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

Telehealth: 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 Telehealth.

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

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

Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities a different ends of the globe.
Telehealth is an expansion of telemedicine, and unlike telemedicine (which more narrowly focuses on the curative aspect) it encompasses preventive, promotive and curative aspects. Originally used to describe administrative or educational functions related to telemedicine, today telehealth stresses a myriad of technology solutions. For example, physicians use email to communicate with patients, order drug prescriptions and provide other health services.

Get the edge, learn EVERYTHING you need to know about Telehealth, 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 Telehealth.

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

This book is your ultimate resource for Telehealth. 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 Telehealth right away. A quick look inside: Telehealth, 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, EHealth, Epocrates, European Health Telematics Association, European Health Telematics Observatory, Google Health, Health 2.0, Health On the Net Foundation, ICan Group, IMedicor, MDLiveCare, Mediangels, MHealth, 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, Telemedicine, 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 Telehealth. It reduces the risk of your technology, time and resources investment decisions by enabling you to compare your understanding of Telehealth 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 Telehealth.

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

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

Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities a different ends of the globe.
Telehealth is an expansion of telemedicine, and unlike telemedicine (which more narrowly focuses on the curative aspect) it encompasses preventive, promotive and curative aspects. Originally used to describe administrative or educational functions related to telemedicine, today telehealth stresses a myriad of technology solutions. For example, physicians use email to communicate with patients, order drug prescriptions and provide other health services.

Get the edge, learn EVERYTHING you need to know about Telehealth, 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 Telehealth.

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

This book is your ultimate resource for Telehealth. 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 Telehealth right away. A quick look inside: Telehealth, 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, EHealth, Epocrates, European Health Telematics Association, European Health Telematics Observatory, Google Health, Health 2.0, Health On the Net Foundation, ICan Group, IMedicor, MDLiveCare, Mediangels, MHealth, 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, Telemedicine, 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 Telehealth. It reduces the risk of your technology, time and resources investment decisions by enabling you to compare your understanding of Telehealth with the objectivity of experienced professionals - Grab your copy now, while you still can.

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Published by: Emereo Publishing on Oct 07, 2011
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List Price: $39.95


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  • 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
  • eHealth
  • Epocrates
  • European Health Telematics Association
  • European Health Telematics Observatory
  • •European Health Telematics Observatory [3]
  • Google Health
  • Health 2.0
  • Health On the Net Foundation
  • iCan Group
  • iMedicor
  • MDLiveCare
  • Mediangels
  • MediAngels
  • mHealth
  • 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
  • Telemedicine
  • 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
  • License



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.

Telehealth 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 eHealth Epocrates European Health Telematics Association European Health Telematics Observatory Google Health Health 2.0 Health On the Net Foundation iCan Group iMedicor MDLiveCare Mediangels mHealth Microsoft Amalga Microsoft HealthVault HealthLinkBC Myca NHS Picture Archiving and Communications System 1 5 6 7 8 9 10 11 13 14 15 16 17 22 29 30 32 34 38 39 40 41 44 49 52 53 54 55 57 81 83 86 89 90

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 Telemedicine 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)

91 97 98 100 106 107 109 117 118 119 120 121 121 125 135 135 137 140 143 144 146 152 155 156 159 161 162 164 166

Article Sources and Contributors Image Sources, Licenses and Contributors 167 170

Article Licenses
License 171

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

Telehealth also benefits patients where traditional delivery of health services are affected by distance and lack of local specialist clinicians to deliver services. Remote patient monitoring In remote monitoring. where the patient is monitored between physician office visits. and medical licensing requirements that may inhibit or deter the provision of telehealth second opinions or primary consultations by physicians. Peripheral devices can also be attached to computers or the video-conferencing equipment which can aid in an interactive examination. in the case of patients. Videoconferencing equipment is one of the most common forms of synchronous telemedicine. With the availability of better and cheaper communication channels. For example. sustainable behaviour through monitoring and improved communications and reducing the requirements to expand . the policies of governments and/or insurers with respect to coverage and payment for telehealth services. 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. while improving patient's quality of life. partnerships have been formed with the following companies: MDLiveCare and Hello Health. a telecommunications link allows instantaneous interaction. Google Health. 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. by car) as well as encouraging healthy.Telehealth 2 Real-time telehealth In real-time telehealth. 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. sensors are used to capture and transmit biometric data. 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. This could be done in either real time or the data could be stored and then forwarded. Examples of real-time clinical telehealth include: • • • • • • • • Tele-audiology Telecardiology Teledentistry Telemental Health -. direct two-way audio and video streaming between centers through computers is leading to lower costs. a personal health information centralization service. This has been shown to significantly reduce hospitalizations and visits to the Emergency Room. a tele-EEG device monitors the electrical activity of a patients brain and then transmits that data to a specialist. To date.[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.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.

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

org/files/ Fit_for_the_Future_NHS_Sept09.tas.gov.com.htm) (established by the Health Resources and Services Administration) • U.ca/english/public/program/telehealth/telehealth_mn.ca) Tasmanian government (http://www.S.org) • Center for Telehealth & E-Health Law (http://www.stoke.sct.gov/index. the UK National Health Service information service NHS Stoke on Trent (http://www.au/) NHS Direct (http://www.org) • National Rural Health Association (http://www.unm.wirelesshealth.edu/) .edu/som/telehealth/) • University of Florida Center for Telehealth (http://telehealth.nhs.health.html) Ontario Telemedicine Network -.ucla.NRHArural.hrsa.The International Educational and Networking Forum for eHealth.au/service_information/services_files/telecare) GP2U Telehealth Australia (http://gp2u.dhhs.telehealthlawcenter.phhp.org) Scottish Centre for Telehealth (http://www.americantelemed.va. gov) • American Telemedicine Association (http://www.nhs.nhs.nhsdirect.lu/) Community for Teledermatology (http://telederm.bcatpr.org/) • National Center for Telehealth & Technology (http://www.t2health.org) • Telemedicine Information Exchange (http://tie.carecoordination.uk/simple) Simple Telehealth Project International Society for Telemedicine & eHealth (http://www.net/) Med-e-Tel . Telemedicine and Health ICT (http://www.Making the Connection for Health (http://www.aspx) 4 United States oriented • Office for the Advancement of Telehealth (http://telehealth.gov.ufl.telemed.org/) • University of New Mexico Telehealth (http://hsc. Department of Veterans Affairs Care Coordination/Telehealth Program (http://www.Telehealth • • • • • • • • • • • • • • Telehealth Ontario (http://www.medetel.otn.lifesize.edu) Fit for the Future.forumforthefuture.pdf) Lifesize Case Study on Telehealth (http://www.uk) British Columbia Alliance on Telehealth Policy and Research (http://www.on.ca) UCLA Wireless Health Institute (http://www.com/Industry_Solutions/Case_Studies/ Case-Study_Village-Church. Scenarios for low-carbon healthcare in 2030 (http://www.isft.scot.uk/).

it was primarily intended a substitution for conventional. David Richards. TBMC Psychiatry 2008. . Retrieved June 15. the team-based applications of cognitive behavioral therapy utilizing a licensed therapist and behavioral coach. . Evette J Ludman. 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. PhD. php?mid=694& xwm=true). 1st Class Adam Shaw. secure instant messaging platform.MIL (The Official Homepage of The United States Army). remote therapy has enjoyed growing popularity as a replacement for traditional therapy and innovative practice made possible by electronic medium.Remote therapy 5 Remote therapy Remote Therapy. Karina Lovell. . Internet-Enabled Therapy Sessions Enhance Access to Cognitive Rehabilitation for Traumatic Brain Injury Patients. The Lancet. WWW. the internet or other electronic media in place of or in additional to conventional face-to-face psychotherapy. 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. PhD. face-to-face therapy in which a client or patient is required to visit a psychotherapists office. Increasingly. . "Psychotherapy mediated by remote communication technologies: a meta-analytic review" (http:/ / www. 2008.[6] References [1] David Hailey.[3] Examples Despite the absence of complete study. "The Effectiveness of Telemental Health Applications: A Review" (http:/ / publications. [4] Sgt. Retrieved November 2008. however. army. [6] "At-Home. Arto Ohinmaa. cellular phone. gov/ content.ARMY. sometimes called Telemental Health Applications[1] or Internet-based Psychotherapy. academics are studying the use of electronic media in treatment to explore the possibility of providing novel and potentially more effective therapies. ncbi. aspx?id=1688). cpa-apc. "Q-West Chaplains Introduce Video Teleconference Counseling for Couples" (http:/ / www. . Leading to High Levels of Patient and Therapist Satisfaction" (http:/ / www. biomedcentral. Vol 374. 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. nlm. com/ we-can-help/ ). org/ media. 2009. Retrieved July 22. [2] Gregory E Simon. MD. Simon Gilbody. gov/ pubmed/ 19699995). . Using an Internet-based. provides remote cognitive rehabilitation sessions to patients who have had an acquired brain injury. Linda Gask and Pamela Roach.[2] is a form of psychotherapy or related psychological practice in which a trained psychotherapist meets with a client or patient via telephone. 2009. "It’s Time for Disruptive Innovation in Psychotherapy" (http:/ / www. the available evidence is limited in quantity and quality. .[4] • AbilTo LLC.[5] uses remote therapy to extend the reach of evidence-based practice and introduce innovative new practices. However. The Canadian Journal of Psychiatry. • Mayo Clinic. 8:60. Risto Roine. [3] Penny E Bee. innovations. com/ 1471-244X/ 8/ 60). More rigorous trials are required to confirm these preliminary estimates of effectiveness. an office-based therapist conducts the rehabilitation session with the patient. Peter Bower. ahrq. nih. Retrieved August 22. who remains in or near his or her home. e.. After reviewing thirteen relevant studies. Initially.g. mil/ -news/ 2009/ 06/ 15/ 22707-q-west-chaplains-introduce-video-teleconference-counseling-for-couples/ ). [5] "Abilto's offerings" (http:/ / abilto.

Service Level Agreements (SLAs). and deploy new telehealth technologies. The AFHCAN system provides an innovative approach to ease of use. support for widely varying clinical workflows. and Support Staff. Integrated Biomedical Peripherals. AFHCAN continues to evolve and expand its services where the number of users and clinical services has grown significantly over the years. Certified Training for Administrators.Alaska Federal Health Care Access Network 6 Alaska Federal Health Care Access Network The Alaska Federal Health Care Access Network (AFHCAN) is managed by the Alaska Native Tribal Health Consortium (ANTHC). As a part of its mission. jointly manages and operates the Alaska Native Medical Center (ANMC). 450 (b) (c) [1] and.C. mobility. Clinical Workflow Assessments. AFHCAN offers a whole product solution that includes: Store and Forward Telehealth Software. AFHCAN Telehealth Cart and other Platforms. and a robust communication platform. Automatic Software Updates. and send data for consultation. USA. Through growing acceptance of telehealth. providing tertiary and specialty healthcare service in the state of Alaska. Users. as defined in 25 U. First and foremost. External links • Official website [2] References [1] http:/ / www. along with the Southcentral Foundation. AFHCAN continues to review. anthc.S. Health care professionals are able to view the data and respond to the case using a standard PC workstation. afhcan. ANTHC is a tribal organization. org . org/ ref/ laws/ [2] http:/ / www. 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. more than 700 users in Alaska continually provide feedback and request new products and features. develop. and Help Desk / Customer Support.

hospitals) do not require the RSA key for login.582 Edmonton area patients. Security Failures From May 15-29.Alberta Netcare 7 Alberta Netcare Alberta Netcare (formerly Wellnet) is the province of Alberta's public Electronic Health Record. ca/ / [2] http:/ / www. and to upload medication dispensations. 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. compromising the privacy of 11. pdf . and an RSA SecurID Key Fob for authentication. Implementation Netcare messaging is performed with HL7-encoded XML messages. Users who are within the trusted networks of the Government of Alberta (eg. Security Netcare uses a two-factor authentication protocol involving a username/password combination. ab. External links • Alberta Netcare official site • Alberta Privacy Commissioner preliminary report on the May breach [2] [1] References [1] http:/ / www. Pharmacies can use the service to verify prescription details. Messages are sent and received over a secure HTTP connection. ca/ Content_Files/ Files/ News/ NR_AHSbreach_8Jul2009. 2009 a Trojan virus was detected on several Alberta Health and Netcare systems. albertanetcare. oipc.

ATA is governed by a Board of Directors elected by the Association's membership. • ATA Annual Meeting . ocular telehealth. and the impact of telemedicine on the quality. The Association implements these objectives by: • • • • Educating government about telemedicine as an essential component in the delivery of modern medical care. ATA provides a broad range of services for its members and the industry as a whole. • ATA Website . Washington. Membership in ATA is open to individuals. government and others to overcome barriers to the advancement of telemedicine through the professional. companies and other healthcare and technology organizations. exclusive news briefs via email about the latest event and activities affecting telemedicine professionals. americantelemed.American Telemedicine Association 8 American Telemedicine Association American Telemedicine Association Location 1100 Connecticut Ave.the single source of who's who in telemedicine.allow members to address issues related to the advancement and application of telemedicine regarding specific areas including home telehealth. academic medical centers. • ATA Online Membership Directory . ethical and equitable improvement in health care delivery. NW Suite 540. technical advances and enabling technologies.the world's largest scientific meeting and exposition focusing exclusively on telemedicine. Regional Chapters and Discussion Groups . e-health. with hundreds of presentations. teledermatology. continuing medical education. posters and workshops. and telerehabilitation. • On-line Member News Updates . technology. and access to health care.a peer-reviewed publication encompassing all aspects of clinical telemedicine practice. ATA goal is to promote access to medical care for consumers and health professionals via telecommunications technology (alternatively referred to as telemedicine. • Telemedicine and e-Health . Fostering networking and collaboration among interests in medicine and technology.direct. The American Telemedicine Association is the leading resource and advocate promoting access to medical care for consumers and health professionals via telecommunications technology. technology and telecommunications companies. cost-effectiveness. Serving as a clearinghouse for telemedical information and services.a widely-used resource for telemedicine news and information. established in 1993 as a non-profit organization. DC 20036 Website http:/ / www. • Spearheading the development of appropriate clinical and industry policies and standards. telemental health. In accordance with the mission of the organization. . telepathology. medical societies. telenursing. ATA seeks to bring together diverse groups from traditional medicine. • Special Interest Groups (SIGs). Promoting research and education including the sponsorship of scientific educational meetings and theTelemedicine and e-Health Journal. org American Telemedicine Association (ATA). telehealth or eHealth).

atmeda. 2006). Fierce Healthcare. Patients Back Telemedicine" [1]. and business support services. Telemedicine Information Exchange In June 2006. It was founded in 1996 by Douglas Perednia. org/ [5] http:/ / www. 1997. 2010. Oregon. • "Tribal Healthcare 2000: Telecommunications and Telemedicine" [3]. com/ story/ telemedicine-growth-examined/ 2006-03-13 [3] http:/ / www. all-inclusive platform for information on telemedicine and telehealth. Candice (March 13. the ATSP announced that it was taking over the hosting and updating responsibilities for the Telemedicine Information Exchange (TIE) [1]. google. Retrieved September 7. 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. html [4] http:/ / www.American Telemedicine Association 9 References • Choi. Retrieved September 7. June 13. • "Telemedicine growth examined" [2]. com/ doc/ 1P1-3985567. External links • Association of Telehealth Service Providers (ATSP) homepage [2] • Telemedicine Information Exchange [1] . 2010. External links • ATA homepage [4] • Wiki for telemedicine (ATAwiki) [5] References [1] http:/ / news. education awareness programs. It is a business-oriented group which focuses on providing members with information and tools to facilitate the success of their telehealth activities. highbeam. Its main activities are advocacy. atawiki. Its executive director is Will Engle. 2010. "Doctors. Retrieved September 7. MD and is located in Portland. unbiased. ATSP believes that telemedicine is a practical tool that can improve the distribution of healthcare services to the benefit of both patients and providers. 2006. com/ newspapers?id=_AA1AAAAIBAJ& sjid=DU8KAAAAIBAJ& pg=3045. March 12.3220792& dq=american-telemedicine-association+ -newswire& hl=en [2] http:/ / www. The TIE's mission is to provide an online. fiercehealthcare. The Ojibwe News. Bangor Daily News.

4280450&_dad=portal& _schema=PORTAL) • Telematics Standards in relation to the Health Sector (https://portal. atsp.be/portal/page?_pageid=56. ehealth-era. Stud Health Technol Inform.be/portal/page?_pageid=56. pdf) Source • Telematics Commission (https://portal.health. Stud Health Technol Inform. 2004.[3] References [1] Belgian Telematics Commission.PDF) (PDF. Digital signature and electronic certificates in health care. 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. Professor Georges De Moor is head of the committee. together with Jos Devlies and Geert Thienpont. 2004.fgov. org/ database/ documents/ ERA_Reports/ Belgium_eHealth-ERA_country-report_final_30-06-2007.Association of Telehealth Service Providers 10 References [1] http:/ / tie. advice) .4280396&_dad=portal& _schema=PORTAL) • Rcommendations (https://portal. between health care participants. org/ [2] http:/ / www. telemed.health. Recommendations regarding national development of standardized electronic health care messages.be/pls/portal/docs/PAGE/ INTERNET_PG/HOMEPAGE_MENU/GEZONDHEIDZORG1_MENU/AUTOMATISERING1_MENU/ SYMPOSIA1_MENU/AVIS25_MENU/AVIS25_DOCS/A01-UK. The BHTC consists of several working groups: • • • • Data Hospitals Telemedicine Label: homologation of (para)medical software Georges De Moor. The committee provides advice on eHealth to the Belgian government[1] [2] . authored the 2006 eHealth strategy and implementation activities in Belgium report.health.fgov.110:87-9 [3] eHealth strategy and implementation activities in Belgium (http:/ / www.fgov.110:112-7 [2] Belgian Telematics Commission.

cardiac resynchronization therapy devices (CRS). balloon catheters. randomized trial. without travelling to a health care facility. implantable cardioverter-defibrillators (ICD). a magnesium bioresorbable stent. or fax. KG. closed-loop stimulation devices (CLS). Germany Website Biotronik References: [1] [2] [3] Biotronik (Biotronik SE & Co. Business focus Biotronik focuses on medical devices for vascular intervention and electrotherapy of the heart. vascular intervention products for treatment of stenosis and occlusion in arterial vessels. Biotronik developed the first German cardiac pacemaker in 1963 and pioneered in the creation of remotely-monitored implanted cardiac devices. stents and stent systems for coronary and peripheral diseases. 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. Depending on the type of device and its programming. catheters. In addition to providing a safety net for individuals with potentially lethal illnesses of the heart. Short Messaging Service (SMS). The physician would have access to the dataflow [6] [7] from the device and could assess the appropriate response. such as landline telephone. and the state of the device.[4] [3] In January 2010. The company has marketed these telemedicine technologies in Europe since 2000. The system is highly integrated with a variety of telecommunication technologies.[2] Biotronik Worldwide) is a privately-held multinational biomedical technology company headquartered in Berlin. Germany. measurement and ablation systems for electrophysiology. Patients who have implants can be monitored as necessary.443 patients enrolled from 105 North American sites. and related technologies such as the external devices used to monitor implants. It is the first study to test remote monitoring and rapid detection of symptomatic and asymptomatic cardiac events in a prospective. cellular telephone.000 systems using the Biotronik technology have been implanted in heart patients. the pacemaker or ICD could alert a physician immediately in the event of an emergency cardiac event. in the USA since 2001.[8] [9] [10] As of the end of 2009. over 230. leads. in more than 55 countries. and in over 50 other countries.[5] Telemedicine Biotronik offers a unique system that allows a patient's implanted device to transmit information about the condition of the patient's health.Biotronik 11 Biotronik Biotronik Type Industry Founded Privately held Medical device manufacturer 1963 Headquarters Berlin. email. The safety of this approach has been confirmed in a clinical study led by the Cleveland Clinic involving over 1. this form of telemedicine allows periodic routine physician review to occur at a distance. which would be determined by the medical necessity in each individual. directly to a secure website where a physician can observe it. guidewires.[5] . Its products include pacemakers.

Retrieved 11 January 2010. Max Schaldach. [5] "BIOTRONIK: Unique Leadless Cardiac Monitoring Device Implanted" (http:/ / www. aspx?id=67474). hoise. org/ cgi/ reprint/ 118/ 22/ 2309). aspx?id=67579). Retrieved 3 April 2011. biotronik. [10] Varma.. com/ companies/ biotronik_gmbh_co_kg/ ). html). [9] Varma. et al. 2010. escardio. aspx). [4] "Pharmaceutical Business Review" (http:/ / www.[13] Biotronik claims to be "the fastest growing medical device company globally"[14] and is expanding its global workforce of over 5. com/ portal/ 4595).com. "Efficiency of calendar based ICD checks: conventional follow-up compared to remote monitoring in the TRUST trial" (http:/ / spo. 2008. com/ vmw/ 01/ articles/ vmw/ LV-VM-11-01-15. aspx?StoryID=166882& full=1). [6] "Unique Leadless Cardiac Monitoring Device Implanted" (http:/ / www. KG" (http:/ / www. . hospitals implant first BIOTRONIK pacemakers with Home Monitoring Technology" (http:/ / www. html). 2009). as owner of the company. unified platform pacemaker series in Europe" (http:/ / www. pp. United States. . Schaldach died in the crash of an aircraft he was piloting in 2001.S. Snapshot" (http:/ / investing. com/ company/ BIOTRONIK_SE__Co_KG/ yrhjtftts-1. Company profiles. . [7] "BIOTRONIK launches its new. Biotronik. pp. businessweek. THE MEDICAL NEWS from News-Medical. net/ news/ 20091027/ BIOTRONIK-launches-its-new-unified-platform-pacemaker-series-in-Europe. . . . pp. January 6. hoovers. com/ research/ stocks/ private/ snapshot. in the 1970s. . Germany. 27 October 2009. Barcelona. in 1963 by physicist Max Schaldach and electrical engineer Otto Franke. and was succeeded by his son. Inc. [8] Varma.Net. streetinsider.[5] Awards Biotronik was nominated for the "Deutscher Zukunftspreis" an award conferred by the German Federal President for achievements in technology and innovation. Virtual Medical Worlds Monthly. Evaluation of efficacy and safety of remote monitoring for ICD follow-up: the TRUST trial (http:/ / circ. news-medical. N. . The company opened its North American headquarters and production facilities in Oregon.. [3] "BIOTRONIK. Hoovers. Retrieved 11 January 2010. Retrieved 12 January 2010. com/ portal/ home [2] "BIOTRONIK SE & Co. html). Retrieved 12 January 2010. [12] Versweyveld. . (August 30. Abstract 86114. devicespace. et al.[12] Prof. Spain: ESC Congress.. N. Spain: ESC Congress. This prize is considered the most important national award for scientific and technological innovations which have already proven themselves on the market. Max Schaldach" (http:/ / www. Retrieved 11 January 2010. N. asp?privcapId=6500053). "Event notification by remote monitoring systems performing automatic daily checks: load. Leslie (23 October 2001). Barcelona.Professor Dr. et al. In 1993 Biotronik developed its first ICD. (August 31. allbusiness. escardio. who developed the first German implantable pacemaker. html). Retrieved 11 January 2010.[11] Biotronik's telemetry-based accessible cardiac devices were first implanted in Europe in 2000 and in the United States in 2001.000 employees. biotronik. com/ Press+ Releases/ Unique+ Leadless+ Cardiac+ Monitoring+ Device+ Implanted/ 5224337. ahajournals. "Two U. . org/ abstract-book/ presentation. Retrieved 11 January 2010. pharmaceutical-business-review. when it acquired Stimulation Technology. characteristics and clinical utility" (http:/ / spo. Circulation: American Heart Association. Retrieved 11 January 2010. com/ news_story. Business Wire.[15] External links • Biotronik [1] References [1] http:/ / www. org/ abstract-book/ presentation. 2009). [13] "OBIT/BIOTRONIK -. Business Week. . 7 May 2001. All Business. 6 January 2010.Biotronik 12 History Biotronik was founded in Berlin. In 1995 the company released a number of devices for vascular intervention such as balloon catheters and stents. [11] "Our History" (http:/ / www. Abstract 87438. com/ company-activities-management/ company-structures/ 6070009-1. . Inc. Dr. Retrieved 11 January 2010. Retrieved 12 January 2010. Retrieved 11 January 2010. 2309–2317 Abstract 4078. .

1 Sept 2008. html . . What is required is a camera for macroscopy or microscopy and a computer with internet connection. 2009. Retrieved 12 January 2010.) to communicate all over the world. Campus Medicus allows the doctors to have a live discussion with several doctors while they see the stored images or a live image. radiologists etc. The written lectures may be printed out as a book. com/ p/ articles/ mi_m0EIN/ is_2008_Sept_1/ ai_n28047799/ ?tag=col1. 13 Campus medicus Campus Medicus is a content management system for telemedicine use. Doctors can discuss about a tumour or other diseases. . They can have a videoconference and they can chat at the same time they see the images. It has three main applications. BNET CBS Interactive. pathologists. Reuters. openpr. cytologists. com/ article/ idUS107222+ 28-Sep-2009+ BW20090928). The lectures may be held as a live lecture or they can be stored and reviewed as a video. [15] "Nominated for the German Federal President's "Deutscher Zukunftspreis" (German Future Award): BIOTRONIK Home Monitoring for Online Monitoring of Heart Patients" (http:/ / www.co-competitors). Campus Medicus can be used for diagnostic consultations. Source Telemedizin in der Mongolei [1] References [1] http:/ / www. Images can even be sent by email to that platform. doctors can send images and text and receive diagnosis via a mobile phone. nursing and others. reuters. Using the mobile health function of Campus Medicus means. de/ news/ 352298/ Telemedizin-in-der-Mongolei. cytology. A single image or a whole slide image can be viewed. Ready-to-use forms are available and forms can be generated easily. The videoconference module allows holding individual lectures for doctors and students all over the world.Biotronik [14] "BIOTRONIK Forges Ahead Toward Medtech Leadership Position" (http:/ / findarticles. surgery. Clinical decision support It allows doctors (surgeons. such as gynaecology. Teaching Ready-to-use lecture notes are available. 28 Sept. Business Wire. Retrieved 12 January 2010. pathology. Documentation Campus Medicus can also be used for cancer registry and epidemiology. The results may be viewed as a statistic.

Infoway’s members are Canada's 14 federal. provincial and national projects which align with the Pan-Canadian EHR Blueprint. Projects Since 2001. Beyond these strategic investments. and may dramatically improve health care for Canadians. in order to enable efficient communication between health care professionals and bringing a deeper understanding of patient needs. leveraging the existing HL7v3 standards. 2008 there were 276 EHR projects under way in Canadian hospitals. Infoway has no mandate to enforce compliance. Development of a network of effective interoperable electronic health record solutions across Canada – linking clinics. itself developed by Infoway. 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. provincial and territorial Deputy Ministers of Health.Canada Health Infoway 14 Canada Health Infoway Canada Health Infoway is an independent. as Canadian healthcare is generally governed at the Provincial level. As a strategic investor. federally-funded.5-billion from Canada Health Infoway. with an investment value of $1. 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. hospitals. 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. It is reported that as of December 31. pharmacies and laboratories. other health-care facilities. Infoway's investments are prioritized toward local. enhance their quality of care and make the health care system more efficient. safer prescriptions and better access to quality health care. not-for-profit organization tasked with accelerating the development of electronic health records (EHR) across Canada.[12] . The results of the project may include shorter medical procedure wait times.

” – Innovation. CTeL offers a variety of services. infoway-inforoute.C. US Commerce . • *The National Telehealth Resource Center (NTRC). 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.. including involvement in public policy. analyzing and disseminating information on legal and regulatory issues information associated with telemedicine. established in 1995 by a consortium including the Mayo Foundation. It also handles underlying issues such as licensure and reimbursement.C. infoway-inforoute. ca/ lang-en/ about-ehr/ ehr-progress-map [2] http:/ / www. ca/ lang-en/ about-infoway/ approach/ investment-programs/ interoperable-ehr [7] http:/ / www. ca/ lang-en/ about-infoway/ approach/ investment-programs/ drug-information-systems [4] http:/ / www. infoway-inforoute. com/ servlet/ story/ RTGAM.Canada Health Infoway 15 Notes [1] http:/ / www. writes reports. In its materials. CTeL briefs public policymakers. ca/ lang-en/ about-infoway/ approach/ investment-programs/ innovation-and-adoption [6] http:/ / www. and the Mid-West Rural Telemedicine Consortium. and provides testimony in support of telehealth. – monthly seminars on various topics of interest in telehealth and e-health. ca/ lang-en/ about-infoway/ approach/ investment-programs/ patient-access-to-quality-care [9] http:/ / www. • Washington Live! Brown Bag Lunches in Washington. Cleveland Clinic Foundation. reduce medical errors. infoway-inforoute. This report is titled “Multi-State Telehealth Practice” and summarizes the current state of physician and nurse licensure issues. and increase patient access to primary and specialty care in both rural and urban settings.[1] CTeL.annual conference dedicated solely to telehealth issues and telehealth advocacy. CTeL activities include: • "Telehealth Leadership Conference" . theglobeandmail. infoway-inforoute. within the Department of Health and Human Services (HHS). 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. 20080218. • In 2004. infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ registries [11] http:/ / www. • Also in 2004. based in Washington. ca/ lang-en/ about-infoway/ approach/ investment-programs/ telehealth [12] http:/ / www. • Telehealth Policy Clerkship Program .infoway-inforoute. infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ infostructure [5] http:/ / www. infoway-inforoute.ca/) Center for Telehealth and E-Health Law The Center for Telehealth & E-Health Law (CTeL). CTeL argues that expanding the use of telehealth can improve patient safety. Demand. wmychart18/ BNStory/ specialScienceandHealth/ External links • Canada Health Infoway (http://www.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. and the Office for the Advancement of Telehealth (OAT). ca/ lang-en/ about-infoway/ approach/ investment-programs/ laboratory-information-systems [8] http:/ / www. is a non-profit organization committed to overcoming legal and regulatory barriers to the utilization of telehealth and related e-health services. ca/ lang-en/ about-infoway/ approach/ investment-programs/ public-health-surveillance [10] http:/ / www. 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. D. infoway-inforoute. specializes in compiling. ca/ lang-en/ about-infoway/ approach/ investment-programs/ diagnostic-imaging-systems [3] http:/ / www. infoway-inforoute. Texas Children's Hospital. infoway-inforoute. & Investment in Telehealth. D.

au/go/research/research-groups/centre-for-e-medicine/e-medicine-projects • The Australian.org/) • Office for the Advancement of Telehealth (http://www.gov/telehealth//) Centre for e-Health The Centre for e-Health aims to further the use of telemedicine in Australia and Asia.org.Telehealth Grantee Directory (http:/ / www. Feb. telehealthlawcenter. 16 References [1] Center for Telehealth and e-Health Law (http:/ / www. The Director of the Centre is Professor Kanagasingam Yogesan. • A stereo optic disc analyser.Center for Telehealth and E-Health Law Department. org/ content/ ?page=9) [2] HRSA .hrsa. Projects in the Centre include: • Development of a portable digital imaging device that has teleophthalmology (retinal and anterior segment imaging). The Centre was launched in August 2005 by then-WA Premier Geoff Gallop. References • http://www. The WA Government contributed $2.25 million to the project.telehealthlawcenter. teleotolaryngology and teledentistry applications enabling remote diagnosis of disease and disorder. teledermatology. gov/ telehealth/ granteedirectory/ overview. Western Australia. • Online visual function testing of eye health. a software tool that analyses stereo images of the retina. htm) External links • CTeL (http://www. It is based at the Lions Eye Institute in Perth. Tuesday August 23 2005. page 30 . 2004.lei. hrsa.

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. The clinic addressed the fundamental problems of delivering occupational and emergency health services to employees and travellers at Boston’s Logan International Airport. and approximately 200 million are Internet users. The vision of the connected health model can be implicitly understood by contemplating the significant impact of technology on other industries. The European Union has roughly an equivalent number of people connected to land lines. but prevails over the U. flexible opportunities for consumers to engage with clinicians and better self-manage their care. Kenneth Bird at Massachusetts General Hospital [2] in 1967. and its more recent relative. According to the International Communications Union. Over 1. It uses technology – often leveraging readily available consumer technologies – to deliver patient care outside of the hospital or doctor’s office. The timing of Dr. chronic disease management and patient compliance of the US and global healthcare systems. Connected health encompasses programs in telehealth. in part due to the high availability of telephone and Internet service as compared to other parts of the world. logistics and personal communications. History Connected health has its roots in telemedicine. quality and efficiency. shopping. telehealth. particularly as related to the chronically ill • Concomitant interests in making healthcare more patient centric by promoting healthcare consumerism through education. Connected health is distinguished from telemedicine by: • A broader concern for healthcare cost. Bird’s clinic more or less coincided with NASA’s foray into telemedicine through the use of physiologic monitors for astronauts3. often leverages existing technologies such as connected devices using existing cellular networks and is associated with efforts to improve chronic care. over 190 million are cell phone users. . often electronic patient record One of the first telemedicine clinics was founded by Dr. Other pioneering programs in telemedicine were designed to deliver healthcare services to people in rural settings. The United States and European Union are two dominant markets for the use of connected health in home care service. Connected health aims to maximize healthcare resources and provide increased. and patient feedback • Efforts in the direction of integrating of data generated outside of traditional healthcare settings such as the home with centralised. The first telemedicine programs were primarily undertaken to address healthcare access and/or provider shortages. located three congested miles from the hospital. Within the United States.000 patients are documented as having received remote treatment from doctors at MGH using the clinic’s 2 two-way audiovisual microwave circuit .S. remote care (such as home care) and disease and lifestyle management. over 260 million people have a land line connected.Connected Health 17 Connected Health Connected Health is a term used to describe a model for healthcare delivery that uses technology to provide healthcare remotely. Proponents of connected health believe that technology can transform healthcare delivery and address many inefficiencies especially in the area of work flow management. such as in banking. with more than 300 million cell phone users and 230 million [1] Internet users. it is predicted that there will be 4 billion mobile phone users worldwide by the end of 20081.

For instance. in which an individual receives healthcare information to facilitate behavior change to improve their fitness and/or general well being. Programs designed to improve patient-provider communication within an individual medical practice (for example. videoconferencing and environmental sensors are all playing a role in connected health today. There are also “lifestyle coaching” programs. and those patients located at an untenable distance from primary or specialty providers. online communications or biosensors and may aim to increase patient-provider communication. or improve upon a health outcome measure in a defined patient population or individual. chronic and remotely located populations. with attendant reductions in: morbidity.Connected Health 18 Connected Health in Operation Two “core platforms” are emphasized in connected health. self-care and remote care. global positioning. 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. Inherent in the concept of connected health is flexibility in terms of technological approaches to care delivery and specific program objectives. the use of email to communicate with patients between office visits) also fall within the purview of connected health. 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. Digital pen technology. They envision: • Reductions in the cost of providing quality care to the chronically ill. involve patients in their care through regular feedback. mortality and the cost of care • Consumer engagement in health and self-management • Safer and more effective clinical trials . elderly. Goals of Connected Health Connected health is viewed by its proponents as a critical component of change in human healthcare. 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 [3] is implementing a range of programs in high-risk. increased control over infectious disease and improved drug safety • Diminished rate of medical errors • Better “customer service” in healthcare • Ongoing preventive health. with programs primarily focused on monitoring and feedback for the chronically ill. (see wellness) or to reduce or eliminate the impact of a particular behavior that presents a risk to their health status. remote monitoring programs might use a combination of cell phone and smart phone technology. with a resultant reduction in epidemics.

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. notify the patient’s primary care physician. it appears that connected health programs are operated and funded primarily by home care agencies and large healthcare systems. In summary. However. connected health has arisen from: 1) a desire on the part of individual physicians and healthcare organizations to provide better access. skyrocketing costs.8. The information is sent daily to a home health nurse.7 Consumer demand for better service and quality in healthcare is the latest source of pressure to improve the healthcare system.D. Kvedar. 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. A signal is then sent that lights up an ambient orb device in the patient’s home to remind them to take their medication. Experts speculate that. 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. believe that consumer engagement in healthcare is on its way to becoming a major force for change.4 The formal establishment of quality improvement organizations in 2002 and rise of independent organizations such as The National Committee for Quality Assurance.S. currently in the beta phase of implementation. blood pressure and weight. which is aimed at improving outcomes and cost of care for patients with high blood pressure. [7]. safety. as is the mass availability of inexpensive technology and ubiquity of the Internet. administrators. The Leapfrog Group [5] and Bridges to Excellence [6] .all of which are dedicated to promoting and monitoring healthcare quality . better survival rates among patients fighting serious diseases. population and longer lifespan are all factors pointing to a need for better ways of delivering healthcare. and intervene to avert potential health crises.6. In addition. in a program being implemented by the Center for Connected Health [8] and Partners Home Care [9]. increases in chronic diseases. cell phones and PDAs. and customer service in healthcare. insurers and employers.11 .5. M. including heart rate. are increasingly interested in connected health for its potential to reduce direct and indirect healthcare costs. troubling ethnic disparities in care.as well as vastly improved access to information about products and services .9 Connected health experts such as Joseph C. EMC Corporation recently launched the first employer-sponsored connected health program. growing provider shortages. over 500 heart failure patients have now been monitored remotely through the collection of vital signs. using simple devices in the patient’s home.Connected Health 19 The Evolution of Connected Health Healthcare is consistently cited in political polls and in surveys as a chief concern for consumers. who bear enormous cost to insure their employees. Evidence While connected health is yet emerging.in other industries. consumers are calling for the same responsiveness from the healthcare system. efficiency and cost transparency . Direct-to-consumer advertising is a demonstrated contributor to the rise in consumer demand.illustrate intense concern over inefficiency. A pilot of this program demonstrated reduced hospitalizations10. employers and clinicians alike. Funding and Implementation Today. an aging U. geographic dispersion of families. having acclimated to greater speed. who can identify early warning signs. there is evidence of its benefit. For example. Together. For example.

medscape. 2008).asp Center for Connected Health.hhs. Partners org/ media-center/ HealthCare. gallup. http://tie. will interpret this charge. com/ poll/ 17785/Election-2008. http:/ / www. “Highlights from the Eighth Annual Meeting of the American Telemedicine Association” (Accessed December 10.atsp. http:/ / www.aspx 2 1 Medscape website.aspx 4 . http://www.xml Gallup website. to the extent that Medicaid reimburses for telemedicine programs. however. “Gallup’s Pulse of Democracy” (Accessed December 10. Resources • • • • • • American Telemedicine Association. http://www. Center for Connected Health.org/articles/article. “A Brief History of Telemedicine” (Accessed December 10. http://www.telemed. itu.gov/healthit/onc/ mission/ • Telemedicine Information Exchange. Robert Kolodner. That infrastructure has been primarily defined as an electronic health records system.asp?path=articles&article=tmhistory_nb_tie95.org/ Center for Studying Health System Change.cfm?pageid=1 Association of Telehealth Service Providers. home-telehealth-connecting-care-within-the-community.org/business/telehealth_books. Edited by Richard Wootton. int/ ITU-D/ ict/ newslog/Worldwide+Mobile+Cellular+Subscribers+To+Reach+4+Billion+Mark+Late+2008.ctel. PHRs intersect with connected health in that they attempt to increase the involvement of healthcare consumers in their care. http://www. 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.connected-health.telemed. Susan L.Connected Health 20 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).com/ Center for Telehealth & Ehealth Law. • The Office of the National Coordinator for Health Information Technology (ONC) is charged with creating an interoperable health information technology infrastructure for the nation. Kvedar. Director.com/viewarticle/457684 3 Telemedicine Information Exchange website.org/ Home Telehealth.hschange. 2008).asp References International Telecommunications Union website (Accessed December 10. or PHRS. MD. (see personal health record) – are essentially medical records controlled and maintained by the healthcare consumer. http://tie. http://www. http:/ / www. http://www. Joseph C.aspx • Office of the National Coordinator for Health Information Technology. 2008). It remains to be seen how his successor.org/default.americantelemed. According to the CMS Web site. at the state’s option. Connecting Care Within the Community. former National Coordinator David Brailer indicated his support for personal health records that are portable and controlled by consumers. Dimmick. 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. By contrast. 2008).org/i4a/pages/index. connected-health. http://www.12 Personal Health Records Personal health records.

cfm 10 11 9 BMJ 2007. 2008) http://www.gov/news/ulp/costs/ulpcosts1.htm 8 PriceWaterhouseCoopers. org/ about-us/ http:/ / www. Prepared for America’s Health Insurance Plans. 2006 Kaiser Family Foundation website. Employees to get an online checkup: Care provider.org/facts/ Agency for Healthcare Research and Quality website. org/ . aspx http:/ / www.com/cgi/content/full/334/7600/942 Kowalczyk. 2006. connected-health. http://www. http://www.americansforhealthcare. boston. bridgestoexcellence. org/ http:/ / www. References [1] [2] [3] [4] [5] [6] [7] [8] [9] http:/ / pewinternet. org/ http:/ / www. To Go. The New York Times. 2008). http://www. The Factors Fueling Rising Healthcare Costs 2006. March 2007 (Accessed December 10. The Boston Globe.ahrq.Connected Health 5 21 The New York Review of Books website.org/insurance/snapshot/chcm030807oth. "The Health Care Crisis and What to Do About It” (Accessed December 10. com/ yourlife/ health/ diseases/ articles/ 2007/ 03/ 03/ employees_to_get_an_online_checkup/?page=1 12 Brailer. September 19. Your Medical History. 334: 942 (5 May). org/ http:/ / www. connected-health. “Health Care Costs: Why Do They Increase? What Can We Do?” (Accessed December 10. http://www.kff. org/ about-us/ leadership/ joseph-c-kvedar. org/ http:/ / www. connected-health. org/ programs. 2006. David J. massgeneral.nybooks. partnershomecare. 2008). http:/ / www. aspx http:/ / www. leapfroggroup. EMC will test a program to cut health costs. aspx/ http:/ / www. 2007. milkeninstitute. 2008). org/ Reports/ 2010/ Gadgets/ Overview. March 3.bmj. “How Changes in Medical Technology Affect Health Care Costs” .com/articles/18802 6 7 Americans for Healthcare website (Accessed December 10. L.

and network hardware from multiple manufacturers into a picture archiving and communication system (PACS). DICOM has been widely adopted by hospitals and is making inroads in smaller applications like dentists' and doctors' offices. It includes a file format definition and a network communications protocol.12: Storage Functions and Media Formats for Data Interchange [16]PDF (593 KB) PS 3.8: Network Communication Support for Message Exchange [13]PDF (901 KB) PS 3.43 MB) PS 3.07 MB) PS 3.[3] DICOM enables the integration of scanners.15: Security and System Management Profiles [18]PDF (1. • PS 3.9: Retired (formerly Point-to-Point Communication Support for Message Exchange) PS 3. Additions to the standard (Supplements and Change Proposals) since that publication are available through the DICOM Web site [5].08 MB) PS 3.14 MB) PS 3.28 MB) PS 3.10: Media Storage and File Format for Data Interchange [14]PDF (406 KB) PS 3.32 MB) PS 3. printing.13: Retired (formerly Print Management Point-to-Point Communication Support) PS 3. and as ISO standard 12052:2006 "Health informatics -.97 MB) PS 3.14: Grayscale Standard Display Function [17]PDF (2.96 MB) 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.11: Media Storage Application Profiles [15]PDF (1. and transmitting information in medical imaging.17: Explanatory Information PDF (3. The National Electrical Manufacturers Association (NEMA) holds the copyright to this standard.[1] It was developed by the DICOM Standards Committee.3: Information Object Definitions [8]PDF (6.16: Content Mapping Resource [20] PS 3. storing. servers.6: Data Dictionary [11]PDF (7.Digital imaging and communication in medicine (DICOM) including workflow and data management". The different devices come with DICOM conformance statements which clearly state the DICOM classes they support. whose members[2] are also partly members of NEMA.46 MB) PS 3.7: Message Exchange [12]PDF (1.4: Service Class Specifications [9]PDF (1. DICOM is known as NEMA standard PS3. printers.00 MB) [19] PDF (3.2: Conformance [7]PDF (6.DICOM 22 DICOM DICOM (Digital Imaging and Communications in Medicine) is a standard for handling.88 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. workstations. DICOM files can be exchanged between two entities that are capable of receiving image and patient data in DICOM format.5: Data Structure and Encoding [10]PDF (1.1: Introduction and Overview [6]PDF (241 KB) • • • • • • • • • • • • • • • • • PS 3.

