TELEMEDICINE PREPARED BY SANGEETA SONI

“TELEMEDICINE PROVIDES HEALTHCARE WHERE THERE IS NONE AND IMPROVES THE HEALTH CARE WHERE THERE IS SOME”

Telemedicine  Means " distance healing “.  Derived from a Greek word " Tele " meaning " distance " and a Latin word " mederi " meaning " to heal “.  Is not one specific technology but a way of providing healthcare services at a distance using telecommunications technology, medical expertise & computer science.  Telemedicine is the future of global healthcare.

Types of Telemedicine Realtime (synchronous) Store and Forward (asynchronous)

Realtime (synchronous)  Could be as simple as a telephone call or as complex as robotic surgery.  Requires the presence of both parties at the same time.  E.g. : Video-conferencing equipment  There are also peripheral devices which can be attached to computers or the video-conferencing equipment which can aid in an interactive examination.  For instance, a tele-otoscope allows a remote physician to 'see' inside a patient's ear; a tele-stethoscope allows the consulting remote physician to hear the patient's heartbeat

Store and Forward (asynchronous)  Involves acquiring medical data (like medical images, biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline.  Does not require the presence of both parties at the same time.  Dermatology, radiology, and pathology.  A properly structured Medical Record preferably in electronic form should be a component of this transfer.  Teleradiology, the sending of x-rays, CT scans, or MRIs (store-and-forward images).  Many radiologists are installing appropriate computer technology in their homes, so they can have images sent directly to them for diagnosis, instead of making an off-hours trip to a hospital or clinic.

Application Adopted  Most beneficial for populations living in isolated communities and remote regions and is currently being applied in virtually all medical domains.  Use a "tele-" prefix;  Useful as a communication tool between a general practitioner and a specialist available at a remote location.  Telepathology  Telecardiology  Teleradiology  Telesurgery  Teleopthalmology

Advantages of Telemedicine  Resource utilization  Early intervention  Avoids unnecessary transportation  Community based care  Medical education and research  Cost saving  Improved patient documentation  Increased range of care and education.

Resource Utilization  In India doctor population ratio is 1:15000 in comparison to 1:500 in developed nations, and these doctors are not distributed equally.  80% Indian population lives in rural and semi urban areas.  Telemedicine can help in cost effective utilization of meager resources and of the same time can decrease patient work load on few referral centers.

Early Intervention  There are factors that inhibit the continuity of care. Issues such as geographic location, inclement weather, socioeconomic barriers.  Patient apathy are significant factors that delay and even prevent the specialty care.  By providing these primary cure sites with the ability to quickly access specialty consultation services.  Patients are able to reap the benefits of early intervention while the health care system maintains quality service and clinical efficiency.

Avoids Unnecessary transportation  Patient can discuss the issues on Video Conferencing with the consultant.  Even the vital parameters and be captured with the help of devices and sent to doctor.  Unnecessary referral and patient transport can be definitely avoided.

Community base Care  People like to receive high quality care in their local community.  This reduces travel time and related stresses associate with many referrals.

Medical Education and Research  When medical students are posted in rural area they can be linked to medical college for grand rounds and they can also do case presentation to teachers in medical colleges.  Physicians living in different parts of the world also use telemedicine in collaborative research, they can also share data or can discuses current trends.

Cost Saving  Reduced physician’s fees and cost of medicine.  Reduced visits to special hospitals.  Reduced travel expenses.

Telemedicine System  ACTUALLY WHAT HAPPENS DURING A TELEMEDICINE PROGRAM?

Telemedicine Infrastructure  This will include minimum standards for all the hardware and software used in a telemedicine system.  Under hardware it will include standards and guidelines for basic telemedicine platform, servers, clinical devices, video conferencing system, communication hardware and power support.  The software standards address operating system, telemedicine software, and server software.

Hardware  Telemedicine platform:  This will include minimum standards for type of platform to be used, processor/minimum speed, memory requirements, interfaces, and peripherals.  Clinical devices  This will include minimum standards for all the clinical devices to be interfaced or integrated with the telemedicine system, including performance specifications for devices measuring diagnostic parameters, imaging devices, compression, and their safety requirements.  Video conferencing units  This will include minimum standards for video conferencing system, including data rate, picture resolution, frame rate, type of camera, audio quality etc.  Communication hardware  This will include minimum standards for various hardware used for interfacing the telemedicine system with the communication network, including all types of terrestrial and satellite based networks.

Software  An operating system  Licensed telemedicine S/W with appropriate User Interface(UI)  Back-end Data Base with the mandatory tables/ fields (if applicable)

Connectivity  Options for telemedicine services  VSAT  PSTN  ISDN  Leased Line  Wireless LAN /WAN

Telemedicine Tools

Barriers of Telecommunication  Low or small bandwidth.  Neither telephone lines nor electricity in rural and remote areas.  Satellite transmission can help but it is very costly.  Unstable electricity supply.  Patient’s fear and unfamiliarity.  Financial unavailability.  Lack of basic amenities.  Literacy rate and diversity in languages.  Quality aspect.  Government support.

Need of Telemedicine in India  The advances in Medical science, biomedical engineering on one side and Telecommunication and Information Technology on the other side are offering wide opportunities for improved health care.  Health coverage to majority of our population is still a distant dream.  India is a vast country gifted with rich and ancient historic background and geographically the nature has provided India with all the varieties like the mountain regions like Ladakh, deserts, green planes and far flung areas in the north east and offshore islands of Andaman’s and Lakshadweep.  1 billion population.  Predominantly rural and distributed in distant geographical locations.

Need of Telemedicine in India  Further this is compounded by the following factors like:  High cost of health care and lack of investment for health care in rural areas.  Inadequate medical facilities in rural & inaccessible areas.  Problem of retaining doctors in rural areas where they are required to serve & propagate widespread health awareness.

Need of Telemedicine in India  A recent survey by the Indian Medical society has found  75% of qualified consulting doctors practice in urban centers and  23% in semi urban areas and  only 2% from rural areas whereas majority of the patients come from rural areas.  Hospital beds / 1000 people is 0.19 in rural and  2.2 in urban areas.  This calls for innovative methods of utilization of science and technology for the benefit, of our society and telemedicine assumes a great significance to revolutionize the health care system in India.

Available today  mHealth

Wi-Fi Smart ScaleOtoscopeBlood Pressure Monitor Bluetooth StethoscopeBlood Glucose Meter Digital Thermometer

Robotics Remote Surgery Live Monitoring via Cell Phones

At Home, at the Office, on the Go, at a Kiosk

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