telemedicine broadband applications for healthcare

Telemedicine Overview - 20/04/23 - 2Confidential

TelemedicineBroadband Applications for Healthcare


Agenda

• Definition and History of Telemedicine• Telemedicine Applications• Case Studies• Challenges for Telemedicine• How Broadband Can Help• Summary


Telemedicine: What is it?

• Electronic access to CHIN database?• Video conferencing with a specialist?• Grand rounds/CME video conferencing

session?• Getting healthcare advice on the

alt.rec.med.quackery?• Just another overhyped term like virtual

reality, artificial intelligence, ...?


A Working Definition

• The use of telecommunications technology to facilitate interactions between geographically disparate people for the purpose of solving medically related problems


Telemedicine Communications

Telemedicine

Store and Forward Real Time

Clinical Admin/Educational

• lower equipment & telecommunications cost

• easier to use

• offers immediacy and clarity of communications

• greater interactivity & knowledge transfer


The Evolution of Telemedicine

Late 50’s Mid 70’s Early 90’s

First Telemedicine Trials

Large Number of Trials

Termination of all Trials

Emphasis on Sustainability

Rebirth of Telemedicine


Benefits of Telemedicine

• Economic• reduced costs• improved economic base for rural hospitals

and inner city clinics • earlier therapeutic intervention resulting in

reduced long term costs


Benefits of Telemedicine

• Social• equal access to healthcare services• reduced professional isolation for rural

healthcare providers• more uniform quality• enhanced continuity of care• efficient use of tertiary care services


Telemedicine Market

Rapid information transfer

14%

Compete in a managed-care environment

11%

Provide medical education

8%

Better physician collaboration

12%

More efficient use of staff resources

18%

Fill specialty access need

37%

0

50

100

150

200

250

300

350

400

1993 1994 1995 1996 1997

Est

imat

ed


Telemedicine Market

YES72%

NO28%

20.4%

21.3%

23.1%

39.8%

43.5%

46.3%

56.5%

44.4%

0% 10% 20% 30% 40% 50% 60%

Teleoncology

Telepathology

Home Healthcare

Emergency Medicine

Psychiatry

Teledermatology

Telecardiology

Teleradiology


Agenda



Telemedicine

Telepathology

Teleradiology

Telecardiology

Expert

ContinuingMedical Education

Telesurgery

Grand Rounds

Wide Area

Home Healthcare

Real-time Ultrasound


User Requirements

Premium qualitymultimedia conferencing

with high speed collaboration

tools

Digital andanalogmedical

instruments

Ease of use

Integration with existing HIS Security

Reliability

Accessibility

Low maintenanceHigh scaleability

Flexibility

MIS

Specialists

Primary CarePhysician


Clinical Requirements

• Majority of “telemedicine” in the past 5 years has simply been video conferencing applied to healthcare

• Move towards products specifically designed for clinical aspects of telemedicine• teleradiology• telepathology• teledermatology• telecardiology • regulatory standards• medical instruments


Telemedicine Peripherals

• Numerous medical devices are suitable or have been modified to work with telemedicine systems

• These devices are available from companies such as Welch Allyn, American Medical Development and Andries Tek


Technology Trends

• Shifting away from...• “simple” video conferencing, dedicated telemedicine

rooms, hub and spoke network design

• Moving toward...• standards based, open systems solutions• desktop telemedicine• new image compression technology• highly reliable and scaleable solutions• systems designed specifically for healthcare

professionals


Agenda



Profile of Early Adopters

• Teaching hospitals• Managed care

organizations• Correctional

facilities• US military• Urban, rural &

inner city applications


Telemedicine in Prisons

• Business drivers• risks (care providers & general population)• cost of transport • litigation

• Benefits• more timely delivery of healthcare services• reduced risk• reduced cost of transportation• reduction in litigation


Telemedicine in Managed Care

• Allina Health System, Minn.• Business drivers

• cost reduction• increased need for communications• competitive advantage/differentiator

• Reported results• 83% very satisfied with telemedicine consultation• expanded patient population• network growing, in third year of operation...


Case Study - Pediatric Care

T3

EmergencyRoom

(StarMED)

ConsultationRoom

(StarMED)

Lecture Hall(StarED)ISDN H.320

Radiology(future DICOM)

RBOC Services Platform

(future)

An additional 6 sites over the

next 2 years


Building a Successful Program

• People• needs assessment, training/development of

trust, access, champion

• Technology• needs assessment, multiple applications to

keep volume high, reliability

• Evaluation• clinical efficacy, impact on practice patterns,

cost


Agenda



Patient Acceptance

• There is strong consensus amongst most studies… patients love telemedicine!• convenience• flexibility• reduced travel for healthcare services• treatment by physicians they know and trust• financial impact


Physician Resistance

• Familiarity with the technology• Fears of predation/disruption of referral

patterns• Inconvenience• Concerns about liability• Inertia


Barriers to Widespread Use

• Reimbursement• Licensure & liability• Scheduling


Issue: Reimbursement

• The biggest single issue which is impeding the widespread use of telemedicine• HCFA• Blue Cross/Blue Shield

• Kansas, Georgia, ...

