Informatics Team

Telemedicine,mhealth
References and Wearables

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 History of Tele-health
• The National Aeronautics and Space Administration (NASA) efforts in
telemedicine began in the early 1960s

• The main goal was to provide remote health support and consultations to
astronauts in space

• In 1989, NASA conducted the first international telemedicine program using one
way video and voice

• Telemedicine consultations were conducted

Period Telegraph Telephone application

1835 Telegraph Used in the American Civil War to deliver casualty lists and order supplies.

Initially used for voice communicaion. About 30 years later, used to transmit
1876 Telephone
ECGs and EEGs.

Used to supply medical advice to seafarer. In 1920 the Seaman’s Church

1895 Radio Institute of New York provided medical care using radio. The CIRM in Rome has
been using it as well

A two-way closed circuit television link was set up between the Nebraska
Psychiatric Institute in Omaha and the state mental hospital in Norfolk for
Late 1960s Video/ television
educational purposes
NASA strted efforts for telehealth and telemedicine

1990s Videoconferencing Videoconferencing for health purposes became more common

Mid-1990s Internet Use of the internet for health purposes

Telemedicine
Telemedicine is defined as:
“the use of electronic information and communication technologies to provide and
support clinical care when distance separates the participants ”

Combinations of:
– Telecommunications Technology
– Medicine (clinical services)
– Access to patients information (records)

-Telemedicine is composed of the Greek word τελε (tele) meaning

'far', and medicine. It is applying medicine when distance is an
separating both sides “healing remotely” “applying medical services
remotely”

- it is the use of telecommunication and information

technologies for the provision of clinical care to individuals
located at a distance
Telemedicine cont… Telemedicine “includes professional in both sides
in the same time using electronic medical record
using hospital network”examples:
Main features of telemedicine: • Tele-radiology “consultation, reading and
•Usually is conducted in clinical settings diagnosing images”
• Both sides include professionals • Tele-pathology sending pathology images for
• Clinical service or clinical practice (clinical services) diagnosis “
• Utilization of secured telecommunications “using infrastructure • Teleconsultations “for second opinion for a case”
-devices and networks that provided by health care provider- not • Tele-ICU “ use to support the icu”
• Tele-surgery “support in surgery or conducting
personal telecommunication”
minimum invasive in procedure”
• Access to patients information (EMR & other records)

Tele-health vs. Tele-medicine

Tele-health is : Tele-medicine is:

the use of electronic information and communication

The delivery of health- related services and information via
technologies to provide clinical care when distance
telecommunications technologies
separates the participants
Provide clinical care
Provide health care related services

EHealth
Also written e-health, is a relatively recent term for healthcare practice which is supported by electronic
processes and communication, some people would argue the term is interchangeable with Health Informatics.

Four essential components make the e-health :

➢ Medical knowledge (data, information, knowledge) that lends itself to being stored in computer files (digital
format)
➢ People who are willing/able to share, apply and use this knowledge
➢ Data processing equipment “tool” to record, store and process this data
➢ Telecommunication facilities to transfer (exchange) this data electronically between remote locations.

Telehealth vs. Telemedicine & ehealth

E-health
Telemedicine Telehealth
Main umbrella ☂

-Tele-radiology -Telecare -Online information

-Tele-pathology -Home monitoring -Online transactions
-Teleconsultations -tele-rehabilitation -Online interfacing with
-Tele-ICU -Remote patient patient/consumer
-Tele-surgery education -local use of e-services
-Consumer awareness and transactions
-Tele-Home support
-coaching
 Telehealth

Tele-health is defined as:

“The delivery of health-related services and information via telecommunications technologies”

Examples:
• Could be: (nonclinical services) “health related” Patient Monitoring (Home care)
Home care Blood pressure monitors
Health education Using videoconferencing
Patient support Interactive Applications
Home monitoring Tele-coaching, Videoconferencing
-coaching
Telehealth would promote: Store and forward applications
Patient-provider communications images, HBA1c
Patient self-management with
feedback Patients are setting at home and use device built in system that could take vital signs as
Health literacy and education an example and send it online to health care provider on the other side
Patient support and follow up It is easy maintaining and support, help in patients education and all of this without need
for travel
Home monitoring

Why Telehealth/telemedicine?
• Access: Time, Travel, Expense, Information storage
• Health Provider Collaboration
• Enhanced Communications in all directions
• Smart Devices & Computer Applications common and non-threatening
• Improved professional education

Telemedicine/telehealth justifications
• Availability of Information management, and Patient information systems
• Medical data (signs, symptoms, test reports, etc..) – Appointment scheduling – Archival and
retrieval of
patient records
• Low cost solutions – Using technologies
• Service to larger population – Through public health care delivery systems
• Development of knowledge-based system – For decision support – For training and
education, etc.

