INSTITUTE OF TECHNOLOGY, ULHASNAGAR.

TELEMEDICINE

PREPARED BY: HEENA LULLA. ABHILASHA MAHAL,403, OPP.BHATIA HOSPITAL, ULHASNAGAR-421005. LULLAHEENA@YAHOO.COM

LEENA LALWANI. HUKUMATRAI APT,37, OPP.VIKAS NURSING HOME, NEHRU CHOWK, ULHASNAGAR-421002. SWEETBABES5150@YAHOO.COM

ABSTRACT Telemedicine has been defined as the use of telecommunications to provide medical information and services (Perednia and Allen 1995). It may be as simple as two health professionals discussing a case over the telephone, or as sophisticated as using satellite technology to broadcast a consultation between providers at facilities in two countries, using videoconferencing equipment or robotic technology.The first telemedicine programs were established almost 40 years ago, but the technology has grown considerably in the past decade. Despite the expansion of telemedicine, the volume of patients receiving services that use the technology remains relatively low (about 21 000 in 1996). During the past 20 years, high-capacity digital networks and improved switching technologies have been deployed in many regions of North America. Computer hardware and software have become fast, powerful, easy to use, and affordable. Compressible, high-resolution digital images can be enhanced and manipulated. The availability of and access to health-related information has improved substantially. Telemedicine has begun to take hold, almost 40 years after the first experiments in providing medical care at a distance demonstrated its feasibility. SOME TELEMEDICINE FACTS 1)Almost 50 different medical subspecialties have successfully used telemedicine. 2)There are approximately 200 active telemedicine networks in the United States, excluding radiology networks. 3)About half of these active networks are providing patient care services on a daily basis. OBJECTIVES OF TELEMEDICINE Use of information and communication technologies: 1)To provide specialized health care consultation to patients in remote locations. 2)To facilitate video conferencing among health care experts for better treatment & care. 3)To provide opportunities for continuing health care education of health care personnel. TYPES OF TELEMEDICINE Telemedicine can be broken into three main categories: store-and-forward, remote monitoring and interactive services.

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 (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/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, clinicianinteractive telemedicine services may be less costly than in -person clinical visits. PROCESS: Signal processing Physiologic samples Electrocardiogram Blood pressure Heart or chest sounds Image enhancement X-ray, CT, MRI Ultra-sound Skin lesions patient visage Arrange Cred eArrangements to practice medicine at a distance Network infrastructure Licensure / Credentialing Start-up Costs / Reimbursement / Long Term Financial Sustainability Re-engineering Practice / Clinical Acceptance Liability

Security Privacy

TELE-RADIOLOGY Most common form of telemedicine Fits workflow of radiology departments Reimbursable First to have clear standards for Telemedicine Imaging equipment Communications (DICOM) The National

Tele-mammography for the Next Generation Internet, Phase II: Digital Mammography Archive:

1)Provide a means to store and retrieve a complete clinical record, consisting of digital, mammographic images as well as radiology and pathology reports and related patient information in standard formats and using standard protocols 2)Multi-layered security 3)Input and retrieval from multiple locations Licensure / Credentialing

BENEFITS OF TELEMEDICINE Benefits to patients 1)Access to specialized health care services to under-served rural, semi-urban and remote areas, 2)Access to expertise of Medical Specialists to a larger population without physical referral, 3)Reduced visits to specialty hospitals for long term follow-up care for the aged and terminally ill patients. Benefits to physicians 1)Improved diagnosis and better treatment management. 2)Access to computerized, comprehensive data (text, voice, images etc.) of patients offline as well as real time. 3)Quick and timely follow-up of patients discharged after palliative care.

