Telemedicine

As social security systems are undergoing a deep crisis even in the most advanced countries as a result of scientific advances and longer living , health care systems are also facing a new problem.

The challenge is the same for the whole world: longer life expectancy and larger use of practices and medicines; difficulties to access and transfer medical information in a fast way; and, mainly, a marked increase in the expenditure generated by a larger number of users.

It is unanimous the criterion that having a unique file with medical information for each citizen, i.e. the Unified Clinical Record, would be one possible solution. This would have the goals of (i) achieving the fastest access to such information; and (ii) reducing costs by decreasing unnecessary practices and consumptions.

The only way to create a file enabling to contain all this accessible and confidential text, image and sound data produced by different practitioners from different institutions, and even from several cities or countries, is through digital support, by using an electronic format to make use of the advantages offered by the Internet.

If we consider that the Internet is basically a safe and efficient means for distant information interchange, nothing more appropriate than applying it for accessing to medical information at any time and place, only by previously authorized users, for the benefit of patients, health care providers and institutions.

The unified clinical record is definitely the best alternative for the overall understanding of the patient´s history, his/her better attention, and the best administration of resources, helping to control practices and consumption in real time.

I. ELECTRONIC CLINICAL RECORD:

It is the digital document which enables doctors, auditors, specialists, authorities of health organizations, and patients to have access to the information in each clinical record, with text, image and sound at any time and place with the following advantages:

• It provides healthcare organizations with an online authorization and audit application at a low cost of implementation • It offers confidentiality and adequacy of the databases essential for the management of sensitive information, protecting and preserving personal data. • It enables patients to have access to their unified clinical record through the Internet

II. WORLD OVERVIEW

UNITED KINGDOM

It is one of the most advanced projects worldwide. With a deep political involvement from the British government, this has been a computerised healthcare plan intended to provide inhabitants with their Electronic Clinical Record within the next 10 years.

The country has been divided in regions, bidding the areas among different providers. British Telecom was assigned the London area and the development and operation of the net which interconnects all the country, so that doctors, medical institutions and patients can access information through the web in real time.

BT Health, a Healthcare Consultant division of British Telecom, is implementing the Unique Electronic Clinical Record project nationwide. This program, called National Programme for Information Technology (NPfIT), is the responsibility of Connecting for Health, an executive agency of the British Ministry of Health, created in the year 2002 to upgrade the English healthcare system. NPfIT creates an infrastructure that improves patient care, increasing the efficacy and efficiency of doctors and staff of the English HealthCare System (NHS).

The project milestones are as follows: • To create the NHS Care Records Service to share Clinical Records at a national level, in a safe way with physicians and healthcare providers depending on their authority. This transactional database will serve 50 million patients. • Appointments in any national hospital through the Internet. • Electronic transmission of prescriptions among pharmacies, hospitals and physician´s offices. • N3 (New National Network): new IT and communication infrastructure that will cover current and future needs through a new and safe national healthcare network. • PACS: Storage and Transmission of all kind of digital images and videos among all healthcare organizations.

Patients will not have to repeat the information from their Medical Record in the different stages of the healthcare process (Primary, Secondary Physicians, etc.), and this will improve the quality of assistance provided to patients.

This will revolutionize healthcare and will turn NHS into one of the of the most advanced organizations in the world, standarizing health information at a national level. (Source: Mariano Groiso, MD- BT Health - London)

UNITED STATES OF AMERICA

As of the HIPAA Standard established by the US Congress in 1996. (HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT - PUBLIC LAW 104-191 AUG. 21, 1996) progress has been made to standarize healthcare electronic transactions, as a means to promote the intensive use of electronic data interchange in the US healthcare system, seeking to simplify the administration of the industry as a whole.

The objective of this regulation, issued to improve coverage portability and continuity of the health insurance, is to fight against fraud and abuse when providing health insurance and medical care, as well as to promote savings in medical expenses, and to improve access to health-related services and coverage, among other purposes.

