Health Information Management
Health Care Delivery in Far Away Places
It is said that necessity is the mother of invention. Sometimes this cliché even helps plot the course we take in life. That’s what happened to Dr. Sajeesh Kumar, assistant professor, Department of Health Information Management. As a young boy in rural India, Kumar’s grandfather was working in the fields when an accident caused a serious eye injury. While the general practitioner did his best, by the time they traveled to the city to consult an eye specialist, Kumar’s grandfather had lost his eyesight.
“I thought, why should we have to go to the city? Why did we have to wait for hours and hours and hours in the clinic?” says Kumar. As he grew older, he realized that when Neil Armstrong walked on the moon in 1969, NASA scientists were able to monitor his heart rate from 250,000 miles away. “Telemedicine isn’t new; we just needed to adapt it to the various medical disciplines.”
So began Kumar’s educational sojourn, first with a degree in vision science from the Medical Research Foundation in India, to a master’s in medical informatics from Erasmus University in The Netherlands, and finally a doctorate in telemedicine from the University of Western Australia.
“Telemedicine uses telecommunications to deliver health care, often over great distances, with potential cost savings, particularly in remote and rural areas. It is a multi-disciplinary undertaking requiring expertise from the telecommunications, health care, and information technology sectors,” Kumar explains. “However, there are also concerns about liability, confidentiality, and other policy and regulatory issues.” So the discipline is working to adopt sound policies and strategic plans that guarantee the provision of high-quality, sustained, and integrated health care services.
And Kumar has studied the practicalities of telemedicine around the world. No more profound an example of where it is successfully being used is the Republic of Seychelles, an archipelago of 115 islands 1,000 miles east of Africa in the Indian Ocean. The total number of inhabitants in the island chain is just 82,300.
There is one primary hospital in the capital of Victoria, some private clinics, and community health centers on just four of the islands, making regular medical care and screenings for the average resident very difficult. Patients need to be transported by boat to the main island for specialist care. Therefore, the Seychelles represented an enormous opportunity to demonstrate the importance of telemedicine.
“With my personal interest in visionrelated diseases, I focused on glaucoma, the second leading cause of blindness today after diabetic retinopathy.
“I wanted to do further investigation of telemedicine and I found Western Australia to be ideal,” Kumar points out. Western Australia is the second largest subnational entity in the world – almost a million square miles – yet has a population of just 2.1 million. As an example, he points to the northern town of Kununurra, with just 3,700 inhabitants, some 1,900 miles from the capital of Perth. Kununurra is too small to support its own hospital, yet too remote for citizens to regularly travel to health care facilities in the capital.
Traditionally, ophthalmologists and other medical personnel would travel to far-flung sections of Western Australia once or twice a year. But this was an expensive undertaking, Kumar points out, often costing $8,000 per week. But the idea of tele-ophthalmology was appealing to the Australian Department of Health. “Web-based eye care makes incredible sense,” says Kumar, noting that it increases efficiency, results in digital, quality images, and newer technology has mitigated band-width problems.
“We can train non-professionals, including retirees, to operate the equipment, which is very user friendly.” Images taken with new, portable devices are stored on a laptop and then uploaded to a centralized server. When a patient is screened, an e-mail is automatically sent to an ophthalmologist who can provide the patient with a diagnosis within 24 hours.
Kumar comments that early in the process, around the year 2000, there was some concern about patient confidentiality. “But today, we have excellent firewalls and secure systems that insure all information is protected.”
The Evolution of Medicine
Telemedicine is just the next step in a medical care system that has evolved over the last century. “There has been a shift in medical care delivery – away from the hospitals and into the community.” In fact $155 million from the American Recovery and Reinvestment Act (ARRA) has been released to establish more than 5,500 community health centers across the nation.
“People now want quality health care in their neighborhoods, or even in their homes,” says Kumar. “They ask their physician for certain treatment or medications. There is extensive information available on the Internet and patients are becoming much more savvy about their care.
“I think the shift in the current century will be toward even earlier diagnosis and prevention rather than treating the disease,” he continues. Continuing advances in genotyping could allow more individualized treatment. “But at the same time, the population is aging, and there will be more morbidity and multiple diseases to treat. I witnessed this in Singapore, where patients required more specialized care. The medical establishment is adjusting to the new paradigm.”
And of course, patients with multiple diseases are a greater challenge to manage. “Electronic medical records are the way of the future. Change is always difficult, but in the end, costs will be reduced, medical errors will be reduced.” The federal government recognizes the importance of electronic records. The ARRA includes $19.2 billion to jumpstart the task of EMR expansion, and President Obama’s proposed budget allocates $76.8 billion over 10 years to continue the process.
As telemedicine becomes more common, the importance of electronic health records will grow. The accessibility of up-to-date information on diagnosis and medications, for example, will be paramount to success. Just as importantly, the records will be updated quickly and easily, ensuring that the next health care professional will have access to the new data. Kumar also points to a green benefit to electronic medical records, “Think of the trees that we’ll save by switching from paper records.”
He takes it a step further, “Offer carbon credits for people who use telemedicine. The health care industry is already one of the biggest users of energy in this country. If we can eliminate the need for patients to drive to see their physicians or health care professionals, we can improve health care delivery and help save our resources.”