HOLY FAMILY COLLEGE OF NURSING

SEMINAR ON TELE- MEDICINE

Submitted to: Ms.Sherly Ma’am Submitted by: Tanvi

Assistant Professor M.Sc Nursing

HFCON 1st Year

HFCON

General information
 Name of the Student teacher Ms.Tanvi Kundra

Subject Advance Nursing Practice

Topic Tele- medicine

Group M.sc 1 st year students

Venue Holy Family College of Nursing

Time Duration 40-50 mins

Size of Group 22-25

Method of Teaching Seminar

A.V Aids PPT, Flip charts, Chalkboard

Previous knowledge of the group:

General Objectives

Group point of view

At the end of the seminar, group will be able to understand about Tele- Medicine, it’s types,
utility and uses.

Student –teacher point of view

At the end of the seminar, student- teacher will be gain more skills and confidence in teaching,
will have in- depth knowledge about tele-medicine

Specific Objectives

The group will be able to:

 Define tele medicine

 Describe utility of tele medicine

 Explain the types of technology used in tele medicine

 Explain about the Infrastructure

INTRODUCTION
Telemedicine is the use of electronic information to communicate technologies to provide and
support healthcare when distance separates the participants.
“Tele” is a Greek word meaning “distance “and “mederi” is a Latin word meaning “to heal”.
Time magazine called telemedicine “healing by wire”. Although initially considered “futuristic”
and “experimental,” telemedicine is today a reality and has come to stay. Telemedicine has a
variety of applications in patient care, education, research, administration and public health.
Worldwide, people living in rural and remote areas struggle to access timely, good-quality
specialty medical care. Residents of these areas often have substandard access to specialty
healthcare, primarily because specialist physicians are more likely to be located in areas of
concentrated urban population. Telemedicine has the potential to bridge this distance and
facilitate healthcare in these remote areas.

Definitions and Concepts

Telemedicine
The World Health Organization (WHO) defines Telemedicine as, “The delivery of healthcare
services, where distance is a critical factor, by all healthcare professionals using information and
communication technologies for the exchange of valid information for diagnosis, treatment and
prevention of disease and injuries, research and evaluation and for the continuing education of
healthcare providers, all in the interests of advancing the health of individuals and their
communities.”

Telehealth
Telehealth is the use of electronic information and telecommunications technologies to support
long-distance clinical healthcare, patient and professional health-related education and
training, public health and health administration.

Telemedicine Consultation Centre (TCC)

Telemedicine Consulting Centre is the site where the patient is present. In a Telemedicine
Consulting Centre, equipment for scanning / converting, transformation and communicating
the patient's medical information can be available.

Telemedicine Specialty Centre (TSC)

Telemedicine Specialty Centre is a site, where the specialist is present. He can interact with the
patient present in the remote site and view his reports and monitor his progress.
 Telemedicine System
The Telemedicine system consists of an interface between hardware, software and a
communication channel to eventually bridge two geographical locations to exchange
information and enable teleconsultancy between two locations.
The hardware consists of a computer, printer, scanner, videoconferencing equipment etc. The
software enables the acquisition of patient information (images, reports, films etc.). The
communication channel enables the connectivity whereby two locations can connect to each
other.

Figure 1

A modern telemedicine system

 Utility of Telemedicine

 Easy access to remote areas

 Using telemedicine in peripheral health set-ups can significantly reduce the time and
costs of patient transportation
 Monitoring home care and ambulatory monitoring
 Improves communications between health providers separated by distance
 Critical care monitoring where it is not possible to transfer the patient
 Continuing medical education and clinical research
 A tool for public awareness
 A tool for disaster management
 Second opinion and complex interpretations
 The greatest hope for use of telemedicine technology is that it can bring the expertise to
medical practices once telecommunication has been established.
 Telementored procedures-surgery using hand robots
 Disease surveillance and program tracking
 It provides an opportunity for standardization and equity in provision of healthcare,
both within individual countries and across regions and continents.
 The Centre for International Rehabilitation recognizes that telecommunication and
telemedicine are important technologies to improve and provide rehabilitation services
in remote areas. Telemedicine cannot be substitutes for physicians in rural areas
especially in developing countries where resources are scarce and public health
problems are in plenty. So it is unrealistic to think at this stage of substituting unwilling
doctors with this technology. However, it can supplement the current health scenario in
a huge way in most countries.

