Techminar: Telemedicine in the future

08 Juli 2021
dr. Tjahaya Purnama
Founder-CEO PeriksaDulu.com
 History of Health Information
Technology in the U.S.
History of Telemedicine

This material (Comp 5 Unit 13) was developed by the University of Alabama at Birmingham, funded by the
Department of Health and Human Services, Office of the National Coordinator for Health Information
Technology under Award Number 90WT0007.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org.
 History of Telemedicine
Learning Objectives
• Define telemedicine
• Describe the differences between telemedicine
and telehealth
• Discuss key developments in the history of
telemedicine
• Identify and describe at least two current
applications of telemedicine

3
 Telemedicine Definitions

• “ the use of medical information exchanged

from one site to another via electronic
communications to improve a patient's health.”
• “ at a minimum, audio and video equipment
permitting two-way, real time interactive
communication.”

Source: (CMS, 2009)

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 Telemedicine Definitions 2

• “Telehealth is the use of electronic information

and telecommunications technologies.”
• “ to support long-distance clinical health care,
patient and professional health-related
education, public health and health
administration.”

Source: (HRSA, 2010)

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 Telemedicine Definitions 3

• Concept of time- and place-independent care

(Joseph Kvedar MD, Harvard Medical School)

Source: (Kvedar, 2010)

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 Telemedicine or Telehealth?

• Telemedicine is the practice of medicine via the

electronic exchange of medical information
– Typically using two-way voice and/or visual
communication by telephone, satellite or computer
– Connects patients to physicians and specialists when
in-person visits are not possible
• Telemedicine has become important for people living in
rural, urban and other underserved areas
– For access to primary and specialized clinical care
– Also for patients to get treatment while remaining in
their homes
Source: (UnitedHealth et.al., 2009)
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 Telemedicine or Telehealth? 2

• Telehealth is the broader term used to describe

both the clinical and non-clinical services these
technologies can provide to advance healthcare
• The term telehealth includes the facilitation of
services
– Remote medical education
– Research
– Health care administration

Source: (UnitedHealth et.al., 2009)

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 History of Telemedicine:
Early 20th Century
• Performing medical
examinations and
evaluations through
telecommunications is as
old as the telephone
• Method for transmitting his
newly-discovered
electrocardiogram

Einthoven in 1906
9
Source: (Wikimedia Commons)
 History of Telemedicine:
Early 20th Century 2
• Hugo Gernsback –
radio technology
enthusiast & publisher
• It is remarkably
similar to today’s
technologies
– Two-way video
– Electronic stethoscope
– Remote pulse monitor
– Facsimile printer for
printing prescriptions (MagazineArt.org/Artist:Howard V. Browne)
10
 History of Telemedicine:
Mid 20th Century 3
• Nebraska Psychiatric
Institute
• First to use closed
circuit television and
radio-transmitted
records for treating
psychiatric patients

Closed Circuit TV System in 1955

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Source: (Nebraska Psychiatric Institute)
 History of Telemedicine:
Mid 20th Century 4
• Massachusetts
General Hospital
• Provided medical
care to over 1000
patients 2.7 miles
away at the Logan
International Airport
Medical Station

Medical Closed Circuit TV System in 1968

12
Source: (Massachusetts General Hospital)
 Telemedicine History Continues

• Interactive television projects were the

telemedicine focus circa 1970
• Television pilot projects operated in many
locations from 1970 to 1975

13
 Telemedicine History Continues 2

• Interest waned between 1975 and1990

– 127 Medline citations 1975-1982
– 71 Medline citations 1982-1990
– 44% decline

14
 Telemedicine History Continues 3

• Interest re-energized with personal computing

around 1990 and the decade following
• Many projects using personal computers and
custom software during this time

15
 Telemedicine History Continues 4

• From 2000 on, significant expansion occurred in

telemedicine due to:
– Availability of lower-cost, higher performing
imaging devices
– Widespread acceptance of Internet for
transmission of information

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 Telemedicine Report to
Congress 1997
• Inventory of federal projects
• Evaluation guidelines
• Safety and standards issues reviewed, payment
policies suggested
• No clear conclusions
• No specific recommendations

17
 Telemedicine Report to
Congress (Updated in 2001)
• Deeper analysis of issues and policy needs
• Identified Issues
– Lack of reimbursement
– Legal issues
– Safety and standards
– Privacy and confidentiality
– Telecommunications infrastructure
• Laid out definite plans for US government
entities to synergize efforts for progress in these
areas
• Results have been mixed 18
 Current Major Applications

• Tele-ICU and home monitoring

– Uses transmission of biomeasurements for
medical decisions
– Allows improved services and better care
management

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 Current Major Applications 2

• Teleradiology, telepathology, and

teledermatology
– Uses transmission of digital images for
diagnostics
– Allows improved services and better specialty
access

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 Current Major Applications 3

• Tele-stroke, virtual visits, remote care, pre-

surgical assessment and follow up
– Uses live video and examination cameras for
medical visits
– Allows improved access and patient
convenience

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 Likely Future Developments

• Continued healthcare system performance

pressures plus patient service expectations will
further the integration of telemedicine into
medical care
• Continued development of device and
telecommunications technologies will improve
– Cost
– Performance
– Safety

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 History of Telemedicine
Summary
• Define telemedicine
• Developments in the history of telemedicine
• Current status of telemedicine

