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MHealth: High-impact Strategies - What You Need to Know: Definitions, Adoptions, Impact, Benefits, Maturity, Vendors

MHealth: High-impact Strategies - What You Need to Know: Definitions, Adoptions, Impact, Benefits, Maturity, Vendors

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Published by Emereo Publishing
The Knowledge Solution. Stop Searching, Stand Out and Pay Off. The #1 ALL ENCOMPASSING Guide to MHealth.

An Important Message for ANYONE who wants to learn about MHealth Quickly and Easily...

"Here's Your Chance To Skip The Struggle and Master MHealth, With the Least Amount of Effort, In 2 Days Or Less..."

mHealth (also written as m-health or mobile health) is a term used for the practice of medicine and public health, supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones and PDAs, for health services and information. The mHealth field has emerged as a sub-segment of eHealth, the use of information and communication technology (ICT), such as computers, mobile phones, communications satellite, patient monitors, etc., for health services and information. mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery of healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vital signs, and direct provision of care (via mobile telemedicine).

Get the edge, learn EVERYTHING you need to know about MHealth, and ace any discussion, proposal and implementation with the ultimate book – guaranteed to give you the education that you need, faster than you ever dreamed possible!

The information in this book can show you how to be an expert in the field of MHealth.

Are you looking to learn more about MHealth? You're about to discover the most spectacular gold mine of MHealth materials ever created, this book is a unique collection to help you become a master of MHealth.

This book is your ultimate resource for MHealth. Here you will find the most up-to-date information, analysis, background and everything you need to know.

In easy to read chapters, with extensive references and links to get you to know all there is to know about MHealth right away. A quick look inside: MHealth, EHealth, Health informatics, Health 2.0, List of open source healthcare software, MLearning, Telehealth, Telemedicine, HRHIS, Remote therapy, Alaska Federal Health Care Access Network, Alberta Netcare, American Telemedicine Association, Association of Telehealth Service Providers, Belgian Health Telematics Commission, Biotronik, Campus medicus, Canada Health Infoway, Center for Telehealth and E-Health Law, Centre for e-Health, Connected Health, DICOM, Distance Learning and Telemedicine Grant and Loan Program, Dossia, E-Patient, Epocrates, European Health Telematics Association, European Health Telematics Observatory, Google Health, Health On the Net Foundation, ICan Group, IMedicor, MDLiveCare, Mediangels, Microsoft Amalga, Microsoft HealthVault, HealthLinkBC, Myca, NHS Picture Archiving and Communications System, NORTH Network, Ontario Telemedicine Network, Patient portal, Picture archiving and communication system, Remote guidance, Remote surgery, Robotic surgery, Skevos Zervos, Tele-audiology, Tele-epidemiology, Telecare, Teledentistry, Teledermatology, Telemental Health, Telenursing, Telepathology, Telephone triage, Telepsychiatry, Teleradiology, Telerehabilitation, The Continua Health Alliance, UNESCO Chair in Telemedicine, Virtual patient, Virtual reality in telerehabilitation, Wireless Health, Wireless Medical Telemetry Service, World Health Imaging, Telemedicine, and Informatics Alliance, Xebra (medical imaging software) ...and Much, Much More!

This book explains in-depth the real drivers and workings of MHealth. It reduces the risk of your technology, time and resources investment decisions by enabling you to compare your understanding of MHealth with the objectivity of experienced professionals - Grab your copy now, while you still can.
The Knowledge Solution. Stop Searching, Stand Out and Pay Off. The #1 ALL ENCOMPASSING Guide to MHealth.

An Important Message for ANYONE who wants to learn about MHealth Quickly and Easily...

"Here's Your Chance To Skip The Struggle and Master MHealth, With the Least Amount of Effort, In 2 Days Or Less..."

mHealth (also written as m-health or mobile health) is a term used for the practice of medicine and public health, supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones and PDAs, for health services and information. The mHealth field has emerged as a sub-segment of eHealth, the use of information and communication technology (ICT), such as computers, mobile phones, communications satellite, patient monitors, etc., for health services and information. mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery of healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vital signs, and direct provision of care (via mobile telemedicine).

Get the edge, learn EVERYTHING you need to know about MHealth, and ace any discussion, proposal and implementation with the ultimate book – guaranteed to give you the education that you need, faster than you ever dreamed possible!

The information in this book can show you how to be an expert in the field of MHealth.

Are you looking to learn more about MHealth? You're about to discover the most spectacular gold mine of MHealth materials ever created, this book is a unique collection to help you become a master of MHealth.

This book is your ultimate resource for MHealth. Here you will find the most up-to-date information, analysis, background and everything you need to know.

In easy to read chapters, with extensive references and links to get you to know all there is to know about MHealth right away. A quick look inside: MHealth, EHealth, Health informatics, Health 2.0, List of open source healthcare software, MLearning, Telehealth, Telemedicine, HRHIS, Remote therapy, Alaska Federal Health Care Access Network, Alberta Netcare, American Telemedicine Association, Association of Telehealth Service Providers, Belgian Health Telematics Commission, Biotronik, Campus medicus, Canada Health Infoway, Center for Telehealth and E-Health Law, Centre for e-Health, Connected Health, DICOM, Distance Learning and Telemedicine Grant and Loan Program, Dossia, E-Patient, Epocrates, European Health Telematics Association, European Health Telematics Observatory, Google Health, Health On the Net Foundation, ICan Group, IMedicor, MDLiveCare, Mediangels, Microsoft Amalga, Microsoft HealthVault, HealthLinkBC, Myca, NHS Picture Archiving and Communications System, NORTH Network, Ontario Telemedicine Network, Patient portal, Picture archiving and communication system, Remote guidance, Remote surgery, Robotic surgery, Skevos Zervos, Tele-audiology, Tele-epidemiology, Telecare, Teledentistry, Teledermatology, Telemental Health, Telenursing, Telepathology, Telephone triage, Telepsychiatry, Teleradiology, Telerehabilitation, The Continua Health Alliance, UNESCO Chair in Telemedicine, Virtual patient, Virtual reality in telerehabilitation, Wireless Health, Wireless Medical Telemetry Service, World Health Imaging, Telemedicine, and Informatics Alliance, Xebra (medical imaging software) ...and Much, Much More!

This book explains in-depth the real drivers and workings of MHealth. It reduces the risk of your technology, time and resources investment decisions by enabling you to compare your understanding of MHealth with the objectivity of experienced professionals - Grab your copy now, while you still can.

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Published by: Emereo Publishing on Sep 02, 2011
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List Price: $39.95


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  • mHealth
  • eHealth
  • Health informatics
  • Health 2.0
  • List of open source healthcare software
  • MLearning
  • Telehealth
  • Telemedicine
  • Remote therapy
  • Alaska Federal Health Care Access Network
  • Alberta Netcare
  • American Telemedicine Association
  • American Telemedicine Association
  • Association of Telehealth Service Providers
  • Belgian Health Telematics Commission
  • Biotronik
  • Campus medicus
  • Canada Health Infoway
  • Center for Telehealth and E-Health Law
  • Centre for e-Health
  • Connected Health
  • Distance Learning and Telemedicine Grant and Loan Program
  • Dossia
  • E-Patient
  • Epocrates
  • European Health Telematics Association
  • European Health Telematics Observatory
  • •European Health Telematics Observatory [3]
  • Google Health
  • Health On the Net Foundation
  • iCan Group
  • iMedicor
  • MDLiveCare
  • Mediangels
  • MediAngels
  • Microsoft Amalga
  • Microsoft HealthVault
  • HealthLinkBC
  • Myca
  • NHS Picture Archiving and Communications System
  • NORTH Network
  • Ontario Telemedicine Network
  • Patient portal
  • Picture archiving and communication system
  • Remote guidance
  • Remote surgery
  • Robotic surgery
  • Skevos Zervos
  • Tele-audiology
  • Tele-epidemiology
  • Telecare
  • Teledentistry
  • Teledermatology
  • Telemental Health
  • Telenursing
  • Telepathology
  • Telephone triage
  • Telepsychiatry
  • Teleradiology
  • Telerehabilitation
  • The Continua Health Alliance
  • Continua Health Alliance
  • UNESCO Chair in Telemedicine
  • Virtual patient
  • Virtual reality in telerehabilitation
  • Wireless Health
  • Wireless Medical Telemetry Service
  • World Health Imaging, Telemedicine, and Informatics Alliance
  • World Health Imaging, Telemedicine and Informatics Alliance
  • Xebra (medical imaging software)
  • Article Sources and Contributors
  • Image Sources, Licenses and Contributors



Kevin Roebuck



High-impact Strategies - What You Need to Know: Definitions, Adoptions, Impact, Benefits, Maturity, Vendors

Topic relevant selected content from the highest rated entries, typeset, printed and shipped. Combine the advantages of up-to-date and in-depth knowledge with the convenience of printed books. A portion of the proceeds of each book will be donated to the Wikimedia Foundation to support their mission: to empower and engage people around the world to collect and develop educational content under a free license or in the public domain, and to disseminate it effectively and globally. The content within this book was generated collaboratively by volunteers. Please be advised that nothing found here has necessarily been reviewed by people with the expertise required to provide you with complete, accurate or reliable information. Some information in this book maybe misleading or simply wrong. The publisher does not guarantee the validity of the information found here. If you need specific advice (for example, medical, legal, financial, or risk management) please seek a professional who is licensed or knowledgeable in that area. Sources, licenses and contributors of the articles and images are listed in the section entitled “References”. Parts of the books may be licensed under the GNU Free Documentation License. A copy of this license is included in the section entitled “GNU Free Documentation License” All used third-party trademarks belong to their respective owners.

mHealth eHealth Health informatics Health 2.0 List of open source healthcare software MLearning Telehealth Telemedicine HRHIS Remote therapy Alaska Federal Health Care Access Network Alberta Netcare American Telemedicine Association Association of Telehealth Service Providers Belgian Health Telematics Commission Biotronik Campus medicus Canada Health Infoway Center for Telehealth and E-Health Law Centre for e-Health Connected Health DICOM Distance Learning and Telemedicine Grant and Loan Program Dossia E-Patient Epocrates European Health Telematics Association European Health Telematics Observatory Google Health Health On the Net Foundation iCan Group iMedicor MDLiveCare Mediangels 1 24 27 35 39 42 49 53 63 65 66 67 68 69 70 71 73 74 75 76 77 82 90 91 93 95 97 98 99 102 105 106 107 108

Licenses and Contributors 186 189 .Microsoft Amalga Microsoft HealthVault HealthLinkBC Myca NHS Picture Archiving and Communications System NORTH Network Ontario Telemedicine Network Patient portal Picture archiving and communication system Remote guidance Remote surgery Robotic surgery Skevos Zervos Tele-audiology Tele-epidemiology Telecare Teledentistry Teledermatology Telemental Health Telenursing Telepathology Telephone triage Telepsychiatry Teleradiology Telerehabilitation The Continua Health Alliance UNESCO Chair in Telemedicine Virtual patient Virtual reality in telerehabilitation Wireless Health Wireless Medical Telemetry Service World Health Imaging. Telemedicine. and Informatics Alliance Xebra (medical imaging software) 110 112 115 118 119 120 126 127 129 135 136 138 146 147 148 149 150 150 153 154 156 159 162 163 165 171 174 175 178 180 181 183 185 References Article Sources and Contributors Image Sources.

Article Licenses License 190 .

largely emerges as a means of providing greater access to larger segments of a population in developing countries. then. real-time monitoring of patient vital signs. such as computers. store. mobile phones. for health services and information."[3] A definition used at the 2010 mHealth Summit of the Foundation for the National Institutes of Health (FNIH) was “the delivery of healthcare services via mobile communication devices”. more actionable public health information. The term mHealth was coined by Professor Robert Istepanian as use of "emerging mobile communications and network technologies for healthcare. The field broadly encompasses the use of mobile telecommunication and multimedia technologies in health care delivery.[1] In a similar vein. patient monitors. eHealth can largely be viewed as technology that supports the functions and delivery of healthcare. and direct provision of care (via mobile telemedicine). For example. eHealth projects many times operate as the backbone of mHealth projects.[1] Definitions Mobile eHealth or mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems. as well as improving the capacity of health systems in such countries to provide quality healthcare. The field. supported by mobile devices. etc. and expanded access to ongoing medical education and training for health workers. delivery of healthcare information to practitioners. improved ability to diagnose and track diseases. timelier.[4] Because mHealth is by definition based on mobile technology such as IPhones. an mHealth project that uses mobile phones to access data on HIV/AIDS rates would required an eHealth system in order to manage.[2] Medical nurse uses a mobile phone in Accra. through information and Malaria Clinic in Tanzania helped by SMS for Life program which uses cell phones to efficiently deliver malaria vaccine . Within the mHealth space.. healthcare. while mHealth rests largely on providing healthcare access.[1] mHealth applications include the use of mobile devices in collecting community and clinical health data. communications satellite. The term is most commonly used in reference to using mobile communication devices. the linkage between mHealth and eHealth is unquestionable. the field has emerged in recent years as largely an application for developing countries. and patients. such as mobile phones and PDAs. researchers. The mHealth field has emerged as a sub-segment of eHealth. stemming from the rapid rise of mobile phone penetration in low-income nations.[4] While there are some projects that are considered solely within the field of mHealth. Ghana While mHealth certainly has application for industrialized nations. Thus. and assess the data. the use of information and communication technology (ICT). including increased access to healthcare and health-related information (particularly for hard-to-reach populations). for health services and information.mHealth 1 mHealth mHealth (also written as m-health or mobile health) is a term used for the practice of medicine and public health. while not clearly bifurcated by such a definition. projects operate with a variety of objectives.

World Health Organization. Additionally.000 inhabitants in 2004. low. nurses and midwives per 1000 population of 0.[11] In addition. The WHO notes critical healthcare workforce shortages in 57 countries—most of which are characterized as developing countries—and a global deficit [8] of 2. including rural areas. 11.and middle-income countries Middle income and especially low-income countries Disability-adjusted life year for all causes per 100. as well as the population of a country as a whole. "WHO Disease and injury country estimates". in a study of the healthcare workforce in 12 countries of Africa. people. low health care workforce. at 2. The second factor is the recent rapid rise in mobile phone penetration in developing countries to large segments of the healthcare workforce. The burden of disease.[6] With greater access to mobile phones to all segments of a country. can better reach areas. such . the potential of lowering information and transaction costs in order to deliver healthcare improves. finds an average density of physicians.6. and/or healthcare practitioners with previously limited exposure to certain aspects of healthcare. Healthcare in low. Both factors are discussed here.[10] The burden of disease is additionally much higher in low. The combination of these two factors have motivated much discussion of how greater access to mobile phone technology can be leveraged to mitigate the numerous pressures faced by developing countries’ healthcare systems. The first factor concerns the myriad constraints felt by healthcare systems of developing nations. Participation does not imply just consumption of health care services. and midwives. measured in disability-adjusted life year (DALY).4 million doctors.  no data  less than 9250  9250-16000  16000-22750  22750-29500  29500-36250  36250-43000  43000-49750  49750-56500  56500-63250  63250-70000  70000-80000  more a than 80000 plethora of constraints in their healthcare systems. free of disease and disability. transport. The motivation behind the development of the mHealth field arises from two factors.mHealth delivery. 2 Motivation of mHealth MHealth is one aspect of eHealth which is pushing the limits of how to acquire. which may not have been possible in the past. extreme poverty.and middle-income countries than high-income countries. process.[9] The density of the same metric is four times as high in the United States. which can be thought of as a measurement of the gap between current health status and an ideal situation where everyone lives into old age. as well as some of the largest burdens of disease. face 2009. large numbers of rural inhabitants.and middle-income countries are forced to face the burdens of both extreme poverty and the growing incidence of chronic diseases. mHealth offers the ability of remote individuals to participate in the health care value matrix. healthcare access to all reaches of society is generally low in these countries. Retrieved Nov. These constraints include high population [5] growth. The WHO notes an extreme deficit within the global healthcare workforce. store. In many cases remote users are valuable contributors to gather data regarding disease and public health concerns such as outdoor pollution. 2009. nurses. .64. a high burden of disease prevalence. These countries face a severe lack of human and physical resources. The WHO. is about five times higher in Africa than in high-income countries. and secure the raw and processed data to deliver meaningful results. and limited financial resources to support healthcare infrastructure and health information systems. drugs and violence. and large population growth rates.

[16] The number of global mobile phone subscribers in 2007 was estimated at 3.and middle-income nations. Improvements in telecommunications technology infrastructure. reduced costs of mobile handsets. there were 4.and middle-income countries are utilizing mobile phones as “leapfrog technology” (see leapfrogging). in the mHealth field. mobile phones have allowed many developing countries. and other diseases.1 billion mobile phones in use in December 2008 .6 billion (47%).[18] Globally. the WHO notes that the healthcare workforce in sub-Saharan Africa would need to be scaled up by as much as 140% to attain international health development targets such as those in the Millennium Declaration. In many countries. malaria. the number of mobile phone subscribers has by-passed the number of fixed-line telephones. in reference to the healtcare condition in sub-saharan Africa.[12] The WHO.[1] Considering poor infrastructure and low human resources. and a general increase in non-food expenditure have influenced this trend. The greatest growth is expected in Asia. with the global Mobile phone penetration rate drastically increasing over the last decade. to bypass 20th century fixed-line technology and jump to modern mobile technology.” [12] Health and development The link between health and development can be found in three of the Millennium Development Goals (MDGs). as set forth by the United Nations Millennium Declaration in 2000.[13] A progress report published in 2006 indicates that childhood immunization and deliveries by skilled birth attendants are on the rise. Mobile Phones Penetration and Drivers of Growth Mobile phones have made a recent and rapid entrance into many parts of the low. deploy and efficiently use the substantial additional funds that are considered necessary to improve health in these countries.and middle-income world.1 billion of an estimated global population of 6.[17] These figures are expected to grow to 4. and Africa.mHealth as diabetes and heart disease. Low. the entrance of other technologies into these nations to facilitate healthcare are also discussed here. or a 64.5 billion by 2012. The MDGs that specifically address health include reducing child mortality.[15] While.and Middle-income Countries Mobile technology has made a recent and rapid appearance into low. That is. and increasing access to safe drinking water. an effect of new-found (relative) affluence. even those with relatively poor infrastructure. the Middle East. improving maternal health.7% mobile penetration rate. See List of countries by number of mobile phones in use. while many regions continue to struggle to achieve reductions in the prevalence of the diseases of poverty including malaria.[14] 3 Mobile Technology in Low. Mobile phone subscribers per 100 inhabitants 1997–2007 . mobile technology usually refers to mobile phone technology. this is particularly true in developing countries. HIV and AIDS and tuberculosis. states: "The problem is so serious that in many instances there is simply not enough human capacity even to absorb. combating HIV and AIDS.

on average. The broad range of potential benefits to the health sector that the simple functions of mobile phones can provide should not be understated. As a result of such technological advances.[22] The appeal of mobile communication technologies is that they enable communication in motion. access to web-based patient information. Indian consumers are getting wealthier and they are spending more and more. while only 9.and middle-income countries. are developing cheaper infrastructure technologies (CDMA) and cheaper phones (sub $50–100.[23] [24] This is particularly beneficial for work in remote areas where the mobile phone. faster. In India. the capacity for improved access to information and two-way communication becomes more available at the point of need. Consumers are shifting their expenditure from necessity to discretionary. although total share of consumption has declined. That being said.and middle-income countries has not reached the sophistication of those in high-income countries. was 66% in urban areas. The all India average was 28. the growth within countries is not generally evenly distributed. such as Nokia. globally. such as mobile phones. The number is expected to drop to 34% by 2015.and middle-income nations. and now increasingly wireless infrastructure.2% at the same time. getting wealthier in low. GPS navigation. causing a rapid increase spending on new technology. In India. Mobile phones are spreading because the cost of mobile technology deployment is dropping and people are. availability and efficiency in both voice and data-transfer systems in addition to rapid deployment of wireless infrastructure will likely accelerate the deployment of mobile-enabled health systems and services throughout the world. allowing individuals to contact each other irrespective of time and place. Although far from ubiquitous. More advanced mobile phone technologies are enabling the potential for further healthcare delivery.4% in rural areas.[19] So. and decentralized health management information systems (HMIS). Non-food consumption expenditure is increasing in many parts of the developing world.and middle-income countries. consumers have become and continue to become wealthier. while per-capita consumption of food and beverages increased 24%.mHealth While mobile phone penetration rates are on the rise. the spread of Smartphone technologies opens up doors for mHealth projects such as technology-based diagnosis support. Mobile penetration. and [25] Increased email through Smartphones is not as well developed in much of the low.[20] Vendors. web browsing. While uptake of Smartphone technology by the medical field has grown in low. by far the greatest growth rates are found in urban areas. compared to 42% in 2005. in September 2008. on average. total consumption of food and beverages increased 82% from 1985 to 2005. 56% of Indian consumers’ consumption went towards food in 1995.[21] Technology Basic SMS functions and real-time voice communication serve as the backbone and the current most common use of mobile phone technology. GPS navigation. as disposable income rises.[26] 4 . for example.and middle-income countries. while mobile penetration rates have increased markedly. there are certainly within-country equity issues to consider. while mobile phones may have the potential to provide greater healthcare access to a larger portion of a population. Smartphone technologies are now in the hands of a large number of physicians and other healthcare workers in low. such as Sun's Java phone). for example. For example. The infrastructure that enables web browsing. with a greater ability to spend on new technologies. remote diagnostics and telemedicine. is able to reach more people. it is worth noting that the capabilities of mobile phones in low.

Some other mHealth technologies include • • • • • • • Patient monitoring devices Mobile telemedicine/telecare devices MP3 players for mLearning Laptop computers Microcomputers Data collection software Mobile Operating System Technology 5 Mobile Device Operating System Technology Technologies relates to the Operating Systems which orchestrate mobile device hardware while maintaining confidentiality. significant [27] such as HD video and benefits can be achieved in the delivery of health care services. Apple’s iPhone OS. while managing display real estate.4% of total mortality. Data is primarily focused on visualizing static text but can also extend to interactive decision support algorithms. Operating systems which control these emerging classes of devices include Google’s Android. ambient light detectors. accelerometers. Many of these technologies. Microsoft's Windows Mobile. Nokia Symbian OS and RIM's BlackBerry OS. GPS.and middle-income nations. applications are beginning to be tailored for and make inroads in low. This may foster greater adoption of mHealth Technologies and Services. while having some application to low. and other health-related data collection. Devices in this class may include Apple's iPad 1&2 and Motorola's Xoom. and also communication capabilities through the integration of e-mail and SMS features. Air Quality Sensing Technologies Environmental conditions have a significant impact to public health.and middle-income countries. As advances in capabilities such as integrating voice. . tested. However. integrity and availability are required to build trust. close to the patient or consumer of the health care service. New sensor technologies audio capabilities. By aggregating this data. Data collection requires both the collection device (mobile phones. Per the World Health Organization. Integrating use of GIS and GPS with mobile technologies adds a geographical mapping component that is able to “tag” voice and data communication to a particular location or series of locations. Data has become an especially important aspect of mHealth. power consumption and security posture. This could include diagnosis. computer. health facilities and services mapping. treatment and monitoring. are developing primarily in high-income countries.0 collaboration tools into mobile devices. video and Web 2. wireless-enabled laptops and specialized health-related software applications are currently being developed.[29] Utilizing Participatory sensing technologies in mobile telephone.mHealth Other mHealth Technologies Beyond mobile phones. and marketed for use in the mHealth field. Operating Systems must be agile and evolve to effectively balance and deliver the desired level of service to an application and end user. by exploiting lower cost multi purpose mobile devices such as tablets pcs and smart phones.[28] which can be utilize to assess the impact of pollution. barometers and gyroscopes[28] can enhance the methods of describing and studying cases. education. public health policy shall be able to craft initiatives to mitigate risk associated with outdoor air pollution. other visual image information. or portable device) and the software that houses the information. outdoor air pollution accounts for about 1. Projects such as the Urban Atmospheres [30] are utilizing embedded technologies in mobile phones to acquire real time conditions from millions of user mobile phones. with broad advocacy campaigns for free and open source software (FOSS). public health research can exploit the wide penetration of mobile devices to collect air measurements. These combined capabilities have been used for emergency health services as well as for disease surveillance.

health clinics. including testing and treatment methods. Education and awareness Education and awareness programs within the mHealth field are largely about the spreading of mass information from source to recipient through short message services (SMS). Overall. Efforts are ongoing to explore how a broad range of technologies. Below is a list of mHealth Education and Awareness projects: . SMSs provide an avenue to reach far-reaching areas—such as rural areas—which may have limited access to public health information and education.mHealth 6 mHealth and Health Outcomes The mHealth field operates on the premise that technology integration within the health sector has the great potential to promote a better health communication to achieve healthy lifestyles. availability of health services. The mHealth field also houses the idea that there exists a powerful potential to advance clinical care and public health services by facilitating health professional practice and communication and reducing health disparities through the use of mobile technology. mobile communication technologies are tools that can be leveraged to support existing workflows within the health sector and between the [33] health sector and the general public. the potential of mHealth lies in its ability to offer opportunities for direct voice communication (of particular value in areas of poor literacy rates and limited local language-enable phones) and information transfer capabilities that previous technologies did not have. In some ways. In education and awareness applications. improve decision-making by health professionals (and patients) and enhance healthcare quality by improving access to medical and health information and facilitating instantaneous communication in places where this was not previously possible. offering patients confidentiality in environments where disease (especially HIV/AIDS) is often taboo. Additionally.and middle-income countries. can improve such health outcomes as well as generate cost savings within the health systems of low. and most recently mHealth technologies. Within the mHealth space. the UN Foundation and Vodafone Foundation[1] report presents six application categories within the mHealth field. more actionable public health information expanded access to ongoing medical education and training for health workers [1] Applications in the mHealth Field While others exist. SMSs provide an advantage of being relatively unobtrusive. and a deficit of healthcare workers[1] . SMS messages are sent directly to users’ phones to offer information about various subjects. • • • • • • • Education and awareness Helpline Diagnostic and treatment support Communication and training for healthcare workers Disease and epidemic outbreak tracking Remote monitoring Remote data collection Each application category as well as specific project within the category will be described. projects operate with a variety of objectives. and disease management. as stated by the UN Foundation and Vodafone Foundation's report on mHealth for Development: • • • • increased access to healthcare and health-related information (particularly for hard-to-reach populations) improved ability to diagnose and track diseases timelier.[31] [32] It follows that the increased use of technology can help reduce health care costs by improving efficiencies in the health care system and promoting prevention through behavior change communication (BCC).

health risk prevention.mHealth 7 Country Name Inception Program size Major services Insights and Outcomes Sponsors Charges Telcom partner role Mexico Vidanet Vidanet gives People Living With HIV (PLWHIV) the ability to register to receive messages to help improve their adherence to their specific treatment. The main objective of this Project for ICS is to develop a strategic model of educational communication by promoting projects involving a telecommunication revolution in favor of health. and adherence to specific prescribed treatments assigned to PLWHIV. With these tools they can generate changes in attitude towards a self-health care. Voxiva has partnered with the Instituto Carso de la Salud (ICS) .

From this assessment the individual begins receiving educational messages encouraging him/her to exercise and eat healthy. diabetes or smoking) as well as blood pressure and cholesterol if known. a solution in self-health care. age. and adherence to prescribed treatments. along with ICS. height.mHealth Mexico Cardionet Voxiva.e. patient education. the individual is evaluated according to the standards set by the World Health Organization (WHO). Based on these answers. Individuals complete a questionnaire asking them questions such as sex. health risk prevention. weight. Examples of health foods and exercise are given to increase the messages effectiveness.org [34] ResultsSMS is an open-source platform compatible with OpenMRS designed to disseminate test results. follow-up appointments and adherence reminders to patients via SMS. has developed CardioNet. ResultsSMS is a partnership between [35] GPAS . Rwanda/Uganda ResultsSMS. other health problems they have (i. FrontlineSMS [36] and Support for International [37] Change with seed funding from the Harvard Initiative for Global Health [38] Voxiva has partnered with the Instituto Carso de la Salud (ICS) 8 .

Aricent. there have been a download of 10. SMS message campaign promoting HIV/AIDS awareness resulted in nearly a tripling of call volume to a local HIV/AIDS helpline. Stigma is a major barrier. Games are free for download through the corporate social responsibility program of [43] ZMQ 9 games are deployed largest mobile on low-end operators of India and was black/white to sophisticated able to reach high-end colored out to over 9 devices. frog design and National AIDS Helpline ‘Please Call Me’ service -free text messages.mHealth India Freedom [39] HIV/AIDS [40] 2005 In the first phase.000 calls answered. Ghetto Ruff. and can send “please call me” message. 95% of South Africa uses prepaid cellular plans. iTeach. MTN. Later. In a span of 15 months. The initiative is supported by Delhi State AIDS Control Society and was launched by Chief Minister of Delhi Shrimati Sheila Dikshit. Nokia Siemens Networks. ZMQ [41] launched four games on Reliance Infocomm one of the Freedom HIV/AIDS comprises four mobile games targeting different mindsets and psychology of mobile users. National Geographic. .060. Praekelt Foundation. PopTech!. million handsets. Children of South African Legacies. The Freedom HIV/AIDS [42] is a social initiative of ZMQ Software Systems (A Technology for Development Social Enterprise) [41] . the games were made available on other mobile carriers taking to 30 million handsets.3 million game sessions South Africa Project [1] Masiluleke 276 Million text messages –one million per day –being sent (2008–2009). MTN has allowed program to use total inventory of “please call me” messages. There is 120 empty characters left in a “please call me” SMS message. causing people to only seek care very late in the illness. encourage HIV/AIDS testing and treatment and halt the disease’s spread. Build awareness of HIV status. 1. Messages in local languages are especially well received.

Apart from English. under the "Star Programme" corporate social responsibility program of ZMQ Many countries FrontlineSMS [39] Free open source software that turns a laptop and a mobile phone into a central communications hub that enables users to send and receive text messages with large groups of people through mobile phones. AIDs Information Centre (AIC).000 mobile HIV/AIDS phone awareness via an subscribers in rural Uganda sent the quiz in the three month pilot test SMS-based multiple choice quiz in exchange for free airtime. Tanzania and Kenya in Eastern Africa. Games are Freedom HIV/AIDS is a free for download social through the initiative of ZMQ . Mozambique and Namibia in Southern Africa Africa Reach Program [39] [40] [44] 2006 In the first phase. and KPN. participants encouraged to come in for testing (fee waived for participants) 40% increase in the number of patients Celtel. Affairs Uganda. without requiring an internet connection . there have been a download of 10. ZMQ launched four games on Reliance Infocomm one of the largest mobile operators of India and was able to reach out to over 9 million handsets. and SMS-based quiz in exchange for free airtime 10 who came in the Dutch for Ministry of HIV/AIDS Foreign testing. Merck. and Malawi. correct answers provided. Actionable insight: Many quiz takers did not think AIDS testing was accurate nor anonymou. the games were made available on other mobile carriers taking to 30 million handsets.Swahili and Shen. Later. the games have been developed in local languages .A Technology for Development Social Enterprise [41] . In a span of 15 months.3 million game sessions Freedom HIV/AIDS introduced two HIV/AIDS awareness games to countries in Africa. a leading Dutch development organization. the largest Dutch telecom company. Africa Reach Program supported by Hivos.mHealth Uganda Text to Change [1] 15.

service complaints. Immunisations rates of children. Cervical Smear Screenings..mHealth UNICEF/Georgia [39] Mobile4Good [39] New Zealand Vensa Health Coverage includes the Improve access to On average primary care services GP Surgeries and Hospitals District Health Patients Boards. equipment. Daily text messages sent to patients to improve appointment attendance. Helpline Helpline typically consists of a specific phone number which any individual is able to call to gain access to a range of medical services. These include phone consultations. and/or available mobile health clinics [1] Below is a list of mHealth Helpline projects: Country Name Inception Program size Australia National Health Call Centre Network or healthdirect [45] Australia HealthDirect (Western [45] Australia) HealthDirect (Northern [45] Territory) Australia Nurse-on-Call [45] (Victoria) HealthDirect (South [45] Australia) 2006 Government-sponsored 1999 Government-sponsored 2007 Major services Insights and Outcomes Sponsors Charges Telcom partner role Government-sponsored Australia Government-sponsored Australia 2006 Government-sponsored .. Flu activities Vaccinations and with patients more. and information on facilities. drugs. counseling. achieve 50% and General reduction in Practice missed around New appointment Zealand rates and achieve 6 time greater response in recall / pre-call Breast screening. receive the Primary Health Organisations messages for free from health organisations 11 whole country and hospital of 4 million appointment plus New attendance in Zealanders receiving daily messages from their GP doctors and Hospitals accordance to Ministry of Health targets.

diarrhea (7%) MNO-sponsored: Telemedicine firm and MNO For profit. Top health complaints: Recurring abdominal pain (13%). information on facilities. private charity Service is free.mHealth Australia Health First (Australia Capital [45] Territory) Bangladesh Healthline [45] 2006 10000 Calls per day Phone consults. malaria. drugs. back pain (9%). pharmacies.00 monthly Voice bearer New Zealand [45] 2006 Healthline Government-sponsored . Voice bearer Colombia Dominican Republic India Independent Independent 2007 50000 Calls per day Phone consults. MedicallHome 1998 [45] Subscription: Billing and unlimited revenue calls for US$ collection. discounts on hospital visits. Shareholder. knee pain (8%) Government-sponsored: Not for Government and a profit. Chronic diseases test result interpretation.21 Marketing and promotion. information on facilities. pneumonia (each 8%). Mission: be the first choice in private health services. Mission: be a first reference point to complement conventional health solutions. discounts at clinics. Government-sponsored 12 (BDT 15) for Billing and 3 minute call revenue collection. Mission: create platform to enable 1 billion virtual and 1 billion physical service contacts. ENT. 5. mobile health clinics (vans). Canada Fonemed (for USA callers) [45] Canada Telehealth [45] (Ontario) Telemedic Telemed HMRI [45] 2001 Government-sponsored 1999 Government-sponsored (40%). Independent Independent: Call center entrepreneurs For profit. early pregnancy. drugs. Top health information on complaints: facilities. counseling and complaints. Service is US$ 0. drugs. Voice bearer [45] [45] Mexico Mexico Telemedic [45] 10000 Calls per day Phone consults.

Service is US$ 0. known as telemedicine.mHealth Pakistan Teledoctor [45] 2008 1000 Calls per day Phone consults. Voice bearer 13 South Africa 2007 Government-sponsored Trinidad and Tobago United Kingdom United States United States Healthcare provider-sponsored Healthcare provider-sponsored United States Independent United States Healthcare provider-sponsored United States United States Independent Independent MedicallHome [45] USA Diagnostic support. other projects provide direct diagnosis to patients themselves. Billing and revenue collection. easy access to experienced doctors. Gynecological ailments and obstetrics. Fever (usually associated with respiratory tract infections) Philippines Fonemed Asia-Pacific [45] Eastern Cape Health Call [45] Centre MedStar Health Information [45] NHS Direct [45] MedicareBlue [45] PPO FirstHelp Nurse Advice [45] Line Telemed (Puerto Rico) [45] Informed Health Line [45] (Aetna) Teladoc [45] 2007 1999 Government-sponsored 2004 Independent planned Independent MNO-sponsored: Telemedicine firm and MNO For profit. (gastro-enteritis). Diarrhea and Mission: vomiting provide cheap. patients might take a photograph of a wound or illness and allow a remote physician diagnose to help treat the medical problem. Top health information on complaints: facilities. treatment support.30 (PKR 24) for 3 minute call Marketing and promotion. In such cases. drugs. Both diagnosis and treatment support projects attempt to mitigate the cost and time of travel for patients located in remote areas[1] . While some projects may provide mobile phone applications—such as a step-by-step medical decision tree systems—to help healthcare workers diagnosis. communication and training for healthcare workers Diagnostic and treatment support systems are typically designed to provide healthcare workers in remote areas advice about diagnosis and treatment of patients.

and communication and training for healthcare workers Country Name Inception Program size Major services Insights and Outcomes India Tele-Doc [39] [46] 2003 Launched as TeleDoc provided handheld a pilot mobile phone devices to village project in 15 health workers in India. convenient and at the lowest possible cost. This involves connecting healthcare workers to other healthcare workers. Supported by the Soros Foundation.000 active clients across India TeleDoc was a project of Jiva Institute. Relevant health content is made available to patients to take care of chronic conditions such as diabetes. Social venture with services starting as low as $1 per month Sponsors Charges Telcom partner role 14 mQure [47] . villages in Haryana in April 2003 permitting them to communicate with doctors who use a web application to help diagnose and prescribe for patients. Patients can get medical help on their mobile phone 24x7 or second opinions. Over 10.50) per consultation. Such projects additionally involve using mobile phones to better organize and target in-person training. heart conditions or pregnant mother/newborn care. ministries of health. medical institutions. information on latest hospital bed availability. India 2010 Services operational across India mQure provides innovative solutions to make healthcare more accessible. an India-based non-profit.mHealth mHealth projects within the communication and training for healthcare workers subset involve connecting healthcare workers to sources of information through their mobile phone. Patients can also manage their chronic conditions or remember to take their medicines on time via Med Reminders. Improved communication projects attempt to increase knowledge transfer amongst healthcare workers and improve patient outcomes through such programs as patient referral processes[1] Below is a list of mHealth projects for both diagnostic and treatment support. or other houses of medical information. Independent entrepreneurs The approximate cost of the entire TeleDoc process was 70 rupees (US$1.

child and maternal health. and disseminate critical program. TRACnet is being deployed to increase the efficiency of Rwanda’s HIV/AIDS program management. retrieve. and is available to health officials in real-time for analysis and decision-making. Rwanda TRACnet [39] [49] TRACnet is Rwanda’s dynamic Information Technology solution designed to collect. medical experts. and enhance the quality of patient care. Health workers in locations without Internet connectivity can access the system using any phone (satellite. and regional hospitals. Under the leadership of the Ministry of Health and the Treatment Research and AIDS Centre (TRAC). or community pay phone). and patient information related to HIV/AIDS care and treatment. The system was implemented to support the Rwandan Government’s vision of rapidly scaling up HIV/AIDS clinical services in a variety of health care settings. All reported data is recorded in a central database. store.and webbased information and communication system for maternal and child health that allows health professionals in remote locations to communicate and exchange critical health information between themselves. Voxiva and The Rwanda Ministry of Health The USAID-funded Pathfinder International program and Voxiva worked with the Regional Health Directorate of Ucayali and the Peru Ministry of Health 15 . malaria. Uganda. mobile. drug. fixed-line. AED Mozambique Satellife [39] [50] Information and communications technologies (ICT) initiatives through the USA-based not-for-profit Academy for Educational Development providing support for HIV/AIDS. and health systems management programs.mHealth Peru Nacer [39] [48] Nacer is a phone.

at this link maintained by DataDyne. Data concerning the location and levels of specific diseases (such as malaria. Amazonas State Health Ministry Brazil Name? [1] 400 test results gathered by 20 field professionals in two days. all with GPS information Containing the spread of the Dengue virus. AESSIMS [52] [39] AESSIMS is designed to build health capacity at the field level by enabling front-line health workers to report disease incidence through an innovative combination of telephone and web based technology that leverages available infrastructure. PATH. district. While some software within this area is specific to a particular content or area. Such projects can be particularly useful during emergencies. TB. There is [51] (the list is also a list of mobile phone-based data collection software. in order to provide current information on their product) Country Name Inception Program size Major services Insights and Outcomes Sponsors Charges Telcom partner role Nokia. Voxiva. Below is a list of mHealth disease and epidemic outbreak tracking projects. Avian Flu) can help medical systems or ministries of health or other organizations identify outbreaks and better target medical resources to areas of greatest need. cheaply. in order to identify where the greatest medical needs are within a country[1] Policymakers and health providers at the national. Health data and GPS location information are integrated to enable immediate analysis and identification of areas with high infection levels. Data collection times dramatically reduced (paper-based system would have taken 2–3 months for lesser information). and community level need accurate data in order to gauge the effectiveness of existing policies and programs and shape new ones. remote data collection. A lack of patient data creates an arduous environment in which policy makes can decide where and how to spend their (sometimes limited) resources. and epidemic outbreak tracking Projects within this area operate to utilize mobile phones’ ability to collect and transmit data quickly. HIV/AIDS. and the Government of Andhra Pradesh (GoAP) . from a practical perspective.mHealth 16 Disease surveillance. other software can be adapted to any data collection purpose. collecting field information is particularly difficult since many segments of the population are rarely able to visit a hospital. and relatively efficiently. and data collection software. Customized questionnaires distributed to field health agents’ mobile phones. AESSIMS enables health officials to better understand the scope of disease impact and strategically allocate resources to areas with the highest prevalence and need.org but each developer organization mentioned has edit access. even in the case of severe illness. In the developing world. End-user acceptance very high.

syndromic surveillance. you could be using EpiSurveyor. and covered by [57] Wired . "Like Gmail for data collection" :-) records from outbreak investigation. InSTEDD [39] . drug [53] stats here ) stock tracking . and coordinated response. Kenya. right now. no meetings. Premium version available. the Guardian . Stockholm Challenge Award. . and others. World Bank functional system for creating mobile data collection systems. and Tech Museum Award. as well as health and economic surveys. the it. EpiSurveyor Vodafone is not a "project" Foundation. Development and support based in Nairobi.org worldwide [53] Since moving from older.org that allows rapid development of forms which can then be downloaded to mobile Major insight: if you make an easy-to-use tool available to Developed with funding from the United Nations Basic service. More info [62] 17 hundreds of phones for data organizations in collection: user can go more than 170 from concept to fully countries have uploaded more than 150.000 completed data functional mobile data collection system in hours. for free. is completely free and requires "no money. many people Foundation will find and use [61] . used by 99% of users. veterinary studies. the Economist [58] [59] . or a "pilot": it is and the a fully. PDA-based version to online version. [60] Voice of America . regardless of the topic. Lemelson-MIT Award for [56] Sustainability .mHealth Kenya and 2003 EpiSurveyor. Voxiva Health [39] [63] Watch Voxiva HealthWatch is an integrated surveillance platform used by public health agencies around the world to support integrated disease surveillance. . and no MOU". and it is available to anyone. Used in more than 170 countries worldwide for anyone online. more than 3500 users from EpiSurveyor is an online system developed by [54] DataDyne. even the tracking of mountain gorillas in Uganda: if you are collecting data on paper. Winner of Wall Street Journal Technology Innovation [55] Award . phones (updated disease surveillance.

can participate in the program. medication regimen adherence. a Health Worker would call back to assist them. ~500 participants. Any diabetic person. who has a TelCel cell phone. Diabediario uses telecommunication to generate changes in attitude towards risk prevention and adherence to prescribed treatments. a solution for changing diabetics’ lifestyles and for controlling and improving their adherence to their diabetic treatment.or two-way communications systems. including chronic disease management Remote monitoring and treatment support allows for greater involvement in the continued care of patients. along with ICS.mHealth 18 Treatment support and medication compliance for patients. Such projects can operate through either one. Patients responded to these message by saying everything was OK. Remote monitoring has been used particularly in the area of medication adherence for AIDS and diabetes[1] Below is a list of mHealth treatment support and remote monitoring projects: Name Country Inception Program size Major services Insights and Outcomes Sponsors Charges Telcom partner role Kenya Weltel [64] 2008 1 year clinical trial. and follow-up scheduling. Diabediario does not replace doctor’s visits or pills but is meant to act as a supplement to outside care. or they had a problem. Voxiva has partnered with the Instituto Carso de la Salud (ICS) . Within environments of limited resources and beds—and subsequently a ‘outpatient’ culture—remote monitoring allows healthcare workers to better track patient conditions. HIV-positive patents were sent weekly text messages inquiring about their well-being. If there was a problem. has developed Diabediario. Prevention (CDC) PEPFAR Public Health Evaluation (PHE) and the International Development Research Centre's Africa Health Systems Initiative Support to African Research Partnerships (AHSI-RES) Mexico Diabediario Voxiva. Positive results The US Centers showing that for Disease mobile phones can Control and be a useful tool in supporting HIV-positive patients. This system empowers the patient to take control of their health by taking all the necessary steps to control their diabetes.

low-literacy diabetic population The device has a voice recorder and a bar code scanner. The device was not stigmatizing. "Are you feeling happy?" Legacy Foundation 90% of patients took their medication. United States Web-based Mobile Support for the Washington D. Mobile health application for dietary insight for a chronically Ill.mHealth Peru Cell-Preven [1] Cell-Preven health workers use mobile phones to send SMS messages with real-time data on symptoms experienced by clinical trial participants. appointment reminders for US service members returning from duty. HIPAA compliant.C. This enables immediate response to adverse symptoms Thailand Name? [1] TB patients were given mobile phones and called daily with a reminder to take their TB medication United States mCare 2009 US Army Medical Department mobile phone messaging application for the case management of reintegrated wounded soldiers. along with context and psychological factors. ? DIMA Dietary Intake Monitoring Application 2009 6-week pilot study with 20 participants. By the end of the study the participants were only using the voice recorder. rather seen as a status symbol. US Army Medical Department Powered by Voxiva 19 . Adding web interface to integrate with telephone quitline Many behavior change things are characterized by success and relapse. Measuring real time behavior. Ported content from "afterdeployment. SMS-based wellness tips. Tobacco Quitline 2009 Currently updating the system to take real time patient smoking cessation data and "close the loop" feedback to improve adherence.org" to a cell phone. Patients use "beam" bar code scanner more easily than pen bar code scanner.

Sproxil and mPedigree) [66] • Clinical care and remote patient monitoring • Health extension services • Health services monitoring and reporting • Health-related mLearning for the general public • Training and continuing professional development for health care workers • Health promotion and community mobilization • Support of long-term conditions *[67] According to Vodafone Group Foundation on February 13. Participants became better problem solvers with the condition.g. evidence-based formulary. which typically collected: pictures of meant they felt food. diabetes. a partnership for emergency communications was created between the group and United Nations Foundation. 5 Used bluetooth glucose meter.g. pictures of confusing food labels. Such partnership will increase the effectiveness of the information and communications technology response to major emergencies and disasters around the world.mHealth United States MAHI Mobile Access to Health Information 2009 49 participants.. month study. database and decision support information available at the point-of-care[65] • Pharmaceutical Supply Chain Integrity & Patient Safety Systems (e. voice notes with specific problems. ndividuals record several switched from Research "external" to "internal" locus of messages per day. recently diagnosed Each time a diabetic patient used a glucose meter the phone would Outcomes: significant Georgia Tech. CDC. are on the verge of . more in charge. Siemens Corporate 20 give them a call to gather data on fraction of why they were using it. Data that were control. and supervision • Mobile synchronous (voice) and asynchronous (SMS) telemedicine diagnostic and decision support to remote clinicians[65] • Clinician-focused. Virtual Health Pet [39] On-Cue SIMpill [39] [39] SMS appliance that monitors medicine compliance by sending a text message when the patient takes medicine. 2008. and better achieved dietary goals. SMS data gathering applications Cell-Life [39] Emerging trends and areas of interest in mHealth • Emergency response systems (e. Being connected by mobile health services. (which were previously isolated) directly or indirectly related to health care delivery mechanism. management. Google Health. Nokia or participants with any java-enabled cell phone. different novel networking among various entities. emergency obstetric care) • Human resources coordination. road traffic accidents.

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Outdoor air pollution : assessing the environmental burden of disease at national and local levels (null ed. 4/1/2010 http:/ / www. Emiliano. Robert. Mamta (2009). "A Mobile Agent Approach for Ubiquitous and Personalized eHealth Information Systems. Mercer. United Nations: New York. D. mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World (http:/ / www. A. . [4] Torgan. Vol. Evans. March 2009. Case paper in India: The impact of mobile phones. [3] Istepanian. Andrew (NaN undefined NaN). & Samaras G. M. and J. 87. [30] http:/ / www. eds (2005). [9] Kinfu. vitalwaveconsulting.. Uppal M.. edu/ viewdoc/ download?doi=10.. WHO: Geneva.

org. washingtonpost. Retrieved on 2010-08-14. org [54] http:/ / www.washingtonpost. cfm?story_id=10950499 [59] http:/ / www.Serios Games Initiative to COmbat HIV/AIDS (http:/ / www. A survey of mobility: A world of witnesses (http://www. wmv [61] http:/ / www. child and maternal health. com/ casestudies. guardian. deaths from measles drop sharply" The Washington Post: November 2007. html [56] http:/ / datadyne. com/ specialreports/ displaystory. freedomhivaids. voanews. php?caseid=21) [53] http:/ / www. Technology plays crucial role in vaccination distribution . Deaths From Measles Drop Sharply (http://www. freedomhivaids. com/ article/ SB10001424052970203440104574399714096167656.myjoyonline.03/04/2008 (http://www. com/ casestudies. P. asp). Retrieved on 2010-08-14. freedomhivaids.mqure. uk/ 1/ hi/ health/ 8436092. in/ FreedomHivAids. datadyne. php?caseid=22) [50] AED-Satellife Center for Health Information and Technology (http:/ / www. malaria. globalhealth.htm). News. org/ [38] http:/ / www. com/ [37] http:/ / sichange. Globally. "Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries?" Globalization and Health 2 (2006): 9. in) [45] GSMA Foundation. [40] Freedom HIV/AIDS (http:/ / www. uk/ activate/ phones-revolution-developing-world [60] http:/ / www. [67] http:/ / news. Discusses use of handheld electronic data collection in managing public health data and activities." August 2007. org/ global-issues/ technology/ mhealth-report. org [36] http:/ / www. co. A Doctor in Your Pocket: Health Hotlines in Developing Countries [46] Tele-doc India (http:/ / www.mHealth [34] http:/ / resultssms. • "A world of witnesses" The Economist: January 2008. episurveyor. harvard.episurveyor. do [39] UN Foundation.com/Articles/2008/04/03/ 230128/technology-plays-crucial-role-in-vaccination-distribution. frontlinesms. htm) An HIV/AIDS awareness initiative using mobile phone games [41] http:/ / www.com (2010-05-14). in [43] ZMQ . [66] Ghana News :: West African Innovation Hits Global Stage ::: Breaking News | News in Ghana | features (http:/ / news. org [55] http:/ / online.com/surveys/displaystory. org/ episurveyor/ faq [63] Voxiva Website: Health Watch (http:/ / voxiva. comminit. google. Retrieved on 2010-08-14. html). healthnet. Computer Weekly (2008-04-03).html). Full text | Can the ubiquitous power of mobile phones be used .. [65] Mechael. "WHO mHealth Review: Towards the Development of an mHealth Strategy. Retrieved on 2010-08-14.com/wp-dyn/content/article/2007/11/29/ AR2007112902021.com. com/ ccc?key=0ArG7kkc9mE75dEdNNktocmVwT0hNbHVjTXl2ZU1VMXc& hl=en& authkey=CKiRppwM [52] Voxiva Case Study: AESSIMS (http:/ / voxiva. php?caseid=29) [49] Voxiva Case Study: TRACnet (http:/ / voxiva. Vital Wave Consulting. zmqsoft. • "Globally. edu/ icb/ icb. com/ casestudies. stm 22 Further reading • "Technology plays crucial role in vaccination distribution" Computer Weekly: April 2008. co. org [35] http:/ / globalpas. voxiva. bbc. economist. php?catname=HealthWatch) [64] Home (http:/ / www. wsj. org/ ) Information and communications technologies (ICT) initiatives through the USA-based not-for-profit Academy for Educational Development providing support for HIV/AIDS. com [44] Freedom HIV/AIDS . Describes role of EpiSurveyor mobile data collection software in contributing to the highly successful fight against measles mortality. unfoundation. org/ ). economist. org [62] http:/ / datadyne. Discusses use of EpiSurveyor (http://www. The Economist. 2008. Vodafone Foundation. and health systems management programs in Uganda and Mozambique [51] http:/ / spreadsheets.com] [48] Voxiva Case Study: Peru Nacer (http:/ / www. myjoyonline. zmqsoft. com/ solutionspage.org) software in public health monitoring in Africa. com/ MediaAssets2/ english/ 2010_01/ MakingADifferenceSelanikio-fixed-20fps-256k. Retrieved on 2010-08-14. org/ news/ wiredukjune2010 [58] http:/ / www. com [42] http:/ / www.computerweekly. • Kaplan. weltel. weltel. org/ news/ lemelsonmit2009 [57] http:/ / datadyne. Warren. mHealth for Development (http:/ / www. com/ features/ 201005/ 46200. unfoundation. com/ en/ node/ 116145) [47] [www.cfm?story_id=10950499).A Technology for Development Company http:/ / www.

(PDF) .org/intradoc/groups/public/documents/UN/ UNPAN030003. Mechael.pdf) Mechael. Mechael. Vital Wave Consulting (February 2009)..cfm?id=1861959 Inter-American Development Bank. Robert et al. February 2009." Public Health & Policy (p. [Community-based health workers in developing countries and the role of m-health. R. • Anta R. Mobilizing Markets: Special Edition of MIT Innovations Journal for the GSMA Mobile World Congress 2009.com (http://www. In Telehealth in Developing Countries]http://www.so why not use it to deliver health care?]" The Economist: 2005.org/document. P. and Giuffrida A.mHealth to improve health outcomes in developing countries? (http://www. United Nations 23 • • • • • • • • • • Foundation. Patricia (2009). Retrieved on 2010-08-14.mhealthinfo.pdf).com/content/2/1/ 9). MONITOR | The doctor in your pocket | Economist.org) offers information on the current use. (http://open. mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World (http://www. London: London School of Hygiene and Tropical Medicine 2006. "Introduction to the Special Section on M-Health: Beyond Seamless Mobility and Global Wireless Health-care Connectivity. Written and compiled by Sally-Jean Shackleton.]http://www.pdf). ISBN 978-0-9821442-0-6 United Nations. The Case for mHealth in Developing Countries.com/pdf/mHealth.org/wiki/ upload/PatriciaMechaelThesisFinalDecember2006.wirelesslifesciences.idrc. Towards the Development of an mHealth Strategy: A Literature Review.http://unpan1. El-Wahab S." IEEE Transactions on Information Technology in Biomedicine: 2004.vitalwaveconsulting. eds. Istepanian.org (http://www. Rapid Assessment of Cell Phones for Development. Information Technology in Systems of Care. Delfin Press. New York: Earth Institute at Columbia University: Working Document.. [Mobile Health: The potential of mobile telephony to bring health care to the majority.htm • mHealthInfo. Istepanian." United Nations: 2006.org/pdfs/ MONITOR_doctorinyourpocket_Economist. Retrieved on 2010-08-14. Sloninsky.iadb. Christopher J. pages 153-168. (2006) M-Health: Emerging Mobile Health Systems. Globalization and Health.intrahealth.ca/en/ev-137420-201-1-DO_TOPIC. 264). Volume 1: Mobile Applications on Health and Learning. P and D. ISBN 0-387-26558-9 UNICEF and Women's Net (2007). potential and limitations of mHealth in low-resource settings .pdf Economist "The doctor in your pocket [Medical technology: Nearly everyone in the developed world carries a mobile phone. Cambridge: MIT Press. • Adesina Iluyemi.globalizationandhealth.un. (2000). Springer Verlag. Olmeda. "Exploring Health-related Uses of Mobile Phones: An Egyptian Case Study. "Compendium of ICT Applications on Electronic Government. 405-413.. Vodafone Foundation. 8(4).

and direct provision of care (via mobile telemedicine). various coding schemes may used in combination with international medical standards. There is also concern about non-confidential data however.[1] Usage of the term varies: some would argue it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health.[2] while others use it in the narrower sense of healthcare practice using the Internet. • mHealth or m-Health: includes the use of mobile devices in collecting aggregate and patient level health data. best practice guidelines or epidemiological tracking (examples include physician resources such as Medscape and MDLinx).[7] Various authors have considered the evolution of the term and its usage and how this maps to changes in health informatics and healthcare generally. front-end data exchange and back-end exchange.[8] [9] [10] Oh et al. specialists etc. • Medical research using Grids: powerful computing and data management capabilities to handle large amounts of [6] heterogeneous data. including: • Electronic health records: enabling the communication of patient data between different healthcare professionals (GPs. work schedule management and other administrative tasks surrounding health. This main concern has to do with the confidentiality of the data. while back-end exchange does not.g. researchers. most specifically the EPR (Electronic patient record). Such . Of the forms of e-Health already mentioned. Such an actions may avoid the cost of an expensive visit to the hospital. A common example of a back-end exchange is when a patient on vacation visits a doctor who then may request access to the patient's health records.[3] [4] [5] Forms of e-health The term can encompass a range of services or systems that are at the edge of medicine/healthcare and information technology.eHealth 24 eHealth eHealth (also written e-health) is a relatively recent term for healthcare practice supported by electronic processes and communication. A common example of a rather simple front-end exchange is a patient sending a photo taken by mobile phone of a healing wound and sending it by email to the family doctor for control. in an overview of latest medical journals. or blood test results. • Consumer health informatics: use of electronic resources on medical topics by healthy individuals or patients.). real-time monitoring of patient vitals. Contested definition Several authors have noted the variable usage in the term. To standardize the exchange of information. • Virtual healthcare teams: consisting of healthcare professionals who collaborate and share information on patients through digital equipment (for transmural care). and patients. patient data management. such as medicine prescriptions. Front-end exchange typically involves the patient. dating back to at least 1999. from being specific to the use of the Internet in healthcare to being generally around any use of computers in healthcare. offered the following definitions of eHealth:[11] E-Health data exchange One of the factors blocking the use of e-Health tools from widespread acceptance is the concern about privacy issues regarding patient records. x-ray photographs. Each medical practise has its own jargon and diagnostic tools. in a 2005 systematic review of the term's usage. • Health knowledge management: e.. providing healthcare information to practitioners. • Telemedicine: physical and psychological treatments at a distance. • Healthcare Information Systems: also often refer to software solutions for appointment scheduling. there are roughly two types.

