Recent telemedicine and physician's perspective of it, patient-doctor relationship and reimbursement problem.

1. Medical Informatics & Applications
Telemedicine Supports
Dani Iswara
Health Management Information System
Field Epidemiology Training Program
Public Health Science
Faculty of Medicine Gadjah Mada University
Yogyakarta, Indonesia
RIGHT Seminar, Jan 10, 2009, Med Fac-UAJ, Jakarta

2. Access Quality Cost-benefit
Sustainability
→ Health outcomes

3. Telemedicine...
Mobile
Non/web-based
Cable, wireless
Data Hospital,
Clinic,
Application Network
Private,
Pharmacy
Ax, physical,
lab exam, Tx
Push/pull
Telemedicine
A/synchronous
station
→ Not-so-new technology
3

4. What is Telemedicine?
Telemedicine (telemedisin = kedokteran jarak
jauh)
Medical/clinical services
●
Long distance (geographics; regional,
●
national, international)
Information & communication technology
●
(ICT)
Telehealth (health care), telecare
4

5. What is Telemedicine offered?
Efficient
●
Effective
●
Interactive
●
Collaborative
●
Ubiquitous
●
5

6. What is Telemedicine for?
Types of telemedicine
Teleconsultation
●
Telephone, SMS, web, email, forum, blog
●
Teleconference (videoconference)
●
Tele-education
●
Telemonitoring (chronical ds, drugs/labs
●
monitoring)
Teleradiology, telesurgery, telecardiology,
●
telepathology, telepsychiatry, teledermatology
6

7. Telemedicine in Indonesia
SMS Gateway (ITB; 2006):
Reporting & monitoring → disaster, TB, lepra
Dasar-dasar Implementasi Telemedicine
(Johan Harlan; PSIK Univ. Gunadarma; 2007)
Standard formats → txt, XML, MPEG, JPEG,
pixel, ICD 10, HL7?
7

8. Telemedicine in Indonesia (2)
Since 2005:
Videoconference equipments
VoIP equipments
Internet
KepMenKes No. 857 Tahun 2007
Pengembangan Jaringan Komputer Online
Sistem Informasi Kesehatan Nasional
(Siknas Online)
8

9. Barriers of Telemedicine
developing countries
Cultural problems
Inapropriate 'experts'
Regulations
Reimbursements
Human resources
Technologies
9

10. Cost Impacts of Telemedicine
Chronic ds
●
Outpatient
●
consultation
Length of stay
●
10

11. Sample
Position Statements of Telemedicine
Internet Prescribing
“Store and forward providers should take care regarding direct
prescribing for patients via electronic communications. Most
states have regulations that discourage or prohibit practitioners
from prescribing for patients that they have not seen face to
face. In many cases, the wording of these regulations is such that
a live and interactive consultation would meet the requirements
for a “face to face exam”. Since most store and forward providers
are working in collaboration with a provider at the point of care,
this should not inhibit patient care. The dermatologist should take
care to recommend as opposed to prescribe.”
American Academy of Dermatology (2004)
11

12. Sample
Statement on Telecomunication
in Medicine
Physician-Patient Relationship
quot;If a patient receives professional advice or
treatment, even gratuitously, there is prima facie
evidence that a physician-patient relationship
exists.quot;
The American College of Obstetricians
& Gynecologists (ACOG)
12

13. Sample
Guidelines for the Surgical Practice
of Telemedicine
Telesurgery (Remote Surgery)
quot;Appropriate Use:
Demonstration and/or teaching technique or procedures...
-- using inanimate trainers as the objects of the procedure.
-- using animate model for purposes of testing technology.
-- on patients under strict guidance of an IRB and only when a
qualified surgeon is present to intervene in a timely fashion if
technical difficulties arise.quot;
Society of American Gastrointestinal
and Endoscopic Surgeons (SAGES); 2004
13

14. Summary
Telemedicine is only a tool
Potentiality of telemedicine
Patient safety first
Guidelines & standards
Researches & evidences
14

15. Thank You...Q & A
You are free to share (copy, distribute, transmit) & adapt this work
under the similar license Creative Commons Attribution­
Noncommercial­Share Alike 3.0 Unported
(CCA­NC­SA 3.0 Unported)
Dani Iswara
daniiswara@gmail.com
http://daniiswara.net/
Last updated: January, 2009
15