Topic 201

Telemedicine: service delivery to isolated and remote areas by Tanay

The term Telemedicine is the delivery of medicine at a distance. Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care.

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

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

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

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

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

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

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



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Telemedicine: service delivery to isolated and remote areas by Taro

The definitions of telemedicine according to Wikipedia are "the delivery of medicine at a distance" or "the use of communications and information technologies for the delivery of clinical care." In the old days, when technology was not yet a tool for passing on information, post messages were sent or received to exchange medical data. In the early 1900s, some Australians used two-way radios as another way. Telemedicine can come in various forms, from simple one to complex one.

There are two basic methods for practicing telemedicine, which are real time and store-and-foreward; sometimes refered to as synchronous and asynchronous. The principle rules of real time telemedicine are that both health professionals have to be present at a certain time and there has to be a linkage between the two so they can communicate and consult. The connection may be just a telephone wire, but the most popular technology f! or this type of telemedicine is video-conferencing equipment, which is in a simple idea, a webcam. The device is attached to computers on either end and so the progression, or examination of the patients, is shown on the screen of one side. Not only are there interchanges of visual images, but also sounds might be sent from one end to the other; sounds in this case would be like heartbeats of a patient.

A tele-stethoscope allows that transmission. At real time one professional is able to give advises to the other based. Store-and-foreward telemedicine on the other hand does not require the medical specialists to be online at the same time, because it is the passing of electronically formated medical data, such as images of the body and typed diagnosis. After they are sent, the remote specialist assesses them and probably makes comments on them. So in a sense, real time telemedicine is more immediate compared to store-and-foreward.

One speciality that applies telemedicine is teleradiology which is the exchange of radiographic images, such as X-rays. For the process to be completed once, there should be an image sending station, a transmission network, and a receiving / image review station. The order of transmission goes respectively. A radiographic image is firstly scanned and then transported to a modem. Next electrical impulses travel to the receiving station through the transmission network. At the receiving station are a modem, a computer with high memory, and a TV monitor which enables the professors to make analysis of specific body parts. It is likely that in addition, a printer is located because in some occasions the receivers need to print hard copies.

Teleradiology consists of three types of connections which are point-to-point, local area, and wide area connection. Point-to-point is just a one to one thing, while local is the interaction of several computers in one building or organization. Wide! are would be more of a grand scale, for example from one country to another.

The use of telemedicine is practiced already in many places around the world and are continuing to spread at a steady speed. The basis of curing diseases and injuries lies at the action of collecting various information in a quick time. This method is aiding this action greatly and hopefully also in the future.