Telemedicine Broadband Applications for Healthcare
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Transcript of Telemedicine Broadband Applications for Healthcare
Telemedicine Overview - 20/04/23 - 2Confidential
TelemedicineBroadband Applications for Healthcare
Telemedicine Overview - 20/04/23 - 3Confidential
Agenda
• Definition and History of Telemedicine• Telemedicine Applications• Case Studies• Challenges for Telemedicine• How Broadband Can Help• Summary
Telemedicine Overview - 20/04/23 - 4Confidential
Telemedicine: What is it?
• Electronic access to CHIN database?• Video conferencing with a specialist?• Grand rounds/CME video conferencing
session?• Getting healthcare advice on the
alt.rec.med.quackery?• Just another overhyped term like virtual
reality, artificial intelligence, ...?
Telemedicine Overview - 20/04/23 - 5Confidential
A Working Definition
• The use of telecommunications technology to facilitate interactions between geographically disparate people for the purpose of solving medically related problems
Telemedicine Overview - 20/04/23 - 6Confidential
Telemedicine Communications
Telemedicine
Store and Forward Real Time
Clinical Admin/Educational
• lower equipment & telecommunications cost
• easier to use
• offers immediacy and clarity of communications
• greater interactivity & knowledge transfer
Telemedicine Overview - 20/04/23 - 7Confidential
The Evolution of Telemedicine
Late 50’s Mid 70’s Early 90’s
First Telemedicine Trials
Large Number of Trials
Termination of all Trials
Emphasis on Sustainability
Rebirth of Telemedicine
Telemedicine Overview - 20/04/23 - 8Confidential
Benefits of Telemedicine
• Economic• reduced costs• improved economic base for rural hospitals
and inner city clinics • earlier therapeutic intervention resulting in
reduced long term costs
Telemedicine Overview - 20/04/23 - 9Confidential
Benefits of Telemedicine
• Social• equal access to healthcare services• reduced professional isolation for rural
healthcare providers• more uniform quality• enhanced continuity of care• efficient use of tertiary care services
Telemedicine Overview - 20/04/23 - 10Confidential
Telemedicine Market
Rapid information transfer
14%
Compete in a managed-care environment
11%
Provide medical education
8%
Better physician collaboration
12%
More efficient use of staff resources
18%
Fill specialty access need
37%
0
50
100
150
200
250
300
350
400
1993 1994 1995 1996 1997
Est
imat
ed
Telemedicine Overview - 20/04/23 - 11Confidential
Telemedicine Market
YES72%
NO28%
20.4%
21.3%
23.1%
39.8%
43.5%
46.3%
56.5%
44.4%
0% 10% 20% 30% 40% 50% 60%
Teleoncology
Telepathology
Home Healthcare
Emergency Medicine
Psychiatry
Teledermatology
Telecardiology
Teleradiology
Telemedicine Overview - 20/04/23 - 12Confidential
Agenda
• Definition and History of Telemedicine• Telemedicine Applications• Case Studies• Challenges for Telemedicine• How Broadband Can Help• Summary
Telemedicine Overview - 20/04/23 - 13Confidential
Telemedicine
Telepathology
Teleradiology
Telecardiology
Expert
ContinuingMedical Education
Telesurgery
Grand Rounds
Wide Area
Home Healthcare
Real-time Ultrasound
Telemedicine Overview - 20/04/23 - 14Confidential
User Requirements
Premium qualitymultimedia conferencing
with high speed collaboration
tools
Digital andanalogmedical
instruments
Ease of use
Integration with existing HIS Security
Reliability
Accessibility
Low maintenanceHigh scaleability
Flexibility
MIS
Specialists
Primary CarePhysician
Telemedicine Overview - 20/04/23 - 15Confidential
Clinical Requirements
• Majority of “telemedicine” in the past 5 years has simply been video conferencing applied to healthcare
• Move towards products specifically designed for clinical aspects of telemedicine• teleradiology• telepathology• teledermatology• telecardiology • regulatory standards• medical instruments
Telemedicine Overview - 20/04/23 - 16Confidential
Telemedicine Peripherals
• Numerous medical devices are suitable or have been modified to work with telemedicine systems
• These devices are available from companies such as Welch Allyn, American Medical Development and Andries Tek