4)Continuing education or training through video conferencing periodically Benefits of Telemedicine (III) Hospital and Insurance Benefits: 1)Significant reduction in unnecessary visits & hospitalization for specialized care at tertiary hospitals, 2)Earlier discharge of patients leading to shorter length of stay in hospitals, 3)Increase in the scope of services without creating physical infrastructure in remote hospitals IMPEDIMENTS TO TELEMEDICINE: The Institute of Medicine identifies five concerns that prevent and slow the growth of telemedicine. The five issue areas are: Professional Licensure, Malpractice Liability, Privacy, Confidentiality, and Security, Payment Policies, and Regulation of Medical Devices. Professional Licensure issues stem from the traditional view of professional practice as involving a face-to-face encounter between clinician and patient. Telemedicine breaks the physical link and may complicate where a telemedicine practitioner should be licensed if the professional and the patient are in different states. Currently, multiple state licenses are required. Malpractice Liability is usually described as a deviation from the accepted medical standard of care. For telemedicine practitioners, the subject of malpractice presents potentially complicated legal issues, since state law generally governs liability. Privacy, Confidentiality, and Security issues relate to serious questions that have been raised about current legal protections for medical privacy and confidentiality. The Hippocratic oath requires that physicians keep silent about what they learn from people, counting such things to be as sacred secrets. consultations using telemedicine have been ineligible for payment in the past, guidelines for reimbursement are still evolving. Currently, Medicare covers interactive video systems (Gringsby and Sanders, 1998), and for this reason most health care organizations are using two-way videoconferencing for their initial telemedicine initiatives. Regulation of Medical Devices is of concern because the federal Food and Drug Administration, through its Center, regulates some of the devices used in telemedicine.

Changes likely to drive the future models telemedicine: Reimbursement Further expansion of Medicare Home and workplace care Employers and Payers demands Leapfrog Group Pacific Business Group on Health Imaging devices/point of care lab tests Electronic Medical Record Sensor technology

Home (Consumer) Telemedicine The Next Frontier: Technology is fostering consumer demand Telemedicine reimbursed Consumer telemedicine paid for by consumer Consumer market is largely unregulated Consumer electronic companies (Sony, Sharp, etc.) all have healthcare device divisions Consumer awareness is being raised by vendors (Microsoft, Google, etc.) Smart Home reimbursed outside of U.S. Smart Car next? Challenges in Implementing Telemedicine 1. Identification of a Suitable site and preparation of site for Telemedicine facility. 2. Synchronization of civil, electrical and equipment related works. 3. Identification of a nodal officer (Other than Superintendent) for coordinating Telemedicine activities in the hospital. 4. Sensitization and repeated hands-on training of concerned Doctors, Technicians and Nurses. 5. Coordinating with referral centers to fix mutually convenient tele-consultation sessions on a regular basis. 6. Ensuring trouble free & smooth connectivity through WAN (ISDN/Leased Line) . Way Forward 1.Hand-holding support to Hospital administration for 3-4 years for stabilization of telemedicine services. 2. Integration of Telemedicine activities with Health Management Information System for regular reporting (preferably web-based)

3. Including Telemedicine activities in the performance appraisal of individuals and institutions. 4. Introducing Telemedicine (concept, technical aspects and implementation arrangements) as part of medical education & continuing medical education.

APPLICATIONS Radiology Applications Plain radiographs Computerised tomography (CT) Ultrasound Magnetic resonance (MR) Angiograms Nuclear medicine Ultrasound Applications Ultrasound-image files are small <100kb and static images are easy to transmit. Fatal ultrasound teleconsultation shows promise. CT/MR Imaging Applications CT and MR imaging are small files <100kb and are easily transmitted for consultation. Further Applications Surgery- used for transmitting angiograms to vascular surgeons for consultation \ Opthalmology- slit lamp and retinal images transmitted to opthalmologist using a retinal camera CONCLUSION Telemedicine will continue to be a dynamic influence within the profession of medicine. The benefits of this innovation will be in two primary areas medical benefits and cost benefits. First, telemedicine is a logical extension of the growth of the technical and technological aspects of health care. The medical benefits of an active telemedicine program are related to how professionals use the technology. A modification of a famous analogy used in educational research when applied to telemedicine summarizes the medical impact of telemedicine. Telemedicine and information technologies are mere vehicles that permit the delivery of health services but which have no greater impact on health care than the truck that delivers our groceries has on nutrition. It is the content of the vehicle that permits effective health care, not the vehicle itself (Clark, 1983).

Second, cost effectiveness is likely to be the most significant outcome of telemedicine. The significant costs of medical care and the increased requirements for services that are projected for the next several decades forecast a cost advantage for the organizations that understand and utilize technologies effectively. Certainly, telemedicine is only one category of technology, but it may soon be the ears and eyes of the health care organization. Summary In summary, telemedicine is a recognized subcategory of the health services profession. As a technique and tool in the modern medical center it has the potential to expand and accelerate the services offered and the impact made. For telemedicine to be successful, its implementation must be a logical extension of the vision and mission of the organization within which it is used. Aeschylus once again provides insight about why an organization should consider telemedicine, resolve is not to seem, but to be, the best.