Telemedicine, Emr, Role Of It In Hm

TELE MEDICINE

Telemedicine - An Overview Telemedicine is defined as the provision of

“any type of medical service from a distance” Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care. Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries.

Telemedicine Applications The major types of telemedicine applications

are: Electronic Medical Records Continuing Medical Education Personalized Health Information Teleconsultation

Electronic Medical Records  Electronic Medical Records (EMR) store all healthcare

information of a person to create an independent set of medical records  Healthcare providers can access the EMR from any location in order to provide diagnosis based on the most complete level of information  The EMR should result in the creation of a Personalized Lifetime Health Plans  The EMR of all the individuals should provide data and services to enhance health planning and policy making at the national level

Continuing Medical Education  Continuing Medical Education (CME) application results

in healthcare professionals, regardless of their physical location, being provided with medical educational materials through a multimedia environment  Through telemedicine CME courses healthcare providers are constantly made aware of the latest medical innovations  Through this ongoing interaction with other medical professionals, healthcare providers in remote locations feel less isolated and more willing to work in such locations

Personalized Health Information • Personalized Health Information (PHI) delivers high quality health information to any multimedia user • A PHI system should provide affordable and reliable health information in a user-friendly manner to individuals • This system should empower individuals to take responsibility for their state of health • It should assist the individuals in maintaining a healthy lifestyle

Teleconsultation  Teleconsultation is the provision of medical opinions

through the use of a telecommunication medium  Teleconsultation is dynamic i.e. it requires interaction from both the referring medical practitioner and the consulting physician whether simultaneously (through video-conferencing) or at different times (through store & forward systems)  An effective teleconsultation system incorporates features of the other three telemedicine applications, in other words it should: Provide electronic medical records of individuals who have used the teleconsultation system Provide practice linked continuing medical education Provide access to relevant information to both healthcare providers and users

Teleconsultation - An Overview  Teleconsultation is the provision of medical

opinions through the use of a telecommunication medium  An effective teleconsultation system should be capable of transmitting:  medical images - x-rays, CT, MRI, etc.  medical data and voice  To be effective, teleconsultation systems have to be: Extremely Reliable Efficient and Fast Cost Effective

An Effective Teleconsultation System  Reliable

A reliable and useful system will require a “Paradigm

Shift” whereby patients, medical officers at the rural sites, specialists at the centers of medical excellence and all other healthcare professionals buy into this new form of healthcare delivery. The Paradigm Shift can occur through: Comprehensive “Change Management” procedures which would carefully and thoroughly explain this new healthcare delivery system A pilot project conducted over a few years involving sites that may be considered to be the most receptive to new ideas Medical validation of system is necessary The system would need to be tested on the prevailing

An Effective Teleconsultation System

 Efficient and Fast Teleconsultation acquisition spokes need to be near

potential customers and be able to transmit cases quickly through existing telecommunications infrastructure Standard Operating Procedures (created through experience and with the active input of healthcare professionals) and checklist to ensure efficiency and reliability  Cost Effective Utilize a system which strives to make both the general and specialist medical practitioner more efficient in utilizing their time Store & Forward technology utilizing normal phone lines

Benefits of Teleconsultation • Extends the reach of specialist healthcare from centers of medical excellence to rural or underserved areas • Through the teleconsultation system, the general practitioners at the acquisition spokes have immediate access to a wide range of medical specialties • Patients eventually have one “Super Family Doctor” monitoring their wellness • Provides immediate benefits in the form of improved diagnostic and treatment recommendations to rural areas • The system retains the patient medical information which can be viewed by the attending medical practitioner even if the patient has moved to a different

ELECTRONIC MEDICAL RECORDS (EMR)

What is an EMR? ”A patient record, in

which all information is stored electronically in such way that it may be found and reused by means of computer tools” This refers to a paperless, digital and computerized system of maintaining patient data, designed to increase the efficiency and reduce documentation errors by streamlining the process.

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Electronic Medical Records (EMR)  Access of patient data by clinical staff at any given location  Accurate and complete claims processing by insurance

companies  Building automated checks for drug and allergy interactions  Clinical notes  Prescriptions  Scheduling  Sending and viewing labs

Medical Records - Access Laws governing access to medical records: In the UK:  Data Protection Acts & Freedom of Information Act 2000  Patients or their representatives have the right to a copy of their record. Except: 

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where information breaches confidentiality (e.g. information from another family member or where a patient has asked for information not to be disclosed to third parties) where information would be harmful to patient's well-being (e.g. some psychiatric assessments).

 Patients have the right to check for any errors in their

record and insist that amendments be made if required.

Medical Records - Access Laws governing access to medical records: In the US:  Only patient and health care providers directly involved in delivering care have the right to view the record.  Patient may grant consent for any person to evaluate the record.  Special Situations.  Capacity

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When a patient does not have capacity, a legal guardian is designated

 Medical emergency involving a non-communicative patient

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Consent is assumed unless written documentation has been drafted previously

 Research, auditing, and evaluation

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Individuals involved in research have access. They are not allowed access to identifying information.

 Risk of death or harm

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Information can be shared without permission if failure to do so

Electronic Medical Records Today’s Reality: “EMRs are ‘mission critical’ applications that are required to work 100% of the time every 10 minutes in primary care.”

The Future of the EMR

As Is

To Be

Vendor Relationships

As Is

To Be

Evolution of Electronic Medical Records

Traditional

Present Day

Future State

Patient Focused EMR

“As Is” (Office-based)

ROLE OF IT IN HOSPITAL MANAGEMENT

IT DEPARTMENTS Role: • Essential to leverage the collective clinical

knowledge that healthcare organizations acquire on a daily basis • Such clinical knowledge could be applied to elevate productivity • Better resource utilization and changing behaviour of healthcare workers by using clinical and best practice guidelines

HEALTHCARE IT Paradox of healthcare technology • Sophisticated diagnostic tools • Medical records, lab. Reports. Often forms

continue to be available in print format! • Information exchange between doctors, labs, pharmacies and hospitals is often done on paper!

HOSPITAL IT SYSTEM • Should help to reduce practice overheads by

improving efficiency, effectiveness and quality care • Need high quality electronic medical records • Need for clinical leadership in development and procurement of IT in healthcare organizations

HOSPITAL IT SYSTEM • Should integrate basic care data across

hospital business systems to create a complete picture of what was done to the patient, ascertain who did it, and at what cost • Importance of clinical data regarding outcomes • Gather longitudinal data - can lead to more fundamental care delivery re-design