment (ART) Provision
• Diagnostic and Treatment Expert System for Hypertension in

Pregnancy

• Nigeria
• Continuous Medical Education
• Telenursing
• mHealth
• Tanzania
• Open source platform for medical records system

Gaspar et al., Pilot Telehealth Project Brazil‐Angola …, Med‐e‐Tel 2013 Zerroug M., Sari Z., Telemonitoring of Patients…, Med‐e‐Tel 2009 Gudu et al. Challenges in the Implementation …, Med‐e‐Tel 2012 Nwuke et al. Effectiveness of mHealth Services…, Med‐e‐Tel 2013 Routen T. Android/OpenMRS, Med‐e‐Tel 2011

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• Afghanistan
• From emergency care to protection of pregnancy & mental health
• Bangladesh
• SMS for motherhood support
• Bhutan
• Health Help Center
• China
• Telemedicine from A to Z ‐ from scientific research and development of systems to manufacturing of

equipment – diagnosis, second opinion, education, etc. SUNPA is serving >500 hospitals

• Wireless hospitals, synchronous Teleconsultation
• …
• India
• >500 Telemedicine units in suburban and rural India
• Mobile eHealth Program
• National Telemedicine Advisory Council
• National Institute of Medical Informatics & Telemedicine
• …

New Zealand (97%) and Australia (95%) – world leaders in application of EPRs

Mishra S. Current Scenario & Future Trends of Indian Telemedicine, Med‐e‐Tel 2013

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• Israel
• Homecare systems
• Chronic care & rehabilitation
• Mobile health systems
• Wireless personal alarm systems
• Tele‐consultation
• Japan
• Various eHealth apps – from speech

rehabilitation to mHealth & maternal care

• Pakistan and Philippines
• Online TB diagnosis
• Report of pregnancy by SMS
• Support of healthcare professionals in rural and

remote areas

• Singapore
• Started the implement of National Electronic

Health Record with $176 million

Hosokawa A. Cost‐Benefit Analysis on Tele‐ Speech‐Language Therapy, Med‐e‐Tel 2011 Ogata Y., Hara K. The Medical ICT Utilization to Perinatal Telemedicine in Remote Areas, Med‐e‐Tel 2013

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• Austria
• From Telemonitoring and homecare to mobile Tele‐

workplaces for radiologist and emergency medicine

• Czech Republic
• EPRs for dental care & cancer screening
• Finland
• Mobile control of diabetes, hypertension ,etc.
• Education
• Germany
• Chronic disease management
• Virtual clinics, emergency care …
• Russia
• From mobile hospitals (trains) and Tele‐nursing to

Tele‐education, homecare and portable telemedicine systems for emergency situations

• …

Cecil S., Bammer M., Schmid G. Measurement

• f Blood Glucose by Near Field Communication

(NFC), Med‐e‐Tel 2013 Elsner et al. Determination of Relevant First Aiders within a Volunteer Notification System, Med‐e‐Tel 2013 Selkov A., Selkova E. Telemedical Consultation Center as a Tool for Promoting Innovative Health Care in Remote Regions of Russia, Med‐e‐Tel 2012

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• Argentina
• Mobile health & eLearning
• Ecuador
• Mobile surgery
• Brazil
• eHealth for the Amazon Region ‐ assisting

urban and Indian populations with skin and mouth lesion complaints in the region of Jiparana City, Rondonia

• Enhancing Education and Training via 3D

Modeling and Computer Graphics Animation

• Tele‐psychiatry
• Peru
• m‐Learning
• USA
• Tele‐pediatrics ‐ children make up 27% of

all emergency departments visits, but only 6% of EDs in the US have all of the necessary supplies for pediatric emergencies

• Tele‐nursing ‐ Trend > 600% increase 5

years in USA

• Smart Home Labs
• Tele‐trauma & Telesurgery …

Resmini et al. Telepsychiatry: A New Tool for Re‐ modeling Mental Health Assistance in South Brazil , Med‐e‐Tel 2009 Alkmim et al. 1,000,000 Electrocardiograms by Distance …, Med‐e‐Tel 2013 Aboutanos et al. Inexpensive Telemedicine Applications and Trauma System Development in Latin America: Ecuador's Experience, Med‐e‐Tel 2007 Murrugarra et al. e-Learning: Education in the Prevention in AIDS/ITS in the Andean Region and Caribeean, Med‐e‐Tel 2010

How Much?

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FAQ:

Is it possible a priori to evaluate the cost effect of eHealth implementation?

