Centers for Medicare and Medicaid Services

(CMS),
• For purposes of Centers for Medicare and Medicaid
Services (CMS),
• “telemedicine seeks to improve a patient's health by
permitting two-way, real time interactive
communication between the patient, and the
physician or practitioner at the distant site.
• This electronic communication means the use of
interactive telecommunications equipment that
includes, at a minimum, audio and video equipment”
 American Telemedicine Association (ATA)

•  “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”.
Federation of State Medical Boards (FSMB)
•  “Telemedicine means the practice of medicine using electronic
communications, information technology or other means
between a licensee in one location, and a patient in another
location with or without an intervening healthcare provider.
• Generally, telemedicine is not an audio-only, telephone
conversation, e-mail/instant messaging conversation, or fax.
• It typically involves the application of secure video
conferencing or store and forward technology to provide or
support healthcare delivery by replicating the interaction of a
traditional, encounter in person between a provider and a
patient.”
 What Is Telehealth?

• Telehealth: The delivery of health care, health

education, and health information services via
remote technologies.
• Telehealth is defined as the delivery and
facilitation of health and health-related
services including medical care, provider and
patient education, health information services,
and self-care via telecommunications and
digital communication technologies
 Teleconsultation
• Teleconsultation is defined as synchronous or
asynchronous consultation using information
and communication technology to omit
geographical and functional distance.
• Its goals are for diagnostics or treatment
between two or more geographically
separated health providers (for example
physicians or nurses) or between health
providers and patients
 Teleconsultation
• Teleconsultation, sometimes referred to as remote consultation
or telehealth,
• refers to interactions that happen between a clinician and a
patient for the purpose of providing diagnostic or therapeutic
advice through electronic means.
• How is Teleconsultation done?
• Making use of telemedicine services is very easy. Traditionally,
the service uses an online account or a toll-free phone number.
• Patients request a visit, submitting basic information on their
condition, and then the physician either accepts or declines the
visit, or schedules it for the future.
 Telemonitoring,
• Defined as the use of information technology to monitor
patients at a distance.
• promising applications for telemonitoring is for chronic
illnesses such as cardiopulmonary disease, asthma, and
heart failure in the home
• Telemonitoring means the use of information technology
to remotely monitor a patient's health status via electronic
means through the use of clinical data while the patient
remains in a residential setting, allowing the provider to
track the patient's health data over time.
• Telemonitoring may or may not take place in real time.
 Tele Treatment
• Treatment provided to the patient through
Telemedicine.
• The specialist at the Specialty Centre could
advise the consulting doctor at the Consulting
Centre about the course of treatment to be
taken.
 Patient Information Record (PIR)

• All information pertaining to the patient for

providing care using Telemedicine.
• This included clinical as well as non-clinical
information.
 Clinical Information

• This includes history of the illness,associated

signs and symptoms, clinical observations,
Clinical interventions, diagnostics and
treatments etc., relevant for providing care,
using Telemedicine
 Non-clinicaI lnformation

• Non-clinical information include information

about the patient's environment demographic
• information, life style, occupation or about
related people, etc., where this is relevant for
providing care using Telemedicine
 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, communicating for
medical information of the patient can be available but it is
not essential.
• A Telemedicine Consulting Centre usually has a General
Practitioner or in very remote locations
• Registered Medical Practitioner who will be able to
communicate to the TCC the symptoms/problems of
• the patient.
 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.
• A Specialty Centre is generally located in a
Specialty or Super Specialty hospital catering
for specific specialties or all specialties
 Healthcare network
• Communications network designed to suit the
health sector and the provision of health
• information via an assortment of electronic
devices (computers, printers, scanners, etc.)
• connected for mutual exchange of digital
information.
 Telemedicine System

• Telemedicine system consists of an interface between

hardware, software and communication channel
• to eventually bridge two geographical locations to exchange
information and enable teleconsultancy between two
locations.
• The hardware consists of computer, printer, scanner,
video conferencing 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.
 Telediagnostics
• Telediagnostics is the use of information and communications
technologies to enable the diagnosis orca patient between geographically
separated individuals.
• Telediagnostics is usually a real time and live dialogue between the
specialist and the doctor at the remote site with regard to the diagnosis
of the patient's illness.
• The specialist is in one location and the consulting doctor/patient is in
another.
• But it is also possible that Telediagnostics could be of a Store and forward
type where the patient's information is transmitted to the TSC
• specialist gives his expert opinion after a specific period of time.
• This could happen in circumstances where the specialist was not
available at the time of receipt of patient information at the TSC
• there was a communication breakdown and it was not possible to give
the opinion in real time.
 Unique Provider Identifiers
• Unique Provider Identifiers in addition to
overcoming communication and coordination
• difficulties,
• identifier would enhance the ability to
eliminate fraud and abuse in health care
programs –
• these include Unique Patient Identifier,
Telemedicine centre identifier.
 Unique Patient Identifier:

• Each and every patient is identified by a unique and

universal Patient Identifier.
• This Universal Patient Identifier will enable the
benefits-
• Same patient can move across multiple providers
• without loss of data, one centralized PIR can be
assimilated,
• Medical records database can be built and queried
across time, Captures one-time patient demographics
for later analysis.
 Telemedicine Centre Identifier:

• Each Telemedicine service center acting as either

Telemedicine Consulting Centre (TCC) or
• Telemedicine Specialist Centre (TSC) or both is
identified by a unique and universal identifier code.
• This Telemedicine Centre identifier -Allows for easy
identification of provider for Telemedicine purpose,
• Only genuine hospitals can get onto Telemedicine
network having proper infrastructure, Allows for
common billing format across providers, Registration
number of providers can be used as identifier.