TELEMEDICINE &
TELEHEALTH NETWORKS
NATIONAL NETWORKS
DR ABU BAKAR SULEIMAN
PRESIDENT
INTERNATIONAL MEDICAL UNIVERSITY
KUALA LUMPUR, MALAYSIA
23 – 25 August 2001
Ann Arbor, Michigan
Health in National
Development
Health:
• Investment for productive & efficient
workforce to build robust,
competitive nation
• Quality of Human Capital
• Welfare of community
Challenges to the Health
Sector
Increasing demand & expectations
Rising healthcare costs
Changing demography
Changing disease patterns
Limited resources
In meeting these
challenges:
(a) Health services need to be more:
• integrated
• cost effective
• available to those in need
(b) Need for maximum use of:
• existing resources
• modern technology
(c) Health services should be provided
• close to those who need them
• in an effective integrated approach
• in a coordinated manner to meet the
needs of the individual
• for management of wellness as well
as for illnesses
(d) Increasing recognition that
• there should be greater priority for
primary health care (PHC) to more
effectively & more equitably deliver
health care services
• PHC should be more effectively
supported by services at secondary
and tertiary levels
• as this occurs, there will be greater
demands at PHC levels
(e) Integration
• key issue for effectiveness
• through network of hospitals &
clinics with appropriate referral
systems
• services delivered conventionally &
through telehealth network
Telehealth/Telemedicine
Networks
Potential to increase efficiency &
increase the reach of health services
Potential solutions can be developed to
address issues in health
Can be viewed as a means to
reorganise, transform or build up new
health structures.
Telehealth/Telemedicine
Networks
care: planning, implementation,
management
issues: cost effectiveness, liability,
confidentiality, policy,
regulatory, etc.
Telehealth/Telemedicine
WHO definition (Dec 1997)
Telemedicine is the delivery of healthcare
services, where distance is a critical factor,
by healthcare professionals using
information and communication
technologies for the exchange of valid
information for diagnosis, treatment and
prevention of disease and injuries, and for
the continuing education of healthcare
providers as well as research and evaluation,
all in the interests of advancing health of
individuals and their communities.
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Health
Medical Technologies
Telehealth
Healthcare
Education
Health
(Creation)
Telehealth Networks
It’s development & its role in health services
should be part of national health planning and
health policies
Should be internalised into national health
programme
Should address - healthcare delivery
continuing medical
education
wellness programme for
the public
Telehealth networks
facilities
It’s development & its role in health
services should be part of national
health planning and health policies
Reinforce national health structure
Training & education for all health
workers
Public health information system for all
Improves quality & efficiency of health
services
Telehealth networks
Technology enabler to realise
vision/mission, goals for health
Development based on needs
Development not technology driven
Telehealth networks
medical & health professionals’
- identify & develop needs
- work with telecommunications, IT
professionals & technology experts
to develop programme
- multidisciplinary approach,
appropriate technology
National Telehealth
policies, strategies, goals
- support national health programme (Health
for AII)
- includes issues: health priorities
funding eg. govt, industry,
health financing, etc.
- technologies – depends on services to be
provided & types of network connections
necessary.
IT, Multimedia Infrastructure
Depends on availability & needs of country programme
Malaysia:
High capacity, fully digital telecommunications
infrastructure (1997-2007)
Fibre Optic Backbone: 2.5-10 gigabit/sec linked with
Corporate Information Super Highway (COINS) (MSC
to rest of Malaysia)
High capacity Direct Fibre links to International
centres with 4 international gateways
Open Standards, High-speed Switching & Multiple
Regional Satellite Communications Protocols
Services
Wireless Communications
Etc.
Legislative Framework &
supporting soft infrastructure
Cyberlaws legal & regulatory
framework:
protecting - The right of citizens
- The interests of business
- Integrity and soundness
of telehealth applications
Cyberlaws
Digital Signatures Act
Computer Crimes Act
Copyright amendment Act
Telemedicine Act
Multimedia & Communications Act
Personal Data Protection Act
Issues
Privacy, Confidentiality, Security
• practical meaning of privacy
• how to distinguish: privacy
confidentiality
security
• what protections : fair
constructive
enforceable
Issues
Health data as public goods
Complete data : health research
quality control
Opting out options: problems
Professional societies: review ethics
guidelines
codes of conduct
Issues
Privacy, Confidentiality issues should be
addressed in development of infrastructures to
support use of data sets for
health planning
quality improvement
Steps necessary to ensure public trust in system
by demonstrating real effort on privacy concern.
Issues
Information: • timely availability
• content - high quality,
evidence based
• technology - organisation
- retrieval
• at point of need
• ethical code of conduct for
publication of health info
Issues
Standards
• defined by industry
• identify & define for use in national
network
Standards
i. Data Standards:
The Electronic Health Record (EHR) Content,
Coding Scheme, Data Structures, Clinical
Vocabulary and Data Integrity
ii. Data Exchange Messaging Standards
iii. Medical Image Capture, Storage and
Transmission standards for different modalities
iv. IT Infrastructure Technical Standards for
Interconnectivity, interoperability and
scalability
v. Clinical Laboratory Equipment Interface
Standards
Standards
vi. Interface standards for linking
Intensive/Critical Care
Instrumentation/Monitors to the Clinical
Information System
vii. Transferring Digital EEG, ECG,
Neurophysical Data and from intensive care
instruments and monitor.
viii. Standards for Identification of Patients, Care
Providers, and Sites of Care.
ix. Health/Medical Knowledge Management
and medical Logic Definition.
x. Drug Information Coding.