Telemedicine Overview - 20/04/23 - 17Confidential
Technology Trends
• Shifting away from...• “simple” video conferencing, dedicated telemedicine
rooms, hub and spoke network design
• Moving toward...• standards based, open systems solutions• desktop telemedicine• new image compression technology• highly reliable and scaleable solutions• systems designed specifically for healthcare
professionals
Telemedicine Overview - 20/04/23 - 18Confidential
Agenda
• Definition and History of Telemedicine• Telemedicine Applications• Case Studies• Challenges for Telemedicine• How Broadband Can Help• Summary
Telemedicine Overview - 20/04/23 - 19Confidential
Profile of Early Adopters
• Teaching hospitals• Managed care
organizations• Correctional
facilities• US military• Urban, rural &
inner city applications
Telemedicine Overview - 20/04/23 - 20Confidential
Telemedicine in Prisons
• Business drivers• risks (care providers & general population)• cost of transport • litigation
• Benefits• more timely delivery of healthcare services• reduced risk• reduced cost of transportation• reduction in litigation
Telemedicine Overview - 20/04/23 - 21Confidential
Telemedicine in Managed Care
• Allina Health System, Minn.• Business drivers
• cost reduction• increased need for communications• competitive advantage/differentiator
• Reported results• 83% very satisfied with telemedicine consultation• expanded patient population• network growing, in third year of operation...
Telemedicine Overview - 20/04/23 - 22Confidential
Case Study - Pediatric Care
T3
EmergencyRoom
(StarMED)
ConsultationRoom
(StarMED)
Lecture Hall(StarED)ISDN H.320
Radiology(future DICOM)
RBOC Services Platform
(future)
An additional 6 sites over the
next 2 years
Telemedicine Overview - 20/04/23 - 23Confidential
Building a Successful Program
• People• needs assessment, training/development of
trust, access, champion
• Technology• needs assessment, multiple applications to
keep volume high, reliability
• Evaluation• clinical efficacy, impact on practice patterns,
cost
Telemedicine Overview - 20/04/23 - 24Confidential
Agenda
• Definition and History of Telemedicine• Telemedicine Applications• Case Studies• Challenges for Telemedicine• How Broadband Can Help• Summary
Telemedicine Overview - 20/04/23 - 25Confidential
Patient Acceptance
• There is strong consensus amongst most studies… patients love telemedicine!• convenience• flexibility• reduced travel for healthcare services• treatment by physicians they know and trust• financial impact
Telemedicine Overview - 20/04/23 - 26Confidential
Physician Resistance
• Familiarity with the technology• Fears of predation/disruption of referral
patterns• Inconvenience• Concerns about liability• Inertia
Telemedicine Overview - 20/04/23 - 27Confidential
Barriers to Widespread Use
• Reimbursement• Licensure & liability• Scheduling
Telemedicine Overview - 20/04/23 - 28Confidential
Issue: Reimbursement
• The biggest single issue which is impeding the widespread use of telemedicine• HCFA• Blue Cross/Blue Shield
• Kansas, Georgia, ...
• Medicare/Medicaid• Managed Care • 1996 Telemedicine Development Act
(California SB 1165)
Telemedicine Overview - 20/04/23 - 29Confidential
Issue: Licensure/Liability
• Jurisdiction• is the medicine being practiced where the
physician is, the patient is, or both?• most favorable legal environment might be
the place sought to litigate• these issues have the potential of
accelerating the application of national rather than local standards of care
Telemedicine Overview - 20/04/23 - 30Confidential
Issue: SchedulingPhysician/Admin contacts Local SF requesting
consultation with possible dates & times
LSF contacts Hub SF to request consultation
HUB SF informs local SF ofpossible times
Facilities match?
Appropriate site to confirm with
consulting physician
If consulting physiciannot resident at Hub
schedule with site admin
LSF notifies localphysician’s office
of consultation timeand date
LSF contact Hub SF to reserve appointment time
LSF contacts Hub physicianto schedule consultation
Physician & facilities match?
