What is Telemedicine?

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IN THE NAME OF GOD Telemedicine
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What is Telemedicine?
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 the continuing education of
healthcare providers, all in the interests of
advancing the health of individuals and their
communities. WHO(2002)
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What is Telemedicine?

• Patient and doctor are located in different
  places
• Patients can be examined, treated and monitored
• Patients data (text, voice, images or even
  video) can be sent from a remote location and
  medical advice offered from a speciality Centre.

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Calling Names

• Virtual Outreach
• Hospitals Without Walls
• Reaching The Unreached
• Bridging the Urban-Rural divide

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Need for Telemedicine

• Emergency Medical Care is designed to overcome
  the factors most commonly implicated in
  preventable mortality, such as delays in seeking
  care, access to health facility and provision of
  adequate care at the facility.
• WHO (2002)

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Need for Telemedicine

• Emergency Medical Care is designed to overcome
  the factors most commonly implicated in
  preventable mortality, such as delays in seeking
  care, access to health facility and provision of
  adequate care at the facility.
• WHO (2002)

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Need for Telemedicine
Golden Hour
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Need for Telemedicine

• Telemedicine ensures delivery of
• right medical advice
• at the right place
• at the right time

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Need for Telemedicine

• Non availability of facilities locally
• Non availability of appropriate skills /
  technology locally
• Travel

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Need for Telemedicine In India

• Huge population (above 1 billion) with
  inequitable distribution of resources
• 70 of Indias population lives in rural areas
  whereas 75 of qualified consultants practice in
  urban centres
• Vast land area with difficult / inaccessible
  terrain
• Seasonal isolation of some tracts of land e.g.
  due to floods, snow, etc

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AIIMS IN-PATIENTS (2004-05)
From Delhi
From outside
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Advantages of TM

• Makes expertise available - anywhere
• Early institution of appropriate treatment
• need for transfers
• Effective utilization of transports
• Saves costs to patient , provider, system

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TYPES

• On the Basis of Time frame
• Store forward
• Real-time

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Applications

• Tm can be utilized in all Clinical applications -
  medical, surgical, diagnostic
• Emergency care
• Military medicine
• Disaster management
• Homecare,
• Rehabilitation
• TELE-EDUCATION

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Types

• Tele-Radiology
• Tele-Cardiology
• Tele-Pathology
• Tele-Ophthalmology
• Tele-Dermatology
• Tele-Psychiatry
• Tele-Surgery
• Tele..Anything

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Features of Telemedicine

• Teleconsultation
• Telediagnosis
• Teletreatment
• Telemonitoring
• Telepresence

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Components of Telemedicine
Effective Telemedicine Solution
Communication Service Provider
Application Service Provider
Hospital Service Provider
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Entities involved in Telemedicine

• Telemedicine Platform.
• Telemedicine Software.
• Clinical Devices.
• Communication Media.

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Telemedicine Platform

• Desktop PC
• Laptop
• Palmtop / PDA
• (System in a Suitcase)
• Clinical Devices
• Videoconferencing Equipment

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Clinical Devices

• Digital ECG
• Electronic Stethoscope
• High Resolution Camera
• Tele-pathology Microscope
• Trinocular Tube
• X-Ray Digitizer
• FHR, PFT, etc
• Digital Camera

Contd.
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Telemedicine Software

• Acquisition,
• Storage and display, and
• Transmission of patient related information

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Application Software Architecture
Acquires images and data from the medical
equipment
interacts with the system
User Interface
Protocols
Image Acquisition System
Backplane
stores and retrieves patient data
unites the Service Areas
Processing
Patient Records
Communications
Secure, transfers data, allocates bandwidth
performs specialized image manipulation
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Telemedicine Software

• Capturing of images / document from scanner.
• Capturing of video / other data from the
  output of
• the medical eqpmt. and conversion to
  DICOM.
• Conversion of DICOM to Non-DICOM format

.
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Media of Connectivity

• Terrestrial Connectivity
• PSTN / POTS
• ISDN
• VSAT
• LAN / WAN
• Mobile Connectivity
• GSM (Global System of Mobile Communication)
• GPRS (General Packet Radio Services)
• 3G Cell phone with serial / USB Interface to
  connect PC
• CDMA

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Transmitted Data

• Text History, examination, blood reports etc .
• Audio (MP3 format )
• (heart sounds, murmurs, voice, etc )
• Still images (JPEG, TIF, GIF Format)
• ECG, X-Rays, Ultrasound, CT scan, MRI etc.
• Video (MPEG2 Format)
• Operative procedures, Echocardiograms,
  Angiograms , Teleconsultation

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Need for speed

• Latency or delay factor
• 1 ½ Seconds (VSAT Link )

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Objectives of TM

• Enable the medical experts to take control of a
  remote medical emergency when required
• The telemedicine system and sub-system especially
  at the remote location should be designed for use
  by non-medical but trained personnel
• The remote telemedicine system should be designed
  for easy portability
• The telemedicine solution should be cost
  effective requiring minimal training,
  installation and maintenance
• The telemedicine equipment used should use a
  optimum bandwidth for data communication

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A Model for TM
TeleMedicine Specialty Center
TM Consulting Centre
Remote Site
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System Required at Base Unit

• The base unit consist of
• Computer with telecommunication facility.
• Multimedia Software for displaying biosignals
  and view Digital images.

Contd.
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Usage Scenario
The patient is examined and the data is
embedded in an encrypted message and sent to
the referring site's server
Diagnosis is sent back and if required video
conferencing is used
The specialist opinion
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Problems

• Reliability of connectivity
• Need for speed- (Bandwidth)
• Legal issues, Licensing
• Data Security, Patient confidentiality
• Learning Curve
• Resistance to change
• Standards

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Reality ?

• Technical demonstrations of the future -
• Tele-presence surgery / Tele - Robotic Surgery
• 1992 experimental demonstrations
• 1997 Lapcholecystectomy
• 1998 - Beating heart surgeries
• Tele Hypnosis

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CONCLUSION

• TM is for real and real-time TM interventions are
  practical
• Potential to reduce costs and save lives

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• Telemedicine is a concept, a tool. Its use is
  limited only by
• your
• imagination.