The following slides are the original lectures.

Only notes were

added and they’re mostly additional information.
431 team notes are in purple color and this year’s notes are in
green color.

For any mistakes contact informatics team leader

Dana Aldubaib
dsd.993@gmail.com

Notes provided by: Danah Aldubaib

 From the note space below
eHealth is also written “e-health”
“is defined as the use of emerging interactive technologies (e.g., Internet, CD-
ROMs, personal digital assistants, interactive television and voice response
systems, computer kiosks, and mobile computing) to enable health improvement
and health care services”

Telehealth
Offered by
Suliman Alomran, RHIA
 Objectives
• Define Telehealth and Telemedicine
• History of Telehealth
• Identify Driving Forces of Telehealth
• List the Advantages of Telehealth
• Identify equipment and technology to sustain
telehealth
• Identify several telehealth applications
 It is Already There!
• Telehealth is projected to reach 1.8 million
patients worldwide by 2017
• In 2012, 308,000 patients remotely monitored for
• Congestive heart failure (CHF),
• Chronic obstructive pulmonary disease (COPD),
• Diabetes
• hypertension and mental health conditions worldwide

http://www.healthcareitnews.com/news/telehealth-growth-mode-worldwide
 Define Telehealth and Telemedicine
• Telehealth defined:
“The delivery of health-related services and information via
telecommunications technologies”
• Could be: (nonclinical services)
• Two healthcare professionals discussing a case over
the phone for example, a dr. at KKUH can talk with another dr. -same
specialty- in another hospital or another city (it is not between patient and dr.)

• Using videoconferencing between providers at

facilities in two countries
From the note space below
Telehealth Provision of information to healthcare providers and consumers and the
delivery of services to clients at remote sites through the use of telecommunication
and computer technology.
Telehealth Generic term used for designation of fields including telemedicine,
telerehabilitation.
Telenuring Practice Guidelines https://www.crnns.ca/documents/Telenursing2014.pdf
 Define Telehealth and Telemedicine

• Telehealth can promote:

• Patient-provider communication
• Patient self-management with provider feedback
example: Patient at home -like the picture-
connected to BP measuring device. It will evaluate
any abnormality and give feedback to the dr
responsible so he could then communicate with the
patient using telehealth.
• Health literacy Search for diagnosis and educate patients
• Provider-provider consultants
Telenuring Practice Guidelines https://www.crnns.ca/documents/Telenursing2014.pdf
 Telehealth System Overview
• Transmits data (Vital Sign) from home to a
healthcare professional by use of ICT.

http://www.ecnmag.com/articles/2011/03/wireless-technologies-build-momentum-telehealth-systems
Top Telehealth Tools for Patients
Top telehealth tool: email.

http://www.hin.com/chartoftheweek/patient_telehealth_tools_printable.html
 Define Telehealth and Telemedicine
From the note space below
Telemedicine is an older and a narrower term, connoting communication between two
persons. Telemedicine is often associated with video-conferencing between patients and
providers.

• Telemedicine defined: between patient and provider

“the use of electronic information and communication
technologies to provide and support health care when
distance separates the participants ”

• Combination of:
• Telecommunications Technology

• Medicine (clinical services)

Telehelath does not directly include patient

Telenuring Practice Guidelines https://www.crnns.ca/documents/Telenursing2014.pdf

 Types of telemedicine interaction
• Real-time (for Emergency use) eg: stroke , trauma
• Parties communicate simultaneously via a
telecommunication network, also called synchronous or
interactive
• Store and forward (Non- Emergency use)
• Involves non-interactive transmission of information
from on site to another.
• Sometimes referred to as asynchronous or pre-recorded
and involves information being captured and then
transmitted to the other party for advice, opinion or
specialist consultation
• Hybrid Method
 Categories of Telemedicine
• Patient Monitoring (Home care)
• Blood pressure monitors
• Interactive Applications
• Teleconsulting, Videoconferencing
• Store and forward applications
• Medical images, lab results
Telehealth: videoconference can be between dr. and dr. for
education or counseling –not always related to a patient-
 Hub Site
Remote
Site

communication

T-1
 From the note space below
Telesurgery: the ability for a
doctor to perform surgery
Telemedicine on a patient even though
• Telesurgery they are not physically in the
• Telepsychiatry same location
• Telecare Telecare: The use of
telecommunication systems
to provide remote
assistance in therapy to
patients (Mantas & Hasman, 2002)

Tele-health

Tele- E-Health/
healthcare Education

(Winters, 2002)
 Telehealth vs. Telemedicine

From the note space below

Telehealth is different from telemedicine because it refers to a broader scope of remote
healthcare services than telemedicine. While telemedicine refers specifically to remote clinical
services, telehealth can refer to remote non-clinical services, such as provider training,
administrative meetings, and continuing medical education, in addition to clinical services.
(Winters, 2002)
 History of Telehealth

(Wittson, Affleck, and Johnson)

