Telemedicine
Encyclopedia
Telemedicine is the use of telecommunication
and information technologies
in order to provide clinical health care
at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care
and emergency situations
.
Although there were distant precursors to telemedicine, it is essentially a product of 20th century telecommunication and information technologies. These technologies permit communications between patient and medical staff with both convenience and fidelity, as well as the transmission
of medical, imaging
and heath informatics data from one site to another.
Early forms of telemedicine achieved with telephone and radio have been supplemented with videotelephony
, advanced diagnostic methods
supported by distributed client/server applications, and additionally with telemedical devices to support in-home care.
" and "eHealth
", which are frequently used to denote broader definitions of remote healthcare not always involving active clinical treatments. Telehealth and eHealth are at times incorrectly 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 involving medical education, administration, and research.
The term eHealth is often used, particularly in the U.K. and Europe, as an umbrella term that includes telehealth, electronic medical record
s, and other components of health information technology
.
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
.
Store-and-forward telemedicine involves acquiring medical data (like medical images
, biosignal
s 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
(cf: teledermatology
), 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. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.
Remote monitoring, also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective.
Interactive telemedicine services provide real-time interactions between patient and provider, to include phone conversations, online communication and home visits. Many activities such as history review, physical examination, psychiatric evaluations and ophthalmology assessments can be conducted comparably to those done in traditional face-to-face visits. In addition, “clinician-interactive” telemedicine services may be less costly than in-person clinical visit
technology with the use of hand-held mobile devices allow healthcare professionals in multiple locations the ability to view, discuss and assess patient issues as if they were in the same room.
Telemedicine can be used as a teaching tool, by which experienced medical staff can observe, show and instruct medical staff in another location, more effective or faster examination techniques. It improved access to healthcare for patients in remote locations. "Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases,shared health professional staffing, reduced travel times, and fewer or shorter hospital stays." Several studies have documented increase patient satisfaction of telemedicine over past fifteen years.
The first interactive telemedicine system, operating over standard telephone lines, for remotely diagnosing and treating patients requiring cardiac resuscitation (defibrillation) was developed and marketed by MedPhone Corporation in 1989 under the leadership of its president and founder, S.Eric Wachtel. A year later the company introduced a mobile cellular version, the MDphone. Twelve hospitals in the U.S. served as receiving and treatment centers.
Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. In general, a patient will have a number of monitoring devices at home, and the results of these devices will be transmitted via telephone to the health care provider. Telemonitoring is a convenient way for patients to avoid travel and to perform some of the more basic work of healthcare for themselves.
In addition to objective technological monitoring, most telemonitoring programs include subjective questioning regarding the patient's health and comfort. This questioning can take place automatically over the phone, or telemonitoring software can help keep the patient in touch with the health care provider. The provider can then make decisions about the patient's treatment based on a combination of subjective and objective information similar to what would be revealed during an on-site appointment.
Some of the more common things that telemonitoring devices keep track of include blood pressure, heart rate, weight, blood glucose, and hemoglobin. Telemonitoring is capable of providing information about any vital signs, as long as the patient has the necessary monitoring equipment at his or her location. Depending on the severity of the patient's condition, the provider may check these statistics on a daily or weekly basis to determine the best course of treatment.
The first Ayurvedic telemedicine center was established in India in 2007 by Partap Chauhan
, an Indian Ayurvedic doctor and the Director of Jiva Ayurveda
.
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 have 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 a doctor uses devices to remotely examine and treat a patient. This new technology and principle of practicing medicine holds significant promise of improving on 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 diagnose and manage the diseases patients will typically visit a general practitioner for.
in order to provide nursing
services in health care whenever a large physical distance exists between patient and nurse, or between any number of nurses. As a field it is part of telehealth, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, telemonitoring, etc.
Telenursing is achieving significant growth rates in many countries due to several factors: the preoccupation in reducing the costs of health care, an increase in the number of aging and chronically ill population, and the increase in coverage of health care to distant, rural, small or sparsely populated regions. Among its benefits, telenursing may help solve increasing shortages of nurses; to reduce distances and save travel time, and to keep patients out of hospital. A greater degree of job satisfaction has been registered among telenurses.
to patients at remote locations where they may not have physical contact with pharmacists. It encompasses drug therapy monitoring, patient counseling, prior authorization, refill authorization, monitoring formulary compliance with the aid of teleconferencing or videoconferencing
. In addition, video-conferencing is vastly utilized in pharmacy for other purposes, such as providing education, training, and performing several management functions.
A notable telepharmacy program is in the United States, conducted at a federally qualified community health center, Community Health Association of Spokane (CHAS) in 2001, which allowed the low cost medication dispensing under federal government’s program. This program utilized videotelephony
for dispensing medication and patient counseling at six urban and rural clinics. There were one base pharmacy and five remote clinics in several areas of Spokane, Washington
under the telepharmacy program at CHAS. “The base pharmacy provided traditional pharmacy study to the clients at Valley clinic and served as the hub pharmacy for the other remote clinics.”
The remote site dispensing and patient education process was described as follows: once the prescription is sent from the remote clinics to the base pharmacy, the pharmacist verifies the hard copy and enters the order. The label is also generated simultaneously, and the label queue is transmitted to the remote site. When the label queue appears on the medication dispensing cabinet known as ADDS, the authorized person can access the medicine from ADDS followed by medication barcode scanning, and the printing and scanning of labels. Once those steps are done, the remote site personnel are connected to the pharmacist at base pharmacy via videoconferencing
for medication verification and patient counseling.
In recent time, the U.S. Navy
Bureau of Medicine took a significant step in advancing telepharmacy worldwide. The telepharmacy program was piloted in 2006 “in the regions served by Naval Hospital Pensacola, Florida, and Naval Hospital Bremerton, Washington.” Starting from March 2010, the Navy expanded its telepharmacy system to more sites throughout the world. According to Navy Lieutenant Justin Eubanks at Navy Hospital Pensacola, Florida, telepharmacy would be initiated at more than 100 Navy sites covering four continents by the end of 2010.
services over telecommunication networks and the Internet. Most types of services fall into two categories: clinical assessment (the patient’s functional abilities in his or her environment), and clinical therapy. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology
, speech-language pathology, audiology
, occupational therapy
, and physical therapy
. Telerehabilitation can deliver therapy to people who cannot travel to a clinic
because the patient has a disability
or because of travel time. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance.
