telemedicine

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Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred through the phone or the Internet and sometimes other networks for the purpose of consulting, and sometimes remote medical procedures or examinations.

Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care.

(See photo from HELP telemedicine clinic) [1]

Care at a distance (also called in absentia care), is an old practice which was often conducted via post. There has been a long and successful history of in absentia health care which, thanks to modern communication technology, has evolved into what we know as modern telemedicine.

In its early manifestations, African villagers used smoke signals to warn people to stay away from the village in case of serious disease. In the early 1900s, people living in remote areas in Australia used two-way radios, powered by a dynamo driven by a set of bicycle pedals, to communicate with the Royal Flying Doctor Service of Australia.

The terms e-health and telehealth are at times wrongly interchanged with telemedicine. Like the terms "medicine" and "health care", telemedicine often refers only to the provision of clinical services while the term telehealth can refer to clinical and non-clinical services such as medical education, administration, and research. The term e-health is often, particularly in the UK and Europe, used as an umbrella term that includes telehealth, electronic medical records, and other components of health IT.

Types of telemedicine

Telemedicine can be broken into three main categories: store-and-forward, remote monitoring and interactive services.

Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. It does not require the presence of both parties at the same time. Dermatology (cf: teledermatology), radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured Medical Record preferably in electronic form should be a component of this transfer. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. The store-and-forward process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.

Remote monitoring, also known as self-monitoring/testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective.

Interactive telemedicine services provide real-time interactions between patient and provider, to include phone conversations, online communication and home visits. Many activities such as history review, physical examination, psychiatric evaluations and ophthalmology assessments can be conducted comparably to those done in traditional face-to-face visits. In addition, “clinician-interactive” telemedicine services may be less costly than in-person clinical visits.

Benefits and Uses of Telemedicine

Telemedicine is most beneficial for populations living in isolated communities and remote regions and is currently being applied in virtually all medical domains. Specialties that use telemedicine often use a "tele-" prefix; for example, telemedicine as applied by radiologists is called Teleradiology. Similarly telemedicine as applied by cardiologists is termed as telecardiology, etc.

Telemedicine is also useful as a communication tool between a general practitioner and a specialist available at a remote location.

The first interactive Telemedicine system, operating over standard telephone lines, for remotely diagnosing and treating patients requiring cardiac resuscitation (defibrillation) was developed and marketed by MedPhone Corporation in 1989. A year latter the company introduced a mobile cellular version, the MDphone. Twelve hospitals in the U.S. served as receiving and treatment centers. (See: Telecommunications, Concepts, Development, and Management, Second Edition, pages 280-282, W. John Blyth, Glencoe/McCgraw-Hill Company,1990)

Monitoring a patient at home using known devices like blood pressure monitors and transferring the information to a caregiver is a fast growing emerging service. These remote monitoring solutions have a focus on current high morbidity chronic diseases and are mainly deployed for the First World. In developing countries a new way of practicing telemedicine is emerging better known as Primary Remote Diagnostic Visits whereby a doctor uses devices to remotely examine and treat a patient. This new technology and principle of practicing medicine holds big promises to solving major health care delivery problems in for instance Southern Africa because Primary Remote Diagnostic Consultations not only monitors an already diagnosed chronic disease, but has the promise to diagnosing and managing the diseases a patient will typically visit a general practitioner for.

Telecardiology

ECG or electrocardiograph can be transmitted using telephone and wireless. This was done by Barr (1958) who transmitted ECG tracings to about 40,000 feet.

Teletransmission of ECG using indigenous methods. One of the oldest known telecardiology system (teletransmission of ECG) was established in Gwalior, India in 1975 at GR Medical college by Dr. Ajai Shanker, Dr. S. Makhija, P.K. Mantri using indegenous technique for the first time in India.

This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of the department of Medicine. Transmission using wireless was done using frequency modulation which eliminated noise. Transmission was also done through telephone lines. The ECG output was connected to the telephone input using a modulator which converted ECG into high frequency sound. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. The ECG was converted to sound waves with a frequency varying from 500 Hz to 2500 Hz with 1500 Hz at baseline.

This system was also used to monitor pacients with pacemakers in remote areas. The central control unit at the ICU was able to correctly interpret arrythmias. This technique helped medical aid reach in remote areas.^[1]

Teleradiology

Teleradiology is the ability to send radiographic images (x-rays) from one location to another. For this process to be implemented, three essential components are required, an image sending station, a transmission network, and a receiving / image review station. The most typical implementation are two computers connected via Internet. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes. Sometimes the receiving computer will have a printer so that images can be printed for convenience.

The teleradiology process begins at the image sending station. The radiographic image and a modem or other connection are required for this first step. The image is scanned and then sent via the network connection to the receiving computer.

An example of teleradiology is the EU-funded project R-Bay [2]. One of the major providers for teleradiology services in Europe is Telemedicine Clinic [3].

See also

• Ontario Telemedicine Network
• Telehealth
• eHealth
• National Rural Health Association
• Robotic surgery
• Teledentistry
• Telepsychiatry
• mHealth
• Professor Skevos Zervos
• UNESCO Chair in Telemedicine

Further reading

• Teleneurology and requirements of the european Medical Devices Directive (MDD) - Telemedical Systems and regulatory affairs for Europe, by Dipl. Ing. Armin Gärtner
• Telemedicine 101: Telemedicine Coming of Age - Telemedicine 101: Telemedicine Coming of Age, by Nancy Brown

References

External links

• Agency for Healthcare Research and Quality (AHRQ) -- Telemedicine for the Medicare Population
• Ontario Telemedicine Network -- Making the Connection for Health
• American Telemedicine Association
• Telemedicine Information Exchange
• Canadian Society of Telehealth
• TELESYNERGY - Telemedicine at the National Institutes of Health
• Telemedicine History
• National Rural Health Association
• International Society for Telemedicine & eHealth (ISfTeH)