Telemedicine

What is Telemedicine?
It is a way to communicate with physicians and medical instructions through
electronical or digital means. Different telecommunications are used in
telemedicine. Some of this telecommunications are:
• Telephone lines
• Internet
• Satellites
*Note: The telecommunications above are the most common way for
telemedicine. However other transmission media can be used.

It requirements for the use of technology

• High resolution and wide screen
• High resolution Webcam
• Microphone
• Speakers
• Back up of aprox 80 GB

How does telemedicine helps?

1. Sends care for patients in their homes and remote areas.
2. Enables doctors collect and transfer media

Types of Telemedicine
1. Real Time: This is the most common type of telemedicine. It consists of
live videos used by providers and specialist.
2. Store and Forward (Asynchronous): If provider and specialist are not
available, they record voice dictations, videos and radiology images if
necessary, which they later send through an email.
3. Home Health Telemedicine: If a patient after a surgery are put under
general observations and due to personal reasons or because there’s not
 bed in the hospital they use telemedicine at home. The bandwith used
however, is low and the system use is POTS (Plain Old Telephone
System)
4. To Rural Physicians and Clinics (Spoke Sites): Physicians and clinics
receive education from a specialist.

Where is it mostly used in medicine?

1. Cardiology
2. Radiology
3. Psychiatry
4. Oncology.
5. Telemedicine, in some cases helps to make possible telesurgery.
6. Physician anId patient education
7. Conferencing between health providers and medical administrators.

Advantages
1. Positive for patient and economy. The patient doesn’t has to spend money
in transportation and doesn’t have to move from where it is.
2. It avoids physicians and specialist nursing homes and hospitals.
3. Questions can be asked face to face and inmediate treatment is given for
the diagnosis.
4. The specialist actually listens the patient history and health issues, so it’s
bertter than receiving it from an email. The physician gets a more accurate
and reliable information from the patient.

Disadvantages
1. Internet could suddenly fall, so connection might break.
2. If there are no ENT peripherals, there can’t be a complete diagnosis done.
3. If the video camera or microphone gets ruin, communication won’t be
possible and reliability will decrease.
4. The patient could be lying about its condition just to get medicines from
the doctors.

ENT Peripherals: Gadgets use in telemedicine to check the patient.

Videos of how it works in clinics and hospitals

http://videos.howstuffworks.com/uc-davis/1705-reaching-rural-hospitals-with-
telemedicine-video.htm

http://www.youtube.com/watch?v=yi-vXsSi7fI
The way telemedicine works :

1- The patient contacts the doctor via video conferencing or

teleconferencing
2- He explains his health issues or the symptoms if he’s feeling sick
3- The doctor evaluates the medical state of the person
4- He looks at the patient’s data in his archives and can alter prescribe any
medication to the patient

Examples of Telemedicine in El Salvador

Since December 2003 Laboratorios Lopez, Hospital Benjamin Bloom and
Infocentros have done lectures and presentations at least once a month to an
average of 400 doctors around the country. The lectures about medical
education are dine via internet and videoconference .The doctors are all using a
laptop where they receive the signal when they can start the presentation
.Doctors if needed, can ask questions to the expert which is talking. Everybody
who is in it can listen to what the other doctors have to say too. The lecture and
presentations takes about an hour – they barely have to move from clinics and
other hospitals.

Impacts on stakeholders
Patient’s -Telemedicine has been
used frequently in order to improve the
efficiency of pediatric care. It
‘improves patient care, cost effective,
enhances echocardiogram quality and
prevents unnecessary transportation
(pediatric cardiology, April 2008)
Therefore we can denote that one of
the impacts is the low cost of service,
people don’t have to pay much for
being part of telemedicine, and also it
stops them from having to look for
transport to other hospitals which have
the pediatric cardiologists.
It also has an impact on the patients
health since it has been proved (Pediatric cardiology, April 2008) that
telemedicine increases echocardiogram quality which means that doctors can
have a clearer view of the patients state of heart and depending on that begin a
new treatment or keep on the treatment or finish it, depending on the person’s
state.
The patient’s health is also affected by the reliability of telemedicine. It’s referred
as reliability since the people’s
health is evaluated by trained
pediatrics which are experienced
and can give better evaluation and
conclusions about the patient’s
state.
Patients are also aloud to cancel or
move their appointments with
much liberty in case they have any
inconveniency and cannot make it
at the time which the appointment
was set. Without telemedicine
patients had to travel to the clinic or hospital for having the appointment and if
they missed it then if affected the rest of the patients and the doctor’s time.
Telemedicine helps the patient since if someday the patient is feeling really weak
and sick then they can just realize a video conferencing with the doctor instead of
traveling all the way to clinic/hospital and by this, there is no chance that the
patient could harm himself or other on his way to the clinic due to their state.
Doctors- Doctors can also be seen as one of the most important stakeholders
since they could really benefit from this technology. It can create an impact on
their education since they are trained in order to use this type of technology and
therefore they can learn how to use videos, computers, and other technologic
equipment. Also their time is affected since they no longer have to waste time
when a patient didn’t make it to the appointment because with telemedicine its
much easier to re schedule the appointment because they take less time and are
easier to make.
Country /government– The country is another stakeholder ( including the
government) since if there are uses of new developed technology in the country,
then the countries profile develops and looked as if its advancing and slowly
developing. Doctors in countries which are given this type of technology , have to
be trained and educated before they use it and therefore, maybe after some
years in the future they could use that education and training that they received,
in order to make a much bigger progress on their carrier of doctor and maybe
develop into a better one and earn more opportunities of work. And if there are
better trained and successful doctors then it means that there is a better medical
assisantance and care of the people and thus the government is positively
affected since they are seen as the principal ones which created all of this by
introducing telemedicine.
Ethical Issues
People and machines - People and machines can be seen as an ethical issue
which would arise from the use of telemedicine since doctors are being trained
and familiarized with new machines and they have to learn how to use and take
advantage of the opportunities that they are giving in their career.
Reliability - Reliability is also considered
as an ethical issues since with
telemedicine, people in some parts of the
countries are able to keep contact and
make appointments with doctors form
other parts of the country which have
more knowledge and capacity to analyze
and evaluate the persons case and state
of health that maybe a doctor in his region
doesn’t have. Therefore if a more
experienced doctor treats the patient then
his evaluations and recommendations
and treatment are going to be more
reliable than from an inexperienced doctor.
Relating telemedicine to case study
Village A already has phone line and internet so in order to make possible
telemedicine, village B and C, which we know by the case study (line 47 – 53),
village b doesn’t has internet and village C also doesn’t has, these two, should
get at least a phone line or internet connection. By the case study (line 65), we
know there were problems with communication between clinics, IT systems and
villages, so with these changes, the clinics will be able to communicate for
educational medical purposes and they will also have the facility to transfer
information about the health of a patient needed. All three villages once they
have gotten the requirements for using telemedicine, are going to benefit
themselves a lot because Dr Ogola will have the facility to communicate between
the clinics and give the patients a much more reliable treatment , and there
wouldn’t be any need of transportation, as (line 55 – 57) mentions “if a case is
too complicated or cannot be addressed in the local clinics, the patient is referred
to the hospital.”, so transportation is complicated to get and affects patients
health. Also doctors from villages can be taught and be educated on how to use
this technology, therefore they are also going to become more familiarized with
IT, and the benefits it gives to humans.
Overall, if the clinics decides to get either phone lines or internet, the best would
be to get internet as a priority because with internet there can be video
interaction which this is not possible with phone lines, so this can help clinics
know how to go through a surgery procedure if necessary.