Commercial equipment supporting ACR/NEMA 2. The Veterans Administration and the Navy also purchased systems off this contract.0. network support added and the Conformance Statement was introduced. version 1. Maryland. Very soon after its release. 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. . Six companies participated in this event. Their first standard. It is not a framework or architecture for achieving a useful clinical workflow. Front page of ACR/NEMA 300. was released in 1985. however. May 21–23. 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. DICOM is a standard directed at addressing technical interoperability issues in medical imaging. DeJarnette Research Systems. it became clear that improvements were needed. like "the 2007 version of DICOM". Switzerland) and SPI. General Electric Medical Systems. The image transmission was specified as over a dedicated 25 differential (EIA-485) pair cable. This version gained more acceptance among vendors. Several extensions to ACR/NEMA 2. like Papyrus (developed by the University Hospital of Geneva. ACR and NEMA joined forces and formed a standard committee in 1983. Instead of using the version number the standard is often version-numbered using the release year. the standard has its limitations. Many soon realized that the second version also needed improvement. New service classes were defined. Merge Technologies. it has been constantly updated and extended since 1993. (Standard Product Interconnect. In 1988 the second version was released. Detrick. The first which was released in 1985 demonstration of ACR/NEMA V2.0. Vortech (acquired by Kodak that same year) and 3M. Its name was then changed to DICOM so as to improve the possibility of international acceptance as a standard. ACR/NEMA 300. DeJarnette Research Systems and Merge Technologies provided the modality gateway interfaces from third party imaging modalities to the Siemens SPI network. While the DICOM standard has achieved a near universal level of acceptance amongst medical imaging equipment vendors and healthcare IT organizations. In 1993 the third version of the standard was released.DICOM 23 History DICOM is the third version of a standard developed by American College of Radiology (ACR) and National Electrical Manufacturers Association (NEMA). the latest version of the standard is still 3.0 interconnectivity technology was held at Georgetown University. Siemens Medical Systems. 1990. driven by Siemens Medical Systems and Philips Medical Systems). Radiologists and medical physicists wanted to use the images for dose-planning for radiation therapy. Officially. 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.0 was presented at the annual meeting of the Radiological Society of North America (RSNA) in 1990 by these same vendors.0 were created. 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 text was vague and had internal contradictions.

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

g. The Service Class User (SCU: similar to a client). DICOM Services DICOM consists of many different services. uses the confirmation from the Service Class Provider (SCP: similar to a server). . an archive station for instance. 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.. For character string value representations. a modality or workstation. Store The DICOM Store service is used to send images or other persistent objects (structured reports. if more than one data element is being encoded. etc. the successive data elements are separated by the backslash character "\". most of which involve transmission of data over a network.) to a PACS or workstation. e. and the file format below is a later and relatively minor addition to the standard. to make sure that it is safe to delete the images locally. each attribute also has a Value Multiplicity to indicate the number of data elements contained in the attribute. 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 25 In addition to a Value Representation. etc.

DICOM restricts the filenames on DICOM media to 8 characters (some systems wrongly use 8. dose delivered. Except for the data set containing. avoiding the need to type such information multiple times (and the mistakes caused by retyping). There is a standard calibration (defined in DICOM Part 14) to help ensure consistency between various display devices. Application areas . There is also an ongoing media exchange test and "connectathon" process for CD media and network operation that is organized by the IHE organization. which provides index and summary information for all the DICOM files on the media. This is a historical requirement to maintain compatibility with older existing systems.2). end time.DICOM 26 Query/Retrieve This enables a workstation to find lists of images or other such objects and then retrieve them from a PACS. It describes how to store medical imaging information on removable media. DICOM files typically have a . It helps give the radiology department a more precise handle on resource (acquisition station) use. but this does not conform to the standard). including hard copy printout. It also mandates the presence of a media directory. Modality Performed Procedure Step A complementary service to Modality Worklist. The Uniform Type Identifier type for DICOM files is org. Printing The DICOM Printing service is used to send images to a DICOM Printer. an image and demography.2. etc. The MIME type for DICOM files is defined by RFC 3240 as application/dicom. normally to print an "X-Ray" film. this enables the modality to send a report about a performed examination including data about the images acquired. 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. it's also mandatory to include the File Meta Information. Modality Worklist This enables a piece of imaging equipment (a modality) to obtain details of patients and scheduled examinations electronically. The DICOMDIR information provides substantially greater information about each file than any filename could. Also known as MPPS. Off-line Media (DICOM Files) The off-line media files correspond to Part 10 of the DICOM standard. No information must be extracted from these names (PS3. for example. beginning time. so there is less need for meaningful file names.dicom.3. This is a common source of problems with media created by developers who did not read the specifications carefully.nema. and duration of a study.10 Section 6.3.dcm file extension if they are not part of a DICOM media (which requires them to be without extension). the DICOMDIR file.

Retired 2008 Modality of type Cinefluorography .Retired Modality of type Digital Subtraction Angiography .Retired Modality of type Electrocardiograms Modality of type Electron Microscope Modality of type Endoscopy Modality of type Fluorescein Angiography .DICOM 27 Modality AS BI CD CF CP CR CS CT DD DG DM DS DX EC ECG EM ES FA FS GM HC LP LS MA MG MR MS NM OT PT RD RF RG RTIMAG RP RS RT SC Description Modality of type Angioscopy .Retired Modality of type Fundoscopy .k.k.Retired 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 Digital Radiography Modality of type Echocardiography .Retired Modality of type Biomagnetic Imaging Modality of type Color Flow Doppler .Retired Modality of type Computed Radiography Modality of type Cystoscopy .a.Retired Modality of type Nuclear Medicine Modality of type Other Modality of type Positron Emission Tomography (PET) Modality of type Radiotherapy Dose (a.a.a RTSTRUCT) Modality of type Radiation Therapy Modality of type Secondary Capture . RTDOSE) Modality of type Radio Fluoroscopy Modality of type Radiographic Imaging (conventional film screen) Modality of type Radiotherapy Image Modality of type Radiotherapy Plan (a. RTPLAN) Modality of type Radiotherapy Structure Set (a.Retired Modality of type General Microscopy Modality of type Hard Copy Modality of type Laparoscopy .k.Retired 2008 Modality of type Diaphanography Modality of type Digital Microscopy .Retired Modality of type Colposcopy .Retired Modality of type Computed Tomography Modality of type Duplex Doppler .

DICOM SM SR ST TG US VF VL XA XC Modality of type Slide Microscopy Modality of type Structured Reporting Modality of type Single-Photon Emission Computed Tomography (retired 2008) Modality of type Thermography Modality of type Ultrasound Modality of type Videofluorography . pdf [10] ftp:/ / medical. ncbi. nema. org/ medical/ dicom/ 2009/ 09_08pu. • 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. org: Industrial Imaging and Communications Section (http:/ / www. org/ medical/ dicom/ 2009/ 09_06pu3. nema. pdf [17] ftp:/ / medical. astm. pdf [11] ftp:/ / medical. org/ members.000 Words. nema. nema. org/ medical/ dicom/ 2009/ 09_14pu. nema. open communication over TCP or UDP The standard recommends but does not require the use of these port numbers. nema. nema. org/ medical/ dicom/ 2009/ 09_16pu. org/ about/ members/ ) "6. nema. nema. pdf [14] ftp:/ / medical. pdf [8] [9] ftp:/ / medical. org/ prod/ security/ indust-Img. org/ SNEWS/ OCTOBER_2003/ voelker_oct03. astm. nema. pdf [21] ftp:/ / medical. nema. org/ medical/ dicom/ 2009/ 09_15pu. nlm. nema. org/ medical/ dicom/ 2009/ 09_04pu. nema. pdf). org/ medical/ dicom/ 2009/ 09_12pu. pdf . nema. many operating systems require special privileges to use it. pdf [20] ftp:/ / medical. nema. pdf [12] ftp:/ / medical. nema. National Electrical Manufacturers Association. Since 104 is in the reserved subset. nema. gov/ pubmed/ 7612705?dopt=Abstract [23] http:/ / www. org/ medical/ dicom/ 2009/ 09_05pu3. pdf) MEMBERS of the DICOM STANDARDS COMMITTEE (http:/ / medical.Retired Modality of type Visible Light Modality of type X-Ray Angiography Modality of type External Camera (Photography) 28 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. org/ medical/ dicom/ 2009/ 09_11pu. Ubiquitous Imaging Is Priceless (http:/ / www. org/ medical/ dicom/ 2009/ 09_10pu. 2006. nema. pdf ftp:/ / medical. pdf [16] ftp:/ / medical. org/ medical/ dicom/ 2009/ 09_01pu. cfm) [25] http:/ / medical. pp. http:/ / dicom. org/ medical/ dicom/ 2009/ 08_01pu. . nema.1 DIMSE Services" (ftp:/ / medical. pdf [22] http:/ / www. org ftp:/ / medical. pdf) NEMA Members (http:/ / www. pdf [13] ftp:/ / medical. org/ dicom/ geninfo/ Brochure. org/ medical/ dicom/ 2009/ 09_17pu. nema. org/ medical/ dicom/ 2009/ 09_18pu. nema. References [1] [2] [3] [4] [5] [6] [7] DICOM brochure (http:/ / medical. Digital Imaging and Communications in Medicine (DICOM) Part 1: Introduction and Overview. org/ medical/ dicom/ 2009/ 09_02pu. nih. pdf [18] ftp:/ / medical. pdf [19] ftp:/ / medical. html) [24] http:/ / www. pdf ftp:/ / medical. org/ medical/ dicom/ 2009/ 09_03pu3. nema. nema. then Pervasive. pdf [15] ftp:/ / medical. nema. 11. org: If a Picture Is Worth 1. org/ medical/ dicom/ 2009/ 09_07pu2. org/ dicom/ 2007/ 07_05pu.

104-127) reauthorized and streamlined the program.L.dclunie.gov/rus Rural utilities service].Contains a long list DICOM software.saravanansubramanian. References •  This article incorporates public domain material from the Congressional Research Service document "Report for Congress: Agriculture: A Glossary of Terms. External links [www. The 1996 farm bill (P.Standard formats including DICOM.html) .dclunie. • Medical Image FAQ part 8 (http://www. Sec.com/dicom-status/status.com/Saravanan/ Articles_On_Software/Entries/2010/2/10_Introduction_to_the_DICOM_Standard. • Collection of DICOM images (clinical images and technical testpatterns) (http://www. DLT is administered by the Rural Utilities Service.org/medical/dicom/2011/) • DICOM Standard Status (approved and proposed changes) (http://www.aycan. The program was also reauthorized in the 2002 farm bill (P.L. 6203).rurdev. Programs.nema.de/main/lp/ sample_dicom_images. pdf . 2005 Edition" [1] by Jasper Womach.html) • Introduction to DICOM using OsiriX (http://www. 107-171. 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. org/ nle/ crsreports/ 05jun/ 97-905. html) • Brief introduction to DICOM (http://www.html) • Medical Image FAQ part 2 (http://www.html) • Example of an applet based DICOM Viewer (http://legeneraliste. References [1] http:/ / ncseonline.cabiatl.com/mricro/dicom/index.usda.perso. and Laws.com/medical-image-faq/html/part2.L.html) .sfr.fr/?p=dicom_eng) 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.dclunie.com/medical-image-faq/html/part8.DICOM 29 External links • The latest DICOM specification (ftp://medical.

Given the number of employees of these combined institutions. 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. COO. employer or physician. Dossia is one of the largest PHR deployments in the world. at any time. Along with Microsoft's HealthVault and Google's Google Health. [3] Dossia differs from traditional tethered PHR services. Users also have the ability to download their full record. Dossia released their API in summer of 2009. . Dossia is based on Open Source software.Dossia 30 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. in electronic form. CEO Steve Munini.org [1] Key people Website Dossia is a Personal health record service offered by some of the largest employers in the United States.[2] Unlike the other two large PHR efforts. Dossia. Massachusetts Michael Critelli. by providing user access to health information regardless of health plan. Dossia could be one of the largest PHR [4] systems in the world.

Board of Directors.Director. private and portable electronic health records. These included the Dossia Foundation and the Dossia Service Corporation. Inc. The Dossia Service Corporation is responsible for delivering the PCHR infrastructure and service to subscribing employers and customers.. Global Benefits Applied Materials Andrew Gold. Walmart Patrick Soon-Shiong. The Dossia Foundation aims at advancing knowledge and progress in the healthcare space through a variety research. Vice President. AT&T.. the Dossia Consortium Board of Directors decided to create two additional organizations within the Dossia umbrella. BP America. • • • • • • • • • • Craig Barrett. Dossia Director of Public Policy. As the system develops. Senior Director. Government Programs. improve communications with their doctors. Dossia continued to roll out its PCHRs to the other Dossia Consortium members including Vanguard. Pitney Bowes. formed an alliance called the Dossia Consortium. and sanofi-aventis. the data will come primarily from insurers’ databases and the patient’s own annotations. The information the system provides will empower individuals to manage their own healthcare. personal. dependents. AT&T Business Solutions Diana Finucane. Executive Chairman. Cardinal Health. WalMart was the first Dossia Consortium member to roll out the PCHRs to their 1.D. Healthcare Marketing.S. Pitney Bowes Steven Lampkin. more informed decisions about their healthcare by offering them Personally Controlled Health Records (PCHR) .. Executive Director. AT&T and BP America. Health and Welfare Benefits. Dossia announced that Abraxis BioScience also joined the Dossia Founders Group. Pitney Bowes Inc. strategy. [5] Following WalMart’s roll out.4 million employees plus their dependents. The Consortium funded the development of a web-based framework through which Consortium employees. Executive Chairman and Chief Executive Officer. Cardinal Health Karl Dalal. and retirees can maintain private. Intel. Later. and ensure more complete and accurate information for healthcare providers than the current fragmented. Secretary. a group of Fortune 500 employers.Dossia 31 Dossia’s History In 2006. Board Of Directors. sanofi-aventis . Global Benefit Planning. Dossia established an agreement to work with Children’s Hospital Boston to provide strategic and technological expertise and guidance in creating. In 2008. Dossia Board Members Dossia’s board is composed of industry leaders from a variety of Fortune 500 companies. Intel Global Benefits Design Director. sanofi-aventis Monica Foster. and portable PCHRs. Vice President of Benefits. Initially. BP America Adena Handly. Wal-Mart. [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. Intel Corporation. in April 2009. Dossia. M. paper-based system. The Consortium’s goal was to empower their employees to make smarter. Director of U. Also during 2008. Benefits Services and Strategic Initiatives. and advocacy initiatives pertaining to Personally Controlled Health Records (PCHRs). additional information will come directly from the patient’s medical chart and various other sources. deploying and operating the electronic health record infrastructure. (formerly) Intel Jean Paul Gagnon. M. Executive VP Strategy and Innovation and Chief Transformation Officer. Vanguard Health Systems • Tami L. In fall of 2008.D. Chairman. including Applied Materials. Intel Corporation • Liz Cirri. Director. Abraxis Health Brad Perkins. Reimbursement. Graham.

emancipated and experts. Enabled to make choices about self-care and those choices are respected. and different (but not always better) relationships with their doctors. cope better with fatigue and other generic features of chronic disease such as role limitation. Retrieved 2010-19-01. com/ 2007/ 10/ 17/ indivo-health-further-details-on-dossia-agreement/ ). . 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.0 / Medicine 2.dossia. enabled." [2] e-Patients are increasingly active in their care and are demonstrating the power of the Participatory Medicine or Health 2. dossia. . pitney "Vanguard Rolls out Dossia PHRs To Employees" (http:/ / www. [3] "Dossia Open API" (http:/ / wiki. Retrieved 2008-11-07.[3] model of care. and who use electronic communication tools (including Web 2.0. or Internet-savvy Patient) are health consumers who use the Internet to gather information about a medical condition of particular interest to them.0 tools) in coping with medical conditions.org/) E-Patient e-Patients (also known as Internet Patient. Retrieved 2008-11-07. "Indivo Health: Further Details on Dossia Agreement" (http:/ / chilmarkresearch. org/ ). Marianne Kolbasuk.Dossia 32 Notes [1] http:/ / www. com/ news/ healthcare/ EMR/ showArticle. jhtml?articleID=222300838& queryText=dossia). John. Retrieved 2008-11-07. 2. many clinicians have underestimated the benefits and overestimated the risks of online health resources for patients. informationweek.[6] [7] [8] • Medical online support groups have become an important healthcare resource. engaged. Retrieved 2008-11-07. Information Week. empowered. e-Patients report two effects of their online health research: "better health information and services. [4] Moore.[4] [5] • Since the advent of the Internet. They are equipped. . and reduce disability and their dependence on hospital care. . • • • • • • • Equipped with the skills to manage their own condition. Marianne (2008-10-01). org/ [2] McGee. • This is one the most important cultural medical revolution of the past century. . External Links Dossia Official Site (http://www.[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. • 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. "Wal-Mart Rolls Out E-Health Records To All Employees" (http:/ / www. pp. mediated and driven by technology. John. informationweek. jhtml?articleID=210605059). pitney. 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. dossia. "Indivo Health: Further Details on Dossia Agreement" (http:/ / chilmarkresearch. com/ 2007/ 10/ 17/ indivo-health-further-details-on-dossia-agreement/ ). com/ news/ software/ database/ showArticle. [6] McGee. equals. [5] Moore.

jmir. doi:10. • It is crucial for medical education to take the e-patient into account. ama-assn. [9] Masters K. Med. Medscape J Med 10 (2): 46. doi:10. PMID 15224975. amcancersoc. Nutr.21. php/ perj/ article/ view/ 244/ 374). PMC 1182328.e22. (July 2005).org/PPF/r/27/presentation_display.6.pmed.356. PMID 17513283. squ. doi:10.3.3322/canjclin. • Laura Landro.1148. "Analysis of cases of harm associated with use of health information on the internet" (http:/ / jama. [5] Eysenbach G (2003). pdf. PMID 12038937. org/ 2008/ 3/ e22/ ). J. • Podiatry Online: Accommodating the Internet-Savvy Patient (http://www. ""I Found it on the Internet:" Preparing for the e-patient in Oman" (http:/ / web. 2007). . European countries seem to lag.1371/journal. "How cancer survivors provide support on cancer-related Internet mailing lists" (http://www. Internet Res. ca/ index. Partnership: the Canadian Journal of Library and Information Practice and Research 2 (1). . "The Growing Clout of Online Patient Groups" (http://liferaftgroup. org/ cgi/ content/ full/ 53/ 6/ 356).com/main. pdf) [3] Eysenbach G Medicine 2. [7] Ahmad F. lib. "How new subscribers use cancer-related online mailing lists" (http://www. "The Internet and primary care physicians: coping with different expectations" (http://www. PMC 1550655. • Meier A. et al. [8] Crocco AG.8.org/cgi/content/full/77/4/1016S). doi:10. Todd. doi:10.2196/jmir. author reply 46.3. asp?id=e5ecd1c850167630052768711a777f70). "What I've learned from E-patients". om/ squmj/ includes/ tng/ pub/ tNG_download. "Are physicians ready for patients with Internet-based health information?".asp). 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. asp?id=e5ecd1c850167630052768711a777f70). 9 (2): e12. • Hoch D. Hollenberg E. Med. om/ squmj/ includes/ tng/ pub/ tNG_download. SQU Med J 10 (2): 169–179. 5/2/2006. The Wall Street Journal (June 13. Ng'ambi D. "The first generation of e-patients" (http://bmj. Ribisl KM. J. 33 References [1] Masters K. Apomediation. "Today’s E-Patients: Hunters and Gatherers of Health Information Online" (http://www. [2] Fox. • Rimer BK. but there is room for improvement in searches and overall Internet access. Todd. org/ ~/ media/ / Files/ Reports/ 2003/ PIP_Health_Report_July_2003. pewinternet. Fallows. 8 (3): e22. pdf). Ng'ambi D. .com/cgi/ content/full/328/7449/1148).287. G (2010).com/docs/WSJ_online_patient_groups. Lyons EJ. SQU Med J 10 (2): 169–179. Forlenza M. Collaboration. G (2010). doi:10. doi:10. Villasis-Keever M. PMID 18382715.328.0: Social Networking. Levinson W (2006). JAMA 287 (21): 2869–71.podiatryonline. CA Cancer J Clin 53 (6): 356–71. Lyons EJ. [6] Jacobson P (2007). edu. 2 (8): e206.0020206. Hudak PL. Jadad AR (June 2002). Health searches and email have become more commonplace. Med.jmir. PMID 16060721.jmir. Clin.org/2007/2/e12). 2003.e12. Pew Internet (http:/ / www. (http:/ / www. pewinternet.pewinternet. PMC 411079. PMID 15998623.org/2005/3/e32/).2196/jmir. and Openness (http:/ / www. .1001/jama. PMID 12663310.10(3):e22 [4] Finding Answers Online in Sickness and in Health. PMC 2018833. cfm?pg=howto&fn=internetpt) • Susannah Fox. Frydman G. edu. Research must combine expertise from specialties that are not used to work together. • van Woerkum CM (1 April 2003).ajcn. • Feder J (2008). "The impact of the Internet on cancer outcomes" (http:/ / caonline. . PLoS Med. "A reader and author respond to "ePatients: engaging patients in their own care"". Ferguson T (August 2005). uoguelph. BMJ 328 (7449): 1148–9.E-Patient • The impact of the e-patient cannot be fully understood and appreciated in the context of pre-internet medical constructs.2196/jmir. J Med Internet Res 2008. ISSN 1911-9593. ""I Found it on the Internet:" Preparing for the e-patient in Oman" (http:/ / web.2869. org/ pdfs/ PIP_Health_Decisions_2006.53.bmjjournals. Bercovitz K. J. Susannah.pdf) (PDF). Senior Editor. Pew Internet & American Life Project (2004-09-27).7. Participation. 77 (4 Suppl): 1016S–1018S. PMC 2270894. PMID 17032638. Deborah.2.1136/bmj.e32. Internet Res. Am. • Ferguson T. "Empowering the physician-patient relationship: The effect of the Internet" (http:/ / journal. . J. PMID 15142894. Rimer BK (2007). squ. PMC 1874721. Internet Res. org/ cgi/ content/ full/ 287/ 21/ 2869).9. Frydman G (May 2004).7449. 7 (3): e32.

• Consumer health informatics: use of electronic resources on medical topics by healthy individuals or patients. Oct 7.time.Trisha Torreys response (http:// patients. researchers.). 2009 • E-patients With a Disability or Chronic Disease (http://www.pewinternet.pewinternet. and patients.Mary Shomons response (http://thyroid. dating back to at least 1999. • Time Magazine article: "When the patient is a Googler" (http://www. • Medical research using Grids: powerful computing and data management capabilities to handle large amounts of [6] heterogeneous data.htm).com/ articles/fr039905.org/Presentations/2009/40-The-rise-of-the-e-patient.[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.htm) .com/b/2007/11/13/ time-magazines-dr-scott-haig-proves-that-patients-need-to-be-googlers.org/).pathoftheblueeye. • Virtual healthcare teams: consisting of healthcare professionals who collaborate and share information on patients through digital equipment (for transmural care).gov/bcp/edu/pubs/consumer/health/hea17. an educational initiative for health marketing communications professionals eHealth eHealth (also written e-health) is a relatively recent term for healthcare practice supported by electronic processes and communication. Lee Rainie from the Pew Internet and American Life Project (http://www. • Telemedicine: physical and psychological treatments at a distance. • mHealth or m-Health: includes the use of mobile devices in collecting aggregate and patient level health data.about.ftc. specialists etc. work schedule management and other administrative tasks surrounding health.org/) • Association of Cancer Online Resources (ACOR) (http://acor.com/time/health/article/ 0.fergusonreport. • Health knowledge management: e.htm) • Who Cares (http://www.aspx). . providing healthcare information to practitioners.pewinternet.8599.pewinternet.com/b/2007/11/24/cnntime-dr-haigs-own-misdiagnosis.pdf) Booklet by the Federal Trade Commission. • Healthcare Information Systems: also often refer to software solutions for appointment scheduling. including: • Electronic health records: enabling the communication of patient data between different healthcare professionals (GPs. 1999 article by Dr.g.about. Tom Ferguson. an aggregate of e-patient online communities for knowledge-sharing about cancer.00.org/) presentation at the Medical Library Association. real-time monitoring of patient vitals. patient data management.com/Data/ empowered-e-patient-infographic) summary of data focusing on e-patients developed by the Path of the Blue Eye Project.E-Patient 34 External links • The rise of the e-patient (http://www.org/PPF/r/222/report_display.1681838. in an overview of latest medical journals. best practice guidelines or epidemiological tracking (examples include physician resources such as Medscape and MDLinx).html) . • E-Patients Prefer eGroups to Doctors for 10 of 12 Aspects of Health Care (http://www. and direct provision of care (via mobile telemedicine).[2] while others use it in the narrower sense of healthcare practice using the Internet. from the Pew Internet and American Life Project (http://www. a guide to health information • Infographic: The Empowered E-Patient (http://community.[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.asp).

or blood test results. To standardize the exchange of information. online pharmaceutical therapy. family and marriage therapy. such as medicine prescriptions. Early adapters Chronic patients over time often acquire a high level of knowlegde about the processes involved in their own care.[14] It also has its own academic peer review journals. explanatory diagnostic information (such as the standard ICD-10) may be exchanged insecurely. which makes standard communication exchange easier.[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. while back-end exchange does not. Such an action may reveal allergies or other prior conditions that are relevant to the visit. from being specific to the use of the Internet in healthcare to being generally around any use of computers in healthcare. E-health manages both flows of information. and often develop a routine in coping with their condition. whether the exchange is initiated by the patient or the caregiver. the E Mental Health movement has its own international organization. Such an actions may avoid the cost of an expensive visit to the hospital.[8] [9] [10] Oh et al. clinical social work. 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. most specifically the EPR (Electronic patient record).eHealth 35 Contested definition Several authors have noted the variable usage in the term. front-end data exchange and back-end exchange. Most notable of all challenges is online security. Each medical practise has its own jargon and diagnostic tools. Of the forms of e-Health already mentioned. For these types of routine patients. there are roughly two types. This main concern has to do with the confidentiality of the data. computer-based interventions. x-ray photographs. in a 2005 systematic review of the term's usage. 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. 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. E Mental Health E Mental Health refers to the delivery of mental health services via the internet through videoconferencing. and online life coaching. 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. various coding schemes may used in combination with international medical standards. and mental health counseling. In general. front-end e-Health solutions tend to be relatively easy to implement. There is also concern about non-confidential data however..[13] 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. a common thesaurus is needed for terms of reference. while ensuring the quality of the data exchange. Testifying to this momentum. E Mental Health encompasses online talk therapy. or email web applications. such as the . Front-end exchange typically involves the patient. cyber mental health approaches. This form of psychological intervention modality offers a series of benefits as well as challenges to providers and clients. and private information (such as personal information from the patient) must be secured. online counseling. chat. The International Society for Mental Health Online.[12] Various medical practises in chronic patient care (such as for diabetic patients) already have a well defined set of terms and actions.

weather inclement populations.g. "What is e-health?" J Med Internet Res 2001. html) [13] Journal of Medical Internet Research (http:/ / www. computer telephony/interactive voice response. The role of e-health and consumer health informatics for evidence-based patient choice in the 21st century. both at the local site and at a distance. org/ 2006/ 1/ e4/ ) [11] Oh et al. public health and business. jmir. Ehealth is making healthcare more efficient. org/ 2010/ 5/ e61/ ) [14] The International Society for Mental Health Online. "What Is eHealth: A Systematic Review of Published Definitions. • 2000 Pretlow (G) E-health is the process of providing health care via electronic means. monitoring ( e. Sullivan F. University of California Davis has initiated a series of studies based on E Mental Health. org/ 2001/ 2/ e20/ ) [8] Della Mea V (2001). 13(7): 12 [4] Eysenbach G. referring to health services and information delivered or enhanced through the Internet and related .[15] The efficacy and effectiveness of E Mental Health approaches are currently being studied by Universities around the world. org/ cgi/ content/ full/ 48/ 2/ 135 Year Source (M = Medline. particularly in the USA and Australia.19(1):11-7 [5] Ball MJ.: Integrating Data Custodians in eHealth Grids – Security and Privacy Aspects (http:/ / www. • 2001 Eysenbach (M) e-health is an emerging field in the intersection of medical informatics. jmir. 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.3(2):e20 (http:/ / www. jmir. E-health: transforming the physician/patient relationship. Kahan JP. These centers offer services to disabled populations. and wellness. jmir. [15] Journal of Medical Internet Research (http:/ / www. and interaction with health care providers. • 2000 JHITA (G) Internet-related healthcare activities • 2000 McLendon (M) Ehealth refers to all forms of electronic healthcare delivered over the Internet. as well as populations who are comfortable using the internet and world wide web. Detmer D. businesses or consumers themselves. itu. de/ publications/ paper/ public/ LR-06-262. For instance. org/ 2005/ 1/ e1/ ) [12] e-Diabetes on the website of the Dutch Diabetes foundation (http:/ / www. http:/ / psy. pdf). in particular over the Internet. org/ 2001/ 2/ e22/ ) [2] International Telecommunication Union (2008). "What is e-Health (2): The death of telemedicine?" J Med Internet Res 2001. as well as interaction with other patients afflicted with the same conditions. NEC Lab Report. MacGillivray S. "What Is eHealth (6): Perspectives on the Evolution of eHealth Research" J Med Internet Res 2006. "What Is eHealth (4): A Scoping Exercise to Map the Field" J Med Internet Res 2005. psychiatryonline. diabetesfederatie.7(1):e9 (http:/ / www.7(1):e1 (http:/ / www. Gregor P. stored and retrieved electronically – for clinical. jmir. Enmark . non-professionals. "Implementing e-Health in Developing Countries: Guidance and Principles" (http:/ / www.eHealth Journal of Medical Internet Research. Phalen JM. int/ ITU-D/ cyb/ app/ docs/ e-Health_prefinal_15092008. PDF) [3] "HIMSS SIG develops proposed e-health definition". jmir. Diepgen TL." J Med Internet Res 2005. Int J Med Inform. org/ home.3(2):e22 (http:/ / www. 2001 Apr. (https:/ / www. jmir. org/ 2001/ 2/ e22/ ) [9] Pagliari C.8(1):e4 (http:/ / www. asp). Clin Dermatol. jmir. Ehealth includes a wide variety of the clinical activities that have traditionally characterized telehealth. Marit Hansen et al. care management. Sloan D. "What is e-Health (2): The death of telemedicine?" J Med Internet Res 2001. Lillis J. ccrl-nece. ismho.3(2):e22 (http:/ / www. org/ 2005/ 1/ e9/ ) [10] Ahern DK. HIMSS News. 2001 Jan-Feb. education. wireless communications. The use in the health sector of digital data – transmitted. physiologic data). Kreslake JM. 2006 [7] Eysenbach G (2001). org/ ) [16] University of California Davis.[16] There are a number of E Mental Health Centers now operating around the world. ranging from informational. 36 References [1] Della Mea V (2001). and direct access to healthcare providers.Frontiers of Medicine (W) (M) E-health is the embryonic convergence of wide-reaching technologies like the Internet. but delivered through the Internet. nl/ ndf/ e-diabetes.61(1):1-10 [6] Jochen Fingberg. educational and commercial "products" to direct services offered by professionals. Simply stated. • 2000 DeLuca. W = Wilson Business Abstracts. rural populations. educational and administrative purposes. It can include teaching. while allowing patients and professionals to do the previously impossible. Oortwijn W.

• 2003 eEurope . healthcare systems and hospitals with consumers 37 References . in the health sector. both at the local site and at a distance • 2003 HMS Europe (G) The practice of leveraging the Internet to connect caregivers. • 2001 Robert J Wood Foundation (G) EHealth is the use of emerging information and communication technology. and account for care. to improve health care locally. affect the health of citizens and patients. to improve our health care system. and manage the health care system. especially the Internet. and. global thinking. • 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. deliver. managers and consumers. regionally. and worldwide by using information and communication technology • 2001 Strategic Health Innovations (G) The use of information technology in the delivery of health care. • 2003 Regional Office for the Eastern Mediterranean . to educate and inform health care professionals. to stimulate innovation in care delivery and health system management. but also a state-of-mind.eHealth2003 (G) The application of information and communication technologies (ICT) across the whole range of functions which one way or another. the term characterizes not only a technical development. to improve or enable health and health care. an attitude. and a commitment for networked. In a broader sense.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. educational and administrative purposes. a way of thinking.eHealth technologies. • 2003 COACH (G) The leveraging of the information and communication technology (ICT) to connect provider and patients and governments. arrange. stored and retrieved electronically-for clinical. of digital data-transmitted.

html?pagewanted=3). Epocrates. html).[5] The company was founded in 1998. San Francisco Business Times. . Inc. . New York Times. . [5] Chris Rauber (August 18. designed to provide information about drugs to doctors and other health care professionals.[5] By 2010 the company said it had 1 million users worldwide. Among its competitors is WebMD. . com/ sanfrancisco/ stories/ 2008/ 09/ 22/ story16. bizjournals. "Healthcare IT company is going public after partnering with Apple" (http:/ / money. html). "Epocrates’ IPO on hold" (http:/ / www. San Francisco Business Times. .[3] The company markets both free and paid versions.[5] Public offering After a 2008 public offering was put on hold. epocrates. 2010. . hoovers. California that makes various mobile health software applications under the "epocrates" name. Inc. US News." (http:/ / www. [6] "Media Room" (http:/ / www. html). The user base was 525. The Race Is On to Put a Computer Into Every Physician's Hand" (http:/ / www. as well as a mobile guide to ICD-9 and Current Procedural Terminology ("CPT") diagnosis codes. com/ company/ Epocrates_Inc/ rhsjjri-1. bizjournals. Hoovers. including 40% of the physicians in the United States. com/ money/ articles/ 2008/ 05/ 14/ ipo-watch-epocrates. Products Epocrates is a publisher of mobile device software applications. usnews.[6] Early versions of epocrates ran on Palm devices[7] and desktop computers.000 users worldwide (including 200. August 31. 2008).[6] History Epocrates' early funders included Bay City Capital. [8] "Epocrates files to raise up to $75M in IPO" (http:/ / www. Interwest Partners. nasdaq. com/ 2001/ 01/ 08/ business/ digital-doctoring-the-race-is-on-to-put-a-computer-into-every-physician-s-hand. Among the software functions is checking for drug interactions. 2006). com/ asp/ SummaryQuote. bizjournals. "Epocrates putting drug info into docs' pockets" (http:/ / www. Medgadget. Germany and Spain.[8] References [1] http:/ / quotes. com/ sanfrancisco/ stories/ 2010/ 07/ 12/ daily88. Sprout Group and Three Arch Partners. com/ company/ mediaroom/ ). . [3] "Epocrates. .[2] news feeds for product announcements and medical news. journal article lookup. asp?symbol=EPOC& selected=EPOC [2] Candice Novak (May 14. [4] "Last Day to Get Epocrates Essentials for Free for Medical Students" (http:/ / www. giving the paid version away for free to medical students.[8] and that it employed more than 250 people. html). providing them reference information about drugs and diseases. San Francisco Business Times. 2010.[5] As of 2006 [5] the company was also active in the United Kingdom. "Digital Doctoring. 2001). html).000 doctors in the United States) in 2006. July 16. and diagnostic tools. nytimes. (NASDAQ: EPOC [1]) is an American company based in San Mateo. html). 2008). com/ sanfrancisco/ stories/ 2006/ 08/ 21/ story11. medgadget.[9] Epocrates filed a registration statement again in July 2010 to raise $75 million. Draper Fisher Jurvetson.Epocrates 38 Epocrates Epocrates.[4] It receives additional revenue from pharmaceutical companies. . com/ archives/ 2010/ 08/ epocrates_free. [7] Milt Freudenheim (January 8. mostly for health care providers. Canada. [9] Chris Rauber (September 19.

96:143-8.com) . Stud Health Technol Inform. we take an holistic view of eHealth. to draw a more complete picture of the benefits and challenges of the deployment of ICT in the fields of health and social care. health insurers (AIM).96:151-6 • Paving the way to sustainable healthcare: telemedicine takes centre stage [1] • EHTEL Telemedicine FAQ [2] . as a neutral forum. We also facilitate the sharing of experience with colleagues and representatives across Europe and beyond. Pharmacists (PGEU.com (http://www. Stud Health Technol Inform.Epocrates 39 External links • epocrates. 2003. 2003. thereby also identifying topics requiring particular attention and further developments at European level. 2002 Jan.. • Range P. As such we collaborate closely with European associations representing Hospitals (HOPE and EHMA).official site European Health Telematics Association The European Health Telematics Association (EHTEL) is a European non-profit organization. Physicians (CPME. which provides a platform to all European eHealth stakeholders to exchange information on eHealth. 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. EuroRec).. as well as professional associations dedicated to quality and certification to care processes and eHealth services (ESQH.epocrates. UEMS). eHealth for Europe. European Patients’ Forum). Legal and social implications of health telematics in the EU. History EHTEL was founded in 1999 and the organization represents about 100 organisations and individuals from 30 countries in and outside Europe. we enable our members to voice their views throughout the eHealth ecosystem. At EHTEL. Source • Dierks C. choice and empowerment. Health Estate. • eHealth is a tool to ensure information. Video communication visions.56(1):30-1 • Richardson R. Nurses (EFN). EAHP). The multitude of backgrounds and interests of these stakeholders enable EHTEL.. patient and citizens (AGE Platform. Martin Denz of the Swiss Society for Telemedicine and eHealth is the current President of EHTEL. 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.

The organization contributes to the deployment of health telematics applications and standards in Europe. ehto. pdf [2] http:/ / www. eu/ telematics/ [3] http:/ / www. EHTEL+ telemedicine+ FAQ+ final. europa. asp?WCI=ShowD& F=english%2Fdti82498%2Fti137. doc [3] http:/ / www.European Health Telematics Association 40 External links • EHTEL [3] References [1] http:/ / www. doc [2] http:/ / cordis. 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. 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. ehtel. org/ . ehtel. katelco. analyses and makes available in a user-friendly form information on developments in the field of health telematics. org/ European Health Telematics Observatory The European Health Telematics Observatory (EHTO) is a non-profit organization which collects. asp?WCI=ShowD& F=english%2Fdti82507%2Fti135. HITE+ article. org/ SHBlob. org/ SHBlob. kz/ UNESCO/ presentations/ HC/ Thienpont. ehtel.

2008 To be discontinued on January 1.com/health Yes [1] Personal health record service Required Continuity of Care Document Google May 20. 2010 Google updated Google Health with a new look and feel. On September 15. however. data will be available for download through January 1.[8] History Google Health has been under development since mid-2006. the service underwent a two-month pilot test with 1. thereby merging potentially separate health records into one centralized Google Health profile.S."[7] Google has filed U. 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. and lab results". allergies. conditions.[10] On June 24. Health currently contains no advertising. 2013. Google Health was released to the general public as a service in beta test stage.[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.[11] . Unlike other Google services. Google Health uses the information to provide the user with a merged health record. and possible interactions between drugs."Method and apparatus for serving advertisements in an electronic medical record system".Google Health 41 Google Health Google Health URL Commercial? Type of site Registration Content license Owner Launched Current status google. The reason of abandoning the project is the lack of widespread adoption.[3] Once entered. Volunteered information can include "health conditions. like many other Google products. 2011 Google announced it is retiring Google Health in January 1. In 2008. Patent Application #20070282632 .[4] Google Health's API is based on a subset of the Continuity of Care Record. information on conditions. medications.600 patients of The Cleveland Clinic. 2012.[5] Google Health.[6] Google has not revealed how it plans to make money with the service. and allergies. 2008.[9] Starting on May 20. but a Wall Street Journal article says that Google "hasn't ruled [advertising] out for the future. is free to use for consumers.

Longs Drugs. partnerships have been formed with the following companies: MDLiveCare and Hello Health. "MediConnect Global"[13] is one such partner. Microsoft released a tool that lets Google Health customers transfer their personal health information to a Microsoft HealthVault account. including those that compete outside the United States.[4] According to its Terms of Service. such as those of Nathan McFeters at ZDNet. and the open-source Indivo project. argue that a personal health record service like Google Health would be impossible if it were HIPAA covered. To date. thus.[17] Post-launch reactions to Google's stance that it is not a covered entity have varied. Quest Diagnostics. the Withings WiFi Body scale enables Google Health users to seamlessly update their weight and other data to their online profiles[14] Recently. Anvita Health. and Walgreens. for a fee.[3] However."[9] Others contend that Google Health may be more private than the current "paper" health record system because of reduced human interaction. Medco Health Solutions. Google Health is not considered a "covered entity" under the Health Insurance Portability and Accountability Act of 1996.[16] In an article covering Google Health's launch. meaning it can only access medical information volunteered by individuals. in response to demand for added convenience.[21] . Drugs. CVS Caremark.[18] Others.[19] Competitors Google Health is a personal health record (PHR) service whose primary competitors in the United States are Microsoft's HealthVault. RxAmerica.[15] Privacy concerns Google Health is an opt-in service. Blue Cross Blue Shield of Massachusetts. 2011.[20] On July 18. it does encourage users to set up profiles for other individuals. 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. Healthgrades.com. It does not retrieve any part of a person's medical records without his or her explicit consent and action. The Cleveland Clinic. Some have been very negative. Since January 2010. including Free/Open Source Software Healthcare activist Fred Trotter. There are numerous other open-source and proprietary PHR systems.Google Health 42 Partners Google Health can currently import medical and/or drug prescription information from the following partners: Allscripts. The Beth Israel Deaconess Medical Center. Dossia. 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.[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. they will gather a user's medical records from around the world and add them to his or her profile. HIPAA privacy laws do not apply to it.