The regulation also deals with the safety and confidentiality of healthcare information, with the object of improving the efficiency of the nation´s healthcare system .

As a Presidential Directive of the current government, the electronic- and web-based Universal Clinical Record will be implemented in the year 2014 for all the citizens of this country.

ARGENTINA
PILOT TEST IN HOSPITAL SIRIO LIBANES DE LA CIUDAD DE BUENOS AIRES

In October 17 2005, with the invaluable support of the authorities of Hospital Sirio Libanés, the cooperation of Telecom de Argentina, Intel, Microsoft, and Certisur, the Fundación Iberoamericana de Telemedicina (Telemedicine Ibero-American Foundation) implemented the computerised system of Electronic Clinical Records called “ACUARIO”. This is an Internet-based pilot test to help the Hospital doctors, authorities and patients to include and/or get to know the information of each clinical record, with text, image and sound, from any place and time in the world.

The goals of the test have been the following:

• To provide Hospital Sirio Libanés de la Ciudad de Buenos Aires with one application for the Control of Health Services and Follow-Ups of their patients.

• To centralize and improve online healthcare authorization and audit administrative procedures at a low implementation cost.

• To provide doctors (treating, specialized, and primary physicians) with a system for consultation and follow-up of the patient´s health.

• To offer patients the possibility of accessing their unified clinical record via Internet. To make appointments through the Web.

Technology:

• The system only requires for PCs connected to the Internet, or GSM mobile phones with GPRS connectivity.

• No chip cards or readers required

• The Hospital establishes the levels of access to the different layers of information

• The hosting has been installed in the data center of Telecom Argentina, what guarantees confidentiality and integrity of the data with more safety and availability, thus avoiding hardware investment, redundant connectivity and security and back up systems in the institution.

Pilot Test Results:

• Over 10,000 Clinical Records processed

• Text Clinical Records with 2 Mb per patient.

• Very low cost of implementation – only PCs and Internet connection

• High level of acceptance from healthcare providers.

CONCLUSIONS (1)

For Hospitals or Health Insurance Companies, the Electronic Clinical Record is a management tool which prevents fraud by making each patient´s unified clinical record accessible to auditors and authorities; it permits to control the doctor´s prescriptions and their authorization in real time, without the need for the patient to go to the organization, as well as to confirm appointments with specialists or labs, and even to set side prescribed (and authorized) medication at local pharmacies.

CONCLUSIONS (2)

For patients, this means having access to their clinical records on the Internet, just with their password, with no chips or special readers, and having the possibility to access texts, images and even sound 24 hours a day all over the world, with the significance that this information represents in case of accidents, risk groups or medical consultations.

FINAL CONSIDERATIONS

The impact of the technological change is not only turbulent but also violent. The change of paradigms is not easy to assimilate in our lives and even less in the regulation but, beyond the advantages of the efficiency and simplification of processes, this new Information and Knowledge Society undoubtedly offers us tools, through TIC (Information and Communication Technologies), which enable us to improve our quality of life.

To provide a good example of the importance of having accurate, fast and timely information, lets imagine we are being assisted in a hospital emergency room by a young professional who needs to become acquainted urgently with our medical history, side effects, and other aspects which might allow him to make a diagnosis and treatment decision our life could depend on. Rejecting this tool is rejecting the right we all have to better medical assistance in case we need it, as ALL OF US ARE PATIENTS.

On the other hand, beyond resistance to change, transparency is essential to face the crisis of healthcare systems which, as a result of the lack of anticipation, bad administration, unnecessary or fraudulent practices, in addition to adult population growth and consumption, today is on the way to disaster.

The authorities of the most developed countries have understood it well, have issued norms, and today this is in the process of implementation.

We hope Latin-American authorities take this example in order to achieve a more fair and perfect society.

Guillermo Schor-Landman
Attorney at Law Associate
Reporter ITU D Q 14/2 Telemedicine (1998-2002)
President of Fundación Iberoamericana de
Telemedicina A Member of Sociedad Científica Argentina