SR CONTENTS PAGE

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1 INTRODUCTION 2

2 EVOLUTION OF TELEMEDICINE 2-3

3 DEFINITION OF TELEMEDICINE 3

4 OBJECTIVES OF TELEMEDICINE 3

5 APPLICATIONS OF TELEMEDICINE 3-4

6 ADVANTAGES OF TELEMEDICINE 4

7 PROCESS OF TELEMEDICINE 4-5

8 EQUIPMENTS REQUIRED 5-6

9 TYPES OF CONNECTIVITY 6

10 COMPONENTS OF TELEMEDICINE 7

11 MODELS OF TELE-HEALTH SYSTEM 7

12 PARTS OF TELEMEDICINE 8

13 BARRIERS IN TELEMEDICINE 8

14 CONCLUSION 9

15 BIBLIOGRAPHY 10

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 TELEMEDICINE
INTRODUCTION

Telemedicine is an upcoming field in health science arising out of the effective fusion of ICT
with medical science having enormous potential in meeting the challenges of health care
delivery to rural and remote areas.

Telemedicine is the use of telecommunication and information technologies in order to

provide clinical health care at a distance. It helps eliminate distance barriers and can improve
access to medical services that would often not be consistently available in distant rural
communities. It is also used to save lives in critical care and emergency situations.

EVOLUTION OF TELEMEDICINE

Telemedicine literally means medicine practiced at a distance. It is not new and has been
practiced since antiquity, using primitive communication technologies. Simple devices such
as bells, flags and signs were used for this purpose in the past. This included the convention
of making lepers ring bells to warn others not to come near. Ships carrying the plague flew
yellow flags to indicate their ship was in quarantine and to keep other ships away. These are
early examples of transmitting health information at a distance. As advances in the
telecommunication technologies have occurred, the medical use of these technologies has
followed.

Landmark Events in the history of Telemedicine:

 1844: Transfer of medical information using public telegraph.

 1876: Alexander Graham Bell‘s invention of the telephone.
 1897: A telephone was used to diagnose a child with croup and the case was reported in
the medical journal Lancet.
 1906: The First Electro Cardio Graphic (ECG) transmission by phone.
1923: Sahlgrens University hospital in Gothenburg, Sweden offered medical advice to fleets
of trade ships by using Morse code.
 1927: The first experimental television transmission was undertaken.
 1949: The Jean-Talon hospital in Montreal used a television to perform X-ray data
transmissions.
 The initial idea behind telemedicine was, and is, to overcome the barriers of time and
distance. From its inception, the emphasis has been on diagnosis. Since diagnosis usually
requires visual information, one needs a device that enables the physician to ‗SEE‘ the
patient.
 Among the early telemedicine efforts was the research and development work into
telemetry undertaken by the National Aeronautics and Space Administration (NASA) in the
USA. Scientists at NASA demonstrated successfully that physicians on earth could monitor
the physiological functions of an astronaut.
 1957: The first interactive video link between the Nebraska Psychiatric Institute in Omaha
and the Norfolk State Hospital 118 kms. away established by Dr. Cecil Wittson.
 1961: The first radio telemetry for monitoring patients in an intensive care unit was
described in the journal of Anesthesiology.

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 1965: Live transmission of a open heart surgery performed by Dr. Michael Ellis DeBakey
of Methodist Hospital. Houston, Texas in the United States to the audience attending a World
Health Organization meeting in Geneva, Switzerland using Comsat‘s Early Bird satellite.
 1967: Physicians provide services for airline passengers at Boston‘s Logan International
airport clinic with an electronic link from the airport to Massachusetts General Hospital
(MGH).
 1972 to 1975: The department of health education and welfare, NASA, Lockheed, and the
Indian Health Service combine to provide health care, to the Papago Indian Reservation in
Arizona known as the Space Technology Applied to Rural Papago Advanced Health Care
(STARPAHC).
 1989: NASA established a Space Bridge to Armenia to extend medical consultations for
the victims of a massive earthquake in the Soviet Republic of Armenia.
 7th September 2001: The first complete long distance surgery performed by a doctor
stationed thousands of kilometres away from the patient. The surgical team in New York sent
high-speed signals to robots operating on the patient in France.

DEFINITION

According to World Health Organisation, telemedicine is defined as, “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 education of healthcare providers, all in the interests of advancing the health of
individuals and their communities”.

Telemedicine, is the use of electronic information and communication technologies to

provide and support health care when distance separate beneficiaries and service provides.

The use of electronic information and communication technologies to provide and support
health care when distance separates the participants

OBJECTIVES OF TELEMEDICINE

 To make high quality health care available to traditionally under privileged

population.
 Save time wasted by both providers and patients in travelling from one geographic
location to another to avail services on time.
 Reduce costs of medical care.

APPLICATIONS OF TELEMEDICINE

 Seconds opinion and complex interpretations

 Remote consultation and critical care monitoring
 Disease surveillance and program tracking
 Continuing medical education
 Public awareness
 Disaster management
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  Home care and ambulatory monitoring
 Disease management
 Telementored/procedure/surgery robotics
 Tele health care
 Tele-education

ADVANTAGES OF TELEMEDICINE

 Eliminates distance barriers and improves access to quality health services.