The Wall Street Journal. The New York Times. . com/ article/ SB121123806355705263. with a few years of experience. uspto. .S. uk/ 2010/ 01/ 29/ wiscale/ [15] "Fall update on Google Health" (http:/ / googleblog. 2011. “ . Jessica E. html). google. com/ health/ html/ faq. Retrieved 2008-05-20. [17] "Humanist → Google Health Can Fix U. . wsj. Retrieved 2009-03-11. Retrieved 2008-05-20. com/ 2011/ 06/ update-on-google-health-and-google. blogspot. [19] "In all Fairness" (http:/ / www. Google. [7] Vascellaro. [9] Lohr. com/ 2011/ 06/ 25/ technology/ 25health. com/ health/ html/ tour/ ). html). [11] "An update on Google Health and Google PowerMeter" (http:/ / googleblog. References [1] http:/ / www. com/ 2009/ 10/ fall-update-on-google-health. CNET. "New York Times: Google Offers Personal Health Records on the Web" (http:/ / www.Google Health 43 Discontinuing On June 24. [21] Jay Greene. [22] http:/ / googleblog. we’ve observed that Google Health is not having the broad impact that we hoped it would. . Retrieved 2009-10-07. google. org/ research): "The Indivo project has its roots in the Guardian Angel project. google. . The New York Times. Steve (2008-05-20). . com/ health [2] Lohr. com/ 2008/ 05/ 23/ in-all-fairness/ ). [13] https:/ / www. 2012. html). Retrieved Jul 18. net [14] http:/ / www. . com/ 8301-10805_3-20080403-75/ microsoft-offers-transfer-tool-to-google-health-users/ ?part=rss& subj=news& tag=2547-1_3-0-20). com/ health/ html/ about/ profiles. "Google tweaks Google Health dashboards" (http:/ / news. Retrieved 2008-05-20. Retrieved 2008-05-20. [6] "Google Health: Frequently Asked Questions" (https:/ / www. mediconnect. html). [8] "Method and apparatus for serving advertisements in an electronic medical record system" (http:/ / appft1. html?_r=1). Retrieved 2008-07-10. blogspot. . nytimes. cnet. theregister. " Microsoft offers transfer tool to Google Health users (http:/ / news. com/ apis/ health/ ccrg_reference. html .subj=news& amp. [18] "RSnake picks on Google Health… yes. nytimes. . html?part=rss& amp. html [23] http:/ / googleblog. December 6. gov/ netacgi/ nph-Parser?Sect1=PTO2& Sect2=HITOFF& u=/ netahtml/ PTO/ search-adv. . Retrieved 2011-06-28.. google. com/ security/ ?p=1166)." Jul 18. google. . . com/ 2011/ 06/ update-on-google-health-and-google. 2011.tag=2547-1_3-0-20). zdnet. co. . html).[22] Google stated that they are discontinuing Google Health because it did not have a broad impact as Google had expected before. com/ 2008/ 05/ 20/ technology/ 20google. "Wall Street Journal: Google Helps Organize Medical Records" (http:/ / online..". com/ health/ directory?url=gh. Fred Trotter. too!" (http:/ / blogs. a collaboration between Harvard and MIT . Retrieved 2008-07-10. Healthcare" (http:/ / humani. html& r=1& p=1& f=G& l=50& d=PG01& S1=20070282632. 2011. 2007. cnet. com/ 2011/ 06/ update-on-google-health-and-google. com/ health/ html/ about/ index. Steve (2011-06-24). ” —From The Official Google Blog [23] Google will continue to operate the Google Health site until January 1. Tom. com/ health/ html/ terms. blogspot. .com. com/ 8301-30684_3-20016562-265. html). Retrieved 2008-05-20. Retrieved 2008-07-11. PGNR.. [20] History of the Personally Controlled Health Record (http:/ / indivohealth. google. ZDNet. google. Google wants your medical records. . html). USPTO. Retrieved 15 September 2010. [5] "Google Health Data API: CCR Reference" (http:/ / code. blogspot. html). Retrieved 2008-05-20.. st/ google-health-can-fix-us-healthcare/ ). the article shows a simple timeline or pedigree of the Personally Controlled Health Record. & OS=dn/ 20070282632& RS=DN/ 20070282632). [10] Krazit. [12] "Google Health: Partner Profiles" (https:/ / www. [4] "Google Health: Take a Tour" (https:/ / www. Retrieved 2008-05-27. html). (2008-05-20). . fredtrotter. google. [16] "Google Health: Terms of Service" (https:/ / www. "Google Is Closing Its Health Records Service" (http:/ / www. Google has announced that Google Health will be discontinued as a service. [3] "About Google Health" (https:/ / www. Retrieved 24 June 2011.

2. and by Physicians and Medical Librarians. apomediation. health professionals. to enable and facilitate specifically social networking. [10] Definitions of Medicine 2. and has come into use after a recent spate of articles in newspapers.0 wiki (not the Wikipedia version). and in particular it potential in public health promotion. tagging.0[1] ) are terms representing the possibilities between health care. eHealth and Web 2. software.0: "Medicine 2.Google Health 44 External links • Official website (http://www.0 as a participatory process between patient and clinician (with a couple of notable twists) -Health 2.0 is participatory healthcare. Podcasts. and community that we collect or create. there are several competing & complementary definitions of Health 2. Communities that capture the accumulated knowledge of patients and caregivers. Enabled by information. that use Web 2. [11] [12] Published in JMIR Tom Van de Belt. 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 catalyst for improving the safety.0 is the use of a specific set of Web tools (blogs. enabling the citizen to become an active and responsible partner in his/her own health and care pathway. 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. Intelligent tools for content delivery—and transactions. and 4.0 (as well as the closely related concept of Medicine 2. One author describes the potential as "limitless.0 defines the combination of health data and health information with (patient) experience through the use of ICT. collaboration. medical professionals. etc) by actors in health care including doctors.0 as a wider system reform-"New concept of health care wherein all the constituents (patients. caregivers.0" term are its applications across health care in general. and openness within and between these user groups. 3. All with the result of patients increasingly guiding their own care[7] Scott Shreeve considers Health 2. using principles of open source and generation of content by users. Retrieved 2010-03-31.[9] Health 2.0 applications.google. and promote health education. collaborate. and the power of networks in order to personalize health care. and scientists.0 technologies as well as semantic web and virtual reality tools. and other stakeholders in health" [6] An expanded version of the traditional definition breaks this into components: 1. patients.0 Health 2. patients. and quality of health care"[8] Then there's the concept of Health 2."[5] Definitions and Inclusions As yet there is no common agreement amongst experts and participants.[2] [3] A concise definition of Health 2. and clinicians—and explain it to the world. their caregivers. physicians. services and tools are Web-based services for health care consumers.google.[4] A possible explanation for the reason that Health has generated its own "2. Lucien Engelen et al systematic review found 46 (!) unique definitions of health 2. but cares about the user experience.0 [13] . we the patients can be effective partners in our own healthcare. participation.wordpress.com/intl/en-US/health/about/integconsults.0 appear to be very similar but typically include more scientific and research aspects—Medicine 2. Health 2. Better integration of data with content.com/health) • Google Health Integration (http://www. but from the Health 2.0. providers. efficiency.html) • "Google Health Architecture: CCR Reference" (http://healthtechsynthesis.com/2009/05/12/ consultant_guide_to_google_health_part_i_of_iv/). and we the people can participate in reshaping the health system itself. Personalized search that looks into the long tail. wikis. search. and biomedical researchers.0.

A key concept is that patients themselves should have greater insight and control into information generated about them.0 setting: A patient goes to see their primary care physician with a presenting complaint. Doctors 2. such as through a personalized genomics service to identify any risk factors that might improve or worsen their prognosis.0 [14] is defined as delivery of healthcare which leverages the use of elements of Semantic Web such as location awareness. already there are signs of Health 3. having first ensured his own medical record was up to date via the internet. in the case of complex chronic diseases. blogs. A hypothetical example demonstrates the increased engagement of a patient operating in a Health 2. They also have the social support of communicating with other patients diagnosed with the same condition throughout the world. the patient can track their health outcomes through a data-sharing patient community to determine whether the treatment is having an effect for them. where information about specific blood results would be of little use to a lay person. As does the desire by healthcare professionals and by patients to embrace new technology and new services. SocialMD. They can also choose to submit more data about themselves.0 is evolving fast as the technology landscape evolves.0 refers to a number of related concepts including telemedicine.Health 2. medical ethics considers such actions to be medical paternalism and are discouraged in modern medicine. give insight about diseases. Here the doctors get a chance to interact and share knowledge with other doctors. Connected Health . 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. are doctor-only social networks. On a second visit a referral might be made to a specialist.0 Health 2. and can stay up to date on research opportunities and clinical trials for their condition. As treatment commences. psychiatric disorders. Increasingly. . Traditional models of medicine had patient records (held on paper or a proprietary computer A model of Health 2. and other more advanced systems. Ozmosis etc. The treating physician might make a diagnosis or send for tests. electronic medical records. the results of which could be transmitted direct to the patient's electronic medical record. The patient might have the opportunity to search for the views of other patients on the best specialist to go to. However. and the use of the internet by patients themselves such as through messageboards.0 emerging. Health 3. Dedicated social networking sites for doctors like Sermo. discuss common healthcare issues. the emerging Internet of Things and embedded sensors. and may have communicated with other patients who have had a similar set of results in the past. 45 Overview Health 2. Doctors are entering into the field of blogging.0 system) that could only be accessed by a physician or other medical professional. and offer simple remedies for them. The specialist gives a diagnosis along with a prognosis and potential options for treatment. mHealth. Such a model operates relatively well in situations such as acute care. 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.0 [15] are also leveraging social media as a powerful tool. Physicians acted as gatekeepers to this information. However. If a second appointment is needed the patient will have had time to research what the results might mean for them. what diagnoses may be likely. where they share their experiences in the form of case studies. telling patients test results when and if they deemed necessary. and in combination with their primary care physician decides who to see. or in general practice where results were generally benign.

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. Podcasts and search tools [18] Users All (medical professionals and public) All (medical professionals and public) Doctors. 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. . 95% confidence interval 38% to 77%) in a 2005 [21] study Collaboration and practice 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. A study examining physician practice has suggested that a segment of 245. symptoms. RSS feeds (and other forms of many-to-many publishing).Health 2. such as the idea that patients may delay seeking medical advice.0.0 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.0 is commonly associated with technologies such as weblogs (blogs). Nurses Staying informed Used to stay informed of latest developments in a particular field Medical education Use for professional development for doctors. wikis. the limitations for Medical Doctors (MDs) to use Google as a diagnostic tool.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. and public health promotion for by public health professionals and the general public Web 2.0 in health. and as an entrepreneurial (rather than academic) movement.[16] this study considers only the broader use of the Internet for health management.0 in Health Care Partly due to weak definitions.0). the novelty of the endeavor. podcasts.[25] Other venues of information are likely to be less useful to the general public.0 46 Level of use of Web 2.[17] Types of Web 2.0 is being used in general. Purpose Description Case example in academic literature RSS.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%. and web application programming interfaces (APIs) (see main article Web 2. indicating that use is beyond the stage of the early adopter with regard to physicians and Web 2.[24] Finally concerns exist about the quality of user generated content leading to misinformation. little empirical evidence exists to understand how much Web 2.000 physicians in the U.0 technology in Health Care Web 2. which may be more effective only for conditions with unique symptoms and signs that can easily be used as search term. social software..0 for their practice. Long-term patients are more likely to [22] connect to a community in Health 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.S are using Web 2.[21] Secondly.0 use in Health Care The following are examples of uses that have been documented in academic literature. social bookmarking. Firstly. Types of Web 2.

Googling for a diagnosis—use of Google as a diagnostic aid: internet based study. htm [25] Economist.12(2):e18)URL: http:/ / www. URL: http:/ / gunther-eysenbach. and Openness (http:/ / www. M. Health 2. Arabnia. 2007 May. BMJ 2006. 2007.0) [12] Gunther Eysenbach's random research rants (Blog). Apomediation. Health 2. D. September 6: 73-74 . Heywood J (2008) How the social web supports patient experimentation with a new therapy: The demand for patient-controlled and patient-centered informatics.0 Empowerment". Wareham J. manhattanresearch. Online Health.January 24. icmcc. Ng JHK.29(4):307-10. by Matthew Holt. org/ 2008/ 3/ e22/ ). Collaboration. jmir. 2008. 333:1283-1284 [4] Hughes B.0: 5 Things You Should Know about the Evolving Online Landscape for Physicians. bulimia blogs and other forms of “user generated” medical information a healthy trend? The Economist. Jupiter Research. British Medical Journal. Journal of Medical Internet Research. by Matthew Holt.4(3):A75. aspx on 20/1/2008 [18] Giustini. 2007 presentation at Health 2. 4(3) : 75 [6] Adapted from Jane Sarasohn-Kahn's "Wisdom of Patients" report.0: A Systematic Review (J Med Internet Res 2010. Denis Carroll. tedeytan.0 : Technology and society: Is the outbreak of cancer videos.0 Conference. Joshi I.e-patients.Health 2. Andy Marsh (eds). jmir. Accessed at http:/ / www. com/ 2008/ 03/ medicine-20-congress-website-launched. Engelen LJ.[4] References [1] Eysenbach G Medicine 2. Review. 2007 Jul. disruptivedemographics. bulimia blogs and other forms of “user generated” medical information a healthy trend? The Economist. acponline. net/ e-Patients_White_Paper. (1996). 2008 [8] Last updated on May 25. 2007.0: Social Networking. Andy Marsh. http:/ / www. 10(3): e23 [5] Crespo. com/ TTPWhitePaper. pl/ research:vision/ 103/ id=98795/ on 20/1/2008 [17] Manhattan Research. Sanjeev Gupta. 2007) [9] "Patient 2. Massagli MP. Med Teach. White Paper: Physicians and Web 2. Wicks P. com/ bin/ item. 2007. Hamid R. How Web 2. pp. 2007. D. Participation. British Medical Journal. Virtual Community Health Promotion. MD . Berben SAA. org/ 2010/ 2/ e18/ [14] http:/ / www. Accessed: 2008-03-07 [13] Van De Belt TH. [22] Ferguson. Haythornthwaite C.0 / Health 2. The. Virtual community health promotion.0 47 Tensions in Health 2. PMID: 17786742 [20] Crespo R. www. socialf5. pdf on 22/1/08 [23] Frost JH.0: these are over the lack of clear definitions. 2007 from http:/ / www.333:1143-5.0 is changing medicine: Editorial. com/ blog/ 2011/ 05/ web-2-0-doctors/ [16] Levy. The. (2009) argue there are four major tensions represent in the literature on Health/Medicine 2. e-patients. LLC. Health 2.0 perspectives. org/ pdf/ ICMCCSWWS08. URL: http:/ / www.0 Congress Website launched (and: Definition of Medicine 2. T. R. September 6: 73-74 [3] Giustini. blogspot.0 and Medicine 2. How Web 2.0 : Technology and society: Is the outbreak of cancer videos.net.10(3):e22 [2] Economist. issues around the loss of control over information that doctors perceive. Schoonhoven L Definition of Health 2. com/ 2010/ 04/ health-30-new-data-on-aging-boomers. pdf [10] Ted Eytan MD. 2007 Scott Shreeve. 333:1283-1284 [19] Sandars J. Prev Chronic Dis.0 is changing medicine: Editorial. Assessing the Risk and Opportunity of Social and One-to-One Media.0 and Medicine 2. June 6.0: Tensions and Controversies in the Field (http:/ / www. 2007. Last updated June 6. Gunther. org/ 2008/ 3/ e23/ ). jupiterresearch. 164–167. Online advice: Good medicine or cyber-quackery? Retrieved September 22. Proceedings of the 2008 International Conference on Semantic Web & Web Services SWWS08. Preventing Chronic Disease. safety and the dangers of inaccurate information. 2006. com/ 2008/ 06/ 13/ 1089 [11] Eysenbach. J Med Internet Res 2008. 2007. org/ journals/ news/ dec96/ cybrquak. E. H. October 22. html [15] http:/ / www. ePatients white paper. AMIA Annu Symp Proc 6:217-21 [24] Ojalvo. 2008. updated from original September 20. Mike Rees. http:/ / www. jmir. 2008 [7] "Holt's evolving view of a moving target". New horizons for e-learning in medical education: ecological and Web 2. Lodewijk Bos. PMID: 17572979 [21] Tan H.0 Hughes et al. and issues of ownership and privacy. Medicine 2. Accessed at http:/ / www. html. 2006.

0 Boston Chapter Health 2.medicine20congress.0_Companies) • A list of medical wiki websites (http://www.org/wiki/Health_2.com/wiki/Main_Page) including links to more than 40 medical wikis • Medicine 2.0 concept.0 48 External links • The term Health 2.com/) is trademarked by this conference series • A set of useful resource on the Health 2.0 Chapters Health 2.org/wiki/Main_Page) including a list of Health 2.Health 2.washingtonpost. which is similar or identical to the Health 2.0 (http://www.0 Congress (http://www.healthplusplus.0 Japan Chapter • Health 2. but also includes "Science 2. October 19.0 Hawaii Chapter Health 2. The Washington Post.health2con.0 NYC Chapter (http://health20nyc.0 companies (http://health20.org/) .com/).html)".0 Wiki (http://health20.0" • " Web Site Harnesses Power of Social Networks (http://www.com/wp-dyn/content/article/ 2009/10/18/AR2009101801844. 2009 Health 2.

or a clear statement if this is not the case The HONcode Logo . The HONcode is voluntary. in the words of the program. reliable medical information and expertise. It is the oldest and the most used ethical and trustworthy code for medical and health related information available on the Internet. Rather. the code only states that the site holds to the standards. HONCode is not designed to rate the veracity of the information provided by a Web site. so that readers can know the source and purpose of the medical information presented.information and advice given only by medical professionals with credentials of author/s.Health On the Net Foundation 49 Health On the Net Foundation Health On the Net Foundation Type Industry Founded Nonprofit Healthcare September 1995 Headquarters Geneva. The unanimous conclusion of this gathering was to create a permanent body that would. "promote the effective and reliable use of the new technologies for telemedicine in healthcare around the world. Following this. 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. healthonnet. 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. Switzerland Products Website Certification. Trusted health search engine and education http:/ / www. Switzerland. HON seeks to contribute to improved health care through patient empowerment and better informed health professionals. Authority . 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. the website is reviewed by a specialized team of health and legal professionals.[2] which means that webmasters and information providers can apply for HONcode certification. The principles of the HONcode are: 1. Mission The mission of the foundation is to guide the growing community of healthcare consumers and providers on the World Wide Web to sound." 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. In this way. The HONcode certification is a dynamic state and is extended every year according to site compliance.

In recent times however. help guide their patients to trustworthy health information. Consumer protection advocate. Transparency of authorship . Transparency of sponsorship . websites which are not in compliance with HONcode may still be displaying the HONcode logo. HON also has a partnership at the French governmental level. indicating that consumers may mistake it as an award or interpret it as an indicator for assessed information. In addition. medical centers or hospitals. of authors should be available 7. well-referenced scientific information 6. not replace. Stephen Barrett. 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. HON has developed ways to counteract the abuse of the HONcode. journal articles and news through its search engines MedHunt [3].details about advertising on the site and clear distinction between advertised and editorial material Currently the HONcode is used by over 5. HON offers all users the trustworthy web sites and support groups.references to source of information (URL if available online)and dates when pages was last updated 5. In a whole "Special to The Washington Post". as Health On the Net Foundation (HON) has no means of obligating the offending webmaster to remove the logo. medical images and terminology. Santeromande. 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.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. HONcode relies on the webmaster for honest representations about compliance with the principles. Health On the Net Foundation was granted on 23 July 2002 NGO status by the Economic and Social Council of the United Nations. product or service must be supported by balanced. Attribution .how the site treats personal and non-personal information of readers 4. directory of registered health professionals. such as credentials (medical or otherwise) as stated on websites displaying the logo. or that copyright or confidentiality is not violated by webmasters. including suggested improvements and his criticisms .information and help are to support.[9] Websites which are not in compliance with HONcode can continue to display the logo. Honesty in advertising and editorial policy .sources of funding for the site 8. medical associations and federal organizations.ch [7] is an extensive database. patient-healthcare professional relationships which is the desired means of contact 3. extensive coverage of his views on the subject were provided. Clicking on that logo (for verification) will not indicate that the site is out of compliance. all medical credentials are verified through national databases of registered medical professionals. Other issues with the HONcode logo were discussed in the Journal of Medical Internet Research (JMiR).any treatment. as HONcode only indicates that sites are "undergoing annual review". It is used to sensitize web publishers to the need for quality information and create awareness in health professionals and so.contact information. Confidentiality . preferably including email addresses.Health On the Net Foundation 2. mainly directed towards the French speaking public of Switzerland and neighbouring France and provides reliable health information. a peer-reviewed eHealth journal. Other problems with the application of the HONcode principles are that HON does not have a means of verifying many of the principles. HONcodeHunt [4] and HONselect [5]. Complementarity . covering 72 countries and has been translated into 34 languages. one on eye diseases and the other on general medical conditions. 50 Abuse of HONcode A journal article raised a number of problems with the HONcode logo. Provisu. Hence.000 certified websites. when it was accredited in 2007 by the French National Authority (HAS) [8] to be the official certifying body for all French health websites. is a strong supporter of the HONcode and has made efforts to improve compliance with its rules and to expose those who abuse it. Justifiability . calling into question the entire principle of HONcode. HON also provides two databases of trustworthy health information.

Med. hon. Attacking Their HONor: Some Dispute Value of Logo Used to Verify Accuracy. Page HE01 [12] "How to be a vigilant user" (http:/ / www. washingtonpost. April 20. html) Special to The Washington Post. fr/ portail/ display. ch/ HONselect/ [6] http:/ / www. jsp?id=c_453883 [9] JMIR article (http:/ / www.jmir.hon. "Setting the public agenda for online health search: a white paper and action agenda".hon. accessed 8 April 2009.[11] In cases of suspected fraudulent websites. hon.hon.org/2000/2/e13/) Provisu website (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. org/ 2000/ 2/ e13/ ) [10] http:/ / www. Lorence D (June 2004). J.ch/MedHunt/) HONcodeHunt (http://www. ch/ [8] http:/ / www. hon.provisu. com/ wp-dyn/ articles/ A25556-2004Apr19.2. PMID 15249267. html [2] Greenberg L. ch/ MedHunt/ [4] http:/ / www. 2004. ch/ [7] http:/ / www.ch) JMIR article (http://www.fr/portail/display. doi:10. hon. PMC 1550592. hon. jsp?id=c_453883) Policing the HONcode (http://www.Health On the Net Foundation of many named abusers. or of abuse of the HONcode.ch/HONselect/) . Internet Res.hon.ch/HONcode/Hunt/) HONselect (http://www. provisu. External links • • • • • • • • • Health On the Net website (http://www. html [11] Christopher Wanjek. [3] http:/ / www.santeromande.ch/) Presentation of HONcode on French National Authority website (http://www. D'Andrea G. hon. Integrity Of Health Web Site Contents. 6 (2): e18.hon.2196/jmir.html) MedHunt (http://www.e18. santeromande.ch/) Santeromande website (http://www. ch/ HONcode/ audience_t. jmir. html) Health On the Net Foundation. Of course.ch/HONcode/policy."[12] 51 References [1] http:/ / www.6. please alert Quackwatch.has-sante. has-sante. if such a site DOES display the HONcode. ch/ HONcode/ Conduct. (http:/ / www. ch/ HONcode/ Hunt/ [5] http:/ / www. ch/ HONcode/ policy. alert us immediately.

The functionality of the real-time video consultations offered through the telehealth portal was recently demonstrated for a local ABC affiliate. justnews. TheiCanGroup. was featured on Pitchmen. . Recently. . com/ Website The iCan Group is a family of companies in the fields of health insurance. html). the iCan Group's insurance brokerage firm. the group launched an on-demand telehealth start-up called InteractiveMD. com/ health/ 23078386/ detail. htm). allowing for the extension of telemedical benefits to members of its group health insurance programs. Billy Mays. as well as general consumers who wish to sign up exclusively for telehealth benefits. Florida Harold Shatz Sam Shatz Steve Tucker http:/ / www. and medical bill advocacy. Retrieved 2010-04-22. Retrieved 2009-10-13. marketing. prweb. com/ releases/ 2009/ 06/ prweb2487594. iCan Benefit. .[1] In June 2009.[2] References [1] "Doctors Make Virtual House Calls" (http:/ / www. [2] "iCan Benefit Group to be Featured on Discovery Channel's Pitchmen" (http:/ / www. a Discovery Channel show hosted by their late spokesperson. telehealth.iCan Group 52 iCan Group iCan Group Type Industry Headquarters Key people Private Health Insurance Boca Raton.

hospitals and other health care providers concerning the handling and privacy protection of vital patient medical data. imprisonment. com/ [4] http:/ / www. External links • iMedicor [3] • Vemics [4] References [1] Advance for Health Information Professionals. imedicor. Virtual Medical Worlds." Some of iMedicor's partner associations include the Association of Black Cardiologists (ABC). in extreme cases. On November 20.Review of iMedicor Portal for Medical Professionals (http:/ / medgadget. the iMedicor portal was given a positive review by Medgadget. advanceweb. Medgadget also stated. and Highway Hypodermics among others and received positive review by the Internet journal Medgadget. Inc.Thursday. The launch of iMedicor’s portal coincides with the entrance of Microsoft's Healthvault and Google Health into the personal health record space. 2007. com/ Article/ The-PHR-Revolution. 2007 . is a set of strict rules to be followed by doctors. com/ Type of site Social network service Owner Vemics. Violations can result in serious fines or.iMedicor 53 iMedicor iMedicor URL http:/ / www. Posted: 09:00 AM (http:// www. html) [3] http:/ / www. The portal's proprietary HIPAA-compliant technology and ability to enable health providers to exchange medical record data. 2007. iMedicor has a proprietary HIPAA-compliant interface. lumped together with a social network for clinicians. the influential Internet Journal of Emerging Medical Technologies. Inc. aspx) [2] Medgadget. community and referrals.com/.000th physician registration on December 12. (http:/ / health-information. Created by Vemics. com/ archives/ 2007/ 11/ imedicor. November 20. and the Hypertrophic Cardiomyopathy Association (HCA). 2007 The iMedicor Web portal. imedicor. It has been discussed in such journals as Healthcare Informatics. 2007. 2007. which went live on October 10. the American Society for Hypertension (ASH).site/news/Stock News/889796/?hcode=relatednews) . Launched October. com/ • iMedicor Announces Agreement With eRx Network . December 06. documentation and images distinguish it from chat-room-style portals for the medical community. HIPAA.[2] The journal said that iMedicor is "strikingly different" from other medical networks such as iMedExchange and Sermo. Advance for Health Information Professionals [1] . which stands for the American Health Insurance Portability and Accountability Act of 1996. is online personal health data exchange and secure messaging portal for physician collaboration. Tuesday.tradingmarkets. vemics. iMedicor reached its 32. "The service behaves more like a typical email provider and a file sharing site.

google. Florida Key people Website Randy Parker https:/ / www. . The integration is the first of its kind on the Google platform.Online Medical Portal Tapped to Help Expand Hypertension Initiative (http://www. com/ MDLiveCare is an on-demand telehealth company that provides patients with remote access via video. .jsp?ndmViewId=news_view&newsId=20080114005818&newsLang=en) 54 MDLiveCare MDLiveCare Type Industry Private Telehealth Headquarters Sunrise. com/ 2009/ 10/ fall-update-on-google-health. Retrieved 2009-10-09.[1] Recently. 09:06 AM Eastern Time . html). [2] "Fall Update on Google Health" (http:/ / googleblog.iMedicor • January 14. . 2008. com). com/ health/ directory?url=ghealth. blogspot. phone.businesswire.[2] References [1] "Google Health Directory of Services" (https:/ / www. MDLiveCare. marking the introduction of telehealth services to Google Health's directory of online services.American Society of Hypertension Partners with iMedicor . 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. mdlivecare.com/portal/site/ google/index. Retrieved 2009-10-09.

Arbinder Singal are the co-founders. launched in 2011.[9] . mediangels. 2011 Mumbai. a private medical consulting firm.[6] Once registered.[1] History MediAngels. the lab personnel come and collect samples from the patient´s residence and deliver reports back as well. typically patients seeking second opinions or those looking for advice from experts not available locally. customers may submit a report to a particular specialty or to the whole panel as such. Second opinions will be provided by the expert chosen. Once the specialist gives his opinion. Dr Debraj Shome and Dr.000). Members can upload scanned reports from their existing physicians and other investigation reports.com provides online consultation from a large pool of medical experts and specialty doctors across the globe to users. Both the patient and the doctor are notified by SMS or email when the same has been done. com MediAngels is a India-based multi-speciality 'e-hospital' service provider. Arbinder Singal http:/ / www. Mediangels allows its subscribers to show medical records and documents on the website by using services like telephonic and video [7] enabled consultations. recently received funding from the private equity unit of HDFC which has bought around 12 per cent stake in the company for Rs 2.[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. This allows the physician to evaluate the investigation reports. managed by Angels Health Private Limited.00.5 crore (approximately USD 5. diagnosis and treatment of medical conditions. Upon making an appointment. the information is processed and translated into a form in which the end-user can understand. India Headquarters Number of locations Mumbai. India Area served Key people Website Worldwide Debraj Shome.Mediangels 55 Mediangels MediAngels Type Industry Founded Private Healthcare Mumbai. These reports are automatically made available on the users´ MediAngels profile. in such a scenario the site administrators (a trained doctor 24/7) forwards the consult to an appropriate consultant. urine tests and other diagnostic tests done from the location of their choice.[8] Consumers can choose to get blood tests.[2] [3] [4] Service Line and Concept Angels Health's website mediangels. India January 26.

asp?b2mid=27095) [2] Online medical service MediAngels receives Rs 2. financialexpress. vccircle. html) [9] eIvnestigation from MediAngels (http:/ / www.[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 [14] for attendance. indiatimes. vccircle. P Raghuram in April 2011 at Mumbai Future plans MediAngels is currently in discussion with the state governments of [Maharashtra] and [Madhya Pradesh] to offer solutions to rural areas. One of the offices also doubles up as MediAngels operation centre. businesswireindia. marketpressrelease. another for the sales & distribution team and the third one for the digital sales and marketing team.com (http:/ / articles. com/ PressRelease. in/ article/ we-aim-to-become-the-webmd-of-medicine/ 17757. html) [14] MediAngels Oration (http:/ / programsinmedicine. com/ Pages/ HomeDoctorsPanel. wsj. com/ india/ news/ mediangels-has-something-more-to-offer/ 441367) [11] MediAngels Panelists (http:/ / www.[12] The portal has also tied up with 21. html) [8] Moneylife-MediAngels (http:/ / www. moneycontrol. [Vadorara] and [Bhopal]. 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. html) [10] MediAngels has something more to offer (http:/ / www.000 laboratories across India for on call diagnostic services. com/ news/ online-medical-service-mediangels-receives-rs-25-crore-funding-hdfc’s-pe-arm) [3] HDFC PE Arm Picks up Stake in Mediangels. com/ 500/ mediangels-aims-at-revolutionizing-the-current-healthcare-paradigm) [7] Young Turks: MediAngels (http:/ / www.Mediangels 56 Specialist base MediAngels as of now has a team of 300 doctors from over 85 super-specialty hospitals across 25 countries. moneycontrol. Dr. business-standard. aspx) [12] Mediangels aims at revolutionizing the current healthcare pariadigm (http:/ / techcircle.5 crore series A from HDFC’s PE arm (http:/ / www. com/ 2011-06-03/ news/ 29617360_1_e-commerce-private-equity-firm-venture-intelligence) [4] Express (http:/ / www. The oration was delivered by breast surgeon. com/ 500/ mediangels-aims-at-revolutionizing-the-current-healthcare-paradigm) [13] Young Turks: MediAngels (http:/ / www. com/ eInvestigation-Pathology-Tests-Blood-Test-Urine-Test--MediAngels-1309349763. References [1] Businesswire India (http:/ / www. Three physical centres at [Indore]. mediangels. html?mod=wsj_india_main) [6] Mediangels aims at revolutionizing the current healthcare pariadigm (http:/ / techcircle. alootechie.[10] MediAngels panel recruitment is by invitation only.[11] MediAngels Centres MediAngels currently has three offices in Mumbai – one for the technology team. economictimes. com/ article/ SB10001424052702304657804576402383145592202. com/ news/ HDFC-acquires-12--stake-in-MediAngels/ 814148/ Financial) [5] Online Medical Services Provider Raises Money-Wall Street Journal (http:/ / online. moneylife. com/ mediangels-kicks-off-its-oration-programme-first-oration-on-breast/ ) . com/ news/ special-videos/ young-turks-mediangelgetting-it-righte-healthcare_556509. com/ news/ special-videos/ young-turks-mediangelgetting-it-righte-healthcare_556509.

the field has emerged in recent years as largely an application for developing countries. then. Ghana While mHealth certainly has application for industrialized nations. supported by mobile devices. largely emerges as a means of providing greater access to larger segments of a population in developing countries. and direct provision of care (via mobile telemedicine).. such as mobile phones and PDAs.mHealth 57 mHealth mHealth (also written as m-health or mobile health) is a term used for the practice of medicine and public health. stemming from the rapid rise of mobile phone penetration in low-income nations. The field broadly encompasses the use of mobile telecommunication and multimedia technologies in health care delivery. etc. including increased access to healthcare and health-related information (particularly for hard-to-reach populations). Within the mHealth space. for health services and information. and expanded access to ongoing medical education and training for health workers. The mHealth field has emerged as a sub-segment of eHealth. researchers. timelier.[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. For example. more actionable public health information. an mHealth project that uses mobile phones to access data on HIV/AIDS rates would required an eHealth system in order to manage. The term mHealth was coined by Professor Robert Istepanian as use of "emerging mobile communications and network technologies for healthcare. delivery of healthcare information to practitioners. the use of information and communication technology (ICT).[4] Because mHealth is by definition based on mobile technology such as IPhones."[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”. eHealth can largely be viewed as technology that supports the functions and delivery of healthcare. while not clearly bifurcated by such a definition. mobile phones.[4] While there are some projects that are considered solely within the field of mHealth. as well as improving the capacity of health systems in such countries to provide quality healthcare. communications satellite. while mHealth rests largely on providing healthcare access. through information and Malaria Clinic in Tanzania helped by SMS for Life program which uses cell phones to efficiently deliver malaria vaccine . healthcare. and patients. projects operate with a variety of objectives. The term is most commonly used in reference to using mobile communication devices.[2] Medical nurse uses a mobile phone in Accra. Thus. patient monitors.[1] In a similar vein. and assess the data. real-time monitoring of patient vital signs. improved ability to diagnose and track diseases. the linkage between mHealth and eHealth is unquestionable. eHealth projects many times operate as the backbone of mHealth projects. for health services and information. such as computers. The field. store.[1] mHealth applications include the use of mobile devices in collecting community and clinical health data.

store.mHealth delivery. The motivation behind the development of the mHealth field arises from two factors. Healthcare in low. The first factor concerns the myriad constraints felt by healthcare systems of developing nations. "WHO Disease and injury country estimates". the potential of lowering information and transaction costs in order to deliver healthcare improves.and middle-income countries are forced to face the burdens of both extreme poverty and the growing incidence of chronic diseases. 2009.64.and middle-income countries than high-income countries. mHealth offers the ability of remote individuals to participate in the health care value matrix.[6] With greater access to mobile phones to all segments of a country. finds an average density of physicians. nurses and midwives per 1000 population of 0. These constraints include high population [5] growth. people. drugs and violence.000 inhabitants in 2004. which may not have been possible in the past. 58 Motivation of mHealth MHealth is one aspect of eHealth which is pushing the limits of how to acquire. Retrieved Nov. Participation does not imply just consumption of health care services. large numbers of rural inhabitants. 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. World Health Organization. free of disease and disability. can better reach areas.[11] In addition. and/or healthcare practitioners with previously limited exposure to certain aspects of healthcare. Both factors are discussed here. healthcare access to all reaches of society is generally low in these countries. a high burden of disease prevalence.  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. The WHO. . extreme poverty.[10] The burden of disease is additionally much higher in low. in a study of the healthcare workforce in 12 countries of Africa. is about five times higher in Africa than in high-income countries. 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.and middle-income countries Middle income and especially low-income countries Disability-adjusted life year for all causes per 100. These countries face a severe lack of human and physical resources. transport. as well as the population of a country as a whole. measured in disability-adjusted life year (DALY). face 2009. nurses. including rural areas. and large population growth rates. low health care workforce. The second factor is the recent rapid rise in mobile phone penetration in developing countries to large segments of the healthcare workforce. process. such . low.6. 11. at 2. and secure the raw and processed data to deliver meaningful results. The burden of disease. In many cases remote users are valuable contributors to gather data regarding disease and public health concerns such as outdoor pollution. as well as some of the largest burdens of disease. and limited financial resources to support healthcare infrastructure and health information systems.[9] The density of the same metric is four times as high in the United States.4 million doctors. 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. The WHO notes an extreme deficit within the global healthcare workforce. Additionally. and midwives.

[16] The number of global mobile phone subscribers in 2007 was estimated at 3. and other diseases.” [12] Health and development The link between health and development can be found in three of the Millennium Development Goals (MDGs). to bypass 20th century fixed-line technology and jump to modern mobile technology.1 billion of an estimated global population of 6. improving maternal health.[17] These figures are expected to grow to 4. 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 the mHealth field. In many countries. and increasing access to safe drinking water.and middle-income world. or a 64. deploy and efficiently use the substantial additional funds that are considered necessary to improve health in these countries. with the global Mobile phone penetration rate drastically increasing over the last decade.and Middle-income Countries Mobile technology has made a recent and rapid appearance into low.[18] Globally. Mobile Phones Penetration and Drivers of Growth Mobile phones have made a recent and rapid entrance into many parts of the low. the entrance of other technologies into these nations to facilitate healthcare are also discussed here.1 billion mobile phones in use in December 2008 . this is particularly true in developing countries. The MDGs that specifically address health include reducing child mortality. HIV and AIDS and tuberculosis. an effect of new-found (relative) affluence. even those with relatively poor infrastructure.and middle-income nations. The greatest growth is expected in Asia. combating HIV and AIDS.[14] 59 Mobile Technology in Low.[1] Considering poor infrastructure and low human resources. and a general increase in non-food expenditure have influenced this trend. Mobile phone subscribers per 100 inhabitants 1997–2007 . states: "The problem is so serious that in many instances there is simply not enough human capacity even to absorb.5 billion by 2012.7% mobile penetration rate. the Middle East. while many regions continue to struggle to achieve reductions in the prevalence of the diseases of poverty including malaria.mHealth as diabetes and heart disease. Low. That is.6 billion (47%). the number of mobile phone subscribers has by-passed the number of fixed-line telephones. mobile phones have allowed many developing countries. there were 4.[12] The WHO.[13] A progress report published in 2006 indicates that childhood immunization and deliveries by skilled birth attendants are on the rise.and middle-income countries are utilizing mobile phones as “leapfrog technology” (see leapfrogging). See List of countries by number of mobile phones in use.[15] While. mobile technology usually refers to mobile phone technology. Improvements in telecommunications technology infrastructure. and Africa. reduced costs of mobile handsets. as set forth by the United Nations Millennium Declaration in 2000. malaria. in reference to the healtcare condition in sub-saharan Africa.

it is worth noting that the capabilities of mobile phones in low. In India. as disposable income rises. Smartphone technologies are now in the hands of a large number of physicians and other healthcare workers in low. although total share of consumption has declined. That being said.and middle-income countries. by far the greatest growth rates are found in urban areas. is able to reach more people. and now increasingly wireless infrastructure. As a result of such technological advances. while mobile penetration rates have increased markedly. the spread of Smartphone technologies opens up doors for mHealth projects such as technology-based diagnosis support. such as Nokia. for example. such as mobile phones. The all India average was 28. and email through Smartphones is not as well developed in much of the low. 56% of Indian consumers’ consumption went towards food in 1995. remote diagnostics and telemedicine. While uptake of Smartphone technology by the medical field has grown in low.and middle-income nations. allowing individuals to contact each other irrespective of time and place. compared to 42% in 2005.mHealth While mobile phone penetration rates are on the rise. faster. total consumption of food and beverages increased 82% from 1985 to 2005.[21] Technology Basic SMS functions and real-time voice communication serve as the backbone and the current most common use of mobile phone technology.[22] The appeal of mobile communication technologies is that they enable communication in motion. there are certainly within-country equity issues to consider. The broad range of potential benefits to the health sector that the simple functions of mobile phones can provide should not be understated. consumers have become and continue to become wealthier. Mobile phones are spreading because the cost of mobile technology deployment is dropping and people are.[20] Vendors. in September 2008.[25] Increased 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. GPS navigation. For example. More advanced mobile phone technologies are enabling the potential for further healthcare delivery. Consumers are shifting their expenditure from necessity to discretionary. the capacity for improved access to information and two-way communication becomes more available at the point of need. with a greater ability to spend on new technologies. The infrastructure that enables web browsing. access to web-based patient information.[26] 60 . The number is expected to drop to 34% by 2015. and decentralized health management information systems (HMIS).and middle-income countries. was 66% in urban areas. In India. web browsing. while only 9. the growth within countries is not generally evenly distributed. for example.2% at the same time. while mobile phones may have the potential to provide greater healthcare access to a larger portion of a population. Indian consumers are getting wealthier and they are spending more and more.[19] So. are developing cheaper infrastructure technologies (CDMA) and cheaper phones (sub $50–100. while per-capita consumption of food and beverages increased 24%.and middle-income countries. causing a rapid increase spending on new technology. getting wealthier in low.4% in rural areas. such as Sun's Java phone).[23] [24] This is particularly beneficial for work in remote areas where the mobile phone. on average. Mobile penetration.and middle-income countries has not reached the sophistication of those in high-income countries. Non-food consumption expenditure is increasing in many parts of the developing world. globally. on average. GPS navigation. Although far from ubiquitous.

and other health-related data collection. Operating Systems must be agile and evolve to effectively balance and deliver the desired level of service to an application and end user. . applications are beginning to be tailored for and make inroads in low. power consumption and security posture. Apple’s iPhone OS.0 collaboration tools into mobile devices. computer. Many of these technologies. with broad advocacy campaigns for free and open source software (FOSS).4% of total mortality. and also communication capabilities through the integration of e-mail and SMS features. while managing display real estate. As advances in capabilities such as integrating voice. Data collection requires both the collection device (mobile phones. are developing primarily in high-income countries. Data has become an especially important aspect of mHealth. However. and marketed for use in the mHealth field. By aggregating this data. These combined capabilities have been used for emergency health services as well as for disease surveillance. while having some application to low. other visual image information. video and Web 2.and middle-income nations. education. New sensor technologies [27] such as HD video and audio capabilities. Per the World Health Organization. treatment and monitoring. close to the patient or consumer of the health care service. health facilities and services mapping. This may foster greater adoption of mHealth Technologies and Services.mHealth Other mHealth Technologies Beyond mobile phones. tested. wireless-enabled laptops and specialized health-related software applications are currently being developed.[28] which can be utilize to assess the impact of pollution. accelerometers. 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. Devices in this class may include Apple's iPad 1&2 and Motorola's Xoom. Data is primarily focused on visualizing static text but can also extend to interactive decision support algorithms. GPS.[29] Utilizing Participatory sensing technologies in mobile telephone. Nokia Symbian OS and RIM's BlackBerry OS. public health policy shall be able to craft initiatives to mitigate risk associated with outdoor air pollution. Air Quality Sensing Technologies Environmental conditions have a significant impact to public health. public health research can exploit the wide penetration of mobile devices to collect air measurements. outdoor air pollution accounts for about 1. ambient light detectors. Operating systems which control these emerging classes of devices include Google’s Android.and middle-income countries. significant benefits can be achieved in the delivery of health care services. 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. by exploiting lower cost multi purpose mobile devices such as tablets pcs and smart phones. integrity and availability are required to build trust. or portable device) and the software that houses the information. This could include diagnosis. 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 61 Mobile Device Operating System Technology Technologies relates to the Operating Systems which orchestrate mobile device hardware while maintaining confidentiality. barometers and gyroscopes[28] can enhance the methods of describing and studying cases. Microsoft's Windows Mobile.

and middle-income countries.[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). Additionally. Efforts are ongoing to explore how a broad range of technologies. availability of health services. mobile communication technologies are tools that can be leveraged to support existing workflows within the health sector and between the health sector and the general public. the UN Foundation and Vodafone Foundation[1] report presents six application categories within the mHealth field. including testing and treatment methods. projects operate with a variety of objectives.[33] Within the mHealth space. and disease management. 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 education and awareness applications. and most recently mHealth technologies. 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. In some ways. offering patients confidentiality in environments where disease (especially HIV/AIDS) is often taboo. SMSs provide an avenue to reach far-reaching areas—such as rural areas—which may have limited access to public health information and education. 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). SMS messages are sent directly to users’ phones to offer information about various subjects. 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. Below is a list of mHealth Education and Awareness projects: . can improve such health outcomes as well as generate cost savings within the health systems of low. SMSs provide an advantage of being relatively unobtrusive. • • • • • • • 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. 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.mHealth 62 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. Overall. and a deficit of healthcare workers[1] . health clinics. 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.

health risk prevention. 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. Voxiva has partnered with the Instituto Carso de la Salud (ICS) . With these tools they can generate changes in attitude towards a self-health care.mHealth 63 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. and adherence to specific prescribed treatments assigned to PLWHIV.