• Medicare/Medicaid• Managed Care • 1996 Telemedicine Development Act

(California SB 1165)


Issue: Licensure/Liability

• Jurisdiction• is the medicine being practiced where the

physician is, the patient is, or both?• most favorable legal environment might be

the place sought to litigate• these issues have the potential of

accelerating the application of national rather than local standards of care


Issue: SchedulingPhysician/Admin contacts Local SF requesting

consultation with possible dates & times

LSF contacts Hub SF to request consultation

HUB SF informs local SF ofpossible times

Facilities match?

Appropriate site to confirm with

consulting physician

If consulting physiciannot resident at Hub

schedule with site admin

LSF notifies localphysician’s office

of consultation timeand date

LSF contact Hub SF to reserve appointment time

LSF contacts Hub physicianto schedule consultation

Physician & facilities match?

Nurse needed during consultation No nurse scheduled

Local SF contacts physician/administratorfor other dates/times

LSF requests consulting physicianavailability info

LSF contacts local physician’soffice with available times

Time match?

Request facilities info

Facilities match?

Consultation scheduled

LSF confirm consultationwith consulting physician

LSF confirm consultationwith local physician

No

LSF schedules nursingservice once

appointment time is set

No

No

No


Agenda



Telemedicine Applications

Low (POTS) (home) (urban/rural) (urban/rural)

Medium (<T1/E1) High (> E1)

Diagnostic

Monitoring• Home Healthcare

•Teleconsultation

•Telediagnosis

• Telepathology• Teleradiology

• CME/Grand Rounds

• Telecardiology

•Telepsychiatry

•Teledermatology

•Telesurgery

Consultation

• Real-time Ultrasound

•Follow-up

Bandwidth

Use


Advantages of Broadband

ColorResolution

Motion


Advantages of Broadband

Modality Resolution Mb/Image Images/Exam Mb/Exam sent @28.8kb sent @T1sent @ 10

Mb/sEthernetsent at

OC3

X-ray/Chest 2kx2kx12 59 1-2 88.4 1 hr 19 min 1 min 28 sec 8.8 sec .6 sec

X-ray/Other 1kx1kx12 12.6 2-5 44 39 min 44 sec 4.4 sec .3 sec

CT 512x512x16 4.2 10-50 126 1 hr 53 min 2 min 6 sec 12.6 sec .8 sec

Fluoroscopy 512x512x10 2.6 5-10 20 18 min 20 sec 2 sec .1 sec

MR 256x256x8 0.5 10-50 16 14 min 16 sec 1.6 sec .1 sec

Ultrasound 512x512x8 2.1 10-50 63 56 min 1 min 3 sec 6.3 sec .4 sec

Nuclear Med 128x128x8 0.1 10-50 4 4 min 4 sec .4 sec .03 sec


ATM and Healthcare

T3/OC3

FDDI

Ethernet

T1/TDM

JPEG/MPEG2

Token Ring

PBX

ATM Switch


Agenda

• Definition and History of Telemedicine• Telemedicine Applications• Case Studies• Challenges for Telemedicine Solutions• How Broadband Can Help• Summary


Summary

• Starvision/Newbridge/Siemens have a comprehensive, end-to-end telemedicine solution• based on inexpensive, widely available hardware• designed to meet the clinical needs of a variety of medical

disciplines• simple to use, developed specifically for healthcare

professionals• medical standards compliant• integrates with existing hospital information systems• true multimedia... much more than just pointing cameras

at doctors• available today!

TheRight

Connectionfor

Healthcare


For More Information

• A Telemedicine Primer: Understanding the Issues• by Jim Reid

• TIE web site• http://tie.telemed.org

• Magazines and journals• Telemedicine Today• Telemedicine Journal• Telemedicine and Telehealth Networks


For More Information

• Conferences• American Telemedicine Association AGM

(Orlando, April)• Telemedicine 2000 (Chicago, June) • TeleCON/TeleMED (Anaheim, Nov.)

• Associations• American Telemedicine Association (ATA)• American Telemedicine Service Providers

Association (ATSP)

telemedicine broadband applications for healthcare

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