Telemedicine
Introduction:
No one can deny that one of the most brilliant ideas [even if it’s the best one ever] through all human history is the revolution of electronics and communication devices that facilitated the interaction between all humans and made the whole earth to be as a very small village. The growth rate of all human activities that has been achieved after the invention of computer systems and the internet is increasing madly and it is a fact that human progress in these 60 years after the development of these new technologies is greater than the rest of progress through whole human history .
IT and communications destroyed the biggest two obstacles at the way of development: Time and effort; all fields gained benefits from IT and communication e.g. industry, agriculture, economics, religion, war, sports… And of course MEDICINE.
Most of developed countries have robust telemedicine programs however, the most wide stepping countries in this field are USA, UK, Sweden, India and Philippines.
Definitions of telemedicine or telehealth:
WHO definitions of telemedicine:
The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for continuing medical education for healthcare providers, all in the interests of advancing the health of individuals and their communities.
Other simpler definitions:
1- Telemedicine is the use of electronic communication and information technologies to provide health care when distance separates the medical professional from the patient. (IOM 2001) 2- Interactive health care over distance using information or telecommunications technology. 3- Telemedicine is the use of modern telecommunications and information technology for the provision of clinical care to the individuals at a distance and the transmission of that information to provide that care.
Uses of telemedicine: Telemedicine is nearly used in all medical fields. The most prominent uses for telemedicine are :
1- Telemedicine and teledermatology (actual physical examination of the patient)
2- Endocrinology (review for the lab results).
3- Teleradiology (reading still and full motion radiographic images)
4- Tele-ophthalmology (Screening for diabetic retinopathy and retinopathy of prematurity)
5- Telepathology ( analysis of tissue histology samples)
6- Geriatric care and monitoring at home
7- In-patient ICU and infectious disease consultation
8- Real-time emergency care
9- Telepsychology
10- Telepharmacy and teleinterpreting
11- Surgeries and surgery fields [general surgery, GIT surgery and special surgeries as vascular, orthopedics, pediatrics, plastic …] are still at early stage of dependency on telemedicine.
How telemedicine is used:
1- Digital Images: Digital images are taken and forwarded to another location (store and forward), used for x-rays, CAT Scans, MRIs any other digital image. Also can be used for non-emergency situations.
2- Two-way Interactive Television: Teleconferencing is used with the patient in the room; it allows “real time” consultations to take place.
Technologies employed in telemedicine:
1- Facsimile
2- Medical data transmission
3- Audio –telephone and radio
4- Still images
5- Full motion videos
6- Recently Robotics and virtual reality interfaces have also been introduced
Peripherals used in telemedicine:
1- Non-medical : VCR, video cameras…
2- Medical: auscultation, imaging, biometric data collections, otoscope, ophthalmoscope, dermoscope, thermometers , blood pressure cuffs, ECGs , spirometers, pulse oximeters for continuous data collection and maintaining records of patients.
3- Special devices and larger bandwidths are required to transfer a video image ( with frame rate of 30/sec or more ) so that examining physician can perceive it as a smooth image.
Causes for the increased demand of telemedicine :
1- Increased healthcare expenditure globally [in USA it’s up to 16% of GDP] and the need for a way to reduce this % without affecting the quality of medical services.
2- Limited healthcare resources in the form of physicians, nurses, technicians and workers.
3- Increased number of population relatively to the number of available doctors and increased area of housing that will take much time for the provider to move to.
4- Increased number of people with chronic illness who need continuous care that might be sometimes defective.
5- Some countries whose nature is full of mountains and/or rural areas.
6- Revolution in IT [e.g. internet, GPS…] and communication infrastructure.
7- lower cost of bandwidth and improvements in video and data compression standards
8- Further advancement is by using satellite technology to broadcast a medical or other consultations in two countries by videoconfercing facilities-mostly in military settings.
Advantages of telemedicine:
1- For the patient:
- Reduced physician’s fees and cost of medicine - Reduced travel expenses - Treatment by qualified physician, iinterpretation of imaging & histopathology, when professionals are distantly placed - Early detection of diseases - Reduced burden of morbidity - Saves work-loss time and increase productivity - Home health care by using telemedical home monitoring device for chronic case
2- For the doctor:
- Telemedicine is an excellent opportunity to share the knowledge between physicians all over the world. - Joint consultation with expert physicians and surgeons for better management of complicated disease. - Local doctors can be updated at any time with the most recent advancement in medicine. - Medical education in the form of teleconferencing.
