Telemedicine is an area that can help us to improve health in our region. Given that child mortality, maternal mortality are critical issues in some countries; telemedicine has huge potential to extend medical care to the areas that does have access to very limited healthcare services. Going beyond, there is also potential to improve care through virtual consultations by removing geographical boundaries.
It is a pleasure for me to share the interview I had with Nazife Baykal, Professor, Director of Informatics Institute at Middle East Technical University. She has been actively involved in health informatics initiatives. Our conversation had a specific focus on tele-medicine and its adoption in Turkey.
Enjoy reading!
Can you please tell me more about METU Informatics Institute and its focus on telemedicine?
Informatics Institute, established in 1996 at METU, is one of the first of its kind in Turkey. Our mission is to promote creative and innovative interdisciplinary academic research from a comprehensive perspective. Informatics Institute provides a unique collaborative research and learning environment in informatics. To provide an interdisciplinary education and research, to train the next generation of researchers in this area and to be a leader in this field, we are bringing together academicians and experts from different disciplines. Our faculty and students are a diverse group with a wide range of experience and interests and our curricula emphasize the interaction and interchange between researchers working in all areas of informatics.
Informatics Institute has established different specialization areas in five departments. Each area has pioneering initiatives in their respective academic field and each is strongly committed to interdisciplinary collaborations within the university and beyond. Department of Medical Informatics is one of the five departments within the Informatics Institute. Telemedicine constitutes an important part of our medical informatics department and in addition to our full time faculty, we have affiliated faculty from various departments of METU and from other universities, such as Hacettepe and Akdeniz universities.
How did you become involved with telemedicine? What are the activities that you / your organization participated in this area?
Telemedicine is one of the major research areas of our Medical Informatics and Medical Data Mining Lab where we have been conducting various telemedicine projects together with our graduate students, research assistants and the industry. One of our recent work on telemedicine is the assistance study we have accomplished for the United Nations Development Program (UNDP) “Telemedicine: Quality Health Service for Poor and Remote Populations” project.
What excites you the most about these projects?
Today, despite all the opportunities provided by the 21st century, we are still experiencing poor health conditions worldwide. According to the United Nations report, child mortality rates, particularly in developing countries, constitute a significant matter. Throughout the world, every minute a woman dies while pregnant or giving birth. It is estimated that 515,000 women die every year as a result of pregnancy and childbirth. More than 99 per cent of these deaths occur in the developing world. In 2007, the number of people newly infected with HIV is estimated to be 2.5 million of which 420 thousand are children. Moreover, Malaria and Tuberculosis remain two of the world's primary killers, causing up to 4 million fatalities per year due to insufficient health care and support. In addition, chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality in the world, representing 60% of all deaths. These are very significant problems of our decade.
Considering all these, telemedicine is seen as a useful and potentially powerful tool: its use can improve the quality of healthcare while facing the challenge of reducing costs. I personally give more importance to high-risk groups and to life-saving research and development projects. In that regard, projects about infant deaths and high-risk pregnancy are very important for our country.
Another point that excites me about telemedicine is its use in preventive medicine through mHealth. Mobile electronic health tools such as cell phones, are rapidly transforming the face and context of health care service delivery around the world. In that, by promoting health-conscious behavior, the mHealth education and awareness programs currently in place have already had positive impacts. I believe, more personal mHealth services will become a part of our daily lives in the near future.
What are the major obstacles for adoption of telemedicine in Turkey? What word of advice you offer to address these challenges?
We can identify the obstacles for telemedicine adoption in four groups: technological; organizational and the human factor; financial and legal.
Technology related obstacles are concerned with adoption to new technologies, low bandwidth connections, portability and interoperability. Interoperability needs to be achieved at different levels through standardization and integration. In that regard, fully interoperable telemedicine stations that can interact with each other and make use of each other’s devices need to be developed. Portability, on the other hand, needs to be assured through portable medical devices and smartcards. These portable devices need to include all systems such as biosignal monitoring, image acquisition and display devices and nomadic computing.
