Telemedicine

By Dr.Maulik Varu

Introduction
The term telemedicine derived from greek tele meaning at a distance and medicine which itself derived from the latin meden meaning healing.
Telemedicine is medicine at a distance.

Defination
The institute of medicine defines telemedicine as the use of electronic information and communications technologies to provide and support healthcare when distance separates the participants.

What is telemedicine?
Telemedicine is a rapidly developing application of clinical medicine where information is transferred via telephone,internet or other networks for the purpose of consulting and sometimes remote medical procedures or examinations.

It may be as simple as two health professionals discussing a case over the telephone or as complex as using satellite technology and videoconferencing equipment to conduct a real time consultation between medical specialists in two different countries.

It encompasses
Diagnosis Treatment Prevention of diseases Continuing medical education Research

What telemedicine is not?

Telemedicine is not a separate or a new branch of medicine or for that matter even new.
It is not the sole territory of computer nerds or technophiles.

History
1900-African villagers-smoke signals Remote Australia 1920-Seamans Church Ins. Of New Yorkradio NASA Telegraphy-bubonic plague in europe A story of Russian sailor

INDIA-The land of diversity

Population of

1.1+billion,28 states &5 union territories. Vast population spread in inaccessible and remote areas in around 6,27,000 villages. 80% of superspeciality in big cities.

Problems with Healthcare

Access to
Rural areas Mountains islands

Solution

Information capture
Documents Electronic medical records Still images Audio video

Drivers of telemedicine
Computing and information technology Network and telecommunication
infrastructure The personnel

Types
Real time Store and forward

Technologies

Standard telephone
PSTN(public switched

telephone network) Readily available form of communication. Obtainable almost anywhere in the world. Unfortunately the bandwidth56k.bit/sec. Important in peripheral areas.

ISDN
Digital counterpart of PSTN. Available in metropolitan cities. Bandwidth 128k.bit/sec-2m.bit/sec. End to end digital connectivity. Greater reliability due to digital nature of
data traffic. Rentals and usage charges high.

Leased lines
Alternative to ISDN. A permanent digital

connection is established between two locations. Bandwidth 64k.bit/sec2m.bit/sec. Fixed rental regardless of use.

Mobile phone

Highly portable. Low cost. Easy to use. Can have radio. Travelling advantage. Bandwidth-19.2100k.bit/sec. CT-scans and ecg recordings .

Internet

Familiar. Easily accessible. Easy to use. VPN(Virtual private network)

Microwave
High quality. Bandwidth 2-

10m.bit/sec. Can be used only over short distances(30kms). Expensive to install but inexpensive to maintain.

Satellite
Advantage of global
coverage. Expensive to install and costly to use.

several telemedicine projects have used satellite linkages to connect mobile sites such as military units or ship at sea.

LEOS(low earth orbiting satellite)

Inexpensive. Hand-held receivers,not much larger than
a standard mobile phone. Very low data rates. This may be acceptable if you need to send only a small file.

Cable modems
A robust wiring
system which connects to homes and businesses. Low cost. Local area can be covered. >1m.bit/sec Principal drawback-if many people in a local area using the service,bandwidth decreases.

ATM
The latest equipment
operating at rates of gigabits/sec. Restricted use. It is very uncommon for ATM to be directly connected at the user level. It is used primarily in the backbone of a network.

DSL(Digital Subscriber Lines)

Reffered to as broad band. >1m.bit/sec Must be located within 5km of the

telephone companys switch. Fine for downloading data but not suitable for realtime videoconferencing.

Telemedicine in India
ISRO Dept of IT Railways State governments Private network by Apollo, AIMS,
ESCORTS etc

ISRO(Indian Space Research organisation)

TM-ISRO initiatives
ISRO initiated
.

telemedicine in 2001 as a special programme. Telemedicine facilities in distant areas to supplement the general healthcare infrastructure

Advantages of satellite communication

Easy reach, quick installation Not affected by environment Flexible network Bandwidth can be shared by number of users High-quality network Extensive and Consistent geographic coverage Efficient support to broadcast and multipoint communications for medical education and consultation sessions Network capacity flexibility, reliability and security

Telemedicine technology
Point to point Point to multipoint

Mobile telemedicine

To overcome the prohibitive costs of

large number of terminals and reaching out to the rural areas

Telemedicine

Benefits
Telemedicine has been shown to be beneficial in a variety of outpatient and inpatient settings

Improves access. Improves communication between providers. Educational to remote and consulting practitioner. High patient and provider satisfaction. Possibly improves process of care and quality of care.

complications
Lack of robust rural infrastructure Funding Question of Insurance reimbursement Technological development Lack of interoperability standards Physician acceptance

Telemedicine is on rise
Decreasing costs of equipment Decreasing costs of telecommunications Increasing quality of telecommunications Opportunities for funding Office for advancement of telehealth Improvements in reimbursement Improvements in quality of care

Road map for future

ISRO to continue leading telemedicine
efforts in India. Enhancing awareness and interest among the stake holders. Independent evaluation of the utilisation and scope for improvement. Introducing Telemedicine in an operational mode. Continue thrust in Rural-Mobile Telehealth programme. Steps towards National Health policy formulation.

Thank you