E-health and Telemedicine

Indians value their health care system above any other social program. India's system of health care faces significant financial and population pressures, relating to cost, access, quality, accountability, and the integration of information and communication technologies (ICTs). The health-system also faces certain unique challenges that include care delivery within a highly decentralized system of financing and accountability. All of these challenges are significant catalysts in the development of technologies that aim to significantly mitigate or eliminate these selfsame challenges.

The promise of e-Health lies in the manner and degree to which it can mitigate or resolve these challenges to the health system and build on advancements in ICTs supporting the development of a health infostructure. India is actively developing and implementing technological solutions to deliver health information and health care services across the country. These solutions, while exciting and promising, also present new challenges, particularly in regard to acceptable standards, choice of technologies, overcoming traditional jurisdictional boundaries, up-front investment, and privacy and confidentially.

Introduction

The term e-Health has been used to describe a variety of activities including almost any electronic exchange of health-related data, voice or video. The definition that most nearly describes what is understood within the context of this article is the following:

E-Health is a consumer-centred model of health care where stakeholders collaborate, utilizing ICTs, including Internet technologies to manage health, arrange, deliver and account for care, and manage the health care system (3)

E-Health has almost no “history”, nor baggage, as it enters the health- care discussion. It offers a means to draw together in collaborative partnerships governments, organizations and professionals in ways that have not before been possible. Numerous stakeholders, including consumers, clinicians, administrators and politicians, are already actively involved in e-Health initiatives. E-Health initiatives provide a means to overcome linguistic and cultural challenges to the health system. In some jurisdictions governments are legally required to provide care in Hindi and English, and in others they provide some level of service in dozens of languages. Repeated clinical interviews and tests, multiple referrals and other repetitive and perhaps unnecessary contacts with the health system and professionals are a barrier to care for many whose abilities in Hindi and/or English are limited. (4)

E-Health can allow for access to patient records by pharmacists, sharing of information between clinicians and even between same-site facilities. Desk-top and live on-line access to patient records, information that supports clinical decision making, and health-system information, such as on-line booking of specialists, along with a host of other possible uses of the new technologies will improve the clinical bench-strength of providers, patients and the consumer. E-Health technologies also allow for the development continuing professional education for providers in isolated locales. E-Health reduces the stress on an often-overburdened system. Seasonal swings in transmittable diseases, such as the flu, have led to crippling overuse of the emergency services in hospitals. E-health mitigates this by providing a means for some out-of-hospital care, and by providing information on what is a condition requiring immediate emergency treatment through tele-triage centres.

By increasing our capacity to meet unique geographic, population and political challenges, e-Health moderates the political debate and public concerns about the sustainability of the current health-system. (1)

E-Health Challenges

India faces a number of challenges in the development of effective e-Health solutions. Of primary concern is the inertia of traditional agendas, and ways of doing things. Divisions between health-professions, the public-private sectors, facilities, levels of government and cultural communities generally mitigate against large national inter-jurisdictional projects in the public sector, and new large-scale investments in the health sector. The technologies themselves, as well as their deployment, are challenging matters. There are questions about how to properly automate the health-system, which technical standards are to be adopted, Is the current level of technology and technological sophistication of the providers and public sufficient to the task. Socioeconomic, cultural and geographic influences limit connectivity, performance and possibilities of Internet. Public and professional acceptance of the new technologies in the place of old ways -such as, keying up a live on-line Internet consultation instead of sitting in a waiting room- is essential. (1,4)

Clearly, large financial and human resources must be invested in e-health to realize the full potential of the technology. Evidence suggests that e-Health is at least 10 years behind other information management intense sectors, such as banking. (7,9,13)

Areas of health informatics (8,9)

· Consumer informatics

· Medical and clinical informatics, and

· Bio informatics.

In this paper, the focus will be on the first two types mentioned.

Consumer informatics

Consumer Informatics is the one commonly referred to as e-health and focuses communications to patients and the public about health topics. Consumer-to-consumer (C-to-C) applications are potentially strong means of empowering individuals and the public. There are 25,000 to 30,000 health-oriented websites and they are among the most visited. These sites are and will be major sources of information and misinformation. There is an urgent need for all concerned, including politicians/lawmakers, health professionals and industry to put in place adequate standards and quality control for these websites.