Nurse needed during consultation No nurse scheduled
Local SF contacts physician/administratorfor other dates/times
LSF requests consulting physicianavailability info
LSF contacts local physician’soffice with available times
Time match?
Request facilities info
Facilities match?
Consultation scheduled
LSF confirm consultationwith consulting physician
LSF confirm consultationwith local physician
No
LSF schedules nursingservice once
appointment time is set
No
No
No
Telemedicine Overview - 20/04/23 - 31Confidential
Agenda
• Definition and History of Telemedicine• Telemedicine Applications• Case Studies• Challenges for Telemedicine• How Broadband Can Help• Summary
Telemedicine Overview - 20/04/23 - 32Confidential
Telemedicine Applications
Low (POTS) (home) (urban/rural) (urban/rural)
Medium (<T1/E1) High (> E1)
Diagnostic
Monitoring• Home Healthcare
•Teleconsultation
•Telediagnosis
• Telepathology• Teleradiology
• CME/Grand Rounds
• Telecardiology
•Telepsychiatry
•Teledermatology
•Telesurgery
Consultation
• Real-time Ultrasound
•Follow-up
Bandwidth
Use
Telemedicine Overview - 20/04/23 - 33Confidential
Advantages of Broadband
ColorResolution
Motion
Telemedicine Overview - 20/04/23 - 34Confidential
Advantages of Broadband
Modality Resolution Mb/Image Images/Exam Mb/Exam sent @28.8kb sent @T1sent @ 10
Mb/sEthernetsent at
OC3
X-ray/Chest 2kx2kx12 59 1-2 88.4 1 hr 19 min 1 min 28 sec 8.8 sec .6 sec
X-ray/Other 1kx1kx12 12.6 2-5 44 39 min 44 sec 4.4 sec .3 sec
CT 512x512x16 4.2 10-50 126 1 hr 53 min 2 min 6 sec 12.6 sec .8 sec
Fluoroscopy 512x512x10 2.6 5-10 20 18 min 20 sec 2 sec .1 sec
MR 256x256x8 0.5 10-50 16 14 min 16 sec 1.6 sec .1 sec
Ultrasound 512x512x8 2.1 10-50 63 56 min 1 min 3 sec 6.3 sec .4 sec
Nuclear Med 128x128x8 0.1 10-50 4 4 min 4 sec .4 sec .03 sec
Telemedicine Overview - 20/04/23 - 35Confidential
ATM and Healthcare
T3/OC3
FDDI
Ethernet
T1/TDM
JPEG/MPEG2
Token Ring
PBX
ATM Switch
Telemedicine Overview - 20/04/23 - 36Confidential
Agenda
• Definition and History of Telemedicine• Telemedicine Applications• Case Studies• Challenges for Telemedicine Solutions• How Broadband Can Help• Summary
Telemedicine Overview - 20/04/23 - 37Confidential
Summary
• Starvision/Newbridge/Siemens have a comprehensive, end-to-end telemedicine solution• based on inexpensive, widely available hardware• designed to meet the clinical needs of a variety of medical
disciplines• simple to use, developed specifically for healthcare
professionals• medical standards compliant• integrates with existing hospital information systems• true multimedia... much more than just pointing cameras
at doctors• available today!
TheRight
Connectionfor
Healthcare
Telemedicine Overview - 20/04/23 - 39Confidential
For More Information
• A Telemedicine Primer: Understanding the Issues• by Jim Reid
• TIE web site• http://tie.telemed.org
• Magazines and journals• Telemedicine Today• Telemedicine Journal• Telemedicine and Telehealth Networks
Telemedicine Overview - 20/04/23 - 40Confidential
For More Information
• Conferences• American Telemedicine Association AGM
(Orlando, April)• Telemedicine 2000 (Chicago, June) • TeleCON/TeleMED (Anaheim, Nov.)
• Associations• American Telemedicine Association (ATA)• American Telemedicine Service Providers
Association (ATSP)