Based on these answers.mHealth Mexico Cardionet Voxiva. height. along with ICS. Rwanda/Uganda ResultsSMS. diabetes or smoking) as well as blood pressure and cholesterol if known. ResultsSMS is a partnership between [35] GPAS . a solution in self-health care. patient education. and adherence to prescribed treatments. follow-up appointments and adherence reminders to patients via SMS. Examples of health foods and exercise are given to increase the messages effectiveness. weight. From this assessment the individual begins receiving educational messages encouraging him/her to exercise and eat healthy.org [34] ResultsSMS is an open-source platform compatible with OpenMRS designed to disseminate test results.e. 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) 64 . health risk prevention. other health problems they have (i. has developed CardioNet. Individuals complete a questionnaire asking them questions such as sex. the individual is evaluated according to the standards set by the World Health Organization (WHO). age.

India Freedom [39] HIV/AIDS [40] 2005 In the first phase, 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. The Freedom HIV/AIDS [42] is a social initiative of ZMQ Software Systems (A Technology for Development Social Enterprise) [41] . The initiative is supported by Delhi State AIDS Control Society and was launched by Chief Minister of Delhi Shrimati Sheila Dikshit. Games are free for download through the corporate social responsibility program of [43] ZMQ


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. million handsets. Later, the games were made available on other mobile carriers taking to 30 million handsets. In a span of 15 months, there have been a download of 10,3 million game sessions South Africa Project [1] Masiluleke 276 Million text messages –one million per day –being sent (2008–2009). 1,060,000 calls answered. Messages in local languages are especially well received. Build awareness of HIV status, encourage HIV/AIDS testing and treatment and halt the disease’s spread. Stigma is a major barrier, causing people to only seek care very late in the illness. SMS message campaign promoting HIV/AIDS awareness resulted in nearly a tripling of call volume to a local HIV/AIDS helpline.

Praekelt Foundation, iTeach, National Geographic, Nokia Siemens Networks, MTN, Ghetto Ruff, Children of South African Legacies, Aricent, PopTech!, frog design and National AIDS Helpline

‘Please Call Me’ service -free text messages. 95% of South Africa uses prepaid cellular plans, and can send “please call me” message. There is 120 empty characters left in a “please call me” SMS message.

MTN has allowed program to use total inventory of “please call me” messages.

Uganda Text to Change [1] 15,000 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; correct answers provided; participants encouraged to come in for testing (fee waived for participants) 40% increase in the number of patients Celtel, AIDs Information Centre (AIC), Merck, and SMS-based quiz in exchange for free airtime


who came in the Dutch for Ministry of HIV/AIDS Foreign testing. Actionable insight: Many quiz takers did not think AIDS testing was accurate nor anonymou. Affairs


PaDiSys (NowPos M Solutions)


Patient Reported Outcome data capture and treatment adherence system via text messaging




Uganda, Tanzania and Kenya in Eastern Africa, and Malawi, Mozambique and Namibia in Southern Africa


Africa Reach Program [39] [40]


In the first phase, 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. Later, the games were made available on other mobile carriers taking to 30 million handsets. In a span of 15 months, there have been a download of 10,3 million game sessions

Freedom HIV/AIDS introduced two HIV/AIDS awareness games to countries in Africa. Apart from English, the games have been developed in local languages - Swahili and Shen.

Freedom HIV/AIDS is a social initiative of ZMQ - A Technology for Development Social Enterprise [41] . Africa Reach Program supported by Hivos, a leading Dutch development organization, and KPN, the largest Dutch telecom company, under the "Star Programme"

Games are free for download through the 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, without requiring an internet connection UNICEF/Georgia [39] Mobile4Good [39] New Zealand Vensa Health Coverage includes the whole country of 4 million plus New Zealanders receiving daily messages from their GP doctors and Hospitals Improve access to primary care services and hospital appointment attendance in accordance to Ministry of Health targets. Daily text messages sent to patients to improve appointment attendance, Immunisations rates of children, Cervical Smear Screenings, Breast screening, Flu Vaccinations and more... On average GP Surgeries and Hospitals achieve 50% reduction in missed appointment rates and achieve 6 time greater response in recall / pre-call activities with patients District Health Boards, Primary Health Organisations and General Practice around New Zealand Patients receive the messages for free from health organisations


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, counseling, service complaints, and information on facilities, drugs, equipment, and/or available mobile health clinics [1] Below is a list of mHealth Helpline projects:




Name Inception Program size

Major services

Insights and Outcomes



Telcom partner role


National Health Call Centre Network or healthdirect [45]




HealthDirect (Western [45] Australia) HealthDirect (Northern [45] Territory) Nurse-on-Call [45] (Victoria) HealthDirect (South [45] Australia) Health First (Australia Capital [45] Territory)













Bangladesh Healthline [45] 2006

10000 Calls per day

Phone consults, information on facilities, drugs, test result interpretation, discounts on hospital visits. Mission: be a first reference point to complement conventional health solutions.

Top health MNO-sponsored: complaints: Telemedicine firm and Chronic diseases MNO (40%), ENT, early pregnancy, malaria, pneumonia (each 8%), diarrhea (7%)

For profit. Service is US$ 0.21 (BDT 15) for 3 minute call

Marketing and promotion, Billing and revenue collection, Voice bearer


Fonemed (for USA callers) [45] Telehealth [45] (Ontario) Telemedic Telemed [45]






Colombia Dominican Republic

Independent Independent


drugs. drugs. Billing and revenue collection. drugs. (8%) Mission: create platform to enable 1 billion virtual and 1 billion physical service contacts. New Zealand Pakistan Healthline Teledoctor [45] [45] 2006 2008 1000 Calls per day Phone consults. information on facilities. easy access to experienced doctors.mHealth India HMRI [45] 2007 50000 Calls per day Phone consults. Mission: be the first choice in private health services. pharmacies. Mexico Mexico Telemedic [45] 10000 Calls per day Phone consults. Top health counseling and complaints: complaints. 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] 1999 Government-sponsored 2004 Independent planned Independent Government-sponsored MNO-sponsored: Telemedicine firm and MNO For profit. knee pain clinics (vans). (13%). Mission: provide cheap. Top health complaints: Diarrhea and vomiting (gastro-enteritis). back pain mobile health (9%). Shareholder. information on Recurring abdominal pain Government-sponsored: Not for Government and a profit. Gynecological ailments and obstetrics. private charity Service is free. Voice bearer Independent Independent: Call center entrepreneurs For profit. discounts at clinics.00 monthly Voice bearer South Africa 2007 Government-sponsored Trinidad and Tobago United Kingdom .30 (PKR 24) for 3 minute call Marketing and promotion. information on facilities. Service is US$ 0. Voice bearer 69 facilities. MedicallHome 1998 [45] Subscription: Billing and unlimited revenue calls for US$ collection. 5.

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. patients might take a photograph of a wound or illness and allow a remote physician diagnose to help treat the medical problem. known as telemedicine. TeleDoc was a project of Jiva Institute. ministries of health. villages in Haryana in April 2003 permitting them to communicate with doctors who use a web application to help diagnose and prescribe for patients. treatment support. Sponsors Charges Telcom partner role . other projects provide direct diagnosis to patients themselves. This involves connecting healthcare workers to other healthcare workers. or other houses of medical information. 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.50) per consultation. In such cases. The approximate cost of the entire TeleDoc process was 70 rupees (US$1. While some projects may provide mobile phone applications—such as a step-by-step medical decision tree systems—to help healthcare workers diagnosis. 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. Supported by the Soros Foundation.mHealth United States United States MedicareBlue [45] PPO FirstHelp Nurse Advice [45] Line Telemed (Puerto Rico) [45] Informed Health Line [45] (Aetna) Teladoc [45] 2007 Healthcare provider-sponsored Healthcare provider-sponsored 70 United States Independent United States Healthcare provider-sponsored United States United States Independent Independent MedicallHome [45] USA Diagnostic support. an India-based non-profit. medical institutions. Such projects additionally involve using mobile phones to better organize and target in-person training. Both diagnosis and treatment support projects attempt to mitigate the cost and time of travel for patients located in remote areas[1] mHealth projects within the communication and training for healthcare workers subset involve connecting healthcare workers to sources of information through their mobile phone.

heart conditions or pregnant mother/newborn care. and is available to health officials in real-time for analysis and decision-making. Peru Nacer [39] [48] Nacer is a phone. The USAID-funded Pathfinder International program and Voxiva worked with the Regional Health Directorate of Ucayali and the Peru Ministry of Health Over 10. Relevant health content is made available to patients to take care of chronic conditions such as diabetes.mHealth India mQure [47] 2010 Services operational across India mQure provides innovative solutions to make healthcare more accessible. Patients can get medical help on their mobile phone 24x7 or second opinions. Health workers in locations without Internet connectivity can access the system using any phone (satellite.000 active clients across India Independent entrepreneurs Social venture with services starting as low as $1 per month 71 . information on latest hospital bed availability. Patients can also manage their chronic conditions or remember to take their medicines on time via Med Reminders. fixed-line. All reported data is recorded in a central database. and regional hospitals.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. mobile. medical experts. convenient and at the lowest possible cost. or community pay phone).

A lack of patient data creates an arduous environment in which policy makes can decide where and how to spend their (sometimes limited) resources. store. drug.org but each developer organization mentioned has edit access. 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.mHealth Rwanda TRACnet [39] [49] TRACnet is Rwanda’s dynamic Information Technology solution designed to collect. Voxiva and The Rwanda Ministry of Health 72 Disease surveillance. TRACnet is being deployed to increase the efficiency of Rwanda’s HIV/AIDS program management. from a practical perspective. retrieve. Uganda. TB. Data concerning the location and levels of specific diseases (such as malaria. Under the leadership of the Ministry of Health and the Treatment Research and AIDS Centre (TRAC). malaria. and disseminate critical program. While some software within this area is specific to a particular content or area. and patient information related to HIV/AIDS care and treatment. in order to identify where the greatest medical needs are within a country[1] Policymakers and health providers at the national. district. 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. other software can be adapted to any data collection purpose. and relatively efficiently. remote data collection. and community level need accurate data in order to gauge the effectiveness of existing policies and programs and shape new ones. child and maternal health. and enhance the quality of patient care. at this link maintained by DataDyne. cheaply. 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. collecting field information is particularly difficult since many segments of the population are rarely able to visit a hospital. and health systems management programs. even in the case of severe illness. There is [51] (the list is also a list of mobile phone-based data collection software. Such projects can be particularly useful during emergencies. and data collection software. Below is a list of mHealth disease and epidemic outbreak tracking projects. in order to provide current information on their product) . HIV/AIDS. In the developing world. and epidemic outbreak tracking Projects within this area operate to utilize mobile phones’ ability to collect and transmit data quickly.

End-user acceptance very high. 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. and the Government of Andhra Pradesh (GoAP) . Amazonas State Health Ministry Customized questionnaires dramatically distributed to field health reduced agents’ mobile phones. Voxiva.mHealth 73 Country Name Inception Program size Major services Insights and Outcomes Sponsors Charges Telcom partner role Brazil Name? [1] 400 test results gathered by 20 field professionals in two days. (paper-based Health data and GPS location information are system would have taken 2–3 integrated to enable months for immediate analysis and lesser identification of areas with information). AESSIMS enables health officials to better understand the scope of disease impact and strategically allocate resources to areas with the highest prevalence and need. PATH. Data collection times Nokia. all with GPS information Containing the spread of the Dengue virus. high infection levels.

the Economist [58] [59] . and covered by [57] Wired . or a "pilot": it is and the a fully. and Tech Museum Award. and no MOU".mHealth Kenya and 2003 EpiSurveyor. Stockholm Challenge Award. and it is available to anyone. Lemelson-MIT Award for [56] Sustainability . . veterinary studies. the Guardian . phones (updated disease surveillance. Premium version available. many people Foundation will find and use [61] . World Bank functional system for creating mobile data collection systems. the it. InSTEDD [39] . more than 3500 users from EpiSurveyor is an online system developed by [54] DataDyne. as well as health and economic surveys. [60] Voice of America . "Like Gmail for data collection" :-) records from outbreak investigation. right now. More info [62] 74 hundreds of phones for data organizations in collection: user can go more than 170 from concept to fully countries have uploaded more than 150. syndromic surveillance. and others.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. and coordinated response. PDA-based version to online version. even the tracking of mountain gorillas in Uganda: if you are collecting data on paper. Development and support based in Nairobi. no meetings. used by 99% of users. drug [53] stats here ) stock tracking . Kenya. is completely free and requires "no money. Winner of Wall Street Journal Technology Innovation [55] Award . regardless of the topic. you could be using 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. for free.org worldwide [53] Since moving from older. EpiSurveyor Vodafone is not a "project" Foundation.000 completed data functional mobile data collection system in hours. Used in more than 170 countries worldwide for anyone online.

~500 participants. 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. Positive results The US Centers showing that for Disease mobile phones can Control and be a useful tool in supporting HIV-positive patients. or they had a problem.mHealth 75 Treatment support and medication compliance for patients. If there was a problem. 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. can participate in the program. Any diabetic person. along with ICS. This system empowers the patient to take control of their health by taking all the necessary steps to control their diabetes. HIV-positive patents were sent weekly text messages inquiring about their well-being. Within environments of limited resources and beds—and subsequently a ‘outpatient’ culture—remote monitoring allows healthcare workers to better track patient conditions. Diabediario does not replace doctor’s visits or pills but is meant to act as a supplement to outside care. Voxiva has partnered with the Instituto Carso de la Salud (ICS) . medication regimen adherence. has developed Diabediario. a Health Worker would call back to assist them. Patients responded to these message by saying everything was OK. including chronic disease management Remote monitoring and treatment support allows for greater involvement in the continued care of patients. 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. who has a TelCel cell phone. Such projects can operate through either one.

Adding web interface to integrate with telephone quitline Many behavior change things are characterized by success and relapse. appointment reminders for US service members returning from duty. ? DIMA Dietary Intake Monitoring Application 2009 6-week pilot study with 20 participants. United States Web-based Mobile Support for the Washington D.C.org" to a cell phone. SMS-based wellness tips. US Army Medical Department Powered by Voxiva 76 .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. The device was not stigmatizing. "Are you feeling happy?" Legacy Foundation 90% of patients took their medication. low-literacy diabetic population The device has a voice recorder and a bar code scanner. Patients use "beam" bar code scanner more easily than pen bar code scanner. Measuring real time behavior. 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. By the end of the study the participants were only using the voice recorder. Mobile health application for dietary insight for a chronically Ill. rather seen as a status symbol. Ported content from "afterdeployment. along with context and psychological factors. HIPAA compliant. Tobacco Quitline 2009 Currently updating the system to take real time patient smoking cessation data and "close the loop" feedback to improve adherence.

different novel networking among various entities. road traffic accidents. and better achieved dietary goals. Siemens Corporate 77 give them a call to gather data on fraction of why they were using it. 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. Being connected by mobile health services. Participants became better problem solvers with the condition.mHealth United States MAHI Mobile Access to Health Information 2009 49 participants. ndividuals record several switched from Research "external" to "internal" locus of messages per day. emergency obstetric care) • Human resources coordination. evidence-based formulary. 2008. a partnership for emergency communications was created between the group and United Nations Foundation. management. month study. 5 Used bluetooth glucose meter. diabetes. Such partnership will increase the effectiveness of the information and communications technology response to major emergencies and disasters around the world. are on the verge of . Nokia or participants with any java-enabled cell phone. recently diagnosed Each time a diabetic patient used a glucose meter the phone would Outcomes: significant Georgia Tech.g. (which were previously isolated) directly or indirectly related to health care delivery mechanism. which typically collected: pictures of meant they felt food. 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. more in charge. Google Health. SMS data gathering applications Cell-Life [39] Emerging trends and areas of interest in mHealth • Emergency response systems (e.g. Data that were control.. CDC. 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. pictures of confusing food labels. and supervision • Mobile synchronous (voice) and asynchronous (SMS) telemedicine diagnostic and decision support to remote clinicians[65] • Clinician-focused.

(2004). 87. [2] Germanakos P. Cellular-news. ISBN 978-0-387-26558-2. 225-230 [13] United Nations.. Tanzeem. html). gr/ ~pgerman/ publications/ published_papers/ A_Mobile_Agent_Approach_for_Ubiquitous_and_Personalized_eHealth_Information_Systems. Mourlas C. P. Public Health & Policy (p. (2006). Mercer. Andrew (NaN undefined NaN). Springer. 2011. 1. worldbank. [4] Torgan. Peebles. London: London School of Hygiene and Tropical Medicine. int/ healthinfo/ global_burden_disease/ estimates_country/ en/ index. org/ WBSITE/ EXTERNAL/ EXTDEC/ EXTDECPROSPECTS/ GEPEXT/ EXTGEP2007/ 0. Choudhury. 2009).2010. Robert. 3. and J. [16] Economist. 4/1/2010 http:/ / www. WHO: Geneva. Davis. Public Health & Policy (p. The Millennium Development Goals Report. WHO Data [11] The Global Burden of Disease 2004 Update 2008. Statistics Physicians density (per 10 000 population) (http:/ / data. vitalwaveconsulting. un. 405-413. The health worker shortage in Africa: are enough physicians and nurses being trained? 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php?caseid=22) [50] AED-Satellife Center for Health Information and Technology (http:/ / www.washingtonpost. com/ casestudies. myjoyonline. Retrieved on 2010-08-14. Warren. healthnet. child and maternal health. org/ [38] http:/ / www.com/Articles/2008/04/03/ 230128/technology-plays-crucial-role-in-vaccination-distribution. html).A Technology for Development Company http:/ / www. News. org [36] http:/ / www. economist. com/ [37] http:/ / sichange. P. Computer Weekly (2008-04-03). "Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries?" Globalization and Health 2 (2006): 9. [66] Ghana News :: West African Innovation Hits Global Stage ::: Breaking News | News in Ghana | features (http:/ / news. weltel. google. • Kaplan. org/ global-issues/ technology/ mhealth-report. economist.episurveyor. • "A world of witnesses" The Economist: January 2008. com http:/ / www. datadyne. org [54] http:/ / www.org. com Freedom HIV/AIDS . globalhealth. in ZMQ ..03/04/2008 (http://www.mHealth [34] http:/ / resultssms. unfoundation. Discusses use of EpiSurveyor (http://www. wsj. Describes role of EpiSurveyor mobile data collection software in contributing to the highly successful fight against measles mortality. uk/ activate/ phones-revolution-developing-world [60] http:/ / www. Globally. wmv [61] http:/ / www. stm Further reading • "Technology plays crucial role in vaccination distribution" Computer Weekly: April 2008.myjoyonline. org [35] http:/ / globalpas.Serios Games Initiative to COmbat HIV/AIDS (http:/ / www. com/ MediaAssets2/ english/ 2010_01/ MakingADifferenceSelanikio-fixed-20fps-256k.com/surveys/displaystory. freedomhivaids. • "Globally. 2008. com/ article/ SB10001424052970203440104574399714096167656." August 2007. asp). cfm?story_id=10950499 [59] http:/ / www. frontlinesms. episurveyor. com/ casestudies. harvard.computerweekly. bbc. org/ ). unfoundation. guardian. Retrieved on 2010-08-14.mqure. freedomhivaids. php?catname=HealthWatch) [64] Home (http:/ / www.com (2010-05-14).htm). Retrieved on 2010-08-14. edu/ icb/ icb. php?caseid=21) [53] http:/ / www. malaria. washingtonpost. com/ ccc?key=0ArG7kkc9mE75dEdNNktocmVwT0hNbHVjTXl2ZU1VMXc& hl=en& authkey=CKiRppwM [52] Voxiva Case Study: AESSIMS (http:/ / voxiva. Retrieved on 2010-08-14. com/ en/ node/ 116145) [47] [www. com/ features/ 201005/ 46200. org/ news/ wiredukjune2010 [58] http:/ / www. org/ ) Information and communications technologies (ICT) initiatives through the USA-based not-for-profit Academy for Educational Development providing support for HIV/AIDS. org [62] http:/ / datadyne. htm) An HIV/AIDS awareness initiative using mobile phone games [41] [42] [43] [44] http:/ / www. weltel. Vodafone Foundation. org/ episurveyor/ faq [63] Voxiva Website: Health Watch (http:/ / voxiva. comminit. zmqsoft. do [39] UN Foundation. mHealth for Development (http:/ / www. A survey of mobility: A world of witnesses (http://www. uk/ 1/ hi/ health/ 8436092. com/ casestudies.com] [48] Voxiva Case Study: Peru Nacer (http:/ / www.com. php?caseid=29) [49] Voxiva Case Study: TRACnet (http:/ / voxiva. Retrieved on 2010-08-14. Full text | Can the ubiquitous power of mobile phones be used .org) software in public health monitoring in Africa. org [55] http:/ / online. and health systems management programs in Uganda and Mozambique [51] http:/ / spreadsheets. zmqsoft. deaths from measles drop sharply" The Washington Post: November 2007. in/ FreedomHivAids. [40] Freedom HIV/AIDS (http:/ / www. voanews. co.cfm?story_id=10950499). Technology plays crucial role in vaccination distribution . com/ specialreports/ displaystory. The Economist. in) 79 [45] GSMA Foundation. Discusses use of handheld electronic data collection in managing public health data and activities.html). Deaths From Measles Drop Sharply (http://www. A Doctor in Your Pocket: Health Hotlines in Developing Countries [46] Tele-doc India (http:/ / www. com/ solutionspage.com/wp-dyn/content/article/2007/11/29/ AR2007112902021. html [56] http:/ / datadyne. Vital Wave Consulting. freedomhivaids. "WHO mHealth Review: Towards the Development of an mHealth Strategy. co. org/ news/ lemelsonmit2009 [57] http:/ / datadyne. [67] http:/ / news. [65] Mechael. voxiva.

(http://open.pdf).cfm?id=1861959 Inter-American Development Bank. United Nations Foundation.pdf) Mechael. (PDF) . mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World (http://www.idrc. Information Technology in Systems of Care." United Nations: 2006. Mechael.mHealth to improve health outcomes in developing countries? (http://www.pdf Economist "The doctor in your pocket [Medical technology: Nearly everyone in the developed world carries a mobile phone. pages 153-168. Vodafone Foundation. Retrieved on 2010-08-14.so why not use it to deliver health care?]" The Economist: 2005. Anta R. Mobilizing Markets: Special Edition of MIT Innovations Journal for the GSMA Mobile World Congress 2009. Olmeda. Written and compiled by Sally-Jean Shackleton.]http://www.intrahealth. London: London School of Hygiene and Tropical Medicine 2006. Christopher J.org/wiki/ upload/PatriciaMechaelThesisFinalDecember2006.. Delfin Press. Retrieved on 2010-08-14.com/pdf/mHealth.. 264). Istepanian.iadb. Adesina Iluyemi. potential and limitations of mHealth in low-resource settings 80 • • • • • • • • • • • • • . Volume 1: Mobile Applications on Health and Learning. Sloninsky.globalizationandhealth. and Giuffrida A. Mechael.un.http://unpan1. [Community-based health workers in developing countries and the role of m-health. Istepanian. eds. El-Wahab S. "Compendium of ICT Applications on Electronic Government. P. (2000). 8(4).vitalwaveconsulting. P and D. Towards the Development of an mHealth Strategy: A Literature Review.pdf).org) offers information on the current use. Rapid Assessment of Cell Phones for Development.mhealthinfo. Robert et al. Patricia (2009).org/document. MONITOR | The doctor in your pocket | Economist." IEEE Transactions on Information Technology in Biomedicine: 2004. In Telehealth in Developing Countries]http://www. "Exploring Health-related Uses of Mobile Phones: An Egyptian Case Study. ISBN 0-387-26558-9 UNICEF and Women's Net (2007). February 2009. ISBN 978-0-9821442-0-6 United Nations.com/content/2/1/ 9). [Mobile Health: The potential of mobile telephony to bring health care to the majority.org/intradoc/groups/public/documents/UN/ UNPAN030003." Public Health & Policy (p. "Introduction to the Special Section on M-Health: Beyond Seamless Mobility and Global Wireless Health-care Connectivity. The Case for mHealth in Developing Countries. 405-413. Globalization and Health. Cambridge: MIT Press.com (http://www. (2006) M-Health: Emerging Mobile Health Systems. R.htm mHealthInfo.ca/en/ev-137420-201-1-DO_TOPIC. New York: Earth Institute at Columbia University: Working Document. Vital Wave Consulting (February 2009).. Springer Verlag.wirelesslifesciences.org (http://www.org/pdfs/ MONITOR_doctorinyourpocket_Economist.

Amalga has the ability to manage more than 40 terabytes of data and provide real-time access to more than 12.Microsoft Amalga 81 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.C. dictated reports of surgery. and Virginia. 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. remained at [5] Washington Hospital Center as director of the emergency department. as well as patient demographics and contact information. and other clips and images. It was developed by doctors and researchers at the Washington Hospital Center emergency department in 1996. including scanned documents. [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. Dr. Amalga can be used to tie together many unrelated medical systems using a wide variety of data types in order to provide an immediate. lab studies. Amalga is also designed to collect financial and operational data for hospital administrators. New York Presbyterian Hospital. Craig F. area. lab results.[4] Besides clinical data. In clinical use since 1996. D. all organized into one customized format to highlight the most critical information for that user. and in 2006 it was acquired by the Microsoft Health Solutions Group. It has since been adopted at a number of leading hospitals and health systems across America including St Joseph Health System. Mark Smith. as part of a plan to enter the fast-growing market for health care information technology. X-rays. electrocardiograms. Maryland. medication and allergy lists.000 data elements associated with a given patient. updated composite portrait of the patient’s healthcare history. a nonprofit network in the Baltimore-Washington. Georgetown University Hospital and five other hospitals in the MedStar [2] Health group. principal designer of the software. MRI scans and other medical imaging procedures. who helped design the system. Microsoft hired Dr. The system was first implemented by the Washington Hospital Center emergency department to reduce average waiting times. Feied. . [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. At the time of acquisition. Since then the Amalga team has grown to include 115 members. [3] A physician using Amalga can obtain within seconds a patient's past and present hospital records. Amalga currently runs on Microsoft Windows Server operating system and uses SQL Server 2008 as the data store. CT Scans.

External links • Microsoft Amalga Home Page (http://www. washingtonpost. "A deal they just couldn't refuse" (http:/ / www.mspx) . [4] Greene. Retrieved 2006-07-27. [5] Lohr. . Steven (2005-03-04). nytimes.Microsoft Amalga 82 References [1] http:/ / www. Steve (2006-07-27). Modern Healthcare Online. Jay (2006-10-24). . com/ amalga/ products/ microsoftamalga/ default. . Greg (2007-03-28). KMWorld. microsoft. The New York Times. Retrieved 2006-07-27. "Microsoft to Offer Software for Health Care Industry" (http:/ / www. [3] Pepus. Retrieved 2006-08-08. com/ Articles/ ReadArticle. html?th& emc=th).microsoft. mspx [2] Pearlstein. aspx?ArticleID=35771).com/amalga/products/microsoftamalga/default. com/ apps/ pbcs. . "The world of super integration" (http:/ / www. kmworld. modernhealthcare. com/ 2006/ 07/ 27/ technology/ 27soft. Retrieved 2006-08-08. The Washington Post. html). com/ wp-dyn/ articles/ A5780-2005Mar3. "Innovation Comes From Within" (http:/ / www. dll/ article?Date=20061024& Category=FREE& ArtNo=61024003& SectionCat=newsletter02& Template=).

more typically. Authorization An individual interacts with their HealthVault record through the HealthVault site. etc. a spouse.Microsoft HealthVault 83 Microsoft HealthVault Microsoft HealthVault Microsoft HealthVault website Developer(s) Microsoft Preview release Beta / October 4. 2007 Type Website Medical database http:/ / healthvault. When an individual first uses a HealthVault application. or. and those data types are the only ones the application can use. . Components A HealthVault record [8] stores an individual's health information. they are asked to authorize the application to access a specific set of data types. Access to the account is through Windows Live ID or a limited set of OpenID providers.com [1] and addresses both individuals [6] and healthcare professionals [7]. a parent.healthvault. An individual can also share part (some data types) or whole of their health record with another interested individual such as a doctor. 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. through an application that talks to the HealthVault platform. Access to a record is through a HealthVault account. the website is accessible at www.[2] [3] [4] [5] Started in October 2007. which may be authorized to access records for multiple individuals. com [1] Microsoft HealthVault is a web-based platform from Microsoft to store and maintain health and fitness information.

This is released by HealthUnity • PassportMD [16]. html) [6] http:/ / www. com/ personal/ websites.4670.00. html?type=application [14] http:/ / www. cfm?subjectid=348945& story_id=9916512). Retrieved 2008-02-04. com/ industry/ index. com/ servlet/ Page/ document/ v5/ content/ subscribe?user_URL=http:/ / www. com/ personal/ index. theglobeandmail. • HealthUnity PHR Gateway [15].1895. healthvault. Competitors HealthVault's primary competitors are Google Health. blood pressure monitors and the Withings wifi bodyscale[9] ) into an individual's HealthVault record. Retrieved 2009-02-09. healthvault. economist.00. com/ article2/ 0. com/ research/ articlesBySubject/ displaystory. healthvault. Dossia and World Medical Card. html [8] http:/ / www. pcmag.com. This is released by PassportMD • ActivePHR [14]. html [9] http:/ / cln-online. healthvault. asp). . com [2] "Microsoft Launches 'HealthVault' Records-Storage Site" (http:/ / www. [13] http:/ / www. foxnews.com. healthvault. . This is released by ActiveHealth References [1] http:/ / www. com/ wires/ 2007Oct04/ 0. html [16] http:/ / www. istartedsomething.Microsoft HealthVault 84 Devices HealthVault Connection Center allows health and fitness data to be transferred from devices (such as heart rate watches. HealthVault Web Applications A comprehensive list of web applications is available at the HealthVault website [13]. .com. PCMAG. economist. htm). healthvault. .2191920. Retrieved 2007-10-08. com/ websites/ activehealth-activephr. healthvault. php?option=com_content& view=article& id=666:microsoftscales& catid=49:wellness& Itemid=105 [10] "Dr. [11] "HealthVault Connection Center" (http:/ / www. html [15] http:/ / www. aspx). healthvault. . com/ websites/ healthunity-phrgateway. Retrieved 2007-10-08. com/ Personal/ index. It can also be used to find and download drivers for medical devices. globeandmail. healthvault. com/ servlet/ story/ RTGAM. Retrieved 2008-02-06. org/ index. [4] "The vault is open" (http:/ / www.[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. . com/ WhatIsConnectionCenter. theglobeandmail. wgtmsfthealth1004/ BNStory/ Technology/ home& ord=18107047& brand=theglobeandmail& force_login=true). Microsoft is now ready to see you" (http:/ / www. com/ 20071004/ microsoft-healthvault/ ).MicrosoftHealthVault. Support for industry standards makes it possible to integrate[12] with many personal health record solutions. html . Retrieved 2008-02-04. [5] Microsoft Launches Health Records Site (http:/ / www. com/ websites/ PassportMD-PassportMD. html [7] http:/ / www. 20071004. recordsforliving. [3] "Microsoft launches medical records site" (http:/ / www. com/ forums/ thread/ 1302. [12] "PHR integration" (http:/ / community. Some of the notable ones are listed below.

com/HealthVault) • HealthVault Review: A Click away from Your Health Information (http://www.com/ microsoft-healthvault-phr) .edocscan.Microsoft HealthVault 85 External links • Microsoft HealthVault (http://www.microsoft.com/) • Microsoft HealthVault Developer Center (http://msdn.healthvault.

Canada English with an additional option of 130 languages Bob Bell. 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. and the HealthLinkBC Files. History The organization was launched in 2001 as the BC HealthGuide Program by BC's Ministry of Health Services. a toll-free telephone line. On November 21. Canada through combined telephone.[4] Health service representatives assist callers with speaking to a registered nurse.[5] HealthLinkBC operates within BC's Ministry of Health Services. its 8-1-1 telephone number. and print resources. along with its 8-1-1 number. These services include Nursing. This brought together all of the organization’s various services under a single brand and telephone number. Translation services in 130 languages are available upon request. Scope of service HealthLinkBC 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. the Executive Council of British Columbia launched a newly branded organization.ca" and "HealthLinkBC Files". which provided a knowledge base of health information and provided links to other credible consumer health information sources and web sites. it consisted of three main components: the BC HealthGuide. Dietitian.[2] [3] HealthLinkBC has two dedicated phone numbers 8-1-1 and 7-1-1 for hearing impaired callers. a medically-approved handbook delivered to all BC households. web and print resources. Pharmacist and Navigation Services. dietitian or pharmacist about health related concerns or find health resources in their area. internet.ca [1] HealthLinkBC is a government-funded telehealth service launched in 2001.HealthLinkBC 86 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. called BC HealthGuide Online. The program provides telephone triage and health information through integrated telephone. which provides non-emergency health information to the residents of British Columbia. At its launch. a series of one-page health information sheets. which is available in pharmacies and by mail. [6] HealthLinkBC. HealthLinkBC is also responsible for the Health and Seniors Information Line at 1-800-465-4911. This service offers information on both health and non-health related federal and provincial government programs and services for British Columbia seniors. Executive Lead Parent organization Ministry of Health Services Website HealthLinkBC. the BC HealthGuide. 2008. . "HealthLinkBC.

Vietnamese and Persian.[9] Yukon residents have access to HealthLinkBC.[10] 'Call Transfer to 8-1-1’ provides access to 8-1-1 (using automated call transfer). provides a secure web-based directory of mental health and addictions resources in BC. This has been specifically developed for licensed general medical practitioners and their medical office assistants. Chinese. and. callers to the Hotline are automatically transferred to 8-1-1. they receive a customised service that reflects the resources and services available to their locale. (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. clients call 8-1-1 and receive a customised service that supplements their ongoing palliative care program.HealthLinkBC 87 Public services Health service representatives provide general health information. and. A number of HealthLinkBC Files have been translated into other languages including: French.[12] .[11] BC Ambulance Service – when a call to 9-1-1 does not warrant the dispatch of an ambulance. Chinese and Punjabi. Registered nurses are available 24 hours a day to provide general and specific health information and advice including palliative care support over the telephone. illness prevention. 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. 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. ‘Customized 8-1-1’ refers to identified callers or groups that are provided customized services by utilizing 8-1-1 resources.ca and 8-1-1 and have been provided with a Yukon version of the HealthGuide handbook in English and French. Professional support services 'Community Healthcare and Resource Directory' (CHARD). French. Punjabi.5 pm to assist callers with dietary and nutrition questions over the telephone. Registered dietitians are available Monday to Thursday 8 am – 8 pm and Friday 8 am . health resource referral information and transfer calls to HealthLinkBC’s professionals over the telephone 24 hours a day. Examples include: FHA Hospice Palliative Care – after-hours. callers are automatically transferred to 8-1-1. Yukon Territory – when a caller accesses 8-1-1 from the Yukon. Spanish. and is offered to other BC health service delivery organizations who also use the phone to provide access to their service. 'HealthLinkBC Files' are a series of health information sheets with BC-specific information on common health topics. 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. HealthLink BC also works with the Government of the Yukon to provide services to residents of the Yukon. FHA Primary Health Care Office – after-hours. The BC HealthGuide is available in English. Examples include: VCHA Newborn Hotline – after-hours. 365 days a year.

bc. hss. org/ gpsc/ gpsc-and-healthlink-bc-pilot-mental-health-and-addiction-resource-directory). 2009-09-30. 2010-06-11. Retrieved 2010-07-08. Retrieved 2010-07-29. aspx?d=SV000412). ccl-cca. "Healthlink BC: British Columbians Have Trusted Health Information at Their Fingertips" (http:/ / www.ca. ca/ cpa/ 1-800. Find. healthlinkbc. Hss. 2009-07-03. ykhealthguide. Donna (2009). ca/ 811. . . Health. pdf). Telecare and Self Help Collaborative" (http:/ / www.HealthLinkBC 88 References [1] http:/ / www. ca/ finalreport. Retrieved 2010-07-25. [6] "Ministry of Healthy Living and Sport . . ca/ hls/ media_gallery/ events/ 2008/ nov/ 8_1_1_service_makes_accessing_health_advice_easier_2008_11_27_55847_M. .1080/15398280902897046. [7] "Restrict Trans Fat | BC Regulation for Food Service Establishments" (http:/ / www. .yk.healthlinkbc. Retrieved 2011-02-03. [12] "Yukon HealthLine . [11] "HealthLink BC : Find Services and Resources" (http:/ / find. bc. . html). Retrieved 2011-02-03. Retrieved 2010-07-29. [5] "-Quality Improvement of Literacy. pdf) (PDF).org. Ykhealthguide. Restricttransfat.ca. 2008-11-21.gov.ca/) .ca.ca.ca. healthlinkbc. .bc. 2006. . Retrieved 2010-07-08. 2009-01-15. External links • Official website HealthLinkBC.ca. informaworld. Retrieved 2011-02-03.811 . Retrieved 2010-07-25. php). bcmj.gov. Healthlinkbc.Health and Social Services. Journal of Applied Research on Learning. 2007. ca/ search. [4] "Toll Free Health Information Lines" (http:/ / www. ca/ bc_trans_fat_regulation.Government of Yukon" (http:/ / www. gov. html). Retrieved 2010-07-29. doi:10. health. [3] MacLeod. [9] "Yukon HealthGuide" (http:/ / www. Gov. [10] "GPSC and HealthLink BC pilot mental health and addiction resource directory | BC Medical Journal" (http:/ / www.ca (http://www. com/ smpp/ content~db=all?content=10. restricttransfat. gov. . ca). HealthLinkBC. ca/ NR/ rdonlyres/ EFF50CAA-19E6-42AB-9AF8-023CCE050000/ 0/ JARLNo1Art317OCT07. gov. Bcmj.bc.org. . Retrieved 2010-07-29. ca/ [2] "HealthLink BC Home Page" (http:/ / www.8-1-1 SERVICE MAKES ACCESSING HEALTH ADVICE EASIER" (http:/ / www. [8] "Changing immigrants’ attitudes towards intentions to use the BC HealthGuide Program: Culturally specific video messaging for health promotion" (http:/ / www. org/ ). 1080/ 15398280902897046). php).healthlinkbc. . BC HealthGuide Program Evaluation Final Report. HealthLinkBC. Journal of Consumer Health On the Internet 13 (2): 173–179. yk.

[4] Doctors are highly implicated in the Hello Health product definition as well.[3] Dr. Myca launched its first Hello Health clinic in July 2008 in Williamsburg. html). MyFoodPhone is a small cell-phone application that provides customers with a full nutrition journal and access to a nutrition professional. Retrieved 2008-08-13. founded by Qualcomm Inc. The Washington Times. Customers take a picture of their meals and send them via MyFoodPhone to be analyzed by a personal nutrition coach or advisor. "Wireless wellness: If you've got a phone. The Myca Platform is commercialized in the United States under the Hello Health trademark. Lindsay (September 10 2007). [4] Hensley. 2008-06-16.htm).cnn. Jay Parkinson. Business 2. The Washington Post. mobile and secure email. "The doctor is in — and hip!" (http:/ / www. The Myca platform provides a full billing back-end service that allows doctors to be reimbursed for their remote visits. . "Consultation médicale par Internet: Myca persiste et signe" (http://www. Kara. hosted in San Diego.O. MPH and Dr. History Myca was founded in 2002 by Nathanial B. . The company's first product was a mobile nutrition platform called MyFoodPhone. Retrieved 2008-08-18. "Health Blog : Technodoc Jay Parkinson Says Hello to Franchising" (http:/ / blogs. "Camera Phones Help Fight Bulge" (http:/ / www. [3] Rowland.0. New York. com/ wp-dyn/ content/ article/ 2005/ 06/ 06/ AR2005060601686. instant messaging. [2] Metz. Activities Started in 2007. Daphnée (Le dimanche 03 février 2008). Consumers can now take cell phone pictures of their meals for nutritional consultations" (http://money. It is headquartered in Quebec City. "Medicine goes 2. Jessica (15 August 2008). phone. com/ health/ 2008/ 06/ 09/ technodoc-jay-parkinson-says-hello-to-franchising/ ). . The Brooklyn paper. . wired. The Wall Street Journal. MD. References [1] Pegoraro. are the first Hello Health doctors and will operate the Williamsburg clinic. NY. washingtonpost. Hello Health operates [3] under the software as a service business model so patients sign up online to communicate with their physician. Sean Khozin. Le Soleil (Québec). Wired (Wired News).[1] [2] MyFoodPhone was rebranded as Myca Nutrition in 2007.0. clinic or online appointments with a doctor. California. Myca developed a practice management system that allows physicians to perform remote consultations by using videoconferencing. you've got a diagnostician". QC. "The Camera Phone Diet" (http:/ / www.0 Magazine. B1. MPH. .com/2007/09/10/technology/Medicine_2. Devlyn Corrigan D. Scott (9 June 2008).. Canada with offices in New York City. brooklynpaper.cyberpresse. 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. Rob (7 June 2005). Findlay. Rachel (27 June 2006). Brooklyn. MD. [5] Firger. p. Dr. com/ science/ discoveries/ news/ 2006/ 06/ 71102). Retrieved 2008-08-13. com/ stories/ 31/ 32/ 31_32_jf_hello_health. • Blakely. • Dion-Viens. Retrieved 2008-08-13. Retrieved 2008-08-13.ca/article/20080203/CPSOLEIL/80202095/-1/CPSOLEIL) (in French).biz2/ index.Myca 89 Myca Myca is a software development company specializing in healthcare. wsj. html). With this platform patients can schedule either home.

jayparkinsonmd.com) MyFoodPhone Home (http://www. accueil (http://www.uk/systemsandservices/pacs .html) (in French). MPH (http://www. Le Devoir.com) Wireless Life Science Alliance (http://www.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. Retrieved 2008-08-13.com/2008/ 02/06/174902.com) Dr.com) Myca Nutrition Home (http://www. Marie-Andrée (mercredi 06 février 2008). External links • http://www.wirelesslifesciences.myca. MD.ca/article/20080201/CPSOLEIL/80131196/6711/CPACTUEL03) (in French). Le Soleil. Claudette (Le vendredi 01 février 2008).Myca • Chouinard.com) Santé Sans File. 90 External links • • • • • • • Myca Home (http://www.mycanutrition. • Samson.myfoodphone.connectingforhealth.ledevoir.hellohealth.santesansfile.nhs. "Santé sans file: consulter le docteur par Internet" (http:// www.cyberpresse.com) Hello Health (http://www. Retrieved 2008-08-13. "Médecine Club Price" (http://www. Jay Parkinson.

