Telemedicine and its application

in public health
Dr. Preeti Tiwari
 Contents
•Introduction
•Objectives
•History
•Supports
•Why it is relevant to our society
•Benefits to health care professionals
•Benefits to patients
•How it can be used?
•Major challenges
 INTRODUCTION
• “Tele” is a Greek word meaning “distance “

• “mederi” is a Latin word meaning “to heal”

• “healing by wire”
 TELEMEDICINE

• The use of electronic information and

communications technologies to provide and
support health care when distance separates the
participants.

• Telemedicine, Telehealth, mHealth, Telecare

• Telemedicine has a variety of applications

 Patient care

 Education

 Research
 Videoconferencing
 Transmission of still images
 E-health
 Remote monitoring of vital signs
 Continuing medical education
 Nursing call centers
Types of technology
Definations
 Telemedicine
• 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 Specialty Centre
• 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.
 History
• Thirty years.

• The National Aeronautics and Space Administration

(NASA)

• NASA’s efforts in telemedicine began in the early 1960s

• Its goals is to provide healthcare to astronauts in space

• In 1989, NASA conducted the first international telemedicine
program

• Telemedicine consultations were conducted using oneway

video and voice technologies between a medical center in
Yerevan, Armenia and four medical centers in the US
 India
• The Apollo group of hospitals

• Pilot project at a secondary level hospital (Aragonda 16 km

from Chitoor )Andhra Pradesh.
• Web cameras and Integrated service digital network (ISDN)
telephone lines

• Videoconferencing system
• The Sriharikota Space Center project (130 km from Chennai)

• Which formed an important launch pad of the Indian Space

Research Organization in this field
Telemedicine
 Objectives
• Information management

– Patient information

– Medical data (signs, symptoms, test reports, etc..)

– Appointment scheduling

– Archival and retrieval of patient records

• Low cost solution

– Using ordinary telephone line

• Service to large population

– Through public health care delivery systems

• Development of knowledge-based system

– For decision support

– For training and education

 Supports
In India, telemedicine programs are being 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
 Why it is relevant to our society
• Poor infrastructure

• Non-availability of experts (disparate distribution)

• Lack of proper medical education

• Low doctor-patient ratio (large population)
• Patients have accepted telemedicine :-

 Pilot program study finds pediatric obesity patients like

telehealth services
– UCLA – December 2013
 Benefits to Healthcare Professionals

11 Click to adddiagnosis
Improved Title and better treatment management

22 Click to add Title and training

Continuing education

1 3 Click to
Quick andadd Title follow-up of discharged patients
timely

24 Access
Click to to
addcomputerized
Title comprehensive data of
patients
1
 Benefits to patients
• Access to specialized health care services to under-served
rural, semi-urban and remote areas

• Early diagnosis and treatment

• Reduced physician’s fees and cost of medicine

• Reduced visits to specialty hospitals

• Reduced travel expenses

• Early detection of disease

• Reduced burden of morbidity

How it can be used?
 Specialist referral services

• Typically involve a specialist assisting a general practitioner

in rendering a diagnosis.
• Involve a patient “seeing” a specialist over a live remote
consult
• The transmission - diagnostic images / video along with
patient data to a specialist for viewing later.
Images
Vector Data
Graphics
Video Clip
 Direct patient care
• Sharing audio/video / medical data between a patient and a
health professional .

• Rendering a diagnosis, treatment plan, prescription or advice.

• This might involve patients located at a remote clinic, a

physician’s office or home.
 Remote patient monitoring
• Uses devices to remotely collect and send data to a monitoring
station for interpretation.

• “home telehealth” applications

 Devices to capture a specific vital sign, such as blood pressure,
glucose, ECG or weight.

• Supplement the use of visiting nurses.

 Medical education and mentoring
• Provision of continuing medical education

• Special medical education seminars

 Targeted groups - expert advice provided

 Medical procedure.
 Consumer medical and health
information
• Includes the use of the Internet for consumers to obtain
specialized health information

• On-line discussion groups to provide peer-to-peer support.

Data for patient management in Telemedicine
Structured Document
 Different types of services
 Telecardiology

 Teleradiology

 Telepathology

 Telepsychiatry

 Early Warning System

[ Prevention and control of endemic and infectious
diseases ]
Different online services

Mobile apps
Wearables
 Available soon

Wi-Fi Smart Scale Otoscope Blood Pressure Monitor

Bluetooth Stethoscope Blood Glucose Meter Digital

Thermometer
 Remote Surgery

Robotics Live Monitoring via

Cell Phones
 Challenges
• Perspective of medical practitioners:

 Doctors are not fully convinced and familiar with e-medicine.

• Patient’s fear and unfamiliarity:

 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:

 Nearly 40% of population lives below the poverty level.
 Basic amenities -are missing
• Literacy rate and diversity in languages:
 Only 65.38% of India’s population is literate
 Only 2% being well-versed in English.

• Technical constraints:
For correct diagnosis and pacing of data-
 advanced biological sensors
 More bandwidth support.
• Government Support

• Poor Data Communication Infrastructure.

• A Large Population Catered by Government Hospitals.

• System Features should be scalable

• Cost of the system should be scalable.

• Neither telephone lines nor electricity in rural areas

• Satellite transmission can help but is pricey
• Unstable electricity supply.
• Longer time for data transfer.
• Poor video quality
 Legal issues

 licensing, registration, authorisation of health professionals

 liability

 personal data protection

Thank you