TELEMEDICINE- AN OVERVIEW

Name: Purva Sanjay Bankar

Admission number: HPGD/JA22/0484
Specialization: Healthcare Management

L.N. Welingkar Institute of Management Development & Research

Year 2023
 Introduction

• Telemedicine has been defined by the World Health Organization (WHO) as

―The delivery of healthcare services, where distance is a critical factor, by
all healthcare professionals using information and communication
technologies for the exchange of valid information for diagnosis, treatment
and prevention of disease and injuries, research and evaluation, and for
continuing education of healthcare providers, all in the interests of advancing
the health of individuals and their communities.
• The term telemedicine has been referred to as the delivery of clinical services
to the patients with the application of information communication and
technology.
• Telemedicine functions by fulfilling to the patient's needs through calls
and video conferencing.
• Globally, Physicians use telemedicine for digital imaging transmission, Fig No. 1 Telemedicine
video
consultations, and remote medical signals.
2
 Brief History of Evolution of Telemedicine

Father of Telemedicine - Dr. Jay Sander

Fig No. 2 Father of Telemedicine

First Setup of Telemedicine Boston Logan Airport to Massachusetts General Hospital 1967.

Fig No. 3 First setup of Telemedicine

 Evolution of Telemedicine

The use of telemedicine to send electrocardiographic (ECG)

data over telephone cables in the early 20th century is one of the
first documented instances of telemedicine. The development of
information and communication technologies, particularly the
internet boom in the 1960s, provided the drive for modern
telemedicine.
Video telephony and telemedical devices that provide access to
in-home health care have essentially replaced the early types
of and telephone communication in telemedicine
radio
Fig No. 4 Evolution of Telemedicine

4
Telemedicine versus Telehealth

Fig No. 5 Telemedicine Vs Telehealth

5
 Need for Telemedicine

• In India only one third of households are in urban areas, with remaining two thirds in
rural areas but majority of healthcare activities and availability of healthcare
activities are present in urban areas.
• Non availability of adequate number of resources and the challenge to overcome can
possibly be done by
a) Making specialist services available in rural/ remote healthcare stings and
b) Making critical care accessible to rural/remote areas

6
 Types of Telemedicine

•Broadly telemedicine can be classified into

three major types, namely:

 Store and forward

 Remote patient monitoring

 Interactive or real time services

Fig No. 6 Types of Telemedicine

7
Store and forward

In this type of telemedicine, there is no physician-patient interaction or the presence of both the parties
concurrently. The patient information in the form of medical images or bio signals are transmitted via
electronic media to the physician, who reviews it at a convenient time and provides expert opinion.

Remote patient monitoring

This type of telemedicine involves monitoring the patient remotely using various technological
devices. It is especially useful in the follow-up of chronic conditions such as diabetes, asthma, and heart
disease. The outcomes appear to be comparable to traditional physician-patient encounters. It might be cost-
effective and saves patients the trouble of traveling long distances with their health condition for frequent
follow-ups.

Interactive and real time services

In this type of telemedicine, there is an interaction between the physician and the patient, for example,
over videoconferencing, with the need for both to be present simultaneously. It is possible to obtain a history8
and perform several assessments in this form of telelmedicine.
 Benefits of Telemedicine

 Availability of healthcare to patients living in rural or underserved areas

without necessity to travel to the hospital.

 Useful in post-disaster, natural calamity situations or other emergency situations

when traveling is not possible.

 Elderly patients and persons with chronic illnesses can have regular follow-up
and monitoring through telemedicine.

 Monitoring of drugs and dose management can be done through telephone.

 The time for travel is saved and the cost of treatment may also come down.

 Facilitates health education by allowing students or health workers to observe and

listen to experts in their respective fields. Medical teaching is possible by making
available academic material and case presentations through webcasts, and
teleconferencing.

Fig No. 7 Benefits of Telemedicine

 Barriers of Telemedicine
 Lack of direct interaction between the physician and the patient

 High cost of communication and data management equipment and its maintenance, which may
not be easy for older people living alone

 Necessity to train personnel technically to handle communication and data management

equipment

 Possibility of error when health care is delivered in the absence of a trained health professional

 Possibility of misuse of patient data through electronic transmission

 In certain instances, time taken to provide health care through telemedicine may actually be
longer than traditional consultations because of increased time taken to assess and treat patients
through virtual interactions
Fig No. 8 Barriers of Telemedicine
 Poor quality of records or images made available to the physician at the receiving end and
omission of relevant clinical information might affect the quality of health care delivered

 Absence of proper legal regulations for some of the telemedicine practices

10
 Equipment of telemedicine

• Video Conferencing Tools: Webcams, Microphones, Speakers and headphones

• PCs or Portable Devices: Work areas, PCs, Tablets, or Smartphones: These
gadgets are involved by both medical services suppliers and patients for
telemedicine meetings.

