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ITU-D/2/153-E
TELECOMMUNICATION
DEVELOPMENT BUREAU
ITU-D STUDY GROUPS / Document 2/153-E
9 June 2000
Original: English only
THIRD MEETING OF STUDY GROUP 1: GENEVA, 11 - 15 SEPTEMBER 2000
THIRD MEETING OF STUDY GROUP 2: GENEVA, 18 - 22 SEPTEMBER 2000
FOR INFORMATION
Question 14/2: Fostering the application of telecommunication in health care. Identifying and documenting success factors for implementing telemedicine
STUDY GROUP 2
SOURCE: MINISTRY OF HEALTH, MALAYSIA
TITLE: ACHIEVING THE MALAYSIAN HEALTH VISION THROUGH TELEHEALTH
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Abstract:
One of Malaysia’s goals is the development of a healthcare system focussed on individuals and lifetime health management. This government’s programme related to the introduction of telemedicine and telecare is part of a much larger programme of information technology. The current status of implementation is presented in this document.
The Malaysian health vision states that Malaysia is to be a nation of healthy individuals, communities and communities, through a health system that is equitable, affordable, efficient, technologically appropriate, environmentally adaptable and consumer friendly, with emphasis on quality, innovation, health promotion and respect for human and community participation towards an enhanced quality of life.
On the basis of their high potential ability to impact positively on health care needs and their feasibility, we have selected four pilot Telehealth Applications as priorities for implementation in Malaysia.
1. The Mass Customised/Personalised Health Information and Education Project will provide continuous generic and person specific health information and education to the community using multiple delivery channels such as computers at homes, work places, schools and primary health care centres, and through information kiosks in public places like shopping malls. These will greatly improve health information and education outreach nationwide and maximise the use of information and education services to enhance health awareness in a way that motivates individuals to maintain/lead a healthy life.
Features like online health assessment, personalised health links based on risk assessment, personalised health information pushed through e-mail, discussion or support groups, the facility to consult an expert or make an health appointment will create, we hope, an online community which keeps coming back for more. Individuals will be invited to create their own lifetime health records either by themselves or through the help of a primary care practitioner. It is our intention that individuals, through lifetime health plans, in print and electronic format, be aware of the health risks attendant in each age category and be aware of the screening and interventions available that would considerably reduce such risks.
2. Lifetime Health Plans Project will create for all individuals electronic lifetime health records supported by proactive and prospective Personalised Lifetime Health Plans (PLHP) to maintain them in the highest possible state of health. Scheduled periodic health examinations supported by these lifetime health plans, offered through employers, insurers and directly to individuals, will ensure that health information will not only be received but acted upon.
At present in Malaysia, such periodic health examinations are already being offerred through a well-structured and organised Antenatal Programme as well as a Under-7 Child Health Programme. In recent years, a Well Person's Programme to reduce cardiovascular risk and cancer risk has been implemented in stages. If we were to add to these the emerging Adolescent Health Plans and the Geriatric Health Plans, we would have most aspects of a schedule of periodic health visits and a Lifetime Health Plan in place.
Through these virtual lifetime health records (which contain detailed wellness information and summary illness information from electronic or traditional medical records at health outlets) and lifetime health plans, seamless medical care based on best practice guidelines and personalised to individual requirements by doctors would come about. Patients would also have access to parts of these records and may be able to enter relevant information into it e.g. weights, blood sugars, peak flow readings. Information required for national planning would be easily available from these Lifetime Health Records through a Health Information Management Module.
The LHP project will be tightly integrated with the MCPHIE project and may appear as one to the user. A stepwise approach will be utilised to ensure the success of this project. Individuals will first be exposed to the concept of lifelong wellness and be taught to use online assessment tools to assess their own health or utilise primary care centres (and general practitioners) to have their health assessed. They will be informed of the risks relevant to their specific age categories and offered screening and/or interventions based on risk assessment. If they have internet access they will receive customised information by push technology or by personalised sets of health hyperlinks.
The results of screening and interventions will be available in a seamless manner to permitted caregivers to allow lifelong management of health in a proactive manner by the individual and his caregivers.
Intelligent care centres may be utilised to provide wellness screening, promote lifetime health plans and records, enroll individuals into lifetime health plans, enter data on behalf of other health outlets without online access into these health records, be training centres on use of LHPs and LHRs for individuals and caretakers, monitor quality and evaluate success of implementation and outcomes. They could act as centres for teleprimary care and offer support for disease management. A schematic overview is provided on page 5.
JAVA allows componentisation of the electronic medical record, downloading only what is required as an applet and assessing this through the World Wide Web. This can offer rapid rollout of core portions of the LHR and EMR at low cost, reduce risk of legacy systems and permit concentration on high return areas.
3. Continuing Medical Education (CME) Project will provide medical practitioners and paramedics access to knowledge databases and learning tools, modular distance learning programs and virtual formal training programs to support the acquisition of postgraduate and postbasic qualifications.
Practitioners will have online access to full text journals and textbooks, medical databases, systematic reviews (all linked together). Local content that will be developed include gateways to international resources, local clinical practice guidelines and protocols, teaching aids, electronic newsletters, Consult a Colleague, discussion groups and the like. It is intended to hyperlink these professional resources to electronic medical records so that this knowledge is integrated into clinical practice.
4. The Teleconsultation Project will provide primary care centres access to consultative and related services using multimedia over a geographic distance, including consultancy, diagnostic support, treatment, tele-monitoring, management of chronic illness and rehabilitation.
Unlike traditional point-to-point applications, this project is designed from the start to be multipoint-to-multipoint, and structured to encourage and support primary care practitioners to provide as many services as possible at their level, and minimise referral to tertiary centres. The teleconsultation project will also support interactive and multimedia medical education.
Healthcare is all about knowledge management. Good healthcare requires the right knowledge being available at the right time in the right place; and this will provide the right results. The pilot applications are a major step in the right direction as they provide consumers equitable and appropriate access to healthcare and will bring the lifelong medical record, consumer health information and provider health information together at the right time and place.
Pilot Applications Inter-relationship. Considered individually, each of the pilot applications has been selected on the basis of its significant potential to impact positively on the health status and wellbeing of all Malaysians. Taken as a whole, however, the four pilots are integrally inter-related in a way which offers outstanding potential. The end result of this relationship is an absolute focus on the sustained wellness of the individual through the personalised lifetime health record and its ability to access, record, influence or plan delivery of all services to be provided by the other applications.
Any one application can stand on its own merits, but the four applications together support and enhance the benefits to be gained from each other, the ultimate expression of which is a person centered system of health care provided by telehealth.
Malaysia's goals are the development of a system of healthcare which is focused on individuals and lifetime health management. Telehealth provides us the means of bringing about this transformation of our healthcare system. Its our hope that successful implementation of our projects will result in Malaysia becoming a centre of excellence for telehealth as well as a model of good healthcare delivery as a whole.
Lifetime Health Records will contain summary information derived from wellness visits, acute care visits and chronic care records. More detailed information can be assessed from the encounter information. Evidence-based health plans/care plans will be incorporated into the respective wellness or chronic disease visit templates.
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ITU-D/2/000-E
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