【AS澳大利亚标准】AS TR 2961-2007 Telehealth standards scoping study.doc

tr 29612007accessed by university of south australia on 04 apr 2008tr 29612007technical reporttelehealth standards scoping studythis australian technical report was prepared by committee it-014, health informatics. it was approved on behalf of the council of standards australia on 29 june 2007.this technical report was published on 20 september 2007.the following are represented on committee it-014:australian and new zealand college of anaesthetistsaustralian association of pathology practicesaustralian electrical and electronic manufacturers associationaustralian information industry associationaustralian institute of health & welfareaustralian institute of radiographyaustralian medical associationaustralian private hospitals associationcentral queensland universitycommonwealth department of health and ageingconsumers federation of australiaconsumers health forum of australiacsiro e-health research centredepartment of health (south australia)department of health western australiadepartment of human services, victoriaengineers australiageneral practice computing grouphealth informatics society of australiahealth information management association of australiahl7 australiamedical industry association of australiamedical software industry associationnational health information management principal committeensw health departmentpharmacy guild of australiapharmaceutical society of australiaqueensland healthroyal australian and new zealand college of radiologistsroyal australian college of general practitionersroyal australian college of medical administratorsroyal college of nursing, australiaroyal college of pathologists of australasiasociety of hospital pharmacists of australiauniversity of sydneyadditional interests:cerner corporationcisco systemsdepartment of health and human services, tasmaniaflinders university of south australiagp assist tasmaniahunter new england area health serviceiclinixintel australia/continuaalliancela trobe universitymater health servicesaccessed by university of south australia on 04 apr 2008medcare systemsroyal prince alfred hospitalstatewide telehealth services queenslanduniversity of western australiastandards australia wishes to acknowledge the participation of the expert individuals that contributed to the development of this standard through their representation on the committee.keeping standards up-to-dateaustralian standards are living documents that reflect progress in science, technology and systems. to maintain their currency, all standards are periodically reviewed, and new editions are published. between editions, amendments may be issued.standards may also be withdrawn. it is important that readers assure themselves they are using a current standard, which should include any amendments that may have been published since the standard was published.detailed information about australian standards, drafts, amendments and new projects can be found by visiting .authe standard is downloaded from standard sharingstandards australia welcomes suggestions for improvements, and encourages readers to notify us immediately of any apparent inaccuracies or ambiguities. contact us via email at .au, or write to standards australia, gpo box 476, sydney, nsw 2001.tr 29612007accessed by university of south australia on 04 apr 2008technical reporttelehealth standards scoping studyfirst published as tr 29612007.copyright standards australiaall rights are reserved. no part of this work may be reproduced or copied in any form or by any means, electronic or mechanical, including photocopying, without the written permission of the publisher.published by standards australia gpo box 476, sydney, nsw 2001, australiaisbn 0 7337 8392 93tr 29612007prefacethis technical report was developed by sub-committee it-014-12, telehealth, during the period february 2006 to april 2007. this group was established by the standards australia technical committee it-014, health informatics, to investigate requirements and opportunities in telehealth standardization efforts for australia. this document is intended primarily as a brief scoping study on the context within which standards and guidelines for all aspects of telehealth would exist.the standard is downloaded from standard sharingaccessed by university of south australia on 04 apr 2008standards australia wishes to thank the department of health and ageing for their continued financial support in helping us to develop this handbook.accessed by university of south australia on 04 apr 2008contentspage1overview of document . 42scope of telehealth2.1 introduction . 52.2 health systems issues. 52.3 role of ict and telehealth . 52.4 health care delivery changes and telehealth . 62.5 benefits of telehealth . 62.6 definitions of telehealth . 63current telehealth environment3.1 australia . 83.2 international initiatives . 104telehealth standards taxonomy4.1 development and structure of the taxonomy . 144.2 overview of existing standards . 175future telehealth standardization needs5.1 multiple dimensions of telehealth . 205.2 needs for standards or guidelines. 225.3 proposed topics for further work. 236bibliography . 2613tr 29612007the standard is downloaded from standard sharingstandards australiatechnical reporttelehealth standards scoping study1 overview of documentthis document provides lists of resources and introduces topics for further research and discussion in the general area of telehealth, which is defined in section 2.6 below. telehealth is an emerging area in health care and many aspects of it are not covered by widely accepted standards. this document aims to help inform the development of standards applicable to telehealth by discussing the scope and context of such standards.section 2 presents some definitions and concepts, which provide an understanding of the term telehealth. section 3 provides an environmental scan of contemporary trends in the area, both nationally and internationally. section 4 introduces a taxonomic approach for representing the standards space for telehealth in terms of two independent dimensions, corresponding to tele (data or equipment) and health (clinical) groupings of concepts. using this taxonomy, a range of existing standards and guidelines relevant to telehealth are presented. section 5 presents some opportunities for development of some specific standards and guidelines suited to australian circumstances.accessed by university of south australia on 04 apr 2008an extensive search of internet entries referring to telehealth and associated terms was undertaken in order to locate definitions, activities and standards, which explicitly refer to this area. there may well be other material, and in particular standards, which are relevant but were not located on the basis of the online search. some technical papers discussing telehealth were also perused when constructing this document but they represent only a small fraction of the total volume available, due to limitations of time and availability. also, the contextual categorization approach adopted for this document is based on individual expert opinions rather than on fundamental theory. these factors may have led to inadvertent omission of some important information. nevertheless, the high level view communicated in this document is believed to provide a sound basis for future considerations and discourse in the area of telehealth by standards australia. standards a.auaccessed by university of south australia on 04 apr 20082 scope of telehealth2.1 introductionthe world health organization description of ehealth as use of information and communication technologies locally and at a distance (document a58/21, 7 april 2005, p1) implicitly includes telehealth as a distinct component. while considerable effort has been devoted to many aspects of health informatics standardization, driven in part by international moves towards electronic health records, the telehealth area has received much less attention. this is partly due to inconsistent views on the coverage of this area, and also because the development of the area is seen by many as a result of technology push rather than demand pull in response to business case or clinical need.2.2 health systems issueshealth systems in australia and comparable economies are facing a number of simultaneous crises. several key issues include:(a) safety and quality of health care, especially away from major centres of expertise.this was exemplified in the camden and bundaberg incidents, which are symptoms of entrenched underlying process or management issues.