Telemedicine – The simple route to Speciality Health Care

Telemedicine – The simple route to Speciality Health Care

Health Change Scenario

Health care is changing by leaps and bounds from Electronic medical record to universal health insurance, from education to sophisticated tele surgery; e-health uses information technology from womb to tomb. The magnitude of the problem in health industry is enormous and extremely dynamic. However, the present day technology has the solution for this problem. The user-friendly equipments make the solution simpler. The only requirement is that the concerned people must have a mind to adopt this.

A meaningful and economical integration of the communication technology, information technology and the medical technology is called Telemedicine. Telemedicine can instantaneously bring to your doorstep the speciality healthcare, no matter where you are. Be it the islands, the hilly terrain, remote places or tribal areas, technologies have been synergised and the concepts have been successfully demonstrated.

Telemedicine system consists of a computer (PC) with customized medical software connected to a few medical diagnostic instruments like ECG or X-Ray Machine or an X-Ray Scanner for scanning the X-Ray photos. Through this computer, which digitizes the X-Ray images and ECG or blood test report, the details are sent to the Specialist hospital through the communication link, which could be a satellite VSAT system, or terrestrial links. This information is, in turn,received at the specialist centre where the specialists examine the reports,diagnose,interact with the patients and suggest appropriate treatment during the video conferencing session through the Telemedicine system.

Telemedicine facility, thus enables the specialist doctor and the patient separated by thousands of kilometers of geographical distance to see each other visually and communicate. This enables the doctor to assess the physical and psychological state of the patient. In this way, the systematic application of information and telecommunication technologies to the practice of healthcare rapidly expands the outreach of the healthcare system. The system have been commissioned and effectively used to treat patients in remote areas. The concept is picking up like wildfire. Obviously the beneficiaries are the people in the remote and rural areas.

Thus Telemedicine is a reality. All that is needed is for the concerned people to apply yheir mind. The systems have to be progressively made more and more user friendly and economical.

When we talk of developing countries like India, we can use this facility right now for Teleconsultation and postoperative consultations without the patients having to travel. But it is also a fact that there are technological developments taking place all over the world. We have the telesurgery, telerobotics, telepathology etc. along with the associated sophisticated equipments and instruments. All these enhance the level of services available to the patients making it possible for patients to get better medical & surgical treatment.

Telemedicine – Network Implementation

The Patient End

The patient end has to prepare an electronic file of the patient’s history and his radiological and pathological reports and forward to specialists. The hardware requirement at the patient end includes various medical equipments like ECG, X-Ray/MRI,Scanner, Ultrasound etc., interfaced with a computer which has the Telemedicine software for preparing and tranfering the patient file.

The Specialist Link

The specialist end has to receive the patient file and display the patients records properly on the monitor in order to enable the specialist doctor make a diagnosis.

This process can be done in an “offline” mode, i.e. without the patient and the specialist simultaneously being present and talking to each other or in “online” mode where simultaneous data tranfer & videoconferencing take place.

The Communication Link

The speed and quality of flow will depend upon the bandwidth available. The link could be a simple telephone line (providing 64kbps) Internet or ISDN line(provides 128or 384 kbps) or fibre optic or satellite link.

Satellite terminals can also be made “Mobile Unit” . Such vans can visit rural areas, establish connectivity and provide consultation from a speciality end and then move on to another location.

Cost and Operability Considerations – Patient end

Besides the medical equipment for collecting patient data like ECG, X-RAY etc, the most important element at the patient end is the Telemedicine software. The cost of this software can be an important consideration in setting up Telemedicine software. The total telemedicine software consists of several packages, with several features and uses certain standards. The cost also depends upon the standards used and licensed for. It may not be necessary to follow all the prescribed international standards. For this purpose, the Ministry of Information Technology in India has defined Indian standards for Telemedicine packages.

Guidelines and Standards

Telemedicine platform

Depending on the application and space constraints, the platform can also be of different types like mobile systems, handheld system or system for home use, the hardware platform can also be a laptop or palmtop computer, a PDA (Personal Digital Assistant) or even a dedicated box (set-top-box) with a processor.

Clinical Devices

These include digital ECG, X-ray Digitizer, Ultra sound (sonography machine), Glucometer, portable X-ray machine, Pulmonary function Test (PFT) machine, Fetal heart rate (FHR) Monitor, Telepathology Microscope(and trinocular tube) etc. for use in different applications like teleradiology ,tele-cardiology, telepathology and tele-ophthalmology

Video-conferencing units

A stand alone box with a network interface with camera, microphone and display and may be sharing the same communication channel.

Communication hardware

The hardware for terrestrial links can be further divided into three major Categories- PSTN/POTSISDNLAN.

Data interchange/exchange Standards-DICOM

DICOM (Digital Imaging and Communications in Medicine) is an industry standard widely recognized for Medical Imaging Communication.

Exchange of clinical messages among systems – HL

HL7 stands for Health Level Seven; the term “Leve7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). H.324 level needs to be maintained, for air-conditioning and illumination of the video conferencing room.

Challenges and Issues

Medical Community should adapt to the changes in health field to reach out. They need to create awareness among doctors, health administrators and public, include Telemedicine as an integral part of training and education. Telemedicine is no more expensive but a financially viable funding and self-sustaining plan of implementation should be developed. Members of cooperatives or family group insurances coupled with telemedicine and involvement of specialty hospitals could play an important role. There needs to be a framework to deal with medico legal issues arising out of telemedicine consultations. There is a freedom of the patient to select any doctor and move with patient record for primary or secondary opinion, which will be restricted by telemedicine consults. Rural patients normally seek treatment from local doctor and then move to district hospital. By creating a National Telemedicine Grid, patient record can be accessed by any doctor at any terminal to maintain continuity of care.

Telemedicine for Primary Care

A comprehensive plan of action had to be evolved to deliver an integrated package of “grass-root” Telemedicine services, including limited teleconsultation, simple telediagnostic ,telecoordination and tele-education. Additionally the system may be employed to improve the quality and efficiency of the existing MIS (Management Information System). This will thereby provide a workable model of telemedicine which is representative of the actual need in the field.

Major areas of application, identified are:

  1. Routine consultation with specialist for any major illness-bringing specialist in close proximity to the distant community.
  2. Emergency obstetric care.
  3. Emergency trauma care.
  4. Any acute illness.
  5. Follow-up for chronic illness.

Health Education

One of the most important concepts of primary healthcare is that of health education. Awareness forms the basic crux of any efficient health care system. The telemedicine may be used efficiently for enhancing the effectiveness of IEC (Information, Education and Communication) strategies under several national and local health programmes. This would not only increase the knowledge of the intended beneficiaries but also help the programme managers to deliver the services effectively. Another component that can be tapped is Continuing Medical Education for the healthcare providers. Skill imparting sessions may also be undertaken via Telemedicine and improve the quality of healthcare.

Conclusion

In this era of constant change, medical field is undergoing rapid transformations and the healthcare providers must be kept abreast of the recent advances and development.

There are different challenges and issues in the implemetation of Telemedicine systems and network and they can be categorized under technical, managerial, ethical, legal and financial aspects and they need to be addressed systematically for establishing a successful telemedicine network. An integrated effort by all agencies is required to promote telemedicine to make our community healthier and to reach out to the remote areas and deprived people for specialist advice.

Contact:
Dr. Sanjeev Singh: 09447133964,
[email protected]

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