TELEMEDICINE

The term 'telemedicine' derives from the Greek 'tele' meaning 'at a distance' and the present word 'medicine' which itself derives from the Latin 'mederi' meaning 'healing'. Telemedicine is a phrase first coined in the 1970s by Thomas Bird, referring to health care delivery where physicians examine distant patients through the use of telecommunications technologies. DEFINITIONS Telemedicine is the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care. Telemedicine includes consultative, diagnostic, and treatment services. Telemedicine is the process of using communication through audio and video to convey or exchange notes about a patient with a doctor or also from one medical professional to another. It is not restricted to one single place and actually can take place between two remote sites located anywhere in the country.

OBJECTIVES To make high quality healthcare available to traditionally under privileged population Save the time wasted by both providers and patients in traveling from one geographic location to another to avail services on time Reduce costs of medical care TYPES Store and Forward - Details related to medical data, images, videos, audios, and reports, are collected and transmitted to the medical expert, for diagnosis. Interactive Telemedicine/Services - Telephonic conversation, home visits, and online interaction between the client and the expert with activities like review of history, physical examination, assessments, and check ups are carried out. Remote monitoring Also called as self testing or self monitoring technique. With lots of technological devices and electrical interaction instruments the medical professionals can monitor the patients. SERVICES Primary care and specialist referral services - provides consultation with a patient or a specialist assisting the primary care physician. Remote patient monitoring - uses devices to remotely collect and send data for interpretation. Consumer medical and health information - uses Internet and wireless devices for consumers to obtain specialized health information and online discussion groups to provide peer-topeer support. Medical Education - provides continuing medical education credits for health professionals and special medical education seminars for targeted groups in remote locations. DELIVERY MECHANISMS Networked programs link tertiary care hospitals and clinics with outlying clinics and community health centers in rural/suburban areas. Pointtopoint connections are used by hospitals and clinics that deliver services directly or outsource specialty services to independent medical service providers. Monitoring center links are used for cardiac, pulmonary or fetal monitoring, home care and related services that provide care in the home. Webbased ehealth patient service sites provide direct consumer outreach and services over the Internet.

USES General: Local doctor can treat without having to leave his place. Telemedicine Centre can levy service charges for each Tele-consultation. Cost reduction on each patient reduces the burden on Government bodies. Makes specialty care more accessible to underserved populations. Video consultations can alleviate travel and associated costs and opens up possibilities for continuing medical education or training for isolated or rural health practitioners. People: Interaction with specialist doctor. Practical, safe, time and cost effective Immediate access to medical specialists for second opinion Quality healthcare at their doorstep Early diagnosis and treatment "Video says it all - more advantageous than voice only communication. Doctors: Effective and efficient use of medical and technological resources Updating medical knowledge in various specialties through periodic referrals Continuing medical education Global Medical Community at the desktop Enhanced Doctor-patient relationship Tertiary Care Institution: Expansion of market share Training for healthcare professionals, Organizational expansion of Services Expansion of tertiary care network Providing support for review cases thereby enhancing the reputation Disadvantages Breakdown in the relationship between health professional and patient and between health professionals Concerns regarding quality of health information and responsibilities and accountabilities Organizational and bureaucratic difficulties - Laws and set code of rules and ethics to be applied. Clinical risk and over-dependence on telemedicine system Risks involved with what is reliable vs. unreliable information Fee and charges for services cannot be certainly stated

TELEMEDICINE IN INDIA Initiatives taken by Healthcare Organizations There are many activities that are going to contribute to the spread of Telemedicine in India. APOLLO (Hyderabad) and ASIA HEART FOUNDATION (Bangalore) are emerging as key players. Madras Medical College is the first Government Medical College to have Telemedicine installed in INDIA. Organizations such as ISRO, have taken innovative approach to facilitate healthcare delivery by launching an exclusive health satellite. General Electric and Wipro are also undertaking Telemedicine stations in Chennai and Hyderabad. Grudges and Hindrances in Indian Population Perspective of medical Practitioners: Doctors are not fully convinced and familiar with Telemedicine. Practitioners in remote areas feel threatened that they will be surpassed due the reach of brand names etc. Patients fear and unfamiliarity: There is a lack of confidence in patients, about the outcome of Telemedicine. Financial unavailability: Technology and Communication costs make it financially unfeasible. Lack of basic amenities: Basic amenities like transportation, electricity, telecommunication, safe drinking water, primary health services, etc. are missing. Any technological advancement cant change a bit when a person has nothing to change. Literacy rate and diversity in languages: Only 65.38 % of Indias population is literate with only 2% well-versed in English. The presence of a large number of regional languages makes the applicability of single software difficult for the entire country. Technical constraints: Telemedicine is supported by various types of software and hardware which still needs to mature. Correct diagnosis and pacing of data require advance biological sensors and more band-width support. Quality aspect: No proper governing body to form guidelines in quality respect and motivate the organizations to follow. Government Support: Any technology in its primary stage needs care and support. There are no such initiatives taken by the government to develop it. Biological consistency: Diagnosis itself is a complex process and symptoms of disease are not consistent in all the patients. In Telemedicine the consultant tests the hypothesis; it may be right or wrong.

The Importance of Right Strategy Planning Remote Areas:Provide basic facilities like Transportation, Electricity, Primary health care centers Integrate Telemedicine with other daily facilities like Education, Health, Banking services. Training the literate people from rural areas Good and Effective advertising by video or by audio, which can be understood by rural people.
Provide Basic Facilities

Integrate Telemedicine with other daily facilities

Remote Areas

Training

Good and effective Advertising

Urban Areas:Build a Healthy computer literate environment by providing good knowledge to learners Hospital Information System can be adopted in big hospitals to promote Telemedicine Mobile Telemedicine services having mobile vans fully equipped with all the equipments of Telemedicine, can take frequent rounds in urban areas to spread awareness Governmental support to leading cybercafs for the spread of knowledge on health issues amongst laymen.

Build a healthy computer literate environment

Hospital Mobile Telemedicine Services

Hospital Information System

Urban Areas

Environment:-

Governmental support

to leading cybercafs

Technical User-friendly technology Flexibility and adaptability Involving the user from the beginning of project Quality control and proper standardizations Making expert systems to help users as well as patients
Technical

Financial

ENVIRONMENT

Social and Political

Educational

Social and Political Active participation of society Strong political will. Involve NGO volunteers. Educational Providing Continuous Medical Education for users. Training programs for health care professionals, patients and other persons. Financial A combined effort from The Government and Private Sector is needed. In private sector the software and hardware companies, computer education institutes, and corporate hospitals can play a major role. Areas where Telemedicine could be applied: Telecardiology Tele-Radiology Telepathology Telepsychiatry Teledermatology Teleneurology Continuing Medical Education Programs Management Information System