3- For the government:
- Reduced rush to the medical facilities in the cities - Improve monitoring facilities at the rural based centres - Increased reliance on the government health care system - Increases stuff productivity - Economizes resources (optimal use of instruments and surgical facilities).
Disadvantages of Telemedicine:
1- The laws and regulations have not caught up with the technology.
2- Reimbursement issues (Many advocates argue telemedicine will not reach its potential without reimbursement so now there is growing advocacy for increased reimbursement in the political arena).
3- Insurance issues (Most health insurance payers do not cover telemedicine services).
Constraints of Telemedicine:
1- Different technological standards, infrastructure and regulatory mechanisms.
2- Different medical cultures, approaches, standards and different medical care resources.
3- Socio-Economic factors such as political and bureaucratic barriers, different languages and literacy levels.
Famous Quote about telemedicine:
"With Proposition 1D we will be able to connect our best hospitals and our best medical schools with clinics in remote areas all over the state of California.” Governor Arnold Schwarzenegger
REFERENCES:
1- Diagnosis, access and outcomes: update of a systematic review of telemedicine services William R Hersh_, David H Hickam_w, Susan M Severance_, Tracy L Dana_, Kathryn Pyle Krages_ and Mark Helfand_w Journal of Telemedicine and Telecare 2006; 12 (Suppl. 2): S2: 3–31
2- Whitten, P., Mair, F., et al. (2002). Systematic review of cost effectiveness studies of telemedicine interventions. British Medical Journal, 324: 1434‐1437.
3- Stachura, M. and Khasanshina, E. (2007). Telehomecare and Remote Monitoring: An OutcomesOverview. Washington, D.C., Advanced Medical Technology Association. http://www.advamed.org/NR/rdonlyres/2250724C‐5005‐45CD‐A3C9‐0EC0CD3132A1/0/TelehomecarereportFNL103107.pdf.
4- Speedie, S. and Davies, D. (2006). Telehealth and the national health information technology strategic framework. Journal of Telemedicine & Telecare, 12(Supp 2): 59‐64.
5- Seto, E. (2008). Cost comparison between telemonitoring and usual care of heart failure: a systematic review. Telemedicine and e‐Health, 14: 679‐686.
6- Mair, F. and Whitten, P. (2000). Systematic review of studies of patient satisfaction with telemedicine. British Medical Journal, 320: 1517‐1520.
7- Jerant, A., Azari, R., et al. (2001). Reducing the cost of frequent hospital admissions for congestive heart failure: a randomized trial of a home telecare inte. Medical Care, 39: 1234‐1245.
8- Hersh, W., Helfand, M., et al. (2002). A systematic review of the efficacy of telemedicine for making diagnostic and management decisions. Journal of Telemedicine and Telecare, 8:197‐209.
9- Hersh, W., Hickam, D., et al. (2006b). Diagnosis, access, and outcomes: update of a systematic review on telemedicine services. Journal of Telemedicine & Telecare, 12(Supp 2): 3‐31.
10- Hersh, W., Helfand, M., et al. (2001). Clinical outcomes resulting from telemedicine interventions: a systematic review. BMC Medical Informatics and Decision Making, 1: 5. http://www.biomedcentral.com/1472‐6947/1/5.
11- Grigsby, J. and Bennett, R. (2006). Alternatives to randomized controlled trials in telemedicine. Journal of Telemedicine & Telecare, 12(Supp 2): 77‐84.
12- Defining Obtrusiveness in Home Telehealth Technologies: A Conceptual Framework Journal of the American Medical Informatics Association Volume 13, Issue 4, July-August 2006, Pages 428-431
13- Web-based telemedicine systems for home-care: technical issues and experiences Computer Methods and Programs in Biomedicine, Volume 64, Issue 3, Pages 175-187 R.Bellazzi
14- JAMIA 1997;4:69-70 doi:10.1136/jamia.1997.0040069 ;Telehealth; The Need for Evaluation: Daniel R Masys.
15- JAMIA 2002;9:89-91 doi:10.1136/jamia.2002.0090089 ,Telehealth;The Need for Evaluation Redux:William R Hersh,Patricia K Patterson,Dale F Kraemer.
16- JAMIA 1996 3: 245-246 William W Stead Informatics of Medical Imaging for Papers on Telehealth and the Focus on the Frontiers of Informatics.
17- http://www.citris-uc.org/system/files/James_Marcin-Telemedicine.pdf
18- http://www.hsi.gatech.edu/2007studentsymposium/gt-si_jattokaren_telemedicine.pdf
19- http://www.telemedindia.org/eseminar/Telemedicine,%20EMR%20&%20Remote%20Connectivity.pdf
Submitted by: Tariq Mohasseb