Types of Technology
Two different kinds of technology make up most of the telemedicine applications in use today.
STORED AND FORWARDED
The first, called store and forward, is used to transfer digital images from one location to
another. A digital image is taken using a digital camera, ‘stored’ and then sent (‘forwarded’) by
a computer to another location. This is typically used for nonemergent situations, when a
diagnosis or consultation may be made in the next 24-48 hours and sent back. Teleradiology,
telepathology and teledermatology are a few examples.
IATV
The other widely used technology, the two-way interactive television (IATV), is used when a
‘face-to-face’ consultation is necessary. The patient and sometimes their provider or more
commonly a nurse practitioner or telemedicine coordinator (or any combination of the three),
are at the originating site. The specialist is at the referral site, most often at an urban medical
center. Videoconferencing equipment at both locations allow a ‘real-time’ consultation to take
place. Almost all specialties of medicine have been found to be conducive to this kind of
consultation including psychiatry, internal medicine, rehabilitation, cardiology, pediatrics,
obstetrics and gynecology and neurology.

Infrastructure
The telemedicine centers could be broadly classified into the following classes:
Primary Telemedicine Center (PTC)
Secondary Telemedicine Center (STC)
Tertiary Telemedicine Center (TTC)
PTCs would be based in Primary Health Centers, STCs in Secondary Medical Centers and TTCs in
Tertiary Medical Centers. The Hardware requirements / standards will be referred in the
context of the Telemedicine Consulting and Specialist Centres (TCC) and (TSC).

The total healthcare spending in India in the year 2011 according to the National health policy
draft was about 4.1% of GDP (gross domestic product) . However, the actual public health
spending was only 1.04% of GDP and was less than 30% of total healthcare spending. The
healthcare spending in India is grossly inadequate for the maintenance of good public health,
and this has been realized lately by the Government. The direct effect of low government
spending on public health has resulted in high out of pocket (OOP) expenditure. High OOP
payments are the main deterrent to common man, especially in rural areas, to access
healthcare services. Several studies have shown that high OOP expenditure is one of the
important contributing factors in pushing common man into poverty.

In India, 68% of the population still lives in the rural areas. Rural health care system is plagued
with several problems like severe shortage of healthcare professionals, lack of necessary
medical supplies as well as non-medical infrastructure such as electricity, clean water, lack of
planning and finances. About 60-80% of the physician positions in various specialties are vacant
in the rural health care service . Thus the task to reform healthcare is daunting. The rural/urban
 healthcare disparity is reflected in the healthcare outcomes as IMR in urban population is 27
whereas in rural population it is 44. Similarly, total fertility rate (TFR) is 1.8 in the urban
population whereas in rural population it is 2.6 . There are no straightforward solutions to
India’s heath care conundrum; however, use of India’s advances in the field of information and
communications technology (ICT) industry in healthcare delivery is an innovative idea to tackle
healthcare disparity. The widespread use of ICT in medicine has opened new horizons to
improve healthcare in India.

Telemedicine in health care delivery in India and its regional distribution

The potential of telemedicine, as a tool for delivery of healthcare was recognized by the
Government of India in the year 2000. Since then the Government of India has been working on
creating telemedicine infrastructure all over the country. The telemedicine initiative was
formulated by the Government of India with the involvement of Department of Information
Technology (DIT), Ministry of Communications and Information Technology and the Indian
Space Research Organization (ISRO), various state governments, and several premier technical
and medical institutions all over the country

In early 2000, DIT started telemedicine projects in different parts of the country. As a prime
organizer of telemedicine projects, DIT has undertaken major initiatives for the development of
technology and standardization of telemedicine in the country. It has established more than 75
nodal centers all over the country to support research and development of telemedicine. In the
state of West Bengal in the eastern part of India, several projects were undertaken in
collaboration with Webel Electronic Communication Systems Ltd (Webel ECS), a state public
sector enterprise under DIT, government of the State of West Bengal, Indian Institute of
Technology (IIT)- Kharagpur and various regional tertiary and primary medical centers . The
main aim of these projects was to deliver healthcare to the most remote parts of the country. It
covered various subspecialties like radiology, pediatrics, orthopedics, internal medicine,
cardiology, neurology, oncology, HIV and dermatology . These projects also created a database
of patient healthcare statistics and their medical records. They also played an important role in
the training of paramedical healthcare professionals and continuing medical education for
healthcare practitioners in remote areas.