Most telerehabilitation is highly visual. As of 2006 the most commonly used modalities are via webcam
s, videoconferencing
, phone lines, videophone
s and webpages containing rich Internet applications. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. It is most widely used for neuropsychological rehabilitation; fitting of rehabilitation equipment such as wheelchair
s, braces or artificial limbs; and in speech-language pathology. Rich internet applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) was first introduced in 2001. This endeavor has recently (2006) expanded as a teletherapy application for cognitive skills enhancement programs for school children. Tele-audiology
(hearing assessments) is a growing application. As of 2006, telerehabilitation in the practice of occupational therapy and physical therapy are very limited, perhaps because these two disciplines are more “hands on”.
Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy, and (2) building new data collection systems to digitize information that a therapist can use in practice. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice, in the future.
In the United States, the National Institute on Disability and Rehabilitation Research
's (NIDRR) http://www.ed.gov/about/offices/list/osers/nidrr/index.html?src=mr supports research and the development of telerehabilitation. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh
, the Rehabilitation Institute of Chicago
, the State University of New York at Buffalo, and the National Rehabilitation Hospital in Washington DC. Other federal funders of research are the Veterans Administration, the Health Services Research Administration in the US Department of Health and Human Services, and the Department of Defense. Outside the United States, excellent research is conducted in Australia and Europe.
As of 2006, only a few health insurers in the United States will reimburse for telerehabilitation services. If the research shows that teleassessments and teletherapy are equivalent to clinical encounters, it is more likely that insurers and Medicare
will cover telerehabilitation services.
s according to a controlled study of the treatment of hepatitis C
. Various specialties are contributing to telemedicine, in varying degrees.
, the inventor of the ECG, actually did tests with transmission of ECG via telephone lines. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. In 1906 Einthoven came up with a way to transmit the data from the hospital directly to his lab.
Teletransmission of ECG using methods indigenous to Asia
One of the oldest known telecardiology systems for teletransmissions of ECGs was established in Gwalior, India in 1975 at GR Medical college by Dr. Ajai Shanker, Dr. S. Makhija, P.K. Mantri using an indegenous technique for the first time in India.
This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of the department of Medicine. Transmission using wireless was done using frequency modulation which eliminated noise. Transmission was also done through telephone lines. The ECG output was connected to the telephone input using a modulator which converted ECG into high frequency sound. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. The ECG was converted to sound waves with a frequency varying from 500 Hz to 2500 Hz with 1500 Hz at baseline.
This system was also used to monitor patients with pacemakers in remote areas. The central control unit at the ICU was able to correctly interpret arrhythmia. This technique helped medical aid reach in remote areas.
In addition, electronic stethoscopes can be used as recording devices, which is helpful for purposes of telecardiology.
In Pakistan
three pilot projects in telemedicine was initiated by the Ministry of IT & Telecom, Government of Pakistan (MoIT) through the Electronic Government Directorate in collaboration with Oratier Technologies (a pioneer company within Pakistan dealing with healthcare and HMIS) and PakDataCom (a bandwidth provider). Three hub stations through were linked via the Pak Sat-I communications satellite, and four districts were linked with another hub. A 312 Kb link was also established with remote sites and 1 Mbit/s bandwidth was provided at each hub. Three hubs were established: the Mayo Hospital (the largest hospital in Asia), JPMC Karachi and Holy Family Rawalpindi. These 12 remote sites were connected and on average of 1,500 patients being treated per month per hub. The project was still running smoothly after two years.
, another aspect of telemedicine, also utilizes videoconferencing
for patients residing in underserved areas to access psychiatric services. It offers wide range of services to the patients and providers, such as consultation between the psychiatrists, educational clinical program, diagnosis and assessment, medication therapy management, etc.
The following are some of the model programs and projects which are undergoing for implementation of telepsychiatry in rural areas in the US.
1. University of Colorado Health Sciences Center (UCHSC) supports two programs for American Indian and Alaskan Native populations
2. Military Psychiatry, Walter Reed Army Medical Center
.
Links for several sites related to telemedicine, telepsychiatry policy, guidelines, and networking are available at the website for the American Psychiatric Association
.
Teleradiology
is the ability to send radiographic
images (x-ray
s, CT, MR, PET/CT, SPECT/CT, MG, US...) 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 most typical implementation are two computers connected via the Internet. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes. Sometimes the receiving computer will have a printer so that images can be printed for convenience.
The teleradiology process begins at the image sending station. The radiographic image and a modem or other connection are required for this first step. The image is scanned and then sent via the network connection to the receiving computer.
Today's high-speed broadband based Internet enables the use of new technologies for teleradiology : the image reviewer can now have access to distant servers in order to view an exam. Therefore, they do not need particular workstations to view the images ; a standard Personal Computer
(PC) and Digital Subscriber Line
(DSL) connection is enough to reach keosys central server. No particular software is necessary on the PC and the images can be reached from wherever in the world.
Teleradiology is the most popular use for telemedicine and accounts for at least 50% of all telemedicine usage.
at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis
, education
, and research. Performance of telepathology requires that a pathologist selects the video
images for analysis and the rendering diagnoses. The use of “television microscopy
”, the forerunner of telepathology, did not require that a pathologist have physical or virtual “hands-on” involvement is the selection of microscopic fields-of-view for analysis and diagnosis.
A pathologist, Ronald S. Weinstein,M.D., coined the term “telepathology” in 1986. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. He, and his collaborators, published the first scientific paper on robotic telepathology. Weinstein was also granted the first U.S. patents for robotic
telepathology systems and telepathology diagnostic networks. Dr. Weinstein is known to many as the "father of telepathology". In Norway, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989. This is still in operation, decades later. A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia.
Telepathology has been successfully used for many applications including the rendering histopathology
tissue diagnoses, at a distance, for education, and for research. Although digital pathology
imaging, including virtual microscopy
, is the mode of choice for telepathology services in developed countries, analog
telepathology imaging is still used for patient services in some developing countries.
and probably one of the most common applications of telemedicine and e-health. In teledermatology, telecommunication technologies are used to exchange medical information (concerning skin
conditions and tumours of the skin) over a distance using audio, visual and data communication. Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuous) education.