 Not important

Period Telegraph Telephone application

1835 Telegraph Used in the American Civil War to deliver

casualty lists and order supplies. Later used to
transmit x-ray images.
1876 Telephone Initially used for voice communicaion. About 30
years later, used to transmit ECGs and EEGs.
1895 Radio Used to supply medical advice to seafarer. In
1920 the Seaman’s Church Institute of New
York provided medical care using radio. The
CIRM in Rome has been using radio to provide
Late Video/ A two-way closed circuit television link was set
1960s up between the Nebraska Psychiatric Institute in
television
Omaha and the state mental hospital in Norfolk
for educational purposes.
1990s Videoconfer Videoconferencing for health purposes became
encing more common
Mid- Internet Use of the internet for health purpose
1990s
 Participants in the telehealth
interaction
• The nature of the communication in health can be
• Patient with practitioner  telemedicine
• Practitioner with Practitioner (Teleradiology)
• Patient with patient (that is, mutual support)  telehealth
with no doctors involved
• Practitioner or patient accessing educational material (that is,
source of health information) )  telehealth
 Participants in the telehealth
interaction
• The nature of the communication in health can be
• Patient with practitioner  telemedicine example
• Telepsychiatry is a common telehealth application usually
performed by videoconferencing
• An evaluation of Telepsychiatry services in Alberta, Canada,
showed that it was acceptable to users and there were
significant cost savings from avoided travel by
psychiatrists and patients

Chapter 19 Telehealth and Communication

http://www.powershow.com/view/12d046NWMxM/Chapter_19_Telehealth_and_Communication_powerpoint_ppt_presentation
 Participants in the telehealth
interaction
• The nature of the communication in health can be
 telehealth example
• Patient with patient (that is, mutual support)
• Support groups : communication between people who
have similar conditions,
• A study of the use of audio conferencing by breast cancer
patients in rural Newfoundland showed that it provided
valuable mutual support, despite the distances.

Chapter 19 Telehealth and Communication

http://www.powershow.com/view/12d046NWMxM/Chapter_19_Telehealth_and_Communication_powerpoint_ppt_presentation
Driving Forces of Telehealth
Quality

Driving forces
Healthcare Big city better access smaller ar
ea don’t have better access

Cost Access
 Low risk patients
will be recognized
by telehealth  Is “At the Point of Care” Too Late?
better prognosis

Health care
Health Status spending

Early
Healthy / At Risk High Risk Clinical
Low Risk Sympto
ms

20% of people
generate
80% of costs
Application will prevent
them from reaching
- Early detection of at-risk patients symptoms phase: social
media like, twitter for
- Provide personalized evidence to enable pro-active decisions low risk and high risk
patients
 Driving Forces of Telehealth
• Quality of Care
• Provide diagnostics. If we apply telehealth in schools, we can observe
students’ conditions and monitor the kids, intervene and diagnose
early.
• New mode of treatment
• Improve patient satisfaction
(early treatment, higher frequency of encounter. Telemedicine reduces
frequency of patient coming to the hospital in Riyadh. For example, if the patient is living
outside of Riyadh (like in Tabouk) , doctor can provide him/her with BP machine.
Feedback will come from Riyadh after monitoring (like if he/she got higher than 140
mmHg  alert will be sent by a nurse in Tabouk.)
From the note space below
Key factors to measure:
Diagnostic accuracy
Delay/Time reduction in providing treatment
Prevented conditions
Adherence to medication
Change in mortality/morbidity
Improved quality of life
 Driving Forces of Telehealth
• Access to Care
• Access for people with situational limitations
(physical disabilities, elderly, etc). Also, females
can’t drive  so, telehealth will increase their
access to health care.
• Minimize distance of travel for people in hard to
reach/isolated locations
• Not limited by time/place
From the note space below
Key factors to measure:
Patients satisfaction
Timely disease detection
 Driving Forces of Telehealth
• Cost of Care
• Prevent/early treatment of disease = lower cost of
care (both to provider and society)
• Lower cost from travel
From the note space below
Key factors to measure:
What does the service cost?
Does the service save money?
What is the balance between costs and
effects?
Which perspective to measure cost:
patient, provider, or society?
 Why Telemedicine/Telehealth?
• Access: Time, Travel, Expense, Information 
No need for travel.
• Health Provider Collaboration.  prevent patients
from becoming advanced cases and acquiring more cost.

• Enhanced Communications
• TV & Computer Applications common and non-
threatening
• Minimize referrals
From the note space below

Access
Provide primary healthcare that would not be available otherwise
Specialty care consultations for isolated specialists, practitioners, and other health care
professionals
Eliminate expensive travel and isolation
Reduce need to move patient
CME for isolated health care providers
 Why do Telemedicine/Telehealth?
• Communication/Collaboration with specialists
• ER ‘front-line’ support.  Small hospital will alert a big
hospital if it couldn't handle a patient  so, it consults for or transports
this patient.

• Improved professional education

• Saves time, travel to outreach clinics
 List the Challenges of Telehealth
• Infrastructure
• Liability
• Privacy Privacy psychiatry patient will be hesitate of using it.

