Page 9 - Telehealth

Although still new, telehealth is nevertheless rapidly changing and recent technological
innovations call for a broadening of such conventional thinking reg arding the utilization and
scope of telehealth applications. Once confined to expensive demonstrations of medical care
to patients in remote areas, telehealth is quickly becoming an integral component in the
delivery of modern healthcare regardless of geographic or socioeconomic status. New
developments in telecommunications, lowered technology cost, and the establishment of
public networks and Internet-based systems will influence the growth of health information
and communication applications in such a way as to result in profound and revolutionary
effects on the delivery of medical care throughout the world. By providing direct links between
the general practitioner and major medical centers it can also sustain the education of the
physician and provide health professionals with a powerful tool to keep current with new
knowledge.

With the dissemination of new technologies, the conventional telehealth “hub and spoke”-
based systems are now being linked into broader networks, expanding their reach and
effectiveness and rapidly transforming the delivery of healthcare and the cost-effective access
to quality healthcare. Recent innovations in the use of computer-driven diagnostic systems,
micro -sensors, Web-based services, and interactive medical technology will most probably
improve the scope and access to applications even further. Direct patient -provider
interactions will increase involving two-way live audio and video visits between patients and
health professionals, patient monitoring data from the home to a clinic, or permitting the
concurrent access to the full patient medical record from any care point.

It is important to recognize that embracing telehealth is an important mechanism in the quest
to address some of the inequities in health. However, we need to underscore the value of
telehealth applications as perceived by local and remote providers and patients in meeting
their needs. Telehealth applications work most effectively when consideration is given to the
environment in which the health system operates. The variety of healthcare models requires a
diversity of informatics solutions that must be affordable and take into account a variety of
stakeholders. Particularly, many healthcare reform processes which emphasize effectiveness,
efficiency, patient safety, and accountability, demand information systems capable of
supporting various perspectives and requirements. Five years ago the cost of a typical
telehealth installation would have been exorbitant and prohibitive to most public health
systems. To day, the cost of hardware has been significantly reduced although it still remains
out of the reach of economically-challenged communities.

The critical issues related to the deployment of telehealth applications are not singularly
technological in nature but related to the organizational and personnel components of health
systems, for the most part precarious in the majority of developing countries. Frequently one
finds a dissonance between the expressed desire for change, and the actual incorporation of
information technology by the sector due to financial restrictions or difficulties faced in the
deployment of technologically complex projects into the public health sector. Other
impediments related to the broader adoption are related to high telecommunications tariffs,
training of health professionals, existing laws and regulations as well as the attitudes of many
involved in the traditional practice of medicine. Many concerns have been raised regarding
the sensitive areas of personal data protection, privacy, and the misuse of health data by third
parties. Other related issues involve data-related standards, authentication, credentialing and
licensure barrier issues, provider reimbursement, physical security of automated systems,
data communication security, liability, and those related to the regulation of
telecommunications and Internet service providers.

The Pan American Health Organization is pleased to partner with CITEL/OAS and the ITU in
launching “Tele-health in the Americas”. This publication attempts to answer some of the
questions, concerns, and possible solutions in the use of advanced information systems in
healthcare services in our Region. Besides an extensive review of the literature, the
document reflects the experience of a large number of Latin American and Caribbean
professionals and institutions. In keeping with the mandates of the Summits of Presidents and
Heads of State and Government, the Pan American Health Organization has emphasized the
importance of capacity building, excellence, and initiatives that aim at guaranteeing equitable
access to health and the wellness of the people of the Americas, of which this book is an
example. I hope this publication will have the widest possible distribution and will act as a
catalyst for the improved utilization of telehealth as one of the mechanisms of addressing the

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