Definition
Closely associated with telemedicine is the term "telehealth," which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telemedicine and telehealth.
Telemedicine enables a physician or specialist at one site to deliver health care, diagnose patients, give intra-operative assistance, provide therapy, or consult with another physician or paramedical personnel at a remote site. Telemedicine system consists of customized medical software integrated with computer hardware, along with medical diagnostic instruments connected to the commercial VSAT (Very Small Aperture Terminal) at each location or fibre optics.
Telemedicine is not a separate medical specialty. Products and services related to telemedicine are often part of a larger investment by health care institutions in either information technology or the delivery of clinical care. Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services.
Perhaps the greatest impact of telemedicine may be in fulfilling its promise to improve the quality, increase the efficiency, and expand the access of the healthcare delivery system to the rural population and developing countries.
Kinds of Technology
Two different kinds of technology make up most of the telemedicine applications in use today. The first, called store and forward, is used for transferring digital images from one location to another. A digital image is taken using a digital camera, ('stored') and then sent ('forwarded') by computer to another location. This is typically used for non-emergent situations, when a diagnosis or consultation may be made in the next 24 - 48 hours and sent back.
The image may be transferred within a building, between two buildings in the same city, or from one location to another anywhere in the world. Teleradiology, the sending of x-rays, CT scans, or MRIs (store-and-forward images) is the most common application of telemedicine in use today.
Telepathology is another common use of this technology. Images of pathology slides may be sent from one location to another for diagnostic consultation. Dermatology is also a natural for store and forward technology (although practitioners are increasingly using interactive technology for dermatological exams). Digital images may be taken of skin conditions, and sent to a dermatologist for diagnosis.
The other widely used technology, two-way interactive television (IATV), is used when a 'face-to-face' consultation is necessary. The patient and sometimes their provider, or more commonly a nurse practitioner or telemedicine coordinator (or any combination of the three), are at the originating site. The specialist is at the referral site, most often at an urban medical center. Videoconferencing equipment at both locations allows a 'real-time' consultation to take place. The technology has decreased in price and complexity over the past five years, and many programs now use desktop videoconferencing systems. There are many configurations of an interactive consultation, but most typically it is from an urban-to-rural location. It means that the patient does not have to travel to an urban area to see a specialist, and in many cases, provides access to specialty care when none has been available previously. Almost all specialties of medicine have been found to be conducive to this kind of consultation, including psychiatry, internal medicine, rehabilitation, cardiology, pediatrics, obstetrics and gynecology and neurology. There are also many peripheral devices which can be attached to computers which can aid in an interactive examination. For instance, an otoscope allows a physician to 'see' inside a patient's ear; a stethoscope allows the consulting physician to hear the patient's heartbeat.
Use Models
Real-Time - This is the most common use in Telemedicine. In this model, live video allows the provider, patient and specialist to all communicate together to achieve the best outcome for the patient.
Store and Forward (asynchronous) - Used when both health providers are not available or not required at the same time. The provider's voice or text dictation on the patient's history, current affliction including pictures and/or video, radiology images, etc. is attached for diagnosis. This record is either emailed or placed on a server for the specialist's access. The specialist then follows up with his diagnosis and treatment plan.
Home Health Telemedicine - When a patient is in the hospital and he is placed under general observation after a surgery or other medical procedure, the hospital is usually losing a valuable bed and the patient would rather not be there as well. Home health allows the remote observation and care of a patient. Home health equipment consists of vital signs capture, video conferencing capabilities, and patient stats can be reviewed and alarms can be set from the hospital nurse's station, depending on the specific home health device.
History and Evolution
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
Shortly after the invention of the telephone, attempts were made to transmit heart and lung sounds to a trained expert who could assess the state of the organs. However, poor transmission systems made the attempts a failure. Below is a time line:
1920s: Help for ships Telemedicine dates back to the 1920s. During this time, radios were used to link physicians standing watch at shore stations to assist ships at sea that had medical emergencies.
1924: The first exposition of Telecare
Perhaps it was the cover showed below of "Radio News" magazine from April 1924. The article even includes a spoof electronic circuit diagram which combined all the gadgets of the day into this latest marvel!
1955: Telepsychiatry
The Nebraska Psychiatric Institute was one of the first facilities in the country to have closed-circuit television in 1955. In 1971 the Nebraska Medical Center was linked with the Omaha Veterans Administration Hospital and VA facilities in two other towns
1967: Massachusetts General Hospital
This station was established in 1967 to provide occupational health services to airport employees and to deliver emergency care and medical attention to travelers.
1970s: Satellite telemedicine
Via ATS-6 satellites. In these projects, paramedics in remote Alaskan and Canadian villages were linked with hospitals in distant towns or cities. The father of electrocardiography, first investigated on ECG transmission over telephone lines in 1906! He wrote an article “Le telecardiogramme” at the Archives Internationales Physiologie.
The Role of NASA in Early Development
While the explosion of interest in telemedicine over the past four or five years makes it appear that it's a relatively new use of telecommunications technology, the truth is that telemedicine has been in use in some form or other for over thirty years. The National Aeronautics and Space Administration (NASA) played an important part in the early development of telemedicine NASA's efforts in telemedicine began in the early 1960s when humans began flying in space. Physiological parameters were telemetered from both the spacecraft and the space suits during missions. These early efforts and the enhancement in communications satellites fostered the development of telemedicine and many of the medical devices in the delivery of health care today. NASA provided much of the technology and funding for early telemedicine demonstrations, two of which are the Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) and the Nebraska Medical Center. There were several pioneering efforts not only in the US, but all over the world.
Benefits
Benefits
Telemedicine has substantial benefits for not just the patient but for physicians, hospitals and other staff. Telemedicine can provide and improve access to health care in areas that were previously un-served or under-served. It allows the consultation to take place among the referring physician, the consulting physician, the patient, and the patient’s family through interactive video with critical information of the patient available on-line.
Also, the physicians or other personnel at remote locations can be educated during the consultations with specialty physicians and other experts, increasing their ability to treat other similar cases in the future.
The travel cost of the patients for specialty care, the travel cost for health care professionals for continuing education or consultation, the personnel / equipment cost for not having to keep specialty care facility in rural hospitals, or build these facilities in remote areas and other costs can be either eliminated or reduced.
Moreover, telemedicine reduces isolation among care providers by providing a peer and specialist contact for patient consultations and continuing education.
For rural population and those in some of the remotest parts of the World where residents have little or no access to medical care, telemedicine is definitely the answer.
Report on Telemedicine (removing barriers) found here.
Report on Telemedicine (removing barriers) found here.
Sources (visited 2/9/2009 – 2/13/2009)
Thank you for sharing this informative post. I have got a-z guide on the types of services and functioning of Telemedicine solutions.
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