In the northeastern states of India, Department of Space (DOS), ISRO and the North Eastern
Council (NEC) collaborated to establish North Eastern Space Applications Centre (NESAC) in the
year 2000. NESAC started an ISRO-NEC telemedicine project in 2004 utilizing satellite
communication through Very Small Aperture Terminal (VSAT) . They formulated a plan to
commission 72 telemedicine regional nodal centers in all districts of north-east, including the
States of Sikkim, Nagaland, Arunachal Pradesh, Tripura, Mizoram, Assam and Meghalaya. The
major objective of this project was to connect district level hospitals to other specialty tertiary
care hospitals both in the region as well as outside the region. This project was a novel concept
because northern parts of the country are particularly poor in infrastructure and healthcare
 services, and telemedicine could be very useful in healthcare delivery.Till date, a total of 25
regional telemedicine centers have been commissioned and remaining 47 are in various stages
of implementation.

Another important initiative undertaken by NESAC is setting up of village resource center (VRC)
in all the northeastern states of India. This is an important initiative, to bring the state-of-the-
art technology to the rural masses. VRCs are expected to provide a variety of services besides
telemedicine, including tele-education, creating and maintaining database on the natural
resources, issuing interactive advisories to farmers and villagers on agriculture and weather
forecasting . Tripura, one the northeastern States of India, has become an example of
successful implementation of telemedicine in the country. In Tripura, telemedicine setup has
been implemented at 20 hospitals, including 3 referral hospitals and 17 nodal hospitals. All
these centers are interconnected with internet speeds of 512 kbps/2 Mbps for data transfer
and data management. This project has successfully treated over 30,000 patients by
telemedicine from June 2005 to March 2013.

Consequently, state of Tripura now has one of the best ratios for IMR, crude birth rate, and
female literacy rates in the country. Tripura has IMR of 26 (national average 42), crude birth
rate of 13.7 (national average 21.4) and female literacy rate of 83.6% (national average 65%)
[22]. Although this achievement cannot be solely attributed to telemedicine services, and may
in part be due to the high female literacy and good educational status of the community [23].
But telemedicine as a means of healthcare delivery system assumes great importance especially
in the northeastern parts of the country, where terrain is treacherous, infrastructure is poor
and health care requires extensive planning and expense. In these areas telemedicine can be a
low cost complementary alternative to the traditional full scale hospital based services. Still, the
role of telemedicine in public health needs more exploration, especially in the area of maternal
and child health, in parts of the country where IMR and maternal mortality are very high.

Another example of the role of ICT in healthcare delivery is in the southern part of the country.
Kerala Oncology Network (Onconet - Kerala) telemedicine project has been successfully
completed by the Centre for Development of Advanced Computing and Regional Cancer Center
in Trivandrum. Its main aim was to explore the role of telemedicine in early detection of cancer,
its treatment, pain management and follow-up services . This project, launched in 2001 also
included the creation of a web enabled Hospital Information System ‘TEJHAS’ (Telemedicine
Enabled Java based Hospital Automation System) - an electronic database of
patient’s medical records, easily accessible to all the medical centers in the region .

The highlight of this project was the online sharing/data transfer of histopathology slides,
electronic medical records and radiology images between the nodal health care centers and
regional cancer center, which facilitated the remote follow up of patients with oncologists
through telemedicine. Telemedicine tools such as video-conferencing and web based transfer
of electronic medical records were used . After the successful implementation of Onconet -
Kerala, the government of India decided to implement ONCONET-India network. In this
ambitious project 25 regional cancer centers all over India will be connected to 100 remote-site
 peripheral healthcare centers/hospitals in India. The goal of this project is to create a
knowledge network all over India for oncology services .It will provide telemedicine services in
the field of cancer treatment, especially follow-up consultations for patients who already have
a defined treatment plans as well as early cancer detection by the use of
telepathology/teleradiology services . ISRO is playing a key role in all these projects by setting
up the technological expertise for the creation of telemedicine network in India (Figure 1) .