3(2):e22 (http:/ / www. online pharmaceutical therapy. Diepgen TL. online counseling. jmir. "Implementing e-Health in Developing Countries: Guidance and Principles" (http:/ / www. front-end e-Health solutions tend to be relatively easy to implement. org/ 2001/ 2/ e20/ ) [8] Della Mea V (2001). NEC Lab Report. "What is e-health?" J Med Internet Res 2001. These centers offer services to disabled populations. This form of psychological intervention modality offers a series of benefits as well as challenges to providers and clients. The International Society for Mental Health Online [14] . HIMSS News.[12] Various medical practises in chronic patient care (such as for diabetic patients) already have a well defined set of terms and actions. "What is e-Health (2): The death of telemedicine?" J Med Internet Res 2001. E-health: transforming the physician/patient relationship. E-health manages both flows of information. The role of e-health and consumer health informatics for evidence-based patient choice in the 21st century. Testifying to this momentum. ccrl-nece. It also has its own academic peer review journals. weather inclement populations. E Mental Health E Mental Health refers to the delivery of mental health services via the internet through videoconferencing. family and marriage therapy. Early adapters Chronic patients over time often acquire a high level of knowlegde about the processes involved in their own care. University of California Davis has initiated a series of studies based on E Mental Health [16] . For instance. int/ ITU-D/ cyb/ app/ docs/ e-Health_prefinal_15092008. The efficacy and effectiveness of E Mental Health approaches are currently being studied by Universities around the world. a common thesaurus is needed for terms of reference. E Mental Health has been gaining momentum in the academic research as well as practical arenas in a wide variety of disciplines such as psychology.: Integrating Data Custodians in eHealth Grids – Security and Privacy Aspects (http:/ / www. de/ publications/ paper/ public/ LR-06-262. pdf). There are a number of E Mental Health Centers now operating around the world.3(2):e22 (http:/ / www. clinical social work. References [1] Della Mea V (2001).19(1):11-7 [5] Ball MJ. such as the Journal of Medical Internet Research [15] . For these types of routine patients. which makes standard communication exchange easier. 13(7): 12 [4] Eysenbach G. 2001 Apr. Clin Dermatol. Int J Med Inform. In general. particularly in the USA and Australia. rural populations. the E Mental Health movement has its own international organization.3(2):e20 (http:/ / www. org/ 2001/ 2/ e22/ ) [2] International Telecommunication Union (2008). computer-based interventions.eHealth an action may reveal allergies or other prior conditions that are relevant to the visit. PDF) [3] "HIMSS SIG develops proposed e-health definition".61(1):1-10 [6] Jochen Fingberg. as well as populations who are comfortable using the internet and world wide web. explanatory diagnostic information (such as the standard ICD-10) may be exchanged insecurely. Most notable of all challenges is online security [13] . while ensuring the quality of the data exchange. and often develop a routine in coping with their condition. "What is e-Health (2): The death of telemedicine?" J Med Internet Res 2001. whether the exchange is initiated by the patient or the caregiver. 2001 Jan-Feb. org/ 2001/ 2/ e22/ ) . Marit Hansen et al. chat. jmir. cyber mental health approaches. 2006 [7] Eysenbach G (2001). and online life coaching. and private information (such as personal information from the patient) must be secured. and mental health counseling. jmir. 25 Thesaurus Successfull e-Health initiatives such as e-Diabetes have shown that for data exchange to be facilitated either at the front-end or the back-end. or email web applications. itu. E Mental Health encompasses online talk therapy. Lillis J.

asp). Oortwijn W. Kreslake JM. while allowing patients and professionals to do the previously impossible. Ehealth is making healthcare more efficient. org/ home. jmir.8(1):e4 (http:/ / www. (https:/ / www.7(1):e1 (http:/ / www. psychiatryonline. businesses or consumers themselves. • 2001 Eysenbach (M) e-health is an emerging field in the intersection of medical informatics. W = Wilson Business Abstracts. • 2000 DeLuca. and manage the health care system. the term characterizes not only a technical development. and account for care. care management. but delivered through the Internet. and worldwide by using information and communication technology • 2001 Strategic Health Innovations (G) The use of information technology in the delivery of health care. to improve health care locally. • 2001 Ontario Hospital eHealth Council (G) EHealth is a consumer-centred model of health care where stakeholders collaborate utilizing ICTs including Internet technologies to manage health. • 2003 Regional Office for the Eastern Mediterranean . in particular over the Internet. regionally. educational and commercial "products" to direct services offered by professionals. (http:/ / www. ismho. to improve our health care system. Sloan D.eHealth [9] Pagliari C. wireless communications. • 2003 eEurope . Kahan JP. jmir. and wellness.nl/ndf/e-diabetes. to stimulate innovation in care delivery and health system management. Detmer D. especially the Internet. It can include teaching. org/ 2005/ 1/ e1/ ) [12] [http://www. education. and interaction with health care providers. in the health sector. Sullivan F. "What Is eHealth (6): Perspectives on the Evolution of eHealth Research" J Med Internet Res 2006. public health and business. affect the health of citizens and patients. Simply stated. jmir.g. computer telephony/interactive voice response. [15] Journal of Medical Internet Research. and a commitment for networked. • 2001 Robert J Wood Foundation (G) EHealth is the use of emerging information and communication technology. global thinking.World Health Organization (G) E-health is a new term used to describe the combined use of electronic communication and information technology in the health sector OR is the use. stored and retrieved electronically-for clinical. educational and administrative purposes. physiologic data). (http:/ / www. as well as interaction with other patients afflicted with the same conditions. arrange. "What Is eHealth: A Systematic Review of Published Definitions. non-professionals. ranging from informational. jmir. jmir. and. org/ 2006/ 1/ e4/ ) [11] Oh et al. org/ ) [16] University of California Davis. • 2000 JHITA (G) Internet-related healthcare activities • 2000 McLendon (M) Ehealth refers to all forms of electronic healthcare delivered over the Internet.Frontiers of Medicine (W) (M) E-health is the embryonic convergence of wide-reaching technologies like the Internet." J Med Internet Res 2005. org/ 2005/ 1/ e9/ ) [10] Ahern DK. monitoring ( e. Phalen JM. • 2003 COACH (G) The leveraging of the information and communication technology (ICT) to connect provider and patients and governments. Enmark .diabetesfederatie. org/ 2010/ 5/ e61/ ) [14] The International Society for Mental Health Online. Ehealth includes a wide variety of the clinical activities that have traditionally characterized telehealth. and direct access to healthcare providers. MacGillivray S.html e-Diabetes on the website of the Dutch Diabetes foundation [13] Journal of Medical Internet Research. to improve or enable health and health care. an attitude. both at the local site and at a distance . a way of thinking. Gregor P. of digital data-transmitted. G = Google) Definition • 1999 Mitchell (G) A new term needed to describe the combined use of electronic communication and information technology in the health sector. http:/ / psy. • 2000 Pretlow (G) E-health is the process of providing health care via electronic means.eHealth2003 (G) The application of information and communication technologies (ICT) across the whole range of functions which one way or another. deliver. referring to health services and information delivered or enhanced through the Internet and related technologies. managers and consumers. but also a state-of-mind. stored and retrieved electronically – for clinical.7(1):e9 (http:/ / www. both at the local site and at a distance. org/ cgi/ content/ full/ 48/ 2/ 135 26 Year Source (M = Medline. to educate and inform health care professionals. In a broader sense. "What Is eHealth (4): A Scoping Exercise to Map the Field" J Med Internet Res 2005. The use in the health sector of digital data – transmitted. educational and administrative purposes.

eHealth • 2003 HMS Europe (G) The practice of leveraging the Internet to connect caregivers, healthcare systems and hospitals with consumers



Health informatics
Health informatics (also called health care informatics, healthcare informatics, medical informatics, nursing informatics, clinical informatics, or biomedical informatics) is a discipline at the intersection of information science, computer science, and health care. It deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine. Health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems. It is applied to the areas of nursing, clinical care, dentistry, pharmacy, public health, occupational therapy, and (bio)medical research.

Electronic patient chart from a health information system

• The international standards on the subject are covered by ICS 35.240.80 in which ISO 27799:2008 is one of the core components.[2] • Molecular bioinformatics and clinical informatics have converged into the field of translational bioinformatics.


Informatics were a central part of the Nazi health care system, which included Nazi eugenics as one of its fundamental principles. New systems and technology, like electronic punch card tabulating and sorting machines, and the science of medical statistics, were used to gather, sort, and analyze personal information on a vast scale unseen before in human history. The information was used to help find and eliminate the 'genetically inferior' through sterilization or wholesale murder. Many of the architects of these systems would go on to play a role in the post-war medical informatics field.[3] World wide use of technology in medicine began in the early 1950s with the rise of the computers.[4] In 1949, Gustav Wager established the first professional organization for informatics in Germany.[5] The prehistory, history, and future of medical information and health information technology are discussed in reference.[6] Specialized university departments and Informatics training programs began during the 1960s in France, Germany, Belgium and The Netherlands. Medical informatics research units began to appear during the 1970s in Poland and in the U.S.[5] Since then the development of high-quality health informatics research, education and infrastructure has been the goal of the U.S. and the European Union.[5] Early names for health informatics included medical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software engineering, and medical computer technology. The health informatics community is still growing, it is by no means a mature profession, but work in the UK by the voluntary registration body, the UK Council of Health Informatics Professions [7] has suggested eight key constituencies within the domain - information management, knowledge management, portfolio/programme/project management, ICT, education and research, clinical informatics, health records(service and business-related), health informatics service management. These constituencies accommodate professionals in and for the NHS, in academia

Health informatics and commercial service and solution providers. Since the 1970s the most prominent international coordinating body has been the International Medical Informatics Association (IMIA).


Medical informatics in the United States
Even though the idea of using computers in medicine sprouted as technology advanced in the early twentieth century, it was not until the 1950s that informatics made a realistic impact in the United States.[4] The earliest use of computation for medicine was for dental projects in the 1950s at the United States National Bureau of Standards by Robert Ledley.[8] The next step in the mid 1950s were the development of expert systems such as MYCIN and Internist-I. In 1965, the National Library of Medicine started to use MEDLINE and MEDLARS. At this time, Neil Pappalardo, Curtis Marble, and Robert Greenes developed MUMPS (Massachusetts General Hospital Utility Multi-Programming System) in Octo Barnett's Laboratory of Computer Science [9] at Massachusetts General Hospital in Boston.[10] In the 1970s and 1980s it was the most commonly used programming language for clinical applications. The MUMPS operating system was used to support MUMPS language specifications. As of 2004, a descendent of this system is being used in the United States Veterans Affairs hospital system. The VA has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture (VistA). A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 health care facilities. In the 1970s a growing number of commercial vendors began to market practice management and electronic medical records systems. Although many products exist, only a small number of health practitioners use fully featured electronic health care records systems. Homer R. Warner, one of the fathers of medical informatics,[11] founded the Department of Medical Informatics at the University of Utah in 1968. The American Medical Informatics Association (AMIA) has an award named after him on application of informatics to medicine.

Current state of health informatics and policy initiatives
Argentina Since 1997, the Buenos Aires Biomedical Informatics Group, a nonprofit group, represents the interests of a broad range of clinical and non-clinical professionals working within the Health Informatics sphere. Its purposes are: • Promote the implementation of the computer tool in the healthcare activity, scientific research, health administration and in all areas related to health sciences and biomedical research. • Support, promote and disseminate content related activities with the management of health information and tools they used to do under the name of Biomedical informatics. • Promote cooperation and exchange of actions generated in the field of biomedical informatics, both in the public and private, national and international level. • Interact with all scientists, recognized academic stimulating the creation of new instances that have the same goal and be inspired by the same purpose. • To promote, organize, sponsor and participate in events and activities for training in computer and information and disseminating developments in this area that might be useful for team members and health related activities. The Argentinian health system is very heterogeneous, because of that the informatics developments shows an heterogeneous stage. Lot of private Health Care center have developed systems, as the German Hospital of Buenos

Health informatics Aires who was one of the first in develop the electronic health records system. Brazil The first applications of computers to medicine and healthcare in Brazil started around 1968, with the installation of the first mainframes in public university hospitals, and the use of programmable calculators in scientific research applications. Minicomputers, such as the IBM 1130 were installed in several universities, and the first applications were developed for them, such as the hospital census in the School of Medicine of Ribeirão Preto and patient master files, in the Hospital das Clínicas da Universidade de São Paulo, respectively at the cities of Ribeirão Preto and São Paulo campi of the University of São Paulo. In the 1970s, several Digital Corporation and Hewlett Packard minicomputers were acquired for public and Armed Forces hospitals, and more intensively used for intensive-care unit, cardiology diagnostics, patient monitoring amd other applications. In the early 1980s, with the arrival of cheaper microcomputers, a great upsurge of computer applications in health ensued, and in 1986 the Brazilian Society of Health Informatics was founded, the first Brazilian Congress of Health Informatics was held, and the first Brazilian Journal of Health Informatics was published. Canada Health Informatics projects in Canada are implemented provincially, with different provinces creating different systems. A national, federally-funded, not-for-profit organization called Canada Health Infoway was created in 2001 to foster the development and adoption of electronic health records across Canada. As of December 31, 2008 there were 276 EHR projects under way in Canadian hospitals, other health-care facilities, pharmacies and laboratories, with an investment value of $1.5-billion from Canada Health Infoway.[12] Provincial and territorial programmes include the following: • eHealth Ontario was created as an Ontario provincial government agency in September 2008. It has been plagued by delays and its CEO was fired over a multimillion-dollar contracts scandal in 2009.[13] • Alberta Netcare was created in 2003 by the Government of Alberta. Today the netCARE portal is used daily by thousands of clinicians. It provides access to demographic data, prescribed/dispensed drugs, known allergies/intolerances, immunizations, laboratory test results, diagnostic imaging reports, the diabetes registry and other medical reports. netCARE interface capabilities are being included in electronic medical record products which are being funded by the provincial government. United States In 2004 the U.S. Department of Health and Human Services (HHS) formed the Office of the National Coordinator for Health Information Technology (ONCHIT). The mission of this office is widespread adoption of interoperable electronic health records (EHRs) in the US within 10 years. See quality improvement organizations for more information on federal initiatives in this area. The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards for electronic health records (EHR) and supporting networks, and certify vendors who meet them. In July, 2006 CCHIT released its first list of 22 certified ambulatory EHR products, in two different announcements.[14]


The European Union's Member States are committed to sharing their best practices and experiences to create a European eHealth Area, thereby improving access to and quality health care at the same time as stimulating growth in a promising new industrial sector. The European eHealth Action Plan plays a fundamental role in the European Union's strategy. Work on this initiative involves a collaborative approach among several parts of the Commission services.[15] [16] The European Institute for Health Records is involved in the promotion of high quality electronic

Many organisations and bodies (look on their own websites. and primary care (1968) emerge. to make choices about their care.Health informatics health record systems in the European Union. Northern Ireland and Wales) but some bodies like UKCHIP (see below ) operate for those 'in and for' all the home countries and beyond.[citation needed] Discussion of open sourcing it as a remedy is occurring. History The broad history of health informatics has been captured in the book UK Health Computing : Recollections and [18] . Interesting. in 2010. this is a situation which the coalition government propose broadly to return to in the 2010 strategy Equity and Excellence: Liberating the NHS (July 2010). The UK health informatics community has long played a key role in international activity. Scotland. Interoperation between primary and secondary care systems is rather primitive. Cambridge was the host for the first EFMI [20] Medical Informatics Europe (1974) conference and London was the location for IMIA’s tenth global congress (MEDINFO2001). They will have increased control over their own care records. Under the aegis of BCS Health [18]. predominantly members of reflections. through an information revolution and greater choice and control’ with shared decision-making becoming the norm: ‘no decision about me without me’ and patients having access to the information they want. immunization (1963). joining TC4 of the International Federation of Information Processing (1969) which became IMIA [19] (1979).[16] The project. and the business of care delivery. In part this was due to some areas of health services (for example the immunization and vaccination of children) still being provided by Local Authorities. Barnett D (Eds. even in the early 1970s were developed in-house by pioneers in the field to meet their own requirements. The book describes the path taken as ‘early development of health informatics was unorganized and idiosyncratic’. It has been provided free to all GPs in Scotland but has developed poorly. standardised GP system. is seriously behind schedule and its scope and design are being revised in real time. England The NHS in England has contracted out to several vendors for a national health informatics system 'NPFIT' that originally divided the country into five regions and is to be united by a central electronic medical record system nicknamed "the spine". as most have made their responses public in detail for information) responded to the consultation and a new strategy is expected in the second quarter of 2011. GPASS was accepted in 1984. The degree of computerisation in NHS secondary care was quite high before NPfIT and that programme has had the unfortunate effect of largely stalling further development of the installed base. Hayes G. stating: "We will put patients at the heart of the NHS. radiotherapy (1962)." These types of statements present a significant opportunity for health informaticians to come out of the back-office and take up a front-line role supporting clinical practice. Almost all general practices in England and Wales are computerised and patients have relatively extensive computerised primary care clinical records. BCS (May 2008) by those active in the field. . Many of these solutions.) BCS Health and its constituent groups. and controlled and developed by NHS Scotland.[17] 30 UK There are different models of health informatics delivery in each of the home countries (England. A focus on interworking (for interfacing and integration) standards is hoped will stimulate synergy between primary and secondary care in sharing necessary information to support the care of individuals. In 2010 a wide consultation was launched as part of a wider ‘Liberating the NHS’ plan. In the early -1950s it was prompted by those involved in NHS finance and only in the early 1960s did solutions including those in pathology (1960). Scotland has the GPASS system whose source code is owned by the State. Scotland has an approach to central connection under way which is more advanced than the English one in some ways. Computerisation is the responsibility of individual practices and there is no single.

New South Wales. Australia The Australasian College of Health Informatics (ACHI) is the professional association for health informatics in the Asia-Pacific region. 31 Emerging Direction (European R&D) The European Commission's preference.[27] ACHI is a sponsor of the "e-Journal for Health Informatics". ACHI has also supported the "Australian Health Informatics Education Council" (AHIEC) since its founding in 2009. the regional group called the Asia Pacific Association for Medical Informatics (APAMI)[23] was established in 1994 and now consists of more than 15 member regions in the Asia Pacific Region. the idea of a profession of health informatics across the UK was first mooted and by 2004 a voluntary open [7] now has a formal Code register was established. Victoria and Western Australia) as well as special interest groups such as nursing (NIA).[22] is for Free/Libre and Open Source Software (FLOSS) for healthcare. standards and ethical practice. as exemplified in the 5th Framework[21] as well as currently pursued pilot projects. industry and medical imaging (Conrick. It represents the interests of a broad range of clinical and non-clinical professionals working within the health informatics sphere through a commitment to quality. Nursing informaticians were the driving force behind the formation of HISA. In conjunction with workforce development tools such as the NHS HI Career Framework it is possible for individuals to compare their skills against typical job roles. determine their professional level. Asia and Oceania In Asia and Australia-New Zealand. In addition. UKCHIP certification is being considered for regulatory purposes. HISA has a number of branches (Queensland. . and for employers to carry out detailed workforce analysis to meet the emerging requirements of the informatics strategies of all the home countries. its trusted advisors and national and international experts in Health Informatics. confirmation of fitness to practice. The membership comes from across the informatics spectrum that is from students to corporate affiliates.[24] Founded in 2002.[29] Although there are a number of health informatics organisations in Australia. the principles and UKCHIP model are being considered internationally (as at 2011). academia and the commercial service and solution providers. The UK Council for Health Informatics Professions (UKCHIP) of Professional Conduct. which is now a company limited by guarantee of the members. In 2011. pathology.Health informatics UK Council for Health Informatics Professions In 2002. the Health Informatics Society of Australia[30] (HISA) is regarded as the major umbrella group and is a member of the International Medical Informatics Association (IMIA). Consistent standards express competences of health informatics professionals in both domain-specific and generic informatics professional areas. re-grading and personal development. self-assessment tools were introduced for use by any interested party. ACHI is increasingly valued[25] for its thought leadership. aged and community care.[28] an indexed and peer-reviewed professional journal. Accreditation of the service organisations that provide health informatics support to NHS operational units involves an NHS Benchmarking Club. standards for expressing competences which are used for entry. The consistency is intended to apply in operational care delivery organizations. 2006). ACHI is an academic institutional member of the International Medical Informatics Association (IMIA)[26] and a full member of the Australian Council of Professions.

is the national organisation that advocates for Health Informatics. • characterize. medical informatics professionals and the IT industry to further promote IT in healthcare in Hong Kong. The Hong Kong Hospital Authority placed particular attention to the governance of clinical systems development. and health informatics tools to: • assess information and knowledge needs of health care professionals and patients. • develop. develop theoretical and applicable knowledge. with radiography images from any HA site being available as part of the ePR.org. Since 2004 radiology image viewing has been added to the ePR. This system has been deployed at all the sites of the Authority (40 hospitals and 120 clinics). Clinical Informatics Clinical Informatics is concerned with use information in health care by clinicians. Health Informatics Law also applies to all matters that involve information technology. The most mature and established is the Otago programme which has been offered for over a decade. and provide scientific and applicable studies.000 clinical staff on a daily basis. The Hong Kong Society of Medical Informatics (HKSMI) was established in 1987 to promote the use of information technology in healthcare.[38] [39] Clinical informaticians transform health care by analyzing.[32] New Zealand Health Informatics is taught at five New Zealand universities. ethical and operational issues that invariably arise when electronic tools. methods. The Health Informatics [31] has close relationship with Information Technology Department and Section in Hong Kong Hospital Authority clinicians to develop healthcare systems for the organization to support the service to all public hospitals and clinics in the region.Healthcare Informatics Review Online www.Health informatics Hong Kong In Hong Kong a computerized patient record system called the Clinical Management System (CMS) has been developed by the Hospital Authority since 1994. improve [patient] care. The eHealth Consortium has been formed to bring together clinicians from both the private and public sectors. The comprehensive records of 7 million patients are available on-line in the Electronic Patient Record (ePR). implementing. with input from hundreds of clinicians being incorporated through a structured process. Saudi Arabia [36] to work under direct supervision The Saudi Association for Health Information (SAHI) was established in 2006 of King Saud University for Health Sciences to practice public activities.[33] Health Informatics New Zealand (HINZ)(www. and refine clinical decision support systems. health care and the interaction of information. Clinical informaticians use their knowledge of patient care combined with their understanding of informatics concepts.hinz. and strengthen the clinician-patient relationship. and . It deals with the circumstances under which data and records are shared with other fields or areas that support and enhance patient care. It addresses the privacy. with a daily transaction of up to 2 millions.hinz.[37] [34] 32 Health informatics law Health informatics law deals with evolving and sometimes complex legal principles as they apply to information technology in health-related fields. information and media are used in health care delivery. and refine clinical processes. implement.nz/journal [35]. and is used by all 30.nz ).org. designing. and evaluating information and communication systems that enhance individual and population health outcomes. with data integrated from all sites. evaluate. HINZ organises a conference every year and also publishes an online journal.

PMID 16799115. Retrieved July 26. europa. The Globe and Mail (Toronto). au). cchit. 2006. timely. usyd. edu/ history-of-health-informatics). htm). Milestones in Computer Science and Information Technology.M2127. implementation. . infoway-inforoute. . 12 August 2009. Retrieved . Baek. European Space Agency.Australian College of Health Informatics" (http:/ / www. Ledley". 161. europa. just a mouse click away" (http:/ / www. au/ health_informatics/ about/ index. 2005. Retrieved 2009-08-26. . esa. harvard. 2009-06-07. "Medical informatics education: the University of Utah experience". cbc. org). eu) [23] "Asia Pacific Association of Medical Informatics" (http:/ / www. org [20] http:/ / www. Nursing Informatics and Health Information Management Degrees. B.Academic Institutional Members . shtml) Current Developments in Health Informatics [26] "International Medical Informatics Association . customization. Journal of the American Medical Informatics Association 6 (6): 457–65. mgh. management. ca/ canada/ story/ 2009/ 06/ 07/ ehealth-kramer. org/ health [19] http:/ / www. htm) [16] European eHealth Action Plan i2010 (http:/ / ec. PMC 61389. Retrieved 3 May 2010. gets big package" (http:/ / www. org [21] Cordis FP5web (http:/ / cordis. wmychart18/ BNStory/ specialScienceandHealth/ ). ukchip. NJ: John Wiley & Sons. int/ esaMI/ Telemedicine_Alliance/ SEMWC7SMD6E_0. apami. [2] Fraser. fhs. "The story behind the development of the first whole-body computerized tomography scanner as told by Robert S. effective. epsos. (2009).Laboratory of Computer Science (http:/ / www. org. eu/ fp5/ ) [22] European Patient Smart Open Services (http:/ / www. [24] "Australasian College of Health Informatics" (http:/ / www. bcs. [12] Priest. htm) [17] "Electronic Health Records for Europe" (http:/ / www.240. html).Australia . theglobeandmail.Australasian College of Health Informatics [25] University of Sydney (http:/ / www. Journal of the American Medical Informatics Association 13 (5): 465–9. Retrieved 2009-01-13. uic. [7] http:/ / www. biostatistiques.1197/jamia. PMC 1561796. O. University of Illinois at Chicago. Clinicians collaborate with other health care and information technology professionals to develop health informatics tools which promote patient care that is safe. . Retrieved 2008-06-15. html).nyuinformatics. [5] "NYU Graduate Training Program in Biomedical Informatics (BMI): A Brief History of Biomedical Informatics as a Discipline" (http:/ / www.80: IT applications in health care technology" (http:/ / www. NYU Langone Medical Center. doi:10. [15] European eHealth Action Plan (http:/ / ec. efmi. efficient. Reilly (2003). ca/ downloads/ Ross_Fraser_-_ISO_27799. imia. org [8] Sittig DF. eu/ information_society/ activities/ health/ policy_action_plan/ index_en. [3] The Nazi Census. [9] MGH . . europa. . ISBN 9780470289532. 33 Translational bioinformatics With the completion of the human genome and the recent advent of high throughput sequencing and genome-wise association studies of single nucleotide polymorphisms. Ledley RS (2006). [18] http:/ / www. Retrieved 2008-06-15. Health Informatics. org/ members/ profiles/ academic. Temple University Press. "Your medical chart. Greenwood Press. 2004 [4] "The History of Health Informatics" (http:/ / healthinformatics. ISO. lcs. K. 20080218. . The engines of Hippocrates: From the Dawn of Medicine to Medical and Pharmaceutical Informatics. org/ iso/ products/ standards/ catalogue_ics_browse. org/ education/ degree-programs).. and equitable. imia-medinfo. ACHI. Retrieved 11 November 2010. lasso?-Search=Action& -Table=CGI& -MaxRecords=1& -SkipRecords=2& -Database=organizations& -SortField=english_vers& -SortOrder=ascending& type=academic& approved=yes). pdf). evaluation. "ISO 27799: Security management in health using ISO/IEC 17799" (http:/ / sl. eu/ information_society/ eeurope/ i2010/ index_en. and continuous improvement of clinical information systems.org. . pp. 2006): CCHIT Announces First Certified Electronic Health Record Products (http:/ / www. iso. Ross. Götz Aly and Karl Heinz Roth. [11] Patton GA. edu. statistical genetics and clinical informatics are converging into the emerging field of translational bioinformatics. Gardner RM (1999). . development. nyuinformatics. htm?ICS1=35& ICS2=240& ICS3=80& ). www. [13] "Head of eHealth Ontario is fired amid contracts scandal. [14] Certification Commission for Healthcare Information Technology (July 18. Lisa (2008-02-18). edu/ ) [10] Edwin D.Health informatics • lead or participate in the procurement. patient-centered. org/ media/ press+ releases/ CCHIT+ Announces+ First+ Certified+ Electronic+ Health+ Record+ Products. ISBN 978-1573565219. . CBC News. PMID 10579604. com/ servlet/ story/ RTGAM.[40] [41] [42] References [1] "35. the fields of molecular bioinformatics. Hoboken. [6] Robson. Ash JS.

002. ha. Ray Kirk. [37] "Saudi Association for Health Informatics (SAHI)" (http:/ / www.A Report to the Tertiary Education Commission" (http:/ / homepages.eJHI. nz/ ~peterk/ healthinformatics/ tec-hi-report-06. Overhage JM. 2008-05-18. [40] Butte. org. [42] Lussier. org.1197/jamia. PMID 19074295. org. L (2010).net) Article about informatics (http://www. Retrieved 2009-01-08. pdf).electronic Journal of Health Informatics (http:/ / www. et al. hisa. its principles. PMID 20470899. html) [32] eHealth Consortium (http:/ / www. mcs. lasso?-Search=Action& -Table=CGI& -MaxRecords=1& -SkipRecords=27& -Database=organizations& -KeyField=Internal Record ID& -SortField=country& -SortOrder=ascending& -SortField=country& -SortOrder=ascending& type=national& type=national). doi:10.dmoz. hk/ hi/ Welcome. . ac. Jan Duke. nz [35] http:/ / www. "Current methodologies for translational bioinformatics. PMC 2810112. Journal of the American Medical Informatics Association 16 (2): 153–7. iproa.org. doi:10. org/ ProjectDetail. "Translational bioinformatics applications in genome medicine. code and standards (http://www.sa/. "Advances in translational bioinformatics: computational approaches for the hunting of disease genes".healthcare-informatics. [39] Safran C. Jim Warren and Shona Wilson (2006). Rowena Cullen. au). PMID 19566916. php).org. sa/ objectives. doi:10. ejhi.ukchip. AJ (2009).".M3045. [38] Gardner RM. nz/ journal [36] "Medical Pharmaceutical Information Association (MedPharmInfo)" (http:/ / www. (2009). Briefings in Bioinformatics 11 (1): 96. Journal of the American Medical Informatics Association 16 (2): 158–66. PMC 2703873. Journal of biomedical informatics 43 (3): 355–7.2010. org.org) Healthcare Informatics Magazine (http://www. PMC 2649328. Genome medicine 1 (6): 64. . doi:10. AHIEC. imia.Health informatics 22 February 2010. org/ members/ profiles/ national.org. Alec Holt.com/1472-6947/9/24) UK Council for Health Informatics Professions. action?id=270) [33] Karolyn Kerr.jbi. [34] http:/ / www.sahi.org/Health/Medicine/Informatics/) at the Open Directory Project Australasian College of Health Informatics (http://www.M3046. hinz. Munger BS.ACHI. doi:10. . YA. (2009). org. (2009). [41] Kann. PMID 20007728. [31] Health Informatics Section in Hong Kong Hospital Authority (http:/ / www.1186/gm64. Butte. hinz. org.com) . php/ ejhi/ about/ journalSponsorship) (open access journal) [29] Australian Health Informatics Education Council (AHIEC) (http:/ / www. [27] ACHI Memberships (http:/ / www.1093/bib/bbp048. au) AHIEC Auspicing Organisations [30] "Health Informatics Society of Australia Ltd" (http:/ / www. net/ ojs/ index. Steen EB.biomedcentral. PMC 2649323. "Program requirements for fellowship education in the subspecialty of clinical informatics".au) e-Journal for Health Informatics (http://www. et al. "Health Informatics Capability Development In New Zealand . PMC 2894568. 34 External links • • • • • • Health informatics (http://www.". G. AJ.1197/jamia. Shabot MM.05. sahi. Hunter. Peter Komisarczuk. PMID 19074296. M.1016/j. "Core content for the subspecialty of clinical informatics". Imia. Retrieved 3 April 2010. au) ACHI memberships: Professions Australia [28] eJHI . . org. vuw. ACHI. Retrieved 2010-07-29. www.

0 emerging. Intelligent tools for content delivery—and transactions.0. However.Health 2. Personalized search that looks into the long tail. efficiency. tagging.0 defines the combination of health data and health information with (patient) experience through the use of ICT. Doctors are entering into the field of blogging. Health 3. Enabled by information. 3. apomediation. enabling the citizen to become an active and responsible partner in his/her own health and care pathway.0" term are its applications across health care in general. that use Web 2.0[1] ) are terms representing the possibilities between health care. [10] Definitions of Medicine 2. Here the doctors get a chance to interact and share knowledge with other doctors. collaboration.0 (as well as the closely related concept of Medicine 2. but cares about the user experience. where they share their experiences in the form of case studies.0 is the use of a specific set of Web tools (blogs. [6] medical professionals.[4] A possible explanation for the reason that Health has generated its own "2. As does the desire by healthcare professionals and by patients to embrace new technology and new services.0 Health 2. The "Traditional" definition focuses on technology as an enabler for care collaboration-"The use of social software and light-weight tools to promote collaboration between patients. One author describes the potential as "limitless.[9] Health 2. and the power of networks in order to personalize health care.0 [15] are also leveraging social media as a powerful tool. and openness within and between these user groups. 2. services and tools are Web-based services for health care consumers. software. and 4.0 wiki (not the Wikipedia version). All with the result of patients increasingly guiding their own care[7] Scott Shreeve considers Health 2."[5] Definitions and Inclusions As yet there is no common agreement amongst experts and participants. using principles of open source and generation of content by users. the emerging Internet of Things and embedded sensors.0: "Medicine 2. their caregivers. search. and quality of health care" Then there's the concept of Health 2.0 is evolving fast as the technology landscape evolves. Dedicated social networking sites for doctors like Sermo.0 [14] is defined as delivery of healthcare which leverages the use of elements of Semantic Web such as location awareness. wikis. are doctor-only social networks. and other stakeholders in health" An expanded version of the traditional definition breaks this into components: 1. we the patients can be effective partners in our own healthcare. health professionals. physicians.0 as a wider system reform-"New concept of health care wherein all the constituents (patients.0 is participatory healthcare.0 applications.0 35 Health 2. but from the Health 2. caregivers.0.0 as a participatory process between patient and clinician (with a couple of notable twists) -Health 2. Lucien Engelen et al systematic review found 46 (!) unique definitions of health 2. Ozmosis etc. and in particular it potential in public health promotion. there are several competing & complementary definitions of Health 2. patients. [11] [12] Published in JMIR Tom Van de Belt. and promote health education. Better integration of data with content.0 technologies as well as semantic web and virtual reality tools. providers. participation. and by Physicians and Medical Librarians. and has come into use after a recent spate of articles in newspapers. and community that we collect or create. collaborate. Podcasts.[2] [3] A concise definition of Health 2. Communities that capture the accumulated knowledge of patients and caregivers. already there are signs of Health 3. and biomedical researchers. and payers) focus on health care value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the [8] catalyst for improving the safety. and scientists. and clinicians—and explain it to the world. eHealth and Web 2.0 appear to be very similar but typically include more scientific and research aspects—Medicine 2. give . and we the people can participate in reshaping the health system itself. patients. Doctors 2. to enable and facilitate specifically social networking. SocialMD.0 [13] Health 2. etc) by actors in health care including doctors.

As treatment commences. A study examining physician practice has suggested that a segment of 245. electronic medical records. medical ethics considers such actions to be medical paternalism and are discouraged in modern medicine. If a second appointment is needed the patient will have had time to research what the results might mean for them.Health 2. and in combination with their primary care physician decides who to see. and can stay up to date on research opportunities and clinical trials for their condition. where information about specific blood results would be of little use to a lay person.. However.0 refers to a number of related concepts including telemedicine. discuss common healthcare issues.0. A hypothetical example demonstrates the increased engagement of a patient operating in a Health 2. and the use of the internet by patients themselves such as through messageboards. and offer simple remedies for them.[16] this study considers only the broader use of the Internet for health management. Level of use of Web 2. the patient can track their health outcomes through a data-sharing patient community to determine whether the treatment is having an effect for them. They can also choose to submit more data about themselves. Connected Health . On a second visit a referral might be made to a specialist. telling patients test results when and if they deemed necessary. and may have communicated with other patients who have had a similar set of results in the past. or in general practice where results were generally benign. 36 Overview Health 2. and as an entrepreneurial (rather than academic) movement. what diagnoses may be likely. Increasingly. The specialist gives a diagnosis along with a prognosis and potential options for treatment. mHealth. indicating that use is beyond the stage of the early adopter with regard to physicians and Web 2. or diseases of unknown etiology patients were at risk of being left without well-coordinated care because data about them was stored in a variety of disparate places and in some cases might contain the opinions of healthcare professionals which were not to be shared with the patient. While it has been estimated that nearly one-third of the 100m Americans who have looked for health information online say that they or people they know have been significantly helped by what they found.[17] .0 is being used in general. A key concept is that patients themselves should have greater insight and control into information generated about them. The patient might have the opportunity to search for the views of other patients on the best specialist to go to.S are using Web 2. in the case of complex chronic diseases. the novelty of the endeavor. The treating physician might make a diagnosis or send for tests.000 physicians in the U.0 system) that could only be accessed by a physician or other medical professional.0 insight about diseases. having first ensured his own medical record was up to date via the internet. Such a model operates relatively well in situations such as acute care. the results of which could be transmitted direct to the patient's electronic medical record. little empirical evidence exists to understand how much Web 2. and other more advanced systems.0 in Health Care Partly due to weak definitions. blogs.0 setting: A patient goes to see their primary care physician with a presenting complaint.0 for their practice. Traditional models of medicine had patient records (held on paper or a proprietary computer A model of Health 2. The patient has the opportunity to research these treatment options and take a more proactive role in coming to a joint decision with their healthcare provider. such as through a personalized genomics service to identify any risk factors that might improve or worsen their prognosis. Physicians acted as gatekeepers to this information. They also have the social support of communicating with other patients diagnosed with the same condition throughout the world. psychiatric disorders.

[24] Finally concerns exist about the quality of user generated content leading to misinformation.[21] Secondly. Nurses Staying informed Used to stay informed of latest developments in a particular field Medical education Use for professional development for doctors. social bookmarking.0 tools use in daily practice for medical professionals to find information and make decisions How podcasts can be used on the move to increase total [19] available educational time or the many applications of [20] these tools to public health Google searches revealed the correct diagnosis in 15 out of 26 cases (58%.Health 2.0 is commonly associated with technologies such as weblogs (blogs).0 in health.0).0 37 Types of Web 2. Long-term patients are more likely to [22] connect to a community in Health 2. and web application programming interfaces (APIs) (see main article Web 2. RSS feeds (and other forms of many-to-many publishing). and outcomes to scientific research improve their decision making ability and carry out scientific [23] research such as observational trials All (medical professionals and public) Criticism of the use of Web 2. and public health promotion for by public health professionals and the general public Collaboration and practice Web 2.[25] Other venues of information are likely to be less useful to the general public. the limitations for Medical Doctors (MDs) to use Google as a diagnostic tool. Podcasts and search tools [18] Users All (medical professionals and public) All (medical professionals and public) Doctors.0 in health Several criticism have been raised in the use of Web 2. long-held concerns exist about the effects of patients obtaining information online. Purpose Description Case example in academic literature RSS.0 technology in Health Care Web 2. though one study has suggested that in certain support groups only 6% of information is factually wrong and that only 3% reported that online advice had caused serious harm. such as the idea that patients may delay seeking medical advice. Firstly. Types of Web 2. wikis. which may be more effective only for conditions with unique symptoms and signs that can easily be used as search term. symptoms. social software. . podcasts. 95% confidence interval 38% to 77%) in a 2005 [21] study Managing a Patients who use search tools to find out particular disease information about a particular condition Shown that patients have different patterns of usage depending Public on if they are newly diagnosed or managing a severe long-term illness.0 use in Health Care The following are examples of uses that have been documented in academic literature.0 Sharing data for research Completing patient-reported outcomes and Disease specific communities for patients with rare conditions aggregating the data for personal and aggregate data on treatments.

Haythornthwaite C. September 6: 73-74 [3] Giustini. ePatients white paper. com/ 2008/ 03/ medicine-20-congress-website-launched. Proceedings of the 2008 International Conference on Semantic Web & Web Services SWWS08. 2007.0 and Medicine 2. pdf [10] Ted Eytan MD. 2007 Jul. com/ 2010/ 04/ health-30-new-data-on-aging-boomers. 10(3): e23 [5] Crespo. How Web 2.0: A Systematic Review (J Med Internet Res 2010. M. Denis Carroll. 2008. H. Wareham J. jmir. tedeytan. Assessing the Risk and Opportunity of Social and One-to-One Media. Lodewijk Bos. (1996).0) [12] Gunther Eysenbach's random research rants (Blog). White Paper: Physicians and Web 2. D.0 Congress Website launched (and: Definition of Medicine 2. LLC. Apomediation. Accessed at http:/ / www. URL: http:/ / www. 164–167. Accessed: 2008-03-07 [13] Van De Belt TH. 2006.0 / Health 2. htm [25] Economist. aspx on 20/1/2008 [18] Giustini. R. Wicks P. org/ pdf/ ICMCCSWWS08. (2009) argue there are four major tensions represent in the literature on Health/Medicine 2. bulimia blogs and other forms of “user generated” medical information a healthy trend? The Economist. September 6: 73-74 . PMID: 17572979 [21] Tan H.net. New horizons for e-learning in medical education: ecological and Web 2. URL: http:/ / gunther-eysenbach. Mike Rees. 2008. e-patients. Virtual community health promotion. PMID: 17786742 [20] Crespo R. www. June 6. 2007 presentation at Health 2. [22] Ferguson. 2008 [8] Last updated on May 25. Arabnia. Massagli MP. Joshi I. 4(3) : 75 [6] Adapted from Jane Sarasohn-Kahn's "Wisdom of Patients" report. Online advice: Good medicine or cyber-quackery? Retrieved September 22. html [15] http:/ / www. html. com/ 2008/ 06/ 13/ 1089 [11] Eysenbach. 2007 from http:/ / www. Med Teach. http:/ / www. 2007. org/ 2010/ 2/ e18/ [14] http:/ / www. 2007. jupiterresearch.0 Hughes et al. jmir. Participation. and Openness (http:/ / www. issues around the loss of control over information that doctors perceive. 333:1283-1284 [4] Hughes B.0 : Technology and society: Is the outbreak of cancer videos. 2007) [9] "Patient 2. The. by Matthew Holt.12(2):e18)URL: http:/ / www. http:/ / www. Gunther. Engelen LJ. Prev Chronic Dis. 2007 May. Online Health.0 Conference.Health 2.[4] References [1] Eysenbach G Medicine 2. 2007 Scott Shreeve. Sanjeev Gupta. Health 2. safety and the dangers of inaccurate information. Heywood J (2008) How the social web supports patient experimentation with a new therapy: The demand for patient-controlled and patient-centered informatics. Andy Marsh (eds). Accessed at http:/ / www. org/ 2008/ 3/ e22/ ). Virtual Community Health Promotion. 2007. British Medical Journal.0 38 Tensions in Health 2. Googling for a diagnosis—use of Google as a diagnostic aid: internet based study.0 Empowerment". British Medical Journal. and issues of ownership and privacy. E. updated from original September 20.0: these are over the lack of clear definitions.0 : Technology and society: Is the outbreak of cancer videos. icmcc. Schoonhoven L Definition of Health 2.e-patients. pl/ research:vision/ 103/ id=98795/ on 20/1/2008 [17] Manhattan Research.333:1143-5.January 24.0: Social Networking. Last updated June 6.0 and Medicine 2. How Web 2. 2008 [7] "Holt's evolving view of a moving target". Journal of Medical Internet Research. The.29(4):307-10.0: Tensions and Controversies in the Field (http:/ / www. J Med Internet Res 2008. by Matthew Holt. bulimia blogs and other forms of “user generated” medical information a healthy trend? The Economist. October 22. blogspot. Hamid R. acponline. com/ TTPWhitePaper. Medicine 2. 2007.0: 5 Things You Should Know about the Evolving Online Landscape for Physicians. Preventing Chronic Disease. disruptivedemographics. Ng JHK. socialf5. Health 2. 2007. Berben SAA. manhattanresearch. T. AMIA Annu Symp Proc 6:217-21 [24] Ojalvo.4(3):A75. jmir. 2006.0 perspectives. MD . Review.0 is changing medicine: Editorial. com/ bin/ item. com/ blog/ 2011/ 05/ web-2-0-doctors/ [16] Levy. Jupiter Research. Andy Marsh. org/ 2008/ 3/ e23/ ).0 is changing medicine: Editorial. pp. D. org/ journals/ news/ dec96/ cybrquak. Collaboration. Health 2.10(3):e22 [2] Economist. 333:1283-1284 [19] Sandars J. BMJ 2006. pdf on 22/1/08 [23] Frost JH. net/ e-Patients_White_Paper.

medicine20congress.0 Congress (http://www. which is similar or identical to the Health 2. • Spatiotemporal Epidemiological Modeler is a tool. originally developed at IBM Research. Software that is freely available.0 Hawaii Chapter Health 2. FreeMED is released under the GPL • (French) FreeMedForms is a full set of medical applications (EMR.com/).html)".0 (http://www.0 39 External links • The term Health 2.0 companies (http://health20. Electronic health or medical record (In alphabetical order) • FreeMED is a practice management and electronic and computer records system. patient sceduling and dental office management.com/wp-dyn/content/article/ 2009/10/18/AR2009101801844.0 NYC Chapter (http://health20nyc. The whole applications are freely available and are released with the full code source (GPLv3). It allows the tracking of medical data. prescriber.0 Wiki (http://health20.healthplusplus.0 concept. for modeling and visualizing the spread of infectious diseases.com/) is trademarked by this conference series • A set of useful resource on the Health 2.0 Chapters Health 2.com/wiki/Main_Page) including links to more than 40 medical wikis • Medicine 2. Dental Management and Patient Record • Open Dental is the first Open Source dental management package with very broad capabilities on record management. The project is administrated and developed by a community of medical doctors and computer scientists. Categories Public Health and Biosurveillance • Epi Info is public domain statistical software for epidemiology developed by Centers for Disease Control and Prevention.org/wiki/Health_2. 2009 Health 2. but also includes "Science 2. The Washington Post. in detail.0_Companies) • A list of medical wiki websites (http://www. .0" • " Web Site Harnesses Power of Social Networks (http://www. with preservation not just of the diagnosis but the reasons for medical encounters.0 Boston Chapter Health 2.0 Japan Chapter • Health 2. drug interaction checker)…). but not licensed under an open source license should be placed in the List of freeware health software.washingtonpost.org/) List of open source healthcare software The following is a list of software packages and applications licensed under an open source license or in the public domain for use in the healthcare industry.Health 2. October 19.health2con.org/wiki/Main_Page) including a list of Health 2.

It is the largest open source healthcare solution serving more than 500 sites including the Primary Care Coalition network in MD with 50 sites and around 100.000 patients. EMR. Clinical Doc. • FreeMED is a practice management and electronic and computer records system. centralized.List of open source healthcare software • • • • • • • • • • • GNUmed is a WxPython application that uses PostgreSQL. It offers a fully comprehensive system which now offers tools like E-Prescribing. Orders. OpenEMR an open-source Electronic Medical Record (EMR) software. in detail. Billing & more. 40 • • • Medical Practice Management Software • ClearHealth covers the five major areas of practice operations including scheduling. SmartCare THIRRA (EHR) is a web based EHR application designed primarily for narrowband. Being very modular. It works on GNU/Linux. OpenMRS is a community-developed. VistA — Veterans Administrations integrated Electronic Health Record system available for non-governmental use as OpenVista or WorldVistA. • GNU Health (aka "Medical") is a Free. HL7. Clinical Doc. Electronic Labs and Lab ordering. centralized. The billing component of the software is specialized for the needs of the Canadian health care providers. OSCAR McMaster an open-source Electronic Medical Record (EMR) software. It was released under the Mozilla Public License and includes communicable diseases biosurveillance feature. and medical billing application. WITS or Web Infrastructure for Treatment Services is a web-based EHR system initially developed for SAMHSA by FEi Systems. HIPAA Security and accounts receivable. Distributed under GPL . GNU Health (aka "Medical") is a Free. Scheduling. Billing & more. Orders. Drug Interactions. electronic medical records. and provider levels and offers full clinical and billing functionality in compliance with HIPAA and 42 CFR Part 2. ZEPRS The ZEPRS application is an electronic patient record system that enables clinicians to enter data from patient visits using a web browser. Scheduling. CodeIgniter and PostgreSQL. highly scalable Health and Hospital Information System • MedinTux MedinTux is a French medical practice management system. Pharmacy. It is specifically targeted at Behavioral Health agencies at the state. It allows the tracking of medical data. Meds. highly scalable Health and Hospital Information System Hospital OS Open source hospital information system in Thai HOSxP Mirth (software) is an open source cross-platform HL7 interface engine that enables bi-directional sending of HL7 messages between systems and applications over multiple transports. PatientOS [1] Healthcare Information System (EHR EMR PMS) for small hospitals and clinics. Pharmacy. Microsoft Windows • Open Dental Dental practice management • OpenEMR A free medical practice management. with a web interface as well as a desktop one. billing. Extensible and scalable EMR based on Java. with preservation not just of the diagnosis but the reasons for medical encounters. open-source. FreeMED is an HIPAA compliant FOSS Practice Management System that handles billing. HL7. enterprise EMR framework. that has been initially to manage a hospital emergency department. • PatientOS [1] Healthcare Information System (EHR EMR PMS) for small hospitals and clinics. Meds. it has been extended to run also many different smaller practices. Distributed under GPL v3. Mac OS X. prescription writing. FreeMED is released under the LGPL GNU license. county. THIRRA uses PHP5.

Complete DICOM Viewer with DICOM network support • ParaView Large Scale Visualization tool • 3DSlicer Platform for medical image visualization and algorithm development. segmentation and registration. Novartis and Vodafone Out of the box distributions • BioLinux • Debian-Med . Displays information in map view. • Endrov Image and data viewer and editor • ITK Segmentation and Registration Toolkit • InVesalius 3D Medical Imaging Reconstruction software • ITK-SNAP Interactive software for 3D image navigation. • SMS for Life is program which uses an open source solution to assist in the delivery of malaria vaccine in Tanzania through the use of cell phones and mapping technology. • VTK Visualization Toolkit • Xebra (medical imaging software) • GIMIAS Workflow-oriented environment focused on biomedical image computing and simulation Medical Information Systems • Caisis is a web based information system for the storage and analysis of cancer patient data intended to bridge the gap between clinic and research (license: GPL) Research • LabKey Server is an extensible platform for integrating.List of open source healthcare software 41 Health System Management • DHIS Open-source district health management information system and data warehouse (license: BSD license) • HRHIS Open-source human resource for health information system for management of human resources for health developed by University of Dar es Salaam. annotation and automatic segmentation • MicroDicom Free DICOM viewer for Windows • OsiriX . It provides secure. Able to import DICOM image stacks. Developed by IBM. DICOM is supported and Voreen is used in medical visualization as well as for visualizing electron microscopy data. Department of Computer Science.3D DICOM Medical Viewer for Mac OS X. for Ministry of Health and Social Welfare (Tanzania) and funded by the Japan International Cooperation Agency (JICA) (license: GPLv3) Imaging/Visualization • Drishti is a volumetric visualisation package for viewing Computer Tomography data. and image guided surgery support. email or web form. • OpenClinica is an open source platform for clinical research. • Voreen Volume Rendering Engine—a library for visually exploring volume data sets. DICOM support. Diffusion MRI processing. Mobile / Handheld Devices • Ushahidi Allows people to submit crisis information through text messaging using a mobile phone. web-based access to research data and includes a customizable data processing pipeline. analyzing and sharing all types of biomedical research data. including electronic data capture (EDC) and clinical data management capabilities.

There is also a new direction in MLearning that adds mobility of the instructor and includes creation of learning materials "on-the-spot. notebooks and mobile phones. patientos. In addition. has different meanings for different communities. filled with tailored learning contents.[1] In other words mobile learning decreases limitation of learning location with the mobility of general portable devices. differance-engine. Using mobile tools for creating learning aides and materials becomes an important part of informal learning.org/topics/view.php/ Open_Source_Software_for_Public_Health) MLearning The term M-Learning. it is distinct in its focus on learning across contexts and learning with mobile devices.org/pjones/wiki/index. cfm?itemID=133551) (California HealthCare Foundation.chcf.net/imiaoswg/index. org/) • Open Source Software for Public Health (http://www. or learning that happens when the learner takes advantage of the learning opportunities offered by mobile technologies.php?Itemid=260&id=1076& option=com_content&task=view) • International Medical Informatics Association Open Source Working group (IMIA OS WG) (http://www. is also collaborative. org External links • Open-Source EHR Systems for Ambulatory Care: A Market Assessment (http://www. or "mobile learning".ibiblio.List of open source healthcare software 42 Interoperability testing • The Certification Commission for Healthcare Information Technology (CCHIT) has developed an open-source program called Laika to test EHR software for compliance with CCHIT interoperability standards. M-Learning also brings strong portability by replacing books and notes with small RAMs.org) • European Federation for Medical Informatics Libre/Free Open Source Software Working Group (EFMI LIFOSS WG) (http://www. MP3 players. Although related to e-learning and distance education. interacting with portable technologies.amia. like other forms of E-learning. sharing is almost instantaneous among everyone using the same content. References [1] http:/ / www.de/ibmi/efmi/index. M-Learning.org) (http://www. • Alternative compilation of Open Source software for the health care sector with structured additional information (medfloss. "in the field" using predominately smartphone with special software such as AHG Cloud Note. January 2008). M-learning focuses on the mobility of the learner. predetermined location. One definition of mobile learning is: Any sort of learning that happens when the learner is not at a fixed. which leads to the reception of instant feedback and tips. M-learning is convenient in that it is accessible from virtually anywhere. it is simple to utilize mobile learning for a more .php) • American Medical Informatics Association Open Source Working group (AMIA OS WG) (http://www.helmholtz-muenchen. and learning that reflects a focus on how society and its institutions can accommodate and support an increasingly mobile population.medfloss. Wikipedia on Nokia 770 is an example of mobile learning The term covers: learning with portable technologies including but not limited to handheld computers.

Apple Classrooms of Tomorrow (ACOT) in partnership with Orange Grove Middle School of Tucson. Analysis (costs / benefits. • Mobile learning supports the learning process rather than being integral to it.MLearning effective and entertaining experience. use mobile computers connected by wireless networks for the 'Wireless Coyote' project. • It will be more light weight device compare to books. Their interim Dynabooks are the first networked workstations 1990s In May 1991. This was followed up in later years as technology improved. Knowledgility creates the first mobile learning modules for CCNA. Content Development Conferences and trade shows were created to specifically deal with mobile learning and handheld education. PCs. • Mobile learning could be utilised as part of a learning approach which uses different types of activities (or a blended learning approach). WMUTE. forecast) Value The value of mobile learning[5] --Tutors commented on the value of mobile learning as follows. SALT Mobile in USA. • Mobile learning can be a useful add-on tool for students with special needs. • Mobile learning needs to be used appropriately. • Good IT support is needed. • It is important to bring new technology into the classroom. to cover compact cassette tapes. . 43 History Pre-1970s Arguably the first instance of mobile learning goes back as far as 1901 when Linguaphone released a series of language lessons on wax cylinders. A+ and MCSE certification using the core tools that later became LMA. for SMS and MMS this might be dependent on the students’ specific disabilities or difficulties involved. • Mobile learning can be used as a ‘hook’ to re-engage disaffected youth. Arizona. Delivery and Tracking 3. 1980s Alan Kay and his colleagues in the Learning Research Group at Xerox Palo Alto Research Center [PARC] propose the Dynabook as a book-sized computer to run dynamic simulations for learning. and CDs[2] 1970s. 8 track tape.[3] Universities in Europe and Asia develop and evaluate mobile learning for students. including: mLearn. However. Authoring and publishing 2. Companies were formed that specialize in three core areas of mobile learning. according to the groups of students involved. ICML in Jordan. Handheld Learning in London. and IADIS Mobile Learning international conference series. 1. etc. Palm corporation offers grants to universities and companies who create and test the use of Mobile Learning on the PalmOS platform. Mobile Learning in Malaysia. 2000s The European Commission funds the major multi-national MOBIlearn and M-Learning [4] projects.

job aids and just-in-time (J. multiple screen sizes. The data indicate that the demand is relatively immune from the recession."[11] The findings of the report indicate that the largest demand throughout the forecast period is for custom development services. and media services and that the healthcare sector accounts for 20% of the total US market for mobile learning.7% and revenues reached $538 million in 2007. workplaces.and m-learning [7] [8] Design of technology to support a lifetime of learning Tracking of results and proper use of this information No restriction on learning timetable Personal and private information and content No demographic boundary Disruption of students' personal and academic lives[9] Access to and use of the technology in developing countries[10] Social and educational challenges include Growth Over the past ten years mobile learning has grown from a minor research interest to a set of significant projects in schools. with different national perspectives.MLearning • It is necessary to have enough devices for classroom use .T. "the US market for Mobile Learning products and services is growing at a five-year compound annual growth rate (CAGR) of 21. The mLearning community is still fragmented. multiple operating systems Reworking existing e-Learning materials for mobile platforms Accessibility and cost barriers for end users: Digital divide. differences between academia and industry. content conversion.I. Current areas of growth include: • • • • • Testing. How to assess learning outside the classroom How to support learning across many contexts Content's security (or) pirating issues Frequent changes in device models/technologies/functionality etc. . museums. Developing an appropriate theory of learning for the mobile age Conceptual differences between e.) learning Location-based and contextual learning Social-networked mobile learning Mobile educational gaming Deliver M-Learning to cellular phones using two way SMS messaging and voice-based CellCasting (podcasting to phones with interactive assessments) According to a report by Ambient Insight in 2008. cities and rural areas around the world. and between the school. surveys. higher education and lifelong learning sectors. 44 Challenges Technical challenges include • • • • • • • • • • • • • • • • • • • • • • Connectivity and battery life Screen size and key size[6] Ability for authors to visualize mobile phones for delivery Possibilities to meet required bandwidth for nonstop/fast streaming Number of file/assets' formats supported by a specific device Content security or copyright issue from authoring group Multiple standards.

Cell or smartphones. In these ways. Smartphones are one of the platforms used for mobile learning. or wireless single-purpose devices can help deliver coaching and mentoring.. It includes the use of mobile/handheld devices to perform any of the following: • • • • • Deliver Education/Learning Foster Communications/Collaboration Conduct Assessments/Evaluations Provide Access to Performance Support/Knowledge Capture Evidence of Learning Activity Today. tests. personal digital assistants (PDAs). mobile learning can enhance and support more traditional learning modes. conduct assessments and evaluations (e. and deliver podcasts.MLearning 45 Future Technologies currently being researched for mobile learning include:[12] • • • • • • • • Location aware learning Point-and-shoot learning with camera phones and 2D codes Near Field Communications (NFC) secure transactions Sensors and accelerometers in mobile devices in behavioral based learning Mobile content creation (including user generated content) Games and simulation for learning on mobile devices Context-aware ubiquitous learning Augmented reality on mobile devices Delivery While many think of mobile learning as delivering eLearning on small form factor devices. provide on-the-job support and access to information. multi-game devices. it has the potential to do much more than deliver courses. Mobile devices can also serve as powerful data [12] collection tools and facilitate the capture of user created content. quizzes. education and references. update alerts. or often referred to as eLearning “lite”. surveys/polls. personal media players (PMPs). or parts of courses. forms and checklists.g. and certifications). any number of portable devices can quickly and easily deliver and support these functions. . making it more portable and accessible.

etc. PDAs. Outdoor • Learning in museums or galleries with handheld or wearable technologies • Learning outdoors. Class management The mobile phone (through text SMS notices) can be used especially for distance education or with students whose course requires them to be highly mobile and in particular to communicate information regarding availability of assignment results. Miller & Newnham 2009). It can also be of value to business people e. Podcasting Podcasting consists of listening to audio recordings of lectures. but only in cases in which students take notes (Callaway & Ewen 2009).g.MLearning 46 Approaches In the classroom • Students using handheld computers. Podcasts may also provide supplemental information to enhance traditional lectures (McGarr 2009) (Steven & Teasley 2009). smartphones or handheld voting systems (such as clickers) in a classroom or lecture room (Tremblay 2010). . Psychological research suggests that university students who download podcast lectures achieve substantially higher exam results than those who attend the lecture in person. The use of mobile learning in the military is becoming increasingly common due to low cost and high portability. For blended learning Mobile learning can provide support that enhances training in a corporate business or other classroom environment. • Continuous learning and portable tools for military personnel. for example on field trips. and can be used to review live lectures (Clark & Westcott (2007) and to provide opportunities for students to rehearse oral presentations. • Students using mobile devices(such as a Pocket PC) in the classroom to enhance group collaboration among students and instructors. At work • On the job training for someone who accesses training on a mobile device "just in time" to solve a problem or gain an update. venue changes and cancellations. Podcasts maybe be delivered using syndication. although it should be noted that this method of delivery is not always easily adopted (Lee. sales representatives who do not wish to waste time away from their busy schedules to attend formal training events.

g. i. provides high speed connection and data transfer rate • Wi-Fi gives access to instructors and resources via internet Authoring: • Learning Mobile Author. but also podcasting (Horkoff Kayes2008) have been used for helping people to acquire a language. or exporting audio files from a learning platform to your phone) Technologies Mobile devices and personal technologies that can support mobile learning.MLearning 47 Lifelong learning and self-learning The use of personal technology to support informal or lifelong learning. in museums and galleries Handheld game console. e. Other • Improving levels of literacy. development and application of mobile and contextual learning.g. . For instance handheld computers. numeracy and participation in education amongst young adults. e. mobile phone.e. Java ME and Smartphone Relevant organisations • The International Association for Mobile Learning[13] • The International Association for Mobile Learning (IAMLearn) has been formed as a membership organization to promote excellence in research. for listening to audio recordings of lectures (podcasting) Personal Digital Assistant. include: • • • • • • • E-book Handheld audio and multimedia guides. and teaching resources. emerging technologies. IAMLearn manages a website to collate and disseminate information about new projects.g. • Using the communication features of a mobile phone as part of a larger learning activity (e. camera phone and SmartPhone Technical and delivery support for mobile learning: • 3GP For compression and delivery method of audiovisual content associated with Mobile Learning • GPRS mobile data service. Mobile technologies and approaches. are also used to assist in language learning. such as using handheld dictionaries and other devices for language learning. It organizes the annual mLearn international conference series. for authoring and publishing WAP.: sending media or texts into a central portfolio. cell phones. modern gaming consoles such as Sony PSP or Nintendo DS Personal audio player. in the classroom and outdoors Tablet PC UMPC. Mobile Assisted Language Learning (MALL).

