Telemedicine

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The term Telemedicine is the delivery of medicine at a distance. The term is composed of the Greek word τελε (tele) meaning 'far', and medicine. Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. It can also involve the use of an unmanned robot [1].

Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care.

Care at a distance (also called in absentia care), is an old practice which was often conducted via post; there has been a long and successful history of in absentia health care, which - thanks to modern communication technology - has metamorphosed into what we know as modern telemedicine.

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.

The terms e-health and telehealth are at times wrongly interchanged with telemedicine. Like the terms "medicine" and "health care", telemedicine often refers only to the provision of clinical services while the term telehealth can refer to clinical and non-clinical services such as medical education, administration, and research. The term e-health is often, particularly in the UK and Europe, used as an umbrella term that includes telehealth, electronic medical records, and other components of health IT.

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[edit] Types of telemedicine

Telemedicine is practiced on the basis of two concepts: real time (synchronous) and store-and-forward (asynchronous).

Real time telemedicine could be as simple as a telephone call or as complex as robotic surgery. It requires the presence of both parties at the same time and a communications link between them that allows a real-time interaction to take place. Video-conferencing equipment is one of the most common forms of technologies used in synchronous telemedicine. There are also peripheral devices which can be attached to computers or the video-conferencing equipment which can aid in an interactive examination. For instance, a tele-otoscope allows a remote physician to 'see' inside a patient's ear; a tele-stethoscope allows the consulting remote physician to hear the patient's heartbeat. Medical specialties conducive to this kind of consultation include psychiatry, internal medicine, rehabilitation, cardiology, pediatrics, obstetrics and gynecology and neurology.

Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. It does not require the presence of both parties at the same time. Dermatology, radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured Medical Record preferably in electronic form should be a component of this transfer.

Telemedicine is most beneficial for populations living in isolated communities and remote regions and is currently being applied in virtually all medical domains. Specialties that use telemedicine often use a "tele-" prefix; for example, telemedicine as applied by radiologists is called Teleradiology. Similarly telemedicine as applied by cardiologists is termed as telecardiology, etc.

Telemedicine is also useful as a communication tool between a general practitioner and a specialist available at a remote location.

The focus of telemedicine has mainly been consultative, meaning a general practitioner consulting a specialist or a specialist consulting another specialist. Monitoring a patient at home using known devices like blood pressure monitors and transferring the information to a caregiver is a fast growing emerging service. These remote monitoring solutions has a focus on current high morbidity chronic diseases and are mainly deployed for the First World. In developing countries a new way of practicing telemedicine is emerging better known as Primary Remote Diagnostic Visits whereby devices examine a patient whereby a connected doctor residing in another location virtually examines the patient and treat him. This new technology and principle of practicing medicine holds big promises to solving major health care delivery problems in for instance Southern Africa because Primary Remote Diagnostic Consultations not only monitors an already diagnosed chronic disease, but has the promise to diagnosing and managing the diseases a patient will typically visit a general practitioner for.

[edit] Teleradiology

Teleradiology is the ability to send radiographic images (x-rays) from one location to another. For this process to be implemented, three essential components are required, an image sending station, a transmission network, and a receiving / image review station.

The teleradiology process begins at the image sending station. The radiographic image and a modem are required for this first step. The image is scanned and then sent to the modem.

The transmission network can be wire, fiber optics, or microwave. After the digital information has been sent to the modem, electrical impulses are sent along to the transmission network to the receiving / image review station. The receiving / image review station consists of a modem, a computer with sufficient storage capabilities, a TV monitor, and sometimes a printer to provide hard copies to the end user. The electrical impulses created through the transmission network are received by the modem on the review station. These impulses are converted back to the original digital image once it reaches the review station. This image is then stored and can be viewed on the TV monitor for diagnostic purposes. A hard copy can be printed for more convenience.

The teleradiology process can be connected in one of three ways. A point-to-point connection consists of a sending station that is connected to a review station via a transmission network. This connection allows viewing from one location in a building to another.

A Local Area Network (LAN) connection is when there are many sending and review station connected through a transmission network. This type of connection allows images to be viewed in several different locations in a building.

A Wide Area Network (WAN) connection is when many Local Area Networks are connected to one another to create a way for images to be viewed in different geographic locations (for example, from one city to another).

Clearly with the number of companies focusing on telemedical devices and the specialization of these companies one can expect telemedicine to become a significant way that physicians, hospitals, and veterinarian offices operate in the near future.

[edit] Applications in Obstructive Sleep Apnea treatment

Obstructive Sleep Apnea is a disease that affects millions of people around the world. For many years flow generator ( CPAP, VPAP, and APAP devices ) manfucturers have had data recording and downloading capabilities in their devices. This data can be used to monitor patient compliance and treatment efficacy. Telemedicine techniques are being used to retrieve this information remotely.

[edit] See also

[edit] Further reading

  • Harnett B., Telemedicine systems and telecommunications, J Telemed Telecare. 2006;12(1):4-15.
  • Whitten P, Love B., Patient and provider satisfaction with the use of telemedicine: overview and rationale for cautious enthusiasm, J Postgrad Med. 2005 Oct-Dec;51(4):294-300.
  • ISRO plans health satellite, The Hindu Business Line, Feb 16, 2002 accessed at [2] Nov 11, 2006

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