Medical/Clinical informatics

This category relates directly to health care structure, processes and outcomes. A main application is computer-based medical records, a sub-category of which is computer-based personal records that will facilitate access to low cost therapies, for example, with certain areas of mental health, such as depression.

Another sub-category is computer-based patient records that will facilitate clinical decision-making. These later records may be linked to knowledge-oriented systems that may contribute to quality control of clinical processes. Such a decision support has been demonstrated to improve outcomes. Computer- based population or community health records are usually anonymized patient and/or personal records. These systems are particularly valuable in public health where one is trying to trace different types of health hazards, linked either to medical, environmental or social agents.

Telemedicine

Finally, telemedicine provides a category by itself. Telemedicine, meaning healthcare delivered by electronic means, has been on the road for over a century, if care provided by telegraph and telephone is considered. However, towards the end of the last century, this emerged as a delivery system with huge potential due to the information technology revolution, which made two-way, audio-visual transmission possible at reasonable cost. [2]. It has a long way to go before it can be effectively integrated into a healthcare delivery system. One crucial difficulty is that many telemedicine applications have yet to be developed, evaluated and implemented in the hospital environment, before application of the system over longer distances. (2)

Telehealth vs. E-health

Although E-health is an outgrowth of telehealth, it is differentiated in several important ways. Telehealth has been largely non-Internet based and has been characterized by point-to-point (e.g., T1) and dial-up (e.g., telephone, ISDN) information exchange. E-health, on the other hand, is more accessible due to its increasingly affordable ability to communicate through a common set of standards and across operating systems. The increase in access has also led to an increase in the number of uses of the Internet for healthcare. These increases also lead to greater concerns for privacy, confidentiality. (2,4)

The Future

Internet-based technologies will soon "converge" with satellite and cable television for full interactive broadcast capabilities delivered through one, seamless technology. Psychologists and patients will be able to interact over the Internet in a secured environment sooner than legal and ethical adaptations can be made. Estimates for the wide-scale deployment of these services range from 24 - 48 months. With continued improvement in security and quality of healthcare websites, consumers and practitioners will be able to increasingly rely upon Ehealth to provide accurate clinical data and support. In the future, Ehealth will include more interactive services and the virtual office will be an integral part of psychology practice. (4,8)

Summary

As mentioned, information technology and e-health have great potential. Research and development studies, however, are needed in assessing narrow and broader implications of IT applications. These cannot be left to IT enthusiasts alone, neither to less well-informed politicians or health professionals. Applications should, in my mind, be built up incrementally by starting from smaller scale pilot projects. At later stages and after careful assessment, larger scale implementations may be appropriate. Nationally and internationally, there is a need for concerted action in developing standards (in order to reach compatibility) and ethical frameworks.

ICT appears to hold the key to meeting some of the challenges that face India’s health care system. The promise of e-health is yet to be realized but appears to be an inevitable part of India’s future reality. The issues that are linked to e-Health are being addressed, in part, by numerous national, provincial and territorial initiatives, and in partnerships between the levels of government and across the public and private sectors.

References

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9. Eysenbach, G. & Diepgen, T. Responses to unsolicited patient email requests for medical advice on the World Wide Web. The Journal of the American Medical Association.1998, 280, 1333-1335.

10.Ferguson, T. Bedside Manna. Wired Magazine.1997, 154-155.

11.Ferguson, T. Digital doctoring-Opportunities and challenges in electronic patient-physician communication. The Journal of the American Medical Association.1998, 280, 1361-1362.

12.Graber, M. A., Roller, C. M., & Kaeble, B. Readability levels of patient education material on the World Wide Web. Journal of Family Practice.1999, 48(1), 58-61.

13.Smalley, R., & Bosworth, K. Development and pilot evaluation of a computer-based support system for women with breast cancer. Journal of Psychosocial Onclogy. 1993,11(4), 69-83.

*Sumit Khanna, Department of Pharmaceutical Sciences, G. J. University, Hisar-125 001

397,Sec-13, Hisar, Haryana, India

GSM: +919416045445

E-mail: sumkhan@hotmail.com