There are many issues of concern regarding the legal and ethical aspects of telemedicine. These include the responsibilities and potential liabilities of the health professional. There is also the issue of reimbursement for care provided using a telemedicine service. In addition, the electronic record may be subject to abuses that can be carried out on a large scale and cause great damage. A wide range of data protection and information security measures will need to be taken to ensure the quality and integrity of such records. In the UK for example, European Union directive was formally adopted in 1995 which sets the obligations of those responsible for data processing as well as a number of important rights for individuals. The responsible teleconsultant or medical officer, as the data controller, must make sure these measures are enforced. In the case of the transmission of medical records to another location, the original data controller may remain liable for abuses. But as different elements of the records are spread throughout the different departments of a hospital or across different geographical locations, it may become difficult to ascertain who is responsible for protecting and controlling what. To this end, the designation of liability by contractual means, between the hospitals and remote users of a telemedicine network, would be the clearest and most straightforward way of achieving uniformity and predictability in terms of the distribution of responsibility for data protection and security.
Moreover, adoption of telemedicine requires an extensive investigation of a number of issues such as security, patient privacy, confidentiality, consent (of the telepatient), responsibility, liability, technical acceptability standards, financial standards, payment policies, telemedicine product liability and safety, improved data security standards and encryption techniques, etc. Financially, cost of initial investment may be an obstacle.
It is also important to mention that for telemedicine to be operational nationwide and to overcome these obstacles for a smooth adoption, a multi-perspective approach needs to be taken where the government, the industry, the academia, civil society institutions and the social security institution form a consortium to work together. Only such a consortium can establish the performance and legal issues related with telemedicine, and can address the issues I have mentioned.
Looking ahead 1, 5, and 10 years from now, where and what do you see in telemedicine?
Without any doubt, I can say that telemedicine will evolve and will benefit from the advances in technology. If the infrastructure that could respond to all the risks associated and that could deal with all the issues I mentioned previously is successfully built, telemedicine will then offer great benefits that we cannot foresee. Telemedicine has the potential to change and restructure health care services. For instance, in a couple of years it will be common to see peer to peer consulting between hospitals or continents. Also integrated systems for distance diagnostics and real time, interactive consulting between medical professionals will be a common experience.
In the near future, telemedicine and clinical decision support will benefit from emerging technologies, including wireless and broad band systems, 4G technologies together with the increase in the speed of transmission and the bandwidth. Smart pills, wearable and portable health devices will be very commonly used. In addition, more ‘personal’ mHealth services will be an inseparable part of future preventive medicine.
Any final thoughts?
It is evident that health expenditures have been rising every year in all countries around the world and important reasons behind this are the increasing rate of population in need of continuous health care like elderly citizens and citizens with chronic diseases. In my opinion, this situation brings an enormous load on health care systems as well as widening the gap of health personnel need. In addition, these conditions introduce direct, indirect, unpredictable loads and costs to national economies. There is no doubt that Turkey, as a developing country, also suffers from this condition. However, telemedicine applications like rural area telemedicine, distant care telemedicine (tele-homecare, elderly care, chronic disease care, etc.) and specific telemedicine applications such as tele-radiology, telepathology, etc. can reduce serious amounts of costs.
Having mentioned financial benefits, without any doubt, Turkey can benefit from telemedicine in many other ways. For instance, telemedicine applications can accommodate the core components, i.e. Equity-Productivity-Effectiveness, of health transformation program of Turkey. In addition to helping to cut down health expenditures, telemedicine can give citizens more effective and efficient health care with increased satisfaction of all stakeholders including patients, health care personnel and others.
I have to mention once again that for telemedicine to be operational in Turkey, the government, the industry, the academia, civil society institutions and the social security institution need to work together so that a common technological platform can be developed, nationwide policies can be made and the performance and legal issues related with telemedicine can be established.
Telemedicine is a necessity for tomorrow.