TELEMEDICINE POLICY AND STANDARDS
Use Standards set by
Common Standards
Electronic Government
Medical Image Storage
and Communication
Additional Standards
Specific to Telemedicine
Health Data Structure
and Communication
Telemedicine Policy &
Standards
Vocabulary ICD 9.0 & ICD10.0
Medical Non-Medical
Text Audio
Stored Data Image Image Video
Type conferencing
DICOM3.0 JPEG/MPEG/ M-JPEG SGML,HTML, MPEG2
Text
Transmission DICOM3.0, HL7, FTP, SMTP, HTTP
Security Authentication / Encryption
Services
Common Electronic Government Information Technology Policy & Standards
Infrastructure
Telemedicine Specific
Standards
- DICOM 3.0 & HL7 & ICD -
ICD 9.0 & 10.0
Internet
DICOM3.0 & HL7
Radiology External
LHR/EMR HL7 laboratories
HL7
HL7
HL7
Hospital labs
Admission transfer
Hospital labs discharge
DICOM3.0: Image Exchange standard
HL7: Sharing clinical data
ICD: Terminology
PROVIDING COMPREHENSIVE GUIDELINES ON
APPLICATION OF STANDARDS
Objective: Define minimum standards required to guarantee seamless integration
Level of recommended standards
Layer Description Examples Coverage Electronic
The desired outcomes from Interopera- Government
ensuring the appropriate bility Standards
Objectives level of commonality across
YES
government applications
and systems Messaging
High level application and services widely
systems requirements accepted by
messaging YES
Policy guidelines
designed to achieve
objectives system
Industry-agreed, specific standards
Telemedicine
Standard systems requirements, YES
recommendations chosen to meet policy SMTP, X 400 Standards
requirements
Product re- Specific applications that Microsoft
commendations comply with standards of exchange, Notes NO
framework in guidelines
Issues
Interoperability
Networks carrying info : telephone, cables,
satellite
Services allowing consumers to use
networks: email, interactive video
Applications offering solutions to users:
teleconsultation, distance learning
Issues
Legal & Administrative requirements (Depends
on model)
e.g. • Lifetime Health Record (LHR) & Lifetime
Health Plan (LHP)
• Requirement to create LHR: at birth
at every health/medical encounter
• Mandatory transmission of LHR data
from private sector facilities
• Confidentiality/Privacy concerns
• Accuracy & Reliability of all data/info.
Issues
Legal & Administrative requirements
(Depends on model)
• Mandatory sharing of clinical data between
health providers
• Legal ownership & custody of LHR/LHP
• Compliance to international standards:
data structure, content, coding,
vocabulary, transmission & exchange
• Interoperability
open systems standards
Management of Change:
Transformation of Health
System
• Empowerment of individuals, families &
communities
• Balance wellness with care of illnesses
• Emphasis on health promotion, disease
prevention, early detection & proactive
management of illness, and patient
involvement in own care.
Management of Change:
Reorganisation of health services
Integration of 1º, 2º, 3º care to provide
integrated services
Develop patient centred health systems
Review & amend relevant laws & regulations
Review health financing system to promote
values above
Changing role of: patients
healthcare providers
healthcare institutions
Health Financing System
Support Telehealth Objectives:
promote wellness
disease prevention
appropriate utilisation of care
services
CRITICAL SUCCESS FACTORS
(e.g. TELEHEALTH –MALAYSIA)
Solutions & Content will be based on:
- common care pathways & care Plans
- evidence-based Medicine
- Use of international Health Informatics
standards
- Content to be accredited
Need for all players to participate
Reliable & high performance infrastructure
System must be easy to use
Ensure high level of data integrity & security
System must be easy to use
Ensure high level of data integrity & security
System must be Interoperable, Scalable & Portable
Need for users to redesign work processes
Telehealth Policy to be operationalised
Solutions to be enhanced incrementally
Appropriate Regulatory Framework to be put in place
Conclusion
Telehealth Networks
• internalised into national health program
• vision/mission, strategy, targets – part of health policy
Driven by needs of services – not technology driven
Telehealth policies, strategies, goals to support national
health programme
Develop, review laws, regulations relevant to programme
Address key issues:
confidentiality & security
timely availability of quality info
standards
management of change
Health Financing
etc.
Case Study of Malaysia
Vision 2020 Information based society
K economy
MSC initiative
Bill of guarantees
4 supporting pillars
Vision for Health Flagship application
Mission for Health Telehealth
4 pilots:
8 Health goals of Health System LHP
National Telehealth Policies MCPHIE
CME
Teleconsultation
Public sector initiated & funded
catalyst for private sector to be driving force
Private Sector
Legislation, regulations, policies
Innovative business models
LEADING HEALTHCARE INTO THE INFORMATION AGE -
MALAYSIA'S TELEMEDICINE BLUEPRINT
HEALTH VISION Vision
HEALTHCARE GOALS Goals
HEALTHCARE SERVICES Services
MULTIMEDIA TOOLS & Tools and
TECHNOLOGIES Technologies
MULTIMEDIA NETWORKS Networks
CHANGE STRATEGIES Organi Processes People Finance
-zation
ENABLING Policies, laws, regulations, standards, technology
FRAMEWORK
Thank You