• Web Connectivity: Rapid Internet: Steady and fast web associations are critical
for smooth video and sound correspondence

• Telemedicine Platforms: Programming and Applications: Stages explicitly

intended for telemedicine, like Doxy.me, Zoom for Medical services, or
concentrated EMR (Electronic Clinical Record) frameworks

• Fringe Devices: Computerized Stethoscopes, Dermatoscopes

• Indicative Devices: Circulatory strain Monitors, ECG Monitors,

Glucose Monitors
F
i
g 11
 Specialties in which Telemedicine can be Employed

• Telenursing Through the use of information and communication technology, telenursing enables
patients to receive nursing care and services even while they are physically separated.
• Telepathology is another area where the transmission of high quality microscopic images
through the
internet can be used for teaching, diagnostic and research purposes.
• Teleradiology – Radiology is one of the areas where telemedicine is employed in a big way.
Radiological images such as x-rays, CT scans and MRI are transmitted via the internet to a radiologist
or physician, who needs to have a computer with a high quality screen display, and if possible, a
printer that prints high quality images.
• Telepharmacy - In telepharmacy, pharmaceutical care is made accessible to patients at locations where
they may not have access to a pharmacist.
• Teleophthalmology - Using digitized medical equipment and communication technology, optimal eye
care facilities and monitoring of chronic eye conditions such as diabetic retinopathy can be done for
patients living in remote locations. 12
 Telemedicine in India

• A ―National telemedicine Taskforce was established in India in the year 2005 and helped in successful completion
of several pilot projects in India healthcare system. Some of the popular healthcare projects associated with these
include ―ICMR-AROGYASREE, NeHA and VRCs.
• Telemedicine Pilot Project in 2001 in India was established by ISRO that linked the Apollo Hospital, Chennai with
the Apollo‘s Rural Hospital situated at a village called Aragonda in the Chittoor district of Andhra Pradesh. Other
popular projects of the government of India that have been linked with the use of telemedicine include ―National
Cancer Network (ONCONET), Integrated Disease Surveillance Project (IDSP), National Rural Telemedicine
Network, and National Medical College Network and the Digital Medical Library Network.
• Some individual pilot projects that have been served to be of remarkable success in association with the Indian
telemedicine healthcare structure. These are inclusive of ―mammography services at Sri Ganga Ram Hospital,
Delhi; oncology at Regional cancer center, Trivandrum and ―surgical services at Sanjay Gandhi Postgraduate
Institute of Medical Sciences, School of Telemedicine and Biomedical Informatics.
• In the present scenario of the telemedicine application in the Indian healthcare system, the tele-health system in
India is regulated by the MoHFW and the Department of Information Technology.
• Telemedicine division of Ministry of Health and Family Welfare, A specific portal for the telemedicine update by
the
Indian Government has been established as the ―National Telemedicine Portal 13
• TEJHAS, the Telemedicine Enabled Java-Based Hospital Automation System, this was an electronic
database effective for the maintenance of the patient medical records and to make the patient
information available to all the medical centers involved in the project.

14
 Conclusion
 Telemedicine has the potential to improve healthcare accessibility in India, particularly in rural and remote areas
where traditional healthcare services may be limited.

 Despite its potential benefits, telemedicine in India faced challenges such as issues related to infrastructure, digital
literacy, and concerns about data security and privacy. These challenges needed to be addressed for the widespread
and sustainable adoption of telemedicine.

 The Indian government took steps to adapt to the growing popularity of telemedicine by introducing guidelines and
regulations. Clearer regulatory frameworks were essential to ensure the quality, reliability, and security of
telemedicine services.

 With the increasing penetration of smartphones and internet connectivity, the Indian population was becoming more
digitally connected, facilitating the adoption of telemedicine services.

 Reduced overall cost of healthcare

15

Telemedicine distance learning programmes can address healthcare professional shortage.

16