Special issue on technology in K–12 education. . "A portable document search engine to support off-line mobile learning" (http:/ / eprints. Taylor. Volume 36 Issue 5. K. html). L. ac. ecs. mobilearn. Retrieved June 8.001. New Scientist.editlib. Proceedings of IADIS International Conference Mobile Learning. "Podcasting in higher education: What are the implications for teaching and learning?". Grant. L. & Allan. soton.htm). 2009. [9] Masters.06. m-learning.C. org/ ) Bibliography • Callaway.au/pubs/procs/2007/08.pdf). pp. "Language Learning by iPod: An Emerging Model" (http://www.. "Podcasting syndication services and university students: Why don't they subscribe?". • Steven. Newnham. 3. "'iTunes university' better than the real thing" (http://www. Communications of the ACM . "After the broadcast: disrupting health sciences’ students' lives with SMS".. . . [3] Wireless Coyote (http:/ / portal. J. doi:10. The Internet and Higher Education 12 (1): 53–59. M. 2008.au/ajet/ajet25/mcgarr. (2007). 28 September 2007. acm. April 2005. MOBIlearn. Ng'ambi D. noe-kaleidoscope. com/ Resources/ Documents/ AmbientInsight_2008-2013_US_MobileLearning_Forecast_ExecutiveOverview. 2009. G (2008).2008. (December 2008). fil. The Internet and Higher Education 12 (2): 88–92. masie. "Using short podcasts to reinforce lectures" (http://science. M.1016/j. Understanding. Teasley. Spain. org/ citation. C. pp.ascilite. . (2007). [10] Masters. • Horkoff. K.p8 [6] Maniar. "Educating the Mobile Generation – using personal cell phones as audience response systems in post-secondary science teaching" (http://www. . S. VA: AACE. Mobile Learning History. . Chesapeake. org/ download/ results/ guidelines. .iheduc. pdf). Kayes. J. • Lee. [11] Adkins. Retrieved June 8. M. Budapest. edu.MLearning 48 Relevant journals • International Journal of Mobile and Blended Learning • International Journal of Mobile Learning and Organisation References [1] "Guidelines for learning/teaching/tutoring in a mobile environment" (http:/ / www. Journal of Software 3 (4): 51–61. Jonathan M. Westcott.. 29(2).org/p/32314). • McGarr. Lisbon.002. 6. Ewen (18 February 2009). com/article/dn16624-itunes-university-better-than-the-real-thing. "The US Market for Mobile Learning Products and Services: 2008-2013 Forecast and Analysis" (http:/ / www. "The effect of mobile phone screen size on video based learning". 2010. Computers & Education 34 (3-4): 177–193. Ambient Insight. (2009). Wireless Coyote: A Computer-Supported Field Trip. Retrieved June 9. [12] "Mobile Learning Update" (http:/ / masieweb.Savill etc.1016/j. pdf). Learning Consortium Perspectives. Portugal. The University of Sydney Symposium. E.. 171–175. Lonn.org. Journal of Computers in Mathematics and Science Teaching. ISBN 978-972-8924-36-2.. Hungary. S. Hand. (2005). October 2003.S.newscientist. org/ archive [5] Mobile learning in practice:Piloting a mobile learning teachers’ toolkit in further education colleges. Hank. com/ p7/ MobileLearningUpdate.. (2008). [8] Moore.2009. (2009). • Clark.com/Research-Articles/language-learning-by-ipod-an-emerging-model. "The design of personal mobile technologies for lifelong learning". 2009. (2000). The MASIE Center. • Tremblay. 217-227. uk/ 17441/ ).uniserve. [2] "Mobile Learning Community" (http:/ / trainandgo. ambientinsight. [13] The International Association for Mobile Learning (http:/ / mlearning. Eric (2010). 57-59 [4] http:/ / www.htm). (2009). "A review of podcasting in higher education: Its influence on the traditional lecture" (http://www. 17. blogspot. Seeing..1016/S0360-1315(99)00044-5. doi:10.html). Miller. Barcelona. N. Proceedings of IADIS International Conference Mobile Learning. (1993). pp. com/ 2010/ 01/ mobile-learning-in-cortina. Stephanie D. hu/ mobil/ 2005/ Masters_final. Learning in the Mobile Age. W. S. 5–13. May 1993. Bennett.iheduc. Australasian Journal of Educational Technology 25 (3): 309–321. pdf). "Low-key m-learning: a realistic introduction of m-learning to developing countries" (http:/ / www. pp.10. 5.. doi:10. [7] Sharples. pdf). cfm?id=155062) Wayne C. Oliver (2009).

this roundtrip could take between 1 minute to 48 hours. radiology and pathology an immediate response is not critical and are conducive to store-and-forward technologies. basic vital signs like Blood Pressure. Telehealth is an expansion of telemedicine. grand rounds. and unlike telemedicine (which more narrowly focuses on the curative aspect) it encompasses preventive. and clinical data are captured and "stored" on the client computer or mobile device. order drug prescriptions and provide other health services. such as dermatology. and patient to asset matching. then at a convenient time transmitted securely ("forwarded") to a clinic at another location where they are studied by relevant specialists.Telehealth 49 Telehealth Telehealth is the delivery of health-related services and information via telecommunications technologies. or as sophisticated as using videoconferencing between providers at facilities in two countries. today telehealth stresses a myriad of technology solutions. Observations of Daily Living (ODLs)[1] . Clinical uses of telehealth technologies • • • • • Transmission of medical images for diagnosis (often referred to as store and forward telehealth) Groups or individuals exchanging health services or education live via videoconference (real-time telehealth) Transmission of medical data for diagnosis or disease management (sometimes referred to as remote monitoring) Advice on prevention of diseases and promotion of good health by patient monitoring and followup. physicians use email to communicate with patients. supervision. video. or even as complex as robotic technology. digital images. Based on the requirements of the participating healthcare entities. listing. promotive and curative aspects. Weight. and movement overall healthcare system management patient movement and remote admission Telehealth modes Store-and-forward telehealth In store-and-forward telehealth. Health advice by telephone in emergent cases (referred to as teletriage) Nonclinical uses of telehealth technologies • • • • • • • • Distance education including continuing medical education. Automated screening and diagnostic tele-audiology is fast becoming another specialty conducive to store-and-forward audiology. . Blood Sugar values are monitored and trended for long term Chronic care. Pulse Oximeter. audio. and presentations research on telehealth online information and health data management healthcare system integration asset identification. In the simplest form of Telehealth application. Originally used to describe administrative or educational functions related to telemedicine. For example. The opinion of the specialist is then transmitted back. and patient education administrative uses including meetings among telehealth networks. Telehealth delivery could be as simple as two health professionals discussing a case over the telephone. In many store-and-forward specialties.

the policies of governments and/or insurers with respect to coverage and payment for telehealth services. partnerships have been formed with the following companies: MDLiveCare and Hello Health. The rate of adoption of telehealth services in any jurisdiction is frequently influenced by factors such as the adequacy and cost of existing conventional health services in meeting patient needs. sensors are used to capture and transmit biometric data. Videoconferencing equipment is one of the most common forms of synchronous telemedicine. in the case of patients. Remote patient monitoring In remote monitoring. sustainable behaviour through monitoring and improved communications and reducing the requirements to expand . a telecommunications link allows instantaneous interaction. This could be done in either real time or the data could be stored and then forwarded. recently began establishing relationships with telehealth providers that will allow their users to sync the data shared during telehealth consultations with their online health records. Examples of remote monitoring include: • • • • Home-based nocturnal dialysis [5] Cardiac and multi-parameter monitoring of remote ICUs Home telehealth Disease management Benefits of telehealth Telehealth adds a new paradigm in healthcare. To date. For example. by car) as well as encouraging healthy. while improving patient's quality of life.Telehealth 50 Real-time telehealth In real-time telehealth. With the availability of better and cheaper communication channels.[2] In the UK Stoke on Trent Primary Care Trust together with mediaburst and the West Midlands Strategic Health Authority have sponsored the development of a low cost Simple Telehealth [3] system "Florence [4]" which primarily operates using text messaging (SMS) and a web application. Google Health. a tele-EEG device monitors the electrical activity of a patients brain and then transmits that data to a specialist. a personal health information centralization service.the use of videoconferencing technology to connect a psychiatrist with a mental health client Teleneurology Telenursing Teleradiology Telerehabilitation In an effort to enhance the real-time telehealth experience. direct two-way audio and video streaming between centers through computers is leading to lower costs. This has been shown to significantly reduce hospitalizations and visits to the Emergency Room. Peripheral devices can also be attached to computers or the video-conferencing equipment which can aid in an interactive examination. Examples of real-time clinical telehealth include: • • • • • • • • Tele-audiology Telecardiology Teledentistry Telemental Health -. where the patient is monitored between physician office visits. There may also be some significant carbon reductions for the NHS to be gained from developing Telehealth and therefore reducing the need to travel (often. and medical licensing requirements that may inhibit or deter the provision of telehealth second opinions or primary consultations by physicians. Telehealth also benefits patients where traditional delivery of health services are affected by distance and lack of local specialist clinicians to deliver services.

51 The state of the market Projections for the growth of the telehealth market are optimistic.org) HealthLink BC (http://www. htm).ca) Telehealth Ontario (http://www. Retrieved 2009-10-07. and the Consumer (http://tie. by Dipl.telemed. Employers (http://www. Armin Gärtner External links • • • • • • • • Telehealth for Patients. uk/ simple [4] http:/ / www. Telehealth. San Francisco: Jossey Bass. Teladoc.D.otn. (2002).com/). ISBN 978-0-9821442-0-6 • Telehealth Technical Assistance Manual (http://www. com/ news/ 2007/ 08/ 30/ 2897900. Providers. & Allen. [2] "Fall update on Google Health" (http:/ / googleblog. tmcnet.nrharural. According to a recent survey. 161 (9). Retrieved 2010-04-26.on. and much of this optimism is predicated upon the increasing demand for remote medical care. Nocturnal hemodialysis: dialysis for the new millennium (http:/ / www. Essentials of Telemedicine and Telecare. • Olmeda.com/). stoke.telenursefirst. blogspot. West Sussex. Retrieved 2010-04-26. ISBN 0-471-53151-0.org/) DOD Defense Centers of Excellence Telehealth wiki (http://www. several major companies are scrambling to establish a foothold in a market that.com/).gov. Post discharge follow-up calls (http://www. cmaj. getflorence. Marlene M. Ace (2001).Telehealth sites to meet increases in Healthcare demands.Telehealth. 2 November 1966.S. co. New York: John Wiley & Sons. html). uk/ [5] Andreas Pierratos. ca/ cgi/ content/ full/ 161/ 9/ 1137) Canadian Medical Association Journal. [6] "Survey: Consumers Keen on Telemedicine" (http:/ / www.php?id=37&L=1) . nhs. October 2006 • Teleneurology and requirements of the european Medical Devices Directive (MDD) (http://www. pdf) Robert Wood Johnson Foundation primer. consumers say they would use telehealth. . Center for Telehealth and Technology (http://t2health. England. and Telemedicine: A Guide to Start-up and Success. C.asp?path=consumer& article=tmcoming_nb_tie96. A.HealthLinkBC. E-Health. Ing. html).baaske. Whitten. is expected to grow to more than $6 billion by 2012 from 900 million in 2007. [7] "Homecare telehealth expected to grow despite current barriers to adoption" (http:/ / it. projecthealthdesign. nearly three-quarters of U. Health Plans. according to market-research firm Datamonitor. • Maheu.A document to assist in the planning of telehealth and telemedicine projects for rural community and migrant health centers and other health care organizations. Telemedicine and Telehealth (http://www. Burgess.ca/english/public/program/telehealth/telehealth_mn. ISBN 0-7879-4420-3.health. .Making the Connection for Health (http://www.ATAwiki. [3] http:/ / www.xml) Online introduction and primer to telehealth and telemedicine from the Telemedicine Information Exchange • Norris. healthdatamanagement. Further reading • Telemedicine.tmhguide.. org/ media/ file/ E-primer_3. Delfin Press.ca) .[7] References [1] Health in Everyday Living (http:/ / www. 1999.Telemedical Systems and regulatory affairs for Europe.teladoc. (2000). Pamela. American Well.org) Telemental Health Guide (http://www. .net/ index. Christopher J. Information Technology in Systems of Care.americanwell. com/ 2009/ 10/ fall-update-on-google-health.pdf) . By Samuel G. com/ news/ telemedicine-38701-1. TeleNurse First. Ltd. MD. Ph.org/pubs/pdf/Telehealth. November 2.html) • Ontario Telemedicine Network -.[6] At present.org/articles/article.

uk/).NRHArural.stoke. the UK National Health Service information service NHS Stoke on Trent (http://www.uk/simple) Simple Telehealth Project International Society for Telemedicine & eHealth (http://www.net/) Med-e-Tel .telemed.org) • Center for Telehealth & E-Health Law (http://www.edu/som/telehealth/) • University of Florida Center for Telehealth (http://telehealth.scot.va.pdf) Lifesize Case Study on Telehealth (http://www.lu/) Community for Teledermatology (http://telederm.aspx) 52 United States oriented • Office for the Advancement of Telehealth (http://telehealth.edu) Fit for the Future.isft.medetel.dhhs.The International Educational and Networking Forum for eHealth.ca) UCLA Wireless Health Institute (http://www.au/agency/pro/telehealth/index.ucla.t2health. Department of Veterans Affairs Care Coordination/Telehealth Program (http://www.php) NHS Direct (http://www.org/files/ Fit_for_the_Future_NHS_Sept09.phhp.unm.sct.org) • National Rural Health Association (http://www.nhsdirect.nhs.com/Industry_Solutions/Case_Studies/ Case-Study_Village-Church.nhs.gov. Telemedicine and Health ICT (http://www.gov/index.carecoordination. gov) • American Telemedicine Association (http://www.bcatpr.forumforthefuture.nhs.org) • Telemedicine Information Exchange (http://tie.htm) (established by the Health Resources and Services Administration) • U.org) Scottish Centre for Telehealth (http://www.org/) • University of New Mexico Telehealth (http://hsc.tas.S.ufl.wirelesshealth.hrsa.Telehealth • • • • • • • • • • • Tasmanian government (http://www.lifesize.org/) • National Center for Telehealth & Technology (http://www.uk) British Columbia Alliance on Telehealth Policy and Research (http://www.edu/) . Scenarios for low-carbon healthcare in 2030 (http://www.americantelemed.telehealthlawcenter.

and pathology are common specialties that are conducive to asynchronous telemedicine. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. imaging and heath informatics data from one site to another. Early precursors In its early manifestations. it is essentially a product of 20th century telecommunication and information U. and other components of health information technology.[3] The term eHealth is often used. A properly structured medical record preferably in electronic form should be a component of this transfer.Telemedicine 53 Telemedicine Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. as an umbrella term that includes telehealth.K. biosignals etc. powered by a dynamo driven by a set of bicycle pedals.) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. Early forms of telemedicine achieved with telephone and radio have been supplemented with videotelephony. electronic medical records.S. particularly in the U. Types of telemedicine Categories Telemedicine can be broken into three main categories: store-and-forward. and Europe. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination. and research.[1] Dermatology (cf: teledermatology).[2] Telehealth and eHealth are at times incorrectly interchanged with telemedicine. advanced diagnostic methods supported by distributed client/server applications. telemedicine often refers only to the provision of clinical services while the term telehealth can refer to clinical and non-clinical services involving medical education. people living in remote areas of Australia used two-way radios. These technologies permit communications between of handheld telemedical devices (2006). It is also used to save lives in critical care and emergency situations. which are frequently used to denote broader definitions of remote healthcare not always involving active clinical treatments.[4] [5] In the early 1900s. to communicate with the Royal Flying Doctor Service of Australia. Like the terms "medicine" and "health care". and additionally with telemedical devices to support in-home care. . African villagers used smoke signals to warn people to stay away from the village in case of serious disease.[2] It does not require the presence of both parties at the same time. patient and medical staff with both convenience and fidelity. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. remote monitoring and (real-time) interactive services. Navy medical staff being trained in the use technologies. as well as the transmission of medical. Although there were distant precursors to telemedicine. administration. Store-and-forward telemedicine involves acquiring medical data (like medical images.[1] Disambiguation Other expressions similar to telemedicine are the terms "telehealth" and "eHealth". radiology.

[9] Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. while the patient may not have to travel or wait the normal distances or times like those from conventional hospital or GP visits. and may be cost-effective.[8] The first interactive telemedicine system. online communication and home visits. These services can provide comparable health outcomes to traditional in-person patient encounters. psychiatric evaluations and ophthalmology assessments can be conducted comparably to those done in traditional face-to-face visits. Some of the more common things that telemonitoring devices keep track of include blood pressure. operating over standard telephone lines.Eric Wachtel. “clinician-interactive” telemedicine services may be less costly than in-person clinical visit Emergency telemedicine Common daily emergency telemedicine is performed by SAMU Regulator Physicians in France. show and instruct medical staff in another location. weight.[1] Many activities such as history review. supply greater satisfaction to patients. or asthma. Brazil. physical examination.S.[7] Telemedicine can be used as a teaching tool. such as heart disease. Telemonitoring is capable of providing information about any vital signs. Interactive telemedicine services provide real-time interactions between patient and provider. reduced travel times. more effective or faster examination techniques. This questioning can take place automatically over the phone.shared health professional staffing. enables medical professionals to monitor a patient remotely using various technological devices. Recent developments in mobile collaboration technology with the use of hand-held mobile devices allow healthcare professionals in multiple locations the ability to view. Aircraft and maritime emergencies are also handled by SAMU centres in Paris. most telemonitoring programs include subjective questioning regarding the patient's health and comfort. a patient will have a number of monitoring devices at home. A year later the company introduced a mobile cellular version. Lisbon and Toulouse. for remotely diagnosing and treating patients requiring cardiac resuscitation (defibrillation) was developed and marketed by MedPhone Corporation in 1989 under the leadership of its president and founder.Telemedicine Remote monitoring. Spain." Several studies have documented increase patient satisfaction of telemedicine over past fifteen years. served as receiving and treatment centers. The provider can then make decisions about the patient's treatment based on a combination of subjective and objective information similar to what would be revealed during an on-site appointment. It improved access to healthcare for patients in remote locations. diabetes mellitus. This method is primarily used for managing chronic diseases or specific conditions. or telemonitoring software can help keep the patient in touch with the health care provider. In general. and fewer or shorter hospital stays.[6] 54 General health care delivery Benefits and uses Telemedicine can be extremely beneficial for people living in isolated communities and remote regions and is currently being applied in virtually all medical domains. Patients who live in such areas can be seen by a doctor or specialist. heart rate. to include phone conversations. Telemonitoring is a convenient way for patients to avoid travel and to perform some of the more basic work of healthcare for themselves. Twelve hospitals in the U. Chile. as . blood glucose. the MDphone. "Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases. also known as self-monitoring or testing. In addition to objective technological monitoring. who can provide an accurate and complete examination. discuss and assess patient issues as if they were in the same room. S. and the results of these devices will be transmitted via telephone to the health care provider. In addition. and hemoglobin. by which experienced medical staff can observe.

and has many points of contacts with other medical and non-medical applications. As a field it is part of telehealth. In addition. When the label queue appears on the medication dispensing cabinet known as ADDS. The first Ayurvedic telemedicine center was established in India in 2007 by Partap Chauhan. the U. The telepharmacy program was piloted in 2006 “in the regions served by Naval Hospital Pensacola.[12] In recent time. Florida. such as telediagnosis. This new technology and principle of practicing medicine holds significant promise of improving on major health care delivery problems. Telenursing is achieving significant growth rates in many countries due to several factors: the preoccupation in reducing the costs of health care. The label is also generated simultaneously. Navy Bureau of Medicine took a significant step in advancing telepharmacy worldwide. prior authorization. refill authorization. There were one base pharmacy and five remote clinics in several areas of Spokane. Among its benefits. Community Health Association of Spokane (CHAS) in 2001. an increase in the number of aging and chronically ill population. the remote site personnel are connected to the pharmacist at base pharmacy via videoconferencing for medication verification and patient counseling. etc.[10] Telepharmacy Telepharmacy is another growing trend for providing pharmaceutical care to patients at remote locations where they may not have physical contact with pharmacists. Southern Africa. whereby a doctor uses devices to remotely examine and treat a patient. rural. and performing several management functions. Depending on the severity of the patient's condition. Washington under the telepharmacy program at CHAS. and Naval 55 .[11] A notable telepharmacy program is in the United States. and to keep patients out of hospital. Monitoring a patient at home using known devices like blood pressure monitors and transferring the information to a caregiver is a fast growing emerging service.S. It encompasses drug therapy monitoring. but has the promise to diagnose and manage the diseases patients will typically visit a general practitioner for. telemonitoring. video-conferencing is vastly utilized in pharmacy for other purposes. because Primary Remote Diagnostic Consultations not only monitors an already diagnosed chronic disease. and the label queue is transmitted to the remote site. conducted at a federally qualified community health center. A greater degree of job satisfaction has been registered among telenurses. teleconsultation. in for instance. training. In developing countries a new way of practicing telemedicine is emerging better known as Primary Remote Diagnostic Visits. small or sparsely populated regions. which allowed the low cost medication dispensing under federal government’s program. and the printing and scanning of labels. or between any number of nurses. These remote monitoring solutions have a focus on current high morbidity chronic diseases and are mainly deployed for the First World. telenursing may help solve increasing shortages of nurses. such as providing education. and the increase in coverage of health care to distant. Once those steps are done. the authorized person can access the medicine from ADDS followed by medication barcode scanning. Telenursing Telenursing refers to the use of telecommunications and information technology in order to provide nursing services in health care whenever a large physical distance exists between patient and nurse. patient counseling.Telemedicine long as the patient has the necessary monitoring equipment at his or her location. an Indian Ayurvedic doctor and the Director of Jiva Ayurveda. the pharmacist verifies the hard copy and enters the order. This program utilized videotelephony for dispensing medication and patient counseling at six urban and rural clinics. to reduce distances and save travel time. monitoring formulary compliance with the aid of teleconferencing or videoconferencing.” The remote site dispensing and patient education process was described as follows: once the prescription is sent from the remote clinics to the base pharmacy. “The base pharmacy provided traditional pharmacy study to the clients at Valley clinic and served as the hub pharmacy for the other remote clinics. the provider may check these statistics on a daily or weekly basis to determine the best course of treatment.

the Navy expanded its telepharmacy system to more sites throughout the world. It is most widely used for neuropsychological rehabilitation.[17] Various specialties are contributing to telemedicine.Telemedicine Hospital Bremerton. in the future. As of 2006. the Health Services Research Administration in the US Department of Health and Human Services. In the United States. Rich internet applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) was first introduced in 2001. Washington. occupational therapy. videoconferencing. actually did tests with transmission of ECG via telephone lines. in varying degrees. the inventor of the ECG. the Rehabilitation Institute of Chicago. Tele-audiology (hearing assessments) is a growing application. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh. the State University of New York at Buffalo. Telerehabilitation can deliver therapy to people who cannot travel to a clinic because the patient has a disability or because of travel time. videophones and webpages containing rich Internet applications. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. 56 Most telerehabilitation is highly visual. or electrocardiographs. Other federal funders of research are the Veterans Administration. audiology. Outside the United States. This endeavor has recently (2006) expanded as a teletherapy application for cognitive skills enhancement programs for school children. excellent research is conducted in Australia and Europe. As of 2006 the most commonly used modalities are via webcams. As of 2006. If the research shows that teleassessments and teletherapy are equivalent to clinical encounters.[18] . Telecardiology ECGs. and (2) building new data collection systems to digitize information that a therapist can use in practice. can be transmitted using telephone and wireless.[13] Telerehabilitation [14] [15] ) is the delivery of rehabilitation services over telecommunication Telerehabilitation (or e-rehabilitation networks and the Internet. Specialist care delivery Telemedicine can facilitate specialty care delivered by primary care physicians according to a controlled study of the treatment of hepatitis C. and the Department of Defense. and clinical therapy. telerehabilitation in the practice of occupational therapy and physical therapy are very limited. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy. and in speech-language pathology. Florida. braces or artificial limbs. and the National Rehabilitation Hospital in Washington DC. it is more likely that insurers and Medicare will cover telerehabilitation services. According to Navy Lieutenant Justin Eubanks at Navy Hospital Pensacola. Willem Einthoven. phone lines. and physical therapy. telepharmacy would be initiated at more than 100 Navy sites covering four continents by the end of 2010. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology. fitting of rehabilitation equipment such as wheelchairs. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice. Most types of services fall into two categories: clinical assessment (the patient’s functional abilities in his or her environment). In 1906 Einthoven came up with a way to transmit the data from the hospital directly to his lab. only a few health insurers in the United States will reimburse for telerehabilitation services. speech-language pathology. the National Institute on Disability and Rehabilitation Research's (NIDRR) [16] supports research and the development of telerehabilitation. perhaps because these two disciplines are more “hands on”.” Starting from March 2010.

The central control unit at the ICU was able to correctly interpret arrhythmia. Government of Pakistan (MoIT) through the Electronic Government Directorate in collaboration with Oratier Technologies (a pioneer company within Pakistan dealing with healthcare and HMIS) and PakDataCom (a bandwidth provider). In Pakistan three pilot projects in telemedicine was initiated by the Ministry of IT & Telecom. This technique helped medical aid reach in remote areas.K. P. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. 1. etc. JPMC Karachi and Holy Family Rawalpindi. [20] The project was still running smoothly after two years. Mantri using an indegenous technique for the first time in India. and four districts were linked with another hub.500 patients being treated per month per hub. It offers wide range of services to the patients and providers. Transmission using wireless was done using frequency modulation which eliminated noise. Ajai Shanker. medication therapy management. diagnosis and assessment. electronic stethoscopes can be used as recording devices.Telemedicine Teletransmission of ECG using methods indigenous to Asia One of the oldest known telecardiology systems for teletransmissions of ECGs was established in Gwalior. telepsychiatry policy. S. India in 1975 at GR Medical college by Dr. These 12 remote sites were connected and on average of 1. Three hubs were established: the Mayo Hospital (the largest hospital in Asia). Dr. Walter Reed Army Medical Center. and networking are available at the website for the American Psychiatric Association. guidelines. Three hub stations through were linked via the Pak Sat-I communications satellite. also utilizes videoconferencing for patients residing in underserved areas to access psychiatric services. Makhija. The ECG output was connected to the telephone input using a modulator which converted ECG into high frequency sound. The following are some of the model programs and projects which are undergoing for implementation of telepsychiatry in rural areas in the US. The Center for Native American Telehealth and Tele-education (CNATT) and b. A 312 Kb link was also established with remote sites and 1 Mbit/s bandwidth was provided at each hub. This system was also used to monitor patients with pacemakers in remote areas.[21] 57 . Telepsychiatry Telepsychiatry. such as consultation between the psychiatrists. University of Colorado Health Sciences Center (UCHSC) supports two programs for American Indian and Alaskan Native populations a.[19] In addition. Transmission was also done through telephone lines. educational clinical program. The ECG was converted to sound waves with a frequency varying from 500 Hz to 2500 Hz with 1500 Hz at baseline. another aspect of telemedicine. This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of the department of Medicine. Telemental Health Treatment for American Indian Veterans with Posttraumatic Stress Disorder (PTSD) 2. which is helpful for purposes of telecardiology. Links for several sites related to telemedicine. Military Psychiatry.

and Asia. did not require that a pathologist have physical or virtual “hands-on” involvement is the selection of microscopic fields-of-view for analysis and diagnosis. The radiographic image and a modem or other connection are required for this first step. Europe.Telemedicine Teleradiology Teleradiology is the ability to send radiographic images (x-rays. In an editorial in a medical [25] He. including virtual microscopy.. at a distance. Telepathology Telepathology is the practice of pathology at a distance..S. The most typical implementation are two computers connected via the Internet. patents for robotic telepathology systems and telepathology diagnostic networks. they do not need particular workstations to view the images . education. MR. Ronald S.[27] Dr. Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. three essential components are required.M. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes. PET/CT. The image is scanned and then sent via the network connection to the receiving computer. an image sending station. No particular software is necessary on the PC and the images can be reached from wherever in the world. Although digital pathology imaging. 58 A CT exam displayed through teleradiology The teleradiology process begins at the image sending station. Teleradiology is the most popular use for telemedicine and accounts for at least 50% of all telemedicine usage. for education. is the mode of choice for telepathology services in developed countries. and for research.) from one location to another. SPECT/CT. coined the term “telepathology” in 1986. and research. analog telepathology imaging is still used for patient services in some developing countries. Sometimes the receiving computer will have a printer so that images can be printed for convenience. Today's high-speed broadband based Internet enables the use of new technologies for teleradiology : the image reviewer can now have access to distant servers in order to view an exam. Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989. [26] and his collaborators. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis. the forerunner of telepathology. journal. . published the first scientific paper on robotic telepathology. and a receiving-image review station. Weinstein is known to many as the "father of telepathology". CT. MG. The use of “television microscopy”.D. Weinstein. Telepathology has been successfully used for many applications including the rendering histopathology tissue diagnoses.[28] In Norway.[29] This is still in operation.. A number of clinical telepathology services have benefited many thousands of patients in North America. a transmission network. US. Weinstein was also granted the first U. A pathologist.[22] For this process to be implemented. decades later. a standard Personal Computer (PC) and Digital Subscriber Line (DSL) connection is enough to reach keosys central server. Therefore.[23] [24] Performance of telepathology requires that a pathologist selects the video images for analysis and the rendering diagnoses.

over the Internet to patients should mandate strict controls on their practice to insure that they stay compliant with the various State Medical Board Regulations concerning Internet Prescribing.[34] Advanced and experimental services Telesurgery Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. licensing and regulatory issues Restrictive licensure laws in the United States require a practitioner to obtain a full license to deliver telemedicine care across state lines. consultation and treatment as well as (continuous) education. and public awareness in the same manner as telehealth and telemedicine. Even if the practitioner never practices medicine face-to-face with a patient in another state. most of these robots are controlled by surgeons at the location of the surgery. While the field of robotic surgery is fairly well established. The first Transatlantic teleaudiology test was performed in April 2009 when Dr James Hall tested a patient in South Africa from Dallas. passing additional oral and written examinations. It is a form of telepresence. consultation. [33] Physicians who will be prescribing Regulations concerning the practice of telemedicine vary from state to state. they described the value of a teledermatologic service in a rural area underserved by dermatologists. Remote surgery combines elements of robotics. In a scientific publication. This term was first used by Dr Gregg Givens in 1999 in reference to a system being developed at East Carolina University in North Carolina. Applications comprise health care management such as diagnoses. The first Internet audiological test was accomplished in 2000 by Givens. USA. exchange medical information (concerning skin conditions and tumours of the skin) over a distance using audio. 59 U. obtaining this license in each state could be an expensive and time-consuming proposition. states with restrictive licensure laws also have several exceptions (varying from state to state) that may release an out-of-state practitioner from the additional burden of obtaining such a license. including paying substantial licensure fees.S. Typically. cutting edge communication technology such as high-speed data connections and elements of management information systems.[32] Teledentistry Teledentistry is the use of information technology and telecommunications for dental care. A number of States require practitioners who seek compensation to frequently deliver interstate care to acquire a full license. visual and data communication. Tele-audiology Tele-audiology is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice. telecommunication technologies are used to applications of telemedicine and e-health. . he/she still must meet a variety of other individual state requirements. If a practitioner serves several states.[31] The dermatologists Perednia and Brown were the first to coin the term “teledermatology” in 1995. education. Balch and Keller. and traveling for interviews.Telemedicine Teledermatology Teledermatology is a subspecialty in the medical field of dermatology and probably one of the most common [30] In teledermatology.

providers. but it will also bring many public health benefits including: • Early detection of infectious disease outbreaks around the country. videotelephony also included image phones which would exchange still images between units every few seconds over conventional POTS-type telephone lines. and insurers. Prevent medical errors. Interoperable HIT will improve individual patient care. and Expand access to affordable care..[36] At the dawn of the technology. where the physical distance between the surgeon and the patient is immaterial. Reduce health care costs. safety and efficiency of the health delivery system (Chaudhry et al. Health information technology Health information technology (HIT) provides the umbrella framework to describe the comprehensive management of health information across computerized systems and its secure exchange between consumers. essentially the same as slow scan TV systems. . for communication between people in real-time. 2006). Health information technology (HIT) is in general increasingly viewed as the most promising tool for improving the overall quality. Increase administrative efficiencies Decrease paperwork.[35] 60 Enabling technologies Further information: List of video telecommunication services and product brands Videotelephony Videotelephony comprises the technologies for the reception and transmission of audio-video signals by users at different locations. It promises to allow the expertise of specialized surgeons to be available to patients worldwide. • Improved tracking of chronic disease management. Currently videotelephony is particularly useful to the deaf and speech-impaired who can use them with sign language and also with a video relay service. and • Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared. and well as to those with mobility issues or those who are located in distant places and are in need of telemedical or tele-educational services. Broad and consistent utilization of HIT will: • • • • • • Improve health care quality.Telemedicine Remote surgery is essentially advanced telecommuting for surgeons. without the need for patients to travel beyond their local hospital. government and quality entities.

164. psych. Principles and Practice of Emergency Medicine. Vol. 2011. 1999 Jul 15. Victoria Steiner. S. "Telemedicine and Telepharmacy: Current Status and Future Implications". Vol. ISBN 9780787966188 [15] Lisa Keaton.1990. Miriam Komaromy. Denise Dion. 22. Arch Path Lab Med 111: 646–652 [27] Kayser. New England Journal of Medicine: 110601140030042. 241. edu/ N/ DS/ s. ISSN 1540-580X. I... ISBN 081211373X. George.189. pdf). J. Glen Murata.15: 1091–1100. Kate. [2] American Telemedicine Association. aspx) [22] Kontaxakis.. Retrieved August 21. Linda L. IEEE Xplore. 2011. RS. virtual microscopy and whole slide imagining: Prospects for the future. pdf). 280 . 2005. Clifford Qualls (2011-06). Ilias. Technical University of Darmstadt. Karen Lance. "Telepathology and the networking of pathology diagnostic services. htm). pp. Pierce. "Telecommunications. D.". ed. Reader's Digest Association Limited. 67:1134-36 [14] E-health care information systems: an introduction for students and professionals. 2006 [23] {{Citation | last = Weinstein | first = RS | author-link = | last2 = Graham | first2 = AM | last3 = Richter | first3 = LC | last4 = Barker | first4 = GP | last5 = Krupinski | first5 = EA | last6 = Lopez | first6 = AM | last7 = Yagi | first7 = Y | last8 = Gilbertson | first8 = JR | last9 = Bhattacharyya | first9 = AK | title = Overview of telepathology. Department of Computer Science. Glencoe/McCgraw-Hill Company. RS (1986). jsp?arnumber=1717870). ISBN 9780276420146. Juan Pablo. Summers Kalishman. Hum Pathol 1991: 514–518 . pp. Haberman. 135. American Telemedicine Association website. and Management". Kumar S. American Journal of Health-System Pharmacy. pdf) [9] W. DOI: 10. K. R. Harbir. ieee. "Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers" (http:/ / www. 2010 Jul 15.4. Concepts. 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[10] Nurses Happier Using Telecare. 1992. html?src=mr [17] Arora. 1056/ NEJMoa1009370). | journal = Hum Pathol | volume = 40 | pages = 1057–1069 | year = 2009 [24] Kumar. Development. Volume 2 (http:/ / books. ed. [20] Pakistan telemedicine (http:/ / 202. Heaton. ISBN 9780812113730. p.. ca/ books?id=NlZ_aST4_hcC). . S (2009). 1982. et al.Z.edu) 2. Mishra. nova. Reader's Digest. gov/ about/ offices/ list/ osers/ nidrr/ index. Weinstein. Selby. Vol. 15 June 2005. com/ pastissues/ JFCD2009/ JFCD-Mar-Apr2009. americantelemed. e-health-insider. Boris Peter. google. "An E-rehabilitation Team Helps Caregivers Deal with Stroke" (http:/ / ijahsp. cfm?ID=1263). Karla Thornton. Says International Survey (http:/ / www. Engum.. "Telepathology: An Audit".C. ca/ books?id=4tgqsTknBcUC). 2006. Vol. pp.34. KJ. Komiya. Bloom. medetel. Second Edition. Schwartz (editor). com/ CTF/ about_telehealth/ what_is_telehealth. 83." American Journal of Health-System Pharmacy. John Blyth. Thomas Burke.280-282. union. ISBN 0276420144.1109/HEALTH. . 56: 1405-26 [12] Dennis Clifton. George R.246471 [6] George R. php?s=8942 [29] Nordrum. Just for Canadian Doctors. org/ Departments/ HSF/ UnderservedClearinghouse/ Linkeddocuments/ telepsychiatry. Germany. americantelemed. DM. Roland. org/ doi/ full/ 10. 29/ egdsite04/ ?p=projimpu) [21] American Psychiatric Association (http:/ / www. John Wiley and Sons. Telemedicine/Telehealth Terminology (http:/ / www. Byer.1056/NEJMoa1009370. Dimitris. ISBN: 0-7803-9704-5. lu/ download/ 2009/ parallel_sessions/ presentation/ day1/ telecardiology_and_tele-ecg_network. org/ files/ public/ abouttelemedicine/ Terminology. pg. . Ilias Image and Medical Data Communication Protocols for Telemedicine and Teleradiology (dissertation) (ftp:/ / 82. Sastrokusumo. American Journal of Health-System Pharmacy. Szymas. Heather. pdf). G. Retrieved 2011-03-26. [5] Nakajima. Jeffrey Dunkelberg. "Provision of Pharmacy Services to Underserved Populations Via Remote Dispensing and Two-Way Videoconferencing. [7] Van't Haaff. [8] What Is Telemedicine? (http:/ / www. coachorg.Telemedicine 61 References [1] Sachpazidis. T. pdf). Wesley Pak. I. 10 July 2008. John Brown. Springer. Steven Jenkusky. No. B. Gene Cayten. htm). The Internet Journal of Allied Health Sciences and Practice (Ijahsp. The Asia Pacific Telecommunity's Telemedicine Activities (http:/ / ieeexplore.2006.: "Integrated Telemedicine Applications and Services for Oncological Positron Emission Tomography". "Virtually On-sight" (http:/ / www. com/ news/ item. doi:10. Canadian Telehealth Forum. org/ files/ public/ abouttelemedicine/ What_Is_Telemedicine.". 17-19 Aug. pg. [19] "Teletransmission of ECG Waveform: An Ingenious Low Priced Technique". Lea & Febiger. Sachpazidis. Kristi. Indian Heart Journal. [18] Telecardiology (http:/ / www. Washington. Ohl. Brooke Parish. nejm. justforcanadiandoctors. [11] Angaran. [4] Did You Know? New Insights Into A World That Is Full of Astonishing Stories and Astounding Facts (http:/ / books. Retrieved from Coach: Canada's Health Teleinformatics Association website on August 21. Retrieved 2011-06-02. E`. eHealth Insider website. Malik.

com/ media. 2005 Teledermatology [32] Perednia. and Management".org) Canadian Society of Telehealth (http://www. Ing.com/PageFiles/Telemedicine.php) National Rural Health Association (http://www.com website.280-282.com) Wiki for telemedicine (ATAwiki) (http://www.ATAwiki.nih.php?id=37&L=1) .teladoc. by Nancy Brown • What is Telemedicine? (http://www.baaske.1990. Interface Surgical Technologies website.Making the Connection for Health (http://www.ttu.Practical Advise for Physicians Who Are Involved In Telemedicine (http:/ / www. Burg et al.org) TELESYNERGY . com/ telemedicine_license.isft. Brown 1995 Bull Med Libr Assoc [33] Information Provided for Physicians: Doctors Seeking a Medical Licensing Service (http:/ / www. org/ icot/ sigtelederm. pp. atmeda.org) Telemedicine Information Exchange (http://tie. January 9. Wurm et al. "Telecommunications.org/Departments/HSF/UnderservedClearinghouse/ Linkeddocuments/telepsychiatry. Telemedicine Pakistan(TelmedPak) (http://www. John Blyth.com website. intersurgtech.com website.org) International Society for Telemedicine & eHealth (ISfTeH) (http://www. thefreedictionary. htm [31] Wooton et al. medlicense.nrharural.icucare.Telemedicine 101: Telemedicine Coming of Age.htm) Ontario Telemedicine Network -.Telemedical Systems and regulatory affairs for Europe.aspx) . 2007 JDDG. html). 2010 62 Further reading • W.gov/clinic/epcsums/telemedsum.Telemedicine at the National Institutes of Health (http://telesynergy.edu/communications/vistas/archive/02-summer/stories/ miracle-of-telemedicine.telmedpak. Retrieved from the FreeDictionary. MedLicense. 2005 Roy soc of med press. [35] http:/ / www.psych. by Dipl.com) External links • • • • • • • • • • • • • Telemedicine and Telehealth (http://www. Retrieved 21 August 2011.gov) Telemedicine History (http://www. McGraw-Hill.americantelemed. asp?path=telemed101&article=tmcoming_nb_tie96.icucare.com/) Teladoc.pdf) .org) Agency for Healthcare Research and Quality (AHRQ) -. Development.net) American Psychiatric Asscoiation (http://www.ca) American Telemedicine Association (http://www.Telemedicine [30] http:/ / www. • Teleneurology and requirements of the european Medical Devices Directive (MDD) (http://www. html).com . [34] MedLicense. com/ telemedicine_advice. 2002. Second Edition.xml) .depts. medlicense.telemed.org/articles/article.otn. Armin Gärtner • Telemedicine 101: Telemedicine Coming of Age (http://tie.net/ index. Concepts.telemed.What is Telemedicine?. by Robert Higgs (www. Glencoe/McCgraw-Hill Company. com/ Videotelephony). MedLicense. [36] McGraw-Hill Concise Encyclopedia of Engineering.Telemedicine for the Medicare Population (http://www.cst-sct. ahrq. html IST's Media Collection]. Videotelephony (http:/ / encyclopedia2.

In Uganda. For example.[5] In Brazil. an open-source HRHIS was implemented under the request of the Ugandan Ministry of Health (MOH). managing and disseminating data and information on human resource for health (HRH). . MOH administrative records.HRHIS 63 HRHIS Tanzania HRHIS Written in PHP Operating system Linux Type Website Human Resource for Health Information System [1] A “Human Resource for Health Information System” (“HRHIS”) — also known within the health care sector as “human resource information system” (“HRIS”) — is a system for collecting. University of Dar es Salaam for the Ministry of Health and Social Welfare (Tanzania). including data from censuses and other national surveys.[7] HRHIS in Tanzania Background: Human Resource for Health (HRH) Strategic Plan The Tanzania Ministry of Health and Social Welfare (MOHSW) has identified health workforce information as a key area that needs to be strengthened in fast tracking implementation of its Human Resource Strategic Plan. and health professional council data. It was then agreed that these sources should be harmonized.[8] The situation analysis conducted during the development of the said plan indicated that there are several databases dealing with human resource for health with mostly same information fields within and outside the ministry. catalyzed by the availability of new information technologies at the level of local health organizations. and may be used to monitor and assess the performance of the overall health system.[2] It is usually an integral part of a comprehensive health management information system. Similar systems have been developed and implemented elsewhere. and including information on numbers and distribution of health workers and track their career information. an HRHIS can be computerized or paper-based. and funded by the Japan International Cooperation Agency (JICA) and other development partners. and housed under Health Management Information System for consistency. the national web-based HRHIS (known in Portuguese as sistema de informação e gestão de recursos humanos em saúde[6] ) was implemented by the Brazilian Ministry of Health under a process of health systems reform and decentralization. independent research studies. to link and better manage a variety of independent sources of health workforce data. Implementation of HRHIS is an effort to improve HRH management. in Tanzania the title Human Resource for Health Information System refers to an open-source software solution for HRH information management developed by the Department of Computer Science. Botswana developed its HRHIS in 1994.[3] [4] The system supports the capture of data linked to any level in an organizational hierarchy and a high degree of customization at both the input and output side. The HRHIS software is a part of Health Management Information System (HMIS) as well the District Health Information System (DHIS) software. Depending on the level of development of a country's health care system and the organization of its workforce. and Ministry of Health staff used the data as a basis for coordinated national workforce planning efforts with other agencies and ministries. The HRHIS is fully integrated with DHIS 2 through import/export mechanism. district level sources. such as the Department of Local Government which employs health workers in local regions. processing.

or. districts and health facilities to be added dynamically without entering into system codes.. Geneva. gov/ pdf_docs/ PNADM275. Accessed 9 March 2011. It can be configured by organization structure according to users' requirements. (http:/ / www. References [1] http:/ / www. usaid. Security measures include a login mechanism such that only authorized personnel can use the system. who. July 2009–June 2015 http:/ / www.. the system can allow additional regions. pdf) Ministerio de Saude and partners. local government. [5] Spero JC et al. html [3] HISP Tanzania: Human Resource for Health Information Software (HRHIS). Health Sector Strategic Plan III. regional. The system was built by UDSM developers and analysts who are considered fully conversant with the changing needs of health sector and Tanzania's context. ‘Tracking and monitoring the health workforce: a new Human Resources Information System (HRIS) in Uganda. It provides flexibility to: • Add any number of datasets or elements required by any sectors (such as central health ministry. such as for the case of the central ministry. 2011. tempsite. Handbook on monitoring and evaluation of human resources for health. Since human resource information/data are personal and confidential. district or facility level. [4] JICA’s Cooperation on Human Resources for Health. and Morogoro. PostgreSQL (database management system) running on multi-platform (Windows. and Linux). Linux) architecture. 9(6) http:/ / www. pdf) Japan International Cooperation Agency. 2009. jica. tz/ hris. hisptanzania.. pdf . but the system allows administrators or authorized users to add additional elements as new needs arise. civil services (PO-PSM) or private providers) • Update organization unit details • Generate different reports including graphical reporting • Store different human resources data and history The system can capture health personnel's data by organization unit and cadre. int/ hrh/ resources/ handbook/ en/ index. (http:/ / obsnetims1. such as national. the HRHIS system was designed and developed taking into account high security measures for protecting the data that has been entered. The HRHIS can also provide import/output mechanism for data at different levels. 2009. Accessed 9 March 2011. and thereafter in Kilimanjaro. January 2011. The initial database was populated with the minimum set of data items as requested by MOHSW. php [2] Dal Poz MR et al. Accessed 9 March 2011.HRHIS 64 HRHIS Software The HRHIS was built using free and open source technologies PHP (server scripting language). and generate various general and aggregated web-enabled reports in different formats including graphical reporting. and also a Users Administration functionality which allows the system administrator to limit users access to the available functions of the system. PostgreSQL. 2010. go. It is used in the Coast region (all districts and regional level) and MOHSW headquarters. World Health Organization. moh. pdf) United States Agency for International Development. jp/ activities/ issues/ health/ pdf/ pamph_jinzai. [7] Using Human Resource for Health Data: Health policy and program planning examples from four African countries. (http:/ / pdf. php) Health Information Systems Programme. com/ content/ 9/ 1/ 6 [6] Sistema de Informação e Gestão de Recursos Humanos em Saúde (SIGRHS). human-resources-health. (http:/ / www. go. The system has been developed based on full open source technologies (PHP. or. hisptanzania. 2009 http:/ / www. and is designed to be user-friendly based on flexible architecture. [8] United Republic of Tanzania Ministry of Health and Social Welfare. and implementation is ongoing in Dar es Salaam. 2008.’ Human Resources for Health. tz/ hris. Accessed 9 March 2011. tz/ documents/ Health_Sector_Strategic_Plan_III. ws/ sigrhs/ site/ manual. Tanga. etc.

Evette J Ludman. 2009. Karina Lovell. org/ media. army.hisptanzania. After reviewing thirteen relevant studies. it was primarily intended a substitution for conventional.udsm. Retrieved June 15. nlm. USAID-supported Capacity Project • University of Dar es Salaam. mil/ -news/ 2009/ 06/ 15/ 22707-q-west-chaplains-introduce-video-teleconference-counseling-for-couples/ ).HRHIS 65 External links • HRIS Strengthening Implementation Toolkit (http://www. "Psychotherapy mediated by remote communication technologies: a meta-analytic review" (http:/ / www. ncbi.tz). Initially. the available evidence is limited in quantity and quality. However. Tanzania Remote therapy Remote Therapy. WWW.g. Vol 374.or.[6] References [1] David Hailey.ac. gov/ pubmed/ 19699995). sometimes called Telemental Health Applications[1] or Internet-based Psychotherapy. an office-based therapist conducts the rehabilitation session with the patient. provides remote cognitive rehabilitation sessions to patients who have had an acquired brain injury. 1st Class Adam Shaw. PhD. cpa-apc. face-to-face therapy in which a client or patient is required to visit a psychotherapists office.. The Lancet. however. TBMC Psychiatry 2008. . remote therapy has enjoyed growing popularity as a replacement for traditional therapy and innovative practice made possible by electronic medium. com/ 1471-244X/ 8/ 60).MIL (The Official Homepage of The United States Army). who remains in or near his or her home. php?mid=694& xwm=true).tz). Arto Ohinmaa. Retrieved July 22. cellular phone. More rigorous trials are required to confirm these preliminary estimates of effectiveness.[3] Examples Despite the absence of complete study. biomedcentral. "The Effectiveness of Telemental Health Applications: A Review" (http:/ / publications. academics are studying the use of electronic media in treatment to explore the possibility of providing novel and potentially more effective therapies. secure instant messaging platform.[2] is a form of psychotherapy or related psychological practice in which a trained psychotherapist meets with a client or patient via telephone.[4] • AbilTo LLC. Retrieved November 2008. Linda Gask and Pamela Roach.ARMY. "It’s Time for Disruptive Innovation in Psychotherapy" (http:/ / www. . the team-based applications of cognitive behavioral therapy utilizing a licensed therapist and behavioral coach. 2009. the internet or other electronic media in place of or in additional to conventional face-to-face psychotherapy. The Canadian Journal of Psychiatry. 8:60. PhD.org/hris/hris-toolkit/). . nih. [4] Sgt. .[5] uses remote therapy to extend the reach of evidence-based practice and introduce innovative new practices. Examples include: • The US Army has initiated a program in which soldiers in combat participate in video-based relationship counseling with their partners at home. Risto Roine. [3] Penny E Bee. [2] Gregory E Simon. Tanzania • Health Information Systems Programme (http://www. "Q-West Chaplains Introduce Video Teleconference Counseling for Couples" (http:/ / www. the authors of a meta-analytic review of psychotherapy mediated by remote communications technology concluded that: Remote therapy has the potential to overcome some of the barriers to conventional psychological therapy services. Computer Science unit (http://cs. Using an Internet-based. Retrieved August 22. Peter Bower. e. Increasingly. 2008. David Richards. Simon Gilbody. • Mayo Clinic. Telephone-based interventions are a particularly popular research focus and as a means of therapeutic communication may confer specific advantages in terms of their widespread availability and ease of operation. MD.capacityproject. .

. and deploy new telehealth technologies. com/ we-can-help/ ). afhcan. The Alaska Federal Healthcare Access Network (AFHCAN) offers a diagnostic “store and forward” telehealth platform with the ability to create a telemedicine case with textual information and data from biomedical peripherals. Integrated Biomedical Peripherals. ahrq. jointly manages and operates the Alaska Native Medical Center (ANMC). Leading to High Levels of Patient and Therapist Satisfaction" (http:/ / www.S. ANTHC is a tribal organization. as defined in 25 U. Automatic Software Updates. Certified Training for Administrators. As a part of its mission. Internet-Enabled Therapy Sessions Enhance Access to Cognitive Rehabilitation for Traumatic Brain Injury Patients. gov/ content. org . Users. Clinical Workflow Assessments.Remote therapy [5] "Abilto's offerings" (http:/ / abilto. org/ ref/ laws/ [2] http:/ / http:/ / www. AFHCAN Telehealth Cart and other Platforms. First and foremost. USA. along with the Southcentral Foundation. 450 (b) (c) [1] and. and Help Desk / Customer Support. 66 Alaska Federal Health Care Access Network The Alaska Federal Health Care Access Network (AFHCAN) is managed by the Alaska Native Tribal Health Consortium (ANTHC). develop. The AFHCAN system provides an innovative approach to ease of use. and send data for consultation. aspx?id=1688). External links • Official website [2] References [1] http:/ / www.C. AFHCAN offers a whole product solution that includes: Store and Forward Telehealth Software. support for widely varying clinical workflows. more than 700 users in Alaska continually provide feedback and request new products and features. providing tertiary and specialty healthcare service in the state of Alaska. and Support Staff. mobility. Through growing acceptance of telehealth. Health care professionals are able to view the data and respond to the case using a standard PC workstation. AFHCAN continues to evolve and expand its services where the number of users and clinical services has grown significantly over the years. AFHCAN continues to review. . anthc. innovations. Service Level Agreements (SLAs). [6] "At-Home. and a robust communication platform.

582 Edmonton area patients. pdf . and to upload medication dispensations. External links • Alberta Netcare official site [1] • Alberta Privacy Commissioner preliminary report on the May breach [2] References [1] http:/ / www. ca/ / [2] http:/ / www. Users who are within the trusted networks of the Government of Alberta (eg. and an RSA SecurID Key Fob for authentication.Alberta Netcare 67 Alberta Netcare Alberta Netcare (formerly Wellnet) is the province of Alberta's public Electronic Health Record. ca/ Content_Files/ Files/ News/ NR_AHSbreach_8Jul2009. Pharmacies can use the service to verify prescription details. compromising the privacy of 11. oipc. Messages are sent and received over a secure HTTP connection. Users There are three main categories of Netcare users: • Health service providers (physicians) • Diagnostic laboratories • Drug dispensing locations (pharmacies) Netcare allows authorized physicians to view the medical records of patients. 2009 a Trojan virus was detected on several Alberta Health and Netcare systems. Implementation Netcare messaging is performed with HL7-encoded XML messages. Security Netcare uses a two-factor authentication protocol involving a username/password combination. albertanetcare. hospitals) do not require the RSA key for login. ab. Security Failures From May 15-29.

• ATA Annual Meeting . telehealth or eHealth).allow members to address issues related to the advancement and application of telemedicine regarding specific areas including home telehealth. continuing medical education. • Spearheading the development of appropriate clinical and industry policies and standards. org American Telemedicine Association (ATA). americantelemed. ATA seeks to bring together diverse groups from traditional medicine. Serving as a clearinghouse for telemedical information and services. The Association implements these objectives by: • • • • Educating government about telemedicine as an essential component in the delivery of modern medical care. technology. cost-effectiveness.direct. • On-line Member News Updates . ATA goal is to promote access to medical care for consumers and health professionals via telecommunications technology (alternatively referred to as telemedicine. • ATA Online Membership Directory .the single source of who's who in telemedicine. and access to health care. academic medical centers. • Telemedicine and e-Health . teledermatology. In accordance with the mission of the organization. The American Telemedicine Association is the leading resource and advocate promoting access to medical care for consumers and health professionals via telecommunications technology. and telerehabilitation. e-health. companies and other healthcare and technology organizations.a peer-reviewed publication encompassing all aspects of clinical telemedicine practice. DC 20036 Website http:/ / www. government and others to overcome barriers to the advancement of telemedicine through the professional. ocular telehealth. NW Suite 540.the world's largest scientific meeting and exposition focusing exclusively on telemedicine. Promoting research and education including the sponsorship of scientific educational meetings and theTelemedicine and e-Health Journal. Washington. posters and workshops. telemental health. technical advances and enabling technologies. Membership in ATA is open to individuals. telepathology. • ATA Website .American Telemedicine Association 68 American Telemedicine Association American Telemedicine Association Location 1100 Connecticut Ave. . and the impact of telemedicine on the quality. with hundreds of presentations. technology and telecommunications companies. medical societies. ATA provides a broad range of services for its members and the industry as a whole.a widely-used resource for telemedicine news and information. • Special Interest Groups (SIGs). Regional Chapters and Discussion Groups . ethical and equitable improvement in health care delivery. telenursing. established in 1993 as a non-profit organization. Fostering networking and collaboration among interests in medicine and technology. exclusive news briefs via email about the latest event and activities affecting telemedicine professionals. ATA is governed by a Board of Directors elected by the Association's membership.

June 13. com/ story/ telemedicine-growth-examined/ 2006-03-13 [3] http:/ / www. 2010.3220792& dq=american-telemedicine-association+ -newswire& hl=en [2] http:/ / www. com/ doc/ 1P1-3985567. Retrieved September 7. and business support services. fiercehealthcare. Candice (March 13. "Doctors. com/ newspapers?id=_AA1AAAAIBAJ& sjid=DU8KAAAAIBAJ& pg=3045. Fierce Healthcare. Telemedicine Information Exchange In June 2006. Its executive director is Will Engle. org Association of Telehealth Service Providers Association of Telehealth Service Providers (ATSP) is an international membership-based trade non-profit organization dedicated to improving health care through growth of the telehealth industry and promoting the use of telecommunications in healthcare. • "Tribal Healthcare 2000: Telecommunications and Telemedicine" [3]. It was founded in 1996 by Douglas Perednia. education awareness programs. google. Retrieved September 7. atmeda. Oregon. the ATSP announced that it was taking over the hosting and updating responsibilities for the Telemedicine Information Exchange (TIE) [1]. 2010. ATSP believes that telemedicine is a practical tool that can improve the distribution of healthcare services to the benefit of both patients and providers. all-inclusive platform for information on telemedicine and telehealth. atawiki. March 12. 2006). The TIE's mission is to provide an online. • "Telemedicine growth examined" [2]. It is a business-oriented group which focuses on providing members with information and tools to facilitate the success of their telehealth activities. External links • ATA homepage [4] • Wiki for telemedicine (ATAwiki) [5] References [1] http:/ / news. External links • Association of Telehealth Service Providers (ATSP) homepage [2] • Telemedicine Information Exchange [1] . 2006. unbiased.American Telemedicine Association 69 References • Choi. MD and is located in Portland. Its main activities are advocacy. 2010. highbeam. Patients Back Telemedicine" [1]. html [4] http:/ / www. org/ [5] http:/ / www. The Ojibwe News. Bangor Daily News. Retrieved September 7. 1997.

be/portal/page?_pageid=56. Professor Georges De Moor is head of the committee. Stud Health Technol Inform.health. org/ Belgian Health Telematics Commission The Belgian Health Telematics Commission (BHTC) is a Belgian government committee working on standards for exchanging and sharing of health information. atsp.[3] References [1] Belgian Telematics Commission. org/ database/ documents/ ERA_Reports/ Belgium_eHealth-ERA_country-report_final_30-06-2007.fgov. Digital signature and electronic certificates in health care.be/pls/portal/docs/PAGE/ INTERNET_PG/HOMEPAGE_MENU/GEZONDHEIDZORG1_MENU/AUTOMATISERING1_MENU/ SYMPOSIA1_MENU/AVIS25_MENU/AVIS25_DOCS/A01-UK. The committee provides advice on eHealth to the Belgian government[1] [2] . Stud Health Technol Inform.health.110:112-7 [2] Belgian Telematics Commission.110:87-9 [3] eHealth strategy and implementation activities in Belgium (http:/ / www. org/ [2] http:/ / www.4280450&_dad=portal& _schema=PORTAL) • Telematics Standards in relation to the Health Sector (https://portal.fgov. 2004. telemed. together with Jos Devlies and Geert Thienpont. The BHTC consists of several working groups: • • • • Data Hospitals Telemedicine Label: homologation of (para)medical software Georges De Moor. authored the 2006 eHealth strategy and implementation activities in Belgium report. advice) .4280396&_dad=portal& _schema=PORTAL) • Rcommendations (https://portal.PDF) (PDF. 2004. ehealth-era. between health care participants.fgov.Association of Telehealth Service Providers 70 References [1] http:/ / tie.be/portal/page?_pageid=56.health. pdf) Source • Telematics Commission (https://portal. Recommendations regarding national development of standardized electronic health care messages.