Members (Member list accurate as of March 30. and may have been the largest network of its kind in the world. NORTH Network As of April 1. NORTH was the busiest telehealth programme in Canada. and delivered healthcare-related administrative services to its member organizations. 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.) 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 . NORTH Network experienced a significant expansion between 2001 and 2003. At the time of its integration into the Ontario Telemedicine Network. which linked more than 226 sites in more than 120 communities across Ontario. NORTH Network's name is an acronym which stands for the Northern Ontario Remote Telehealth Network. 2006.000 physicians and other allied health professionals used the Network.NORTH Network 91 NORTH Network NORTH Network was a telehealth organization serving communities in Northern and Central Ontario.100 clinical consultations each month and an additional 500 educational and administrative events. Its size and volumes have increased significantly since forming a province-wide network. More than 2. 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. NORTH was a program of Sunnybrook Health Sciences Centre. NORTH also connected healthcare professionals and students in the north to educational programmes. Mandate and Operations NORTH provided patients in rural and under-serviced communities access to specialized medical care using videoconferencing and other tele-diagnostic equipment. and received funding from the provincial government's Ministry of Health and Long Term Care. Launched in four sites in 1998. NORTH's head office was located in Toronto and its clinical headquarters in Timmins. NORTH was facilitating over 2. thanks to funding from Health Canada's Canadian Health Infostructure Partnerships Program (CHIPP). Specialists remotely examined and prescribed treatment to patients in their home communities.

Site Russell St.C.'s Group of Health Services Anson General Hospital 92 .NORTH Network • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Centre for Addiction and Mental Health College St.I. 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. Site Queen St.

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. 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 .Sault Ste. 93 Educational and Community Organizations . Marie Health Sciences North Institute for Safe Medication Practices Inc.

Methuen Health Centre Keene Health Centre Kerr.) Medical Associates Physicians Clinic NorWest Community Health Centre Armstrong Site 94 Public Health Teleprimary Care Sites with collaborating family physicians . Joseph's Care Group Heritage Site Hogarth Riverview Manor Rehab/ Chronic Pain Mngt. L.NORTH Network • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Laurentian University . & Addington Health Unit Middlesex-London Health Unit North Bay Parry Sound District Health Unit Regional Niagara Public Health unit Thunder Bay District Health Unit Apsley Medical Centre Argyle Nursing Station Britt Nursing Station Havelock . 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. Joseph's Villa St. Site Sister Margaret Smith Centre Surrey Place Centre University of Toronto .W.Belmont . (Dr.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.O.Faculty of Medicine Kingston. Frontenac and Lennox. W. (Dr.) McMullen.

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 .Brampton Hamilton Niagara Haldimand Brant Local Health Integration Network .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.Thunder Bay • Toronto Central Local Health Integration Network .Markham Central East Local Health Integration Network .Grimsby North Simcoe Muskoka Local Health Integration Network .Ajax Central West Local Health Integration Network .Orillia North East 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 .North Bay 95 Government • North West 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 96 .

([3] ) OTN supports access to care across a wide variety of clinical therapeutic areas of care. In fiscal 2010-11. clinics. more than 134. professional organizations. ([6] ) Use of Telemedicine in the Province resulted in an avoidance of 121 million kilometres of patient travel and an elimination of nearly 33.595 educational events.000 patients received care via OTN. In fiscal 2010-11. OTN hosted more than 1.000 health care professionals participate in OTN-facilitated [5] education each year. ([7] ) . and 13. nursing stations. OTN hosted 11.146 administrative events. ([4] ) In addition to facilitating the delivery of patient care. First Nations Communities. physician offices. medical and nursing schools.otn.Ontario Telemedicine Network 97 Ontario Telemedicine Network Ontario Telemedicine Network Industry Founded Telemedicine April 2006 Headquarters Toronto. internal medicine. a 30% increase over the same period the previous year. CANADA Employees Website 195 (2011) www. In fiscal 2010-11. OTN enables teaching and learning at a distance via videoconferencing and webcasting. OTN Members and Network Partners The Network has nearly 600 Members. educational facilities and public health. including all public hospitals. long-term care homes. Ontario. a 67% increase over the previous year.ca [1] The Ontario Telemedicine Network (OTN) is one of the largest telemedicine networks in the world. There was also a 19% increase in viewership of archived webcasts over 2009-2010. LHIN offices.500 webcasts. Family Health Teams. for a total of 28.5KG of pollutants. surgery and rehabilitation services. OTN facilitates the delivery of distance education and meetings for health care professionals and patients. More than 390. Community Care Access Centres. It uses two-way videoconferencing to provide access to care for patients in every hospital and hundreds of other health care locations across the province.264 views.([2] ) OTN Utilization The Network consists of more than 1200 sites and 2200 endpoints and more than 3200 health care referrers and consultants use the Network to provide care to patients. In addition to clinical care. The top five clinical categories supporting patient care are mental health and addictions. oncology.

order eyeglasses and contacts. Other portal applications are integrated into the existing web site of the healthcare provider. Some patient portal applications exist as stand-alone web sites and sell their services to healthcare providers. Patient portal applications might allow patients to register and complete forms online. Benefits and Features of Patient Portals The central feature which makes a system. Virtually all patient portals allow the patient to interact in some way with the health care provider.ca [6] OTN 2010-11 Annual Report [7] OTN 2010-11 Annual Report External links • Ontario Telemedicine Network website (http://www. Still others are modules added onto an existing electronic medical record system. otn. . personal health record. a patient portal. The lines between a electronic medical record. pay bills.ca/) • OTN 2010-11 Annual Report 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. For example. and expose patient data via the Internet so can be viewed as patient portal. is the ability to expose personal. review lab results. or a part of a system. and a patient portal are blurring.otn. patient health information securely via the Internet. access medical records. Typically. which can streamline and shorten visits to clinics and hospitals.otn. Patient portals also typically allow patients to directly communicate with healthcare providers by asking questions and leaving comments. and schedule necessary medical appointments. Google Health and Microsoft HealthVault. What all of these share is the ability of the patient interacting with their medical information via the Internet.Ontario Telemedicine Network 98 References OTN 2010-11 Annual Report [1] http:/ / www. portal services are available on the Internet at all hours of the day. such as physicians and hospitals. describe themselves as personal health records (PHRs). ca/ [2] OTN 2010-11 Annual Report [3] OTN 2010-11 Annual Report [4] OTN 2010-11 Annual Report [5] www. Many portal applications also allow patients to request prescription refills online. but can interface with EMRs and communicate via the Continuity of Care Record standard.

sinus infections. payments. personal health record systems. . The best demographic for e-visits are patients who live far away from their clinics. This makes e-visits a very interesting proposition for insurance companies. Something as seemingly trivial as a name is viewed by HIPAA as protected health information. Practice Portals Portal applications for practices typically exist in tandem with patient portals. 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. It is for this reason that patient portals exist . These regulation specify what patient information must be held in confidence. Possibly because of the strictness of HIPAA regulations. For this reason. an individual's health data are primarily in physicians' files.Patient portal 99 Disadvantages of Patient Portals The major shortcoming that most patient portals have is that they are tied to only one organization.[2]. or the lack of financial incentives for the health care providers. security has always been a top concern for the industry when dealing with the adoption of patient portals. 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. cough. Some possible symptoms could be common cold. diarrhea and back pain.[1] Most patient portals require the practice to have some type of electronic medical record or patient management system. and messages from patients. have kids. At the same time as the conversion to patient portals and EMR systems. Because the conversion to EMR is typically complex. certainly most patient and practice portals are secure and compliant with HIPAA regulations. Providing a route for patients to take that does not require them to come to the clinic benefits them and your organization. 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. although few actually re-imburse for them currently.to give the patient a view into their information. The funding will offset. as well as schedules. Currently. The use of SSL and access control patterns are commonplace in the industry. PHRs. The financial industry has been particularly adept at using the Internet to grant indivdual users access to their information. At that point we will begin seeing physician portals. Patient access is typically validated with a user name and password. Many organizations find that overall utilization drops when e-visits are implemented. The Future of Patient Portals E-visits may soon be one of the most commonly used options of patient portals that are available. the best documentation of patients history could be data outside the physicians office. potentially pay for electronic medical records systems for practicing physicians. the adoption of patient portals has lagged behind other market segments. some places by as much as 25%. While there may be systems that are not HIPAA compliant. and the development of clear interoperable standards. allowing access to patient information and records. are becoming more common and available. Security Health care providers in the US are bound to comply with HIPAA regulations. urinary problems. 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. This results in a fragmented view of their data. as the patient data needs to be stored in a data repository then retrieved by the patient portal. History Internet portal technology has been in common use since the 90s. Given the mobility of patients.

images from multiple modalities (source machine types). this eliminates the need to manually file. PACS has the ability to deliver timely and efficient access to images. distribution. and archives for the storage and retrieval of images and reports. and convenient access to. cardiology.[1] Electronic images and reports are transmitted digitally via PACS. computed radiography (CR) ophthalmology. and display. gov/ EducationMaterials/ Downloads/ HIPAAChecklist. may be incorporated using consumer industry standard formats like PDF (Portable Document Format). retrieve. Combined with available and emerging web technology. Non-image data. oncology. PACS breaks down the physical and time barriers associated with traditional film-based image retrieval. also allow the patient to update their allergies. mammograms (MG). magnetic resonance (MR).Patient portal E-visits. vital signs. . An image as stored on a picture archiving and communication system (PACS) Types of images Most PACSs handle images from various medical imaging instruments. a secured network for the transmission of patient information. including ultrasound (US). gastroenterology and even the laboratory are creating medical images that can be incorporated into PACS. such as scanned documents. 100 References [1] http:/ / practiceportals. or transport film jackets. positron emission tomography (PET). (see DICOM Application areas). Clinical areas beyond radiology. workstations for interpreting and reviewing images. 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. and related data. Additional sharpening and measurement tags added by the system types of image formats are always being added. and history information. (DR). once encapsulated in DICOM. A PACS consists of four major components: The imaging modalities such as X-ray computed tomography (CT) and magnetic resonance imaging (MRI). etc. The universal format for PACS image storage and transfer is DICOM (Digital Imaging and Communications in Medicine). interpretations. pdf Picture archiving and communication system A picture archiving and communication system (PACS) is a medical imaging technology which provides economical storage of. Digital radiography The same image following contrast adjustment. endoscopy (ENDO). with the proper functionality. com/ [2] http:/ / cms. computed tomography (CT). hhs.

a technologist a QA workstation. Practice Management Software. The central storage device (archive) stores images and in some cases reports. telediagnosis). usually via VPN (Virtual Private Network) or SSL (Secure Sockets Layer). Note that this section does not cover integration to a Radiology Information System. and magnetic resonance imaging (MRI). • Electronic image integration platform: PACS provides the electronic platform for radiology images interfacing with other medical automation systems such as Hospital Information System (HIS). Architecture The architecture is the physical implementation of required functionality. depending on the user. PACSs provide a growing cost and space advantage over film archives in addition to the instant access to prior images at the same institution. The first step in PACS workflow diagram typical PACS systems is the modality. The diagram above shows a typical workflow in most imaging centers and hospitals. measurements and other information that resides with the images. or what one sees from the outside. The reading workstation is where the radiologist reviews the patient's study and formulates their diagnosis. If the study information is correct the images are passed to the archive for storage.Picture archiving and communication system 101 Uses PACS has four main uses: • Hard copy replacement: PACS replaces hard-copy based means of managing medical images. such as film archives. PACS is offered by virtually all the major medical imaging equipment manufacturers. ultrasound. there is normally CD/DVD authoring software used to burn patient studies for distribution to patients or referring physicians. More and more PACS include web-based interfaces to utilize the internet or a Wide Area Network as their means of communication. The composite view is rather different for the various vendors. Normally tied to the reading workstation is a reporting package that assists the radiologist with dictating the final report. Ancillary to the workflow mentioned. It enables practitioners in different physical locations to access the same information simultaneously for teleradiology.[2] Typically a PACS consists of a multitude of devices. Web Access to DICOM Objects (WADO) . Reporting software is optional and there are various ways in which doctors prefer to dictate their report. Digital copies are referred to as Soft-copy. nuclear medicine. Modalities are typically computed tomography (CT). medical IT companies and many independent software companies. • Radiology Workflow Management: PACS is used by radiology personnel to manage the workflow of patient exams. The client side software may use ActiveX. while a PACS administrator might spend most of their time in the climate-controlled computer room. Hospital Information System and other such front-end system that relates to the PACS workflow. With the decreasing price of digital storage. A radiologist typically sees a viewing station. • Remote access: It expands on the possibilities of conventional systems by providing capabilities of off-site viewing and reporting (distance education. Basic PACS software can be found free on the Internet. positron emission tomography (PET). and Radiology Information System (RIS). JavaScript and/or a Java Applet. There are different views. 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. Electronic Medical Record (EMR). 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 QA workstation is a checkpoint to make sure patient demographics are correct as well as other important attributes of a study. Depending on the facility's workflow most modalities send to a quality assurance (QA) workstation or sometimes called a PACS gateway. The next step in the PACS workflow is the reading workstations.

Typically a radiologist is looking for prior studies on a patient to compare the progression of some pathology. the Security Rule's Technical Safeguards section of HIPAA requires that the images be encrypted during transmission.) Depending on upload bandwidth and image volume. the patient ID tag is filled with the patient's ID. • The client creates empty tags (tags with zero length string values) for all the tags it wishes to receive from the server. • The client prepares a query object which is an empty dicom dataset object. to query for a patient ID.g. 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.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). In some cases prior studie(s) may be on an off-site archive or a long term storage device.0018) in the query object. The content of these copies must be protected via encryption from exposure to unauthorized personnel or stiff penalties can be assessed. the radiologist or radiology technical must query the off-site or long term archive for the prior exam(s). The hope is that the copies won't ever be needed. Image archival and backup Digital medical images are typically stored locally on a PACS for retrieval. but sometimes overlooked. • The server sends back to the client a list of response dicom objects. Ideally. PACS image backup is a critical. Images are retrieved from a PACS server through a C-MOVE request. There are several methods of backing up the images. as defined by the DICOM network protocol. 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. DVDs or other media that can hold many patients' images) that is physically transferred off-site.[3] . 102 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. they need to be available if needed. the goal in image back-up is to make it automatic and as easy to administer as possible. (If using the Internet. copies of images should be streamed off-site as they are created. This request specifies where an image instance should be sent through an identifier known as the destination Application Entity Title (AE Title). preferably off-site. in-turn sending the study from the archive to the device requesting the study. • The query object is sent to the server. Without stepping outside the focus of the PACS architecture. but they typically involve automatically sending copies of the images to a separate computer for storage. and as a consequence the server must know in advance all the AE Titles that it will ever be requested to send images to. A query typically looks as follows: • The client establishes the network connection to the PACS server. as with other disaster recovery and business continuity planning. 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. this may not be practical if the back-up system cannot be configured to tune bandwidth usage and frequency of back-ups.g. but with different tags. but. In the example being used. HIPAA requires that backup copies of patient images be made in case of image loss from the PACS. • The client fills in the query object with the keys that should be matched. WADO becomes the solution to cross platform capability and can increase the distribution of images and reports to referring physicians and patients. While each facility is different. • The client extracts the tags that are of interest from the response dicom objects. E. The server must be configured with mapping of the AE Title to a TCP/IP address and port. Other options include removable media (hard drives. E.

Images will be created after images scanning and then forwarded to PACS Server. rather than just protecting the drives through RAID. whether they span the entire enterprise or are localized within a department. Such systems are also often not connected to the departmental information system. should also interface with existing hospital information systems: Hospital information system (HIS) and Radiology Information System (RIS). largely because of the large image size. or via a Storage Area Network (SAN). until PACS penetration is complete. 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. Ultrasound. via HL7 protocol. Patient ID and Orders will be sent to Modality (CT. More recently. failed drives may be physically replaced (hot swapping) without interruption of service. These data are sent from HIS to RIS via integration interface. workstations and storage (a so-called "mini-PACS"). inexpensive disc in another machine at another location. 103 Integration A full PACS should provide a single point of access for images and their associated data. These may take the form of a localized. 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. Since costs of computers has fallen. modality-specific network of modalities. Typically. Out: Diagnosis Report and Images created accordingly. 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. RAIDs are fragile and can be rendered useless by one erroneous hit on the controller. to a slower. and intervention by regulators. in all departments. However the storage is attached. highly specialized reading workflow and display requirements. Full Field digital mammography (FFDM) has taken a similar approach. Some sites make two such backups and remove them from the site on a rotating basis. 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 . Further. Data stored on disk may also be backed up to tape or optical media or copied. some means of rapidly transferring all of its images back to the PACS is required. in most of hospital. Nuclear Medicine and Cardiology Cath Labs are often departments that adopt such an approach. The back-up infrastructure may also be capable of supporting the migration of images to a new PACS. Diagnosis Report is created based on the images retrieved for presenting from PACS Server by physician/radiologist and then saved to RIS System. preferably whilst the PACS continues to receive and provide current images.MR. Historically. 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.etc) via DICOM protocol (Worklist). In the event that it is necessary to reconstruct a PACS partially or completely from the back-up images. All PACS. However. The hard drives may be configured and attached to the PACS server in various ways. some sites opt for fully redundant Archives.Picture archiving and communication system Images may be stored both locally and remotely on off-line media such as tape or optical media. it should support all digital modalities. Network-attached storage (NAS). throughout the enterprise. That is. or partially or exclusively on hard disks ("spinning") media. individual islands of digital imaging not yet connected to a central PACS may exist. The latter is becoming more common. either as Direct-Attached Storage (DAS). in real time. the drives themselves are usually configured as a Redundant Array of Inexpensive (or Independent) Discs RAID.

Providing a robust method of merging datasets from multiple hospitals. avoiding typing delays for urgent results. • Provides a single tool for quality control and audit purposes.Picture archiving and communication system with HIS in hospitals (In most of cases.[5] Dr Harold Glass. Workloads and turn-around time can be reported automatically for management purposes. the PACS can compare the embedded image data with a list of scheduled studies from RIS. but it can also be made available for access by physicians. allowing later analysis (as may be required under radiation protection legislation). allowing images to be pre-fetched from off-line storage or near-line storage onto online disk storage. patient number. .[6] Dr Glass died a few months after the project came live but is credited with being one of the pioneers of PACS. 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. or retained in case of typing error. Rejected images can be tagged. 104 History The principles of PACS were first discussed at meetings of radiologists in 1982. The first large-scale PACS installation was in 1982 at the University of Kansas. 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. • Improved use of online storage and nearline storage in the image archive. preventing data entry errors during acquisition. credits Dr Judith M. accession number) for upcoming cases and present that to the technologist. • Data saved in the PACS can be tagged with unique patient identifiers (such as a social security number or NHS number) obtained from HIS. though. and can flag a warning if the image data does not match a scheduled study. The PACS can obtain lists of appointments and admissions in advance. Prewitt for introducing the term. Kansas City.[2] This first installation became more of a teaching experience of what not to do rather than what to do in a PACS installation. even where the different centers use different ID systems internally. Once the acquisition is complete. This avoids needless double-reading.[4] Dr Samuel Dwyer. An interface can also improve workflow patterns: • When a study has been reported by a radiologist the PACS can mark it as read. The report can be attached to the images and be viewable via a single interface. Various people are credited with the coinage of the term PACS. Clinical Physician gets reminder of Diagnosis Report coming and then queries images from PACS Server). These may offer a number of advanced features: • Dictation of reports can be integrated into a single system. Recognition of the importance of integration has led a number of suppliers to develop fully integrated RIS/PACS. The recording is automatically sent to a transcript writer's workstation for typing. Cardiovascular radiologist Dr Andre Duerinckx reported in 1983 that he had first used the term in 1981.

ISBN 9780971886735 [3] HealthcareITnews: HHS cracks down: provider to pay $100.htm) List of free PACS and DICOM software available on the web • History of PACS (http://www. Diana Manos. "The benefits of hospital-wide picture archiving and communication systems: a survey of clinical users of radiology services". com/ news/ hhs-cracks-down-provider-pay-100000-hipaa-penalties-over-lost-laptops) [4] Duerinckx AJ.. Herman. edited by G. [8] USFDA (30 May 2008). Filmless Picture Archiving and Communication System (PACS) in Diagnostic Radiology. gov/ MedicalDevices/ DeviceRegulationandGuidance/ GuidanceDocuments/ ucm107549.[7] Some specific applications. PACS and DICOM Software (http://www.asp) • PACS History Web Site (http://www. [5] Samuel J. [6] Bryan S.imagingeconomics. 2008. In: Proceedings of the SPIE. Buxton MJ (1999). . Retrieved 11 February 2010. Pisa EJ. R. Proc SPIE 1982.rtstudents. . Weatherburn GC. Picture archiving and communication systems: an overview. PACS Fundamentals.63L) . July 17.edu/abs/2003SPIE. Dwyer III. Siegel. "Medical Imaging 2000: PACS Design and Evaluation: Engineering and Clinical Issues". References [1] Choplin. A personalized view of the history of PACS in the USA. External links • Teleradiology. "Guidance for the Submission Of Premarket Notifications for Medical Image Management Devices" (http:/ / www.harvard.3980:2-9. In general they are subject to Class 2 controls and hence require a 510(k). "Guidance for Industry and FDA Staff: Display Accessories for Full-Field Digital Mammography Systems-Premarket Notification (510(k)) Submissions" (http:/ / www. 2000. fda. Br J Radiol 72 (857): 469–78. James Blaine and Eliot L.com/library/200505-01. order No 388. PMID 10505012. gov/ MedicalDevices/ DeviceRegulationandGuidance/ GuidanceDocuments/ ucm073720.000 in HIPAA penalties over lost laptops. and hence if for sale are regulated by the USFDA.pacshistory. Senior Editor (http:/ / www. 2004.org/) • USC IPILab Research Article on Backup (http://adsabs.. Aubrey: OTech Inc.com/pacs/free-dicom-viewers. Reprinted in IEEE Computer Society Proceedings of PACS'82. htm).Picture archiving and communication system 105 Regulatory concerns In the US PACS are classified as Medical Devices. Radiographics January 1992 12:127-129 [2] Oosterwijk.9-18. such as the use for primary mammography interpretation. though individual PACS components may be subject to less stringent general controls.318. are additionally regulated[8] within the scope of the Mammography Quality Standards Act. [7] USFDA (27 July 2000). (1992). healthcareitnews. fda.. Retrieved 11 February 2010. Watkins JR. htm).5033.

Remote diagnostics Remote diagnostics refers to a real time telemedical application which achieves diagnostic level quality and information exchange. MacTech Magazine. body of object. NASA researchers have successfully demonstrated remote guidance of diagnostic level cardiac ultrasonography using an ultrasound on the space station. from a remote location.html • Froehlich J. to as far away as another continent or even planet. gynecologic. from a distance. In the tele-medical context specific to radiologic images these images often are consistent with the DICOM standard. By way of example. In cases where also corrective actions are made. a radiologist may guide an ultrasound examination from a remote location.org/laparascopic-surgery/lights-lap-camera-tele-action/ http://www. References • • • • see also Remote diagnostics for RD in technical systems http://www. Formula 1 and major assests such as ships.trains etc.com/go/5283/ 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. Easily capture video from any VGA or DVI device. spacecrafts. pelvis. for example ultrasound machines has facilitated this new capability. This falls in the realm of real time telemedicine applications. 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. As such the proximate requisite expertise to accomplish a medical task is significantly diminished. the term 'Remote Diagnostic & Maintenance' is more appropriate.gizmag.Remote guidance 106 Remote guidance Remote guidance.sportandtechnology. In this sense. This is an example of teleradiology If appropriately configured.com/features/0335. More general Remote Diagnostics (RD) refers to detecting which fault or faults are present in a system. video product of medical devices has typically not been available for remote interaction. In the previous example. non-medical astronauts performing the exam as guided by a terrestrially located expert. in the medical context. cardiac and vascular evaluations has shown potential for remote diagnosis only of late. the remote guidance can originate from another room or floor in the same building. The inclusion of the VGA output gives the opportunity for frame grabber devices to stream such outputs to the internet. refers to the supervision or guidance of a medical task.remoteguidance. musculoskeletal. it refers to an expectation for quality sufficient for making or excluding a medical diagnosis. Recent improvements in scanning devices. usually a procedures or test. Technical aspects While still imagery can be e-mailed and forwarded in a multitude of methods. Ultrasound scanning commonly utilized for abdomen. Examples of use: aeroplanes. 2007 .

remote surgery has been conducted many times in numerous locations. where the physical distance between the surgeon and the patient is immaterial. even to patients in regions which have traditionally lacked proper medical facilities. robots might one day be able to perform surgeries with little or no human input. It is a form of telepresence. the surgical room responds to the surgeon’s voice commands in order to control a variety of equipment at the surgical site.Remote surgery 107 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. 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 . Canada. Canada. Sinai Hospital in Toronto. Even though he uses a VPN over a non-dedicated fiberoptic connection that shares bandwidth with regular telecommunications data. Dr.[1] That operation. With continuing advances in communication technologies. . a city 400 kilometres from Hamilton. It promises to allow the expertise of specialized surgeons to be available to patients worldwide. has developed a software program that uses data collected from several surgeons and thousands of operations to perform the surgery without human intervention [4] . with a surgeon (Dr. most of these robots are controlled by surgeons at the location of the surgery. The possibility of being able to project the knowledge and the physical skill of a surgeon over long distances has many attractions. has conducted numerous remote surgeries on patients in North Bay. Remote surgery is essentially advanced telecommuting for surgeons. Unassisted robotic surgery As the techniques of expert surgeons are studied and stored in special computer systems. Anvari.[2] Applications Since then. The Lindbergh Operation One of the earliest remote surgeries was conducted on 7 September 2001 across the Atlantic Ocean. Jacques Marescaux) in New York performing a cholecystectomy on a 68-year-old female patient 6. Anvari has not had any connection problems during his procedures.230 km away in Strasbourg. the ease and cost effectiveness of deploying remote surgery units is likely to increase rapidly. To date Dr. Rapid development of technology has allowed remote surgery rooms to become highly specialized. Carlo Pappone. and telerobotics can potentially save the lives of battle casualties by providing them with prompt attention in mobile operating theatres. A study conducted at Guy’s Hospital in London. There is considerable research underway in the subject. an Italian surgeon. At the Advanced Surgical Technology Centre at Mt. the availability of greater bandwidth and more powerful computers. was conducted over a dedicated fiberoptic link to ensure guaranteed connectivity and minimal lag. complicated surgeries much more widely available. cutting edge communication technology such as high-speed data connections and elements of management information systems. called Project Lindbergh after Charles Lindbergh’s pioneering transatlantic flight from New York to Paris. the position of the operating table and the surgical tools themselves. This could one day make expensive. without the need for patients to travel beyond their local hospital. Remote surgery combines elements of robotics. including the lighting in the operating room. a laparoscopic surgeon in Hamilton. teleoperation. While the field of robotic surgery is fairly well established. Another potential advantage of having robots perform surgeries is accuracy. France named Operation Lindbergh. The armed forces have an obvious interest since the combination of telepresence.

org/wnet/innovation/episode7_essay1. However this can be much more difficult when the view is presented on a flat computer screen. html [2] Event videos: http:/ / www.com (http:/ / web. guardian. Also. Nevertheless.First transatlantic surgery (http://news.co. Humans binocular vision make this easy in a three dimensional environment.Remote surgery 108 Force-Feedback and Time Delay The ability to carry out delicate manipulations relies greatly upon feedback.howstuffworks.html) • PBS article on telesurgery (http://www.uk/1/hi/sci/tech/1552211.com/archive/Aug96/1290.on.htm) • Article in Pulse of the Planet about remote surgery (http://www. co.Revolutionary Telemedicine Techniques (http://www.com/robotic-surgery. Operation Lindbergh proved that the technology exists today to enable delivery of expert care to remote areas of the globe. archive. or Haptic technology. remote surgery is not a widespread technology in part because it does not have sponsorship by the governments. This system is intended to aid wounded soldiers in the battlefield by making use of the skills of remotely located medical personnel.11381. com/ media. For example. many issues will need to be resolved. In robotic surgery. However these systems are very sensitive to time-delays such as those present in the networks used in remote surgery. intersurgtech. Depth Perception Being able to gauge the depth of an incision is crucial.mtsinai. training. html) [4] Robot Successfully Completes Unassisted Heart Surgery Digital Lifestyle Magazine @ dlmag.pulseplanet. html [3] Robo-ops set to cut out the human factor | Special reports | Guardian Unlimited (http:/ / www. 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. Limitations For now.ca/Publications/YHRFall2001/Hospital/ virtualreality.805662. Another future possibility could be the use of remote surgery during long space exploration missions.intersurgtech. intersurgtech. Before its acceptance on a broader scale.html) • BBC News SCI/TECH -. org/ web/ 20060820022121/ http:/ / www.com/tele-medicine. have been developed to simulate this.htm) • How robotic surgery works (http://electronics.bbc.stm) • High Performance Network Video in support of Telesurgery / NEEMO7 Mission . Possible Uses One possible use of remote surgery is the Trauma-Pod project conceived by the US military under the Defense Advanced Research Agency. References [1] http:/ / www.com/download-center/case-studies/telesurgery-cmas) .00. Systems known as force-feedback.html) • Using remote surgery as a teaching tool (http://www.haivision. html) External links • Article and Media Gallery for telesurgery (http://www. dlmag. established clinical protocols. and global compatibility of equipment must be developed.pbs. com/ media. For example it is easy to learn how much pressure is required to handle an egg. uk/ medicine/ story/ 0. surgeons need to be able to perceive the amount of force being applied without directly touching the surgical tools. com/ 1653/ robot-successfully-completes-unassisted-heart-surgery.

com/1653/robot-successfully-completes-unassisted-heart-surgery. cardiac valve repair and anywhere in the world. that minimally invasive techniques have so failed to supplant. Robotically-assisted surgery was developed to overcome both the limitations of minimally invasive surgery or to enhance the capabilities of surgeons performing open surgery. In computer-controlled systems the surgeon uses a computer to control the robotic arms and its end-effectors. The main object of such smart instruments is to reduce or eliminate the tissue trauma traditionally associated with open surgery without requiring more than a few minutes' training on the part of surgeons. instead of directly moving the instruments. This approach seeks to improve that lion's share of surgeries.archive. it turned out to be more useful for minimally invasive on-site surgery. indeed the surgeon could be prostatectomies. though these systems can also still use telemanipulators for their input. The patents for the early .dlmag.[2] ) The da Vinci Surgical System comprises three components: a surgeon’s console. ZEUS is no longer being actively marketed. 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. autonomous instruments (in familiar configurations) replace traditional steel tools. feedback-controlled motions than could ever be achieved by a human hand. Although the telesurgical robot was originally intended to facilitate remotely performed surgery in battlefield and other remote environments.html) 109 Robotic surgery Robotic surgery. 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. and a high-definition 3D vision system. In gynecologic surgical procedures the case of enhanced open surgery. (Intuitive Surgical bought Computer Motion in 2003. Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas.[1] In 1988. developed at Imperial College London. leading to the possibility for remote surgery. One advantage of using the computerised method is that A robotically assisted surgical system used for the surgeon does not have to be present. was used to perform prostatic surgery. the PROBOT. a patient-side robotic cart with 4 arms manipulated by the surgeon (one to control the camera and three to manipulate instruments). particularly cardio-thoracic. the surgeon uses one of two methods to control the instruments .Remote surgery • Robot Successfully Completes Unassisted Heart Surgery (http://web. computer-assisted surgery. the PUMA 560. The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement. In the case of robotically assisted minimally invasive surgery. performing certain actions (such as rib spreading) with much smoother. and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures. 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-effectors and manipulators to perform the actual surgery on the patient. either a direct telemanipulator or by computer control. History In 1985 a robot. was used to place a needle for a brain biopsy using CT guidance.

California. 2001. Mohan S.the first closed-chest beating heart cardiac hybrid revascularization procedure is performed at the London Health Sciences Centre (London. Jacques Marescaux and Dr. Professor and Chief. Gundeti of the University of Chicago Comer Children's Hospital performed the first robotic pediatric neurogenic bladder reconstruction. The same team performed eight more fully robotic-assisted kidney transplants over the next six months. Dr. Dr.000 procedures in 2006 and sells for about $1. • On 2 September 1999.000 similar operations. the Eindhoven University of Technology announced the development of the Sofie surgical system. It also detects and filters out any tremors in the surgeon's hand movements. The da Vinci senses the surgeon’s hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. This multi-step procedure marked one of the first integrative approaches to treating coronary disease. The robot used was the first true robot. and is used in more than 800 hospitals in the Americas and Europe. The operation was performed on a 10-year-old girl. • In October 1999 the world's first surgical robotics beating heart coronary artery bypass graft (CABG) was performed in Canada by Dr. 1999 . Ohio under the direction of Dr. Randall Wolf and Dr. [8] [9] • In February 2008.[5] • On November 22. used the Zeus robotic system to remotely perform a cholecystectomy on a 68-year-old female patient who was in Strasbourg. Reiza Rayman using the ZEUS surgical robot. so that they are not duplicated robotically. New Jersey by Dr. Professor of Cardiology of the University of Western Ontario. the first robotic operation at the femoral vasculature was performed at the University Medical Centre Ljubljana by a team led by Borut Geršak. The da Vinci System was used in 48.[11] • In January 2009. hysterectomy and mitral valve repair.Robotic surgery prototype were sold to Intuitive Surgical in Mountain View. Douglas Boyd and Dr. 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. Dr. Dr. Robert Michler performed the first robotically assisted heart bypass in the USA at The Ohio State University. Michel Gagner.) • In May 2006 the first AI doctor-conducted unassisted robotic surgery on a 34 year old male to correct heart arythmia.75 million. • In January 2009. distal of the 2-dof handwrist (MiroSurge). was "more than qualified to operate on any patient. 2009 currently sells for $1. Ontario). and so.[4] • In May 1998. Dr. The machine had a database of 10. completed an angioplasty revascularization on the patient's second occluded coronary vessel. Robert E. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. In the next step of the procedure William Kostuk. in the words of its designers.[12] • In September 2010. MD. meaning it was not . In the first step of a two step procedure Dr. Michler.[6] • On September 7. Cardiothoracic Surgery. Friedrich-Wilhelm Mohr using the da Vinci Surgical System performed the first robotically assisted heart bypass at the Leipzig Heart Centre in Germany. single-vessel heart bypass surgery on a 55 year-old male patient's left anterior descending artery. The new da Vinci HD SI released in April. France. The da Vinci System is FDA cleared for a variety of surgical procedures including surgery for prostate cancer.[3] 110 Timeline • In 1997 a reconnection of the fallopian tubes operation was performed successfully in Cleveland using ZEUS.[10] • In June 2008 the German Aerospace Center (DLR) presented the first robotic system for minimally invasive surgery with force-feedback in 7 dof in the tip of the instrument.[7] (See: the Lindbergh Operation. while in New York. The first robotic surgery took place at The Ohio State University Medical Center in Columbus. Stuart Geffner. Douglas Boyd used Zeus to perform an endoscopic.2 million. the first all-robotic-assisted kidney transplant was performed at Saint Barnabas Medical Center in Livingston. The results were rated as better than an above-average human surgeon. the first surgical robot to employ force feedback." The designers believe that robots can replace half of all surgeons within 15 years.[13] • In September 2010.

Compared with other minimally invasive surgery approaches.500 per procedure. minimally invasive surgery and unmanned surgery. and quicker healing time. Reduced recovery times are not only better for the patient. Robotic techniques are also associated with reduced duration of hospital stays. decreased blood loss. Data is absent that proves the increased costs can be justified. In addition. they also reduce the number of staff needed during surgery. This approach can be associated with postoperative infection and pain. Some major advantages of robotic surgery are precision. the surgical robot can continuously be used by rotating surgery teams. opinions differ dramatically.200. Moreover during the training phase. 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. and. these may not be representative of surgeons with lesser experience.[20] [21] In 2007. Naturally occurring hand tremors are filtered out by the robot’s [18] While the use computer software.[19] The robotic system does not come cheap and has a learning curve. critics point out that studies that indicate that long-term results are superior to those after laparoscopic surgery are lacking. and use of pain medication. nursing care required after surgery. robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site.) 111 Advantages and disadvantages Major advances aided by surgical robots have been remote surgery. but was guided by pressing on buttons.[17] Advantages of this technique are that the incisions are small and patient recovery is quick.000 dollars and disposable supply costs of $1. miniaturization. In April 2008. smaller incisions.[14] [15] (See the vascular surgery section of this article. surgeons no longer have to stand throughout the surgery and do not tire as quickly. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity. the hospital stay is shorter. therefore. reduced blood loss and less pain. transfusions. the overall cost of hospital stays. and prolonged time to complete recovery. Surgeons report that. leading to operating room tie ups and surgical staffs keeping patients under anesthesia for longer periods. of robotic surgery has become an item in the advertisement of medical services. Additional surgical training is needed to operate the system. blood loss.[17] Numerous feasibility studies have been done to determine whether the purchase of such systems are worthwhile. Pier Cristoforo Giulianotti. led by Prof. the University of Illinois at Chicago medical team. Finally. Further advantages are articulation beyond normal manipulation and three-dimensional magnification. minimally invasive operations can take up to twice as long as traditional surgery. Because patient recovery after robot-assisted heart surgery is quicker. the same team of surgeons performed the world's first fully minimally invasive liver resection for living donor . resulting in improved ergonomics. reported a pancreatectomy and also the Midwests fully robotic Whipple surgery. then gains access to the heart by splitting the sternum (breast bone) and spreading open the rib cage. although the manufacturers of such systems provide training on this new technology. the cost of the procedure is higher. In medical literature. As it stands.Robotic surgery simply mirroring the movement of human hands. improved outcomes. 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.[19] Applications General surgery In early 2000 the field of general surgical interventions with the daVinci device was explored by surgeons at Ohio State University. However. very experienced surgeons tend to publish their results with robotic systems. The patient is then placed on a heart-lung machine and the heart is stopped for a period of time during the operation. less pain. the surgeon makes a ten to twelve-inch incision. In traditional open-heart surgery.[16] Higher expectations may explain higher rates of dissatisfaction and regret.[16] With the cost of the robot at $1. the learning phase is intensive and surgeons must operate on twelve to eighteen patients before they adapt.

Murphy). commensurate with higher procedural complications. The system allows for automated 3-D mapping of the heart and vasculature. East Carolina University. lung resection."[23] The Hansen Medical Sensei robotic catheter system uses a remotely operated system of pulleys to navigate a steerable sheath for catheter guidance. esophagectomy.[24] [25] [26] At present. It allows precise and more forceful positioning of catheters used for 3-D mapping of the heart and vasculature. Randolph Chitwood). it is expected that the applications of robots in cardiovascular surgery will expand. Mitral valve repairs and replacements have been performed.[27] These three surgery types are: • Atrial septal defect repair — the repair of a hole between the two upper chambers of the heart. Ongoing research on the outcomes of robotic assisted CABG and hybrid CABG is being done by Dr. Dr.Robotic surgery transplantation. • Coronary artery bypass — rerouting of blood supply by bypassing blocked arteries that provide blood to the heart. Douglas Boyd and Kenneth Stahl) reported and published their preliminary experience with minimally invasive "hybrid" procedures. Dr. • Mitral valve repair — the repair of the valve that prevents blood from regurgitating back into the upper heart chambers during contractions of the heart. and the system utilizes two magnets to remotely steerable catheters. longer procedure times but lower fluoroscopy dosage to the patient. yet allowing him to leave the hospital just a couple of days after the procedure. Atlanta (Dr Douglas A. Dr. Greenville (Dr W. Robert Poston. proven to reduce contrast usage and access tortuous anatomy unreachable by manual navigation. The Ohio State University. . Juan Crestanello. Michler. and MNS has also been used in interventional cardiology for guiding stents and leads in PCI and CTO procedures. The system provides doctors with estimated force feedback information and feasible manipulation within the left atrium of the heart. 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. In 2002. Columbus (Dr. and Good Samaritan Hospital. Cincinnati (Dr J. Saint Joseph's Hospital. tumor resections. mitral valve. in very good condition. As surgical experience and robotic technology develop. The Sensei has been associated with mixed acute success rates compared to manual.[22] 112 Cardiothoracic surgery Robot-assisted MIDCAB and Endoscopic coronary artery bypass (TECAB) operations are being performed with the da Vinci system. Robert E. three types of heart surgery are being performed on a routine basis using robotic surgery systems. removing 60% of the patient's liver. Since the first robotic cardiac procedure performed in the USA in 1999. Andrea Natale has referred to the new Stereotaxis procedures with the magnetic irrigated catheters as "revolutionary. 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. Paul Vesco) has performed CABG. 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. among other robotic assisted procedures and serves as a training site for other surgeons. Michael Smith) have popularized this procedure and proved its durability with multiple publications. surgeons at the Cleveland Clinic in Florida (Dr.

congenital diaphragmatic hernia repair. The Center for Robotic Surgery at Children's Hospital Boston provides a high level of expertise in pediatric robotic surgery.[32] Pediatrics Surgical robotics has been used in many types of pediatric surgical procedures including: tracheoesophageal fistula repair. including bariatric surgery. The results are less pain. sells the "Acrobot Sculptor". nissen fundoplication. Robotic surgery can be used to treat fibroids. This includes the use of the da Vinci surgical system in benign gynecology and gynecologic oncology. Aurora Health Center (Dr. pancreatectomy. The need for large abdominal incisions is virtually eliminated. total knee replacement and anterior cruciate ligament reconstruction.S. KG.'s Joseph Prezzato and Burton Brodsky have utilized this equipment for gynecological procedures in Southeastern Michigan. Jay Bringman) and The University of Tennessee.Robotic surgery 113 Gastrointestinal surgery Multiple types of procedures have been performed with either the 'Zeus' or da Vinci robot systems. Scott Kamelle). 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. Northwestern University (Dr. Using the robotic system. abnormal periods. and lymph node biopsies.[31] Another example is the CASPAR robot produced by U. Memphis (Dr. morgagni's hernia repair. shorter hospital stays. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices.-Ortho GmbH & Co. West Virginia University (Dr.[21] Specific procedures have been more fully evaluated. Saurabh Kumar). gynecologists can perform hysterectomies. Gynecology Robotic surgery in gynecology is one of the fastest growing fields of robotic surgery. Todd Tillmanns. cholecystectomy.R. Dr. Inc. 2002. 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. myomectomies. faster recoveries. which merged into CUREXO Technology Corporation. On January 17. The Acrobot Company Ltd. specifically esophageal fundoplication for the treatment of gastroesophageal reflux[28] and Heller myotomy for the treatment of achalasia. which is used for total hip replacement. Orthopedics The ROBODOC system was released in 1992 by Integrated Surgical Systems. The University of Tennessee. and female cancers. Donald Chamberlain) have extensively studied the use of robotic surgery and found it to improve morbidity and mortality of patients with gynecologic cancers. Neurosurgery Several systems for stereotactic intervention are currently on the market. MD Robotic's NeuroArm is the world’s first MRI-compatible surgical robot.[30] Also. esophagectomy and robotic approaches to pelvic disease have also been reported. and happier patients and families. and others. Dr. endometriosis. kasai portoenterostomy. Specially-trained surgeons use a high-tech robot to perform complex and delicate operations through very small surgical openings.[29] Other gastrointestinal procedures including colon resection. Robot assisted hysterectomies and cancer staging are being performed using da Vinci robotic system. smaller scars. pelvic prolapse. ovarian tumors. Chattanooga (Dr. a robot that constrains a bone cutting tool to a pre-defined volume. Patrick Lowe). .