The dermatologists Perednia and Brown were the first to coin the term “teledermatology” in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists.
and telecommunications for dental care, consultation, education, and public awareness in the same manner as telehealth
and telemedicine.
to provide audiological services and may include the full scope of audiological practice.
This term was first used by Dr Gregg Givens in 1999 in reference to a system being developed at East Carolina University
in North Carolina, USA. The first Internet audiological test was accomplished in 2000 by Givens, Balch and Keller.
The first Transatlantic teleaudiology test was performed in April 2009 when Dr James Hall tested a patient in South Africa from Dallas.
If a practitioner serves several states, obtaining this license in each state could be an expensive and time-consuming proposition. Even if the practitioner never practices medicine face-to-face with a patient in another state, he/she still must meet a variety of other individual state requirements, including paying substantial licensure fees, passing additional oral and written examinations, and traveling for interviews.
Regulations concerning the practice of telemedicine vary from state to state. Physicians who will be prescribing over the Internet to patients should mandate strict controls on their practice to insure that they stay compliant with the various State Medical Board Regulations concerning Internet Prescribing.
on a patient even though they are not physically in the same location. It is a form of telepresence
. Remote surgery combines elements of robot
ics, cutting edge communication technology
such as high-speed data connections and elements of management information system
s. While the field of robotic surgery
is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.
Remote surgery is essentially advanced telecommuting
for surgeons, where the physical distance between the surgeon and the patient is immaterial. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.
At the dawn of the technology, videotelephony also included image phones which would exchange still images between units every few seconds over conventional POTS
-type telephone lines, essentially the same as slow scan TV
systems.
Currently videotelephony is particularly useful to the deaf and speech-impaired
who can use them with sign language
and also with a video relay service
, and well as to those with mobility issues
or those who are located in distant places and are in need of telemedical
or tele-educational
services.
Interoperable HIT will improve individual patient care, but it will also bring many public health benefits including:
Telecommunication
Telecommunication is the transmission of information over significant distances to communicate. In earlier times, telecommunications involved the use of visual signals, such as beacons, smoke signals, semaphore telegraphs, signal flags, and optical heliographs, or audio messages via coded...
and information technologies
Information technology
Information technology is the acquisition, processing, storage and dissemination of vocal, pictorial, textual and numerical information by a microelectronics-based combination of computing and telecommunications...
in order to provide clinical health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care
Trauma (medicine)
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
and emergency situations
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...
.
Although there were distant precursors to telemedicine, it is essentially a product of 20th century telecommunication and information technologies. These technologies permit communications between patient and medical staff with both convenience and fidelity, as well as the transmission
Transmission (telecommunications)
Transmission, in telecommunications, is the process of sending, propagating and receiving an analogue or digital information signal over a physical point-to-point or point-to-multipoint transmission medium, either wired, optical fiber or wireless...
of medical, imaging
Medical imaging
Medical imaging is the technique and process used to create images of the human body for clinical purposes or medical science...
and heath informatics data from one site to another.
Early forms of telemedicine achieved with telephone and radio have been supplemented with videotelephony
Videotelephony
Videotelephony comprises the technologies for the reception and transmission of audio-video signals by users at different locations, for communication between people in real-time....
, advanced diagnostic methods
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
supported by distributed client/server applications, and additionally with telemedical devices to support in-home care.
Disambiguation
Other expressions similar to telemedicine are the terms "telehealthTelehealth
Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities at different ends of the...
" and "eHealth
EHealth
eHealth is a relatively recent term for healthcare practice supported by electronic processes and communication, dating back to at least 1999...
", which are frequently used to denote broader definitions of remote healthcare not always involving active clinical treatments. Telehealth and eHealth are at times incorrectly interchanged with telemedicine. Like the terms "medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
" and "health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
", telemedicine often refers only to the provision of clinical services while the term telehealth can refer to clinical and non-clinical services involving medical education, administration, and research.
The term eHealth is often used, particularly in the U.K. and Europe, as an umbrella term that includes telehealth, electronic medical record
Electronic medical record
An electronic medical record is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office...
s, and other components of health information technology
Health information technology
Health information technology provides the umbrella framework to describe the comprehensive management of health information across computerized systems and its secure exchange between consumers, providers, government and quality entities, and insurers...
.
Early precursors
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 of AustraliaAustralia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
used two-way radios, powered by a dynamo
Electrical generator
In electricity generation, an electric generator is a device that converts mechanical energy to electrical energy. A generator forces electric charge to flow through an external electrical circuit. It is analogous to a water pump, which causes water to flow...
driven by a set of bicycle pedals, to communicate with the Royal Flying Doctor Service of Australia
Royal Flying Doctor Service of Australia
The Royal Flying Doctor Service of Australia is an emergency and primary health care service for those living in rural, remote and regional areas of Australia...
.
Categories
Telemedicine can be broken into three main categories: store-and-forward, remote monitoring and (real-time) interactive services.Store-and-forward telemedicine involves acquiring medical data (like medical images
Medical imaging
Medical imaging is the technique and process used to create images of the human body for clinical purposes or medical science...
, biosignal
Biosignal
Biosignal is a summarizing term for all kinds of signals that can be measured and monitored from biological beings. The term biosignal is often used to mean bio-electrical signal but in fact, biosignal refers to both electrical and non-electrical signals.Electrical biosignals are usually taken to...
s 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
Dermatology
Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
(cf: teledermatology
Teledermatology
Teledermatology is a subspecialty in the medical field of dermatology and probably one of the most common applications of telemedicine and e-health. In teledermatology, telecommunication technologies are used to exchange medical information over a distance using audio, visual and data communication...
), radiology
Radiology
Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...
, and pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
are common specialties that are conducive to asynchronous telemedicine. A properly structured medical record
Medical record
The terms medical record, health record, and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdiction....
preferably in electronic
Electronic medical record
An electronic medical record is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office...
form should be a component of this transfer. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.
Remote monitoring, also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective.
