pawan..telemedicine and e-health

8/10/2019 Pawan..Telemedicine and E-health

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TELEMEDICINE AND E-HEALTH

Enabling Specialty Healthcare to the

Rural and Remote Population of India


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Use of information and communication technologies:

i) To provide specialized health care consultation to patients in

remote locations,

ii) To facilitate video-conferencing among health care experts for

better treatment & care,

iii) To provide opportunities for continuing education of healthcare personnel.

Objectives of Telemedicine


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Relevance of Telemedicine

Inadequate infrastructure in rural/district hospitals

Large number of indoor/outdoor patients requiring referral for

specialized care

Low-availability of Health Experts in district/remote hospitals

Dearth of adequate opportunities for training or continuing

Medical Education for Doctors in Rural/Remote Health facilities.


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Telemedicine : The Model

Patient under treatment

Physician treating the patient

A remote telemedicine console having

audio visual and data conferencing

facilitiesNodal Hospital

Referral Hospital

An expert / specialised doctor

A central telemedicine server having

audio visual and data conferencing

facility


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NEED OF TELEMEDICINE

Indiasbooming population,currently 1.1 billion and

growing at 2% annual rate.

infrastructure: woefully

inadequate to meet theincreasing healthcare

Demands.

Although nearly 75% of

Indians live in rural villages.Most of the 620 million

rural Indians lack access to

basic health care facilities

it impossible to retaindoctors in villages .


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Can Telemedicine Bridge the Divide?

Telemedicine may turn out to be the cheapest, as well as the

fastest, way to bridge the ruralurban health divide. Taking

into account India's huge strides in the field of information and

communication technology, telemedicine could help to bring

specialized healthcare to the remotest corners of the country

The efficacy of telemedicine has already been shown through

the network established by the Indian Space Research

Organization (ISRO), which has connected 22 super-specialtyhospitals with 78 rural and remote hospitals across the country

through its geo-stationary satellites


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Technology of Telemedicine


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Telemedicine is a confluence of Communication Technology,Information Technology, Biomedical Engineering and MedicalScience.

The Telemedicine system consists of customised hardware and

software at both the Patient and Specialist doctor ends with some ofthe Diagnostic Equipments like ECG, X-ray and pathologyMicroscope/Camera provided at the patient end.

They are connected through a Very Small Aperture Terminal

(VSAT) system and controlled by the Network Hub Station

Through a Telemedicine system consisting of simple computer withcommunication systems, the medical images and other information

pertaining to the patients can be sent to the specialist doctors


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Either in advance or on a real time basis through the satellite

link in the form of Digital Data Packets.

These packets are received at the specialist centre, the images

and other information is reconstructed.

so that the specialist doctor can study the data and suggest the

appropriate treatment during a Video Conference with the

patient end.

In this way, the systematic application of Information and

Communication Technologies to the practice of healthcare

rapidly expands the outreach of the healthcare system


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Sequence of Tele-consultation (I)

PATIENT IN

Patient visits OPD

Local Doctor checks up

Patient receives treatment

and is not referred to

telemedicine system

Patient referred to the Telemedicine system (some

special investigations may be suggested)

Patient visits Telemedicine data-entry console.

Operator enters patient record, data and images of

test results, appointment date is fixed for online

telemedicine session

OUT

OUT

Offline Data

transfer

from Nodal

Centre


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Patient 1

Patient 2

Patient 3

Patient 4.

.

.

Online video conference & tele-

consultation for patients between

local doctors at the nodal hospital and

specialist doctors at the referralhospital

Patient queue

IN OUT

Sequence of Tele-consultation (II)


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Telemedicine Technology Evolution in

India

Point to point

Point to multipoint

Multipoint to multipoint

Tele-education


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Telemedicine Technology Evolution

Point to Point System - One patient end connect to One

Specialist Doctor within the hospital.

Point to Multi Point System - One patient end at a time

connect to any of the specialist Doctors end within the

hospital.

Multi Point to Multi Point System - Several patients end

simultaneously connect to different Doctors end at different

hospitals at different geographical locations


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Major areas of Telemedicine Technology

Adopted

Tele-consultation, Tele-diagnosis, Tele-treatment-The patient

with the local doctor consults the specialist, obtains the line of

treatment.