In March 2011. Children's Hospital physicians have developed a number of new applications to expand the use of the robot. The research was led by Borut Geršak.[46] Vascular surgery In September 2010. the University of Nebraska Medical Center has led a multi-campus effort to provide collaborative research on mini-robotics among surgeons. Slovenia. surgeons use the technology for many procedures and perform more pediatric robotic operations than any other hospital in the world. pulmonary complications decrease to 0 percent from 9 percent.5 days to 5 days). Mounted on the robot is a compact X-band linac that produces 6MV X-ray radiation. some are attempting to miniaturize the robots.[14] [15] Miniature robotics As scientists seek to improve the versatility and utility of robotics in surgery. For example. engineers and computer scientists. Children's Hospital Boston was the first pediatric hospital to acquire a surgical robot.and since 2009.[33] 114 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. It is also utilized for kidney cancer surgeries and to lesser extent surgeries of the bladder. New minimally invasive robotic devices include [35] for selective excisions of kidney tumors. Geršak explained that the robot used was the first true robot in the history of robotic surgery. length of hospitalization is reduced from 8. Most Illinois transplant centers do not take anyone for renal transplant with a BMI of over 40. have done 13 procedures (100 percent patient and graft survival with no complications). They report fewer complications among this high-risk population (wound infections go from 15 percent in open surgery to 0 percent. just like one would play a video game.Robotic surgery In 2001. steerable flexible needles [36] [37] for use in prostate ultrasound probes [38] [39] [40] [41] [42] [43] [44] [45] brachytherapy. Analysing the problem and sending the information back to the hospital. Mounting the radiation source on the robot allows very fast repositioning of the source. the President of Slovenia Danilo Türk underwent robot-assisted prostate cancer treatment at the Urology Institute in Innsbruck. The robot was imported to Slovenia from the United States. Today. 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. Urology Robotic surgery in the field of urology has become very popular. especially in the United States. The system uses a German KUKA KR 240. In 2000.[47] There may also be a day and age where nanorobots may be inserted into peoples bloodstreams to act as general practitioners. and train surgeons from around the world on its use. which becomes their only other available therapy.and so those patients have no other access to kidney transplantation and experience high mortality rates while on dialysis. .having BMIs (body mass indexes) over 50. the first robot-assisted laparoscopic radical prostatectomy was performed.[17] Surgeons at the University of Illinois at Chicago College of Medicine were the first to offer robotic kidney transplantation to morbidly obese patients. the first robotic operations at the femoral vasculature were performed at the University Medical Centre Ljubljana (UMC Ljubljana). the head of the Department of Cardiovascular Surgery at the centre.[34] It has been most extensively applied for excision of prostate cancer because of difficult anatomical access. 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.

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[16] Estey. gov/ fdac/ features/ 2005/ 405_computer. Poster Session II. Dhinoja. [18] Gerhardus. Vats A. Ortmaier. 8 November 2010.. robot. "Results Unproven.. prnewswire. ncbi. Schneider C. com/ articles/ 2008/ 11/ 20/ surgeons. G. Int J Surg. M. V.. 153–161. Khan MS. IEEE Trans. . Engng. Surgical Endoscopy. [14] "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. gov/ pubmed/ 12908224). PMID 20428292. [12] New Robot Technology Eases Kidney Transplants (http:/ / wcbstv. 17: 1521-1524. over.. . physorg. Ellison EC. L. Retrieved March 11. J. . G.sgs. html) [3] McConnell. Jonckheere.Robotic versus Manual Catheter Ablation for Atrial Fibrillation [26] R. "Robotic Applications in Cardiac Surgery". Konietschke. tue. National Heart Centre . Ellison EC.Singapore . S. worlds. gov/ pubmed/ 19735746?dopt=Abstract) [23] TCAI Press Release. . PI. 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. htm) [42] "Benefits of Robotic Surgery" (http:/ / video. Langenburg S.. usnews.Robotic surgery [29] Melvin WS. uk/ Sculptor. com/ watch?v=-KWsS6lPVK0) [40] The Robot Surgeon (http:/ / www. January 2006 (http:/ / www. newscientist. Springer.35 ppSA113-119. Jaramaz. Dragoi. DI. berkeley. R. cbslocal.Reduction of femoral shaft fractures in vitro by a new developed reduction robot system "RepoRobo" . Berlin 2007. [43] "The Robot Is In" (http:/ / www. Falcone T. aspx) [46] "President Has Prostate Tumour Removed" (http:/ / www. "Robotic prostatectomy: what we have learned and where we are going. robodoc. Klein MD. php?id=1621924). Peter F. com/ releases/ 2007/ 05/ 070511203200. com/ about. Yonsei Med J 50 (2): 177-81. org/ robotics) [34] Lee. Fox News TV. sta. com/ assets/ the-robot-surgeon) [41] Robot Provides Guiding Hand (http:/ / health. Dundon JM. htm) [39] How is Prostate Cancer Detected? (http:/ / www. doi:10. Surgery. Branislav.3349/ymj. • Dharia SP. protomag. com/ article. google. jhu. Heeckt. • Pott PP. youtube. theprostatecentre. 2005 Oct. com/ search-results/ m/ 22119007/ the-robot-is-in. Curr Opin Pediatr.Total knee replacement: robotic assistive technique". G. Schwarz MLR. 31 March 2011. ISBN 978-1-4419-1125-4 . Robotics in reproductive medicine. . Computer and robotic assisted hip and knee surgery. [33] Children's Hospital Center for Robotic Surgery (http:/ / www. foxnews.. Scharf H-P. Steinmann & H.2. Anthony M. Retrieved May 7. Talamini MA. Hesse.Wiley. Mai. com/ about_us/ Specialist_Team/ Professor_Roger_Kirby. .J. 400) 116 Sources • Monkman. . Hente. PMID 19430547. discussion 558-9. 101-132. Retrieved May 7. Satava (Eds.J.177. B. ABC TV. edu/ projects/ needlesteering) [37] Johns Hopkins University: Needle Steering (http:/ / lcsr. R.Systems Applications and Visions. Robots : From Science Fiction to Technological Revolution. [30] ROBODOC history (http:/ / www. Frederic et al. Schunk – Robot Grippers . [45] The Prostate Centre (http:/ / www. com/ crozer/ 1818/ ). . 127–156. si/ en/ vest. In DiGioia. [44] "Robotic Assisted Prostatectomy" (http:/ / www. R.15(3):262-6. Larenzo xR3Nz0x Jun.". ISBN 019850943X. Nerlich . 2005. 2009. [35] Henry Ford Pioneers robotically controlled ultrasound probe (http:/ / detroit. Robotics and the pediatric surgeon. Mai. 14 1994 • Jacob Rosen . childrenshospital.50. html) [31] Acrobot Sculptor (http:/ / www. Kober. Elsevier 2004. com/ 2011/ 04/ 03/ henry-ford-pioneers-robotically-controlled-ultrasound-probe) [36] UC Berkeley: Needle Steering (http:/ / automation. Horgan S. Retrieved May 7. Fertil Steril 84:1-11. acrobot.2005. (Apr 2009). Monkman & M. com/ usnews/ health/ articles/ 060723/ 31robot_3. Richard M.2009. • Daniel Ichbiah. "Chapter 12 . 10. S.. 2003 Jun. Today’s State of the Art of surgical Robotics. S.. Sabine.com. html) [32] Siebert. Journal of Computer Aided Surgery. • Füchtmeier. (2004-12-30). Computer Enhanced Robotic Telesurgery Reduces Esophageal Perforation During Heller Myotomy. or-live. Blake Hannaford. Innovative Procedure Minimizes Prostate Incontinence After Prostatectomy (http:/ / www. G.2. Picard. Slovenian Press Agency. W. edu/ NeedleSteering) [38] Quick. sciencedaily. co. com/ videoplay?docid=-1942642524056655700& hl=en/ ). ns?id=mg18925366. Egersdoerfer. 2009.) (2011) Surgical Robotics . • Lorincz A. pp. htm/ ). [47] New Scientist Magazine. D.Injury .138(4):553-8. 2009. Oxford University Press. Orlive. • Campbell A. Rudolf.

the local Kalymnean Government erected a life-size statue of him.nlm. 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. Santa Cruz • "Doctor Robot. who became a local and national benefactor in Greece. The data could be transmitted in any place around the world. There Skevos developed a system that allowed him to examine a patient from a distance. influential. Virtues of the system were demonstrated in several experiments conducted in plenary sessions of the Athens Medical Society at the National University of Athens. there is a statue bust dedicated to Nikephoros Zervos.htm) Robots are set to revolutionize healthcare (International Electrotechnical Commission. this surgery was officially recognised by the Russian Surgeon Serge Voronoff. On March 7 1948. In 1910. In 1934. Skevos in his elder years married. the capital of the island Kalymnos. This operation was successful. Skevos was a Medical Professor of the School of Medicine at the National and Kapodistrian University of Athens. 239(1): 14–21. however he had no children.ncbi.roboticsurgery. I presume?" (http://www. a pioneer surgeon in Transplants and Telemedicine. the first high school set up in Kalymnos. Skevos was the first surgeon to perform the testicle transplantation from an ape to a man. Greece. July 2011) • Robotic Surgery . University of California. Diving for sponges is a part of the traditional diving heritage of Greece and the Aegean Sea.Bionics Lab.A Current Perspective (http://www. Skevos was born and raised in Kalymnos City or Pothia. The communication at this time could not be afforded and the system was not used.edu/research/surgical_index. also known as Skevos Zervos (Greek: Σκεύος Γεώργιος Ζερβός. As a posthumous honor. which was used as a steering wheel/base tied as a line of communication with the boat. In his honor the ’disease of the naked sponge divers’ was named ’Skevos Zervos disease’.com (http://www.soe. His scientific research was published in the Annals of the Athens Medical Society (1946–1956). . Skevos was a member of a local wealthy. In 1919.iec. This examination was concerning auscultation and cardiac pulses. he was a paragon of the Central Dodecanese Committee and was present in Rhodes.nih. His brother was a local prominent citizen called Kleanthes Zervos and his nephew was the local Christian Bishop of Kalymnos. returned the Dodecanese region to the then government of Greece.gov/pmc/articles/PMC1356187/) Annals of Surgery 2004 January.com/) • Robotic gynecological surgery in SE Michigan (http://www. distinguished and aristocratic family on the island.ch/etech/2011/etech_0711/ind-2. when the United Nations.davinciiobgyn. The family of Skevos had built the local hospital and local orphanage 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.com/services-procedures/) Skevos Zervos Skevos Georges Zervos[1] . Nikephoros Zervos whom in 1905 founded and established the Nikephoros High School. • roboticsurgery. 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. In front of the high school. 1875–1966) was a prominent Greek Professor. Skevos dived with a traditional and multi-purpose tool called a Skandalopetra. Skevos in his student years was a traditional free naked sponge diver in Kalymnos.ucsc.Robotic surgery 117 External links • Surgical Robotics (http://bionics. and through this they became local benefactors.html) .

References .87 Sources http://www. in the link below • http://babel. Since that historic event the interest in tele-audiology increased significantly.aspx?ID=355 http://conganat.hathitrust.htm) • A Catalogue of Paris Peace Conference delegation propaganda in the Hoover War Library.page=root.edu/ICVHAP/conferencias/017/history. 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.greekedirectory. Volumes 1-4. Revolution.num=86 • • • • • Tele-audiology Tele-audiology is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice. and Peace Stanford University Press.asp Skevos Zervos (1875-1966) and the first transplants of monkey testicles to a man (http://www.gr/History_of_Kalymnos/Kalymnos_in_the_19th_Century/index. Gregg Givens in 1999 in reference to a system being developed at East Carolina University in North Carolina. This term was first used by Dr. USA. The first Internet audiological test was accomplished in 2000 by Givens.org/cgi/pt?id=uc1. Balch and Keller. find-health-articles.Skevos Zervos 118 Reference [1] A Catalogue of Paris Peace Conference delegation propaganda in the Hoover War Library.com/the-Skandalopetra-Freediving-Games/2006/ http://kalymnos.size=125. 1926.kalymnos-hotels.seq=90.htm http://www.com/articleview.com/rec_pub_15726751-skevos-zervos-1875-1966-transplants-monkey-testicles-man. Hoover Institution on War.uninet.view=image.%24b584268. Volumes 1-4 p.agni.

html [3] http:/ / www. and field support during health emergency response. unvienna. Earth observation.) and to "tele-epidemiology" in this more restricted sense. the term often designates the cross-disciplinary area linking specifically the applications of satellite technologies for earth observations (remote-sensing) to epidemiological research. positioning systems. Geographical Information Systems. oosa. php?rubrique64 . html [2] http:/ / www. biostatistics. an industrial plant suspected of a point source contamination of air or water) or non-visible characteristics of a land area (for example. the term includes applications of all space-based systems to the field of epidemiology. the area of tele-epidemiology is closely related to the domain of landscape epidemiology. etc. org/ oosa/ SAP/ comm/ tele.) in the study of the space and time distribution of health events or disease process in populations. In this restricted sense. MEDES: [1] United Nation Office for Outer Space Affairs: [2] Redgems website [3] References [1] http:/ / www. fr/ home_fr/ telemedecine/ teleepidemiologie.. 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. In this broader sense. calculation of the NDVI index in relation to the distribution of species of mosquitoes) to assess health risk in surrounding populations. redgems. 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.Tele-epidemiology 119 Tele-epidemiology Tele-epidemiology is a methodological and application area of epidemiology concerned with the application of space-based systems (communication. org/ spip. telesurgery etc. The use of a satellite communication system to support the investigation of an infectious disease outbreak. the use of a remote-sensing satellite to recognize and locate physical features on Earth (for example.. By recent usage. External links Télé-épidemiologie. health surveillance.

These may include falls. tunstall. html) [3] Tunstall . In the UK it is grounded in the social care framework and focuses on the meaning described above. doctor or the emergency services. Some telecare. 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. providing the care and reassurance needed to allow them to remain living in their own homes. 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. Technologically more advanced systems use sensors. Technological advances result in the possibility of promoting independence and for providing care from the social initiative sector.Telecare 120 Telecare Telecare is a term given to offering remote care of old and physically less able people. and navigation/positioning systems. telecaretechnology. The meaning and usage of the term 'telecare' has not yet settled into consistent use. the movement monitoring[6] and more. It is important to note that 'telecare' is not just a warning system if someone strays from home but is also preventative measure whereby people are brought back and kept in the community through regular communication. as well as environmental changes in the home such as floods. uk/ en/ Publicationsandstatistics/ Publications/ PublicationsPolicyAndGuidance/ DH_4115303) [2] Independent Living Telecare (http:/ / www. whereby a range of potential risks can be monitored. or people at risk of falling. such as GPS for people with dementia or other cognitive impairments. Carers of people with dementia my be alerted if the person leaves the house or other defined area. Telecare is specifically different from telemedicine and telehealth. In its simplest form. which then automatically calls a 24-hour monitoring centre where trained operators can take appropriate action.Pill Dispenser (http:/ / www.[2] There are now a large range of telecare services available with some of the most well known being the pendant alarm[3] . whether it be contacting a local key holder. uk) . gov. dh. References [1] Building Telecare in England (http:/ / www. co. All play a role in maintaining people's independence and allowing people to stay in their own homes.Movement Monitoring (http:/ / www. fire and gas leaks. telephone prompt service [5] . it can refer to a fixed or mobile telephone with a connection to a monitoring centre through which the user can raise an alarm. uk) [5] Telecare Technology . 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. uk) [4] Pivotell . co. independentliving. uk/ telecare. justchecking.Telephone Prompt Service (http:/ / www. pill dispenser[4] .[1] Most telecare mitigates harm by reacting to untoward events and raising a help response quickly. The use of sensors may be part of a package which can provide support for people with illnesses such as dementia. com) [6] Just Checking . co. When a sensor is activated it sends a radio signal to a central unit in the user's home. 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.Pendant Alarm (http:/ / www. In other countries 'telecare' may be applied to the practice of healthcare at a distance. which now contemplates eCare. co. pivotell.

In real-time/ live interactive teledermatology applications. nih. telecommunication technologies are used to exchange medical information (concerning skin conditions and tumours of the skin) over a distance using audio. htm [3] http:/ / jada. Teldentistry can also be used to assist general dentists with spciality work. ada. visual and data communication. 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. 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). gov/ pubmed/ 11323836 [2] http:/ / www.[1] education. full Teledermatology Teledermatology is a subspecialty in the medical field of dermatology and probably one of the most common applications of telemedicine and e-health. they described the value of a teledermatologic service in a rural area underserved by dermatologists. Both participants must be available at the same time.Telecare 121 External links • International Society for Telemedicine & eHealth (http://www. It can be as easy as sending an email with a digital image of a lesion to seek advice for a skin condition. gov/ Research/ ResearchResults/ ScienceBriefs/ Archive/ archive2008/ December/ Teledentistry.isft. consultation and treatment as well as (continuous) education.net/) Teledentistry Teledentistry is the use of information technology and telecommunications for dental care.[1] In teledermatology. consultation. ncbi. 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.[2] The dermatologists Perednia and Brown were the first to coin the term “teledermatology” in 1995. and public awareness in the same manner as telehealth and telemedicine. org/ content/ 134/ 3/ 342. This mode generally requires more sophisticated and costly technology than used in the SAF mode. nih. .[3] References [1] http:/ / www. nidcr.[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.[2] and improveservices to undersrved populaitons such as in rural or lessdeveloped areas. It may also involve remote surgery and the use of telerobotic microscopes in dermatopathology. In a scientific publication. nlm.

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. melanoma). . epiluminescence microscopy) is the technical field of using an epiluminescence microscope for viewing skin lesions in magnification in-vivo. Digital dermoscopic images can be taken with a digital camera attached to a dermatoscope or special video cameras suited for dermoscopy.[4] Home telehealth/telehomecare involves an individual with a chronic condition being examined and managed remotely at home. Teledermatology can help to reduce the time and costs involved in the follow-up of such conditions. e. In this field. mobile applications of teledermatology gain importance.[5] Education and information Medical education/continuous education are a major advantage of telemedicine/e-health. it could be very valuable in the near future. This can be done on the web-based telediagnostic network Campus Medicus [8] Dermoscopy (dermatoscopy. It is particularly useful in the early detection of malignant skin lesions (i. The specialist then helps the GP in rendering a diagnosis. 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. They are also able to join peer support groups with others affected by the same condition. as a triage tool. providing management options et cetera. the FotoFinder. such as individuals affected by a skin condition. through the internet. computer based training and Web applications in this field principally aimed at medical students.. digital dermoscopic lesion images (with or without clinical images) are transmitted electronically to a specialist for examination. particularly in dermoscopy. It requires active participation of the individual and without appropriate guidance may lead to improper management.[7] Domains with special interest Teledermoscopy In teledermoscopy.[6] General medical/health information may be accessed by non-professionals. and their relatives. Telediagnosis in the absence of personal contact with health care workers to the individual is complex. 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. Since dermoscopy is based on examination of a two-dimensional image it is very well suited for digital imaging and teledermatology. leading the individual directly to the appropriate specialist for his/her disease. Specialist training courses via internet are also available. Numerous universities offer online courses.Teledermatology 122 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.g.e. However.

vitiligo.[14] .e. In the everyday clinical setting. Some studies have observed that eczema and follicular lesions were diagnosed with relatively more certainty.e.[12] [13] Suitability of cases for Teledermatology Not all cases are suitable for teledermatology. Unlike in western studies where pigmented lesions suspicious of melanomas are one of the most referred cases for teledermatology (with or without teledermatoscopy). referral based on the severity and character of their skin condition). mobile teledermatology seems to be especially suited for patient filtering or triage. Another possible practical application is for follow-up of individuals with chronic skin conditions mentioned above (see home care). acne vulgaris. skin biopsies are taken by the physician directly responsible for the individual and are assessed by a dermatopathologist. (i. In order to facilitate access to medical advice and enable individuals to play a more active role in managing their own health status. and superficial bacterial and fungal infections. These limitations can be overcome by teledermoscopically-aided dermatopathology whereby a patient history and clinical data may increase the sensitivity of diagnosis.The type of cases suited for teledermatology is a topic.while in some other studies it was seen that diagnoses were made with more certainty in cases like viral warts. for instance) uses wireless or mobile equipment[11] (i. These can be then assessed on a computer screen similar to conventional microscopy. 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.[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. allowing the pathologist to maneuver around the image and view every part of the slide at any magnification.Teledermatology 123 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). This pathologist has most likely never seen the clinical aspect of the lesion and might not have any information about the person. which requires more studies. herpes zoster. irritant dermatitis.[10] Additionally it has been shown that provision of such data may improve the level of diagnostic confidence held by the assessing dermatopathologists. 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. In the latter method (SAF) a rather new development is the introduction of virtual slide systems (VSS). handheld devices). Mobile Teledermatology Mobile telemedicine is a system in which at least one participant (the person seeking advice or the doctor. Asian studies have fewer cases referred based on the suspicion of melanoma. in contrast to conventional stationary telemedicine platforms. mobile phones.

1371/journal. 2007 Dec. Argenziano G: telederm. Wurm et al. net [12] Ebner et al. Human Pathol. Dong H. Soyer HP.see http://dx. Lozzi G P.P. Brown NA.: EDF White Book. Arch Derm [6] see http:/ / www. Evaluating Patient Acceptance of a Teledermatology Link. Leinweber B. 2006 e&i [13] http:/ / www.155(3):546-51 • Scheinfeld N. 2007 • Soyer HP. Soyer H P. 4:148-151 • Massone C. Dietz K. 2006. dermnetnz.: Mobile Teledermatology coming of age. Arch Dermatol. Žgavec B. com [9] Massone et al.pmed. org/ icot/ sigtelederm. Gabler G. Fisher M. Kerl H. Blum A. Di Stefani A. Lozzi GP. Gabler G. Vassilaki I. JDDG 6:106-12. campusmedicus. Skinmed. Zelger B. nih. Bugatti L.org/10. Burg et al.: Correlation with digital dermoscopic images can help dermatopathologists to diagnose equivocal skin tumours. htm [2] Wooton et al. Soyer H. Gabler G. Hofmann-Wellenhof R. (2005): Teledermatology In: Frisch P.org: Freely Available Online Consultations in Dermatology. 83(1): 42–47 • Wurm EM. Brown 1995 Bull Med Libr Assoc [4] see http:/ / www. Oakley A: Teledermatology. Br J Dermatol. medunigraz. at/ IDD [7] see http:/ / www. Long H.: Feasibility and diagnostic agreement in teledermatopathology using a virtual slide system. Salmhofer W. Soyer HP. Royal Society of Medicine Press Ltd.Teledermatology 124 Footnotes [1] http:/ / www. 2002 • Burg G. org [8] http:/ / www. Janjua S. e & i. Metzler G. Mehregan C. Indian J Dermatol Venereol Leprol 2009. 130-133 • Perednia DA. Venkitakrishnan S.doi. Soyer HP. Teledermatology: Clinical case profiles and practical issues. Soyer HP. Asgari M. 2(4): e87 . Hofmann-Wellenhof R. fcgi?artid=1868781& blobtype=pdf [14] Kaliyadan et al. Wurm EM. Genis P. 1995.0020087 • Binder B.: Teledermatology: one application of telemedicine. 2009 Indian J Dermatol Venereol Leprol References • R Wootton R.2:159-167. Kerl H. Rongioletti F. . 2007 JDDG.75:32-5. Massone C. Burgdorf W. "PMID 14673291" • Kaliyadan F. Leinweber B. 38(4): 546-554 • Bauer J. Chimenti S. Skin Diseases in Europe. handyscope. Bull Med Libr Assoc. Fezal Ozdemir F. Mashayekhi V. org/ [5] Binder et al. Ferrara G. PLoS Med 2005. BoldrinI R. • Ebner C. pubmedcentral. Berlin. 2007. gov/ picrender. 2003. 2008. 2005 Roy soc of med press. 2007 Human Pathology [10] Bauer et al. atmeda. Wurm R. Kodama K.: Teledermatological monitoring of leg ulcers in cooperation with home care nurses. Hofmann-Wellenhof R. Hofmann-Wellenhof R. Cerroni L. 2006.143(12):1511-4. Massone C. Canzonieri V. telederm. * A. Hofmann-Wellenhof R. 2005 Teledermatology [3] Perednia. Garbe C. 2006 Br J Dermatol [11] http:/ / www.: Telemedizin und Teledermatologie: Vergangenheit Gegenwart und Zukunft. Leitz N. Okcu A.

Types of telemedicine Categories Telemedicine can be broken into three main categories: store-and-forward.Telemedicine 125 Telemedicine Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. Store-and-forward telemedicine involves acquiring medical data (like medical images.S. A properly structured medical record preferably in electronic form should be a component of this transfer. Early forms of telemedicine achieved with telephone and radio have been supplemented with videotelephony. radiology. 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.[2] It does not require the presence of both parties at the same time. administration. as well as the transmission of medical. it is essentially a product of 20th century telecommunication and information U. electronic medical records. Early precursors In its early manifestations. and additionally with telemedical devices to support in-home care.[3] The term eHealth is often used. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination. imaging and heath informatics data from one site to another.K. and research. which are frequently used to denote broader definitions of remote healthcare not always involving active clinical treatments. and other components of health information technology. and Europe. Navy medical staff being trained in the use technologies. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. biosignals etc. . and pathology are common specialties that are conducive to asynchronous telemedicine. African villagers used smoke signals to warn people to stay away from the village in case of serious disease.) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. people living in remote areas of Australia used two-way radios. as an umbrella term that includes telehealth. patient and medical staff with both convenience and fidelity. These technologies permit communications between of handheld telemedical devices (2006).[2] Telehealth and eHealth are at times incorrectly interchanged with telemedicine. to communicate with the Royal Flying Doctor Service of Australia. advanced diagnostic methods supported by distributed client/server applications. Although there were distant precursors to telemedicine. particularly in the U. remote monitoring and (real-time) interactive services. Like the terms "medicine" and "health care".[4] [5] In the early 1900s. It is also used to save lives in critical care and emergency situations.[1] Dermatology (cf: teledermatology). It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. powered by a dynamo driven by a set of bicycle pedals.[1] Disambiguation Other expressions similar to telemedicine are the terms "telehealth" and "eHealth".

Telemonitoring is a convenient way for patients to avoid travel and to perform some of the more basic work of healthcare for themselves. In addition to objective technological monitoring. Some of the more common things that telemonitoring devices keep track of include blood pressure. This questioning can take place automatically over the phone. Twelve hospitals in the U. or asthma. Spain. a patient will have a number of monitoring devices at home. Lisbon and Toulouse.[7] Telemedicine can be used as a teaching tool. also known as self-monitoring or testing. supply greater satisfaction to patients.Telemedicine Remote monitoring. discuss and assess patient issues as if they were in the same room. and fewer or shorter hospital stays. Recent developments in mobile collaboration technology with the use of hand-held mobile devices allow healthcare professionals in multiple locations the ability to view. psychiatric evaluations and ophthalmology assessments can be conducted comparably to those done in traditional face-to-face visits. the MDphone.S. diabetes mellitus. In general. S. physical examination. served as receiving and treatment centers. while the patient may not have to travel or wait the normal distances or times like those from conventional hospital or GP visits. enables medical professionals to monitor a patient remotely using various technological devices.Eric Wachtel.[6] 126 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. and the results of these devices will be transmitted via telephone to the health care provider.shared health professional staffing.[1] Many activities such as history review. more effective or faster examination techniques. "Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases. most telemonitoring programs include subjective questioning regarding the patient's health and comfort. show and instruct medical staff in another location. by which experienced medical staff can observe. Chile. Interactive telemedicine services provide real-time interactions between patient and provider. such as heart disease.[8] The first interactive telemedicine system. blood glucose. reduced travel times. 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. Patients who live in such areas can be seen by a doctor or specialist. Telemonitoring is capable of providing information about any vital signs. These services can provide comparable health outcomes to traditional in-person patient encounters. weight. online communication and home visits. 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. heart rate. 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. as .[9] Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. Aircraft and maritime emergencies are also handled by SAMU centres in Paris. operating over standard telephone lines. who can provide an accurate and complete examination." Several studies have documented increase patient satisfaction of telemedicine over past fifteen years. A year later the company introduced a mobile cellular version. In addition. and may be cost-effective. and hemoglobin. “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. Brazil. to include phone conversations. It improved access to healthcare for patients in remote locations.

rural. Once those steps are done. As a field it is part of telehealth. an increase in the number of aging and chronically ill population. In developing countries a new way of practicing telemedicine is emerging better known as Primary Remote Diagnostic Visits. Among its benefits. Florida. such as telediagnosis. an Indian Ayurvedic doctor and the Director of Jiva Ayurveda.” 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. and the increase in coverage of health care to distant. whereby a doctor uses devices to remotely examine and treat a patient. and the printing and scanning of labels. small or sparsely populated regions. There were one base pharmacy and five remote clinics in several areas of Spokane. 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. This new technology and principle of practicing medicine holds significant promise of improving on major health care delivery problems. A greater degree of job satisfaction has been registered among telenurses.S. to reduce distances and save travel time. training. such as providing education. in for instance. The label is also generated simultaneously. 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. patient counseling. and has many points of contacts with other medical and non-medical applications.[11] A notable telepharmacy program is in the United States. Southern Africa. the pharmacist verifies the hard copy and enters the order.[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. conducted at a federally qualified community health center.Telemedicine long as the patient has the necessary monitoring equipment at his or her location.[12] In recent time. and the label queue is transmitted to the remote site. When the label queue appears on the medication dispensing cabinet known as ADDS. the provider may check these statistics on a daily or weekly basis to determine the best course of treatment. Washington under the telepharmacy program at CHAS. the U. It encompasses drug therapy monitoring. “The base pharmacy provided traditional pharmacy study to the clients at Valley clinic and served as the hub pharmacy for the other remote clinics. telenursing may help solve increasing shortages of nurses. The telepharmacy program was piloted in 2006 “in the regions served by Naval Hospital Pensacola. the authorized person can access the medicine from ADDS followed by medication barcode scanning. prior authorization. which allowed the low cost medication dispensing under federal government’s program. In addition. and performing several management functions. and Naval 127 . telemonitoring. Community Health Association of Spokane (CHAS) in 2001. but has the promise to diagnose and manage the diseases patients will typically visit a general practitioner for. refill authorization. The first Ayurvedic telemedicine center was established in India in 2007 by Partap Chauhan. or between any number of nurses. because Primary Remote Diagnostic Consultations not only monitors an already diagnosed chronic disease. Telenursing is achieving significant growth rates in many countries due to several factors: the preoccupation in reducing the costs of health care. monitoring formulary compliance with the aid of teleconferencing or videoconferencing. Depending on the severity of the patient's condition. This program utilized videotelephony for dispensing medication and patient counseling at six urban and rural clinics. teleconsultation. video-conferencing is vastly utilized in pharmacy for other purposes. etc. Navy Bureau of Medicine took a significant step in advancing telepharmacy worldwide. These remote monitoring solutions have a focus on current high morbidity chronic diseases and are mainly deployed for the First World. and to keep patients out of hospital. the remote site personnel are connected to the pharmacist at base pharmacy via videoconferencing for medication verification and patient counseling.

In the United States. audiology. the State University of New York at Buffalo. and clinical therapy. This endeavor has recently (2006) expanded as a teletherapy application for cognitive skills enhancement programs for school children. and physical therapy. excellent research is conducted in Australia and Europe. and the National Rehabilitation Hospital in Washington DC. Other federal funders of research are the Veterans Administration. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance. in varying degrees. Telerehabilitation can deliver therapy to people who cannot travel to a clinic because the patient has a disability or because of travel time. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh. the National Institute on Disability and Rehabilitation Research's (NIDRR) [16] supports research and the development of telerehabilitation.” Starting from March 2010. Washington. it is more likely that insurers and Medicare will cover telerehabilitation services. only a few health insurers in the United States will reimburse for telerehabilitation services. Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy.[18] . If the research shows that teleassessments and teletherapy are equivalent to clinical encounters. and (2) building new data collection systems to digitize information that a therapist can use in practice. the Health Services Research Administration in the US Department of Health and Human Services. 128 Specialist care delivery Telemedicine can facilitate specialty care delivered by primary care physicians according to a controlled study of the treatment of hepatitis C. Tele-audiology (hearing assessments) is a growing application. According to Navy Lieutenant Justin Eubanks at Navy Hospital Pensacola. Florida. telepharmacy would be initiated at more than 100 Navy sites covering four continents by the end of 2010. phone lines. the Navy expanded its telepharmacy system to more sites throughout the world. Outside the United States. Rich internet applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) was first introduced in 2001. It is most widely used for neuropsychological rehabilitation. speech-language pathology.[13] Telerehabilitation Telerehabilitation (or e-rehabilitation[14] [15] ) is the delivery of rehabilitation services over telecommunication networks and the Internet. the inventor of the ECG. braces or artificial limbs. and in speech-language pathology. and the Department of Defense. the Rehabilitation Institute of Chicago. actually did tests with transmission of ECG via telephone lines. As of 2006. can be transmitted using telephone and wireless. In 1906 Einthoven came up with a way to transmit the data from the hospital directly to his lab. videoconferencing. videophones and webpages containing rich Internet applications. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology. occupational therapy. Telecardiology ECGs. perhaps because these two disciplines are more “hands on”. telerehabilitation in the practice of occupational therapy and physical therapy are very limited. or electrocardiographs. in the future. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice. fitting of rehabilitation equipment such as wheelchairs. As of 2006 the most commonly used modalities are via webcams.Telemedicine Hospital Bremerton.[17] Various specialties are contributing to telemedicine. Most types of services fall into two categories: clinical assessment (the patient’s functional abilities in his or her environment). This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. Most telerehabilitation is highly visual. Willem Einthoven. As of 2006.

telepsychiatry policy. also utilizes videoconferencing for patients residing in underserved areas to access psychiatric services.[20] Telepsychiatry Telepsychiatry. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. 129 . The following are some of the model programs and projects which are undergoing for implementation of telepsychiatry in rural areas in the US. JPMC Karachi and Holy Family Rawalpindi.500 patients being treated per month per hub. educational clinical program. Three hub stations through were linked via the Pak Sat-I communications satellite. This system was also used to monitor patients with pacemakers in remote areas.K. Mantri using an indegenous technique for the first time in India. which is helpful for purposes of telecardiology. In Pakistan three pilot projects in telemedicine was initiated by the Ministry of IT & Telecom. and four districts were linked with another hub. Transmission was also done through telephone lines.[19] In addition. Links for several sites related to telemedicine. Makhija. diagnosis and assessment. These 12 remote sites were connected and on average of 1. such as consultation between the psychiatrists. Walter Reed Army Medical Center. 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. The ECG output was connected to the telephone input using a modulator which converted ECG into high frequency sound. guidelines. The project was still running smoothly after two years. Ajai Shanker. Transmission using wireless was done using frequency modulation which eliminated noise. University of Colorado Health Sciences Center (UCHSC) supports two programs for American Indian and Alaskan Native populations a. The ECG was converted to sound waves with a frequency varying from 500 Hz to 2500 Hz with 1500 Hz at baseline. P. It offers wide range of services to the patients and providers. S. and networking are available at the [21] website for the American Psychiatric Association.Telemedicine Teletransmission of ECG using methods indigenous to Asia One of the oldest known telecardiology systems for teletransmissions of ECGs was established in Gwalior. India in 1975 at GR Medical college by Dr. The Center for Native American Telehealth and Tele-education (CNATT) and b. another aspect of telemedicine. etc. Three hubs were established: the Mayo Hospital (the largest hospital in Asia). Dr. medication therapy management. Telemental Health Treatment for American Indian Veterans with Posttraumatic Stress Disorder (PTSD) 2. A 312 Kb link was also established with remote sites and 1 Mbit/s bandwidth was provided at each hub. The central control unit at the ICU was able to correctly interpret arrhythmia. Military Psychiatry. electronic stethoscopes can be used as recording devices. 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). This technique helped medical aid reach in remote areas. 1.

.. journal. patents for robotic telepathology systems and telepathology diagnostic networks.[22] For this process to be implemented. a transmission network. US. A number of clinical telepathology services have benefited many thousands of patients in North America.S.) from one location to another. PET/CT. coined the term “telepathology” in 1986. they do not need particular workstations to view the images . Weinstein is known to many as the "father of telepathology". The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes.[29] This is still in operation. three essential components are required. an image sending station.M. The radiographic image and a modem or other connection are required for this first step.D. Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989.[25] He. a standard Personal Computer (PC) and Digital Subscriber Line (DSL) connection is enough to reach keosys central server. and Asia. The use of “television microscopy”. and a receiving-image review station. Therefore. Weinstein. and research. the forerunner of telepathology. In an editorial in a medical . The image is scanned and then sent via the network connection to the receiving computer. A pathologist.Telemedicine Teleradiology Teleradiology is the ability to send radiographic images (x-rays. published the first scientific paper on robotic telepathology. CT. SPECT/CT. No particular software is necessary on the PC and the images can be reached from wherever in the world. education. Telepathology has been successfully used for many applications including the rendering histopathology tissue diagnoses.[23] [24] Performance of telepathology requires that a pathologist selects the video images for analysis and the rendering diagnoses. is the mode of choice for telepathology services in developed countries. and his collaborators. decades later. Ronald S. MG. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis. The most typical implementation are two computers connected via the Internet. for education. at a distance. Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. Telepathology Telepathology is the practice of pathology at a distance. MR. 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. Although digital pathology imaging.[26] Weinstein was also granted the first U. Europe. Sometimes the receiving computer will have a printer so that images can be printed for convenience.. 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. analog telepathology imaging is still used for patient services in some developing countries. and for research. including virtual microscopy.[28] In Norway. 130 A CT exam displayed through teleradiology The teleradiology process begins at the image sending station.[27] Dr. Teleradiology is the most popular use for telemedicine and accounts for at least 50% of all telemedicine usage.

Remote surgery combines elements of robotics. education.[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. Tele-audiology Tele-audiology is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice. cutting edge communication technology such as high-speed data connections and elements of management information systems. most of these robots are controlled by surgeons at the location of the surgery. obtaining this license in each state could be an expensive and time-consuming proposition. passing additional oral and written examinations. Typically.[32] Teledentistry Teledentistry is the use of information technology and telecommunications for dental care. and traveling for interviews. Even if the practitioner never practices medicine face-to-face with a patient in another state. Applications comprise health care management such as diagnoses.S. consultation. 131 U. 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. and public awareness in the same manner as telehealth and telemedicine.[33] Physicians who will be prescribing 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.Telemedicine Teledermatology Teledermatology is a subspecialty in the medical field of dermatology and probably one of the most common applications of telemedicine and e-health. 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. . It is a form of telepresence. If a practitioner serves several states. Balch and Keller. 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.[31] The dermatologists Perednia and Brown were the first to coin the term “teledermatology” in 1995. While the field of robotic surgery is fairly well established. telecommunication technologies are used to exchange medical information (concerning skin conditions and tumours of the skin) over a distance using audio. he/she still must meet a variety of other individual state requirements. The first Internet audiological test was accomplished in 2000 by Givens. USA. In a scientific publication. A number of States require practitioners who seek compensation to frequently deliver interstate care to acquire a full license.[30] In teledermatology. including paying substantial licensure fees. visual and data communication. 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. The first Transatlantic teleaudiology test was performed in April 2009 when Dr James Hall tested a patient in South Africa from Dallas. consultation and treatment as well as (continuous) education.

and insurers. Broad and consistent utilization of HIT will: • • • • • • Improve health care quality. essentially the same as slow scan TV systems. 2006). Interoperable HIT will improve individual patient care. providers.[35] 132 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. Reduce health care costs. Increase administrative efficiencies Decrease paperwork. for communication between people in real-time. videotelephony also included image phones which would exchange still images between units every few seconds over conventional POTS-type telephone lines. without the need for patients to travel beyond their local hospital.Telemedicine Remote surgery is essentially advanced telecommuting for surgeons. government and quality entities. It promises to allow the expertise of specialized surgeons to be available to patients worldwide.. where the physical distance between the surgeon and the patient is immaterial.[36] At the dawn of the technology. 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. but it will also bring many public health benefits including: • Early detection of infectious disease outbreaks around the country. and • Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared. 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. safety and efficiency of the health delivery system (Chaudhry et al. Health information technology (HIT) is in general increasingly viewed as the most promising tool for improving the overall quality. and Expand access to affordable care. . Prevent medical errors. 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. • Improved tracking of chronic disease management.