Reasons and justifications

• Poor infrastructure in healthcare facilities “health care centers and hospitals are not well distributed and don’t
have proper access for the patients”
• Unavailability of experts (disparate distribution) “especially in rural areas”
• Lack of proper medical education “especially in small villages”
• Low physician-patient ratio and large populations “make it more difficult to patient to hve enough attention from
physician and health care provider”
• Poor home care for elderly and special needs patient
• Poor choric disease management such as diabetes
• Ruler and isolated areas
• Low quality of health care and low access “because it is assumed that tele health and telemedicine should improve
quality and accessibility for health care services”
 Telemedicine/telehealth main objectives

• Improve diagnosis and better treatment and management

• Continuing education and training
• Quick and timely follow-up for patients
• Better and quicker access to comprehensive patients data
• Access to specialized healthcare services to under- served rural, semi-urban and remote areas
• Early diagnosis and prediction and treatment
• Reduce physician’s fees and cost of medicine
• Reduce visits to specialty hospitals
• Reduce travel expenses
• Early detection of disease help in follow up
• Reduce burden of morbidity
• Sharing medical data between patients and health care professional
• Discussing a diagnosis, treatment plan, prescription or advice. which might involve patients located at a
remote clinic, a physician’s office or home.
• Specialist and consultants assisting general practitioners in rendering and diagnosis
• The transmission of images / videos along with patient data for diagnosis and second opinion
• Remote patient monitoring
• Collect and share data remotely for monitoring and interpretation and management
• “home telehealth” applications:
– Devices to capture a specific vital sign, such as blood pressure, glucose, ECG or weight. Which Supplement the use
of visiting healthcare professionals .

Medical education and mentoring For juniors, residents,physicians under training

– Provision of continuing medical education

– Special medical education seminars
– Targeted groups - expert advice provided
– Medical procedure training and discussion.
Ability to use intrusive to provide
education and awareness for
Consumer medical & health information consumers not only patients and
create hyper communication between
patients and consumers and
– the use of the Internet for consumers to obtain specialized health information professionals to provide support “for
example cancer patients”
– On-line discussion groups to provide peer-to-peer support.

Types of telehealth/telemedicine interaction can be classified as:

Real-time “synchronous” Store and forward Remote monitoring

Record video or message that can be

At the same time like in video seen later
conference Involves non-interactive transmission
A technique to monitor patients at
Parties communicate simultaneously of information from on site to another.
home, in a nursing home or in a
via a telecommunication network, Sometimes referred to as asynchronous
hospital for personal health
also called synchronous or or pre-recorded and involves
information or disease management
interactive information being captured and then
transmitted to the other party for
advice, opinion or specialist consultation
 Participants interactions

The nature of the communication in health can be:

1– Patient with practitioner (as we see in Telehealth)
-Telepsychiatry is a common application usually performed by videoconferencing (having telemedicine in telepsychiatry, the privacy for
the patients is the main issue, this is why in most cases there’s no other professional for other side)
-An evaluation of Telepsychiatry services in Alberta, Canada, showed that it was acceptable to users and there were significant cost
savings from avoided travel by psychiatrists and patients

2– Patient with patient (that is, cyber community support)

-Support groups : communication between people who have similar condition. (To support each other and share experiences)
-A study of the use of audio conferencing by breast cancer patients in rural Newfoundland showed that it provided valuable mutual
support, despite the distances.
– Website like PatientslikeMe provide both synchronous and asynchronous telehealth

3– Practitioner with Practitioner (like Telemedicine or Telehealth for education)

4– Practitioner or patient only (like the self education)

Telehealth/Telemedicine Settings

Schools Assisted Prisons and

Rural area
(Where there is a
(Either telehealth for
education & health Clinics Hospitals living isolated areas
promotion or for (People with (Because they’re not
distance) supporting if we have a
disability or aging frequently able to access
physician in the school) (For teleconsultation) problems) medical services)

Driving Forces of Telehealth/telemedicine

Quality of Care Cost of care Access of care Others

-Provide diagnostics & -Prevent/early treatment of -Access for people with situational (For
better consultation disease = lower cost of care limitations (physical disabilities, people in
-New mode of treatment (both to provider and society) elderly, etc) prisons
-Improve patient -Lower cost from travel -Minimize distance of travel for people and not
satisfaction (early in hard to reach/isolated locations have
treatment, higher frequency (Reducing the cost, so we will -Not limited by time/place services)
of encounter provide services for more (So we can use it if there’s an issue with
patients) time or place)

Identify equipment and technology to sustain telehealth

Four types of information transfer common in telehealth: Audio, text, still images, video

The following should be consider:

-Equipment to capture the information at each site (for example: the vital signs)
-Communication technology to transmit this information between the sites
-Equipment to display the information at the relevant sites
-Patient devices are easy to use and user friendly
-Harm free
-Secure communications
Emerging Telehealth/telemedicine applications