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 History of Telemedicine
References
References
Kvedar J. Emotional automation: bonding with technology to improve health. The cHealth Blog
[Internet]. Boston: Center for Connected Health. 2010 Oct 26. Available from:
chealthblog.connected-health.org
Telehealth [Internet]. US Health Resources and Services Administration, Rural Health. US Department
of Health and Human Services [accessed 2010 March 15]. Available from: www.hrsa.gov)
US Department of Commerce; US Department of Health and Human Services. Telemedicine report to
Congress. 1997 Jan 31; Available from: www.ntia.doc.gov
2001 Telemedicine Report to Congress. US Department of Health and Human Services. Health
Resources and Services Administration. Office for the Advancement of Telehealth. 2001. Available
from: www.hrsa.gov
UnitedHealth Group, Cisco and Project HOPE Joint Briefing Event -- Washington, DC. 2009 July
15. [cited 2010 May 10]. Available from: www.connectedcareamerica.com)
US Centers for Medicare and Medicaid Services – CMS (2009) [cited 2010]. Available from:
www.cms.gov
 History of Telemedicine
References 2
Images
Slide 8: Einthoven Available from: commons.wikimedia.org
Slide 9: Front Cover of Radio News, Available from: www.magazineart.org MagazineArt.org/Artist:
Howard V. Browne
Slide 10: Nurse with closed-circuit TV, Photo courtesy of UNMC Archives, Special Collections
Department, McGoogan Library of Medicine, University of Nebraska Medical Center. Source
Name: Nebraska Psychiatric Institute
Slide 11: Man at console Source Name: Dr. Joseph Kvedar at Partner's Connected Health/
Massachusetts General Hospital
 History of Health IT in the US
History of Telemedicine

This material was developed by the

University of Alabama at Birmingham,
funded by the Department of Health and
Human Services, Office of the National
Coordinator for Health Information
Technology under Award Number
90WT0007.
29
 Technology in Medicine

• Computers in health care

• Medical information systems
• Administrative applications
Office management systems
• Clinical and special purpose systems
 Other Applications

• Computer-assisted surgery

• Prosthetics

• Pharmacy
 Computer-assisted surgery

• Computer-assisting surgical planning

• Robotics
• Minimally invasive surgery
– endoscopic surgery
– laparoscopic surgery
 Prosthetic Devices

• Myoelectric limbs
• Microprocessors
• Computer technology for vision and
hearing
 The Computerized Pharmacy

• Computers and drug errors

• The automated community pharmacy
• Hospital pharmacy robot and bar-
codes
• Point-of-use drug dispensing
Radiology and Digital Imaging

• X-rays
• Traditional vs. digital x-ray
• Mammography
• Ultrasound
• Digital imaging
• Computerized tomography
• Magnetic resonance imaging
• Positron emission tomography
 Bloodless surgery

• Interventional radiology
• Stereotactic radiosurgery
• Focused ultrasound surgery
 Telemedicine

• Definition: “The use of computers, the

Internet, and other communication
technologies to provide medical care to
patients at a distance.”
• Forms:
– Voice
– Data
– Still images
– Motion picture
 Telemedicine

• Includes:

– Diagnoses
– Patient monitoring
– Treatments
 Telemedicine

• Telehealth:

– Larger field that includes health-

related education
– public health research
– health services administration
 Telemedicine

• Advantages:
– Brings high quality medical care to
anyone regardless of distance
– Decreases patient wait time
– Decreases patient travel time
 Telemedicine

• Teleradiology: Oldest form of telemedicine using

computers and telecommunications .
• Interactive video conferencing: Conferencing
that allows medical professionals and patients to
consult in real-time, using telephones and video
screens.
 Telemedicine

• Telepathology: Transmission of microscopic

images over telecommunications lines allowing
the pathologist to view images on a monitor
instead of under a microscope.
• Telepsychiatry: Uses teleconferencing to deliver
psychotherapy. May not be suitable for some
types of mental illness.
 Telemedicine

• Remote monitoring devices

– Telespironmetry-
o used for asthma patients
o information transmitted over telephone lines to
remote location
– Arrhythmia monitoring
o ECG telemetry that monitors a patient’s cardiac
status and sends it to a remote location
 Effectiveness of Telemedicine

• Examining a patient at a distance is not the

same as examining that patient face to face
• In prisons, telemedicine has led to decreased
costs and improved health care for inmates
 Effectiveness of Telemedicine

• Medical assistants at the remote sites may be

useful
• Distance and transmission rates create
questions
• Small hospitals and clinics may find hardware
costs prohibitive
• Research studies generally favorable for
medical and cost effectiveness
 Use of Telemedicine (Federal)

• Health care to the elderly (homebound)

• Connect rural primary care physicians to
urban specialists
• Allow families of high-risk newborns to watch
babies’ hospital care from home
• Data can be transmitted from ambulance to
ER
• Patients with chronic illnesses can receive
medication reminders at home
 Issues in Telemedicine

• Technical issues
– appropriate telecommunications
infrastructure must be in place
– not available in some rural and
urban areas
– requires high bandwidth (cable
modem)
 Issues in Telemedicine

• Insurance issues
– insurance may not cover all telemedicine
• Legal issues
– State licensing laws differ in each state
– liability is not clear
• Privacy issues
– electronic medical record subject to misuse
(more accessible and subject to abuse)
– HIPPA (Health Insurance Portability and
Accountability Act of 1996)
 Take Home Messages

• Teknologi tidak akan dapat berjalan sendiri

tanpa campur tangan manusia sedikit apa pun
• Manusia tetap sebagai core processor
• Semakin canggih teknologi yang dibangun maka
akan mendekati ketidaksempurnaan,
Mitos/Fakta?
• Sistem dibangun untuk mempermudah atau
mempersulit?
• Teratur atau tersulitkan? Butuh adaptasi.
• Semua yang baik perlu pengorbanan (Waktu,
Pikiran, Biaya) Mitos/Fakta? 49
Data vs Instincts

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Terima Kasih atas perhatiannya!
Thankyou for your attention

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