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"Virtually On-sight" (http:/ / www. Visvikis. Kristi. pg. . Department of Computer Science. jsp?arnumber=1717870). 1056/ NEJMoa1009370). [5] Nakajima. cfm?ID=1263). ISBN 9780276420146. Tanuma. [11] Angaran.189. Vol. 67:1134-36 [14] E-health care information systems: an introduction for students and professionals. "Navy takes Telepharmacy Worldwide". Szymas. Selby. Jeffrey Dunkelberg. Gilbertson.edu) 2. "Telepathology and the networking of pathology diagnostic services. org/ Departments/ HSF/ UnderservedClearinghouse/ Linkeddocuments/ telepsychiatry. Just for Canadian Doctors. Vol. Ilias. "Provision of Pharmacy Services to Underserved Populations Via Remote Dispensing and Two-Way Videoconferencing. Dunn BE (editors).15: 1091–1100. EA. Principles and Practice of Emergency Medicine. Ohl. Karen Lance. Second Edition. Retrieved 2011-03-26. 280 . S. eHealth Insider website.". 1982. Byer. Kumar S. DOI: 10. AM. Springer. Karla Thornton.280-282. 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Concepts. Videotelephony (http:/ / encyclopedia2. "Telecommunications.com website. com/ media.telemed. [35] IST's Media Collection (http:/ / www. Retrieved 21 August 2011. January 9. 280–282.teladoc.Telemedicine at the National Institutes of Health (http://telesynergy. Development.aspx) . asp?path=telemed101&article=tmcoming_nb_tie96.icucare.telemed.Making the Connection for Health (http://www. Armin Gärtner • Telemedicine 101: Telemedicine Coming of Age (http://tie. ahrq. by Robert Higgs (www.org) Canadian Society of Telehealth (http://www. pp.com/PageFiles/Telemedicine.Telemedicine for the Medicare Population (http://www.php) National Rural Health Association (http://www.xml) .net) American Psychiatric Asscoiation (http://www. and Management".pdf) . thefreedictionary.psych.americantelemed. Retrieved from the FreeDictionary.gov) Telemedicine History (http://www. Glencoe/McCgraw-Hill Company.com website.htm) Ontario Telemedicine Network -. John Blyth. MedLicense.Telemedical Systems and regulatory affairs for Europe.com/) Teladoc. by Dipl. com/ Videotelephony). medlicense. Second Edition. [34] MedLicense.1990. • Teleneurology and requirements of the european Medical Devices Directive (MDD) (http://www. 2010 134 Further reading • W.telmedpak. html). [36] McGraw-Hill Concise Encyclopedia of Engineering.com website.gov/clinic/epcsums/telemedsum. com/ telemedicine_advice.icucare. medlicense. Interface Surgical Technologies website. MedLicense.edu/communications/vistas/archive/02-summer/stories/ miracle-of-telemedicine.org/Departments/HSF/UnderservedClearinghouse/ Linkeddocuments/telepsychiatry.org) Telemedicine Information Exchange (http://tie. 2002. Telemedicine Pakistan(TelmedPak) (http://www.Telemedicine 101: Telemedicine Coming of Age. McGraw-Hill.ttu.org/articles/article.cst-sct.nih.Practical Advise for Physicians Who Are Involved In Telemedicine (http:/ / www.ATAwiki. Ing.php?id=37&L=1) . intersurgtech.otn.ca) American Telemedicine Association (http://www.org) Agency for Healthcare Research and Quality (AHRQ) -.org) International Society for Telemedicine & eHealth (ISfTeH) (http://www. html). Brown 1995 Bull Med Libr Assoc [33] Information Provided for Physicians: Doctors Seeking a Medical Licensing Service (http:/ / www.nrharural.baaske.org) TELESYNERGY .Telemedicine [32] Perednia. by Nancy Brown • What is Telemedicine? (http://www. html).net/ index.com) External links • • • • • • • • • • • • • Telemedicine and Telehealth (http://www. com/ telemedicine_license.What is Telemedicine?.com) Wiki for telemedicine (ATAwiki) (http://www.com .depts.isft.

telemonitoring.. etc. tmhguide. Among its many benefits. such as telediagnosis. teleconsultation. A greater degree of job satisfaction has been registered among telenurses. Despite the early success of telemental health care services however. internet. while showing early promise. or live in remote or difficult to reach places. In normal home health care. will likely require considerable development to be made practical. telenursing may help solve increasing shortages of nurses. such as neural degenerative diseases (Parkinson's disease. ALS). [Needs source] A common application of telenursing is also used by call centers operated by managed care organizations. While telecommunications have been used for decades to provide some mental health services (usually on an emergency basis or for experimental purposes). org 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. videoconferenced consultations on routine and urgent mental health cases using a "virtual" case management team. External links • Telemental Health Guide [1] References [1] http:/ / www. due to several factors: the preoccupation in driving down the costs of health care. and providing direct mental health care services through two-way interactive systems. patients who are immobilized. etc. For example. typically as a result of geographic isolation.[1] Applications One of the most distinctive telenursing applications is home care. information and counseling as a means of regulating patient access and flow and decrease the use of emergency rooms. such as chronic obstructive pulmonary disease. may stay at home and be "visited" and assisted regularly by a nurse via videoconferencing. it was only in the 1990s that telemental health care services truly came into their own. Examples of telemental health services include providing health workers in remote areas with continuing education on mental health topics. One of the most controversial telemental health care applications is providing treatment services over the Internet directly which. or between any number of nurses. one nurse is able to visit up to 5-7 patients per day. etc. handicapped individuals. Alzheimer's disease. Telenursing is achieving a large rate of growth in many countries. and to keep patients out of hospital. small or sparsely populated regions. one nurse can “visit” 12-16 patients in the same amount of time. diabetes. or disabilitating diseases. rural. Using telenursing. citizens who have chronic ailments. ostomies. . wide-scale implementation remains dependent on policy and funding initiatives although the outlook remains positive. to reduce distances and save travel time. the care of wounds. and the increase in coverage of health care to distant. As a field it is part of telehealth. videophone. congestive heart disease.Telemental Health 135 Telemental Health Telemental Health is the use of telecommunications technology to provide mental health services to individuals in communities or locations that are underserviced. 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. Still other applications of home care are the care of patients in immediate post-surgical situations. and has many points of contacts with other medical and non-medical applications. etc.

net Telehealth: Issues for Nursing (http://www. (http:// www. August 1999. htm#nursing).org/news/selected2004. Nurse Triage site specializing in personalized health information and support (http://www.com/Nursing/Telenursing/). May.org/articles/article.ncsbn. Telenursing (http://www. By Simpson. com/ news/ item. American Nursing Association. eHealth Insider website. IOS Press. cfm?ID=1263).ana.ch/matters_telenursing. healthcontactpartners.com/). International Council of Nurses. Telehome Care Clinical Guidelines^ (http://www. Says International Survey (http:/ / www. ethical and regulatory issues Telenursing is fraught with legal. ethical and regulatory issues.htm).icn. By Charles C Sharpe. there are many considerations related to patient confidentiality and safety of clinical data. International Council of Nurses. AFIP. e-health-insider.asp?path=articles& article=telenursingLicensure_gw_tie02. TeleNurse First.ch/bookshop. Powerpoint presentations during the Annual Conference of the American Telemedicine Association. Nursing Risk Management 2002. Telehealth: Are you at risk? (http://www.xml).atmeda.bne. References Notes [1] Nurses Happier Using Telecare.tx. and assistance to physicians in the implementation of medical treatment protocols. Martin. In addition.org/Departments/legalmed/jnrm2002/georgia.pdf).atmeda. Hasman. By Glenn W.htm).allhealthnet.Telenursing Telenursing can also involve other activities such as patient education. 2001.htm) External links • • • • • • • • • Post discharge follow-up calls (http://www.org/readroom/tele2. 504 pg.org/news/list. Wachter. Board of Nursing Examiners. AllHealth.telenursefirst. 15 June 2005. A. 136 Legal. 280 pg. are also still largely unsolved and difficult to address. 2000.telemed.htm) By Georgia A. Legal issues such as accountability and malpractice. New nursing technologies: What you need to know (http://www.com/p/articles/mi_qa3689/ is_199708/ai_n8760283). Roy L.org/news/selected2003. American Telemedicine Association.icn. In many countries. Telenursing and Licensure (http://www. retrieved 2009-04-04. Mantas.findarticles. 2002.com/) The National Council of State Boards of Nursing Position Paper on Telenursing: A Challenge to Regulation (http://www. 2002.html). as it happens with telehealth as a whole. 40 pg. examination of results of medical tests and exams.us/telenurse.org/public/news/res/Telenursing Paper. nursing teleconsultations. • Textbook in Health Informatics: A Nursing Perspective.htm).afip. Bibliography • Telenursing: Nursing Practice in Cyberspace. Edited by J. etc. • International Standards for Telenursing Programmes. Nursing. August 1997.htm#nursing) and Telemedicine Applications in Telenursing 2004 (http://www.atmeda. Telenursing Fact Sheet (http://www. • • • . 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). The National Council of State Boards.state. Telemedicine Applications in Telenursing 2003 (http://www. Interstate Licensure for Telenursing (http://tie. TIE.

there are drawbacks to each.[4] Weinstein was also granted the first U. 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. the consultant actively operates a robotically controlled motorized microscope located at a distant site—changing focus. The use of “television microscopy”. analog telepathology imaging is still used for patient services in some developing countries. He.M.Telenursing Working Group 137 Telepathology Telepathology is the practice of pathology at a distance. and virtual slide systems. In an editorial in a medical [3] journal. and for research. introducing their own workflow challenges in . for education. Virtual slide telepathology is emerging as the technology of choice for telepathology services. over the Internet. education. decades later. With real-time systems. Weinstein is known to many as the "father of telepathology". Virtual slide systems utilize automated digital slide scanners that create a digital image file of an entire glass slide (whole slide image). published the first scientific paper on robotic telepathology. from a distance. including virtual microscopy. illumination.isft. They have the significant drawback in only being able to capture a selected subset of microscopic fields for off-site evaluation.[6] In Norway. Europe.net) . Weinstein. coined the term “telepathology” in 1986. Telepathology has been successfully used for many applications including the rendering histopathology tissue diagnoses. is the mode of choice for telepathology services in developed countries. using a [8] browser. Static image systems have benefits of being the most reasonably priced and usable systems. virtual slide digital files are relatively large. Expense is an issue with real-time systems and virtual slide systems as they can be costly. patents for robotic telepathology systems and telepathology diagnostic networks. 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. Digital imaging is required for virtual microscopy. Storing and simultaneously retrieving large numbers of telepathology whole slide image files can be cumbersome. Types of telepathology systems Telepathology systems are divided into three major types: static image-based systems. and research. Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989.D.[1] [2] Performance of telepathology requires that a pathologist selects the video images for analysis and the rendering diagnoses. magnification.[7] This is still in operation. but performance may suffer if employed during periods of high network traffic or using the Internet proper as a backbone. at a distance. Also.[5] Dr. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis. A pathologist. and field of view—at will. While real-time and virtual slide systems offer higher diagnositc accuracy when compared with static-image telepathology. Either an analog video camera or a digital video camera can be used for robotic microscopy. 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.S. Although digital pathology imaging. high throughput virtual slide scanners (those producing one virtual slide or more per minute) are currently expensive. Ronald S. A number of clinical telepathology services have benefited many thousands of patients in North America.Telenursing • International Society for Telemedicine & eHealth (ISfTeH) (http://www.. However. Real-time robotic microscopy systems and virtual slides allow a consultant pathologist the opportunity to evaluate histopathology slides in their entirety. the forerunner of telepathology. often exceeding one gigabyte in size. Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. and his collaborators. This file is stored on a computer server and can be navigated at a distance. real-time systems. Real-time systems perform best on local area networks (LANs).

LA. and skin pathologist ([dermatopathologist]). Kiehl. DL. "Primary frozen section diagnosis by robotic microscopy and virtual slide telepathology: the University Health Network experience. I. Ordonez. Hum Pathol 38: 546–554 [13] Dee. R.[13] compentency assessment.[9] primary histopathology diagnoses. Start RD. AR. Dennis T. JT. FR (2009). et al (1991). Weinstein (1999). 41:91-109. union. Choi. Dee. Leinweber. . TH.. Hum Pathol 1997. Kerr. KJ (1987).Telepathology the clinical laboratory. Gabler. Galgano MT. education. 38:1330-4. K. Ghazarian. "Digital pathology virtual slide technology in tissue-based diagnosis. Szymas.". "Telepathology: An Audit". Scott. Recla. "Feasibility and diagnostic agreement in teledermatology using a virtual slide system".. Kreiter. Lian. Hum Pathol 40: 1122–1128 Bibliography • Cross SS. In: Telepathology (Springer-Verlag Berlin Heidelberg): 225–229 [3] Weinstein. [10] [11] [12] second opinion diagnoses. Clarke.[14] and research. Histopathology 2002. Leaven. for immediate consultations. Telepathology: current status and future prospects in diagnostic histopathology. Another benefit can be gaining direct access to subspecialty pathologists such as a kidney pathologist (renal pathologist). AK. Arch Path Lab Med 111: 646–652 [5] Kayser. BA. 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. J. Hum Pathol 17: 443-434 [4] Weinstein. RS. • Frierson HF Jr. H. Molnar. B. HP. C. Wagenman. G. Chetty. LC. subspecialty pathology expert diagnoses. Current experiences with internet telepathology and possible evolution in the next generation of Internet services. Hum Pathol 40: 1112–1121 [14] Bruch. Rinde. "Telepathology and the networking of pathology diagnostic services. Richter. Grasso. GP. Hum Pathol 40: 1129–1136 [12] Massone. Kumar S. BP. "Competency assessment of residents in surgical pathology using virtual microscopy.". Graham AR. Diagnostic accuracy of an international static-imaging telepathology consultation service. De Young. 138 Uses and benefits of telepathology Telepathology is currently being used for a wide spectrum of clinical applications including diagnosing of frozen section specimens. DiStefani.". Soyer. Bloom. TC. K. B.". Springer. F. nervous system pathologist ([neuropathologist]). Benefits of telepathology include providing immediate access to off-site pathologists for rapid frozen section diagnoses. JB et al. edu/ N/ DS/ s.. BL. Hum Pathol 1991: 514–518 [8] Kayser.". 21:127-34. Ilaalagan. et al. "Virtual slide telepatholgoy for an academic teaching hospital surgical patholgoy quality assurance program. VSV Interdisciplinary Medical Publishing (Berlin): 1–193 [9] Evans. NY: 1–186 [6] http:/ / www. Engum. • Halliday BE. Weinstein. ed. | journal = Hum Pathol | volume = 40 | pages = 1057–1069 | year = 2009 [2] Kumar. S. CD. RS (1986). S et al.". Anal Cell Pathol 2000. FR (2009). Beltrami CA. Lozzi. E`. S (2009). "Prospect for telepatholgy (Editorial)". Carpenter. • Della Mea V. Hum Pathol 40: 1069–1081 [10] Dunn. virtual microscopy and whole slide imagining: Prospects for the future. Electronic Education and Publication in Pathology". Bhattacharyya AK. KM. "Remote frozen section service: A telepathology project to northern Norway. Dunn BE (editors). php?s=8942 [7] Nordrum. "Telepathology: Telecommunications. BR. et al. research and education.". Frozen-section diagnosis by wireless telepathology and ultra portable computer: use in pathology resident/faculty consultation. Bhattacharyya. "Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a 12-year experience. Haugen. Henderson. 28:17-21. SE. TR. Hum Pathol 40: 1092–1099 [11] Graham. AJ. RS. BE. A. LL. B. Hum Pathol 2007. "Virtual microscopy in pathology education". Croul.

32:1283-99. 2009. Arch Path Lab Med 1987. 2009. 2009. editors. Practical pathology informatics.org/apps/cap. Practical applications of telepathology using morphology-based anatomic pathology. • Sinard JH. Ultrasructural telepathology: remote EM diagnostic via Internet. Human Path 1986. 15:1197–1204.org/home. 139 External links Informative sites or links • Accelpath . • Weinstein RS.com/) • American Telemedicine Association (http://www. et al. Kaplan KJ. 14:179-204. Yagi Y. New York. Hum Pathol 1997. Descour MR. Lopez AM. Rozek LS: Telepathology and the networking of pathology diagnostic services. et al. • Nordrum I.com/index. Overview of telepathology. Barker GP. 26:194-205.28:1–7.html) (a national digital pathology conference) • Association for Pathology Informatics (http://www. Telepathology: a ten-year progress report. AccelPath. Rozek LS. Use of robotic telepathology for frozen-section diagnosis: a retrospective trial of a telepathology system for intraoperative consultation.org/) • Digital Pathology Association (http://www. Bloom KJ.org/) • Digital Pathology Blog (http://www. 6:63-69. Telepathology.Telepathology • Kaplan KJ.americantelemed. 6:63-87.portal) • United States and Canadian Academy of Pathology (http://www. Krupinski EA. Erps KA. Liang C. • O'Malley DP. • Weinstein RS. Berlin. Virtual slide telepathology workstation-of-the-future: lessons learned from teleradiology.digitalpathologyassociation.tissuepathology. • Weinstein RS. Remote frozen section service in Norway. Weinstein RS. Burgess JR. Telepathology for patient care: what am I getting myself into? Adv Anat Pathol 2010. Springer. Berlin. Hum Pathol 2001. Dunn BE. In: Kumar S. Springer.org/i4a/pages/index. 40: 1057-1069. editors. Medicolegal aspects of telepathology.com/) • APIII (http://www.Accelerated Digital Telepathology .pathinformatics. In: Kumar S. Sandberg GD.cap. Becich MJ. Gilbertson JR. Advances in Path Lab Med 1993. • Weinstein RS. Bhattacharyya AK. Bhattacharyya AK. Dunn BE.edu/) (a national pathology informatics meeting's website with archived presentations and contact information for faculty) • Pathology Visions (http://www. Arch Anat Cytol Pathol 1995.pitt. Henricks WH.pathologyinformatics. 111:646-652. De Vico G. 17:130-49. 43:253-256. • Maiolino P.pathologyvisions. Springer. Arch Pathol Lab Med 2008. Bloom KJ. Semin Diagn Pathol 2009.uscap.typepad. • Krupinski EA. • Schroeder JA. • Williams S. Progress in telepathology: System implementation and testing. Richter LC. Hum Pathol. Telepathology overview: from concept to implementation. virtual microscopy and whole slide imagining: Prospects for the future. • Leung ST. Telepathology. Hum Pathol 2009. Mod Pathol 2002. (Editorial). Eide TJ. • Weinstein RS: Prospects for telepathology. Graham AM. 132:743-4. et al. Graham AR. Telepathology in veterinary diagnostic cytopathology. 2006:265-286. et al.cfm?pageid=1) • College of American Pathologists (http://www.htm) . • Krupinski E. 17:433 434.Digital Pathology and Telepathology solutions (http://www. 40:1137-1142.

flagshipbio.brown. Nurses may also direct clients to obtain a second medical opinion.springerlink. Telephone triage Telephone triage is defined as the management of patient health concerns and symptoms via a telephone interaction (telecommunications) by “advice nurses”.upenn. large call centers and hospices. metapress.ldc. “telepractitioners”. medication questions. newborn rashes.edu/) Other relevant sites • Digital pathology: DICOM-conform draft.upmc. educating and advising clients.onkol. Kielce) Pathomorphology Department virtual slides (http://www. possible allergic reactions.org/citation.cs. and appropriate dispositions—all by telephone.Telepathology 140 Links to articles • New Developments in Digital Pathology: from Telepathology to Virtual Pathology Laboratory (http://iospress. and making safe.pl/index. or advise them where to find relevant. current health information. from “chest pain to chicken pox”. testbed.edu/W/ W04/W04-0607. and first results (http://portal. in paper or electronic format to help sort symptoms. It is thus an aspect of telenursing. chest pain.edu/Courses/Digital_Path/) • Holycross Cancer Center (Poland.acm.edu/ ).php?page=wszystkie_slajdy) • Digital Pathology Imaging Group at University of Pittsburgh Medical Center (http://telepathology. Telephone triage nurses have a range of titles: “advice nurses”. Telephone triage involves ranking clients' health problems according to their urgency.cmu. and seasonal flu and fevers. and takes place in settings as diverse as emergency rooms. In one 8-hour shift. AIDS counseling and child abuse hotlines to 911 and telemetry monitoring. It can also be considered an aspect of telemedicine and telehealth utilizing an older form of technology (telephone lines). . a telenurse may field 60-80 telephone calls—one every 6 – 10 minutes—painstakingly assessing headaches. 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. “telepractice nurses” or “consulting nurses”.com/content/hgjhbq80evk7x8un/) • Feeding OWL: Extracting and Representing the Content of Pathology Reports (http://acl.C library that provides a simple interface to read whole-slide images (http://openslide. Telephone triage nurses utilize protocols or guidelines. What was traditionally done informally in emergency rooms.kielce. “telenurses”. They might counsel or perform crisis intervention for a threatened suicide.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.pdf) • Organizing Knowledge in a Semantic Web for Pathology (http://www. clinics. and physicians' offices for years has evolved into a new nursing subspecialty called telephone triage. Uses of Telephone Triage Triage means a sorting out.1282636&jmp=cit&coll=GUIDE&dl=GUIDE&CFID=72380999& CFTOKEN=86827451#CIT/) • Guidon Blog on whole slide image analysis (http://www. telepatologia.com/blog/) • OpenSlide . It may include everything from disease management. cfm?id=1282562. effective.

telephone triage has been compared to the work of air traffic controllers. In the 1970s. Ph. training and guidelines are essential to support the nurse. seeing that these new tools could help their practices. college health centers. Thus. Protocols may be in paper or electronic format. Vimla Patel. effective and appropriate disposition of health related problems by RNs — always involves “decision-making under conditions of uncertainty and urgency. In 1990. physicians performed telephone advice. hospices. from large medical call centers. and emergency departments. Telephone management has always comprised a large percentage of several physicians' practices – pediatrics. She discovered that these nurses used pattern recognition. physician’s offices. rules of thumb and context should be incorporated into all elements of any decision support system as well as telenurse training and forms. Some developers see protocols as decision-making tools. In new research. A wide variety of similar systems have sprung up over the last decade.. clinics. disease management call centers. 1979). . several health maintenance organizations began utilizing nurses to give telephone advice—in the role that physicians once served. physicians were quick to install telephones in their offices. Generally.Telephone triage Telenurses practice in a range of settings. 1996) “Uncertainty” because decisions are often made based on partial or inaccurate information. 141 Research on Telenurse Decision-making Telephone triage — the safe. the term "telephone triage" appeared on Medline indexes—a formal acknowledgement of this new subspecialty. Potential problems and misunderstandings can be averted through instruction in the correct and safe operation of the protocols and documentation form. The strategies of pattern recognition. experience and specialized training combined with strong decision support tools are the best approach to telepractice.D. rules of thumb and context as major strategies to make decisions. described how a group of RNs working in an emergency department setting made “real world” decisions in telephone triage. Telephone triage is a high-risk area of practice.” (Patel. one of the first calls made by Alexander Graham Bell was for assistance following a battery acid burn (Grumet. poison centers. Relying on protocols to take the place of formal instruction can be a mistake. Initially. gowri Brief history Informal telephone triage is as old as the telephone itself. and over reliance on a decision-making tool can lead to mistriage. In fact. EMDs and firefighters — all high stakes activities. This is an area of controversy in this new field. In the early days. Women’s Health and Family Practice specialties. The goal should be to mimic how the brain naturally solves problems in "real world" situations. The research on nurse decision-making by Patel and other experts has important implications for protocol design. primarily because nurses cannot see the patient with whom they are speaking. “urgency” because calls must be processed within a brief time frame — usually 6–10 minutes average. others as decision support tools. Protocols Protocols or guidelines are essentially“ standing orders” for nurses for the assessment and management of a range of symptoms.

Computer literacy is desirable. the nursing process. audiotapes analysis/critique. there are exceptions to this rule. telephone triage had few job qualifications—most nurses were felt to be qualified. • Wheeler. There must be a good match between the work—high volume. while increased experience results in more appropriate decisions. (1993) Telephone Triage: Theory. with little or no bedside decision-making experience will require time to build up these skills. protocol use and medical legal aspects. new graduates were not considered the best candidates for the task of telephone triage. written exercises in interview and documentation. Preceptors can support and counsel the new advice nurse in the first three to six months.Telephone triage 142 Telephone triage formalization In the early 70’s. National conferences provide a broad perspective and opportunity to network and problem solves.Q. we know that less experience results in over triage (Patel. The new RN. Since 1994. S. dedication to service). Delmar Thomson. Role-play is an excellent method to cumulatively integrate the new skills and tools (protocols and documentation form) and to simulate the actual task.Q. Two types of training and education currently exist—in-house and national conferences. Aspen Publishers. discussion. Thus. managers discovered that the high-stakes. As the field evolved into a recognized subspecialty. high stress work required seasoned RNs with many years of “bedside” decision-making experience. Since the 70’s most training was “on the job”.com . J. Each new advice nurse had to learn through trial and error. Orientation addresses an overview of the field and the nursing role. hospital or in the emergency department setting. In house trainers employ a variety of training methodologies. communication aspects. The final step in formal education will be accreditation—not yet a reality—but anticipated within the next five to ten years. but they are also “the lowest paid person who can safely do the job” (Schmitt. Gaithersburg. personable. formal training programs emerged. References • Wheeler. S. history taking. five to ten year’s experience provides the foundation necessary for good decision making by phone—a considerably more difficult task. However. resourceful. essentially “reinventing the training wheel” with each new employee. Albany. Telephone triage requires excellence in interpersonal skill or “telephone charisma” (articulate. MD. do one. Present and Future www. and Windt. lecture. mature and patient. the best training programs have a minimum of 40 hours. Currently. teach one”. 1996). since research demonstrates that individuals learn differently and learning happens best when all senses are utilized. • Wheeler. high-pressure decision making under conditions of uncertainty and urgent—and the practitioner’s temperament—calm. S. NY. (2000) Telephone Triage: Past. essentially “see one. preceptor programs and role-play of mock calls.teletriage. Certainly. In-house training techniques include reading.Q. In the 90’s. office. interview and documentation skills. conferences on telephone triage have provided a national forum for manager and practitioner alike to network and share experience and expertise. “shadowing”. Practice and Protocol Development. 1980). RNs are considered the best choice not only because they are autonomous professionals. Whether in the clinic. (2003) Telephone Triage Protocols for Adult and School Age Populations with Women’s Health and Infant/Child Protocols.

pay equally for telepsychiatry as for face to face psychiatric medication management visits. org/ [6] http:/ / www.1218-a. homidical.org. "Forensic Telepsychiatry" (http:/ / www. com/ Telepsychiatry Telepsychiatry is the application of Telemedicine to the field of Psychiatry. Retrieved 2010-07-10.2007. and there are a large number of grass roots telepsychiatry programs springing up in the United States and elsewhere to address this problem. and acutely anxious patient.[3] A recent innovation is the development of the subspecialty of emergency psychiatry via telemedicine.[5] References [1] Jardine. com/ [4] http:/ / www. and home-based telepsychiatry. Hilty DM. 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. depressed. uk/ Home/ ForensicTP/ tabid/ 332/ Default. telenursefirst. aspx) (Electronic). telephone-triage.1016/j. It has been the most successful of all the telemedicine applications so far. community mental health centers. manic. psychotic. PMC 1986661. PMID 17484936. com/ [3] http:/ / www. There are sub-specialties like forensic telepsychiatry. David (January/February 2007). asp [5] http:/ / www. accessing the physician via webcam and high-speed internet. nhs. jails. [3] Surface.59.[4] Emergency telepsychiatry services are being provided to hospital emergency departments. violent. org/ ~/ media/ Files/ PDF/ T/ TelepsychiatryProgramsED. chcf. . and schools. doi:10..[1] in which the patient is typically an inmate accessing the psychiatrist who is from a supporting institution. pdf) (PDF). org/ homepage. substance abuse treatment facilities. because of its need for only a good videoconferencing facility between the patient and the psychiatrist. healthcontactpartners. Social Work 7 (1): 28–31 [4] Shore JH. [2] "Treatment of Opioid Dependence via Home-Based Telepsychiatry . psychiatryonline. General Hospital Psychiatry 29 (3): 199–206.[2] whereby the patient is in his own home or office. slam.S. Psychservices.psychiatryonline. teletriage. as well as nearly all private health insurance providers. . . Medicare and the various state Medicaids. doi:10.genhosppsych. [5] "Telepsychiatry in the Emergency Department: Overview and Case Studies" (http:/ / www. especially for follow-up.013.Ikelheimer 59 (10): 1218 . .01. Retrieved 2010-07-10. "Country Comfort: Mental Health Telemedicine in Rural America".10. "Emergency management guidelines for telepsychiatry". Retrieved 07-10-2010.Telephone triage 143 Resources • • • • • • Post discharge follow up calls [1]. 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.Psychiatr Serv" (http:/ / psychservices. aaacn.ps. Yellowlees P (2007). In the U. com/ [2] http:/ / www. org/ cgi/ content/ full/ 59/ 10/ 1218-a). telepsychiatry. atsp. Richard.1176/appi.

Neuroradiologist.1604. Teleradiology improves patient care by allowing Radiologists to provide services without actually having to be at the location of the patient.2004.asp A review on the effectiveness Some related links (http://telemed.org) http://www. "Recent advances in telepsychiatry: an updated review". Telemedicine Journal and E-health 10 (4): 455–8.tmhguide.1089/tmj. doi:10.org/publications/archives/Bulletin/2003/october/hilty.jsahealthmd. Psychiatric Services 54 (12): 1604–9. Elhai JD. Canadian Journal of Psychiatry 49 (1): 12–23.10. Pediatric Radiologist. Yellowlees PM.455. Teleradiology utilizes standard network technologies such as the internet. Monnier J.com) Teleradiology Teleradiology is the transmission of radiological patient images.org/europe/links/telepsych. images can be sent to another part of the hospital. Urness D. or to other locations around the world.455.slam. telephone lines. doi:10. PMID 14645799. External links • • • • • • • • Telemental Health Guide (http://www. CTs. Monnier J.1089/tmj.54. Knapp RG (2004). and MRIs. or over a local area network (LAN).nhs.08.telelive. "Telepsychiatry treatment outcome research methodology: efficacy versus effectiveness". wide area network (WAN).com) JSA Health Telepsychiatry (http://www. Grubaugh AL. Nesbitt TS (January 2004).2004. such as x-rays. Knapp RG.uk/Portals/9/douments/final. Teleradiology allows for trained specialists to be available 24/7.Telepsychiatry 144 Further reading • Frueh BC. "Telepsychiatry treatment outcome research methodology: efficacy versus effectiveness".org) Voyager Telepsychiatry (http://www.telepsychiatry.telepsychiatry.cpa-apc. • Hilty DM.12. Elhai JD. Telemedicine Journal and E-health 10 (4): 455–8. PMID 14763673. Teleradiology is a growth technology given that imaging procedures are growing approximately 15% annually against an increase of only 2% in the Radiologist population. Through Teleradiology.org) (http://www.asp) A feasibility study (http://www.ps. • Frueh BC.10.doc) American Association for Emergency Psychiatry (http://emergencypsychiatry.version. . Frueh BC (December 2003). Technologies such as advanced graphics processing. or Musculoskeletal Radiologist is needed. Marks SL. 03. doi:10. PMID 15689650.1176/appi. 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. PMID 15689650. This is particularly important when a sub-specialist such as a MRI Radiologist. voice recognition. from one location to another for the purposes of interpretation and/or consultation. Grubaugh AL. and image compression are often used in Teleradiology. "Clinical and educational telepsychiatry applications: a review". • Monnier J. since these professionals are generally only located in large metropolitan areas working during day time hours. Knapp RG (2004).feasibility.

Quality teleradiology must abide by important HIPAA rules to ensure patients’ privacy is protected. 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. The connections were made through standard analog phone lines. Subspecialties Some teleradiologists are fellowship trained and have a wide variety of subspecialty expertise including such difficult-to-find areas as Neuroradiology. Pediatric Neuroradiology. 7 days a week coverage. advanced teleradiology systems must also be HIPAA compliant. or more. Regulations In the United States.com boom of firms and groups that provided outsourced. off-site teleradiology on-call services to hospitals and Radiology Groups around the country. Teleradiology Final Reports can be provided for emergent and non-emergent studies. Also State laws governing the licensing requirements and medical malpractice insurance coverage required for physicians vary from state to state. was the first to station U. often in the radiologists home. As an example. which helps to ensure patients’ privacy. soil in order to qualify for reimbursement of the Final Read. radiologists went from working 8–10 hours a day.S. Teleradiology Preliminary or Final Reports can be provided for all doctors and hospitals overflow studies. the turnaround time is extremely rapid with a 30 minute standard turnaround and expedited for critical and stroke studies. HIPAA (Health Insurance Portability and Accountability Act of 1996) is a uniform.Teleradiology 145 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. Teleradiology can be available for intermittent coverage as an extension of practices and will provide patients with the highest quality care. Nighthawk. Nuclear Cardiology. This became a particularly acute challenge in smaller rural facilities that only had one solo radiologist with no other to share call. In addition. Mammography. five and half days a week to a schedule of 24 hours a day. The occasional 2-3 x ray studies a week soon became 3-10 CT scans. founded by Dr. Preliminary Reports include all pertinent findings and a phone call for any critical findings. Final reports include all findings and require access to prior studies and all relevant patient information for a complete diagnosis. federal floor of privacy protections for consumers. Some firms even used overseas doctors in locations like Australia and India. Musculo-skeletal MRI. These circumstances spawned a post dot. Medicare and Medicaid laws require the Teleradiologist to be on U. Paul Berger. licensed . a teleradiology firm might cover trauma at a hospital in Indiana with doctors based in Texas. For some Teleradiology services. Because ER physicians are not trained to read CT scans or MRI's. a night. Phone calls with any critical findings are signs of quality services.S. Ensuring compliance with these laws is a significant overhead expense for larger multi-state teleradiology groups. 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. Industry growth Until the late 1990s teleradiology was primarily used by individual radiologists to interpret occasional emergency studies from offsite locations.

It is most widely used for neuropsychological rehabilitation. PR Newswire. on September. Providence Equity Partners acquired and took private Virtual Radiologic. and in speech-language pathology. telerehabilitation in the practice of occupational therapy and physical therapy are very limited. This endeavor has recently (2006) expanded as a teletherapy application for cognitive skills enhancement programs for school children. and Virtual Radiology Consultants (VRC or VRN most recently). nytimes. . Currently teleradiology firms are facing pricing pressures. html). . braces or artificial limbs. phone lines. The Radlinx Group. videophones and webpages containing rich Internet applications. speech-language pathology. As of 2006. Telerehabilitation Telerehabilitation (or e-rehabilitation[1] [2] ) is the delivery of rehabilitation services over telecommunication networks and the internet. hospitals." (http:/ / dealbook. pioneered the expansion of teleradiology services beyond just night coverage to also provide coverage to hundreds of small rural hospitals and clinics. and clinical therapy. .[1] Moreover. [3] The Radlinx Group. 2010. [2] "Virtual Radiologic and NightHawk Radiology Announced a Merger. videoconferencing. Virtual Radiologic (vRad) and NightHawk Radiology announced the completion of their previously announced merger. 2010-05-17. and (2) building new data collection systems to digitize information that a therapist can use in practice. on December 23. founded by Greg Lowenstein and Mark Bakken. Imaging Technology News.[2] Finally.S. com/ news-releases/ virtual-radiologic-and-nighthawk-radiology-announce-merger-103849613.S. large and small. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. became multi million dollar companies today. who otherwise had no on-site access to full-time radiologists. throughout the United States. Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy. New York Times. Rich internet applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) was first introduced in 2001. perhaps because these two disciplines are more “hands on”. 2010-09-27. Virtual Radiologic and NightHawk Radiology Announced their Merger. Most telerehabilitation is highly visual." (http:/ / www. on May 17. However. itnonline. [3] "VRad and Nighthawk Radiology Complete Merger. 146 References [1] "Providence to Take Virtual Radiologic Private. and physical therapy. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance. The early innovators in this field like Teleradiology Solutions. Telerehabilitation can deliver therapy to people who cannot travel to a clinic because the patient has a disability or because of travel time. As of 2006 the most commonly used modalities are via webcams..Teleradiology radiologists overseas (initially Australia and later Switzerland) to maximize the time zone difference to provide nightcall in U. Tele-audiology (hearing assessments) is a growing application. fitting of rehabilitation equipment such as wheelchairs. com/ 2010/ 05/ 17/ providence-to-take-virtual-radiologic-private/ ). Ground-breaking research in telehaptics (the sense of touch) and virtual reality may . 2010-12-23. net/ node/ 38565/ 3/ ). with NightHawk continuing as a wholly owned subsidiary of vRad. Nighthawk (symbol: NHWK) and VRC (symbol: VRAD) ultimately went public and established almost a billion dollars in market capitalization. Most types of services fall into two categories: clinical assessment (the patient’s functional abilities in his or her environment). audiology. occupational therapy. 2010." (http:/ / www. throughout the U. prnewswire. 27. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology. Nighthawk Radiology. Industry consolidation is likely as there are more than 500 of these firms. 2010.

is reviewed in Winters (2002). . Some state universities have obtained state funding to operate tele-clinics in rural areas. If the research shows that tele-assessments and tele-therapy are equivalent to clinical encounters. The conference was attended by the incoming president of the American Telemedicine Association (ATA). In contrast. and its motivation. Angaran published “Telemedicine and Telepharmacy: Current Status and Future Implications” in the American Journal of Health-System Pharmacy. As of 2006. Cases included post-stroke. and the radiology profession. rural health care systems. There are several programs that provide annual physical exams or monitoring and consultation for veterans with spinal cord injuries. This RERC was renewed in 2010. Three early adopters of telemedicine were state penitentiary systems. As of 2006. some state Medicaid programs (for poor people and people with disabilities) have pilot programs using telecommunications to connect rural practitioners with subspecialty therapists. D. engineers. Outside the United States. and the Department of Defense. Similarly. It was awarded to a consortium of biomedical engineering departments at the National Rehabilitation Hospital and The Catholic University of America. The State of Science Conference held in 2002 convened most of military and civilian clinicians. Most of this funding comes through the Health Services Research Administration and the Department of Commerce. the Health Services Research Administration in the US Department of Health and Human Services. autism. and the National Rehabilitation Hospital in Washington DC. the Rehabilitation Institute of Chicago. NIDRR funded the second 5-year RERC on telerehabilitation in 2004. 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. only a few health insurers in the United States will reimburse for telerehabilitation services. 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. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh. 147 History In 1999. few (if any) of these programs are known to financially break-even. the Sister Kenny Rehabilitation Institute in Minnesota. He provided a comprehensive history of telecommunications. Other federal funders of research are the Veterans Administration. Some of this early research work. both located in Washington. and government officials interested in using telecommunications as a modality for rehabilitation assessment and therapy. Rural telemedicine in the United States is heavily subsidized through federal agency grants for telecommunications operations. the internet and telemedicine since the 1950s. An argument can be made that "telerehabilitation" began in 1998 when NIDRR funded the first RERC on tele-rehabilitation. post-polio. 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. the Veterans Administration is relatively active in using telemedicine for people with disabilities. 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. and wheel-chair fitting. and the East Carolina University in North Carolina. In the United States. This led to an invitation by ATA to the conference attendees to form a special interest group on telerehabilitation.Telerehabilitation broaden the scope of telerehabilitation practice.M. the State University of New York at Buffalo. both agencies continue to fund advances in telemedicine. it is more likely that insurers and Medicare will cover telerehabilitation services. Winters & Lauderdale (2002). a summary is provided in Rosen. excellent research is conducted in Australia and Europe. in the future. DC. awarding it to the University of Pittsburgh. mostly because the Medicare program for people over age 65 (the largest payer) is very restrictive about paying for telehealth.

3.E. Videophones are used with POTS lines and include a camera. a patient's data is accessible from where ever the therapist is located. PDAs/PDA in telerehabilitation 11. Haptic technology/Haptic technology in telerehabilitation 8. Motion technology/Motion technology in telerehabilitation 5. Videotelephony/Videotelephony in telerehabilitation The use of improved quality video-assisted telecommunication devices. Palsbo published an article in the Journal of Telemedicine and Telecare that explored how telemedicine can become a profitable business for hospitals. 4. with only a handful of equivalence trials. and telephone. 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. The applications can be accessed from any location where one has access to an internet connected computer. Likewise. M. 2. directly to the patient. Research in telerehabilitation is in its infancy. display screen. This can be solved by using a large screen or television as a screen. however small display screens make them problematic for individuals with vision problems. It is unethical to limit paymente for telerehabilitation services only to patients in rural areas. This computer technology allows the development of three-dimensional virtual environments. Sensors and body monitoring/Sensors and body monitoring in telerehabilitation 7. Artificial intelligence/Artificial intelligence in telerehabilitation 9. such as videoconferencing. Virtual reality/Virtual reality in telerehabilitation Virtual reality in telerehabilitation is one of the newest tools available in that area. O. introduced the first web based. Rehabilitation researchers need to conduct many more controlled experiments and present the evidence to clinicians (and payers) that telerehabilitation is clinically effective. As of 2006. just as if they were installed in your computer (called Rich Internet Applications). McCue and S.J. Videophones use telephone lines that are available in most homes. The patient can login to do their therapy from home. Any updates or changes to the software system are instantly available to all subscribers. Plain old telephone service (POTS) uses standard analog telephone lines. webcams and telepresence to assist in treatments. 6. so are easy to set up. this system formed the basis of a new system designed as a cognitive skills enhancement program for school children. Wireless technology/Wireless technology in telerehabilitation 10. The discipline of speech-language pathology is far head of occupational therapy and physical therapy in demonstrating equivalence over various types of telecommunications equipment. Web-based approaches/Web-based approaches in telerehabilitation Applications that run over the internet. for the telerehabilitation presentation of cognitive rehabilitation therapy. In 2006. Secondly. the therapy prescription set up and controlled by the member clinician.Telerehabilitation In 2001. Mobile telephony/Mobile telephony in telerehabilitation . This system first provides the subscriber clinician with an economical means of treating their own patients over the internet. Plain old telephone service (POTS) with videophones/Phones in telerehabilitation There are several types of connections used with real time exchanges. most peer-reviewed research in telemedicine are case reports of pilot programs or new equipment. the system then provides. 148 Technologies 1. In 2006. Individual children or whole classrooms can participate in this program over the internet. A person subscribes to the website rather than purchase the software. Bracy. a neuropsychologist. represent a new direction in software development. All applications and response data are transported via the internet in real time. the library or anywhere they have access to an internet computer. rich internet application. Neither the application nor the patient's data is tied to one computer.

Cahill. As a result. Ward.. Russell. To date. A recent Australian pilot study has investigated the feasibility of an Internet-based assessment of speech disorder in six children (Waite. Theodoros. Theodoros. Brennan. In addition. a videoconferencing platform has been used successfully to provide follow-up treatment to an adult who had previously received intensive therapy (Kully. Cahill. 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. stuttering. 2006. these studies have revealed positive treatment outcomes. Theodoros. 2004) and the assessment and treatment of motor speech disorders (Hill. the parents and children responded positively to the program delivered at a distant. Reports of telerehabilitation applications in paediatric speech and language disorders are sparse. Onslow & Lincoln. Russell. a computer controlled video laserdisc over the telephone and a closed-circuit television system to assess speech and language disorders (Wertz et al. 1997). 2. 6. 1976. Wilson & Wootton. Using a high speed videoconferencing system link. 5. Wilson. 1999. voice disorders. 2004. Review of telerehabilitation research on clinical populations Professional to professional (clinic to clinic applications) Telehealth – Information access Clinical approaches 1. speech disorders in children. and swallowing dysfunction. in press) following brain impairment and Parkinson's disease. Clark. More recent applications have involved the use of sophisticated Internet-based videoconferencing systems with dedicated software which enable the assessment of language disorders (Georgeadis. Sicotte. Barker. and a satellite-based videoconferencing system to assess patients in rural areas (Duffy. Lehoux. speech intelligibility. Georgeadis. applications have been developed to assess and/or treat acquired adult speech and language disorders. Constantinescu. 2. Baron & Barker. et al. Wilson & Onslow. 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. The treatment of stuttering has been adapted to a telerehabilitation environment with notable success. 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. 1987). 1987). while assessment and diagnoses have been found to be comparable to face-to-face evaluations. Wertz. 200). the number of telerehabilitation applications in speech-language pathology tend to outnumber those in other allied health professions. Ward. & Baron. High levels of agreement between the online and face-to-face clinicians for single-word articulation. Brennan. and oro-motor tasks were obtained suggesting that the .Telerehabilitation 12. Electronic medical records/Electronic medical record telerehabilitation 149 Clinical applications of telerehabilitation 1. Collectively. Overall. in press). 3. Werven & Aronson. 7. 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. 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. Russell. Two Australian studies (Harrison. 4. 4. 3. Busuttin.

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) . This system enabled the capture and display of images in real-time with only a three to five second delay. Speech-language pathology Audiology Physical therapy Occupational therapy Psychology Nursing Social work Rehabilitation counseling/Vocational rehabilitation Standards and training requirements 1. 4. Voice therapy across a variety of types of voice disorders has been shown to be effectively delivered via a telerehabilitation application. 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. suggesting that the majority of traditional voice therapy techniques can be applied to distance treatment. 5.Telerehabilitation Internet-based protocol had the potential to be a reliable method for assessing paediatric speech disorders. 8. 4. 2. 3. Lalor. Mashima et al. 3. The authors reported positive post treatment results with no significant difference in measures between the traditional and videoconferencing group. 2. 7. 6. (2003) using PC based videoconferencing and speech analysis software compared 23 patients treated online with 28 persons treated face-to-face. 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. Although obvious limitations exist. 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. 150 Disciplines and therapies 1. 5. telerehabilitation applications for the assessment of swallowing function have also been used with success.

