International Symposium on Telemedicine
(Including Telecare, Telehealth, E-Health and Distance Learning)

Gothenburg, Sweden
27 June - 1 July 2000

Background

Telemedicine (including telecare, telehealth, e-health and distance learning), which has developed significantly during the 1990s, from routine projects to those run by enthusiasts, is set to change the nature of healthcare. For various reasons, there is a great deal of variation from country to country concerning the development and use of telemedicine.

To exploit the possibilities offered by telemedicine, a multidisciplinary approach is necessary, involving, for example, the medical, public health, economical, organisational, technological, and industrial fields. This is equally true if we are to increase the quality of healthcare in its broadest sense, i.e. improvement of health, cost efficiency, education and research.

Aim of the symposium

The aim of the symposium was to focus on the development in the various fields of telemedicine, by bringing together a multidisciplinary team of international participants and a substantial number of invited speakers, to gain a deeper understanding of the needs and the factors determining the acceptance and diffusion of telemedicine.

An important part of the symposium involved targeting young researchers (up to the age of 35) from the European Union member states and associated countries. The symposium was supported by the European Union, under the Human Potential Programme, allowing travel and accommodation grants to be awarded to 21 young researchers. The aim was to enhance the skills of the young researchers in telemedicine, establish a basis for personal professional networking, and promote cross-border co-operation and research.

Arrangements

The symposium was organised by Telia Research, the R&D Company of Telia, the national tele-operator in Sweden, and was supported by European Union, under the Human Potential Programme. The symposium was run in a summer-school atmosphere, and boarding-school accommodation was offered. The host institution, the Nordic School of Public Health, enjoying a riverside location by the harbour port of Gothenburg, offered excellent conditions for lectures, studies, work and relaxation.

The symposium was attended by about 125 participants from 30 countries. The 21 young researchers came from Austria, Bulgaria, the Czech Republic, Estonia, France, Hungary, Ireland, Latvia, Lithuania, Norway, Poland, Romania, Slovakia, Slovenia, Spain, Sweden and the UK.

Contributions from 20 invited lecturers and discussion leaders from Belgium/EU, Estonia, Japan, Norway, South Africa, Sweden, Switzerland/ITU/WHO, UK and USA formed the basis of the scientific part of the symposium.

In addition to presentations from invited speakers and senior and young researchers, a scientific poster session was given including industrial information about products, services and systems. To stimulate as much interaction as possible between the lecturers and participants, not least for the benefit of the young researchers, "Meet-with-Professor" sessions were arranged in small groups that offered informality as well as personnel networking opportunities.

So that the participants could also learn about applications and systems in practice, four study visits were arranged:

• Air and maritime rescue co-ordination centre, MRCC, Gothenburg.
• Telemedicine at sea, "tele-ECG", at Stena Germanica (a ferry cruising between Kiel, Germany, and Gothenburg, Sweden).
• Telemedicine experience in head and neck cancer by using video-conferences for distant multidisciplinary treatment sessions, Sahlgrenska University Hospital.
• Picture Archiving and Communication System, PACS, Sahlgrenska University Hospital.

Lectures and poster sessions

The main conference themes, presentations and discussions are reported below:

The introductory part of the programme focused on global and national developments in telemedicine, including e-health, etc., covering industrial as well as developing countries. Presentations pointed clearly to an increased interest in telemedicine in industrialised countries, although a significant number of challenges remain before telemedicine can be implemented and used to its full potential. In developing countries, there is an urgent need to involve worldwide partners in public and private ventures to support the development of policies and render technical assistance. However, some developing countries have already launched national telemedicine programmes as well as application projects.

There is no doubt that telemedicine will reform healthcare organisation, structure and work processes. The aim is to realise higher quality, open up new diagnostic and treatment possibilities, contain costs, and meet patient requirements.

There is a growing and significant interest in telemedicine in the field of home care, care of the elderly, and the support of chronically ill persons. The need for support in these areas is backed up by statistics from many countries demonstrating that the age distribution will in future change from being a pyramid shape, to resembling a dome and finally a tower with even distribution between all ages. In some countries, 20% of the population is already above the age of 65. The increased need for care will be age related, with the prevalence of dementia, diabetes, hip fracture, stroke, cancer and heart failure likely to increase by 40-60% over the next 30 years. However, the need for care is context dependent and sensitive to supplier-induced demand.

Distance learning, web-based or on-line sessions with different degrees of interactivity, is rapidly developing and a new pedagogic approach is emerging. However, much has to be done in pedagogic development and the amount of work needed to develop efficient distance-learning courses and programmes should not be underestimated. But the need is evident, at different levels: at medical student level, specialisation (resident level), sub-specialisation level and in continuing education. The possibility of accessing and sharing expert knowledge regardless of distance is of course very attractive.

The use of the Internet and "Doctor on the Net" was also a part of the programme. Two main types of user can be identified: (a) doctors and other professionals, who need to be kept updated in their field; and (b) patients (and relatives), who need to be kept more informed about their illness, which will influence the way patients relate to healthcare.

Internet and web interactivity is also being developed to support medical-decision-making processes (between professionals) and support chronically ill persons (e.g. diabetics). One example reported was developing work on a web-based service for the interpretation of myocardial perfusion images.

Internationally there has been a growing interest in health technology assessment in general. Telemedicine methods and applications should be assessed as well as other new medical methods and technologies. As demonstrated during the symposium, telemedicine often uses a multidisciplinary range of technologies and often several outcomes should be measured. Assessment is still a methodological challenge for telemedicine.

The legal and ethical aspects of telemedicine were discussed. There is an increasing international interest in this subject. It seems that the legal aspects of telemedicine practised within a country are often mainly covered by existing rules and laws (e.g. in Sweden). However, as soon as telemedicine is practised in a cross-country-border setting, many questions arise, such as licensure, authorisation, malpractice liability defence, insurance, and use of paper versus electronic media and signatures. At present there is no legal basis, professional support or real justification for the creation of a supranational medical authority that would set harmonised standards that facilitated cross-border telemedicine practice throughout Europe. However, voluntary schemes have been set up by professional associations in Europe. A need for a more global approach to this subject is evident.

In the scientific and industrial information session, about 25 posters showed progress and results in fields such as the need for and experience of telemedicine in specific countries, cross-border telemedicine projects, telemedicine applications for sportsmen, applications in immunopathology, applications for disabilities, technical standards, and broadband telecommunication applications. The industry showed telemedicine products and systems regarding e.g. home care, care of the elderly, pre-hospital care, mobile care, and in professional consultations.

The symposium concluded that telemedicine will significantly change and enhance the way healthcare is to be delivered. Many aspects and applications of telemedicine have to be further explored, developed and assessed. Cross-border co-operation and research should be encouraged to accelerate the creation of a systematic knowledge base covering the needs for telemedicine in different contexts, concepts, policies, technologies and the use of telemedicine to ultimately enhance the health of citizens and support patients and their relatives.

Reference:

Proceedings of the International Symposium on Telemedicine (Including Telecare, Telehealth, E-Health and Distance Learning)
Focusing on developments in health care and health.
27 June - 1 July 2000, Gothenburg, Sweden.

For further information or to request copies of the symposium proceedings, please contact:

Silas Olsson, Telia Research
SE-123 86 Farsta, Stockholm, Sweden
Email: silas.a.olsson@telia.se. Mobile/Cellular: +46-70-5675505

Course participants