Telemedicine: A new generation technology to improve health care
To visualize the concept just one scene from the movie 3Idiots will be helpful: lady delivering a child far away from the hospital. This scene depicts one such application of the Telemedicine. The concept of telemedicine is that to provide the medical help to a person far away from the doctor. It uses telecommunication and information technology for the purpose of delivering health care. The barrier of distance will be reduced and it will be a boon for the rural villages placed far away.
It is an era of going everything online from grocery to apparels. The technology has made everything to reach the doorstep. The technology has taken a one more step closer helping us to consult the physician at our convenience. Bye bye the long waiting hours at the clinic. This has made possible to reduce the service cost by making one-to-one as one-to-many.
What is telemedicine?
Telemedicine is sometimes also referred as telehealth or e-health. But there exists some difference between these two terminologies. Telehealth is an extended version of telemedicine or it can be said as the next of telemedicine or broader expansion of rural health care. The telemedicine can be defined as the use of technology by the medical professionals to evaluate, diagnose and treat patients sitting in remote locations. It is basically an exchange of medical information from one location to another using the electronic medium of communication to provide clinical services. It is a boon for the persons located in the remote location to reach the doctor at the earliest. In rural or remote parts the presence of clinic can be finger counted and the accessibility is also a big question. This telemedicine technology allows the physician to offer his service and be present at many locations simultaneously without leaving his place. The term telehealth refers providing clinical and non-clinical services to the required persons.
The features of the telemedicine are:
Video conferencing
E-health monitoring of patients
Remote monitoring of vital signals
Medical education continuation
Getting medical help
The main advantages of this telemedicine system are:
Efficient use of limited resources
Expert consultation to patients located at multiple locations
To deliver the service to remote areas in a cost-effective way.
It provides a network to be established between different physicians to get expert advice whenever needed.
The main requirement for this telemedicine set up is:
PC
High speed data communication system
Peripherals required for the diagnosis
Types of telemedicine
The concept of telemedicine can be categorized as:
Real time/ Synchronous telemedicine-
The presence of the two persons at the same time for the clinical service is real time telemedicine. The communication should be made at the same time itself. Commonly used methodology is video conferencing.The peripherals that are used with this includes
Tele-otoscope for inspecting inside the patients ear.
Tele-stethoscope for monitoring patient’s heartbeat.
This telemedicine technology used generally for the treatment in the areas related to
Psychiatry
Internal medicine
Family practice
Neurology
Rehabilitation
Cardiology
Pediatrics
Obstetrics
Gynecology
Speech-language pathology
Pharmacy
Store-and-Forward/Asynchronous telemedicine-
The medical information related to the patient is transmitted to the doctor, which he can access offline. A medical record is maintained to update the health status of the patient. This technology is generally used in:
Dermatology
Radiology
Pathology
Home health telemedicine-
This system is used for monitoring the patients who require observation from their home. Health monitoring equipment will be installed to record his vital signals, patient’s health status monitoring, and option for video conferencing and in case of emergency alerting the nursing staff. The first telemedicine system was developed by MedPhone Corporation in 1989. This telemedicine system was developed for the cardiac defibrillation.
Some of the terminologies and applications linked with the telemedicine are given below:
Application Service Provider or ASP provides the necessary applications on a central sever.
Asynchronous were the data transmission occurs in one side. It is basically represents store and forward type.
Authentication to ensure the identity of the person.
Bandwidth gives the capacity of the channel to carry the information.
Clinical Information system to keep all the data’s relevant to the patient’s medical history using telemedicine technology.
Codec or coder –decoder system.
Compressed video
Computer based patient record system
Data compression
Diagnostic equipment’s the peripherals connected to the computer to do the necessary diagnostics of the patient under the telemedicine set up.
Digital camera to take the images of the patient. It is useful when he is undergoing treatment related to dermatology or any wounds.
Disease management to provide continuous health management and assessment of the patient.
Distance learning to provide audio/video training to the required students was the trainer can’t travel to the location.
Distance site refers to the location were the physician is providing the medical service to the patient. The other terms are referral site, hub site, specialty site and provider/physician site.
Document camera which displays the written or typed documents.
Electronic data interchange or EDI refers to the communication of electronic data’s between the sender and receiver.
Electronic patient record maintains all the relevant data’s related to the patient like reports, remainders, alerts etc.
Encryption encoding of data so as to be retrieved by the concerned person only.
