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Telemedicine - Definition Any healthcare related activity – diagnosis, advice, treatment, or monitoring – that involves people who are physically separated, for example a family physician in a surgery with a patient at home, or specialists in different hospitals consulting together. The activity is facilitated through the use of communication systems, such as video and computers, to provide remote diagnoses and healthcare, allowing more care to be provided in the community or at home. The European Commissions health care telematics programme defines telemedicine as Rapid access to shared and remote medical expertise by means of telecommunications and information technologies, no matter where the patient of relevant information is located. The term telemedicine is derived from the Greek tele meaning at a distance and the word medicine which itself is derived from the Latin mederi meaning healing.

Telemedicine – Levels of Care Primary care is a locally, community based, first point of contact health service. It is comprised of a range of services from health promotion and screening to diagnosis and treatment of medical conditions, provided by a range of community based health practitioners and support workers. Secondary care is usually provided in hospitals following a referral from a general practitioner or a community health professional. Tertiary care services are provided by specialized hospitals or departments that are often linked to medical schools or teaching hospitals. Secondary to tertiary care Secondary to secondary care Primary to secondary care Primary, community & home care

Telemedicine - Stages In general, we may define four stages of telemedicine: Primary care physician (GP) - patient consultation. Transfer of clinical data and images. Telemedicine consultation and video conferencing. Direct patient – specialist consultation.

Telemedicine – Forms There are several forms of telemedicine, namely: Teleradiology – reading still and full motion radiographic images Telepathology – analysis of tissue histology samples Telemonitoring – guiding surgical and other procedures from a remote location Teledermatology – actual physical examination of a patient

General Exam Camera This general examination camera is an example of an essential tool for primary care physician consultations with specialists. It is a video imaging system to combine power zoom, auto focus, frame capturing and electronic image polarization. Important features are: Magnification: Auto-zoom from 1-50x allowing both close focus and wide angle images Accurate colours: one-button white balance sets highly accurate colours Freeze Frame: A push button delivers the clearest possible image Pixels: 410,000

General Exam Camera – Actual Images The transfer of examination images from the patients primary care physician to a specialist will enable: Sharing experiences for the benefit of the patient. Eliminating professional isolation of physicians in rural settings. Breaking down barriers between primary and secondary care. Opening new ways to use resources and provide care. Enabling tele-education - eLearning.

Telemedicine – Essential Tools There are a number of interesting essential tools for telemedicine, as illustrated here, namely: ENT/Otoscope, combines the functionality of a high performance otoscope, short sinus scope and oral exam scope in a single diagnostic device. 12-lead ECG laptop. Vital sign monitor. Digital electronic stetho- scope, with great sound and powerful analytical software and communi- cations flexibility.

Store-and-forward (S-F) S-F pertains to telemedicine communications, in which messages are received at intermediate routing points and recorded, i.e., stored, and then transmitted (forwarded), to the next routing point or to the ultimate recipient.

Critical Questions 1.Is the image quality (resolution) high enough to make a clinical decision? 2.If appropriate, is the audio quality satisfactory enough for an effective patient/physician encounter? 3.Is the transmission speed of the image and/or sound appropriate to the application? We need to focus on the following three critical questions:

Telehealth – The Benefits Sharing of ideas. Access to support and information. Shared patient care. Better use of resources. Reshaping health services to meet requirements.

Responsibility Issues Who is responsible for patient diagnosis: the referring or the consulting physician? Which site determines standards of care? What kind of reimbursement will be provided for tele-consultations? How is the patient data security and privacy protected? Who owns the patient records? There are several issues of a medical-legal nature, namely:

Telemedicine – Summary Telemedicine is not simply technology. It is not an alternative to face-to- face health care. It is a tool that health care providers can use to enhance health services; both access to and delivery of. Telemedicine promotes individual and community health.

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