Barriers in Telemedicine Practicee



The practice of telemedicine – through transmission of digitized data, audio, video and images – is getting popular all over the world as it provides hitherto unavailable access to tertiary level specialist healthcare even in geographically remotest areas without displacement of the patient, physician or the equipment. It is not only cost-effective to the patient but cost-beneficial to the society also. More and more doctors and patients are resorting to the use of telemedicine due to its advantages of convenience and cost-saving. The practice of telemedicine, however, has brought with it several complicated issues. These issues involve not only healthcare workers and consumers but the society, technologists and the lawmakers also. Those interested in the specialty of telemedicine need to address these issues.

Physician/Patient Acceptance

TPhysicians and patients have unique technological resources available to improve the patient-physician relationship. It has been found that patients have no difficulty in accepting telemedicine program. The survey conducted by SGPGIMS tele-follow up program for the patients of Orissa state revealed that 99% patients were satisfied with using telemedicine technology. In almost all the cases the patients are more than happy and satisfied as they don’t have to travel 1500 km to show their diagnostic reports to their doctors. In tele-consultation they were also happy that they get the specialist consultation and their cases has been seen by some expert doctors.

Accessibility:

Although information technology has reached in all corner of the country but the accessibility of people living in remote and rural area to the nearest health center (PHCs, CHCs or district hospital) may not be easy due to poor infrastructure of road and transport. It may be possible that the available telemedicine system in thee health centers may not function becaue of the interruption in power supply.

Reliability:

Some healthcare professionals has doubt about the quality of images transmitted for tele-consultation and tele-diagnois. In tele-radiology, telepathology, tele-dermatology the quality of image (colour, resolution, field of view, etc) should be international standards to avoid any wrong interpretation and mis-diagnosis. The delay in transmission of data may be of critical importance in tele-mentoring and robotic surgery and have to be reduced to the minimum.

Funding/ Reimbursement Issues:

There should be a format to calculate the investment and recurring cost of the telemedicine system. The insurance companies have to decide whether the cost of tele-healthcare should be reimburse or not.

Lack of Trained Manpower:

Telemedicine is a new emerging field, there is lack of training facilities with regards to application of IT in the field of medicine. Most of the healthcare and IT professionals are not familiar with the terms commonly used in telemedicine such as HIS, EMR, PACS, etc. Telemedicine is also not the part of course curriculum of medical schools.

Legal & Ethical:

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?

Privacy and Security Concerns:

There are many issue that should be considered regarding the security, privacy and confidentiality of patient data, in telemedicine consultations How are patients’ rights of confidentiality of their personal data ensured and protected How to ensure security of the data and restrict its availability to only those for whom it is intended and who are authorised and entitled to view it? How to prevent misuse and even abuse of electronic records in the form of unauthorised interception and/ or disclosure?