• End-user lack of knowledge about the benefits, services

available in other settings
• Compromised relationship between health professional and
patient
• Lack of time to adopt telemedicine

From the note space below

Equipment costs , Connectivity costs ,Reimbursement , A lack of appropriate ,training and

educational facilities , The legal and ethical issues including licencing, privacy and
confidentiality
 Identify equipment and technology to
sustain telehealth
• Equipment to capture the information at each site
• Communication equipment to transmit this
information between the sites
• Equipment to display the information at the
relevant sites
• Four types of information transfer common in
telehealth
• Audio, text, still images, video

Chapter 19 Telehealth and Communication

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 Telemedicine Settings

• Rural area From the note space below

• Schools School-based Care

• Dialysis
• Clinics • Support groups
• Speech therapy
• Hospitals • Remote ultrasounds
• Pre-commitment
• Prisons can’t go to hospital assessments
• Sign Language

• Assisted living. elderly homes interpretation

• Dietary counseling
• Rehab services
• Supervision
 Emerging Telemedicine applications

• Telestroke • Telepsychiatry
• Teledermatology • Telepathology
• Teleconsults • Teleradiology
• TeleEndocrine
• Telewound care
• TeleTrauma
• TeleICU • TelePediatrics
• Teleophthalmology • eVisits
• Telecardiology
• Pre and post-surgical
care
 Emerging Telemedicine applications

• Telehealth Post-discharge
• Reduce hospital
readmissions
• Improve clinical
outcomes, compliance
• Improve patient quality of
life
• Improve patient education
and self-care
 Emerging Telemedicine applications
• For Stroke Patients:
“To be effective, clot-dissolving therapies must be
given within three to four and a half hours after
you experience stroke symptoms.”

http://www.mayoclinic.org/tests-procedures/stroke-telemedicine/basics/definition/prc-20021080
 From the note space below
Case Study:
In a stroke telemedicine consultation, an emergency medicine doctor at your
regional hospital (the spoke) will examine you. If your doctor suspects an acute
stroke, he or she will activate the stroke telemedicine hotline at the hub hospital,
which has a dedicated hotline and group paging system and vascular neurologists
on call 24 hours a day, 365 days a year. The hub's on-call vascular neurologist
usually responds within five minutes.After you have a CT scan at the spoke
hospital, the vascular neurologist at the hub performs a live, real-time audiovisual
consultation. The vascular neurologist may discuss your medical history and review
your test results. The vascular neurologist evaluates you, works with your doctor to
determine the most appropriate treatment and sends the treatment
recommendation electronically to the spoke hospital.Having a prompt evaluation
increases the possibility that clot-dissolving therapies (thrombolytics) can be
delivered in time to reduce stroke-related disability. To be effective, clot-dissolving
therapies must be given within three to four and a half hours after you experience
stroke symptoms.
Link
http://www.mayoclinic.org/tests-procedures/stroke-
telemedicine/basics/definition/prc-20021080
 Emerging Telemedicine applications

• Telestroke
• ER Consultant do a CT Scan;
• Trained neurologist performs a live, real-
time audiovisual consultation
• make diagnosis and appropriate treatment
recommendations;
• Send documentation electronically

http://www.mayoclinic.org/tests-procedures/stroke-telemedicine/basics/definition/prc-20021080
 Emerging Telemedicine applications

• Teledermatology
• Inpatient and emergency consults for hospitals
without dermatology coverage.
• Timely transmission of images and clinical
information.
• Educational opportunities for residents and fellows.
 Emerging Telemedicine applications

• Emergency Care and Trauma

• Timely trauma evaluations for patients in remote or
rural areas.
• Assistance with triage and transfer decisions.
• Learning opportunities for community providers.
 Emerging Telemedicine applications

• Tele Wound Care

• Remote consults for patients with poorly healing
wounds.
• Real-time transmission and review of images.
• Reduced patient transfer rates.
 Emerging Telemedicine applications

• Telesurgery: the ability for a doctor to perform

surgery on a patient even though they are not
physically in the same location. Communicate
by robotics.
• Teleradiology: the transmission of radiological
patient images, such as x-rays, CTs, and MRIs,
from one location to another for the purposes of
interpretation and/or consultation
 Identify several telehealth applications

• Telecare: The use of telecommunication

systems to provide remote assistance in
therapy to patients
• Teledentistry
• Health Education
• Geographically isolated health care workers
• TeleICU. when the on call doctor leaves.
From the note space below
Systematic and regular updating of skills and knowledge ae essential elements in effective
healthcare provision and Internet supports this development
 Telemedicine in Saudi Arabia
Successes and Challenges in the Implementation and
Application of Telemedicine in the Eastern Province of
Saudi Arabia
by Azza Ali El-Mahalli, MD, PhD; Sahar Hafez El-khafif, PhD; and Mona Faisal Al-
Qahtani, PhD

http://perspectives.ahima.org/successes-and-challenges-in-the-implementation-and-
application-of-telemedicine-in-the-eastern-province-of-saudi-arabia/#.VHw2EJOUd9k

For your Information only

Chapter 19 Telehealth and Communication

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