Interactive telemedicine services provide real-time interactions between patient and provider, to include phone conversations, online communication and home visits. Many activities such as history review, physical examination, psychiatric evaluations and ophthalmology assessments can be conducted comparably to those done in traditional face-to-face visits. In addition, “clinician-interactive” telemedicine services may be less costly than in-person clinical visit
Emergency telemedicine
Common daily emergency telemedicine is performed by SAMU Regulator Physicians in France, Spain, Chile, Brazil. Aircraft and maritime emergencies are also handled by SAMU centres in Paris, Lisbon and Toulouse.Benefits and uses
Telemedicine can be extremely beneficial for people living in isolated communities and remote regions and is currently being applied in virtually all medical domains. Patients who live in such areas can be seen by a doctor or specialist, who can provide an accurate and complete examination, while the patient may not have to travel or wait the normal distances or times like those from conventional hospital or GP visits. Recent developments in mobile collaborationMobile collaboration
Mobile collaboration is a technology-based process of communicating utilizing electronic assets and accompanying software designed for use in remote locations...
technology with the use of hand-held mobile devices allow healthcare professionals in multiple locations the ability to view, discuss and assess patient issues as if they were in the same room.
Telemedicine can be used as a teaching tool, by which experienced medical staff can observe, show and instruct medical staff in another location, more effective or faster examination techniques. It improved access to healthcare for patients in remote locations. "Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases,shared health professional staffing, reduced travel times, and fewer or shorter hospital stays." Several studies have documented increase patient satisfaction of telemedicine over past fifteen years.
The first interactive telemedicine system, operating over standard telephone lines, for remotely diagnosing and treating patients requiring cardiac resuscitation (defibrillation) was developed and marketed by MedPhone Corporation in 1989 under the leadership of its president and founder, S.Eric Wachtel. A year later the company introduced a mobile cellular version, the MDphone. Twelve hospitals in the U.S. served as receiving and treatment centers.
Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. In general, a patient will have a number of monitoring devices at home, and the results of these devices will be transmitted via telephone to the health care provider. Telemonitoring is a convenient way for patients to avoid travel and to perform some of the more basic work of healthcare for themselves.
In addition to objective technological monitoring, most telemonitoring programs include subjective questioning regarding the patient's health and comfort. This questioning can take place automatically over the phone, or telemonitoring software can help keep the patient in touch with the health care provider. The provider can then make decisions about the patient's treatment based on a combination of subjective and objective information similar to what would be revealed during an on-site appointment.
Some of the more common things that telemonitoring devices keep track of include blood pressure, heart rate, weight, blood glucose, and hemoglobin. Telemonitoring is capable of providing information about any vital signs, as long as the patient has the necessary monitoring equipment at his or her location. Depending on the severity of the patient's condition, the provider may check these statistics on a daily or weekly basis to determine the best course of treatment.
The first Ayurvedic telemedicine center was established in India in 2007 by Partap Chauhan
Partap Chauhan
Partap Chauhan is an Indian Ayurvedic doctor and the pioneer of online Ayurvedic medicine. He started the world’s first online Ayurvedic clinic, Ayurvedic.org, in the year 1995...
, an Indian Ayurvedic doctor and the Director of Jiva Ayurveda
Jiva Ayurveda
Jiva Ayurveda is an Ayurvedic company based in India. Founded in 1992, the company is headquartered in Faridabad, Haryana, and is registered in the name of Jiva Ayurvedic Pharmacy Limited. Jiva Ayurveda was founded by Ayurvedic doctor, Dr. Partap Chauhan, who is considered to be the pioneer of...
.
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 have 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 a doctor uses devices to remotely examine and treat a patient. This new technology and principle of practicing medicine holds significant promise of improving on 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 diagnose and manage the diseases patients will typically visit a general practitioner for.
Telenursing
Telenursing refers to the use of telecommunications and information technologyInformation technology
Information technology is the acquisition, processing, storage and dissemination of vocal, pictorial, textual and numerical information by a microelectronics-based combination of computing and telecommunications...
in order to provide nursing
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
services in health care whenever a large physical distance exists between patient and nurse, or between any number of nurses. As a field it is part of telehealth, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, telemonitoring, etc.
Telenursing is achieving significant growth rates in many countries due to several factors: the preoccupation in reducing the costs of health care, an increase in the number of aging and chronically ill population, and the increase in coverage of health care to distant, rural, small or sparsely populated regions. Among its benefits, telenursing may help solve increasing shortages of nurses; to reduce distances and save travel time, and to keep patients out of hospital. A greater degree of job satisfaction has been registered among telenurses.
Telepharmacy
Telepharmacy is another growing trend for providing pharmaceutical carePharmaceutical care
Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life...
to patients at remote locations where they may not have physical contact with pharmacists. It encompasses drug therapy monitoring, patient counseling, prior authorization, refill authorization, monitoring formulary compliance with the aid of teleconferencing or videoconferencing
Videoconferencing
Videoconferencing is the conduct of a videoconference by a set of telecommunication technologies which allow two or more locations to interact via two-way video and audio transmissions simultaneously...
. In addition, video-conferencing is vastly utilized in pharmacy for other purposes, such as providing education, training, and performing several management functions.
A notable telepharmacy program is in the United States, conducted at a federally qualified community health center, Community Health Association of Spokane (CHAS) in 2001, which allowed the low cost medication dispensing under federal government’s program. This program utilized videotelephony
Videotelephony
Videotelephony comprises the technologies for the reception and transmission of audio-video signals by users at different locations, for communication between people in real-time....
for dispensing medication and patient counseling at six urban and rural clinics. There were one base pharmacy and five remote clinics in several areas of Spokane, Washington
Spokane, Washington
Spokane is a city located in the Northwestern United States in the state of Washington. It is the largest city of Spokane County of which it is also the county seat, and the metropolitan center of the Inland Northwest region...
under the telepharmacy program at CHAS. “The base pharmacy provided traditional pharmacy study to the clients at Valley clinic and served as the hub pharmacy for the other remote clinics.”