Type Industry Founded Headquarters Website Privately held Medical device manufacturer 1963 Berlin, Germany Biotronik References: [1] [2] [3]

BIOTRONIK (BIOTRONIK SE & Co. KG;[2] BIOTRONIK Worldwide) is a privately-held multinational biomedical technology company headquartered in Berlin, Germany. BIOTRONIK developed the first German cardiac pacemaker in 1963 and pioneered in the creation of remotely-monitored implanted cardiac devices. The company has marketed these telemedicine technologies in Europe since 2000, in the USA since 2001, and in over 50 other countries.

Business focus
BIOTRONIK focuses on medical devices for vascular intervention and electrotherapy of the heart. Its products include pacemakers, implantable cardioverter-defibrillators (ICD), closed-loop stimulation devices (CLS), cardiac resynchronization therapy devices (CRS), leads, catheters, a magnesium bioresorbable stent, measurement and ablation systems for electrophysiology, vascular intervention products for treatment of stenosis and occlusion in arterial vessels, guidewires, balloon catheters, stents and stent systems for coronary and peripheral diseases, and related technologies such as the external devices used to monitor implants.[4] [3] In January 2010, the company announced its first implantation of a "leadless" cardiac monitoring device for continuous accurate detection and recording of cardiac arrhythmias without the need for any electrodes placed in the patient’s heart.[5]

BIOTRONIK offers a unique system that allows a patient's implanted device to transmit information about the condition of the patient's health, and the state of the device, directly to a secure website where a physician can observe it. The system is highly integrated with a variety of telecommunication technologies, such as landline telephone, cellular telephone, Short Messaging Service (SMS), email, or fax. Depending on the type of device and its programming, which would be determined by the medical necessity in each individual, the pacemaker or ICD could alert a physician immediately in the event of an emergency cardiac event. The physician would have access to the dataflow from the device and could assess the appropriate response.[6] [7] In addition to providing a safety net for individuals with potentially lethal illnesses of the heart, this form of telemedicine allows periodic routine physician review to occur at a distance. Patients who have implants can be monitored as necessary, without travelling to a health care facility. The safety of this approach has been confirmed in a clinical study led by the Cleveland Clinic involving over 1,443 patients enrolled from 105 North American sites. It is the first study to test remote monitoring and rapid detection of symptomatic and asymptomatic cardiac events in a prospective, randomized trial.[8] [9] [10]

Biotronik As of the end of 2009, over 230,000 systems using the BIOTRONIK technology have been implanted in heart patients, in more than 55 countries.[5]


BIOTRONIK was founded in Berlin, Germany, in 1963 by physicist Max Schaldach and electrical engineer Otto Franke, who developed the first German implantable pacemaker. The company opened its North American headquarters and production facilities in Oregon, United States, when it acquired Stimulation Technology, Inc. in the 1970s. In 1993 BIOTRONIK developed its first ICD. In 1995 the company released a number of devices for vascular intervention such as balloon catheters and stents.[11] BIOTRONIK's telemetry-based accessible cardiac devices were first implanted in Europe in 2000 and in the United States in 2001.[12] Prof. Schaldach died in the crash of an aircraft he was piloting in 2001, and was succeeded by his son, Dr. Max Schaldach, as owner of the company.[13] BIOTRONIK claims to be "the fastest growing medical device company globally"[14] and is expanding its global workforce of over 5,000 employees.[5]

BIOTRONIK was nominated for the "Deutscher Zukunftspreis" an award conferred by the German Federal President for achievements in technology and innovation. This prize is considered the most important national award for scientific and technological innovations which have already proven themselves on the market.[15]

External links
• Biotronik [1]

[1] http:/ / www. biotronik. com/ portal/ home [2] "BIOTRONIK SE & Co. KG" (http:/ / www. hoovers. com/ company/ BIOTRONIK_SE__Co_KG/ yrhjtftts-1. html). Company profiles. Hoovers. . Retrieved 3 April 2011. [3] "BIOTRONIK, Inc. Snapshot" (http:/ / investing. businessweek. com/ research/ stocks/ private/ snapshot. asp?privcapId=6500053). Business Week. . Retrieved 11 January 2010. [4] "Pharmaceutical Business Review" (http:/ / www. pharmaceutical-business-review. com/ companies/ biotronik_gmbh_co_kg/ ). . Retrieved 11 January 2010. [5] "BIOTRONIK: Unique Leadless Cardiac Monitoring Device Implanted" (http:/ / www. devicespace. com/ news_story. aspx?StoryID=166882& full=1). 6 January 2010. . Retrieved 11 January 2010. [6] "Unique Leadless Cardiac Monitoring Device Implanted" (http:/ / www. streetinsider. com/ Press+ Releases/ Unique+ Leadless+ Cardiac+ Monitoring+ Device+ Implanted/ 5224337. html). January 6, 2010. . Retrieved 11 January 2010. [7] "BIOTRONIK launches its new, unified platform pacemaker series in Europe" (http:/ / www. news-medical. net/ news/ 20091027/ BIOTRONIK-launches-its-new-unified-platform-pacemaker-series-in-Europe. aspx). THE MEDICAL NEWS from News-Medical.Net. 27 October 2009. . Retrieved 11 January 2010. [8] Varma, N; et al.. Evaluation of efficacy and safety of remote monitoring for ICD follow-up: the TRUST trial (http:/ / circ. ahajournals. org/ cgi/ reprint/ 118/ 22/ 2309). 2008. Circulation: American Heart Association. pp. 2309–2317 Abstract 4078. . Retrieved 11 January 2010. [9] Varma, N.; et al. (August 30, 2009). "Efficiency of calendar based ICD checks: conventional follow-up compared to remote monitoring in the TRUST trial" (http:/ / spo. escardio. org/ abstract-book/ presentation. aspx?id=67474). Barcelona, Spain: ESC Congress. pp. Abstract 86114. . Retrieved 11 January 2010. [10] Varma, N.; et al. (August 31, 2009). "Event notification by remote monitoring systems performing automatic daily checks: load, characteristics and clinical utility" (http:/ / spo. escardio. org/ abstract-book/ presentation. aspx?id=67579). Barcelona, Spain: ESC Congress. pp. Abstract 87438. . Retrieved 11 January 2010. [11] "Our History" (http:/ / www. biotronik. com/ portal/ 4595). Biotronik. . Retrieved 12 January 2010. [12] Versweyveld, Leslie (23 October 2001). "Two U.S. hospitals implant first BIOTRONIK pacemakers with Home Monitoring Technology" (http:/ / www. hoise. com/ vmw/ 01/ articles/ vmw/ LV-VM-11-01-15. html). Virtual Medical Worlds Monthly. . Retrieved 12 January 2010.

[13] "OBIT/BIOTRONIK -- Professor Dr. Max Schaldach" (http:/ / www. allbusiness. com/ company-activities-management/ company-structures/ 6070009-1. html). Business Wire. All Business.com. 7 May 2001. . Retrieved 12 January 2010. [14] "BIOTRONIK Forges Ahead Toward Medtech Leadership Position" (http:/ / findarticles. com/ p/ articles/ mi_m0EIN/ is_2008_Sept_1/ ai_n28047799/ ?tag=col1;co-competitors). Business Wire. BNET CBS Interactive. 1 Sept 2008. . Retrieved 12 January 2010. [15] "Nominated for the German Federal President's "Deutscher Zukunftspreis" (German Future Award): BIOTRONIK Home Monitoring for Online Monitoring of Heart Patients" (http:/ / www. reuters. com/ article/ idUS107222+ 28-Sep-2009+ BW20090928). Reuters. 28 Sept. 2009. . Retrieved 12 January 2010.


Campus medicus
Campus Medicus is a content management system for telemedicine use. It has three main applications.

Clinical decision support
It allows doctors (surgeons, pathologists, cytologists, radiologists etc.) to communicate all over the world. Campus Medicus can be used for diagnostic consultations. Images can even be sent by email to that platform. Using the mobile health function of Campus Medicus means, doctors can send images and text and receive diagnosis via a mobile phone. Doctors can discuss about a tumour or other diseases. Campus Medicus allows the doctors to have a live discussion with several doctors while they see the stored images or a live image. They can have a videoconference and they can chat at the same time they see the images. A single image or a whole slide image can be viewed. What is required is a camera for macroscopy or microscopy and a computer with internet connection.

Campus Medicus can also be used for cancer registry and epidemiology. Ready-to-use forms are available and forms can be generated easily. The results may be viewed as a statistic.

Ready-to-use lecture notes are available, such as gynaecology, pathology, cytology, surgery, nursing and others. The videoconference module allows holding individual lectures for doctors and students all over the world. The lectures may be held as a live lecture or they can be stored and reviewed as a video. The written lectures may be printed out as a book.

Telemedizin in der Mongolei [1]

[1] http:/ / www. openpr. de/ news/ 352298/ Telemedizin-in-der-Mongolei. html

in order to enable efficient communication between health care professionals and bringing a deeper understanding of patient needs.Canada Health Infoway 74 Canada Health Infoway Canada Health Infoway is an independent. The results of the project may include shorter medical procedure wait times. provincial and territorial Deputy Ministers of Health.[12] . Infoway has also recently developed a pan-Canadian electronic health information standard. pharmacies and other points of care – is intended to improve access to health care services for Canadians. itself developed by Infoway. not-for-profit organization tasked with accelerating the development of electronic health records (EHR) across Canada. Development of a network of effective interoperable electronic health record solutions across Canada – linking clinics. Infoway’s members are Canada's 14 federal. enhance their quality of care and make the health care system more efficient. they work with Canadian provinces and territories with the goal of creating an electronic health record for 50% of Canadians by the end of 2010. Infoway has no mandate to enforce compliance. and may dramatically improve health care for Canadians. Infoway's investments are prioritized toward local. hospitals. It is reported that as of December 31. with an investment value of $1.5-billion from Canada Health Infoway. as Canadian healthcare is generally governed at the Provincial level. provincial and national projects which align with the Pan-Canadian EHR Blueprint. other health-care facilities. leveraging the existing HL7v3 standards. Infoway has approved projects [1] in the following targeted program areas: • • • • • • • • • • Diagnostic Imaging Systems [2] Drug Information Systems [3] Infostructure [4] Innovation and Adoption [5] Interoperable EHR [6] Laboratory Information Systems [7] Patient Access to Quality Care [8] Public Health Surveillance [9] Registries [10] Telehealth [11] Goals The goal of Canada Health Infoway is to contribute to the development of a network of EHR systems. pharmacies and laboratories. safer prescriptions and better access to quality health care. 2008 there were 276 EHR projects under way in Canadian hospitals. As a strategic investor. Projects Since 2001. federally-funded. Beyond these strategic investments.

reduce medical errors. and the Office for the Advancement of Telehealth (OAT). CTeL argues that expanding the use of telehealth can improve patient safety. ca/ lang-en/ about-infoway/ approach/ investment-programs/ drug-information-systems http:/ / www. CTeL was recognized by the United States Department of Commerce: “[The] progress there has been in resolving such issues can be attributed to a very recent and concentrated effort by such stakeholders as… Center for Telemedicine Law. based in Washington.annual conference dedicated solely to telehealth issues and telehealth advocacy. • Telehealth Policy Clerkship Program . and increase patient access to primary and specialty care in both rural and urban settings. ca/ lang-en/ about-infoway/ approach/ investment-programs/ infostructure [5] http:/ / www. infoway-inforoute. and provides testimony in support of telehealth. • *The National Telehealth Resource Center (NTRC). is a non-profit organization committed to overcoming legal and regulatory barriers to the utilization of telehealth and related [e-health] services. Texas Children's Hospital. infoway-inforoute. 20080218. and the Mid-West Rural Telemedicine Consortium. CTeL briefs public policymakers. D. D. infoway-inforoute. infoway-inforoute. infoway-inforoute. • Washington Live! Brown Bag Lunches in Washington. ca/ lang-en/ about-infoway/ approach/ investment-programs/ registries [11] http:/ / www. one of several telehealth resource centers funded through a grant from the Office for the Advancement of Telehealth at the Health Resources and Services Administration [2] (HRSA) in the Department of Health and Human Services. • In 2004. infoway-inforoute. US Commerce . CTeL offers a variety of services. including involvement in public policy. theglobeandmail. ca/ lang-en/ about-infoway/ approach/ investment-programs/ laboratory-information-systems [8] http:/ / www.Canada Health Infoway 75 Notes [1] [2] [3] [4] http:/ / www. writes reports.” – Innovation. ca/ lang-en/ about-infoway/ approach/ investment-programs/ patient-access-to-quality-care [9] http:/ / www.C. wmychart18/ BNStory/ specialScienceandHealth/ External links • Canada Health Infoway (http://www. ca/ lang-en/ about-infoway/ approach/ investment-programs/ telehealth [12] http:/ / www. infoway-inforoute. infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ diagnostic-imaging-systems http:/ / www. • Also in 2004. CTeL worked with HRSA’s Office for the Advancement of Telehealth (OAT) and the University of Colorado Health Sciences Center to perform an analysis of the use of telehealth in skilled nursing facilities for a report to Congress.[1] CTeL.C. This report is titled “Multi-State Telehealth Practice” and summarizes the current state of physician and nurse licensure issues.. com/ servlet/ story/ RTGAM. analyzing and disseminating information on legal and regulatory issues information associated with telemedicine. infoway-inforoute. infoway-inforoute. It also handles underlying issues such as licensure and reimbursement. – monthly seminars on various topics of interest in telehealth and e-health.ca/) Center for Telehealth and E-Health Law The Center for Telehealth & E-Health Law (CTeL). Cleveland Clinic Foundation. infoway-inforoute.infoway-inforoute. CTeL activities include: • "Telehealth Leadership Conference" . Demand. ca/ lang-en/ about-infoway/ approach/ investment-programs/ innovation-and-adoption [6] http:/ / www. specializes in compiling. ca/ lang-en/ about-ehr/ ehr-progress-map http:/ / www. ca/ lang-en/ about-infoway/ approach/ investment-programs/ interoperable-ehr [7] http:/ / www. & Investment in Telehealth. In its materials. ca/ lang-en/ about-infoway/ approach/ investment-programs/ public-health-surveillance [10] http:/ / www. within the Department of Health and Human Services (HHS).offered for second and third year law students interested in public policy and legal issues as they apply to advancing communication technologies in the practice of medicine. established in 1995 by a consortium including the Mayo Foundation.

org/) • Office for the Advancement of Telehealth (http://www. Projects in the Centre include: • Development of a portable digital imaging device that has teleophthalmology (retinal and anterior segment imaging). page 30 .lei. a software tool that analyses stereo images of the retina.Center for Telehealth and E-Health Law Department. teledermatology. Tuesday August 23 2005.org. htm) External links • CTeL (http://www.gov/telehealth//) Centre for e-Health The Centre for e-Health aims to further the use of telemedicine in Australia and Asia. References • http://www. Feb. org/ content/ ?page=9) [2] HRSA . It is based at the Lions Eye Institute in Perth. hrsa. The Centre was launched in August 2005 by then-WA Premier Geoff Gallop. 2004. telehealthlawcenter.au/go/research/research-groups/centre-for-e-medicine/e-medicine-projects • The Australian. 76 References [1] Center for Telehealth and e-Health Law (http:/ / www.hrsa. The WA Government contributed $2. Western Australia. The Director of the Centre is Professor Kanagasingam Yogesan.25 million to the project. • Online visual function testing of eye health.Telehealth Grantee Directory (http:/ / www. teleotolaryngology and teledentistry applications enabling remote diagnosis of disease and disorder. gov/ telehealth/ granteedirectory/ overview. • A stereo optic disc analyser.telehealthlawcenter.

often leverages existing technologies such as connected devices using existing cellular networks and is associated with efforts to improve chronic care. logistics and personal communications. flexible opportunities for consumers to engage with clinicians and better self-manage their care. telehealth. and approximately 200 million are Internet users. According to the International Communications Union. quality and efficiency. History Connected health has its roots in telemedicine. chronic disease management and patient compliance of the US and global healthcare systems. and patient feedback • Efforts in the direction of integrating of data generated outside of traditional healthcare settings such as the home with centralised. over 190 million are cell phone users. Proponents of connected health believe that technology can transform healthcare delivery and address many inefficiencies especially in the area of work flow management. and its more recent relative.000 patients are documented as having received remote treatment from doctors at MGH using the clinic’s two-way audiovisual microwave circuit2. in part due to the high availability of telephone and Internet service as compared to other parts of the world. often electronic patient record One of the first telemedicine clinics was founded by Dr. located three congested miles from the hospital. . shopping. The first telemedicine programs were primarily undertaken to address healthcare access and/or provider shortages. The European Union has roughly an equivalent number of people connected to land lines. More recent data collected by Pew Internet: Americans and their Gadgets suggest that 86% of US residents own a mobile phone and this number is as high as 96% among Americans aged 18 to 29 years. but prevails over the U. Bird’s clinic more or less coincided with NASA’s foray into telemedicine through the use of physiologic monitors for astronauts3. with more than 300 million cell phone users and 230 million [1] Internet users. over 260 million people have a land line connected. Within the United States. Connected health is distinguished from telemedicine by: • A broader concern for healthcare cost. The United States and European Union are two dominant markets for the use of connected health in home care service. Kenneth Bird at Massachusetts General Hospital [2] in 1967. The vision of the connected health model can be implicitly understood by contemplating the significant impact of technology on other industries. It uses technology – often leveraging readily available consumer technologies – to deliver patient care outside of the hospital or doctor’s office. it is predicted that there will be 4 billion mobile phone users worldwide 1 by the end of 2008 .Connected Health 77 Connected Health Connected Health is a term used to describe a model for healthcare delivery that uses technology to provide healthcare remotely. particularly as related to the chronically ill • Concomitant interests in making healthcare more patient centric by promoting healthcare consumerism through education. Other pioneering programs in telemedicine were designed to deliver healthcare services to people in rural settings. The timing of Dr. remote care (such as home care) and disease and lifestyle management. Over 1.S. such as in banking. The clinic addressed the fundamental problems of delivering occupational and emergency health services to employees and travellers at Boston’s Logan International Airport. Connected health aims to maximize healthcare resources and provide increased. Connected health encompasses programs in telehealth.

Some of the most common types of connected health programs in operation today include: • Home care via remote monitoring of chronically ill patients including surveillance connected devices or patient controlled monitoring of health parameters • Traditional telehealth programs. self-care and remote care. global positioning. the use of email to communicate with patients between office visits) also fall within the purview of connected health. For instance. mortality and the cost of care • Consumer engagement in health and self-management • Safer and more effective clinical trials . elderly. They envision: • Reductions in the cost of providing quality care to the chronically ill. [3] is implementing a range of programs in high-risk. with attendant reductions in: morbidity. estimated by the Center for Health Care Economics at the Milken Institute [4] to be over $1 trillion per year • Improved global and local public health surveillance. involve patients in their care through regular feedback.Connected Health 78 Connected Health in Operation Two “core platforms” are emphasized in connected health. videoconferencing and environmental sensors are all playing a role in connected health today. and those patients located at an untenable distance from primary or specialty providers. or improve upon a health outcome measure in a defined patient population or individual. Programs designed to improve patient-provider communication within an individual medical practice (for example. online communications or biosensors and may aim to increase patient-provider communication. with a resultant reduction in epidemics. with programs primarily focused on monitoring and feedback for the chronically ill. There are also “lifestyle coaching” programs. remote monitoring programs might use a combination of cell phone and smart phone technology. in which an individual receives healthcare information to facilitate behavior change to improve their fitness and/or general well being. increased control over infectious disease and improved drug safety • Diminished rate of medical errors • Better “customer service” in healthcare • Ongoing preventive health. Goals of Connected Health Connected health is viewed by its proponents as a critical component of change in human healthcare. Digital pen technology. chronic and remotely located Inherent in the concept of connected health is flexibility in terms of technological approaches to care delivery and specific program objectives. (see wellness) or to reduce or eliminate the impact of a particular behavior that presents a risk to their health status. where care is provided in remote areas by teams of local clinicians or community healthcare workers teamed up with specialists in medical centers • Monitoring programs whose aim is to ensure the safety and quality of life of elderly parents living at a distance from their relatives • Web-based second opinion services for patients in need of medical care • Lifestyle and fitness coaching for wellness or health risk reduction The Center for Connected Health populations.

in a program being implemented by the Center for Connected Health [8] and Partners Home Care [9].11 . However. [7].9 Connected health experts such as Joseph C. Another initiative at the Center for Connected Health uses cellular telephone technology and a “smart” pill bottle to detect when a patient has not taken their scheduled medication. using simple devices in the patient’s home.Connected Health 79 The Evolution of Connected Health Healthcare is consistently cited in political polls and in surveys as a chief concern for consumers.all of which are dedicated to promoting and monitoring healthcare quality . growing provider shortages. consumers are calling for the same responsiveness from the healthcare system. administrators. as is the mass availability of inexpensive technology and ubiquity of the Internet. A signal is then sent that lights up an ambient orb device in the patient’s home to remind them to take their medication.in other industries.5.illustrate intense concern over inefficiency. Funding and Implementation Today. over 500 heart failure patients have now been monitored remotely through the collection of vital signs. believe that consumer engagement in healthcare is on its way to becoming a major force for change. The information is sent daily to a home health nurse. EMC Corporation recently launched the first employer-sponsored connected health program. having acclimated to greater speed. efficiency and cost transparency . it appears that connected health programs are operated and funded primarily by home care agencies and large healthcare systems. skyrocketing costs.4 The formal establishment of quality improvement organizations in 2002 and rise of independent organizations such as The National Committee for Quality Assurance. an aging U. Direct-to-consumer advertising is a demonstrated contributor to the rise in consumer demand.8. which is aimed at improving outcomes and cost of care for patients with high blood pressure.S.D. In summary. Experts speculate that. blood pressure and weight. population and longer lifespan are all factors pointing to a need for better ways of delivering healthcare. are increasingly interested in connected health for its potential to reduce direct and indirect healthcare costs. Together. For example. and customer service in healthcare. For example. A pilot of this program demonstrated reduced hospitalizations10. safety. there is evidence of its benefit. geographic dispersion of families. who can identify early warning signs. better survival rates among patients fighting serious diseases. and intervene to avert potential health crises.6. quality and efficiency of care 2) dynamics of the healthcare economy (such as rising costs and changing demographics) 3) consumerism in health care and a drive towards patient centric healthcare. Evidence While connected health is yet emerging. troubling ethnic disparities in care.7 Consumer demand for better service and quality in healthcare is the latest source of pressure to improve the healthcare system. notify the patient’s primary care physician. currently in the beta phase of implementation. employers and clinicians alike. cell phones and PDAs. increases in chronic diseases. M. The Leapfrog Group [5] and Bridges to Excellence [6] . these factors are providing impetus for connected healthcare in the United States and many other industrialised nations and forcing innovation both from within and outside the system. insurers and employers. connected health has arisen from: 1) a desire on the part of individual physicians and healthcare organizations to provide better access. In addition. who bear enormous cost to insure their employees. Kvedar. including heart rate.as well as vastly improved access to information about products and services .

http://tie. 2008).asp References International Telecommunications Union website (Accessed December 10. to the extent that Medicaid reimburses for telemedicine programs.org/ Center for Studying Health System Change. • The Office of the National Coordinator for Health Information Technology (ONC) is charged with creating an interoperable health information technology infrastructure for the nation.hschange. gallup.org/articles/article.org/i4a/pages/index.com/ Center for Telehealth & Ehealth Law.cfm?pageid=1 Association of Telehealth Service Providers. Resources • • • • • • American Telemedicine Association. “A Brief History of Telemedicine” (Accessed December 10. Dimmick. MD. Susan L. or PHRS. http://www. That infrastructure has been primarily defined as an electronic health records system. however.ctel. at least 18 states are allowing reimbursement for services provided via telemedicine for reasons that include improved access to specialists for rural communities and reduced transportation costs. electronic medical records (EMRs) (see electronic medical record) are digital medical records or medical records systems maintained by hospitals or medical practices and are not part of connected health delivery. at the state’s option. It remains to be seen how his 12 successor. Personal Health Records Personal health records.org/business/telehealth_books.hhs. itu. PHRs intersect with connected health in that they attempt to increase the involvement of healthcare consumers in their care. home-telehealth-connecting-care-within-the-community. Robert Kolodner. http://tie. Center for Connected Health. By contrast.connected-health. Connecting Care Within the Community. “Highlights from the Eighth Annual Meeting of the American Telemedicine Association” (Accessed December 10. 2008). com/ poll/ 17785/Election-2008.medscape.americantelemed. http://www. “Gallup’s Pulse of Democracy” (Accessed December 10. http://www. http:/ / www.telemed. http://www.aspx 2 1 Medscape website.asp Center for Connected Health.aspx • Office of the National Coordinator for Health Information Technology. (see personal health record) – are essentially medical records controlled and maintained by the healthcare consumer.telemed. 2008). connected-health. org/ media-center/ HealthCare.xml 3 Gallup website.org/ Home Telehealth. will interpret this charge. Director. int/ ITU-D/ ict/ newslog/Worldwide+Mobile+Cellular+Subscribers+To+Reach+4+Billion+Mark+Late+2008.Connected Health 80 US Government and Connected Health Government agencies involved in connected health include: • The Office for the Advancement of Telehealth • The Centers for Medicare & Medicaid Services (CMS). Kvedar. http:/ / www. http://www. Edited by Richard Wootton. http://www. Joseph C.com/viewarticle/457684 Telemedicine Information Exchange website. 2008).atsp. former National Coordinator David Brailer indicated his support for personal health records that are portable and controlled by consumers.aspx 4 . http://www.asp?path=articles&article=tmhistory_nb_tie95. Partners http:/ / www. According to the CMS Web site.org/default.gov/healthit/onc/ mission/ • Telemedicine Information Exchange.

“How Changes in Medical Technology Affect Health Care Costs” . boston. http://www. org/ . com/ yourlife/ health/ diseases/ articles/ 2007/ 03/ 03/ employees_to_get_an_online_checkup/?page=1 12 Brailer. org/ programs. 2007.bmj. massgeneral. bridgestoexcellence. 334: 942 (5 May).com/articles/18802 Americans for Healthcare website (Accessed December 10. To Go. aspx http:/ / www. Employees to get an online checkup: Care provider. org/ Reports/ 2010/ Gadgets/ Overview. connected-health. org/ http:/ / www. Prepared for America’s Health Insurance Plans. org/ about-us/ leadership/ joseph-c-kvedar.nybooks. 2006. org/ http:/ / www.ahrq.americansforhealthcare. 2008) http://www.org/facts/ 6 7 Agency for Healthcare Research and Quality website. partnershomecare. connected-health. http://www. "The Health Care Crisis and What to Do About It” (Accessed December 10.cfm 10 11 9 BMJ 2007. aspx http:/ / www. March 3. 2008). org/ about-us/ http:/ / www. 2006. connected-health.kff. The Factors Fueling Rising Healthcare Costs 2006.com/cgi/content/full/334/7600/942 Kowalczyk.Connected Health 5 81 The New York Review of Books website. org/ http:/ / www. org/ http:/ / www. http://www. leapfroggroup. The Boston Globe.org/insurance/snapshot/chcm030807oth. 2008). David J. EMC will test a program to cut health costs. The New York Times. http://www. milkeninstitute. Your Medical History. http:/ / www. L. “Health Care Costs: Why Do They Increase? What Can We Do?” (Accessed December 10. September 19. March 2007 (Accessed December 10. aspx/ http:/ / www. 2008).gov/news/ulp/costs/ulpcosts1. 2006 Kaiser Family Foundation website. References [1] [2] [3] [4] [5] [6] [7] [8] [9] http:/ / pewinternet.htm 8 PriceWaterhouseCoopers.

08 MB) PS 3. DICOM is known as NEMA standard PS3.32 MB) PS 3. The different devices come with DICOM conformance statements which clearly state the DICOM classes they support. The National Electrical Manufacturers Association (NEMA) holds the copyright to this standard.Digital imaging and communication in medicine (DICOM) including workflow and data management".DICOM 82 DICOM DICOM (Digital Imaging and Communications in Medicine) is a standard for handling. • PS 3. servers.2: Conformance [7]PDF (6.14: Grayscale Standard Display Function [17]PDF (2.8: Network Communication Support for Message Exchange [13]PDF (901 KB) PS 3. whose members[2] are also partly members of NEMA.1: Introduction and Overview [6]PDF (241 KB) • • • • • • • • • • • • • • • • • PS 3.00 MB) [19] PDF (3.4: Service Class Specifications [9]PDF (1.16: Content Mapping Resource [20] PS 3. and network hardware from multiple manufacturers into a picture archiving and communication system (PACS).9: Retired (formerly Point-to-Point Communication Support for Message Exchange) PS 3.7: Message Exchange PDF (1.3: Information Object Definitions [8]PDF (6. DICOM has been widely adopted by hospitals and is making inroads in smaller applications like dentists' and doctors' offices.96 MB) PS 3. printers.43 MB) [11] PDF (7. It includes a file format definition and a network communications protocol.5: Data Structure and Encoding [10]PDF (1. storing. and as ISO standard 12052:2006 "Health informatics -.13: Retired (formerly Print Management Point-to-Point Communication Support) PS 3.15: Security and System Management Profiles [18]PDF (1.12: Storage Functions and Media Formats for Data Interchange [16]PDF (593 KB) PS 3.28 MB) PS 3.97 MB) PS 3. Parts of the DICOM Standard The DICOM standard is divided into related but independent parts:[4] The links below are to the 2009 version published in January 2010.14 MB) PS 3.46 MB) PS 3.10: Media Storage and File Format for Data Interchange [14]PDF (406 KB) PS 3.18: Web Access to DICOM Persistent Objects (WADO) [21]PDF (291 KB) . The communication protocol is an application protocol that uses TCP/IP to communicate between systems.[3] DICOM enables the integration of scanners.6: Data Dictionary [12] PS 3.[1] It was developed by the DICOM Standards Committee.11: Media Storage Application Profiles [15]PDF (1.88 MB) PS 3. workstations.07 MB) PS 3. printing. and transmitting information in medical imaging. DICOM files can be exchanged between two entities that are capable of receiving image and patient data in DICOM format.17: Explanatory Information PDF (3. Additions to the standard (Supplements and Change Proposals) since that publication are available through the DICOM Web site [5].

New service classes were defined. ACR and NEMA joined forces and formed a standard committee in 1983. In the beginning of the 1980s it was almost impossible for anyone other than manufacturers of computed tomography or magnetic resonance imaging devices to decode the images that the machines generated. was released in 1985. It is not a framework or architecture for achieving a useful clinical workflow. Switzerland) and SPI. The text was vague and had internal contradictions. Merge Technologies. DeJarnette Research Systems and Merge Technologies provided the modality gateway interfaces from third party imaging modalities to the Siemens SPI network. Their first standard. like Papyrus (developed by the University Hospital of Geneva.0 was presented at the annual meeting of the Radiological Society of North America (RSNA) in 1990 by these same vendors. Commercial equipment supporting ACR/NEMA 2. In 1988 the second version was released. In 1993 the third version of the standard was released.0.DICOM 83 History DICOM is the third version of a standard developed by American College of Radiology (ACR) and National Electrical Manufacturers Association (NEMA). Six companies participated in this event. like "the 2007 version of DICOM". the standard has its limitations. Very soon after its release. Many soon realized that the second version also needed improvement. Radiologists and medical physicists wanted to use the images for dose-planning for radiation therapy. Several extensions to ACR/NEMA 2. Siemens Medical Systems. Detrick. it became clear that improvements were needed. over a dedicated 25 differential (EIA-485) pair cable.0. Officially. ACR/NEMA 300. Maryland. DeJarnette Research Systems.0 interconnectivity technology was held at Georgetown University. Loral part of the MDIS (Medical Diagnostic Imaging Support) Aerospace and Siemens Medical Systems led a consortium of companies in deploying the first US military PACS (Picture Archiving and Communications System) at all major Army and Air Force medical treatment facilities and teleradiology nodes at a large number of US military clinics. (Standard Product Interconnect. network support added and the Conformance Statement was introduced. it has been constantly updated and extended since 1993. Vortech (acquired by Kodak that same year) and 3M.0 were created. May 21–23. This version gained more acceptance among vendors. RSNA's Integrating the Healthcare Enterprise (IHE) initiative layered on top of DICOM (and HL-7) provides this final piece of the medical imaging interoperability puzzle. The image transmission was specified as Front page of ACR/NEMA 300. The first large scale deployment of ACR/NEMA technology was made in 1992 by the US Army and Air Force as [22] program run out of Ft. While the DICOM standard has achieved a near universal level of acceptance amongst medical imaging equipment vendors and healthcare IT organizations. version 1. the latest version of the standard is still 3. The Veterans Administration and the Navy also purchased systems off this contract. driven by Siemens Medical Systems and Philips Medical Systems). Its name was then changed to DICOM so as to improve the possibility of international acceptance as a standard. . however. The first which was released in 1985 demonstration of ACR/NEMA V2. General Electric Medical Systems. 1990. Instead of using the version number the standard is often version-numbered using the release year. DICOM is a standard directed at addressing technical interoperability issues in medical imaging.

the main object has no "header" as such: merely a list of attributes. But note that the attribute may contain multiple "frames". A DICOM data object consists of a number of attributes. actually contains the patient ID within the file. Another example is NM data. and Run-length encoding (RLE). including the pixel data).43 MiB) Value Representation AE AS AT CS DA DS DT FL FD Description Application Entity Age String Attribute Tag Code String Date Decimal String Date/Time Floating Point Single (4 bytes) Floating Point Double (8 bytes) . the format for each Data Element is: GROUP (2 bytes) ELEMENT (2 bytes) VR (2 bytes) LengthInByte (2 bytes) Data (variable length).or four-dimensional data can be encapsulated in a single DICOM object. OW. DICOM Value Representations Extracted from Chapter 6. but not all. DICOM uses three different Data Element encoding schemes. and also one special attribute containing the image pixel data (i. For the other Explicit Data Elements or Implicit Data Elements. With Explicit Value Representation (VR) Data Elements.[23] • DICOS . but when written to a file. see section 7. LZW (zip) compression can be used for the whole data set (not just the pixel data) but this is rarely implemented. so that the image can never be separated from this information by mistake. ID. OF. usually a true "header" (containing copies of a few key attributes and details of the application which wrote it) is added.DICOM 84 Derivations There are some derivations from the DICOM standard into other application areas.. That means that a file of a chest X-Ray image. SQ. UT. or UN. JPEG Lossless.e. allowing storage of cine loops or other multi-frame data. logically.5: Data Structure and Encoding [25]PDF (1. etc. In these cases three. JPEG 2000.[24] DICOM Data Format DICOM differs from some.Digital Imaging and Communication in Nondestructive Evaluation. A single DICOM object can only contain one attribute containing pixel data. for example.Digital Imaging and Communication in Security was established in 2009 to be used for image sharing in airport security. The same basic format is used for all applications.2 of • PS 3. where an NM image by definition is a multi-dimensional multi-frame image. This includes • DICONDE . including JPEG. This is similar to the way that image formats such as JPEG can also have embedded tags to identify and otherwise describe the image. this corresponds to a single image. for VRs that are not OB. including network and file usage.1 of Part 5 of the DICOM Standard. including items such as name. was established in 2004 as a way for nondestructive testing manufacturers and users to share image data. data formats in that it groups information into data sets. For many modalities. Pixel data can be compressed using a variety of standards.

Store The DICOM Store service is used to send images or other persistent objects (structured reports. For character string value representations.. etc. e.g. . the successive data elements are separated by the backslash character "\". most of which involve transmission of data over a network. burnt to a CD).DICOM IS LO LT OB OF OW PN SH SL SQ SS ST TM UI UL UN US UT Integer String Long String Long Text Other Byte Other Float Other Word Person Name Short String Signed Long Sequence of Items Signed Short Short Text Time Unique Identifier Unsigned Long Unknown Unsigned Short Unlimited Text 85 In addition to a Value Representation. DICOM Services DICOM consists of many different services. each attribute also has a Value Multiplicity to indicate the number of data elements contained in the attribute. a modality or workstation. to make sure that it is safe to delete the images locally. The Service Class User (SCU: similar to a client). and the file format below is a later and relatively minor addition to the standard.) to a PACS or workstation. Storage Commitment The DICOM storage commitment service is used to confirm that an image has been permanently stored by a device (either on redundant disks or on backup media. etc. uses the confirmation from the Service Class Provider (SCP: similar to a server). an archive station for instance. if more than one data element is being encoded.

Also known as MPPS. It also mandates the presence of a media directory. dose delivered. The MIME type for DICOM files is defined by RFC 3240 as application/dicom. DICOM restricts the filenames on DICOM media to 8 characters (some systems wrongly use 8. for example.dcm file extension if they are not part of a DICOM media (which requires them to be without extension). This is a common source of problems with media created by developers who did not read the specifications carefully.2.10 Section 6.nema. this service allows a modality to better coordinate with image storage servers by giving the server a list of objects to send before or while actually sending such objects. DICOM files typically have a . which provides index and summary information for all the DICOM files on the media. and duration of a study. Application areas . beginning time.3. Modality Performed Procedure Step A complementary service to Modality Worklist. etc. Modality Worklist This enables a piece of imaging equipment (a modality) to obtain details of patients and scheduled examinations electronically. It helps give the radiology department a more precise handle on resource (acquisition station) use. It describes how to store medical imaging information on removable media. end time. including hard copy printout. this enables the modality to send a report about a performed examination including data about the images acquired.DICOM 86 Query/Retrieve This enables a workstation to find lists of images or other such objects and then retrieve them from a PACS. an image and demography. but this does not conform to the standard). it's also mandatory to include the File Meta Information. No information must be extracted from these names (PS3. There is a standard calibration (defined in DICOM Part 14) to help ensure consistency between various display devices.3.2). the DICOMDIR file.dicom. so there is less need for meaningful file names. normally to print an "X-Ray" film. This is a historical requirement to maintain compatibility with older existing systems. Off-line Media (DICOM Files) The off-line media files correspond to Part 10 of the DICOM standard. Printing The DICOM Printing service is used to send images to a DICOM Printer. avoiding the need to type such information multiple times (and the mistakes caused by retyping). The DICOMDIR information provides substantially greater information about each file than any filename could. There is also an ongoing media exchange test and "connectathon" process for CD media and network operation that is organized by the IHE organization. The Uniform Type Identifier type for DICOM files is org. Except for the data set containing.

DICOM 87 Modality BI CD CR CT DD DG DX EC EM ES GM LS MA MG MR MS NM OT PT RF RG RT SC SM ST TG US VL XA XC Description Modality of type Biomagnetic Imaging Modality of type Color Flow Doppler-Retired 2008 Modality of type Computed Radiography Modality of type Computed Tomography Modality of type Duplex Doppler-Retired 2008 Modality of type Diaphanography Modality of type Digital Radiography Modality of type Echo cardiography (retired) Modality of type Electron Microscope Modality of type Endoscopy Modality of type General Microscopy Modality of type Laser Surface Scan Modality of type Magnetic Resonance Angiography (retired) Modality of type Mammography Modality of type Magnetic Resonance Modality of type Magnetic Resonance Spectroscopy (retired) Modality of type Nuclear Medicine Modality of type Other Modality of type Positron Emission Tomography Modality of type Radio Fluoroscopy Modality of type Radiographic Imaging (conventional film screen) Modality of type Radiation Therapy Modality of type Secondary Capture Modality of type Slide Microscopy Modality of type Single-Photon Emission Computed Tomography (retired 2008) Modality of type Thermography Modality of type Ultra Sound Modality of type Visible Light Modality of type X-Ray Angiography Modality of type External Camera (Photography) Examples of Modalities supported in DICOM are: • • • • • • • • AS = Angioscopy-Retired BI = Biomagnetic Imaging CD = Color Flow Doppler-Retired CF = Cinefluorography (retired) CP = Colposcopy Retired CR = Computed Radiography CS = CystoscopyRetired CT = Computed Tomography .

a.a.DICOM • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • DD = Duplex Doppler Retired DF = Digital Fluoroscopy (retired) DG = Diaphanography DM = Digital Microscopy (retired) DS = Digital Subtraction Angiography Retired DX = Digital radiography EC = Echocardiography Retired ES = Endoscopy FA = Fluorescein Angiography Retired FS = Fundoscopy Retired HC = Hard Copy LP = Laparoscopy Retired LS = Laser Surface Scan MA = Magnetic resonance angiography Retired MG = Mammography MR = Magnetic Resonance MS = Magnetic Resonance Spectroscopy Retired NM = Nuclear Medicine OT = Other PT = Positron Emission Tomography (PET) RF = Radio Fluoroscopy RG = Radiographic Imaging (conventional film screen) RTDOSE (a. • 2761 registered port for DICOM using Integrated Secure Communication Layer (ISCL) over TCP or UDP • 2762 registered port for DICOM using Transport Layer Security (TLS) over TCP or UDP • 11112 registered port for DICOM using standard. many operating systems require special privileges to use it. . RS) = Radiotherapy Structure Set SR = Structured Reporting ST = Single-photon Emission Computed Tomography Retired TG = Thermography US = Ultrasound VF = Videofluorography (retired) XA = X-Ray Angiography XC = eXternal Camera ECG = Electrocardiograms 88 DICOM transmission protocol port numbers over IP DICOM have reserved the following TCP and UDP port numbers by the Internet Assigned Numbers Authority (IANA): • 104 well-known port for DICOM over TCP or UDP.k. Since 104 is in the reserved subset.a.k. open communication over TCP or UDP The standard recommends but does not require the use of these port numbers. RD) = Radiotherapy Dose RTIMAGE = Radiotherapy Image RTPLAN (a.k. RP) = Radiotherapy Plan RTSTRUCT (a.

org/ medical/ dicom/ 2009/ 09_05pu3. nema. org: Industrial Imaging and Communications Section (http:/ / www.html) • Introduction to DICOM using OsiriX (http://www. org/ medical/ dicom/ 2009/ 09_04pu.saravanansubramanian.DICOM 89 References [1] [2] [3] [4] DICOM brochure (http:/ / medical. nema. then Pervasive. pdf [22] http:/ / www. nema.dclunie. nema. nema. nema. org/ medical/ dicom/ 2009/ 09_01pu.Contains a long list DICOM software. pdf [9] ftp:/ / medical. nema.000 Words. html) [24] http:/ / www. nema. • Medical Image FAQ part 8 (http://www. gov/ pubmed/ 7612705?dopt=Abstract [23] http:/ / www. nema. nema.nema. . org [6] ftp:/ / medical. org/ dicom/ geninfo/ Brochure. org/ medical/ dicom/ 2009/ 08_01pu. org/ medical/ dicom/ 2009/ 09_07pu2. cfm) [25] http:/ / medical. org/ medical/ dicom/ 2009/ 09_06pu3.dclunie. pdf [17] ftp:/ / medical. pdf [20] ftp:/ / medical. nih. org/ medical/ dicom/ 2009/ 09_14pu. nlm.1 DIMSE Services" (ftp:/ / medical.dclunie. org/ about/ members/ ) "6. pdf [13] ftp:/ / medical. nema. org: If a Picture Is Worth 1.org/medical/dicom/2009/) • DICOM Standard Status (approved and proposed changes) (http://www.cabiatl. nema. [5] http:/ / dicom. pdf) NEMA Members (http:/ / www. org/ medical/ dicom/ 2009/ 09_11pu. 2006.com/mricro/dicom/index. pdf [12] ftp:/ / medical.html) . org/ SNEWS/ OCTOBER_2003/ voelker_oct03. nema.com/Saravanan/ Articles_On_Software/Entries/2010/2/10_Introduction_to_the_DICOM_Standard.html) . pdf [19] ftp:/ / medical. nema. org/ medical/ dicom/ 2009/ 09_17pu.html) • Medical Image FAQ part 2 (http://www. org/ members. ncbi. pdf [7] ftp:/ / medical. nema. org/ medical/ dicom/ 2009/ 09_15pu.com/dicom-status/status. org/ medical/ dicom/ 2009/ 09_12pu.html) • Example of an applet based DICOM Viewer (http://legeneraliste.sfr.aycan. pdf [16] ftp:/ / medical. pdf [14] ftp:/ / medical. org/ dicom/ 2007/ 07_05pu.com/medical-image-faq/html/part8. nema.fr/?p=dicom_eng) .de/main/lp/ sample_dicom_images. org/ medical/ dicom/ 2009/ 09_03pu3. org/ medical/ dicom/ 2009/ 09_18pu. pdf) MEMBERS of the DICOM STANDARDS COMMITTEE (http:/ / medical. pdf [8] ftp:/ / medical.perso. org/ medical/ dicom/ 2009/ 09_10pu. pdf External links • The latest DICOM specification (ftp://medical. Ubiquitous Imaging Is Priceless (http:/ / www. nema.com/medical-image-faq/html/part2. pp. pdf [15] ftp:/ / medical. 11. nema. org/ medical/ dicom/ 2009/ 09_08pu.Standard formats including DICOM. National Electrical Manufacturers Association. nema. pdf [10] ftp:/ / medical. nema. html) • Brief introduction to DICOM (http://www. pdf [11] ftp:/ / medical. pdf [21] ftp:/ / medical. astm. pdf [18] ftp:/ / medical. Digital Imaging and Communications in Medicine (DICOM) Part 1: Introduction and Overview. nema. org/ prod/ security/ indust-Img. org/ medical/ dicom/ 2009/ 09_16pu. pdf). nema. nema. • Collection of DICOM images (clinical images and technical testpatterns) (http://www. astm. nema. org/ medical/ dicom/ 2009/ 09_02pu.

rurdev. External links [www. 2005 Edition" [1] by Jasper Womach. DLT is administered by the Rural Utilities Service.usda. References [1] http:/ / ncseonline. 101-624) to provide grants to rural schools and health care providers to help them invest in telecommunications facilities and equipment to bring educational and medical resources to rural areas where the services otherwise might be unavailable. The 1996 farm bill (P. References •  This article incorporates public domain material from the Congressional Research Service document "Report for Congress: Agriculture: A Glossary of Terms.L. Sec. 107-171. Programs.gov/rus Rural utilities service]. pdf . and Laws.L.Distance Learning and Telemedicine Grant and Loan Program 90 Distance Learning and Telemedicine Grant and Loan Program The Distance Learning and Telemedicine Grant and Loan Program (DLT) is a program authorized by the 1990 farm bill (P. 104-127) reauthorized and streamlined the program. The program was also reauthorized in the 2002 farm bill (P. org/ nle/ crsreports/ 05jun/ 97-905. 6203).L.

Dossia could be one of the largest PHR [4] systems in the world. Dossia released their API in summer of 2009. Given the number of employees of these combined institutions. . by providing user access to health information regardless of health plan. Dossia is one of the largest PHR deployments in the world. Along with Microsoft's HealthVault and Google's Google Health. It is an initiative formed from the following companies: • • • • • • • • • • AT&T Applied Materials BP America Cardinal Health Intel Pitney Bowes Sanofi-aventis Walmart Abraxis BioScience Vanguard Health Systems Dossia is formed by some of the largest employers in the United States with the intention of offering a PHR to its employees. CEO Steve Munini. employer or physician.[2] Unlike the other two large PHR efforts. Users also have the ability to download their full record. at any time.Dossia 91 Dossia Dossia Industry Founder(s) Healthcare AT&T Applied Materials BP America Cardinal Health Intel Pitney Bowes sanofi-aventis Walmart Abraxis BioScience Vanguard Health Systems Headquarters  United States Cambridge. Massachusetts Michael Critelli. Dossia. [3] Dossia differs from traditional tethered PHR services. COO.org [1] Key people Website Dossia is a Personal health record service offered by some of the largest employers in the United States. Dossia is based on Open Source software. in electronic form.

a group of Fortune 500 employers. and portable PCHRs. Cardinal Health Karl Dalal. private and portable electronic health records. Pitney Bowes. sanofi-aventis . Initially. Also during 2008. [6] Dossia’s PHP(Personal Health Platform) The Dossia system enables individuals to gather copies of their own medical data (in digital form) from multiple sources and to create and utilize their own personal. improve communications with their doctors. Pitney Bowes Steven Lampkin. Chairman. Executive Director. and sanofi-aventis. The Dossia Foundation aims at advancing knowledge and progress in the healthcare space through a variety research. (formerly) Intel Jean Paul Gagnon. paper-based system. additional information will come directly from the patient’s medical chart and various other sources. AT&T. strategy. M. [5] Following WalMart’s roll out. The Consortium’s goal was to empower their employees to make smarter. M. including Applied Materials. Global Benefits Applied Materials Andrew Gold. The information the system provides will empower individuals to manage their own healthcare. in April 2009. Executive Chairman. Dossia Director of Public Policy. the Dossia Consortium Board of Directors decided to create two additional organizations within the Dossia umbrella.Director. Secretary. Intel Global Benefits Design Director. Director. more informed decisions about their healthcare by offering them Personally Controlled Health Records (PCHR) . Board Of Directors.. Abraxis Health • Brad Perkins.S.D. Health and Welfare Benefits. and retirees can maintain private. Reimbursement. • • • • • • • • • Craig Barrett. the data will come primarily from insurers’ databases and the patient’s own annotations. Graham. and advocacy initiatives pertaining to Personally Controlled Health Records (PCHRs). Walmart Patrick Soon-Shiong. personal. Intel. WalMart was the first Dossia Consortium member to roll out the PCHRs to their 1. Executive VP Strategy and Innovation and Chief Transformation Officer. In 2008.4 million employees plus their dependents.Dossia 92 Dossia’s History In 2006. Inc. and ensure more complete and accurate information for healthcare providers than the current fragmented. Vice President of Benefits. Dossia Board Members Dossia’s board is composed of industry leaders from a variety of Fortune 500 companies. BP America Adena Handly. Intel Corporation • Liz Cirri. Cardinal Health. Wal-Mart. Vice President. Board of Directors. As the system develops.. Dossia. The Consortium funded the development of a web-based framework through which Consortium employees. These included the Dossia Foundation and the Dossia Service Corporation. Healthcare Marketing. Global Benefit Planning. The Dossia Service Corporation is responsible for delivering the PCHR infrastructure and service to subscribing employers and customers. Benefits Services and Strategic Initiatives. Government Programs. Later. In fall of 2008. BP America. Intel Corporation. Senior Director. AT&T Business Solutions Diana Finucane. deploying and operating the electronic health record infrastructure. sanofi-aventis Monica Foster.. Director of U. Dossia continued to roll out its PCHRs to the other Dossia Consortium members including Vanguard.D. Vanguard Health Systems • Tami L. dependents. Executive Chairman and Chief Executive Officer. formed an alliance called the Dossia Consortium. Pitney Bowes Inc. AT&T and BP America. Dossia announced that Abraxis BioScience also joined the Dossia Founders Group. Dossia established an agreement to work with Children’s Hospital Boston to provide strategic and technological expertise and guidance in creating.

Retrieved 2010-19-01. informationweek. External Links Dossia Official Site (http://www.[3] model of care. dossia. Retrieved 2008-11-07.org/) E-Patient e-Patients (also known as Internet Patient. e-Patients report two effects of their online health research: "better health information and services. many clinicians have underestimated the benefits and overestimated the risks of online health resources for patients. emancipated and experts. Enabled to make choices about self-care and those choices are respected.0 / Medicine 2.dossia. [5] Moore. com/ news/ healthcare/ EMR/ showArticle. . • • • • • • • Equipped with the skills to manage their own condition.0. "Indivo Health: Further Details on Dossia Agreement" (http:/ / chilmarkresearch.[1] The term encompasses both those who seek online guidance for their own ailments and the friends and family members (e-Caregivers) who go online on their behalf. ." [2] e-Patients are increasingly active in their care and are demonstrating the power of the Participatory Medicine or Health 2. Based on the current state of knowledge on the impact of e-patients on the healthcare system and the quality of care received: • A growing number of people say the internet has played a crucial or important role as they helped another person cope with a major illness. Information Week. jhtml?articleID=210605059). Retrieved 2008-11-07. pitney "Vanguard Rolls out Dossia PHRs To Employees" (http:/ / www.0 tools) in coping with medical conditions. [3] "Dossia Open API" (http:/ / wiki. and different (but not always better) relationships with their doctors.Dossia 93 Notes [1] http:/ / www.[6] [7] [8] • Medical online support groups have become an important healthcare resource. 2. empowered. com/ news/ software/ database/ showArticle. . . Marianne Kolbasuk. dossia. Empowered Engaged patients are engaged in their own care Equals in their partnerships with the various physicians involved in their care Emancipated Expert patients can improve their self-rated health status. Marianne (2008-10-01). and reduce disability and their dependence on hospital care. pp. engaged. cope better with fatigue and other generic features of chronic disease such as role limitation. "Wal-Mart Rolls Out E-Health Records To All Employees" (http:/ / www. Retrieved 2008-11-07. informationweek. com/ 2007/ 10/ 17/ indivo-health-further-details-on-dossia-agreement/ ). and who use electronic communication tools (including Web 2. They are equipped. . [4] Moore. • This is one the most important cultural medical revolution of the past century. mediated and driven by technology. John. or Internet-savvy Patient) are health consumers who use the Internet to gather information about a medical condition of particular interest to them. pitney. • The net friendliness of clinicians and provider organizations—as rated by the e-patients they serve—is becoming an important new aspect of healthcare quality.[4] [5] • Since the advent of the Internet. org/ [2] McGee. John. [6] McGee. jhtml?articleID=222300838& queryText=dossia). org/ ). com/ 2007/ 10/ 17/ indivo-health-further-details-on-dossia-agreement/ ). enabled. equals. Retrieved 2008-11-07. "Indivo Health: Further Details on Dossia Agreement" (http:/ / chilmarkresearch.

com/cgi/ content/full/328/7449/1148). .bmjjournals. Hollenberg E.0: Social Networking.2196/jmir. PMC 1550655. Hudak PL.53. PMID 15142894.1371/journal. org/ cgi/ content/ full/ 53/ 6/ 356).0020206. 2007).6. • Feder J (2008). "A reader and author respond to "ePatients: engaging patients in their own care"". 2003. • It is crucial for medical education to take the e-patient into account. Villasis-Keever M. "Analysis of cases of harm associated with use of health information on the internet" (http:/ / jama.E-Patient • The impact of the e-patient cannot be fully understood and appreciated in the context of pre-internet medical constructs. "What I've learned from E-patients". Todd. J.2196/jmir.7449. Internet Res.e22. Lyons EJ.3322/canjclin. [2] Fox. "The first generation of e-patients" (http://bmj. . Apomediation. • van Woerkum CM (1 April 2003). J.pdf) (PDF). Partnership: the Canadian Journal of Library and Information Practice and Research 2 (1). Pew Internet & American Life Project (2004-09-27). . PMC 1182328. PMC 2270894.jmir. squ. Am. om/ squmj/ includes/ tng/ pub/ tNG_download. JAMA 287 (21): 2869–71. 77 (4 Suppl): 1016S–1018S. cfm?pg=howto&fn=internetpt) • Susannah Fox. Med. edu. .com/main. Senior Editor. lib.pewinternet. . • Podiatry Online: Accommodating the Internet-Savvy Patient (http://www. ""I Found it on the Internet:" Preparing for the e-patient in Oman" (http:/ / web. and to prepare students for medical practice that encompasses the e-patient[9] The proportion of e-patients in selected patient populations seem to be highest in the US and Canada.21. G (2010). Med. edu. doi:10. PMC 2018833. J Med Internet Res 2008.e12. 5/2/2006.ajcn. Frydman G (May 2004). pdf) [3] Eysenbach G Medicine 2. Internet Res. doi:10.org/2007/2/e12). J.2869.pmed. [8] Crocco AG.com/docs/WSJ_online_patient_groups.3. ISSN 1911-9593. doi:10. PMID 17513283. 8 (3): e22.1148. Med. php/ perj/ article/ view/ 244/ 374).2196/jmir. Levinson W (2006). Ribisl KM. PMID 17032638. BMJ 328 (7449): 1148–9.asp). "Today’s E-Patients: Hunters and Gatherers of Health Information Online" (http://www. (July 2005). Pew Internet (http:/ / www. uoguelph. pewinternet.328. SQU Med J 10 (2): 169–179.org/PPF/r/27/presentation_display. ""I Found it on the Internet:" Preparing for the e-patient in Oman" (http:/ / web. Fallows. European countries seem to lag.1136/bmj. squ. Todd.3.org/cgi/content/full/77/4/1016S). CA Cancer J Clin 53 (6): 356–71. Lyons EJ. The Wall Street Journal (June 13. Deborah. PMID 15998623.7. ca/ index. Rimer BK (2007). PLoS Med. pdf. Collaboration. G (2010). ama-assn. PMID 16060721.287. pdf). doi:10.podiatryonline. • Laura Landro. org/ 2008/ 3/ e22/ ). org/ cgi/ content/ full/ 287/ 21/ 2869). J. Clin. SQU Med J 10 (2): 169–179. Internet Res. asp?id=e5ecd1c850167630052768711a777f70). et al. and Openness (http:/ / www. 2 (8): e206. Ng'ambi D.10(3):e22 [4] Finding Answers Online in Sickness and in Health.356. org/ ~/ media/ / Files/ Reports/ 2003/ PIP_Health_Report_July_2003. Participation. PMC 1874721. Susannah. doi:10. "Are physicians ready for patients with Internet-based health information?". "Empowering the physician-patient relationship: The effect of the Internet" (http:/ / journal. pewinternet. Ferguson T (August 2005).e32. PMC 411079. jmir. Bercovitz K. 94 References [1] Masters K.9. [6] Jacobson P (2007). Health searches and email have become more commonplace. asp?id=e5ecd1c850167630052768711a777f70). Forlenza M. author reply 46. . • Meier A. Jadad AR (June 2002). org/ pdfs/ PIP_Health_Decisions_2006. "The Internet and primary care physicians: coping with different expectations" (http://www. 7 (3): e32. Frydman G. Medscape J Med 10 (2): 46. om/ squmj/ includes/ tng/ pub/ tNG_download. [5] Eysenbach G (2003). 9 (2): e12. [9] Masters K. "The impact of the Internet on cancer outcomes" (http:/ / caonline. PMID 15224975. Nutr. doi:10.jmir. Ng'ambi D. doi:10. PMID 12663310. "How cancer survivors provide support on cancer-related Internet mailing lists" (http://www. [7] Ahmad F. amcancersoc. • Ferguson T. PMID 12038937. but there is room for improvement in searches and overall Internet access. • Rimer BK.org/2005/3/e32/). "How new subscribers use cancer-related online mailing lists" (http://www. "The Growing Clout of Online Patient Groups" (http://liferaftgroup. (http:/ / www.2. PMID 18382715. Research must combine expertise from specialties that are not used to work together.8. • Hoch D.1001/jama.

from the Pew Internet and American Life Project (http://www.1681838. including 40% of the physicians in the United States.000 users worldwide (including 200. California that makes various mobile health software applications under the "epocrates" name.pewinternet. 1999 article by Dr.htm) .[5] Among its competitors is WebMD.ftc. giving the paid version away for free to medical students.[4] It receives additional revenue from pharmaceutical companies.org/Presentations/2009/40-The-rise-of-the-e-patient. Tom Ferguson. Among the software functions is checking for drug interactions.org/).about.com/ articles/fr039905.com/Data/ empowered-e-patient-infographic) summary of data focusing on e-patients developed by the Path of the Blue Eye Project.org/PPF/r/222/report_display.000 doctors in the United States) in 2006.[3] The company markets both free and paid versions. mostly for health care providers.fergusonreport.htm). Lee Rainie from the Pew Internet and American Life Project (http://www.aspx).Mary Shomons response (http://thyroid.com/b/2007/11/13/ time-magazines-dr-scott-haig-proves-that-patients-need-to-be-googlers.[5] As of 2006 the company was also active in the United Kingdom.pewinternet.html) .pdf) Booklet by the Federal Trade Commission. and diagnostic tools.org/) presentation at the Medical Library Association. Germany and Spain. journal article lookup.pewinternet. designed to provide information about drugs to doctors and other health care professionals.asp).[6] . • E-Patients Prefer eGroups to Doctors for 10 of 12 Aspects of Health Care (http://www.gov/bcp/edu/pubs/consumer/health/hea17.pathoftheblueeye. The user base was 525.[5] The company was founded in 1998.about.00. (NASDAQ: EPOC [1]) is an American company based in San Mateo. Products Epocrates is a publisher of mobile device software applications.E-Patient 95 External links • The rise of the e-patient (http://www. Inc. • Time Magazine article: "When the patient is a Googler" (http://www.[2] news feeds for product announcements and medical news. Oct 7.8599.Trisha Torreys response (http:// patients.[5] By 2010 the company said it had 1 million users worldwide.org/) • Association of Cancer Online Resources (ACOR) (http://acor.[8] and that it employed more than 250 people. 2009 • E-patients With a Disability or Chronic Disease (http://www. as well as a mobile guide to ICD-9 and Current Procedural Terminology ("CPT") diagnosis codes. a guide to health information • Infographic: The Empowered E-Patient (http://community. an educational initiative for health marketing communications professionals Epocrates Epocrates.pewinternet.time. Canada. an aggregate of e-patient online communities for knowledge-sharing about cancer. providing them reference information about drugs and diseases.htm) • Who Cares (http://www.[6] Early versions of epocrates ran on Palm devices[7] and desktop computers.com/b/2007/11/24/cnntime-dr-haigs-own-misdiagnosis.com/time/health/article/ 0.

