Medical Informatics & Applications

Telemedicine SupportsTelemedicine Supports

Dani IswaraHealth Management Information System

Field Epidemiology Training ProgramPublic Health Science

Faculty of Medicine Gadjah Mada UniversityYogyakarta, Indonesia

RIGHT Seminar, Jan 10, 2009, Med Fac-UAJ, Jakarta

AccessAccess QualityQuality Cost-benefitCost-benefit

→ → Health outcomesHealth outcomes

SustainabilitySustainability

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Telemedicine...Telemedicine...

TelemedicineTelemedicinestationstation

NetworkDataData

Application

→ Not-so-new technology

Ax, physical,lab exam, Tx

Non/web-based

A/synchronous

Push/pull

Cable, wireless

Mobile

Hospital,Clinic,Private,Pharmacy

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What is Telemedicine?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

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What is Telemedicine offered?What is Telemedicine offered?

● Efficient● Effective● Interactive● Collaborative● Ubiquitous

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What is Telemedicine for?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

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Telemedicine in IndonesiaTelemedicine 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?

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Telemedicine in Indonesia (2)Telemedicine in Indonesia (2)

Since 2005:

Videoconference equipments

VoIP equipments

Internet

KepMenKes No. 857 Tahun 2007Pengembangan Jaringan Komputer Online

Sistem Informasi Kesehatan Nasional(Siknas Online)

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Barriers of TelemedicineBarriers of Telemedicinedeveloping countriesdeveloping countries

Cultural problems

Inapropriate 'experts'

Regulations

Human resources

Technologies

Reimbursements

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Cost Impacts of TelemedicineCost Impacts of Telemedicine

● Chronic ds● Outpatient

consultation● Length of stay

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SampleSample

Position Statements of TelemedicinePosition 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)

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SampleSample

Statement on TelecomunicationStatement on Telecomunicationin Medicinein 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)

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SampleSample

Guidelines for the Surgical Practice Guidelines for the Surgical Practice of Telemedicineof 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 Gastrointestinaland Endoscopic Surgeons (SAGES); 2004

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SummarySummary

Telemedicine is only a tool

Potentiality of telemedicine

Patient safety first

Guidelines & standards

Researches & evidences

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Thank You...Q & AThank You...Q & A

You are free to share (copy, distribute, transmit) & adapt this work under the similar license Creative Commons Attribution­Noncommercial­Share Alike 3.0 Unported

(CCA­NC­SA 3.0 Unported)

Dani Iswara

daniiswara@gmail.com

http://daniiswara.net/

Last updated: January, 2009