we can defineTelemedicine as the use of
telecommunications to provide medical information and services. 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 video conferencing equipment or
robotic technology.
Telemedicine generally refers to the use of ICT for the
delivery of clinical care
Telemedicine is practiced on the basis of two concepts:
real time which can also be called as (synchronous) and
store-and-forward which is called as (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.
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.
Teleradiology, the sending of x-rays, CT scans, or MRIs
(store-and-forward images) is the most common application of telemedicine in
use today. There are hundreds of medical centers, clinics, and individual
physicians who use some form of teleradiology. Many radiologists are installing
appropriate computer technology in their homes, so they can have images sent
directly to them for diagnosis, instead of making an off-hours trip to a
hospital or clinic.
Telemedicine is most beneficial for populations living in
isolated communities and remote regions and is currently being applied in
virtually all medical domains. Specialities 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
Telepathology is another common use of this technology.
Images of pathology slides may be sent from one location to another for
diagnostic consultation.
Dermatology is also a natural for store and forward
technology (although practitioners are increasingly using interactive
technology for dermatological exams). Digital images may be taken of skin
conditions, and sent to a dermatologist for diagnosis.
The other widely used technology, two-way interactive
television (IATV), is used when a 'face-to-face' consultation is necessary. The
patient and sometimes their provider, or more commonly a nurse practitioner or
telemedicine coordinator (or any combination of the three), are at the
originating site. The specialist is at the referral site, most often at an
urban medical center.
Video conferencing equipment at both locations allow a
'real-time' consultation to take place. The technology has decreased in price
and complexity over the past five years, and many programs now use desktop
video conferencing systems.
There are many configurations of an interactive
consultation, but most typically it is from an urban-to-rural location. It
means that the patient does not have to travel to an urban area to see a
specialist, and in many cases, provides access to speciality care when none has
been available previously.
Almost all specialities of medicine have been found to be
conducive to this kind of consultation, including psychiatry, internal
medicine, rehabilitation, cardiology, paediatrics, obstetrics and gynaecology
and neurology.
There are also many peripheral devices which can be attached
to computers which can aid in an interactive examination.
For instance, an tele-otoscope
allows a physician to
'see' inside a patient's ear;
a tele-stethoscope allows the consulting physician to hear
the patient's heartbeat.
Teleradiology is the ability to send radiographic images
(x-rays) 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 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.