Telestroke Teledermatology Teleconsults Telewound care TeleICU

(Very easy to use)

Teleophthalmology Telecardiology Telepsychiatry Telepathology Teleradiology

TeleEndocrine Teletrauma TelePediatric Pre& post-surgical care eVisits

Telestroke: Emergency Care and Trauma:

– ER Consultant conduct a CT Scan; – Timely Trauma Evaluations For Patients In Remote Or
– Trained neurologist performs a live, real-time rural areas.
– Assistance With Triage And Transfer Decisions.
audiovisual consultation – Learning Opportunities For Community Providers.
– Make diagnosis and appropriate treatment
recommendations;
– Send documentation electronically

Mobile health

Mobile health (mHealth): is a term used for the practice of medicine and public health supported by mobile
devices and applications.
(It is Utilizing mobile services & applications for medical and clinical practice and public health domains)
-The term mHealth has been defined as “medical and public health practice supported by mobile devices, such
as mobile phones, patient monitoring devices, personal digital assistants and other wireless devices.”
-The term is mainly used in reference to using mobile communication devices, such as mobile phones, tablets
and PDAs, for health services and information.
-The mobile Health is a sub-segment of eHealth.
-The mHealth market earned estimated revenues of $230 million in 2010 and estimated to reach $392 million
in 2015 in USA, according to a new report from research firm Frost & Sullivan.
-It was reported in 2016 that there were 259,000 health apps available globally and the trend is now slowing.
-Only 24% of healthcare apps recorded more than 50,000 downloads, most likely due to too many choices.
-In general, health apps do not generate that much income so not all will survive.(this is one issue of M-health
applications)
-Consumer apps are the most popular type of healthcare app,
-in 2018 they recorded 106,4277 apps

Saudi Arabia: Internet Growth and Population Statistics Consumer Health Informatics
(Now our population having more access to internet, this is a very • Mobile and internet subscriptions:
supporting fact that we can reach the patients) – In 2014 mobile services subscriptions 52.7 m (171%)
– In 2014 mobile data subscriptions 31.5 m (100%)
– In 2017 mobile services subscriptions 40.7 m (127%)
– In 2018 mobile services subscriptions 43 m (132%)
– In 2018 mobile data subscriptions 29.1 m (89.3%)
-Mobile is the most Pervasive technology ever invented

20111 USERS- > 12,500,000

2014 USERS- > 16,500,000
2015 USERS- > 21,500,000
2022 USERS- > 32,500,000
 Mobile health uses

Health care providers use mobile health technology Patients use mobile health technology to:
to: – track their own health data through mHealth apps
– access clinical information (e.g., through mobile health and devices, like the Fitbit®
apps and mobile-enabled electronic health records) – access their clinical records through
– collaborate with care teams (e.g., with secure text mobile-enabled patient portals, (to access their data &
messaging) hospital information system, for example: E-Sihi)
– communicate with patients(e.g.,through patient portals – communicate with their providers (e.g., through
and text messaging), (for patients education & HIPAA compliant e-mail and secure text messaging).
teleconsultation) – Receive clinical services, and consultations
– offer real-time monitoring of patients – Track Their Health Vital Signs
– conduct research – Receive Health Education And Awareness
– provide healthcare remotely

Mobile health challenges

Distraction: mobile technology, in particular

smartphones and specifically text messaging can be Privacy/security: (big threat)
distracting when combined with activities such as clearly, mobile technology represents a security risk for
driving an automobile. Several studies have confirmed patient data and the healthcare system’s network.
that mobile technology is also distracting in a medical
environment. Which could increases medical.
malpractice.48

Source of infection: there is evidence that mobile Interference with medical equipment: there is a
devices contain bacteria that could be harmful in certain potential risk of smartphone electromagnetic radiation
locations such as the operating room. on pacemakers and other cardiac equipment. Some
argue that phones should be kept at a distance of
greater than 1 meter to be safe.

Lack of quality control: Due to the proliferation of

mobile apps many argued that there needed to be a Lack of evidence:
means to judge the quality of apps, particularly mHealth despite more than 500 mHealth studies, there is a
apps.(this is one main issue that the industry should be well paucity of high quality evidence to show that mHealth
organised and well monitored because it is serving a very big positively impacts patient outcomes.
sector: the patients, consumers, relatives)
– In 2015, an Australian expert panel convened and
developed
the 23-item scale Mobile App Rating Scale (MARS). This scale
has excellent internal consistency (alpha = .90) and interrater
reliability intraclass correlation coefficient (ICC = .79).52

Financial unavailability: Literacy rate and diversity in languages:

-The technology and communication costs being too – Some areas and countries has very low literacy rates
high, sometimes make Telemedicine financially examples in Africa and Asia.
unfeasible. – Only very low rate of populations being well versed in
-cost effectiveness and return on investment are not English.
well studied and communicated.
(Very important to evaluate the cost effectiveness & in the
same time communicate and publish these results to the
decision maker)
 Characteristics of Patient Centered Care

-Respect for patients values, preferences & needs and privacy

-Coordinated and integrated care
-Information, Communication & Education (very important element)
-Physical Comfort
- Emotional Support
- Involvement of family & friends
-Continuity of care (one of the key element, it is like for patients who aren’t able to travel most of the time)
-Access to care (so they can request referrals, discuss cases with professionals, asko for refill their medications with
no need to travel)

It’s a Different Ball game

In an eHealth environment, Information Moves rather than the Physician or the Patient
eHealth
ePhysician - eConsumer !

Telemedicine/ Telehealth & mhealth Outcomes

Is “At the Point of Care” Too Late?

-Better control over the disease with less overall costs.
-Improve patient's quality of life.
-Less visits to the emergency department.
-Increase satisfaction.

- Early detection of at-risk patients

- Provide personalized evidence to enable
pro-active decisions

Telemedicine in Saudi Arabia

Few studies have been conducted about telemedicine in Saudi Arabia and three studies have conducted
recently the last 2-3 years
-Telemedicine Towards Better Health Outcomes in Saudi Arabia: A Scoping Review
-Assessment of the Attitude and Current Utilization of Telehealth Applications Among Diabetic Patients in King Saud
University Medical City, Riyadh Saudi Arabia
-Assessment of Physician's Knowledge and Attitude of Telemedicine in Riyadh Region, Saudi Arabia
Assessment of Physician's Knowledge and Attitude of Telemedicine in
Riyadh Region, Saudi Arabia

Objectives: Assess the knowledge and perception of telemedicine and its applications among health professionals.
Secondly, to determine their willingness towards adopting telemedicine in clinical practice.
Target group: Healthcare providers in Riyadh. 2017-2018
Methods: Cross sectional study conducted in 2016 in 4 medical cities: King Abdulaziz Medical City, King Faisal
Specialist Hospital and Research Center, King Saud Medical City and King Saud University Medical City.
Adapted questionnaire from previous studies.
Results:
-Characteristics:
391 Healthcare Providers
301 Male
90 Females
61% aged between 20-30
73% Saudis and 27% non Saudis.
-Technology use: 90% of Saudi participants have more than two smart devices compared to non-Saudis 87%.
-95% Agreed and showed significant (P = 0.048) are willing to implement telemedicine.
-67 % of participants think that telemedicine is a viable approach for providing medical care services to patients.

Very important that

should be proper
communication between
clinicians, ITs and
informaticians.

One of the main issues

Conclusion:
The findings of the study concluded that majority of the health professionals have moderate level of knowledge
about telemedicine technology, however, majority of them have a high positive perceptions and are willingness to
adopt it. The major barriers in the adoption of telemedicine reported are privacy, lack of training, cost and issues
related to information and communication technology (ICT).
 MCQs
1.Which of the following is 2. What are some examples of
3.Which of the following is
considered an essential nonclinical services provided
promoted by telehealth?
component for e-health? through telehealth?
A) Increased
A) Medical knowledge stored in A) Surgical procedures conducted
patient-provider
physical files (analog format) remotely
communications
B) People who are reluctant to B) Prescription medication
B) Reduced patient
share and apply medical delivery to patients' homes
self-management with
knowledge C) Health education through
feedback
C) Data processing equipment videoconferencing
C) Limited health literacy
that cannot store and process D) In-person consultations with
and education
data digitally healthcare providers
D) Decreased patient
D) Telecommunication facilities
support and follow up
for electronic data transfer
between remote locations

4. Support groups is an example 5. A term used for the practice 6. What is the most important
of which one of the participants of medicine and public health element of Characteristics of
interactions? supported by mobile devices Patient Centered Care?
and applications, it is a
A) Patient with practitioner. definition of: A) Information,
B) Patient with patient. communication, education.
C) Practitioner with A) Telemedicine. B) Physical comfort.
practitioner. B) Telehealth. C) Emotional support.
D) Patient or practitioner C) Mobile health. D) Involvement of family &
only. D) Bioinformatics. friends.

Answer key
1.D 2.C 3.A 4.B. 5.C 6.A
 Members Board

Team leaders
Ghada Bin Slmah Rand AlJarallah Meshari Alshathri

Team members

deema aljuribah Nawaf Alrefaei

Layan Aldoukhi Sara Almajed
Fatima Halawi Fay aldossari
Raneem Alwatban Hazem almalki
Maram Beyari Abdulaziz Saad Alqahtani
Raid almadi Mohammed alzeer
Amani Alotaibi. Raghed Alnadeef