SOCIOECONOMIC ENVIRONEMENT IN TELEMEDICINE
O.Ferrer-Roca. Unesco Chair of Telemedicine.
VIII Summer Course 17-19th September 2000. Paris
The classical barriers encountered in the use of Telemedicine are ( )
1 / Medical licensing2 / Professional liability
3 / Hospital credential
4 / Patient confidentiality
5 / Data security
6 / Physicians and patient acceptance
7 / Regulatory issues
8 / Reimbursement
Seven of the eight above mentioned issues take into consideration legal and regulatory aspects that should be clarified in the forthcoming years. Most of them, can be handled using the existing norms and rules, but in order to assure a complete integration of the Health Care activities in the Information Society an extensive legislation work should be done.
LIMITATIONS
Probably the organizational changes in health care to get adapted to Telemedicine environments, will achieve the expected reduction on health expenditure. But we do not have to forget that the structure and organizational environment is unique in each location related with the history of the country or its religion, with its economy, geography and culture. All this issues not only produce hierarchical structures and peculiar specializations but specific health care environments link to the proportion of private and public health, the relevance of the primary care, freedom to choose the doctor, criteria of patients derivations, reimbursement policies, costs per patient (medicine, pharmacy and rehabilitation), legal framework and provision of trans-border medicine. With this scenario, Telemedicine is envisaged as the tool that will bring a greater structural changes in the health care organization, forcing the change in the analysis of problems and modifying the pre-established rules of health care sector.
As an example, Telemedicine will modify the inter consultations and derivations of patients, the reimbursement forcing to redefined the concept of “personal patient”; telemedicine will change the health territories, will change the area of influence of the medical specialists and force the cooperation between primary and secondary health care together with home-care to chronic patients.
Such revolution will modify the prior health care organizational scheme towards the forthcoming Information Society advances. Health organization require an urgent revision.
Organizational limitations are clearly demonstrated studying the impact of the hundreds of telemedicine pilots already implemented. Their real effect on their immediate environments had been limited :
Telemedicine integration in the HIS (Health Information Systems) environment is very limited
Their impact on the health care provision in the society is limited
There is a lack of demonstration of how telemedicine modify: the methods of work in health care, health care delivery or organization and how modify the structure of the health care system.
There is a lack of projects that show to politicians and health care managers the benefits of Telemedicine.
The novelty of this health delivery explain the rejection not only of some professionals, but also of Institutions that bring indifference and barriers to promote Telemedicine. This situation is not new in the field of Medicine that require a permanent updating of knowledge and skills as recognized in the Deontological Code that specifically stated ( art21 of the Spanish Deontological code of conduct) that “ it is an individual duty of a doctor and a compromise of all health organizations and authorities that participate in the profession to assure the knowledge updating”.
That is the reason why the CATAI [1] association that I preside together with 13 European partners from 8 European countries, had established that minimal knowledge to achieve the adequate health assistance quality providing medicine at distance. The “Body of Knowledge”[2]of telemedicine have been settle in 12 chapter that can be analyzed in TABLE 1, and that include from sociological to technology transfer issues up to a detail study of the standards and EU rules o quality guaranties. This experience have been summarized in the only existing text-book of Telemedicine
CHAPTER / CONTENTS1 / History of Telemedicine
2 / Minimal Technical Requirements
3 / Main Telemedicine Applications
4 / Basic Technical Knowledge
5 / Quality Control and Assessment
6 / Use and Indication of Telematic Tools in Telemedicine: Internet
7 / Training, including Distance Training, Teleworking and Teleteaching
8 / Data Security and Privacy
9 / Liability and Legal Aspects
10 / Health Economics in Telemedicine
11 / Technology Transfer and Social Aspects
12 / Emerging Issues
Table 1 Body of Knowledge (BoK) of Telemedicine
References:
1.- Ferrer-Roca O. y Sosa-Iudicisa M. Handbook of Telemedicine. Amsterdam IOS Press. 1998. 2º Edition 2000.
2.- Ferrer-Roca O. Telemedicina en el siglo XXI. Biblioteca Fundación Retevisión nº 2, 2000.Madrid.
[1]
[2]Ferrer-Roca O. The telemedicine body of knowledge. J.Telemed and Telecare. 1998; 4: 183-184.
Ferrer-Roca O. European teaching. Europ Telemed. 1998-99: 154-156.