Introduction to Telemedicine

What is Telemedicine

Telemedicine is an upcoming field in health science arising out of the effective fusion of Information and Communication Technologies (ICT) with Medical Science having enormous potential in meeting the challenges of healthcare delivery to rural and remote areas besides several other applications in education, training and management in health sector. It may be as simple as two health professionals discussing medical problems of a patient and seeking advice over a simple telephone to as complex as transmission of  electronic medical records of clinical information, diagnostic tests such as E.C.G., radiological images etc. and carrying out real time interactive medical video conference with the help of IT based hardware and software, video-confernce using broadband telecommunication  media provided by satellite  and terrestrial network.

Definition

There are several definitions of telemedicine. 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”.

Types of Telemedicine Process

Telemedicine process can be categorised in two ways i.e. technology involved and application adopted.

(a)  Technology involved:

(b) Application adopted:

Types of connectivity:

• Point-to-Point communication:
  In networking, the Point-to-Point Protocol (PPP), is a data link protocol commonly used to establish a direct connection between two nodes over terristrial and satelleite link e.g. SGPGIMS, Lucknow is connected to the medical colleges of Orissa through point to point connectivity via satellite link and District Hospital, Rae Bareli via fiber optic cable network. 

• Point-to-multipoint communication
  is a term that is used in the telecommunication field which refers to communication which is accomplished via a specific and distinct type of multipoint connection, providing multiple paths from a single location to multiple locations e.g. two District Hospitals of Uttaranchal state are linked to SGPGIMS via ISDN link.

Applications of Telemedicine:

1. Tele-health care: It is the use of information and communication technology for prevention, promotion and to provide health care facilities across distance. It can be divided in the following activities
   - Teleconsultation
   - Telefollow-up
2. 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.
   
   
3. 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.
   
   
4. 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.

Advantages of Telemedicine:

The main objetctive of telemedicine is to cross the geographical barries and provide healthcare facilities to rural and remote areas (health for all) so it is beneficial for the population living in isolated communities. Besides this other advantages telemedicine  are

Barriers in Telemedicine Practice

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

Physicians 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.

However, some resistance is seen amongst doctors. Doctors in government sector tend to look upon telemedicine as an additional duty or workload. Therefore, there is need to weave telemedicine into the routine duties of the doctors. The private doctors sometime fear that telemedicine is likely to reduce their practice. They need to realize that this technology enhances their reach and exposure and is only likely to increase their practice further. 

Availability of Technology at a Reasonable Cost:

It is myth that to establish a telemedicine platform is an expensive. The basic system needs hardware, software and telecommunication link. In all the areas there is a significant reduction in the prices. Most of these costs are well within the reach of most of the hospitals, and can be recovered by nominal charge to the patients and students in case of tele-education which would be much less than the physically traveling.

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?