Pierce. Retrieved 2011-03-26. dmoz. ISBN 9780787966188 [2] Lisa Keaton. . Victoria Steiner. John Wiley and Sons. 2005.nova. org/ Health/ Medicine/ Informatics/ Telemedicine/ Projects/ / ) at the Open Directory Project . "An E-rehabilitation Team Helps Caregivers Deal with Stroke" (http:/ / ijahsp.edu) 2. 219.Telerehabilitation 151 References [1] E-health care information systems: an introduction for students and professionals. htm).4. Linda L. Karen Lance. External links Telerehabilitation (http:/ / www. The Internet Journal of Allied Health Sciences and Practice (Ijahsp. ISSN 1540-580X. nova. p. edu/ articles/ vol2num4/ pierce-keaton.

[2] Continua Health Alliance is working toward establishing systems of interoperable telehealth devices and services in three major categories: chronic disease management. United States Worldwide Clint McClellan (President) Charles Parker (Executive Director) ContinuaAlliance. 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.org [1] Website Continua Health Alliance is an international non-profit.The Continua Health Alliance 152 The Continua Health Alliance Continua Health Alliance Industry Founded Headquarters Area served Key people Trade association June 2006 Beaverton. Through collaborations with government agencies and other regulatory bodies. and fitness device companies. The technology platforms for these products and services are defined by the members and published in the Continua guidelines. . communications. Overview Continua Health Alliance aims to establish a system of personal connected healthcare solutions. signifying that the product is interoperable with other Continua-certified products. medical. open industry group of nearly 240 healthcare providers. The group released the guidelines to the public in June 2009. Continua members intend to create systems and devices for improving personal health.[3] The group is establishing a product certification program using its recognizable logo. aging independently. and health & physical fitness. 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. Products made under Continua Health Alliance guidelines will provide consumers with increased assurance of interoperability between devices. The goal of developing the solutions is to promote delivery of healthcare in the home providing independence. Oregon. Continua Health Alliance members aim to develop a system to deliver personal and individual healthcare. empowering individuals and providing the opportunity for truly personalized health and wellness management. enabling them to more easily share information with caregivers and service providers.

[9] Members Continua Health Alliance currently has nearly 240 member companies. • Use Case Working Group • Wellness Solutions Working Group . the Nonin 2500 PalmSAT handheld pulse oximeter with USB. ZigBee will be used for networked low-power sensors such as those enabling independent living. 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.[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. 2008 at the Partners Center for Connected Health 5th Annual Connected Health Symposium in Boston.[7] By the end of September 2010 there were fourteen certified products. Bluetooth Low Energy is to be used for low-power mobile devices. on January 26. and continuously improving the Test and Certification process and tools. 2006[4] Continua Health alliance performed its first public demonstration of interoperability on October 27.The Continua Health Alliance Continua Alliance products make use of the ISO/IEEE 11073 Personal Health Data (PHD) Standards. 2009.[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.[5] Continua Health Alliance certified its first product [6].The Test and Certification Working Group is responsible for defining. 153 Major milestones and Status Information Continua Health Alliance was founded on June 6. implementing. 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 . Inc.

html) [11] Board of Directors (English) (http:/ / www. html [5] http:/ / continuaalliance. com/ News. ttu. html [3] http:/ / www. org/ default. html [7] http:/ / www. pdf [6] http:/ / continuaalliance. pdf [13] [14] [15] [16] http:/ / www.The Continua Health Alliance 154 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/ static/ cms_workspace/ Continua_06082009_vFINAL. americantelemed. org/ certified-products/ nonin-2500-palmsat%C2%AE-pulse-oximeter. continuaalliance. edu/ communications/ vistas/ archive/ 02-summer/ stories/ miracle-of-telemedicine. pdf [10] Member Companies (English) (http:/ / www. External links • Continua Health Alliance website [1] • • • • American Telemedicine Association MobiHealthNews [14] Telemedicine History [15] Association of Telehealth Service Providers [16] [13] References [1] http:/ / www. org/ about-the-alliance/ member-companies. continuaalliance. org/ products/ certified-products. org/ about-the-alliance. html [9] http:/ / www. a directory of qualified products. and a clear statement of their mission. continuaalliance. org/ i4a/ pages/ index. org/ static/ cms_workspace/ Continua_Version_One_Design_Guidelines_Now_Available_final. asp . org/ static/ cms_workspace/ Continua_Overview_Presentation_v15_3. org/ static/ binary/ cms_workspace/ Continua_Update_release_v_FINAL_2_. continuaalliance. continuaalliance. org [2] http:/ / www. com/ http:/ / www. org/ about-the-alliance/ board-of-directors. nonin. pdf [4] http:/ / continuaalliance. html) [12] http:/ / continuaalliance. aspx?NewsID=86 [8] http:/ / www. continuaalliance. cfm?pageid=1 http:/ / mobihealthnews. php http:/ / atsp. continuaalliance. depts. org/ news-and-media/ press-releases/ founding-continua.

Venezuela. technology and organizational issues.and psychiatry -particularly childhood psychiatry). economics. CHS or Citizen Home Services. Mali and Uganda. Argentina.IT. In the 4th Ed-2002 is the author of the Electronic Clinical Record. Ordesa award in paediatrics 1989. . Kenya) Obtained awards: • • • • Economical initiatives. Leader in Canary Islands and in the main land . Belfast-IRL.E. world wide known by Winter and Summer Courses of Telemedicine training following the “Telemedicine Body of Knowledge". Canary islands 1995. Chile. technology transfer. Athens-GR. Tele-ECG and Tele-ultrasounds -particularly obstetrics & gynaecology. Innsbruck-AU. • CATAI developed the Videophone network in Canary Islands in 1991 for distant support. 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. KOD or knowledge on demand. Peru. it was applied to image analysis prognostic factors in breast cancer. complemented with a CD multimedia material particularly designed for developing countries. Aveiro-PT. • Fist in the world (1991) to carry out distant DNA quantitation. CATAI published the first text-book of Telemedicine in English. CATAI-CTC) UNESCO Chair of Telemedicine was involved in developing countries health support through the Midjan group-ITU-D working group of Telemedicine.FR. Promoting the network of Telemedicine together with Argentina. with enrolment of 3 continents: Europe. Partner in 5 EU projects ( Smart-USB. Undertakes international activities related to the promotion of the information society and fights against technology transfer problems having the role of an “intermediate body”. Leonardo-DGXXII Teaching Medical informatics).UNESCO Chair in Telemedicine 155 UNESCO Chair in Telemedicine UNESCO Chair of Telemedicine (UNES_CT) was founded in 1999. Genova-IT. Award Portugal-Spanish cooperation 1994. These activities link mainly technological firms of the UK and Germany. 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. to gain a minimal structured knowledge in Medical Informatics. Is participating in all editions of the European Telemedicine Glossary edited by the EC-DG Information Society. have established the “Telemedicine Body of Knowledge” covering sociology. standardization. • CATAI was the promoter of the Centre of Excellence in Telemedicine. TeleInViVo ultrasound devices with pilots in Katastan. At the present moment the book is translated into 6 languages (SP. and participated in ITU-Developing Word Congress in Malta 1997. Berlin-D.Barcelona. The expertise of the UNESCO chair of Telemedicine as a University Institution is based in the previous CATAI’s 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.of a project on Telephonic Medicine. and Georgia Telemedicine meeting in 1999. security and liability aspects in co-operation with the Universities of Queens-UK. The Chair is the first UNESCO Telemedicine Chair [1]. Udine-IT.D) and is published in Spanish (PanAmerican Editorial) with title : [2] “Telemedicine” 2001. Is currently actively working with South-America ( Venezuela.GR. Cuba. Science Park-DGXIII) and participating in other two (DGXIIITeleultrasound for developing countries. sponsored by Science Park DG-XIII. At the present it includes the best practice implementation pilots in phone medicine (oncology -particularly home-care. Award Royal Academy Medicine 1993 and 1999. ASKLEPIOS. Objective image analysis and prognostic factors have been incorporated into the regional breast cancer registry of 3000 patients (see above). Peru) and Africa (Uganda. Leader of two EU projects (Leonardo-DG XXII .

• Physical simulators: mannequins (sometimes spelled 'manikins').CATAI . modern technologies and the innovative concept of game-based learning. net/ catai [3] http:/ / portal. [4] and Virtual • Electronic case-studies and scenarios where users work through problems.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. 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. electronic health records (EHRs). es Virtual patient The term virtual patient is used to describe interactive computer simulations used in health care education. Virtual patients combine scientific excellence. the physiologic processes of a given organ or entire systems (systems biology) in a given organism. org/ education/ en/ ev. nominated by the STOA European Parliament Office. unesco. • 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. models or related artefacts. unesco. However the overarching principle is that of interactivity .g. . These are sometimes called e-patients. Included in the 3rd Ed. php-URL_ID=2989& URL_DO=DO_TOPIC& URL_SECTION=-465. 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. 156 External links • UNESCO Chair in Telemedicine . html [2] http:/ / www. of “Who is Who in Science and Engineering”.[1] The special focus is targeted on the simulation of clinical processes with virtual patients.UNESCO Chair in Telemedicine • Included in “Who is Who in the World” since 1996 scheduled up to 2000. teide. org/ education/ en/ ev.University of La Laguna (Spain) [2] • UNESCO Education Portal [3] • University of La Laguna [4] References [1] http:/ / portal. php-URL_ID=48712& URL_DO=DO_TOPIC& URL_SECTION=201. • the Lattice Price 99 of ESF (European Science Foundation) in Innovation & Research in teaching. 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. html [4] http:/ / www. 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. ull. • Real patients: reflected in data e. situations or similar narrative-based activities. In this case the virtual patient is the reflection of the real patient in terms of data held about them.

simulated patients can be accessed on demand and they can be endlessly replayable to allow the user to explore different options and strategies. eg in major projects like eViP. If more tests can be done on Artificial patients to filter out possibly unnecessary tests or experiments. which must also be proven by real patient studies clinical trial. making them less dependent on actual cases to learn how to handle different situations.Virtual patient 157 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. This standard has been very successful and is now widely adopted. this standard attained status as an ANSI standard. 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. They can be structured with narratives that represent real situations while challenging the user with a wide range of tasks. The Artificial patients insilico modeling are still in the early to middle developmental stages. They should be viewed as augmenting existing modes and methods of clinical teaching. Despite their efficacy simulated patients are still a tangent and a prosthesis to reality. Possible Benefits of Physical Simulators and Simulated Patients Simulated patients increase the availability of training opportunities for medical students. In 2010. informed research and development predictive simulation. fewer subjects pharmacovigilance maybe needed. Unlike real patients. American_National_Standards_Institute . It will require continual updates and development with the endless availability of new data. 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. which enables efficient exploration. 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.

ac. virtualpatientsgroup. html [6] http:/ / meld.http:/ / www.09 [2] Imison M. edu/ view/ url/ H1185C/ 471802/ 490012/ [16] http:/ / www. org/ primers/ virtual_patients_cases_ellaway. tufts. htm [7] http:/ / www. ufl. medbiq. lime. Medical College of Georgia. org/ primers/ virtual_patients_cases_ellaway. htm [4] http:/ / www. Available http:/ / www. campusvirtualpatients. student generated online case studies in medical education. com/ [18] http:/ / www. ict. com/ [13] http:/ / openlabyrinth. edu/ Virtual_Patient_Projects. ed. cise. Hughes C(2008) The virtual patient project: using low fidelity. mvm. net/ vp/ [12] http:/ / www. uk/ schools/ pharm/ vp/ [17] http:/ / www. 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. uk/ [15] http:/ / tusk. WISE-MD) WebSP from Karolinska Institutet [9] 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. CLIPP.Virtual patient 158 Examples Electronic Cases • • • • • • • • • • [8] (SIMPLE. net . keele. html [5] http:/ / vrpsych. ca/ [14] http:/ / labyrinth. ac. medbiq. jisc. University of Central Florida. tinkering. ki. bidmc. fmCASES. ac. uk/ whatwedo/ programmes/ elearningcapital/ reproduce/ revip. inmedea-simulator. ascilite. org [9] http:/ / websp. edu/ VPTutorials/ [11] http:/ / www. in Hello? Where are you in the landscape of educational technology? Proceedings ascilite Melbourne 2008. au/ conferences/ melbourne08/ procs/ imison. Available http:/ / meld. usc. harvard. medbiq. aspx accessed 08.06. se/ [10] http:/ / research. org. org/ [8] http:/ / med-U. pdf [3] Ellaway R (2009) Modelliing virtual patients and virtual cases. edu/ research/ vegroup/ vp.

The system was effective as a training device. eu [24] http:/ / inmedea.[8] A recently completed project at the University of Strathclyde has resulted in the development of a wheelchair motion platform which.[2] Virtual reality is a practical. entelos. VR has potential to enhance the practice. Therapists then monitor the patient's progress via the web and modify the therapy asynchronously without real-time interaction or training.[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. com/ [22] http:/ / www. and scientific interest in virtual environments is inspired. the technology might have a wider applicability to the rehabilitation field. The current popular. technical. State of the art of VR-based telemedicine applications is used in remote or augmented surgery as well as in . by the advent and availability of increasingly powerful and affordable visually oriented. therapists using virtual reality-based telerehabilitation prescribe exercise routines via the web which are then accessed and executed by patients through a web browser. interactive. ecologically valid stimulus environments within which behavioral response can be recorded and measured. Subsequently. limbsandthings.[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. medbiq. and modern. affordable technology for the practice of clinical medicine. graphical display systems and techniques lacking only sense and sensibility. com/ document.[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.[9] Many cases have applied virtual reality technology to telemedicine and telerehabilitation service development. laerdal.[1] Background The computer technology that allows development three-dimensional virtual environments consists of both hardware and software. high-fidelity virtual reality systems have practical applications in areas ranging from psychiatry to surgical planning and telemedicine. artificially created computer-aided design (CAD) models. it offers clinical assessment and rehabilitation options not available with traditional methods.[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. asp?docid=1022609 [21] http:/ / www. and an internet video link. Because telemedicine focuses principally on transmitting medical information. The traditional virtual reality world is typically constructed using simplistic. com/ [20] http:/ / www.[3] Through VR’s capacity to allow the creation and control of dynamic 3-dimensional. com 159 Virtual reality in telerehabilitation Virtual reality in telerehabilitation is a method used first in the training of musculoskeletal patients using asynchronous patient data uploading. in addition. html [23] http:/ / www. The term "virtualized reality" (VR) was coined and introduced in a paper by Kanade. in large part. VR starts with the real-world scene and virtualizes it. org/ working_groups/ virtual_patient/ index.Virtual patient [19] http:/ / www. 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. virtualpatients. can be used to address issues of accessibility in the built environment. in conjunction with a virtual reality facility.

Space Requirements for Wheeled Mobility: An International Workshop. PMID 11110636. NeuroRehabilitation 12 (1): 63–72. "The role of virtual reality technology in the assessment and training of inexperienced powered wheelchair users". "The interaction of spatial ability and motor learning in the transfer of training from a simulator to a real task". E. R. ISBN 1-58603-143-0.826858. James D. Boeren and R.1267/METH03050519 (inactive 2010-03-20). "Virtual reality-based orthopedic telerehabilitation". [9] Grant. Calif.10. PMID 10761773. haptics and telemedicine".[11] To improve understanding of deficits in autism and in left visual-spatial neglect.[13] Researchers from Rutgers University and Stanford University developed a virtual reality-based orthopedic telerehabilitation system. [16] Burdea. Rander (1995). "Stroke rehabilitation at home using virtual reality. E. investigated face gaze behavior in autism and right hemisphere stroke. com/ link. IEEE Transactions on Information Technology in Biomedicine 4 (1): 45–51. Albert A. doi:10. "A new postural balance control system for rehabilitation training based on virtual cycling". M. "Virtual reality in telemedicine". ISBN 1586034987. PMID 10163763. "Virtual rehabilitation—benefits and challenges".1089/153056200750040183.J. different researchers have tried to use virtual environments in medical visualization and for assessment and rehabilitation in neuropsychology. practical. Studies in Health Technology and Informatics 81: 521–7.1080/09638280110111360. G.1037/0090-5550. IOS Press.1995... PMID 12661483.2004. Narayanan and P. 1999. Mogel. "A virtual-reality-based telerehabilitation system with force feedback". PMID 11001524. C. California State University at Northridge. .W. [7] Tracey.476854. 294.[10] Case studies for VR applications were conducted that were internet deliverable and they identified technical.. C. Randy S. [15] Popescu.867886. Maria T. V. Greg T.. Los Alamitos.wheelchair simulation in VR. doi:10. Bouzit and V. G. Burdea. [13] Rydmark. and user challenges of remote VR treatment programs. "Wheelchair Simulation in Virtual Reality" (http:/ / www. Jong Yun Kim and Nam Gyun Kim (June 2004). . Rosen and Corinna Lathan. Retrieved 2007-07-26. J. R. ISBN 0-8186-7122-X. Cheryl. doi:10. doi:10.184. P. PMID 15458128. Methods of Information in Medicine 42 (5): 519–23. PMID 15319048. Rose. [17] Viirre. [5] Trepagnier.1109/WVRS. Albert A. IEEE Transactions on Rehabilitation Engineering 8 (3): 430–2. Disability & Rehabilitation 24 (11-12): 599–606. ISSN 0090-5550. R.1109/86. doi:10. Proceedings.. however. Luciano Gamberini (2000).296. Colbert (September 2000). PMID 11317801. using virtual reality and gaze sensing technology. 2003. org/ csun_99/ session0241. "Telerehabilitation and virtual reality technology for rehabilitation: preliminary results" (http:/ / www.. Studies in Health Technology and Informatics 85: 434–7. [6] Song. PMID 14654886. G. p. Rizzo (August 2001). Conference on Technology and Persons with Disabilities.. Attree (2002). "The application of virtual reality technology in rehabilitation". "Virtual environments for the investigation and rehabilitation of cognitive and perceptual impairments" (http:/ / iospress. He stated that an appropriately designed VR experience could greatly increase the rate of adaptation in these patients. ap.. htm). C. [2] Kanade. B. "Virtualized Reality: Concepts and Early Results".G. F. E.. Recently. [12] Trepagnier. [11] Rizzo.. [10] Riva. Richard A. Robb. A. Chul Gyu. metapress. : IEEE Computer Society Press. G.1089/tmj.. 1995. pp. V. Hoffman. doi:10. IEEE Transactions on Information Technology in Biomedicine 8 (2): 200–207. Lathan (2001). Trepagnier et al.[12] An at-home stroke telerehabilitation service was developed using virtual reality haptics. A. Medicine Meets Virtual Reality 13: The Magical Next Becomes The Medical Now.. Studies in Health Technology and Informatics 29: 299–305. (1996). Telemedicine Journal and e-Health 10 (2): 184–95. T. doi:10. Vosburgh (2005). . "The challenge of using virtual reality in telerehabilitation". asp?id=k3w4811mjpgulujd). Hentz and K.1109/4233. G. Retrieved 2006-07-26. [14] Burdea. doi:10..2004. "Vestibular telemedicine and rehabilitation". 69–76. M. Phillips. IEEE Workshop on Representation of Visual Scenes. . both of which are critically dependent on eye–hand coordination. Pasher (2002). Amherst. Cheryl C. (2003). doi:10.828887. M. c1995. G. Dorothy Strickland and Stéphane Bouchard (2004). html). edu/ idea/ space workshop/ Papers/ Michael Grant/ M Grant . Hentz (March 2000). R. Helene M.46. Michael J. Haluck. buffalo. D. dinf. M.[14] 160 [15] [16] 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.1109/TITB. V.[17] References [1] Westwood.. C. 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html> http:/ / www.Wireless Health 161 Wireless Health Wireless Health is the integration of wireless technology into traditional medicine. Zarlink. calories out and sleep quality. aspx?p=24243 http:/ / mobihealthnews.com/news_verizon4G. Used in combination with a food log.[1] Enabling Technologies 3G.[2] 4G. com/ 11198/ 10-mobile-health-diabetes-management-companies/ 4/ [11] http:/ / mobihealthnews.[5] Bluetooth low energy. com/ 11198/ 10-mobile-health-diabetes-management-companies/ 5/ [9] http:/ / www. 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.[11] References [1] http:/ / marketplace.[8] • A&D makes connected activity monitors. informit. designed for wireless sensor networks that require low-energy consumption and low data transmission.[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/ 9855/ ces-preview-slideshow-mobile-health-devices/ 8/ . com/ 2460/ verizon-wireless-health-care-key-example-of-4g-services/ [4] [5] [6] [7] <http://blhealthcare.[10] • A weight management system consisting of an armband and an online Activity Manager that automatically tracks activity and sleep. com/ 1053/ which-technology-should-continua-pick/ http:/ / mobihealthnews. com/ medical [10] http:/ / mobihealthnews. weight scales and blood pressure monitors with software to gather and analyze personal health data. com/ articles--~~~~/ article.[4] Bluetooth. Mobile Cardiac Outpatient Telemetry (MCOT) allows for immediate arrythmia detection. Mobile broadband connectivity is useful in reaching new patients in remote areas while improving productivity and convenience through data transmission. org/ display/ web/ 2009/ 03/ 10/ pm_body_computing/ [2] http:/ / mobihealthnews. such as diagnosis. the system provides a complete picture of the three components of weight loss: calories in. ANT+ (ANT+ is a wireless networking protocol that allows communication between multiple sensors and devices.). com/ 7312/ indias-mhealth-gets-3g-to-connect-the-unconnected/ [3] http:/ / mobihealthnews.[3] LTE.[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. monitoring and treatment of illness. and other radios such as BodyLAN (BodyLAN is a low-power wireless networking protocol that transmits data from medical and fitness devices).[6] Examples • Cardionet’s 3G-enabled wireless service line. publicradio. com/ 4337/ cardionet-announces-enhanced-mcot-system/ [8] http:/ / mobihealthnews. as well as other tools that can help individuals improve their personal health and wellbeing. etc. andonline.

This meant that wireless medical telemetry operations had to accept interference from the primary users of these frequency bands. there are seven geographical areas in which WMTS and non-medical telemetry operations have "flipped" the bands in which each enjoys primary status.C. 1395-1400 MHz and 1427-1432 MHz. 2000. 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). (2) the Washington.Wireless Medical Telemetry Service 162 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). even if that meant shutting down the medical telemetry operation.4-2. termed the "carve-out" areas.. i. At the same time.5 MHz band.11 or Bluetooth radios. In a Report and Order released on June 12. that are regulated under Part 90 of the FCC's Rules. but is secondary . in addition to WMTS. more typically. However.5 MHz band. MI. MI. The FCC was concerned that certain regulatory developments. Prior to the establishment of the WMTS. To ensure that wireless medical telemetry devices can operate free of harmful interference. PA. FCC statements There is an FCC statement on coexistence[1] of WMTS in various frequency bands. if a wireless medical telemetry operation caused interference to television or private land mobile radio transmissions. would result in more intensive use of these frequencies by the primary services. The frequencies in the 1427-1432 MHz band are shared by WMTS with non-medical telemetry operations. and (7) Spokane. (5) Battle Creek. the FCC decided to establish the WMTS. The bands defined are 608-614 MHz. (4) Austin/Georgetown. In these seven areas. WA. and. WMTS has primary status in the 1429-1431. These seven areas. Further. are (1) Pittsburgh. it adopted a number of regulations to ensure that the WMTS frequencies are used effectively and efficiently for their intended medical purpose. WMTS operations are accorded primary status over non-medical telemetry operations in the 1427-1429. many manufacturers have created devices that transmit data in the ISM bands such as 902-928 MHz. Because of this. subjecting wireless medical telemetry operations to greater interference than before and perhaps precluding such operations entirely in many instances. in contrast to the rest of the country. the user of the wireless medical telemetry equipment would be responsible for rectifying the problem.5 GHz. VA. including the advent of digital television (DTV) service. Devices using these bands are typically proprietary. The WMTS rules took effect on October 16. the use of these bands has not been internationally agreed to. Further.5-1432 MHz band. TX. Generally. (3) Richmond/Norfolk. but are treated as secondary to non-medical telemetry operations in the 1429. metropolitan area. often using IEEE 802. such as utility telemetry operations. the television broadcasters and private land mobile radio licensees. D.e. so many times devices cannot marketed or used freely in countries other than the United States. the FCC allocated a total of 14 megahertz of spectrum to WMTS on a primary basis. 2. It was created in 2000 because of interference issues due to establishment of digital television. (6) Detroit. 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.

Wireless Medical Telemetry Service to non-medical telemetry operations in the 1427-1429 MHz band. risk managers. htm?job=about& id=wireless_medical_telemetry) [2] (http:/ / wireless. and nursing home directors. gov/ services/ index. gov/ Radiation-EmittingProducts/ RadiationSafety/ ElectromagneticCompatibilityEMC/ ucm116574. fda. in part: Because of concerns for interference with the present wireless medical telemetry systems. fcc. In general. 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. directors of biomedical/clinical engineering. gov/ services/ index. and the introduction of the WMTS. fcc. References [1] FCC statement on coexistence (http:/ / wireless. htm) . 163 FDA comments Comments from US FDA[3] . CDRH has issued a public health advisory to hospital administrators. htm?job=service_bandplan& id=wireless_medical_telemetry) [3] (http:/ / www.

Telemedicine. and Informatics Alliance 164 World Health Imaging. sustainable. WHITIA’s vision is to facilitate the deployment of thousands of digital medical imaging systems worldwide. WHITIA announced its partnership with SIIM. IL. US Chicago. WHITIA announced strategic partners including SEDECAL. Remi-d. which will allow both organizations to collaborate on specific initiatives. institutions. Its strengths in these areas stem from the higher burden of Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) co-infection. imaging industry innovators and academic institutions in order to integrate and deliver meaningful.World Health Imaging.[1] [5] WHITIA cultivates high-level strategic relationships with non-governmental organizations. receiving extensive coverage in Health IT magazines and publications. Illinois. diagnostic technology to underserved communities worldwide. and organizations in the radiology industry. Dave Kelso. a remote-operated screening X-ray system for use in the developing world. Carestream Health and Merge Healthcare. Minow. 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. providing one billion people with access to diagnostic imaging. Telemedicine and Informatics Alliance Founder(s) Type Founded Location [1] Mike Hoaglin. WHITIA's first formal public launch was in April 2009 at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference & Exhibition in Chicago. Health Information technology. X-ray. and Informatics Alliance World Health Imaging. Michael Diamond 501(c)(3) Non-profit Organization Chicago. high incidences of Black Lung disease. Ferro. Matt Glucksberg.[11] At the 2009 RSNA Annual Meeting. Chair of the Board [2] Michael W. The teleradiology and remote-controlled features of Remi-d allow resource-limited areas such .. Telemedicine.[7] [8] At the 2009 Annual Conference of the Society for Imaging Informatics in Medicine (SIIM) in Charlotte. or outbreaks of other infectious respiratory diseases. North Carolina. Vice Chair Ivy Walker. sustainability One digital image can save a life worldhealthimaging.[6] WHITIA was formerly known as the World Health Imaging Alliance (WHIA) until it formally expanded its scope in June 2009. WHITIA launched. CEO [3] Key people Area served Worldwide Focus Motto Website Low-cost medical imaging. Jr.org [4] The World Health Imaging.[9] [10] WHITIA was recently ranked #15 of the top 25 most influential people. Illinois. Illinois United States Newton N.

Yahoo Finance. com/ 25_Most_Influential_in_Radiology_Recognizing_the_movers_and_shakers_in_the_radio/ content=9004J05E48B6A084409698724488B0441). McCormick School of Engineering and Applied Science. html). org/ [7] "Not-for-Profit Has a Vision to Help a Billion People" (http:/ / www. [10] "World Health Imaging Alliance poised to bring imaging diagnostics and data to the developing world" (http:/ / www. com/ news/ Merge-Healthcare-Commits-1-bw-14855801. They are designed to be models for the wider expansion of the WHITIA network throughout the clinics in need in urban and rural Guatemala. Retrieved 2009-12-01. [3] "Personnel" (http:/ / www. asp). . South and Central America and Southeast Asia. html?x=1& . 146+ M5a262949a06. . Retrieved 2011-01-09. [13] "SIIM to Support World Health Imaging Alliance" (http:/ / www. html). reuters. Retrieved 2009-07-04. Retrieved 2009-07-02. [4] http:/ / www. com/ news/ home/ 20090605005136/ en). . . org [5] "World Health Imaging Alliance Partners For X-Rays in Developing World" (http:/ / www. 2009-04-06. net/ news/ 20091130/ WHITIA-launches-digital-medical-X-ray-device-for-screening-infectious-diseases-in-developing-countries. Retrieved 2009-07-02. [12] "WHITIA launches digital medical X-ray device for screening infectious diseases in developing countries" (http:/ / www. . . Northwestern University. . [2] "Board of Directors" (http:/ / www. northwestern. Retrieved 2009-07-02. Retrieved 2009-10-22. mccormick. Retrieved 2009-07-02. THE MEDICAL NEWS. Retrieved 2009-07-02. 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. Reuters. com/ article/ pressRelease/ idUS111037+ 06-Apr-2009+ BW20090406). edu/ news/ articles/ 494). [8] "World Health Imaging Alliance Poised to Bring Imaging Diagnostics and Data to the Developing World" (http:/ / finance. mccormick. Retrieved 2009-07-02. healthtechwire. edu/ FA2007/ Xray. news-medical. [6] http:/ / www. yahoo. Retrieved 2009-07-02. businesswire. worldhealthimaging.[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. Robert R. [9] "World Health Imaging Alliance (WHIA) Announces Support From The Society for Imaging Informatics in Medicine (SIIM)" (http:/ / www. HealthTech Wire.World Health Imaging. worldhealthimaging. . html). northwestern. Business Wire. v=1). 0. and Informatics Alliance as sub-Saharan Africa. rt-image. where radiologists and technologists are in short supply to have a functioning X-ray service. org/ board. com/ news/ 2009-06-17_01. worldhealthimaging. . aspx). com/ The-Industry-s-News-unb. . . . html). Telemedicine. worldhealthimaging. Business Wire. com/ news/ home/ 20110104006502/ en/ WHITIA-Announces-Completion-Digital-X-ray-Pilot-Sites).[14] References [1] "McCormick students and faculty tackle health care challenge in the developing world" (http:/ / magazine. .[13] 165 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. McCormick School of Engineering. [11] "25 Most Influential in Radiology" (http:/ / www. [14] "WHITIA Announces the Completion of Digital X-ray Pilot Sites in Urban and Rural Guatemala" (http:/ / www. rt Image. businesswire. imagingeconomics. Imaging Economics. Retrieved 2009-07-02. org/ personnel.

0.php?articleID=1554620) • WHITIA Announces the Completion of Digital X-ray Pilot Sites in Urban and Rural Guatemala Press Release (http://www.com/id/31121000/) • (http://www. hxti.dotmed.com/The-Industry-s-News-unb.worldhealthimaging. Telemedicine. com/ 1194405140/ index_html [4] http:/ / sourceforge.cnbc.com/news/story/8681/) • (http://www. 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. Shown at Rotary International Convention 2008 (http://www.org/) • Video interview with WHITIA staff and overview of mission. cross-platform.tradingmarkets.pdf) Xebra (medical imaging software) Xebra (medical imaging software) is an open source.org/WHITIA Guatemala_01-04-2011press_release.com/articles/145456.site/news/Stock News/2362104/) • (http://www. and Informatics Alliance 166 External links • Official webpage (http://www.worldhealthimaging. Xebra is based on open standards including JPEG2000. 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.healthtechwire. thin client and server written in Java for web-based distribution and clinical review of radiology data in DICOM format. WADO and IHE XDS-I.html) • (http://www. Here is a copy of PR statement released "[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. 2007.php) • (http://www. net/ projects/ xebra/ .World Health Imaging.com/. Unlike its closed and proprietary predecessors locked to a single vendor.com/watch?v=sv0q0hD-flM) • (http://www.youtube. jsp?id=CCB30F65-E324-4325-8B5C-15C061C926F1) • (http://www.smartbrief."1 [3] External links • Xebra project page on SourceForge [4] References [1] http:/ / www.newsrx.com/article. com [2] http:/ / linuxmednews. Written in Java. to LinuxMedNews [2]: Xebra was officially released by Hx Technologies [1] on November 6.com/news/aaaa/industryBW-detail.146+M5a262949a06. com [3] http:/ / linuxmednews.medicalnewstoday.

Dicomprogrammer. Trident13. Mais oui!. JDDC1.org/w/index. Gobonobo. Timberframe.org/w/index. Dirk Koekemoer. Plastikspork. Mayla21. SpuriousQ. Kmasters0. Xxdude200xX. Mwarf. GRIFFEY366. Klughammer. Rodw. Dana boomer. Rsabbatini. Alphachimp. Sweet tea van. Skariface. Rich Farmbrough. Luchital. Malcolma. 25 anonymous edits E-Patient  Source: http://en. Kheerand. 17 anonymous edits iCan Group  Source: http://en.php?oldid=448292432  Contributors: Asav.wikipedia. DARTH SIDIOUS 2. Avernet. Whoisjohngalt. Vzach. Nicolas Barbier. Susievet. Dmannsanco. GargoyleMT. Intellijean. Zoicon5. Socialf5. Djln. Ronz. Andreala.org/w/index. Rougue scholar. Lambiam. Rsabbatini. Luk. Rlee0001. Xenva. Riggs77. SDaley2010. MMsharpie30. Shyamdash. Piotrus. Rsabbatini. 11 anonymous edits eHealth  Source: http://en.wood. PaulWicks.doman. Wavelength. Clueless. Spencerk. Kosherfrog. Slon02. FayssalF. 5 anonymous edits DICOM  Source: http://en. Arina. Johny9991. Wikieditor47. GRIFFEY366. 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David from Downunder. Sabathecat.wikipedia. Rjwilmsi. Jeanhcjean. Frap. Rhcoe. Ceyockey. Barryob. Beevee. Bwr54.org/w/index. EugeneBorukhovich.php?oldid=420974671  Contributors: Haruth. Lyjusinski.wikipedia. Rav 75. MrOllie. MattKingston. Slp1. Kpjas. Funandtrvl.wikipedia.org/w/index. Tma-medical. Argon233. Imran qau. Derekleungtszhei. Ronz. Rsabbatini. Templarion. WLU. Malcolma. 1 anonymous edits Canada Health Infoway  Source: http://en. P0per. Jose Ramos. Bondegezou. PaulWicks. Dondegroovily. Mathieu. Brian310207. Jane023. Drilnoth. Jeffrey Henning.coleman24. NatureBoyMD. Encephalon. T. Rsabbatini. Bearcat.php?oldid=452189596  Contributors: AbdiViklas. Surv1v4l1st.brown. Mootros.org/w/index. Rbardwell. Ömer Cengiz Çelebi. Movses. Glider87. Postcard Cathy. Telehealth. Peter Karlsen. Rachelellaway. Fasten. TRosenbaum. Chruck. Kolmigabrouil. Rsabbatini. Privatechef. Eastmain. Rsabbatini. PKT. Pipedreamergrey.php?oldid=446151537  Contributors: Dr.php?oldid=336751807  Contributors: Allen4names. Riteview. Stephan Leeds.Article Sources and Contributors 167 Article Sources and Contributors Telehealth  Source: http://en. Bslewis1. Karl. Edward. Senimazarine. Giraffedata. Dglane001.org/w/index. Chris Paton. Khcf6971. Schubert. Varano. 7 anonymous edits . Erianae. Blofeld.wikipedia. LincolnSt. Nsaa.php?oldid=450142200  Contributors: Bigmantonyd. Jonl. LordAbernathy. Bmludwig. Sanesto. Mco44. ‫ 712 . Oxymoron83.php?oldid=336753104  Contributors: Pvosta. T@nn. Jfdwolff. Soundray. Arcadian. Ehheh. Rsabbatini. Phatom87. Versageek. THB.wikipedia. Kku.wikipedia. Johnkmetha. Aipetri. Sevák Tzevánerig. Jamesfreeman404. Webchick40. Kattmamma. Zabdiel. Leussen. Rsabbatini. MrRadioGuy. Whoisjohngalt. Spencerk. Glengold. Aliceh z.php?oldid=336752215  Contributors: Asod123123. Mike Rosoft. Sjschen. N5iln. Cntras.org/w/index.org/w/index. Healthjab. Test21. Kimun.wikipedia. 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LennoxMI6140. Iridescent. Samir. Rüdiger Marmulla. Tlspiegel. Wavelength. Sbbhattacharyya. Khalid hassani. Crazymonkey1123.org/w/index.Archer. Oh Snap.php?oldid=450849686  Contributors: Alusayman.org/w/index. Devactivity. 4 anonymous edits Telemedicine  Source: http://en.org/w/index. 관인생략. Ohnoitsjamie. Opal8164. Dr P Michel. Info IST. HalJor. DMacks. Rjwilmsi. Vincej. Rsabbatini. Horselover Frost. JivaGroup. Stillplaygbc. TheRedClay. Earlypsychosis. Tide rolls. Broadband118. Sheara33. Kunalkhurana1. Nyttend. FiachraByrne. Metju.org/w/index. DJ Clayworth. Tempodivalse. 11 anonymous edits Teledermatology  Source: http://en. Tri57angle. MrOllie. Mandi. Gynonc. Rmlahey. Decltype. Stokedbloke.php?oldid=432442546  Contributors: Algray1977. Chris the speller. Kraftlos. NatureBoyMD. Hariva. Archanamiya. Eastmain. Mild Bill Hiccup. GRIFFEY366. Yazmínmx3. Cheeze1010101. Megcagley. Harborrat99. Odontastic. ZeiP. Alephnyc. Jfdwolff. Speechpathology. Dialectric. Beetstra.org/w/index. Chillin69x. 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Riteview. Wyatt915. Teletriage. 19 anonymous edits The Continua Health Alliance  Source: http://en.wikipedia. JHunterJ. AvicAWB. Hargle. TexasAndroid. Rich Farmbrough. J04n. Chowbok. Ronz. Ciscoperin. Crystallina. Lovelac7. Jbkim486. Rsabbatini. Suepalsbo. Castlewalk. Pearle.php?oldid=439986713  Contributors: Alvin Seville.org/w/index. Mitesh harlalka.php?oldid=442746737  Contributors: Catai2008. Micru. Rsabbatini. Ferritecore. Pascal666. Jeff3000. 2 anonymous edits Wireless Health  Source: http://en. The Rambling Man.php?oldid=445888139  Contributors: Acutetech. Lamro. Mysoberlife. Gary King. Kc8ukw. Wtshymanski. Scottalter. Rich Farmbrough. Muhandes. 5 anonymous edits Telepsychiatry  Source: http://en. SJP. Jlittlet. Anschaefer. Michaelmdx. Salad Days. Colinlee. Rdowney14. L Kensington. Mwarf. Continua. Koavf. FlyHigh. Josh Parris. Dawynn.php?oldid=425217552  Contributors: CliffC.php?oldid=441861039  Contributors: Aesopos. Alansohn. Jmoock. Propaniac. Tesseran. Greasybackflop.wikipedia. Woohookitty. Rsabbatini. MrOllie. Kirkewing. 127 anonymous edits Telerehabilitation  Source: http://en. 7 anonymous edits UNESCO Chair in Telemedicine  Source: http://en. Belovedfreak. Oli Filth. Katharineamy.org/w/index. B Pete. Steve carlson. Salamurai. Amy D. Ground Zero. Schubert. Rickwjenn.wikipedia. Usteleradiology. Zvar. Sunidesus. Harryzilber.php?oldid=353654061  Contributors: Bobwhitten. Rsabbatini. Skysmith. TreasuryTag. Shanetapper. Bocasurf. Eeekster. Sturm br. MrOllie. Asharafshahi. TeflonII.org/w/index.org/w/index. Wouterstomp. Ecohn. Woohookitty. Welsh.php?oldid=451208946  Contributors: Adilkhan1234. Kpearce. TransporterMan.wikipedia. Hibana. Niaz. Pearle. KAErps. Kukini. Sunidesus. OlYeller21.wikipedia.wikipedia. Gobonobo. Leolaursen. Cornellrockey. Blabberhand. Bddmagic. 13 anonymous edits Telephone triage  Source: http://en. From That Show!. MikeWazowski. LilHelpa. AppForCalPERSMCII. Malcolmxl5. BuffaloConspiracy. WAvegetarian.wikipedia. Rjwilmsi.mdel.wikipedia. SummerPhD. 4 anonymous edits Xebra (medical imaging software)  Source: http://en. Kittiseth. Anna Lincoln. Barticus88. Jn. Jkeirn. Mechanistic. Maelwys. 1 anonymous edits Virtual patient  Source: http://en. Jeepersjoseph. Drbreznjev.henderson. Wireless friend World Health Imaging. Longhair.org/w/index. Arcadian. WhatamIdoing. Rsabbatini. Obracy. Piotrus. Mandarax. Jsfouche. Barkeep. RyanGerbil10. and Informatics Alliance  Source: http://en. FauxClaud. Fabrictramp. Piotrus. Circeus. Sam Blacketer. Printerbuilder.org/w/index. Jsfouche. Malcolma. Davecrosby uk.php?oldid=415191513  Contributors: (aeropagitica). Apparition11. RTG.org/w/index. Supten.php?oldid=414812234  Contributors: Barkeep. Arcadian. Briancua. RSWeinstein. Topps.php?oldid=446863135  Contributors: Acebrock. Janezp.org/w/index. VishalB. Alansohn. Rsabbatini. Yegg13. Homepsychiatry. Wayne Miller. Rsabbatini. Philip Trueman.wikipedia. Rsabbatini. Rsabbatini. Nick Number. Radiologygenius. Paf25.Article Sources and Contributors Telepathology  Source: http://en. Harryzilber.org/w/index. Uanfala. Manuelpaul.wikipedia. Qcomsara Wireless Medical Telemetry Service  Source: http://en. McSly. FreplySpang. Fæ. G825e3. Britot. 14 anonymous edits Virtual reality in telerehabilitation  Source: http://en. Rjwilmsi. Mhoaglin.org/w/index. That Guy. WikHead.wikipedia. Boing! said Zebedee.org/w/index. Rachelellaway. PGPirate. Sueotis. Interoperable.org/w/index. Rsabbatini. WikHead. RJFJR. Hercule. Rougue scholar. CommonsDelinker. 4 anonymous edits 169 . Ithilias.wikipedia. Dbrienza. Gene Hobbs. Alvestrand. Malcolma. 6 anonymous edits Teleradiology  Source: http://en. WhatamIdoing.org/w/index.php?oldid=452074891  Contributors: Arthur Holland. Erechtheus. Auntof6.php?oldid=446286890  Contributors: Bearcat. STHayden. Flowanda. VirtualizationGuru. Jeff3000. Rwwww. Vegaswikian. Dekisugi. Trlovejoy.php?oldid=421839545  Contributors: Afishkind.wikipedia. Joel7687. Woohookitty. Wireless friend. AidenRyan. Telemedicine. Sianclaireowen. Clicketyclack. DGG. Jim. Chris Capoccia. Chris the speller.

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