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Wednesday, June 6, 2012

The Future of e-, m-, tele-health: Integration

Don Newsham is  CEO of  COACH: Canada’s Health Informatics Association.

Whatever your current acronym of choice when it comes to technology and health care, there is a huge need to integrate the eHealth, mHealth and telehealth services to target accurate, timely, comprehensive and accessible data, all focused on and serving the patient and his or her health care providers. Telehealth is one of those key foundations; it has now grown up and is ready to be that integral part of providing health care from a distance.

I never cease to be amazed at the usage statistics in our device-happy world. From the now often quoted 6 billion cell phone devices worldwide, to the expected 15 billion network-connected devices by 2015, to the 62% of primary care physicians owning a smart phone (with over 80% using such for professional purposes), it seems that BYOD (bring your own device) is so very real for work wherever you are. [All these stats are taken from presentations at the Spring 2012 Forum on Emerging Technologies, presented by COACH and the BC Health Information Management Professionals Society (BCHIMPS)]. No matter what stats you believe, our electronic world is advancing incredibly.

In Canada, telehealth alone has impressive stats on usage.  We are an ideal setting to use the technologies of the Internet and many telehealth-supported devices for our rural and remote regions, communities and peoples. The Ontario Telemedince Network (OTN) is achieving excellent results in providing clinical services remotely across the province, as are many other provincial telehealth programs, east and west. But what happens to all the good data captured in that clinical session?  And what happens when the patient returns home? How does the health care provider know what happened four virtual patient visits ago?

With some telehealth leaders espousing the virtualness of much or our health technology use and associated electronic records, it seems clear to me that we need and are starting a convergence of our eHealth-based platforms, mobile health devices and telehealth services.  And, we must always think from the patient’s view first.

What if I’m in Fort Severn, a First Nations community on Hudson Bay and the most northern community in Ontario, needing resolution to a major diabetes issue? (Note: I have been there with KO Telemedicine.) Yes, I could fly to Sioux Lookout, then on to Thunder Bay for a clinic assessment of the bruising and numbness in my extremities. But the local nursing clinic has great telehealth access to specialists “down south” and I can receive quick assessment and treatment. So, the patient stays in Fort Severn, gets an update on his/her blood glucose levels and requires frequent monitoring of those levels over the next few days. Living outside of town, with poor access over spring breakup – OK, stretching the scenario here, but stick with me – he takes home a glucometer that links to his iPhone and three times a day sends his readings to the specialist and his EMR system, along with pictures of his bruises to the specialist’s iPad. Three days later, the readings are returning to normal and the bruising and numbness is subsiding. The specialist, in touch daily by email, sends a record of the care to the GP’s electronic medical record (EMR) and a scheduled booking for the GP’s next community visit in a week; the patient continues being restored to better health.

This scenario, albeit contrived, demonstrates the use of all technologies of eHealth (EMRs, scheduling, clinical data record of tests and pictures), mobile health (iPhone connection to glucometer and to the physician, with his iPad and BlackBerry for evening readings response) and telehealth (direct interaction with the specialist from a remote community clinic). However, this only works in reality and in real health care interactions with an integrated set of services, data and technologies. Drop one of those “e” services and the patient care flow breaks down.

Telehealth needs the data capacity of eHealth solutions and the electronic health records system platforms now being implemented in provinces and territories across Canada. The common vision led by Canada Health Infoway and implemented in our jurisdictions fully includes health care at a distance – telehealth. And telehealth needs to incorporate the data capture and exchange in a standardized and structured manner that provider EMRs can receive. Similarly, mobile device connectivity to those platforms, whether home health monitoring devices or personal devices, must be facilitated in an interoperable and safe manner.

I’ve no doubt that many health informatics professionals, in hospitals, regions, clinics and vendor organizations, are demonstrating or planning this level of integration right now. We need such integration, ubiquitously implemented and adopted across all parts of Canada. I’m excited that the leadership in our telehealth community has already recognized, envisioned and begun to deliver integrated solutions to serve the needs of patients at any distance from their health care provider. I’m more than pleased that COACH has a telehealth forum (CTF) that provides leadership, education and services in promoting the practice and adoption of telehealth in Canada. We have the foundations of “e”, “m” and “t” health, and now we’re moving to an integrated support of health care where those technologies are fully unified and adopted for all patient services and information, enabling the transforming and sustaining of health care in this great country.

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