1. IS 466 ADVANCED TOPICS IN INFORMATION SYSTEMS LECTURER : NOUF ALMUJALLY 14 – 11 – 2011 College Of Computer Science and Information, Information Systems Department

2. Telemedicine 2

3. What is Telemedicine Telemedicine may be defined as the use of computers and telecommunication technologies to provide medical information and services from distant locations It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities.

4. Why it is relevant to poor society Poor infrastructure Non-availability of experts Low doctor-patient ratio ( large population ) Lack of proper medical education

5. Major Challenges Poor Data Communication Infrastructure. A Large Population Catered by Government Hospitals. System Features should be scalable. Cost of the system should be scalable

6. Aim of the Telemedicine System Information management – Patient information – Medical data (signs, symptoms, test reports, etc..) – Appointment scheduling – Archival and retrieval of patient records Low cost solution – Using ordinary telephone line Service to large population – Through public health care delivery systems Development of knowledge-based system – For decision support – For training and education

7. Nodal Hospital Referral Hospital A patient getting treated A Doctor A remote telemedicine console having audio visual and data conferencing facilities An expert/ specialized doctor A central telemedicine server having audio visual and data conferencing facility POTS / ISDN Requirement Specification

8. PATIENT IN Patient visits OPD Local Doctor checks up Patient receives local treatment and not referred to telemedicine system Patient referred to the Telemedicine system (some special investigations may be suggested) Patient visits Telemedicine data-entry console. Operator entries patient record, data and images of test results, appointment date is fixed for online telemedicine session OUT Offline Data transfer from Nodal Centre Day One Sequence of Operation

9. Patient 1 Patient 2 Patient 3 Patient 4. Online conference for the patient. Patient, local doctors at the nodal hospital and specialist doctors at the referral hospital Patient queue IN OUT Day Two Sequence of Operation

10. Digital camera Referral Hospital Nodal Hospital PSTN/ISDN/VSAT link Scanner Printer Modem Microscope and other medical instruments Video Conference Telephone Hardware Configuration

11. Offline Activities Online Activities Software Modules

12. Data Acquisition Data Distributor Temp Files Local DB Data Encryption Data Sender Data Receiver Data Distributor Patient data Browser User Interface Data Decryption Master Database Temp Files D A T A Acknowledgement NODAL CENTREREFERRAL CENTRE Data Flow Diagram For Off line Communication Offline Module

13. Data Acquisition Online Session Coordinator and communicator Online Session Coordinator and communicator Local DB Online Session Coordinator and communicator Online Session Coordinator and communicator Master DB Secure Communication Channel NODAL CENTREREFERRAL CENTRE Data Flow Diagram For Online Communication Video Conferencing Online Module

14. The Data Data related to a patient’s personal information Data related to a patients medical information Data for patient management in Telemedicine Data related to the doctors Data for system management

15. Referral end A group of specialist doctors System Administrator Studio technician Referral end A group of specialist doctors System Administrator Studio technician Nodal end A group of general physicians System administrator Data entry operator Studio technician Patients Nodal end A group of general physicians System administrator Data entry operator Studio technician Patients Personnel Involved

16. Patient’s personal information Patient ID Name Age Address ……

17. Patient’s medical information Textual Plain Text Structured Document Image Graphics Video Vector

18. Plain Text

19. Structured Document

20. Images

21. Vector Data

22. Graphics

23. Video Clip

24. Data for patient management in Telemedicine

25. Data related to the doctors Doctor’s personal information Unique Identification key

26. Data for system management Users’ list Password file Log files

27. Types of telemedicine 27

28. Types of telemedicine 28 Telemedicine can be classified into three main types: store-and-forward remote monitoring interactive services

29. 1- Remote monitoring 29 This type is also called ‘self-monitoring/testing’ This type of telemedicine facilitates doctors to check a patient remotely using different technological equipments. This method is mainly used for handling chronic diseases or specific conditions like heart disease, diabetes mellitus, or asthma. These services can provide comparable health results to conventional in-person patient encounters, provide major level of satisfaction in patients, and can be economical also

30. 2- Interactive telemedicine services 30 This service real-time interactions between patient and doctor. This service includes phone conversations, online communication and home visits. Several activities such as history assessment, physical tests, and ophthalmology evaluation can be performed comparably to those done in traditional face-to-face treatments. Also, “clinician-interactive” telemedicine services may be cheaper than personal clinical visits.

31. 3- Store-and-forward telemedicine 31 This type involves obtaining medical information, such as medical images, bio-signals etc. and then conveying this information to a doctor or medical specialist at a suitable time for evaluation offline. This type of telemedicine does not require the presence of both parties together. An appropriately prearranged Medical Record, if possible, in electronic form should be a part of this transfer. A major difference between traditional in-person patient meetings and telemedicine is the exclusion of a regular physical assessment and history. In this store-and-forward process, the doctor depends on a history report and audio/video data for of a physical assessment.

32. What are the methods of Delivery? 32

33. What are the methods of Delivery? 33 Point-to-point connections using private networks are used by hospitals and clinics that transport services directly or out sourced specialty services to self-governing medical service providers at ambulatory care areas. Web-based e-health patient service sites offer direct consumer outreach and services over the Internet. These include those areas that offer direct patient care, under telemedicine.

34. What are the methods of Delivery? 34 Networked programs connect tertiary care hospitals and clinics with remote clinics and community health centers in rural or suburban areas. The connections may use high-speed lines or the Internet for telecommunication links between sites. It is determined that there are about 200 telemedicine networks in the United States involving close to 3,500 medical and healthcare institutions throughout the country

35. What are the methods of Delivery? 35 Primary or specialty care to the home connections involves connecting primary care providers, specialists and home health nurses with patients over single line phone-video systems for interactive clinical consultations.

36. What are the benefits of Telemedicine? 36

37. What are the benefits of Telemedicine? 37 Better Access Telemedicine has been used to transport healthcare services to patients in remote locations, for over 40 years. In addition to improving access to patients, telemedicine also permits physicians and health services to develop their reach, beyond their own offices. Economical Decreasing the cost of healthcare is one of the major reasons for funding and adopting telemedicine technologies. Telemedicine has been shown to decrease the cost of healthcare and increase efficiency through improved management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays or visits.

38. What are the benefits of Telemedicine? 38 Reduced stress level in patients Clients require telemedicine. The large impact of telemedicine is on the patient, their family and their group of people. With the usage of telemedicine technologies, the travel time and stress associated with it are reduced for the patient. Telemedicine improves support for patients and families. Patients can stay in their local communities and, when hospitalized away from home, can keep in contact with family and friends.

39. Questions ?? 39