Telemedicine Support in Medical Informatics

Faculty of Medicine Atma Jaya University, Jakarta, Indonesia, invited me to presenting Telemedicine Support in their Medical Informatics Seminar.
You can find the downloadable files on downloads section of my blog (Dani Iswara .Net).

Text transcript is available below.

Telemedicine Support – Presentation Transcript

1. Medical Informatics & Applications Telemedicine Supports
   Dani Iswara
   Health Management Information System
   Field Epidemiology Training Program
   Public Health Science
   Faculty of Medicine Gadjah Mada University
   Yogyakarta, Indonesia
   RIGHT Seminar, Jan 10, 2009, Med Fac-UAJ, Jakarta
2. Access Quality Cost-benefit Sustainability → Health outcomes
3. Telemedicine… [diagram]
   Mobile, Non/web-based, Cable, wireless, Data, Hospital, Clinic, Applications, Network, Private, Pharmacy, Ax, physical, lab exam, Tx, Push/pull, Telemedicine, A/synchronous, station → Not-so-new technology
4. What is Telemedicine?
   • Telemedicine (telemedisin = kedokteran jarak jauh)
   • Medical/clinical services
   • Long distance (geographics; regional, national, international)
   • Information & communication technology (ICT)
   • Telehealth (health care), telecare
5. What is Telemedicine offered?
   • Efficient
   • Effective
   • Interactive
   • Collaborative
   • Ubiquitous
6. What is Telemedicine for?
   • Types of telemedicine
   • Teleconsultation (Telephone, SMS, web, email, forum, blog)
     • Teleconference (videoconference)
   • Tele-education
   • Telemonitoring (chronical ds, drugs/labs, monitoring)
   • Teleradiology, telesurgery, telecardiology, telepathology, telepsychiatry, teledermatology
7. Telemedicine in Indonesia
   • SMS Gateway (ITB; 2006): Reporting & monitoring → disaster, TB, lepra
   • Dasar-dasar Implementasi Telemedicine (Johan Harlan; PSIK Univ. Gunadarma; 2007): Standard formats → txt, XML, MPEG, JPEG, pixel, ICD 10, HL7?
8. Telemedicine in Indonesia (2)
   • Since 2005: Videoconference equipments VoIP equipments Internet.
   • KepMenKes No. 857 Tahun 2007: Pengembangan Jaringan Komputer Online Sistem Informasi Kesehatan Nasional (Siknas Online).
9. Barriers of Telemedicine in developing countries
   • Cultural problems
     • Inapropriate ‘experts’
     • Regulations
     • Reimbursements
     • Human resources
     • Technologies
10. Cost Impacts of Telemedicine
    Chronic ds, outpatient, consultation, length of stay
11. Sample Position Statements of Telemedicine
    • Internet Prescribing

    • Store and forward providers should take care regarding direct prescribing for patients via electronic communications. Most states have regulations that discourage or prohibit practitioners from prescribing for patients that they have not seen face to face. In many cases, the wording of these regulations is such that a live and interactive consultation would meet the requirements for a “face to face exam”. Since most store and forward providers are working in collaboration with a provider at the point of care, this should not inhibit patient care. The dermatologist should take care to recommend as opposed to prescribe (American Academy of Dermatology [2004]).

12. Sample Statement on Telecomunication in Medicine
    • Physician-Patient Relationship

    • If a patient receives professional advice or treatment, even gratuitously, there is prima facie evidence that a physician-patient relationship exists (The American College of Obstetricians & Gynecologists [ACOG]).

13. Sample Guidelines for the Surgical Practice of Telemedicine
    • Telesurgery (Remote Surgery)

    • Appropriate Use: Demonstration and/or teaching technique or procedures…

      • using inanimate trainers as the objects of the procedure
      • using animate model for purposes of testing technology
      • on patients under strict guidance of an IRB and only when a qualified surgeon is present to intervene in a timely fashion if technical difficulties arise

      (Society of American Gastrointestinal and Endoscopic Surgeons [SAGES]; 2004).

14. Summary
    • Telemedicine is only a tool
    • Potentiality of telemedicine
    • Patient safety first
    • Guidelines & standards
    • Researches & evidences
15. Thank You…Q & A
    • You are free to share (copy, distribute, transmit) & adapt this work under the similar license Creative Commons Attribution­ Noncommercial­Share Alike 3.0 Unported (CCA­NC­SA 3.0 Unported)

    • Dani Iswara
      daniiswara at gmail dot com

      http://daniiswara.net/

      Last updated: January, 2009 15

Read also the Indonesian version and some discussion of the seminar on telemedisin (Dani Iswara .Net).

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