UNIT I INTRODUCTION TO
HOSPITAL ADMINISTRATION
Lecture 7: Telemedicine
Dr. R. S ubashini
SSN Co lleg e o f Eng ineering
What is Telemedicine?
. . . the use of electronic information and
communications technologies to provide and
support health care when distance separates
the participants.
Institute of Medicine, 1996
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Aim of the Telemedicine System
• Information management
– Patient information
– Medical data (signs, symptoms, test reports, etc..)
– Appointment scheduling
– Archival and retrieval of patient records
• Low cost solution
– Using ordinary telephone line
• Service to large population
– Through public health care delivery systems
• Development of knowledge-based system
– For decision support
– For training and education
Coldeway’s Quadrants
ST DT
SP SP
ST DT
DP DP
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Quadrants Defined
• ST/SP
– Same Time/Same Place
• DT/SP
– Different Time/Same Place
• ST/DP
– Same Time/Different Place
• DT/DP
– Different Time/Different Place
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Different types of services
• Telecardiology
• Teleradiology
• Telepathology
• Telepsychiatry
• Early Warning System
[ Prevention and control of endemic and infectious
diseases ]
Telemedicine in India
• Existing system limited only to private hospital
– APPOLO Group of Hospitals.
– RN Tagore Cardiac Hospital, Calcutta. (Asia Heart
Foundation)
• No Telemedicine system for public health care
• Corporate Sectors Offering Telemedicine Systems
– APPOLO Group
– Online Telemedicine System, Ahmedabad.
– WIPRO GE
– SIEMENS
–
Why it is relevant to our society
Poor infrastructure
Non-availability of experts (disparate distribution)
Low doctor-patient ratio (large population)
Lack of proper medical education
Special attention required for Public
Health Care System
Major Challenges
• Poor Data Communication
Infrastructure.
• A Large Population Catered by
Government Hospitals.
• System Features should be scalable.
• Cost of the system should be scalable.
Technical issues over Low Bandwidth
Problem Solution
• Longer time • Store and
for data forward policy
transfer • Transferring
• Poor video sequence of still
quality images
Requirement Specification
Nodal Hospital • A patient getting treated
• A Doctor
• A remote telemedicine console having audio visual
and data conferencing facilities
POTS / ISDN
• An expert/ specialized doctor
• A central telemedicine server having
Referral Hospital audio visual and data conferencing facility
Sequence of Operation
PATIENT IN
Patient visits OPD Patient receives local treatment and
OUT
Local Doctor checks up not referred to telemedicine system
Day One
Patient referred to the Telemedicine system (some special
investigations may be suggested)
Patient visits Telemedicine data-entry console.
Operator entries patient record, data and images of test OUT
results, appointment date is fixed for online telemedicine
session
Offline Data transfer
from Nodal Centre
Sequence of Operation
Patient 1
Patient 2
Online conference for the patient.
Day Two
Patient 3
Patient 4
. IN Patient, local doctors at the nodal hospital OUT
. and specialist doctors at the referral
. hospital
Patient queue
Hardware Configuration
Video Conference
Modem Telephone
Referral Hospital Microscope and other
medical instruments
Video Conference
PSTN/ISDN/VSAT link
Digital camera
Scanner
Telephone Modem Printer
Nodal Hospital
Software Modules
Offline Activities
Online Activities
Other Issues
•Incorporation of Standard.
• Health Level Seven (HL7)
• Digital Imaging Communication in Medicine (DICOM)
•Data Security.
•Legal & Ethical Issue
Telemedicine Networks
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Telemedicine Applications
1. Remote Consultation
2. Remote Monitoring
3. Remote Education
4. Telementoring
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1. Remote Consultation
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1.a Telepsychiatry
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1.b. Telemedicine for Children
with Disabilities
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2. Remote Monitoring
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2.a Collaboration
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2.b Access to Information
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3. Remote Education
37
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4. Telementoring
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When do we use telemedicine?
•Maldistribution of health resources urban and/or rural
•Capitated populations
•Access
•Distance/Time/Travel
• Patients and Families
• Outreach Physician
•Isolation of Provider
•National/International
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Trends
• Market place reform/managed care
• Shifting site of care Hospital>Clinic>Home
• Case Management/Team Care
• Improved communications between provider and
patient
• Health care practices and affiliations
• Digital convergence
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Benefits Patient Perspective
• Access: Time, Travel, Expense
• Health Provider Collaboration
• Enhanced Communications
• TV & Computer Applications common and non-
threatening
• Added attention may enhance confidence that all
that can be done is being done
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Benefits - Provider Perspective
• Communication/Collaboration with
specialists
• ER ‘front-line’ support
• CME/Life Long Learning
• Saves time, travel to outreach
clinics
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Challenges
• Lack of reimbursement
• Licensing and Credentialing issues
• Liability
• Privacy
• Infrastructure
• End-user Issues
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Recommendations
• Conduct a comprehensive telemedicine aud
it/assessment
• Explore Financial Issues
• Develop a short, mid and long range telemedicine
plan
• Build training initiatives
• Systematic implementation of plan
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