2008). nasdaq. [9] Chris Rauber (September 19. bizjournals. Draper Fisher Jurvetson. . asp?symbol=EPOC& selected=EPOC [2] Candice Novak (May 14.[8] References [1] http:/ / quotes. . New York Times. [3] "Epocrates. [4] "Last Day to Get Epocrates Essentials for Free for Medical Students" (http:/ / www. 2008). Epocrates. "Healthcare IT company is going public after partnering with Apple" (http:/ / money.official site . [6] "Media Room" (http:/ / www.epocrates." (http:/ / www. Sprout Group and Three Arch Partners. External links • epocrates. medgadget. com/ company/ mediaroom/ ). August 31. The Race Is On to Put a Computer Into Every Physician's Hand" (http:/ / www. html?pagewanted=3). [5] Chris Rauber (August 18. com/ archives/ 2010/ 08/ epocrates_free. html). html). html). Hoovers. epocrates. bizjournals.com (http://www. html). . "Digital Doctoring. hoovers. nytimes. com/ company/ Epocrates_Inc/ rhsjjri-1. 2001). com/ 2001/ 01/ 08/ business/ digital-doctoring-the-race-is-on-to-put-a-computer-into-every-physician-s-hand. 2006). [7] Milt Freudenheim (January 8. 2010. Interwest Partners.Epocrates 96 History Epocrates' early funders included Bay City Capital. Inc.[5] Public offering After a 2008 public offering was put on hold.com) . . San Francisco Business Times. usnews. html). com/ sanfrancisco/ stories/ 2008/ 09/ 22/ story16. html). com/ sanfrancisco/ stories/ 2010/ 07/ 12/ daily88. com/ sanfrancisco/ stories/ 2006/ 08/ 21/ story11. 2010. San Francisco Business Times. . "Epocrates’ IPO on hold" (http:/ / www. .[9] Epocrates filed a registration statement again in July 2010 to raise $75 million. . com/ asp/ SummaryQuote. US News. bizjournals. "Epocrates putting drug info into docs' pockets" (http:/ / www. . July 16. com/ money/ articles/ 2008/ 05/ 14/ ipo-watch-epocrates. San Francisco Business Times. [8] "Epocrates files to raise up to $75M in IPO" (http:/ / www. Medgadget.

2002 Jan. 2003. UEMS).. EAHP). thereby also identifying topics requiring particular attention and further developments at European level. • eHealth is a tool to ensure information. we enable our members to voice their views throughout the eHealth ecosystem.. choice and empowerment. Pharmacists (PGEU. 2003.96:151-6 • Paving the way to sustainable healthcare: telemedicine takes centre stage [1] • EHTEL Telemedicine FAQ [2] .96:143-8. Source • Dierks C. EuroRec). We also facilitate the sharing of experience with colleagues and representatives across Europe and beyond. Stud Health Technol Inform. Physicians (CPME. Vision EHTEL’s Vision • eHealth is a cooperative process intensifying and changing the interactions of all stakeholders in health and social care for the purpose of improving Continuity of Care and Patient Safety. European Patients’ Forum). patient and citizens (AGE Platform. as requested by European consumers and patients • eHealth must comprise multiple communication channels for ensuring both equal access to services and their ubiquity Mission EHTEL: The European eHealth Multidisciplinary Stakeholder Platform Through our growing membership of currently 60 organisations.. The multitude of backgrounds and interests of these stakeholders enable EHTEL. eHealth for Europe. • Range P. which provides a platform to all European eHealth stakeholders to exchange information on eHealth. as a neutral forum. Nurses (EFN). we take an holistic view of eHealth. Martin Denz of the Swiss Society for Telemedicine and eHealth is the current President of EHTEL. health insurers (AIM). Legal and social implications of health telematics in the EU.European Health Telematics Association 97 European Health Telematics Association The European Health Telematics Association (EHTEL) is a European non-profit organization. as well as professional associations dedicated to quality and certification to care processes and eHealth services (ESQH. Video communication visions. to draw a more complete picture of the benefits and challenges of the deployment of ICT in the fields of health and social care. At EHTEL.56(1):30-1 • Richardson R. Health Estate. As such we collaborate closely with European associations representing Hospitals (HOPE and EHMA). Stud Health Technol Inform. History EHTEL was founded in 1999 and the organization represents about 100 organisations and individuals from 30 countries in and outside Europe.

Participants • • • • • • • Portugal: Portugal Telecom Belgium: RAMIT (Research in Advanced Medical Informatics and Telematics) France: CNEH (Centre National de l’Equipement Hospitalier) Ireland: IHC Centre for Health Informatics Spain: IETT Ingenieria y Prevencion de Riesgos Greece: BIOTRAST Finland: VTT Information Technology Source • EHTO [1] (Doc) • European Telematics [2] External links • European Health Telematics Observatory [3] References [1] http:/ / www. eu/ telematics/ [3] http:/ / www. europa. asp?WCI=ShowD& F=english%2Fdti82498%2Fti137. pdf [2] http:/ / www. The organization contributes to the deployment of health telematics applications and standards in Europe. kz/ UNESCO/ presentations/ HC/ Thienpont. org/ SHBlob. analyses and makes available in a user-friendly form information on developments in the field of health telematics. org/ SHBlob. ehtel. ehto. ehtel. doc [2] http:/ / cordis. asp?WCI=ShowD& F=english%2Fdti82507%2Fti135. EHTEL+ telemedicine+ FAQ+ final. EHTO works on the dissemination of results of the European Telematics Applications Programme (TAP) of the Fourth Framework Programme to the European health care sector. org/ European Health Telematics Observatory The European Health Telematics Observatory (EHTO) is a non-profit organization which collects.European Health Telematics Association 98 External links • EHTEL [3] References [1] http:/ / www. ehtel. HITE+ article. katelco. doc [3] http:/ / www. org/ .

600 patients of The Cleveland Clinic. Patent Application #20070282632 .[4] Google Health's API is based on a subset of the Continuity of Care Record. 2010 Google updated Google Health with a new look and feel.[9] Starting on May 20. 2008. and allergies. Volunteered information can include "health conditions. is free to use for consumers. the service underwent a two-month pilot test with 1. 2008 To be discontinued on January 1. however. Health currently contains no advertising. 2012."[7] Google has filed U.S. but a Wall Street Journal article says that Google "hasn't ruled [advertising] out for the future. medications. Google Health uses the information to provide the user with a merged health record. and possible interactions between drugs. allergies. 2011 Google announced it is retiring Google Health in January 1. data will be available for download through January 1.[6] Google has not revealed how it plans to make money with the service.[8] History Google Health has been under development since mid-2006. Google Health was released to the general public as a service in beta test stage. thereby merging potentially separate health records into one centralized Google Health profile. and lab results". like many other Google products.[2] The service allows Google users to volunteer their health records – either manually or by logging into their accounts at partnered health services providers – into the Google Health system. 2012 Google Health was a personal health information centralization service (sometimes known as personal health record services) by Google introduced in 2008 and announced for withdrawal in 2011. 2013. In 2008.[5] Google Health. information on conditions. Unlike other Google services. The reason of abandoning the project is the lack of widespread adoption.[11] . On September 15.Google Health 99 Google Health Google Health URL Commercial? Type of site Registration Content license Owner Launched Current status /health Yes [1] Personal health record service Required Continuity of Care Document Google May 20.[10] On June 24.[3] Once entered."Method and apparatus for serving advertisements in an electronic medical record system". conditions.

Microsoft released a tool that lets Google Health customers transfer their personal health information to a Microsoft HealthVault account.[4] According to its Terms of Service. thus. Blue Cross Blue Shield of Massachusetts. Google Health began establishing relationships with telehealth providers that will allow their users to sync the data shared during telehealth consultations with their online health records.com. they will gather a user's medical records from around the world and add them to his or her profile. Quest Diagnostics.[15] Privacy concerns Google Health is an opt-in service. argue that a personal health record service like Google Health would be impossible if it were HIPAA covered.[16] In an article covering Google Health's launch. To date.[20] On July 18. Longs Drugs.[12] Users whose health records reside with other providers may either manually enter their data or pay to have a Google Health partner perform the service.[18] Others. Google Health is not considered a "covered entity" under the Health Insurance Portability and Accountability Act of 1996. the Withings WiFi Body scale enables Google Health users to seamlessly update their weight and other data to their online profiles[14] Recently.[19] Competitors Google Health is a personal health record (PHR) service whose primary competitors in the United States are Microsoft's HealthVault.Google Health 100 Partners Google Health can currently import medical and/or drug prescription information from the following partners: Allscripts. such as those of Nathan McFeters at ZDNet. Healthgrades. CVS Caremark. Some have been very negative. for a fee. in response to demand for added convenience. the New York Times discussed privacy issues and said that "patients apparently did not shun the Google health records because of qualms that their personal health information might not be secure if held by a large technology company. and the open-source Indivo project. It does not retrieve any part of a person's medical records without his or her explicit consent and action. There are numerous other open-source and proprietary PHR systems. Drugs. 2011."[9] Others contend that Google Health may be more private than the current "paper" health record system because of reduced human interaction. RxAmerica. Medco Health Solutions. Dossia. The Beth Israel Deaconess Medical Center. including Free/Open Source Software Healthcare activist Fred Trotter. "MediConnect Global"[13] is one such partner.[21] . it does encourage users to set up profiles for other individuals. including those that compete outside the United States. partnerships have been formed with the following companies: MDLiveCare and Hello Health.[3] However. The Cleveland Clinic. HIPAA privacy laws do not apply to it. Anvita Health. and Walgreens. meaning it can only access medical information volunteered by individuals.[17] Post-launch reactions to Google's stance that it is not a covered entity have varied. Since January 2010.

org/ research): "The Indivo project has its roots in the Guardian Angel project. gov/ netacgi/ nph-Parser?Sect1=PTO2& Sect2=HITOFF& u=/ netahtml/ PTO/ search-adv. External links • Official website (http://http://www. too!" (http:/ / blogs. [11] "An update on Google Health and Google PowerMeter" (http:/ / googleblog.google. html). fredtrotter. Retrieved 2008-07-10. uspto. a collaboration between Harvard and MIT . Retrieved 2008-05-20. nytimes. html). theregister.google. google. [17] "Humanist → Google Health Can Fix U. Retrieved 2008-05-20. Google. [8] "Method and apparatus for serving advertisements in an electronic medical record system" (http:/ / appft1. google. . The Wall Street Journal. Retrieved 2008-05-20. Retrieved 2010-03-31. Retrieved 2008-07-10. com/ article/ SB121123806355705263. USPTO. com/ health http:/ / www. google. & OS=dn/ 20070282632& RS=DN/ 20070282632). . . cnet. [5] "Google Health Data API: CCR Reference" (http:/ / code. com/ 8301-10805_3-20080403-75/ microsoft-offers-transfer-tool-to-google-health-users/ ?part=rss& subj=news& tag=2547-1_3-0-20). [20] History of the Personally Controlled Health Record (http:/ / indivohealth. . Jessica E. wsj. December 6. 2011. blogspot. . [7] Vascellaro." Jul 18. google. [18] "RSnake picks on Google Health… yes. [16] "Google Health: Terms of Service" (https:/ / www. Retrieved 2008-05-20. google. Retrieved 2008-05-20. Healthcare" (http:/ / humani. ZDNet. 2007..". 2011. com/ apis/ health/ ccrg_reference. Retrieved 2008-07-11. google. . (2008-05-20). html). html& r=1& p=1& f=G& l=50& d=PG01& S1=20070282632. [12] "Google Health: Partner Profiles" (https:/ / www.com/health) • Google Health Integration (http://www. the article shows a simple timeline or pedigree of the Personally Controlled Health Record. uk/ 2010/ 01/ 29/ wiscale/ [15] "Fall update on Google Health" (http:/ / googleblog. Steve (2008-05-20). [19] "In all Fairness" (http:/ / www. html). . PGNR. html). com/ 2009/ 10/ fall-update-on-google-health. com/ health/ html/ terms.Google Health 101 References [1] [2] [3] [4] http:/ / www. . com/ health/ html/ tour/ ).html) • "Google Health Architecture: CCR Reference" (http://healthtechsynthesis. Tom.S. html). . .tag=2547-1_3-0-20). . com/ health/ html/ about/ profiles.com/intl/en-US/health/about/integconsults. com/ health/ html/ about/ index. Retrieved 2009-03-11. html?part=rss& amp. html). com/ 2008/ 05/ 20/ technology/ 20google. blogspot. "New York Times: Google Offers Personal Health Records on the Web" (http:/ / www. com/ security/ ?p=1166).com/2009/05/12/ consultant_guide_to_google_health_part_i_of_iv/). com/ 8301-30684_3-20016562-265. cnet. Retrieved 24 June 2011. [13] https:/ / www. html?_r=1 "About Google Health" (https:/ / www. [10] Krazit. com/ 2008/ 05/ 23/ in-all-fairness/ ). mediconnect. com/ 2011/ 06/ 25/ technology/ 25health. CNET.. Fred Trotter. google. "Google tweaks Google Health dashboards" (http:/ / news. "Google Health: Take a Tour" (https:/ / www. html). . . Retrieved 15 September 2010. Retrieved Jul 18. zdnet. " Microsoft offers transfer tool to Google Health users (http:/ / news.wordpress. The New York Times. [21] Jay Greene. net [14] http:/ / www. html). st/ google-health-can-fix-us-healthcare/ ). . Retrieved 2009-10-07. com/ health/ directory?url=gh. "Wall Street Journal: Google Helps Organize Medical Records" (http:/ / online. google. Google wants your medical records. com/ 2011/ 06/ update-on-google-health-and-google. Retrieved 2011-06-28. nytimes. . Retrieved 2008-05-27. [9] Lohr.com. [6] "Google Health: Frequently Asked Questions" (https:/ / www.subj=news& amp. . Retrieved 2008-05-20. co. com/ health/ html/ faq.

HON seeks to contribute to improved health care through patient empowerment and better informed health professionals. Switzerland Products Website Certification. Following this. The HONcode is [2] voluntary. In this way.Health On the Net Foundation 102 Health On the Net Foundation Health On the Net Foundation Type Industry Founded Nonprofit Healthcare September 1995 Headquarters Geneva. in the words of the program." The HON Foundation became one of the first organizations to guide both lay users and medical professionals to reliable sources of health information in cyberspace. which means that webmasters and information providers can apply for HONcode certification. reliable medical information and expertise. Authority . so that readers can know the source and purpose of the medical information presented. Trusted health search engine and education http:/ / www. healthonnet. Mission The mission of the foundation is to guide the growing community of healthcare consumers and providers on the World Wide Web to sound. org Health On the Net Foundation (HON) is a not-for-profit organization founded in 1995 under the auspices of the Geneva Ministry of Health and based in Geneva. The principles of the HONcode are: 1. Switzerland. Rather. the code only states that the site holds to the standards. The HONcode certification is a dynamic state and is extended every year according to site compliance. This came about following the gathering of 60 of the world's foremost experts on telemedicine to discuss the growing concerns over the unequal quality of online health information.information and advice given only by medical professionals with credentials of author/s. HONCode is not designed to rate the veracity of the information provided by a Web site. "promote the effective and reliable use of the new technologies for telemedicine in healthcare around the world. or a clear statement if this is not the case The HONcode Logo . It is the oldest and the most used ethical and trustworthy code for medical and health related information available on the Internet. the website is reviewed by a specialized team of health and legal professionals. Certification HON Foundation issued a code of conduct (HONcode) [1] for medical and health Web sites to address reliability and usefulness of medical information on the Internet. The unanimous conclusion of this gathering was to create a permanent body that would.

is a strong supporter of the HONcode and has made efforts to improve compliance with its rules and to expose those who abuse it. one on eye diseases and the other on general medical conditions. of authors should be available 7. directory of registered health professionals. It is used to sensitize web publishers to the need for quality information and create awareness in health professionals and so. In recent times however. well-referenced scientific information 6. Consumer protection advocate.ch [7] is an extensive database.information and help are to support. HON also provides two databases of trustworthy health information. journal articles and news through its search engines MedHunt [3]. Hence. One of these is the use of an active and dynamic logo [10] which shows its validity and reflects the site compliance in real time. indicating that consumers may mistake it as an award or interpret it as an indicator for assessed information. all medical credentials are verified through national databases of registered medical professionals. HON has developed ways to counteract the abuse of the HONcode. HONcode relies on the webmaster for honest representations about compliance with the principles.any treatment. medical centers or hospitals. calling into question the entire principle of HONcode. Transparency of sponsorship . Attribution . HON has always encouraged the internet community to demand for quality health information and the general public plays a large role in the policing of the HONcode by HON. HONcodeHunt [4] and HONselect [5]. a peer-reviewed eHealth journal. Transparency of authorship . such as credentials (medical or otherwise) as stated on websites displaying the logo. websites which are not in compliance with HONcode may still be displaying the HONcode logo. 103 Abuse of HONcode A journal article raised a number of problems with the HONcode logo. HON also has a partnership at the French governmental level. Other issues with the HONcode logo were discussed in the Journal of Medical Internet Research (JMiR).sources of funding for the site 8. as Health On the Net Foundation (HON) has no means of obligating the offending webmaster to remove the logo. HON offers all users the trustworthy web sites and support groups. Complementarity . when it was accredited in 2007 by the French National Authority (HAS) [8] to be the official certifying body for all French health websites.Health On the Net Foundation 2. including suggested improvements and his criticisms . patient-healthcare professional relationships which is the desired means of contact 3. or that copyright or confidentiality is not violated by webmasters. help guide their patients to trustworthy health information. Confidentiality . In addition. medical images and terminology.[9] Websites which are not in compliance with HONcode can continue to display the logo.contact information. Honesty in advertising and editorial policy .how the site treats personal and non-personal information of readers 4. preferably including email addresses. Justifiability . covering 72 countries and has been translated into 34 languages.ch [6] is a database of reliable health information on all eye diseases and is accessible by those with poor or no vision through its variability of letter size and audio version. Other problems with the application of the HONcode principles are that HON does not have a means of verifying many of the principles. not replace. product or service must be supported by balanced. mainly directed towards the French speaking public of Switzerland and neighbouring France and provides reliable health information. Health On the Net Foundation was granted on 23 July 2002 NGO status by the Economic and Social Council of the United Nations. as HONcode only indicates that sites are "undergoing annual review". Clicking on that logo (for verification) will not indicate that the site is out of compliance. Provisu.details about advertising on the site and clear distinction between advertised and editorial material Currently the HONcode is used by over 5. Stephen Barrett.references to source of information (URL if available online)and dates when pages was last updated 5.000 certified websites. medical associations and federal organizations. extensive coverage of his views on the subject were provided. In a whole "Special to The Washington Post". Santeromande.

has-sante. washingtonpost.ch/) Presentation of HONcode on French National Authority website (http://www. "Setting the public agenda for online health search: a white paper and action agenda". html) Health On the Net Foundation. PMC 1550592. J. please alert Quackwatch. fr/ portail/ display.2.hon. hon. (http:/ / www. hon.provisu. doi:10.hon. hon. com/ wp-dyn/ articles/ A25556-2004Apr19. ch/ HONcode/ Conduct. Page HE01 [12] "How to be a vigilant user" (http:/ / www. Of course.[11] In cases of suspected fraudulent websites. [3] http:/ / www. ch/ HONselect/ [6] http:/ / www.2196/jmir. ch/ MedHunt/ [4] http:/ / www. 2004. santeromande. provisu.ch/) Santeromande website (http://www.html) MedHunt (http://www. Attacking Their HONor: Some Dispute Value of Logo Used to Verify Accuracy. org/ 2000/ 2/ e13/ ) [10] http:/ / www. jsp?id=c_453883 [9] JMIR article (http:/ / www.Health On the Net Foundation of many named abusers. hon. html [11] Christopher Wanjek. D'Andrea G.ch/HONcode/policy.hon.org/2000/2/e13/) Provisu website (http://www. ch/ [7] http:/ / www. PMID 15249267. Integrity Of Health Web Site Contents. hon.santeromande. accessed 8 April 2009.ch/MedHunt/) HONcodeHunt (http://www.6. ch/ [8] http:/ / www.ch/HONselect/) . html [2] Greenberg L.ch/HONcode/Hunt/) HONselect (http://www. HON advises internet users to alert Quackwatch or HON itself: "If you come across a healthcare Web site that you believe is either possibly or blatantly fraudulent and does NOT display the HONcode. Lorence D (June 2004).hon. has-sante. or of abuse of the HONcode. 6 (2): e18. External links • • • • • • • • • Health On the Net website (http://www."[12] 104 References [1] http:/ / www. jsp?id=c_453883) Policing the HONcode (http://www. April 20. ch/ HONcode/ policy. ch/ HONcode/ Hunt/ [5] http:/ / www. hon. html) Special to The Washington Post. Internet Res.ch) JMIR article (http://www. jmir.jmir. ch/ HONcode/ audience_t. Med. if such a site DOES display the HONcode.hon.e18. alert us immediately.fr/portail/display.

a Discovery Channel show hosted by their late spokesperson. Billy Mays. Florida Harold Shatz Sam Shatz Steve Tucker http:/ / www. Recently. htm). html). the iCan Group's insurance brokerage firm. . com/ releases/ 2009/ 06/ prweb2487594. TheiCanGroup. allowing for the extension of telemedical benefits to members of its group health insurance programs. com/ Website The iCan Group is a family of companies in the fields of health insurance.[2] References [1] "Doctors Make Virtual House Calls" (http:/ / www. [2] "iCan Benefit Group to be Featured on Discovery Channel's Pitchmen" (http:/ / www. iCan Benefit. The functionality of the real-time video consultations offered [1] through the telehealth portal was recently demonstrated for a local ABC affiliate. the group launched an on-demand telehealth start-up called InteractiveMD. marketing. as well as general consumers who wish to sign up exclusively for telehealth benefits. com/ health/ 23078386/ detail. Retrieved 2010-04-22.iCan Group 105 iCan Group iCan Group Type Industry Headquarters Key people Private Health Insurance Boca Raton. and medical bill advocacy. justnews. was featured on Pitchmen. Retrieved 2009-10-13. telehealth. prweb. In June 2009. . .

2007. html) [3] http:/ / www. imedicor. aspx) [2] Medgadget. lumped together with a social network for clinicians. November 20. in extreme cases. Advance for Health Information Professionals [1] .site/news/Stock News/889796/?hcode=relatednews) . Inc. 2007. advanceweb. 2007 . the influential Internet [2] Journal of Emerging Medical Technologies. imprisonment. community and referrals.com/. (http:/ / health-information.Review of iMedicor Portal for Medical Professionals (http:/ / medgadget. Inc.iMedicor 106 iMedicor iMedicor URL http:/ / www. External links • iMedicor [3] • Vemics [4] References [1] Advance for Health Information Professionals." Some of iMedicor's partner associations include the Association of Black Cardiologists (ABC). com/ Article/ The-PHR-Revolution. Tuesday. HIPAA. The portal's proprietary HIPAA-compliant technology and ability to enable health providers to exchange medical record data. 2007. and the Hypertrophic Cardiomyopathy Association (HCA). and Highway Hypodermics among others and received positive review by the Internet journal Medgadget. vemics. which stands for the American Health Insurance Portability and Accountability Act of 1996. Created by Vemics. December 06. It has been discussed in such journals as Healthcare Informatics. the American Society for Hypertension (ASH). Launched October. com/ • iMedicor Announces Agreement With eRx Network . documentation and images distinguish it from chat-room-style portals for the medical community. com/ archives/ 2007/ 11/ imedicor. Medgadget also stated. 2007. com/ Type of site Social network service Owner Vemics. iMedicor has a proprietary HIPAA-compliant interface. the iMedicor portal was given a positive review by Medgadget. The launch of iMedicor’s portal coincides with the entrance of Microsoft's Healthvault and Google Health into the personal health record space. Virtual Medical Worlds. On November 20. is a set of strict rules to be followed by doctors. hospitals and other health care providers concerning the handling and privacy protection of vital patient medical data.tradingmarkets. Violations can result in serious fines or. which went live on October 10. "The service behaves more like a typical email provider and a file sharing site. Posted: 09:00 AM (http:// www. 2007 The iMedicor Web portal. iMedicor reached its 32. imedicor. is online personal health data exchange and secure messaging portal for physician collaboration. com/ [4] http:/ / www.Thursday.000th physician registration on December 12. The journal said that iMedicor is "strikingly different" from other medical networks such as iMedExchange and Sermo.

. The integration is the first of its kind on the Google platform. 09:06 AM Eastern Time . google.jsp?ndmViewId=news_view&newsId=20080114005818&newsLang=en) 107 MDLiveCare MDLiveCare Type Industry Private Telehealth Headquarters Sunrise. com/ 2009/ 10/ fall-update-on-google-health. com). 2008.businesswire. . Retrieved 2009-10-09. mdlivecare. html). Florida Key people Website Randy Parker https:/ / www.[2] References [1] "Google Health Directory of Services" (https:/ / www.[1] Recently. marking the introduction of telehealth services to Google Health's directory of online services. phone. [2] "Fall Update on Google Health" (http:/ / googleblog. and secure email to board certified doctors and licensed therapists. the company partnered with Google Health to allow their users to sync the data shared during telehealth consultations with their online health records.iMedicor • January 14. Retrieved 2009-10-09.com/portal/site/ google/index.American Society of Hypertension Partners with iMedicor . blogspot. MDLiveCare. . com/ MDLiveCare is an on-demand telehealth company that provides patients with remote access via video. com/ health/ directory?url=ghealth.Online Medical Portal Tapped to Help Expand Hypertension Initiative (http://www.

recently received funding from the private equity unit of HDFC which has bought around 12 per cent stake in the company for Rs 2. Both the patient and the doctor are notified by SMS or email when the same has been done.[1] History MediAngels. Arbinder Singal http:/ / www.Mediangels 108 Mediangels MediAngels Type Industry Founded Private Healthcare Mumbai. Arbinder Singal are the co-founders. 2011 Mumbai. urine tests and other diagnostic tests done from the location of their choice. com MediAngels is a India-based multi-speciality 'e-hospital' service provider.5 crore (approximately USD 5. managed by Angels Health Private Limited. India January 26.[7] Members can upload scanned reports from their existing physicians and other investigation reports. customers may submit a report to a particular specialty or to the whole panel as such.[5] According to the company website this online venture MediAngels was positioned it as an e-hospital to provide information and services for the prevention. a private medical consulting firm. typically patients seeking second opinions or those looking for advice from experts not available locally.[2] [3] [4] Service Line and Concept Angels Health's website mediangels. in such a scenario the site administrators (a trained doctor 24/7) forwards the consult to an appropriate consultant.000).[9] . India Area served Key people Website Worldwide Debraj Shome. Upon making an appointment. launched in 2011. Second opinions will be provided by the expert chosen.com provides online consultation from a large pool of medical experts and specialty doctors across the globe to users. Dr Debraj Shome and Dr. These reports are automatically made available on the users´ MediAngels profile. Mediangels allows its subscribers to show medical records and documents on the website by using services like telephonic and video enabled consultations. This allows the physician to evaluate the investigation reports.[6] Once registered. the information is processed and translated into a form in which the end-user can understand.00.[8] Consumers can choose to get blood tests. diagnosis and treatment of medical conditions. India Headquarters Number of locations Mumbai. mediangels. the lab personnel come and collect samples from the patient´s residence and deliver reports back as well. Once the specialist gives his opinion.

000 laboratories across India for on call diagnostic services. vccircle. com/ article/ SB10001424052702304657804576402383145592202. wsj. Dr. html) [14] MediAngels Oration (http:/ / programsinmedicine. html) [8] Moneylife-MediAngels (http:/ / www. com/ india/ news/ mediangels-has-something-more-to-offer/ 441367) [11] MediAngels Panelists (http:/ / www. com/ news/ special-videos/ young-turks-mediangelgetting-it-righte-healthcare_556509.[11] MediAngels Centres MediAngels currently has three offices in Mumbai – one for the technology team.[13] MediAngels Oration Programme The first MediAngels Oration was accredited by the Maharashtra Medical Council (the state governmental body for accrediting doctors) as a Continuing Medical Education (CME) program of substance and was awarded 1 CME point for attendance. economictimes. [Vadorara] and [Bhopal]. moneylife.[12] The portal has also tied up with 21. com/ news/ HDFC-acquires-12--stake-in-MediAngels/ 814148/ Financial) [5] Online Medical Services Provider Raises Money-Wall Street Journal (http:/ / online. html?mod=wsj_india_main) [6] Mediangels aims at revolutionizing the current healthcare pariadigm (http:/ / techcircle. com/ news/ special-videos/ young-turks-mediangelgetting-it-righte-healthcare_556509. com/ 500/ mediangels-aims-at-revolutionizing-the-current-healthcare-paradigm) [13] Young Turks: MediAngels (http:/ / www. P Raghuram in April 2011 at Mumbai[14] Future plans MediAngels is currently in discussion with the state governments of [Maharashtra] and [Madhya Pradesh] to offer solutions to rural areas. businesswireindia. com/ mediangels-kicks-off-its-oration-programme-first-oration-on-breast/ ) . One of the offices also doubles up as MediAngels operation centre. alootechie.[10] MediAngels panel recruitment is by invitation only. marketpressrelease. com/ eInvestigation-Pathology-Tests-Blood-Test-Urine-Test--MediAngels-1309349763. com/ news/ online-medical-service-mediangels-receives-rs-25-crore-funding-hdfc’s-pe-arm) [3] HDFC PE Arm Picks up Stake in Mediangels. The oration was delivered by breast surgeon. another for the sales & distribution team and the third one for the digital sales and marketing team. mediangels. business-standard.Mediangels 109 Specialist base MediAngels as of now has a team of 300 doctors from over 85 super-specialty hospitals across 25 countries. financialexpress. aspx) [12] Mediangels aims at revolutionizing the current healthcare pariadigm (http:/ / techcircle. asp?b2mid=27095) [2] Online medical service MediAngels receives Rs 2. com/ 500/ mediangels-aims-at-revolutionizing-the-current-healthcare-paradigm) [7] Young Turks: MediAngels (http:/ / www. com/ Pages/ HomeDoctorsPanel. com/ 2011-06-03/ news/ 29617360_1_e-commerce-private-equity-firm-venture-intelligence) [4] Express (http:/ / www. Patients have the option to choose from amongst the panel of specialists available for each medical specialty and information including the resume as well as their degree and fellowship certificates of each specialist will be available on the website. com/ PressRelease. html) [9] eIvnestigation from MediAngels (http:/ / www. html) [10] MediAngels has something more to offer (http:/ / www. moneycontrol.com (http:/ / articles.5 crore series A from HDFC’s PE arm (http:/ / www. in/ article/ we-aim-to-become-the-webmd-of-medicine/ 17757. moneycontrol. indiatimes. References [1] Businesswire India (http:/ / www. Three physical centres at [Indore]. vccircle.

remained at Washington Hospital Center as director of the emergency department.Microsoft Amalga 110 Microsoft Amalga Microsoft Amalga Original author(s) Washington Hospital Center Developer(s) Operating system Website Microsoft Health Solutions Group Windows Server Amalga's product page [1] on Microsoft's website Microsoft Amalga Unified Intelligence System (formerly known as Azyxxi) is a unified health enterprise platform designed to retrieve and display patient information from many sources. D. .[5] Since then the Amalga team has grown to include 115 members. updated composite portrait of the patient’s healthcare history. [4] The Cleveland Clinic recently installed the system in a pilot project as an imaging and data integration system. and 40 members of the development team at Washington Hospital Center. CT Scans.000 data elements associated with a given patient. Since then it has also been used by the District of Columbia Department of Health for management of such mass-casualty incidents as a bioterrorism attack and in a variety of other settings in Arizona. and views of relevant X-rays. [3] A physician using Amalga can obtain within seconds a patient's past and present hospital records. dictated reports of surgery. lab studies. medication and allergy lists. Maryland. New York Presbyterian Hospital. who helped design the system. electrocardiograms. Amalga has the ability to manage more than 40 terabytes of data and provide real-time access to more than 12. It has since been adopted at a number of leading hospitals and health systems across America including St Joseph Health System. principal designer of the software. and in 2006 it was acquired by the Microsoft Health Solutions Group. It was developed by doctors and researchers at the Washington Hospital Center emergency department in 1996. and other clips and images. Georgetown University Hospital and five other hospitals in the MedStar [2] Health group. The system was first implemented by the Washington Hospital Center emergency department to reduce average waiting times. as well as patient demographics and contact information. Amalga can be used to tie together many unrelated medical systems using a wide variety of data types in order to provide an immediate.[4] Besides clinical data. all organized into one customized format to highlight the most critical information for that user. Amalga currently runs on Microsoft Windows Server operating system and uses SQL Server 2008 as the data store. a nonprofit network in the Baltimore-Washington. including scanned documents. X-rays. At the time of acquisition. Dr. Craig F.C. area. [3] All of Amalga’s components are integrated using middleware software that allows the creation of standard approaches and tools to interface with the many software and hardware systems found in hospitals. as part of a plan to enter the fast-growing market for health care information technology. Mark Smith. In clinical use since 1996. Feied. MRI scans and other medical imaging procedures. Microsoft hired Dr. lab results. Amalga is also designed to collect financial and operational data for hospital administrators. and Virginia.

. .com/amalga/products/microsoftamalga/default. html). The Washington Post. [4] Greene. Steve (2006-07-27). mspx [2] Pearlstein. Greg (2007-03-28). Retrieved 2006-07-27. "A deal they just couldn't refuse" (http:/ / www. com/ apps/ pbcs. aspx?ArticleID=35771). "Innovation Comes From Within" (http:/ / www. KMWorld.microsoft. "Microsoft to Offer Software for Health Care Industry" (http:/ / www. kmworld. Modern Healthcare Online. html?th& emc=th). "The world of super integration" (http:/ / www. [3] Pepus. [5] Lohr. com/ amalga/ products/ microsoftamalga/ default. Jay (2006-10-24). . Steven (2005-03-04). washingtonpost. . microsoft. Retrieved 2006-08-08. Retrieved 2006-07-27. Retrieved 2006-08-08. dll/ article?Date=20061024& Category=FREE& ArtNo=61024003& SectionCat=newsletter02& Template=). com/ 2006/ 07/ 27/ technology/ 27soft.mspx) . modernhealthcare.Microsoft Amalga 111 References [1] http:/ / www. nytimes. com/ wp-dyn/ articles/ A5780-2005Mar3. External links • Microsoft Amalga Home Page (http://www. The New York Times. com/ Articles/ ReadArticle.

An individual can also share part (some data types) or whole of their health record with another interested individual such as a doctor. etc.healthvault. Access to a record is through a HealthVault account. and those data types are the only ones the application can use.[2] [3] [4] [5] Started in October 2007. . When an individual first uses a HealthVault application. Components A HealthVault record [8] stores an individual's health information. Access to the account is through Windows Live ID or a limited set of OpenID providers. 2007 Type Website Medical database http:/ / healthvault. more typically. the website is accessible at www. a spouse. a parent. through an application that talks to the HealthVault platform. Authorization An individual interacts with their HealthVault record through the HealthVault site. or. com [1] Microsoft HealthVault is a web-based platform from Microsoft to store and maintain health and fitness information. so that a mother may manage records for each of her children or a son may have access to his father's record to help the father deal with medical issues.com [1] and addresses both individuals [6] and healthcare professionals [7]. they are asked to authorize the application to access a specific set of data types. which may be authorized to access records for multiple individuals.Microsoft HealthVault 112 Microsoft HealthVault Microsoft HealthVault Microsoft HealthVault website Developer(s) Microsoft Preview release Beta / October 4.

[5] Microsoft Launches Health Records Site (http:/ / www. com/ article2/ 0. com/ 20071004/ microsoft-healthvault/ ). html [9] http:/ / cln-online. Retrieved 2008-02-04. . wgtmsfthealth1004/ BNStory/ Technology/ home& ord=18107047& brand=theglobeandmail& force_login=true).00. healthvault. html [7] http:/ / www. foxnews.[10] [11] Interoperability HealthVault supports a number of exchange formats including industry standards such as the Continuity of Care Document and the Continuity of Care Record.4670. healthvault. healthvault. healthvault. cfm?subjectid=348945& story_id=9916512). blood pressure monitors and the Withings wifi bodyscale[9] ) into an individual's HealthVault record. html [16] http:/ / www. theglobeandmail. Retrieved 2009-02-09. 20071004. com/ personal/ websites. com/ research/ articlesBySubject/ displaystory. html) [6] http:/ / www. . Competitors HealthVault's primary competitors are Google Health. This is released by PassportMD • ActivePHR [14]. [3] "Microsoft launches medical records site" (http:/ / www. .Microsoft HealthVault 113 Devices HealthVault Connection Center allows health and fitness data to be transferred from devices (such as heart rate watches.00. com/ personal/ index. Retrieved 2008-02-04. "HealthVault Connection Center" (http:/ / www. com/ websites/ PassportMD-PassportMD. This is released by ActiveHealth References [1] http:/ / www. globeandmail. com/ wires/ 2007Oct04/ 0.com. . aspx). This is released by HealthUnity • PassportMD [16]. Dossia and World Medical Card. pcmag.com. economist. recordsforliving. com/ WhatIsConnectionCenter. PCMAG. com/ forums/ thread/ 1302.MicrosoftHealthVault. healthvault. • HealthUnity PHR Gateway [15]. htm). theglobeandmail. HealthVault Web Applications A comprehensive list of web applications is available at the HealthVault website [13]. . com/ industry/ index. It can also be used to find and download drivers for medical devices. Retrieved 2007-10-08. com [2] "Microsoft Launches 'HealthVault' Records-Storage Site" (http:/ / www. economist. php?option=com_content& view=article& id=666:microsoftscales& catid=49:wellness& Itemid=105 [11] [12] [13] [14] [10] "Dr. html . [4] "The vault is open" (http:/ / www. asp). com/ servlet/ Page/ document/ v5/ content/ subscribe?user_URL=http:/ / www. html?type=application http:/ / www.2191920. istartedsomething. Retrieved 2008-02-06. healthvault. http:/ / www. healthvault. healthvault. html [8] http:/ / www. org/ index. Retrieved 2007-10-08. "PHR integration" (http:/ / community. Some of the notable ones are listed below.1895. com/ Personal/ index.com. com/ servlet/ story/ RTGAM. com/ websites/ activehealth-activephr. com/ websites/ healthunity-phrgateway. healthvault. . html [15] http:/ / www. Microsoft is now ready to see you" (http:/ / www. Support for industry standards makes it possible to integrate[12] with many personal health record solutions.

com/) • Microsoft HealthVault Developer Center (http://msdn.healthvault.com/HealthVault) • HealthVault Review: A Click away from Your Health Information (http://www.microsoft.edocscan.com/ microsoft-healthvault-phr) .Microsoft HealthVault 114 External links • Microsoft HealthVault (http://www.

web and print resources.ca" and "HealthLinkBC Files". HealthLink BC. and the HealthLinkBC Files.[2] [3] HealthLink BC has two dedicated phone numbers 8-1-1 and 7-1-1 for hearing impaired callers. On November 21. Dietitian. internet. and print resources. which is available in pharmacies and by mail. The program provides telephone triage and health information through integrated telephone. the BC HealthGuide.HealthLinkBC 115 HealthLinkBC Formation Type Purpose/focus Region served Official languages Key people 2001 (2008) Government-Funded To provide health information and advice to British Columbians British Columbia.[5] HealthLink BC operates within BC's Ministry of Health Services. a medically-approved handbook delivered to all BC households. staffed by registered nurses 24/7/365 who provide confidential health information and triage services over the telephone and a website. a printed handbook that contains information on common health topics. its 8-1-1 telephone number. Canada through combined telephone. the Executive Council of British Columbia launched a newly branded organization. along with its 8-1-1 number. dietitian or pharmacist about health related concerns or find health resources in their area.[6] This brought together all of the organization’s various services under a single brand and telephone number. which provides non-emergency health information to the residents of British Columbia. Pharmacist and Navigation Services. History The organization was launched in 2001 as the BC HealthGuide Program by BC's Ministry of Health Services. called BC HealthGuide Online. a toll-free telephone line.ca [1] HealthLink BC is a government-funded telehealth service launched in 2001. These services include Nursing. Chief Operating Officer Parent organization Ministry of Health Services Website HealthLinkBC. Canada English with an additional option of 130 languages Bob Bell. At its launch. 2008.[4] Health service representatives assist callers with speaking to a registered nurse. . which provided a knowledge base of health information and provided links to other credible consumer health information sources and web sites. Scope of service HealthLink BC provides health information services to all regions of British Columbia via its website which contains BC-specific health information and a publicly available database of government-funded and not-for-profit health services and resources in British Columbia. a series of one-page health information sheets. "HealthLinkBC. it consisted of three main components: the BC HealthGuide.

and. Spanish.5 pm to assist callers with dietary and nutrition questions over the telephone. This has been specifically developed for licensed general medical practitioners and their medical office assistants. and is offered to other BC health service delivery organizations who also use the phone to provide access to their service. Licensed pharmacists are available every day between 5 pm – 9 am to provide confidential information and advice on prescription and over-the-counter medications over the telephone. provides a secure web-based directory of mental health and addictions resources in BC. Registered dietitians are available Monday to Thursday 8 am – 8 pm and Friday 8 am . Professional support services 'Community Healthcare and Resource Directory' (CHARD). (This service was developed in response to BC’s 2009 legislation restricting the use of trans fats in the province’s food service establishments)[7] 'BC HealthGuide' is a 400+ page printed medical handbook available free-of-charge to residents of British Columbia. illness prevention. 'HealthLinkBC Files' are a series of health information sheets with BC-specific information on common health topics. Yukon Territory – when a caller accesses 8-1-1 from the Yukon. health resource referral information and transfer calls to HealthLink BC’s professionals over the telephone 24 hours a day. FHA Primary Health Care Office – after-hours. A number of HealthLinkBC Files have been translated into other languages including: French. callers to the Hotline are automatically transferred to 8-1-1. callers are automatically transferred to 8-1-1.ca and 8-1-1 and have been provided with a Yukon version of the HealthGuide handbook in English and French. Punjabi. The BC HealthGuide is available in English.[10] 'Call Transfer to 8-1-1’ provides access to 8-1-1 (using automated call transfer).[9] Yukon residents have access to HealthLinkBC. Registered nurses are available 24 hours a day to provide general and specific health information and advice including palliative care support over the telephone. French. 365 days a year. HealthLink BC also works with the Government of the Yukon to provide services to residents of the Yukon. ‘Customized 8-1-1’ refers to identified callers or groups that are provided customized services by utilizing 8-1-1 resources.HealthLinkBC 116 Public services Health service representatives provide general health information. they receive a customised service that reflects the resources and services available to their locale. and. Chinese. Vietnamese and Persian. Examples include: FHA Hospice Palliative Care – after-hours.[12] . clients call 8-1-1 and receive a customised service that supplements their ongoing palliative care program. home treatment and when to see a health professional.[8] It provides information on common health topics such as how to recognize and cope with common health issues. Chinese and Punjabi.[11] BC Ambulance Service – when a call to 9-1-1 does not warrant the dispatch of an ambulance. Examples include: VCHA Newborn Hotline – after-hours. The 'Trans Fat Information Line' is a specialized service which provides food industry workers with education and coaching on food handling practices to restrict trans fat. callers are automatically transferred to 8-1-1.

BC HealthGuide Program Evaluation Final Report. ca/ hls/ media_gallery/ events/ 2008/ nov/ 8_1_1_service_makes_accessing_health_advice_easier_2008_11_27_55847_M.gov. Find.ca. Retrieved 2010-07-29.ca/) . Hss. aspx?d=SV000412).8-1-1 SERVICE MAKES ACCESSING HEALTH ADVICE EASIER" (http:/ / www. 2009-09-30. Telecare and Self Help Collaborative" (http:/ / www.bc.ca. pdf) (PDF). html). [3] MacLeod. HealthLinkBC.org. Retrieved 2011-02-03. healthlinkbc.ca. ykhealthguide. Retrieved 2010-07-29. . ccl-cca. hss. bc. informaworld.811 . Gov. [6] "Ministry of Healthy Living and Sport . [8] "Changing immigrants’ attitudes towards intentions to use the BC HealthGuide Program: Culturally specific video messaging for health promotion" (http:/ / www.healthlinkbc. ca/ [2] "HealthLink BC Home Page" (http:/ / www. . bc.yk.1080/15398280902897046. Restricttransfat. ca/ search. Healthlinkbc. gov. doi:10. Donna (2009). [5] "-Quality Improvement of Literacy. . html). 2008-11-21. gov. Retrieved 2011-02-03. "Healthlink BC: British Columbians Have Trusted Health Information at Their Fingertips" (http:/ / www. org/ ). 2007. .ca (http://www. 1080/ 15398280902897046). Ykhealthguide. Retrieved 2010-07-25. Bcmj. 2010-06-11. Retrieved 2010-07-29. Retrieved 2011-02-03.gov. . Retrieved 2010-07-08. 2009-01-15. yk. External links • Official website HealthLinkBC.Government of Yukon" (http:/ / www. [12] "Yukon HealthLine . ca/ bc_trans_fat_regulation. Health. [11] "HealthLink BC : Find Services and Resources" (http:/ / find. ca/ NR/ rdonlyres/ EFF50CAA-19E6-42AB-9AF8-023CCE050000/ 0/ JARLNo1Art317OCT07.healthlinkbc. HealthLinkBC. . restricttransfat. Journal of Applied Research on Learning. ca/ 811. [4] "Toll Free Health Information Lines" (http:/ / www. . org/ gpsc/ gpsc-and-healthlink-bc-pilot-mental-health-and-addiction-resource-directory).HealthLinkBC 117 References [1] http:/ / www.ca.ca. pdf).bc. [9] "Yukon HealthGuide" (http:/ / www. [7] "Restrict Trans Fat | BC Regulation for Food Service Establishments" (http:/ / www.Health and Social Services.ca. ca). . php). 2009-07-03. ca/ cpa/ 1-800. Journal of Consumer Health On the Internet 13 (2): 173–179. com/ smpp/ content~db=all?content=10. . [10] "GPSC and HealthLink BC pilot mental health and addiction resource directory | BC Medical Journal" (http:/ / www. gov. healthlinkbc. 2006. Retrieved 2010-07-25. Retrieved 2010-07-08. Retrieved 2010-07-29. health. ca/ finalreport.org. bcmj. . . php).

Lindsay (September 10 2007). The company plan to offer its service elsewhere in the New York area [5] Partnerships Myca is a gold member of the Wireless Life Science Alliance. Jessica (15 August 2008). MyFoodPhone is a small cell-phone application that provides customers with a full nutrition journal and access to a nutrition professional. [4] Hensley. Findlay. New York.Myca 118 Myca Myca is a software development company specializing in healthcare. B1. Business 2.[1] [2] MyFoodPhone was rebranded as Myca Nutrition in 2007. Retrieved 2008-08-13. NY. Myca developed a practice management system that allows physicians to perform remote consultations by using videoconferencing. Rachel (27 June 2006).0. "Camera Phones Help Fight Bulge" (http:/ / www.com/2007/09/10/technology/Medicine_2. Retrieved 2008-08-13. mobile and secure email. [3] Rowland. com/ health/ 2008/ 06/ 09/ technodoc-jay-parkinson-says-hello-to-franchising/ ). Brooklyn. instant messaging. Retrieved 2008-08-18. "Wireless wellness: If you've got a phone. With this platform patients can schedule either home. [2] Metz. Le Soleil (Québec). com/ wp-dyn/ content/ article/ 2005/ 06/ 06/ AR2005060601686. html). • Dion-Viens. Consumers can now take cell phone pictures of their meals for nutritional consultations" (http://money. "Health Blog : Technodoc Jay Parkinson Says Hello to Franchising" (http:/ / blogs.[4] Doctors are highly implicated in the Hello Health product definition as well. hosted in San Diego. The Myca platform provides a full billing back-end service that allows doctors to be reimbursed for their remote visits. html). com/ science/ discoveries/ news/ 2006/ 06/ 71102).biz2/ index. clinic or online appointments with a doctor. Scott (9 June 2008). 2008-06-16. MD. .htm). .cyberpresse. phone. • Blakely.0. Dr. Retrieved 2008-08-13.0 Magazine. Rob (7 June 2005). Retrieved 2008-08-13. brooklynpaper. are the first Hello Health doctors and will operate the Williamsburg clinic.cnn. California. . p. Devlyn Corrigan D. . Myca launched its first Hello Health clinic in July 2008 in Williamsburg. Jay Parkinson. Wired (Wired News). you've got a diagnostician".O. The Washington Post. The Wall Street Journal. wired. . com/ stories/ 31/ 32/ 31_32_jf_hello_health. Activities Started in 2007. washingtonpost. "Consultation médicale par Internet: Myca persiste et signe" (http://www. "Medicine goes 2. References [1] Pegoraro. Customers take a picture of their meals and send them via MyFoodPhone to be analyzed by a personal nutrition coach or advisor. MD. It is headquartered in Quebec City. The Brooklyn paper. History Myca was founded in 2002 by Nathanial B. MPH and Dr. Sean Khozin. The Myca Platform is commercialized in the United States under the Hello Health trademark. [5] Firger. Daphnée (Le dimanche 03 février 2008). QC. MPH.ca/article/20080203/CPSOLEIL/80202095/-1/CPSOLEIL) (in French). "The doctor is in — and hip!" (http:/ / www. Canada with offices in New York City. The Washington Times. Kara.. "The Camera Phone Diet" (http:/ / www. wsj. The company's first product was a mobile nutrition platform called MyFoodPhone. founded by Qualcomm Inc.[3] Dr. Hello Health operates [3] under the software as a service business model so patients sign up online to communicate with their physician.

• Samson.wirelesslifesciences. Le Devoir. Jay Parkinson.myca.santesansfile.com) Wireless Life Science Alliance (http://www.nhs. External links • http://www. accueil (http://www. MPH (http://www. Marie-Andrée (mercredi 06 février 2008).com) Santé Sans File. "Santé sans file: consulter le docteur par Internet" (http:// www.com) Dr. 119 External links • • • • • • • Myca Home (http://www.uk/systemsandservices/pacs .org/) NHS Picture Archiving and Communications System The NHS Picture Archiving and Communications System is a medical picture archiving and communications system run by NHS Connecting for Health for the English National Health Service.connectingforhealth.jayparkinsonmd. Retrieved 2008-08-13.com/2008/ 02/06/174902.com) Myca Nutrition Home (http://www.mycanutrition.ledevoir.Myca • Chouinard.html) (in French).com) MyFoodPhone Home (http://www.cyberpresse. Retrieved 2008-08-13. Le Soleil.myfoodphone.hellohealth. "Médecine Club Price" (http://www. Claudette (Le vendredi 01 février 2008).com) Hello Health (http://www. MD.ca/article/20080201/CPSOLEIL/80131196/6711/CPACTUEL03) (in French).

NORTH also connected healthcare professionals and students in the north to educational programmes. Its size and volumes have increased significantly since forming a province-wide network. NORTH was the busiest telehealth programme in Canada. NORTH Network As of April 1. At the time of its integration into the Ontario Telemedicine Network. Mandate and Operations NORTH provided patients in rural and under-serviced communities access to specialized medical care using videoconferencing and other tele-diagnostic equipment.100 clinical consultations each month and an additional 500 educational and administrative events. which linked more than 226 sites in more than 120 communities across Ontario. 2006 NORTH Network merged with Ontario's two other regional telehealth service providers (Videocare (Southwestern Ontario) and Careconnect (Eastern Ontario) to form the Ontario Telemedicine Network. thanks to funding from Health Canada's Canadian Health Infostructure Partnerships Program (CHIPP). and delivered healthcare-related administrative services to its member organizations. NORTH was a program of Sunnybrook Health Sciences Centre.NORTH Network 120 NORTH Network NORTH Network was a telehealth organization serving communities in Northern and Central Ontario. NORTH Network experienced a significant expansion between 2001 and 2003. and received funding from the provincial government's Ministry of Health and Long Term Care. History NORTH began as a feasibility study sponsored by the Ontario Medical Association that examined how telemedicine could improve access to health care for citizens of rural and remote Ontario. NORTH's head office was located in Toronto and its clinical headquarters in Timmins. Launched in four sites in 1998. More than 2. Members (Member list accurate as of March 30.000 physicians and other allied health professionals used the Network.) Hospitals • • • • • • • Atikokan General Hospital Baycrest Centre for Geriatric Care Blind River District Health Centre Brantford General Hospital Bridgepoint Health Campbellford & District Community Mental Health Centre Campbellford Memorial Hospital . and may have been the largest network of its kind in the world. NORTH was facilitating over 2. NORTH Network's name is an acronym which stands for the Northern Ontario Remote Telehealth Network. 2006. Specialists remotely examined and prescribed treatment to patients in their home communities.

Site Chapleau Health Services Collingwood General & Marine Hospital Credit Valley Hospital Dryden Regional Health Centre Englehart & District Hospital Espanola General Hospital Geraldton District Hospital Guelph General Hospital Haliburton Highlands Health Services Haliburton Site Minden Site Hamilton Health Sciences Centre Chedoke Campus General Hospital Site Henderson Campus Juravinski Cancer Centre McMaster Children's Hospital McMaster University Campus Headwaters Health Care Centre Hornepayne Community Hospital Hospital for Sick Children (The) Huronia District Hospital James Bay General Hospital Kirkland and District Hospital Lady Dunn Health Centre Lake of the Woods District Hospital Lakeridge Health Beaverton Thorah Health Centre Bowmanville Oshawa Port Perry New Life Centre Whitby Manitoulin Health Centre Little Current Site Mindemoya Site Manitouwadge General Hospital Mattawa General Hospital McCausland Hospital Meno-Ya-Win Health Centre 5th Avenue Site 7th Avenue Site M.I. Site Queen St. Site Russell St.'s Group of Health Services Anson General Hospital 121 .NORTH Network • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Centre for Addiction and Mental Health College St.C.

Catharines General Site Welland Hospital Site Nipigon District Memorial Hospital North Bay and District Hospital North York General Hospital Northumberland Hills Hospital Notre Dame Hospital Penetanguishene General Hospital Penetanguishene Mental Health Centre Peterborough Regional Health Centre Riverside Health Care Facilities LaVerendrye Health Care Centre Rainy River Health Care Centre Red Lake Margaret Cochenour Memorial Hospital Cambrian College of Applied Arts & Technology Canadian Hearing Society Canadian Institute for Health Information Canadian Mental Health Association (The) Cancer Care Ontario CCAC of the District of Thunder Bay CCAC for Kenora & Rainy River Districts Dryden Site Fort Frances Site Kenora Site Centre for Mountain Health Services Centre for Movement Disorders Cochrane District Community Care Access Centre College of Physicians & Surgeons of Ontario Community Care Access Centre of the District of Thunder Bay Dryden and District Association for Community Living Ear Falls Community Health Centre George Jeffrey Children's Centre Group Health Centre .NORTH Network • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Bingham Memorial Hospital Lady Minto Hospital Mount Sinai Hospital Muskoka-East Parry Sound Health Services Burk's Falls & District Health Centre Huntsville District Memorial Hospital South Muskoka Memorial Hospital Niagara Health System Greater Niagara General Site Niagara-on-the-Lake Hospital Site Port Colborne General Site St. Marie Health Sciences North Institute for Safe Medication Practices Inc. 122 Educational and Community Organizations .Sault Ste.

L. Infection Control Network Ontario Addiction Treatment Centres Richmond Hill Site Thunder Bay Site Ornge Ontario Hospital Association Ontario Medical Association Pioneer Manor Rural Ontario Medical Program Sioux Lookout & Hudson Association for Community Living St.Faculty of Medicine Kingston. & Addington Health Unit Middlesex-London Health Unit North Bay Parry Sound District Health Unit Regional Niagara Public Health unit Thunder Bay District Health Unit 123 Public Health Teleprimary Care Sites with collaborating family physicians • Apsley Medical Centre • Argyle Nursing Station • • • • • • • • Britt Nursing Station Havelock . Joseph's Care Group Heritage Site Hogarth Riverview Manor Rehab/ Chronic Pain Mngt. W.Belmont . Site Sister Margaret Smith Centre Surrey Place Centre University of Toronto .O.) Medical Associates Physicians Clinic NorWest Community Health Centre Armstrong Site .Methuen Health Centre Keene Health Centre Kerr.NORTH Network • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Laurentian University .) McMullen. (Dr.W. Joseph's Villa St.School of Nursing Mary Berglund Community Health Centre McMaster University Department of Family Medicine Faculty of Health Sciences Michael DeGroote Centre for Learning Mohawk Site Northeast Mental Health Centre North Bay Psychiatric Hospital Northeastern Ontario Medical Education Corporation Northern Ontario School of Medicine N. Frontenac and Lennox. (Dr.

Toronto Keewaytinook Okimakanak Telehealth • • • • • • • • • • • • • • • • • • • • • • • • Bearskin Lake First Nation Beausoleil First Nation Health Centre Big Trout Lake Nursing Station Cat Lake First Nations Health Authority Deer Lake Nursing Station Eabametoong First Nation Emily Anderson Memorial Nursing Station Fort Severn Nursing Station Judas & Emily Winter Memorial Clinic Keewaytinook Okimakanak Northern Chiefs Council Keewaytinook Okimakanak Telehealth Keewaywin Nursing Station Kingfisher Lake Nursing Station Lac Seul First Nation Nellie Fiddler Memorial Health Centre Neskantaga Nursing Station New Osnaburgh Nursing Station Nibinamik First Nation Nodin CFI.Markham Central East Local Health Integration Network .Ajax Central West Local Health Integration Network .North Bay 124 Government • North West Local Health Integration Network .Brampton Hamilton Niagara Haldimand Brant Local Health Integration Network .Thunder Bay • Toronto Central Local Health Integration Network .Grimsby North Simcoe Muskoka Local Health Integration Network .NORTH Network • • • • • • • • • • • • • • • • • • Longlac Site Thunder Bay Site Pointe au Baril Nursing Station Registered Nurses Association of Ontario Rosseau Nursing Station Whitestone & Area Nursing Station Wright Clinic Ministry of Community Safety and Correctional Services Central East Correctional Centre Monteith Correctional Facility Ministry of Health and Long-Term Care Emergency Management Unit Central Local Health Integration Network .Sioux Lookout First Nations Health Authority North Spirit Lake Nursing Station Pikangikum First Nation Poplar Hill Nursing Station Sachigo Lake First Nation Sandy Lake Nursing Station .Orillia North East Local Health Integration Network .

