Tele-health for the Americas

To understand the true meaning of “tele-health,” we must take an approach both realistic and idealistic, and also refer to the definition of experts, which is that telehealth is a compound term that includes activities related to health, services, and methods, which are carried out at a distance with the help of information and communications technology (Experts group of the WHO, Geneva, 1997).  The objective is to improve public health, control disease and medical care, and education, management, and research in the health area.

All countries should have in place policies identifying the key issues in the introduction of tele-health programs and providing a strategy for its introduction.  That is an idealistic position.

Realistically, tele-health affords benefits such as:

• Cost reductions through fewer hospitalizations and associated costs

• Extension of health coverage

• Improvements in health indices

Tele-health includes telemedicine, distance education, tele-research, and tele-administration.

Specifically, telemedicine is the use of telecommunications and informatics for medical purposes.  (J. Preston, 1993).  It is the supply of health care services by health professionals, in places where distance is a critical factor, using information and telecommunication technology to exchange reliable information for diagnosis, treatment, and prevention of diseases, research, evaluation, and continuing medical education, with the goal of improving individuals’ and peoples’ health.

All new advances in implementing improvements in public and private health administration systems involve obstacles to the incorporation of tele-health programs:

a.   Political/economic:  Expectations, insufficient demand;

b.   Social/cultural:  Attitude of and training for health care professionals; existence of flow of traditional information;

c.   Ethical/legal:  Data confidentiality and protection; transaction malpractice; professional credentials;

d.   Technical/financial: Regulatory and training framework; telecommunication networks; user assistance; cost policies, data and method evaluation.

There are many and varied applications in computerized health care:

• Access to databases
• Electronic medical records
• Distance training
• Operation monitoring
• Tele-ambulance
• Home care
• Epidemiological surveillance and prevention

 There are also specializations such as tele-pediatrics and tele-psychiatry (via videoconferencing).

We could also mention consumer and health care technologies.  The first are:  intelligent homes, personal communications equipment (PDAs, cell phones, etc.); broadband (cable, DSL, satellite); digital cameras, video, and wireless technologies such as WLL, WiFi, WiMax, OFDM, EVDO.  Health care technologies are:  remote patient monitoring, personal medical records/electronic medical records, electronic prescriptions (ePrescribing); eDisease management; sensors, traditional medical devices (which are made smaller, with Internet access capacity.  They may even be implantable); call centers and customer relations management technologies (CRM); Internet/web-based technologies (interactive web pages; doctor/patient e-mail; virtual medical consultations).

Among tele-medicine innovations could be mentioned those being implemented by Latin American companies such as Easy Truck.  This Brazilian firm developed a chip and cell phone enabling users to be located and assisted.  It was originally conceived for use with children aged 3 to 10 and adults over 65, but this technology may also be used for diabetics or persons with chronic heart disease, attaching remote monitoring equipment to them.

A major world chip provider, this company is developing systems interoperable between today’s medical devices and cell phones through interaction of the latter with biosensors for health monitoring applications.

Medical care and tele-health technology can make a difference in people’s quality of life.  Well-implemented national tele-health programs would reduce hospitalization needs and permit more efficient use of public and/or private resources.  This is the case of the United Kingdom’s NHS CFS (National Programme for IT), where systems for measurements were implemented using biometric equipment or devices, including blood pressure, weight, heart rate, and blood oxygen content (digital oximeters), temporary thermometer, glucose meters, espirometers, and wireless ECG systems via Bluetooth, where the system collects all patient health information and answers parameterized questions on the disease in question.  Health information is automatically sent over standard telephone lines or cellular lines to the central station for review.

Many other companies could be mentioned that have equipment now making tele-health a reality in the developed countries, such as: Card Guard AG, CardioNet, MyFoodPhone; Pulse Tracer, VitaPhone, etc..  However, in developing countries, this is only an ideal, at least for now.  For it to become reality, it is essential for the governments of developing countries to follow in the footsteps of the developed countries in their efforts to implement tele-health systems that help people, wherever they area, establishing programs that improve quality of life, make chronically-ill patients more independent, and improve health control and health and hospital cost administration.

To implement tele-health and tele-medicine programs, governments must pursue policies to that end.  More than that, they must make this a priority for the development and health of their peoples.  There are many Latin American countries with very dispersed and unserved populations and, like the universal service concept for provision of basic telephony to the country’s entire population, regardless of distance, here too, in tele-health/tele-medicine, we should speak of Universal Tele-health Service, which makes effective, by means of technological development, people’s right to guaranteed health care and medical services.

Martha De Cunha de Killian
Director, Business Development
Killian & Asociados
[email protected]