The remote site dispensing and patient education process was described as follows: once the prescription is sent from the remote clinics to the base pharmacy, the pharmacist verifies the hard copy and enters the order. The label is also generated simultaneously, and the label queue is transmitted to the remote site. When the label queue appears on the medication dispensing cabinet known as ADDS, the authorized person can access the medicine from ADDS followed by medication barcode scanning, and the printing and scanning of labels. Once those steps are done, the remote site personnel are connected to the pharmacist at base pharmacy via videoconferencing
Videoconferencing
Videoconferencing is the conduct of a videoconference by a set of telecommunication technologies which allow two or more locations to interact via two-way video and audio transmissions simultaneously...
for medication verification and patient counseling.
In recent time, the U.S. Navy
United States Navy
The United States Navy is the naval warfare service branch of the United States Armed Forces and one of the seven uniformed services of the United States. The U.S. Navy is the largest in the world; its battle fleet tonnage is greater than that of the next 13 largest navies combined. The U.S...
Bureau of Medicine took a significant step in advancing telepharmacy worldwide. The telepharmacy program was piloted in 2006 “in the regions served by Naval Hospital Pensacola, Florida, and Naval Hospital Bremerton, Washington.” Starting from March 2010, the Navy expanded its telepharmacy system to more sites throughout the world. According to Navy Lieutenant Justin Eubanks at Navy Hospital Pensacola, Florida, telepharmacy would be initiated at more than 100 Navy sites covering four continents by the end of 2010.
Telerehabilitation
Telerehabilitation (or e-rehabilitation) is the delivery of rehabilitationPhysical medicine and rehabilitation
Physical medicine and rehabilitation , physiatry or rehabilitation medicine, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician having completed training in this field is referred to as a...
services over telecommunication networks and the Internet. Most types of services fall into two categories: clinical assessment (the patient’s functional abilities in his or her environment), and clinical therapy. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology
Neuropsychology
Neuropsychology studies the structure and function of the brain related to specific psychological processes and behaviors. The term neuropsychology has been applied to lesion studies in humans and animals. It has also been applied to efforts to record electrical activity from individual cells in...
, speech-language pathology, audiology
Audiology
Audiology is the branch of science that studies hearing, balance, and related disorders. Its practitioners, who treat those with hearing loss and proactively prevent related damage are audiologists. Employing various testing strategies Audiology (from Latin , "to hear"; and from Greek , -logia) is...
, occupational therapy
Occupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
, and physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
. Telerehabilitation can deliver therapy to people who cannot travel to a clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...
because the patient has a disability
Disability
A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...
or because of travel time. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance.
Most telerehabilitation is highly visual. As of 2006 the most commonly used modalities are via webcam
Webcam
A webcam is a video camera that feeds its images in real time to a computer or computer network, often via USB, ethernet, or Wi-Fi.Their most popular use is the establishment of video links, permitting computers to act as videophones or videoconference stations. This common use as a video camera...
s, videoconferencing
Videoconferencing
Videoconferencing is the conduct of a videoconference by a set of telecommunication technologies which allow two or more locations to interact via two-way video and audio transmissions simultaneously...
, phone lines, videophone
Videophone
A videophone is a telephone with a video screen, and is capable of full duplex video and audio transmissions for communication between people in real-time...
s and webpages containing rich Internet applications. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. It is most widely used for neuropsychological rehabilitation; fitting of rehabilitation equipment such as wheelchair
Wheelchair
A wheelchair is a chair with wheels, designed to be a replacement for walking. The device comes in variations where it is propelled by motors or by the seated occupant turning the rear wheels by hand. Often there are handles behind the seat for someone else to do the pushing...
s, braces or artificial limbs; and in speech-language pathology. Rich internet applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) was first introduced in 2001. This endeavor has recently (2006) expanded as a teletherapy application for cognitive skills enhancement programs for school children. Tele-audiology
Tele-audiology
Tele-audiology is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice.This term was first used by Dr. Gregg Givens in 1999 in reference to a system being developed at East Carolina University in North Carolina, USA...
(hearing assessments) is a growing application. As of 2006, telerehabilitation in the practice of occupational therapy and physical therapy are very limited, perhaps because these two disciplines are more “hands on”.
Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy, and (2) building new data collection systems to digitize information that a therapist can use in practice. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice, in the future.
In the United States, the National Institute on Disability and Rehabilitation Research
National Institute on Disability and Rehabilitation Research
National Institute on Disability and Rehabilitation Research is a United States governmental institution that provides leadership and support for a comprehensive program of research related to the rehabilitation of individuals with disabilities...
's (NIDRR) http://www.ed.gov/about/offices/list/osers/nidrr/index.html?src=mr supports research and the development of telerehabilitation. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh
University of Pittsburgh
The University of Pittsburgh, commonly referred to as Pitt, is a state-related research university located in Pittsburgh, Pennsylvania, United States. Founded as Pittsburgh Academy in 1787 on what was then the American frontier, Pitt is one of the oldest continuously chartered institutions of...
, the Rehabilitation Institute of Chicago
Rehabilitation Institute of Chicago
The Rehabilitation Institute of Chicago , ranked the "#1 Rehabilitation in America" by U.S. News & World Report every year since 1991 is a rehabilitation hospital located in Chicago, Illinois, United States. It also operates a network of alliance hospitals and outpatient and day rehabilitation...
, the State University of New York at Buffalo, and the National Rehabilitation Hospital in Washington DC. Other federal funders of research are the Veterans Administration, the Health Services Research Administration in the US Department of Health and Human Services, and the Department of Defense. Outside the United States, excellent research is conducted in Australia and Europe.
As of 2006, only a few health insurers in the United States will reimburse for telerehabilitation services. If the research shows that teleassessments and teletherapy are equivalent to clinical encounters, it is more likely that insurers and Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
will cover telerehabilitation services.
Specialist care delivery
Telemedicine can facilitate specialty care delivered by primary care physicianPrimary care physician
A primary care physician, or PCP, is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis....
s according to a controlled study of the treatment of hepatitis C
Hepatitis C
Hepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...
. Various specialties are contributing to telemedicine, in varying degrees.
Telecardiology
ECGs, or electrocardiographs, can be transmitted using telephone and wireless. Willem EinthovenWillem Einthoven
Willem Einthoven was a Dutch doctor and physiologist. He invented the first practical electrocardiogram in 1903 and received the Nobel Prize in Medicine in 1924 for it....