NORTH Network • • • • • • Sena Memorial Nursing Station Shibogama First Nations Council Sioux Lookout Diabetes Program Slate Falls First Nation Webequie First Nation Wunnumin Lake Nursing Station 125 .

First Nations Communities. clinics. LHIN offices. NORTH Network in Central and Northern Ontario. leveraged the networks’ successes. In 2007.000 health care professionals deliver care using OTN. otoscopes and patient examination cameras. assets and resources to ensure that telemedicine will continue to grow and satisfy demand for services. Today. educational facilities and public health. OTN Members and Network Partners OTN has more than 240 partners including: academic health science centres. over 32. and VideoCare in Southwestern Ontario. Community Care Access Centres. Ontario. provincially-funded telemedicine networks: CareConnect in Eastern Ontario. supported by the Ontario Ministry of Health and Long-Term Care (MOHLTC) and Canada Health Infoway (CHI).ca/) • French-language website (http://www. OTN helps deliver clinical care and professional education among health care providers and patients. medical and nursing schools. not-for-profit organization that is funded by the Government of Ontario.ca [1] The Ontario Telemedicine Network (OTN) is an independent. "Telemedicine" (TM) is the delivery of health-related services and information using telecommunications technologies. community hospitals.otn.otn.otn.000 clinical consultations in Ontario were conducted using telemedicine. otn.Ontario Telemedicine Network 126 Ontario Telemedicine Network Ontario Telemedicine Network Industry Founded Headquarters Employees Website Telemedicine April 2006 Toronto.ca/fr/) . more than 2. long-term care homes. professional organizations. This merger. nursing stations. CANADA 180 (2008) www. A province-wide telemedicine solution OTN was created through the April 2006 merger of three award-winning. Using two-way videoconferencing systems and tele-diagnostic instruments like digital stethoscopes. ca/ External links • Ontario Telemedicine Network website (http://www. psychiatric hospitals. References [1] http:/ / www.

Disadvantages of Patient Portals The major shortcoming that most patient portals have is that they are tied to only one organization. is the ability to expose personal. which can streamline and shorten visits to clinics and hospitals. Patient portal applications might allow patients to register and complete forms online. review lab results. What all of these share is the ability of the patient interacting with their medical information via the Internet. allowing access to patient information and records. Google Health and Microsoft HealthVault. Many portal applications also allow patients to request prescription refills online. and messages from patients. Typically. but can interface with EMRs and communicate via the Continuity of Care Record standard. or a part of a system. patient health information securely via the Internet. Security Health care providers in the US are bound to comply with HIPAA regulations. and expose patient data via the Internet so can be viewed as patient portal. a patient portal. as the patient data needs to be stored in a data repository then retrieved by the patient portal.[2]. order eyeglasses and contacts. and a patient portal are blurring. access medical records. payments. The use of SSL and access control patterns are commonplace in the industry. For example. Other portal applications are integrated into the existing web site of the healthcare provider. While there may be systems that are not HIPAA compliant. and schedule necessary medical appointments. Benefits and Features of Patient Portals The central feature which makes a system. . If a patient travels to many organizations for their healthcare they normally need to log into each organization’s portal to get access to their information. such as physicians and hospitals. Some patient portal applications exist as stand-alone web sites and sell their services to healthcare providers.[1] Most patient portals require the practice to have some type of electronic medical record or patient management system. Something as seemingly trivial as a name is viewed by HIPAA as protected health information. pay bills. personal health record. Virtually all patient portals allow the patient to interact in some way with the health care provider. The lines between a electronic medical record. Patient access is typically validated with a user name and password. Practice Portals Portal applications for practices typically exist in tandem with patient portals. This results in a fragmented view of their data. These regulation specify what patient information must be held in confidence. For this reason. describe themselves as personal health records (PHRs). Still others are modules added onto an existing electronic medical record system. certainly most patient and practice portals are secure and compliant with HIPAA regulations. Patient portals also typically allow patients to directly communicate with healthcare providers by asking questions and leaving comments. security has always been a top concern for the industry when dealing with the adoption of patient portals. portal services are available on the Internet at all hours of the day. as well as schedules.Patient portal 127 Patient portal Patient Portals are healthcare-related online applications that allow patients to interact and communicate with their healthcare providers. Patient portals benefit both patients and health care providers by increasing efficiency and productivity.

the best documentation of patients history could be data outside the physicians office. and the development of clear interoperable standards. the adoption of patient portals has lagged behind other market segments. Because the conversion to EMR is typically complex. com/ [2] http:/ / cms.Patient portal 128 History Internet portal technology has been in common use since the 90s. PHRs. a likely upshot of the transition to EMR is a transition first to patient portals followed by a complete conversion to a full blown EMR. cough. although few actually re-imburse for them currently. References [1] http:/ / practiceportals. The funding will offset. The financial industry has been particularly adept at using the Internet to grant indivdual users access to their information. have kids. Some possible symptoms could be common cold. personal health record systems. pdf . or the lack of financial incentives for the health care providers. Possibly because of the strictness of HIPAA regulations. and history information. potentially pay for electronic medical records systems for practicing physicians. It is for this reason that patient portals exist . or who don’t want to spend 2-4 hours for a trip to the doctor when all they need is a quick answer or diagnosis for a minor symptom. Currently. some places by as much as 25%. This makes e-visits a very interesting proposition for insurance companies. gov/ EducationMaterials/ Downloads/ HIPAAChecklist. are becoming more common and available. The Future of Patient Portals E-visits may soon be one of the most commonly used options of patient portals that are available. At the same time as the conversion to patient portals and EMR systems. an individual's health data are primarily in physicians' files. The American Recovery and Reinvestment Act of 2009 (ARRA) in particular the HITECH Act inside the ARRA sets aside approximately $19 Billion for Health IT. also allow the patient to update their allergies. vital signs. Many organizations find that overall utilization drops when e-visits are implemented. Providing a route for patients to take that does not require them to come to the clinic benefits them and your organization. Given the mobility of patients. Providing e-visits allows the standard healthcare organization to offer a product that can compete on price with the retail clinics that are popping up in strip malls and Walmart. diarrhea and back pain. At that point we will begin seeing physician portals. E-visits. sinus infections. The best demographic for e-visits are patients who live far away from their clinics. hhs.to give the patient a view into their information. urinary problems. with the proper functionality.

such as scanned documents. including ultrasound (US). Clinical areas beyond radiology. and convenient access to. The universal format for PACS image storage and transfer is DICOM (Digital Imaging and Communications in Medicine). this eliminates the need to manually file. gastroenterology and even the laboratory are creating medical images that can be incorporated into PACS. interpretations. oncology. positron emission tomography (PET). distribution. Additional sharpening and measurement tags added by the system types of image formats are always being added. A PACS consists of four major components: The imaging modalities such as X-ray computed tomography (CT) and magnetic resonance imaging (MRI). or transport film jackets. and display. and archives for the storage and retrieval of images and reports. Combined with available and emerging web technology. PACS has the ability to deliver timely and efficient access to images. (DR). (see DICOM Application areas).Picture archiving and communication system 129 Picture archiving and communication system A picture archiving and communication system (PACS) is a medical imaging technology which provides economical storage of. may be incorporated using consumer industry standard formats like PDF (Portable Document Format). computed tomography (CT). Non-image data. images from multiple modalities (source machine types). cardiology. retrieve. An image as stored on a picture archiving and communication system (PACS) Types of images Most PACSs handle images from various medical imaging instruments. magnetic resonance (MR). etc. a secured network for the transmission of patient information. endoscopy (ENDO). PACS breaks down the physical and time barriers associated with traditional film-based image retrieval. . computed radiography (CR) ophthalmology. once encapsulated in DICOM. and related data. mammograms (MG). workstations for interpreting and reviewing images.[1] Electronic images and reports are transmitted digitally via PACS. Digital radiography The same image following contrast adjustment.

PACSs provide a growing cost and space advantage over film archives in addition to the instant access to prior images at the same institution. • Remote access: It expands on the possibilities of conventional systems by providing capabilities of off-site viewing and reporting (distance education. a technologist a QA workstation. there is normally CD/DVD authoring software used to burn patient studies for distribution to patients or referring physicians. telediagnosis). The diagram above shows a typical workflow in most imaging centers and hospitals. Electronic Medical Record (EMR). JavaScript and/or a Java Applet.Picture archiving and communication system 130 Uses PACS has four main uses: • Hard copy replacement: PACS replaces hard-copy based means of managing medical images. Digital copies are referred to as Soft-copy. Normally tied to the reading workstation is a reporting package that assists the radiologist with dictating the final report. PACS is offered by virtually all the major medical imaging equipment manufacturers. A radiologist typically sees a viewing station. nuclear medicine. • Radiology Workflow Management: PACS is used by radiology personnel to manage the workflow of patient exams. The QA workstation is a checkpoint to make sure patient demographics are correct as well as other important attributes of a study. As the need for distribution of images and reports become more widespread there is a push for PACS systems to support DICOM part 18 of the DICOM standard. such as film archives. while a PACS administrator might spend most of their time in the climate-controlled computer room. depending on the user. and Radiology Information System (RIS). Modalities are typically computed tomography (CT). medical IT companies and many independent software companies. Basic PACS software can be found free on the Internet. Practice Management Software. Architecture The architecture is the physical implementation of required functionality. or what one sees from the outside. The first step in PACS workflow diagram typical PACS systems is the modality. The reading workstation is where the radiologist reviews the patient's study and formulates their diagnosis. ultrasound. and magnetic resonance imaging (MRI). Ancillary to the workflow mentioned. There are different views. • Electronic image integration platform: PACS provides the electronic platform for radiology images interfacing with other medical automation systems such as Hospital Information System (HIS). It enables practitioners in different physical locations to access the same information simultaneously for teleradiology. More and more PACS include web-based interfaces to utilize the internet or a Wide Area Network as their means of communication. Hospital Information System and other such front-end system that relates to the PACS workflow. If the study information is correct the images are passed to the archive for storage. Note that this section does not cover integration to a Radiology Information System. Depending on the facility's workflow most modalities send to a quality assurance (QA) workstation or sometimes called a PACS gateway. The composite view is rather different for the various vendors. With the decreasing price of digital storage. usually via VPN (Virtual Private Network) or SSL (Secure Sockets Layer). Reporting software is optional and there are various ways in which doctors prefer to dictate their report. Web Access to DICOM Objects (WADO) . The central storage device (archive) stores images and in some cases reports.[2] Typically a PACS consists of a multitude of devices. positron emission tomography (PET). More robust PACS clients are full applications which can utilize the full resources of the computer they are executing on and are unaffected by the frequent unattended Web Browser and Java updates. The next step in the PACS workflow is the reading workstations. measurements and other information that resides with the images. The client side software may use ActiveX.

if the client wishes to receive an ID that it can use to receive images (see image retrieval) it should create the tag SOPInstanceID (0008. the goal in image back-up is to make it automatic and as easy to administer as possible. The hope is that the copies won't ever be needed. • The client prepares a query object which is an empty dicom dataset object. but. Without stepping outside the focus of the PACS architecture. in-turn sending the study from the archive to the device requesting the study. Image archival and backup Digital medical images are typically stored locally on a PACS for retrieval. they need to be available if needed. WADO becomes the solution to cross platform capability and can increase the distribution of images and reports to referring physicians and patients. DVDs or other media that can hold many patients' images) that is physically transferred off-site.g.Picture archiving and communication system creates the necessary standard to expose images and reports over the web through truly portable medium. part of the PACS Architecture (see below).) Depending on upload bandwidth and image volume. and as a consequence the server must know in advance all the AE Titles that it will ever be requested to send images to. E. E. It is important (and required in the USA by the Security Rule's Administrative Safeguards section of HIPAA) that facilities have a means of recovering images in the event of an error or disaster. • The query object is sent to the server. as with other disaster recovery and business continuity planning. as defined by the DICOM network protocol. Other options include removable media (hard drives.g. The server must be configured with mapping of the AE Title to a TCP/IP address and port. but sometimes overlooked. HIPAA requires that backup copies of patient images be made in case of image loss from the PACS.[3] . the radiologist or radiology technical must query the off-site or long term archive for the prior exam(s). • The client creates empty tags (tags with zero length string values) for all the tags it wishes to receive from the server. While each facility is different. The content of these copies must be protected via encryption from exposure to unauthorized personnel or stiff penalties can be assessed. to query for a patient ID. this may not be practical if the back-up system cannot be configured to tune bandwidth usage and frequency of back-ups. • The client fills in the query object with the keys that should be matched. • The client extracts the tags that are of interest from the response dicom objects. Typically a radiologist is looking for prior studies on a patient to compare the progression of some pathology. In some cases prior studie(s) may be on an off-site archive or a long term storage device. but with different tags. There are several methods of backing up the images. Images are retrieved from a PACS server through a C-MOVE request. preferably off-site. The archive receives the C-FIND and if the C-FIND is successful the archive invokes a C-MOVE on the study to the called AE Title. the patient ID tag is filled with the patient's ID. In the example being used. copies of images should be streamed off-site as they are created. A query typically looks as follows: • The client establishes the network connection to the PACS server. Ideally. PACS image backup is a critical. but they typically involve automatically sending copies of the images to a separate computer for storage. the Security Rule's Technical Safeguards section of HIPAA requires that the images be encrypted during transmission. This request specifies where an image instance should be sent through an identifier known as the destination Application Entity Title (AE Title). • The server sends back to the client a list of response dicom objects.0018) in the query object. 131 Querying (C-FIND) and Image Retrieval (C-MOVE) The communication with the PACS server is done through dicom objects that are similar to dicom images. (If using the Internet.

failed drives may be physically replaced (hot swapping) without interruption of service.etc) via DICOM protocol (Worklist). some means of rapidly transferring all of its images back to the PACS is required. Patient ID and Orders will be sent to Modality (CT. modality-specific network of modalities. in real time. 132 Integration A full PACS should provide a single point of access for images and their associated data. via HL7 protocol. rather than just protecting the drives through RAID. Some sites make two such backups and remove them from the site on a rotating basis. Further. These data are sent from HIS to RIS via integration interface. the drives themselves are usually configured as a Redundant Array of Inexpensive (or Independent) Discs RAID. either as Direct-Attached Storage (DAS). individual islands of digital imaging not yet connected to a central PACS may exist. The hard drives may be configured and attached to the PACS server in various ways. preferably whilst the PACS continues to receive and provide current images. largely because of the large image size. should also interface with existing hospital information systems: Hospital information system (HIS) and Radiology Information System (RIS). Ultrasound. However. Network-attached storage (NAS). The rapid deployment of FFDM in the US following the DMIST study has led to the integration of Digital Mammography and PACS becoming more commonplace. That is. However the storage is attached. inexpensive disc in another machine at another location. Diagnosis Report is created based on the images retrieved for presenting from PACS Server by physician/radiologist and then saved to RIS System. to a slower. workstations and storage (a so-called "mini-PACS"). Diagnosis Report is sent back to HIS via HL7 usually and Images are sent back to HIS via DICOM usually if there is a DICOM Viewer integrated . All PACS. some sites opt for fully redundant Archives. whether they span the entire enterprise or are localized within a department. There are several data flowing into PACS as inputs for next procedures and back to HIS as results corresponding inputs: In: Patient Identification and Orders for examination. Nuclear Medicine and Cardiology Cath Labs are often departments that adopt such an approach. Typically. Historically. which may be configured to provide appropriate combination of faster disk access or protection against the failure of one (or even two) discs in the physical RAID array. and intervention by regulators. in most of hospital. More recently. Such systems are also often not connected to the departmental information system. in all departments. Out: Diagnosis Report and Images created accordingly. until PACS penetration is complete.MR. or via a Storage Area Network (SAN). Since costs of computers has fallen. RAIDs are fragile and can be rendered useless by one erroneous hit on the controller.Picture archiving and communication system Images may be stored both locally and remotely on off-line media such as tape or optical media. throughout the enterprise. it should support all digital modalities. The back-up infrastructure may also be capable of supporting the migration of images to a new PACS. highly specialized reading workflow and display requirements. In the event that it is necessary to reconstruct a PACS partially or completely from the back-up images. Full Field digital mammography (FFDM) has taken a similar approach. or partially or exclusively on hard disks ("spinning") media. Images will be created after images scanning and then forwarded to PACS Server. or may consist of a small cluster of modalities directly connected to A chest image displayed via a PACS reading workstations without long term storage or management. The latter is becoming more common. These may take the form of a localized. Data stored on disk may also be backed up to tape or optical media or copied.

[2] The first large-scale PACS installation was in 1982 at the University of Kansas.[4] Dr Samuel Dwyer. credits Dr Judith M. avoiding typing delays for urgent results. Recognition of the importance of integration has led a number of suppliers to develop fully integrated RIS/PACS. or retained in case of typing error. Various people are credited with the coinage of the term PACS. Interfacing between multiple systems provides a more consistent and more reliable dataset: • Less risk of entering an incorrect patient ID for a study – modalities that support DICOM worklists can retrieve identifying patient information (patient name. This avoids needless double-reading. . Once the acquisition is complete. preventing data entry errors during acquisition. the PACS can compare the embedded image data with a list of scheduled studies from RIS. Rejected images can be tagged.[5] Dr Harold Glass. a medical physicist working in London in the early 1990s secured UK Government funding and managed the project over many years which transformed Hammersmith Hospital in London as the first filmless hospital in the United Kingdom. These may offer a number of advanced features: • Dictation of reports can be integrated into a single system. • Data saved in the PACS can be tagged with unique patient identifiers (such as a social security number or NHS number) obtained from HIS. The recording is automatically sent to a transcript writer's workstation for typing. The PACS can obtain lists of appointments and admissions in advance. accession number) for upcoming cases and present that to the technologist. • Improved use of online storage and nearline storage in the image archive. patient number. • Provides a single tool for quality control and audit purposes. The report can be attached to the images and be viewable via a single interface. even where the different centers use different ID systems internally. allowing images to be pre-fetched from off-line storage or near-line storage onto online disk storage.Picture archiving and communication system with HIS in hospitals (In most of cases. though. Clinical Physician gets reminder of Diagnosis Report coming and then queries images from PACS Server). Cardiovascular radiologist Dr Andre Duerinckx reported in 1983 that he had first used the term in 1981. Workloads and turn-around time can be reported automatically for management purposes. Prewitt for introducing the term. An interface can also improve workflow patterns: • When a study has been reported by a radiologist the PACS can mark it as read. 133 History The principles of PACS were first discussed at meetings of radiologists in 1982. This first installation became more of a teaching experience of what not to do rather than what to do in a PACS installation. Kansas City. allowing later analysis (as may be required under radiation protection legislation). but it can also be made available for access by physicians. and can flag a warning if the image data does not match a scheduled study. Providing a robust method of merging datasets from multiple hospitals.[6] Dr Glass died a few months after the project came live but is credited with being one of the pioneers of PACS.

rtstudents.com/pacs/free-dicom-viewers. Dwyer III. fda. Retrieved 11 February 2010. [5] Samuel J. James Blaine and Eliot L. (1992). fda. A personalized view of the history of PACS in the USA. PMID 10505012. "The benefits of hospital-wide picture archiving and communication systems: a survey of clinical users of radiology services". Watkins JR.htm) List of free PACS and DICOM software available on the web • History of PACS (http://www. com/ news/ hhs-cracks-down-provider-pay-100000-hipaa-penalties-over-lost-laptops) [4] Duerinckx AJ. Buxton MJ (1999). PACS and DICOM Software (http://www. Filmless Picture Archiving and Communication System (PACS) in Diagnostic Radiology. [8] USFDA (30 May 2008). edited by G. . 2000.. 2004. order No 388.asp) • PACS History Web Site (http://www. [7] USFDA (27 July 2000). PACS Fundamentals. R.3980:2-9. In general they are subject to Class 2 controls and hence require a 510(k). htm). Retrieved 11 February 2010.. "Guidance for the Submission Of Premarket Notifications for Medical Image Management Devices" (http:/ / www.org/) • USC IPILab Research Article on Backup (http://adsabs. healthcareitnews.[7] Some specific applications.000 in HIPAA penalties over lost laptops. "Guidance for Industry and FDA Staff: Display Accessories for Full-Field Digital Mammography Systems-Premarket Notification (510(k)) Submissions" (http:/ / www. Picture archiving and communication systems: an overview. Senior Editor (http:/ / www.Picture archiving and communication system 134 Regulatory concerns In the US PACS are classified as Medical Devices.5033. Radiographics January 1992 12:127-129 [2] Oosterwijk. Br J Radiol 72 (857): 469–78. Aubrey: OTech Inc. are additionally regulated[8] within the scope of the Mammography Quality Standards Act.edu/abs/2003SPIE.. ISBN 9780971886735 [3] HealthcareITnews: HHS cracks down: provider to pay $100. such as the use for primary mammography interpretation. External links • Teleradiology.318. htm). though individual PACS components may be subject to less stringent general controls. Pisa EJ. Reprinted in IEEE Computer Society Proceedings of PACS'82.com/library/200505-01.63L) .harvard.imagingeconomics. Diana Manos. . July 17. Herman. and hence if for sale are regulated by the USFDA.9-18. "Medical Imaging 2000: PACS Design and Evaluation: Engineering and Clinical Issues". 2008. Proc SPIE 1982. Siegel. gov/ MedicalDevices/ DeviceRegulationandGuidance/ GuidanceDocuments/ ucm107549. gov/ MedicalDevices/ DeviceRegulationandGuidance/ GuidanceDocuments/ ucm073720. In: Proceedings of the SPIE.pacshistory. [6] Bryan S. Weatherburn GC. References [1] Choplin.

Remote guidance 135 Remote guidance Remote guidance. spacecrafts. the remote guidance can originate from another room or floor in the same building. NASA researchers have successfully demonstrated remote guidance of diagnostic level cardiac ultrasonography using an ultrasound on the space station. In this sense. a radiologist may guide an ultrasound examination from a remote location. The inclusion of the VGA output gives the opportunity for frame grabber devices to stream such outputs to the internet. This falls in the realm of real time telemedicine applications. from a remote location. Ultrasound scanning commonly utilized for abdomen. Formula 1 and major assests such as ships. for example ultrasound machines has facilitated this new capability.html • Froehlich J. in the medical context. Easily capture video from any VGA or DVI device. Recent improvements in scanning devices.org/laparascopic-surgery/lights-lap-camera-tele-action/ http://www. Given bandwidth issues universally plaguing the healthcare environment imagery beyond still images and brief video has not yet become standard expectation of care environments or PACS systems.gizmag. In the previous example. body of object. a diagnostic quality ultrasound can be accomplished by non-medically trained individuals manipulating an ultrasound device located with the patient under guidance from a remote location. Remote diagnostics Remote diagnostics refers to a real time telemedical application which achieves diagnostic level quality and information exchange. musculoskeletal. it refers to an expectation for quality sufficient for making or excluding a medical diagnosis. 2007 . from a distance.trains etc. gynecologic. This is an example of teleradiology If appropriately configured. cardiac and vascular evaluations has shown potential for remote diagnosis only of late. refers to the supervision or guidance of a medical task. video product of medical devices has typically not been available for remote interaction.com/features/0335. In cases where also corrective actions are made. the term 'Remote Diagnostic & Maintenance' is more appropriate. MacTech Magazine. In the tele-medical context specific to radiologic images these images often are consistent with the DICOM standard. usually a procedures or test. References • • • • see also Remote diagnostics for RD in technical systems http://www. non-medical astronauts performing the exam as guided by a terrestrially located expert. More general Remote Diagnostics (RD) refers to detecting which fault or faults are present in a system.remoteguidance. As such the proximate requisite expertise to accomplish a medical task is significantly diminished. By way of example. Examples of use: aeroplanes.sportandtechnology. pelvis. Technical aspects While still imagery can be e-mailed and forwarded in a multitude of methods. to as far away as another continent or even planet.com/go/5283/ http://www.

England compared the success of kidney surgeries in 304 dummy patients conducted traditionally as well as [3] remotely and found that those conducted using robots were more successful in accurately targeting kidney stones . a laparoscopic surgeon in Hamilton. While the field of robotic surgery is fairly well established. the availability of greater bandwidth and more powerful computers. the ease and cost effectiveness of deploying remote surgery units is likely to increase rapidly. robots might one day be able to perform surgeries with little or no human input. It promises to allow the expertise of specialized surgeons to be available to patients worldwide. with a surgeon (Dr. an Italian surgeon. To date Dr. The armed forces have an obvious interest since the combination of telepresence. Jacques Marescaux) in New York performing a cholecystectomy on a 68-year-old female patient 6. a city 400 kilometres from Hamilton. Remote surgery is essentially advanced telecommuting for surgeons. Anvari. The possibility of being able to project the knowledge and the physical skill of a surgeon over long distances has many attractions. Remote surgery combines elements of robotics. It is a form of telepresence. remote surgery has been conducted many times in numerous locations. Unassisted robotic surgery As the techniques of expert surgeons are studied and stored in special computer systems. Carlo Pappone. cutting edge communication technology such as high-speed data connections and elements of management information systems. Even though he uses a VPN over a non-dedicated fiberoptic connection that shares bandwidth with regular telecommunications data. There is considerable research underway in the subject. complicated surgeries much more widely available.230 km away in Strasbourg. A study conducted at Guy’s Hospital in London. has developed a software program that uses data collected from several surgeons and thousands of operations to perform the surgery without human intervention [4] . where the physical distance between the surgeon and the patient is immaterial. most of these robots are controlled by surgeons at the location of the surgery. teleoperation. Sinai Hospital in Toronto. This could one day make expensive. called Project Lindbergh after Charles Lindbergh’s pioneering transatlantic flight from New York to Paris. was conducted over a dedicated fiberoptic link to ensure guaranteed connectivity and minimal lag. Another potential advantage of having robots perform surgeries is accuracy.Remote surgery 136 Remote surgery Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. . At the Advanced Surgical Technology Centre at Mt.[1] That operation. Canada. and telerobotics can potentially save the lives of battle casualties by providing them with prompt attention in mobile operating theatres. Rapid development of technology has allowed remote surgery rooms to become highly specialized.[2] Applications Since then. Dr. including the lighting in the operating room. Canada. the position of the operating table and the surgical tools themselves. the surgical room responds to the surgeon’s voice commands in order to control a variety of equipment at the surgical site. even to patients in regions which have traditionally lacked proper medical facilities. With continuing advances in communication technologies. The Lindbergh Operation One of the earliest remote surgeries was conducted on 7 September 2001 across the Atlantic Ocean. has conducted numerous remote surgeries on patients in North Bay. Anvari has not had any connection problems during his procedures. without the need for patients to travel beyond their local hospital. France named Operation Lindbergh.

guardian. Systems known as force-feedback. html [3] Robo-ops set to cut out the human factor | Special reports | Guardian Unlimited (http:/ / www. html) External links • Article and Media Gallery for telesurgery (http://www. Humans binocular vision make this easy in a three dimensional environment.uk/1/hi/sci/tech/1552211.com/archive/Aug96/1290.11381.ca/Publications/YHRFall2001/Hospital/ virtualreality.html) • PBS article on telesurgery (http://www.howstuffworks. However these systems are very sensitive to time-delays such as those present in the networks used in remote surgery.pulseplanet. dlmag. intersurgtech. archive.html) • BBC News SCI/TECH -. Possible Uses One possible use of remote surgery is the Trauma-Pod project conceived by the US military under the Defense Advanced Research Agency. com/ media. References [1] http:/ / www.00.intersurgtech. uk/ medicine/ story/ 0. many issues will need to be resolved.com/tele-medicine.805662. This system is intended to aid wounded soldiers in the battlefield by making use of the skills of remotely located medical personnel. Operation Lindbergh proved that the technology exists today to enable delivery of expert care to remote areas of the globe. Nevertheless. have been developed to simulate this. For example.htm) • How robotic surgery works (http://electronics.com (http:/ / web. co. In robotic surgery. html) [4] Robot Successfully Completes Unassisted Heart Surgery Digital Lifestyle Magazine @ dlmag. However this can be much more difficult when the view is presented on a flat computer screen.org/wnet/innovation/episode7_essay1. html [2] Event videos: http:/ / www.co. Limitations For now. Also. com/ 1653/ robot-successfully-completes-unassisted-heart-surgery.com/download-center/case-studies/telesurgery-cmas) . training. and global compatibility of equipment must be developed.stm) • High Performance Network Video in support of Telesurgery / NEEMO7 Mission .First transatlantic surgery (http://news.com/robotic-surgery. surgeons need to be able to perceive the amount of force being applied without directly touching the surgical tools. org/ web/ 20060820022121/ http:/ / www. remote surgery is not a widespread technology in part because it does not have sponsorship by the governments. com/ media.pbs.Remote surgery 137 Force-Feedback and Time Delay The ability to carry out delicate manipulations relies greatly upon feedback. established clinical protocols.[citation needed] Before its acceptance on a broader scale. Depth Perception Being able to gauge the depth of an incision is crucial.mtsinai.html) • Using remote surgery as a teaching tool (http://www. or Haptic technology. there is still the need for an anesthesiologist and a backup surgeon to be present in case there is a disruption of communications or a malfunction in the robot. Another future possibility could be the use of remote surgery during long space exploration missions.on.htm) • Article in Pulse of the Planet about remote surgery (http://www. For example it is easy to learn how much pressure is required to handle an egg. intersurgtech.haivision.Revolutionary Telemedicine Techniques (http://www.bbc.

computer-assisted surgery.archive.com/1653/robot-successfully-completes-unassisted-heart-surgery. Robotically-assisted surgery was developed to overcome the limitations of minimally invasive surgery. A telemanipulator is a remote manipulator that allows the surgeon to perform the normal movements associated with the surgery whilst the robotic arms carry out those movements using end-effectorss and manipulators to perform the actual surgery on the patient. One advantage of using the computerised method is that the surgeon does not have to be present. The patents for the early prototype were sold to Intuitive Surgical in Mountain View. The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement. so that they are not duplicated robotically. History A robotically assisted surgical system used for prostatectomies.dlmag. ZEUS is no longer being actively marketed. leading to the possibility for remote surgery. Instead of directly moving the instruments. The da Vinci senses the surgeon’s hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. developed at Imperial College London. and is used in more than 800 hospitals in the Americas and Europe. it turned out to be more useful for minimally invasive on-site surgery. the surgeon uses one of two methods to control the instruments . It also detects and filters out any tremors in the surgeon's hand movements. The da Vinci System is FDA cleared for a variety of surgical procedures including surgery for prostate cancer. was used to perform prostatic surgery. the PUMA 560. either a direct telemanipulator or by computer control. Further development of robotic systems was carried out by Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. cardiac valve repair and gynecologic surgical procedures In 1985 a robot. a patient-side robotic cart with 4 arms manipulated by the surgeon (one to control the camera and three to manipulate instruments). hysterectomy and mitral valve repair. though these systems can also still use telemanipulators for their input. In computer-controlled systems the surgeon uses a computer to control the robotic arms and its end-effectors. The da Vinci System was used in 48. and a high-definition 3D vision system. and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures. Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas. Although the telesurgical robot was originally intended to facilitate remotely performed surgery in battlefield and other remote environments. the PROBOT. (Intuitive Surgical bought Computer Motion in 2003.[2] ) The da Vinci Surgical System comprises three components: a surgeon’s console.Remote surgery • Robot Successfully Completes Unassisted Heart Surgery (http://web. California. was used to place a needle for a brain biopsy using CT guidance[1] .html) 138 Robotic surgery Robotic surgery. The original telesurgery robotic system that the da Vinci was based on was developed at SRI International in Menlo Park with grant support from DARPA and NASA.org/web/20061106000002/http:/ /www. In 1988. indeed the surgeon could be anywhere in the world.000 procedures in 2006 and sells for .

and so.[4] • In May 1998. used the Zeus robotic system to remotely perform a cholecystectomy on a 68-year-old female patient who was in Strasbourg. Cardiothoracic Surgery. the Eindhoven University of Technology announced the development of the Sofie surgical system. Reiza Rayman using the ZEUS surgical robot.[12] • In September 2010. completed an angioplasty revascularization on the patient's second occluded coronary vessel. in the words of its designers. Jacques Marescaux and Dr. was "more than qualified to operate on any patient. New Jersey by Dr. but was guided by pressing on buttons. the first all-robotic-assisted kidney transplant was performed at Saint Barnabas Medical Center in Livingston. meaning it was not simply mirroring the movement of human hands. Michel Gagner.Robotic surgery about $1. 1999 . In the first step of a two step procedure Dr. Michler." The designers believe that robots can replace half of all surgeons within 15 years. The first robotic surgery took place at The Ohio State University Medical Center in Columbus.[7] (See: the Lindbergh Operation. The new da Vinci HD SI released in April. Robert Michler performed the first robotically assisted heart bypass in the USA at The Ohio State University. The operation was performed on a 10-year-old girl. Todd Tillmanns reported the results of the largest multi-institutional study on the use of the da-Vinci robotic surgical system in gynecologic oncology and included learning curves for current and new users as a method to assess their acquisition of skills using the device.000 similar operations.[5] • On November 22. Friedrich-Wilhelm Mohr using the da Vinci Surgical System performed the first robotically assisted heart bypass at the Leipzig Heart Centre in Germany. Ontario). The machine had a database of 10. Stuart Geffner. The robot used was the first true robot.the first closed-chest beating heart cardiac hybrid revascularization procedure is performed at the London Health Sciences Centre (London. Dr. Dr. while in New York. Dr. This multi-step procedure marked one of the first integrative approaches to treating coronary disease.[10] • In January 2009.[6] • On September 7 2001. the first surgical robot to employ force feedback. • In October 1999 the world's first surgical robotics beating heart coronary artery bypass graft (CABG) was performed in Canada by Dr. Professor and Chief. the first robotic operation at the femoral vasculature was performed at the University Medical Centre Ljubljana by a team led by Borut Geršak. The results were rated as better than an above-average human surgeon. • In January 2009.2 million. [8] [9] • In February 2008.) . single-vessel heart bypass surgery on a 55 year-old male patient's left anterior descending artery. In the next step of the procedure William Kostuk.[11] • In September 2010. • On 2 September 1999.) • In May 2006 the first AI doctor-conducted unassisted robotic surgery on a 34 year old male to correct heart arythmia. Douglas Boyd and Dr. Ohio under the direction of Dr. MD. Douglas Boyd used Zeus to perform an endoscopic.[3] 139 Timeline • In 1997 a reconnection of the fallopian tubes operation was performed successfully in Cleveland using ZEUS. Robert E.[13] [14] (See the vascular surgery section of this article. The same team performed eight more fully robotic-assisted kidney transplants over the next six months.75 million. Gundeti of the University of Chicago Comer Children's Hospital performed the first robotic pediatric neurogenic bladder reconstruction. Dr. Professor of Cardiology of the University of Western Ontario. Mohan S. Dr. 2009 currently sells for $1. France. Randall Wolf and Dr.

led by Prof. surgeons no longer have to stand throughout the surgery and do not tire as quickly. blood loss.[18] The robotic system does not come cheap and has a learning curve. although the manufacturers of such systems provide training on this new technology. in very good condition. transfusions. the overall cost of hospital stays.[16] Numerous feasibility studies have been done to determine whether the purchase of such systems are worthwhile. opinions differ dramatically. the surgical robot can continuously be used by rotating surgery teams. Finally. they also reduce the number of staff needed during surgery. minimally invasive operations can take up to twice as long as traditional surgery. However. Moreover during the training phase. less pain. nursing care required after surgery. decreased blood loss. the University of Illinois at Chicago medical team. As it stands. very experienced surgeons tend to publish their results with robotic systems. In addition. reported a pancreatectomy and also the Midwests fully robotic Whipple surgery. and quicker healing time. therefore. The patient is then placed on a heart-lung machine and the heart is stopped for a period of time during the operation. Pier Cristoforo Giulianotti. and. yet allowing him to leave the hospital just a couple of days after the procedure. On average patients leave the hospital two to five days earlier than patients who have undergone traditional open-heart surgery and return to work and normal activity 50% more quickly.[21] . minimally invasive surgery and unmanned surgery. Naturally occurring hand tremors are filtered out by the robot’s computer software. removing 60% of the patient's liver. these may not be representative of surgeons with lesser experience.200. Surgeons report that. Reduced recovery times are not only better for the patient. resulting in improved ergonomics. Further advantages are articulation beyond normal manipulation and three-dimensional magnification.[15] Higher expectations may explain higher rates of dissatisfaction and regret. Additional surgical training is needed to operate the system. and prolonged time to complete recovery. and use of pain medication. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity. Data is absent that proves the increased costs can be justified. Furthermore the patient can also leave with less pain than a usual surgery due to the four puncture holes and not a scar by a surgeon. Reports were published in esophageal and pancreatic surgery for the first time in the world and further data was subsequently published by Horgan and his group at the University of Illinois and then later at the same institution by others. robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. This approach can be associated with postoperative infection and pain. reduced blood loss and less pain. Because patient recovery after robot-assisted heart surgery is quicker.[15] With the cost of the robot at $1. improved outcomes. then gains access to the heart by splitting the sternum (breast bone) and spreading open the rib cage.000 dollars and disposable supply costs of $1. critics point out that studies that indicate that long-term results are superior to those after laparoscopic surgery are lacking.Robotic surgery 140 Advantages and disadvantages Major advances aided by surgical robots have been remote surgery. Robotic techniques are also associated with reduced duration of hospital stays.[19] [20] In 2007. leading to operating room tie ups and surgical staffs keeping patients under anesthesia for longer periods.[16] Advantages of this technique are that the incisions are small and patient recovery is quick. the hospital stay is shorter.500 per procedure. the cost of the procedure is higher. smaller incisions. In April 2008. the learning phase is intensive and surgeons must operate on twelve to eighteen patients before they adapt. the same team of surgeons performed the world's first fully minimally invasive liver resection for living donor transplantation. Compared with other minimally invasive surgery approaches. the surgeon makes a ten to twelve-inch incision. In traditional open-heart surgery. miniaturization. In medical literature.[18] Applications General surgery In early 2000 the field of general surgical interventions with the daVinci device was explored by surgeons at Ohio State University. Some major advantages of robotic surgery are precision.[17] While the use of robotic surgery has become an item in the advertisement of medical services.

Columbus (Dr. including bariatric surgery. three types of heart surgery are being performed on a routine basis using robotic surgery systems. In 2002. Robert E. It allows precise and more forceful positioning of catheters used for 3-D mapping of the heart and vasculature. Dr."[22] The Hansen Medical Sensei robotic catheter system uses a remotely operated system of pulleys to navigate a steerable sheath for catheter guidance. surgeons at the Cleveland Clinic in Florida (Dr. Ongoing research on the outcomes of robotic assisted CABG and hybrid CABG is being done by Dr. and Good Samaritan Hospital. and MNS has also been used in interventional cardiology for guiding stents and leads in PCI and CTO procedures. among other robotic assisted procedures and serves as a training site for other surgeons.[28] Other gastrointestinal procedures including colon resection. . tumor resections.[23] [24] [25] At present.Robotic surgery 141 Cardiothoracic surgery Robot-assisted MIDCAB and Endoscopic coronary artery bypass (TECAB) operations are being performed with the da Vinci system. longer procedure times but lower fluoroscopy dosage to the patient. Andrea Natale has referred to the new Stereotaxis procedures with the magnetic irrigated catheters as "revolutionary. The system provides doctors with estimated force feedback information and feasible manipulation within the left atrium of the heart. Since the first robotic cardiac procedure performed in the USA in 1999. Greenville (Dr W. • Mitral valve repair — the repair of the valve that prevents blood from regurgitating back into the upper heart chambers during contractions of the heart. pancreatectomy. Mitral valve repairs and replacements have been performed. Atlanta (Dr Douglas A. Cincinnati (Dr J.[26] These three surgery types are: • Atrial septal defect repair — the repair of a hole between the two upper chambers of the heart. it is expected that the applications of robots in cardiovascular surgery will expand.[20] Specific procedures have been more fully evaluated. Michler. Randolph Chitwood). Cardiology and electrophysiology The Stereotaxis Magnetic Navigation System (MNS) has been developed to increase precision and safety in ablation procedures for arrhythmias and atrial fibrillation while reducing radiation exposure for the patient and physician. commensurate with higher procedural complications. specifically esophageal fundoplication for the treatment of gastroesophageal reflux[27] and Heller myotomy for the treatment of achalasia. Saint Joseph's Hospital. The Sensei has been associated with mixed acute success rates compared to manual. and the system utilizes two magnets to remotely steerable catheters. Dr. esophagectomy and robotic approaches to pelvic disease have also been reported. Juan Crestanello. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices. Paul Vesco) has performed CABG. esophagectomy. These procedures combined robotic revascularization and coronary stenting and further expanded the role of robots in coronary bypass to patients with disease in multiple vessels. The system allows for automated 3-D mapping of the heart and vasculature. lung resection. • Coronary artery bypass — rerouting of blood supply by bypassing blocked arteries that provide blood to the heart. Murphy). Douglas Boyd and Kenneth Stahl) reported and published their preliminary experience with minimally invasive "hybrid" procedures. Robert Poston. Michael Smith) have popularized this procedure and proved its durability with multiple publications. East Carolina University. proven to reduce contrast usage and access tortuous anatomy unreachable by manual navigation. Gastrointestinal surgery Multiple types of procedures have been performed with either the 'Zeus' or da Vinci robot systems. The Ohio State University. Dr. As surgical experience and robotic technology develop. mitral valve.

Children's Hospital physicians have developed a number of new applications to expand the use of the robot. Jay Bringman) and The University of Tennessee. Orthopedics The ROBODOC system was released in 1992 by Integrated Surgical Systems. On January 17. and female cancers. Northwestern University (Dr. In 2001. ovarian tumors. Todd Tillmanns. Neurosurgery Several systems for stereotactic intervention are currently on the market. Today. Specially-trained surgeons use a high-tech robot to perform complex and delicate operations through very small surgical openings. The results are less pain.'s Joseph Prezzato and Burton Brodsky have utilized this equipment for gynecological procedures in Southeastern Michigan. nissen fundoplication.[30] Another example is the CASPAR robot produced by U. KG. Dr.[31] Pediatrics Surgical robotics has been used in many types of pediatric surgical procedures including: tracheoesophageal fistula repair. Saurabh Kumar). smaller scars. MD Robotic's NeuroArm is the world’s first MRI-compatible surgical robot. shorter hospital stays. Robot assisted hysterectomies and cancer staging are being performed using da Vinci robotic system. Dr. The Acrobot Company Ltd. gynecologists can perform hysterectomies. and others. congenital diaphragmatic hernia repair. They have also for the first time reported robotic surgery learning curves for current and new users as a method to assess acquisition of their skills using the device. which is used for total hip replacement. pelvic prolapse. surgeons use the technology for many procedures and perform more pediatric robotic operations than any other hospital in the world. morgagni's hernia repair.R. Patrick Lowe).-Ortho GmbH & Co. Using the robotic system. total knee replacement and anterior cruciate ligament reconstruction. Donald Chamberlain) have extensively studied the use of robotic surgery and found it to improve morbidity and mortality of patients with gynecologic cancers. a robot that constrains a bone cutting tool to a pre-defined volume. Children's Hospital Boston was the first pediatric hospital to acquire a surgical robot. Inc. abnormal periods.S. and lymph node biopsies. The Center for Robotic Surgery at Children's Hospital Boston provides a high level of expertise in pediatric robotic surgery. The need for large abdominal incisions is virtually eliminated. Aurora Health Center (Dr. [32] and train surgeons from around the world on its use. cholecystectomy. surgeons at Children's Hospital of Michigan in Detroit performed the nation's first advanced computer-assisted robot-enhanced surgical procedure at a children's hospital. Memphis (Dr. This includes the use of the da Vinci surgical system in benign gynecology and gynecologic oncology. faster recoveries. kasai portoenterostomy.[29] Also.Robotic surgery 142 Gynecology Robotic surgery in gynecology is one of the fastest growing fields of robotic surgery. 2002. . Chattanooga (Dr. which merged into CUREXO Technology Corporation. myomectomies. Robotic surgery can be used to treat fibroids. and happier patients and families. sells the "Acrobot Sculptor". endometriosis. Scott Kamelle). The University of Tennessee. West Virginia University (Dr.

[35] [36] [37] [38] [39] [40] [41] [42] In 2000. . the head of the Department of Cardiovascular Surgery at the centre. The research was led by Borut Geršak. which becomes their only other available therapy. meaning the user interface was not resembling surgical instruments and the robot was not simply imitating the movement of human hands but was guided by pressing buttons. pulmonary complications decrease to 0 percent from 9 percent. Urology Removing the prostate gland for cancer.[13] [14] Miniature robotics As scientists seek to improve the versatility and utility of robotics in surgery. They report fewer complications among this high-risk population (wound infections go from 15 percent in open surgery to 0 percent. Most Illinois transplant centers do not take anyone for renal transplant with a BMI of over 40. Mounted on the robot is a compact X-band linac that produces 6MV X-ray radiation. For example. repair bladder abnormalities and remove diseased kidneys. Analysing the problem and sending the information back to the hospital. The robot was imported to Slovenia from the United States.5 days to 5 days). The system uses a German KUKA KR 240.and since 2009. the first robot-assisted laparoscopic radical prostatectomy was performed.having BMIs (body mass indexes) over 50. some are attempting to miniaturize the robots.[16] Surgeons at the University of Illinois at Chicago College of Medicine were the first to offer robotic kidney transplantation to morbidly obese patients. have done 13 procedures (100 percent patient and graft survival with no complications). engineers and computer scientists.and so those patients have no other access to kidney transplantation and experience high mortality rates while on dialysis. New minimally invasive robotic devices using steerable flexible needles are currently being developed[33] [34] for use in prostate brachytherapy. length of hospitalization is reduced from 8. the first robotic operations at the femoral vasculature were performed at the University Medical Centre Ljubljana (UMC Ljubljana). the President of Slovenia Danilo Türk underwent robot-assisted prostate cancer treatment at the Urology Institute in Innsbruck. Slovenia.[43] Vascular surgery In September 2010. In March 2011. the University of Nebraska Medical Center has led a multi-campus effort to provide collaborative research on mini-robotics among surgeons.Robotic surgery 143 Radiosurgery The CyberKnife Robotic Radiosurgery System uses image guidance and computer controlled robotics to treat tumors throughout the body by delivering multiple beams of high-energy radiation to the tumor from virtually any direction. Mounting the radiation source on the robot allows very fast repositioning of the source. Geršak explained that the robot used was the first true robot in the history of robotic surgery.[44] There may also be a day and age where nanorobots may be inserted into peoples bloodstreams to act as general practitioners. which enables the system to deliver radiation from many different directions without the need to move both the patient and source as required by current gantry configurations. repair obstructed kidneys. just like one would play a video game.

PMC 2859140. [27] Melvin WS. [16] Finkelstein J. php?lng=en). gov/ fdac/ features/ 2005/ 405_computer. Retrieved January 19. Melvin WS. Biomed. Ellison EC. Khan MS. presented at HRS 2009: PO04-35 . nl/ nl/ nieuws/ artikel/ ?tx_ttnews[tt_news]=10041& tx_ttnews[backPid]=465& cHash=ebb243e7ff) (in Dutch). R.Robotic surgery 144 References [1] Kwoh. International Journal of Advanced Robotic Systems 1 (2): 87–92. [9] "Robot surgeon carries out 9 hour operation by itself" (http:/ / www. National Heart Centre . Virtual Medical Worlds Monthly. (Oct 2009). Dhinoja. html). robot. TU/e. 8 November 2010. F. Robotic Surgery Wins Converts" (http:/ / www. reconstruction) [11] New Robot Technology Eases Kidney Transplants (http:/ / wcbstv. gov/ pubmed/ 19735746?dopt=Abstract) [22] TCAI Press Release. . Surgical Endoscopy. com/ about. engadget. dnevnik. [10] Surgeons perform world's first pediatric robotic bladder reconstruction (http:/ / esciencenews. PMID 20428292. . Surgery. . perform. worlds. [18] Gina Kolata (February 13. Horgan S. html) . prnewswire. "Results Unproven. 27 September 2010. 2011. bladder. S.Singapore . [2] FDA: Computer-Assisted Surgery: An Update (http:/ / www. nih. Journal of Gastrointestinal Surgery 6(1): 11-16. [5] "World's First Closed-Chest Beating Heart Bypass Surgery Successfully Performed" (http:/ / findarticles. J. Sporton. 2009: http:/ / news. Retrieved January 19. [6] Robotics: the Future of Minimally Invasive Heart Surgery (http:/ / biomed. html). Journal of Healthcare Management 48 (4): 242–251. et al. Chapman WC. com/ ViewContent. Poster Session II. "Robotic prostatectomy: The new standard of care or a marketing success?". Krause KR. html). June 22.. com/ news67222790. fr/ event/ lindbergh/ index. 1055154. edu/ Courses/ BI108/ BI108_2000_Groups/ Heart_Surgery/ Robotics. nih. . Earley. Schneider C. wtb. 2010). net/ index. hoise. and Hayall. Krause KR. nytimes. 1999). Needleman BJ. 7:431-440 (http:/ / www. ncbi. si/ novice/ zdravje/ 1042434634) (in Slovene). Canadian Urological Association Journal 3 (6): 488–90.accessed July 8. physorg. M. com/ p/ articles/ mi_m0EIN/ is_1999_Oct_6/ ai_56012592/ ). 2. [13] "V UKC Ljubljana prvič na svetu uporabili žilnega robota za posege na femoralnem žilju [The First Use of a Vascular Robot for Procedures on Femoral Vasculature]" (http:/ / med. Schilling. .138(4):553-8. 1999. Djavan B (2010). 910 [26] Kypson. W. nlm.. October 6. Eckersberger E. robodoc. Baker.1097/01. [29] ROBODOC history (http:/ / www. ircad. "Robotic Applications in Cardiac Surgery". com/ vmw/ 99/ articles/ vmw/ LV-VM-11-99-1. 2009 [12] "Beter opereren met nieuwe Nederlandse operatierobot Sofie" (http:/ / w3. html) [3] McConnell. Y. 2010. "History and development of robotic cardiac surgery". Lahey Clinic. The New York Times. . Chitwood Jr. tue. Problems in General Surgery 20 (2): 20–30. Hou. Reviews in Urology 12 (1): 35–43. “Robotic” Resection of A Pancreatic Neuroendocrine Tumor. E. com/ 2010/ 02/ 14/ health/ 14robot. 30 March 2011. Schneeberger. Priest O. 2011. Goromonzi. Michler. Retrieved 10 October 2010. "ZEUS robot system reverses sterilization to enable birth of baby boy" (http:/ / www. Vats A. EP (2009).03671. Ashrafian H. 2002 [28] Melvin WS. arXiv:cs/0412055. Current status of robotic assisted pelvic surgery and future developments. com/ articles/ 2008/ 11/ 20/ surgeons. Needleman BJ. [4] Leslie Versweyveld (September 29. PMID 20019980. 35(2). EW.. [17] Gerhardus.6e.London . February 1988. Lepor H. CBS News. G.Robotic versus Manual Catheter Ablation for Atrial Fibrillation [25] R. Barts and the London NHS Trust . Taneja SS. [21] Ahmed K. Retrieved 1 April 2011. Computer–Enhanced versus Standard Laparoscopic Antireflux Surgery.sgs. D (2003). HRS 2008 [24] Barnebei et al.United Kingdom European Heart Journal ( 2009 ) 30 ( Abstract Supplement ). "Robot-assisted surgery: the future is here" (http:/ / www. Dundon JM. ncbi. Liew. IEEE Trans. Patel V. Int J Surg. 2009 . html). Ellison EC. Talamini MA. . Lessons Learned and Techniques Altered Following Early Experience of the Hansen Robotic System During Catheter Ablation of Atrial Fibrillation. Computer Enhanced Robotic Telesurgery Reduces Esophageal Perforation During Heller Myotomy. Sadri H. brown. discussion 558-9. com/ health/ da. Thomas. pediatric. S. PMID 12908224. Finlay. [14] "UKC Ljubljana kljub finančnim omejitvam uspešen v razvoju medicine [UMC Ljubljana Successfully Develops Medicine Despite Financial Limitations]" (http:/ / www. first. over. M. 2005 Oct. gov/ pubmed/ 12908224). . doi:10. [15] Estey. html) [7] "Linbergh Operation . nlm. 2003. [19] Melvin WS. Engng. Journal of Laparoendoscopic & Advanced Surgical Techniques 13(1):33-36.0000081182. Jonckheere. 153–161. L. PMC 2792423. vinci. Business Wire. Randolph (2004). . S.Singapore. [8] "Autonomous Robotic Surgeon performs surgery on first live human" (http:/ / www. RE (2003). Nagpal K. Retrieved March 11. Evaluation of 211 “Robotic” Surgical Procedures. aspx?ACCT=109& STORY=/ www/ story/ 03-03-2009/ 0004982135& EDATE [23] Natale et al.IRCAD/EITS Laparoscopic Center" (http:/ / www. M.. PI. March 3rd. . Alan P. robotic. A. com/ 2006/ 05/ 19/ robot-surgeon-performs-worlds-first-unassisted-operation). Horgan S. V. Vecht JA. fda. "Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience". 17: 1521-1524. php?full=1& id=25545& title=V_UKC_Ljubljana_prvi___na_svetu_uporabili___ilnega_robota_za_posege_na_femoralnem___ilju) (in Slovene). Richmond. [20] Talamini M. 2003. A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery.

com/ usnews/ health/ articles/ 060723/ 31robot_3. [32] Children's Hospital Center for Robotic Surgery (http:/ / www. • Lorincz A. .com/) • (http://www.ucsc. In DiGioia. sciencedaily.J. R. com/ about_us/ Specialist_Team/ Professor_Roger_Kirby.Systems Applications and Visions. R. newscientist.ncbi.ch/etech/2011/etech_0711/ind-2. 2005. Egersdoerfer. childrenshospital. S. Orlive. Robotics in reproductive medicine. Jaramaz. youtube. Heeckt. • Campbell A. Kober. Oxford University Press. Anthony M. .nih. Elsevier 2004. I presume?" (http://www. B.. ISBN 019850943X. htm/ ). co. si/ en/ vest. Mai. Fertil Steril 84:1-11. Schunk – Robot Grippers . Berlin 2007. html) [31] Siebert. ABC TV. theprostatecentre.Reduction of femoral shaft fractures in vitro by a new developed reduction robot system "RepoRobo" . 10. Picard. Springer. . .roboticsurgery. Richard M. Retrieved May 7. google. Scharf H-P. Satava (Eds. G. Slovenian Press Agency. berkeley. Blake Hannaford. Hente.Injury . Fox News TV.edu/research/ surgical_index. Dragoi. [41] "Robotic Assisted Prostatectomy" (http:/ / www. acrobot. ISBN 978-1-4419-1125-4 External links • Surgical Robotics .. org/ robotics) [33] UC Berkeley: Needle Steering (http:/ / automation.Robotic surgery [30] Acrobot Sculptor (http:/ / www. Nerlich . 14 1994 • Jacob Rosen . [42] The Prostate Centre (http:/ / www. Retrieved May 7.wikipedia. Retrieved May 7. 2003 Jun.htm) Robots are set to revolutionize healthcare ( International Electrotechnical Commission (http://en. com/ crozer/ 1818/ ). com/ releases/ 2007/ 05/ 070511203200. 127–156. aspx) [43] "President Has Prostate Tumour Removed" (http:/ / www.nlm. D. com/ article. Computer and robotic assisted hip and knee surgery. G. 2009. Klein MD. "Chapter 12 . htm) [39] "Benefits of Robotic Surgery" (http:/ / video.. S. Falcone T.com/services-procedures/) Robotic gynecological surgery in SE Michigan . Steinmann & H. com/ search-results/ m/ 22119007/ the-robot-is-in. edu/ projects/ needlesteering) [34] Johns Hopkins University: Needle Steering (http:/ / lcsr. [40] "The Robot Is In" (http:/ / www. Hesse. Schwarz MLR. Monkman & M. Larenzo xR3Nz0x Jun. Peter F.soe. com/ assets/ the-robot-surgeon) [38] Robot Provides Guiding Hand (http:/ / health. uk/ Sculptor.Wiley. Mai. Robots : From Science Fiction to Technological Revolution. protomag. php?id=1621924).iec. 2009. usnews. Branislav. 2009. Curr Opin Pediatr. • Füchtmeier. R.Santa Cruz (http://bionics. Robotics and the pediatric surgeon. 101-132.2. foxnews. Sabine.J. W. com/ videoplay?docid=-1942642524056655700& hl=en/ ). com/ watch?v=-KWsS6lPVK0) [37] The Robot Surgeon (http:/ / www.2005.davinciiobgyn. (2004-12-30).35 ppSA113-119. January 2006 (http:/ / www. Today’s State of the Art of surgical Robotics.. Journal of Computer Aided Surgery. • Daniel Ichbiah. 400) 145 Sources • Monkman. Innovative Procedure Minimizes Prostate Incontinence After Prostatectomy (http:/ / www.org/wiki/ International_Electrotechnical_Commission). Langenburg S. 31 March 2011.University of California . jhu.com.html) • "Doctor Robot. Rudolf. edu/ NeedleSteering) [35] Quick. • Dharia SP. Frederic et al.15(3):262-6. July 2011) • (http://www. htm) [36] How is Prostate Cancer Detected? (http:/ / www..) (2011) Surgical Robotics . or-live. [44] New Scientist Magazine.Total knee replacement: robotic assistive technique". • Pott PP. sta.gov/pmc/articles/PMC1356187/) • (http://www. ns?id=mg18925366. pp.Bionics Lab .

Skevos was a member of a local wealthy. also known as Skevos Zervos (Greek: Σκεύος Γεώργιος Ζερβός. a pioneer surgeon in Transplants and Telemedicine. 1875–1966) was a prominent Greek Professor. and through this they became local benefactors. Skevos dived with a traditional and multi-purpose tool called a Skandalopetra. however he had no children. when the United Nations. the local Kalymnean Government erected a life-size statue of him. Nikephoros Zervos whom in 1905 founded and established the Nikephoros High School. Skevos assisted the Greek Politician Eleftherios Venizelos who travelled to the Paris Peace Conference in regaining the Dodecanese as a part of the modern state of Greece. which was used as a steering wheel/base tied as a line of communication with the boat. His scientific research was published in the Annals of the Athens Medical Society (1946–1956). he was a paragon of the Central Dodecanese Committee and was present in Rhodes. In 1910. The data could be transmitted in any place around the world. influential. Skevos in his student years was a traditional free naked sponge diver in Kalymnos. Virtues of the system were demonstrated in several experiments conducted in plenary sessions of the Athens Medical Society at the National University of Athens. Skevos was born and raised in Kalymnos City or Pothia. His brother was a local prominent citizen called Kleanthes Zervos and his nephew was the local Christian Bishop of Kalymnos. As a posthumous honor. this surgery was officially recognised by the Russian Surgeon Serge Voronoff.Skevos Zervos 146 Skevos Zervos Skevos Georges Zervos[1] . . Skevos was the first surgeon to perform the testicle transplantation from an ape to a man. This examination was concerning auscultation and cardiac pulses. This operation was successful. distinguished and aristocratic family on the island. His system was proposed to be used on board of the Greek Ships that were offering regular service between Piraeus and New York. The communication at this time could not be afforded and the system was not used. Diving for sponges is a part of the traditional diving heritage of Greece and the Aegean Sea. who became a local and national benefactor in Greece. Skevos in his elder years married. Greece. Skevos was a Medical Professor of the School of Medicine at the National and Kapodistrian University of Athens. at the National Technical University of Athens and at the Athens Academy during the signals were transmitted from several Athens hospitals and various Greek cities. There Skevos developed a system that allowed him to examine a patient from a distance. the first high school set up in Kalymnos. On March 7 1948. returned the Dodecanese region to the then government of Greece. In front of the high school. In his honor the ’disease of the naked sponge divers’ was named ’Skevos Zervos disease’. the capital of the island Kalymnos. In 1934. In 1919. there is a statue bust dedicated to Nikephoros Zervos. The family of Skevos had built the local hospital and local orphanage on the island.