(b) high cost of health care, especially for patients who require tertiary-level care or complex care regimes due to advanced chronic disease, where typically over half of lifetime health care costs are incurred in the last few years of life.(c) stretched workforce, due to fewer trained professionals in the workforce as well as greater volumes of new information and specialized knowledge, and with city-centred geographical distribution so that it is not well placed to provide services for regional and rural patients.(d) overflow of demand for access to health care services and facilities, due to our ageing population profile, increased prevalence of chronic diseases and impact of their earlier onset or diagnosis, and greater hospital access leading to bed blockage effects.it is widely considered in health policy circles that these issues cannot be addressed by simple resource allocation and deployment adjustments, and that many fundamental and extensive changes in the systems and mechanisms for delivering health care will be necessary. the use of technology in health care generally (and for the purpose of this report, information and communication technologies or ict) is seen as supporting and indeed often catalysing such changes.2.3 role of ict and telehealththe role of ict in providing innovative methods for many conventional clinical activities in disease prevention, diagnosis, treatment and management is extensive. in addition, ict can play a major role in ensuring that whenever information and expertise can improve health outcomes, such information will be available where and when it is needed, and in the form that it is needed. this provision of information and expertise should occur seamlessly over a continuum from major referral hospitals, through local hospitals and health care facilities, individual practitioners and health carers, and ultimately the homes of patients. it is this paradigm shift, that information and presence is transferred by electronic means rather than requiring physical displacement of the people involved, which distinguishes telehealth from conventional means of health care delivery. this is consistent with current changes in work practice being promoted through new moves such as patient-distributed health care, community-based health care, locally managed care and patient-centric care. it is also consistent with the emergence of multi-disciplinary care teams, which by their very nature cannot be physically collocated at will. a wide range of such delivery approaches can be contemplated and for convenience may be referred to generically as telehealth. in this we include telemedicine, teleconsultation and telecare, and various clinically alignedthe standard is downloaded from standard sharingadoptions of telecommunications-based activities such as telepathology, teleradiology, telepsychiatry, telepaediatrics, teledermatology and teleopthalmology. we also include the use of telecommunications-based activities in health services and related processes such as critical care monitoring, forensic services, and virtual education specific to health.2.4 health care delivery changes and telehealthsome of the more prominent health care delivery changes relevant to telehealth are as follows:(a) health agencies are moving towards more localized (i.e. decentralized) models for point-of-care delivery which allow more individualized, patient-centric care and ease pressure on hospitals through promotion of community and home care.(b) requirements for mobility of patients, carers, health workers and clinicians to attend provider locations place an unnecessary travel burden on the mobile party and leads to avoidable time wastage and associated distress.(c) capacity to systematize elements of care addresses variations in safety and quality of service and decisions due to lack of patient-specific detailed information and different levels of experience and training in care team members.2.5 benefits of telehealththe anticipated health systems benefits to be obtained from widespread application oftelehealth include:(a) health professionals should be able to deliver care and treatment to patients outside of conventional institutions and closer to the patients home (indeed even within the home), and as a consequence, at earlier stages in the progression of disease than is now possible. this would also boost the level at which self-managed care and personal health monitoring could be adopted. furthermore it could establish more equity of access and standards of care for patients in regional and rural locations.accessed by university of south australia on 04 apr 2008(b) there should be significant potential for increasing safety and quality, especially outside the major cities. the bundaberg hospital royal commission showed interest in technologies to support real-time collaboration between clinicians at different locations, as part of a safety and quality network. the systematization of diagnosis and treatment or care planning through collaboration of clinicians, and the related education and continuous improvement capabilities, can lead to improved clinical outcomes.(c) reductions in the cost of health care delivery should be realized by better use of clinician and allied health worker time, and by reduction of avoidable hospital utilization (e.g. readmissions) due to better standards of care being achieved. savings arising from localized care and telehealth have been identified in the medical literature as 60-70% of the cost of conventional approaches.2.6 definitions of telehealththe world health organization in 1997 defined telehealth as the delivery of health care services, where distance is a critical factor, by health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, and for the continuing education of health care providers as well as research and evaluation, all in the interests of advancing health of individuals and their communities.suleiman, a. telemedicine and telehealth networks: national networks. presentation atann arbor, 23-25 august 2001.accessed by university of south australia on 04 apr 2008the international organization for standardization defines telehealth as the use of telecommunication techniques for the purpose of providing telemedicine, medical education, and health education over a distance, while drawing a distinction between this and telemedicine, which is defined as the use of advanced telecommunication technologies to exchange health information and provide health care services across geographic, time, social and cultural barriers.iso/tr 16056 (2004) interoperability of telehealth systems and networks, iso tc 215.a number of australian state health departments have telehealth programs and consequently provide lo