Telehealth, eHealth and mHealth Surahyo Sumarsono, B.Eng., M.Eng.Sc. Sistem Informasi Manajemen Kesehatan Fakultas Kedokteran Universitas Gadjah Mada surahyo.sumarsono@ugm.ac.id

The Taxonomy “In the history of telemedicine, various definitions have been published and numerous terminologies have been coined. The introduction of new technologies played an important role in the changing definitions. After four decades of experience in telemedicine and its variations, the need for a single taxonomy that is detailed enough to define all the terms introduced until today is evident…..” B. Tulu, S. Chatterjee, and S. Laxminarayan, 2005

Overlapping concept

Definitions eHealth (WHO 2005) Telehealth (various sources) “the use of information and communication technologies (ICT) for health. Examples include treating patients, conducting research, educating the health workforce, tracking diseases and monitoring public health” Telehealth (various sources) eHealth conducted by two or more points separated by distance mHealth (various sources) The integration of mobile technology, computing devices, and emerging delivery system capabilities into a patient-centered model of care.”

Telemedicine Subset of telehealth practiced by medical professionals “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status” (American Telemedicine Association) “the practice of medicine over a distance, in which interventions, diagnostics and treatment decisions and recommendations are based on data, including voice and images, documents and other information transmitted through telecommunication systems” (World Medical Association)

eHealth in Indonesia

Telemedicine Pilot Projects in Indonesia

Challenges in Indonesia the simultaneously high prevalence of both chronic degenerative and acute communicable diseases the limited number of and access to healthcare professionals further accompanied by the typical limitation in the telecommunication infrastructure

Telemedicine Level Adoption – HIMSS 2015

Telemedicine Roadmap in Indonesia

Pervasive Healthcare the application of pervasive computing technologies in healthcare to facilitate the delivery of healthcare service anywhere, anytime and to anyone include monitoring of bodily signals, their transfer through communication networks (wireless or cellular) and immediate healthcare response or advice received by the user The key enabling technology of pervasive healthcare is a network-connected sensor system: sophisticated dedicated sensors, such as wearable or environmental sensors simpler smartphone-based sensors even simpler smartphone-based applications accepting manual input from offline sensors

Categories of Pervasive Healthcare The wellness category focuses on providing the users with healthy lifestyle advice and encouragement to exercise while promoting the respective health benefits. The risk management and prevention category offers tailored health advice to an at-risk population based on routine monitoring of generic bodily signals, such as body weight, blood pressure, heart rate, temperature, etc. The chronic disease management applications cater to a specific patient category (e.g. hypertension, diabetes, asthma) and their clinical care providers by facilitating continuous monitoring of specific physiological indicators (e.g. blood pressure, blood glucose, electrocardiogram, heart pulse) as a part of the disease management.

Categories of Pervasive Healthcare The acute disease management category offers the clinical care provider with the possibility to monitor their patients during the relevant time course of the disease regardless of their location, assuring timely receipt of relevant information immediately after the onset of the disease. The assisted living category supports elderly and/or disabled people so that they can live safely and independently by transmitting user-activated and/or automated alert signals to the relevant healthcare professionals and family members should an emergency event occur

What is mHealth? There is not a consensus on what mHealth is. Questions to Consider: What kind of connection does it have to have? Broadband? Wifi? Wired Internet? What technology does it include? Cell phones? PDAs? Devices? Computers? What’s the application? Clinical Data? Community Health? Personal Health? What’s it part of? Telehealth? eHealth? http://vimeo.com/17125591

What is mHealth? All the definitions focus on mobile communications and healthcare. Broader definitions seem to be gaining more steam. “The integration of mobile technology, computing devices, and emerging delivery system capabilities into a patient-centered model of care.” – Indian Health Service US Department of Health and Human Services

mHealth Applications Management Promotion Surveillance Personal Population Public

Applications: Management Patient-centered personal health management. Patient or care-giver driven. Typically includes a device or smartphone application. PHR and EHR integration is possible. Particularly beneficial for conditions where continual tracking is warranted: Diabetes Asthma/COPD CHF Aging in Place Medication Adherence 21

Applications: Promotion Educational messages targeted at behavior modification. Third Party driven (public health depts, governments, insurance companies) Usually utilizes cell phone messaging because it’s quick, easy, and cheap. May be one way or two way messaging. Particularly beneficial for chronic. Smoking Cessation Sexual Health Pregnancy Depression 22

Applications: Surveillance Allows people to design forms for data collection on the internet. Data is entered into the forms using either a smart phone application or SMS messaging. Allows for real-time data uploads and analysis. Been used to evaluate: anti-malarial bednet distribution and vaccination campaigns in sub-Saharan Africa clean water initiatives in Vietnam drug supplies in several African countries health delivery systems in Guatemala "drastically cut costs while facilitating quality control and improving implementation speed.“ - The World Bank * 2011 World Bank Report: http://siteresources.worldbank.org/INTLAC/Resources/257803-1269390034020/EnBreve_166_Web.pdf

mHealth in General Current trends show that the utilization of mHealth will increase. Its applications are numerous and widely encompassing: Management: Connecting mHealth applications with traditional health IT systems will provide a groundbreaking continuum of personal care, particularly for those with chronic conditions, keeping them out of hospitals. Promotion: Wide scale education and behavior modification will improve the health of the public due to its ability to be anywhere the person is at anytime. Surveillance: Real-time health tracking and data aggregation leads to actionable information for preventing disease outbreaks and improving population health. Source: http://www.healthcareitnews.com/news/mhealth-apps-forecast-increase-threefold-2012-0

mHealth in Indonesia mHealth allows communication over a wide range of complexity : very simple communication such as exchanging information via SMS or email more advanced systems that enable access to personal medical data even the most advanced systems that use an embedded sensor in a smartphone to sense aspects of health or disease status

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