Consumer Health InformaticsCHI

The Distance Between the Consumer and the Healthcare System?

• Jeffery is an 18-year old high school senior, who is newly

diagnosed with Type I diabetes following an acute

hyperglycemic episode which required hospitalization. After

four days he is medically stable and ready for discharge. He

is able to measure his blood glucose and can safely

administer the appropriate dose of insulin. The nurse notes

that Jeffery sometimes has trouble calibrating the insulin

dose to the blood glucose reading. She also notes that his

father is short and impatient with Jeffery, expressing many

concerns that Jeffery “may not be able to handle such a

complex medical problem on his own”.

Telemedicine & Telehealth

They have the ability to bring professionals and

patients closer together

Telemedicine

• information is transferred through interactive

audiovisual media for the purpose of

consulting, and sometimes remote medical

procedures or examinations

Telehealth

• Delivery of health-related services and

information via telecommunication

technologies. It provides communication with

patients, order drug prescriptions and provide

other health services

• Both CHI and telehealth are ways to bridge the distance between patients and necessary health resources.

CHI

• Importance of the patient as a full participant in

health care.

• They participate by self-monitoring, by

evaluating and choosing therapeutic strategies

from a set of acceptable alternatives, by

implementing the therapies, and by evaluating

the effects.

Historical Perspectives

• Australian Royal Flying Doctor Service (RFDS),

founded in 1928 - telehealth consultations

• Morse Code, and later voice, radio

communications to the remote sheep stations

• Standardized medical chest - 1942.

• The chest contains diagnostic charts and

medications, identified only by number.

• 1948 when the first

transmission of a radiograph

over a phone line was reported.

• Video-based telehealth can be

traced to 1955

• 1964 mental health facility to

support education and

teleconsultation to remote

states.

• 1967 – microwave link

• 1971 – NASA satellites

• 1991 – Military Teleradiology using radio lines

• 1993 – Telehealth• 2000 – Internet – High bandwidth lines - high

resolution images, Video conferencing etc

Categorization:• synchronous (or real-time) and asynchronous

(or store-and-forward)

Health Information Resources

• Professional-developed CHI resources - healthcare clinicians and their organizations.

• Self help perspective - address daily living concerns and lifestyle issues

Consumer Health Networks and Health-Related Messaging:

• Networks provide patients with access to information;

• Opportunity for individuals to connect with other people who share similar concerns and with their healthcare providers.

• Network-based consumer health services include both specialty and public access networks.

• It provides both static information about health problems and management and specialized health-communications utilities.

• Text messaging is emerging as a popular mode of communication between patients and providers.

• The field of telemedicine and telehealth focused on video and largely ignored the audio-only telehealth.

• Telephone consultations are not reimbursed by most insurance carriers.

• Remote monitoring is a subset of telehealth focusing on the capture of clinically relevant data in the patients’ homes or other locations outside of conventional hospitals.

• It transmit the data to central locations for review.

• Remote monitoring focuses on management, rather than on diagnosis.

• The measurement of the parameter and the transmission of the data are typically separate events.

• The patient will log onto a server at the central site (either

over the Web or by direct dial-up) and then type in the

data.

• Alternately, the patient may connect the measurement

device to a personal computer or specialized modem and

transfer the readings electronically.

• A major advantage of direct electronic transfer is that it

eliminates problems stemming from manual entry,

including falsification, number preference and

transcription errors.

• Remote interpretation is a category of store-and-forward telehealth that involves the capture of images, or other data, at one site and transmission to another site for interpretation.

• This may include radiographs (teleradiology), photographs (teledermatology, teleophthalmology, telepathology), or wave forms, such as ECGs (telecardiology).

• Teleradiology is the largest category of remote interpretation, and probably the largest category of telehealth.

• Teleradiololgy and telepathology represent the most mature clinical domains in telehealth.

Video-based Telehealth - Videoconferencing• hire a full-time scheduler• requires a stable data stream,at least 128Kbs -

384Kbs• categories of synchronous video telehealth stand:

telepsychiatry, correctional telehealth and home telehealth

Telepsychiatry:• Diagnosis is based primarily on observing and talking

to the patient.

Correctional Telehealth:• Transporting prisoners to medical centers is an

expensive proposition.Home Telehealth - telehealth activities into

patients’ homes• telehome care - patients recently discharged

from the hospital- frequent video visits between nurses

• home telehealth centers - management of chronic diseases

- longer duration of care and less frequent interactions

• Telepresence - allow clinicians to not only view

remote situations, but also to act on them.

• telepresence application is telesurgery

• robotic surgical instruments

• high reliability connections

• conventional video telehealth system with a

remote controlled robot

Limitations

• Huge amount of data• Security• medical licensure - practitioners to hold a

full, unrestricted license