Firewall to provide a secure network.
Full-motion video to provide a good streaming of video signals without interruption.
Guideline a set of procedure or policy required to assist in setting up standards.
The different technical standards used for the compression of video conferencing signals are H.320, H.323 and H.324.
HL-7 or high level-7 data communication protocol provides the guideline related to the transmission of health related documents.
Health information portability act or HIPAA
Informatics
ISDN or integrated services digital network used for dial-up communication.
ITV/IATV/VTC or interactive video/television is a type of video conferencing technique which allow 2-way synchronous interactive video and audio signals for the purpose of telemedicine.
IP or internet protocol
Interoperability is the ability of the 2 or more systems to interact with each other to exchange data related to telemedicine. It can be classified as:
Human/operational
Clinical
Technical
ISDN BRI is the base rate interface that provides 128k of bandwidth for the communication purpose. Multiple links can be connected using a multiplexer.
ISDN PRI is the primary rate interface that uses 23 64k channels and 1 64k data channel. Proper multiplexing is required.
Joint commission for accreditation of healthcare organizations or JCAHO.
Loseless a type of data compression in a ratio of less than 2:1. When the data is reproduced almost all original data is retrieved.
Lossy is a type of data compression at higher ratio were some permanent loss of data occurs while reconstruction.
Medical/Nursing call centers
Mobile telehealth providing the healthcare services using a mobile unit.
Multiplexer or MUX
MCU or multi-point control unit act as a bridge which connects multiple video conferencing sites into a single video conference.
Multi-point teleconferencing is to interact with 2 or more user using MCU.
Network integrators are those organizations which develop software’s required for the sharing of data and communication to one another.
Originating site or spoke site or patient site or remote site or rural site where the patient is located for the consultation.
Patient exam camera for the general examination of the patient.
Peripheral devices
Presenter is required for assisting the examination of the patient properly so to provide correct information to the physician sitting miles away.
Regional health information organization RHIO
Router provides an interface between 2 networks providing the best route between the 2 sites.
Switch is an electronic device which selects the path for video transmission.
Synchronous means were the communication occurs concurrently at the same time.
System/network integration uses software for the sharing of data’s and communication with another devices and systems.
T1/DS1 and T3/DS3 are the digital carrier signals were former has a speed of 1.544 Mbps and later has 45 Mbps.
TCP/IP
Telecommunication providers
Teleconferencing
Telematics is the use of information technology to process data’s and telecommunication to transfer program and data to another system.
Telementoring is to guide or direct a physician in some medical practice in some distance place.
Telemonitoring is used to monitor the health of a patient in some remote location.
Telepresence is the use of robotics or any other device which allows a physician to perform some clinical procedure situated at remote location with time to time update, feedback and accordingly manipulating the device to perform.
Teleradiology and picture archiving and communication a system PACs is used for sharing and storing information related to radiology.
So far we have discussed the concept of telemedicine, its types and different terminologies used in the field of telemedicine. Now we will see its relevance and where it finds its application and how it is implemented for the cause.
Monitoring the patient using telemedicine
Now a day the availability of bed in hospital is a big issue. For mere monitoring keeping the patient in the hospital is the waste of resource. Here telemedicine can come as aid. The patient will be remotely monitored for its vital signal from his home itself. The values will be automatically getting updated to a cloud system and the nurses in the nursing station of hospital will be monitoring the values. If any abnormalities reported the necessary medical treatment will be initiated to shift the patient to hospital.
Expert Advice and guidance using telemedicine
Another example is when expertise opinion is required for some medical cases and the person will be located in some far place. Using telemedicine technology the case file can be send to the concerned person for his opinion. Even this can be useful for the doctors while performing complicated operations getting guidance from the expertise.
Learning using telemedicine
The medical students can learn from the experts located far away using this technology like an online classes.
Rural health sector using telemedicine
The condition of rural health sector is not up to the mark as compared to its urban counterpart. The facilities and availability of the medical practitioner is limited. In such places a reliable telemedicine system will be a boon. General consultation can be performed and the villagers won’t require traveling miles to get the facility.
The concept of telemedicine is not new but still it is in budding stage and its full potential is still to be explored. The many concerns are also attached with the telemedicine like the reliability of the network, peripheral devices, the payment process to the concerned person etc. As the technology booms hopefully these will be answered and will help in setting up a reliable, low cost medical health care in every nook and corner.