Tele-education, Tele-training- For Continuing Medical

Education, Training for doctors & paramedics from a higher

level Hospital/Institution.

Tele-monitoring- Regular monitoring for intensive care &

emergency care.

Tele-support- Support during disaster management.


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Different types of services

Telecardiology

Teleradiology

Telepathology

Telepsychiatry


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Telecardiology

Electrocardiography (ECG or EKG) is the recording of the

electrical activity of the heart.

ECG or electrocardiograph can be transmitted using telephone

and wireless.

This system enabled wireless transmission of ECG from the

moving ICU van or the patients home to the central station in

ICU of the department of Medicine.

The ECG output was connected to the telephone input using a

modulator which converted ECG into high frequency sound.


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ECG CIRCUIT

Instrumentation

Amplifier

1. Get differential signal

2. High input impedance3. High CMRR

A further stage in this

is to use band pass

filter


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TELERADIOLOGY

Teleradiology is the ability to send radiographic images (x-rays) from one location to another.

For this process to be implemented, three essential componentsare 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 forclinical purposes.

Sometimes the receiving computer will have a printer so thatimages can be printed for convenience.


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Telepathology

Tele-pathology is the practice of pathology at a distance i.e. the

electronic transmission of pathological images using

information and communication technology

The minimum equipment required for tele-pathology purposes

are:

1. A light microscope.

2. A high resolution camera either digital or analog with a

frame grabber card.

3. PC work station.

4. Access to telecommunication network, either by modem or

digitized data transfer card.


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TYPES OF TELEMEDICINE

Real time

(Synchronous)

Store-and-Forward(Asynchronous)


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Real time Telemedicine

Real time telemedicine could be as simple as a telephone callor as complex as robotic surgery.

It requires the presence of both parties at the same time and a

communications link between them.

The advantage of real- time telemedicine is that decisions may

be made immediately at the time of the session


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Store-and-forward Telemedicine

Involves acquiring medical data and then transmitting at a

convenient time for assessment offline.

Digital image may be send via email direct to the specialist,

e.g. Teleradiology.

It does not require the presence of both parties at the same

time.


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Telemedicine Infrastructure

Hardware


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Skype

Skype is free video-call software which can be downloaded

and installed on a computer.

Skype has over 600 million users world-wide.

To use Skype, it is necessary for each party conducting video

communication to have downloaded the software and to have

created a Skype account.

Skype sound and imagery quality will be very high on a good

connection using good equipment.


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Getting the best quality service

Make sure your internet speed is as high as possible (minimum 512Kbps - 1 Mbps upload speed). If possible install a separate

broadband connection preferably ADSL2.

Avoid Skype for long consultations: there is a significant risk ofSkype dropping out at least once over an hour or more

If there is a loss of transmission and you donthave an alternativesoftware program ready, use the telephone to maintain the audio linkuntil the video link is resumed.

If it is likely that video calls will be used regularly for critical orurgent clinical consultations it is advisable not to rely on Skype.Instead use more reliable video conferencing software for yourTelehealth work. A list is available on the

ACRRM Technology Directory.


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Security Risks of Video Sessions

Skype is encrypted during transmission; the risk of a

transmission being intercepted is low if there is a direct

connection between the two users

Skypes file-transfer function does not integrate with any

antivirus products, although Skype claims to have tested its

product against antivirus Shieldproducts.


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Application of Telemedicine


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Benefits of Telemedicine (I)

Benefits to Patients:

Access to specialized health care services to under-served rural,

semi-urban and remote areas,

Access to expertise of Medical Specialists to a larger population

without physical referral,

Reduced visits to specialty hospitals for long term follow-up care

for the aged and terminally ill patients.


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Benefits to Physicians:

Improved diagnosis and better treatment management

Access to computerized, comprehensive data (text, voice,

images etc.) of patients offline as well as real time

Quick and timely follow-up of patients discharged after

palliative care

Continuing education or training through video

conferencing periodically

Benefits of Telemedicine (II)


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Advantages

Reduce travelling.

Saves time for the patient.

Can get specialist advice when not available locally.

Results of tests and images readily.


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Disadvantages

Lack of telecommunication access in rural areas.

Not so effective when compared to personal discussion

between a doctor and a patient. Cost is very high.


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References


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