Revolution. This term was first used by Dr. in the link below • http://babel. and Peace Stanford University Press. The first Transatlantic teleaudiology test was performed in April 2009 when Dr James Hall tested a patient in South Africa from Dallas at the AAA conference.kalymnos-hotels. Gregg Givens in 1999 in reference to a system being developed at East Carolina University in North Carolina.%24b584268.org/cgi/pt?id=uc1. Hoover Institution on War. References . Since that historic event the interest in tele-audiology increased significantly.Skevos Zervos 147 Reference [1] A Catalogue of Paris Peace Conference delegation propaganda in the Hoover War Library. Volumes 1-4 p.uninet.htm http://www.agni.hathitrust.gr/History_of_Kalymnos/Kalymnos_in_the_19th_Century/index. 1926.greekedirectory.htm) • A Catalogue of Paris Peace Conference delegation propaganda in the Hoover War Library.seq=90. Balch and Keller.num=86 • • • • • Tele-audiology Tele-audiology is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice.com/articleview.com/the-Skandalopetra-Freediving-Games/2006/ http://kalymnos.87 Sources http://www. The first Internet audiological test was accomplished in 2000 by Givens. Volumes 1-4.size=125.aspx?ID=355 http://conganat. USA.edu/ICVHAP/conferencias/017/history.asp Skevos Zervos (1875-1966) and the first transplants of monkey testicles to a man (http://www. find-health-articles.view=image.page=root.com/rec_pub_15726751-skevos-zervos-1875-1966-transplants-monkey-testicles-man.

medes. the use of a remote-sensing satellite to recognize and locate physical features on Earth (for example. The United Nation Programme on Space Applications often refers to telehealth for applications linking communication systems (and for all health disciplines such as teleophtalmology. MEDES: [1] United Nation Office for Outer Space Affairs: [2] Redgems website [3] References [1] http:/ / www. php?rubrique64 . positioning systems. org/ spip. or the use of global positioning satellites (GPS) to track the migration of animals to better understand possible route of malaria transmission are all illustrations of tele-epidemiology. Earth observation. By recent usage. and field support during health emergency response. the term often designates the cross-disciplinary area linking specifically the applications of satellite technologies for earth observations (remote-sensing) to epidemiological research. oosa. etc. In this restricted sense. In this broader sense.. redgems.) and to "tele-epidemiology" in this more restricted sense. html [3] http:/ / www. biostatistics. The use of a satellite communication system to support the investigation of an infectious disease outbreak. Geographical Information Systems. External links Télé-épidemiologie. the area of tele-epidemiology is closely related to the domain of landscape epidemiology. unvienna. org/ oosa/ SAP/ comm/ tele. health surveillance.Tele-epidemiology 148 Tele-epidemiology Tele-epidemiology is a methodological and application area of epidemiology concerned with the application of space-based systems (communication.. telesurgery etc. fr/ home_fr/ telemedecine/ teleepidemiologie.) in the study of the space and time distribution of health events or disease process in populations. calculation of the NDVI index in relation to the distribution of species of mosquitoes) to assess health risk in surrounding populations. html [2] http:/ / www. the term includes applications of all space-based systems to the field of epidemiology. an industrial plant suspected of a point source contamination of air or water) or non-visible characteristics of a land area (for example.

tunstall. gov. uk) [5] Telecare Technology . fire and gas leaks. such as GPS for people with dementia or other cognitive impairments. Technological advances result in the possibility of promoting independence and for providing care from the social initiative sector.[1] Most telecare mitigates harm by reacting to untoward events and raising a help response quickly.Pill Dispenser (http:/ / www. html) [3] Tunstall . which now contemplates eCare. uk/ en/ Publicationsandstatistics/ Publications/ PublicationsPolicyAndGuidance/ DH_4115303) [2] Independent Living Telecare (http:/ / www. All play a role in maintaining people's independence and allowing people to stay in their own homes. Technologically more advanced systems use sensors.Pendant Alarm (http:/ / www. whereby a range of potential risks can be monitored. telecaretechnology. and navigation/positioning systems. Telecare refers to the idea of enabling people to remain independent in their own homes by providing person-centred technologies to support the individual or their carers. doctor or the emergency services. In the UK it is grounded in the social care framework and focuses on the meaning described above.Telephone Prompt Service (http:/ / www. co. Telecare also comprises standalone telecare which does not send signals to a response centre but supports carers through providing local (in-house) alerts in a person's home to let the carer know when a person requires attention. which then automatically calls a 24-hour monitoring centre where trained operators can take appropriate action. uk) . There are now a large range of telecare services available with some of the most well known being the pendant alarm[3] . the movement monitoring[6] and more. Some telecare. independentliving. uk/ telecare. uk) [4] Pivotell . co. telephone prompt service [5] . pivotell. The use of sensors may be part of a package which can provide support for people with illnesses such as dementia. In other countries 'telecare' may be applied to the practice of healthcare at a distance. providing the care and reassurance needed to allow them to remain living in their own homes. co. pill dispenser[4] . The meaning and usage of the term 'telecare' has not yet settled into consistent use. or people at risk of falling. When a sensor is activated it sends a radio signal to a central unit in the user's home.Movement Monitoring (http:/ / www. In 2005 the UK's Department of Health published Building Telecare in England to coincide with the announcement of a grant to help encourage its take up by local councils with social care responsibilities. co. Telecare is specifically different from telemedicine and telehealth. justchecking. These may include falls. it can refer to a fixed or mobile telephone with a connection to a monitoring centre through which the user can raise an alarm. dh. Carers of people with dementia my be alerted if the person leaves the house or other defined area. com) [6] Just Checking . such as safety confirmation and lifestyle monitoring have a preventive function in that a deterioration in the telecare user's wellbeing can be spotted at an early stage.Telecare 149 Telecare Telecare is a term given to offering remote care of old and physically less able people. In its simplest form. as well as environmental changes in the home such as floods. References [1] Building Telecare in England (http:/ / www. It is important to note that 'telecare' is not just a warning system if someone strays from home but is also preventative [2] measure whereby people are brought back and kept in the community through regular communication. whether it be contacting a local key holder.

In real-time/ live interactive teledermatology applications. Both participants must be available at the same time. Areas of application Health care management Direct consultation involves an individual with a skin condition contacting a dermatologist via telecommunication to request diagnosis and treatment. and public awareness in the same manner as telehealth and telemedicine. In a scientific publication. education. they described the value of a teledermatologic service in a rural area underserved by dermatologists. consultation and [2] treatment as well as (continuous) education. leading the individual directly to the appropriate specialist for his/her disease. telecommunication technologies are used to exchange medical information (concerning skin conditions and tumours of the skin) over a distance using audio.isft. It requires active participation of the individual and without appropriate guidance may lead to improper management.[3] Modes of data transmission Teledermatology (as telemedicine) is practised on the basis of two concepts: Store and forward (SAF) and real time/live interactive teledermatology. The dermatologists Perednia and Brown were the first to coin the term “teledermatology” in 1995. consultation. mobile applications of teledermatology gain importance. It can be as easy as sending an email with a digital image of a lesion to seek advice for a skin condition. References Teledermatology Teledermatology is a subspecialty in the medical field of dermatology and probably one of the most common applications of telemedicine and e-health. In this field. This mode generally requires more sophisticated and costly technology than used in the SAF mode. The SAF method is most commonly used in teledermatology: It involves sending (forwarding) digital images associated with (anonymous) medical information to the data storage unit of a consulted specialist. provider and individuals usually interact via live videoconferencing. Applications comprise health care management such as diagnoses. Hybrid modes also exist (combining SAF and real time applications). However. . visual and data communication. as a triage tool. It may also involve remote surgery and the use of telerobotic microscopes in dermatopathology. Advantages of this method are that it does not demand the presence of both parties at the same time and does not usually require expensive equipment.net/) Teledentistry Teledentistry is the use of information technology and telecommunications for dental care.Telecare 150 External links • International Society for Telemedicine & eHealth (http://www. it could be very valuable in the near future. Telediagnosis in the absence of personal contact with health care workers to the individual is complex.[1] In teledermatology.

e. Specialist training courses via internet are also available. Since dermoscopy is based on examination of a two-dimensional image it is very well suited for digital imaging and teledermatology. This pathologist has most likely never seen the clinical aspect of the lesion and might not have any information about the person.e.g. providing management options et cetera. The specialist then helps the GP in rendering a diagnosis. In the everyday clinical setting. These limitations can be overcome by teledermoscopically-aided dermatopathology whereby a patient history and clinical data may increase the sensitivity of diagnosis. This can be done on the web-based telediagnostic network Campus Medicus [8] Dermoscopy (dermatoscopy.[10] . Digital dermoscopic images can be taken with a digital camera attached to a dermatoscope or special video cameras suited for dermoscopy. An important field of interest of telehomecare in dermatology is the follow-up treatment of individuals with skin conditions requiring regular follow-up such as crural ulcers. Teledermoscopically-aided dermatopathology This is the transmission of crucial medical data and dermoscopic as well as clinical images to a pathologist who renders the conventional histopathologic diagnosis. These can be then assessed on a computer screen similar to conventional microscopy.[6] General medical/health information may be accessed by non-professionals. through the internet. epiluminescence microscopy) is the technical field of using an epiluminescence microscope for viewing skin lesions in magnification in-vivo. Crural ulcers are a common skin condition that needs follow up visits up to twice a week demanding significant time commitments by the individuals in addition to causing a financial burden on the health care system. such as individuals affected by a skin condition. They are also able to join peer support groups with others affected by the same condition. Teledermatology can help to reduce the time and costs involved in the follow-up of such conditions. skin biopsies are taken by the physician directly responsible for the individual and are assessed by a dermatopathologist. computer based training and Web applications in this field principally aimed at medical students. melanoma). particularly in dermoscopy. and their relatives. allowing the pathologist to maneuver around the image and view every part of the slide at any magnification.[4] Home telehealth/telehomecare involves an individual with a chronic condition being examined and managed remotely at home.[7] Domains with special interest Teledermoscopy In teledermoscopy.[5] 151 Education and information Medical education/continuous education are a major advantage of telemedicine/e-health. the FotoFinder.[9] Virtual slides are made by digitally scanning an entire glass slide at a high resolution and then sending the images to a storage system.Teledermatology Specialist referral is a major area of application in teledermatology A general practitioner (or other medical professional) that sees the individual consults a specialist/ specialised centre via telecommunication in order to get a second opinion. Numerous universities offer online courses. digital dermoscopic lesion images (with or without clinical images) are transmitted electronically to a specialist for examination.. In the latter method (SAF) a rather new development is the introduction of virtual slide systems (VSS). It is particularly useful in the early detection of malignant skin lesions (i. Teledermatopathology Teledermatopathology is the transmission of dermatopathologic images either in real-time with the aid of a robotic microscope or using a store-and-forward system (transmission as a single file).

e. Wurm R. for instance) uses wireless or mobile equipment[11] (i. handheld devices). fcgi?artid=1868781& blobtype=pdf [14] Kaliyadan et al. com Massone et al. 2009 Indian J Dermatol Venereol Leprol References • R Wootton R. Asian studies have fewer cases referred based on the suspicion [14] of melanoma. org http:/ / www. PLoS Med 2005. nih. referral based on the severity and character of their skin condition). Soyer HP. vitiligo. dermnetnz. 2005 Roy soc of med press. Royal Society of Medicine Press Ltd. 130-133 • Perednia DA. (i. org/ icot/ sigtelederm. Oakley A: Teledermatology. Unlike in western studies where pigmented lesions suspicious of melanomas are one of the most referred cases for teledermatology (with or without teledermatoscopy).: Teledermatology: one application of telemedicine.The type of cases suited for teledermatology is a topic. gov/ picrender.org/10. Chimenti S. JDDG 6:106-12. atmeda. Argenziano G: telederm. 2002 • Burg G. irritant dermatitis. which requires more studies. htm Wooton et al. in contrast to conventional stationary telemedicine platforms. Dong H.see http://dx. Some studies have observed that eczema and follicular lesions were diagnosed with relatively more certainty. Fezal Ozdemir F. 2(4): e87 .while in some other studies it was seen that diagnoses were made with more certainty in cases like viral warts.Teledermatology Additionally it has been shown that provision of such data may improve the level of diagnostic confidence held by the assessing dermatopathologists. Burg et al. Arch Derm see http:/ / www. and superficial bacterial and fungal infections. mobile teledermatology seems to be especially suited for patient filtering or triage. telederm.e. Footnotes [1] [2] [3] [4] [5] [6] [7] [8] [9] http:/ / www.doi. 83(1): 42–47 • Wurm EM. Hofmann-Wellenhof R. org/ Binder et al. 2006 e&i [13] http:/ / www. 2008. handyscope. Massone C. 2007 JDDG.P. Brown NA. In order to facilitate access to medical advice and enable individuals to play a more active role in managing their own health status. (2005): Teledermatology In: Frisch P.[12] [13] Suitability of cases for Teledermatology Not all cases are suitable for teledermatology. Hofmann-Wellenhof R. Brown 1995 Bull Med Libr Assoc see http:/ / www. at/ IDD see http:/ / www. Bull Med Libr Assoc. mobile phones. Gabler G. Skin Diseases in Europe. 152 Mobile Teledermatology Mobile telemedicine is a system in which at least one participant (the person seeking advice or the doctor.: EDF White Book. Soyer H. medunigraz. herpes zoster.: Telemedizin und Teledermatologie: Vergangenheit Gegenwart und Zukunft. . pubmedcentral. 2007 Human Pathology [10] Bauer et al. Wurm et al. Travellers who develop skin lesions as well as doctors who are on the move in hospital/non-hospital area can benefit from this new development in teledermatology. acne vulgaris. Another possible practical application is for follow-up of individuals with chronic skin conditions mentioned above (see home care). 1995. 2006 Br J Dermatol [11] http:/ / www. net [12] Ebner et al. campusmedicus. 2005 Teledermatology Perednia. Berlin. 2007 • Soyer HP.org: Freely Available Online Consultations in Dermatology. Burgdorf W.

While telecommunications have been used for decades to provide some mental health services (usually on an emergency basis or for experimental purposes). "PMID 14673291" • Kaliyadan F. Hofmann-Wellenhof R. Asgari M. Arch Dermatol.2:159-167. Žgavec B. Leinweber B. typically as a result of geographic isolation. Soyer H P.155(3):546-51 • Scheinfeld N. Okcu A. Metzler G. Salmhofer W. Hofmann-Wellenhof R. Ferrara G. Zelger B. Genis P. Mashayekhi V. org . it was only in the 1990s that telemental health care services truly came into their own.Teledermatology 1371/journal.: Feasibility and diagnostic agreement in teledermatopathology using a virtual slide system. wide-scale implementation remains dependent on policy and funding initiatives although the outlook remains positive. Rongioletti F. Despite the early success of telemental health care services however. 2007. will likely require considerable development to be made practical. Bugatti L.pmed. Lozzi G P. and providing direct mental health care services through two-way interactive systems. Gabler G. Kerl H. videoconferenced consultations on routine and urgent mental health cases using a "virtual" case management team. * A. One of the most controversial telemental health care applications is providing treatment services over the Internet directly which. 2006. Wurm EM. Evaluating Patient Acceptance of a Teledermatology Link. Canzonieri V. 4:148-151 • Massone C. Vassilaki I. Blum A. tmhguide. Gabler G.75:32-5. Janjua S.143(12):1511-4. Leinweber B. Massone C. Indian J Dermatol Venereol Leprol 2009. 38(4): 546-554 • Bauer J. Soyer HP. Venkitakrishnan S. Kerl H. 2007 Dec. Kodama K. Di Stefani A.: Mobile Teledermatology coming of age. Garbe C.: Teledermatological monitoring of leg ulcers in cooperation with home care nurses.: Correlation with digital dermoscopic images can help dermatopathologists to diagnose equivocal skin tumours. 153 Telemental Health Telemental Health is the use of telecommunications technology to provide mental health services to individuals in communities or locations that are underserviced. Skinmed. 2006. Long H. Fisher M. Soyer HP. e & i. Leitz N.0020087 • Binder B. External links • Telemental Health Guide [1] References [1] http:/ / www. Human Pathol. Hofmann-Wellenhof R. Soyer HP. 2003. • Ebner C. Mehregan C. BoldrinI R. while showing early promise. Examples of telemental health services include providing health workers in remote areas with continuing education on mental health topics. Teledermatology: Clinical case profiles and practical issues. Lozzi GP. Br J Dermatol. Cerroni L. Dietz K.

and has many points of contacts with other medical and non-medical applications. Using telenursing. are also still largely unsolved and difficult to address. such as neural degenerative diseases (Parkinson's disease. an increase in the number of aging and chronically ill population. which are staffed by registered nurses who act as case managers or perform patient triage. . Alzheimer's disease. [Needs source] A common application of telenursing is also used by call centers operated by managed care organizations.. As a field it is part of telehealth. For example. or between any number of nurses. such as telediagnosis. congestive heart disease. or disabilitating diseases. Legal. etc. ethical and regulatory issues. and to keep patients out of hospital. the care of wounds. interstate and intercountry practice of telenursing is forbidden (the attending nurse must have a license both in her state/country of residence and in the state/country where the patient receiving telecare is located). etc. ostomies. telemonitoring. nursing teleconsultations. Still other applications of home care are the care of patients in immediate post-surgical situations. videophone. one nurse can “visit” 12-16 patients in the same amount of time. may stay at home and be "visited" and assisted regularly by a nurse via videoconferencing. small or sparsely populated regions. teleconsultation. Telenursing can also involve other activities such as patient education. examination of results of medical tests and exams. or live in remote or difficult to reach places. A greater degree of job satisfaction has been registered among telenurses. one nurse is able to visit up to 5-7 patients per day. etc. In addition. ALS). ethical and regulatory issues Telenursing is fraught with legal. there are many considerations related to patient confidentiality and safety of clinical data. information and counseling as a means of regulating patient access and flow and decrease the use of emergency rooms. diabetes. etc.Telenursing 154 Telenursing Telenursing refers to the use of telecommunications and information technology for providing nursing services in health care whenever a large physical distance exists between patient and nurse. rural. handicapped individuals. patients who are immobilized. telenursing may help solve increasing shortages of nurses. Legal issues such as accountability and malpractice. and the increase in coverage of health care to distant. to reduce distances and save travel time. In many countries. as it happens with telehealth as a whole. citizens who have chronic ailments. Among its many benefits. internet. etc. Telenursing is achieving a large rate of growth in many countries. and assistance to physicians in the implementation of medical treatment protocols.[1] Applications One of the most distinctive telenursing applications is home care. such as chronic obstructive pulmonary disease. due to several factors: the preoccupation in driving down the costs of health care. In normal home health care.

American Nursing Association.org/news/selected2003.findarticles. com/ news/ item.com/p/articles/mi_qa3689/ is_199708/ai_n8760283). IOS Press.Telenursing Working Group • • • • .html). Telenursing (http://www.net) .asp?path=articles& article=telenursingLicensure_gw_tie02.htm) External links • • • • • • • • • Post discharge follow-up calls (http://www. htm#nursing). Telehealth: Are you at risk? (http://www. healthcontactpartners.xml).org/public/news/res/Telenursing Paper. • Textbook in Health Informatics: A Nursing Perspective. International Council of Nurses. TeleNurse First. By Charles C Sharpe.org/articles/article. International Society for Telemedicine & eHealth (ISfTeH) (http://www.state.com/Nursing/Telenursing/). Telenursing and Licensure (http://www.com/).htm#nursing) and Telemedicine Applications in Telenursing 2004 (http://www. 15 June 2005.htm) By Georgia A. Telehome Care Clinical Guidelines^ (http://www.org/news/selected2004.htm). Roy L. Nurse Triage site specializing in personalized health information and support (http://www. 2002. International Council of Nurses. cfm?ID=1263). eHealth Insider website.ana.ch/bookshop. 2002.icn. 280 pg. Edited by J. August 1999. May. retrieved 2009-04-04. AllHealth.telenursefirst.icn. 2001. Telenursing Fact Sheet (http://www.org/news/list. e-health-insider.atmeda.allhealthnet.pdf).ch/matters_telenursing. AFIP.atmeda. Says International Survey (http:/ / www.htm). Martin. Nursing. New nursing technologies: What you need to know (http://www. 40 pg. A.atmeda.ncsbn. Mantas.com/) The National Council of State Boards of Nursing Position Paper on Telenursing: A Challenge to Regulation (http://www. (http:// www.net Telehealth: Issues for Nursing (http://www.telemed.afip. By Glenn W. • International Standards for Telenursing Programmes. Wachter.bne. Powerpoint presentations during the Annual Conference of the American Telemedicine Association. 2000. 504 pg. Hasman.us/telenurse.isft.Telenursing 155 References Notes [1] Nurses Happier Using Telecare.tx. By Simpson. Interstate Licensure for Telenursing (http://tie.htm). Bibliography • Telenursing: Nursing Practice in Cyberspace.org/readroom/tele2. Nursing Risk Management 2002. Telemedicine Applications in Telenursing 2003 (http://www. The National Council of State Boards. TIE.org/Departments/legalmed/jnrm2002/georgia. Board of Nursing Examiners. August 1997. American Telemedicine Association.

A pathologist. Expense is an issue with real-time systems and virtual slide systems as they can be costly. did not require that a pathologist have physical or virtual “hands-on” involvement is the selection of microscopic fields-of-view for analysis and diagnosis. but performance may suffer if employed during periods of high network traffic or using the Internet proper as a backbone. Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. at a distance. for education. illumination. magnification. and for research. Although digital pathology imaging. Weinstein is known to many as the "father of telepathology". However. and field of view—at will.[6] In Norway. Weinstein. Static image systems have benefits of being the most reasonably priced and usable systems.Telepathology 156 Telepathology Telepathology is the practice of pathology at a distance.[5] Dr.[4] Weinstein was also granted the first U.S. analog telepathology imaging is still used for patient services in some developing countries. there are drawbacks to each. coined the term “telepathology” in 1986. Real-time systems perform best on local area networks (LANs). Ronald S. introducing their own workflow challenges in the clinical laboratory. Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989. Another form of real-time microscopy involves utilizing a high resolution video camera mounted on a path lab microscope to send live digital video of a slide to a large computer monitor at the pathologist's remote location via encrypted store-and-forward software. and virtual slide systems. decades later. Types of telepathology systems Telepathology systems are divided into three major types: static image-based systems.[1] [2] Performance of telepathology requires that a pathologist selects the video images for analysis and the rendering diagnoses. The use of “television microscopy”. While real-time and virtual slide systems offer higher diagnositc accuracy when compared with static-image telepathology. virtual slide digital files are relatively large. . It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis.[3] He. Telepathology has been successfully used for many applications including the rendering histopathology tissue diagnoses. published the first scientific paper on robotic telepathology. and Asia. and his collaborators. the forerunner of telepathology. high throughput virtual slide scanners (those producing one virtual slide or more per minute) are currently expensive. Storing and simultaneously retrieving large numbers of telepathology whole slide image files can be cumbersome. Virtual slide systems utilize automated digital slide scanners that create a digital image file of an entire glass slide (whole slide image). using a browser. An echo-cancelling microphone at each end of the video conference allows the pathologist to communicate with the person moving the slide under the microscope. Either an analog video camera or a digital video camera can be used for robotic microscopy. real-time systems. A number of clinical telepathology services have benefited many thousands of patients in North America. With real-time systems. This file is stored on a computer server and can be navigated at a distance.. the consultant actively operates a robotically controlled motorized microscope located at a distant site—changing focus. Real-time robotic microscopy systems and virtual slides allow a consultant pathologist the opportunity to evaluate histopathology slides in their entirety. Virtual slide telepathology is emerging as the technology of choice for telepathology services. In an editorial in a medical journal. from a distance. Europe.M. education. patents for robotic telepathology systems and telepathology diagnostic networks. over the Internet. and research.[7] This is still in operation.[8] Digital imaging is required for virtual microscopy. including virtual microscopy. They have the significant drawback in only being able to capture a selected subset of microscopic fields for off-site evaluation. often exceeding one gigabyte in size. Also. is the mode of choice for telepathology services in developed countries.D.

et al. References Footnotes [1] {{Citation | last = Weinstein | first = RS | author-link = | last2 = Graham | first2 = AM | last3 = Richter | first3 = LC | last4 = Barker | first4 = GP | last5 = Krupinski | first5 = EA | last6 = Lopez | first6 = AM | last7 = Yagi | first7 = Y | last8 = Gilbertson | first8 = JR | last9 = Bhattacharyya | first9 = AK | title = Overview of telepathology. Telepathology: current status and future prospects in diagnostic histopathology. Lian. "Remote frozen section service: A telepathology project to northern Norway. Henderson. G. K. Weinstein. Carpenter. subspecialty pathology expert diagnoses. education. B. Richter. Benefits of telepathology include providing immediate access to off-site pathologists for rapid frozen section diagnoses. FR (2009). AK. Sandberg GD. and skin pathologist ([dermatopathologist]). A. Engum. CD. et al. Kiehl. LC. Beltrami CA. "Feasibility and diagnostic agreement in teledermatology using a virtual slide system". Lozzi.". RS. nervous system pathologist ([neuropathologist]). et al.". Haugen. In: Telepathology (Springer-Verlag Berlin Heidelberg): 225–229 [3] Weinstein. "Telepathology: Telecommunications. Electronic Education and Publication in Pathology". 15:1197–1204. "Competency assessment of residents in surgical pathology using virtual microscopy. Leinweber. Ilaalagan. Diagnostic accuracy of an international static-imaging telepathology consultation service. RS. "Telepathology and the networking of pathology diagnostic services. TC.Telepathology 157 Uses and benefits of telepathology Telepathology is currently being used for a wide spectrum of clinical applications including diagnosing of frozen section specimens. S. Clarke. VSV Interdisciplinary Medical Publishing (Berlin): 1–193 [9] Evans. B. Anal Cell Pathol 2000. DL. Mod Pathol 2002. Leaven. NY: 1–186 [6] http:/ / www. Ghazarian. Arch Path Lab Med 111: 646–652 [5] Kayser. Chetty. Hum Pathol 40: 1112–1121 [14] Bruch. Choi. Hum Pathol 17: 443-434 [4] Weinstein. "Virtual microscopy in pathology education". BR. Hum Pathol 40: 1129–1136 [12] Massone.. Use of robotic telepathology for frozen-section diagnosis: a retrospective trial of a telepathology system for intraoperative consultation. Kreiter. F. Dennis T. • Frierson HF Jr. Start RD. S et al.[9] primary histopathology diagnoses. Hum Pathol 38: 546–554 [13] Dee. Bloom. for immediate consultations. research and education. B. 28:17-21. R. Kumar S. "Prospect for telepatholgy (Editorial)". Soyer. Wagenman. Rinde. KJ.". H. Croul. Szymas. • Kaplan KJ. BE. • Halliday BE. ed. Weinstein. Frozen-section diagnosis by wireless telepathology and ultra portable computer: use in pathology resident/faculty consultation. "Telepathology: An Audit". "Digital pathology virtual slide technology in tissue-based diagnosis.". Scott. Another benefit can be gaining direct access to subspecialty pathologists such as a kidney pathologist (renal pathologist). 41:91-109. Hum Pathol 1991: 514–518 [8] Kayser. php?s=8942 [7] Nordrum.[13] compentency assessment. Histopathology 2002. Grasso. JB et al. Kerr. Bhattacharyya AK.. K. Dee. FR (2009). . Burgess JR. HP. [10] [11] [12] second opinion diagnoses. Hum Pathol 40: 1092-1099 [11] Graham. JT. Hum Pathol 2007.. RS (1986). BA. 38:1330-4. TH. J.[14] and research.". E`. "Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a 12-year experience. GP. LL. SE. Recla. "Virtual slide telepatholgoy for an academic teaching hospital surgical patholgoy quality assurance program. virtual microscopy and whole slide imagining: Prospects for the future. TR. Hum Pathol 1997. Galgano MT.". 21:127-34. S (2009). I. Springer. Bhattacharyya. Hum Pathol 40: 1122–1128 Bibliography • Cross SS. C. Gabler.". Current experiences with internet telepathology and possible evolution in the next generation of Internet services. | journal = Hum Pathol | volume = 40 | pages = 1057–1069 | year = 2009 [2] Kumar. KM. union. LA. DiStefani. BL. et al. BP. AR. "Primary frozen section diagnosis by robotic microscopy and virtual slide telepathology: the University Health Network experience. edu/ N/ DS/ s. Hum Pathol 40: 1069-1081 [10] Dunn. AJ. Ordonez. Graham AR. Dunn BE (editors). Molnar. De Young. • Della Mea V.

De Vico G. Berlin. Telepathology for patient care: what am I getting myself into? Adv Anat Pathol 2010. 26:194-205. • Weinstein RS. 111:646-652. Ultrasructural telepathology: remote EM diagnostic via Internet.com/) • American Telemedicine Association (http://www. Springer.pathinformatics.com/index.Telepathology • Krupinski E. Rozek LS: Telepathology and the networking of pathology diagnostic services.Accelerated Digital Telepathology . Arch Anat Cytol Pathol 1995. Berlin. Rozek LS. • Weinstein RS. Barker GP. Bloom KJ. Springer. 43:253-256. Hum Pathol 2001.org/) • Digital Pathology Association (http://www.28:1–7. 2009.typepad. editors. • Williams S. 132:743-4.cfm?pageid=1) • College of American Pathologists (http://www. Telepathology. Remote frozen section service in Norway. Kaplan KJ. 2009. • Nordrum I. 40:1137-1142.portal) • United States and Canadian Academy of Pathology (http://www. AccelPath. Descour MR.americantelemed. • O'Malley DP. Virtual slide telepathology workstation-of-the-future: lessons learned from teleradiology. Arch Path Lab Med 1987. 2009. Krupinski EA. Graham AR. Hum Pathol 1997. • Krupinski EA. Practical applications of telepathology using morphology-based anatomic pathology. et al.pathologyinformatics.edu/) (a national pathology informatics meeting's website with archived presentations and contact information for faculty) • Pathology Visions (http://www. Arch Pathol Lab Med 2008. Bhattacharyya AK. 158 External links Informative sites or links • Accelpath . Bloom KJ. Springer. • Weinstein RS: Prospects for telepathology. Overview of telepathology. Weinstein RS.org/apps/cap. Semin Diagn Pathol 2009. et al. • Weinstein RS.uscap. Becich MJ. Gilbertson JR. Bhattacharyya AK. New York. 14:179-204. Liang C. Practical pathology informatics.org/) • Digital Pathology Blog (http://www.pitt. Dunn BE. Telepathology: a ten-year progress report. et al.Digital Pathology and Telepathology solutions (http://www. Graham AM. • Maiolino P. 17:130-49.org/home. • Schroeder JA.htm) . Progress in telepathology: System implementation and testing. Hum Pathol. • Weinstein RS.cap. 2006:265-286. 17:433 434. 32:1283-99. Eide TJ. Telepathology in veterinary diagnostic cytopathology. Erps KA. Telepathology overview: from concept to implementation. Human Path 1986. • Leung ST. 6:63-87.pathologyvisions. Henricks WH. Richter LC. editors.digitalpathologyassociation. In: Kumar S.com/) • APIII (http://www. (Editorial). Dunn BE. 6:63-69.org/i4a/pages/index. In: Kumar S. Lopez AM.tissuepathology. 40: 1057-1069. Medicolegal aspects of telepathology. virtual microscopy and whole slide imagining: Prospects for the future. • Sinard JH.html) (a national digital pathology conference) • Association for Pathology Informatics (http://www. Yagi Y. Advances in Path Lab Med 1993. Hum Pathol 2009. Telepathology.

or advise them where to find relevant. “telepractice nurses” or “consulting nurses”. Telephone triage Telephone triage is defined as the management of patient health concerns and symptoms via a telephone interaction (telecommunications) by “advice nurses”.com/content/hgjhbq80evk7x8un/) • Feeding OWL: Extracting and Representing the Content of Pathology Reports (http://acl. metapress. Telehealth is defined as the delivery of health related services and information via telecommunications technologies and is now the umbrella term describing all the possible variations of healthcare services using telecommunications. “telenurses”. AIDS counseling and child abuse hotlines to 911 and telemetry monitoring. and making safe. Telephone triage nurses utilize protocols or guidelines.upenn.php?page=wszystkie_slajdy) • Digital Pathology Imaging Group at University of Pittsburgh Medical Center (http://telepathology. large call centers and hospices.cmu. and appropriate dispositions—all by telephone. . from “chest pain to chicken pox”. and physicians' offices for years has evolved into a new nursing subspecialty called telephone triage. Telephone triage involves ranking clients' health problems according to their urgency.edu/W/ W04/W04-0607. They might counsel or perform crisis intervention for a threatened suicide. and seasonal flu and fevers. in paper or electronic format to help sort symptoms. possible allergic reactions. and first results (http://portal.edu/Courses/Digital_Path/) • Holycross Cancer Center (Poland. current health information.flagshipbio.edu/ ). In one 8-hour shift. Nurses may also direct clients to obtain a second medical opinion.kielce. Kielce) Pathomorphology Department virtual slides (http://www. testbed. What was traditionally done informally in emergency rooms. medication questions.com/content/ 17k5vbjjawljmrd7/) • Digital medicine in the virtual hospital of the future Academic digital pathology sites • Welcome to Digital Pathology at Brown Medical School (http://www. clinics.Telepathology 159 Links to articles • New Developments in Digital Pathology: from Telepathology to Virtual Pathology Laboratory (http://iospress.upmc.org/citation.1282636&jmp=cit&coll=GUIDE&dl=GUIDE&CFID=72380999& CFTOKEN=86827451#CIT/) • Guidon Blog on whole slide image analysis (http://www. It can also be considered an aspect of telemedicine and telehealth utilizing an older form of technology (telephone lines). cfm?id=1282562.C library that provides a simple interface to read whole-slide images (http://openslide. and takes place in settings as diverse as emergency rooms.cs.springerlink. chest pain.acm.pl/index.pdf) • Organizing Knowledge in a Semantic Web for Pathology (http://www. “telepractitioners”. Telephone triage nurses have a range of titles: “advice nurses”. telepatologia.brown. It is thus an aspect of telenursing.edu/) Other relevant sites • Digital pathology: DICOM-conform draft. a telenurse may field 60-80 telephone calls—one every 6 – 10 minutes—painstakingly assessing headaches. educating and advising clients. Uses of Telephone Triage Triage means a sorting out.com/blog/) • OpenSlide . It may include everything from disease management.ldc. newborn rashes.onkol. effective.

rules of thumb and context as major strategies to make decisions. and emergency departments. Telephone triage is a high-risk area of practice. college health centers. EMDs and firefighters — all high stakes activities. poison centers. Protocols Protocols or guidelines are essentially“ standing orders” for nurses for the assessment and management of a range of symptoms. The goal should be to mimic how the brain naturally solves problems in "real world" situations. others as decision support tools.Telephone triage Telenurses practice in a range of settings. Protocols may be in paper or electronic format. In the early days. “urgency” because calls must be processed within a brief time frame — usually 6–10 minutes average. from large medical call centers. Women’s Health and Family Practice specialties. Generally. physicians performed telephone advice. In fact. rules of thumb and context should be incorporated into all elements of any decision support system as well as telenurse training and forms. disease management call centers. Thus. training and guidelines are essential to support the nurse. 160 Research on Telenurse Decision-making Telephone triage — the safe. physician’s offices.” (Patel. the term "telephone triage" appeared on Medline indexes—a formal acknowledgement of this new subspecialty.. telephone triage has been compared to the work of air traffic controllers. Relying on protocols to take the place of formal instruction can be a mistake. Initially. described how a group of RNs working in an emergency department setting made “real world” decisions in telephone triage. She discovered that these nurses used pattern recognition. A wide variety of similar systems have sprung up over the last decade. In new research. experience and specialized training combined with strong decision support tools are the best approach to telepractice. primarily because nurses cannot see the patient with whom they are speaking. 1996) “Uncertainty” because decisions are often made based on partial or inaccurate information. physicians were quick to install telephones in their offices. clinics. In 1990. The research on nurse decision-making by Patel and other experts has important implications for protocol design. Some developers see protocols as decision-making tools. and over reliance on a decision-making tool can lead to mistriage. gowri Brief history Informal telephone triage is as old as the telephone itself. seeing that these new tools could help their practices.D. Potential problems and misunderstandings can be averted through instruction in the correct and safe operation of the protocols and documentation form. effective and appropriate disposition of health related problems by RNs — always involves “decision-making under conditions of uncertainty and urgency. The strategies of pattern recognition. one of the first calls made by Alexander Graham Bell was for assistance following a battery acid burn (Grumet. . several health maintenance organizations began utilizing nurses to give telephone advice—in the role that physicians once served. hospices. Ph. Telephone management has always comprised a large percentage of several physicians' practices – pediatrics. 1979). This is an area of controversy in this new field. Vimla Patel. In the 1970s.

Albany. hospital or in the emergency department setting. mature and patient. Orientation addresses an overview of the field and the nursing role. telephone triage had few job qualifications—most nurses were felt to be qualified. with little or no bedside decision-making experience will require time to build up these skills. The final step in formal education will be accreditation—not yet a reality—but anticipated within the next five to ten years. (2000) Telephone Triage: Past. Aspen Publishers. there are exceptions to this rule. In the 90’s. “shadowing”. The new RN. the nursing process. lecture. Delmar Thomson. protocol use and medical legal aspects. formal training programs emerged.Q. Certainly. Gaithersburg. preceptor programs and role-play of mock calls. interview and documentation skills. Currently.Telephone triage 161 Telephone triage formalization In the early 70’s. Role-play is an excellent method to cumulatively integrate the new skills and tools (protocols and documentation form) and to simulate the actual task. five to ten year’s experience provides the foundation necessary for good decision making by phone—a considerably more difficult task. audiotapes analysis/critique. Since the 70’s most training was “on the job”. NY. There must be a good match between the work—high volume. References • Wheeler. written exercises in interview and documentation. Computer literacy is desirable. 1980). Thus. Present and Future www. However. essentially “reinventing the training wheel” with each new employee. MD. teach one”. As the field evolved into a recognized subspecialty. do one. since research demonstrates that individuals learn differently and learning happens best when all senses are utilized. Two types of training and education currently exist—in-house and national conferences. • Wheeler. history taking.com . Whether in the clinic. dedication to service). personable. Preceptors can support and counsel the new advice nurse in the first three to six months. Telephone triage requires excellence in interpersonal skill or “telephone charisma” (articulate.teletriage. essentially “see one. discussion. Practice and Protocol Development. the best training programs have a minimum of 40 hours. RNs are considered the best choice not only because they are autonomous professionals. Each new advice nurse had to learn through trial and error. J. resourceful. managers discovered that the high-stakes. S. S.Q. communication aspects. (1993) Telephone Triage: Theory. while increased experience results in more appropriate decisions.Q. S. but they are also “the lowest paid person who can safely do the job” (Schmitt. office. and Windt. high-pressure decision making under conditions of uncertainty and urgent—and the practitioner’s temperament—calm. we know that less experience results in over triage (Patel. In house trainers employ a variety of training methodologies. Since 1994. National conferences provide a broad perspective and opportunity to network and problem solves. (2003) Telephone Triage Protocols for Adult and School Age Populations with Women’s Health and Infant/Child Protocols. In-house training techniques include reading. conferences on telephone triage have provided a national forum for manager and practitioner alike to network and share experience and expertise. • Wheeler. 1996). high stress work required seasoned RNs with many years of “bedside” decision-making experience. new graduates were not considered the best candidates for the task of telephone triage.

[3] A recent innovation is the development of the subspecialty of emergency psychiatry via telemedicine. substance abuse treatment facilities. depressed. Hilty DM. telepsychiatry. uk/ Home/ ForensicTP/ tabid/ 332/ Default. Telenurse First Teletriage consulting site by Sheila Wheeler [2] Teletriage consulting site by Carol Rutenberg [3] Association of Telehealth Service Providers [4] American Academy of Ambulatory Care Nursing (AAACN) [5] Nurse Triage site specializing in personalized health information and support [6] References [1] http:/ / www. and home-based telepsychiatry. Retrieved 07-10-2010. "Forensic Telepsychiatry" (http:/ / www. [3] Surface. doi:10. violent.1016/j. "Country Comfort: Mental Health Telemedicine in Rural America". com/ [3] http:/ / www. asp [5] http:/ / www. community mental health centers. because of its need for only a good videoconferencing facility between the patient and the psychiatrist. . especially for follow-up. David (January/February 2007). There are [1] sub-specialties like forensic telepsychiatry.Psychiatr Serv" (http:/ / psychservices..013. healthcontactpartners. com/ Telepsychiatry Telepsychiatry is the application of Telemedicine to the field of Psychiatry.psychiatryonline. "Emergency management guidelines for telepsychiatry".S. It has been the most successful of all the telemedicine applications so far. Yellowlees P (2007). In the U. Psychservices. PMC 1986661. . . atsp.[5] References [1] Jardine. and there are a large number of grass roots telepsychiatry programs springing up in the United States and elsewhere to address this problem. nhs.org. manic. pay equally for telepsychiatry as for face to face psychiatric medication management visits. org/ homepage. and acutely anxious patient. PMID 17484936.[2] whereby the patient is in his own home or office. homidical.Ikelheimer 59 (10): 1218 .10. psychiatryonline. chcf. Retrieved 2010-07-10. pdf) (PDF). accessing the physician via webcam and high-speed internet.1176/appi. Medicare and the various state Medicaids. Retrieved 2010-07-10.ps. org/ cgi/ content/ full/ 59/ 10/ 1218-a). jails. com/ [2] http:/ / www. doi:10.01. org/ ~/ media/ Files/ PDF/ T/ TelepsychiatryProgramsED. . psychotic. slam. teletriage. aspx) (Electronic). telenursefirst.59. org/ [6] http:/ / www.1218-a. [5] "Telepsychiatry in the Emergency Department: Overview and Case Studies" (http:/ / www. and schools.genhosppsych. aaacn.Telephone triage 162 Resources • • • • • • Post discharge follow up calls [1]. [2] "Treatment of Opioid Dependence via Home-Based Telepsychiatry . as well as nearly all private health insurance providers.2007. com/ [4] http:/ / www. telephone-triage. Social Work 7 (1): 28–31 [4] Shore JH. Another common application is for patients in rural or underserved areas. Research is currently on-going to develop the unique guidelines required to provide consultation for emergency psychiatric patients such as the evaluation of the suicidal. in which the patient is typically an inmate accessing the psychiatrist who is from a supporting institution.[4] Emergency telepsychiatry services are being provided to hospital emergency departments. Richard. General Hospital Psychiatry 29 (3): 199–206.

Frueh BC (December 2003).doc) American Association for Emergency Psychiatry (http://emergencypsychiatry. Telemedicine Journal and E-health 10 (4): 455–8.org/europe/links/telepsych.com) JSA Health Telepsychiatry (http://www.1089/tmj. Teleradiology improves patient care by allowing Radiologists to provide services without actually having to be at the location of the patient. Yellowlees PM. Canadian Journal of Psychiatry 49 (1): 12–23.asp) A feasibility study (http://www. such as x-rays.10. doi:10. 03.455. PMID 15689650.org) (http://www. • Monnier J. Monnier J. Pediatric Radiologist. wide area network (WAN). "Telepsychiatry treatment outcome research methodology: efficacy versus effectiveness". or over a local area network (LAN). Knapp RG. • Frueh BC. CTs. Psychiatric Services 54 (12): 1604–9.telelive. . PMID 14645799.54.2004.tmhguide. Monnier J. or to other locations around the world. Grubaugh AL.feasibility.1176/appi. Elhai JD. and MRIs.jsahealthmd.Telepsychiatry 163 Further reading • Frueh BC. and image compression are often used in Teleradiology. Nesbitt TS (January 2004). Specialized software is used to transmit the images and enable the Radiologist to effectively analyze what can be hundreds of images for a given study. Teleradiology allows for trained specialists to be available 24/7. doi:10. images can be sent to another part of the hospital.1604. This is particularly important when a sub-specialist such as a MRI Radiologist. "Telepsychiatry treatment outcome research methodology: efficacy versus effectiveness". Telemedicine Journal and E-health 10 (4): 455–8. Knapp RG (2004). voice recognition. telephone lines.org) Voyager Telepsychiatry (http://www.telepsychiatry. Urness D.455. Through Teleradiology.org) http://www. Grubaugh AL. Teleradiology is a growth technology given that imaging procedures are growing approximately 15% annually against an increase of only 2% in the Radiologist population.10. External links • • • • • • • • Telemental Health Guide (http://www.1089/tmj.slam.com) Teleradiology Teleradiology is the transmission of radiological patient images. "Clinical and educational telepsychiatry applications: a review". since these professionals are generally only located in large metropolitan areas working during day time hours. "Recent advances in telepsychiatry: an updated review".asp A review on the effectiveness Some related links (http://telemed.12.08. Marks SL.telepsychiatry. doi:10. Technologies such as advanced graphics processing. Neuroradiologist. Teleradiology utilizes standard network technologies such as the internet.2004. Elhai JD. PMID 15689650. PMID 14763673.cpa-apc. Knapp RG (2004).nhs. • Hilty DM.version. or Musculoskeletal Radiologist is needed.ps.uk/Portals/9/douments/final.org/publications/archives/Bulletin/2003/october/hilty. from one location to another for the purposes of interpretation and/or consultation.

These circumstances spawned a post dot. Teleradiology Final Reports can be provided for emergent and non-emergent studies. Phone calls with any critical findings are signs of quality services. or more. Teleradiology can be available for intermittent coverage as an extension of practices and will provide patients with the highest quality care. a night. Also State laws governing the licensing requirements and medical malpractice insurance coverage required for physicians vary from state to state. The connections were made through standard analog phone lines. Teleradiology Preliminary or Final Reports can be provided for all doctors and hospitals overflow studies. HIPAA (Health Insurance Portability and Accountability Act of 1996) is a uniform. radiologists went from working 8–10 hours a day. a teleradiology firm might cover trauma at a hospital in Indiana with doctors based in Texas.Teleradiology 164 Reports Teleradiologists can provide a Preliminary Read for emergency room cases and other emergent cases or a Final Read for the official patient record and for use in billing. which helps to ensure patients’ privacy. 7 days a week coverage. Ensuring compliance with these laws is a significant overhead expense for larger multi-state teleradiology groups. Regulations In the United States. Subspecialties Some teleradiologists are fellowship trained and have a wide variety of subspecialty expertise including such difficult-to-find areas as Neuroradiology. often in the radiologists home. Musculo-skeletal MRI. In addition. was the first to station U. Some firms even used overseas doctors in locations like Australia and India. five and half days a week to a schedule of 24 hours a day. Nighthawk. Teleradiology expanded rapidly as the growth of the internet and broad band combined with new CT scanner technology to become an essential tool in trauma cases in emergency rooms throughout the country. Because ER physicians are not trained to read CT scans or MRI's. Mammography. As an example. The occasional 2-3 x ray studies a week soon became 3-10 CT scans. licensed . federal floor of privacy protections for consumers. For some Teleradiology services. Final reports include all findings and require access to prior studies and all relevant patient information for a complete diagnosis.S. Industry growth Until the late 1990s teleradiology was primarily used by individual radiologists to interpret occasional emergency studies from offsite locations.com boom of firms and groups that provided outsourced. Nuclear Cardiology.S. soil in order to qualify for reimbursement of the Final Read. Paul Berger. This became a particularly acute challenge in smaller rural facilities that only had one solo radiologist with no other to share call. Medicare and Medicaid laws require the Teleradiologist to be on U. Quality teleradiology must abide by important HIPAA rules to ensure patients’ privacy is protected. It limits the ways that entities can use patients’ personal information and protects the privacy of all medical information no matter what form it is in. founded by Dr. Preliminary Reports include all pertinent findings and a phone call for any critical findings. the turnaround time is extremely rapid with a 30 minute standard turnaround and expedited for critical and stroke studies. off-site teleradiology on-call services to hospitals and Radiology Groups around the country. advanced teleradiology systems must also be HIPAA compliant. Pediatric Neuroradiology.

Industry consolidation is likely as there are more than 500 of these firms. This endeavor has recently (2006) expanded as a teletherapy application for cognitive skills enhancement programs for school children. The early innovators in this field like Teleradiology Solutions. 2010-05-17. 27. and clinical therapy. phone lines. itnonline. [3] The Radlinx Group. Imaging Technology News. .S." (http:/ / dealbook. and physical therapy. [2] "Virtual Radiologic and NightHawk Radiology Announced a Merger. As of 2006 the most commonly used modalities are via webcams. Rich internet applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) was first introduced in 2001. Currently teleradiology firms are facing pricing pressures. videoconferencing. occupational therapy. Telerehabilitation Telerehabilitation (or e-rehabilitation[1] [2] ) is the delivery of rehabilitation services over telecommunication networks and the internet. html). com/ 2010/ 05/ 17/ providence-to-take-virtual-radiologic-private/ ). perhaps because these two disciplines are more “hands on”. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology. with NightHawk continuing as a wholly owned subsidiary of vRad. 2010.. fitting of rehabilitation equipment such as wheelchairs. [3] "VRad and Nighthawk Radiology Complete Merger. 165 References [1] "Providence to Take Virtual Radiologic Private. Nighthawk Radiology. throughout the United States. New York Times. Virtual Radiologic (vRad) and NightHawk Radiology announced the completion of their previously announced merger. founded by Greg Lowenstein and Mark Bakken. speech-language pathology. throughout the U. . com/ news-releases/ virtual-radiologic-and-nighthawk-radiology-announce-merger-103849613.[1] Moreover. 2010-12-23. on December 23. Telerehabilitation can deliver therapy to people who cannot travel to a clinic because the patient has a disability or because of travel time.S. on September. nytimes. became multi million dollar companies today.[2] Finally. braces or artificial limbs. net/ node/ 38565/ 3/ ). PR Newswire. Nighthawk (symbol: NHWK) and VRC (symbol: VRAD) ultimately went public and established almost a billion dollars in market capitalization. Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. The Radlinx Group. Most telerehabilitation is highly visual." (http:/ / www. audiology. Tele-audiology (hearing assessments) is a growing application. It is most widely used for neuropsychological rehabilitation. and (2) building new data collection systems to digitize information that a therapist can use in practice. 2010. and in speech-language pathology. large and small. hospitals. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance. telerehabilitation in the practice of occupational therapy and physical therapy are very limited. prnewswire. Most types of services fall into two categories: clinical assessment (the patient’s functional abilities in his or her environment). . who otherwise had no on-site access to full-time radiologists. on May 17. 2010-09-27. Virtual Radiologic and NightHawk Radiology Announced their Merger." (http:/ / www. As of 2006. 2010.Teleradiology radiologists overseas (initially Australia and later Switzerland) to maximize the time zone difference to provide nightcall in U. Providence Equity Partners acquired and took private Virtual Radiologic. However. pioneered the expansion of teleradiology services beyond just night coverage to also provide coverage to hundreds of small rural hospitals and clinics. videophones and webpages containing rich Internet applications. and Virtual Radiology Consultants (VRC or VRN most recently). Ground-breaking research in telehaptics (the sense of touch) and virtual reality may .

If the research shows that tele-assessments and tele-therapy are equivalent to clinical encounters. The Department of Defense (DoD) and the National Aeronautics and Space Administration (NASA) spearheaded the technology in the United States during the Vietnam War and the space program. This led to an invitation by ATA to the conference attendees to form a special interest group on telerehabilitation. both located in Washington. NIDRR funded the second 5-year RERC on telerehabilitation in 2004. autism. This RERC was renewed in 2010. Cases included post-stroke. There are several programs that provide annual physical exams or monitoring and consultation for veterans with spinal cord injuries. DC. the Rehabilitation Institute of Chicago. The conference was attended by the incoming president of the American Telemedicine Association (ATA). and government officials interested in using telecommunications as a modality for rehabilitation assessment and therapy. and its motivation. engineers. Three early adopters of telemedicine were state penitentiary systems. the internet and telemedicine since the 1950s. rural health care systems. and the Department of Defense. As of 2006. both agencies continue to fund advances in telemedicine. few (if any) of these programs are known to financially break-even. Some state universities have obtained state funding to operate tele-clinics in rural areas. a summary is provided in Rosen. and the radiology profession. mostly because the Medicare program for people over age 65 (the largest payer) is very restrictive about paying for telehealth. The National Rehabilitation Hospital in Washington DC and Sister Kenny Rehabilitation Institute in Minneapolis provided assessment and evaluations to patients living in Guam and American Samoa. only a few health insurers in the United States will reimburse for telerehabilitation services. Winters & Lauderdale (2002). 166 History In 1999. Telemedicine makes business sense for the states because they do not have to pay for security escorts to have a prisoner receive care outside the prison.M. the State University of New York at Buffalo. As of 2006. Outside the United States. The State of Science Conference held in 2002 convened most of military and civilian clinicians. It was awarded to a consortium of biomedical engineering departments at the National Rehabilitation Hospital and The Catholic University of America. In contrast. Similarly. Rural telemedicine in the United States is heavily subsidized through federal agency grants for telecommunications operations. it is more likely that insurers and Medicare will cover telerehabilitation services.Telerehabilitation broaden the scope of telerehabilitation practice. post-polio. Some of this early research work. is reviewed in Winters (2002). In the United States. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh. Most of this funding comes through the Health Services Research Administration and the Department of Commerce. and the East Carolina University in North Carolina. awarding it to the University of Pittsburgh. D. . the Sister Kenny Rehabilitation Institute in Minnesota. the Health Services Research Administration in the US Department of Health and Human Services. excellent research is conducted in Australia and Europe. A few school districts in Oklahoma and Hawaii offer school-based rehabilitation therapy using therapy assistants who are directed by a remote therapist. the National Institute on Disability and Rehabilitation Research's (NIDRR) [16] supports research and the development of telerehabilitation. in the future. Angaran published “Telemedicine and Telepharmacy: Current Status and Future Implications” in the American Journal of Health-System Pharmacy. He provided a comprehensive history of telecommunications. some state Medicaid programs (for poor people and people with disabilities) have pilot programs using telecommunications to connect rural practitioners with subspecialty therapists. the Veterans Administration is relatively active in using telemedicine for people with disabilities. and wheel-chair fitting. and the National Rehabilitation Hospital in Washington DC. An argument can be made that "telerehabilitation" began in 1998 when NIDRR funded the first RERC on tele-rehabilitation. Other federal funders of research are the Veterans Administration.

Mobile telephony/Mobile telephony in telerehabilitation . Individual children or whole classrooms can participate in this program over the internet. however small display screens make them problematic for individuals with vision problems. In 2006.J. Motion technology/Motion technology in telerehabilitation 5. rich internet application. 6. so are easy to set up. This computer technology allows the development of three-dimensional virtual environments. Videophones are used with POTS lines and include a camera. It is unethical to limit paymente for telerehabilitation services only to patients in rural areas. The applications can be accessed from any location where one has access to an internet connected computer. 3. such as videoconferencing. All applications and response data are transported via the internet in real time. for the telerehabilitation presentation of cognitive rehabilitation therapy. O. most peer-reviewed research in telemedicine are case reports of pilot programs or new equipment. Virtual reality/Virtual reality in telerehabilitation Virtual reality in telerehabilitation is one of the newest tools available in that area. 4. Palsbo published an article in the Journal of Telemedicine and Telecare that explored how telemedicine can become a profitable business for hospitals. Neither the application nor the patient's data is tied to one computer. Sensors and body monitoring/Sensors and body monitoring in telerehabilitation 7. webcams and telepresence to assist in treatments. 167 Technologies 1. introduced the first web based. Any updates or changes to the software system are instantly available to all subscribers. the system then provides. display screen. M. represent a new direction in software development. Videotelephony/Videotelephony in telerehabilitation The use of improved quality video-assisted telecommunication devices. Videophones use telephone lines that are available in most homes. Wireless technology/Wireless technology in telerehabilitation 10.E. and telephone. This system first provides the subscriber clinician with an economical means of treating their own patients over the internet. As of 2006. Bracy. directly to the patient. A person subscribes to the website rather than purchase the software. This can be solved by using a large screen or television as a screen. a neuropsychologist. with only a handful of equivalence trials.Telerehabilitation In 2001. They argue that telerehabilitation should be expanded so that people with disabilities and people in pain (perhaps after hip-replacement surgery or people with arthritis) can get the rehabilitative therapy they need. Web-based approaches/Web-based approaches in telerehabilitation Applications that run over the internet. just as if they were installed in your computer (called Rich Internet Applications). Rehabilitation researchers need to conduct many more controlled experiments and present the evidence to clinicians (and payers) that telerehabilitation is clinically effective. PDAs/PDA in telerehabilitation 11. Plain old telephone service (POTS) uses standard analog telephone lines. this system formed the basis of a new system designed as a cognitive skills enhancement program for school children. 2. Likewise. Artificial intelligence/Artificial intelligence in telerehabilitation 9. The patient can login to do their therapy from home. a patient's data is accessible from where ever the therapist is located. the library or anywhere they have access to an internet computer. In 2006. McCue and S. Haptic technology/Haptic technology in telerehabilitation 8. Research in telerehabilitation is in its infancy. The discipline of speech-language pathology is far head of occupational therapy and physical therapy in demonstrating equivalence over various types of telecommunications equipment. the therapy prescription set up and controlled by the member clinician. Secondly. Plain old telephone service (POTS) with videophones/Phones in telerehabilitation There are several types of connections used with real time exchanges.

and oro-motor tasks were obtained suggesting that the . Lehoux. 3. Using a high speed videoconferencing system link. 1987). Ward. Russell. 1976. 5. More recent applications have involved the use of sophisticated Internet-based videoconferencing systems with dedicated software which enable the assessment of language disorders (Georgeadis. while assessment and diagnoses have been found to be comparable to face-to-face evaluations. Fortier-Blanc and Leblanc (2003) assessed and treated six children and adolescents with a positive reduction in the frequency of dysfluency that was maintained six months later. Onslow & Lincoln. Electronic medical records/Electronic medical record telerehabilitation 168 Clinical applications of telerehabilitation 1. Barker. the number of telerehabilitation applications in speech-language pathology tend to outnumber those in other allied health professions. 2004. High levels of agreement between the online and face-to-face clinicians for single-word articulation.Telerehabilitation 12. As a result. Russell. Brennan. voice disorders. Theodoros. Brennan. Baron & Barker. 2004) involving the distance delivery of the Lidcombe program to children who stutter have utilized the telephone in conjunction with offline video recordings to successfully treat several children. stuttering. Werven & Aronson. 4. Theodoros. Cahill. In addition. 1997). 2. and swallowing dysfunction. Georgeadis. Constantinescu. Overall. these studies have revealed positive treatment outcomes. Wilson. Reports of telerehabilitation applications in paediatric speech and language disorders are sparse. a videoconferencing platform has been used successfully to provide follow-up treatment to an adult who had previously received intensive therapy (Kully. Busuttin. Wilson & Wootton. Early applications to assess and treat acquired adult speech and language disorders involved the use of the telephone to treat patients with aphasia and motor speech disorders (Vaughan. 7. applications have been developed to assess and/or treat acquired adult speech and language disorders. 2. 200). Wilson & Onslow. and a satellite-based videoconferencing system to assess patients in rural areas (Duffy. 2004) and the assessment and treatment of motor speech disorders (Hill. 1999. Assessment Monitoring Intervention Telesupervision (of licensed assistants) Telementoring Tele-education Telementoring Speech-language pathology The clinical services provided by speech-language pathology readily lend themselves to telerehabilitation applications due to the emphasis on auditory and visual communicative interaction between the client and the clinician. Collectively.. 3. Review of telerehabilitation research on clinical populations Professional to professional (clinic to clinic applications) Telehealth – Information access Clinical approaches 1. a computer controlled video laserdisc over the telephone and a closed-circuit television system to assess speech and language disorders (Wertz et al. Russell. Sicotte. & Baron. 4. 1987). The technology involved in these applications has ranged from the simple telephone (Plain Old Telephone System – POTS) to the use of dedicated Internet-based videoconferencing systems. 6. speech disorders in children. Cahill. in press) following brain impairment and Parkinson's disease. 2006. Ward. The treatment of stuttering has been adapted to a telerehabilitation environment with notable success. the parents and children responded positively to the program delivered at a distant. in press). Theodoros. To date. et al. A recent Australian pilot study has investigated the feasibility of an Internet-based assessment of speech disorder in six children (Waite. speech intelligibility. Clark. Wertz. Two Australian studies (Harrison.

