International Telecommunication Union Telecom Americas 2000 – Rio de Janeiro 10-15 April 2000 Telecom Development Symposium TDS.2 – Medicine: Telemedicine Applications 1 Telemedicine and the Transformation of Healthcare Practice in the Information Age Roberto J. Rodrigues Regional Advisor in Health Services Information Technology Essential Drugs and Technology Program Division of Health Systems and Services Development Pan American Health Organization / World Health Organization Washington, D.C., USA Telecommunications and informatics technologies applied to the health sector are critical for attaining the goal of improving access to equitable healthcare and the practice of evidence- based quality health interventions, for the cost-efficient operation and management of health services and health programs, and for the provision of individualized healthcare. Healthcare organization and delivery are undergoing a shift from an institution-centered to a citizen- centered model. The prime feature of the model is a new emphasis on continuity of services supporting health promotion and maintenance. It encompasses informed citizens caring for their health and an assortment of stakeholders responsible for the delivery of a continuum of health services within a region. The variety of environments, priorities, organization, and op- erational demands of the healthcare sector require Telemedicine applications and technolo- gies capable of providing support for the challenging and complex interdependent clinical, public health, and managerial decisions and interventions that characterize health practice. 1. Introduction Telemedicine applications comprise a broad and expanding domain that use the resources of inter- active communication technologies. Telemedicine combines the use of telecommunications, computer technologies, and informatics – the applied science of collecting, storing, and retrieving data to support informed decision making – to improve the effec- tiveness and efficiency of healthcare. It liberates caregivers from the traditional constraints of place and time, empowers individuals to make informed choices, and changes the way health practice is conducted in a competitive marketplace. Although the use of telecommunications in healthcare dates back to the early ‘50s experiences in the United States and Canada, especially with the Arizona Pa- pago Indian Reservation Project (NASA/Lockheed) and the Dartmouth Medical School link of a New Hampshire teaching hospital with outlying rural clinics, the term only became of common usage in the early ‘90s. Cybermedicine and Telehealth are other terms fre- quently used for this application domain. They are not necessarily synonymous with Telemedicine – although the technologies involved are basically the same, the ends are somewhat different. Telemedi- cine is most frequently used to describe care- related applications while Telehealth encompasses other functions such as education and training, health promotion, public health, health services management, technical information retrieval, etc. Cybermedicine, more properly refers to the inter- section of health and bioengineering, implantable intelligent hardware, automation of processes, ro- botics, biosensors, nanotechnology, etc. In the context of this paper we will used the term Tele- medicine in its broadest possible scope including functions and applications of both Telehealth and Cybermedicine. Interactive communication technologies are shaping the future of healthcare and Telemedicine solutions. They reinforce, complement, and enhance existing health programs and healthcare delivery systems, offer new solutions for health interventions, and create the opportunity for the establishment and operation of innovative practice models. Telemedi- cine is not happening in isolation but is closely linked – although lagging behind – to similar devel- opments in commercial, education, entertainment, and industrial areas. Areas of application include: consultation services and remote care; clinical, epi- demiological, and administrative data management and communication; provision of diagnostic and