Involvement of private enterprise in the field of telemedicine in India

Private sector/healthcare industry has also recognized the potential of telemedicine. Through
successful implementation of several pilot projects involving the government and private
enterprises, telemedicine has been established as a solid and reliable healthcare delivery
system in India . The Apollo Telemedicine Networking Foundation, a not-for-profit organization
and a part of the Apollo Hospitals Group has been undertaking telemedicine projects. Under
the leadership of Dr. Ganapathy, a prominent neurosurgeon and widely regarded as the father
of Indian Telemedicine, Apollo Hospitals collaborated with ISRO to set up India’s first Rural
Telemedicine Center at Aragonda, a small village in the State of Andhra Pradesh. The world's
first VSAT enabled, modern secondary care hospital was established on 24th March 2000. Since
then Aragonda Apollo telemedicine center and Hospital has been the cornerstone case study
model for the entire telemedicine healthcare industry. Today ATNF has emerged as India's
single largest private healthcare provider in the area of Telemedicine with over 125 peripheral
centers in India and 10 overseas .

Figure 1: ISRO telemedicine network in India

The Apollo Telemedicine network includes a telemedicine specialty center and a telemedicine
consultation center. Currently all the telemedicine specialty centers located at the tertiary care
facilities of Apollo Hospitals are in big cities such as Chennai, Hyderabad, Delhi, Ahmedabad,
Kolkata, Bangalore and Madurai are linked to telemedicine nodal centers all over India through
variety of internet connectivity protocols such as VSAT, Integrated Services Digital Network line,
internet protocol, or broadband internet . More than 69,000 Tele-consultations were provided
by ATNF till May 2011, through the telemedicine specialty centers located at the Apollo tertiary
care facilities.

The potential of telemedicine has been recognized in many subspecialties of medicine,

including cardiology, neurology, dermatology, and ophthalmology. Narayan Hrudayalaya, a
leading healthcare institution in the southern part of India has been working in the field of
telecardiology. It was named among the 50 most innovative companies of the world by the
popular online magazine Fast Company in the year 2012 . The first pilot project of Narayan
Hrudayalaya related to telemedicine was establishment of Cardiac Care Unit in the District
Hospital, Chamarajanagar, Karnataka, in south India in February 2002. This project involved
hardware and ICT support from ISRO and financial support from the World Bank with additional
support from Karnataka Health System Development Project . Since 2001-02, this project has
established another 130 telemedicine centers all over India and treated over 64,000 patients,
including 10,000 patients in coronary care units with tele-consultations.

Stroke is the third leading cause of mortality in India. The role of ICT in the field of neurology,
especially in stroke care and management of epilepsy has been recently emphasized in several
studies. Presently, there is a severe shortage of trained neurologists and stroke care specialists,
particular in the rural areas in India . There are many studies which have shown that
telemedicine can substantially improve acute stroke care . Most of the work in the field
of neurology in telemedicine in India has been done by Apollo Telemedicine Networking
Foundation and includes continuing medical education of health professionals and tele-
consultations.

Dermatology is another clinical specialty that can make substantial use of the advances in ICT
because of its inherently visual nature in both diagnosis as well as follow-up. This makes it ideal
for the utilization of virtual medicine. In India, Kantiraj et al validated the store and forward
teledermatology and videoconferencing in a large number of patients while using gold standard
(face-to-face) comparison between teledermatologists and clinical dermatologists . Nair and
Nair also reported that teledermatology is a viable alternative to face to face encounters via
both store and forward and videoconferencing options. Based on their experience, they
implemented a project identifying common skin disorders via this approach. It is of note that
teledermatology can be used not only in the diagnosis and treatment of patients, but also in the
education of healthcare professionals .