, the inventor of the ECG, actually did tests with transmission of ECG via telephone lines. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. In 1906 Einthoven came up with a way to transmit the data from the hospital directly to his lab.
Teletransmission of ECG using methods indigenous to Asia
One of the oldest known telecardiology systems for teletransmissions of ECGs was established in Gwalior, India in 1975 at GR Medical college by Dr. Ajai Shanker, Dr. S. Makhija, P.K. Mantri using an indegenous technique for the first time in India.
This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of the department of Medicine. Transmission using wireless was done using frequency modulation which eliminated noise. Transmission was also done through telephone lines. The ECG output was connected to the telephone input using a modulator which converted ECG into high frequency sound. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. The ECG was converted to sound waves with a frequency varying from 500 Hz to 2500 Hz with 1500 Hz at baseline.
This system was also used to monitor patients with pacemakers in remote areas. The central control unit at the ICU was able to correctly interpret arrhythmia. This technique helped medical aid reach in remote areas.
In addition, electronic stethoscopes can be used as recording devices, which is helpful for purposes of telecardiology.
In Pakistan
Pakistan
Pakistan , officially the Islamic Republic of Pakistan is a sovereign state in South Asia. It has a coastline along the Arabian Sea and the Gulf of Oman in the south and is bordered by Afghanistan and Iran in the west, India in the east and China in the far northeast. In the north, Tajikistan...
three pilot projects in telemedicine was initiated by the Ministry of IT & Telecom, Government of Pakistan (MoIT) through the Electronic Government Directorate in collaboration with Oratier Technologies (a pioneer company within Pakistan dealing with healthcare and HMIS) and PakDataCom (a bandwidth provider). Three hub stations through were linked via the Pak Sat-I communications satellite, and four districts were linked with another hub. A 312 Kb link was also established with remote sites and 1 Mbit/s bandwidth was provided at each hub. Three hubs were established: the Mayo Hospital (the largest hospital in Asia), JPMC Karachi and Holy Family Rawalpindi. These 12 remote sites were connected and on average of 1,500 patients being treated per month per hub. The project was still running smoothly after two years.
Telepsychiatry
TelepsychiatryTelepsychiatry
Telepsychiatry is the application of Telemedicine to the field of Psychiatry.It has been the most successful of all the telemedicine applications so far, because of its need for only a good videoconferencing facility between the patient and the psychiatrist, especially for follow-up...
, another aspect of telemedicine, also utilizes videoconferencing
Videoconferencing
Videoconferencing is the conduct of a videoconference by a set of telecommunication technologies which allow two or more locations to interact via two-way video and audio transmissions simultaneously...
for patients residing in underserved areas to access psychiatric services. It offers wide range of services to the patients and providers, such as consultation between the psychiatrists, educational clinical program, diagnosis and assessment, medication therapy management, etc.
The following are some of the model programs and projects which are undergoing for implementation of telepsychiatry in rural areas in the US.
1. University of Colorado Health Sciences Center (UCHSC) supports two programs for American Indian and Alaskan Native populations
- a. The Center for Native American Telehealth and Tele-education (CNATT) and
- b. Telemental Health Treatment for American Indian Veterans with Posttraumatic Stress Disorder (PTSD)
2. Military Psychiatry, Walter Reed Army Medical Center
Walter Reed Army Medical Center
The Walter Reed Army Medical Center was the United States Army's flagship medical center until 2011. Located on 113 acres in Washington, D.C., it served more than 150,000 active and retired personnel from all branches of the military...
.
Links for several sites related to telemedicine, telepsychiatry policy, guidelines, and networking are available at the website for the American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
.
Teleradiology
Teleradiology
Teleradiology is the transmission of radiological patient images, such as x-rays, CTs, and MRIs, from one location to another for the purposes of sharing studies with other radiologists and physicians. Teleradiology is a growth technology given that imaging procedures are growing approximately 15%...
is the ability to send radiographic
Radiography
Radiography is the use of X-rays to view a non-uniformly composed material such as the human body. By using the physical properties of the ray an image can be developed which displays areas of different density and composition....
images (x-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s, CT, MR, PET/CT, SPECT/CT, MG, US...) 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 most typical implementation are two computers connected via the Internet. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes. Sometimes the receiving computer will have a printer so that images can be printed for convenience.
The teleradiology process begins at the image sending station. The radiographic image and a modem or other connection are required for this first step. The image is scanned and then sent via the network connection to the receiving computer.
Today's high-speed broadband based Internet enables the use of new technologies for teleradiology : the image reviewer can now have access to distant servers in order to view an exam. Therefore, they do not need particular workstations to view the images ; a standard Personal Computer
Personal computer
A personal computer is any general-purpose computer whose size, capabilities, and original sales price make it useful for individuals, and which is intended to be operated directly by an end-user with no intervening computer operator...
(PC) and Digital Subscriber Line
Digital Subscriber Line
Digital subscriber line is a family of technologies that provides digital data transmission over the wires of a local telephone network. DSL originally stood for digital subscriber loop. In telecommunications marketing, the term DSL is widely understood to mean Asymmetric Digital Subscriber Line ,...
(DSL) connection is enough to reach keosys central server. No particular software is necessary on the PC and the images can be reached from wherever in the world.
Teleradiology is the most popular use for telemedicine and accounts for at least 50% of all telemedicine usage.
Telepathology
Telepathology is the practice of pathologyPathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
, education
Medical education
Medical education is education related to the practice of being a medical practitioner, either the initial training to become a doctor or additional training thereafter ....
, and research. Performance of telepathology requires that a pathologist selects the video
Video
Video is the technology of electronically capturing, recording, processing, storing, transmitting, and reconstructing a sequence of still images representing scenes in motion.- History :...
images for analysis and the rendering diagnoses. The use of “television microscopy
Microscopy
Microscopy is the technical field of using microscopes to view samples and objects that cannot be seen with the unaided eye...
”, the forerunner of telepathology, did not require that a pathologist have physical or virtual “hands-on” involvement is the selection of microscopic fields-of-view for analysis and diagnosis.
