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                           Telemedicine: Introduction

                                                   Applications

                                                   Advantages

                                                   Details

Introduction

Telemedicine is defined as ‘rapid access to remote medical expertise through telecommunication and information technology’. A telemedicine system creates a ‘virtual’ medical consultation where the local medical attendant becomes the eyes, ears and hands of the remote medical expert, collects the necessary information for decision making, and serves to implement the necessary actions and treatment. Telemedicine is a novel concept in field of health care, where Information Communication Technologies (ICT’s) is being used by hospitals to provide specialized services to patients living in the different parts of the globe. By using the computeraided transmission of audiovisual data, a doctor can diagnose the case of a patient in a distant location using an identified specialist from any location. Telemedicine provides tertiary health care to people at remote areas through a virtual reduction in distance. Text, sounds, pictures and videos are being merged and interconnected in completely new way. For e.g. use of live video to examine patients, electronic transmission of patients records and x rays, recording of ECG data and transmission over telephone, is possible and this is termed digital convergence.

Telemedicine has three generic applications, namely:

· clinical applications

· administrative applications and

· educational applications.

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Application

Telemedicine finds application in a wide area. Given below are areas of application and the advantages accrued thereof.

Specialist consultations between two or more hospitals: Advantage to patients due to higher accuracy of diagnosis and treatment. Leads to shorter hospital stay, faster turnover, increased availability of hospital beds and conservation of medical assets.

Opinions on special investigations: Secondary medical centers can send  investigations like ECGs, EEGS, TMTs, ultrasound/CAT/MRI scans, etc for reporting/ opinions to specialists at tertiary centers. This would conserve  scarce resources, in this case, the specialists and lead to their better  utilization.

Specialist opinions to GPs at small towns and villages: A 'Telemed Unit' once made available to a general practitioner (GP) at a remote site would connect him and hundreds like him to a Central Specialist Center (CSC). The CSC would provide these GPs with 24 hrs 7 days a week specialist consultancy. This would result in a good number of patients being treated locally, though being monitored by specialists, remotely. Franchising of such units would be a viable business proposition. 

Chronic patients monitored from home: Chronic pts can be monitored from home regularly by remote consults, cutting down on trips to distant hospitals. This methodology applies well to certain cardiovascular, respiratory, diabetic, renal, psychiatric and dermatological  cases.

Medical Lectures, Updates, tutorials: Lectures and updates can be provided online for on-the-job training.

Treatment of patients in inaccessible areas: Patents in inaccessible areas like mountains, ships at seas, islands when cut off due to weather conditions or natural disasters can be treated and monitored till they get access to a hospital.

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The advantages of   a telemedicine application are as follows:

For the patient.

Availability of selected basic, intermediate and advanced medical facilities within 3 to 5 KMs of a patient's residence.
Reduction in travel to distant referral medical centers.
Reduction in cost of medicare.
Better diagnoses of diseases due to availability of specialist opinions.
Increased and better monitoring of chronic cases.
Increased domiciliary care.
Tele-counseling of selected psychiatric cases.

For the GP.

Better diagnoses of diseases due to availability of specialist opinions.
Reduction in nosocomal infections due to increased OPD and domiciliary care.
Increased and better monitoring of chronic cases.
Ability to update oneself.
Ability to  discuss cases with peers and request advice from specialists.

For the state.

Better monitoring of disease patterns and trends.
Reduction in diseases due to increased OPD and domiciliary care.
Early notification of communicable diseases.
Reduced cost of medicare.
Reduction in urban migration from villages due to better medicare.
Improved preventive health care measures.

For the corporate hospital/business man.

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Details

A telemedicine application consists of mainly 3  components:

The Central Control Unit

The communication link

The Peripheral Unit 

The Central Control Unit:
The central control unit is the nerve center of the telemedicine application. Generally sited at a large tertiary hospital, it is manned 24 hours a day 7 days a week, is fully IT enabled and capable of  the following:

Replies by specialists to  queries  based on Electronic Medical Records (EMR) of patents, transmitted to them from the periphery.
Opinions on  ECGs, EEGs, CATs, MRIs, X-Rays, Ultrasounds, images of pathological specimens, histological slides, skin, ear, nose, throat, eyes, fundus, etc transmitted digitally.
Live chat with GPs on patient care.
Teleconferencing between patient-GP, GP-Specialist.
chat/teleconferencing between specialists.
Remotely monitored surgical procedures.
Monitoring chronic cases.
Counseling of selected psychiatric cases. 

In addition the center will also host an Intranet web site with medical updates, advisories, lecture series for patients, paramedics and medical personnel, etc.

The communication link:
  Depending upon various factors, communication between the Central and peripheral units could be by telephone lines (analog, ISDN), mobile phones, satellite phones, fibre-optic cables, wireless LANs, satellite links, etc. The methodology adopted will depend on various factors like, necessity, finances, availability, legalities, commercial constraints, etc. 

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