Similarly application of telemedicine in ophthalmology has been successfully implemented in

India by Sankar Nethralaya and Aravind Eye Hospital in Chennai in the southern state of Tamil
Nadu . John et al treated over 54,751 patients by organizing telemedicine camps across four
states in India . They found that uncorrected refractive error was the commonest cause of
avoidable blindness (59%), followed by cataract (30%). The other diseases include retinal
diseases (3.3%), mainly diabetic retinopathy and corneal diseases (1%). Presently
Teleophthalmology has been firmly established as a healthcare delivery system by various
projects in rural India.
 Telemedicine in public health: Improving healthcare utilization, and epidemiological
surveillance

The farthest reaching contribution telemedicine can make in healthcare in India is in the arena
of public health. Presently, most applications of telemedicine are concentrated in curative
services. Telemedicine can play a major role in health promotion especially in improving the
knowledge, beliefs and attitudes of common people. It is common knowledge that amongst the
most common reasons for the underperformance of major public health programs in India, are
the lack of knowledge of prevention of many communicable diseases by vaccines and
erroneous beliefs and practices in the rural population.

Notably, ISRO and North Eastern Space Applications Centre (NESAC) already have the required
infrastructure in 25 nodal telemedicine centers in northeastern states and are working on 47
centers currently. Besides Village Resource Centers, an important part of ISRO – NEC initiative,
can play an important role in the dissemination of knowledge and brining about changes in
healthcare attitudes and practices. There have been studies which show that simple quality
improvement initiatives can improve vaccination rates in rural populations.

Telemedicine can also play an important role in the epidemiological surveillance with the
development of Geographic Information Systems (GIS). GIS is a new method of studying
healthcare data. It includes healthcare spending and outcomes in a particular geographic area
and compares it to other area/s to develop ideal healthcare delivery systems and guide
healthcare policy.

Telemedicine applications and electronic health profile of populations can give insight into the
geographical distribution of various diseases, their prevalence and overall health of a
population. The integration of GIS with telemedicine, in the telemedicine nodal hospitals/rural
health centers can help bring real changes in healthcare in rural India. The integration of
telemedicine and GIS can help in understanding of epidemiology of diseases,especially the role
of climate , environment and disease transmission in various communicable and vector-borne
diseases, both regionally and nationally . Both GIS and telemedicine network are needed for the
public health programs all over India, especially in the areas of childhood vaccination programs,
maternal mortality and IMR.
 1.Development and implementation of low cost rural telemedicine
infrastructure in the rural peripheral health centers (PHC) for Tele-
consultation with the district/regional hospital acting as hub.

2. Initiation of “Village Tele-ambulance System and rural

emergency healthcare services/Trauma care healthcare delivery
system”, a new concept, through mobile telemedicine network.

3. Formation of Rural Health Knowledge Resource and national

database for healthcare at Ministry of health and family welfare.

4. Supplementation of rural healthcare delivery systems.

Table 1: Aims of the National Rural Telemedicine Network in India.

The federal Ministry of Health and Family Welfare has also recognized the positive impact of
telemedicine in improving healthcare in country. It has decided to set up national rural
telemedicine network. In this project, a national network for interlinking all medical
colleges/University Hospitals across the country has been proposed. This network named
National Medical College Network is for continuing medical education and e-health services all
over the country. Already 150 medical colleges around the country have been interconnected
by high speed fiber - optic based internet under National Knowledge Network Project. In the
field of healthcare delivery, National Rural Telemedicine Network is trying to interconnect
peripheral healthcare centers in rural areas with district hospital/tertiary care centers and
academic teaching hospitals. The aims of this project are summarized in Table 1.
 TELECOMMUNICATION TECHNOLOGIES

The first among the challenging questions arising when planning a telemedicine network is
‘What is bandwidth?’ Bandwidth is the capacity that determines how quickly bits may be sent
down the channels in a telecommunication medium. Bandwidth is proportional to the
complexity of the data for a given level of system performance. The following technologies are
currently in use:

Integrated Services Digital Network (ISDN)

ISDN is a dial-up (not dedicated but used on a call-by-call basis) digital connection to the
telecommunication carrier. An ISDN line can carry information at nearly five times the fastest
rate achievable using analog modems over POTS (plain old telephone service).

T-1
This is the backbone of digital service provided to the end user (typically business) in USA today
which transmits voice and data digitally at 1.554 megabits per second (Mbps). It can be used to
carry analog and digital voice, data and video signals and can even be configured for ISDN
service.