8. 169 Disciplines and therapies 1. 4. A more sophisticated telerehabilitation application for the assessment of swallowing was developed by Perlman and Witthawaskul (2002) who described the use of real-time videofluoroscopic examination via the Internet. 5. Mashima et al. There continues to be a need for ongoing research to develop and validate the use of telerehabilitation applications in speech-language pathology in a greater number and variety of adult and paediatric communication and swallowing disorders. Voice therapy across a variety of types of voice disorders has been shown to be effectively delivered via a telerehabilitation application. telerehabilitation applications for the assessment of swallowing function have also been used with success. 7. This system enabled the capture and display of images in real-time with only a three to five second delay. 2. 6. 2. The authors reported positive post treatment results with no significant difference in measures between the traditional and videoconferencing group. Telerehabilitation standards Reimbursement policies/Reimbursement in telerehabilitation Legislative activities/Legislative activities in telerehabilitation Ethics and privacy issues/Ethics and privacy issues in telerehabilitation Clinical and technology training issues Related organizations • • • • • • American Telemedicine Association (ATA) American Speech-Language-Hearing Association (ASHA) Association of Telehealth Service Providers (ATSP) National Institute on Disability and Rehabilitation Research (NIDRR) Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Special Interest Group on Telerehabilitation (SIGOT) . suggesting that the majority of traditional voice therapy techniques can be applied to distance treatment. 5. Brown and Cranfield (2000) were able to obtain an initial assessment of the nature and extent of swallowing dysfunction in an adult via a videoconferencing link although a more complete evaluation was restricted due to the inability to physically determine the degree of laryngeal movement. 3. Lalor. Although obvious limitations exist.Telerehabilitation Internet-based protocol had the potential to be a reliable method for assessing paediatric speech disorders. 3. 4. (2003) using PC based videoconferencing and speech analysis software compared 23 patients treated online with 28 persons treated face-to-face. Speech-language pathology Audiology Physical therapy Occupational therapy Psychology Nursing Social work Rehabilitation counseling/Vocational rehabilitation Standards and training requirements 1.

Victoria Steiner. Linda L. . edu/ articles/ vol2num4/ pierce-keaton. 219. Karen Lance. p. Pierce. John Wiley and Sons.Telerehabilitation 170 References [1] E-health care information systems: an introduction for students and professionals. 2005. htm). ISBN 9780787966188 [2] Lisa Keaton. org/ Health/ Medicine/ Informatics/ Telemedicine/ Projects/ / ) at the Open Directory Project .4. nova. dmoz. ISSN 1540-580X. "An E-rehabilitation Team Helps Caregivers Deal with Stroke" (http:/ / ijahsp. The Internet Journal of Allied Health Sciences and Practice (Ijahsp. Retrieved 2011-03-26.edu) 2. External links Telerehabilitation (http:/ / www.nova.

The group released the guidelines to the public in June 2009.[3] The group is establishing a product certification program using its recognizable logo. open industry group of nearly 240 healthcare providers. aging independently.The Continua Health Alliance 171 The Continua Health Alliance Continua Health Alliance Industry Founded Headquarters Area served Key people Trade association June 2006 Beaverton. signifying that the product is interoperable with other Continua-certified products. Products made under Continua Health Alliance guidelines will provide consumers with increased assurance of interoperability between devices. . Continua Health Alliance members aim to develop a system to deliver personal and individual healthcare. Oregon. and fitness device companies.org [1] Website Continua Health Alliance is an international non-profit. and health & physical fitness. The goal of developing the solutions is to promote delivery of healthcare in the home providing independence. medical. Continua works to provide guidelines for the effective management of diverse products and services from a global network of vendors. the Continua Certified Logo program. enabling them to more easily share information with caregivers and service providers. Overview Continua Health Alliance aims to establish a system of personal connected healthcare solutions.[2] Continua Health Alliance is working toward establishing systems of interoperable telehealth devices and services in three major categories: chronic disease management. Through collaborations with government agencies and other regulatory bodies. The technology platforms for these products and services are defined by the members and published in the Continua guidelines. Continua members intend to create systems and devices for improving personal health. empowering individuals and providing the opportunity for truly personalized health and wellness management. communications. United States Worldwide Clint McClellan (President) Charles Parker (Executive Director) ContinuaAlliance. Devices and Services Continua Health Alliance version 1 design guidelines are based on proven connectivity technical standards and include Bluetooth for wireless and USB for wired device connection.

2008 at the Partners Center for Connected Health 5th Annual Connected Health Symposium in Boston. on January 26. Cisco Systems Kaiser Permanente Medtronic Panasonic Philips Qualcomm Samsung Electronics Sharp Organisational Structure The Organisation is primarily staffed by volunteers from the member organisations that are organised in to working groups that address the goals of the alliance. and continuously improving the Test and Certification process and tools.The Test and Certification Working Group is responsible for defining. • Use Case Working Group • Wellness Solutions Working Group .[10] Continua's Board of Directors is currently composed of the following companies:[11] • • • • • • • • • • • • • • Intel Corporation Roche Diagnostics Partners HealthCare Price Waterhouse Coopers Ascension Health CA. Inc.[8] Continua selected Bluetooth Low Energy and ZigBee wireless protocols as the wireless standards for its Version 2 Design Guidelines which are yet to be released.[7] By the end of September 2010 there were fourteen certified products. 2006[4] Continua Health alliance performed its first public demonstration of interoperability on October 27. 172 Major milestones and Status Information Continua Health Alliance was founded on June 6. 2009. implementing. the Nonin 2500 PalmSAT handheld pulse oximeter with USB. Bluetooth Low Energy is to be used for low-power mobile devices.The Continua Health Alliance Continua Alliance products make use of the ISO/IEEE 11073 Personal Health Data (PHD) Standards. Below the board of directors sit the following main working groups:[12] • • • • • Global Policy Strategy Working Group Marketing Working Group Regulatory Working Group Technical Working Group Test & Certification Work Group .[5] Continua Health Alliance certified its first product [6].[9] Members Continua Health Alliance currently has nearly 240 member companies. ZigBee will be used for networked low-power sensors such as those enabling independent living.

html) [12] http:/ / continuaalliance. org/ about-the-alliance/ member-companies. org/ i4a/ pages/ index. org/ certified-products/ nonin-2500-palmsat%C2%AE-pulse-oximeter. php [16] http:/ / atsp. org/ static/ cms_workspace/ Continua_Overview_Presentation_v15_3. org/ products/ certified-products. cfm?pageid=1 [14] http:/ / mobihealthnews. pdf [4] http:/ / continuaalliance. pdf [6] http:/ / continuaalliance. html [5] http:/ / continuaalliance.The Continua Health Alliance 173 Relevant standards • • • • • • • ISO/IEEE 11073 ISO/IEEE 11073 Personal Health Data (PHD) Standards Bluetooth USB HL7 Integrating the Healthcare Enterprise Zigbee Website The Continua Alliance website contains a full listing of member organisations. org/ news-and-media/ press-releases/ founding-continua. org/ about-the-alliance. continuaalliance. continuaalliance. continuaalliance. a directory of qualified products. org/ about-the-alliance/ board-of-directors. continuaalliance. aspx?NewsID=86 [8] http:/ / www. edu/ communications/ vistas/ archive/ 02-summer/ stories/ miracle-of-telemedicine. External links • • • • • Continua Health Alliance website [1] American Telemedicine Association [13] MobiHealthNews [14] Telemedicine History [15] Association of Telehealth Service Providers [16] References [1] http:/ / www. org/ static/ binary/ cms_workspace/ Continua_Update_release_v_FINAL_2_. continuaalliance. pdf [10] Member Companies (English) (http:/ / www. nonin. depts. html [7] http:/ / www. americantelemed. html [9] http:/ / www. html) [11] Board of Directors (English) (http:/ / www. and a clear statement of their mission. html [3] http:/ / www. org/ static/ cms_workspace/ Continua_Version_One_Design_Guidelines_Now_Available_final. com/ [15] http:/ / www. continuaalliance. ttu. org/ default. com/ News. org [2] http:/ / www. org/ static/ cms_workspace/ Continua_06082009_vFINAL. pdf [13] http:/ / www. continuaalliance. asp .

At the present it includes the best practice implementation pilots in phone medicine (oncology -particularly home-care. • CATAI was the promoter of the Centre of Excellence in Telemedicine. Promoting the network of Telemedicine together with Argentina. and Georgia Telemedicine meeting in 1999. Science Park-DGXIII) and participating in other two (DGXIIITeleultrasound for developing countries.IT. Peru) and Africa (Uganda. Leader in Canary Islands and in the main land . Is currently actively working with South-America ( Venezuela. Belfast-IRL. Award Portugal-Spanish cooperation 1994. Peru. sponsored by Science Park DG-XIII.of a project on Telephonic Medicine. CATAI-CTC) UNESCO Chair of Telemedicine was involved in developing countries health support through the Midjan group-ITU-D working group of Telemedicine. Kenya) Obtained awards: • • • • Economical initiatives. economics. • CATAI developed the Videophone network in Canary Islands in 1991 for distant support. to gain a minimal structured knowledge in Medical Informatics. CATAI published the first text-book of Telemedicine in English. Africa and America to concentrate best practice examples as well as top experts to implement real world applications and development of hardware-software systems ready to be used. security and liability aspects in co-operation with the Universities of Queens-UK. CHS or Citizen Home Services. Argentina. Award Royal Academy Medicine 1993 and 1999. These activities link mainly technological firms of the UK and Germany. Chile.E. Objective image analysis and prognostic factors have been incorporated into the regional breast cancer registry of 3000 patients (see above). Tele-ECG and Tele-ultrasounds -particularly obstetrics & gynaecology. Leader of two EU projects (Leonardo-DG XXII . Aveiro-PT.Barcelona. standardization. Leonardo-DGXXII Teaching Medical informatics). . Mali and Uganda.GR. complemented with a CD multimedia material particularly designed for developing countries. have established the “Telemedicine Body of Knowledge” covering sociology. In the 4th Ed-2002 is the author of the Electronic Clinical Record. The Chair is the first UNESCO Telemedicine Chair [1]. Undertakes international activities related to the promotion of the information society and fights against technology transfer problems having the role of an “intermediate body”.D) and is published in Spanish (PanAmerican Editorial) with title : “Telemedicine” 2001. Berlin-D. and participated in ITU-Developing Word Congress in Malta 1997.UNESCO Chair in Telemedicine 174 UNESCO Chair in Telemedicine UNESCO Chair of Telemedicine (UNES_CT) was founded in 1999. Canary islands 1995. Innsbruck-AU. Is participating in all editions of the European Telemedicine Glossary edited by the EC-DG Information Society. KOD or knowledge on demand. it was applied to image analysis prognostic factors in breast cancer. Venezuela. with enrolment of 3 continents: Europe. Cuba. The expertise of the UNESCO chair of Telemedicine as a University Institution is based in the previous CATAI’s [2] expertise founded in 1994 in the field of Information Society/Telemedicine with which is collaborating closely and from which received part of the sponsorship: • Training and teaching aspects. technology transfer. • Fist in the world (1991) to carry out distant DNA quantitation. Genova-IT. ASKLEPIOS. Ordesa award in paediatrics 1989. world wide known by Winter and Summer Courses of Telemedicine training following the “Telemedicine Body of Knowledge". Udine-IT. At the present moment the book is translated into 6 languages (SP.FR. Partner in 5 EU projects ( Smart-USB. TeleInViVo ultrasound devices with pilots in Katastan. Athens-GR. technology and organizational issues. and his activity is related with development and diffusion of Telemedicine and Information Society in Health Care in developing areas and undeveloped countries particularly South-America and Africa.and psychiatry -particularly childhood psychiatry).

html [4] http:/ / www. . These can be used in different phases of a compound or drug in development in a given pharmacological research as a preliminary to testing on animals and humans for the drug development processes. unesco. php-URL_ID=48712& URL_DO=DO_TOPIC& URL_SECTION=201. Included in the 3rd Ed.University of La Laguna (Spain) [2] • UNESCO Education Portal [3] • University of La Laguna [4] References [1] http:/ / portal. Forms of Virtual Patients Virtual patients may take a number of different forms: • Artificial patients: computer simulations of biochemical processes such as the effect of drugs in organisms. 175 External links • UNESCO Chair in Telemedicine .a virtual patient will have mechanisms for the learner to interact with the case and material or information is made available to the learner as they complete a range of learning activities[3] The interactivity is non sequential. • Real patients: reflected in data e. ull. • Physical simulators: mannequins (sometimes spelled 'manikins'). unesco. models or related artefacts.CATAI . situations or similar narrative-based activities.UNESCO Chair in Telemedicine • Included in “Who is Who in the World” since 1996 scheduled up to 2000. partly in response to increasing demands on health care professionals and education of students but also because they allow opportunity for students to practice in a safe environment[2] There are many different formats a virtual patient may take. [4] and Virtual • Electronic case-studies and scenarios where users work through problems. org/ education/ en/ ev. es Virtual patient The term virtual patient is used to describe interactive computer simulations used in health care education. These are sometimes called e-patients. • Simulated patients: where the patient is recreated by humans or computer-generated characters Humans [5] acting as such or engaging in other kinds of role-play. php-URL_ID=2989& URL_DO=DO_TOPIC& URL_SECTION=-465. org/ education/ en/ ev. electronic health records (EHRs).[1] The special focus is targeted on the simulation of clinical processes with virtual patients. net/ catai [3] http:/ / portal. Virtual patients allow the learner to take the role of a health care professional and develop clinical skills such as making diagnoses and therapeutic decisions[2] The use of virtual patient programmes is increasing in healthcare education. Virtual patients combine scientific excellence. the physiologic processes of a given organ or entire systems (systems biology) in a given organism. nominated by the STOA European Parliament Office.g. of “Who is Who in Science and Engineering”. In this case the virtual patient is the reflection of the real patient in terms of data held about them. modern technologies and the innovative concept of game-based learning. html [2] http:/ / www. However the overarching principle is that of interactivity . • the Lattice Price 99 of ESF (European Science Foundation) in Innovation & Research in teaching. teide.

this standard attained status as an ANSI standard. This was in part to address the problem of exchanging and reusing virtual patients and in part to encourage and support easier and wider use of virtual patients in general. They can be structured with narratives that represent real situations while challenging the user with a wide range of tasks. This standard has been very successful and is now widely adopted. Despite their efficacy simulated patients are still a tangent and a prosthesis to reality. fewer subjects pharmacovigilance maybe needed. making them less dependent on actual cases to learn how to handle different situations. In 2010. simulated patients can be accessed on demand and they can be endlessly replayable to allow the user to explore different options and strategies. informed research and development predictive simulation. If more tests can be done on Artificial patients to filter out possibly unnecessary tests or experiments. It will require continual updates and development with the endless availability of new data. Possible Benefits of Physical Simulators and Simulated Patients Simulated patients increase the availability of training opportunities for medical students. which must also be proven by real patient studies clinical trial. which enables efficient exploration. Unlike real patients. The Artificial patients insilico modeling are still in the early to middle developmental stages. eg in major projects like eViP. They should be viewed as augmenting existing modes and methods of clinical teaching. Virtual Patient Data Standards The MedBiquitous consortium [7] established a working group in 2005 to create a free and open data standard for expressing and exchanging virtual patients between different authoring and delivery systems. Possible Benefits of Artificial Patients Artificial patients increase the possibility of exploring millions of hypothesis driven experiments on known areas of biological systems to extrapolate the unknown.Virtual patient 176 Types of Interaction with Simulated or Electronic Patients A number of different modes of virtual patient delivery have been defined [6]: • • • • • • Predetermined scenario [directed mode] The learner may build up the patient or case data from observations and interactions [blank mode] The learner may view and appraise or review an existing patient or scenario [critique mode or rehearsal mode] The VP may be used as a mechanism to address particular topics [context mode] The learner may use a scenario or patient to explore personal/professional dimensions [reflective mode] Banks of patients or scenarios may collectively address broad issues of healthcare [pattern mode] Types of Interaction with Artificial Patients • To create and run a mathematical quantitative simulation of a healthy person (physiology) and diseased person to test multiple hypothesis against known and unknown processes in a given set or sets of processes to help fill gaps in knowledge of the physiology or system under investigation. American_National_Standards_Institute .

net . aspx accessed 08. se/ [10] http:/ / research. ed. bidmc. WISE-MD) [9] WebSP from Karolinska Institutet Virtual Patients from Harvard Medical School [10] Virtual Patient Project from New York University [11] Virtual Patients from Centre for Virtual Patients (University of Heidelberg) [12] OpenLabyrinth from Canada [13] Labyrinth from the University of Edinburgh [14] TUSK Case Simulator from Tufts University [15] Virtual Patient from Keele University School of Pharmacy [16] Virtual Patients Group Consortium at the University of Florida. ict. ac. student generated online case studies in medical education. ufl. CLIPP. ca/ [14] http:/ / labyrinth. usc. uk/ whatwedo/ programmes/ elearningcapital/ reproduce/ revip. Medical College of Georgia. inmedea-simulator. edu/ research/ vegroup/ vp. au/ conferences/ melbourne08/ procs/ imison. virtualpatientsgroup. ascilite. uk/ schools/ pharm/ vp/ [17] http:/ / www. in Hello? Where are you in the landscape of educational technology? Proceedings ascilite Melbourne 2008. ki. htm [7] http:/ / www. com/ [13] http:/ / openlabyrinth.http:/ / www. University of Central Florida. org/ primers/ virtual_patients_cases_ellaway.06. tufts. org. edu/ Virtual_Patient_Projects. mvm. edu/ VPTutorials/ [11] http:/ / www. medbiq. org/ [8] http:/ / med-U. org [9] http:/ / websp. pdf [3] Ellaway R (2009) Modelliing virtual patients and virtual cases. html [5] http:/ / vrpsych. medbiq. harvard. ac. net/ vp/ [12] http:/ / www. tinkering. lime.Virtual patient 177 Examples Electronic Cases • • • • • • • • • • [8] (SIMPLE. keele. fmCASES. and University of Georgia [17] • [18] (A whole virtual clinic with 25 different faculties and offer 250 virtual patients) Simulators • Limbs and Things simulators [19] • SimMan simulator [20] • “Harvey” mannequin Virtual physiology • Entelos PhysioLabs / Biologic Systems / Quantitative Mathematical Models [21] External links • MedBiquitous Virtual Patient Working Group [22] • The electronic Virtual Patient (eViP) programme [23] • eLearning since 1996 [24] Notes and references [1] JiSC (2009) Repurposing existing virtual patients. cise. htm [4] http:/ / www. campusvirtualpatients. uk/ [15] http:/ / tusk. Hughes C(2008) The virtual patient project: using low fidelity. medbiq. org/ primers/ virtual_patients_cases_ellaway. com/ [18] http:/ / www. Available http:/ / meld. jisc. Available http:/ / www. edu/ view/ url/ H1185C/ 471802/ 490012/ [16] http:/ / www.09 [2] Imison M. html [6] http:/ / meld. ac.

can be used to address issues of accessibility in the built environment. in addition. artificially created computer-aided design (CAD) models. com 178 Virtual reality in telerehabilitation Virtual reality in telerehabilitation is a method used first in the training of musculoskeletal patients using asynchronous patient data uploading. org/ working_groups/ virtual_patient/ index. ecologically valid stimulus environments within which behavioral response can be recorded and measured. in large part. Because telemedicine focuses principally on transmitting medical information. virtualpatients.[1] Background The computer technology that allows development three-dimensional virtual environments consists of both hardware and software.[5] Korean researchers developed and assessed the value of a new rehabilitation training system to improve postural balance control by combining virtual reality technology with an unfixed bicycle. and an internet video link. Subsequently.[9] Many cases have applied virtual reality technology to telemedicine and telerehabilitation service development. high-fidelity virtual reality systems have practical applications in areas ranging from psychiatry to surgical planning and telemedicine. laerdal. The system was effective as a training device.Virtual patient [19] http:/ / www. limbsandthings. The term "virtualized reality" (VR) was coined and introduced in a paper by Kanade. State of the art of VR-based telemedicine applications is used in remote or augmented surgery as well as in . and modern.[4] Application The value of VR systems for the investigation and rehabilitation of cognitive and perceptual impairments and current and potential applications of VR technology address six neurorehabilitation issues. entelos.[8] A recently completed project at the University of Strathclyde has resulted in the development of a wheelchair motion platform which. graphical display systems and techniques lacking only sense and sensibility. technical. the technology might have a wider applicability to the rehabilitation field. Therapists then monitor the patient's progress via the web and modify the therapy asynchronously without real-time interaction or training. The traditional virtual reality world is typically constructed using simplistic. asp?docid=1022609 [21] http:/ / www. The current popular. by the advent and availability of increasingly powerful and affordable visually oriented.[6] Tracy and Lathan investigated the relationship between motor tasks and participants' spatial abilities by training participants within a VR based simulator and then observing their ability to transfer training from the simulator to the real world. interactive. VR starts with the real-world scene and virtualizes it. and scientific interest in virtual environments is inspired. affordable technology for the practice of clinical medicine. it offers clinical assessment and rehabilitation options not available with traditional methods. VR has potential to enhance the practice. com/ document. in conjunction with a virtual reality facility. therapists using virtual reality-based telerehabilitation prescribe exercise routines via the web which are then accessed and executed by patients through a web browser. The study demonstrated that subjects with lower spatial abilities achieved significant positive transfer from a simulator based training task to a similar real world robotic operation task.[3] Through VR’s capacity to allow the creation and control of dynamic 3-dimensional. medbiq.[7] Virtual environments were applied to assess the training of inexperienced powered wheelchair users and demonstrated that the two virtual environments represent a potentially useful means of assessing and training novice powered wheelchair users. eu [24] http:/ / inmedea. com/ [20] http:/ / www.[2] Virtual reality is a practical. com/ [22] http:/ / www. html [23] http:/ / www.

"Stroke rehabilitation at home using virtual reality. Medicine Meets Virtual Reality 13: The Magical Next Becomes The Medical Now. Burdea. Popescu. [3] Bergeron. E. IOS Press. investigated face gaze behavior in autism and right hemisphere stroke. Hoffman.184. using virtual reality and gaze sensing technology. [11] Rizzo. [6] Song. E. M.. Rosen and Corinna Lathan. [8] Harrison. PMID 15458128. Greg T. Jong Yun Kim and Nam Gyun Kim (June 2004).. . G. Boeren and R. p. IEEE Workshop on Representation of Visual Scenes. [2] Kanade. Lathan (2001). R. Chul Gyu. PMID 12182799.. "Virtual reality in telemedicine". C.Virtual reality in telerehabilitation surgical training. V. "Virtual environments for the investigation and rehabilitation of cognitive and perceptual impairments" (http:/ / iospress. doi:10. PMID 10761773.2004. James D. Haluck. ISBN 90-5199-250-5. [7] Tracey. com/ link. Proceedings. ISBN 1-58603-143-0.. G.1109/86. Derwent.1995. V. html). [9] Grant. doi:10. Studies in Health Technology and Informatics 81: 521–7. asp?id=k3w4811mjpgulujd). c1995.[13] Researchers from Rutgers University and Stanford University developed a virtual reality-based orthopedic telerehabilitation system.G. "The interaction of spatial ability and motor learning in the transfer of training from a simulator to a real task".W. [15] Popescu. Rose. dinf. (2003). Telemedicine Journal and e-Health 6 (3): 327–40. M. "Virtual reality-based orthopedic telerehabilitation".[12] An at-home stroke telerehabilitation service was developed using virtual reality haptics. Space Requirements for Wheeled Mobility: An International Workshop. Studies in Health Technology and Informatics 29: 299–305. Bouzit and V. Studies in Health Technology and Informatics 85: 434–7. htm). Retrieved 2006-07-26. B. ISBN 1586034987. A. Methods of Information in Medicine 42 (5): 519–23. (2003). V.. Maria T. Giuseppe. Luciano Gamberini (2000). PMID 14654886.. ISBN 1-58603-203-8. edu/ idea/ space workshop/ Papers/ Michael Grant/ M Grant . P. [10] Riva. [4] Schultheis. [17] Viirre. [5] Trepagnier. buffalo. PMID 11001524.46.476854. different researchers have tried to use virtual environments in medical visualization and for assessment and rehabilitation in neuropsychology. 2003. Los Alamitos. PMID 11110636.. Rizzo (August 2001). Dorothy Strickland and Stéphane Bouchard (2004). G. Hentz (March 2000). doi:10. M. "The application of virtual reality technology in rehabilitation". Robb. PMID 15319048. "Virtual rehabilitation—benefits and challenges".[17] 179 [15] [16] References [1] Westwood. "The role of virtual reality technology in the assessment and training of inexperienced powered wheelchair users". doi:10. D.J.867886. [13] Rydmark.[14] The use of virtual reality technologies in the rehabilitation of patients with vestibular system disorders and in the provision of remote medical consultation for those patients. Colbert (September 2000). K.1037/0090-5550.[10] Case studies for VR applications were conducted that were internet deliverable and they identified technical. pp.296.1109/WVRS. and user challenges of remote VR treatment programs.. [16] Burdea. R. C.[11] To improve understanding of deficits in autism and in left visual-spatial neglect. Retrieved 2007-07-26. doi:10. doi:10. metapress. (January 1999). A.1267/METH03050519 (inactive 2010-03-20). Rehabilitation Psychology 46 (3): 296–311. haptics and telemedicine". Conference on Technology and Persons with Disabilities. Mogel. Richard A. PMID 10163763. [12] Trepagnier. org/ csun_99/ session0241.. C. PMID 12661483. ap.2004. E. 1999. Recently. A. 294.1089/153056200750040183. IEEE Transactions on Rehabilitation Engineering 8 (3): 430–2. Randy S..3. G. .10. PMID 11317801. R. Cheryl C. "Virtual reality applications in clinical medicine". "A virtual-reality-based telerehabilitation system with force feedback". doi:10. Hentz and K. California State University at Northridge.1109/4233. J. Phillips. however. Journal of Medical Practice Management 18 (4): 211–5. C. ISBN 0-8186-7122-X. G. T. 1995. Enticknap.1109/TITB. Pasher (2002). IEEE Transactions on Information Technology in Biomedicine 4 (1): 45–51. PMID 15217265. IEEE Transactions on Information Technology in Biomedicine 8 (2): 200–207. both of which are critically dependent on eye–hand coordination. doi:10.1089/tmj. Albert A. "The challenge of using virtual reality in telerehabilitation".. Cheryl..wheelchair simulation in VR. M. (1996).828887. practical. [14] Burdea. "A new postural balance control system for rehabilitation training based on virtual cycling".. Helene M. Albert A.1080/09638280110111360. "Virtualized Reality: Concepts and Early Results". : IEEE Computer Society Press. . R. Disability & Rehabilitation 24 (11-12): 599–606. doi:10. "Wheelchair Simulation in Virtual Reality" (http:/ / www. NeuroRehabilitation 12 (1): 63–72. 69–76. Amherst. Calif. ISSN 0090-5550. Vosburgh (2005).. Telemedicine Journal and e-Health 10 (2): 184–95.826858. Michael J. He stated that an appropriately designed VR experience could greatly increase the rate of adaptation in these patients. Narayanan and P. "Telerehabilitation and virtual reality technology for rehabilitation: preliminary results" (http:/ / www. Attree (2002). Trepagnier et al. G. . Rander (1995). F. "Vestibular telemedicine and rehabilitation".

[9] • Entra makes integrated bluetooth-enabled blood glucose meters that work with an online data collection network to upload and report patient blood glucose readings.[4] Bluetooth.[1] Enabling Technologies 3G. calories out and sleep quality.[3] LTE.[8] • A&D makes connected activity monitors. Wireless health differs from mHealth in that wireless health solutions will not always be mobile and mobile health solutions will not always be wirelessly enabled. Zarlink.[2] 4G.[11] References [1] http:/ / marketplace. publicradio. weight scales and blood pressure monitors with software to gather and analyze personal health data. such as diagnosis. org/ display/ web/ 2009/ 03/ 10/ pm_body_computing/ [2] http:/ / mobihealthnews. Mobile broadband connectivity is useful in reaching new patients in remote areas while improving productivity and convenience through data transmission.[6] Examples • Cardionet’s 3G-enabled wireless service line. com/ 11198/ 10-mobile-health-diabetes-management-companies/ 4/ [11] http:/ / mobihealthnews. com/ articles--~~~~/ article. com/ 4337/ cardionet-announces-enhanced-mcot-system/ http:/ / mobihealthnews.html> [5] [6] [7] [8] http:/ / www. com/ medical [10] http:/ / mobihealthnews. com/ 1053/ which-technology-should-continua-pick/ http:/ / mobihealthnews. as well as other tools that can help individuals improve their personal health and wellbeing. informit. com/ 2460/ verizon-wireless-health-care-key-example-of-4g-services/ [4] <http://blhealthcare. monitoring and treatment of illness. Mobile Cardiac Outpatient Telemetry (MCOT) allows for immediate arrythmia detection.Wireless Health 180 Wireless Health Wireless Health is the integration of wireless technology into traditional medicine. andonline.[7] • Dexcom makes glucose sensing technologies with an FDA-approved product that enables users to manage diabetes with real-time glucose information and trends that can detect potentially dangerous glucose levels. com/ 7312/ indias-mhealth-gets-3g-to-connect-the-unconnected/ [3] http:/ / mobihealthnews. aspx?p=24243 http:/ / mobihealthnews.com/news_verizon4G.). com/ 9855/ ces-preview-slideshow-mobile-health-devices/ 8/ . etc.[10] • A weight management system consisting of an armband and an online Activity Manager that automatically tracks activity and sleep. the system provides a complete picture of the three components of weight loss: calories in. com/ 11198/ 10-mobile-health-diabetes-management-companies/ 5/ [9] http:/ / www. and other radios such as BodyLAN (BodyLAN is a low-power wireless networking protocol that transmits data from medical and fitness devices). Used in combination with a food log. designed for wireless sensor networks that require low-energy consumption and low data transmission.[5] Bluetooth low energy. ANT+ (ANT+ is a wireless networking protocol that allows communication between multiple sensors and devices.

and (7) Spokane.5 MHz band. (6) Detroit. the FCC allocated a total of 14 megahertz of spectrum to WMTS on a primary basis. The bands defined are 608-614 MHz. TX. This meant that wireless medical telemetry operations had to accept interference from the primary users of these frequency bands. Prior to the establishment of the WMTS. The frequencies in the 1427-1432 MHz band are shared by WMTS with non-medical telemetry operations. WA. many manufacturers have created devices that transmit data in the ISM bands such as 902-928 MHz. there are seven geographical areas in which WMTS and non-medical telemetry operations have "flipped" the bands in which each enjoys primary status.. 2. Further. that are regulated under Part 90 of the FCC's Rules.5 MHz band. At the same time. However. In a Report and Order released on June 12. it adopted a number of regulations to ensure that the WMTS frequencies are used effectively and efficiently for their intended medical purpose. D. PA. subjecting wireless medical telemetry operations to greater interference than before and perhaps precluding such operations entirely in many instances. even if that meant shutting down the medical telemetry operation. termed the "carve-out" areas. Because of this. metropolitan area. The FCC was concerned that certain regulatory developments. the user of the wireless medical telemetry equipment would be responsible for rectifying the problem.5 GHz.Wireless Medical Telemetry Service 181 Wireless Medical Telemetry Service Wireless Medical Telemetry Service (WMTS) is a wireless service specifically defined in the United States by the Federal Communications Commission (FCC) for transmission of data related to a patient's health (biotelemetry). (4) Austin/Georgetown.C.11 or Bluetooth radios. 2000 WMTS rules by FCC Band Plan[2] : The frequencies currently allocated for WMTS are divided into three blocks: the 608-614 MHz frequency band (which corresponds to UHF TV channel 37 but is not used by any TV station because it is used for radio astronomy) and the 1395-1400 MHz and 1427-1432 MHz frequency bands (both of which had been used by the Federal Government but were reallocated to the private sector under the Omnibus Budget Reconciliation Act of 1993). including the advent of digital television (DTV) service. These seven areas. such as utility telemetry operations. Generally.4-2. FCC statements There is an FCC statement on coexistence[1] of WMTS in various frequency bands. would result in more intensive use of these frequencies by the primary services. Devices using these bands are typically proprietary. the television broadcasters and private land mobile radio licensees. the FCC decided to establish the WMTS. but is secondary . VA. 1395-1400 MHz and 1427-1432 MHz. It was created in 2000 because of interference issues due to establishment of digital television. WMTS operations are accorded primary status over non-medical telemetry operations in the 1427-1429. if a wireless medical telemetry operation caused interference to television or private land mobile radio transmissions. (2) the Washington. MI. more typically. medical telemetry devices generally could be operated on an unlicensed basis on vacant television channels 7-13 (174-216 MHz) and 14-46 (470-668 MHz) or on a licensed but secondary basis to private land mobile radio operations in the 450-470 MHz frequency band. (3) Richmond/Norfolk. are (1) Pittsburgh. in contrast to the rest of the country. and. 2000. MI. The WMTS rules took effect on October 16. in addition to WMTS.e. so many times devices cannot marketed or used freely in countries other than the United States. often using IEEE 802. WMTS has primary status in the 1429-1431. (5) Battle Creek. Further. To ensure that wireless medical telemetry devices can operate free of harmful interference. but are treated as secondary to non-medical telemetry operations in the 1429. i. In these seven areas. the use of these bands has not been internationally agreed to.5-1432 MHz band.

fcc. References [1] FCC statement on coexistence (http:/ / wireless. CDRH has issued a public health advisory to hospital administrators. fda. In general. htm?job=about& id=wireless_medical_telemetry) [2] (http:/ / wireless. CDRH encourages manufacturers and users of medical telemetry devices to move to the new spectrum because of its protections against interference from other intentional transmitters and because frequency coordination will be provided. 182 FDA comments Comments from US FDA[3] . and nursing home directors. gov/ services/ index. directors of biomedical/clinical engineering. gov/ services/ index. and the introduction of the WMTS. fcc. in part: Because of concerns for interference with the present wireless medical telemetry systems. htm?job=service_bandplan& id=wireless_medical_telemetry) [3] (http:/ / www. htm) . risk managers.Wireless Medical Telemetry Service to non-medical telemetry operations in the 1427-1429 MHz band. gov/ Radiation-EmittingProducts/ RadiationSafety/ ElectromagneticCompatibilityEMC/ ucm116574.

[9] [10] WHITIA was recently ranked #15 of the top 25 most influential people. imaging industry innovators and academic institutions in order to integrate and deliver meaningful. Telemedicine. a remote-operated screening X-ray system for use in the developing world. and Informatics Alliance 183 World Health Imaging.[7] [8] At the 2009 Annual Conference of the Society for Imaging Informatics in Medicine (SIIM) in Charlotte. North Carolina. Minow. Carestream Health and Merge Healthcare. institutions. WHITIA announced its partnership with SIIM. WHITIA launched.World Health Imaging. Health Information technology. Chair of the Board [2] Michael W. which will allow both organizations to collaborate on specific initiatives. Ferro. WHITIA's first formal public launch was in April 2009 at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference & Exhibition in Chicago. Illinois. Telemedicine and Informatics Alliance (WHITIA) is a non-profit global health technology and social venture established in 2006 by affiliates of Northwestern University near Chicago. The teleradiology and remote-controlled features of Remi-d allow resource-limited areas such . Dave Kelso. Telemedicine. WHITIA’s vision is to facilitate the deployment of thousands of digital medical imaging systems worldwide. WHITIA announced strategic partners including SEDECAL. diagnostic technology to underserved communities worldwide. receiving extensive coverage in Health IT magazines and publications. CEO [3] Key people Area served Worldwide Focus Motto Website Low-cost medical imaging. and Informatics Alliance World Health Imaging. Vice Chair Ivy Walker. Its strengths in these areas stem from the higher burden of Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) co-infection. sustainability One digital image can save a life worldhealthimaging.. providing one billion people with access to diagnostic imaging. Michael Diamond 501(c)(3) Non-profit Organization Chicago. high incidences of Black Lung disease. Remi-d. IL. Illinois. or outbreaks of other infectious respiratory diseases. sustainable.[11] At the 2009 RSNA Annual Meeting.org [4] The World Health Imaging. Illinois United States Newton N.[6] WHITIA was formerly known as the World Health Imaging Alliance (WHIA) until it formally expanded its scope in June 2009. Jr. Telemedicine and Informatics Alliance Founder(s) Type Founded Location [1] Mike Hoaglin. Matt Glucksberg.[1] [5] WHITIA cultivates high-level strategic relationships with non-governmental organizations. and organizations in the radiology industry. X-ray. US Chicago.

Retrieved 2009-07-02. where radiologists and technologists are in short supply to have a functioning X-ray service. . aspx). com/ The-Industry-s-News-unb. [13] "SIIM to Support World Health Imaging Alliance" (http:/ / www. northwestern. . yahoo. html). Retrieved 2011-01-09. com/ news/ home/ 20110104006502/ en/ WHITIA-Announces-Completion-Digital-X-ray-Pilot-Sites). . . mccormick.[12] WHITIA currently has pilot integrated digital X-ray sites in South Africa and Guatemala at established clinics in need and is expanding to new qualified sites in partnership with NGOs such as Rotary International while cooperating with the local and national governments. [9] "World Health Imaging Alliance (WHIA) Announces Support From The Society for Imaging Informatics in Medicine (SIIM)" (http:/ / www. [2] "Board of Directors" (http:/ / www. org/ [7] "Not-for-Profit Has a Vision to Help a Billion People" (http:/ / www. The system's specific design for Guatemala City is an integration of some of WHITIA's partners' strengths and generosity: • SEDECAL provides the X-ray generator and controls • Carestream Health donates the computed radiography (CR) digital scanner and plates • Kane X-ray donates personnel to perform installation and set up of the CR and PACS This project was largely funded by several US and Guatemalan Rotary clubs along with the key resource support of the Guatemalan municipal and national governments. . McCormick School of Engineering. HealthTech Wire. [3] "Personnel" (http:/ / www. [14] "WHITIA Announces the Completion of Digital X-ray Pilot Sites in Urban and Rural Guatemala" (http:/ / www. . com/ news/ 2009-06-17_01. com/ news/ home/ 20090605005136/ en). [12] "WHITIA launches digital medical X-ray device for screening infectious diseases in developing countries" (http:/ / www. mccormick. McCormick School of Engineering and Applied Science. 0. businesswire. Retrieved 2009-07-02. 2009-04-06. imagingeconomics. . healthtechwire. Imaging Economics. Retrieved 2009-10-22. html). Retrieved 2009-07-02.World Health Imaging. . northwestern. [4] http:/ / www. [8] "World Health Imaging Alliance Poised to Bring Imaging Diagnostics and Data to the Developing World" (http:/ / finance. Retrieved 2009-07-02. edu/ news/ articles/ 494). rt Image. org [5] "World Health Imaging Alliance Partners For X-Rays in Developing World" (http:/ / www. Yahoo Finance. com/ 25_Most_Influential_in_Radiology_Recognizing_the_movers_and_shakers_in_the_radio/ content=9004J05E48B6A084409698724488B0441). Retrieved 2009-07-02. Retrieved 2009-07-02. edu/ FA2007/ Xray. businesswire. news-medical. com/ article/ pressRelease/ idUS111037+ 06-Apr-2009+ BW20090406). net/ news/ 20091130/ WHITIA-launches-digital-medical-X-ray-device-for-screening-infectious-diseases-in-developing-countries. Reuters. Business Wire. THE MEDICAL NEWS. 146+ M5a262949a06.[14] References [1] "McCormick students and faculty tackle health care challenge in the developing world" (http:/ / magazine. . html). Retrieved 2009-12-01. Robert R. They are designed to be models for the wider expansion of the WHITIA network throughout the clinics in need in urban and rural Guatemala. org/ board. org/ personnel. worldhealthimaging. Retrieved 2009-07-02. worldhealthimaging. Telemedicine. worldhealthimaging. reuters. html?x=1& . South and Central America and Southeast Asia. asp). Business Wire. and Informatics Alliance as sub-Saharan Africa. html). . com/ news/ Merge-Healthcare-Commits-1-bw-14855801. worldhealthimaging. Retrieved 2009-07-02. Retrieved 2009-07-04. . [11] "25 Most Influential in Radiology" (http:/ / www.[13] 184 Guatemala clinics The Guatemala pilot sites in urban Guatemala City and rural Río Hondo provide essential healthcare technology to thousands of people in the communities served. [10] "World Health Imaging Alliance poised to bring imaging diagnostics and data to the developing world" (http:/ / www. Northwestern University. [6] http:/ / www. v=1). . . rt-image.

com/news/story/8681/) • (http://www. Written in Java. 2007. the software is designed to run on any operating system with an ultra-thin client that can be launched over the Web without any installation required by the end user. com/ 1194405140/ index_html [4] http:/ / sourceforge.newsrx.youtube. WADO and IHE XDS-I.html) • (http://www. hxti.pdf) Xebra (medical imaging software) Xebra (medical imaging software) is an open source. net/ projects/ xebra/ . cross-platform. com [2] http:/ / linuxmednews.org/WHITIA Guatemala_01-04-2011press_release.dotmed.smartbrief. Here is a copy of PR statement released to LinuxMedNews [2]: "[Xebra] provides healthcare organizations and software developers with all the necessary components to securely transmit and review medical images over a network such as the Internet. Xebra is intended to work alongside any picture archiving and communication system (PACS) and to provide advanced imaging capabilities to a wide range of healthcare IT applications. Unlike its closed and proprietary predecessors locked to a single vendor.com/id/31121000/) • (http://www.com/watch?v=sv0q0hD-flM) • (http://www.site/news/Stock News/2362104/) • (http://www.medicalnewstoday. Xebra was officially released by Hx Technologies [1] on November 6.com/The-Industry-s-News-unb.org/) • Video interview with WHITIA staff and overview of mission. Xebra is based on open standards including JPEG2000.com/article.World Health Imaging.php?articleID=1554620) • WHITIA Announces the Completion of Digital X-ray Pilot Sites in Urban and Rural Guatemala Press Release (http://www.146+M5a262949a06. com [3] http:/ / linuxmednews.0.worldhealthimaging.com/.php) • (http://www. and Informatics Alliance 185 External links • Official webpage (http://www.cnbc. Telemedicine.com/news/aaaa/industryBW-detail. jsp?id=CCB30F65-E324-4325-8B5C-15C061C926F1) • (http://www. thin client and server written in Java for web-based distribution and clinical review of radiology data in DICOM format."1 [3] External links • Xebra project page on SourceForge [4] References [1] http:/ / www.tradingmarkets.com/articles/145456.healthtechwire.worldhealthimaging. Shown at Rotary International Convention 2008 (http://www.

LennoxMI6140. Cforrester101. Neurolysis. RexNL. Peterjm. Kshuyler. Mereda.alrajhi. Khalid hassani. Epsos. Euchiasmus. Gmcressman. Idegtev. Plasma east. DARTH SIDIOUS 2. Middayexpress. Wonglkd.. ArmadilloFromHell. Lotje. ElinorD. Codish. Balsamfir. LeilaniLad. Scatter22. Tdoune. Leonardlow. Jselanikio. Richard 2010 CL. Finikas1911. Argon233.brown. PaulWicks. SeaLion. Mhealth. Elicitfungi. Larsonbennett. Spotharaju. Eilily. Roberta F. Menaljham. Leussen. Ehheh. Beetstra.jc. Babis d.brown. Leontios. ShaneCavanaugh. Saturnine42. Boilermanc. Donama. Yushkevich. Gdbanks.php?oldid=446207209  Contributors: APH. Rsabbatini. Dmannsanco. Onco p53. Xs935.M. Daskalak. Wmahan. VentureBridge.. Twcook.brown. Macksdaddy65. The Anome. Alexav8. Danapsimer. Ohnoitsjamie.coleman24. Shekharsahu. Phaedrus86. Wanscher. Sjjupadhyay. ShelfSkewed. Bluemoose. Jfdwolff. Frap. Interoperable. 9831236gddshs. Perspectoff. Glengold. Prachid. Kozuch. Wavelength. PigFlu Oink. HJ Mitchell. Zeeshanchattha. Ya5irha55an. 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Deville.org/w/index. Rufustfirefly. Pedro Morhy Leal. Vbhise. Podkayneofmars. Edknol. Badgettrg. EditingFrenzy. Csimon3. Asargent. Falcon. Capricorn42. Kalivd. Rodw. Robert A West. DOC DS. Difu Wu. Tgeairn. Jerryobject. Dmckay84. FireFish. Kumar245.brown. Denots. Arina. HexiToFor. Ixfd64. Bazzargh. Gogo Dodo. GB fan. Chasingsol. Vendomedpt.Article Sources and Contributors 186 Article Sources and Contributors mHealth  Source: http://en. Versageek. Rsabbatini . Chris the speller. Jayron32. Skariface.Archer. Varadarajan. Aiacono. Interoperable. Rsabbatini. Cassiemarantz. Hmwith. Cwallsdc. TechHerding. ChristofG. Mrnicksmith. Drkhalifa. Bainca. Ph. Iauixpr. CCRadvocate. Crusio. Rsabbatini. Thielst. Ohnoitsjamie. Mkoole. Iridescent. EugeneBorukhovich. Varano. Hmbr. Canyonchaser. Jasontn. Ugm6hr. SpuriousQ. Thenthorn. Oloftheotherreindeer. GRBerry. Dodoïste. Dmasys. Gaius Cornelius. Giraffedata. Carty. Kmasters0. Kauczuk. Morganpeters. Books fan. Ceyockey. Danny. Calliopejen1. Versageek. 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Simeon antonov. Closedmouth. Ian Pitchford.turner. GRIFFEY366. YSSYguy. Blowdart. Ngtm. Pumas214. Rsabbatini. NatureBoyMD. Gauri Batra. Comte0. Wasabi Wasabi Wasabi. Youngtiger. Jdegreef. SarekOfVulcan. Spencerk. Jleder. Lingmac. JonHarder. Tom1965. Bondegezou. Pch123. Angela. Eilily. Ex nihil. Blofeld.php?oldid=416919885  Contributors: Funandtrvl. EhJJ. Dabormida. Mobiletelephony. Udo Altmann. Tim!. JivaGroup. Mootros. Wocky. Sabathecat. Cankersore. Jpanther2. 244 anonymous edits HRHIS  Source: http://en. Abmac. Barek. Dgilperez. Argon233. Rodw. JohnDavidson. Optigan13. Funandtrvl. Severoon. Lavanian. Ninelocks. ChrisCork. Groenpj. WeisheitSuchen. Vlad. Kate. Nicolas Barbier. Justin Ormont. Ashishof77. Toussaint. Kinyagu. Rougue scholar.brown. Yuanxu4107587. Jan1nad.org/w/index. Monkeyman. MrOllie. MrOllie.brown.0  Source: http://en.php?oldid=420974671  Contributors: Haruth. Beland. Optigan13. Teapotgeorge.wikipedia. Stuart. Marwae t. Rjwilmsi. John of Reading.wikipedia. WurmE. 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Rich Farmbrough. Ncouture.org/w/index. BillgTO. Alfie66. Trident13. TastyPoutine. Rjwilmsi. RDBrown. Charles Matthews. Chowbok. Dana boomer. Harry.org/w/index. Sanesto. Tide rolls. 264 anonymous edits Remote guidance  Source: http://en. Joel7687. DJ Clayworth.php?oldid=336753104  Contributors: Pvosta. Alex.wikipedia. GoingBatty. Smelnikov. Notdum. Medconn. GregorB. Malcolmxl5. Chaosdruid.wikipedia. Kr-val. Wingman4l7. Test21. JohnCD. Christopher Kraus. Malcolma. Jfdwolff. Oddharmonic. Ftrotter. Rahilns. Shmaarts MDLiveCare  Source: http://en. Mikael Häggström. SketchArtist.wikipedia. Kierano. Danim. Abecedare. Beevee.org/w/index.wikipedia. Ceejayoz. Urda.org/w/index. Drjainviraljain. 6 anonymous edits Campus medicus  Source: http://en. Lambiam. Ceyockey. Synahelp. Mono. Bootlace897. Rjwilmsi. Interoperable. Fasten. Archanamiya.Article Sources and Contributors Biotronik  Source: http://en. Stokedbloke. Rsabbatini.php?oldid=445114271  Contributors: Aiden Fisher. Edward. Threexk. Rsabbatini. Ohnoitsjamie. Med imaging. Frap. Phe. Gr1st. Panthouse. Sjschen. Oh Snap. Mreddy08. LeadSongDog.coker. Chruck.wikipedia. Peter Karlsen.php?oldid=409813374  Contributors: Gigacephalus NORTH Network  Source: http://en. Mean as custard. Keesiewonder.org/w/index. Rlee0001. Rich Farmbrough. Pmg. Kweeket.php?oldid=437847665  Contributors: ErikNilsson. WhatamIdoing. ZimZalaBim. Rsabbatini. Ph. Indon. Ceejayoz. Rldoromor.eyes. 4 anonymous edits Myca  Source: http://en. Sabreshark.php?oldid=370151362  Contributors: FreedomFireCom. Reedts. Jonpro. Gleb. Mandi. Azertus. Cntras. Rsabbatini. Moxy. Medtechmonitor. Alphachimp. Polly. Harryzilber. Davidcohen. Pearle. Mandarax. Rsabbatini. Rrburke.org/w/index. TracyGeo. Chrylis. Bsadowski1. Lanmlanm. Nubiatech. Charlesb. Arcadian. MrOllie. Zipswich. Mfawal. Grahamec. WereSpielChequers.php?oldid=436254663  Contributors: Alusayman. WhatamIdoing.wikipedia. Thumperward. Fish and karate. Eezip.wikipedia. Cuthbert8. Clueless. Medconn. Rsabbatini. Mathieu.org/w/index. Wikieditor47. Blappen. Mark Asread. Ean5533. Lyjusinski.wikipedia. Jncraton. Agilestyle.php?oldid=390191198  Contributors: PSE teh 1nf0. LincolnSt. Corto. Jcarroll. Frozen Wind. DrAdamInCA. Lyjusinski. YUL89YYZ. 1 anonymous edits Centre for e-Health  Source: http://en. Tuqui. Gscshoyru. Rsabbatini. Kku. Malcolma.php?oldid=430718822  Contributors: Shortride. Zhou Yu.org/w/index. Thumperward. Movses. Deetdeet. Ömer Cengiz Çelebi. Dclunie. Supten. Ecoleetage. Rich Farmbrough. Pvosta.wikipedia. Simeon antonov.wikipedia. SeanAhern.wikipedia. JediLofty. Sedmic. Nucleon. Vincej. AlistairMcMillan. Sir Escher. Brighterorange. Fram. Zoicon5. Kbouchard. Johnkmetha. Jack Bauer00. Michael Hardy. Mco44. Johnkmetha. Networkvideo. Karamfiles.org/w/index. Intellijean. Alexf. Gary King.org/w/index. Ftrotter. Hariva.tan. Wikidemon.wikipedia.wikipedia. Rjhawkin. Pmg.org/w/index. Wgs18820. Recury. Kbdank71. Davidmack. Jdeutsch. Rjwilmsi. Jauerback. Khanafer. Ganesha Freya. Soundray. NorthernThunder. Rjwilmsi. InverseHypercube. Kgwikipedian.wikipedia. Smoth 007.org/w/index. WhiteDragon. Irubinfeld. Ddlamb.Gunnerson. Harryzilber. Djln. Lancetfluke. WulfTheSaxon. Dicomprogrammer.php?oldid=417280345  Contributors: Canis Lupus. Rlee0001. Umls04aa. Giraffedata. 21 anonymous edits Microsoft HealthVault  Source: http://en. Courcelles. Manscher. N5iln. Zoicon5. Ronz. Belovedfreak.php?oldid=417270431  Contributors: JDDC1.org/w/index. MrOllie. PhilKnight. Kosherfrog. Kvng. Lovecreak. Rajnishbhatt. Soumyasch. Amelio Vázquez.org/w/index. Dineshkoka. SandyGeorgia. Vicki Rosenzweig. MrSerif. AstonishedDolphin. Rbardwell. Senimazarine. Zabdiel.org/w/index. ‫ 512 . Surv1v4l1st. ChumpusRex. Whoisjohngalt. Peter Damian. Dclunie.php?oldid=336751807  Contributors: Allen4names.php?oldid=443326212  Contributors: Akshaygn.wikipedia.php?oldid=444004023  Contributors: BullRangifer. Whoisjohngalt. Mmaurn. Threexk. Donama. Markaud. Trevor MacInnis Dossia  Source: http://en. 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wikipedia. Abedhammoud. CliftonRugby. Paul foord. TelecareTechnology.wikipedia. Wikiphile1603. TheRedClay. Pearle. Micru. Jsfouche. Rickwjenn. Scottalter. MikeWazowski. Requestion.php?oldid=445748481  Contributors: 122589423KM. Kirkewing. WurmE. 4 anonymous edits Xebra (medical imaging software)  Source: http://en. Mhoaglin. WikHead. 1 anonymous edits Tele-epidemiology  Source: http://en. Wtshymanski. Rsabbatini.org/w/index. Dbrienza. PGPirate. Jake Wartenberg. Barticus88. 365 anonymous edits Skevos Zervos  Source: http://en. Wireless friend. PRPLwiki. AuroraIT. Jim. 11 anonymous edits Teledermatology  Source: http://en. David. Jaquesk. Ronsword. Anschaefer.org/w/index. Katharineamy. Sunidesus. Docmarcg. Mwanner. Woohookitty.wikipedia.org/w/index. J04n. Soumzzzz. Alephnyc. Basawala. 6 anonymous edits Teleradiology  Source: http://en. GoingBatty. 7 anonymous edits UNESCO Chair in Telemedicine  Source: http://en. Sam Blacketer. Lovelac7. JHunterJ. Sueotis. John of Reading. Alievrenkut. 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CommonsDelinker.wikipedia. Kpearce. Briancua. TenOfAllTrades. Whitejay251. JPDMichel. Kraftlos. MMC. Malcolma. Shoeofdeath. Metju. LouisBB.php?oldid=426880562  Contributors: -fin. Mushroom. Greasybackflop. Rvitelli. Muad. D6. Wizardman. Rougue scholar. Rsabbatini. Booyabazooka. Jd027. Auntof6. Vegaswikian.php?oldid=414812234  Contributors: Barkeep. Brobdignagian.org/w/index. Ekem. Decltype. Schubert. Wyatt915. Amy D. Harrypuns. 127 anonymous edits Telerehabilitation  Source: http://en. Pearle.mdel. Z22. Gobonobo. Pgillman. 4 anonymous edits 188 .wikipedia. Animagi1981. Stevenfruitsmaak.php?oldid=427535961  Contributors: DGG. BrainyBroad. OlEnglish. Alinja. Vandido. Rsabbatini. WhatamIdoing. Crazymonkey1123. Cheeze1010101. Mysoberlife. Qingostarr. Zzuuzz. Jamesontai. HardJeans.php?oldid=441861039  Contributors: Aesopos. OlYeller21. Rich Farmbrough. Clicketyclack. Closedmouth. Muhandes. Salad Days. Kahmed198. Almazan. Extransit. That Guy. AppForCalPERSMCII. Mtreat. Leolaursen. Harryzilber. Philip Trueman. Faradayplank. H3llkn0wz. Darrelljon. Woohookitty. Pascal666. Ben Ben. Dekisugi. Dirk. WikHead. Gynonc. Rich Farmbrough. Biggleswiki. Rsabbatini.wikipedia. Waacstats. THB. FiachraByrne.wikipedia. John of Reading. Mission Fleg. The Rambling Man. Joel7687.org/w/index.php?oldid=442746737  Contributors: Catai2008. Rachelellaway. GiggsHammouri. Hargle. LilHelpa. Harborrat99. Earlypsychosis. Autocracy. Boing! said Zebedee. RyanGerbil10. Drsaurabhk. Blabberhand. KrakatoaKatie.php?oldid=439986713  Contributors: Alvin Seville. WODUP. Speechpathology. TexasAndroid. J. Maelwys. Khatru2. TreasuryTag. Toyokuni3. Steve carlson. Wingman4l7. Headbomb. Printerbuilder. Salamurai. Chris Capoccia. RTG. Kiwi128. Helloher. Sunidesus. Jbkim486. Chaosdruid. WhatamIdoing. Alansohn.org/w/index. Math Champion. STHayden. Stillplaygbc.koekies. Afein.wikipedia. Hercule. GeneralAtrocity. Chowbok. Anetode. Usteleradiology. Mechanistic. Rsabbatini.wikipedia. John of Reading. Wayne Miller. 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while you still can. Much More! This book explains in-depth the real drivers and workings of MHealth. the use of information and communication technology (ICT). Teleradiology. Telecare. World Health Imaging. time and resources investment decisions by enabling you to compare your understanding of MHealth with the objectivity of experienced professionals . Remote surgery. background and everything you need to know. . Virtual patient. In easy to read chapters. Center for Telehealth and E-Health Law. Robotic surgery. such as computers. Health 2. EHealth. It reduces the risk of your technology. Dossia. European Health Telematics Observatory. Myca. Telepsychiatry.. this book is a unique collection to help you become a master of MHealth. and Informatics Alliance. Ontario Telemedicine Network. HealthLinkBC. MLearning. learn EVERYTHING you need to know about MHealth. real-time monitoring of patient vital signs. NORTH Network. “Here’s Your Chance To Skip The Struggle and Master MHealth. Wireless Medical Telemetry Service. List of open source healthcare software.. HRHIS. for health services and information. Teledentistry. Stop Searching. IMedicor. patient monitors. Telehealth. and patients. faster than you ever dreamed possible! The information in this book can show you how to be an expert in the field of MHealth. proposal and implementation with the ultimate book – guaranteed to give you the education that you need. researchers.. A quick look inside: MHealth. communications satellite. Xebra (medical imaging software) .and Much. An Important Message for ANYONE who wants to learn about MHealth Quickly and Easily.. Telenursing. MDLiveCare. Skevos Zervos. Google Health. Are you looking to learn more about MHealth? You’re about to discover the most spectacular gold mine of MHealth materials ever created. Teledermatology. and direct provision of care (via mobile telemedicine). Biotronik. Tele-audiology. Remote guidance.Grab your copy now. The Continua Health Alliance. for health services and information. such as mobile phones and PDAs.0. Get the edge. ICan Group. Patient portal. Microsoft HealthVault. The mHealth field has emerged as a sub-segment of eHealth. Remote therapy. etc. Health On the Net Foundation. Epocrates. Telemedicine. Canada Health Infoway. The term is most commonly used in reference to using mobile communication devices. mobile phones. Campus medicus. The #1 ALL ENCOMPASSING Guide to MHealth. Microsoft Amalga. analysis. In 2 Days Or Less.” mHealth (also written as m-health or mobile health) is a term used for the practice of medicine and public health. Alaska Federal Health Care Access Network. Stand Out and Pay Off. European Health Telematics Association. Telephone triage. delivery of healthcare information to practitioners. Alberta Netcare. supported by mobile devices. Telerehabilitation. This book is your ultimate resource for MHealth. Health informatics.The Knowledge Solution. mHealth applications include the use of mobile devices in collecting community and clinical health data. DICOM. Tele-epidemiology. Distance Learning and Telemedicine Grant and Loan Program. Picture archiving and communication system... Virtual reality in telerehabilitation. Association of Telehealth Service Providers. UNESCO Chair in Telemedicine. NHS Picture Archiving and Communications System. with extensive references and links to get you to know all there is to know about MHealth right away. Here you will find the most up-to-date information.. Centre for e-Health. Wireless Health. Connected Health. With the Least Amount of Effort. American Telemedicine Association. Belgian Health Telematics Commission. and ace any discussion. E-Patient. Telepathology. Telemedicine. Telemental Health. Mediangels.

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