A pathologist, Ronald S. Weinstein,M.D., coined the term “telepathology” in 1986. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. He, and his collaborators, published the first scientific paper on robotic telepathology. Weinstein was also granted the first U.S. patents for robotic
Robotics
Robotics is the branch of technology that deals with the design, construction, operation, structural disposition, manufacture and application of robots...
telepathology systems and telepathology diagnostic networks. Dr. Weinstein is known to many as the "father of telepathology". In Norway, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989. This is still in operation, decades later. A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia.
Telepathology has been successfully used for many applications including the rendering histopathology
Histopathology
Histopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...
tissue diagnoses, at a distance, for education, and for research. Although digital pathology
Digital Pathology
Digital Pathology is an image-based information environment enabled by computer technology that allows for the management of information generated from a digital slide...
imaging, including virtual microscopy
Virtual microscopy
Virtual microscopy is a method of posting microscope images on, and transmitting them over, computer networks. This allows independent viewing of images by large numbers of people in diverse locations. It involves a synthesis of microscopy technologies and digita l technologies...
, is the mode of choice for telepathology services in developed countries, analog
Analog signal
An analog or analogue signal is any continuous signal for which the time varying feature of the signal is a representation of some other time varying quantity, i.e., analogous to another time varying signal. It differs from a digital signal in terms of small fluctuations in the signal which are...
telepathology imaging is still used for patient services in some developing countries.
Teledermatology
Teledermatology is a subspecialty in the medical field of dermatologyDermatology
Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
and probably one of the most common applications of telemedicine and e-health. In teledermatology, telecommunication technologies are used to exchange medical information (concerning skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
conditions and tumours of the skin) over a distance using audio, visual and data communication. Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuous) education.
The dermatologists Perednia and Brown were the first to coin the term “teledermatology” in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists.
Teledentistry
Teledentistry is the use of information technologyInformation technology
Information technology is the acquisition, processing, storage and dissemination of vocal, pictorial, textual and numerical information by a microelectronics-based combination of computing and telecommunications...
and telecommunications for dental care, consultation, education, and public awareness in the same manner as telehealth
Telehealth
Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities at different ends of the...
and telemedicine.
Tele-audiology
Tele-audiology is the utilization of telehealthTelehealth
Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities at different ends of the...
to provide audiological services and may include the full scope of audiological practice.
This term was first used by Dr Gregg Givens in 1999 in reference to a system being developed at East Carolina University
East Carolina University
East Carolina University is a public, coeducational, engaged doctoral/research university located in Greenville, North Carolina, United States. Named East Carolina University by statute and commonly known as ECU or East Carolina, the university is the largest institution of higher learning in...
in North Carolina, USA. The first Internet audiological test was accomplished in 2000 by Givens, Balch and Keller.
The first Transatlantic teleaudiology test was performed in April 2009 when Dr James Hall tested a patient in South Africa from Dallas.
U.S. licensing and regulatory issues
Restrictive licensure laws in the United States require a practitioner to obtain a full license to deliver telemedicine care across state lines. Typically, states with restrictive licensure laws also have several exceptions (varying from state to state) that may release an out-of-state practitioner from the additional burden of obtaining such a license. A number of States require practitioners who seek compensation to frequently deliver interstate care to acquire a full license.If a practitioner serves several states, obtaining this license in each state could be an expensive and time-consuming proposition. Even if the practitioner never practices medicine face-to-face with a patient in another state, he/she still must meet a variety of other individual state requirements, including paying substantial licensure fees, passing additional oral and written examinations, and traveling for interviews.
Regulations concerning the practice of telemedicine vary from state to state. Physicians who will be prescribing over the Internet to patients should mandate strict controls on their practice to insure that they stay compliant with the various State Medical Board Regulations concerning Internet Prescribing.
Telesurgery
Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgerySurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
on a patient even though they are not physically in the same location. It is a form of telepresence
Telepresence
Telepresence refers to a set of technologies which allow a person to feel as if they were present, to give the appearance of being present, or to have an effect, via telerobotics, at a place other than their true location....
. Remote surgery combines elements of robot
Robot
A robot is a mechanical or virtual intelligent agent that can perform tasks automatically or with guidance, typically by remote control. In practice a robot is usually an electro-mechanical machine that is guided by computer and electronic programming. Robots can be autonomous, semi-autonomous or...
ics, cutting edge communication technology
Telecommunication
Telecommunication is the transmission of information over significant distances to communicate. In earlier times, telecommunications involved the use of visual signals, such as beacons, smoke signals, semaphore telegraphs, signal flags, and optical heliographs, or audio messages via coded...
such as high-speed data connections and elements of management information system
Management information system
A management information system provides information needed to manage organizations efficiently and effectively. Management information systems involve three primary resources: people, technology, and information. Management information systems are distinct from other information systems in that...
s. While the field of robotic surgery
Robotic surgery
Robotic surgery, computer-assisted surgery, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures....
is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.
Remote surgery is essentially advanced telecommuting
Telecommuting
Telecommuting or telework is a work arrangement in which employees enjoy flexibility in working location and hours. In other words, the daily commute to a central place of work is replaced by telecommunication links...
for surgeons, where the physical distance between the surgeon and the patient is immaterial. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.
Videotelephony
Videotelephony comprises the technologies for the reception and transmission of audio-video signals by users at different locations, for communication between people in real-time.At the dawn of the technology, videotelephony also included image phones which would exchange still images between units every few seconds over conventional POTS
Plain old telephone service
Plain old telephone service is the voice-grade telephone service that remains the basic form of residential and small business service connection to the telephone network in many parts of the world....
-type telephone lines, essentially the same as slow scan TV
Slow-scan television
Slow-scan television is a picture transmission method used mainly by amateur radio operators, to transmit and receive static pictures via radio in monochrome or color.A technical term for SSTV is narrowband television...
systems.
Currently videotelephony is particularly useful to the deaf and speech-impaired
Speech disorder
Speech disorders or speech impediments are a type of communication disorders where 'normal' speech is disrupted. This can mean stuttering, lisps, etc. Someone who is unable to speak due to a speech disorder is considered mute.-Classification:...
who can use them with sign language
Sign language
A sign language is a language which, instead of acoustically conveyed sound patterns, uses visually transmitted sign patterns to convey meaning—simultaneously combining hand shapes, orientation and movement of the hands, arms or body, and facial expressions to fluidly express a speaker's...
and also with a video relay service
Video Relay Service
A Video Relay Service , also sometimes known as a Video Interpreting Service, is a videotelecommunication service that allows deaf, hard-of-hearing and speech-impaired individuals to communicate over video telephones and similar technologies with hearing people in real-time, via a sign language...