Plain Old Telephone Service (POTS)

POTS transmits data at a rate of up to 56 kilobits per second (kbps) (Bezar 1995) and is the most
widely available telecommunication technology in the world. POTS can be suitable for audio
conferencing, store-and-forward communication, Internet and low bandwidth videophone
conferencing.

Internet
The Internet has a strong impact in delivering certain kinds of care to patients. In a survey of
1,000 Chief Intelligence Officers (CIOs) conducted by Internet Health Care Magazine, 65% said
their organization had a Web presence and another 24% had one in development. With the
increasing proliferation of e-health sites on the Web today, many consumers are finding access
to online patient scheduling, health education, review of lab work and even e-mail
consultations.
TELEMEDICINE IN INDIA
In Utopia, every citizen may have immediate access to the appropriate specialist for medical
consultation. In the real world however, this cannot even be a dream. It is a fact of life that “All
Men are equal, but some are more equal than others.” We in India are at present, unable to
provide even total primary medical care in the rural areas. Secondary and tertiary medical care
is not uniformly available even in suburban and urban areas. Incentives to entice specialists to
practice even in suburban areas have failed.
In contrast to the bleak scenario in healthcare, computer literacy is developing quickly in India.
Healthcare providers are now looking at Telemedicine as their newly found Avatar.
Theoretically, it is far easier to set up an excellent telecommunication infrastructure in
suburban and rural India than to place hundreds of medical specialists in these places. We have
realized that the future of telecommunications lies in satellite-based technology and fiber optic
cables.

The Beginning
The Apollo group of hospitals was a pioneer in starting a pilot project at a secondary level
hospital in a village called Aragonda 16 km from Chitoor (population 5000, Aragonda project) in
Andhra Pradesh. Starting from simple web cameras and ISDN telephone lines today, the village
hospital has a state-of-the-art videoconferencing system and a VSAT (Very Small Aperture
Terminal) satellite installed by ISRO (Indian Space Research Organisation). Coupled with this
was the Sriharikota Space Center project (130 km from Chennai) which formed an important
launch pad of the Indian Space Research Organisation in this field.

Current Efforts
In India, telemedicine programs are actively supported by:

 Department of Information Technology (DIT)

 Indian Space Research Organization
  NEC Telemedicine program for North-Eastern states
 Apollo Hospitals
 Asia Heart Foundation
 State governments
 Telemedicine technology also supported by some other private organizations

DIT as a facilitator with the long-term objective of effective utilization / incorporation of

Information Technology (IT) in all major sectors, has taken the following leads in Telemedicine:

 Development of Technology
 Initiation of pilot schemes-Selected Specialty, e.g., Oncology, Tropical Diseases and
General telemedicine system covering all specialties
 Standardization
 Framework for building IT Infrastructure in health

The telemedicine software system has also been developed by the Centre for Development of
Advanced Computing, C-DAC which supports Tele-Cardiology, Tele-Radiology and Tele-
Pathology etc. It uses ISDN, VSAT, POTS and is used to connect the three premier Medical
Institutes of the country (viz. All India Institute of Medical Sciences (AIIMS), New Delhi, Sanjay
Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow and Post Graduate
Institute of Medical Education and Research (PGIMER), Chandigarh). Now it is being connected
to include Medical centres in Rohtak, Shimla and Cuttack.
The telemedicine system has been installed in the School of Tropical Medicine (STM), Kolkata
and two District Hospitals. In West Bengal, two hospitals where telemedicine centres have been
established are the First Coronary Care Unit inaugurated in Siliguri District Hospital, Siliguri,
West Bengal on 24 June, 2001 and Bankura Sammilani Hospital, Bankura, West Bengal
inaugurated on 21 July, 2001. Apart from the project at STM, the Second Telemedicine Project
has been implemented by Webel ECS at two Referral Centres (Nil Ratan Sircar Medical College
and Hospital (NRS MC and H), Kolkata and Burdwan MC and H, Burdwan) and four Nodal
Centres (Midnapore (W) District Hospital, Behrampur District Hospital, Suri District Hospital and
Purulia District Hospital). The Project uses a 512 kbps leased line and West Bengal State Wide
Area Network (WBSWAN) (2 Mbps fiber optic link) as the backbone.
In the past three years, ISRO's telemedicine network has expanded to connect 45 remote and
rural hospitals and 15 superspecialty hospitals. The remote / rural nodes include the offshore
islands of Andaman and Nicobar and Lakshadweep, the mountainous and hilly regions of
Jammu and Kashmir including Kargil and Leh, Medical College hospitals in Orissa and some of
the rural / district hospitals in the mainland states.
The Telemedicine project is a “NonProfitable” project sponsored by Rabindranath Tagore
International Institute of Cardiac Sciences (RTIICS) Calcutta, Narayana Hrudayalaya (NH)
Bangalore, Hewlett Packard, Indian Space Research Organisation (ISRO) and the state
governments of the seven North Eastern states of India. The Rabindranath Institute at Kolkata
and Narayana Hrudayalaya at Bangalore will be the main Telemedicine linking hub for the seven
states. The specialists at both the institutions will offer their services for this project entirely
free of charge. A 100 bedded hospital will be identified in each of these seven states and the
hospitals will be selected based on distance from the state capital and the lack of a coronary
care unit.
In the past two years, the pilot project on Telemedicine in Karnataka has already provided more
than 10,000 teleconsultations. In the operational phase, the Karnataka Telemedicine Project is
expected to bring multi-specialty healthcare to a significant section of the rural population of
Karnataka. This network would serve as a model for the utilization of ‘HEALTHSAT,’ which is
proposed for launch in the future.
BENEFITS OF TELEMEDICINE

