1. Telemedicine and E-health - ICT to make people better more quickly Dr Jim Briggs University of Portsmouth Talk given at the ICT Study Day 7th December 2004

2. 2 Contents Who am I and where do I work? Definitions Types of telemedicine Case studies E-health Unanswered questions

3. 3 Who am I? Dr Jim Briggs Principal Lecturer in Information Systems and Computer Applications Leader of the Healthcare Computing Group Director of the UK Telemedicine and E ‑ health Information Service (TEIS)

4. 4 Where do I work? University of Portsmouth Medium-sized university Mainly city-centre location Lots of new student accommodation Excellent social life Excellent study facilities By the sea 30 courses in the computing/IT field Computer Engineering Computer Science Software Engineering Information Systems Animation, Games, ET Mobile/wireless Website http://www.port.ac.uk

5. Telemedicine and E-health

6. 6 Definitions Telemedicine: medicine at a distance cf television, telephone, etc. E-health: health services delivered electronically cf E-commerce, E-learning, E-government, etc.

7. 7 Characteristics of tm systems Interaction style real-time (e.g. videoconferencing) store-and-forward (e.g. email) Data types text (e.g. patient's notes) image (e.g. x-ray) Equipment general purpose (e.g. PCs) specialist (e.g. electronic stethoscope) http://jhi.sagepub.com/cgi/content/abstract/7/3-4/222

8. 8 Case study 1: Cornwall MIUs

9. 9 Case study 1 cont. Minor Injury Units: replacing "unviable" accident & emergency departments nurse led deal with "straight-forward" problems Linked to central A&E department by video link to provide expert backup http://www.bthealth.com/casestdy/cstudy/case11.htm

10. 10 Case study 2: ambulance links

11. 11 Case study 2 cont. ECG, etc. links from ambulance to hospital Expert backup for paramedics Reducing "call to needle" time for rural heart attack patients Dundee study reduced average time from 125 to 52 minutes [Pedley et al; BMJ 2003] Also, advance warning to A&E staff of details of incoming cases http://www.rcsed.ac.uk/fellows/bcpaterson/chest_pain.htm

12. 12 Case study 3: dermatology

13. 13 Case study 3 cont. Overload on specialist dermatologists - long waiting lists for referrals tds Telemedicine Ltd. provides a commercial service specially trained nurses take digital photos specialist software routes to consultant dermatologists (anywhere in UK) for diagnosis consultant can work from home tds replaces local consultant but not totally http://www.tds-telemed.com/

14. 14 Case study 4: WorldCare

15. 15 Case study 4 cont. Consortium of 4 big American hospitals Provide "second opinion" service worldwide (20 countries) tele-radiology tele-pathology patient management consultation Local physician remains responsible http://www.worldcare.com/

16. 16 Case study 5: NHS Direct Biggest telemedicine project in the world Mainly telephone service Expanding to: web online diagnosis for common conditions health encyclopaedia my NHS healthspace (personal info portal): news, reminders, knowledge digital TV http://www.nhsdirect.nhs.uk/

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18. E-health - the future of health? Making health care more easily accessible to the patient

19. 19 The banking metaphor Most transactions carried out by the customer Centralisation of specialist services Decentralisation of non-specialist services

20. 20 Integration of IT into business sectors Integration of IT IT as a gadget Trojan horse: networks, … Full Integration of IT into Business (Organisational, Legal) Re-engineering of the system 198019902000 Jean-Claude Healy May 2000 Manufacturing Business Services (Banks) Public Services (Health…)

21. 21 Are hospitals a thing of the past?

22. 22 New sources of "health" 1

23. 23 New sources of "health" 2

24. 24 New sources of "health" 3

25. 25 e-health - Busan, S Korea Medical Tourism 2 hours by air for 2 billion people 1% with disposable income = 20 million Cardiac - Cancer - Mental Health Costs can be competitive Popular tourist resort for families

26. Some questions left unanswered

27. 27 Medico-legal/ethical issues Who is (legally) responsible for the patient's treatment? What country's laws apply? Can a correct diagnosis be made by telemedicine?

28. 28 Economics of telemedicine Communication is getting faster and cheaper Equipment is getting smaller (more mobile) and cheaper People costs are rising How do we adapt? Who pays?

29. 29 What makes tm a success? Why has telemedicine caught on in some disciplines and some places, but not in others?

30. 30 Which is the future of health? www.teis.nhs.uk