 In emergency and critical care situations.
 Facilitate patients and rural practitioner's access to specialist health services and
support.
 Lessen the inconvenience and cost of patients transfers.
 Reduce unnecessary travel time for health professionals.
 Reduce isolation of rural practice by upgrading their knowledge through time
education

PROCESS OF TELEMEDICINE

telemedicine process

technology involved application involved

real time or telepatho- tele- teleradio telesur- telepath

synchronous store and logy cardiology logy gery mology
forward
telemedici
ne(asynch
ronous)

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Tele-Pathology: Tele-pathology services have enhanced the ability to confer, educate and
communicate to the referring physician, which in turn provides better service to increase the
consultation base. Equally important is the decreased expense and time investment. Earlier
consultation could take many days for reports to be prepared. Many times, the consult slides
were lost, broken, mixed up or not returned. Tele-pathology services provide a direct contact;
the images can be stored permanently and are available for repeat consultation. They can be
sent to many experts at the same time who can make real-time interactions among
themselves.
Tele-Cardiology includes trans-telephonic electro-cardiography, echocardiography,
angiography, stethoscopy and tele-transfer of hemodynamic, blood gas and bio-chemistry
parameters for intensive cardiac care services.

Tele-Radiology: Tele-radiology is claimed as most mature telemedicine application. In late

1950, the work started in Montreal and by 1990 technology was largely tested and found
acceptable for all but a small subset of cases with very high-resolution demands such as
mammography. State-of-art is reflected in development of filmless direct-digital-technology
(DDT); its advantages are:
Elimination of films and processing chemicals.
No film processing delay.
Direct assession of images, which eliminates need for expensive film digitizers.

TELESURGERY

Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on
a patient even though they are not physically in the same location. It is a form of
telepresence. Remote surgery combines elements of robotic, cutting edge communication
technology such as high-speed data connections and elements of management information
systems. While the field of robotic surgery is fairly well established, most of these robots are
controlled by surgeons at the location of the surgery.
Remote surgery is essentially advanced telecommuting for surgeons, where the physical
distance between the surgeon and the patient is immaterial. It promises to allow the expertise
of specialized surgeons to be available to patients worldwide, without the need for patients to
travel beyond their local hospital.

EQUIPMENTS FOR TELEMEDICINE

 Tele cardiology
- APC workstation
- digital stethoscope
- digital ECG machine 10-12 leads.
- access to telemedicine network
 Tele-pathology
- a light microscope
- a high resolution camera
- PC workstation

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 - access to tele communication network
 IT equipments hardware
- PC, Ethernet port
- keyboard, mouse
- multimedia speaker
- head phone and mic
- web camera, large printer
- UPS 1KVA
 Software
- window vista
- MS office
- customized telemedicine
- EMR interoperability
 Telemedicine software
- mercury integrated telemedicine solution
- Sanjeevani integrated telemedicine solution
- tele-med integrated telemedicine solution
- tele-vital integrated telemedicine solution
- tele medix
- medintegra
- prognosis

Types of connectivity:

Point-to-Point communication:
In networking, the Point-to-Point Protocol (PPP), is a data link protocol commonly
used to establish a direct connection between two nodes over terrestrial and satellite
link.

Point-to-multipoint communication:
is a term that is used in the telecommunication field which refers to communication
which is accomplished via a specific and distinct type of multipoint connection,
providing multiple paths from a single location to multiple locations.

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COMPONENTS OF TELEMEDICINE

IT
equipmen
t

Telecomm
Medical
unication
devices
euipment
compoments of
telemedicine

Video- Telemedic
conferenci ine
ng system software

MODEL OF TELE HEALTH SYSTEM

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 Telehealth
application
technology

People telehealth
user and providres COMPONENTS OF
TELEMEDICINE

Telecommunicatio
n and network link

PARTS OF TELEMEDICINE

Remote
diagnosis

Remote Remote
guidance training
network

Tale Remote
surgery ICU
Commun
ity
centre

BARRIERS IN TELEMEDICINE PRACTICE

 Lack of health infrastructure and services.

 Shortage of computer savvy health care personnel.
 Out flow of doctors.

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  Lack of training facilities with regards to the application of ICT in medicine.
 Physician/patient un-acceptance.
 Unavailability of technology at a reasonable cost.
 Out of approach for rural and remote areas.
 Remole areas
 Reliability
 Funding and reimbursement issue related to insurance companies.
 Legal and ethical issues.
 No exposure to the application of ICT in curriculum of medical college.
 Inadequate communication services.

CONCLUSION

Technology has great potential for connecting rural public health providers and consumers
with resources outside of their community. Essentially, telemedicine more narrowly focuses
on the curative aspects of health care. Tele-health uses a variety of technology solutions such
as a health care provider communicating by e-mail with clients, ordering medications from a
pharmacy, consulting with other health care providers, or accessing advanced or continuing
education offered by a university located some distance from the receiving site. More
specifically, telecommunication technology could be as simple as nurses in two or more
different public health settings consulting over the telephone or via computer video
conferencing co-ordinating local health fairs, or as complex as nurse scholars collaborating
with international peers on a community health-focused research project or a medical
specialist located at a health science centre completing complex robotic surgical technology
on a client who is located in another country

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Bibliography:

 Soni Samta, “Textbook Of Advance Nursing Practice”, 1st Edition 2013, Jaypee
brothers medical publications(P)Ltd publication, pp:510 – 513.

 Kaur Navdeep, “Textbook of Advanced Nursing Practice”,1st Edition 2015,Jaypee

brothers medical publications(P) Ltd publication, p:190-199

Internet reference

 en.wikipedia.org/wiki/Telemedicine

 www.news-medical.net/health/what-is-telemedicine.aspx

 www.telemedicineindia.com/

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 TELEMEDICINE

SUBMITTED TO SUBMITTED BY

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MRS. BHAGYA DEVI DAS THONGBAM REBIKA
LECTURER IN PAEDIATRIC NURSING DEPT. M.SC NURSING
SMCON 1st YEAR

SUBMITTED ON:
22/11/2013

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