Resource utilization

Early intervention

Avoids unnecessary transportation

Community based care

Medical education and research

Cost saving

Improved patient documentation

Increased range of care and education.

RESOURCE UTILIZATION First benefit of telemedicine is proper utilization of resources.

In India doctor population ratio is 1:15000 in comparison to 1:500 in developed nations, and
these doctors are not distributed equally.

80% Indian population lives in rural and semi urban areas.

Telemedicine can help in cost effective utilization of meager resources and of the same time
can decrease patient work load on few referral centers.

EARLY INTERVENTION

One of the most effective means of providing medical intervention is by early detection and
treatment.

There are factors that inhibit the continuity of care. Issues such as geographic location,
inclement weather, socioeconomic barriers.
 Patient apathy are significant factors that delay and even prevent the specialty care. By
providing these primary cure sites with the ability to quickly access specialty consultation
services.

Patients are able to reap the benefits of early intervention while the health care system
maintains quality service and clinical efficiency.

AVOIDS UNNECESSARY TRANSPORTATION

Local health provides discusses case of a patient on phone with a specialist and it specialist is
not getting clear picture.

After few questions he will able to send the patient but if by video conferencing he has clear
picture of patient.

Unnecessary referral and patient transport can be definitely avoided.

Which Data Can be Transferred Basically four types of data are used in telemedicine. - Text for
patient notes, generally having a file of less than 10 KB. - Audio – electronic stethoscope, with
file size of around 10 KB. - Still image X-rays which are still images having a size of around 1 MB.
- Video movie – ultrasound / patient visualization – movie images have a size of 10 MB or more
the patient can be seen by a doctor at a remote place using cameras.

COMMUNITY BASED CARE Community based care is another big advantage of telemedicine.

People like to receive high quality care in their local community.

This reduces travel time and related stresses associate with many referrals.

MEDICAL EDUCATION AND RESEARCH Telemedicine is also useful in medical education.

When medical students are posted in rural area they can be linked to medical college for grand
rounds and they can also do case presentation to teachers in medical colleges. In India Indira
Gandhi National Open University (IGNOU) carries out regular monthly session of teaching of its
diploma in maternal and child health (PGDMCH) students. Physicians living in different parts
of the world also use telemedicine in collaborative research, they can also share data or can
discuses current trends.
 TELEMEDICINE BARRIERS