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The Answer – eHealth Economics

• Assesses the costs benefits of an eHealth initiative over time

and for several stakeholders, including citizens, patients, carers, health professionals and other health workers, healthcare provider organization’s and payers

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• The cost (C) for transferring the patient and the distance (D) is

C = a.D, where “a” represents transportation cost per kilometer

• Savings (S) have to be calculated as

S = .С = .a.D where “” is the eHealth activity efficiency or this is the percentage of avoided referrals caused by the use of eHealth in relation to the total number of referrals

• In order an eHealth activity (X) to be economically efficient its cost has to be at

least equal to the saving (S) or Х = .a.D

• Based on this simple equation, the minimum distance for cost effectiveness has to

be Dmin = Х / .a

• Or, if the referral distance for a specific city/medical practice/municipality, is

>Dmin the implementation of eHealth distant consultation system will result in savings for that particular city/medical practice/municipality

Preliminary Evaluation of Cost Effect

(after Figueira et al., 2012)

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eHealth implementation is successful and highly beneficial for citizens if it:

• Is based on knowledge, confidence and credibility
• Meets the needs of the community
• Respects

local traditions, culture, business development, avoids copy‐cat‐approach, etc.

• Uses the already developed healthcare system

Never forget “Wisdom lies neither in fixity nor in change, but in the dialectic between the two”

Octavio Paz (1914‐1968)

In Sum:

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from Others

• Learning from others is one of the best ways to grow
• There is always something new to learn and someone

there to learn from!

• Especially important is for developing countries not to

underestimate the exchange knowledge, expertise and ideas between themselves, as their goals, problems and resources are similar

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The way forward is networking and partnership in order to make the benefits of science, information and technology,availableto all A major international forum helps bringing experts and stakeholders together

Source: http://tequilabattle.com/wp‐content/uploads/2013/01/316416_10150341224833805_1402871151_n.jpg

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www.isfteh.org

ISfTeH is THE International Federation of national associations who represent their country’s Telemedicine and eHealth stakeholders

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Mission Statement

“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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Main Activities

• Promoting & Supporting Telemedicine/eHealth activities around the

globe

• Incubating & Assisting the start‐up of new national organizations
• Networking & Scientific Platform
• Annual International Events
• Supporting member countries in the field of Telemedicine/eHealth
• Strategy & Policies
• Regulations & Standards
• Business Model & Reimbursement
• Education & Training
• …

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Worldwide Membership (82 countries – November 2013)

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International Relations

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Communication Tools

• Website www.isfteh.org
• Discussion Forum (on the website)
• ISfTeH Newsletter (quarterly)
• ISfTeH e‐Journal
• National eHealth Strategies
• Australia
• Ghana
• Kenya
• Rwanda
• Scotland
• South Africa
• Sweden

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• Education and e‐Journal
• eHealth Economics
• Medical‐ and Bio‐Informatics
• Open Source
• Students
• Junior Doctors
• Chronic Disease Management
• Tele‐Nursing
• Tele‐Odontology
• Tele‐Ophtalmology
• Women and eHealth – WoW
• Good Practice Models
• e‐Portuguese
• e‐Hispanic

Dental cross

ISfTeH Working Groups

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Annual Event: Med‐e‐Tel

The International Educational and Networking Forum for eHealth, Telemedicine and Health ICT, www.medetel.eu

Med‐e‐Tel 2014: Abstract submission deadline – December 22, 2013!

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Knowledge Resource Center

Download for free! >3700 abstracts, papers and PPT

Per year Per country Per topic Evidence based

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• ISfTeH has proved that networking and collaboration are essential!
• Knowledge
• f

what is globally going

• n

in the field

• f

Telemedicine/eHealth supports professionals in:

• Building up a common level of understanding and knowledge
• Influencing local policy where the role of Telemedicine/eHealth in

the Health care sector is concerned

• Building public awareness about Telemedicine/eHealth and its

potentials

• Having constructive and meaningful dialogues and building

multi‐stakeholder consensus on principles, policies, and strategies related to effective, technologically appropriate and culturally sensitive eHealth implementation

Sometimes, it is just as important to know where to go for available information as to receive the exact information itself

Do not miss

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• There is no way back!
• The future of eHealth does not evolve between two parallel lines.

It evolves between two permanently enlarging axes, meaning that, as we speak, the scope becomes broader and the potential increases day by day.

• Let’s hope that eHealth will grow in such a controlled way that, maybe

within the 10‐20‐50 years, there will be no more need to talk about it, as it will have melted entirely in the common practice of medicine and health policies!

• But never forget: it is all about the Patient/Citizen!

Past Present and Future

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Thank You!