second-opinion advice: tools for tele-consultations (on/off-line - - PowerPoint PPT Presentation

Maria Zolfo

Tools and delivery options for second-opinion advice: tools for tele-consultations (on/off-line services)

History

• Smoke signals
• In early 1900s, in Australia two-way radios (bicycle

dynamo) to communicate with the Royal Flying Doctor Service of Australia

• To transmit basic clinical information: e.g. in 1948 X-ray

images were sent between New York and Pennsylvania through telephone lines (Viegas, 1998)

• Interactive video for telemedicine: 1964, use of a two-

way closed circuit television system - Nebraska Psychiatric Institute & Norfolk Hospital with the University of Nebraska (Wittson and Benschoter, 1972)

Definition

• There is no generally accepted definition of

telemedicine

• The literal meaning is ‘health at a distance’

Thus, telemedicine may represent health care practised in real time, using a video or asynchronously by email

• It can be used for: diagnosis, management,

education – of staff, patients and the general population – and for administrative meetings, …

• R. Wootton, RMS Press 2009

Types of telemedicine

• Real-time telemedicine, synchronous

(all parties being able to interact at once)

• Store-and-forward telemedicine,

asynchronous (information stored in some format = pre-recorded)

Types of telemedicine, cont

• The interaction between patient and physician

– Pre-recorded (store-and-forward): tele-radiology – Real time (synchronous): tele-psychiatry

• Type of information being transmitted

– Text, audio, still images, video pictures, sound

• Types of communication technology;

fixed lines (telephone, internet), mobile telephony, satellite, ...

• > ensure that we are talking about the same

Advantages of types of telemedicine

Store-and-forward Real-time

More convenient – no need for simultaneous meetings to be arranged Immediate result. Also the specialist can ask any missing information immediately Low-bandwidth interaction – cheaper telecommunications; cheaper equipment Meets consumer expectations – patients like the 3-way consultations Educational benefit Educational benefit

Wide range of services

• Clinical services (diagnostics, e.g. tele-

pathology, tele-surgery, ...)

• Expert consultations/ 2nd opinion (between

professionals)

• Tele-monitoring
• Communication/Interaction between different

levels in the health care system (also patients)

• Health information/ prevention
• Peer support

Data transfer

Soon-to-be mother and midwife Obstetrician

Transmitting ultrasound

Specialist Patient and assistant

Tele-

• phtalmology

Tele- dermatology

Specialist GP/nurse and patient

Monitoring blood glucose levels

• Child with type 1

diabetes and parent

• Sensor + mobile

telephone

• Automatic data transfer

SMS to parent Blood sugar data

Telemedisinsk avdeling

Camera that can send video images to other departments

• r hospitals

Virtual screen dumps Headset and microphone Electronic stethoscope that loads the result directly into the computer Personal digital assistant Small computer with wireless network access Nametag that can include an electronic ID that activates sensors in the patients room Wearable computer connected to the wireless network. Smaller versions can be sown into the clothing GPS (primarily for General practitioners)

Second opinion-advice, examples

• Partners Healthcare, Boston, USA
• iPath Association, Basel, Switzerland
• Swinfen Charitable Trust, UK
• Réseau Afrique Francophone de

Télémédecine (RAFT), Geneva, Switzerland

http://telemedicine.itg.be

Interactive sites, 2009

Faculty Cases/year

183 159 149 151 164 146 20 40 60 80 100 120 140 160 180 200 1st year (+SHCH) 2nd year 3rd year 4th year 5th year 6th year

Benefit

Forum

6 years

(n: 952 referrals)

Cases/questions distribution

10 20 30 40 50 60

2003-04 2004-05 2005-06 2006-07 2007-08 2008-09

HON code http://www.hon.ch/

• 1. Authoritative
• 2. Complementarity
• 3. Privacy
• 4. Attribution
• 5. Justifiability
• 6. Transparency
• 7. Financial disclosure
• 8. Advertising policy

How to organizing a telemedicine service?

7 key questions

• 1. What is the clinical problem to be solved?
• 2. What is the background?
• 3. What organizational changes will be required?
• 4. What is the right telemedicine technique to be

used (real time or prerecorded)?

• 5. Who will be responsible for training, support

and evaluation?

• 6. What is the minimum quality equipment

required?

• 7. What technology is required?

Principles for success

(according to Yellowlees PM, JTT 2005)

• Select applications and sites pragmatically
• Clinicians and users must own the system
• Follow proven-practice principles
• User-friendly technology
• Training and support
• Evaluation and sustainability
• Share the information

Why physicians fail to accept new information systems

(Treister NW, Phys Exec, 1988)

Why isn’t demand escalating?

• Free telemedicine service not valued?
• Cultural problem?
• Inappropriate experts?
• Referrers too busy?
• Perceived loss of control?
• Digital divide
• Computer literacy
• Intuitive/user friendly

interphase

Evaluation?

Outcome measures

• 1. User satisfaction (physicians, patients)
• 2. Medical outcome (morbidity, mortality)
• 3. Financial measures (cost benefit)

Users' satisfaction

(387 questionnaires, June 2006 and December 2008)

19% response rate (73/387)

37 43 36 271 non w ebsite users: answ ered non w ebsite users: not answ ered w ebsite users: answ ered w ebsite users: not ansew erd 43 + 37 users 271 + 36 non-users

Performance metrics in teleconsultation networks

Go on line and register to the discussion forum: http://telemedicine.itg.be

CME

Annual CME program certificate

Computer-based is sexy

Why CME?

CME, archive 2009

Ahhhh ... ANOTHER CME!!!!

Build CME modules to mimic real situations …

How to build a CME:

3 essential questions

• 1. Learning objectives (make the CME relevant to the

learner)

• 2. Help the learner understand how he will use the

information

• 3. Use a way for the learner to prove they understand it

Right people into your eLearning project …

• Project manager
• Content expert
• Instructional designer
• Graphic designer
• Flash programmer
• Courseware developer
• LMS expert
• IT support

CME, archive 2010

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Acknowledgements

The Telemedicine project is supported by the Belgian Directory General of Development Cooperation (DGDC)

Thank you!