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

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 A&E 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 A&E staff of details of incoming cases

• http://www.rcsed.ac.uk/fellows/bcpaterson/chest_pain.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

Inte

gra

tion

of

ITIn

teg

rati

on

of

IT

IT as a gadgetTrojan horse: networks, …Full Integration of IT into Business (Organisational, Legal) Re-engineering of the system

19801980 19901990 20002000 Jean-Claude HealyJean-Claude HealyMay 2000May 2000

Manufacturing

Business Services(Banks)

Public Services(Health…)

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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

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