 Perspective of medical practitioners: Doctors are not fully convinced and familiar with
e-medicine.
 Patients' fear and unfamiliarity: There is a lack of confidence in patients about the
outcome of e-Medicine.
 Financial unavailability: The technology and communication costs being too high,
sometimes make Telemedicine financially unfeasible.
 Lack of basic amenities: In India, nearly 40% of population lives below the poverty level.
Basic amenities like transportation, electricity, telecommunication, safe drinking water,
primary health services, etc. are missing. No technological advancement can change
anything when a person has nothing to change.
 Literacy rate and diversity in languages: Only 65.38% of India's population is literate
with only 2% being well-versed in English.
 Technical constraints: e-medicine supported by various types of software and hardware
still needs to mature. For correct diagnosis and pacing of data, we require advanced
biological sensors and more bandwidth support.
 Quality aspect: “Quality is the essence” and every one wants it but this can sometimes
create problems. In case of healthcare, there is no proper governing body to form
guidelines in this respect and motivate the organizations to follow-it is solely left to
organizations on how they take it.
 Government Support: The government has limitations and so do private enterprises.
Any technology in its primary stage needs care and support. Only the government has
the resources and the power to help it survive and grow. There is no such initiative
taken by the government to develop it.
 TELENURSING

DEFINITION OF TELENURSING

Telenursing is a subset of Tele health in which the focus is an nursing practice via
telecommunication. -By American Nurses Association

Tele nursing is defined as the practice of nursing using protocols through telecommunication
technology. - Arkansas Staff Board of Nursing

THE PRACTICE OF TELEPHONE NURSING

Standards and Quality Center is Telephone Nursing. Competencies Required in Telephone

Nursing High Quality Practice Settings. Decision Support Systems Using Nursing Titles
applies to telephone nursing practice. Designated Agent

GUIDELINES FOR TELENURSING Nurses and midwives practising in telenursing shall be

registered nurses or midwives. Enrolled nurses involved by telenursing need to be under the
supervision of registered nurse or midwife.

Nurses and midwives practising telenursing are personally responsible for ensuring that their
nursing and or midwifery skills and expertise remain current for their practise.

Nurses and midwives who are practises telenursing in Australia are effected to practice with
is the frame work of the ANMC National Competences standards of the midwife the ANMC
code of professional conducts for nurses in Australia, code of ethics for nurses in Australia and
other relevant professional standards.

Nurses and midwives should inform consumers of the telehealth process including other
persons/professionals who may be participations or presence is the telehealth consultations
and urban consent before proceeding.

Nurses are midwives in televisions have a duty to provide privacy and confidentiality in all
interactions.

Nurses and midwives practises in telenursing should be aware of both the evidence base for
their practise and the areas or practice is need or research.

Nurses and midwives practising telenursing should engage in evaluation of their practise in
relations to issue of quality safety and patient outcomes.
 ISSUES IN TELENURSING

Models of Case Privatizations Work line from nursing staff Patient safety Cross Border
License Issues

CLINICAL FUNCTIONS OF THE TELEHEALTH NURSES

Telehealth nurses are monitoring patients with chronic diseases.

Helping patterns manage their symptoms and co-ordinations care of patients who require
service from homeruns health professionals.

BENEFITS OF TELENURSING When patient stand seeing of their own day, they stand
connecting the data above their processes. Managing their disease better reduce their
utilization of acute case services such as emergency department visits and hospitalization.
Saving time achievable because driving time to reach patient residence by significantly reduced.
Nurses are able to spend more time on direct patient care.

Telehealth Nurses Provide Nursing Care by

Using Clinical Algorithms, Protocols, or Guidelines to Systematically Assess Patient Needs and
Symptoms.

Prioritizing the urgency of patients needs.

Collaborating and developing a plan or care with the patient and supportive, disciplines which
may include recommendation for cure, call back educations.

Evaluation outcomes.

Conclusion
It does not require too much of a stretch of imagination to realize that telemedicine will soon
be just another way to see a health professional. Remote monitoring has the potential to make
every minute count by gathering clinical data from many patients simultaneously. However,
information may be lost due to a software glitch or hardware meltdown. Therefore, relying too
heavily on a computer system to prevent errors in healthcare data may be problematic. There
has to be a smart balance between total dependence on computer solutions and the use of
human intelligence. Striking that balance may make all the difference in saving someone's life.
In 2008, the potential of telemedicine, tele-health and e-health is still left to our imaginations.
Time alone will tell that Telemedicine is a “forward step in a backward direction” or to
paraphrase Neil Armstrong “one small step for IT but one giant leap for Healthcare”.

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