, and well as to those with mobility issues
Disability
A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...
or those who are located in distant places and are in need of telemedical
Telerehabilitation
Telerehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet. Most types of services fall into two categories: clinical assessment , and clinical therapy...
or tele-educational
Distance education
Distance education or distance learning is a field of education that focuses on teaching methods and technology with the aim of delivering teaching, often on an individual basis, to students who are not physically present in a traditional educational setting such as a classroom...
services.
Health information technology
Health information technology (HIT) provides the umbrella framework to describe the comprehensive management of health information across computerized systems and its secure exchange between consumers, providers, government and quality entities, and insurers. Health information technology (HIT) is in general increasingly viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system (Chaudhry et al., 2006). Broad and consistent utilization of HIT will:- Improve health care quality;
- Prevent medical errors;
- Reduce health care costs;
- Increase administrative efficiencies
- Decrease paperwork; and
- Expand access to affordable care.
Interoperable HIT will improve individual patient care, but it will also bring many public health benefits including:
- Early detection of infectious disease outbreaks around the country;
- Improved tracking of chronic disease management; and
- Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared.
See also
- American Telemedicine AssociationAmerican Telemedicine AssociationAmerican Telemedicine Association , established in 1993 as a non-profit organization, ATA goal is to promote access to medical care for consumers and health professionals via telecommunications technology...
- Centre for e-HealthCentre for e-HealthThe Centre for e-Health aims to further the use of telemedicine in Australia and Asia.It is based at the Lions Eye Institute in Perth, Western Australia.The Centre was launched in August 2005 by then-WA Premier Geoff Gallop...
- Connected HealthConnected HealthConnected Health is a term used to describe a model for healthcare delivery that uses technology to provide healthcare remotely. Connected health aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their...
- eHealthEHealtheHealth is a relatively recent term for healthcare practice supported by electronic processes and communication, dating back to at least 1999...
- List of video telecommunication services and product brands
- Medical deviceMedical deviceA medical device is a product which is used for medical purposes in patients, in diagnosis, therapy or surgery . Whereas medicinal products achieve their principal action by pharmacological, metabolic or immunological means. Medical devices act by other means like physical, mechanical, thermal,...
- mHealthMHealthmHealth is a term used for the practice of medicine and public health, supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones and PDAs, for health services and information...
- Mobile collaborationMobile collaborationMobile collaboration is a technology-based process of communicating utilizing electronic assets and accompanying software designed for use in remote locations...
- National Rural Health AssociationNational Rural Health AssociationThe National Rural Health Association is a national nonprofit professional association in the United States with more than 18,000 members. The association’s mission is to provide leadership on rural health issues, which it attempts to carry out through education, communication, and advocacy...
- Ontario Telemedicine NetworkOntario Telemedicine NetworkThe Ontario Telemedicine Network is one of the largest telemedicine networks in the world. It uses two-way videoconferencing to provide access to care for patients in every hospital and hundreds of other health care locations across the province...
- Remote therapyRemote therapyRemote Therapy, sometimes called Telemental Health Applications or Internet-based Psychotherapy, is a form of psychotherapy or related psychological practice in which a trained psychotherapist meets with a client or patient via telephone, cellular phone, the internet or other electronic media in...
- Robotic surgeryRobotic surgeryRobotic surgery, computer-assisted surgery, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures....
- Tele-epidemiologyTele-epidemiologyTele-epidemiology is a methodological and application area of epidemiology concerned with the application of space-based systems in the study of the space and time distribution of health events or disease process in populations.In this broader sense, the term includes...
- TelecareTelecareTelecare is a term given to offering remote care of old and physically less able people, providing the care and reassurance needed to allow them to remain living in their own homes. The use of sensors may be part of a package which can provide support for people with illnesses such as dementia, or...
- TelehealthTelehealthTelehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities at different ends of the...
- Telemental HealthTelemental HealthTelemental Health is the use of telecommunications technology to provide mental health services to individuals in communities or locations that are underserviced, typically as a result of geographic isolation...
- Telephone triageTelephone triageTelephone triage is defined as the management of patient health concerns and symptoms via a telephone interaction by “advice nurses”. It is thus an aspect of telenursing....
- UNESCO Chair in TelemedicineUNESCO Chair in TelemedicineUNESCO Chair of Telemedicine was founded in 1999. Undertakes international activities related to the promotion of the information society and fights against technology transfer problems having the role of an “intermediate body”...
- Women on WebWomen on Webis an online abortion help service for countries where there is no access to "safe abortion service". The abortion is done with Mifepristone and Misoprostol at home before the 9th week of pregnancy, the medicines are sent by mail under the supervision of a doctor.Women on Web's goal is to prevent...
Further reading
- W. John Blyth. "Telecommunications, Concepts, Development, and Management", Second Edition, Glencoe/McCgraw-Hill Company,1990, pp. 280–282.
- Teleneurology and requirements of the european Medical Devices Directive (MDD) - Telemedical Systems and regulatory affairs for Europe, by Dipl. Ing. Armin Gärtner
- Telemedicine 101: Telemedicine Coming of Age - Telemedicine 101: Telemedicine Coming of Age, by Nancy Brown
- What is Telemedicine? - What is Telemedicine?, by Robert Higgs (www.icucare.com)
- Critical Care 24/7 by Christina Thielst
External links
- Telemedicine and Telehealth Teladoc.
- Telemedicine Pakistan (TelmedPak)
- Wiki for telemedicine (ATAwiki)
- Agency for Healthcare Research and Quality (AHRQ) -- Telemedicine for the Medicare Population
- Ontario Telemedicine Network -- Making the Connection for Health
- American Telemedicine Association
- Telemedicine Information Exchange
- Canadian Society of Telehealth
- TELESYNERGY - Telemedicine at the National Institutes of Health
- Telemedicine History
- National Rural Health Association
- International Society for Telemedicine & eHealth (ISfTeH)
- American Psychiatric Asscoiation