TELEMEDICINE

our vision to future

DR.RAJU
 Definition of Telemedicine

Telemedicine is the use of telecommunication

and information technologies in order to
provide clinical health care at a distance. It
helps eliminate distance barriers and can
improve access to medical services that would
often not be consistently available in distant
rural communities.
 What is Telemedicine?
Telemedicine is the use of medical
information exchanged from one site to another
via electronic communications to improve a
patient’s clinical health status. Telemedicine
includes a growing variety of applications and
services using two-way video, email, smart
phones, wireless tools and other forms of
telecommunications technology.
 Telemedicine as Defined by
WHO
According to World Health Organisation, telemedicine
is defined 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 continuing
education of healthcare providers, all in the interests of
advancing the health of individuals and their
communities”.
 Benefits to patients
Access to specialized health care services to under-served
rural, semi-urban and remote areas
Early diagnosis and treatment
Access to expertise of Medical Specialists
Reduced physician’s fees and cost of medicine
Reduced visits to specialty hospitals
Reduced travel expenses
Early detection of disease
Reduced burden of morbidity
 Benefits to Healthcare
Professionals

Improved diagnosis and better treatment management

Continuing education and training

Quick and timely follow-up of discharged patients

Access to computerized comprehensive data of patients, both

offline & real time
 HEALTHCARE IN RURAL
INDIA
• 70 % of India’s population live in
rural areas
••
90% of secondary & tertiary care
facility are in cities and towns
•Lack of investment in health care in
rural areas

•Inadequate medical facilities in rural

areas

• Problem of retaining doctors in

rural areas specially the specialist
doctors
Types of technology
2 types

Store and forward Two-way interactive television

 Raising of ICT Empowers
Telemedicine
Advances in ICT have
heightened public awareness and
health sophistication (with
greater public awareness of
behavioural risk factors, ready
access to sources of health
information, and an active and
extensive lay referral system),
thereby increasing demand for
medical care.
 Telemedicine is Investment in
Information Technology
Telemedicine is often
part of a larger
investment by health
care institutions in
either information
technology or the
delivery of clinical
care
 Telemedicine connects any
Remote area
Four Decades ago with
demonstrations of hospitals
extending care to patients in
remote areas, the use of
telemedicine has spread rapidly
and is now becoming integrated
into the ongoing operations of
hospitals, specialty departments,
home health agencies, private
physician offices as well as
consumer’s homes and
workplaces.
 Telemedicine becomes Health
Information Technology
Telehealth is sometimes used
to refer to a broader
definition of remote
healthcare that does not
always involve clinical
services, Telemedicine is
closely allied with the term
health information
technology (HIT).
 What Services Can Be
Provided By Telemedicine?
 Primary care and Specialist
referral Services
Primary care and specialist referral
services may involve a primary
care or allied health professional
providing a consultation with a
patient or a specialist assisting the
primary care physician in rendering
a diagnosis. This may involve the
use of live interactive video or the
use of store and forward
transmission of diagnostic
images, vital signs and/or video
clips along with patient data for
later review.
 Remote Patient Monitoring,
Remote patient monitoring,
including home Telehealth, uses
devices to remotely collect and send
data to a home health agency or a
remote diagnostic testing
facility (RDTF) for interpretation.
Such applications might include a
specific vital sign, such as blood
glucose or Heart ECG or a variety
of indicators for homebound patients.
Such services can be used to
supplement the use of visiting
nurses.
 Consumer Medical and Health
Information

Consumer medical and health

information includes the use
of the Internet and wireless
devices for consumers to
obtain specialized health
information and on-line
discussion groups to provide
peer-to-peer support.
 Telemedince Empowers Chronic
Patents who are less Mobile

The telemedicine intervention in

chronic disease management
promises to involve patients in
their own care, provides
continuous monitoring by their
healthcare providers, identifies
early symptoms, and responds
promptly to exacerbations in
their illnesses.
 Telemedicine Empowers
Medical Education
Medical education
provides continuing
medical education
credits for health
professionals and special
medical education
seminars for targeted
groups in remote
locations.
What Delivery Mechanisms
Can Be Used?
 Networked Programs
Networked programs link
tertiary care hospitals and
clinics with outlying
clinics and community
health centres in rural or
suburban areas. The links
may use dedicated high-
speed lines or the Internet
for telecommunication
links between sites
 Point-to-point connection
Point-to-point connections using
private high speed networks are
used by hospitals and clinics that
deliver services directly or
outsource specialty services to
independent medical service
providers. Such outsourced
services include radiology,
stroke assessment, mental
health and intensive care
services.
 Monitoring Centre links
Telemedicine
Monitoring centre links are used
for cardiac, pulmonary or fetal
monitoring, home care and
related services that provide care
to patients in the home. Often
normal land-line or wireless
connections are used to
communicate directly between
the patient and the center
although some systems use the
Internet.
 Web-based e-health patient
service sites

Web-based e-health patient

service sites provide direct
consumer outreach and
services over the Internet.
Under telemedicine, these
include those sites that
provide direct patient care.
What Are the Benefits of
Telemedicine?
Telemedicine has been growing rapidly because
it offers four fundamental Benefits:

Improved Access
Cost Efficiencies
Improved Quality
Patient Demand
 Improved Access
Improved Access – For over 40
years, telemedicine has been
used to bring healthcare
services to patients in distant
locations. Not only does
telemedicine improve access to
patients but it also allows
physicians and health facilities
to expand their reach, beyond
their own offices.
 Cost Efficiencies
Cost Efficiencies – Reducing
or containing the cost of
healthcare is one of the most
important reasons for funding and
adopting telehealth technologies.
Telemedicine has been shown to
reduce the cost of healthcare and
increase efficiency through better
management of chronic diseases,
shared health professional
staffing, reduced travel times, and
fewer or shorter hospital stays.
 Improved Quality in
Telemedicine
Improved Quality – Studies have
consistently shown that the
quality of healthcare services
delivered via telemedicine are as
good those given in traditional
in-person consulations. In some
specialties, particularly in mental
health and ICU care,
telemedicine delivers a superior
product, with greater outcomes
and patient satisfaction.
 Patient’s Too Demand
Service
Patient Demand – Consumers
want telemedicine. The greatest
impact of telemedicine is on the
patient, their family and their
community. Using telemedicine
technologies reduces travel time
and related stresses for the
patient
 Raise of Telemedicine
Rising use of telemedicine takes
different forms. Traditionally
telemedicine has played the
biggest role in rural areas where
visits to doctors are difficult and
in consultations with specialists
like radiologists and oncologists
where value is created by
connecting a patient to the best
expert.
 Google Joins Telemedicine
Revolution
Google's recent
announcement that it will
provide telemedicine
services was the crescendo
to a swelling volume of
recent interest: However
it has been popular
around for a generation.
 Tele-Education
Tele-education: Tele-Education
should be understood as the
development of the process of
distance education (regulated or
unregulated), based on the use of
information and
telecommunication technologies,
that make interactive, flexible
and accessible learning possible
for any potential recipient.
 Telemedicine Disaster
Management:
Disaster Management: Telemedicine
can play an important role to provide
healthcare facilities to the victims of
natural disasters such as earthquake,
tsunami, tornado, etc and man-made
disaster such as war, riots, etc. During
disaster, most of the terrestrial
communication links either do not
work properly or get damaged so a
mobile and portable telemedicine
system with satellite connectivity and
customized telemedicine software is
ideal for disaster relief.
 Tele-home health care:
Tele-home health care: Telemedicine technology can be applied to provide
home health care for elderly or underserved, homebound patients with
chronic illness. It allows home healthcare professionals to monitor
patients from a central station rather than traveling to remote areas
chronically ill or recuperating patients for routine check-ups. Remote
patient monitoring is less expensive, more time savings, and efficient
methodology. Tele-home care virtual visits might lead to improved home
health care quality at reduced costs, greater patient satisfaction with care,
increased access to health care providers and fewer patients needing
transfer to higher, more costly levels of care. A Computer Telephone
Integrated (CTI) system can monitor vital functions of patients twenty
four hours a day and give immediate warnings.
 Telemedicine empowers
Relationship Medicine
Telemedicine enables relationship-
based medicine: doctors can
maintain the conversation with the
patient in a manner that is far more
efficient and effective than 100%
reliance on traditional encounters;
they can serve more patients well.
Patients can get attention faster
and more conveniently when they
need it. This is the most powerful
reason that telemedicine is likely
to boom.
 Telemedicine empowered by
Broadband Services

This is expanding because

broadband network coverage is
improving, patients and
doctors are more comfortable
with computers, pressure for
cost savings is increasing, and
an emerging policy consensus
favours telemedicine. This all
makes sense.
 The framework for Information Technology
Infrastructure for Health (ITIH)
India

Recognizing the need for a standard system across the country

that meets the needs of the diverse groups that record, use,
transfer and disseminate health information, legal policies that
govern the healthcare structure, and education system to help
reinforce the strengths and values of the changing face of Indian
healthcare system, and to be able to offer value to the most
important stakeholder – the patient. As part of this endeavor, the
Department of Technology (DIT), Ministry of Communications
and Information Technology (MCIT), has undertaken the
initiative to prepare the ground for the Information Technology
Infrastructure for Healthcare (ITIH) in India.
ISRO’s Telemedicine Network
Telemedicine Projects
Mobile
 Legal & Ethical: Issues
Telemedicine
Telemedicine technology has been
proved and established and its
advantages and benefits are well
known but still many healthcare
professionals are reluctant to engage
in such practices due to unresolved
legal and ethical concerns. In case
of a cross-border tele-
consultation which country’s
litigation laws will be applied in
case– those of the country in which
the patient is living or those of the
remote physician?
HAVE VISION TO FUTURE IN
TELEMEDICINE WORLD IS
CHANGING
Just make use of your Smartphone it is
Smart tool for Medical Resources
 CHALLENGES
Patients' fear and unfamiliarity

Financial unavailability

Lack of basic amenities

Literacy rate and diversity in languages

Quality aspect

Government Support

Perspective of medical practitioners

 CHALLENGES
• Low bandwidth

 Neither telephone lines nor electricity in rural areas

 International bandwidth of RAFT countries is very limited

End 2004: 18 Mbps for the entire country, 1,34 bps/capita (Mali)

Switzerland 2002: 66.000 Mbps, 9.040 bps per capita

(Source: ITU World Telecommunication Indicators Database)

 Satellite transmission can help but is pricey

 Mobile communication is gaining ground

• Unstable electricity supply.

 GOALS AND NEEDS
Looking to the past experience for success of telemedicine:
• Video conferencing

• Accompanied by data and image transfer (live)

• Common software usage at both ends, thus globalization of a single database software

• Role of trained technical personnel is equally important and necessary at the patient end.

• Successful remuneration system to attract private practitioners

THANQ YOU