By Claus Pedersen, International Manager, Medcom International
Information and communications technology (ICT) is an umbrella term that includes any communication device or application, encompassing:
- Television
- Radio
- Cellular phones
- Computers
- Network hardware and software
- Satellite systems
- Various services and applications associated with them, such as videoconferencing and distance learning
ICT is often spoken of in a particular context, such as education, health care, or libraries. The term is somewhat more common outside of the United States.1
How ICT betters healthcare
ICT has improved healthcare delivery. One of the most promising developments is the use of videoconferencing, which is becoming central to the practice of telemedicine, the delivery of clinical services using ICT. Over the past two years, the Danish Health Service has undertaken about sixteen telemedicine projects using videoconferencing, inspired by the belief that off-the-shelf technology could radically change and improve the way we deliver healthcare.
The off-the-shelf aspect is important regardless of the industry you're in. Any ICT project comprises these technical and social challenges:
- The difficulty of integrating new technologies and applications
- The problems that come from trying to change the way people work
Although videoconferencing is not as mature a technology as one would like (the lack of standardization can present particular challenges in the areas of security and privacy), its largely off-the-shelf nature greatly reduces the technical challenges, leaving more energy and time for dealing with the workflow and social issues.
In Healthcare, Time Is More Than Just Money
In healthcare, time is more than just money, it's often life itself. A good example of the importance of time in healthcare is the treatment of strokes. A stroke can be either ischemic (caused by a blood clot) or hemorrhagic (caused by a burst blood vessel). Following a stroke, there's a three-hour window during which, if the stroke is determined to be ischemic, the administration of thrombolytic (clot-dissolving) drugs can reverse the damage, or greatly reduce the likelihood of grave incapacity. However, administering these drugs in the case of a hemorrhagic stroke will kill the patient. It takes an MRI scan and consultation with a skilled radiologist to make the proper determination. MRI machines, while expensive, can be installed in multiple locations, but radiologists with this particular skill are quite scarce.
In South Denmark (Syddanmark), that expertise is available only at Odense University Hospital, which meant that about 40% of the region's 1.2 million inhabitants were close enough to get to that hospital within the treatment window in the case of a stroke. But now, using high-speed networking to deliver high-resolution MRI images and videoconferencing for consultation, virtually everyone in the region has timely access to this life-saving treatment. In fact, from September 2007 through February 2008, 75 people were evaluated using the new system, and five of them turned out to have an ischemic stroke that was successfully treated using thrombolytic therapy. Without this particular telemedicine application, those five people would have been dead, or severely incapacitated.
Talking It Over
Clinical medicine involves consultation between healthcare professionals and videoconferencing can deliver notable benefits. It is also quite useful in consultations between patients and doctors. You might think that patients would insist on face-to-face meetings with their doctors, but there are applications where they seem to prefer videoconferencing. One is in the treatment of alcohol abuse.
The original impetus for using videoconferencing in alcohol abuse treatment was much the same as that for stroke treatment: reaching more people with specialized treatments. With videoconferencing, we don't have to shift them around to different treatment centers as we change modalities, which makes it more likely they'll stick to it, and saves money for the Danish Health Service.
We found that young people were even more comfortable videoconferencing-not surprising, given the "always connected" lifestyle that seems the norm for teens. This is particularly important, as alcohol abuse among young people has historically been a problem in Denmark; their readiness to accept video consultation has helped us reach more people with the care they need at a lower cost.
Challenges of Videoconferencing
Deciding when and where videoconferencing makes sense isn't very different in healthcare than in any other industry, and the challenges are similar, but you should ask yourself these questions::
- Does videoconferencing makes business sense?
- Is videconferencing more efficient and/or does it deliver higher quality services?
- Is this part of our core business competence, or are we being distracted by something flashy but unimportant?
- Can the system we've chosen scale up to support our normal daily business, and will be economically sustainable?
- How well does videoconferencing fit into the normal workflow?
Dealing with social change
Many times, we've found that the clinical personnel are the ones pushing for change: they see how videoconferencing could make their job easier. But other times, you'll be pushing a new kind of workflow on them, and unless you make every effort to listen to them and involve them in the journey, the social challenges of the project will consume far too much of your time and energy. And, once you've got the doctors and nurses on your side, it's a lot easier to bring the administrators and bureaucrats around!
Finally, don't forget the interplay of process and innovation. A good example of this challenge, one especially germane to videoconferencing, involves payment processes, especially where national healthcare is involved. A hospital that offers telemedical consultation may find it a money-losing operation because payment is predicated on "who has the body," so that the hospital at the other end of the video connection gets the money. Unless you can come up with a fair revenue or payment-sharing process, innovation will be stifled.
